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United States General Accounting Office: 
GAO: 

Report to the Subcommittee on Oversight and Investigations, Committee 
on Energy and Commerce, House of Representatives. 

May 2002: 

Prescription Drugs: 

State Monitoring Programs Provide Useful Tool to Reduce Diversion: 

GAO-02-634: 

Contents: 

Letter: 

Results in Brief: 

Background: 

PDMPs Vary in Objectives, Design, and Operation: 

State Programs Have Helped Shorten Investigation Time and Reduced 
illegal Drug Diversion: 

Challenges Exist in Establishing and Expanding State PDMPs: 

National Efforts Have Focused on Providing Guidance and Technical 
Assistance: 

Concluding Observations: 

Agency Comments: 

Appendix I: Key Features of Selected State Prescription Drug 
Monitoring Programs: 

Appendix II: GAO Contact and Staff Acknowledgments: 

Tables: 

Table 1: Characteristics of State Prescription Drug Monitoring 
Programs: 

Table 2: Key Features of Selected State Prescription Drug Monitoring 
Programs: 

Figure: 

Figure 1: Status of Prescription Drug Monitoring Programs, by State, 
April 2002: 

Abbreviations: 

DEA: Drug Enforcement Administration: 

HIPAA: Health Insurance Portability and Accountability Act of 1996: 

ODC: Office of Diversion Control: 

PDMP: prescription drug monitoring program: 

[End of section] 

United States General Accounting Office: 
Washington, DC 20548: 

May 17, 2002: 

The Honorable James C. Greenwood: 
Chairman: 
The Honorable Peter Deutsch: 
Ranking Minority Member: 
Subcommittee on Oversight and Investigations: 
Committee on Energy and Commerce: 
House of Representatives: 

The increasing diversion of prescription drugs for illegal use is a 
disturbing trend in the nation's battle against drug abuse. 
Prescription drug diversion is the channeling of licit pharmaceuticals 
for illegal purposes or abuse. It can involve activities such as 
"doctor shopping" by individuals who visit numerous physicians to 
obtain multiple prescriptions, illegal sales of prescription drugs by 
physicians or pharmacists, and prescription forgery. The most 
frequently diverted prescription drugs are those that are prone to 
abuse, addiction, and dependence,[Footnote 1] such as hydrocodone (the 
active ingredient in Lortab and many other drugs), diazepam (Valium), 
methylphenidate (Ritalin), and oxycodone (the active ingredient in 
OxyContin and many other drugs). According to the Drug Enforcement 
Administration (DEA), increases in the extent of prescription drug 
abuse and in emergency room admissions related to prescription drug 
abuse, as well as an increase in the theft and illegal resale of 
prescription drugs, indicate that drug diversion is a growing problem 
nationwide. In 2000, the most recent year for which data are 
available, about 9 million Americans aged 12 and older reported using 
prescription drugs, including pain relievers, tranquilizers, 
stimulants, or sedatives, for nonmedical purposes.[Footnote 2] The 
abuse of illegally diverted prescription drugs is associated with 
serious consequences, including addiction, overdose, and death. 

Fifteen states currently operate prescription drug monitoring programs 
(PDMPs) as a means to control the illegal diversion of prescription 
drugs. PDMPs collect, review, and analyze prescription data from 
pharmacies. They provide data and analysis to state law enforcement 
and regulatory agencies to assist in identifying and investigating 
activities potentially related to the illegal prescribing, dispensing, 
and procuring of prescription drugs. Because of your interest in the 
issues of prescription drug diversion and control, you asked us to 
address the following questions: (1) How do the 15 PDMPs compare 
across states in terms of objectives, design, and operation? (2) What 
benefits have state PDMPs produced? (3) What challenges do states face 
in implementing and using PDMPs? (4) What efforts are being made at 
the national level to address the illegal diversion of prescription 
drugs? 

To address the questions concerning the state PDMPs, we reviewed 
information from DEA and the National Alliance for Model State Drug 
Laws[Footnote 3] on the features of the existing programs.[Footnote 4] 
To gain a more in-depth understanding of these programs and the 
challenges they face, we studied the PDMPs in Kentucky, Nevada, and 
Utah. We selected these three because they were the most recently 
established programs. We interviewed PDMP administrators and 
stakeholders in these three states. Although the stakeholders varied 
in each state, they included officials of state medical and pharmacy 
associations, state attorneys general offices, state drug enforcement 
agencies, state police, and a state medical examiner's office. We also 
spoke with officials from practitioner licensure boards and state law 
enforcement agencies, as well as DEA representatives. We also 
discussed PDMPs with officials from Purdue Pharma L.P., the 
manufacturer of OxyContin and other prescription drugs. To determine 
what activities are being pursued at the national level to reduce 
illegal diversion of prescription drugs, we interviewed experts from 
DEA, the National Alliance for Model State Drug Laws, the National 
Association of State Controlled Substance Authorities, and the Bureau 
of Justice Assistance in the Department of Justice, and reviewed 
pertinent documents. We performed our work from October 2001 through 
April 2002 in accordance with generally accepted government auditing 
standards. 

Results in Brief: 

All 15 state PDMPs collect information about the prescribing, 
dispensing, and use of prescription drugs and distribute it to medical 
practitioners, pharmacies, and state law enforcement and regulatory 
agencies, but the programs differ in terms of objectives, design, and 
operations. In addition to helping law enforcement identify and 
prevent prescription drug diversion, a program's objectives may 
include education of the public, physicians, and pharmacists regarding 
the nature and extent of the problem and medical treatment options for 
abusers of diverted drugs. With regard to design, the programs vary 
primarily in terms of the specific drugs they cover and the type of 
state agency in which they are housed. Some PDMPs cover only those 
prescription drugs that are most prone to abuse and addiction, whereas 
others provide more extensive coverage. In addition, most programs are 
administered by a state law enforcement agency, a state department of 
health, or a state board of pharmacy. Finally, some programs use the 
prescription data proactively, to identify trends or patterns of use, 
as well as to respond to requests from law enforcement officials, 
whereas others use it only to respond to requests. 

States with PDMPs have realized benefits in their efforts to reduce 
drug diversion. These include improving the timeliness of law 
enforcement and regulatory investigations. For example, Kentucky's 
state drug control investigators took an average of 156 days to 
complete the investigation of an alleged doctor shopper prior to the 
implementation of the state's PDMP. The average investigation time 
dropped to 16 days after the program was established. In addition, law 
enforcement officials in Kentucky and other states view the programs 
as a deterrent to doctor shopping, because potential diverters are 
aware that any physician from whom they seek a prescription may first 
examine their prescription drug utilization history based on PDMP data. 

