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The Verde Independent | Cottonwood, Arizona

home : latest news April 29, 2016

7/26/2011 1:31:00 PM
Prescription monitoring system has potential to curb drug abuse
Prescription drugs, primarily painkillers, are being abused at an alarming rate. In Yavapai County, 46 deaths resulted from drug overdoses in 2009 as opposed to 10 such deaths in 1999. Mark Duncan/VVN
Prescription drugs, primarily painkillers, are being abused at an alarming rate. In Yavapai County, 46 deaths resulted from drug overdoses in 2009 as opposed to 10 such deaths in 1999. Mark Duncan/VVN

Pharmacist Amy Kille uses the state-run prescription monitoring system whenever she or any of the other pharmacists at Prescott’s Goodwin Street Pharmacy suspect the possibility of abuse. The system is currently used at only 11-12 percent of its capability. Mark Duncan/VVN
Pharmacist Amy Kille uses the state-run prescription monitoring system whenever she or any of the other pharmacists at Prescott’s Goodwin Street Pharmacy suspect the possibility of abuse. The system is currently used at only 11-12 percent of its capability. Mark Duncan/VVN

Mark Duncan
Enterprise Reporter

YAVAPAI COUNTY - It's no secret that the abuse of prescription drugs has risen to a deadly level. A new federal study by the office of National Drug Control Policy entitled Epidemic: Responding to America's Prescription Drug Abuse Crisis indicates that, nationwide, the per person use of prescription opioids (synthetic or semi-synthetic opiates), a classification that includes some of the most powerful medications available, increased by more than 400 percent from 1997 to 2007. Opiate overdoses, once almost always attributed to heroin, "are now increasingly due to abuse of prescription painkillers," such as oxycontin, percodan, vicodin and others.

The April 2011 report also states that prescription painkillers are now "the second-most abused category of drugs after marijuana, and the second leading cause of accidental death in the U.S. after car accidents."

In Arizona, drug overdose deaths are at an all-time high. More than 1,100 people died from drug-related incidents in 2009, doubling the 543 such cases in 1999. And in Yavapai County, 46 deaths were attributed to drugs in 2009 as opposed to 10 such deaths in 1999.

"I strongly believe that increase is from prescription drugs," said Marilee Fowler, executive director of MATForce, Yavapai County's drug prevention coalition. "I've talked to kids who are addicted and they tell me that to get off it is horrible, harder to kick than heroin."

The dangers of these substances are insidious, according to Sgt. James Gregory, director of PANT (Partners Against Narcotic Trafficking), the countywide drug law enforcement task force.

"People think it's not as bad as regular street drugs because it came from a doctor," Gregory said. "That's wrong."

So wrong, in fact, that as many as a dozen overdose deaths in the Yavapai County have been at least tentatively attributed to the abuse of prescription drugs in the past several months.

In one of those deaths, that of a 21-year-old woman, investigation by the Cottonwood Police Department indicated that a suspect involved in selling the drugs to the victim had received prescriptions for painkillers from at least six doctors, and had filled those prescriptions at two different pharmacies.

The federal report identifies four areas - education, monitoring, proper disposal and enforcement - in which officials and the public can combat the growing problem.

Of those four, monitoring the distribution of the drugs for signs of abuse may have the best chance of combating the problem by reducing supplies.

Arizona is one of 33 states that has a prescription monitoring program in place but, according to Dean Wright, prescription monitoring program director of the Arizona Board of Pharmacy, only 11-12 percent of pharmacists and prescribing practitioners access the CSPMP (controlled substance prescription monitoring program) database while determining what medications to prescribe and dispense.

"We've got practitioners adding to the database constantly," Wright said, adding that the system has accumulated 33 million records since its inception in 2007, with additional records added at a rate of about 1,500 per day. "But the only time a practitioner is required to use the database (to research a patient's prescription history) is when they get involved in medical marijuana."

MATForce's Fowler thinks that more diligent use of the system would have a great effect on the availability of the drugs for abuse. "We have an awesome system that's barely being used," she said.

