Blue Cross and NC DHHS data shows thousands of doctors violating opioid law
Law enforcement in North Carolina could gain access to a statewide database containing information from any doctor who has recorded prescribing controlled substances to their patients.
It's part of a continuing push at the Legislature to grapple with the opioid epidemic. More than 13,000 North Carolinians have died from opioid-related overdoses since 1999, state officials say, and the pace of deaths has increased more than tenfold in that time.
Some doctors and privacy advocates question what police access will mean for patients.
Dr. Rebecca Love, a family medicine specialist from Shelby, worries patients might be reluctant to cooperate with doctors if they believe their information isn’t completely private.
"There is a lot of confidentiality in doctor-patient relationships," Love said. "It's important for us to find out things and heal people. We have to have that confidentiality."
The Controlled Substance Reporting System is a database of prescriptions that doctors and pharmacists can use to see if a patient is getting controlled substances from multiple doctors.
The system tracks controlled substances levels two through five, with level two being categorized as having a high potential for abuse. Controlled substances at a level two include cocaine, raw opium, codeine, morphine, Ritalin and others. Level three drugs include anabolic steroids, some barbiturates and ketamine, a popular party drug. Some of the level four drugs being tracked are Valium and Xanax, commonly prescribed for anxiety. And finally, level five is any over-the-counter cough medicine with codeine in it.
The database was first fully implemented in 2007 and has been revamped since a 2017 law, known as the STOP Act for Strengthen Opioid Misuse Prevention, took effect. The database is purged every six years, so that's how far back law enforcement would be able to look.
The latest changes are in a bill that supporters have dubbed the HOPE Act for Heroin and Opioid Prevention and Enforcement Act.
The bill has been introduced by state legislators with the support of Attorney General Josh Stein.
'Minutes and seconds matter'
According to the bill, investigators must be working on an active case in order to request prescription information. They would not have open access to the full database if the bill passes.
The State Bureau of Investigation would also receive a copy of every request submitted.
Rep. Craig Horn, a Weddington Republican, is a co-sponsor of the bill. He was also a sponsor of the STOP Act.
“When an investigator begins to see patterns, they can then do perhaps some predictive analysis. It helps them build a case so they can get to the right person,” Horn said when asked why investigators would need access to the CSRS.
“Law enforcement needs the ability to identify those folks that are either intentionally or unintentionally accessing prescription drugs or drugs in general. By the same token, we have to always be concerned about the people’s right to privacy, so it’s a balance,” Horn said.
“[The database] is a tool that law enforcement does not have ready access to. There is a procedure, but it is not a timely procedure,” Garner police Chief Brandon Zuidema said.
“This is not for all law enforcement. This is for specially trained detectives," said Zuidema, president of the North Carolina Association of Chiefs of Police.
According to Zuidema, law enforcement needs a court order to get access to the database.
"That unfortunately is not time-efficient. That component of the HOPE Act is to get timely information. It’s generally not same-day service," said Zuidema.
In a recent news conference, Rep. Greg Murphy, a Greenville Republican, talked about the need for law enforcement to have fast access to the database.
“Under very strict and very stringent guidelines, our law enforcement community will have access to the Controlled Substance Reporting System to help them in their efforts to investigate and prosecute individuals who obtain legal prescription medication by illegal means, as well as those who distribute illegal illicit medication and illegal opioids,” Murphy said. “They need this access in real time so they can investigate in real time, for minutes and seconds matter when it comes to opioids.”
Snooping in your medicine cabinet?
The North Carolina Medical Society has been working on the bill alongside legislators to ensure patient privacy, said Elaine Ellis, spokeswoman for the doctors' group.
Ellis said patient privacy is the most important thing to the group, but it also wants to help those with addictions.
She said law enforcement access wouldn't violate federal patient privacy laws.
The North Carolina ACLU said it would be the first law of its kind in the nation if law enforcement gets access to the system.
The state would be giving law enforcement the ability to “snoop around a person’s medicine cabinet,” said Mike Meno, spokesman for the state chapter of the American Civil Liberties Union.
"None of that information is useful towards combating the opioid epidemic. I think a lot of North Carolinians would agree with us. Government agents should not be allowed to snoop through a person’s drug history," Meno said.
Love, the family physician, said she's unclear about how law enforcement officials will be able to coordinate with medical workers under the bill.
“[We need] something that allows collaboration on the community level that allows us to be responsive to people's need, rather than systems of care that are managed from above and all uniform across the state or across hospital systems,” Love said.
Humans aren't the only ones whose prescriptions will be available to police.
The system also includes information from veterinarians across the state who have prescribed controlled substances to animals. It has been reported in other states that owners are abusing their animals in hopes of getting opioid prescriptions to satisfy their addictions.
"Veterinarians are very aware. They keep very detailed logs. So if there is something out of sort — veterinarians keep their antennas up," said Dr. Tod Schadler, the executive director of the North Carolina Veterinary Medical Board. "It’s something I think most pharmacies are checking much more diligently. So if we see things that fall outside of expectations, in many cases, we opt to prescribe a different medication."
Horn, the lawmaker supporting the new bill, said law enforcement can only do so much.
“We also have to be concerned about the fact that addiction is a disease," he said. "We are not going to arrest our way out of the addiction epidemic.”