Witness Testimony
The Honorable Harold Rogers
Member of Congress
United States House of Representatives
2406 Rayburn House Office Building
Washington, DC, 20515
Prescription Drug Monitoring: Strategies to Promote Treatment and Deter Prescription Drug Abuse
Subcommittee on Health
March 4, 2004
1:00 PM
Thank you for allowing me to testify before you today regarding prescription
drug abuse and prescription drug monitoring programs. This subject is of
critical importance to me, the people in my district, and the nation as a whole.
The hills and valleys of Southern and Eastern Kentucky are home to some of
the most beautiful scenic wonders in the country. Although we have been
historically isolated from the rest of the country by the Appalachian Mountains,
Eastern Kentuckians are proud of our rich heritage. The area is the birthplace
of bluegrass music and is the location of the Cumberland Gap which allowed
Daniel Boone and other pioneers to carve their way out west.
Unfortunately, these same remote hills and valleys have not been isolated
from the scourge of prescription drug abuse. This is the most devastating thing
I've ever seen in my more than twenty years of public service. Drugs are tearing
families apart, ruining lives, and stretching the resources of law enforcement
and social service agencies to the absolute limit.
The problem has literally reached epidemic proportions in my District. In
fact, Southern and Eastern Kentucky has become the prescription pain-killer
capital of the United States. An analysis of federal drug data found that, on a
per capita basis, our drugstores, hospitals, and other legal outlets received
more prescription pain-killers than anywhere else in the nation.
From 1998 to 2001, nearly half a ton of narcotics reached seven small
mountain counties - the equivalent of more than 3,000 milligrams for every adult
who lives there. For reference, a typical pill might contain 10 to 20
milligrams. While some of this medication is for legal purposes - too much of it
is not. These drugs are hitting the streets resulting in addiction, crime, and
death.
Our courts are unable to keep up with the overwhelming pace of new crimes. A
public defender in Perry County, a small mountain area in my Congressional
District, estimated that 95% of his clients either sell or abuse prescription
drugs. Eastern Kentucky court dockets are jammed with drug cases - in recent
years charges for controlled substances jumped 348%. Subsequently cases are
delayed for months, if not over a year, before they are brought to trial. These
delays can lead to unreasonable plea bargains or dismissal altogether. In either
case, justice is not truly served and pill pushers go back to plying their
trade.
Additionally, Kentucky's residential drug treatment centers are overwhelmed,
with admissions tripling since 1998. A Prestonsburg, KY drug treatment program
director reports that the new patients, most hooked on OxyContin, are younger
and sicker than clients in previous years. Over half of newly admitted patients
to drug treatment centers in Kentucky have identified OxyContin as their drug of
choice.
Most tragic of all, our people are dying. Nationwide, OxyContin played a
major role in 464 overdose deaths throughout the nation between May of 2000 and
February of 2002 - about a quarter of these deaths occurred in Kentucky and
Virginia alone. These deaths are more than just statistics - these numbers
represent real people that have been taken away forever.
For me, two of these deaths made an indelible impression, putting a face on
the tragic consequences stemming from Oxycontin abuse. In 2001, I invited Pastor
Ron Coots to testify before the Commerce, Justice, State Appropriations
Subcommittee for a hearing we held on Oxycontin abuse. His son Joshua, -- a
bright young man from a good home with a promising future -- had been hooked on
OxyContin and sat by his side during the hearing. Joshua had gone to rehab and
was clean of OxyContin when he came before our Subcommittee. I'll never forget
Pastor Coots telling me about the pain that Joshua's drug problem caused his
family but how proud he was that Joshua had confronted his problem and beaten
it. Less than a year after that hearing, Joshua got hooked on OxyContin again
and died of an overdose.
Another tragic story I want you to share with you is that of Sheriff Sam
Catron. Sam was a friend of mine and one of the finest law enforcement officials
Kentucky has ever seen. On Saturday, April 13, 2002, Sheriff Catron began the
day like any other day putting on the brown and yellow uniform of his proud
department. That Saturday happened to be an important day for him as well. He
was set to appear on television's America's Most Wanted to help in the search
for a fugitive from justice. Up for re-election, Sam also had a candidate's
night in Shopville, KY. After meeting with local citizens, he headed to his car
in order to travel home - to see himself on TV no doubt. But from the shadows
came the shot from a snipers rifle; in an instant, Sam lay dead on the ground. I
gave his eulogy later that week.
It turns out that the man who pulled the trigger was an OxyContin addict. He
was hired to assassinate Sheriff Catron by Sam's political rival and in his need
to buy more OxyContin, he did perform the job. In this case, OxyContin addiction
took one life and completely ruined another as the killer will spend the rest of
his life behind bars.
Why do we have such a terrible problem with OxyContin abuse in my district?
Simply put, too much of this product is on the market and is finding its way
into the hands of the wrong people. There is a veritable glut of OxyContin
making its way onto our streets.
Purdue Pharma has improperly marketed OxyContin as a "safe"
alternative for long lasting pain relief. The truth is there is no hard
epidemiological data to support that claim. The New York Times reported that
Judge Sidney H. Stein of the Federal District Court in Manhattan ruled that
Purdue Pharma's patents for OxyContin were invalid because of misrepresentation.