When a dispensing practitioner or pharmacist supplies a controlled substance to a patient, that doctor or pharmacist must enter the patient's ID, as well as the type and amount of the drug, into the CSPMP database. The pharmacist also enters the identity of the prescribing doctor. The result, then, is an easily searched log of who is getting the drugs and who is prescribing and dispensing them. Authorities, in the course of an active investigation, can unearth evidence against a suspect who may be "doctor-shopping" for painkillers, either for excessive personal use or in search of profit. They can also determine if a doctor is over-prescribing.

Doctors can access the system and see what medications a patient has recently received, and pharmacists can use it to see the prescription history of the customer in front of them.

Dr. Leon Cattolico of Cottonwood has been on a bit of a mission of late, trying to educate doctors and pharmacists alike to the benefits of the program.

"If a physician is treating patients with pain medications, he should be using this," Cattolico said at a recent MATForce gathering, citing a couple of examples that he found while doing research on his own patients.

One man, whom Cattolico said he promptly dropped as a patient, had filled three 90-day prescriptions for a pain medication within three weeks.

The problem, he said, is that pharmacists in some of the big chain stores were unable to use access the system for research, even though those same businesses met the letter of the law in reporting prescriptions they had filled.

"The pharmacists I've spoken to so far say that corporate won't let them have access to the Internet," he said. Still, he said that his efforts have had an apparent indirect effect.

"There's an underground cooperative going on right now," he said, "where if they (pharmacists) suspect something they'll call the others." That appears to extend, as well, to a willingness to call the prescribing doctor.

"In the last 30 days I've gotten calls from pharmacies I've never had calls from before," Cattolico said.

John Phillips, owner of Prescott's Goodwin Street Pharmacy, agrees that the database is a valuable tool, albeit one that could use a bit of improvement.

"The beauty is it alerts us to people who doctor-shop," Phillips said, adding that he has seen numerous examples, some extreme, of customers trying to line their pockets with profits from the sales of pills such as oxycontin, which can go for from $50 to $80 apiece. He said he has seen people fill a prescription for 240 oxycontin pills, then return two weeks later for a refill.

When a pharmacist discovers through the database that a customer has received what they perceive as too many prescriptions, he or she has the option of contacting the doctor who wrote the prescription and discussing the data.

"We call the doctor and sometimes they listen and sometimes they ignore us," Phillips said. "But I can refuse to fill a prescription for any reason."

The system can only work effectively, though, if doctors use it when prescribing controlled substances and pharmacists refer to it at the time of contact with the customer. And that can be a problem for a pharmacist faced with impatient shoppers and an often-immense workload.

Phillips, back from a recent industry convention, heard just that from some of his peers.

"They say, 'We're so inundated, we're so understaffed, we don't have time,'" Phillips said. "It's a problem for someone who's trying to fill 400 prescriptions a day."

Phillips also has a suggestion for improving the effectiveness of the system.

"I think it should be mandatory on the part of the prescriber" (to check the database for the patient's history), he said. "I think if physicians were forced to do this, it would go a long way toward fixing the problem."

Phillips has just three pharmacists in his single Prescott location, and they use the system any time they suspect that a customer is obtaining the drugs for purposes of abuse.

But it turns out to be at least partly true that pharmacists in the chain stores are cut off from the tool by corporate decisions.

Mike DeAngelis, public relations director for CVS pharmacies, said that, while the chain conforms to the legal reporting requirements in Arizona and other states that have monitoring programs, pharmacists in CVS stores do not have access to the CSPMP data in individual stores.

"They do not," he said. "The database is set up so that prescribers can consult the data before they write the prescriptions."

DeAngelis added that pharmacists are trained to recognize indicators that a customer might be trying to get the drugs for illicit reasons. CVS operates more than 130 pharmacies in Arizona.

Wright, who agrees that the chain outlets reluctance to get on board with the program "has created a problem," said he very recently had contact from CVS headquarters, where someone told him "there are discussions going on now about a possible change in policy."

Fry's management, on the other hand, wants their pharmacists to use the system wherever they see a need.

"We actively encourage our pharmacists to make good therapeutic decisions," said Crane Davis, Fry's pharmacy supervisor. "Our stores are able to use the Internet and access this system. We encourage them to do so when there's any sign there may be abuse."

