RACH goal: Stop 'doctor-shopping'
May 10, 2012
FORT SILL, Okla.-- The abuse of prescription drugs has reached an "epidemic level" in the United States, according to the Centers for Disease Control and Prevention in Atlanta.
Recent statistics show that one-third of the prescription drugs filled in the United States were taken by someone other than who they were prescribed for. Some drugs are sold by the patient, given away or stolen, often by young people ages 18 to 24. Another alarming practice by prescription drug seekers is called "doctor-shopping," going to multiple doctors and seeking prescriptions for controlled substances. The Army is not immune to this behavior, according to Dr. Michelle Val, Reynolds Army Community Hospital Primary Care director.
"What we are doing at RACH is making it much more difficult for people to go around the system," said Val. "Because we are seeing an upsurge in patients who are paying cash for their prescriptions and not using their benefits and we are catching them that way. We don't see them on Tricare if they pay cash, but they come up on the Oklahoma prescription monitoring program."
Pharmacies are required to put patient information into the system as soon as they are filling the prescriptions, and if the pharmacists see something that concerns them, they can contact the prescribing physician, according to Val.
"At RACH we can actually go into the Oklahoma database and pull up the patient's name and all of the prescriptions they have had filled, because we have medical staff who have Oklahoma licenses. Our system is not perfect, but we have identified the problems and are working to solve them," she added.
To deal with this problem RACH now has advanced testing for patients who are on chronic controlled substances. These tests make sure the patients are actually taking what they are supposed to be taking on a daily basis, and not taking drugs that haven't been prescribed for them, or any illegal substances.
"These are huge red flags when a patient tests positive for multiple medications on urinalysis tests, especially if the drugs overlap and can cause very serious harm if taken together," Val said. She also emphasized that it is illegal for Soldiers and their family members to take medications that have not been prescribed for them. Military personnel who abuse drugs or take drugs that are not currently prescribed to them are subject to AR 600-85 of the Uniform Code of Military Justice.
On May 1, the Department of Defense implemented a new policy regarding the use of drugs prescribed to Army personnel. Under this new Army policy, prescriptions will have six-month tenure for use. If a Soldier uses that medication after the six month period and it hasn't been renewed, they will be in violation of Army policy if they test positive on a random urinalysis screening. So Soldiers and family members shouldn't hold onto medications after their prescription has expired.
"From the RACH perspective, if they are in that much pain that they would take a previous prescription, they need to come in and be seen because we need to know if it is the appropriate medicine for their pain," Val said.
She also emphasized that those unused medications are one of the biggest sources for abuse. "A lot of teenagers are getting leftover medications out of their parent's medicine cabinet and then they take them. So we've started to give those controlled medications in short-term courses, and emphasize to Soldiers and family members that when they are done with them, they need to turn them in for disposal. Don't keep the drugs around the house and don't flush them down the toilet," Val added.
"Many of our patients are on chronic medications. They become tolerant to, and dependent on them, but not necessarily addicted to the drugs. But those patients who are more prone to addictive behaviors, we want to be monitoring them very closely so that if they start developing an addiction or using other medications, we will be able to identify that behavior very quickly and get them appropriate help."
"We always termed our 'sole-provider policy' at RACH to mean patients who are on controlled substances would get those medications from only one provider. We've kind of shifted that from being a more punitive program, meaning 'we caught you doing something bad, so you can only get medication from one provider,' to being more proactive, so we can identify the Soldiers or family members who are having problems. And we're starting to make that shift now," Val said.
"Patients who are very stable and have been on the same dose for a long period of time are going to require less monitoring. But there still needs to be a good relationship between that patient and their provider. And there needs to be some trust between them," she added.
Val stated that patients should be getting their medications solely from one provider, so they are not "doctor-shopping" even within the hospital, because that is a problem.
"We have patients who will try to go to another provider because they think they can find a doctor who will give them the medications they want. Fortunately, we do have our electronic health records, but there are a handful of patients who try to 'doctor-shop' and we know what they have received," she stated.
"Education, monitoring, testing and counseling are vital parts of what we do. Our patients need to remember that we are here to help them," Val said.