Let’s see how PDMPs are working for the state of Massachusetts

http://onlinelibrary.wiley.com/doi/10.1002/pds.1878/abstract

12/14/2009, Usefulness of prescription monitoring programs for surveillance—analysis of Schedule II opioid prescription data in Massachusetts, 1996–2006

Conclusions. PMPs can become a useful public health surveillance tool to monitor the medical and non-medical use of prescription opioids and to inform public health and safety policy.

http://www.patriotledger.com/article/20140927/NEWS/140926953

9/27/2014, LAURA MARTIN: Time to end the silence about heroin

For the past four years, I’ve been an assistant district attorney in Quincy District Court’s Drug Court. My brother Danny Martin was a graduate of Norwell High School where he played varsity football and lacrosse, Suffolk University and, in September 2004, he was about to start his first year at New England School of Law. On Aug. 1, 2004, Danny overdosed in his childhood bedroom. Unfortunately, my story is not unique nor is my brother Danny’s. But both are rarely shared because of the stigma surrounding addiction…

Danny’s struggle with addiction began in high school after he was prescribed painkillers for a sports injury. He maintained his addiction to painkillers until it became too expensive at which time he started using heroin… 

He needed help, but he was ashamed to ask for it. In the final year of his life, he placed himself in a few detox facilities, but, despite all his willpower, he simply couldn’t stop using. Danny knew this and so in the summer of 2004 he went on his own to Quincy District Court and filed a Section 35 commitment on himself. With no criminal record or prior long term treatment history he was offered a bed at Men’s Addiction Treatment Center. When the judge provided him with this alternative, Danny declined explaining that he had to go somewhere he knew he couldn’t leave. So he went to Bridgewater State Hospital. After spending 30 days at his commitment, he was released. Three days later, he overdosed and died…

I wonder what the rate of overdose is for those who don’t go to treatment?

ADA’s are not involved in the Section 35 civil commitment process…

Civil commitment is the answer?  How scary is that?

My brother Danny never had the opportunity to go into a residential treatment facility. 

So, first your brother didn’t get adequate treatment at numerous detox centers (even though you blame him for the failures), and then didn’t get any treatment at all while at Bridgewater State Hospital?  Is “commitment” a nice way of saying “jail”?

Early on in my career I met a young man with a serious opiate addiction. His family knew my background and came to me for help. He did okay for a while but inevitably always fell back into using. He once told me that he had overdosed over 20 times… On a whim he called him one night. His friend said he would be there the next morning to take him to detox. True to his word the next morning he came banging on his door and took him to detox. He has been clean ever since.

“On a whim”?  I thought drug addicts had to be at “rock bottom” before being turned around… like how patients can’t use buprenorphine until they’ve started to detox.  And just because detox and abstinence saved this person, that doesn’t mean these treatments should be mandated for everyone else.

http://www.patriotledger.com/article/99999999/News/308299803

1/9/2015, OVERDOSE: Killer drugs next door

The median age of overdose victims is 41. And they’re not the dregs of society. They are homemakers, professionals, students and laborers.

Yeah, since the overdose victims are no longer just the “dregs of society,” we must now pay attention, right?  That’s just… rude and tacky.

http://www.wcvb.com/health/massachusetts-4-months-and-185-heroin-deaths/25342776

4/5/2014, Massachusetts: 4 months and 185 heroin deaths

Heroin overdoses are on the rise in Massachusetts, fueled by its relatively cheap price and high potency. Police suspect some heroin has been laced with the prescription painkiller fentanyl, making it especially dangerous… State police say 185 people died from suspected heroin overdoses in Massachusetts from November through Feb. 26, a figure that does not include overdose deaths in the state’s three largest cities. The number of all opioid-related deaths, which includes heroin, OxyContin and other prescription pain relievers, increased from 363 in 2000 to 642 in 2011, the most recent year for which statewide figures were available.

Patrick’s emergency order, announced March 27, will allow first responders to carry the overdose drug Narcan and make the antidote more accessible by prescription to family and friends of people battling addiction. Massachusetts health officials say the state’s Narcan nasal spray distribution program has stopped more than 2,000 overdoses since 2007. The governor said his administration will dedicate an additional $20 million for addiction and recovery services. State lawmakers passed a 911 Good Samaritan law in 2012 to provide limited immunity from arrest or prosecution for minor drug law violations for people who call for medical help for themselves or others who have overdosed.

http://www.mass.gov/eohhs/docs/dph/substance-abuse/opioid/overdoseresponsestrategies.pdf

Opioid Overdose Response Strategies in Massachusetts, April 2014

Overdose is a common experience among opioid users…  

Seriously?  If it was so common, and since so many millions of Americans take opioids, wouldn’t the overdose rates be a lot higher than they are now?  In fact, it sure would be nice for someone to calculate the percentage of people who take opioids and the number of people who overdose — just on opioids, as well as with a combination of other drugs.  Is it safer to take opioids or to be treated at a hospital?  Is it safer to take opioids or to drive your car every day?

