First of all according to according to the Psychiatric Diagnostic Manual, substance abuse is a mental health disease. So the war on drugs is going after people with untreated/undiagnosed mental health issues and throwing them into the legal system. Since the Harrison Narcotic Act 1914… we have been doing this “fill and chase” process.. Ask a DEA agent what the agency’s charge is.. if they will tell you the truth… it is not about preventing diversion.. it is about arresting those that will divert drugs.
Some thirty odd states have created Prescription Monitoring Programs (PMP) which pharmacies are required to electronically submit – usually in real time – to this database the basic information about the person getting the medication, the prescriber who wrote it and the pharmacy that filled it. Sounds pretty pretty straight forward – RIGHT?…. WRONG !!!
First of all, both the prescriber and the pharmacy have no choice but to accept the ID (driver’s license) of the person in front of them. Just Google “create fake ID” to see how many entities will teach anyone how to make a fake ID and sell them the supplies to do it. So now we have a good risk of the PMP being filled with data of prescriptions filled to “ghost patients”… A healthcare professional can search the PMP database to find if the person wanting a controlled substance prescribed or filled until the “cows come home” and they may not show up… or show no evidence of abuse or buying an excessive amount of controlled substances.
Aside from those who abuse substances.. they suffer from a DISEASE …it is the diverters that are the real problem… they are the ones whose business plan is all about getting drugs to the street…and the profits into their pockets that can be generated.
With current technology, the solution is rather simple and straight forward. Allow healthcare professionals access to the states’ drivers license database and social security database.
It would unfold something like this… A person sees a healthcare professional seeking to have a controlled substance prescribed or dispensed. They present their Driver’s License, State issued ID and/or SSN. The healthcare professional enters/scan the number into a computer terminal. One of few things will happen.. the number is invalid and the system comes back and states so. The number is valid and displays a image of the license that was originally provided would be displayed.. If the name, date of birth and picture does not match what the healthcare professional has in hand and/or doesn’t match the person in front of them… prescribing/dispensing a controlled substance is declined and the ID and paper prescription is confiscated. If all the data points match and confirmed by the healthcare professional to the system… the system then does a match to the Medicaid and/or health insurance/prescription reference database… if a person states that they are paying cash.. but have insurance that would pay for such… service is once again declined. The system then checks the PMP database, where continued number crunching.. flags particular patients as “patient of concern”… at that point the system notifies the healthcare provider that this patient is a “patient of concern” and asks if the healthcare provider wishes a report.. to evaluate if they wish to prescribe/fill a controlled substance for this particular patient.
Currently, we are asking healthcare professionals to make decisions about prescribing/filling controlled substances for a particular patient, when they are basically “in the dark” and the system seems to be intentionally keeping these healthcare professionals “in the dark”… yet wants to make those same healthcare professional responsible for not being 100% accurate in assessing the person in front of them is who/what they say they are and what medical care they really need.
This process would make the data in the PMP more valid overall. If the PMP would regularly (weekly/monthly/quarterly) compare the ID numbers in the PMP against the state’s database and if there is a bunch of non-matching ID in the PMP database.. that would suggest that the prescriber and/or pharmacy is not validating the ID’s of the person(s) they are prescribing/filling controlled substances for. Law enforcement could focus their efforts on those who appear to be contributing to drug diversion and legal drugs getting to the street. We move from nearly 100 years of “fill and chase” and move to a process of “validate or confiscate”. The bureaucrats admit… by adding more and more “fill and chase” programs.. that this proccess is not working.
Why do we still continue to go down the same path? Once can only speculate. We know that the DEA at the federal level spends > 2.1 BILLION a year, and unknown amount at the state and local level fighting this war on drugs. We know that for every DEA in the field… there is one DEA employee .. sitting at a desk somewhere. There are a lot of jobs depending on the war on drugs to continue.
On the “war on drugs tree” the low hanging fruit is typically those drugs at/around the street level… As you move up the tree… you run into people who tend to me more violent.. so keeping the low hanging fruit on the tree… helps keep people employed and not being killed/harmed on the job. Doesn’t all of us want a safe work environment?
Then there are the private companies that run many of our prisons. The people that are arrested in the war on drugs, most tend to be non-violent, so these private prisons tend to be more of a “baby-siting service”. A little known fact is that these private prison operators are behind the scenes lobbying for TOUGHER prison sentences for these non-violet offenders… TO BOOST THEIR PROFITS …http://www.pbs.org/now/shows/419/index.html
Is this “war on drugs” become a self-perpetuating industry… that is targeting those in our society that are mentally ill and more focused on growing a bureaucracy and job security for those involved?
I am waiting for someone to prove me wrong.. but not holding my breath
Filed under: General dumb-ass problems
There is no question that the overall war on drugs has been a complete (and expensive) failure. I think that an entire overhaul of the strategies used to fight this war is warranted. And what is worse is the fact that prescription drug abuse is growing the fastest. Fueled by prescribers that are generous and easy access- drug abuse has become easier and easier to start and maintain.
We’ve all got to think out the box to find ways to reduce drug abuse. And the core of that new strategy should include a real evaluation of the reasons why people become addicted in the first place. Treatment needs to include a lot more than throwing more drugs at these patients. There needs to be an entire system in place to treat these patients including mental health treatment. But, I just don’t know if we will ever get past the old ways of fighting drug abuse and really try to tackle the problem at hand. My gut tells me it will never happen.
As a targeted physician (Author of Target: Pain Doc), I wholeheartedly agree with everything you say. I’ve been staying all along they are in this for the money. Why else would they come after me because of a lousy $65 and make me a felon for it, after 2 years of scrutinizing my records and not being able to find anything wrong with my medical care? They are protecting their jobs financed by the government grants to “target drug abuse.”
In my area patients are too naive to do what you talk about, making phony IDs, so I like the PMP. The problem here is that most doctors don’t refer to it. I always checked it and found many patients doctor hopping between other doctors that didn’t have a clue. (Again, though, I’m the one that gets raided?)
They go where the money is and the guns aren’t (a guote from a former US Attorney that switched sides. Instead of putting the real crooks in prison, they give them freedom from jail if they’ll lie about the doctor’s they’ve seen.
The situation isn’t going to change until the people suffering stand up and fight. But the problem is they have been beaten down for so long, they don’t have the strength. And that breeds more addiction. Pills don’t cause addiction. Anxiety and despair from your situation do. The pill just gives you an avenue, albeit short, of escape. And now that they have taken good, caring doctors out of the clinics, the drug lords are opening them up. Drugs will still be there for the addicts, but real pain patients won’t find treatment.
http://www.lindacheekmd.com
Target: Pain Doc