- Associated Press - Sunday, August 10, 2014

BILLINGS, Mont. (AP) - In Sunday church pews, in the grandstands of the baseball game, in the big box store checkout line, most of the people around you have gotten a prescription for painkillers in the past year.

In fact, there are 82 painkiller prescriptions for every 100 Montanans and more than 300 deaths from prescription drug overdoses in 2010 and in 2011.

We know this because governments and medical professionals have been keeping track of prescription drugs since it became clear that both the prescriptions and related deaths were skyrocketing. From 1999 to 2010, the number of painkiller overdose deaths nationally quadrupled, according to the Centers for Disease Control.

Those 300 prescription drug deaths in Montana in 2010 outnumbered car crash deaths, according to the state Justice Department. The state now requires that all prescriptions for painkillers be registered with the Board of Pharmacy. The list, less than two years old, is 5 million prescriptions long and growing as more scripts for opioids like OxyContin, Diluadid, Demoral and morphine are added.

“It’s not as bad as it used to be. They’re getting a hold on it,” said Elisha Finley, a Billings mother whose hydrocodone prescription for an injured shoulder in 2010 turned into an addiction that led to a bad car wreck and sobriety in 2012. “The problem is, people who legitimately get their pain meds oftentimes sell them.”

Statistics would suggest the state is gaining the upper hand on prescription drug abuse. The number of prescription drug-related deaths in Montana numbered 109 in 2013, according to the state Department of Public Health and Human Services. The number of people prosecuted for prescription drug crimes in Yellowstone County has fallen 70 percent from 2011 to 2013.

And yet there’s criticism that Montana’s prescription drug work is incomplete, specifically concerning the prescription drug registry. County attorneys say the drug registry is so wrapped up in judicial red tape that it’s difficult for law enforcement to use.

All Montana doctors and pharmacists are required to report prescriptions to the state registry, but they aren’t required to check a patient’s name against the registry before writing a prescription. Many don’t.

“I’ve accessed it a couple times and had varying degrees of success,” said Wyatt Glade, Custer County attorney. For law enforcement, accessing the list “not only takes law enforcement involvement, it takes prosecutor involvement because it takes an investigative subpoena.”

Investigative subpoenas require a judge’s signature, which doesn’t come unless there’s agreement that a criminal offense has probably been committed and that the information relative to the offense is in the registry.

Montana’s privacy laws make the process so difficult the drug registry hasn’t been a go-to source for law enforcement, which isn’t to say that the registry hasn’t curbed prescription drug abuse.

In Yellowstone County, the number of criminal cases of fraudulently obtained dangerous drugs dropped from 42 the year before the registry was created to 13 last year, said Scott Twito, Yellowstone County attorney. The attorney assumes the decline is because people shopping for prescriptions are being turned away by doctors and pharmacists.

“I think it’s done more to prevent fraudulently obtaining dangerous drugs,” Twito told The Billings Gazette (http://bit.ly/Vdaj5d). “Pharmacists are able to communicate better and get better information. Doctors are able to communicate better. As a tool for us, we still have to go through the subpoena process.”

The Board of Pharmacy does receive subpoena requests, said Marcie Bough, executive director. Since the registry went live in October 2012, prosecutors have received responses to 264 subpoenas. Health care licensing boards have also requested information for 18 investigations of care providers.

“We consider it to be very successful in terms of how far we have come at this stage,” Bough said.

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