As the Latah County Coroner for 15 years, and as a practicing family physician, I was well aware of the prescription drug abuse problem long before I came to the Idaho legislature. Over 200 Idahoans die annually from prescription drug overdose. At the same time, there is increased pressure to treat chronic pain.
Complex problems deserve careful consideration, and I have come to realize the legislature and the laws we pass are often blunt instruments. Our founders did not make it easy to pass laws and it should not be, for laws can harm as well as help. A colleague in the Idaho Senate had a constituent approach him about their young sons tragic accidental overdose death. He showed his proposed solution to me, a law requiring prescribers to access the prescription data bank before writing a controlled substance prescription under threat of penalty. Other states have adopted this. I supported a different approach.
In 2011 I asked representatives of the Boards of Medicine, Nursing, Pharmacy, Dentistry, as well as representatives of the professional associations to meet and address this problem. It is called the Prescription Drug Abuse Prevention Work Group(in short: Rx Work Group). We have met quarterly, I usually attend by teleconference. Some good ideas have been brought forward.
Understand that we have a tool in this battle. Idaho has a Prescription Monitoring Program (PMP), administered by the Board of Pharmacy. The Rx Work Group found we had to change the law to allow sharing of information between the professional boards. We did this. We also advocated that all practitioners who have a Controlled Substances Permit from the Board of Pharmacy be required to register with the PMP. This law has also been passed. I’m not opposed to all laws, but I believe it’s important to act responsibly, not just pass sweeping legislation then beat one’s chest about solving a complicated problem, when in fact, the culture needs to change. My interest was to get the tool (PMP) to be used to improve the quality of prescribing by practitioners. To do this we needed a common agreement about the goals of prescribing controlled substances and cooperation between the various licensing boards to improve the prescribing practices of their licensees (doctors, dentists, nurse practitioners, pharmacists, etc.).
So in 2015, with the input from board directors and professional organizations I drafted a statement of purpose and guidelines for practice. This was adopted as a base for the ongoing quality improvement process to be administered by the Office of Drug Policy.
There has been ongoing surveillance of prescribing and constant feedback between the PMP, Board of Pharmacy, Board of Medicine and Board of Dentistry, and Nursing, all in an effort to make these improvements. We struggled to gather the appropriate data to make sure our efforts had any effect. Many times, the death certificates (filled out by county coroners) have incomplete information, so that is another part of the loop that needs to be closed.
I hope the Governors Office of Drug Policy (ODP)can shepherd this effort. Instead, I see their focus to be building a wall around Idaho as the states around us liberalize the use of marijuana. ODP works for the governor, not the legislature, but that would have been an effort of mine in the future, had I been relected.
I believe prescription drug abuse, the irresponsible prescribing by practitioners, and the culture of inappropriate pain treatment has done more harm to our state than illegal drugs have. But maybe the work can continue. It is worth it.