State given list of patient prescriptions, but not for law enforcement

Cy Ryan and Judy Odierna

Thursday, Jan. 2, 2003 | 11:17 a.m.

Every month Nevada pharmacists transmit to the state the names of people who have purchased painkillers and other potentially addictive drugs prescribed by doctors -- and that information is available to law enforcement officials.

Nevada is one of 17 states in which police are able to collect the information under the auspices of a federal program that has pharmacists file regular reports that include patients' names, the names of their prescriptions, the amount of the medication they receive and the names of their doctors. The states' programs fall under the national umbrella of the Prescription Drug Monitoring Program.

Nevada authorities say their system is different from those of other states where the information is routinely funneled to police agencies.

"This is not used as a law enforcement tool," said Louis Ling, attorney for Nevada's Prescription Controlled Substance Abuse Prevention Task Force.

That 15-member task force tracks everything from hard-core narcotics to prescribed painkillers and anti-anxiety medication like the frequently prescribed Xanax and Valium pills. It is composed of representatives from boards that license doctors, veterinarians, dentists and pharmacists as well as physicians who specialize in the treatment of addiction. One member is from the Nevada Division of Investigations.

"Nevada is unique," Ling said. "These people (who are suspected of abusing prescription drugs) don't need to be arrested. They need to be treated."

In Nevada, use by law enforcement of the prescription drug information is limited, he said. The task force turns over the data to police only after it is verified that they have an open investigation of the individual. That must be verified, Ling said.

"That doesn't take very much, does it?" said Alan Lichtenstein, general counsel for the American Civil Liberties Union of Nevada.

Civil libertarians around the nation have said they are troubled by what they see as the "Big Brother" aspect of the reporting system and the way it breaches doctor-patient confidentiality.

"We're talking about medical information that is supposed to be private and giving law enforcement open access to that," Lichtenstein said.

Ling said the Nevada task force is sensitive to those types of concerns.

"We are not snooping around in somebody's medicine chest," he said.

There are fewer than 100 cases of police access a year, Ling said. And the federal Drug Enforcement Administration cannot get Nevada's information about prescription drug users unless the DEA is working with a Nevada law enforcement agency, Ling said.

Susan Griffin of Reno didn't realize her children's Ritalin prescription records are reviewed by state authorities and could be turned over to law enforcement, but she said she's OK with it.

"It's a controlled drug, it should be monitored," said Griffin, a volunteer with Children and Adults with Attention Deficit Disorder. "I'm not shocked that it happens. If the drugs are being abused it should be monitored."

People who are going to one or two doctors for prescriptions are not singled out by the task force, no matter how many drugs they take, Ling said.

The computer that holds this confidential information for the task force is not hooked up to any outside line, so there cannot be any unauthorized access, he said.

The task force meets once or twice a year to decide how to use the data that the state receives from about 2 million prescriptions a year. Ling said the primary mission is to identify those who might be abusing controlled substances. A doctor who is treating a patient can request from the task force all of the prescriptions filled for that individual over the past six months or past year. The task force gets about 10,000 of those requests a year.

Ling said this helps physicians determine the amounts and varieties of drugs the individual is using and whether he or she is "doctor shopping" -- going to various doctors to get prescriptions and filling them at numerous pharmacies.

"The doctors love this," he said.

Lichtenstein said not all doctors love it, however. He said the system keeps some doctors from providing enough pain relief to their patients.

"A lot of people with terminal cancer or patients that are dying in agony are not getting the proper pain medication because doctors are frightened about being investigated for being a drug pusher," Lichtenstein said.

Lichtenstein cited a national study that last month gave hospitals in Nevada the lowest possible grade because they offered few pain management services.

And in May 2000, the Nevada Board of Medical Examiners said a regulation was needed to ensure that patients receive adequate drugs to ease persistent and extreme pain and at the same time protect doctors from sanctions.

Ling, however, said the task force does not investigate doctors or druggists who appear to be over-prescribing. But it does provide information to the appropriate licensing board if such a board has started an investigation of a doctor or pharmacist.

Dr. Warren Evins, president of the Clark County Medical Society, said many physicians are supportive of the program.

"I think it's a good program and I use it frequently," he said. "I think most patients know that certain drugs are controlled substances and that the DEA regulates it. All physicians are aware of it. I would think patients are aware too but I'm not positive about that."

Tricia Leland, a program director with the American Cancer Society of Southern Nevada, said she believes the records that are under scrutiny are not those of terminally ill patients.

"They are actually targeting people who are not ill and don't need the medications; that's what they are trying to control," Leland said. "I don't think it pertains to cancer patients."

The task force does look for profiles of people who are going to numerous doctors for prescriptions and having their prescriptions filled at numerous pharmacies to avoid detection. The records of such patients are sent to the doctors and drugstores that are providing the drugs, Ling said. The task force finds fewer than 1,000 of those cases a year, he said.

The goal in those cases is to get doctors or pharmacists to encourage those patients to seek treatment for drug abuse. Ling said there have been many success stories in which individuals reduced the amount of drugs they were taking or kicked the habit altogether.

Typically, those drug abusers are not recreational users but people who have suffered from intense pain, Ling said. Among the most commonly abused prescription drugs are OxyContin, Vicodin, Lontab and Narco, which are classified as Schedule III painkillers.

Federal law breaks lists a number of controlled drugs on five "schedules." The schedules set control guidelines and regulations as to how each of the listed drugs can be prescribed, as well as other control measures.

According to the U.S. Department of Justice, more than 1.7 million controlled substance prescriptions were filled in 1997, the first year of Nevada's prescription tracking program. Of those, 761,043 were Schedule IV drugs such as Xanax and Valium.

In 1997, 4,680 patients exceeded what experts considered to be normal amounts of the prescriptions but only 38 cases were referred to the Nevada Department of Investigations. In 1998, 5,412 patients exceeded the drug threshold, but only 28 were referred to the Nevada Department of Investigations.