Prescriptions for opioid painkillers would get greater scrutiny from doctors and pharmacists under proposals to be considered by the state's pharmacy and medical boards this summer.
The plans also aim to better educate everyone involved about the dangers of overprescribing or becoming addicted to pills such as hydrocodone and OxyContin.
The move comes as New Mexico's overall drug-overdose death rate is the highest in the country, and new statistics from the state Department of Health show a dramatic rise in the sale of opioid drugs, up 131 percent from 2001 to 2010.
"The board was very alarmed at the overdose rate in the state," said state Board of Pharmacy Director Bill Harvey. "We're very serious about reducing the amount of opioids or controlled substances that are available for abuse," he said.
On June 21, the board will consider various proposals, including one to increase the number of prescribers who use the state's prescription-drug monitoring program.
That electronic database gives doctors and pharmacists access to a patient's prescription-drug history. Providers update the information at least every seven days -- an improvement over the monthly updates that were previously all that was required. Proponents say the database is critical to understanding a patient, but not all doctors use it when writing prescriptions.
Under one proposal, practitioners including doctors, dentists, veterinarians, pharmacists and certified nurse practitioners would be required to register and train for the program when they complete their controlled-substance registration.
While that proposal doesn't require doctors to use the program, a separate proposal to be considered by the New Mexico Medical Board in August would require its use in the case of prescribing certain controlled substances to first-time patients. The rule also would apply to established patients who have continuing prescriptions for opioid pain relievers.
The Board of Pharmacy proposal would require a pharmacist to pull a year's worth of a patient's history under certain conditions, such as when a patient shows potential abuse of the drugs by asking for early refills, has multiple prescribers or appears intoxicated or sedated when presenting the prescription. The same would be true for patients who ask for certain drugs by their street name or who offer to pay cash, even though they have insurance.
The proposal also calls on pharmacists to look more closely at prescriptions written by doctors who are located out of state or outside the pharmacy's typical prescriber area.
A pharmacist also would look at a year of patient history when filling an opioid prescription for a patient receiving care for chronic pain for more than 12 weeks.
The pharmacy board proposals also tighten rules on how soon prescriptions may be refilled. Under the measures, controlled-substance prescriptions that go directly to a patient could not be refilled before 75 percent of the days have passed since the prescription was filled, unless a doctor approves the refill.
Prescriptions that go to a patient indirectly, such as through a mail-order service, couldn't be refilled until 66 percent of the days in a 90-day supply have gone by, or half of the days in a 30-day supply.
The proposal also would limit new over-the-phone prescriptions for some controlled substances to a 10-day supply that cannot be refilled. Currently, a phone prescription for those drugs can be refilled up to five times in six months.
A system with holes
Along with the issue of people getting painkillers legally are the problems of stolen pills and fake prescriptions. Harvey said law-enforcement officials at the board receive an average of four reports of forged prescriptions a day, which he estimated is about half the number of actual forgeries.
Investigations into forgeries begin with a look at the prescription-monitoring program.
Cases of forgery often aren't isolated. Harvey said he's seen as many as 200 forged prescriptions from one person. Faking a prescription is a fourth-degree felony.
Criminals who obtain pills under false pretenses can do it by stealing or buying prescription pads or by pretending to be a provider when calling in a prescription to a pharmacy. In some cases, workers with access to drugs steal from a pharmacy's supply.
"There are so many ways to beat the system," Harvey said. "That's why we are busy all the time."
In the past, many of the forgeries were for hydrocodone and Xanax. Last year, Harvey saw an increase in oxycodone.
Mike Landen, deputy state epidemiologist at the Department of Health, said oxycodone is the "big player" in overdose deaths. Since 2001, the amount of oxycodone sold in the state has increased 296 percent, and since 2008, it has topped the list of prescription-drug overdoses.
Information a key tool
To better educate doctors about proper prescribing habits and the dangers of painkillers, the New Mexico Medical Board is considering changes for physicians and physician assistants who are registered with the U.S. Drug Enforcement Administration and have a license to prescribe opioids.
Among the changes is a requirement for five hours of training related to prescriptions for pain management before June of 2013. After that, 10 of the 75 hours of continuing education that doctors must complete for each license renewal will focus on pain management.
This is the first time the board has moved to direct specific continuing education, said Lynn Hart, executive director of the New Mexico Medical Board.
Hart called the changes "major" and said they reflect the board's understanding of the seriousness of the problem.
At the same time, the board is considering requiring doctors to register with the drug-monitoring program and pull a year of prescription history before prescribing certain controlled substances for a new patient. The files of established patients on a continuing prescription for opioid pain relievers would have to be reviewed at least every six months, according to the proposal. The board takes up the idea Aug. 10.
"That [monitoring program] really is a tool that is so valuable," Hart said. "It is the most important tool available."
Leslie Hayes, a doctor at the El Centro Family Health Center in Española, agreed. Hayes called the program a "godsend," especially now that it is easier to use. She said it gives her an accurate picture of the prescription drugs her patients have been using.
Hayes treats heroin and painkiller addicts with buprenorphine, which reduces cravings. Such addictions are among the easiest to treat, she said, but there are federal limits on who can give treatments like buprenorphine. She isn't taking new patients.
Along with increased use of the monitoring program by doctors, Hayes said she would like to see more education of potential users about painkillers. She said a majority of her patients started using the prescription drugs for recreational use, not after a sports injury or a surgery, for example.
Still, doctors can play a big role in that education, she said.
"I think one thing we are trying to do is more education, when people get the prescription, on the need to use them for a short term only," she said.
Contact Kate Nash at 986-3036 or firstname.lastname@example.org. Follow her on Twitter @katenashnm.
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