You will not believe this

[Pharmacist.steve]

I was talking this AM to the Pharmacist in charge of one of state level NASPER type databases http://www.nasper.org/

These databases are an invaluable tool for health care professional to weed-out bogus patients, by reviewing their controlled substance Rx history.

I was told that two of the major national chains will not allow their Pharmacists access to the internet .. so they are not capable of getting to this database on their store's computer.

I was also told that some rural hospital will not let their ER docs access this database.. because the hospital does not want to turn away revenue on nights and weekends ... which would have to be done if the doc confirms that the patient is getting controlled substances from multiple sources.

Here is the "kicker" ..this agency has a grant from the federal gov to fund time/resources to provide information presentations to various healthcare organization within the state to make them aware/familiar with this database. Many of these organization will not put these presenters on their meeting's agenda.

Bottom line .. if you are in one of the 12 or so states that have these databases available to healthcare professionals. You might want to ask your Pharmacist if they have access to the particular database for their state. If they don't or their employer won't allow them to... a legit chronic pain patient can be viewed just like any other "high user" of opiates... because the Pharmacist has no way to determine otherwise. IMO, you run the risk of being considered guilty until proven innocent and there is no way to prove your innocents.

[jimac]

Steve, What are the 12 or so states that have these databases?
I plan to ask my Pharm if my state has such a database.
Jim

[Pharmacist.steve]

Steve, What are the 12 or so states that have these databases?
I plan to ask my Pharm if my state has such a database.
Jim

According to the nasper.org website:

States' Recognition of the Need for Such Databanks: The need for an electronic monitoring system is evident from the fact that 15 states, including California, Hawaii, Idaho, Illinois, Indiana, Kentucky, Michigan, Nevada, Oklahoma, Texas and Utah, have created such systems.

[Mark N]

Steve, I hope that this data base is private and if so I hope the companies and hospitals get on board and crack down on the abuse of our meds so we don't get lumped in with the abusers.

[shotspine]

What is the reason for the resistance to using this/these databases? I just don't get it. I use a Mom and Pop pharmacy for all RX's except things like glycolax and lidoderm patches because I pick them up at a close pharmacy, vs. all my Mom and Pop Pharmacy stuff is thru the mail. The cost of shipping the above 2 items is just too much. My reg. Pharmy and my Drs. are aware of this BUT....what if I was 'double dipping'? I'm not, and have impeccable records but......what if????

I am so sick of paying for programs that don't work and then to have to pay for programs that DO work but aren't used.........please tell me there is a GOOD reason. This is infuriating!!!!!

ER's don't want to lose business but then they are paranoid about offering pain control for those that need it because they don't want to lose the ER charge? Well, I better stop as I can keep asking the same stupid question in several different ways while I cool my heels on this news.

Thanks so much for all the info you give us. It is very helpful, albiet very frustrating at times.

ss

[Pharmacist.steve]

Steve, I hope that this data base is private and if so I hope the companies and hospitals get on board and crack down on the abuse of our meds so we don't get lumped in with the abusers.

The two states that I have access to.. I had to fill out a form.... give copies of licenses...one I even had to have notarized.. and it took a few days to get access/login after that.

One state, Indiana has had a database (INSPECT) since early 90's but only law enforcement had access to the database until last year.. when access was granted to all healthcare professionals.

If I am suspect of a patient and I run a report and see everything at the pharmacy I am working at and single doc... end of search... INNOCENT.. If I find multiple pharmacies/docs/drugs.. depending the magnitude of the numbers..I may or may not fill the Rx.. I really don't want to thrown someone into withdrawal and maybe suicide... but.... I will call all the prescriber listed and pharmacies involved and suggest that they run a report on this particular patient...put a note in the pharmacy computer about what I had found and done date/time... I will also probably have "a talk" with the patient about their need/use of seeing multiple docs and going to multiple pharmacies.

This is normally enough to get them from showing up at my Rx counter again. If the prescribers don't care/follow thru.. then - for whatever reason - things are not going to change for this patient. I am not going to waste my time... trying to change some prescriber's ethics and apathy.

[Kathi49]

Steve,

Thanks for the information. I knew Indiana had something in place and knew it was available to law enforcement. I just didn't know it was now available to ALL healthcare professionals. I think that's a good thing or invaluable as you put it. And I wonder, just a thought, if this is another reason that myself and maybe even Mark haven't had to sign a pain management agreement. I just haven't ever had to and like I said...just a thought and only because if this system is in place and the pharmacists and docs have access to it, then they could readily search on anyone. I wonder too if there any stats on how well Indiana is doing with it. Anyway, I use the same pharamacy I always do; there has only been one time where I had to go elsewhere but it wasn't a problem.