Fry's operates 121 pharmacies in Arizona.

Walmart representatives did not choose to answer questions on the topic, despite several efforts to contact both Arizona and national media representatives.

Walgreens media relations representative Robert Elfinger said the chain conforms to legal reporting requirements and that in-store pharmacists at Walgreen's 247 Arizona locations "can look into the database and use their professional judgment."

Safeway spokeswoman Nancy Keane declined to directly answer the question about pharmacists' access to the CSPMP database, but she did relay this statement from Sean Duffy, the head of the chain's pharmacy division: "Our pharmacists make sure they dispense the appropriate amount of each prescription to ensure its compliance with physician directives and patient safety."

In addition to Wright's efforts, MATForce is in the process of composing letters to doctors, pharmacists and corporate entities, urging them to take part in the program.

"A change in policy," a draft letter to a corporate distributor reads, "would directly result in the reduction of the abuse of prescription drugs and in turn result in saving the lives of young people in our community."

Taylor Waste
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Reader Comments

Posted: Friday, July 29, 2011
Article comment by: Wake Up Arizona To New Legal Drug

People are not able to get their hands on prescription drugs like they used to, or have gotten caught and put on probation with U/A's, so they are turning to designer drugs the biggest "bath salt" nothing you use in your bath, goes by many brand names at our local Yavapi County smoke shoppes and is totally legal in AZ! Teens, young adults, and previous meth addicts are using this drug.. It's use is rampant all over our state but is alarming in the Verde Valley among our youth!

Bath salts contain manmade chemicals like mephedrone and methylenedioxypyrovalerone, or MDPV, also known as substituted cathinones. Both drugs are related to khat, an organic stimulant found in Arab and East African countries that is illegal in the United States.

MDPV, and plant fertilizer are the main ingredients in this drug..

Emergency room doctors at Banner Good Samaritan Medical Center in Phoenix, said he had to administer general anesthesia in recent weeks to bath salt users so agitated that they did not respond to large doses of sedatives. people arriving so agitated, violent and psychotic that a small army of medical workers was needed to hold them down.

Other doctors described dangerously elevated blood pressure and heart rates and people so agitated that their muscles started to break down, releasing chemicals that led to kidney failure.

The Louisiana Poison Center, said some doctors had turned to powerful antipsychotics to calm users after sedatives failed. “If you take the worst attributes of meth, coke, PCP, LSD and ecstasy and put them together,” he said, “that’s what we’re seeing sometimes.”

These drugs are far worse than any illegal or prescription drugs being abused.

The "bath salt" drug causes extreme paranoia, people to become psychotic, violent toward others, mutilate themselves, and commit suicide.

People do not eat, stay awake for days on end, and have enormous amounts of energy, along with not living in reality because of the schizophrenic effects this drug MDPV causes in their brain along with not being able to sleep..

People are dying from this legal drug, and killing others while using it.. Several cases in others states have led to it becoming illegal. Arizona needs to wake up to this drug, our kids are going to the smoke shoppes in old town Cottonwood, the one on Western Drive, and Camp Verde and buying this stuff.. It's is flying off the shelves they can not keep up with the demand for it. It permanently can damage peoples brain even after they stop using it..

Poison control centers around the country received 3,470 calls about bath salts from January through June, according to the American Association of Poison Control Centers, up from 303 in all of 2010.

“Some of these folks aren’t right for a long time,” said Karen E. Simone, director of the Northern New England Poison Center. “If you gave me a list of drugs that I wouldn’t want to touch, this would be at the top.”

Gary Boggs, a special agent at D.E.A. headquarters in Washington, said the agency had started looking into whether to make MDPV and mephedrone controlled Schedule I drugs like heroin and ecstasy.

At least 28 states have banned bath salts. Arizona needs to act quick to fallow this ban, it is killing our youth. Illegal Prescription drug use in on the decline and this legal drug is on a major incline. We have got to stop this drug, and all of the other synthetic drugs that are coming on the market.. This is a huge human disaster!

