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January 10, 2012

Fletcher Allen's Family Medical Practices Adopt New Painkiller-Dispensing Procedure

PillsGot pain? If so, you can't just sit on the couch anymore and phone in your re-up for an extra 50 percocets or oxycontins, as if your doctor's office were a pizza-delivery service. In an effort to crack down on Vermont's rising tide of prescription drug abuse, Vermont Fletcher Allen's Family Medicine Health Care Service, which employs more than 40 physicians, nurse practitioners, physician assistants and mental-health professionals at six locations, has instituted a new procedure for dispensing narcotic painkillers including codeine, hydrocodone, vicodin, oxycodone, percocet, morphine, hydromorphone, fentanyl and dilaudid.

Patients of Fletcher Allen's Family Medicine Health Care Service, which includes the Colchester Family PracticeMilton Family PracticeSouth Burlington Family PracticeBerlin Family HealthHinesburg Family Health and the Walk-In Care Center at the Fanny Allen Campus, may notice a new sign in the reception area that reads:

"Because there are many potential problems associated with prescribing this medication, we are changing our prescribing policy. Effective January 1, 2012, we will no longer accept phone requests for any narcotic, refills or prescriptions. If you run out of pain medication, no more will be prescribed until you are seen for an office visit by your primary care physician. If this is a usual and chronic medication, you should be sure that you have adequate prescriptions to last you until your next visit. If this is for a short-term condition and you feel that you need more pain medication, then you should be reevaluated with an office visit."

By all measures, prescription drug misuse has become one of the leading causes for Vermonters to seek substance-abuse treatment. According to a report issued last week by the Vermont Department of Health on the Vermont Prescription Drug Monitoring System, in 2006 prescription pain meds surpassed heroin as the primary source of opiate addiction for people entering state-funded treatment programs. By 2008, Vermont had the second highest per-capita rate of admissions to treatment for prescription opiates in the country. The majority of those admissions — 60 percent — were of young people 20 to 29 years old.

The Vermont Legislature created the Vermont Prescription Monitoring System (VPMS), a statewide database that's maintained by the Vermont Department of Health, in 2006. All pharmacies in the state are now required to submit weekly reports to the database about certain controlled substances they dispense. Those reports include the patients' names, the name and quantity of the drugs that were dispensed, the date and who prescribed them.

So, who has access to that cornucopia of pharmacopeia? Doctors, dentists, advance-practice nurses, pharmacists and physician assistants. And who else is trying to sneak a peek — without a search warrant? The police. Last week, Public Safety Commissioner Keith Flynn told members of the House Human Services Committee that it would really, really help them in getting illegal drug dealers off the streets if they could, you know, nose through that digital archive every now and again. This despite the fact that state legislators were pretty specific in 2006 about not allowing the cops access to that database. In fact, they actually wrote that ban into the law due to legitimate privacy concerns. Ironically, a 1968 Vermont law already allows state police in Vermont to walk into an individual pharmacy and nose through their records without a warrant. Go figure.

As Rep. Sandy Haas (P/D-Rochester) explains, "The bill we passed [in 2006] was a health care bill, not a law enforcement tool. It was carefully crafted to give access only to those dispensing and prescribing controlled substances." The legislative intent of VPMS was to stop patients from "doctor shopping" and, if necessary, get them into drug treatment — not send them to prison. In other words, treat drugs as a public-health problem, not a law enforcement one. Now, there's a novel approach that might actually work. 

Photo courtesy of Be.Futureproof via Flickr's Creative Commons.

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