WASHINGTON – By October 2009, the Maryland State Board of Physicians had heard numerous complaints from pharmacists across the state about abusive prescription practices.
So news that came late that month about Dr. Nicola Tauraso overprescribing the pain killer oxycodone — an addictive and often-abused sythetic opiate — from a barn on his residential property in Frederick came as little surprise.
Dr. Peter R. Cohen, medical director for the Maryland Alcohol and Drug Abuse Administration, said Tauraso, whose license was suspended in August 2010, is indicative of a growing problem in Maryland: doctors who overprescribe pain killers to patients.
“This is where we’re most vulnerable,” said Cohen. “Unregulated pain management treatment without appropriate standards or guidelines.”
Overuse of prescription drugs causes addiction, leads to increased hospital visits and is potentially deadly, particularly when the drugs are mixed with alcohol or other substances, the medical literature indicates.
In the short term, painkiller abuse can prompt lethargy, an inability to concentrate, nausea, vomiting and breathing problems, according to theantidrug.com. The site lists Vicodin, Tylenol with Codeine, and Percocet in addition to OxyContin as some of the most commonly abused medications.
Prescription drug abuse is rampant in the U.S., according to a late February report from the Washington Post. Cohen said a prescription drug monitoring program law is the best solution to this escalating dilemma because it would ensure that the state addresses not only abuse but also addiction.
Florida leads the pack in phony prescriptions, with medical practitioners purchasing 41.3 million oxycodone pills in early 2010, according to the Post report. And while it has a prescription monitoring law on its books, the regulation is not being enforced because of resistance from Gov. Rick Scott.
Maryland hasn’t even gotten that far. Maryland is not among the current 43 states, including Florida, that have passed a prescription monitoring program law, according to the National Alliance for Model State Drug Laws. The question facing Maryland health professionals is whether their state is on its way to catching Florida’s record.
Gene Ransom, executive director for The Maryland State Medical Society, said he doubts Maryland will eclipse Florida in overprescriptions, despite its lack of a prescription monitoring law.
“We are not in a similar situation,” said Ransom. “People who do this in Maryland are punished. And in some ways, we might be a little too aggressive in going after them.”
One of the chief ways overprescribing is discovered in Maryland is from complaints from pharmacists, and Ransom said the Maryland State Board of Physicians takes those complaints seriously. Still, one area the state can improve is its implementation of clinical monitoring programs, he said.
“This is a very complex issue, and it would be nice if there were a tool that (clinicians) could use to make sure the people who are in pain get what they need,” Ransom said. “If people have an ailment unrelated to pain, we want to make sure they are not misdiagnosed and (given medication they don’t need).”
Cohen disagrees, contending that clinical monitoring programs only skim the surface of this issue.
“MedChi is making an argument that is three years old,” said Cohen. “It doesn’t move the conversation forward at all. (Proposing a clinical monitoring program) is the best they can do to respond.”
The Maryland General Assembly passed a bill legalizing a monitoring program in 2006, but then Gov. Robert Ehrlich vetoed it. Renewing momentum, several Maryland officials testified before the state’s Senate Finance Committee in Annapolis last week about the need for a prescription drug management program and declared their support for measures HB 1229 and SB 883, both pro-painkiller management program bills.
The measures would establish the Prescription Drug Monitoring Program in the Maryland Department of Health and Mental Hygiene and create an Advisory Board on Prescription Drug Monitoring that assists in the design, implementation, and evaluation of the program.
The Maryland Advisory Council on Prescription Drug Monitoring released a legislative report on December 31, 2009, in which it made several recommendations for the state. These recommendations included identifying the prescription drugs to be monitored; identifying the types of dispensers required to submit information to a prescription drug monitoring program; and determining the process for submitting prescription drug monitoring data to a prescription drug monitoring program.
Maj. Vernon J. Conaway, commander for the Maryland State Police’s Drug Investigation Command, said the number of prescription drug trafficking cases now nears the tens of thousands in Maryland with the most significant one occurring along the I-95 corridor in June 2009. That’s when a Maryland State Trooper stopped the driver of a Florida-registered Toyota in route to New York, transporting 34,000 oxycodone pills, he said.
Conaway said lax attitudes about prescription drug abuse contribute to this uptick in trafficking.
“There’s this misconception that the abuse of prescription pills is somehow less harmful than the abuse of harder drugs,” he said. “That’s incorrect.” Conaway said both pose tremendous dangers.
Doctor shoppers or patients who hop between various medical practitioners for prescriptions present another problem, the experts said.
“We don’t have the kind of data mechanisms in place that would allow a pharmacist to alert a physician about doctor shopping,” said Cohen. Such a mechanism, he said, would make it easier to detect and suspend the licenses of faulty practitioners.