From Dr. Mark Romanoff, a Charlotte anesthesiologist and past president of the Mecklenburg County Medical Society, in response to “Prescription drug log hasn’t buoyed oversight” (Nov. 26):
Misuse of prescribed pain drugs is a growing problem in our state and throughout the nation.
As a pain management physician, I prescribe narcotics almost every day along with other medications and procedures to relieve suffering and improve my patients’ quality of life.
Obviously, narcotics can be addictive and if not handled properly, can cause deaths. This is particularly so in North Carolina. The General Accounting Office cited our state as one of the five with the highest incidence of narcotics abuse. There are more than 900 deaths in North Carolina each year from accidental prescription medication overdoses, slightly less than motor vehicle deaths. It will soon be the leading cause of accidental deaths in our state.
The solution involves providers, pharmacies, the legislature and patients.
I am also a founding member of the Advisory Board for the North Carolina Controlled Substance Reporting Service, which helps prevent abuse by tracking the more than 19 million controlled substance prescriptions made annually.
Medical providers and others check the database more than 3,300 times every day – almost three every minute. Certainly it could be used more, and allowing designated medical staff to access the system and present the data to the doctor will go a long way to improving medical care and reducing complications.
The advisory board also reviews egregious misuse of controlled substances by individuals we consider to be “doctor shopping.” These cases are regularly sent to the attorney general for investigation.
Checking the database is important, but other measures are needed to help reduce the number of accidental deaths. About half of these deaths involve people who have never been prescribed a narcotic, so checking the database would not have helped them.
At Southeast Pain Care, our physicians use the database and a contract to help prescribe these medications safely. We use the least amount of medication to control the pain. The contract states that we will do random drug testing and count pills at every visit, and requires the patient to use only one pharmacy. It also says no other provider will prescribe pain medications unless there is an emergency. This ensures that patients are taking their medications appropriately and not diverting any for non-prescribed uses.
State authorities should consider additional measures, such as mandating pharmacy participation in the database, encouraging pharmacist access to the database and allowing database access to medical office professionals.
Lastly, the patients must bear responsibility. These medications must be kept locked away from children and adolescents. Unused medications must be disposed of properly.
Accidental deaths from prescription medications affect us all and must be prevented. Medical providers realize that these medications save lives and reduce suffering, and all of us want to reduce the number of accidental deaths to zero. Shedding light on this problem and continued vigilance by all involved will ensure that this valuable treatment option remains available and safe.