North Carolina should require medical providers to get routine training about prescription drug abuse and should improve monitoring of how controlled substances are dispensed, legislative researchers recommended this week in a report looking at how to better curb abuse and reduce overdoses.
The Program Evaluation Division, the legislature’s watchdog agency, released recommendations on curbing abuse of drugs that the public commonly obtains for legitimate needs through doctors, nurses and pharmacists.
The rate of unintentional poisoning deaths has risen from fewer than 7.4 deaths per 100,000 residents in most counties from 1999 to 2001 to more than 18.5 deaths per 100,000 in 21 counties in 2012, the report said. Of the 947 accidental overdose deaths in 2010, 44 percent were associated with controlled substance prescriptions filled within 60 days of the death, the study said, citing state data.
The increase in overdose death rates comes with increased volumes of prescriptions for opioid medications such as methadone and oxycodone. More than 17 million prescriptions for legally permissible controlled substances were dispensed in North Carolina in 2012, the report said.
Attractive to abusers
Prescription drugs are attractive to potential abusers in part because they know the drug is of good quality, division director John Turcotte told a General Assembly oversight committee.
Abusers can “get high on something they can get much easier, and know how much to take to get high,” Turcotte said. The study’s recommendation as a whole, he said, could help decrease abuse.
The report found North Carolina lacks statewide prescribing guidelines for doctors, dentists and other medical providers who are subject to state licensing. It said the General Assembly should direct state health officials and occupational licensing boards like the N.C. Medical Board and N.C. Board of Nursing to develop them for opioids.
Legislators also should require these and other boards to require licensees who prescribe controlled substances to receive at last one hour of continuing education on prescription drug abuse as a condition of license renewal.
Pharmacists must record identifying information about patients and certain prescribed controlled substances. Doctors and pharmacists are encouraged to check a database for unusual patterns that could hint at addiction or patient doctor-shopping to sell the product illegally.
While database registration has grown in recent years, the database was accessed just 6 percent of the time when a prescription for a controlled substance was written or filled, the report said. Federal drug agents should be given better access to the database, which also should be linked to similar records in adjoining states, the report said.
The report also said the state Department of Health and Human Services should improve a program that limited access for certain Medicaid patients to certain drugs through only one health care provider and one pharmacy.
The “lock-in” program, designed to curb drug abuse, hasn’t operated since last July due to technical problems with the state’s Medicaid billing system, costing the state up to $2 million, the report said.
In a response attached to the report, DHHS largely agreed with the recommendations, which also asked the agency to develop a strategic plan to combat prescription drug abuse. The billing system’s vendor is working to get the lock-in program running again, the response said.
The oversight committee directed staff to draft legislation based on the report. The General Assembly convenes in two weeks.