NEWARK – Between November 3 and December 7, 2011, a single patient obtained a four-month supply of oxycodone and methadone by presenting prescriptions, now believed to be forged, to three New Jersey pharmacies on a total of 14 occasions. The patient circumvented the safeguards that pharmacies and insurance carriers use to spot such abuse by spreading out his visits between the pharmacies, and by paying with cash in some instances and by insurance in others.
As a result, in one month the individual obtained a total of 2,520 doses of highly addictive, narcotic medications classified as Controlled Dangerous Substances.
The apparently abusive pattern of purchasing drugs was revealed this month – and the discovery was made thanks to the New Jersey Prescription Monitoring Program (NJPMP).
Attorney General Jeffrey S. Chiesa unveiled the NJPMP as a powerful new tool in the State’s fight against the abuse and diversion of prescription drugs, and the often-heavy reimbursement costs of fraudulently-obtained prescription medication borne by health insurance companies, the State, and ultimately taxpayers.
Attorney General Chiesa noted that prescription drug abuse is growing at an alarming rate as a threat to public health and safety:
- In 2010, New Jersey saw 7,238 admissions to State-licensed or certified substance abuse treatment programs as a result of prescription painkiller abuse. That number represents a striking 230 percent increase from 2005, according to statewide statistics collected by the Substance Abuse and Mental Health Services Administration (SAMHSA)
- Every day, 40 Americans die from abusing narcotic prescription painkillers, according to the U.S. Centers for Disease Control and Prevention. Prescription drug abuse deaths have more than tripled in the past decade and now kill more people in the U.S. than heroin and cocaine combined. Opioid pain medication abuse accounts for the most common poisonings treated in emergency departments and nearly 1 million Americans are currently addicted to some type of opiate – costing insurance companies, according to some reports, upwards of $75.5 million a year.
- The New Jersey State Commission of Investigation in June 2011 reported that a growing number of young people are abusing prescription drugs, and noted a significant trend in which young people who became addicted to painkillers eventually turned to heroin as a cheaper substitute.
The NJPMP, established by State legislation and maintained by the Division of Consumer Affairs, has been collecting detailed data from 2,000 pharmacies statewide since September 1, 2011. Pharmacies provide data every 15 days on all prescription sales of drugs classified as Controlled Dangerous Substances (CDS) and Human Growth Hormone (HGH).
The result is a searchable database that includes detailed information on the sale of these high-risk drugs when they are dispensed in outpatient settings in New Jersey, or by out-of-state pharmacies dispensing into New Jersey. The information on each transaction includes, among other things: the patient’s name and date of birth; the dates at which the prescription was written and the drug was dispensed; the name, quantity, and strength of the medication; the method of payment for the medication; and the identities of the prescriber and pharmacy. The database now includes information on approximately 4 million prescriptions dispensed in New Jersey since September 1.
“The New Jersey Prescription Monitoring Program is one of several new tools in our statewide effort to halt the abuse and diversion of prescription drugs and promote fiscal integrity in the healthcare sector,” Attorney General Chiesa said. “The database will help the Division of Consumer Affairs and other law enforcement agencies identify and investigate individuals and businesses suspected of fraudulently diverting controlled drugs for abuse. By highlighting the location, nature, and extent of abuse throughout the state, the information collected will also better inform our healthcare initiatives and addiction-treatment efforts.”
Patient information in the database is kept confidential in compliance with Health Insurance Portability and Accountability Act of 1996 (HIPAA) and Privacy and Security Rules. Under HIPAA and the State law that establishes the NJPMP, the Division of Consumer Affairs on January 4, 2012, began allowing State-licensed prescribers and pharmacists to obtain free accounts to access and search the database through a secure website.
Registered practitioners must certify they are seeking data only for the purpose of providing healthcare to current patients. Any practitioners who access or share NJPMP data for any other purpose are subject to civil penalties of up to $10,000 for each offense, and disciplinary action by the practitioner’s professional licensing board.
The Division of Consumer Affairs will also provide case-specific NJPMP information to law enforcement agencies, pursuant to grand jury subpoenas or court orders and certifications that the information is requested for a bona fide investigation of a specific practitioner or patient. In addition, the Division is required to notify law enforcement agencies or professional licensing boards if the Division determines a prescriber, pharmacist, or patient may have violated the law or committed a breach of prescribers’ or pharmacists’ standards of practice.