Officials from DEA, the Alliance, and state PDMPs told us that states 
considering establishing a PDMP, or expanding an existing one, face 
several challenges. These include educating the public and 
policymakers about the extent of prescription drug diversion and abuse 
in their state and the benefits of a PDMP, responding to the concerns 
of physicians, patients, and pharmacists regarding the confidentiality 
of prescription information, and funding the cost of program 
development and operations. Given a state's particular funding 
availability and budget priorities, program costs can be a major 
hurdle. The start-up costs for the three most recent PDMPs were 
$415,000 for Kentucky, $134,000 for Nevada, and $50,000 for Utah. 
Estimated annual operating costs for these PDMPs varied from a high of 
about $500,000 in Kentucky, to $150,000 in Utah and $112,000 in 
Nevada. Costs in these three states vary because of differences in the 
PDMP systems implemented, the number of pharmacies reporting drug 
dispensing data, and the number of practitioners and law enforcement 
agencies seeking information from the systems. (See appendix I.) 

National efforts to assist states in addressing illegal diversion have 
focused on providing guidance and technical assistance. The Alliance 
has provided a useful source of information for the development of 
recent state programs. In addition to identifying the key features of 
a model PDMP, the Alliance has provided a draft model law for states 
interested in establishing their own PDMP. The Alliance has also 
provided technical assistance to states in implementing the 
recommendations in the model program. Funding has recently been made 
available for grants to states that are planning to start a PDMP or 
expand an existing program. Two million dollars in grants from the 
Department of Justice's Bureau of Justice Assistance are to be 
administered jointly with the DEA. 

DEA, the Alliance, and the PDMPs in Kentucky, Nevada, and Utah 
reviewed a draft of this report and in general agreed with its 
contents. Their technical comments have been incorporated where 
appropriate. 

Background: 

The diversion and abuse of prescription drugs are associated with 
incalculable costs to society in terms of addiction, overdose, death, 
and related criminal activities. DEA has stated that the diversion and 
abuse of legitimately produced controlled pharmaceuticals constitute a 
multibillion-dollar illicit market nationwide.[Footnote 5] One recent 
example of this growing diversion problem is the controlled substance 
oxycodone, the active ingredient in over 20 prescription drugs, 
including OxyContin, Percocet, and Percodan. OxyContin has become the 
nation's number one prescribed narcotic medication for treating 
chronic severe and moderate pain. A single 40-milligram OxyContin 
tablet legally selling for about $4 is worth about $40 on the illicit 
market. As of February 2002, OxyContin has been involved in 464 deaths 
from prescription drug abuse, as reported by DEA on the basis of 
medical examiners' autopsy findings for 2000 and 2001 from 32 states. 

Combating the illegal diversion of prescription drugs while ensuring 
that the pharmaceuticals remain available for those with legitimate 
medical need involves the efforts of both federal and state government 
agencies. The Controlled Substances Act of 1970[Footnote 6] provides 
the legal framework for the federal government's oversight of the 
manufacture and wholesale distribution of controlled substances. The 
states address these issues through their regulation of the practice 
of medicine and pharmacy.[Footnote 7] 

Controlled Substances Act: 

The Controlled Substances Act of 1970 established a classification 
structure for drugs and chemicals used in the manufacture of drugs 
that are designated as controlled substances. Controlled substances 
are classified into five schedules on the basis of their medicinal 
value and potential for abuse, addiction, and dependence. Schedule I 
drugs—including heroin, marijuana, and hallucinogens such as LSD and 
PCP—have a high potential for abuse and no currently accepted medical 
use. Schedule II drugs—including methylphenidate (Ritalin) and opiates 
such as hydrocodone, morphine, and oxycodone—have a high potential for 
abuse and may lead to severe physical dependence, but have a currently 
accepted medical use. Drugs on Schedules III through V have medical 
uses and successively lower potentials for abuse and dependence. 
Schedule III drugs include anabolic steroids, codeine, hydrocodone in 
combination with aspirin or acetaminophen, and some barbiturates. 
Schedule IV contains such drugs as the anti-anxiety medications 
diazepam (Valium) and alprazolam (Xanax). Schedule V includes 
preparations such as cough syrups with codeine. All drugs but those in 
Schedule I are legally available to the public with a prescription. 
[Footnote 8] 

Under the act, DEA has the authority to regulate transactions 
involving the sale and distribution of controlled substances at the 
manufacturer and wholesale distributor levels. DEA's Office of 
Diversion Control (ODC) provides legitimate handlers of controlled 
substances—including manufacturers, distributors, hospitals, 
pharmacies, practitioners, and researchers—with registration numbers, 
which are used in all transactions involving controlled substances. 
Registrants must comply with a series of regulatory requirements 
relating to drug security and accountability through the maintenance 
of inventories and records. Although all registrants, including 
pharmacies, are required to maintain records of controlled substance 
transactions, only manufacturers and distributors are required to 
report their transactions involving Schedule II drugs and Schedule Ill 
narcotics, including sales to the retail level, to ODC. The data 
provided to ODC are available for use in investigations of illegal 
diversions at the manufacturer and wholesaler levels. Although data 
are reported to ODC regarding purchases by pharmacies, the act does 
not require the reporting of dispensing information by pharmacies at 
the patient level to ODC. 

State Regulation of the Practice of Medicine and Pharmacy: 

State laws govern the prescribing and dispensing of prescription drugs 
by licensed health care professionals. All states require that 
physicians practicing in the state be licensed, and state medical 
practice laws generally outline standards for the practice of medicine 
and delegate the responsibility of regulating physicians to state 
medical boards. State medical boards license physicians and grant them 
prescribing privileges.[Footnote 9] In addition, state medical boards 
investigate complaints and impose sanctions for violations of the 
state medical practice laws. Every state requires resident pharmacists 
and pharmacies to be licensed. The regulation of the practice of 
pharmacy is based on state pharmacy practice acts and regulations 
enforced by the state boards of pharmacy. The state boards of pharmacy 
are also responsible for ensuring that pharmacists and pharmacies 
comply with applicable state and federal laws and for investigating 
and disciplining those that fail to comply. All state pharmacy laws 
require that records of prescription drugs dispensed to customers be 
maintained and that state pharmacy boards have access to the 
prescription records. 

