The Hundred Years’ War

Steve AriensOur country seems obsessed with “fighting wars”: Korean, Vietnam, War on Poverty, No Child Left Behind (a.k.a., War on Illiteracy), and the granddaddy of all wars, THE WAR ON DRUGS. History suggests that the last war we fought that had a final victory was World War II, and that took two H-bombs to bring to a close.

How it began

Unofficially, the war on drugs started with the Harrison Narcotic Act of 1914, which established the Bureau of Narcotics. In 1968, this bureau merged with FDA’s Bureau of Drug Abuse Control to become the Bureau of Narcotics and Dangerous Drugs (BNDD). By 1971, the BNDD had 1,500 agents and a budget of $43 million.

In 1973, the BNDD morphed into the Drug Enforcement Administration (DEA), which by 2011 had a total of 10,000 employees and a $2 billion budget.

There is at least one group of former law enforcement officers as well as others in the justice system who believe that the war on drugs is a waste of time: the members of the organization Law Enforcement Against Prohibition (www.leap.cc).

PMPs 

The first prescription monitoring program (PMP) was funded by one of the pharmaceutical manufacturers; however, most of the laws that created these programs in the various states prohibited data mining to uncover doctor- and pharmacy-shoppers.

Today, these databases operate in real time and transmission of data is transparent, from the pharmacy point of view.

Unfortunately, retrieval of reports on patients is, to say the very least, time-consuming. It makes one wonder why the data goes in easily, but getting reports out of the system is just the opposite.

It has been reported that several of the chain pharmacies do not allow their prescription departments to have access to the internet, which is the only way to retrieve a report from the PMP. Is that because they don’t want staff wasting time running reports - or because they don’t want to lose any revenue, which would happen if pharmacists rejected prescriptions from doctor- and pharmacy-shoppers?

The big glitch

Then there is a major flaw in the entire PMP system: Healthcare professionals must accept the patient’s ID at face value - but anyone can obtain fake ID nowadays.

The general public’s access to technology has surpassed the original intent of the PMP program. Just Google “how to create fake driver’s license” to see how easy it is to get the material and instructions.

On October 4, 2010, the Boston Globe reported the case of a man who stole dozens of IDs and used them to fill forged prescriptions all over Massachusetts (http://b.globe.com/172k3Qn).

The case involved
76 counts of stolen IDs, 76 counts of forged prescriptions, and 40 counts of insurance fraud. And that’s just one example.

There’s more

I learned a few years ago in an e-mail from the Indiana Board of Pharmacy that the Indiana PMP asked the state’s Bureau of Motor Vehicles to allow a cross-reference of the IDs in the PMP database against the state’s BMV database, in order to validate the IDs in the PMP database. This was denied by the BMV, and the decision was supported by the state’s attorney general.

How many other state PMPs have encountered similar obstacles?

Spiked guns in the war on drugs

So the war on drugs is being fought with:

• A system that uses a PMP that has unknown number of forged IDs

• Many employers who will not provide internet access to pharmacists so that they can use the PMP

• PMPs that mandate transparent submission of data but don’t mandate easy retrieval of reports

• A system that will not provide for an easy way to validate the IDs of new patients seeking controlled meds against an official database

• An untold number of healthcare professionals who do not want to be the “police.”

Then there is the DEA, whose charge, we assume, is to prevent the diversion of drugs. A DEA agent has told me that in fact, its purpose is to arrest those who divert, and I believe it.

Follow the money

If you follow the money trail, everyone from pharmaceutical manufacturers to physicians to pharmacies - everyone - stands to profit from the flow of money connected with the prescribing and selling of controlled drugs. And the DEA can justify larger budgets and job security by pointing to the continued flow of drugs getting to the street. 

Steve Ariens is National Public Relations Director for The Pharmacy Alliance (www.the pharmacyalliance.com). You can e-mail him at steve@steveariens.com or check out his blog, pharmacist steve (http://www.pharmaciststeve.com/).