In the future, will we have to take out separate insurance coverage if we want to take drugs that may cause addiction or overdose?

If government desires to be a more trustworthy organization, then it should stop lying.  (And being hypocrites.)

On Thursday, March 27, 2014, Governor Deval Patrick declared a public health emergency in
Massachusetts in response to the growing opioid addiction epidemic.

Well, the PDMP in Massachusetts appears to be the program that’s been around the longest. So, what do you think, is it working?

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(2009) The Influence of Prescription Monitoring Programs on Chronic Pain Management

http://www.painphysicianjournal.com/2009/may/2009;12;507-515.pdf

Background: Abuse of prescribed controlled substance has become a serious social as well as health care issue over the past decade. A particularly alarming trend exists among patients aged 12 to 17. [This is from 2009, but the current problem is not in this age group.] Common abuse behaviors include doctor shopping, drug theft, feigned pain symptoms to gain health care access, drug sharing, prescription forgery, and improper prescription practices. In response to this epidemic of abuse, many states have adopted prescription monitoring programs (PMPs). Such programs first originated in the early twentieth century. As of 2006, 38 states had such programs, many of which are supported by federal grants. As PMPs become more widespread, they have also increased in sophistication. By keeping a record of the prescription and dispensing of narcotics, these programs are able to build a comprehensive data network for tracking [certain] prescription medications. These databases aid law enforcement agencies in investigations of narcotic trafficking; they also help state regulatory boards to monitor improper prescription practices.

Is there any purpose listed here that would help patients or doctors?  No, this is strictly for law enforcement.

And if these programs have been around since 2006 — and we’re in the middle of this opioid “epidemic” — it doesn’t look like they’re providing much help, does it?

Of course, since illegal heroin isn’t tracked by the PDMPs, the current heroin “epidemic” isn’t getting much help from these federally-funded programs either.  But if you think about it, what kind of help would the PDMPs offer the DEA for reducing the supply of illegal heroin?  Why, since it is often quoted that opioid medications are the gateway to heroin abuse in a “majority” of cases (I’ve seen quotes as high as 90%), then finding the patients who “abuse” opioids will be like the “broken windows” policy of catching potential criminals before they become actual criminals.

Conclusion: Many states have developed PMPs to help regulatory agencies as well as physicians detect prescription drug abuse. Limited data so far suggest that such programs reduce abuse practices. In addition, proactive usage of the data further prevents abuse.

Since drug abuse is a crime, “detecting” it means involving law enforcement.  And if you’re a pain patient, and your history includes a mistake and/or the involvement of any kind of law enforcement, then you will no longer find access to treatment through the health care system. You will be blacklisted.

And it is my contention that the PDMPs are a blacklist for pain patients.

Wikipedia’s page for Blacklist (computing):  In computing, a blacklist or block list is a basic access control mechanism that allows through all elements (email addresses, users, URLs, etc.), except those explicitly mentioned. Those items on the list are denied access.

As a pain patient, who’s side are you on?

Why do I spend so much time reading and posting about the drug war?  Because I want to be able to see an overall view of the problem — I need this information to be able to make decisions for my own treatment as a chronic pain patient.  Which treatments will I have access to (and be able to afford), and what will I have to do (and how much will I have to spend) for that access?

Looking back over my 25-year history as a chronic pain patient, I realized that my inability to see the whole picture has caused me to make treatment decisions that I now regret. (Not that regret is a bad thing, as one person’s regret is another person’s chance to learn from it.)

A big part of the problem is the criminalization of pain patients, which includes the use of Prescription Data Monitoring Programs (PDMPs).  Here’s what the U.S. Department of Justice, Drug Enforcement Division, Office of Diversion Control website has to say about PDMPs:

(Visiting the DEA website, which no doubt left cookies on my computer, is just one of the many risks I’ve had to take as a pain patient.  I include the link for verification purposes, but I do not advise clicking on it.)

http://www.deadiversion.usdoj.gov/faq/rx_monitor.htm

State Prescription Drug Monitoring Programs, Questions & Answers

Updated October 2011

1. What is a prescription drug monitoring program (PDMP)?

According to the National Alliance for Model State Drug Laws (NAMSDL), a PDMP is a statewide electronic database which collects designated data on substances dispensed in the state. The PDMP is housed by a specified statewide regulatory, administrative or law enforcement agency. The housing agency distributes data from the database to individuals who are authorized under state law to receive the information for purposes of their profession.

