Starting next year, dozens of states will begin knitting together databases to watch prescription drug abuse, from powerful painkillers to diet pills.
With federal money and prodding, states are being asked to sign onto an agreement allowing police, pharmacies and physicians to check suspicious prescription pill patterns from Nevada to North Carolina.
Civil liberties and privacy advocates have objected to the state databases, which would be linked with technology and standards developed by the Justice and Homeland Security departments.
Thirty-four states operate databases to fight a drug problem authorities say is growing more deadly than heroin.
"I've got people that are kin to me that's addicted and I see firsthand what it does," said Tracy Carter, sheriff in Lee County, N.C.. about 30 miles southwest of Raleigh. "The thing that's so darn frustrating is our young people don't think it's that big of a deal. 'It's a pill. It won't hurt me. The doctor prescribed it.' But it's worse than crack cocaine."
North Carolina had 826 unintentional deaths due to controlled substances last year, said Bill Bronson, the state health official in charge of the database. In comparison, there were 482 homicides statewide.
Nationally, there were 27,658 overdose deaths from prescription medication in 2007 _ more than heroin and cocaine combined, the Centers for Disease Control and Prevention reported in July. The threat is increasing as the most addictive pain relievers including OxyContin, which can produce a euphoric feeling, become more common, the Drug Enforcement Administration said.
Penney Cowan, founder of the American Chronic Pain Association, said she understands the need for monitoring potential abuse. But she worries the databases will discourage people who legitimately need painkillers. Physicians already are spooked by the fear their legitimate prescribing may trigger interest from investigators, she said.
"What we never hear about is how people with pain, who because they take these medications, are able to function, to be a productive part of society," Cowan said.
The databases alert physicians and pharmacies to patients who see several doctors to collect multiple prescriptions, letting them judge whether to refuse a potential abuser. Law officers say the databases allows them to document a pattern of abuse after investigations or informants point to a suspected pill dealer or dirty doctor.
A 2006 report conducted for the Justice Department said prescription drug databases cut the supply of painkillers and stimulants, reducing the probability of their abuse. The rate of painkiller abuse would have been 10 percent higher by 2003 without the databases, the report said.
The Prescription Monitoring Program Information Exchange would swap information through a central hub at Ohio's Board of Pharmacy. State databases were checked more than two million times in 2008, the Justice Department said. The databases flagged prescription activity on nearly 500,000 more potential abusers.
A proposed interstate compact will be unveiled in time for legislatures to consider it when they assemble next year, said John Mountjoy, policy and research director of the Council of State Governments, a national nonprofit based in Lexington, Ky.
The contract would preserve state-by-state differences that include control of the databases by law enforcement agencies in Texas and California, health departments in North Carolina and Alabama, and pharmacy boards in more than a dozen states.
Doctors are encouraged to check the databases, but in 19 states the law says they aren't required to do so, according to the National Alliance for Model State Drug Laws.
There are also differing limits on law officers' access. Some states require investigators to get a warrant or court order, while others just require an active investigation on a suspect. Vermont doesn't allow law officers to access the database.
Some privacy groups are worried about hackers and identity theft after millions of electronic records were stolen from Virginia's database last year.
North Carolina radio talk shows and bloggers erupted in September when sheriffs proposed changing state law to give them easier access to the database. A common complaint was that investigators could invade their privacy, though most didn't know sheriff's deputies have been able to query the database since 2007.
"The problem is the public doesn't know about this database," said Daren Bakst, legal and regulatory studies director of the conservative John Locke Foundation in Raleigh. "You have access to a database of so many innocent individuals in order to find a tiny percentage who may be abusing."