State PDMPs: 

PDMPs are designed to facilitate the collection, analysis, and 
reporting of information on the prescribing, dispensing, and use of 
prescription drugs within a state. An overriding goal of PDMPs is to 
uphold both the state laws ensuring access to appropriate 
pharmaceutical care by citizens and the state laws deterring 
diversion. The first PDMP was established in California in 1940. The 
number of states with PDMPs has grown only slightly over the past 
decade, from 10 in 1992[Footnote 10] to 15 in 2002. (See figure 1.) 
Nevertheless, PDMPs cover about 47 percent of the nation's population, 
about 47 percent of the nation's DEA-registered practitioners, and 
about 45 percent of the nation's pharmacies.[Footnote 11] 

The nationwide number of PDMPs has been changing. West Virginia 
terminated its PDMP in 1998, and New Mexico in 2000. West Virginia has 
taken steps to create a new PDMP, however. Legislation to establish a 
new program, again to be operated by the state's board of pharmacy, 
was enacted and approved by the governor in March 2002. In addition, a 
number of other states have enacted or are considering legislation to 
establish a program. (See figure 1.) 

Figure 1: Status of Prescription Drug Monitoring Programs, by State, 
April 2002: 

[Refer to PDF for image: map of the United States] 

States that have prescription drug monitoring programs: 

California: 
Hawaii: 
Idaho: 
Illinois: 
Indiana: 
Kentucky: 
Massachusetts: 
Michigan: 
Nevada: 
New York: 
Oklahoma: 
Rhode Island: 
Texas: 
Utah: 
Washington: 

States that have recently introduced legislation to establish a 
program: 

Connecticut: 
Maine: 
Ohio: 
Vermont: 
Virginia: 
West Virginia[B]: 

States that have a task force and are considering legislation to 
establish a program: 

Alabama: 
Colorado:
New Hampshire: 

States that do not have prescription drug monitoring programs: 

Alaska: 
Arizona: 
Arkansas: 
Delaware: 
Florida: 
Georgia: 
Iowa: 
Kansas: 
Louisiana: 
Maryland: 
Minnesota: 
Mississippi: 
Missouri: 
Montana: 
Nebraska: 
New Jersey: 
New Mexico[C]: 
North Carolina: 
North Dakota: 
Oregon: 
Pennsylvania[A]: 
South Carolina: 
South Dakota: 
Tennessee: 
Wisconsin: 
Wyoming: 

[A] Pennsylvania does not have a PDMP, but requires pharmacies to 
submit data to the state attorney general's office. 

[B] West Virginia terminated its PDMP in 1998 and has enacted 
legislation in 2002 to create a new program. 

[C] New Mexico terminated its PDMP in 2000. 

Source: National Alliance for State Model Drug Laws, 2002, and 
discussions with officials in New Mexico, Pennsylvania, and West 
Virginia. 

[End of figure] 

National Alliance for Model State Drug Laws: 

Since 1993, the Alliance has served as a resource center for states 
interested in identifying legislative and program improvements in drug 
abuse reduction and prevention. Each year since fiscal year 1995, the 
Alliance has received a $1 million grant from the Department of 
Justice, administered by the President's Office of National Drug 
Control Policy. These funds are used to identify legislative, policy, 
and program initiatives to address the supply of, abuse of, and 
addiction to alcohol and other drugs. The model laws cover a broad 
range of issues, including money laundering, forfeiture, housing, 
education, treatment, prevention, and intervention. The funds also 
support statewide model drug law summits that serve as intensive needs 
assessments and planning vehicles for the states. The Alliance has 
also sponsored a Prescription Monitoring Work Group composed of 
representatives from pharmaceutical manufacturers, state licensing 
boards for physicians and pharmacists, state attorneys general, and 
administrators of state PDMPs. 

PDMPs Vary in Objectives, Design, and Operation: 

The 15 PDMPs have a common goal of reducing prescription drug 
diversion and abuse, but vary in their objectives, design, and 
operation. In addition to helping law enforcement identify and prevent 
prescription drug diversion, state programs may include education 
objectives to provide information to physicians, pharmacies, and the 
public. Program design also varies across states, in terms of which 
drugs are covered, how prescription information is collected, and 
which agency is given responsibility for the program. Additionally, 
methods for analyzing the data to detect potential diversion activity 
differ among PDMPs. Finally, the cost of the program varies according 
to differences in these design and operational factors. 

Program Objectives Include Education as Well as Law Enforcement: 

Although the primary objective of PDMPs is to assist law enforcement 
in detecting and preventing drug diversion, states have also used the 
programs for educational purposes. Programs assist law enforcement 
authorities both by providing information in response to requests for 
assistance on specific investigations and by referring matters to law 
enforcement officials when PDMP evaluations reveal atypical 
prescribing or dispensing patterns that suggest possible illegal 
diversion. PDMPs have also been used to educate physicians, 
pharmacies, and the public about the existence and extent of 
diversion, diversion scams, and the drugs most likely to be diverted 
by individuals. Programs have provided educational materials to 
physicians on ways to prevent drug diversion and to educate their 
patients about the diversion problem. They have evaluated prescribing 
patterns to identify medical providers that may be overprescribing and 
inform them that their patterns are unusual. They have also identified 
patients who may be abusing or diverting prescription drugs and 
provided this information to practitioners. For example, PDMPs in 
Nevada and Utah send physicians drug utilization letters containing 
patient information that signal potential diversion activity, 
including the number and types of drugs prescribed to the patient 
during a given time period and the pharmacies that dispensed the 
drugs. PDMPs have also provided physicians with information on 
addiction treatment options for patients identified as drug abusers or 
diverters. For example, Nevada's PDMP encourages physicians to refer 
identified doctor shoppers to pain management or drug treatment 
programs that can help them manage their chronic pain more effectively 
or treat their addiction. 

Program Designs Differ Across States: 

Program design varies across state programs, in terms of which drugs 
are covered, how prescription information is monitored and collected, 
and which agency is given the responsibility for the program. (See 
table 1.) 

Table 1: Characteristics of State Prescription Drug Monitoring 
Programs: 

State: California[A]; 
Year implemented: 1940; 
Controlled substance schedule(s) monitored: II; 
Type of monitoring system: Electronic and triplicate form[B]; 
Administrative agency: Pharmacy and law enforcement. 

State: Hawaii; 
Year implemented: 1943; 
Controlled substance schedule(s) monitored: II; 
Type of monitoring system: Electronic; 
Administrative agency: Law enforcement. 

