PMPS = Prescription Monitoring Program State.
I am curious as to if/when the state of Maryland will become one of these states.
I found this link that states Maryland is thinking about it. Just curious if anyone knows when it may become a state that invades other’s medical privacy and allows big brother to look out for it’s residents.
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Let’s try Great Debates - see if Big Brother can be found over there.
Moved.
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A monitoring bill has been introduced for the past few years. It actually passed both the house and senate last year, but was vetoed by the governor.
Would be nice if the OP provided some details.
Is there a debate here, or is this a Pitting of Maryland?
Well, while there’s always room for a pitting of Maryland :), I think this was a General Question that got moved to GD because of the whole “invading medical privacy” and “big brother” language.
Basically, long story short, as near as I can tell, back in 2002, the federal government, being concerned about the abuse of prescription drugs, set up a grant program called the “Harold Rogers Prescription Drug Monitoring Program”. This was a program that gave grants to states in order to set up voluntary electronic state databases that monitored drug prescriptions. The idea is that, by electronically monitoring prescription data, it’s easier to tell if there is prescription forging, doctor shopping, and so on. Before this, most states required that records be kept manually, which is obviously, more tedious.
Given the accelerated trend in Maryland towards nanny-statism (which is evidently desired by its citizens, given the 2006 election results), it seems quite likely that this will pass.
According to my research, two bills were introduced in 2006, both were adopted by the legislature but then vetoed.
Both were entitled “Prescription Drug Monitoring Program.”
Not sure why they were vetoed, we could probably google that. I haven’t seen anything similar intro’d so far this year.
Well that was easy!
Here we have a letter from former Gov. Robert Ehrlich (R) talking about why he vetoed the HB.
He talks about there not being enough funding for the program, and also the “potential encroachment” on adequate pain management." He said that the bill would have a “chilling effect on providers prescribing pain management,” and that the bill “focuses on law enforcement, not treatment.” He also said that the bill “does not adequately address patient confidentiality.”
There is a new Democratic governor this year in Maryland, although like I said I have not seen any similar bills introduced so far this session (I monitor state legislation on this topic).
BTW the OP’s link that says that MD is considering such legislation is probably based on info from last year, so it’s old probably not taking into account that MD’s bill was vetoed and no similar ones intro’d yet.
I’m afraid this might pass now that Maryland has a Democrat Governor. And I would provide details, but I don’t have any to provide except the link in my original post. Not sure why this was moved to another section, but I guess Rico had a reason. Thanks, guys !
I’m afraid this might pass now that Maryland has a Democrat Governor. And I would provide details, but I don’t have any to provide except the link in my original post. Not sure why this was moved to another section, but I guess Rico had a reason. Thanks, guys !
Well, just to make it a debate…
I’m a primary care doctor in a part of the world where prescription drug diversion is prevalent enough to drive the economy. (My town is where the term “Hillbilly Heroin” came from.) I’ve never found a way to get people to understand just what an ingrained part of the culture it is around here. I don’t think it’s exaggeration to say that it has devastated this region in the last ten years.
For my first few months in practice, I was bombarded by patients looking for narcotics and benzos. I probably had twenty brand-new patients a day asking for Lorcet and Xanax. I still have at least one or two every day. So how do you separate the “legitimate” patients (and there’s plenty of debate to be had as to what constitutes a “legitimate” chronic pain pill or benzo patient) from the drug seekers and doctor shoppers? It’s pretty much impossible.
KASPER (our monitoring system) is one of the few tools I have at my disposal to help with this. I can at least be sure that I am the only doctor giving the patient controlled substances. Without it, there would be nothing stopping the drug seekers from seeing a dozen doctors all across the state.
I’m not completely unsympathetic to those concerned about the “Nanny State”, but this is one of those times that the benefit greatly outweighs the intrusion. If anyone has a better idea, I’d (seriously) love to hear about it.
Amen! I want to take care of my patients’ medical needs, not feed addictions! I’m damn happy to be in a system now where I can go online and verify what prescriptions my patients are getting, and who wrote them.
Back in private practice, I’d fire patients if they violated narcotic contracts which specified that they’d only get their pain meds from me (or my covering associates) for the pain diagnosis I was seeing them for.
But the only way I’d find out about these violations was generally when a pharmacist would call me to inform me that they were filling oxycodone scrips for my patient from a different doc, and did I really want them to get my latest Rx for methadone on top of that?
Agreed completely. I work for a health insurance company having a large proportion of its membership in Eastern Kentucky. (I wonder if you’re one of our docs?) As much as we can look for substance abuse via internal searches, members swap insurers (and/or go into/out of Medicaid) all the time. So we don’t get the longitudinal history that a system like KASPER makes possible. I’m glad it’s there.
It should also be noted that the “Harold Rogers Prescription Drug Monitoring Program” is named after Kentucky congressman Hal Rogers, who represents Southeastern KY and is a Republican. So the assumptions being made herein regarding this being a GOP-vs-Democrat issue are, IMHO, simplistic. Spend some time in, say, Lee County, and the need for this program, at least here, will become self-evident.
