Two committees in the House are grappling with the enduring, and escalating, problem of prescription drug abuse in Vermont.
Physicians offered members of the Human Services and Judiciary committees a range of recommendations, but no cure-all solution last week.
Dr. Cyrus Jordan is the medical director of the Vermont Medical Society’s Education & Research Foundation and the author of a November 2012 study that analyzed health care professionals’ assessment of the problem.
Jordan outlined a handful of steps the Vermont Legislature could take to curb prescription drug abuse, but he cautioned them against crafting statutes to address what he called “an evolving problem.” Instead, Jordan encouraged the committee members to adopt statewide standards for doctors who deal with patients who complain of chronic pain.
The health care payment system helps drive prescription drug abuse, Jordan said. He quoted a physician who observed that the fee-for-service system makes doctors more pressed for time and inclined to recommend more expedient, pharmaceutical cure-alls.
“It’s almost as if the fee-for-service program is encouraging us to prescribe pills,” he said.
Part of the problem, Jordan said, is that there aren’t enough pain specialists in the state, and lawmakers should figure out a way to entice them to come to Vermont.
He also suggested that lawmakers could require that benefit plans cover pain management practices such as acupuncture and massage as an alternative to addictive opioid pain medications.
Jordan urged lawmakers to “just be careful” about how they handle the interplay behind law enforcement and physicians. The prevalence of prescription drug abuse has created a “really fuzzy interface between law enforcement and doctors” and has led to a “chilling effect on people’s access to opioids, people that actually need them because of law enforcement and professional regulation.”
Jordan said federal funding might be available for some of the initiatives he recommended from the Risk Evaluation and Management Strategy. Under the program, the Federal Drug Administration requires drug companies to fund prescription monitoring systems, professional education and public education in exchange for allowing pharmaceutical corporations to market drugs that have unforeseen, adverse effects.
Lawmakers quizzed Jordan and several pain specialists about the Vermont Prescription Monitoring System — a database set up to alert physicians and pharmacists to possible drug abuse among patients. Dr. Zail Berry, a pain specialist and professor at the University of Vermont College of Medicine, said she relies on the system, but she discouraged the committees from requiring its use.
“It’s a wonderful tool … but mandatory checking is going to up the hassle factor without really improving care,” she said.
Berry suggested that it would be more effective for the state to invest in a notification system that alerts doctors when patients have seen four or more doctors — an indication, she said, that they may be doctor-shopping.
After the day’s testimony, the chair and co-chair of the Judiciary Committee said they were left with the impression that the problem extends beyond the doctor’s office.
“I was really interested in the recommendation that insurance covers things like acupuncture and massage … that is something we could look at in terms of legislation,” said Rep. Maxine Jo Grad, D-Moretown, vice chair of the Judiciary Committee. A drop-off center is a place where people can dispose of the extra pills form their prescription. Grad said making drop-off centers — locations where leftover prescription medicines can be left for safe disposal — more accessible is another solution within the purview of committee.
Rep. Bill Lippert, chair of the committee, said the testimony raises questions about how the medical system is aiding and abetting prescription drug abuse.
“You would not think based on the testimony we heard today that most of it is coming from the actual prescribers,” Lippert said. “There are also suggestions that we could do everything to tighten this up, to keep people from doctor-shopping, but there are other avenues through which prescription drugs reach the streets.”