State: Idaho; 
Year implemented: 1967; 
Controlled substance schedule(s) monitored: II, III and IV; 
Type of monitoring system: Electronic; 
Administrative agency: Pharmacy board. 

State: Illinois; 
Year implemented: 1961; 
Controlled substance schedule(s) monitored: II; 
Type of monitoring system: Electronic; 
Administrative agency: Public health. 

State: Indiana; 
Year implemented: 1995; 
Controlled substance schedule(s) monitored: II; 
Type of monitoring system: Electronic; 
Administrative agency: Law enforcement. 

State: Kentucky; 
Year implemented: 1999; 
Controlled substance schedule(s) monitored: II, III, IV and V; 
Type of monitoring system: Electronic; 
Administrative agency: Public health. 

State: Massachusetts; 
Year implemented: 1992; 
Controlled substance schedule(s) monitored: II; 
Type of monitoring system: Electronic; 
Administrative agency: Public health. 

State: Michigan[C]; 
Year implemented: 1989; 
Controlled substance schedule(s) monitored: II; 
Type of monitoring system: Single form; 
Administrative agency: Commerce. 

State: Nevada; 
Year implemented: 1997; 
Controlled substance schedule(s) monitored: II, III, and IV; 
Type of monitoring system: Electronic; 
Administrative agency: Pharmacy board and law enforcement. 

State: New York[D]; 
Year implemented: 1977; 
Controlled substance schedule(s) monitored: II; 
Type of monitoring system: Electronic; 
Administrative agency: Public health. 

State: Oklahoma; 
Year implemented: 1991; 
Controlled substance schedule(s) monitored: II; 
Type of monitoring system: Electronic; 
Administrative agency: Law enforcement. 

State: Rhode Island; 
Year implemented: 1979; 
Controlled substance schedule(s) monitored: II, III; 
Type of monitoring system: Electronic; 
Administrative agency: Public health. 

State: Texas[E]; 
Year implemented: 1982; 
Controlled substance schedule(s) monitored: II; 
Type of monitoring system: Electronic; 
Administrative agency: Law enforcement. 

State: Utah; 
Year implemented: 1997; 
Controlled substance schedule(s) monitored: II, III, IV, and V; 
Type of monitoring system: Electronic; 
Administrative agency: Commerce's Licensing Division. 

State: Washington[F]; 
Year implemented: 1987; 
Controlled substance schedule(s) monitored: Determined by disciplinary 
authority; 
Type of monitoring system: Triplicate form[B]; 
Administrative agency: Public health. 

[A] California is currently testing an electronic monitoring program 
for Schedule II controlled substances. Until the pilot program is 
completed on July 1, 2003, pharmacies will also have to continue 
submitting copies of the triplicate forms to the state monitoring 
agency. 

[B] A triplicate prescription form is a paper prescription form issued 
by the state to prescribers, who must use it when writing 
prescriptions for covered controlled substances. The prescriber keeps 
one copy after writing the prescription, and the pharmacist keeps a 
copy when the prescription is filled and sends the third copy to the 
state PDMP. 

[C] In 2001, Michigan enacted legislation to convert its PDMP to an 
electronic monitoring program. Until the new electronic system is 
implemented, the program will continue to require pharmacies to submit 
copies of state-issued official prescription forms for schedule II 
controlled substances. 

[D] As of January 1, 2002, New York switched to an electronic 
monitoring system from a paper-based system using a triplicate form. 
The new electronic system is supplemented by a state-issued, single-
copy prescription form that includes a number of security features to 
prevent counterfeits. 

[E] Beginning in September 1999, Texas permitted pharmacies to submit 
prescription data electronically rather than submitting paper copies 
of prescription forms. In March 2002, Texas switched from triplicate 
to single-copy forms with a number of security features to prevent 
counterfeits. The requirement to submit prescription forms to the 
state agency will continue until the electronic system is fully 
implemented. 

[F] The Washington program applies only to licensed practitioners 
whose prescribing practices require monitoring because of past drug 
abuse or inappropriate prescribing. The drugs the program covers vary, 
depending on the prescriber, from one controlled substance to all 
prescriptions. 

Source: National Alliance for Model State Drug Laws. Information is 
current through February 4, 2002. 

[End of table] 

State programs vary in the controlled substance schedules they cover, 
in part because of differences in available resources and other state-
specific factors such as levels of drug abuse. As shown in table 1, 
nine PDMPs cover only Schedule II controlled substances, which have 
the highest potential for abuse and addiction. Two states, Kentucky 
and Utah, cover all schedules, and Nevada covers Schedules III and IV, 
as well as II. Washington's program is used as a disciplinary tool and 
covers a variety of controlled substance schedules on a case-by-case 
basis for each practitioner. Most experts agree that covering all 
schedules prevents drug diverters from avoiding detection by bypassing 
Schedule II drugs and switching to drugs in other schedules. Program 
officials in Kentucky and Utah also told us that covering all 
schedules allows them flexibility to respond if drugs on other 
schedules become targets for diversion. Covering more than Schedule II 
drugs greatly increases the number of prescriptions that must be 
reported to the state PDMP. This can require additional resources to 
review and interpret the additional data and conduct necessary follow-
ups. These officials, as well as officials from DEA and the Alliance, 
agree that comprehensive coverage of all schedules offers the most 
effective monitoring program. However, the Alliance's work group 
recommended that each state determine the schedules its program will 
cover. 

Most PDMPs use electronic monitoring systems, in which pharmacies 
transmit prescription data for covered drugs electronically to the 
designated state agency or a private contractor at least once a month. 
Experts agree that electronic systems make it easier for law 
enforcement to identify drug diverters, reduce investigation time and 
paperwork, and provide easier access to information. Recently, New 
York and Illinois converted from paper-based to electronic programs, 
and Texas and Michigan have recently passed legislation to convert 
their programs to electronic systems. 

Five states—-California, Idaho, Michigan,[Footnote 12] New York, and 
Texas—-supplement their electronic systems with state-issued paper 
prescription forms to help prevent forgeries and counterfeits. These 
forms can be either single or triplicate and are made available by the 
state to prescribers. New York and Texas have recently switched or are 
in the process of switching from triplicate to single forms. The 
single forms include a number of safety features that prevent them 
from being photocopied or scanned, such as watermarks. Kentucky 
requires prescribers to use non-state-issued secure safety forms when 
dispensing controlled substances. 

States have assigned the administrative responsibility for PDMPs to 
various state agencies and regulatory bodies. Most programs are 
administered by a law enforcement agency, a state department of 
health, or a state board of pharmacy. 

