unintended consequences from bureaucrats interfering with the healthcare system

Doctors resist new painkiller prescribing procedures

http://www.cbsnews.com/news/doctors-resist-new-painkiller-prescribing-procedures/

It has been reported that only 47% of prescribers are ready/capable of sending electronic control medications Rxs.  Whereas 95% of the pharmacies are able to accept electronic controlled Rxs.  Using averages, for every million people population there are 11,000 pts that need to get a controlled Rx filled EVERYDAY. If only 47% of prescribers are capable of generating electronic controlled Rxs… how many pts are going to be thrown into cold turkey withdrawal every day going forward ?  How many are going to suffer from a hypertensive crisis… resulting in a stroke or death ?

Unintended consequences: 

prescriber sends a C-II to a pharmacy that is out of inventory or Pharmacist is “not comfortable”… the C-II Rx becomes DOA. It can’t be transferred to another pharmacy.. the prescriber could be drug into participating into the “pharmacy crawl” trying to find a pharmacy that has or is comfortable filling a C-II.  If the Rx is C-III -C-V… will the pharmacy/Pharmacist be willing to participate in the “pharmacy crawl” to find another pharmacy to fill the Rx ?  Technically, the prescription is the property of the pt, but now in NY… the pt never receives a written Rx and remains in the possession of the pharmacy it was first transmitted to. What is the obligation of the receiving Pharmacist to help assure the pt gets the medication that the prescriber intended for the pt to get?

WASHINGTON –The nation’s top health officials are stepping up calls to require doctors to log in to pill-tracking databases before prescribing painkillers and other high-risk drugs.

The move is part of a multi-pronged strategy by the Obama administration to tame an epidemic of abuse and death tied to opioid painkillers like Vicodin and OxyContin.

But physician groups see a requirement to check databases before prescribing popular drugs for pain, anxiety and other ailments as being overly burdensome.

Helping push the administration’s effort forward is an unusual, multi-million lobbying campaign funded by a former corporate executive who has turned his attention to fighting addiction.

“Their role is to say what needs to be done, my role is to get it done,” says Gary Mendell, CEO of the non-profit Shatterproof, which is lobbying in state capitals to tighten prescribing standards for addictive drugs.

Mendell founded the group in 2011, after his son committed suicide following years of addiction to painkillers. Previously, Mendell was CEO of HEI Hotels and Resorts, which operates upscale hotels. To date, Mendell has invested $4.1 million of his own money in the group to hire lobbyists, public relations experts and 12 full-time staffers.

A new report from Shatterproof lays out key recommendations to improve prescription monitoring systems, which are currently used in 49 states.

The systems collect data on prescriptions for high-risk drugs that can be viewed by doctors and government officials to spot suspicious patterns. The aim is to stop “doctor shopping,” where patients rack up multiple prescriptions from different doctors, either to satisfy their own drug addiction or to sell on the black market. But in most states, doctors are not required to check the databases before writing prescriptions.

Last week, the White House sent letters to all 50 U.S. governors recommending that they require doctors to check the databases and require pharmacists to upload drug dispensing data on a daily basis.

The databases are “a proven tool for reducing prescription drug misuse and diversion,” said Michael Botticelli, National Drug Control Policy Director, in a statement.

But government health officials say virtually all state systems need improvements, including more up-to-date information.

“There isn’t yet a single state in the country that has an optimal prescription drug monitoring program that works in real time, actively managing every prescription,” said Dr. Tom Frieden, director of the Centers for Disease Control and Prevention, in a press conference last week.

Physicians warn about the unintended consequences of mandating use of programs that can be slow and difficult to use. Patients may face longer waits and less time with their physicians, says Dr. Steven Sacks, president of the American Medical Association.

“There really is a patient safety and quality-of-care cost when you mandate the use of tools that are not easy to use,” Sacks said.

The report from Shatterproof highlights the gaps in current prescribing systems. When doctors are not required to log in, they generally only do so 14 percent of the time, according to data from Brandeis University.

The report points to positive results in seven states that have mandated database usage: Kentucky, New York, Tennessee, Connecticut, Ohio, Wisconsin and Massachusetts. In Kentucky, deaths linked to prescription opioids fell 25 percent after the state required log-ins in 2012, along with other steps designed to curb inappropriate prescribing.

