Photo taken 7/15/2015.
Day: 07/19/2015
Prescription Drug Monitoring Programs – Much Promise But Limited Progress
Fundamentally, a PDMP is a central repository of prescribing and dispensing records pertaining to medications classified as scheduled, controlled substances by the U.S. Drug Enforcement Administration, but a PDMP may include any drug/substance of interest or determined to have abuse potential.
These days, the information is stored in online electronic databases allowing easy access to authorized individuals or agencies, such as law enforcement and drug control agencies, practitioner licensure boards, medical examiners, drug courts and criminal diversion programs, addiction treatment programs, public and private third-party payers, medication dispensers (e.g., pharmacies) and prescribers, and other healthcare providers. States vary widely in which categories of users are permitted to request and receive prescription history reports and under what conditions.
Individual state PDMPs also differ as to required prescribing information — such as, drugs of interest, dose/quantity, date dispensed, and dispenser, prescriber, and patient information, etc. — and time of entry into the database. Only one state, Oklahoma, collects data in real time — that is, at the same time that a prescription is filled — whereas, most states allow up to a week or longer for submission of data to the PDMP…
Beyond 1990, and with support from the U.S. Drug Enforcement Administration (DEA), PDMP administrators formed an alliance for mutual support and information exchange, and to help promote expansion of PDMPs to other states. At this time, PDMPs also started to extend data collection beyond Schedule II drugs; although, each state was free to select the drugs included. This also marked a new generation of PDMPs using electronic technology for prescription information collection, largely abandoning the need for serialized prescription forms…
Continued interest at the federal level, and focusing on reducing opioid-related problems, resulted in various economic support programs; e.g., Harold Rogers Prescription Drug Monitoring Program Grants and the National All Schedules Prescription Electronic Reporting (NASPER) Act. The U.S. Bureau of Justice Assistance helped to form PDMP assistance and training programs with a special emphasis on evidence-based practices. Through the years, other government agencies (e.g., ONDCP, CDC, etc.) and private industry (Purdue Pharma) provided additional assistance and support for program development.
According to the most current information, by the end of 2014 all 50 states and the District of Columbia (Washington DC) had or were nearing realization of a PDMP…
As a newly added concern, the recent hacking of online, electronic databases threatens the integrity of PDMP programs and the security of confidential patient information…
Ideally, PDMP reports would include data on all prescription medications, beyond just CII opioids, but most PDMPs are not designed to capture such extensive information…
Furthermore, while it is claimed that PDMPs do not infringe on the legitimate prescribing of controlled substances and simply make it possible to spot potential problems in patients deserving a closer look, an end result often has been a “chilling effect” on the prescribing of opioids overall…
Several dozen published and unpublished empirical studies on PDMP effectiveness have been summarized in the Pew report, which more than anything points to the difficulties of such investigations. At best, studies have been observational in nature, but most have been case reports of select aspects of PDMPs (e.g., increases in user satisfaction); the vast majority of studies reported favorable outcomes related to PDMP applications and practices. It is important to note, however, that none of the studies were of high quality and none examined improvements in patient care or health outcomes as a result of PDMP implementation and use.
The few broader-scope comparisons of all states with versus states without PDMP programs did not show outcomes favoring PDMPs. For example, an observational study by Paulozzi, Jones, et al. (2011) of early program effectiveness, spanning 1999 through 2005, found that states with PDMPs demonstrated unfavorably increased trends in drug overdoses and mortality, along with significantly greater consumption of hydrocodone. Interestingly, the only states showing improvements in overdose deaths and opioid consumption at the time included 3 states with PDMPs still using special prescription forms rather than newer electronic approaches. This suggested there were many challenges still to be overcome in developing electronic PDMPs and, while it cannot be stated that PDMPs themselves caused negative outcomes, the researchers concluded that, “…it can be said unequivocally that PDMP states did not do any better than the non-PDMP states in controlling the rise in drug overdose mortality.” …
Prescribers have not widely embraced the use of PDMPs, even though there could be some advantages of PDMPs for patient care. For example, a comprehensive and accurate history of pharmacotherapy-management is essential for clinical evaluation of a new patient with chronic pain. While reliance on the patient’s self-reported history is generally considered acceptable, it may lead to dangerous misprescribing. A PDMP might help to identify patients who are receiving multiple legitimate prescriptions for opioids or benzodiazepines, from different healthcare providers, and are at risk for complications from polypharmacy — but only if the PDMP tracks more than class CII opioids…
In states with PDMPs administered by law enforcement agencies, usage by healthcare providers was lower than in states with PDMPs managed by health or pharmacy boards.