A Few PDMPs Operate Proactively, but Most Operate Reactively: 

States use different approaches to analyzing the prescription 
information they receive. A few states routinely analyze prescription 
data collected by the PDMPs to identify individuals, physicians, or 
pharmacies that have unusual use, prescribing, or dispensing patterns 
that may suggest potential drug diversion, abuse, or doctor shopping. 
States refer to this as a proactive approach to identifying drug 
diversion. Trend analyses are shared with appropriate entities, such 
as law enforcement, practitioners, and regulatory and licensing 
boards. In contrast, most state PDMPs generally use the prescription 
data to respond to requests for information. These requests may come 
from physicians or from law enforcement or state officials based on 
leads about potential instances of diversion. According to state 
program officials, most PDMPs operate in the latter fashion because of 
the increased amount of resources required to operate a proactive 
system. 

Design and Operational Factors Affect Program Costs: 

The differences in program costs among all PDMP states reflect a 
number of design and operational factors. In addition to the choice of 
controlled substance schedules monitored, these factors include 
computer programming choices, number and type of staff and 
contractors, turnaround times and report transmittal methods, number 
and type of requests, and number of reporting entities, such as 
pharmacies. 

If the PDMP is electronically based, there are ongoing computer 
maintenance and programming costs. If a private contractor collects 
the raw data from dispensers and converts them to a standardized 
format, the PDMP pays annual contracting costs for database 
maintenance. Kentucky and Nevada privately contract with the same 
company to collect data for their program database. Utah, in contrast, 
collects and maintains drug-dispensing data in-house, using its own 
software and hardware. 

The number and type of staff a state chooses to operate its PDMP also 
vary and affect program costs. Kentucky's PDMP employs four full-time 
and four part-time staff to help ensure the accuracy of its reports, 
including a pharmacist-investigator who reviews each report before it 
is sent. Nevada's PDMP operates with one employee because a private 
contractor collects the data. In contrast, Utah's PDMP, with three 
full-time employees and no private contractor, has one program 
administrator who collects all dispensing data and converts them to a 
standardized format for monitoring, and maintains the database. The 
two other staff answer requests. 

If the PDMP seeks to provide same-day responses to report requests, 
the costs involved in returning the response to the requester may 
increase. For example, Kentucky has spent up to $12,000 in 1 month for 
faxing reports. PDMP officials from Kentucky, Nevada, and Utah 
estimated 3- to 4-hour turnaround times for PDMP data requests, and 
all mainly use faxing, rather than more costly mailing, to return the 
report to the requester. Same-day PDMP responses may be preferable for 
physicians who want the prescription drug history for a patient being 
seen that day, and for law enforcement users who need immediate data 
for investigations of suspected illegal activity. 

As users become more familiar with the benefits of PDMP report data, 
requests and the attendant costs to provide them may increase. In 
Kentucky, Nevada, and Utah, usage has increased substantially, mostly 
because of the increased number of requests by physicians to check 
patients' prescription drug histories. In Kentucky, these physician 
requests increased from 28,307 in 2000, the first full year of 
operation, to 56,367 in 2001, an increase of nearly 100 percent. Law 
enforcement requests increased from 4,567 in 2000 to 5,797 in 2001, an 
increase of 27 percent. Similarly, Nevada's requests from all 
authorized users have also increased—from 480 in 1997, its first full 
year, to 6,896 in 2001, an increase of about 1,400 percent. 

Additionally, as a PDMP matures, the needs it addresses may change, 
and operating costs may increase as a result. If users want PDMP 
reports to reflect more timely information, dispensing entities would 
have to report their data at the time of sale, rather than submitting 
data biweekly or monthly, to capture the most recent prescription 
dispensing. If users want to be alerted if a certain drug, 
practitioner, or pharmacy may be involved in a developing diversion 
problem, PDMPs would have to initiate periodic data analysis to 
determine trends or patterns. Such PDMP enhancements would entail 
additional costs, including costs for computer programming, and data 
analysis. Kentucky's PDMP is currently seeking $1.4 million in 
additional operating funds to meet costs related to increased PDMP 
usage by all users, particularly physicians, and to be able to provide 
periodic reports about state drug usage trends and possible diversion. 

State Programs Have Helped Shorten Investigation Time and Reduced 
Illegal Drug Diversion: 

States with PDMPs have experienced considerable reductions in the time 
and effort required by law enforcement and regulatory investigators to 
explore leads and the merits of possible drug diversion cases. The 
presence of a PDMP helps a state reduce its illegal drug diversion, 
but diversion activities may increase in contiguous states without 
PDMPs. 

Investigation Time and Productivity Have Improved: 

The ability of PDMPs 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. States that do not have PDMPs must rely 
on tips from patients, practitioners, or law enforcement authorities 
to identify possible prescription drug abuse and diversion. Following 
up on these leads requires a lengthy, labor-intensive investigation. 
In contrast, PDMPs provide information that allows investigators to 
pinpoint the physicians' offices and pharmacies where drug records 
must be reviewed to verify suspected diversion and thus eliminates the 
need to search records at physicians' offices and pharmacies that have 
no connection to a case. 

Prior to implementation of Kentucky's PDMP, its state drug control 
investigators took an average of 156 days to complete the 
investigation of alleged doctor shoppers. Following the 
implementation, the average investigation time dropped to 16 days. 
Similarly, Nevada reduced its investigation time from about 120 days 
to about 20 days, and a Utah official told us that they experienced an 
80 percent reduction in investigation time. 

Programs Have Helped Reduce Availability of Abused Drugs: 

Officials from Kentucky, Nevada, and Utah told us that PDMPs have 
helped reduce the unwarranted prescribing and subsequent diversion of 
abused drugs in their states. In both Kentucky and Nevada, an 
increasing number of PDMP reports are being used by physicians to 
check the prescription drug utilization history of current and 
prospective patients to determine whether it is necessary to prescribe 
certain drugs that are subject to abuse. Law enforcement officials 
told us that they view these drug history checks as initial deterrents—
a front-line defense—to prevent individuals from visiting multiple 
physicians to obtain prescriptions, because patients are aware that 
physicians can review their prescription drug history. For an 
individual who may be seeking multiple controlled substance 
prescriptions, the check allows a physician to analyze the 
prescription drug history to determine whether drug treatment appears 
questionable, and if so, to verify it with the listed physicians. In 
Kentucky, a physician can request a PDMP report the same day as a 
patient's appointment, and usually receives the patient's drug history 
report within 4 hours of making the request. Kentucky's PDMP typically 
receives about 400 physician requests daily, and can provide data 
current to the most recent 2 to 4 weeks. 