The same information can be used to prevent deadly drug interactions between opioids and other common medications, including anti-anxiety drugs like Valium of Xanax.

Opioids are highly addictive drugs that include both prescription painkillers like codeine and morphine, as well as illegal narcotics, like heroin. Deaths linked to opioid misuse and abuse have increased fourfold since 1999 to more than 29,000 in 2014, the highest figure on record, according to the CDC.

Earlier this month, the CDC released the first-ever national guidelines for prescribing opioids, urging doctors to try non-opioid painkillers, physical therapy and other methods for treating chronic pain.

But pain specialists fear requiring pill-tracking databases will discourage doctors from prescribing the drugs even when appropriate, leaving patients in pain. Dr. Gregory Terman says it takes him three minutes to log in to the system used in his home state of Washington.

“If it was easier to use, more people would use it,” said Terman, who is president of the American Pain Society, a group which accepts money from pain drugmakers. Like many physicians, Terman says he supports the technology but doesn’t think it should be required.

Last week, two states targeted by Shatterproof signed into law database-checking requirements: Massachusetts and Wisconsin. Mendell says his staffers are lobbying now in California and Maryland.

“I don’t think we can afford to wait decades for this to slowly get implemented into the system,” he says. “I think we need to take action now.”

3 Responses

  1. The since 1999 stats are entirely a misrepresentation. More OD’s are a result of Comorbidity… chronic pain and/or addiction & moreover, w/regard to drugs found in the system at time of death the OD’s are usually the result of mixing opioids with other depressants like alcohol, benzo’s, or heroine or whatever the addicts want to abuse.

    I know many CPP’s and not one of them have ever experienced breathing issues nor do they mix their drugs … let alone with illicit drugs.

    As far as diversion goes and the majority believing that illicit users obtain their oxycodone primarily from a legal prescription does not bode well with me. I recall reading an article years ago that stated the vast majority of “oxy” found in OD victims could NOT be traced back to a legal prescription. So, what gives? Why are legal, law abiding, rule abiding, good, decent, and kind people being thrown under the bus?

    Why are addicts being given an additional 6 months to titrate!? Their the root problem to my suffering and yet they receive a reprieve?

    Not that any of us ought to be limited to a dose that barely gets us out of bed!

    If I believed for one moment that responding to my pain emotionally in a positive manner would mitigate the intensity of my pain I’d be one HAPPY go lucky CPP! But seriously, I know when I’m upset and stressed out that my pain will be more intense. So, I reduce those feelings by watching a comedy, spewing frustration to my bf & bgf! I am NOT an idiot. Most CPP’s are not idiots. We KNOW a pill doesn’t solve everything but it does make things solvable…. b/c the strength is there to take a walk around the back 40, to clean the house so our environment makes us happy, allows us to work, to learn and most importantly to “love”.

    Look… we ALL know that there’s been a problem but throwing effective doses under the bus along with the bodies of CPP’s in need is flat out ungodly, cruel, unnecessary, illogical, and plain mean.

    My medications have been reduced for about 3 years now. I’m still waiting to feel better. I’m still waiting to get NO relief when I take what little medication I am now allowed to beg for.

    And pharmacies!? They all seem to REALLY enjoy making me wait HOURS to fill my rxs. They promise the brand I need & replace it w/something else. They swear they don’t know if they can get it in by a weeks end. But only want us to call 3 days ahead.

    I’m truly sorry for all the families that’ve lost loved ones. I’m sorry for all the addicts. But please someone be sorry for me… for all of us for whom opioids are effective and for who opioids have lent us the ability to avoid suicide.

    Thanks for your time. Want to chat? You can find me on FB

  2. Well now I know why I couldn’t get my piddly tramadol rx adjusted by my doctors office (to what it was originally supposed to be, mind you, I wasn’t actually asking for an increase) last week. The doctor was leaving so it wasn’t his problem, the nurses are famous for not wanting to do their jobs if there’s an issue, and the hospital has a bad track record in general. In Wisconsin do avoid any hospital or ER under the Wheaton or Wheaton Franciscan name for any pain concerns or otherwise.

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