So—setting aside the potential privacy issues, and assuming that the main point of this system is to reduce the amount of prescription drugs obtained illicitly—if this is implemented, will it end up benefiting legitimate pain patients or hurting them? I’ve read that undertreatment of pain is a common problem, often due to doctors’ fear of reprisal if they frequently write narcotics prescriptions. And frankly (speaking as a non-doctor, and currently not a pain patient) I think I would prefer that a dozen hillbillies get scripts for drugs they don’t need than for one patient who legitimately requires the medication to have to live with the pain and do without.
Since a “legitimate” patient will disclose his full medical history to the doctor, including any other doctors he’s gotten controlled meds from, it shouldn’t affect them at all. In fact, I’d say it helps them, because it reassures the doctor that they’re being responsible.
The only potential problem is when information in the report is incorrect. This happened to me once, when a patient’s KASPER inexplicably included his father’s prescriptions. But that’s one out of well over 1000 reports we’ve requested.
Or they just pay cash. If you can get a doc to give you four Percoset 10s and three 1mg Xanax a day–bafflingly, a fairly standard regimen around here–you could probably get $1500 for it, so an $80 office visit is nothing.
A broken clock, and all that.
My personal opinion is that Schedule III narcotics should be OTC. Being a chronic pain patient, I have resorted to going to a Methadone clinic to get something on a daily basis that helps with pain and also elminates my need to take 20 Lortab a day. For 15 bucks a day, I get 85mg of liquid Methadone that lasts all day. It takes away my pain and cravings for narcotics. Two birds with one stone…
The Doctors around here very anal about prescribing anything narcotic and when they do, it’s 15 Vicodin 5mg BID for a month ! They act like I asked them to forfeit their medical license when I ask for something stronger and enough to last a month.
I just don’t understand why some Doctors have no compassion for pain patients. Is it because they have never experienced pain themselves? Maybe. Is it because the DEA watches and regulates them strictly? Who knows?
I personally feel that they are concerned about the patient becoming addicted. But that goes back to the “big brother” argument. Who are they to tell me I’m not in pain? The same could be made about the seatbelt law argument.
I can understand Schedule II drugs being prescribed, but man, if I want to go out and get a bottle of Norco 10s, I should be able to do that. I know when I’m in pain and if I get addicted, so be it. At least it’s taking my pain away.
I tell ya, being in pain from a back injury is the worst thing in the world. sory for being vulgar, but you can’t wipe your ass, you can’t bathe, you can’t get dressed, roll over in bed, stand up straight, have sex etc… It is a burden.
So to all the Doctors who read this, please, please be compassionate for the legitimate pain patients. It may be hard to distinguish from drug seekers and pain patients, but hell, just give us a script for 120 Vicodin ES or Norco 10 and send us on our way. It’s not hard to tell with an MRI or CT scan. Thanks for listening to my rant.
I know my opinion isn’t a popular one, but fuggit. I’m tired of feeling like a criminal and treated like a drug addict just because I’m in pain.
There isn’t much difference in analgesic effect between the Schedule II oxycodone and the Schedule III hydrocodone. I’m not completely sure why they’re classed differently. (Some people respond better to one or the other, but every table I’ve ever seen list them as equianalgesic.)
Am I supposed to do this for everybody who walks in to my clinic and asks for it?
A 10mg hydrocodone (like a Vicodin ES or a Norco 10) goes for $10-15 around here, and the demand is bottomless. There are people parked in the parking lot who ask everyone coming out of the pharmacy what they got and offer to buy it.
If I did what you suggest, I’d have 50-60 people every single day here to get their prescriptions. How many of those would you think are legitimate, and how many are feeding their own addictions or selling them?
I agree that it’s better for a few people to abuse or sell their narcotics than it is for legit pain patients to go without. But it isn’t a few around here. I’m telling you, prescription drug diversion has done every bit as much damage to this area as crack and heroin have done to the inner cities.
Yes, it is. Most middle-aged adults will not have a completely normal MRI of the low back, if the radiologist is willing to overread every little thing (as ours are). If someone’s MRI shows your usual degenerative changes, or tiny non-encroaching disc bulges, is that worth 40mg of hydrocodone a day?
I’m still not sure why prescription monitoring programs hurt the legitimate pain paitient–that is, the one who is getting scheduled meds from a single source and using them responsibly.
What DoctorJ said. Especially his last line.
The role of narcotics for the treatment of non-malignant chronic pain is a limited one. It is never the first treatment modality that should be employed. And it is relatively contra-indicated for patients with a history of substance abuse. (Some experts say it is absolutely contra-indicated in those circumstances. From my own clinical experience, I can see why they feel that way.)
It’s an especially poor treatment for conditions like chronic back pain of non-radicular origin. (It does tend to work better where the disc is bulging or ruptured and impinging on the nerve.)
diggleblop, by your description, it sounds like you get your methadone from a clinic that does “methadone maintenance”, not from a pain clinic. True?
As a former opiate addict myself, with chronic pain issues due to old injuries from a plane crash, I do empathize. But the solution to problems such as yours and mine is not to make opiates more widely available for the asking.
My email’s in my profile. Feel free. Even if you just want to yell at me.
QtM, grateful to have that awful monkey off my back for over 16 years now.