Posted: Thursday, July 28, 2011
Article comment by: You have a valid point there, Mr. Bill

When a pharmacy or MD has been suspected of abusing the sale of legal pain killers, their businesses and office contents should be conviscated and seized for evidence and sold. If you get caught with a marijuana joint and your car is paid for, DEA/PANT/MatForce will seize your car sell it. Get caught with a one marijuana plant and PANT/MATForce will seize your house and it will become theirs to sell. Let's see PANT/MatForce do this to the MD's that have over prescribed these deadly narcotic drugs and the pharmacies that have filled these drugs to the people that have died here in the Verde Valley. Make it a mandatory that anytime one of these pills is precribed that it has to be entered in the database from the MD's office, or their practice will be seized and sold. This is the only way that the problem can be solved. The DEA/PANT/MatForce are focusing on the marijuana users, not the real dealers and drug abusers.

Posted: Wednesday, July 27, 2011
Article comment by: Carl Nye - Jerome

to Tom Babbit:

Whether the prescription system prevents abuse depends in part on the culture of the citizens. Thirty years ago (can't speak for today) when I was in the Navy and made a port stop in Korea, we sailors were told that the Korean pharmacies were "off limits" (prohibited for us to go there). Why? Because at that time, there was no prescription system in Korea. The doctor told the patient that drug x would help their condition. The patient walked in to any pharmacy and bought drug x without a prescription. Any person could buy drug x, whether on a doctor's recommendation or not. On the other side of the world, at about the same time, New York State had a three-copy prescription system. When a doctor wrote a prescription, he had to keep one copy, one copy was kept by the pharmacy, and the third copy went to a state office that supposedly monitored every prescription written in the state. Talk about Big Brother watching you. But there you have the two ends of the prescription spectrum. The difference is/was in the trustworthiness of the people.

Posted: Wednesday, July 27, 2011
Article comment by: Tom Babbitt

The prescription system is a drug monitoring system with the sole purpose of preventing abuse.

Posted: Wednesday, July 27, 2011
Article comment by: DUH Stupid!! Great Article

Good job Verde Independent. Just like when the News does a story on bombs and then tells you what ingredients to use to make a bomb. Now all of those doctor-shoppers and drug seekers know which pharmacy's to target. What, do you think that they don't know how to read? Yes, it is an important issue, but do you really need to make a list of which pharmacies do and don't use the monitering database?

Posted: Wednesday, July 27, 2011
Article comment by: Dave House

The pain killing properties of cannabis is more effective than Opiates and nobody had ever died from an overdose.
Mr. Duncan you are hypocrite for not promoting it's legalization.
Instead the pharmacies will continue to lobby for marijuana prohibition so that they can continue getting their victims hooked on heroin in a pill.

Posted: Tuesday, July 26, 2011
Article comment by: Bill Covington

So, why don't Pant and MATForce move against the pharmacists and doctors and put them in jail and seize their pharmacies and medical offices? Would that be too easy? Would they put themselves out of a job if they stopped preying on the users? Or, could it be because the pharmacists and doctors play golf with the judges and prosecutors? Maybe all those mentioned above are making too much money from these drugs to want to solve the problem. Ya think?

Posted: Tuesday, July 26, 2011
Article comment by: Lost Too Many Friends to This Poison

This report doesn't even address the people who commit suicide because of what these drugs do to their brains. I know of two very close friends who were hopelessly addicted to Oxicodone and Soma, They both took their life because they couldn't handle being out of the drugs. I got some painkillers for shingles a few months back and people were knocking down my door to find out if I had any painkillers I wanted to sell to them. Scary stuff

Posted: Tuesday, July 26, 2011
Article comment by: I find it rather ironic .....

that patients who use Marijuana to treat a medical condition have to be logged into this monitering database. Marijuana is a drug that NO ONE has ever died from an overdose. Yet patients that use deadly drugs like Oxycontin, don't have to be registered or monitered. It just goes to show you who is behind the anti marijuana movement--the Big Pharmacuetical Companies! It's ok to kill thousands of people a year from their drugs, but they don't want marijuana legalized has it would cut into their profits. That is something they fear the most.

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