Drug dealers and addicts don't necessarily respect state borders when trying to obtain opioids and other narcotics illicitly from physicians and pharmacies.
If a doctor in New Jersey refuses to prescribe drugs to a patient suspected of so-called "doctor shopping" to obtain prescription drugs, the patient can travel to New York, Delaware or Pennsylvania to try his luck with a doctor there.
And while almost every state now has a monitoring program up and running to track information about prescription drug sales, patients and prescribing physicians, only a handful have agreements granting out-of-state doctors and pharmacists access to their home state's data.
That blind spot was a talking point for the House Bipartisan Heroin Task Force during its latest roundtable meeting on Monday, as lawmakers wrestle with whether federal legislation or guidelines are needed.
Congressman Tom MacArthur, R-3rd of Toms River, New Jersey, is among the lawmakers who said a federal program may be needed, although he cautioned that safeguards must be put in place to protect patients' privacy and health records.
"We need to consider a federal program to encourage us to require doctors and states to cooperate and enter the data," said MacArthur, who co-chairs the task force, in an interview Tuesday.
During Monday's roundtable meeting, task force members heard testimony from Dr. Matthew Salzman, an assistant professor of medical toxicology at the Cooper Medical School at Rowan University, and Stephen C. Mulleniz, senior vice president of public policy and industry relations for the National Council for Prescription Drug Programs.
MacArthur said the anecdotes from Salzman were that New Jersey's monitoring program was working to prevent "doctor shopping" — the practice of going to multiple doctors to obtain prescriptions for opioid drugs and other narcotics — but that more can be done to encourage doctors to check the database and for states to share data.
"(Salzman) might turn down someone he suspects, but he knows they'll go someplace else, too," the congressman said.
New Jersey, which created its monitoring program in 2011, has had some success in partnering with other states to share data. It entered into an agreement with Pennsylvania in April to give prescribers and pharmacists access to the New Jersey database and vice versa. The Garden State also has similar agreements with Delaware, Maine, Massachusetts, New Hampshire, New York and West Virginia.
Rep. Donald Norcross, D-1st of Camden, said New Jersey's success with monitoring prescriptions and sharing information needs to be replicated across the nation.
"The task force is looking at ways to improve prescription drug monitoring programs, as well as ways to expand information sharing between those programs in different states. We held a roundtable on PDMPs specifically so we could ask experts, including a doctor from South Jersey, questions about how we can move things forward quickly," said Norcross, a task force vice chairman. "We’ve had notable successes in our area, and people are taking note. Now we want to avoid doctor shopping everywhere, and we want to do it in a sensible, realistic way.”
MacArthur stressed that any federal database or program must be manageable so to not create a burden for doctors and pharmacists to input or review data. It must also be secure and have safeguards to protect patient privacy.
"I don't want to have some kind of Equifax hack, where people's health records are spread all over the place," he said. "We have to be careful, and it has to be done in a way where people don't feel like their privacy is being eroded or that they're being targeted."
Making sure monitoring programs don't create an atmosphere that is overly restrictive is another concern.
"As much as we need to shut down the sourcing of (illegal prescription drug sales), the fact is that most (addicts) start in their own medicine chests," he said. "There are people on the brink now. We need to be careful we're not driving them into the streets to buy heroin because they have no place else to go."
Ensuring people have access to treatment continues to be a major priority for the task force, and members continue to push for President Donald Trump's administration to grant states relief from a federal Medicaid restriction that prevents drug treatment centers with more than 16 beds from billing Medicaid for residential treatment services.
The Medicaid Institutions for Mental Diseases exclusion was designed to prevent Medicaid funding from going to private mental health institutions accused of warehousing patients. But it has been cited by lawmakers and advocates as a major obstacle for people suffering from substance abuse disorders to receive inpatient treatment.
New Jersey has applied for a waiver from the restriction but continues to wait for approval from the federal government, which is still developing "standardized language" setting the terms and conditions for IMD waivers, officials said.
"We have every reason to believe that waiver will be granted very soon," New Jersey Gov. Chris Christie said earlier this month.
MacArthur said he expects the administration will be able to move quickly on IMD waivers once it formally declares the opioid epidemic a national public health emergency.
Trump announced his intention to issue a declaration over a month ago, saying on Aug. 10 that the opioid crisis was "a serious problem, the likes of which we have never had" and that "officially right now it is an emergency. It’s a national emergency." However, he has yet to take formal action on a declaration.
MacArthur said he and other leaders of the task force, including Norcross and Congressman Brian Fitzpatrick, R-8, of Middletown, another vice chairman, were continuing to press the administration to make good on Trump's pledge.
"It will allow the administration to move quickly on IMD and will allow it to deal with drug prices and other issues, like the availability of Narcan," he said.
Norcross said action on a declaration is overdue.
"While it’s promising the president agreed the opioid epidemic is a national emergency in one press briefing, that fact was already painfully obvious to the millions of families across America who have loved ones who are struggling with, or who have been lost to, addiction," he said. "Now it’s well past time to follow up the words with actions. Every delay means more loved ones will die.”
Fitzpatrick has also called for a national database to combat doctor and pharmaceutical shopping, and help lobby the U.S. Department of Health and Human Services to award Pennsylvania a $26 million grant to improve its monitoring program.
He has also spoken in favor of a national public health declaration, and penned legislation to eliminate the IMD restriction on drug treatment centers.
"We are all stakeholders in the mission to eradicate this epidemic — be it through education, community involvement, recovery efforts or law enforcement support," Fitzpatrick said in a statement. "Constant engagement between federal, state and local leaders partnering with law enforcement, health care professionals and educators will set us on the path to free our community from the advance of opioid abuse. A solution is possible, but only if we are willing to work together.”