MD's prescription drug monitoring program

[Brooklyn]

I've seen both sides of this and can completely agree with both. I had an ex-wife who, after a bad car accident, got ramped up to the highest legal levels of Oxycodone and Oxycontin by a Falston pain management doc that was subsequently shut down by the DEA. That was some horrible stuff, and pretty much cost me a marriage. I would love to see some of that crap regulated out of existence.

I've also had to call around to 10 different pharmacies for my dad as he fought stage 4 cancer, desparately trying to find a place that had the pain meds to keep him as comfortable as he could be until he lost the battle.

I watched my best friend as he had to bury his neice and her boyfriend after they OD'd together on prescription heroin.

I can't say it should be eliminated, because for a small percentage of people, it's the only comfort modern medicine can offer. But there needs to be some way to get the people who don't need it from screwing it up for those that do.

One way is to have DR. with a reasonable belief that a patient is abusing meds tom report same to the Dept of health for investigation.. This would be less than Probable cause and bit more than reasonable suspicion -- and to would be targeted and thus less likely to do harm.

Another method would be to require a second Dr to sign off for dosages over a certain threshold or for extended use..


In general, it is best to be targeted when generating solutions-- if that's your goal. My guess the primary goal is to generate another bureaucracy and database by what ever pretext. You will note that Government, particularly government run by liberals is not noted for a deft touch.


The liberal shuffle works like this.

1. Identify or invent a problem
2. Blame the greed or negligence of the proposed targets of regulation for the problem and exaggerate its scope.
3. Provide a very heavy handed 'solution' of dubious value -- make sure everyone knows that ' we must do something'
4. ignore any other proposals. no natter how reasonable, as being insufficient -- claim that they only cover part of the problem -- make sure to claim that a heavy handed approach is better because it covers more.
5. provide no evidence of any kind-- if pressed say ' we need to try it to know if it will work -- make sure to 'prove that any counter proposals can't work by asserting that they also have no data-- if they do have data -- insist that your heavy handed solution be tried first since it will 'cover more ' and serve as a needed control to test the counter proposals deny the need for a control to test the heavy handed solution because ' its better' --
6. In the event of a failure of steps 2-5 redefine the problem and go to step 1.


And thus I can reject out of hand any solution that is not targeted in scope without guilt -- I know the game and I refuse to play anymore ..

 

[Ragnar]

It's just a matter of time before this system gets hacked like Target or Snapchat and the prescription drug use of everybody in the state gets posted to a Web page run by Anonymous.

 

[Mark75H]

It's just a matter of time before this system gets hacked like Target or Snapchat and the prescription drug use of everybody in the state gets posted to a Web page run by Anonymous.

Or somebody high up in MD gov decides its "Ok for different departments to share data, jus' 'cause I think so today" ... I think we've heard that one before

 

[teratos]

One way is to have DR. with a reasonable belief that a patient is abusing meds tom report same to the Dept of health for investigation.. This would be less than Probable cause and bit more than reasonable suspicion ..

The Department of Health doesn't care. They aren't investigating anything. I have had several instances where I caught people. Hat the names and office numbers of 10 other docs and they were getting over 1000 tablets of 15mg and 30mg oxycodone each month. Street value of over $20,000 per MONTH. There were at least 3 other people working with this guy. I had a copy of their drivers licenses. Called the County police, State police and the DEA. Nobody could be bothered to even take a f'ing report. This was a gimme. I tried to push, but gave up. WTF can the Department of Heath do?

The authorities have no desire at all to prosecute these people. Sadly, the only way it will stop is if prescribers can police it themselves and this system allows it. I don't want to write prescriptions that are going to go to kids. Nobody but the prescribers has any desire to stop this.

 

[DadOSix]

I've seen both sides of this and can completely agree with both. I had an ex-wife who, after a bad car accident, got ramped up to the highest legal levels of Oxycodone and Oxycontin by a Falston pain management doc that was subsequently shut down by the DEA. That was some horrible stuff, and pretty much cost me a marriage. I would love to see some of that crap regulated out of existence.

I've also had to call around to 10 different pharmacies for my dad as he fought stage 4 cancer, desparately trying to find a place that had the pain meds to keep him as comfortable as he could be until he lost the battle.

I watched my best friend as he had to bury his neice and her boyfriend after they OD'd together on prescription heroin.

I can't say it should be eliminated, because for a small percentage of people, it's the only comfort modern medicine can offer. But there needs to be some way to get the people who don't need it from screwing it up for those that do.

