Update: According to the Committee of Interns and Residents, which advocated for resident access to the database, the state has now fixed this gap and residents can be entered into the system at the hospitals where they work.
By Dr. David Scales
State officials are promising that by this March, they will fix a long-standing problem: Currently, doctors in training — more than 5,000 of us statewide — have no direct access to the database that lets us check a patient’s opioid history.
Sometimes, it seems, it takes a crisis to push for change. With the opiate epidemic in full swing, some fixes for long-standing problems that make no sense are finally happening. If only we could fix more of the ridiculous aspects of our health care system — some elements of our electronic medical records come quickly to mind — without waiting for a crisis.
The database is a major piece of the state’s effort to stem the overdose epidemic. Checking its critical data on patients’ past prescriptions can mean the difference between prescribing a much-needed pain medication or wrongly prescribing what turns out to be an overdose.
More Coverage Of The Opioid Addiction Crisis In Mass.
- Insurers Step In To Fight Crisis
- Mass. Sober Home Certification
- Who Is Overdosing In Boston
- Drug Cocktails Fuel The Crisis
- Plans For Heroin ‘Safe Space’
I first learned that residents had no access to the database when I started my own residency in 2013. At my first outpatient appointment, I saw a homeless man on such high doses of morphine and Dilaudid, an opioid pain drug, that I was surprised he was alive. Doses that high would cause most people to overdose.
His legs were swollen to the size of tree trunks, with skin a texture not too far from bark. But he was on opiates for pain control after a recent hernia repair that was complicated by an infection. During his recovery at a rehabilitation facility, a physician had thoughtlessly escalated his medication regimen. Now he was about to be back on the street, and had no one to prescribe his pain medications. When opioids are abruptly stopped, withdrawal can include intense symptoms from abdominal pain and vomiting to skin-crawling and muscle aches.
Yet only one physician in our clinic had access to the online prescription drug database and it took days to get the printout she kindly provided. Fortunately, we could wait, because the man was still hospitalized, but even as a new resident, I could see that this gap in the system simply made no sense. Multiply my experience by the 5,500 resident physicians in Massachusetts and you see the scope of the problem: One out of every seven doctors in the state is excluded from this key database.
Jennifer Lipman is a third-year podiatry resident colleague at Cambridge Health Alliance, and her story is even more absurd. For one patient, Jennifer called seven pharmacies, spending close to an hour listening to hold muzak while pharmacists searched their databases for prescriptions of controlled substances.
The online prescription monitoring program was developed in the first place to avoid situations exactly like Jennifer’s. It provides faster, easier access to information on prescriptions from hospitals and pharmacies across the state, to indicate whether a patient has been visiting multiple health care providers to gather prescriptions for controlled substances.
But Jennifer couldn’t access the database directly because of technical problems that impede access for individual residents. Currently, log-in privileges are tied to official registration numbers for physicians. Residents have a number linked to their residency program rather than an individual one like fully licensed doctors.
Many residents in Jennifer’s shoes would have given up. But through sheer persistence, she found out her patient had been prescribed a lot of Vicodin: 270 tablets in the past 30 days from various sources. That was a helpful red flag. It would have been more helpful if it had taken her two minutes instead of an hour.
Access to the database may seem like a small thing, but it has big implications. Continue reading