PDMPs and the privacy of patients and doctors


That’s when Lewis turned to the courts, arguing the board had gone fishing for a case against him. In a twist, he asserted that regulators violated not his rights, but those of his patients under the state constitution’s privacy provisions. Lewis’ lawyer, Ben Fenton of Los Angeles, said regulators should get a court order or a signed patient release to look through the databases, just as they must do for a patient’s medical records. After losing at lower court levels, Fenton took the case to the state Supreme Court, which has agreed to hear it this year but not scheduled a date.

Though access by law enforcement officials to prescription databases has been challenged in various states – successfully in Oregon — the California case is believed to be among the first in the country to challenge unrestricted access by medical boards to state prescription drug databases…

The California database, maintained by the state Department of Justice, contains details including physicians’ and patients’ names and is based on weekly reports from pharmacies about prescriptions they have filled for certain high-risk drugs including powerful painkillers. By law, the justice department must provide reports to certain civil and criminal investigators and no court order or warrant is required for access, including for medical board investigators.

Like California, nearly every state now has prescription drug monitoring programs, often known by their acronym PDMP. PDMPs were set up to detect “doctor shopping” by addicts and dealers who seek pain prescriptions from multiple physicians – the purpose that often gets the most attention. But those databases also give licensing boards and law enforcement a way to spot and rein in reckless prescribing by doctors…

As it stands, states tend to put up few barriers to medical licensing boards seeking information as part of their duties. Experts at the PDMP Center for Excellence at Brandeis University outside Boston knew of only one state — Iowa – that requires medical boards get a court order before looking at the databases…

Lewis’ lawyer, Fenton, noted that the original complaint against his client had nothing to do with drug prescriptions, yet the board still ran Lewis through the voluminous database, which contains patient names and medications. According to testimony cited in court papers, an investigator with the medical board said officials routinely check the names of physicians under investigation in the database…

The AMA weighed in in support of Lewis. While the organization supports keeping drug prescription databases…

Unlike medical records, prescriptions of controlled substances “are subject to regular scrutiny by law enforcement and regulatory agencies,” the court wrote when turning down Lewis’ appeal. As a result, the court said, patients have a “diminished expectation of privacy” about their information in the databases…

Under comments:

Anne, on April 28, 2015 at 4:22 pm said:
PDMP…..so open law enforcement don’t need warrants always…..many times they can just “say ”they are doing an investigation. Who can’t see this data? In Alabama, you the patient are expressly prohibited from reviewing YOUR OWN RECORDS even if you contest the accuracy. I have had eleven errors that I know of in my records since early 2011!

painkills2, on April 29, 2015 at 12:11 am said:
I was recently told by a nurse at the hospital that once information is entered into your electronic health record, it cannot be removed — doesn’t matter if it’s true or not.

So if a doctor believes a patient isn’t using her prescriptions (maybe because of an inaccurate drug test result) and is illegally selling them, that doctor will input that information into both your EHR and a PDMP. The doctor doesn’t need to be right — a drug test result is all that’s needed to label you for life.

I assume information cannot be removed from the PDMPs either. Once your records say you are a drug seeker, addict, or criminal, those labels will follow you forever. Every doctor you see will view that information, and my guess is that there will be many doctors who will refuse to treat any patient with those labels, especially pain patients.

Nothing can protect patients from the drug war, including HIPAA.

Our judiciary, in the DEA’s back pocket



The ruling by U.S. District Judge Lee Rosenthal, which was made public late Monday, heads off a potentially embarrassing civil trial that was supposed to start early next month at the federal courthouse…

Back in November 2011, A DEA task force was supposed to be watching truck driver Chapa from the ground and the air as he delivered a load of marijuana fresh from the Rio Grande Valley to Houston. The plan was for Chapa to take them to where the load was to be delivered and arrest cartel members there.

But as the truck entered northwest Houston under the watch of approximately two dozen law enforcement officers, several heavily armed Los Zetas cartel-connected soldiers in sport utility vehicles converged on Patty’s truck.

In the ensuing firefight, Patty’s truck was wrecked and riddled with bullet holes, and a plainclothes Houston police officer shot and wounded a plainclothes Harris County Sheriff’s Office deputy who was mistaken for a gangster.

The truck’s driver was killed and four attackers were arrested and charged with capital murder.
Patty’s truck was impounded and later released to him, but was out of service for months. The DEA refused to pay for the damages, as did Patty’s insurance company, which ruled that the truck had been used in a criminal act, and therefore the damages weren’t covered.

