The high-profile overdose death of former Wild hockey player Derek Boogaard has turned a spotlight on prescription drug abuse and doctor shopping.
Two years ago Minnesota set up a prescription drug monitoring program to help physicians and others who prescribe drugs to detect patients who might be addicted to pain medication. Supporters say the database probably couldn't have flagged Boogaard's extensive efforts to obtain prescription pain drugs since the hockey player transferred to a team in another state shortly after Minnesota's monitoring program began operating.
The database has helped doctors detect other patients who are abusing prescription narcotics. But supporters are disappointed though that many Minnesota prescribers are still not searching the database.
Al Anderson, medical director for Medical Pain Management LTD in St. Louis Park, Minn., said whenever he fills a prescription he checks the Minnesota Prescription Monitoring Program database, to see whether his patient has failed to disclose similar prescriptions from other physicians. Most of Anderson's patients are not addicted to the controlled-substances he prescribes, but there's always the risk that some might be.
But he said, "we've found people who have been doctor shopping."
Doctor shopping refers to the practice of a patient seeking care from multiple doctors and obtaining multiple prescriptions for the same type of drug.
To deter patients from manipulating the health care system this way, Minnesota collects data on certain controlled-substance prescriptions and makes the information available to physicians who are registered to search the database.
In the two years that Anderson has been using the monitoring program, the database has not flagged huge numbers of suspicious cases in his practice. But he said doctor shopping occurs frequently enough to be a concern.
"I probably see about three to four patients a month that I would not take because of their record with utilization of the medications," Anderson said.
Minnesota's system isn't capable of catching everyone who is doctor shopping. Searching the database only requires a patient's name and birth date. That makes it somewhat easy to outwit by using phony identification. Anderson said he once had a patient who had five aliases.
But the potential use of an alias is only one weakness in Minnesota's prescription database.
A PRESCRIPTION WITHOUT MANDATE
A much bigger issue is the voluntary nature of the monitoring system.
"The system only works if people use it and there's no requirement to use it," said Cody Wiberg, executive director of the Minnesota Board of Pharmacy. It administers the Minnesota Prescription Monitoring Program.
Wiberg said when he was drafting the legislation that created the prescription database some doctors complained that they didn't want to participate in a system that could be used to track their prescribing patterns. That worried legislators who didn't want to give doctors a reason to stop prescribing pain medication to people who really need it.
So Minnesota lawmakers decided to make the database optional and penalty-free, Wiberg said.
"The system only works if people use it and there's no requirement to use it."
"If they use it and make a decision they have some immunity from civil, criminal and administrative liability," he said. "If they fail to use it or don't use it and something happens, they also have immunity."
Even with those assurances, there are still thousands of physicians and others who prescribe medications who haven't registered with the database yet. So far about 7,500 prescribers have signed up to use it. That's only about 26 percent of the medical and other professionals who are eligible to use the system — although Wiberg said all of the state's pain management doctors and most emergency medicine physicians are using the database.
"Don't get me wrong," he said. "We definitely would like more to be signed up for the program. But in some of those key specialties I think we have a lot of sign up."
Wiberg doesn't think there are many physicians who are opposed to the database anymore since he says most of their privacy concerns have already been addressed. He suspects most have simply forgotten about the monitoring system and probably need another reminder to use it.
Recent media coverage of the Derek Boogaard prescription drug overdose story appears to have served that purpose for some physicians. Data from the Minnesota Board of Pharmacy show that new registrations for the monitoring program doubled last week in the days following the latest round of Boogaard stories.