The presence of a PDMP may also have an impact on the use of drugs 
more likely to be diverted. For example, DEA rank-ordered all states 
for 2000 by the number of OxyContin prescriptions per 100,000 people. 
[Footnote 13] Eight of the 10 states with the highest number of 
prescriptions—-West Virginia, Alaska, Delaware, New Hampshire, 
Florida, Pennsylvania, Maine, and Connecticut—had no PDMPs, and only 2 
did—-Kentucky and Rhode Island. Six of the 10 states with the lowest 
number of prescriptions—-Michigan, New Mexico,[Footnote 14] Texas, New 
York, Illinois, and California-—had PDMPs, and 4-—Kansas, Minnesota, 
Iowa, and South Dakota-—did not. 

The existence of a PDMP within a state, however, appears to increase 
drug diversion activities in contiguous non-PDMP states. When states 
begin to monitor drugs, drug diversion activities tend to spill across 
boundaries to non-PDMP states. One example is provided by Kentucky, 
which shares a boundary with seven states, only two of which have 
PDMPs—Indiana and Illinois. As drug diverters became aware of the 
Kentucky PDMP's ability to trace their drug histories, they tended to 
move their diversion activities to nearby nonmonitored states. 
OxyContin diversion problems have worsened in Tennessee, West 
Virginia, and Virginia—all contiguous non-PDMP states—because of the 
presence of Kentucky's PDMP, according to a joint federal, state, and 
local drug diversion report.[Footnote 15] 

Challenges Exist in Establishing and Expanding State PDMPs: 

States that are considering establishing or expanding a PDMP face a 
variety of challenges. One challenge is the lack of awareness of the 
extent to which prescription drug abuse and diversion is a significant 
public health and law enforcement problem. States also face concerns 
about the confidentiality of the information gathered by the PDMP, 
voiced by patients who are legitimately using prescription drugs and 
by physicians and pharmacists who are legitimately prescribing and 
dispensing them. Another challenge states face is securing adequate 
funding to initiate and develop the program and to maintain and modify 
it over time. 

Extent of Diversion and Abuse Is Not Always Recognized: 

One challenge faced by states attempting to control diversion and 
abuse of controlled substances is a lack of awareness of the 
seriousness of this public health and law enforcement problem. 
Nationally, prescription drug abuse involves a multibillion-dollar 
illegal diversion market, results in deaths of abusers, and is as 
significant a problem as abuse of illegal drugs. In Kentucky, the 
state police alerted state officials, including the attorney general 
and the governor, about the extent of the state's prescription drug 
abuse problem. A task force was established with state legislators and 
representatives from law enforcement, public health, and education, 
which recommended that the state establish a PDMP. About 3 years 
later, the abuse and diversion of OxyContin in eastern Kentucky became 
a major concern, prompting the governor to create an OxyContin task 
force. The task force recommended enhancing the PDMP's capability to 
identify doctor shoppers by increasing the timeliness of data 
collection, analysis, and dissemination through development of an 
online, real-time data entry system for pharmacists. Another 
recommendation was to develop an educational program so PDMP users, 
such as physicians, pharmacists, and law enforcement officials, could 
better understand the system's enhanced capabilities. 

Physicians, Patients, and Pharmacists Express Concerns About 
Confidentiality: 

Both physicians who legitimately prescribe prescription drugs and 
patients who legitimately use them are concerned that the information 
collected, centrally maintained, and monitored by state PDMPs may be 
used inappropriately or compromised. All states, regardless of whether 
there is a state PDMP, have the authority under their laws to conduct 
investigations of the records of individuals alleged to be involved in 
prescription drug diversion and abuse, including the records of 
prescribing physicians and dispensing pharmacies. PDMPs, particularly 
those with electronic databases, raise additional confidentiality 
concerns, however, because their databases contain complete dispensing 
records that can more quickly identify individual patients, 
physicians, and pharmacies and provide an individual report on their 
prescription drug history. Physicians are concerned that their 
prescribing decisions and patterns may be questioned and that they 
could be investigated without sufficient cause. Some physicians 
contend that patients may suffer because physicians will be reluctant 
to prescribe appropriate controlled substances to manage a patient's 
pain or treat their condition. Patients are concerned that their 
personal information may be used inappropriately by those with 
authorized access or shared with unauthorized entities. Pharmacists 
have also expressed concerns. In New Mexico, the Board of Pharmacy 
repealed the administrative regulations necessary to operate the 
state's electronic PDMP following confidentiality concerns raised by 
some pharmacists who were apprehensive they might be targeted for 
investigation based on the volume of controlled substance drugs they 
dispensed. 

Some states have attempted to address these concerns statutorily. For 
example, some state laws to regulate controlled substances and to 
operate a PDMP include health privacy protection provisions.[Footnote 
16] In addition, states with PDMPs generally have statutory and 
regulatory protections to limit access and use of confidential health 
care data, as well as statutory penalties for misuse. Under Kentucky's 
electronic PDMP, for example, the authorized users of its information 
are statutorily delineated, the knowing misuse of the data can result 
in a felony conviction, and the PDMP itself is statutorily accountable 
for ensuring that only authorized users receive its data. Kentucky law 
also prohibits any person who receives PDMP data from sharing that 
information with anyone else, unless required by a court, and the 
Kentucky PDMP advises data recipients of this prohibition. Nevada's 
state law similarly protects the confidentiality of its PDMP 
information by requiring a court order for disclosure to nonauthorized 
entities. Also, Nevada's Board of Pharmacy has legal authority to 
discipline and fine an individual for violating the confidentiality 
law. For example, the board brought legal action against a pharmacist 
who provided an employer with prescription utilization information on 
a worker whom the employer subsequently fired. The pharmacist was 
fined $2,000 and was given probationary discipline. 