Patty had argued that he and his family lived through extreme emotional distress after fears that the cartel would come after them for some perception they had been complicit with police. He also said that losing the truck for nearly 90 days after it had been damaged nearly crippled his business, which only had two trucks at the time.

Fred Shepherd, who worked with Vickery on the case said his client is astonished that he has no recourse. “It is not just that you can’t sue the federal government., but that fed law enforcement agencies under this ruling can use anybody’s property to do anything they want to further their law enforcement mission and not have to go get the permission from the owner of the property to do it.”

Disband The DEA


I wouldn’t have posted this, except it looks like my comment has been censored…

painkills2 a day ago Pending

It made sense to legalize and regulate alcohol, so we did that. It makes sense to do the same for cannabis, so we’re going to do that too. “Hard” drugs like heroin and meth are actually legally available in regulated formulations through Big Pharma, so why discriminate against them?

Drugs are drugs, including caffeine, nicotine, and sugar. An end to the drug war includes legalizing and regulating all drugs, as these are medical issues, not criminal ones. Drug users end up being criminalized, including those who suffer from addiction, and everyone knows that’s not right. Imprisoning those who suffer from mental health issues isn’t right. How can anyone disagree with that?

And giving the FDA more power is not the answer. The FDA brought us drugs like antidepressants and Vioxx. The agency removes drugs like Pallodone from the market, when methadone has the exact same problems:

“high levels of palladone could slow or stop breathing, or cause coma or death; combining the drug with alcohol use could lead to rapid release of hydromorphone, in turn leading to potentially fatally high levels of drugs in the system”


And because methadone is cheap, it’s prescribed to Medicaid patients, some of whom have died of overdoses. And then those deaths are blamed on “opioids,” and now there’s a war against chronic pain patients.

The only answer is: No. More. Drug. War.

It’s Never Too Late For Peace


What’s Happening In Baltimore Didn’t Just Start With Freddie Gray

The gradual attrition of jobs that paid a decent wage rendered Baltimore particularly vulnerable to the drug trade, which has become almost synonymous with the city thanks to media depictions like HBO’s “The Wire.” Starting in the late 1970s, drug kingpins began recruiting children and teenagers — who, if caught, could usually escape the criminal justice system more easily and more cheaply than adults — to aid with the day-to-day business of selling illicit substances. For many young people, the drug trade offered much more lucrative possibilities than the weak local economy.

Compounding all these issues has been the subprime crisis of the past several years. Predatory lenders allegedly targeted black communities in Baltimore, steering people into untenable, high-interest mortgages that would eventually wipe out their wealth and leave the city riddled with foreclosed and vacant homes…

The neighborhood is also plagued by a “rate of lead paint violations almost four times as high as it was citywide,” according to Slate. Lead paint is linked to a host of health problems and is highly correlated with increased levels of violent crime…

Between 2011 and September 2014, the city of Baltimore shelled out $5.7 million to cover police brutality lawsuits, according to a Baltimore Sun investigation…

“Where was the peace when we were getting shot? Where’s the peace when we were getting laid out? Where is the peace when we are in the back of ambulances? Where is the peace then?” Thomas said. “They don’t want to call for peace then. But you know when people really want peace? When the white people have to get out of bed, when cops have to wear riot gear, when the cops start talking about, oh we got broken arms. Then they want peace.”

“Peace?” Thomas went on. “It’s too late for peace.”

(Photo taken today.)

Error message in WordPress

This webpage is not available



The “dns probe finished no internet” error usually appears when you try to access the internet via the Google Chrome browser even though the internet works fine on other internet browsers like Mozilla or Internet explorer for Windows 8. This will prevent you from accessing any kind of web pages until you fix it. So you will only need to follow the tutorial posted below for a quick fix on this error and prevent it from appearing again…

There are 38 steps to this fix… seriously.  And although I keep getting this error message, it usually happens if my computer is busy downloading another web page, and it resolves if I close out of the other web page and reload WordPress.  You’d think that since I have a Core i5, which is supposed to let me do more than one thing at a time, I wouldn’t have these kinds of problems. I think this is partly due to my Verizon internet service, which especially at certain times of the day, is extremely slow.


Putin Mar 6, 2015 12:40AM
go to START and Run and type in the following commands:
cmd (enter)

c:\netsh winsock reset (enter)

remember restart your computer

Bernie Sanders To Launch Presidential Campaign



Senator Sanders might be the champion marijuana advocates have been looking for; he is not opposed to legalizing recreational use and supports medical use. “I have real concerns about implications of the war on drugs. We have been engaged in [it] for decades now with a huge cost and the destruction of a whole lot of lives of people who were never involved in any violent activities,” he told Time Magazine.

