A third of Georgia's physicians and half of the state's dentists failed to meet the Jan. 1 deadline to register for the state's prescription drug monitoring program, a crucial tool in the state's effort to combat the opioid crisis.
A state law passed last year required all of the state's prescribers to create accounts with the pill-tracking database, which doctors can use to see if a patient is getting multiple prescriptions for highly-addictive drugs. As of July 1, doctors, dentists and other prescribers must start checking the database before writing prescriptions for opioid medications that treat pain and benzodiazepines that are used for anxiety, insomnia and other conditions.
The Georgia Department of Public Health said some of the state’s licensed doctors and dentists and other providers are not required to register because they are not seeing patients and do not have a DEA number. But the department has not been able to determine how many of those who had not registered by the deadline fall into that category.
Health care practitioners who fail to comply with the law may be subject to discipline by their professional licensing board.
The failure to register on time by some prescribers is a reflection of the day-to-day burdens most health care providers face and does not reflect a lack of concern, said Dr. Cynthia A. Mercer, a practicing physician who is a member of the Georgia Board of Public Health.
And some prescribers may still not fully understand the mandates in the new law.
“There’s been a lot of confusion out there on what is actually required,” said Donald J. Palmisano Jr., executive director and CEO of the Medical Association of Georgia, which has fielded calls from doctors around the state about the changes in the prescription monitoring program.
That confusion was evident at the Department of Public Health’s board meeting this week, when a board member who is a practicing physician asked whether he had to register. Dr. Mitch Rodriguez, a neonatologist on the board, said he was unsure about the need to register since it is rare for him to prescribe opioids and such prescriptions would take place only in a hospital setting.
Board staff clarified what they have been telling the state’s prescribers since last fall — professionals with a DEA number must register. That includes physicians, physician assistants, dentists, optometrists, podiatrists, nurses with prescriptive authority, and medical residents and interns with prescriptive authority, according to the law.
Rodriguez registered immediately after the board meeting, the Department of Public Health said.
Georgia lawmakers first authorized the pill-tracking database in 2011, but it was voluntary for doctors and dentists to use it. Few ever registered. Last year, the Georgia General Assembly updated the law, transferred oversight of it to the Department of Public Health and required doctors and other prescribers to sign up and start checking it before writing certain prescriptions.
The Department of Public Health said it will continue to work with associations and licensing boards to make sure prescribers understand the law.
Public Health plans to use the system to send an alert to prescribers if a patient is getting a high number of prescriptions or a potentially dangerous combination, so the provider can then follow up and make sure the patient is not in danger. The database can also be used by law enforcement or licensing boards, after obtaining a subpoena, when a doctor or other health care provider is under investigation for improper prescribing.
The Department of Public Health plans to analyze the prescribing data to identify hot spots and trends that might help the state combat the opioid crisis.
Palmisano, of the medical association, said doctors support the pill-tracking database and understand it can help them spot patients who are addicted to medications. He said doctors want it to be a fast and easy process for them to check the database, since their time with patients is already limited.
Dr. J. Patrick O’Neal, Georgia’s public health commissioner, said the department is working to make the system more user-friendly. Public health is hoping state lawmakers will authorize changes to allow neighboring states to tap into Georgia’s database, since many Georgia patients cross states lines to see doctors or fill prescriptions.
Public health also wants a change that would allow the databate information to be included in a patient’s electronic health record, which would make it easier for doctors to run checks.
“Physicians have a very limited amount of time,” O’Neal said. Checking the system should enhance patient care, not interfere by taking too much time if doctors have to switch from one electronic system to another when seeing a patient, he said.
» Read the AJC's award-winning investigation, Doctors & Sex Abuse: AJC 50-state investigation
Signups lagging
Health care providers who have DEA numbers and can prescribe controlled substances had to sign up with the state’s Prescription Drug Monitoring Program by Jan. 1, but some have not yet complied.
These are the type of providers covered, the number licensed and the percent registered*
- Medical doctors, 29,536, 67%
- Dentists, 5,796, 51%
- Podiatrists, 517, 52%
- Optometrists, 1,540, 45%
- Medical residents w/prescribing authority, 2,271, 83%
- Nurse practitioners/Clinical specialists, 10,638, 30%
- Physician assistants, 4,432, 49%
- Midwives, 552, 10%
Source: Georgia Department of Public Health
*Note: Licensed health care providers are not required to register with the PDMP if they do not have a DEA number. These statistics include all licensed providers.
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