Among Teenagers Marijuana Use on the Rise

More teens are turning to pot and see it as less of a risk at the same time alcohol use among the same age group has dipped to historic lows, according to an annual national survey of drug use released Wednesday. The findings were based on a survey of 47,000 eighth-, 10th- and 12th-graders conducted by the University of Michigan for the National Institute on Drug Abuse ( see http://www.ns.umich.edu/new/multimedia/9-videos/20124-marijuana-use-continues-to-rise-among-us-teens-while-alcohol-use-hits-historic-lows). Among the more important findings from this year's Monitoring the Future survey of U.S. secondary school students are the following: Marijuana use among teens rose in 2011 for the fourth straight year—a sharp contrast to the considerable decline that had occurred in the preceding decade. Daily marijuana use is now at a 30-year peak level among high school seniors. Synthetic marijuana," which until earlier this year was legally sold and goes by such names as "K2" and "spice," was added to the study's coverage in 2011; one in every nine high school seniors (11.4%) reported using that drug in the prior 12 months. Alcohol use—and, importantly, occasions of heavy drinking—continued a long-term gradual decline among teens, reaching historically low levels in 2011. Energy drinks are being consumed by about one third of teens, with use highest among younger teens. SUMMARY: The proportion of young people using any illicit drug has been rising gradually over the past four years, due largely to increased use of marijuana—the most widely used of all the illicit drugs. The proportion of students reporting using any illicit drug other than marijuana has been following a gradual decline for some years, but has remained fairly stable over the most recent three years, with 2011 levels being similar to the 2008 levels. Yours Bernd

Florida Medicaid Pilot

On Thursday the federal officials agreed to extend Florida's five-county Medicaid managed-care experiment to 2014 but required the state to make significant improvements to the program. They include the denial of the medical-loss-ratio waiver requiring the participating private health plans to spend 85 percent of funds on patient care and the denial to cap benefit levels for Medicaid beneficiaries preventing the termination of Medicaid services because recipients had already met their $500,000 maximum for the year. These requirements will protect patients from arbitrary insurance service denials and will force private health insurance plans to manage taxpayers dollars efficiently and responsibly. Meanwhile, we should continue to oppose any expansion of the pilot project UNLESS the State of Florida can provide solid and indisputable data that the pilot project improves access and enhances the quality of care for all  Medicaid enrollees. So far I have not found any evidence to substantiate Governor Scott's claim that "we've seen higher quality in administration of care, produced cost savings and consumers in the pilot have found improved access for Medicaid recipients." Looking forward to your feedback. Yours Bernd For more information see: http://htpolitics.com/2011/12/15/feds-make-key-decisions-on-medicaid-and-health-insurance-for-floridians http://blogs.orlandosentinel.com/news_politics/2011/12/what-is-changing-in-florida-medicaid-maybe.html

Prescription Drug Abuse Update

Attached you find facts and information regarding the prescription abuse epidemic in the US and Florida: In October 2011 the Drug Enforcement Administration on Friday announced the formation of a new squad created to solely investigate the illegal use and distribution of prescription drugs in Central Florida. That squad is investigating rogue doctors and pharmacies, and details of their first probe — involving a Winter Park pharmacy — was one of several cases statewide announced by the nation's top law-enforcers. In this context it is of concern in June 2011, DEA received 263 applications for new pharmacy licenses nationwide. Of those, 139 were from Florida. That means that the drug dealers in white coat referring their "patients" to "friendly" pharmacies to fill their prescriptions for controlled substances. Most of these clinics are probably owned by the same business people who run pain clinics. About 170,000 Medicare patients sought prescriptions for frequently abused drugs from five or more physicians and other health professionals in 2008, a Government Accountability Office analysis of claims data found.The Oct. 4 report accused 1.8% of the Part D beneficiary population of doctor shopping for one or more of 14 abused drugs, such as painkillers hydrocodone and oxycodone. Spending on the drugs cost the program $148 million, representing 5% of the total spent on these drugs in 2008. Some examples quoted in the report include: One Georgia patient obtained prescriptions for a 1,679-day supply of oxycodone pills from 58 prescribers, the GAO said. A physician treating the patient recalled her asking for early refills of the painkiller repeatedly; A patient in California received prescriptions for fentanyl from 21 prescribers in 2008. The patient's physician later received a letter from the state prescription drug-monitoring program informing her that within a four-month period the patient had 33 prescriptions from 10 prescribers. The physician then notified the patient that she would no longer treat the patient. The best way to prevent doctor shopping is through state prescription drug-monitoring programs. Each of us by now should have access to E-FORCSE, Florida's Prescription Drug Monitoring Program, and use it to look up each and every patient who is being prescribed a controlled substance. The House of Representatives voted on 12.08. 2011 to ban synthetic drugs nicknamed "bath salts" and other compounds that mimic marijuana, cocaine and methamphetamines (http://www.miamiherald.com/2011/12/08/2537445/house-votes-to-ban-synthetic-drugs.html#ixzz1gZAWX7YG).Rep. Charlie Dent, R-Pa., said his legislation identifies chemical compounds that affect the brain in ways similar to THC, the active ingredient in marijuana. They would be added to the highly restrictive Schedule I of the Controlled Substances Act. The bill also bans chemical compounds in synthetic drugs marketed as "bath salts" or "plant food" and under brand names such as K2 and Spice that have been used as substitutes for cocaine and other narcotics. They are now sold legally in some states.The vote was 317-98, with some Democrats saying the bill went too far in restricting chemicals that could be valuable to researchers looking for cures to diseases such as Parkinson's disease. When a drug is placed on Schedule I, said California Democrat Zoe Lofgren, "It becomes difficult to obtain not only for illegal purposes but for researchers who wish to study its pharmaceutical and medical potential.A Miami Herald editorial titled "Dangerous prescription" the Miami Herald called for a federal law banning the online sale of narcotics. Such a legislation must be enforced through a strong, combined effort. Authorities along with domain registering websites, social media networks and credit card companies need to be alert to spot online pill mills and report suspicious activity involving illegal, counterfeit and dangerous products. We should strongly support such efforts because questionable online pharmacies skillfully abuse loopholes to provide anyone with controlled substance of their choice provided they can pay. Read more: http://www.miamiherald.com/2011/12/09/2539336/dangerous-prescription.html#ixzz1gZByFnoW

