By Joseph Teel, MD
Note: Guest blogger Joseph Teel, MD, is Assistant Professor of Clinical Family Medicine and Community Health in the Perelman School of Medicine at the University of Pennsylvania in Philadelphia. He also serves as Medical Director and Director of Obstetrics for the department.
It's easy to see that Pennsylvania has a prescription drug abuse epidemic.
Physicians encounter this issue on a daily basis. In many ways, it impacts how we care for patients.
That is why I'm anxiously awaiting the launch of Pennsylvania's new prescription drug monitoring system.
What's the big deal? In a just a few words: Peace of mind.
Peace of mind that patients are not seeking this medication elsewhere. Peace of mind that these medications are doing what they are made and prescribed to do (i.e., temporarily alleviating patients' pain) instead of driving them deeper into addiction.
If you've never practiced in a state that has had a well-functioning controlled substance monitoring system, you might not appreciate its benefits.
Before coming to my current job in Philadelphia, I practiced community medicine in Virginia. During that time, I had access to Virginia's prescription data monitoring system for controlled substances.
It was an extremely user-friendly system that any clinician in the state could access.
It required some basic information from the provider – your name and DEA number. The day-to-day use of it was very simple because it was web based and reports were run instantaneously.
This tool truly enhanced my ability to care for patients in Virginia.
If I was caring for someone on pain medication or some sort of anxiety or behavioral health medication, I could quickly enter the database from my office laptop, put their name and date of birth in, and within seconds have all their state pharmacy-based data for refills for controlled substances.
As a result, I could have a constructive conversation and engage with my patient on this topic and address any concerns before they became an issue.
Since moving back to Pennsylvania, I've felt very uncomfortable about prescribing chronic pain medications.
Philadelphia has a number of large health systems and it's easy for patients to get lost in the mix. It was very uncomfortable to know that patients could go from my office to another health care facility or medical practice, and then fill those prescriptions at whatever pharmacies they chose.
If they pay cash for these medications, their insurance company can't track it.
As a result, I can count on my one hand the number of times I've prescribed chronic pain medications since moving back to Pennsylvania.
My practice patterns have totally changed. I have no insight into what's going on other than that really narrow patient encounter.
This is not only a huge source of anxiety for my experienced colleagues, but also for my resident physician trainees. That has to do with the lack of transparency.
The Pennsylvania Medical Society supported the passage of a law that called for the creation of this database. Once it's operational, Pennsylvania will be the 49th state to have a drug monitoring database that physicians can access.
There have been numerous delays in getting the database up. The bill passed in late 2014 but we waited until late 2015 before the Commonwealth found funding for it. This was largely a result of the state budget stalemate.
The state Department of Health has hired a vendor to create the database and says it will be available to physicians by August 2016. If you ask me, it can't come soon enough.
The database isn't a magic bullet. It won't solve this epidemic by itself. We need physicians and patients to take ownership of this problem.
But the database will be an important step.