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It's a dilemma doctors face all the time. A new patient claims to be in serious pain and asks for Vicodin or OxyContin. Is the pain real or is the patient an addict?
Now, a new, controversial statewide database is supposed to help them figure that out. Starting this week, pharmacies are required to collect patient and doctor information on every prescription they fill in an effort to address the national epidemic of painkiller abuse. According to state estimates, 117,000 Minnesota adults abuse prescription drugs every year.
When it's fully up and running in March, the database will allow Minnesota doctors and pharmacists, for the first time, to check whether patients are getting too many prescriptions for the same narcotics from different providers. Also known as doctor-shopping, it's a way for addicts to feed their habit without tipping off individual physicians or pharmacies.
But Minnesota doctors are divided over the new registry. Some, like emergency room doctors, are relieved that they now will have a way to be sure they are not simply feeding someone's habit. But others say it will scare doctors into writing fewer needed prescriptions for fear of being investigated by law enforcement or professionally disciplined.
"Physicians are very squeamish about prescribing and being scrutinized," said Dr. Miles Belgrade, a pain specialist at the University of Minnesota Medical Center who testified against the proposed plan at the Legislature in 2007.
Even drugs for pets
Minnesota is the 34th state to monitor prescriptions for controlled substances such as amphetamines, barbiturates and even some diet pills. The database, funded with a $400,000 federal grant, will track more than 1 million prescriptions per year.
Under the law, almost every Minnesota pharmacy that provides controlled substances now must submit the name and address of the patient -- and even the name of the animal if it's for a pet -- the name of the prescriber and the pharmacy that fills it.
Doctors will be able to check the Minnesota Prescription Monitoring Program database when they doubt a patient's story, said Cody Wiberg, executive director of the Minnesota Board of Pharmacy, which manages it. They can see, for instance, whether the patient has filled five prescriptions for Vicodin at five different pharmacies in the past two weeks.
That's the kind of information that Fairview Health System discovered when it looked at patient charts from several of its hospital emergency departments.
"We would see people going from one hospital to the next on the same day and on the next day and not telling the second and third doctor about the other visits," said Susan Van Pelt, director of quality improvement for Emergency Physicians Professional Association, a doctor group that staffs some of Fairview's emergency rooms.
Getting help for abusers
With the database, doctors can make a more informed decision about the patient, Wiberg said. The main goal, he said, is to help patients, not catch criminals.
"We're hoping that somewhere along the line, a health professional is going to intervene and try to get this person the help that they might need," Wiberg said. Some might be addicts who need treatment, and some might be people with under-treated chronic pain who need the help of specialists.
The law that created the database is designed to keep out those who just want to find wrongdoers. The government is prohibited from using it to check on doctors' prescribing habits for fear of discouraging them from prescribing painkillers to people who really need them, said Robert Leach, executive director of the Minnesota Board of Medicine.
"We didn't want ... to have a chilling effect on the treatment of pain," he said.
But Belgrade says that the chilling effect still could be a problem. "The law may say that, but that and the psychological effect on physicians are two separate things," he said. Other states have found that the number of prescriptions declined after they began monitoring prescriptions. But no one knows if that's because it worked as intended or if doctors simply wrote fewer of them.
The law also states that criminal investigators must have a search warrant or a court-ordered subpoena to access the database, but that, too, is of little comfort to Belgrade.
"I don't know how hard it is to get a subpoena," he said.
Staff writer Maura Lerner and the Associated Press contributed to this story. Josephine Marcotty • 612-673-7394