Glennc75,

Sorry to hear about the trouble with your dad's rx for his cancer pain.

Here is a tip for all of you.

Make sure you work with your dad's existing pharmacy.

Make sure your family has a relationship established with a pharmacist that knows your family and we will do everything possible to help you out.

When a patient or family has to start calling around to find narcotics, you will learn that no one has any at all in stock. Phone callers are almost always frustrated when trying to find these meds.

I get at least 5 calls a day looking for narcotics because 'no one has any in stock'

Some, I am sure are legit, but most are just seekers.

There was a time a year or so ago, when every pharmacy around here was getting calls for the 'holy trinity' Oxycodone, alprazolam, and Soma. When the DEA started 'cracking down' on Florida pharmacies (some big names), these guys came out of the woodwork.

Will you fill these?
They are from a FL doc who does my pain management.
Oh, btw - I live in KY, yet have a WV cell phone number.
Right and I am coming all the way to MD to get my Rx filled.

Geez !

There are some good big box pharmacists out there, but you are not going to get the service level you get with an independent.

Sort of like buying from a LGS / IP vs DSG or whatever.

No I don't have ammo like a certain retailer, but they don't have ME!

 

[DadOSix]

The Department of Health doesn't care. They aren't investigating anything. I have had several instances where I caught people. Hat the names and office numbers of 10 other docs and they were getting over 1000 tablets of 15mg and 30mg oxycodone each month. Street value of over $20,000 per MONTH. There were at least 3 other people working with this guy. I had a copy of their drivers licenses. Called the County police, State police and the DEA. Nobody could be bothered to even take a f'ing report. This was a gimme. I tried to push, but gave up. WTF can the Department of Heath do?

The authorities have no desire at all to prosecute these people. Sadly, the only way it will stop is if prescribers can police it themselves and this system allows it. I don't want to write prescriptions that are going to go to kids. Nobody but the prescribers has any desire to stop this.

Teratos,

You live in the wrong end of the state! Come West, young doctor! We have LEO that are all over this stuff.

You docs are not the only ones who want to stop this ride. Pharmacists want it too.

I admire that you are diligent in weeding these folks out!

Some docs I call to verify know that the meds are diverted, but just say the Rx is valid anyway. Pharmacists have a corresponding duty to fill what is 'medically necessary.'

Sorry, sir - Out of stock on this one.

 

[Brychan]

If this data base was limited to Dr's only it could be a good thing for people with real pain, like say I hurt my back and go to the ER and they can see my med history and since it shows I'm not taking pain meds they maybe more willing to give me a Rx for something to help with the pain without worrying that I am just shopping for drugs. I can't remember what they gave me when I had a ruptured kidney, but when I was released from the hospital my wife had to go to several pharmacies to find one that even carried the stuff to fill my Rx.

 

[teratos]

Teratos,

You live in the wrong end of the state! Come West, young doctor! We have LEO that are all over this stuff.

You docs are not the only ones who want to stop this ride. Pharmacists want it too.

I admire that you are diligent in weeding these folks out!

Some docs I call to verify know that the meds are diverted, but just say the Rx is valid anyway. Pharmacists have a corresponding duty to fill what is 'medically necessary.'

Sorry, sir - Out of stock on this one.

You are right, Pharmacists are usually the ones who discover this. It's amazing how many don't care. I've gotten calls from pharmacists at the big chains who will sometimes tell me that a patient has been getting oxycodone from 6 different doctors filled at their pharmacy for a year and a half. Really? Oh, BTW, that is the pharmacist who is just "filling in". You wonder why someone didn't call before. I guess there is a lot of apathy if docs aren't willing to do something about it. I appreciate the work good pharmacists do.

 

[Sundazes]

So question for the pharmacists: do most really not stock those meds and have to order them or are they just saying that? Like I said in a earlier post, I just had surgery and was prescribed a small about of oxycontin and oxycodone. We were told to fill them at the hospital before I was discharged or we may have trouble getting them. They said most pharmacies would have to order it and it would take a couple of days. I am just curious about all this. I never knew the problem was that bad.

 

[Brooklyn]

The Department of Health doesn't care. They aren't investigating anything. I have had several instances where I caught people. Hat the names and office numbers of 10 other docs and they were getting over 1000 tablets of 15mg and 30mg oxycodone each month. Street value of over $20,000 per MONTH. There were at least 3 other people working with this guy. I had a copy of their drivers licenses. Called the County police, State police and the DEA. Nobody could be bothered to even take a f'ing report. This was a gimme. I tried to push, but gave up. WTF can the Department of Heath do?