In a recent survey of PDMP users in Oregon, almost all (95%) reported accessing the database when they suspected drug abuse or diversion in a patient, but fewer than half checked it routinely for every new patient or every time they prescribed a controlled drug. Clinicians also reported a variety of problems that arose when a PDMP report included “worrisome” information: patients often reacted with anger or denial (at least 88% reacted this way sometimes); nearly three-quarters of clinicians (73%) said that those patients sometimes did not return; less than a quarter (22%) reported that the confronted patients asked for help with drug addiction or dependence problems…
Who’s side are you on?
http://brainblogger.com/2015/01/30/opioids-for-chronic-pain-an-interview-with-dr-webster-pain-guru/
Opioids for Chronic Pain – An Interview with Dr. Webster, Pain Guru
To develop an addiction, a person must be exposed to the drug. Avoiding the use of opioids whenever possible decreases exposure. Decreasing exposure reduces the chance for the disease of addiction to be expressed…
If an opioid is to be prescribed, an assessment for risk factors should be performed followed by close monitoring for aberrant behavior. Addiction can be triggered with the first dose or develop after prolonged exposure. People with a “loaded” genome may express an addiction earlier than those who are spared many of the genetic risks. People who develop an addiction later may have less of a genetic vulnerability, but the stress associated with chronic pain can tip toward destructive use behaviors. Using urine drug testing and prescription drug monitoring is essential to detecting non-adherence, which could be a sign of addiction.
For more on how to prevent opioid addiction see my book, Avoiding Opioid Abuse While Managing Pain…
I personally believe that the FDA should set a deadline for when all ER formulations must meet a minimum standard of abuse-deterrent properties to remain on the market. If this were to occur, the cost of ER formulations would likely increase, but this may be a reasonable trade-off for potentially safer products. Of course, this move will not eliminate all dangers; people can still overdose if they take multiple pills of an abuse-deterrent formulation…
It is important that prescribers have access to interstate data sharing because patients can easily move from one area to another if they intend to deceive the prescriber. In some cases, physicians can access data from prescription monitoring programs in surrounding states by contacting those states, but this takes more time and work than is desirable. For years there has been a push for a nationally centralized database of prescriptions. However, funding has been lacking to make that happen…
Pain Guru or Addiction Guru?
Voices from the past show it’s just getting worse
http://commonhealth.wbur.org/2012/04/painkiller-addiction
Jacks • a year ago
I have been on 30mg oxycodone 5x a day. Have been prescribed this for 6 yrs. I have 2small children, I stay home with them. They are my job. A lot of physical demands on my body. My doctor got his license taken away for righting controlled substances (2many and shady shit with his receptionist he wasn’t aware of) I am starting to feel serious withdraws. How do I deal with this pain? I agree with Ms.Johnson. I’m a good girl who takes my meds to function not to get high. Any suggestions. Tried a pain management office just to basically get a script or suggestions. Right away I felt this dr. Was sizing me up without listening to me. I’m in pain. Very irritable nasty with my kids who don’t deserve it. What do I do? Can’t cry about this anymore. Try emergency room? Please any suggestions would help. It helps to see other people going through this also.
