States want to share patient Rx use to curb abuse

Unbreakable

Bluelighter
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On his night shift in a busy emergency room, Dr. Jacob Khushigian inevitably finds a few patients more likely to be hunting for drugs than medical attention.

The guy who claims he has severe abdominal pain doesn't grimace when sitting up. A woman who recently moved to the area fails to disclose she sees a doctor elsewhere. An ambulance patient complaining of a sore leg and back doesn't reveal she was turned away by another hospital.

There was a time Khushigian's hunches took weeks to confirm and required phoning or faxing the attorney general's office to obtain a patient's prescription drug information. Nowadays, a computer helps him catch cheaters. But it can only reach so far.

While a state online drug database went into effect last year to thwart addicts who bounce from doctor to doctor to feed a habit or make a small fortune peddling meds, there's now a push to extend it beyond state lines to snare so-called doctor shoppers and curb drug abuse.

"The whole purpose of this is to have states communicating with one another," said Dr. Laxmaiah Manchikanti, chief executive officer of the American Society of Interventional Pain Physicians. "If you know a patient is abusing, a doctor isn't going to give that patient a prescription any more."

Doctors can be hamstrung in making critical decisions about prescribing painkillers if they aren't able to find out if patients filled prescriptions elsewhere.

A nationwide network might have helped Michael Jackson's doctor better monitor the medication he was receiving from multiple doctors.

Dr. Conrad Murray, who was recently charged with involuntary manslaughter in the singer's death, told police Jackson gave few details when Murray repeatedly asked about Jackson's medications, according to an affidavit. The Los Angeles County coroner said Jackson was killed by a mix of a powerful anesthetic and a sedative.

Police have searched for information in three states to see if Jackson's medical history played a role in his June death.

Jackson's death and those of other celebrities such as former Playboy Playmate Anna Nicole Smith and actor Corey Haim highlight the dangers of prescription drug abuse. More U.S. teens used prescription drugs over any other illicit drug except marijuana, the Office of National Drug Control Policy reported.

Forty states have passed legislation to allow prescription drug monitoring programs, but only 34 are operating.

Under the National All Schedules Prescription Electronic Reporting Act signed by President Bush in 2005, more than $50 million has been appropriated to states for programs where doctors and other authorized users, such as police in some cases, can access patient records.

The law aims to have a coordinated national system, but there are no estimates what that would cost and a majority of the federal money hasn't been allocated.

Joanee Quirk, who runs Nevada's prescription monitoring program, said having access to other state databases would help stop those from Southern California or Hawaii who come to Las Vegas or Reno to score Vicodin or OxyContin.

Nevada's four-year-old program has grown to more than 225,000 patient requests in 2009 from about 155,000 in 2008.

Most prescription monitoring programs are voluntary, but Nevada requires doctors to check a patient's drug history during a first visit.

"If we took it away the practitioners would have a revolution," Quirk said. "It's almost like getting a lab test, where the doctors are trying to figure out what is wrong with this person and whether they are trying to get drugs legally."

Some privacy groups are concerned databases could invade patients' privacy. Virginia's database was hacked into in April 2009 and millions of electronic records were stolen by a thief still at large.

"There is a significant intrusion into the lives of individuals who are taking these medications legitimately," said Pam Dixon of World Privacy Forum, a nonprofit public interest research group. "There needs to be more restrictions about who can access this information."

The response to having secure, online access to patient records has been overwhelming so far in California. More than 2,300 doctors, pharmacists, physician assistants and registered nurses have used the Web site since September to access more than 134,000 patient reports. The state had averaged about 60,000 requests annually when they received requests by phone or fax.

Katherine Ellis, who runs the database of about 100 million prescriptions, said emergency room doctors would benefit most from a multistate system.

"If there was a way for ER doctors to sign on as they are triaging that patient and see if that person has been doctor shopping, then they may not elect to give them the controlled substances," she said.

Khushigian, 52, who works at Kaweah Delta District Hospital in Visalia in the Central Valley, is glad he no longer has to rely solely on his gut every night. He uses the database two or three times a night to shut down potential abusers.

"When they get caught, there isn't much they can say," he said.

Source:

http://news.yahoo.com/s/ap/20100503/ap_on_hi_te/us_drug_databases
 
What happens with a drug user is in legitimate pain? Do we make them suffer for all the nights they got high?
 
