Why are the Centers for Disease Control and Prevention and U.S. Department of Justice making it more difficult to access grant money meant to combat the opioid crisis?
That’s what boards of pharmacy around the country and congressional delegations from at least three states, including Minnesota, want to know.
Amid an opioid crisis that the CDC says kills more than 130 people each day, the Justice Department’s Bureau of Justice Assistance grants provide resources to state, local, and tribal lands to help curb abuse. But recent Trump administration guidelines say that now, the grants will come with new conditions: states needed to adopt RxCheck, a Department of Justice system that would provide a central hub for monitoring doctors’ drug distribution in each state.
At least four states currently use RxCheck, but the problem, detractors say, is that states already have their own prescription drug monitoring programs or PDMPs, systems that do exactly the same thing; that the RxCheck technology, which is relatively untested, may make things worse; and more specifically in Minnesota, that the adoption of the RxCheck system may be a violation of current state law.
This puts states like Minnesota in a tough position: If states do not implement the changes, they may lose out on millions in grant money. In Minnesota in particular, $750,000 of grant money is immediately at stake. And if the state doesn’t adopt the new system, it could jeopardize a much larger grant — in Minnesota, $3.9 million per year for the next three years, $11.7 million in total.
A duplicate system
Cody Wiberg, the executive director of the Minnesota Board of Pharmacy, said the state system for monitoring prescriptions of controlled substances was created by the Legislature in 2007 and was activated in 2010. Minnesota’s PDMP is administered by the Minnesota Board of Pharmacy, and it allows doctors and pharmacies to see whether patients have similar prescriptions from other doctors. Working through the National Association of Boards of Pharmacy, a national network allows prescribers and dispensers to check with neighboring states to stop “doctor shopping” and forgeries.
Currently, 49 states, the District of Columbia and Puerto Rico participate in the Boards of Pharmacy system (California does not participate).
“It is the first thing the state did to respond to opioids abuse,” Wiberg said. While opioids were the top priority it is also useful in keeping an eye on stimulants and drugs like Valium, he said.
Because each state has different laws and rules — Minnesota for example requires law enforcement to get a court order before it is given access to patient data — the information isn’t stored in a central location. Instead, the central hub processes requests between states and allows sharing. Once the information is transferred, it is “scrubbed” from the process. The system also requires the laws of states providing the data are respected by the states receiving the data; for example, a state requesting data from Minnesota has to agree not to share it with law enforcement without a court order, whether or not the receiving state has such a legal requirement.
The multi-state aspects of the system let a doctor in, for example, Winona, check a patient’s prescription history in Minnesota, Wisconsin and Iowa. If the doctor knows the patient winters in Florida, he or she can include that state in the search as well.
Wiberg said the system took two years to get through the state Legislature because medical associations were concerned about patient privacy and did not want to create a system that could be used to police and discipline doctors and pharmacists.
He believes the problem with RxCheck is that it duplicates many of the features already provided by PDMP’s and the National Association of Boards of Pharmacy.
Wiberg said the federal government sees one benefit in having the two systems as competition. But he said while having multiple bidders for software and systems makes sense, it doesn’t make sense to have more than one national hub holding or processing sensitive patient and doctor information.
“We’re talking about a national hub through which states can share data,” he said. “You don’t want multiple hubs, you want one hub and that’s to limit the access points to the data. That’s one less hub that could be hacked into, for example.”
The conditions “do not require a state to switch or abandon its current interstate or intrastate data-sharing platform,” said Debra Houry, Director of the National Center for Injury Prevention and Control at the CDC, in a letter to the National Association of Chain Drug Stores. However, Houry’s letter did not address how the additional burden of adding the RxCheck system would impact states like Minnesota.
Wiberg said he worries that Minnesota could be unable to use the RxCheck system because it doesn’t align with state law and lose out not only on grants specific to prescription drug monitoring but unrelated health care grants.
“The board of pharmacy is not going to jeopardize a nearly $800,000 grant that we received and any grants that the Health Department might receive, which could be in the millions,” Wiberg said. “We’re not going to jeopardize that by refusing to link to RxCheck. So if we can do it in a legal way we will do it. We just don’t think it is a necessary thing to do.”
In a letter to the CDC, all members of the Minnesota congressional delegation said they are concerned that “the operation of multiple interstate and intrastate platforms could lead to additional administrative or financial costs for the state” and asked the CDC to explain how the conditions “will not create an undue burden for the states.”
The move has been panned by at least two other bipartisan congressional delegations: Indiana and North Dakota. The group of congressional members objecting to the rule includes everyone from Mike Pence’s brother, Greg Pence, who represents eastern Indiana to Ilhan Omar of Minneapolis.
After a roundtable in Minneapolis with Minnesota Gov. Tim Walz, Minnesota Sen. Tina Smith and Wisconsin Gov. Tony Evers, U.S. Sen. Tammy Baldwin endorsed the current system of PDMPs and said she wants to enhance it.
Baldwin called the system “one of the tools in fighting the opioid epidemic” and alerts doctors and pharmacists to patients who “might be exhibiting drug-seeking behaviors.”
“The PDMPs have proven extremely useful both within states and increasingly between states, especially when you’re looking at a long border as we have here.” She described herself as “totally committed” to making more effective and that data be easier to share across state lines while safeguarding patient confidentiality.
“Our states have both seen the horrifying impacts of opioid abuse and other drug abuse. This is one tool for the prescribed drugs that we can use. I would fight any attempt to defund at the state level and at the federal level would support making it easier to access across state lines.”