Personhood Amendment

On November 8th Mississippi voters will be asked to decide on a proposed amendment to the state constitution, which would define as a person “every human being from the moment of fertilization, cloning, or the functional equivalent thereof.” For most voters it sounds like a good idea and it will most probably pass. Therefore, several other states, including Florida http://personhoodfl.com/, are preparing similar constitutional amendments. Florida Senate Majority Leader and former US Senate Candidate Mike Haridopolos recently signed the FL Personhood Amendment!! The ambiguous language in the Florida and Mississippi 'personhood' amendment are intentionally not being represented properly by the proponents of this ballot initiative. A recent New York Times article http://www.nytimes.com/2011/10/31/opinion/mississippis-ambiguous-personhood-amendment.html correctly points out the following problems: "First, what does “fertilization” mean? As embryologists recognize, fertilization is a process, a continuum, rather than a fixed point. The term “fertilization” — which is sometimes considered synonymous with “conception” — could mean at least four different things: penetration of the egg by a sperm, assembly of the new embryonic genome, successful activation of that genome, and implantation of the embryo in the uterus. The first occurs immediately; the last occurs approximately two weeks after insemination (or, in the case of embryos created through in vitro fertilization that do not get implanted, never). Thus, on some reasonable readings of the amendment, certain forms of birth control, stem cell derivation and the destruction of embryos created through in vitro fertilization would seem impermissible, while on other equally reasonable readings they are not." Following the "logic" of the "personhood" advocates doctors can be charged with manslaughter or even murder by prescribing morning after pills, because it can irritate the lining of the uterus (endometrium) so as to inhibit implantation of a fertilized egg, i.e. "killing a person." A doctor could also be criminally charged by inserting an IUD because it adversely affects a new embryo as it enters the uterus, thus preventing it from implanting in the uterine lining . Again, according to the "personhood" advocates this constitutes the "killing of a person." Even though, abortions are still being protected by federal law women may still face criminal charges according to state law. Other unintended consequences include the question if the treatment of an ectopic or a molar pregnancy requires first a court order to overrule a "personhood" amendment in the respective state constitution. Needless to mention that any delay of these time-sensitive treatment decisions may harm the mother and even jeopardize the life and well-being of a women. I urge all of you to speak up against any such ballot initiatives, to protect the physician-patient relationship and to guard against further state intrusion into our lives. Yours Bernd

Drug Treatment Instead of Prison

Attached a link http://www.sun-sentinel.com/news/opinion/editorials/fl-prison-bill-editorial-dl-20111030,0,3676874.story to an interesting editorial published in today's Sun Sentinel titled " State prisons need drug treatment alternative." The Sun Sentinel Editorial Board supports legislation — CS/HB 177 and SB 448 — which intends to establish a re-entry program for nonviolent offenders that offers intensive substance abuse treatment, adult education courses and vocational training as alternatives to long prison sentences. The idea is to reduce recidivism, which is essential if state officials want to get a handle on the costs of incarceration. The bills are sponsored by State Sen. Ellyn Bogdanoff, R-Fort Lauderdale, and State Rep. Ari Porth, D-Coral Springs. The two lawmakers are trying to pass needed, positive legislation to help the state of Florida reduce the costs of operating its prisons. In my opinion we should support this legislation and begin lobbying members of the Florida House and Senate. E-mail, twitter, mail or call your representative because " Unlike prison privatization and the more controversial ideas to cut state prison costs, the re-entry program is a simple solution that promises both savings and a much-needed reduction in the state's ongoing recidivism problem." Yours Bernd