Something like this is going on here in Texas and it is great for me because now my pain management clinic waiting room isn't full of coughin, sneezing, dirty looking opiate seekers. Some might be in pain, but most are just doctor shoppers. While I see the downsides to this system, it needs to be controlled to some extent so those of us who actually need the pain meds don't have to spend 3 hours of their day just to get their scripts.
 
Well perhaps this is a good idea. It certainly would stop the Dr. shopping. And maybe then they would be more willing to give drugs.
 
This is a horrible idea and a flagrant violation of the spirit of HIPAA. I just saw a show on the history channel, an episode of hooked that had to do with opiates. It said that the US signed a convention banning the trade in opium. The US in 1914 passed the Harrison Narcotics act- but this act 1 major obstacle. I document written 140 years early called the US Constitution. It violated the provision that what is not explicily in the document is reserved for the states (this is why states have individual medical liscencing bodies), and it prohibited the federal government from prohibiting people from putting substances in their bodies for whatever reason, health, moral, and otherwise.
So this Harrison character figured a way around the constitution by passing it as a tax and controlling the dispensing of narcotics through tax measures like who gets the priveledge to be taxed and who doesn't. The who doesn'ts had to get their dope or became underworld figures.

In the 1920s a suprsing group of victims of this law emerged. Physicians themselves. So physicians, acting out of compasion, best practice, or motivated by avarice were jailed. So this sacred document, a beacon of hope for people living in tyrany around the world got another shit stain.

In the 60s, Nixon not to be detered by a small thing like the constitution enacted the control substance act of 1970 to deal with the opiate abuse among troops. But to his credit he expanded the methadone maintenance system.

Anyway... so much for health care privacy. The Chinese solved their drug problem after WWII. When the commies came to power the shot addicts, sometimes whole families publically and to their credit it worked. What cost are we willing to pay?

The fallout of the 1920s jailings. Patients were undertreated for pain for generations. Sensible physical pain management principles and psychological pain management principles were so close to being implemented recently- now this.

The past is prologue... What path to we want to follow for our posterity...to restablish the land of the free and home of the brave or go down the path that leads to tyranny the path of no privacy and informing on your neighbor. The path of apathy and being afraid to speak ones mind....fascisim and communism, 2 sides of the same coin with the bloated bureaucracies and scared shitless citizens to prove it.
 
bumpity-bump
there's a thread about being straight up with your doc but this was kinda off that thread topic. anyway, there's a whole lot of monitoring of medical records and Rxs that people don't realize.
nothing about your medical history is private. people think HIPAA protects them from being "labeled" but it does not. if you have had a blood test, Rx, EKG, x-ray, MRI, etc., etc. that information is collected by Medical Information Bureau inc aka MIB. they've been around for over 100 years but very few people know this company exists or what they do. if i didn't work in healthcare i most likely wouldn't know anything about them. just like you can order a credit report, you can even order a copy of whatever health info they have about you.

also Intelliscript will provide your Rx records to anyone from insurance company to your employer or potential employer -with the proper HIPAA paperwork. how many of you folks have completely read HIPAA paperwork before you have signed it? if you do completely read the form, do you ask questions about anything you might not fully understand? or does the office person at the doctor's or hospital say "this paper is about your HIPAA rights and it just says blah blah blah. sign here."
HIPAA does not stop your medical information from being complied and reported to MIB, et al. it is false security. patient information has been shared for many years.
here's a few links if you're interested

http://www.rxhistories.com/faq.html

http://www.privacyrights.org/fs/fs8-med.htm

http://www.mib.com/html/consumer_guide.html

-izzy
 
What about a legitimate chronic pain patient who looks like a drug seeker, or fits the profile by being young, or is simply profiled for being a minority, or having poor English skills?

I would prefer that we relax restrictions and allow ten thousand people who don't need pain meds to get them than that we make the system convoluted enough to deny medication or, far worse, appropriate attention and treatment to even one genuinely ill individual who truly needs the best care available.

I realize that this isn't a perfect world, however, and that drug seekers sometimes make things more difficult for legitimate chronic pain patients, but it seems that legitimate can at times be a fine line, and frankly, I think that this is stupid, and could care less who gets medications for whatever reason, as long as they are never denied to those who truly need them thanks to overzealous legislators out to protect that ubiquitous motif of the children, or to protect adults from themselves.
 
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