The authorities have no desire at all to prosecute these people. Sadly, the only way it will stop is if prescribers can police it themselves and this system allows it. I don't want to write prescriptions that are going to go to kids. Nobody but the prescribers has any desire to stop this.

I do not doubt this. Nor am I suggesting that Dr area at fault..

I am just pointing out that of 2 methods

,one that arguably invades the privacy of every person on Meds, intrudes on the Dr patient confidentiality ( without foundation) , creates a neat president for every other intrusion they many some day dream up ( Slippery slope problem ), and practically guarantees a black market will form ( or in this case grow) and the other that does not do any of that and may actually work they chose the former.


I claim this is not an accident.


The DOH could maintain a database of persons that have been reported by physicians on a reasonable belief basis. They could get a court order ( substantive due process ) to require such persons to get a secondary sign off for such drugs.

In order words if the gave a damn about rights and used and appropriate legal process they could to a lot even if DOJ tells them to bork off.


And let me clarify that I do not think DR are 'in on it' in any way.. This is just a logical step in the Public health monstrosity some in Washington are intent on building..

Dr generally -- and every one I have ever met-- have good motives. Moreover since they know that they would never abuse power they assume no one else ever will either.. This is the risk... our system is supposed to protect us from persons who do not mean well-- not just those who do.


Most liberals are in fact honorable kind people, who assume that if they can be trusted so can others.. It like when they assume that if they are not going to hurt anyone then no one will hurt them. Magical thinking like this is very dangerous.

 

[teratos]

So question for the pharmacists: do most really not stock those meds and have to order them or are they just saying that? Like I said in a earlier post, I just had surgery and was prescribed a small about of oxycontin and oxycodone. We were told to fill them at the hospital before I was discharged or we may have trouble getting them. They said most pharmacies would have to order it and it would take a couple of days. I am just curious about all this. I never knew the problem was that bad.

Many of the pharmacies around me only keep in what they need for their "regulars". They are sick of being held up and are sick of dealing with drug seekers. If a pharmacy has them in stock all the time, they will get every dirt bag this side of the Mississippi bringing in Rx's to get filled. I'm sure some of the pharmacists will chime in as well.

 

[DadOSix]

So question for the pharmacists: do most really not stock those meds and have to order them or are they just saying that? Like I said in a earlier post, I just had surgery and was prescribed a small about of oxycontin and oxycodone. We were told to fill them at the hospital before I was discharged or we may have trouble getting them. They said most pharmacies would have to order it and it would take a couple of days. I am just curious about all this. I never knew the problem was that bad.

sundazes,

Like I said above, it we dont know you and dont know the doc, you will have a hard time getting filled. I have patients here in the area that travel to Mercy in Balto, or similar. Those docs are legit and we know who they are and what they routinely order. So those are OK. Now, if you just see dr. Y at the 3rd st 'x' clinic and you get an rx for 120 oxycontin and are now 90 miles from home 'staying with the relatives' you are s.o.l.

The problem is compounded by the DEA's pressure on wholesalers to monitor each pharmacies controlled purchases. We now have averages that are historical and our allotment is based onthat historical use. So, we must, as teratos said, keep stock for our regular patients.

The system is flawed due to these limits. Read back in the news about DEA cracking down on wholesalers and pain clinics in Florida. The solution has been to create problems nationwide for legit pharmacies, prescribers and patients by restricting the supply line, rather than remove DEA numbers and hence, prescribing ability for narcotics from those offending practitioners.

Best advice is to fill at the hospital- fewer problems because they have larger allocations.

 

[glennc75]

Many of the pharmacies around me only keep in what they need for their "regulars". They are sick of being held up and are sick of dealing with drug seekers. If a pharmacy has them in stock all the time, they will get every dirt bag this side of the Mississippi bringing in Rx's to get filled. I'm sure some of the pharmacists will chime in as well.

This is what I ran into as well. Most of the time, big box or independant alike, the pharmacist had to order the quanitiies that were needed, as they didn't have them on hand. I remember at one point there was a recall on one of the Oxysomething-or-others and it caused a nationwide shortage. That was scary, because nobody had anything, and had no idea when they would get shipments. It was basically the pain med version of the current state of ammo, except the effects of ammo withdraw aren't quite as scary!