“We all know that prescription medication, when used properly, can alleviate pain and illness. The darker, lesser-known side of prescription medication is that, when abused, it can be just as dangerous, addictive, and deadly as heroin,” said Thomas R. Calcagni, Director of the New Jersey Division of Consumer Affairs. “Nationwide surveys show that many still mistakenly believe prescription medication is harmless – and this misperception is fueling a nationwide epidemic that’s sending thousands of New Jerseyans into addiction treatment centers each year, and 40 Americans to the grave each day. The NJPMP is an important tool in our statewide effort to halt the soaring problem of prescription drug abuse and diversion.”
The January 2012 launch is the first phase of a three-phase process during which the NJPMP will be further enhanced and expanded, culminating in approximately May 2012.
In addition to its current application for basic searches of patient- or prescriber-specific information, the Division of Consumer Affairs is developing enhancements that will enable more complex, statistical analyses. When fully expanded, the NJPMP will generate reports on geographical areas with unusual CDS or HGH prescription activity during a specific time frame; identify practitioners in each county who prescribed the largest quantities of a specific drug during a given time period; and provide other information that can help identify and compare troubling patterns of CDS and HGH activity.
Brian R. Crowell, Special Agent in Charge of the U.S. Drug Enforcement Administration, New Jersey Division, stated, “The DEA New Jersey Division is committed to fighting the prescription drug problem with every available tool possible in order to protect our citizens. The New Jersey Prescription Monitoring Program will serve as an invaluable tool to thwart the spread of this significant drug threat.”
High levels of prescribing and dispensing of controlled drugs are not necessarily indicators of illegal activity or drug abuse, Attorney General Chiesa noted. “While working to stop abuse, we must remain mindful of the legitimate uses for medication and ensure practitioners are empowered to meet their patients’ healthcare needs,” he said.
Certain medical practices, such as those that specialize in pain management, prescribe larger amounts of CDS medications than others during the normal course of providing patient care. The Division’s NJPMP Administrator will work with investigators from the Division’s Enforcement Bureau to analyze the information behind NJPMP data reports.
“This database is an important tool for physicians and other health care practitioners to have a complete picture of their patient’s use of prescription medications that are classified as Controlled Dangerous Substances and Human Growth Hormones,” said Health and Senior Services Commissioner Mary E. O’Dowd. “With access to this information, practitioners and pharmacists will be able to identify an individual with a possible substance abuse problem and refer them to appropriate treatment.”
Jennifer Velez, Commissioner of the Department of Human Services, said, “The Department is proud to partner with the Attorney General’s Office on efforts to stem the misuse and abuse of prescription medication. This new tracking and monitoring system will serve as a necessary safeguard and empower pharmacists in prevention efforts, as well.”
The launch of the NJPMP is one component of the Division of Consumer Affairs’ comprehensive effort to halt the diversion and abuse of prescription drugs, which includes:
- Enhanced enforcement initiatives, including a reorganization of and additional staffing for the Division’s Enforcement Bureau, which investigates prescription drug diversion cases on behalf of the State Board of Medical Examiners, Board of Pharmacy, and New Jersey’s other healthcare-related professional licensing boards.
- Effecting a reduction in supply, by encouraging practitioners to prescribe only the amount of medication needed for treatment; working with pharmacies to develop a set of statewide best practices for drug security; and encouraging parents and grandparents to maintain their medication securely within the home, and to dispose of their unwanted medications safely and responsibly through Project Medicine Drop (see www.NJConsumerAffairs.gov/meddrop for details), a pilot program providing New Jerseyans medication disposal opportunities 24 hours a day, 365 days a year.
- Educating constituencies, including an outreach campaign for prescribers, pharmacists, parents, and teenagers, about the dangers of prescription drug abuse and ways to prevent abuse.
- Enabling recovery for persons struggling with addiction by advancing measures that will facilitate abusers’ access to treatment and the treatment community’s access to patient-specific prescription information.
For much more information on the New Jersey Division of Consumer Affairs’ initiative to halt the diversion and abuse of prescription drugs, view the Division’s NJPMP website, and the Division’s Project Medicine Drop website.