Maine has had a prescription drug monitoring program since 2003. Designed to prevent and detect prescription drug diversion, it's an electronic database of all transactions involving controlled substances. In other words, it's a way for pharmacists and physicians to keep track of the types and quantities of pills that are being prescribed. But the program is voluntary. And with drug overdoes deaths climbing, Maine's attorney general says it's time to beef up the program and its mission.
Maine is one of more than 40 states with similar monitoring programs in place. And, like Maine, many of them are confronting a surge in overdose deaths.
At a recent meeting of her counterparts from around the country, Maine Attorney General Janet Mills said a major topic was how to improve these state programs and how to coordinate information on the use of scheduled drugs like oyxcontin and other opioids.
"I think 176 lives lost last year alone is a significant problem in this state," she said. "Thirty-four of those people were heroin users but they were also sometimes mixing heroin with prescription drugs."
Mills said confronting this problem will require action by not only the state and federal governments, but by the entire medical community, from prescribers to pharmacists.
"Two of the major concerns remain, number one: interstate operability - in other words sharing information, for instance, between Maine and New Hampshire, Maine and Florida, wherever people are coming in and out of states," Mills said. "And secondly, real time data access."
Guy Cousins, director of the Office of Substance Abuse Services, says Maine is doing better than many states. Prescription data used to be loaded every month. Then it was loaded every two weeks. Then weekly. And by the end of this year, Cousins says it will be entered on a daily basis.
"The ideal would be live," Cousins says, "but there'll be some costs that would be involved in that. The 24-hour data upload will be quite manageable for us."
Gordon Smith, of the Maine Medical Association, agrees that Maine is making progress, but he says the focus needs to be on drug treatment, as well as drug diversion. Smith points out that, in addition to drug deaths, there were 900 drug-affected babies born in Maine last year - that's 900 babies born to mothers with a serious drug problem.
Smith says sharing data would help identify them and get them the help they need.
"This is a community problem. This isn't a problem of just the doctors, or just one group or another, it's everybody has to be involved in this," Smith says. "And certainly if you are in health care and are dealing with the drugs themselves, you've got to step up to the plate."
Maine is currently involved in a pilot project to share prescription data with Alabama. But some states, including New Hampshire, haven't yet implemented prescription monitoring programs. And Smith says that makes data sharing difficult.
"You know, in truth, probably if the Congress was not so dysfunctional, they should pass a law having a federal, nationwide prescription monitoring program and have the states be partners in it," Smith says.
Mills says another problem is that not all prescribers are part of the system. After first participating and then dropping out, the Veterans administration is now moving to get back into Maine's monitoring program. But Mills says a federal law provides a loophole for methadone clinics.
"There are methadone patients who are dying because they are mixing methadone with other drugs or with alcohol, in a combination - a cocktail combination - of things, and they are overdosing and dying," she says. "And wouldn't it be good to know, if you are a primary care physician, that your patient is also getting methadone from a clinic up the street."
Mills says while the federal government needs to act, the state should not use that as an excuse not to improve its monitoring program. She says when the new Legislature meets next January she expects bolstering the prescription drug monitoring program will be a priority.
