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Thread: How would you know if you have been flagged as a "drug seeker?"

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    How would you know if you have been flagged as a "drug seeker?" 
    #1
    Just a few questions...
    Do medical offices contribute information to a larger, possibly state/nationwide database?
    What about pharmacies?
    If a pharmacist sees a "trend" and they flag you, does that flag go beyond the pharmacy (such as, do they inform any new doctors you fill a Rx with or your insurance company)?
    Do insurance companies flag you and if so, when you see a new physician and they record your insurance info, are they notified?
    How do you know when you are flagged...and if you don't know, can you request your medical records alongside the physician notes taken during any exams?
    What is the criteria for being flagged?

    I know that certain physician networks would naturally be linked as well as large, national pharmacies (such as Walgreen's) but how far does it go?

    Thanks in advance!
     

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    #2
    Bluelighter Artificial Emotion's Avatar
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    How does it work in the UK as well, please?
     

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    #3
    I'd need to do a little more research (providing the time is available), but I would initially surmise that it would be fairly difficult to label a person a "drug-seeker" unless a verifiable (i.e., charges filed and/or convictions for something like forged prescriptions) history of fraud were involved.

    The reason being is that one person's "pain patient" is another's "drug-seeker."
     

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    #4
    Bluelighter Artificial Emotion's Avatar
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    What about admissions of drug use?
     

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    #5
    ^ Well it would depend on the type of drug and the condition you were being treated for. If a physician knew you were a former or current heroin user, he/she would likely be much more cautious in prescribing opiates (I'm being Captain Obvious here).

    But would that necessarily mean you were a drug-seeker relative to a painful condition you were being treated for? To me, "drug-seeker" is a term so prone to subjective interpretations. The problem here is that no one but you really knows the amount of pain you're in (although there are physiological indicators such as elevated blood pressure and serum glucose--but these things are also caused by things other than pain), but e.g., we probably could all agree that people who aren't in physical pain but still try to get opiates prescribed to them might be called "drug-seekers."
     

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    #6
    Quote Originally Posted by nestea View Post
    Just a few questions...
    Do medical offices contribute information to a larger, possibly state/nationwide database?
    What about pharmacies?
    If a pharmacist sees a "trend" and they flag you, does that flag go beyond the pharmacy (such as, do they inform any new doctors you fill a Rx with or your insurance company)?
    Do insurance companies flag you and if so, when you see a new physician and they record your insurance info, are they notified?
    How do you know when you are flagged...and if you don't know, can you request your medical records alongside the physician notes taken during any exams?
    What is the criteria for being flagged?

    I know that certain physician networks would naturally be linked as well as large, national pharmacies (such as Walgreen's) but how far does it go?

    Thanks in advance!
    I'll try to answer your question the best that I can, as I must admit that I don't know everything about what goes in to being called a "drug seeker."

    First, about the "state/national database" question, as far as I am aware, there is no national database to track prescriptions (the DEA keeps records obviously, but as far as I know it's nothing like some of the state systems that I know of; the DEA is more concerned about doctors).

    As for state databases, it depends on the state. One state that comes to mind quickly for prescription tracking and "red flagging" is Tennessee (and I believe Kentucky too). With those states, medical offices are required to send information to the state about narcotic medications that they prescribe, how much they prescribe, and to whom they prescribe. This of course does not happen in every state. Florida is an example of a state that does not have any tracking system in place.

    So, the short answer is that some states do track prescriptions to find "drug seekers" and some don't. I don't have a comprehensive list for you I'm afraid, but I'll take a look later and see if I can add that.

    As for pharmacies, I don't believe that they have to contribute any information to any state or national databases (for Tennessee and Kentucky they might), however, pharmacies probably will report you to at least your PCP if you're found to be filling multiple prescriptions from different doctors for scheduled medications. If you don't have a PCP, then they'll probably hand it over to law enforcement (even if you do have a PCP they may still hand it directly over to LE anyway). National chains, such as Walgreens (they are notorious for this), have no problem handing people over to LE to investigate, but any pharmacy getting a ton of prescriptions for the same medication for one person will most likely let someone know.

    Pharmacies are required to keep records of scheduled medications for the DEA, but that is mostly to make sure that there is no diversion.

    As for what happens if pharmacies "flag" you, generally they won't fill prescriptions for you and it will be forwarded to either your doctor or LE (or both). I don't believe that pharmacies contact insurance companies, and I am not aware of insurance companies "flagging" their customers. It may happen, but I've never heard of it.

    As for your medical records, HIPAA gives you the right to inspect and copy your medical records from virtually any physician that you see in the US, and there are also state laws that go beyond HIPAA in making sure that you can obtain your records. Virtually every doctor's office in the country has a "Request from medical records" form that you can fill out to request your records.

    Once you fill the form out, the office has 30 days to comply with the request, ask for an extension (they have to explain why they need it) or deny you the request (if they deny you, it has to be for a very specific and limited reason, which you can appeal). You can either have your medical records copied and mailed to you (they can charge you for copying the records but not for pulling them) or you can review them in person.

    It is possible that you will have problems pulling your records, either because the office is stonewalling you (some physicians hold the idea that patients shouldn't be allowed to see their records) or they're disorganized. If the 30 days has passed and you haven't heard anything, start calling the office. If that doesn't work, start making noise about contacting federal agencies. If that doesn't work, contact the Office of Civil Rights and file a formal complaint against the doctor's office (also, make sure you get a copy of your request for medical records when you submit it to the doctor's office (and if you can get it with the doctor's office rep's signature, even better)). If none of this works (some offices do ignore the OCR), start contacting the State level agencies that oversee the office (like the Department of Health) and consider hiring a lawyer. You can't sue them for your records federally, but it may be possible to file a lawsuit at the state level.

    Anyway, to answer your other question, you will know if you are flagged via several ways:

    One, you see it in your medical records (and it's not always labeled "drug seeker").

    Two, pharmacies refuse your scheduled prescriptions (and some may tell you that you are flagged).

    Three, you are contacted by local law enforcement or someone turns you in, at which point the DEA will flag you (assuming you are convicted).

    Despite all of this, the flow of medical information is really just a patchwork right now, so it can be difficult to tell if someone has flagged you as a drug seeker. The most reliable way of knowing is to check your medical records. A lot of this, I should also note, depends on the state that you live in.

    As for the "criteria" for being flagged, it varies so much it's silly. All it takes is one doctor who thinks you're a drug seeker to cause you problems. If this is the case, you can easily sue them for libel. More likely, however, you have to be filling multiple prescriptions for the same medication and the same pharmacy within a short time period. For the short answer though, it varies on the state and the doctors that you see.

    Hope this helps, and if anyone sees something wrong here, please correct me.
     

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    #7
    Bluelighter
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    I can't imagine how a state can be provided with HIPPA protected information regarding the medications you take.
     

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