Warren is less liberal than you may think when it comes to pot. Although she loves a light beer on occasion (“One beer and I’m like, ‘Woah, I’m ready to par-tay,” she reportedly said), she was opposed to legalizing marijuana two years ago.


At a St. Patrick’s Day breakfast in South Boston this past weekend, Senator Elizabeth Warren (D-Massachusetts) took a jab at pro-legalization Republican State Representative Dan Winslow (R-Norfolk), who is currently vying for the Republican nomination for Senate in Massachusetts’s upcoming special election.  Addressing the crowd, Senator Warren said, “I advise everyone to pay very close attention to Dan Winslow’s platform. He has a 100 percent ranking from the gun lobby and he’s for the legalization of marijuana. He wants us armed and stoned.” …

I’m in constant pain and I need cannabis.  And I need it to be affordable, which means legalization. It looks like Bernie Sanders is my candidate for 2016.  (As if I would ever vote for Hillary Clinton.)

The Beautiful Way Hawaiian Culture Embraces A Particular Kind Of Transgender Identity


In Native Hawaiian culture, for instance, the idea of someone who embodies both the male and female spirit is a familiar and even revered concept. Gender identity is considered fluid and amorphous, allowing room for māhū, who would fall under the transgender umbrella in Western society.

“Māhū is the expression of the third self,” Kaumakaiwa Kanaka‘ole, a Native Hawaiian activist and performer told Mana magazine. “It is not a gender, it’s not an orientation, it’s not a sect, it’s not a particular demographic and it’s definitely not a race. It is simply an expression of the third person as it involves the individual. When you find that place in yourself to acknowledge both male and female aspects within and accept the capacity to embrace both … that is where the māhū exists and true liberation happens.”

As an upcoming PBS documentary “Kumu Hina,” about a transgender woman and teacher, shows, māhū are thought to inhabit “a place in the middle.” …

Study Finds Frozen Shrimp Are Totally Disgusting

I really love shrimp (especially over pasta), but not only is it expensive, it appears rather unhealthy for you…


The magazine’s investigators bought 342 packages of frozen shrimp, some raw and some cooked, from several major supermarket chains. They tested the shellfish for pathogens and antibiotics, and found that 60 percent contained one of four types of bacteria that can be cause disease in humans — including 16 percent of the cooked, ready-to-eat samples. These bacteria included vibrio, a potentially lethal bacteria closely associated with raw oysters that is becoming more common as the temperature of the world’s oceans rises.

More worrisome still, Consumer Reports found traces of antibiotics in 11 of the samples, all of them imported from Asia. The FDA forbids the use of antibiotics in shrimp aquaculture because they contribute to the spread of antibiotic-resistant bacteria. But some producers, especially abroad, use them to ward off disease and increase their output — and 94 percent of the shrimp sold in America is imported from other countries…

Failed back surgery syndrome

Considering the large number of chronic pain patients who suffer from back pain, I find it somewhat odd that my back doesn’t usually bother me.  Maybe if the pain in my head wasn’t at such a high level, I might notice pain in other areas of my body.  Maybe if I had agreed to surgery for the degenerative disk disease in my neck, I might now be suffering from chronic back pain.  Who knows.

But I find the information on Failed Back Surgery Syndrome to be incomplete and not very logical.  Just the name of the condition, including the word “failed,” which seems to blame the pain patient for problems experienced after surgery.  After my TMJ surgery, my pain got worse, so I can certainly empathize with those who suffer from this poorly-named condition.

This is an abstract from 1991:


