The Senate Health and Provider Services Committee on Wednesday threw its support behind a bill that would require Indiana physicians to check the state prescription database 鈥� called INSPECT鈥� before prescribing powerful drugs, including opioids.
currently require both physicians and pharmacists to check someone鈥檚 drug history, but Indiana isn鈥檛 one of them.
The INSPECT database, which contains information about a patient鈥檚 past prescriptions from all providers, allows doctors and pharmacists to check a patient鈥檚 drug history with the hopes of preventing over-prescribing and drug-seeking behavior such as doctor shopping.
The state has started integrating INSPECT into electronic health records, reducing a system that took precious minutes to seconds. The change made it easier to check the system, but the practice is still optional.
The new bill, authored by Sen. Erin Houchin (R-Salem), has earned a thumbs-up from the Indiana Hospital Association, the Indiana Professional Licensing Agency, State Health Commissioner Kristina Box and Gov. Eric Holcomb鈥檚 office.
Holcomb voiced support for a mandatory query of the system in his State of the State address last week, saying the state is 鈥渕oving forward to require Indiana physicians to use INSPECT before ever issuing an opioid prescription.鈥�
If it becomes law, the new requirement to check the system would be rolled out in stages. First, emergency room physicians would be required to check INSPECT before prescribing beginning in 2019, followed by hospital practitioners a year later and finally all other doctors in 2021.
鈥淓arly in my career, I had to rely simply on what [patients] told me鈥� an honor system, where I took their word for it,鈥� said Commissioner Box, herself an OB-GYN. 鈥淭oday I can look at a patient鈥檚 record and get a much clearer record of the medications she鈥檚 taken. But the system is only as good as the number of physicians using it.鈥�
But not all testimony was positive. One of Box鈥檚 predecessors, physician and former state health department head Richard Feldman, said though he applauds the spirit of the idea, he鈥檚 worried about over-taxing harried family practitioners, especially since the bill requires doctors to query the database before prescribing popular drugs such as Xanax, Atavan and Valium, not just opioids. (Those drugs, known as benzodiazepines, are potentially fatal when taken with painkillers.)
Sen. Liz Brown (R-Fort Wayne) said she worries the three-year rollout is too rapid, and wants to make sure all doctors have integrated INSPECT into their electronic health records before they could be penalized for not using it.
Even then, INSPECT Director Kara Slusser told committee members she estimates 15 percent of physicians don鈥檛 use electronic records to keep track of patient data.
Brown also wondered why dispensers such as pharmacists weren鈥檛 included in the bill. Dispensers are currently the only practitioners required to take any action regarding INSPECT; the law requires dispensers to upload prescription data into the system, but doesn鈥檛 require them to check it before dispensing.
鈥淭hat is certainly something that could follow,鈥� said Box, who said mandatory dispenser queries 鈥渨ould be very appropriate. In my past career, a lot of alerts have come from pharmacists.鈥�
A similar, less aggressive bill has been put forth by Sen. Jim Merritt (R-Indianapolis). Merritt鈥檚 legislation would require all practitioners and dispensers to register with the drug monitoring database, as a precursor to a mandatory query.
Patrick Knue, director of the Prescription Drug Monitoring Program Training and Technical Center at Brandeis University, has said mandatory checks 鈥� which are required in some other states, such as Indiana鈥檚 neighbor Kentucky 鈥� are the most effective way to get states to use monitoring systems.
Despite the objections, the committee moved the bill unanimously to the Senate floor.
This story was produced by , a reporting collaborative focused on public health.
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