Securing Program Funding Is a Critical Challenge: 

According to officials from the National Alliance for Model State Drug 
Laws, the National Association of Drug Diversion Investigators, and 
the DEA, securing program funding is a critical challenge faced by 
states that choose to develop, maintain, or expand a PDMP. They add 
that funding availability is crucial to states' ability to establish 
and continue PDMPs. Given a state's particular funding availability 
and priorities, PDMP costs can involve a major hurdle. According to 
state officials, the start-up costs for the three most recent PDMPs 
were $415,000 for Kentucky in 1999, $134,000 for Nevada in 1996, 
[Footnote 17] and $50,000 for Utah in 1996. Estimated annual operating 
costs for these PDMPs varied from a high of about $500,000 in Kentucky 
to $112,000 in Nevada and $93,000 in Utah. These three PDMPs are 
supported by state funds and do not charge fees for providing data 
reports to their users. In contrast, the West Virginia PDMP was 
terminated in 1998 primarily because of a lack of state funding 
support, according to an official of the state board of pharmacy, 
which operated the program. The board had been required to fund the 
PDMP through the revenue generated by its licensing and related fees, 
without additional state funds, but was unable to sustain operation of 
both its licensing and regulatory program and its PDMP through these 
revenues alone. 

National Efforts Have Focused on Providing Guidance and Technical 
Assistance: 

Efforts at the national level to assist states in addressing illegal 
diversion have focused on providing guidance and technical assistance. 
The National Alliance for Model State Drug Laws has identified the key 
features of a model PDMP and drafted a model law that states could 
adopt. Both the Alliance and DEA have provided information to states 
about the nature of drug diversion problems and guidance on how to 
deal with them. DEA has also assisted states in initiating new PDMPs 
and improving existing ones. 

The Alliance Provides Models and Technical Assistance for States: 

The Alliance published the final report from its Prescription 
Monitoring Work Group in February 2002. The report identified the key 
features of a model PDMP. It recommended that PDMPs cover all 
schedules of controlled substances, use some form of an electronic 
monitoring system, safeguard the confidentiality of the prescription 
data collected, analyze the data to provide information for law 
enforcement and medical professionals, provide education to health 
professionals regarding the monitoring system and pain management, and 
include an evaluation component to assess its costs and benefits. 
Along with its work group report, the Alliance provided a draft model 
state law. 

The Alliance also facilitates communication between states that are 
considering a PDMP and states that have programs in place, and 
provides technical assistance to states on implementing its 
recommendations. It reviews draft bills and provides information on 
current PDMP status, trends, and legal matters to state legislatures. 
For example, the Alliance work group recently stressed the need for 
states to assess the impact of the HIPAA privacy provisions on state 
PDMPs. 

DEA Has Assisted States in Dealing with Drug Diversion and Abuse: 

Since the 1980s, DEA has been supportive of state PDMP efforts to 
detect and prevent illegal diversion of prescription drugs at the 
retail level. DEA's aid has been largely in the form of providing 
technical assistance to states that are seeking to reduce diversion 
and abuse, and only recently in the form of making start-up funding 
available to states. 

Historically, DEA has routinely supplied educational materials to 
practitioners, dispensers, and the general public on drug diversion. 
It has also provided states with computerized information and 
intelligence on the distribution of certain controlled substances and 
coordinated major investigations. In addition, DEA has served as a 
program resource for states seeking assistance with developing PDMPs 
and drafting and promulgating regulations. 

Over the past 11 years, three states have obtained federal funds to 
initiate PDMPs: Kentucky (1998), Massachusetts (1992), and Oklahoma 
(1991). More recently, additional funding has been made available for 
grants to states that are planning to start a PDMP or expand an 
existing program. Two million dollars in grants from the Department of 
Justice's Bureau of Justice Assistance is to be administered jointly 
with the DEA.[Footnote 18] DEA and the Bureau of Justice Assistance 
designed the grant program to allow states with legislation or 
regulations for a PDMP program in place or pending to apply for 
funding. There are also grants available for states with existing 
PDMPs to improve program capabilities through enhanced technology. 
According to DEA, seven New Program Grants of $180,000 and two 
Enhanced Program Grants of $220,000 will be available. Several states 
have expressed an interest in applying for the grants because of their 
increased awareness of drug diversion. 

Concluding Observations: 

Illegal diversion and abuse of prescription drugs and the associated 
criminal activity are growing problems in many states. Prescription 
drug monitoring programs offer states a more efficient means of 
detecting and deterring illegal diversion. These programs provide 
state health care licensing and regulatory agencies and law 
enforcement with quick access to comprehensive information on the 
prescribing, dispensing, and purchasing of controlled substances that 
are most likely to be targets for diversion. 

Although state PDMPs have aided investigators and helped to reduce 
doctor shopping, the number of states with PDMPs has grown only 
slightly over the past decade, from 10 in 1992 to 15 in 2002. A lack 
of awareness of the magnitude of the problem, concerns about 
confidentiality on the part of patients, physicians, pharmacists, and 
legislators, and difficulty in accessing funding have kept the numbers 
of PDMPs low. 

Cooperative efforts at the state and national levels are seeking to 
overcome these challenges and increase the number of states with 
programs. For states considering establishing PDMPs, the report by the 
Alliance's Prescription Monitoring Work Group provides a useful 
roadmap of the critical factors each state needs to consider in order 
to create an effective program. Moreover, the $2 million in grants 
available from the Bureau of Justice Assistance, and to be 
administered jointly with DEA, provides states with a potential source 
of funding to start a PDMP. 

Agency Comments: 

We obtained comments on a draft of this report from DEA, the Alliance, 
and state PDMP officials in Kentucky, Nevada, and Utah. In general, 
they agreed with the report and thought it provided useful information 
on state drug monitoring programs. They also provided technical 
comments, which we incorporated where appropriate. 

As agreed with your office, unless you publicly announce the contents 
of this report earlier, we plan no further distribution until 30 days 
from the report date. At that time, we will send copies of this report 
to the Attorney General of the United States, the Administrator of the 
Drug Enforcement Agency, and others who are interested. We also will 
make copies available to others upon request. In addition, the report 
will be available at no charge on the GAO Web site at [hyperlink, 
http://www.gao.gov]. 

If you or your staffs have any questions about this report or would 
like additional information, please call me at (202) 512-7118. Another 
contact and key contributors to this report are listed in appendix II. 

Signed by: 

Janet Heinrich: 
Director, Health Care—Public Health Issues: 

[End of section] 

Appendix I: Key Features of Selected State Prescription Drug 
Monitoring Programs: 

This table summarizes the key features of the state prescription drug 
monitoring programs (PDMPs) in Kentucky, Nevada, and Utah. 

Table 2: Key Features of Selected State Prescription Drug Monitoring 
Programs: 

Key features: Census 2000 population; 
Kentucky: 4.04 million; 
Nevada: 1.99 million; 
Utah: 2.23 million. 

Key features: Year operational; 
Kentucky: 1999; 
Nevada: 1997; 
Utah: 1997. 