The failed back or postlaminectomy syndrome is obviously multidimensional. Failure of therapy may result from structural abnormalities in the back, psychosocial influences, or a combination of both. The causes of back pain are largely unknown. Correlations with diagnostic studies are uncertain. The lack of precise diagnoses is reflected in a multiplicity of nonspecific treatments, mostly of unproven value. Our current disability-litigation system adds greatly to the problem. Patients are rewarded for nonfunction. Some physicians become advocates for patients, others for insurance carriers and employers. Decisions concerning appropriate treatment are often made by patients, attorneys, the disability determination system, employers, and judges for extraneous reasons, which include financial gain or personal bias and often reflect lack of current information. Even when correct decisions are made, there is a lack of adequate programs for diagnosis and comprehensive treatment of these individuals. The failed back syndrome is not likely to disappear quickly. Large numbers of these patients require care. The best available evaluation includes thorough, but not overly minute investigation using the best current imaging techniques. These studies combined with the history and physical examination should provide a reasonably accurate assessment of the patient’s condition. Concomitant evaluation of psychosocial issues is mandatory, and those who treat these patients without understanding the importance of the various comorbidities discussed are likely to be detrimental. Reparative surgery has real, but limited use. Nerve root compression and instability are the only two conditions demonstrated to be correctable at the present time. However, even when a potentially remediable lesion is found, these patients should undergo a reasonable attempt at physical rehabilitation with attention to both local factors and general function. The best data available today suggest that most of the patients suffering from failed back syndrome are incapacitated by psychiatric, psychologic, and social/vocational factors, which relate to the back complaint only indirectly. Those currently suffering from this problem can be best treated by comprehensive programs that address these complex psychosocial issues. New additions to this category can be reduced by rigorous attention to physical abnormalities, so that surgery is undertaken only for clear indications, and appreciation of the importance of the psychologic aspects of disability from low back pain. The smaller group suffering principally from physical abnormalities can be improved by reparative surgery or pain-relieving procedures if intensive conservative rehabilitation efforts fail. All surgical procedures fail occasionally, and as long as there is a need for reparative surgery, some patients will fail to benefit or be worsened by the procedures.

No doubt insurance companies love it when doctors blame chronic pain on psychological issues, but that negates everything that led up to the problems, including inadequate treatment, treatments that result in even more harm, misdiagnosis, and surgical interventions.

All surgical procedures fail “occasionally”?  I just don’t think that’s true.  But because the medical industry thinks it’s more important to protect itself than the patients it serves, we’ll probably never know just how often surgeries do fail.

This abstract appears to blame everyone except the doctors who send pain patients to surgeons because they don’t know what else to do, along with the surgeons who’s only job it is to cut, regardless of the likely outcome.

More current information doesn’t place as much blame on the patient:


Failed Back Surgery Syndrome (FBSS) refers to a subset of patients who have new or persistent pain after spinal surgery for back or leg pain. The pain can be reduced but still present, or may get worse within a few months after surgery due to a buildup of scar tissue around spinal nerve roots, along with persistent tissue pain and muscle spasm. The term refers to a condition of continuing pain and is not meant to imply there was necessarily a problem during surgery. While published reports estimate the incidence of failed back surgery syndrome to be between 20 – 40%, the likelihood is considered greater with repeated surgery, and the condition will be more prevalent in regions where spinal surgery is more common.

Initial treatment may involve injections, nerve blocks, or a treatment to temporarily block pain signals called radiofrequency neurotomy, which heats up small nerve endings and temporarily blocks the pain. In addition to those pain relief measures, an exercise program to gradually recover muscle strength may also a component of a recovery program.

If the pain is disabling and does not respond to initial measures, neuromodulation treatment may be an option. Electrical neurostimulation can be tried out, in which one or more leads with small electrical contacts are placed near the nerves (such as the spine or the peripheral nerves beyond the spine along the lower back). If pain is reduced during the trial, a small battery, similar to the device used to power a heart pacemaker, is implanted to provide ongoing stimulation.

Large, carefully conducted clinical trials have shown spinal cord stimulation to have superior results, at lower cost, than repeat back surgery for the treatment of FBSS.

Another neuromodulation treatment option is intrathecal drug delivery. Rather than rely on medication taken by mouth, this involves placement of a catheter that delivers pain medication directly to the affected area, requiring less medication and causing fewer side effects.

Reviewed June 11, 2012
Executive Officer, International Neuromodulation Society, 2011-2014
Hunter Pain Clinic, Broadmeadow, NSW Australia


SpineUniverse: When a patient comes to you and their surgery was not successful, what do you do?

Dr. Rashbaum: We find out what went wrong. Typically, the patients I see that clearly have failed back surgery syndrome (FBSS) go back to their doctor, only to find that their doctors are totally disengaged in finding the truth. Unfortunately, this is common.

I’m sorry, I’ve done everything I can; I did it the right way, – by implication they’re alleging they didn’t commit malpractice, and, frankly, most of them haven’t.

I can’t help you, you’ll have to go someplace else, doesn’t help the situation. They don’t arrange for the “someplace else,” and basically what happens is these people become a referral base or repository in chronic pain syndrome in a pain doctor’s clinic.

One of the biggest concerns pertains to whether or not the patient is being subjected to a robust reassessment by the operating surgeon. I’d like to think that they were, but they’re not – at least not uniformly. They’re just sending these people down the road, where the problem could easily be assessed by repeating diagnostic studies like an MRI with gadolinium; an enhancer that helps us ferret out scar tissue from a recurrent disc herniation. You can’t get anywhere if you operate on somebody with scar tissue for leg pain, but you certainly can if they have a recurrent disc herniation…

SpineUniverse: Once you find out what went wrong, what are the next steps?

