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?

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