The Florida Prescription Drug Monitoring Database, or E-FORCSE® (Electronic-Florida Online Reporting of Controlled Substance Evaluation Program), is a statewide program that requires pharmacists and encourages physicians to enter all controlled substances that they prescribe or dispense. For pharmacists, there is a state requirement to check the database before dispensing any addictive medication, like opiate painkillers and sedatives, allowing them to identify whether or not a patient is getting multiple prescriptions for the same or similar drugs.
Called “doctor shopping,” this practice has long been a common method of diversion for those who are looking to sustain an addiction that is not managed by a normal prescription. That is, when tolerance for the drug of choice grows to the point that the individual needs a higher dose in order to stave off withdrawal symptoms and/ r get high and doctors will not write a larger script, they may go to another doctor and act as if they are not currently receiving any prescriptions in order to get a double script for their drug of choice.
Similarly, there are those who do not have a medical need for prescription painkillers at all, but go to different doctors presenting with a range of false claims in order to get a prescription for addictive sedatives, stimulants, and/or painkillers with the goal of selling them on the black market for a profit.
With E-FORCSE, pharmacists can see if a patient is doubling up on scripts by using more than one doctor in the state – if all doctors are inputting the information into the database. This is where the difficulty comes in. According to a report out of the University of Florida published in the Journal of Opioid Management, only about 21 percent of prescribing physicians are registered to use the database, and perhaps as a result of this low rate of buy-in, only about 57 percent of pharmacists are signed up to use E-FORCSE. How many of those registered doctors actually check the database before prescribing painkillers or other addictive drugs, and how many registered pharmacists check the database before dispensing a prescription, is unknown.
While pharmacists are required to make use of the database in Florida, physicians are not currently. Despite the value in being able to identify if someone may be pill seeking rather than reaching out for legitimate medical care, many doctors say that they simply do not have the time to check the database and/or enter in prescriptions for each and every patient they treat for pain management. As it is, they already feel that their schedules are so packed that they have little face time with their patients, and most say that they prefer to spend their time treating their patients rather than doing paperwork.
Unfortunately, the result has been a severely underutilized tool that can help to save many patients from the development of an addiction and help others connect with treatment services that can help them to heal if they are struggling with a prescription abuse problem and/or addiction.
In order to address the problem, state Senator Lizbeth Benacquisto has filed Senate Bill 8 that would implement a requirement that all doctors in the state of Florida register with and use E-FORCSE. The goal is to increase use of the program so it can have the maximum benefit possible, helping to stop the diversion of painkillers to the black market and identify patients who are living with a substance use disorder that requires treatment.
What Do You Think?
It is already difficult for many patients to get in to see their physician when they are sick, and many feel they do not get enough time with the doctor in person to get effective treatment. Others have seen the devastating effect that loosely managed chronic pain can have when a loved one develops an addiction to their painkillers and is able to get far more pills than medically necessary.
Do you think that doctors should be required to log all prescriptions for controlled substances in E-FORCSE and check the database before prescribing medications? Is it just part of the job that must be done or a nuisance that prohibits effective care of patients?