Maryland's attorney general has called for tighter regulation of prescription drugs and harsher penalties for illegally diverting them after a report by his office that suggests abuse of the drugs is growing, especially among teenagers.
The proliferation of Internet sites dealing in prescription drugs has contributed to the problems, Attorney General J. Joseph Curran Jr. said.
"The abuse of prescription drugs has gone unnoticed," Curran (D) said in a telephone interview last week. "The more you read, the more you understand that prescription drugs intended to do wonders are being abused."
Curran has proposed the creation of a centralized electronic program to monitor prescriptions, similar to those in 21 states. Ten more states are developing such databases to help identify patients and providers who abuse prescription drugs, he said.
The aim of the databases is to identify abuses such as "doctor shopping," the practice of going from doctor to doctor to acquire more medication, such as painkillers, to treat an illness.
Associations representing pharmacists say such a system is helpful in curbing abuses, but they urge care to protect patients' privacy and to guard against overzealous efforts by law enforcement.
"In theory, it's a good idea to have electronic monitoring," said Howard Schiff, executive director of the Maryland Pharmacists Association. "But we'd like to see it in the health department, not in law enforcement. If it's just in law enforcement hands, then law enforcement is going to go looking for people using, in their minds, excess amounts of drugs."
Schiff, whose group represents about 1,000 pharmacists, also said financial consideration should be given to compensate for "an unfunded mandate" that would require pharmacists to upgrade their computers.
In August, President Bush signed the National All Schedules Prescription Electronic Reporting Act, which set aside $60 million in grants to create state-run databases.
Laxmaiah Manchikanti, president of the American Society of Interventional Pain Physicians, said his group, which represents about 3,300 physicians, lobbied for the federal monitoring bill.
"This will really help physicians to weed out people abusing drugs. If a doctor is doing it properly, you don't have to worry about it as far as the doctor is concerned," said Manchikanti, a physician with practices in Kentucky and Illinois.
Curran said Maryland should also begin regulating unlicensed pharmacy technicians and strengthen penalties for obtaining prescription drugs with intent to distribute them.
Many such violations are misdemeanors that can carry sentences of a year or two, officials said. Curran's office is seeking to make the crimes felonies, punishable by up to five years in prison. Mandatory minimum sentences should be considered for repeat offenders, he said.
But Curran's report cautioned lawmakers and law enforcement officials to tread carefully to avoid creating a climate of fear that might discourage medical practitioners from giving patients medications that could alleviate pain or illness.
The report cited surveys, for example, suggesting that some doctors have been reluctant to give patients certain pain medications because of the "chilling effect" caused by aggressive prosecutions. Also, some physicians' groups have accused the federal government of whipping up hysteria about abuse of drugs such as OxyContin, a pain reliever. Curran also acknowledged privacy concerns in creating statewide prescription databases that could be monitored by law enforcement officials.
Schiff said he was pleased that Curran raised a cautionary note against overreaction.
"You tend to feel law enforcement agencies are watching over your shoulder all the time. The physicians feel the same thing," he said.
The attorney general's report, released Sept. 7 and titled "Prescription for Disaster," details the flip side to the wide availability of pharmaceuticals to treat pain, depression and many other problems. As some forms of drug abuse have shown signs of decline, such as use of the illegal drug ecstasy and hallucinogens, the number of people misusing narcotic painkillers has grown, the report says.
Prescription drug abuse among young people has become more common than the use of all illegal drugs except marijuana, the report says. Abuse is defined as using prescription drugs for a nonmedical purpose.
Carolyn Quattrocki, a special assistant who worked on the report, said the problem has increased with the proliferation of Web sites offering drugs, such as OxyContin, without a prescription or without much more than an online registration. The sites have grown from a handful in the 1990s to 1,000 or more, she said.
"A kid can do it," Quattrocki said.
Citing a report published in July by the National Center on Addiction and Substance Abuse at Columbia University, Quattrocki said the rate of first-time abuse of prescription narcotics among youths 12 to 17 had increased fivefold between 1992 and 2002, with girls slightly more likely to use them than boys.
J. JOSEPH CURRAN JR.