Indiana bricklayer • 2 years ago
I just want to cry!! Had ankle surgery 2 months ago,I’m still in crazy pain..my dr. Is blaming me saying I’m hooked on the pills. That I don’t understand pain…im 42..6 kids own a masonry company and feeling like I’ve done something wrong
clarasanta Indiana bricklayer • 2 years ago
I feel for you bricklayer, I too am in pain from hard working for 40 odd years. Sometimes, and I told this to my doctor the other day, I don’t know who the doctor is her or the FDA. The FDA spooks the medical society very easily and they react not in the patients favor. My doctor was put off by my inquiry of whoom is the doctor but I am tired of almost begging my doctor and the pharmacy for what helps me say play golf. Am I not allowed to play golf because some FDA thug hasn’t figured out that I prefer the pot high for that and oxycodone for my chronic pain and my desire to play a round of golf. Despicable is all I can say and I hope in the future that if my doctor declares me too dizzy to take my oxycodone that the streets are allowed to carry the pain killer that works for me. Doctor/FDA please let me finish my life without the GD pain this is not the time for preaching the morals thing.
Linda • 2 years ago
Here is a balanced perspective, I hope, from someone who knows. My elderly mother was a chronic pain patient for fifteen years. She took oxycontin, She got up to 30 mg twice a day and doctors would allow nothing higher. The time came when she needed oxycontin to feel normal. If she went off it, pain from neuropathy and severe spinal arthritis would return, plus she would feel awful just like someone in drug withdrawal would. When she went to assisted living there were real problems with several nurses who liked to “hold doses” because “your mother seemed a little unsteady on her feet” (she had an inner ear problem). Oxycontin did not make Mom dizzy, it made her feel normal, but many nurses did not understand this and caused terrible suffering for her. The drug did not make her high at all, she was acclimated to it, she felt normal when she took it. When the time came for Mom to die, there was a bad problem. The levels of morphine she was allowed did not help her enough because she was acclimated to narcotics. She was uncomfortable at the time of her death. (In our case we could have gotten permission to try another increase the dose but she passed away before we could. In other cases, they will not allow a high enough dose because what the person needs to stop feeling pain would be fatal, and doctors will not write prescriptions that cause death in most states.) I am grateful my mothers’ pain and discomfort did not go on too long since she also had very bad pneumonia which took her quickly. It could have potentially gone on for weeks or months or years if it had been some other problem increasing her level of pain. So my advise is this: Some people need oxycontin and their doctor can determine that and determine the dose. They should not feel guilty, and should go ahead and take it as their doctor prescribes, perhaps after getting a second opinion to confirm need for it.. But it is potentially tragic if they need it, because they risk pain that nothing can alleviate at the end of their life due both to nurses who “hold doses” and to hospice levels of morphine that are not enough to help them.
erin Linda • a year ago
Omg. I just read your story, I’m so sorry for your loss. In my experience the doctor s may be afraid of higher doses but they should have and can give large doses to a opiate tolerate person, it wont kill them, but i get what ypur saying. Your story reminded me of the same thing my sister went thru when her husband just died of lung cancer they actually stopped his morphine. I couldn’t bare to watch. . I hope your doing ok. God bless
DaveKurtz • 2 years ago
I was prescribed percocet for a dislocated shoulder about 5 years ago. The percocet helped, but the addiction grew. I went from 5mg. to 7.5mg to 10mg and then oxycodone 10mg pink. Throughout the habit forming to physical addiction process, I became so dependent that I did not feel normal without oxycodone. It got to the point that if I didn’t take them, I felt weak, lethargic, tired, and no energy no matter how much I slept.
I automatically went through withdrawal symptoms several times when my body just couldn’t take it anymore, The last time, I was bedridden for 2-3 days, muscle aches, spasms, leg kicking, and the most terrible feeling like the flu x10.
I have been clean now for 4+ months, however, I just tested positive for Lyme disease and I knew back when there was something not right with me. So now, I have moderate joint and muscle pain associated with Lyme, and I really don’t want to take any narcotics, because I know if I do, that will be the end of me.
