After many years of gestation that accelerated when opiate addiction became a national crisis, drug prescription monitoring programs exist in all 50 states of the U.S. Problem: they mostly work independently of each other, and they vary in effectiveness. Can it be coordinated into cohesive, clear communication lines for doctors, pharmacists and law enforcement?

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Possibly, but not without some growing pains, according to shore Representative Tom MacArthur (R-3) at the end of the latest roundtable of the Bipartisan Heroin Task Force that he co-chairs with New Hampshire Representative Annie Kuster.

MacArthur is now creating legislation that would set standards that all states would be induced to meet, with the reward of federal resources to support their programs if they meet compliance.

PDMPs allow professionals to check prescription histories, which lets them detect patterns, expose "doctor-shopping," and even identify doctors or pharmacists with high traffic density.

"Some states do it really well, and have a very robust program of high enforcement. And other states have a single person sitting by a computer," MacArthur said. "To make it worse, only 13 states are cooperating with other states." New Jersey's program now has five states sharing data.

Representative Tom MacArthur (Alexander Heller, Ocean County College)

"What good is it to stop someone from filling a prescription in their own state, if they're struggling with an addiction," he asked rhetorically, "when they can drive an hour or two, or even minutes, to another state?"

After the dialogue, MacArthur spoke with members of the National Office of Drug Control Policy. He left the meeting with reservations about a flat-out federal program.

"I think it's going to be impossible to increase compliance if states aren't really buying into it," he said, which led to his decision to craft a bill that encourages an all-in approach.

The hurdle is part of an evolution of thinking to effectively attack the problem from supply, and demand, perspectives.

"We've done a lot to curb demand," MacArthur said. "We've tried to prevent drug use  from starting in the first place. We've tried to people recover. We've tried to help people who are overcoming addictions immediately."

"We need to get to the supply side, and two actions this past week will help. One, for South Jersey, is the HIDTA designation [Ocean County's federal desigantion as a High Intensity Drug Trafficking Area], so we can really crack down on these criminal rings. The second is to get to one of the root causes behind our current addiction crisis, and that is the over-prescription of opioids."

MacArthur noted that opiate prescriptions declined 12 percent in the past year, "and that's a good direction." But the United States still prescribes more opiates than the entire European Union - times 20."

Would it be of any value to start with global pharmaceutical manufacturers, many in the U.S., who saturate media with ads for mood-altering substances and pills as preventatives for conditions you might not even have, complete with a lengthy list of negative side effects? When the Surgeon General's office found a causal link between tobacco and cancer a half-century ago, warning labels were slapped on tobacco products, and cigarette ads were yanked off the airwaves. It didn't stop smoking-related cancer, but it curbed the temptation, and combined with exorbitant taxes placed on tobacco and smoke-free policies, has placed definable border around that matter.

For MacArthur, it's apples and oranges. "There's no medically-approved use for tobacco," he observed.

"It's a difficult issue for a lot of people, and I empathize with anyone who's struggling with it. The difference is that opioids were thought to be a miracle drug - and these painkillers are, in some respects - when they're not overused. I think the pharmaceuticals have to be a responsible leader, and in my experience, they are. I'm not interested in pointing fingers as part of the problem. I'm interested in engaging them as part of the solution. I think they're trying to help solve the problem, and I want to encourage that sort of reponsible behavior."