This is the first time I’ve heard of the “National Alliance for Whatever.”

2. Does the Drug Enforcement Administration (DEA) oversee PDMPs?

The DEA is not involved with the administration of any state PDMP.

Involved with administration?  Perhaps not, just with creation, funding, and access, right?

3. What are the benefits of having a PDMP?

The overview provided by NAMSDL clearly identifies the benefits of a PDMP: as a tool used by states to address prescription drug abuse, addiction and diversion, it may serve several purposes such as:

*support access to legitimate medical use of controlled substances,
*identify and deter or prevent drug abuse and diversion,
*facilitate and encourage the identification, intervention with and treatment of persons addicted to prescription drugs,
*inform public health initiatives through outlining of use and abuse trends, and
*educate individuals about PDMPs and the use, abuse and diversion of and addiction to prescription drugs.

See, it’s for the public good, for our own good… We, the DEA, so swear.  Trust us.

4. Which states currently have a PDMP?

According to the Alliance of States with Prescription Monitoring Programs, (www.pmpalliance.org) as of October 16, 2011, 37 states have operational PDMPs that have the capacity to receive and distribute controlled substance prescription information to authorized users. States with operational programs include:

Alabama, Arizona, California, Colorado, Connecticut, Florida, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Massachusetts, Michigan, Minnesota, Mississippi, Nevada, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Utah, Vermont, Virginia, West Virginia, and Wyoming.

Eleven states (Alaska, Arkansas, Delaware, Georgia, Maryland, Montana, Nebraska, New Jersey, South Dakota, Washington, and Wisconsin) and one U.S. territory (Guam), have enacted legislation to establish a PDMP, but are not fully operational.

You’d think that agencies as well-funded as the Department of Justice and the DEA would be able to keep their website updated, but no, this information is from 2011.

8. Who can access the PDMP information collected?

Each state controls who will have access and for what purpose.

I think I’m gonna need the DEA’s definition of “control.”  Is that like how each state controls the “administration” of the program?

9. Is federal funding available for PDMPs?

The Harold Rogers Prescription Drug Monitoring Program (HRPDMP) is administered by the U.S. Department of Justice, Office of Justice Programs, Bureau of Justice Assistance, to provide three types of grants: planning, implementation, and enhancement. Since inception of the grant program in FY 2002, grants have been awarded to 47 states and 1 U.S. territory. For FY 2011, HRPDMP funding is approximately $5.6 million. Additional information can be found at http://www.ojp.usdoj.gov/BJA/grant/prescripdrugs.html

(Don’t click on this link either.)

It doesn’t matter how you explain it, or which words you use, it still comes down to a system that was created and funded by law enforcement.

The National All Schedules Prescription Electronic Reporting Act (NASPER), enacted in 2005, created a U.S. Department of Health and Human Services grant program for states to implement or enhance prescription drug monitoring programs. In FY 2009 and FY 2010 NASPER received $2 million to support NASPER grants in 13 states. Information on NASPER can be found at http://www.samhsa.gov.

States can participate in both funding programs, but requirements and priorities for each program may vary.

Sure, you can siphon the funding through state departments of health — gives the program more legitimacy, right?  But the funding still comes from law enforcement, and so do the goals of the program.

10. What is the difference between HRPDMP and NASPER?

The purpose of the HRPDMP is to enhance the capacity of regulatory and law enforcement agencies as well as public health officials to collect and analyze controlled substance prescription data through a centralized database administered by an authorized state agency.

NASPER administers a grant program under the authority of HHS. The intent of the law was to foster the establishment or enhancement of PDMPs that would meet consistent national criteria and have the capacity for the interstate exchange of information.

“I’ll be watching you.”  Sting

(Whenever I read about PDMPs, that’s the song that plays in my head :D)

The purpose of PDMPs is to track and monitor certain legal drugs — not illegal drugs.  Just think about that for a minute…

Does the PDMP track insulin, anti-depressants or anti-psychotics?  Acetaminophen?  (Vodka?)

I’ve read that some pain patients actually welcome all the monitoring and tracking, as if they are hoping that these processes will validate their pain.  I can understand that, and it’s probably true. Doctors verify medical conditions through tests and documentation, including chronic pain, just like they monitor other medical conditions when drugs are involved, like diabetes and heart problems.

But see, doctors don’t use (or really need) the information from the PDMPs unless there’s a lack of trust involved or suspicions arise with a patient. In fact, part of the reason PDMPs have yet to be connected nationwide is because doctors only use them (when not required to) when they want to check up on a patient — doctors don’t look up patients they believe and trust.