Key features: Start-up funding; 
Kentucky: $415,000 in federal start-up grant funds; 
Nevada: $134,000[A] in state funds; 
Utah: $50,000 in one time state funds. 

Key features: Controlled substance schedules monitored; 
Kentucky: II, III, IV, V; 
Nevada: II, III, IV; 
Utah: II, III, IV, V. 

Key features: Electronic data collection and reporting; 
Kentucky: Yes; 
Nevada: Yes; 
Utah: Yes. 

Key features: Private contractor receives dispensing information and 
creates database; 
Kentucky: Yes; 
Nevada: Yes; 
Utah: No. 

Key features: Annual operating costs (estimate); 
Kentucky: $500,000; 
Nevada: $112,000; 
Utah: $150,000. 

Key features: Staff; 
Kentucky: 4 full-time (1 licensed pharmacist investigator, 2 pharmacy 
technicians, 1 data entry operator) and 4 part-time; 
Nevada: 1 full-time with all administrative duties; 
Utah: 3 full-time including manager and 2 support staff. 

Key features: Number of pharmacies reporting dispensing data 
(estimate); 
Kentucky: 1,300; 
Nevada: 387; 
Utah: 375. 

Key features: Number of daily data requests received (estimate); 
Kentucky: 400; 
Nevada: 20; 
Utah: 130 to 150. 

Key features: Report turnaround time to requestor (estimate); 
Kentucky: 4 hours; 
Nevada: 4 hours; 
Utah: 3 hours. 

Key features: Penalty for unauthorized use or disclosure of PDMP data; 
Kentucky: Class D felony[B]; 
Nevada: PDMP statute has no penalty; 
Utah: Third-degree felony[C]. 

[A] Nevada received $265,000 for the first 2 years of its program's 
operations, including 2-year grants from two pharmaceutical companies 
and the state board of medical examiners. 

[B] Kentucky law defines a class D felony as one carrying a sentence 
of at least 1 year, but not more than 5 years in prison. 

[C] Utah law defines a third-degree felony as one carrying a sentence 
of not more than 5 years in prison. 

Source: GAO interviews with PDMP administrators. 

[End of table] 

[End of section] 

Appendix II: GAO Contact and Staff Acknowledgments: 

GAO Contact: 

John C. Hansen, (202) 512-7105: 

Acknowledgments: 

In addition to the above, Robert Dee, Preety Gadhoke, Opal 
Winebrenner, Roseanne Price, and George Bogart made key contributions 
to this report. 

[End of section] 

Footnotes: 

[1] According to the National Institute on Drug Abuse, addiction is a 
chronic, relapsing disease, characterized by compulsive drug seeking 
and use and by neurochemical and molecular changes in the brain, 
whereas physical dependence is an adaptive physiological state that 
can occur with regular drug use and results in withdrawal symptoms 
when drug use is discontinued. 

[2] 1999-2000 National Household Survey on Drug Abuse, Substance Abuse 
and Mental Health Services Administration, Department of Health and 
Human Services. 

[3] In this report, we refer to this organization as the Alliance. The 
Alliance, a nonprofit association, is the successor to the President's 
Commission on Model State Drug Laws. 

[4] All references to state laws relating to PDMPs were provided to us 
by the National Alliance for Model State Drug Laws and were not 
independently verified. 

[5] Drug Enforcement Administration and the National Alliance for 
Model State Drug Laws, A Closer Look at State Prescription Monitoring 
Programs [hyperlink, 
http://www.deacliversion.usdoj.gov/pubs/program/rx-onitor/summary.htm] 
accessed September 17, 2001). 

[6] Title II of the Comprehensive Drug Abuse Prevention and Control 
Act of 1970 (Pub. L. No. 91-513, §§100-103, 84 Stat. 1236, 1242-1284). 

[7] According to the Kentucky PDMP administrator, the state has also 
chosen to regulate drug manufacturers and wholesalers. 

[8] Some Schedule V drugs that contain limited quantities of certain 
narcotic and stimulant drugs are available over the counter without a 
prescription. 

[9] The types of practitioners who prescribe drugs and may be 
monitored by a PDMP vary among states. Physicians are the majority of 
covered practitioners, but in most states many nonphysicians also have 
prescribing authority, including physician assistants, dentists, 
optometrists, podiatrists, veterinarians, and certain types of nurses, 
such as nurse practitioners and advanced practice nurses. 

[10] U.S. General Accounting Office, Prescription Drug Monitoring: 
States Can Readily Identify Illegal Sales and Use of Controlled 
Substances, [hyperlink, http://www.gao.gov/products/GAO/HRD-92-115] 
(Washington, D.C.: July 21, 1992). 

[11] These percentages include two states that subsequently terminated 
their PDMPs—-New Mexico and West Virginia. 

[12] Michigan is moving to an electronic system. 

[13] 0xyContin, Hearings Before the Subcommittee on the Departments of 
Commerce, Justice, and State, the Judiciary, and Related Agencies, 
House Committee on Appropriations, 107th Cong. Part 10, pp. 21, 22 
(2001) (Statement of Asa Hutchinson, Administrator of the Drug 
Enforcement Administration). 

[14] New Mexico's PDMP was terminated in June 2000. 

[15] Appalachia High Intensity Drug Trafficking Area Investigative 
Support Center, with the assistance of the National Drug Intelligence 
Center, The OxyContin Threat in Appalachia, August 2001. 

[16] The federal Health Insurance Portability and Accountability Act 
of 1996 (HIPAA) generally preempts state health information privacy 
laws, unless they provide a higher level of protection than the act. 
(Pub. L. No.104-191, §262, 110 Stat. 1936, 2029.) However, these state 
privacy provisions may not be preempted if the Secretary of Health and 
Human Services determines that the state law has as its principal 
purpose the regulation of the manufacture, registration, distribution, 
dispensing, or other control of any controlled substances (as defined 
in 21 U.S.C. §802), or that is deemed a controlled substance by state 
law. (45 C.F.R. §160.203 (a)(2)) 

[17] Nevada received a total of $265,000 for the first 2 years of the 
program's operations, including 2-year grants from two pharmaceutical 
companies and the state board of medical examiners. 

[18] Departments of Commerce, Justice, and State, the Judiciary, and 
Related Agencies Appropriations Act, 2002, Pub. L. No. 107-77 (2001). 
The $2 million grant is itemized as the "Harold Rogers Prescription 
Drug Monitoring Program" (H.R. Conf. Rep. No. 107-278, at 90(2001)). 

[End of section] 

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