Opioid monitoring system an 'important tool' for doctors, pharmacists
Over the past six months, pharmacists like Joe Thibeault and physicians like Dr. Sudhir Kadian have been spending more time sending, receiving and checking patient information on the Connecticut Prescription Monitoring and Reporting System, one of the state’s main uses of technology in the battle against opioid abuse.
“It’s a very important tool for monitoring chronic opioid use,” Kadian, medical director at the Shoreline Interventional Pain Center in New London, said Monday. “We use it on every patient who’s using a controlled substance.”
The state Department of Consumer Protection website was created in 2008 to track opioid prescribing, but its features and requirements for use have been ramped up significantly since then in response to the worsening crisis of abuse and addiction to prescription opioids and their illegal cousins, heroin and fentanyl, according to Rodrick Marriott, drug control director at the consumer protection department.
In the latest changes to the system, a law that took effect July 1 began requiring pharmacists to report to the system within 24 hours of filling a prescription for Oxycontin, Percocet or another opioid, instead of once a week as it had been previously. The law also requires doctors to review a patient’s record in the system whenever they prescribe more than three days’ worth of opioids.
“The system helps a lot,” said Thibeault, pharmacist and co-owner of Quality Care Drug in New London. “The most helpful part is if you have a question or a customer you don’t know, the system shows you what else they’re using. We have refused to fill prescriptions sometimes.”
Since fall, the system has also been sending alerts to doctors and pharmacists whenever a patient has five or more opioid prescriptions from five or more doctors within a three-month period, Marriott said.
“If you suspect your patient is doctor shopping or forging scripts, please contact your local police department,” the alert reads.
Alerts are also being sent whenever a patient taking benzodiazepine — often given for anxiety and insomnia — is also prescribed an opioid, because of potentially lethal drug interaction. An alert is also generated when a patient is being given more than 90 milligrams of opioids. That is a threshold level that substantially elevates the risk of overdose, according to the alert notice.
“What doctors and pharmacists do with the alerts is up to them,” Marriott said. “The alerts are tools. They don’t make a decision for you. They’re like a lab report.”
Jacqueline Murphy, immediate past president of the Connecticut Pharmacists’ Association, said she uses the monitoring system and the information from the alerts several times a day at her New Haven pharmacy.
“I open it up first thing in the morning, and I’m on it a lot throughout the day,” she said. “Anytime I have a new patient, I check it, and anytime someone comes in paying cash I check it. You can’t give me enough information when it comes to this population to help tell me whether I’m doing the right thing.”
Like Thibeault, Murphy said she has refused to fill prescriptions based on information she’s learned from the monitoring website.
Because of the alerts and reporting requirements on the system, Thibeault said he is calling doctors and nurses more often with questions about opioid prescriptions.
“There’s more communication between us,” he said. “It can be a fine line between medically necessary prescribing and abuse. But the problem comes in with the potential for addiction. It’s not something you can automatically just stop.”
Kadian said the more frequent alerts from the state, in tandem with the loss of one of the region’s main prescribers when Dr. John Paggioli of Norwich relinquished his narcotics prescribing permit, have made some area doctors more reluctant to prescribe opioids for pain. As one of only four pain specialists in southeastern Connecticut, Kadian said his office has been inundated with calls from patients looking for opioid prescription refills.
“It’s getting harder and harder to find prescribers,” he said.
When he sees a new patient who has had an opioid prescription from another doctor, however, he will not automatically refill it. He reviews the patients' records and gives them an examination, then often recommends an alternative treatment.
“Opioid prescriptions are being written excessively,” he said. “Opioids should not be the first line of treatment for chronic, noncancer pain. There are tons of other methods of pain management.”
These include nonaddictive medications, physical therapy and spinal cord stimulator implants.
Kadian said some patients come to him after a decade or more of taking opioids, long past when their bodies have developed tolerance and the drugs are effective at quelling pain.
“They tell me the drugs are ineffective, that they’re addicted, or that they’re using them to treat depression,” he said. “Many patients use these medications as depression and anti-anxiety medications.”
He tapers them off the opioids gradually, offering them the help of an addiction specialist if needed, and advises them to seek mental health treatment for their depression and anxiety.
For those patients for whom opioids are appropriate, Kadian said, he is doing more educating both to them and their families about the dangers.
“I’m making them more aware that there is more risk of dying from these drugs than from their pain,” he said. “These are deadly drugs, as deadly as a firearm.”