The Failure of the Prescription Drug Monitoring Program

The Coach's Team ^ | 10/3/16 | Dr. John D. Lilly

[Oldpuppymax]

Deaths in the U.S. due to prescription drug overdose are reaching crisis proportions. The increase in the death rate due to all prescription drugs has been primarily due to the increase in prescription opioid pain medications. State governments are looking for a solution to the problem. Historically, it has been very easy for people to obtain opioid prescriptions from multiple doctors; therefore, an obvious solution is to monitor who is receiving all opioid prescriptions. States enacted Prescription Drug Monitoring Programs (PDMP) which record who is filling opioid prescription medications at every pharmacy in the state. The information goes into a database that can be accessed by doctors and pharmacists. The assumption was that having access to this information would stop individuals from obtaining medication from multiple providers, commonly known as “doctor shopping.” However, the death rate due to opioids continues to rise despite the fact that every state except Missouri has a PDMP.

Prescription medications that are controlled by the Food and Drug Administration (FDA) are classified on five different schedules from I to V. Schedule II through V drugs are prescribed by physicians. Schedule II drugs are the most addictive and are the most controlled. They include opioid pain medicines like hydrocodone (Lortab®, Vicodin®), oxycodone (OxyContin®, Percocet®), morphine (Roxanol®, MS Contin®), and methadone (Dolophine®). Schedule IV drugs include benzodiazepines like alprazolam (Xanax®) and diazepam (Valium®). They are less addictive, but more habit forming.

A National Institute on Drug Abuse report shows the number of deaths caused by all prescription drugs for the entire country has increased from 7,885 in 2000 to 25,760 in 2014 and the number of deaths per 100,000 population, age adjusted, has increased from 2.81 in 2000 to 8.00 in 2014. That is a 226% increase over 15 years or 15% per year. A subset of...

[ClearCase_guy]

They are less addictive, but more habit forming.

For all I know, that is (somehow) an accurate statement. But it makes me think that the English language just means whatever.

[Mr. Douglas]

Actually, it’s kinda like “nail biting” is habit forming, but not addictive.

[Larry Lucido]

So Cooch Steam is not only a blog pimp. She is a fascist too

[zerosix]

I'm sick and tired of government "monitoring" of everything!

Not necessary - period!

[Carthego delenda est]

It seems as though every few months there’s some new regulation imposed upon doctors and their patients regarding these types of prescription meds. The ones who need them the most are having more and more government intrusion imposed upon their life and having to jump through more and more hoops. It really sucks. The addicts are going to find a way to get their fix no matter how many laws and regulations are passed, and if they can’t get pharmaceuticals, many will then switch to ‘street drugs’, which will have the result of even more overdoses and enriching the cartels.

[Boomer One]

Solution in Florida was to enact laws requiring more doctor visits, prescription review, and higher use of alternative medications and/or treatments. So far the results have been higher medical costs and abusers turning to new drugs, some more deadly or with devastating side effects. Politicians forget that whenever you create a vacuum there is always something else waiting to rush in. In the meantime, millions of pain sufferers are being denied cheap and effective treatment.

Article would have been more interesting if more information were given regarding increase in deaths. Are these accidental or suicide, age or abuse related, etc.

[Carthego delenda est]

“I’m sick and tired of government “monitoring” of everything!”

We have entered the darkest days in our nation’s history. The government has become controlling of everything. It sickens me that so many want to go to the polls and vote for even more control and fascism in exchange for a small hand out and a false sense of security.

[trebb]

The only people I know of that have been cut off from getting opioids are the one's who have valid reasons and who try to follow the rules. A friend has been under pain management for a long time and has been getting Percosets for a while. He went to another doctor for another issue - regular doctor referred him - and the new doctor wrote a prescription for the same drug. Since he was almost out, and his regular doctor would have to be visited again to get a new prescription, he opted to get the new one filled. If it had come from his regular doctor, there would have been no problem but since it was from a different doctor, the system flagged him and pretty much disallowed him from getting any more of them. The new doctor told him that being reinstated would be a tedious prospect and opted to refer him to surgeons to fix both his existing problem and his latest problem.

Way more expensive than Obama's "solution" to just treat pain for older folks instead of actually treating them (and them making it harder and harder to obtain the pain medications) but it worked well for him.

I have a hip that's disintegrating from arthritis and have been prescribed Percoset. It didn't really stop the pain but the soporific effects of taking maximum dosage (2 at 6 hour intervals) at night allowed some sleep to occur. During the day I just gutted it out to keep my head clear so I could drive and such. Had an injection and it worked for a few weeks so I stopped taking the pills and have about 50 of them left. The pain has come back big time but I resist taking any more because I really hate putting anything like it in my system - I have a surgical consult in a few weeks with hopes that they will replace the hip and negate the pain so I am resisting them even though the pain has become the central focus of my existence lately. After taking them for about 3 months, there was a light but noticeable withdrawal from them but it wasn't really something that made me crave them - more like getting used to them and noticing when they stop. Cigarettes were/are much harder to kick that Percoset - fortunately, I was down to 3-4 a day when I had my prostate surgery and I got a couple week break that allowed me to dump them --- for now at least.

[zerosix]

You're correct - these ARE dark days!

Young and not so young people look to our federal Nanny to tell them something is "good for them" or "not good for them, yet think conservatives want to "control them" because some lying liberal says so!

Sad indeed!

[grumpygresh]

Some type of opiate dosing cap is probably the best solution. If a physician exceeds a cap on an individual patient, more oversight can be applied such as a case review by an expert panel. This would be a rational approach and gain physician cooperation as long as this process is not exploited by over-zealous law enforcement. Patient would need to understand/agree that if they need the higher dose, their case could go to such a panel.
UDTs are the best way to detect aberrant behavior and likely diversion- such as pill shaving. Psychometric testing is also helpful.
Pill counts are not that effective.
Those individuals intent on diversion will know enough to keep some pills in reserve to pass the pill count. If there is a drug ring, several “patients” can share pills. In some cases patients legitimately might not come in for pill counts because of transport issue and work conflicts.

[contrarian]

We have an opioid monitoring program in North Carolina and I am glad we do. I work in outpatient medicine and hardly go a day where some person comes in with a sad story of how bad their pain is for one of many invisible problems who SWEAR that all they take is tylenol but the opioid database reveals multiple visits in multiple towns often one or two days apart. Are there parts of the program I don’t like yes, but I didn’t go through my medical training to be someones drug pusher.Real pain should be addressed but recreational pharmacology should be illegal and punishable.While I am on my soapbox, just an observation, is there a reason that most medical marijuana patients look like Willie Nelson ? : 0 just wondering.

[Right-wing Librarian]

I contend that it is not an opium problem, but a spiritual problem. The distance a person’s spirit is from God is, IMO, in direct proportion to their willingness to abuse drugs.

That said, I will state that I support the individual’s right to put whatever substance they want into their own bodies, without having to grovel like children asking their gov’t masters for permission.

Years ago, I read the Japanese gov’t created “free drug” places where citizens can go and get all the drugs they want. I think I recall their only stipulation was the people had to stay at these places, which they did. This reduced crimes against their citizenry, committed by people needing money to buy drugs. Innovative and effective solution.

For a different perspective on medical marijuana, here is an interesting interview with Jesse Ventura, author of his most recent book entitled Marijuana Manifesto:

https://www.lewrockwell.com/podcast/marijuana-manifesto/

[B4Ranch]

I wonder if it has occurred to anyone on the research team that Americans are getting older and our bodies are breaking down, especially our joints and bones. Therefore most folks will gladly take a morphine pill every once in a while so they can get a good night sleep.