DENVER–The Colorado legislature is considering expanding a state-run database of prescriptions of controlled substances, primarily narcotics and other highly regulated drugs, to now include every prescription dispensed in Colorado.
The Prescription Drug Monitoring Program (PDMP) was enacted in 2007 with the intent of allowing pharmacists and physicians immediate access to their patient’s history of controlled substances–those regulated by the U.S. Drug Enforcement Agency (DEA)–to help stem drug abuse and detect “doctor shopping,” in which a person goes to multiple doctors to be prescribed the same narcotics several times.
The law has been expanded and amended several times since 2007 and House Bill 1012 now proposes to expand the program to include all prescriptions for medicines dispensed in Colorado.
The bill, sponsored by Representatives Janice Rich, R-Grand Junction and Kyle Mullica, D-Northglenn and Senators Brittany Pettersen D-Lakewood and Don Coram, R-Montrose, has passed the House Health & Insurance committee and is awaiting action in the House Appropriations Committee.
Rich told Complete Colorado in an interview Friday that she was contacted by Quality Health Network in Grand Junction and another provider about adding all prescription drugs to the database.
“It’s all about patient, safety. This provides the most comprehensive and up-to-date info on a patient. It helps reduce adverse drug events and it will positively impact safety by giving all info to the provider,” said Rich. “If the physician has all of the information available to them, they may be able to better assist the patient. I know my husband takes a lot of medications, he doesn’t carry that list around with him. A lot of [people] don’t.”
The patient information in the database is considered a medical record under state and federal law, including the Health Insurance Privacy and Portability Act (HIPPA) and is supposed to be strictly confidential. Violations are punishable by civil fines of $1,000 to $10,000. There are no criminal penalties in the statute.
According to a 2014 article, The Colorado Medical Society says from 2007 through 2014 the State Board of Pharmacy, which enforces privacy protection, has handled five cases of unlawful use of the database, including a $10,000 fine for a doctor who accessed data on a former spouse.
Asked about the potential for hacking the data Rich said, “I’m not going to disagree with you there. But since this has been in place, this system has not been hacked. And if this bill were to pass, we are going to recommend that additional safeguards be put in place.”
Asked about privacy and whether patients should have to give permission for their non-narcotic prescriptions to be included, Rich said, “That was heavily discussed, but then you would have incomplete information on patients. Their medical records are already online if they don’t know that.”
But that is not entirely true. Some patients insist that their medical records not be computerized for reasons of personal privacy, and computerization is not mandatory under the Affordable Care Act (ACA). But if the bill passes their history of all prescription drugs they use would be in the state database.
But even assuming that medical records are online, that just shows a lack of need for an expanded PDMP according to Linda Gorman, director of health care policy at the Independence Institute, a free market think tank in Denver. “If medical records are already online, then that means prescription drug are already online,” Gorman told Complete Colorado. “So therefore the state doesn’t need this database, unless the real goal is to control patient treatment.”
“The PDMP was supposed to reduce drug abuse,” continued Gorman. “In fact, it has made life more difficult for patients in pain and the physicians who treat them. And, drug abuse has skyrocketed. State government will eventually use the prescription drug database to control treatments and pricing as it has in Medicaid. It will degrade medical care and patients will suffer.”
“The only person that has access to that is your medical doctor that you have a relationship with. The doctor down the street doesn’t have access to your records,” said Rich. But prior amendments authorized out-of-state pharmacists to access patient records and expanded the ability of law enforcement to obtain PDMP records on pharmacists, doctors and patients in a criminal investigation pursuant to a subpoena.
The bill also permits researchers and the Colorado Department of Health and Environment (CDPHE) to access the data, but does not specify that the records be anonymized or aggregated before allowing anyone but the patient’s physician (including emergency room doctors) to access it.
“This database invades doctor/patient privacy, because it makes the treatments being given obvious to state officials,” continued Gorman. “It gives the state power to punish doctors and their patients for not following clinical guidelines that the state may wish to enforce, but that may not be the best treatment for a specific patient.”
In addition to the major changes in HB 1012, another bill, Senate Bill 098, would reauthorize the PDMP through 2028. The program was scheduled to automatically be repealed on July 1 of this year and has been under sunset review since 2020.