[slipnslide]

Steve,

I for one use multiple pharmacies!!! Every week or two there will be a coupon in the newspaper for a $20 or $30 gift card to a local Top Name grocery store or chain Pharmacy when you fill a transferred or new RX with them. I'll be the first to admit that I'm not rich, so if I take my one RX to the Pharmacy that is offering a $20 gift card for filling it with them, and then take another one of my Rx's to the grocery store pharmacy who honors competitors coupons, I get another $20 gift card. God knows, with the price of everything these days, I take advantage of coupons offering gift cards that help put food on my table. I sure hope that anyone using the database pays attention to the fact that these meds are only being filled once a month as prescribed, and only being prescribed by one doctor.

[Pharmacist.steve]

IMO, most of those pain contracts are worth not more than the paper they are written on. By and large they intimidate the legit patient - who is going to follow the rules anyway and give the "drug seekers" a map telling them how to get around "the rules"

If you could see one of these controlled substance reports... it doesn't take a statistical analysis major to easily spot a patient that is most likely a pseudo addict or drug seeker. Likewise, the legit patient's report stands out as well.

The challenge at that point - for the healthcare professional - is to figure out who is the pseudo addict and who is the drug seeker... most healthcare professionals want to get the former the help they need - and get the latter "off the streets"

[Kathi49]

Agree Steve,

It's just good to know that Indiana has something in place and available to both law enforcement and the healthcare professionals.

[911]

thanks steve for the 411 , i having just moved to florida and now with the second doc here ( hopefully the last ) have been after them to do a contract but they do not use them for some reason , i think this office is prolly more geared to getting people off the opiods atleast from the liturature i have seen iin the office ,i am a legit pataint i do not use mulitple docs same one infact he has a pharmasist that i see more than the doc i actually like him alot and am going to give him this addy for this site so hopefuilly he will look ????? thats all from me ,,,,,,,, thanks again ,,,,,,,,,,,, Dave

[Gimpy]

Steve,

I for one use multiple pharmacies!!! Every week or two there will be a coupon in the newspaper for a $20 or $30 gift card to a local Top Name grocery store or chain Pharmacy when you fill a transferred or new RX with them. I'll be the first to admit that I'm not rich, so if I take my one RX to the Pharmacy that is offering a $20 gift card for filling it with them, and then take another one of my Rx's to the grocery store pharmacy who honors competitors coupons, I get another $20 gift card. God knows, with the price of everything these days, I take advantage of coupons offering gift cards that help put food on my table. I sure hope that anyone using the database pays attention to the fact that these meds are only being filled once a month as prescribed, and only being prescribed by one doctor.


I do the same thing. Or, there have been times, when the pharmacy didn't have what I needed and had to go somewhere else.

ANYTHING done on a computer is failable.

[Pharmacist.steve]

Steve,

I for one use multiple pharmacies!!! Every week or two there will be a coupon in the newspaper for a $20 or $30 gift card to a local Top Name grocery store or chain Pharmacy when you fill a transferred or new RX with them. I'll be the first to admit that I'm not rich, so if I take my one RX to the Pharmacy that is offering a $20 gift card for filling it with them, and then take another one of my Rx's to the grocery store pharmacy who honors competitors coupons, I get another $20 gift card. God knows, with the price of everything these days, I take advantage of coupons offering gift cards that help put food on my table. I sure hope that anyone using the database pays attention to the fact that these meds are only being filled once a month as prescribed, and only being prescribed by one doctor.

Everyone must do what they must... however... in doing so.. if you run into a opiophobic Pharmacist at one of these stores... you may find yourself getting your Rx not filled or "held" until things can be clarified... if that is Friday or a weekend... you could find yourself without your pain meds for several days. I am not saying this is what SHOULD HAPPEN ...just what COULD HAPPPEN

[Pamster]

My pain mngt contract says I have to use ONE pharmacy so I can't take advantage of offers like those. You might get in trouble for doing it if your contract said the same thing slipnslide, just wanted to post about this to warn you just in case your contract said something simliar.

[slipnslide]

I had my first experience with the Pharmacist telling me they could not fill one of my Percocet RX's on tues. I was given an RX for Percocet 10's in the ER, so when I tried to fill my regular RX from my PM for Percocet, and the one from the ER, the Pharmacist (who is listed on my pain contract) said only one could be filled. I'll still have to go back and fill the one from the ER because for the past couple days I've been taking them every 4 hours for pain, as prescribed by the ER doc, but now that will make me come up short with my usual dosage of every 8 hours with the Percocet 10's that my PM RX'd. I had asked to speak to the Pharmacist when I was filling the scripts, and I asked him about being prescribed the same medication by the ER doc, and "was I supposed to take it on top of what I was already taking", he told me "no, just more frequently", he said he could try to fill it by calling the ER and getting the doctor's consent or I could call. I got on my cell and called the ER, not to get the doctor's consent, but to ask why they would send me home with a script for a pain medication i was already taking when I showed up in the ER, all doubled over in pain. The woman responded "in case you run out", I told her that "I showed up in the ER while already taking Percocet, so obviously it wasn't helping my pain, why would I be given what I already take, if that's not the stupidest thing I've ever heard"....that's when she repeated "in case you run out" and hung up on me! I'll go back to the pharmacy and tell the Pharmacist what I was told, he can check with them if he wishes, but now I have to get it filled or I'll be short on my meds come the end of the RX.

