How a low-key pharmacy could help ease the opioid epidemic
Drug addicts are resourceful when they want chronic pain medication.
They can go "doctor shopping," looking for doctors who fail to check the state's drug monitoring database. They can duplicate prescriptions that are supposed to be filled in the months ahead. And they can steal, a method that has ranked Indiana highest for pharmacy robberies.
Now, a new pharmacy hopes to tackle the state's opioid epidemic by keeping a tight rein on prescriptions and thieves away from their front door.
Cordant Health Solutions, a Denver-based health care company, opened a controlled substance pharmacy in Indianapolis in October. Physicians send drug prescriptions for chronic pain electronically or via couriers to the pharmacy. After checking the state's prescription drug database and, if applicable, a patient's drug test results, the pharmacy delivers the medication to the patient's home or work.
It is not a walk-in pharmacy. The doors are closed to the public. The address is not shared publicly.
"Unfortunately, the opioid epidemic has become the new normal, and we're trying to provide this private-sector solution to doctors and hospital systems and other stakeholders to get control of this problem," said Bob Mann, vice president of Cordant Health Solutions.
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Franciscan Physician Network, which has 65 physicians, nurse practitioners and physician assistants in Central Indiana who could potentially use the service, in April signed a contract with Cordant. Medical Director of Quality Dr. Susan E. Hartman says the approach Cordant takes can help thwart prescription fraud.
Under Indiana law, Hartman said, patients using chronic prescription medications are required to see their doctors every four months. Doctors have the option to give patients the first prescription with a month's worth of pills and print three more prescriptions until the next visit. But once patients leave the office with four prescriptions, doctors have no control. This is when illegal duplication of prescriptions or alterations can take place.
Working with Cordant avoids that potential for trouble.
"Because Cordant gives the prescription filled directly to the patient, we assure that the patient is receiving the medication on time and that there are no lost prescriptions, no calling to the office for early refills," Hartman said. "That’s the best we can do to keep someone compliant."
Hartman said that under Franciscan Physician Network's policy, patients using chronic pain substances are tested for drugs annually or more frequently at the discretion of the physician. If within those months of treatment a urine drug screen is ordered and shows something illicit, it can be difficult to recapture and control the prescriptions not yet filled, she said.
Patients also can test negative for the prescribed medications, meaning the drugs are being used by somebody else. In these cases, physicians can call Cordant and cancel the next refills.
Cordant has prevented at least 300 prescriptions so far this year from being dispensed, either after the provider changed the treatment or when the patient was suspected of abuse.
Rigo Garcia, CEO of addiction treatment facility Parkdale Center for Professionals, said controlled substance pharmacies are helpful and well-intentioned, but addicts may figure out which doctors contract with Cordant.
"The resourceful, desperate addict is a formidable force," Garcia said. "If it is not universal, and everybody doesn't get on the same page, that's a way for different loopholes to pop up, and we'll be chasing those loopholes as well."
Support is building for wider use of electronic prescriptions.
Steven C. Anderson, president and CEO of the National Association of Chain Drug Stores, sent a letter July 6 to New Jersey Gov. Chris Christie, who is chairman of the President's Commission on Combating Drug Addiction and the Opioid Crisis.
Anderson said the association backs draft federal legislation that would require electronic prescriptions for all controlled substances in the Medicare Part D Prescription Drug Program and urged the commission to address current limitations to widespread adoption of e-prescribing technologies.
E-prescriptions are just one part of Cordant's approach to deter illegal behavior. For example, state law requires physicians to check the state's drug monitoring database before prescribing chronic pain medication, but all physicians don't always do so. This gives opioid addicts a chance to shop for physicians who are known for not checking the database.
Contracting with Cordant transfers that administrative task from physicians to the pharmacist, Cordant's Mann said.
"We hope we're making a difference, and we feel that we are," Mann said.
"If the doctor is doing a drug test, we also check the drug test to see that if what they’ve been prescribed is in their system and that there’s nothing else there," Mann said. "If everything looks good, we call the patient, and we schedule delivery."
Hartman said she has had elderly patients ask her not to prescribe medication for chronic conditions because they are afraid of getting assaulted at drugstores.
"We're looking for patients' safety and compliance while not shutting out people who definitely need the pain medication," Hartman said. "We want to provide an avenue to get them the medication they need while keeping them safe."
Cordant plans to expand to New York, Massachusetts and Kentucky in the next 12 to 18 months.
Follow IndyStar reporter Elena Mejia Lutz on Twitter: @elenamejialutz.