To win its patents, Purdue Pharma claimed that OxyContin was unique because 90
percent of patients got pain relief by taking very little medicine. In reality,
OxyContin's inventor had done no clinical studies and had no evidence to
validate this claim. Despite acknowledging that this figure was manufactured in
the mind of its inventor, Purdue Pharma executives continued to assert the
validity of this claim even though they knew there was no evidence to back it
up!
General practitioners in rural areas became an easy target for Purdue Pharma
and its sales force. Family doctors rarely have much formal training in pain
management and can be wary of prescribing morphine because of its track record
of addiction and abuse. The company invested $500 million into a marketing
campaign and its sales representatives enticed doctors with claims that
OxyContin was the "safe" alternative to morphine. In reality, a 1999
Purdue-sponsored study concluded that Oxycontin is nearly twice as potent as an
equal amount of morphine.
Further compounding the problem is the fact that the Food and Drug
Administration has approved OxyContin for "moderate-to-severe" pain.
Due to the subjective nature of "moderate" pain, OxyContin is far too
easy to prescribe and obtain. Many doctors are issuing this powerful medication
for everything from a backache to a sore toe. While it is a wonderful drug for
terminally ill cancer patients or others suffering from severe chronic pain, the
FDA dropped the ball in their initial review of OxyContin by failing to
recognize the drugs' potential for widespread abuse. It is clear to me that the
FDA should limit the prescribing of this drug to severe pain only.
The moderate indication also makes it much easier for patients to
"doctor-shop" and trick unsuspecting practitioners. Moving from doctor
to doctor with feigned injuries, scores of patients are putting their hands on
these powerful narcotics and either getting high themselves or selling the drugs
for a tidy profit. A $6 pill of Oxycontin can sell for $80 while a bottle of 40
milligram pills can fetch $2,000 on the street.
Unfortunately some of the very people sworn to protect life are actually
peddling these drugs for their own personal gain. For instance, a doctor
practicing in the northern Kentucky region was arrested by federal authorities
last September for prescribing drugs without a lawful purpose. On average this
doctor was handing out 800 prescriptions a month, which balances out to almost
40 prescriptions each working day.
What is most appalling in this case is that this doctor actually expressed
concern after his colleagues gave him grief about the amount of OxyContin he was
prescribing. He expressed this concern to his Purdue Pharma sales
representative. How did his Purdue Pharma representative respond to one of his
top purchasers? The sales representative reassured the doctor by telling him
that he was "doing the right thing."
Another doctor in Kentucky prescribed more than 2.3 million pain pills of
different varieties to more than 4,000 patients during a span of 101 workdays.
Officials likened his operation to a drive-thru prescription service.
Still another doctor in Harlan County, who is currently serving 20 years on a
federal drug conviction, saw 133 patients in one day, even though his office had
no electricity. It was reported that he had been prescribing OxyContin and
Viagra to teenage boys. This is just a sampling of the problem from Kentucky;
similar stories can be repeated across the nation.
In order to combat the epidemic of drug abuse in my Congressional District, I
have initiated a program called Operation UNITE (Unlawful Narcotic Interdiction
Treatment and Education) with $16 million in appropriations over the last two
fiscal years. There are three main components to the program: Law Enforcement,
Treatment, and Community Involvement. The success of this program lies in its
ability to bring people together for the greater good. Federal, state, and local
officials work alongside members of the community to eradicate the scourge of
drug abuse from the region.
Drug abuse has stretched the resources of law enforcement to the breaking
point in my area. Operation UNITE addresses this problem by creating 3 regional
task forces and hiring 32 law enforcement officers to perform undercover
operations, which is twice the number of undercover narcotics street agents
currently employed by the entire Kentucky State Police. We are also working to
create greater coordination among local, state, and federal law enforcement
agencies. As a result of these combined efforts, we expect the number of arrests
and prosecutions for street-level trafficking to increase dramatically.
Resources will also be provided to overburdened prosecutors so they can
effectively convict dealers and keep them off of our streets. The creation of a
new forensic drug lab will dramatically decrease the wait for narcotics analyses
thereby decreasing the time it takes to bring cases to trial.
Getting dealers and corrupt doctors off the street is one thing - real
success lies in getting those hooked on drugs back on track. As I mentioned
earlier, our treatment centers are overwhelmed. Operation UNITE will address the
issue in three stages. In the short term, treatment resources will be
coordinated to maximize their potential, making the most of what we already have
today. In the intermediate term, drug courts will be created in all 29 UNITE
counties. This two-pronged approach will allow our criminal courts to focus on
convicting dealers and the drug courts to sentence those of lesser crimes to the
treatment they sorely need. Finally, our long term goal is to create new
residential treatment centers and after-care programs in order to reduce the
waiting period for those who want help kicking the drug habit.