[lobelsteve]

My agreement (not contract) with patients is such that it states they should use one pharmacy. But in reality, they just need to notify my office where they fill all of my prescriptions.

Bad people will not tell me they are Dr shoppers. But their pharmacies often call my office to let me know anyways. Pharmacists talk to each other and to docs in my area and I think we are doing a fair job of keeping tabs on the prescription abuse.

In states with Rx monitoring, the bad guys just drive over state lines to get their cash paid Rx's filled. THey use their insurance to get the in state filling done.

[slipnslide]

My agreement (not contract) with patients is such that it states they should use one pharmacy. But in reality, they just need to notify my office where they fill all of my prescriptions.

Bad people will not tell me they are Dr shoppers. But their pharmacies often call my office to let me know anyways. Pharmacists talk to each other and to docs in my area and I think we are doing a fair job of keeping tabs on the prescription abuse.

In states with Rx monitoring, the bad guys just drive over state lines to get their cash paid Rx's filled. THey use their insurance to get the in state filling done.

So, is it safe to assume that what you are saying is that even though I'm using my Insurance, and using local Pharmacies, I SHOULD notify my PM as to what Pharmacies I use and why?

[lobelsteve]

So, is it safe to assume that what you are saying is that even though I'm using my Insurance, and using local Pharmacies, I SHOULD notify my PM as to what Pharmacies I use and why?

I would be happy if my patients did that for me (most do). It is another piece of paperwork in the chart showing the legitimacy of the doctor patient relationship and tht responsible care is beingprovided while monitoring for aberrant behaviors, abuse, addiction, diversion.

The state medical boards and DEA do not require this, but it shows them we are trying our best.

[911]

i agree with steve , i do my best to use just one pharmacy and i even went so far as to use the same pharmacy here as i did in maine so my records have followed me and i do know my cp doc has my record from maine from my old cp doc , so i think i have done my best to follow thru ,ps : i also notifie my docs if i need to use a diff pharmacy but so far CVS has been great to me here as they were in maine ,,,,,,,,,, Dave

[Cervie Barb]

I use one doctor and one pharmacy, but I'm not sure I'm comfortable with these databases. Why should the authorities (a cop stopping me for a traffic infraction?) have access to any of my medical records?

I just think the potential for abuse of privacy, and hacking, are too high.

[debhun]

Steve,

I for one use multiple pharmacies!!! Every week or two there will be a coupon in the newspaper for a $20 or $30 gift card to a local Top Name grocery store or chain Pharmacy when you fill a transferred or new RX with them. I'll be the first to admit that I'm not rich, so if I take my one RX to the Pharmacy that is offering a $20 gift card for filling it with them, and then take another one of my Rx's to the grocery store pharmacy who honors competitors coupons, I get another $20 gift card. God knows, with the price of everything these days, I take advantage of coupons offering gift cards that help put food on my table. I sure hope that anyone using the database pays attention to the fact that these meds are only being filled once a month as prescribed, and only being prescribed by one doctor.

I would be kicked out of my PM if I did that. I can only go to 1 Rx's


I go to Walgreen's and they have been the best to me than any one. Okay I has 1 mom &Pop that did great but she had to close. But when hubby lost ins Walgreen's stepped up and really help me with my med. She got with my doc and my meds went from over $8or 900.+ a month to about $175.

Now about my family Doc. For years like 14 years I had been going to him. he told me one day he couldn't give me any more meds. He said (they who is they? ) were looking at him. That is when I asked about PM. and he said that would be better cause they could do more for me then he could. I never took more than what I was to take. But took around the clock.I was on 10/750 Perc I think at that time. His RX was take 1-2 every 4-6 hours as needed for pain. He wrote 120 at a time with refills 3x. But I did fine out the DEA was watching him. He did give out a lot. When he told me this I called my Ins com and asked about it. Ins people told me I was fine and with in my limits. there was no trouble with them. One day I went to see my Family Doc and at the time I was on Opana. He said that is very strong meds. I said I didn't know what is strong but it works great for my pain and I was very happy with my PM Doc. I feel that some Doc are just not educated enough about pain meds. My PM doc told me I should have been on long acting meds a long time ago. So this tells me that My Doc had no idea how many people he had on pain meds. Not good. I know there are a lot of Dr's that don't know. Just like the other day the lady that Gave the 19 year old morphine. Her Dr would just write out a Rx's and goes on to the next patient. So if they need the data it should be for Doc too.I thing everyone should go though and PM and not their Family Dr. But I think they will have trouble with this and cause a lot of trouble for us folks with CP. Just my 2 cents.

