(3) Effect Upon Voluntary Compliance Association members were asked to assess board effectiveness in complaint review. Respondents also indicated the manner in which formal hearings (a major disciplinary procedure) are initiated.

• Effectiveness of the State Board Complaint Review Process

When the group, consisting of one member of each association, was asked to assess the effectiveness of the complaint review process used by the State professional boards, 42 percent (102) indicated that investigative support could be improved. The respondents also indicated that complaints from practitioners and the public were handled in a satisfactory manner. Among physicians (MDs), 69 percent (22), felt

that investigative support could be improved. Overall, 26 percent (64) of the respondents stated that they were satisfied with the process. (See Table 19.)

• Initiation of Formal Hearings

Formal hearings arise in various ways: written complaints from the public, State board referrals, enforcement agency referrals, and complaints from member professionals. No one source appears to account for significantly more hearings than do the others. Three responses per individual board representative indicate that most hearings result from multiple sources. (See Table 20.)

5. RECOMMENDATIONS

The following recommendations are designed to provide effective methods to curtail diversion to the DEA and to compliance inspectors maintained by the State licensing boards.

(1) State Compliance Inspectors

The cost or the level of funding for a State board is an important consideration when State compliance inspectors are used by State boards. For example, 25 of the 50 States and the District of Columbia have more than 5,000 registrants. Each registrant can prescribe or dispense controlled drugs. The number of registrants ranges from 5,000 in Arizona to 62,000 in California. The cost of employing sufficient compliance inspectors to review periodically records for a populous State would be prohibitive. Keeping the cost factor in mind, it would seem that diversion could be more effectively curtailed through the use of the following:

• Increased compliance reviews (may be subject to severe funding constraints)

Commonwealth of Virginia
Board of Pharmacy

• Improving State regulations and/or statutes which pertain to the prescribing and dispensing of controlled drugs.

• Close liaison with police and drug enforcement agencies to identify problems.

(2) DEA

To aid State and local law enforcement officials in curtailing drug traffic stemming from retail outlets, DEA should do the following:

• Conduct drug accountability invesitgations of drug wholesalers, manufacturers, distributors, and packagers

• Handle complaints against practitioners concerning major diversions of controlled subst

ances

• Conduct joint field investigations with State and local officials

• Share intelligence and other information with State authorities

• Coordinate with State officials on major drug abuse problems.

(3) Continuing Education

Given changes in abuse patterns, diversion techniques, and DEA/FDA regulations, information on drug-related matters should be provided to practitioners through continuing education programs rather than through the university and

college health care professional curriculum. Given the increasingly flexible and personalized nature of these professional education programs, continuing practitioner education on drug-related issues is the favored approach to improving practitioner accountability in drug-related areas.

Board representatives from all professions endorsed the concept of continuing education as part of State licensing and other regulatory activities. Seventeen percent (39) of those questioned indicated that continuing education is presently a mandatory part of State licensing. Another 44 percent (102) indicated a desire for a voluntary program, and 25 percent (57) favored a mandatory program. These figures are presented in Table 21.