Hawaii News New system keeps tabs on patients’ medication behavior By Rob Shikina April 1, 2012 Mahalo for supporting Honolulu Star-Advertiser. Enjoy this free story! GEORGE F. LEE2012 March 12 CTY - Vicodin. HSA PHOTO BY GEORGE F. LEE Read more Mahalo for reading the Honolulu Star-Advertiser! You're reading a premium story. Read the full story with our Print & Digital Subscription. Subscribe Now Read this story for free: Watch an ad or complete a survey Log In Already a subscriber? Log in now to continue reading this story. Activate Digital Account Print subscriber but without online access? Activate your Digital Account now. Physicians and pharmacists in Hawaii can now check the drug prescription history of patients in an effort to curb abuse and diversion of painkillers and other medications. The Department of Public Safety in February set up an online prescription drug monitoring system, accessible to every pharmacy and doctor with a license to dispense drugs in the state. ABUSE ON THE RISE Fatal drug overdoses have tripled in Hawaii over the past two decades. Officials examined death certificates and found: 405 People died of unintentional drug overdoses in Hawaii from 2006 to 2010. 137 People died of unintentional drug overdoses in Hawaii from 1991 to 1995. Unintentional drug overdoses are the third leading cause of fatal injury in Hawaii, behind falls and suicides. The system will have far-reaching benefits, such as helping law enforcement reduce diversion, or unlawful use, of prescription drugs, and helping doctors assist patients with reducing their reliance on drugs, said Derek Nakamura, acting administrator of the state Narcotics Enforcement Division. While the system is still being ramped up, it will eventually be updated with information about a patient picking up a prescription from a pharmacist within seven days. That will help those doctors, who are not the primary care physician of the patient, know if the patient was drug-shopping for multiple prescriptions. "It’s an invaluable tool in the office," Nakamura said. "It helps point us in the right direction." The department can use the system to run reports such as the top 100 most-prescribed patients in the state or the most-prescribing doctors, Nakamura said. The Centers for Disease Control and Prevention says the country is suffering from an epidemic of prescription painkiller overdoses, with nearly 15,000 people overdosing in 2008 — more than three times the number in 1999. It ranked Hawaii 40th in the nation for the rate of residents who died of a prescription painkiller overdose in 2008. Despite Hawaii’s low ranking compared with the rest of the nation, some say the increase in Hawaii raises a concern. "It’s a relatively new phenomenon, so that’s why we’re trying to collect all this data to intervene," said Heather Lusk, who works with the CHOW Project, a nonprofit that exchanges sterile needles for drug users to prevent the spread of disease. "What I think is happening now, it went from only affecting the population that I work with, to now it’s affecting grandma, grandpa, auntie, who’s getting prescribed legitimate pain medication, but maybe not getting the understanding of how addicting it is or how easy it is to build tolerance and how it might cause overdose." According to Dan Galanis, an injury epidemiologist at the state Department of Health, fatal drug overdoses have tripled in Hawaii over the past two decades. He said officials examined death certificates and found 405 people died of unintentional drug overdoses in Hawaii from 2006 to 2010, compared with 137 from 1991 to 1995. The increase has made unintentional drug overdoses the third leading cause of fatal injury in Hawaii, behind only falls and suicides. Galanis said more data are needed to determine how many of the deaths are related to prescription drugs, but he believes most of them are prescription drug-related. "It’s part of a similar trend nationwide," Galanis said recently. "Hawaii’s certainly not alone in the emergence of prescription and drug overdoses." Nakamura said diversion of prescription drugs will always happen, but the new monitoring system will arm physicians with the tools to work with patients who need to be weaned off drugs. The system is a newer version of the state’s prescription drug monitoring system, in place since 1992, that could only be accessed by the Department of Public Safety. Physicians had to request information from the department about a patient, which took a few days. The new system will eventually contain data back to 2009 on all people who picked up a prescription in Hawaii. Veterinarians can also access the system because they prescribe prescription drugs for animals that can be abused by people, such as horse tranquilizers. The system — run by private vendor RelayHealth — cost $170,000 in federal funds to set up and will be maintained with $35,000 in annual federal funds. IN THE EMERGENCY room at the Queen’s Medical Center, Dr. Ronald Kuroda said he often worries about diversion of prescription drugs onto the street. He said he’s had patients in the emergency department who threaten to score the drugs off the street if he doesn’t give them medication. There are also patients who "are trained to give the right cues" to score a pain prescription. He said the abuse of prescription drugs leads to patients coming in unresponsive and not breathing on their own. "We can try and bring their heart back, but if they’ve been breathing so shallowly and don’t have enough oxygen to their brain, you bring their heart back, you bring their body back, but their brain is basically fried, and they’re never going to be normal again," he said. "Then they’re dead to themselves, they’re dead to their family, and their body is alive. "The most dangerous thing for me to see is somebody who’s young and inexperienced with it, using the medication and having an odd sensation, but they like it," he said. "It’s somebody who says that I tried somebody else’s medicine for the first time and I feel kind of weird, but it feels kind of good. "That’s kind of scary because if they don’t realize how dangerous it is, and it makes them feel good in some way, then they’re at a risk for doing it again or promoting it with other people," he said. Galanis, of the Health Department, said death certificates provide limited data on the drugs that caused the deaths, but more data can be gleaned from autopsy reports. According to records from the Honolulu Medical Examiner’s Office from 2004 to 2008, most — 46 percent — of the 270 people who overdosed on prescription painkillers were using drugs that were prescribed to them. Of the 270 deaths, 70 percent were accidental. Dr. William Haning, a professor in the University of Hawaii’s Department of Psychiatry, said the most lethal prescription drugs are primarily the opiates or painkillers. "If you haven’t developed a tolerance for them as a result of chronic administration, (you) can have a pretty narrow margin between what’s therapeutic and what will kill you," he said. Sometimes just doubling the effective dose will be enough to put a person in respiratory arrest, which is one reason, besides their addictiveness, they are classified as a Schedule II controlled substance by the Drug Enforcement Administration, he said. Overdoses most likely occur because people do not know that their tolerance to the drug will fall if they stop using it, he said. They overdose when they start taking the same amount they were using before they stopped using the drug. "It stops your breathing," Haning said. "It paralyzes from the front of the brain to the back of the brain. First consciousness goes, then respiration." In recent years, variations on prescription opiates like oxycodone or hydrocodone have increased. "The problem of course has been that these medications have been handed out with increasing frequency for every kind of pain problem," he said. He suspected that if there is a problem with growing prescription drug overdoses in Hawaii, it is likely because of the availability of drugs, many of which were not used up from a prescription and left on shelves where children or guests can take them. They are popular because they are rapidly absorbed, effective pain relievers and euphorigenic. "There’s always a willing market out there to buy them," he said. "It’s just real, real easy right now to get prescriptive drugs on the street." Previous Story Arson suspected in fatal blaze Next Story Young writers find a loving publisher: Thanks, Mom and Dad!