Next Steps for NASPER: A Q&A with Dr. John F. Dombrowski

Making prescription drug monitoring programs (PDMPs) a valid priority in states across the country has been one of the goals of the American Society of Interventional Pain Physicians for more than five years now.

With the passing of the National All Schedules Prescription Electronic Reporting Act (NASPER) in 2005, the climate for establishing state prescription monitoring programs seemed to be moving in a brighter direction, but some issues still remain. The law is reaching its five-year mark and members of ASIPP are gathering together to suggest to congress what steps should be taken next.

Interventional pain physician John F. Dombrowksi, MD, ASIPP board member, discusses NASPER and just why state PDMPs are essential to pain-management medicine. Dombrowski is board certified in anesthesiology and pain medicine. He’s been featured on the NBC Today Show and his comments have been featured in publications such as the New York Times. Dombrowski runs a traditional pain medicine practice and has been in the industry for about 18 years.

How did you get involved with the American Society of Interventional Pain Physicians?

I had been a member for quite some years, so it was natural to be a part of this organization. ASIPP’s been a real leader with respect to the education of physicians, education of patients, and also the political battle in terms of educating our politicians in terms of what is appropriate pain care for patients with injection technology or techniques. I think the role of interventional pain physicians that ASIPP and the American Society of Anesthesiologists represent is that we realize that opiates for some patients, an unfortunate majority, could be a real dead end. But, if they get to the right physician for their care such as an interventional pain physician perhaps they can have better care, a better quality of life, without the need for constant opiate management.

NASPER is a bill that was proposed by the ASIPP and this goes back to as early as 1999. And, it’s designed to help track drug prescribing data and help protect patients and physicians, correct?

Right, I mean it does both sides of it. Number one, right now, writing opiates can be quite a challenge for the physician as well as the patient and both parties need to be protected. Unfortunately, what can happen in some practices, like I know in the state of Florida there are basically just pill mills; they just write medications. Some patients will take advantage of that. Other times, patients will take advantage of a physician in their area. They go to one doctor, “Oh geez, I’ve got back pain,” I get medication, they go to another doctor, “I’ve got back pain, give me medication.” And unfortunately, we as doctors aren’t going to communicate with each other and the patient may not be forthcoming to say “hey I was at so and so’s and I just got 20 Vicodin from him and now I’m going to get 20 Vicodin from you.” They’re probably not going to tell you that.

And, so within the state, a lot of the pharmacies can talk to each other electronically, “hey, I’ve got this patient, this is his social security number he’s picked this medication up two days ago and now he’s writing a new one and so they would give the physician a call and say “did you know this and if you did, did you want us to refill it?” and obviously we don’t know it and hence we would say “great, don’t write that medication.”

Was there any one person who was really involved in pushing this idea forward?

Sure, he’s really the founder of ASIPP, his name is Dr. Laxmaiah Manchikanti. He’s been a real spearhead because he’s actually in Kentucky. Kentucky is a border state with Ohio and it had this issue all the time. Patients would come to see him, because he’s well known and from the state of Ohio he writes medication and sometimes patients inappropriately would seek him out and he wanted to have the ability to communicate with other pharmacies to make sure he’s writing the appropriate pain medication that they’re not getting from anyone else.

I mean, the tragedy that we’ve seen of this explosion of schedule II substances, which are narcotics, is the use in children between the teenage years. I mean, it has been a real explosion. And why is that? I’m not writing a 13-year-old Vicodin. It’s that it’s out there on the street. And it’s out there on the street because patients are either diverting the medication, selling it or perhaps it’s being stolen from other patients that legitimately need it.

Could you lay out some of the primary objectives of this bill?

The primary objective of the bill, obviously, is patient safety and what I mean by that is so they won’t doctorshop in terms of getting their pain medications, because that’s inappropriate and these people are in trouble. They either have pain that’s out of control that they only think is going to get better by opiates and that’s inappropriate.

The second thing that it does is protect the physician, because if this patient doctorshops and all that sort of stuff, my medications are sitting in his or her medicine cabinet and god forbid something bad happens to the individual, say they take an overdose and die, I’m responsible. So, this protects me, so the patient doesn’t have all these medications rolling around.

It also protects the community at large because this way it will kind of prevent or at least decrease the amount of diversion because we have less pills on the street and it also protects the physician and his practice in that if there’s a way to track these patients or track physicians that take care of these patients I will feel comfortable writing these medications so the DEA will not be coming after me or the state boards won’t be coming after me.

Since the passing of this bill in 2005 have you seen any direct positive effects from this? Are there any strides being made?

Well, from my understanding it’s been passed, but I think it has not been funded. So yeah the law has been passed, well that’s great but there’s no money to back it up.

At the end of the third or fourth week in June, ASIPP has a legislative conference here in D.C. in northern Virginia and then what they will do is lobby legislatures and say listen “you passed this bill, unfortunately it’s not funded.” The D.A. is coming down on practitioners; people aren’t getting the right care. All these drugs are on the street. We need a remedy for this just as we kind of laid out the positive reasons for this bill that’s been passed so it’s law.

When this bill was passed there was a plan that money would be allotted to the states within the following five years. Now it’s 2010. Is it up for reconsideration; are there any plans to reauthorize the law?

Well, I think we’re just fighting the same old battle. The bill is law. There’s little to no money in this. Okay, so basically we passed a feel-good bill. “We should do this.” “Great, I like it.” “Who’s going to pay for it?” I mean, that’s where the rubber meets the road. That’s why we as physicians who are interventional pain specialists need to lobby congress and say “listen, this is a great idea. If you’re going to spend money, spend it on this. Protect our patients. Save money in the long run. Protect the community from all these drugs that are floating out there. Protect our physicians."

This is a huge input for the community, not only pain, but obviously the risk of abuse, addiction, dependency and depression.

What are some of the ways physicians can get involved in this, if they aren’t already?

Well through publications like yours or to simply be a member of ASIPP where they actually do a targeted campaign to practitioners. We need your help. Write your congressman; write your senator. It’s basically advocacy. Have your patients write a letter on your behalf. All these things are very positive and again it’s done through societies. So, being a member of ASIPP is a great way to start.