Substance Abuse in WV - West Virginia State Medical Association

Special Issue | Scientific Articleon previous incidences wasmentioned by several physicians.One physician commented:“Unless the law enforcementmakes a priority to follow-up onmy report and actually go ‘get’that patient, it’s no use to keepreporting it. I even had patientsthat were caught altering myprescriptions, and the state troopersdid nothing to investigate.”Other comments pertained tothe use of the Board of Pharmacywebsite. Several physiciansnoted that the website is notalways up to date, and that itis difficult to access at times.DiscussionThe results of this study suggestthat doctor shopping is a commonoccurrence, especially in theemergency department, where almost90 percent of emergency physicianssuspect a patient of doctor shoppingweekly. In addition, we note thatmost West Virginia physicians areaware of the WVBoP ControlledSubstances Monitoring Programwebsite, and use it for patients theysuspect of doctor shopping. Only 1 in5 physicians currently report doctorshopping to law enforcement. Studiesinvolving other states’ prescriptionmonitoring programs have shownsimilar awareness and usage ofsuch resources. 5 Of note, 85 percentresponded that they would be morelikely to report if granted immunityby legislative action. HIPAA andconfidentiality issues were citedby the majority of physicians whodo not report doctor shopping.Qualitatively, the surveydemonstrates the need to addressissues with the BoP website’saccessibility, and underscoresthe need for cooperation on thisissue with bordering states. Theneed for a streamlined reportingprocess was also noted.Current West Virginia lawexplicitly states that doctor shoppingfor controlled substances is a crime.In addition, HIPAA regulationsstate that it is a permitted disclosurefor a covered entity (physician) toreport protected health informationon a patient when that patient isengaged in criminal conduct on the(physician’s) premises (HIPPA, 42CFR 164.512(f)(5)). Furthermore,the state legislature could pass a billgranting immunity to physicianswho report doctor shoppers to lawenforcement. This bill would besimilar in nature to the one passed in2008 (Code of West Virginia §17B-3-13) that granted physicians thepermission to report protected healthinformation to the Division of MotorVehicles of patients they determineto be unsafe to operate a motorvehicle. It is similar in that it wouldallow the reporting of confidentialinformation to a state agency forthe protection of the public health.Some may question the ethicsof allowing physicians to reportconfidential patient information. Theneed for physicians to balance patientconfidentiality and the welfareof the public is well-established.For example, despite a patient’spreference for confidentialityto be maintained, public healthlaws require the reporting ofsexually transmitted diseases. TheAmerican Medical Association’sPrinciples of Medical Ethics indicatethat physicians have multiple andpotentially competing obligations. 8Principle IV states that “a physician…shall safeguard patient confidencesand privacy within the constraintsof the law,” and Principle VIIrecognizes the responsibility ofphysicians “to participate in activitiescontributing to the improvement ofthe community and the bettermentof public health.” Much like theepidemic of sexually transmitteddiseases required public healthreporting to curb the problem, itappears that prescription drugabuse and diversion which hasreached epidemic proportions insome West Virginia counties willrequire similar action. The scope ofthis problem has been documented,and West Virginia’s death rate percapita from prescription overdoses,which leads the nation, substantiatesthe need for a new approach.One limitation of this study is thatnot all physicians in West Virginiawere surveyed. However, we choseto survey those physicians who aremost likely to come into contactwith doctor shoppers- emergencyphysicians and primary carephysicians. Also, surveys of thisnature are subject to responder bias.However, our response rate of 61percent from emergency physiciansshows a robust sample. The overallresponse rate was comparable toother physician surveys, 6 and theavailability of an online survey didnot seem to increase participation,as demonstrated previously. 7ConclusionSuccessfully combating theproblem of prescription drug abuseand diversion in West Virginia willrequire a multifaceted approach. Thissurvey of over 250 West Virginiaphysicians revealed the complexityof the problem. Physiciansidentified difficulties with obtaininginformation on doctor shoppersin border states and the userfriendlinessof the WVBoP ControlledSubstances Monitoring Programwebsite. They also cited the failure oflaw enforcement to respond to theirreports of doctor shoppers and theneed for a central center with an 800number to which they could reportdoctor shoppers. In this study, WestVirginia physicians emphaticallystated that this problem must beaddressed, and with a change inthe law, they report they will dotheir part to reduce this problem.SUBSTANCE ABUSE IN WV | Vol. 106 13