Michigan urged to overhaul Rx monitoring system

James David Dickson
The Detroit News
  • Less than half the medical professionals eligible to register for MAPS are registered. Fewer use it.
  • MAPS does not allow doctors or pharmacists to delegate other users, tying up valuable time.
  • If Tennessee’s example is followed, doctor-shopping will fall with strong Rx drug monitoring system
  • Michigan once a pioneer in Rx drug monitoring; with old technology, it has fallen behind the times

Michigan’s prescription drug monitoring system, thought to be a major tool in the state’s effort to reduce opioid-related deaths,needs to be revamped to make it more efficient and comprehensive, according to a task force named by Gov. Rick Snyder.

Opioid addiction and related problems are growing in Michigan: Deaths have surged over the past 15 years, rising from 99 opiate-related fatalities in 1999 to 840 in 2013. according to the Michigan Department of Health and Human Services.

The addictions that sometimes result when a person is prescribed opioids for pain management often turn into full-blown heroin use, experts say.

The task force recommended upgrading the Michigan Automated Prescription System last month. Snyder impaneled the task force in June to make policy recommendations on how Michigan can end its epidemic of opioid and heroin-related deaths. MAPS is an electronic prescription monitoring system for drugs ranging from Schedule V (least addictive) to Schedule II (second-most addictive), according to the federal Drug Enforcement Administration.

Examples of Schedule II drugs include oxycodone and morphine; Schedule V drugs include such medications as cough syrup with codeine.

Doctors, pharmacists and veterinarians use the system in prescribing and dispensing medications.

But MAPS has many limitations, such as limited capacity, slow speed and a mismatch between those who use the system and those who should be required to use it, critics say.

Lt. Gov. Brian Calley, chairman of the governor’s opioid task force, told The News that MAPS “needs to be updated or replaced in order to achieve its actual goals.”

MAPS went live in 2003 and has had “very few upgrades” since being built, said Kim Gaedeke, director of the state Bureau of Professional Licensing Affairs, which oversees MAPS.

Several task force members cited the system as not user-friendly or interactive.

The idea behind the system was to give physicians and pharmacists information on who is accessing medications and how many doctors a patient is using to help the state fight abuse and drug diversion (obtaining prescription medicines and giving them to others).

But if every doctor and pharmacist in Michigan were to register with MAPS and use it before writing painkiller prescriptions or filing those prescriptions, the system would crash, according to several task force members, including Calley. MAPS crashes regularly now, users say, even though it has only 31,130 active users, according to state health officials.

Michigan has 14,282 licensed pharmacists and 47,247 licensed doctors. There are 36,677 DEA-registered prescribers in Michigan.

That means the system can’t handle the demands on it, even with tens of thousands of potential users offline. And that’s not including the 4,060 licensed veterinarians in Michigan.

Some doctors have to pull up MAPS reports the night before to ensure they’ll be ready the next day.

“Just logging into MAPS can take two-and-a-half minutes,” said Dr. R. Corey Waller, a task force member and president of the Michigan Society of Addiction Medicine. “Multiply that across 30 patients a day, and that’s an hour of a doctor’s time.”

No doctors, other than those who also dispense medications, are required to enroll in or use MAPS.

On the pharmacy end, drug dispensers are required to register for MAPS and to complete daily updates on patients who receive Schedule II through V drugs.

But pharmacists are not required to run a MAPS report before filling painkiller prescriptions.

Some task force members believe MAPS could be updated from its current base. Others say it needs to be scrapped and rebuilt.

The Department of Licensing and Regulatory Affairs had been working for years to rewrite MAPS, Gaedeke said, but held off on its work when the governor’s task force was convened. Had there been no task force, there’s a “possibility” the rewrite would be done by now, she said.

At this point, Gaedeke said, it is likely that overhauling MAPS would require a new appropriation by the legislature.

State Rep. Anthony Forlini, R-Harrison Township, a task force member, argues the private sector will need to build a prescription monitoring system that works.

Task force member Dr. Steve Bell, an osteopath, said he uses MAPS “every day” in his work. He says the system is “underpowered, without adequate software or hardware to enable its mission.”

“(MAPS) was probably really good when it came out” in 2003, Bell said, but it is “not up to the task of what we need it to do today. If I were to pull it up during an appointment, it may work, and it may not.”

Bell, who is president of the Wayne County Osteopathic Association, says the state should buy an existing, off-the-shelf system, one being used effectively in another state.

“They’re out there. They do exist. What we have now isn’t up to the task,” he said.

One such system exists in Tennessee.

What Michigan can learn from Tennessee

Dr. Richard Frank, assistant secretary for planning and administration with the U.S. Department of Health and Human Services, said in October testimony before the U.S. House that “utilization of monitoring programs changes prescribing behavior.”

Tennessee’s controlled substances monitoring database program was mentioned as a model system in the task force’s recommendations. The database, first authorized in 2002, went live in 2006 and was strengthened in 2013.

In 2006, Michigan was one of only 20 states with a monitoring system; today, Missouri is the only state that doesn’t have such a system.

Tennessee requires all pharmacists who dispense drugs in Schedules II through V, and all doctors with a DEA number, to register with its controlled substance monitoring database program and use it before prescribing or dispensing opioids or benzodiazepines.

Some 42,000 medical professionals use the Tennessee database regularly.

Tennessee permits doctors to have two other staffers in their office to access the database. Pharmacists can have their assistants check it as well.

MAPS, Gaedeke said, lacks the functionality to have non-principals use the system.

“Moving forward, we will definitely be trying to incorporate that,” she said.

Waller told The News that the inability to have other health professionals in his office pull up MAPS reports costs time and money.

“You have your most expensive person in the office running reports,” he said.

MAPS users say the system doesn’t operate in real time. In Tennessee, 72 percent of prescribers surveyed in 2013 said the database “typically provides a patient report less than 10 seconds after submitting a query,” according to the database program’s annual report to the legislature.

Doctors and pharmacists in Tennessee say their practices have changed since use of the database was mandated. Some 41 percent of prescribers and 47 percent of dispensers report being less likely to prescribe painkillers. Some 85 percent of prescribers and dispensers surveyed said the database has helped them curb doctor-shopping by patients.

But Waller says fixing the overprescribing of opioids is easier said than done, regardless of technology. It will require training doctors differently about pain management and addiction in medical school, and throughout their career.

“It’ll take more than hanging up signs at doctors’ offices that say ‘opioids are bad, please change,’” Waller said.