Gwen • 2 years ago
[…] Just an FYI. Pharmacies are allotted a small quantity of Oxycodone per month. If you call to inquire if they have it in stock, they will tell you that they don’t or will tell you that they are not allowed to tell you. If you send a friend to a pharmacy to have your RX filled, they won’t fill it. (I know, as I had my hired helper go to seven pharmacies with each disallowing him from getting my script filled. It took my having to go into a pharmacy, (having my hospital tag still on my wrist and a gauze bandage on my hand and with my looking as sick as I felt) for the pharmacist to fill the script. I have been told that the best way to get Oxycodone filled is for you to go, in person, to a pharmacy. The ER doctor told me that if a pharmacist doesn’t like how you look, (i.e., seeing tattoos), they will tell you that they can’t fill the script.
rantrightdave Paddy • 2 years ago
I agree with you, and understand that these meds are what allow me to function. However, I too hate the dependency and the sickness of withdrawal. When I stop, I also hate the terrible pain that crushes my skull and face like “freeze brain” that’s all over and doesn’t subside. And I hate looking back at 30 years of visiting (and waiting for) every type of doctor and specialist and test imaginable.
When not using Percoset, only a needle with Torodol brings relief, but those 3AM trips to the emergency room get expensive. There was a brief period where a nasal spray non narcotic Torodol called Sprix worked, but it was taken off the market a year or two ago without comment.
The cycle of starting and stopping accounts for more than half of all suicides. Sucks either way.
Critclimbs • 3 years ago
[…] I feel that stigma every time I take a pill, and I take pills less often for that reason alone. I am in pain because of the stigma that comes with every pill…
How the War on Drugs Is Hurting Chronic Pain Patients
https://edsinfo.wordpress.com/2015/07/19/how-the-war-on-drugs-is-hurting-chronic-pain-patients/
Maia Szalavitz interviewed me and wrote about my recent accident and subsequent reluctance to seek emergency medical care…
https://www.vice.com/read/how-the-war-on-drugs-is-hurting-chronic-pain-patients-716
July 16, 2015
by Maia Szalavitz
When 58-year-old Zyp Czyk* had a serious mountain biking accident in June, she refused to go to the emergency room even though her injuries knocked her out cold and her husband pleaded for her to seek help.
Instead, Czyk slept for two days—contrary to the conventional wisdom of what you’re supposed to do after sustaining a head injury. Only then did she finally agree to go to an urgent care center, where she discovered she had broken her collarbone and some ribs and needed surgery.
Czyk isn’t afraid of doctors, hospitals, or pain medication, and she’s not opposed to Western medicine. In fact, she’s been taking Oxycontin for chronic pain for nearly two decades. And that’s the problem: She feared that if she went to the hospital she might be labeled a drug-seeker, which could lead to her doctor cutting off her opioid prescription, leaving her without the treatment that makes her life bearable…
“I can’t begin to tell you how stressful it’s been,” she tells me, echoing the voices of other chronic pain patients who are often ignored in media coverage of the opioid “crisis” but appear in the comments en masse under most such articles…
(6/12/2015) Baker: $27 Million Needed To Fight Deadly Painkiller Addiction Epidemic
Since addiction often begins with the abuse of prescription painkillers, the task force’s recommendations include strengthening the state’s prescription-monitoring program and requiring education in safe prescribing practices. It also calls for appointing addiction specialists to state boards that oversee doctors, nurses, physician assistants and dentists…
The task force, which was chaired by Secretary of Health and Human Services Marylou Sudders and included Attorney General Maura Healey, seeks a change in the state’s civil commitment law that would allow an individual with a substance abuse problem to be taken, involuntarily if necessary, for assessment.
“We are not going to arrest or incarcerate our way out of this,” said Healey, who along with Baker noted the opiate crisis was affecting families in all corners of the state, urban and rural, and regardless of income. Sudders said addiction must be treated as a chronic medical disease no different than diabetes, heart disease or others….
I wouldn’t describe the activity in the comment section of any article on the war against pain patients to be “…en masse under most such articles.” After all, there are so many of them, how is one supposed to keep up? It’s exhausting, fighting the same ignorant comments, time after time (after time). It’s never-ending. (Like bugs.)
All Things Chronic 