By Scott Waggoner
Edited by Brett Weisband and Sarah Robbins
Every month, pharmacist Ed Casner creates spreadsheets showing all the controlled substances he dispensed the previous month and adds them to the 30 million records already in South Carolina's prescription drug abuse database.
SCRIPTS, the South Carolina Reporting and Identification Prescription Tracking System, is supposed to let pharmacists and state officials know whether someone is abusing prescription drugs. They might be filling multiple prescriptions at different pharmacies, or a doctor might be prescribing unusual quantities. Often, this can be the result of forgery by the customer.
But there's a hole. Casner, a pharmacist at Ridgeland Main Street Pharmacy, wouldn't know if a customer was hopping among pharmacies in different states. The 35 states with monitoring programs don't link their data.
"Not having access to the prescriptions filled in Georgia or Florida leaves little chance of catching someone getting illegitimate prescriptions when they come to us," Casner said.
The Justice Department, with approximately $600,000 budgeted a year, is working to close that loophole through the Prescription Monitoring Information Exchange project. This technology is being developed through a secure server in Ohio, and will eventually allow the federal program to link databases.
But it's slow going because the states store their data differently and laws governing access vary, said Sheila Jerusalem, spokeswoman for the Bureau of Justice Assistance, which is leading the effort to link the databases.
"The determination of what information is shared, and with whom, must be carefully made in accordance with each state's polices and regulations, and this requires time and resources to accomplish," Jerusalem said.
Ohio and Kentucky began sharing test data last year and are expanding to all their data. States' reluctance to share data and the tangle of state laws, many aimed at privacy concerns, mean all the states probably won't be linked until next year, Jerusalem said.
Prescription drugs are second behind marijuana in abuse, with an estimated 7 million people abusing prescription drugs each year, according to the National Institute on Drug Abuse. Abuse has risen notably among teens with one in five having abused prescription drugs, the National Council on Patient Information and Education says.
Casner is one of 4,109 pharmacists, doctors, nurses and veterinarians with access to the South Carolina data, according to Adam Myrick, spokesman for the state Department of Health and Environmental Control. DHEC runs South Carolina's database, created in February 2008.
Casner enters information on as many as 500 prescriptions a month. He doesn't have a choice. State law says failing to report the sale of a prescribed controlled drug could bring a $2,000 fine and two years in prison.
The database doesn't track things like robberies or thefts, but Casner knows that dark side of the prescription drug firsthand.
Two men, one with a gun, looking for the painkiller OxyContin held up Casner and another pharmacist one afternoon in June 2009. The robbers took about a dozen bottles, Casner said, but the other pharmacist called police, who stopped the robbers a few hundred yards away.
"It was quite an experience, but it's something fairly common, especially for pharmacies near state borders," Casner said.
Some of the problems with sharing the databases across states can be found in South Carolina.
"The data is only updated once a month, and with more prescriptions being written every year, it still provides opportunities for abuse," said Michael Gleaton, a pharmacist at Hawthorne Pharmacy in Columbia.
Pharmacies have up to six weeks to report filling a prescription, but most larger pharmacies send reports weekly, Myrick said. DHEC uploads the reports within 72 hours, he said.
A pharmacy must be reviewed and registered by DHEC before being given access to the database.
With privacy a major concern, DHEC doesn't give out-of-state pharmacies access to the S.C. database unless they hold a South Carolina license, according to its online fact sheet.
"Data security is a huge priority, and we try to do everything that is humanly possible to avoid violating federal health privacy law," DHEC spokesman Jim Beasley said. The best way to combat prescription abuse is through education, said Richland County sheriff's Lt. Mark McColman. Part of the Drug Abuse Resistance Education program many law enforcement agencies use deals particularly with over-the-counter drugs.
Chrissy Mobley, executive director of the Union County Commission on Alcohol and Drug Abuse, said that about 60 percent of the patients her counselors see have abused prescription medicine. The most common health effects she sees are liver damage, heart failures and seizures.
Increased stress in people's lives also has helped lead to abuse, says John Black, immediate past president of the S.C. Medical Association.
"It follows what is happening in our society, avoiding responsibility and desiring an escape from the realities of life," Black said.
Painkillers like oxycodone and hydrocodone, sleeping pills such as Ambien and antidepressants like Valium are the most commonly abused prescriptions, Black said.
Physicians are becoming more aware of prescription abuse and are looking for deceptive behavior, especially from new patients. But it's still difficult to catch those who have a way with lying and who want pills to sell on the street, Black said.