Minnesota is in a standoff with the federal government that could cost the state more than $12 million in grants earmarked to help fight the opioid epidemic.
At issue is the U.S. Justice Department's insistence that the states use a federal prescription-tracking computer system that critics say is not as good as the one currently in use by most states. Several other states are also pushing back against the government's demand.
The current tracking system, developed by Minnesota and other states, helps them share information about prescription drug recipients and prevent "doctor shopping," the practice of patients visiting several doctors to get addictive medications like pain pills.
The federal version "has never really worked, and no more than a handful of states are interested in using it," said Cody Wiberg, executive director of the Minnesota Board of Pharmacy.
Because some people will cross state lines to avoid detection in their quest for drugs, the National Association of Boards of Pharmacy built a data-sharing system that allows doctors and pharmacies to check for prescriptions filled in other states.
But the U.S. Department of Justice (DOJ) is pressing states to use a different data-sharing system.
In fact, federal officials are withholding grant money from states that don't sign up for their preferred system, to the surprise of several states, including Minnesota. Minnesota can't spend a $750,000 DOJ grant awarded last fall to help run its prescription drug database until it connects to the new federal system.
In addition, the U.S. Centers for Disease Control and Prevention (CDC), the largest nationwide funder of state public health efforts, is making enrollment in the new system a requirement for its latest round of opioid epidemic grants.
Minnesota was recently awarded $12 million by the CDC to help study opioid use and prevent abuse — funds that will be frozen unless Minnesota connects to the new federal system.
"That could cut into prevention and other efforts that the Minnesota Health Department would be making to address this epidemic," said Wiberg.
All 10 members of Minnesota's congressional delegation have signed a letter sent in August to the DOJ and CDC asking them to address the state's concerns and ensure that the conditions for accepting grant funds "will not create an undue burden for states."
The federal push is also opposed by the National Association of Chain Drug Stores, which represents 80 chains that operate over 40,000 pharmacies. The group said it "strongly urges the CDC to remove these needless restrictions," in a letter to the CDC and DOJ sent in June.
The Minnesota Health Department said it also wants the matter resolved. "We are aware of the situation and are in conversation with our federal and state partners to try to find a solution," the department said in a statement.
One concern is that the new federal tracking system might not comply with Minnesota's medical confidentiality laws, an issue that the state's information technology experts are studying.
The current data-sharing system allows Minnesota to block inquiries from unauthorized users. Under Minnesota law, for example, law enforcement officers need a search warrant to obtain prescription user data from the system. Some states don't have that restriction, but the data-sharing system knows how to block queries that would be illegal in some states.
"We have to make certain that only people who are eligible to look at the data can look at the data," said Wiberg.
A DOJ official said the agency could not immediately make anyone available for comment.
'You want one hub'
Minnesota's prescription drug database came online in 2010, in an early effort to block the abuse of addictive prescription drugs. It's fed data by pharmacies after they fill a prescription for certain drugs that have an addictive potential. In addition to opioids, it tracks amphetamines and other drugs such as Valium and Xanax.
More than 45 similar state drug databases are now linked, using a system developed by a national group that represents state pharmacy boards, which launched it in 2014. States do not have to pay to use the system.
A second concern is that having two competing tracking systems is impractical and that access to information will be cut off between states that choose different systems.
"You don't want multiple hubs," said Wiberg. "You want one hub."
Before data sharing among states became available, it was easier for people to cross state lines to get drugs. Wiberg recalled a case eventually discovered by the North Dakota program, which found a woman who traveled up Interstate 94 from the Twin Cities and across the border, stopping at pharmacies along the way.
"They are going to wind up shutting down our system," said Carmen Catizone, executive director of the National Associations of Boards of Pharmacy. "We are not making any money on it. We are doing it because of the patient safety issue."
In a notice to agencies applying for opioid abuse prevention money, the CDC acknowledged that states must "establish and maintain access" to the federal government's preferred system, but said states still have choices. "CDC is committed to ensuring that states have access to multiple platforms," the agency said.
Catizone said it doesn't appear that the agencies are going to remove the restrictions despite "a groundswell of opposition."