In the past, a lack of coordination between organizations providing drug
treatment services existed so that one hand did not always know what the other
was doing. Some areas or segments of the population were over-served while
others were completely neglected. The important messages being sent out could
become muddled or, worse yet, conflicting. Operation UNITE will coordinate these
efforts and everyone will be encouraged to become part of the solution. Local
citizens will be empowered to join together. The significant resources and
abilities of faith based groups and civic organizations will be tapped. Schools
will be a focal point so that students can help fight the problem instead of
becoming a part of it.
While Operation UNITE is the latest step in the effort to fight drug abuse in
Eastern Kentucky, I have been working to address this problem on a national
level for many years. Recognizing that Kentucky's problems with drug diversion
do not simply exist within its geographic borders, I started the national 'Hal
Rogers Prescription Drug Monitoring Program' in 2001.
This program is managed by the Bureau of Justice Administration in
cooperation with the Drug Enforcement Administration and awards grants to states
either looking to either start a Prescription Drug Monitoring Program (PDMP) or
enhance an existing program. The National Alliance of Model State Drug Laws
provides technical assistance for states who seek it. The Alliance also
facilitates communication between states that are considering PDMPs and states
that already have a program in place to encourage compatibility. The Alliance
receives $1 million annually from the Department of Justice through the ONDCP to
assist them in their work.
DEA also offers tremendous help to states building PDMP's or those that are
working to improve their existing program. The Controlled Substances Act of 1970
gave DEA oversight of doctors and pharmacies for the prescribing and dispensing
of federally controlled substances. Since the 1980's the DEA has promoted state
PDMP efforts to detect the illegal diversion of drugs. DEA has long served as an
important program resource for states seeking assistance in developing PDMPs and
provide valuable assistance to states that have questions about promulgating
monitoring regulations.
I am pleased to report to this Subcommittee that this state-by-state approach
is working. In fact, just two days ago it was announced that the Hal Rogers
Prescription Drug Monitoring Grant program is one of the cornerstones of the
President's new National Drug Control Strategy on prescription drug abuse. To
date, Congress has appropriated $16.5 million for this program. By the end of
2004, we expect 22 states to have prescription drug monitoring programs in place
with that number possibly reaching as high as 25 pending action from three
different state legislatures.
From the late 1930's, when the first prescription drug monitoring program was
established in California, until 2001, 15 states had established prescription
drug monitoring programs. While it took over 60 years to establish those first
15 programs, 7 new programs will be up and running just three years after the
Hal Rogers Prescription Drug Monitoring Program was created. That's nearly a 50%
increase in a very short period of time.
In a 2002 report, the GAO found that Prescription Drug Monitoring Programs
have helped reduce the availability of abused drugs. In fact, it was found that
the institution of a PDMP in a state typically leads to a decrease in diversion
while neighboring states without a program find increased diversion.
Furthermore, the GAO also found that, "The ability of PDMP's to focus law
enforcement and regulatory investigators on suspected drug diversion cases to
specific physicians, pharmacies, and patients who may be involved in the alleged
activities is crucial to shortened investigation time and improvements in
productivity." In Kentucky, for example, drug control investigators took an
average of 101 days to complete an investigation prior to the implementation of
the KASPER system in 1999. That average has since dropped to 19 days. Nevada
reduced its investigation time from 120 days to 20 days. Utah has experienced an
80% reduction in its investigation time.
One of the hallmarks of this program is the flexibility it provides states in
setting up their own prescription drug monitoring program. Of the 18 programs
currently up and running, each one is unique and set up according to the
diversion needs of that particular state. Each state addresses concerns over
access and privacy in a manner acceptable to their respective citizens. Some
states, like Kentucky, house their program in a health services agency while
others, like Texas, house it in a law enforcement agency. Because of this
localized approach, each state with a PDMP finds their program to be an
unqualified success.
As legislators we all know that a program will only succeed if the entity
running it has bought into the system. The federal government must allow states
to begin a PDMP when they have the financial, technical, and administrative
means necessary to put together a system that works and that will last for the
long haul.
While it is essential that this program work on a state-by-state basis, we
must continue providing encouragement and assistance for new states to come on
line and for existing states to make their programs interoperable with
neighboring states. It is my goal to see that all 50 states have some form of a
prescription drug monitoring system and that those systems communicate
regionally in order to prevent cross border doctor shopping. Although budgets,
both federally and locally, are tight, states should also look to incorporate
real-time reporting systems. This would enable doctors, pharmacists, and law
enforcement to quickly recognize when drugs are falling into the wrong patients'
hands.
The problems associated with drug abuse are ones that we as a society do not
take lightly. The social, moral, and economic costs are staggering. Families are
torn apart and promising lives can be lost when individuals venture down the
path of sustained drug abuse. For too long we focused our drug control strategy
on illicit substances like marijuana and cocaine and forgot about the plague
that could be hiding behind each of our medicine cabinets. Prescription drug
monitoring programs serve as important law enforcement, regulatory, and doctor
intervention tools and have proven highly effective in fighting drug diversion.
I am gratified that our President has recognized the importance of fighting
prescription drug abuse and am honored to be a part of his plan. I am also
pleased with the progress Congress has made in helping spread monitoring
programs across the country. I look forward to working with each of you to
continue these efforts in the years to come.
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