The patient at Boston Medical Center needed painkillers, but Dr. Sara Schlotterbeck had concerns: The medical record suggested past misuse of opioids by the man.
She wanted to check the Prescription Monitoring Program, a state-run database of every prescription for controlled substances, to see whether the patient had obtained opioids from multiple providers. But Schlotterbeck, who is in her first year of residency training after completing medical school, can't get into the database on her own.
Medical residents don't have access — even though they're allowed to prescribe controlled substances.
As the state grapples with a deadly and still-growing opioid abuse epidemic, this gap has drawn the attention of legislators and policymakers. State Representative Nick Collins, a South Boston Democrat, filed legislation that would require the state to enable medical residents to log in to the prescription database.
The Committee of Interns and Residents, a union representing doctors-in-training at Boston Medical Center and Cambridge Health Alliance, is collecting signatures on a letter asking Governor Charlie Baker to expand access. And the state Department of Public Health is working "to address this issue in a timely fashion," spokesman Scott Zoback said.
In the case of her recent patient, Schlotterbeck managed to track down a fully licensed physician who had time to look up the patient's record for her. She learned the patient had received more than 50 prescriptions from about 20 medical professionals in the past year.
That led to a conversation with the patient about drug dependence and chronic pain management — "that whole difficult conversation that I'm just learning how to have as a new doctor," she said. The database "gave us concrete information to start the conversation."
She also talked about the patient's history with the clinicians who would be taking care of him after discharge, gave him a limited number of pills, and recommended a pain clinic.
The Prescription Monitoring Program is "a really important tool," Schlotterbeck said. "If we really try hard, if we take that extra 15 or 20 minutes — which is actually a lot of time — we're able to get it. . . . You need a system that makes it easy for people, not just a system that depends on individuals to be advocates and go out of their way."
There is little disagreement on the need to fix this loophole.
"It's not sensible that residents are not able to access" the program, said Dr. Dennis M. Dimitri, president of the Massachusetts Medical Society. If allowed, he said, consulting the database "will become part of the culture for residents in training."
Collins has proposed legislation requiring a system for giving residents access; it would be an amendment to the governor's sweeping bill addressing the opioid crisis. But the Department of Public Health has the authority to make the change without legislation. Doing so would involve creating log-ins for residents, who have limited licenses that permit them to prescribe but require that they work in a supervised setting.
Zoback, the health department spokesman, said improving the Prescription Monitoring Program is "a critical priority" in the Baker administration. The department "recognizes the challenges that hospitals and facilities face when residents don't have access" to the database and is working to fix that, he said.
Schlotterbeck hopes that learning to use the Prescription Monitoring Database, and appreciating its importance, can soon become part of residents' training — to benefit not just current patients but future ones as well. "We're picking up all the habits we'll carry through the rest of our careers," she said.