I went to my Pm yesterday and she was very happy with me. She said I was doing the best in a long time. That we got my meds right. She said it took a year but we did it. She told me to enjoy wile it last. cause it will change. She said she had a pland for me in the winter. I asked what and she said to clean her house. I told her I didn't do house cleaning. She laught so hard. I have been there 1 year now and yesterday was the first time I had to do a pee test. I am not worryed in the less. She was a little concern about my speech was a little slured. But she said the Meth can do that some times. And I told her I have alway had trouble for I have a very very soft voice. A lot of people can hear me. Oh will Have to go Jayden just dumped pennys all over the floor.



Deb

[Naominjw]

My state uses this database. I know people on it--blacklisted from getting pain meds... and they are NOT abusers! One person even moved to another state (disabled vet with a horrendously painful spinal cord injury). They get put on it just for being a high user, or, in two cases I know personally, because they had so many surgeries, and chronic pain, combined with high tolerance to the meds. Now, they go in for surgery and they are told to just take Tylenol when they go home.

So... That's apparently the dark side of the database. Not sure how they are supposed to contest their names being on it.

[lobelsteve]

My state uses this database. I know people on it--blacklisted from getting pain meds... and they are NOT abusers! One person even moved to another state (disabled vet with a horrendously painful spinal cord injury). They get put on it just for being a high user, or, in two cases I know personally, because they had so many surgeries, and chronic pain, combined with high tolerance to the meds. Now, they go in for surgery and they are told to just take Tylenol when they go home.

So... That's apparently the dark side of the database. Not sure how they are supposed to contest their names being on it.

Tylenol after surgery (depending on the surgery) may constitute malpractice.
The surgeon would need to work with an addictionologist or pain specialist to ensure appropriate steps are taken to manage the post operative pain.

My patients undergoing surgery have the surgeon fax me the suggested Rx, bring in the Rx, or have the surgeon send me a note to Rx more meds for more pain in the post-op period. We never have issues.

[Mary Diane]

I signed a pain contract with my pain dr, so I took copies to all my other drs to put in my files. It just seemed like the thing to do as they all write scripts for me. This way we're all covered if there's ever any question. They were all surprised, and pleased that I had thought of it. This also keeps them current on my meds.

Toodles,

Mary Diane

[Spiney]

The last time I had surgery, my pain doc called the slice and dice boys and firmly requested that a pain specialist manage me post op. I am not a problem patient but these good old boys have you down to hydrocodone on day 2 post op. The first time they worked on me (3 levels), they pulled that and I just about lost it. It was a good thing I had the pain doc the second time because I popped up with a post op staff infection right away and was stuck there for ten days before they could transfer me back home to my local phys rehab hospital.

[Tbackpain1]

Pharm Steve,

I know for a fact that CVS here in NY does not allow internet access in their stores. When I was first dealing with the Fentanyl patch recall issues with correct product that I wasn't allergic to the adhesive, I ended up giving my pharmacist all the information from Jansen/Sandoz b/c he had no access to information, other than the recall notice that was sent to corporate.

I can see where these databases can have a good side and a bad side to them. There are ways to abuse/avoid any current systems we have available to us. As a conscientious patient, who also has a medical background, I know the other side of the system, so I do my best to go beyond what's expected of me to be compliant with all the rules and common sense practices regarding my scripts and treatments.

Often patients don't have any idea that their actions have implications that could affect future treatment. It bothers me when I hear of patients that are given the short end of the stick in situations, but who knows what was or wasn't done previously. At least with a database, a provider can find out some of the information before making a decision regarding treatment.

There's no right or wrong with the situation. I do think that pharmacies should have internet access, but corporate probably banned it because productivity was down from people playing solitaire and checking their personal e-mails on company time. IMHO they should give limited internet access and require PIN codes, so they can track who's doing what on the internet.

Theresa

[Lil E]

Obviously no one is using this database at the hospital I go to. I always have to give an explanation of why I need the amount of meds I do when I go to the ER, even though its the only ER I use. When hospitalized I have to fight with the admitting doctor to make sure I get ALL my meds. Then I have to explain that not only do I need meds for the pain I'm in, for but also for my CP!

I've had the same PM for 8 or 9 years. I can't find anyone closer than him who will treat me and he's 50 miles each way. He's great but the drive isn't. I've never done anything to be treated this way. Perhaps accessing this data base should be mandatory when someone like me comes in.