(Although I wouldn’t be surprised if doctors started running credit reports on pain patients.)

If you’re a pain patient who’s following all the rules, you might think that the PDMPs are no big deal…  Why not help law enforcement catch the ones who aren’t following the rules?  If I have to follow these ridiculous and expensive rules, everyone else should be forced to also.  I mean, it’s the ones who are breaking the rules, the drug addicts, who are making it so much harder for everyone else…

And then maybe, at some point in the hopefully not-too-distant future… when all the rule-breakers have been caught and imprisoned… maybe law enforcement will back off and leave pain patients alone… Yeah, sure, I can see it… everything could go back to the way it was…

It looks like the DEA can’t force doctors to use the PDMPs, unless each state allows it. However, the DEA doesn’t really need that — the fear created by the agency is enough for doctors to fall in line.  And the federal government easily uses state government agencies — like medical boards and departments of health — to achieve its goals.

Now, as a pain patient, which side of the drug war are you on?

Soldiers Help Grow And Protect Poppy Fields For Heroin Production

http://www.pharmaciststeve.com/?p=8575#comment-7323

My comment:

Painkills2
January 9th, 2015 at 21:15
The protection of international poppy fields is not only for the protection of the illegal drug trade, but also for the legal one. The U.S does not want poppy fields in our country, so other countries have to grow the plants that are made into extracts, manufactured into pill form (usually in some other country), which finally end up behind the drug counter at Walgreens and CVS.

I read recently that prescription drugs obtained through the take-back and disposal programs run by the DEA and state district attorneys are returned to pharmacies and the legal drug supply… So, where did your pain pills really come from?

Does the DEA sell the diverted supply back to the pharmacies? I’ve read that those take-back programs receive thousands and thousands of pills — sounds like somebody’s making a lot of money under the counter.

———

What does the DEA do with all the prescription drugs that are returned through take-back and disposal programs?  The DEA allegedly destroys all the marijuana it confiscates.  Does it do the same for prescription drugs?

Look, some doctors are fighting back…

http://www.pharmaciststeve.com/?p=8572

http://www.bizjournals.com/portland/blog/health-care-inc
/2015/01/oregon-docs-to-feds-hands-off-our-prescription.html?
utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+vertical
_18+%28Legal+Services+Industry+News%29&page=all

1/8/2015, Oregon docs to feds: Hands off our prescription drug info

Eight other state medical associations and the American Medical Association signed on to support the OMA in the brief it filed last month. The suit is pending before the U.S. Ninth Circuit Court of Appeals. The State Attorney General’s office filed the original suit in U.S. District Court in Portland in the fall of 2012.

“We remain concerned about the potential for re-purposing the database away from a public health tool toward a law enforcement resource for federal agencies,” said Ken Cole, the OMA’s director of marketing and communications.

Doctors should also be worried about the loss of trust in the patient/physician relationship.  Loss of trust and lack of need for doctors who’s strings are pulled by the DEA and insurance companies (instead of medical science).

He said when the database was set up, Oregon lawmakers built safeguards to require law enforcement agencies to demonstrate probable cause before receiving limited access.
Since DEA subpoenas do not need to be based on probable cause, Oregon sued to determine whether the state needed to comply.

Oregon built safeguards against everyone except the DEA?  (Like you can build safeguards against the DEA, NSA, FBI, CIA…)  That doesn’t make much sense.  But since law enforcement’s definition of “probable cause” can be determined by “suspicious behavior,” “probable cause” ceases to have any meaning.

Do you think patients will feel better or more secure if the DEA has to prove probable cause first?  Face it, the PDMPs are mainly for the DEA and law enforcement — that’s what they were set up for, regardless of any other uses for the information.

How do PDMPs help patients?  Do pain patients receive any benefit from being monitored and criminalized?  Or does it put the process of seeking medical care out of the reach of millions and millions of people in pain?

“If the DEA walked into my house and rifled through my medicine cabinet, that clearly would be a violation of the Constitution,” Wessler said. “The rules shouldn’t be be any different because the records are sitting in a secure state database.”

“Secure state database” — that’s funny.  Who are they trying to fool?

The state established the monitoring program in 2009 as an electronic database of prescriptions filled by Oregon pharmacies. It was intended to promote public health and patient care by giving providers a way to identify and address problems related to side effects, risks associated with the combined effects of prescriptions and overdose. Pharmacies submit prescription data to the system for all Schedule II, III and IV drugs (including opioids) they dispense. About 7 million prescription[s] have been reported each year since 2011, when it became operational.

So, how is that PDMP working for Oregon?  Is it doing what it was set up to do?  Stay tuned…

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