Dr. Rashbaum:  Sometimes we’ll do injection therapy to help us figure out where the pain is coming from. We need to determine if the pain now is mechanical facet joint pain, mechanical disc degeneration, or painful disc syndrome. Above all, we don’t give up on these patients. We do whatever is needed to reinvestigate, because the important issue with FBSS is that time is of the essence.

SpineUniverse: Do many of these patients need to undergo revision surgery?

Dr. Rashbaum:  What you’re asking is what percentage of FBSS patients could undergo a second surgery and recover with improvement. I hate to say this, but the number of those people that are likely to successfully recover from a second surgery, let alone a third, is not great. Every time you have a re-operation, the likelihood of success diminishes substantially, so by the time you get to the third and fourth surgery, you’re not doing very well. Patients who have failed to benefit from surgery and/or revision surgery and continue to have pain are often good candidates for neuromodulation–spinal cord stimulation…


(2011) Failed back surgery syndrome.

BACKGROUND:  Failed back surgery syndrome (FBSS) is a chronic pain condition that has considerable impact on the patient and health care system. Despite advances in surgical technology, the rates of failed back surgery have not declined. The factors contributing to the development of this entity may occur in the preoperative, intraoperative, and postoperative periods. Due to the severe pain and disability this syndrome may cause, more radical treatments have been utilized. Recent trials have been published that evaluate the efficacy and cost-effectiveness of therapeutic modalities such as spinal cord stimulation for the management of patients with failed back surgery…

Most of the research I’ve read on spinal cord stimulation has been positive — overwhelmingly so. But that doesn’t match the stories of pain patients who have tried this treatment, although I admit I haven’t come across very many of them.  Even though spinal cord stimulation isn’t considered “surgery” by the medical industry, it definitely is, just not as in depth as other surgical treatments.

It appears spinal cord stimulation works for some pain patients, but if you’re in that percentage of patients who suffer complications, you’re in for more pain and suffering. And this invasive treatment doesn’t appear to last very long, but since there are so few options for those suffering from chronic back pain, it’s a treatment that doctors are using more often (even though it’s very expensive).

Just like I’m not interested in trying Lyrica (as Neurontin did not help me at all) or more antidepressants, I’m not interested in trying spinal cord stimulation either (especially after the TENS unit just irritated the hell out of me).  

As often as I request other pain patients to tell me about their experiences, I’ve gotten little feedback.  But that won’t stop me from asking again, so if you have experience with spinal cord stimulation, I would love to hear from you.

Binge Drinking: Young Women Take to the Bottle Big Time


Despite the increases in heavy drinking, the percentage of people who drink any alcohol has remained relatively unchanged over time, researchers found…

The increase in binge drinking doesn’t surprise Terri Fukagawa, clinical director of the New Life Recovery Centers in San Jose, California, where 15 of her 24 treatment beds are filled with clients primarily addicted to alcohol. She said she’s seen more people seeking treatment for alcoholism in the past four years…

Taxes on alcohol have not risen along with the Consumer Price Index, so wine, beer and liquor have gotten cheaper over time in real dollars, he said.

Alcohol advertising, particularly for hard liquor, has increased in recent years. A Federal Trade Commission study found that companies spent about $3.45 billion to advertise alcoholic beverages in 2011.

Alcohol control policies, such as limits on when and where alcohol can be sold and how long bars can stay open, have weakened in past decades, Greenfield said. That may partly explain rising consumption nationwide, particularly in some states where “blue laws” once prohibited alcohol sales on Sundays or in supermarkets…

You will never find bud lovers suffering from the same kind of damage that alcoholics suffer from.  And while sin taxes for alcohol stagnate, there’s a sin tax on medical cannabis at every dispensary.  How fair is that?

Because… Butter

These rolls (which I made into sandwich buns) are flavored with crushed red peppers, oregano leaves, and ranch dressing spice mix, with melted Land O’Lakes butter (mixed with garlic salt) poured on top.

Now, since I’ve posted a free advertisement for Land O’Lakes butter, I’ll just sit back and wait for my free carton of butter to arrive…

Indescribably Delicious

“In one sentence, I’d describe myself as indescribable. But, I wouldn’t end it with a period. I’d end it with three dots.”  Jason Schwartzman

Photo taken this morning, and yes, my apartment still smells like yeasty, fresh-baked bread.  (In this case, rolls, which I made into sandwich buns.)