A new way to curb the proliferation of prescription painkillers in West Virginia is in the works: "Prescriber report cards."
The state Board of Pharmacy is developing a system that will rank doctors by specialty based on the number of prescriptions they write for pain medications.
"We're going to categorize prescribers, and then send notifications of how they rank among their peers with their prescribing practices," said Michael Goff, a pharmacy board administrator. "It's a way of telling them, 'Hey, among other doctors in your field, doctors who do what you do, here's where you rank.'"
It would be unfair to compare all doctors based on their prescription numbers, Goff said. For instance, an orthopedic surgeon who fixes broken bones and torn tendons would presumably write many more prescriptions for pain than, say, a pediatrician who cares for children.
"We can come up with a list of who writes the most prescriptions, but that doesn't really mean anything," Goff said.
One drawback: The report cards won't be made public. State law requires such information to be kept confidential. Doctors would only see their own numerical ranking, not a complete list of rankings by specialty.
"This is an educational component," Goff said. "It's not for disciplinary reasons."
The pharmacy board also hopes to alert doctors about the overall strength of their patients' prescription opioids. The drug-monitoring program would analyze a person's medications and calculate a "morphine milligram equivalent." Doctors would see the score when they examined a patient's prescription history.
"They take all the drugs they're on and equate them to morphine," Goff said. "Doctors will have some idea, with all the drugs they're on, here's the level they're at."
Three states - Maine, Washington and Massachusetts - have laws that set a cap on the daily strength of opioid medications that doctors can prescribe. Such laws exempt cancer patients, people with terminal diseases and those receiving end-of-life care. The U.S. Centers for Disease Control and Prevention recommends that opioids be restricted to 90 morphine milligram equivalents per day.
West Virginia lawmakers have not discussed a cap on prescription painkillers. Maine lawmakers passed a cap earlier this year.
"It is a very well-conceived plan and could benefit West Virginia," said Delegate Don Perdue, D-Wayne. "However, one needs to be very careful when considering terminal and intractable pain patient requirements."
Goff said the board also is exploring setting up a system that notifies doctors about "high-risk" patients who could be an overdose risk and secure pain-pill prescriptions from multiple doctors. Tennessee identifies such patients with "red" and "yellow" alerts.
In the coming months, West Virginia doctors will be able to check a patient's prescription history in about 20 additional states. West Virginia physicians already can access patient prescription information from all neighboring states except Pennsylvania.
Goff praised Kroger supermarket pharmacies for setting up a new program that automatically pulls up a customer's prescription history on a computer screen each time a prescription is filled.
"It's a hard stop at the pharmacy level," Goff said. "A lot of times, they may be suspicious, but they don't want to take the time to log into the system. This way, they have to acknowledge they looked at the patient's prescription history."
The pharmacy board also is looking at ways to link its controlled substances database to patient electronic medical records. Doctors now have to exit the electronic health record to log onto the database.
Reach Eric Eyre at ericeyre@wvgazettemail.com, 304-348-4869 or follow @ericeyre on Twitter.