How does the state keep overdose deaths down now?

(Harrisburg) — Solving the addiction crisis will take a concerted effort from state government, the medical and treatment community, and health insurance companies.

Experts consider a prescription drug monitoring program an important piece.

As Pennsylvania puts together its own comprehensive system, it may want to learn from other states’ experiences.

A prescription drug monitoring program is really just a fancy way of saying a database.

Once it’s in place, doctors and pharmacists will be able to check what potentially addictive drugs you’ve been prescribed in the past.

How does this work in Massachusetts?

“We actually ask our providers to do it periodically in the patients that they do have on opiates, not just at the beginning when they’re trying to figure out whether or not this is a reasonable thing to do for that patient to get them started,” says Dr. Philip Bolduc, associate director of special populations at Family Health Center in Worcester, Massachusetts, a working-class city.

“You’ll be able to see, oh yeah it’s just been me prescribing their, whatever, MS Contin, or no they’re getting it from me and they’re also getting it from somewhere else.”

Bolduc says it’s taken some convincing in order to get primary care doctors on board. Waiting rooms aren’t getting any less crowded.

“It’s something that we need to step up to the plate and take responsibility for because the problem doesn’t go away just by kinda kicking it out of your office.”

“It still exists in your community.”

The Bay State was one of the first to get a system in place – but, that also meant it made plenty of mistakes.

Finding a patient with a common last name was hard, and records could be difficult to decipher.

Training is key

Carl Alves is executive director of an advocacy group that trained doctors on the Massachusetts system and helps treat drug addicts.

“Quite frankly that education is important, because it’s great to have the system, but one of the challenges that we’ve found was that a lot of docs might be registered but don’t actively use it, or use it as often as they perhaps could,” says Alves.

But when doctors deny people addicted to pain pills more drugs, another problem comes up. Some move on to heroin, and end up as overdose victims.

“The right way to use that information for a physician or a dispenser is to do an intervention on the spot and actually hook them up with somebody to do an assessment and get them into treatment. That’s really the only way to do it,” says Pennsylvania’s Department of Drug and Alcohol Programs Secretary Gary Tennis.

To be clear, over the long term, the system keeps people who would get hooked on prescription drugs away from them, and thus, away from heroin.

Tennis says he, Health Secretary Karen Murphy and Physician General Rachel Levine are watching the problem.

“They get it. The three of us are determined that Pennsylvania is going to be the first state to get it right.”

How this could affect people who are addicted now

“I built up a tolerance, so he would increase the doses and this went on for about 8 years while I was seeing him,” says Bonnie Rothermel.

From 2003 to almost 2011, she was addicted to prescription painkillers while trying to deal with tendinitis.

After talking to people, she found a doctor who was willing to prescribe her what she wanted.

“And by the time I got to the end of it, he was prescribing me, about 240 10-milligram Percocets a month and also 180, 30-miligram Oxycontin a month and also Zanax, sleeping pills, like all kinds of different things,” she details.

Bonnie, who now works at the RASE Project in Lebanon and Harrisburg, remembers those days as dark ones, consumed with trying to manage her addiction while still working.

“It’s like going down a roller coaster hill, it just builds up speed and it goes faster and faster. And when you start taking, you start out with maybe one every couple hours. Before you know it, you’re taking four or five every couple hours.”

“And your body wants more than the doctor can prescribe, so it just turns into this out of control monster. You need more, you need more, you need more.”

Now, she’s clean. She says if the prescription drug monitoring system had been in place when she was getting treated, she may have been stopped.

Granted, that’s no guarantee. There will likely be at least a small uptick in heroin deaths after the system is in place.

“You can catch people earlier on, it shifts the culture a little bit,” says Secretary Tennis.

“The long range prognosis is very very good. What we want to do here in Pennsylvania, we’re going to do our very best, is to avoid that uptick in heroin by trying to refer more people into treatment.”

Tennis says the timing is great for the database – with Medicaid expansion in place in Pennsylvania, more people have access to more treatment services.

But despite the Legislature authorizing the program to start last month, it’s never been funded.

Governor Wolf’s proposed budget includes money for it, but it may be a year before the database is up and running.

Health Secretary Karen Murphy says the time will be used to do more research on similar programs in other states.

This story has been edited to reflect that Bonnie Rothermel works in Harrisburg and Lebanon, not Carlisle. The RASE Project is based in Carlisle.