AFN working on system to monitor drug use

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The Assembly of First Nations (AFN)is working to develop a national system to track prescription drug use among First Nations people

Regional Chief Bill Erasmus, who chairs the AFN Secretariat on Health and Social Development, said such a system would be designed to protect the personal privacy of the people included in the system database while working to prevent abuse of prescription drugs.

Part of the challenge to putting together such a program is the number of jurisdictions that have to be involved, Erasmus said.

"You've got our own people that are caring for some aspects of health. You've got Health Canada that's involved. And you've also got the provinces. So each of the entities have to come to agreement on how to pursue this and that's part of the difficulty. You've got to get a national consensus."

The province of Saskatchewan has recently changed the way it tracks prescription drug use. Saskatchewan Health has expanded the scope of its monitoring system to include all prescriptions filled in the province regardless of who is footing the bill. That means prescriptions not covered under the province's drug plan, or those paid for by the federal government-including those filled for First Nation patients and veterans-will now be monitored.

One of the goals of the system is to track a patient's medical conditions and the types of prescription drugs they're using so that pharmacists can catch any possible adverse drug interactions. Another is to flag situations where people may be abusing prescription drugs by going to a number of different doctors or pharmacies to obtain drugs.

The changes to the province's monitoring system have been made in response to recommendations coming out of a coroner's inquest into the death of Darcy Dean Ironchild in February 2000. Ironchild, a 33-year-old Native man, died from an overdose of prescription medications. Testimony given during the inquest indicated that, in the year before his death, Ironchild had had more than 300 prescriptions filled.

The idea of a system that monitors every prescription filled in the province isn't a new one. In British Columbia such a system-PharmaNet-has been in place for about a decade. The primary reason PharmaNet was implemented in B.C. was to identify potential negative drug interactions among patients, said Michelle Stewart, communications director with Health Services in B.C.

"Because prior to that it wasn't possible for pharmacists to be aware of what other medications an individual might be on at the time they were prescribed medication."

According to Stewart, First Nation leaders have never expressed concerns about the prescription-monitoring program. There were some privacy-related concerns that were raised when PharmaNet was first brought online, she said. "But those were addressed and we didn't have significant outcry from any particular group."

The program has strict controls in place to keep unauthorized people from accessing health information contained in the system, Stewart said. "It's monitored, and if people are inappropriately accessing a file then that can be picked up on the system because everybody who goes on to the system has an identifier. Not even the Ministry of Health could access that information. The data is held by the College of Pharmacists. So no one in the ministry, for example, could identify or have access to that database to potentially look up a patient, for example. That's all strictly controlled by the College of Pharmacists."

The decision to bring in changes to the way Saskatchewan Health monitors prescriptions filled in the province was made four years ago, said Saskatchewan Minister of Health John Nilson. Consultations were held and the necessary changes to the province's Prescription Drug Plan were passed in the legislature in 2002, but it's taken since then to implement the changes across the province.

"It's been quite a complicated technical task to have allof the IT (information technology) specialists working together with the pharmacists and pharmacies, the medical doctors and all of our existing systems, both federally and provincially, and through some of the big pharmacy chains, to get all of the information," Nilson said. "And that's now all been completed. And we had a trial period in the fall using a limited number of pharmacies and that's sort of worked out the last kinks, and it's been in effect now since January."

The news that the province would now be monitoring prescription drugs purchased by First Nation patients wasn't received all that well by the Federation of Saskatchewan Indian Nations (FSIN). A few days after Saskatchewan Health made its announcement, the FSIN made one of their own, with Vice Chief Morley Watson voicing his disappointment with the provincial department's move, and criticizing the government for not consulting with First Nations before bringing in such a change. In the press release Watson, who holds the health portfolio for the FSIN, compared the situation to Health Canada's failed attempt to require Aboriginal clients to sign a consent form in order to receive health services and prescription drugs.

The province did in fact consult with the FSIN, Nilson said. But, because the process to implement the new policy has taken so long, a changing of the guard has taken place within the federation executive, with a new chief and a new vice-chief responsible for health. Nilson said he has spoken to Watson to try to clear things up. He also said that, although the FSIN press release linked the province's new system for monitoring prescriptions with Health Canada's failed consent form initiative, there is no relation between the two.