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home : most recent : statewide implications December 11, 2018

4/16/2018 5:59:00 PM
'INSPECT' legislation to change little, but risk of doctor shopping remains

Chelsea Boulrisse, Greater Fort Wayne Business Weekly

Recent legislation expands access to the INSPECT database for local health-care providers in hopes of curbing the widespread opioid epidemic.

Although further awareness for doctors about what and how many drugs their patients are taking could prevent more people from falling victim to addiction, it could also encourage the practice of “doctor shopping” among addicts just trying to find another script for another fix.

INSPECT is a database run by the Indiana Professional Licensing Agency that logs what controlled substances a patient has been prescribed as well as the doctor who prescribed it and the pharmacy that filled the prescription. On the agency website, INSPECT is billed as not only a resource for doctors, but also a tool for law enforcement to use during investigations.

During the 2018 session of the Indiana General Assembly, Senate Bill 221 was authored by Senators Erin Houchin, R- Salem, Ed Charbonneau, R- Valparaiso, and Joseph Zakas, R-Granger in an effort to expand the use and access of the database within the health-care community. The bill would require doctors, on a gradual timeline, to reference Inspect prior to prescribing an opioid or benzodiazepine to a patient.

Per the details of the bill, the requirement will first start with mandating doctors whose patients’ medical records are integrated into the INSPECT system. In 2019, emergency-room doctors will be included in the requirement, followed by more expansions in 2020 and an ultimate goal of requiring all medical practitioners to refer to Inspect by 2021.

The bill managed to pass with unanimous support from both the senate and the house and it was signed into law by Gov. Eric Holcomb on March 22.

According to Allen County Health Commissioner Dr. Deb McMahan, though, this bill won’t change much. She pointed out that most doctors already used INSPECT regularly when it was still optional, so the laws would be simply bringing in that final 10 to 20 percent of doctors who don’t use Inspect routinely. As a result, McMahan predicts that this newest development won’t impact the bottom line for most practices, since they have already gone through the initial phases of transitioning to regular Inspect use.

“I think most of the changes in behavior and costs are on the front end and implementing it into practice then they become a routine part of practice,” McMahan said. “On the front end, it takes a bit more time…Initially, it’ll be more prescriptions written and maybe more frequent lab testing and drug screenings.”

With more doctors aware of a patient’s drug history and a hesitation to prescribe opioids to those whose records suggest a case of substance-use disorder, McMahan agreed that this could result in more addicts doctor shopping or bouncing from place to place until someone agrees to write them a prescription. In addition, while most “pill mills” in the area have been shut down, the temptation to cater to these demands could come back as well.

“I do think that people who have substance-use disorder if they’re nothing else, they’re persistent,” McMahan said. “I think those folks when you put a barrier up…they probably will try and move onto somebody else. I wouldn’t be surprised that it would happen, but thankfully most (doctors) are using this practice.”

Of course, legislators and doctors alike know that these new requirements will not be the long-awaited panacea for the opioid crisis. Stopping the over-prescribing of opioids in the doctor’s office may stop or slow down the progression of addiction in some patients. Now, the focus must be on expanding care for those living with substance-use disorder right now and finding alternative ways to treat chronic pain that don’t involve opioids.

“We’re really trying to increase access to medication-assisted treatment,” McMahan said. “And we need to continue to look for ways to manage chronic pain, looking for better ways for that.”

Related Stories:
• 4 new laws to combat Indiana's opioid crisis among measures recently enacted by Holcomb
• Hoosier legislators to return to Statehouse in May 2018; could last three days
• Medical practices changing in face of opioid crisis

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