Substance Abuse Counseling and Preventive Health Care

Attached a link http://www.ama-assn.org/amednews/2011/10/17/bica1017.htm to an interesting article titled "Counseling on alcohol helps patients and is billable" published in AMA News and posted on October 17th, 2011. Several highlights:

* Since early 2011, many commercially insured patients have been able to receive alcohol counseling paid at 100% with no co-pay or deductible, and the same is expected to be true for Medicare beneficiaries as of Jan. 1, 2012.
* Just asking about alcohol abuse will not necessarily lead to reimbursable payment, but treating those who screen positive most probably will. In addition to the usual fee-for-service, other incentives on the table should further make dealing with the issue more financially feasible for practices and make it more likely that patients will enter treatment.
* Tracking the percentage of adolescents and adults with new episodes of alcohol or other drug dependence who initiate treatment is on the list of eligible professional measure specifications from the Centers for Medicare & Medicaid Services.
* Information should be noted in the patient's chart, along with the time spent on this task. Counseling sessions longer than 15 minutes are billable, but shorter ones are not.
* On July 19, CMS issued a proposed decision memo stating that, as of Jan. 1, 2012, Medicare will cover annual alcohol misuse screening. (A final decision has not yet been made.) Under the proposal, Medicare would pay for four brief, face-to-face behavioral counseling interventions a year. The American Medical Association and other medical societies support his move.
* In addition, alcohol misuse screening and counseling is on the list of preventive services that non-grandfathered health plans must cover at 100% with no deductible or co-pay, according to the Patient Protection and Affordable Care Act. Grandfathered health insurance plans are those that have not changed since the health system reform law was enacted. Non-grandfathered ones are new policies issued after Sept. 23, 2010, and must cover a recommended list of preventive services with no cost-sharing with patients.
* When billing private insurers, the CPT codes are 99408 for an intervention lasting 15 to 30 minutes. An intervention longer than 30 minutes should be coded 99409. H0049 is the code for alcohol and drug screening of Medicaid beneficiaries. H0050 can be used for every 15 minutes of intervention. The services can be provided by a nurse practitioner or physician assistant as well as a physician.

Yours
Bernd

Drug Testing Halted

Attached a link http://www.miamiherald.com/2011/10/24/2470519/florida-welfare-drug-testing-halted.html to another article titled "Florida's welfare drug testing halted by federal judge" reporting that A federal judge in Orlando on Monday temporarily blocked Florida’s controversial law requiring welfare applicants be drug tested in order to receive benefits. Judge Mary Scriven issued a temporary injunction against the state, writing in a 37-page order that the law could violate the Constitution’s Fourth Amendment ban on illegal search and seizure.Gov. Rick Scott, who signed the measure into law on May 31, touted it as a way to ensure taxpayer money isn’t “wasted” on those who use drugs. “Hopefully more people will focus on not using illegal drugs,” he said then.
But, in her order, Scriven issued a scathing assessment of the state’s argument in favor of the drug tests, saying the state failed to prove “special needs” as to why it should conduct such searches without probable cause or reasonable suspicion, as the law requires. “If invoking an interest in preventing public funds from potentially being used to fund drug use were the only requirement to establish a special need,” Scriven wrote, “the state could impose drug testing as an eligibility requirement for every beneficiary of every government program. Such blanket intrusions cannot be countenanced under the Fourth Amendment.”
Fortunately, our legal system still provides protection against the growing government intrusion in our lives spearheaded by a conservative majority in our legislature. We need to continue to push back the growing number of bills threatening not only the practice of medicine but also the freedoms each and every citizen is entitled to.
Yours
Bernd

Florida Prescription Drug Monitoring Program

Attached a link http://www.usatoday.com/news/nation/story/2011-10-13/pill-mill-drug-trafficking/50896242/1?loc=interstitialskip to an interesting article in USA Today titled "States target prescriptions by 'pill mills'" highlighting the Florida painmill problem, the actions taken to combat this issue which include the Prescription Drug Monitoring Program ( PDMP) . We should be ware that the death rate from oxycodone in Florida increased 265% from 2003 to 2009, the CDC found. By 2009, the number of deaths involving prescription drugs was four times the deaths involving street drugs, the CDC said in a July report. Hopefully, the number will decrease but this requires our active participation and support INCLUDING our use of the just recently launched PDMP, or E-FORCSE.
I am using this program now for the last week and am pleased to report that it truly works! For example, I have implemented a protocol which requires that the prescription record of each and every patient who receives a controlled substances has to be crosschecked with the medication listed on E-FORCSE.
I have already discovered that several of my patients did not inform me that they visit different physicians to receive controlled substances. One patient who is currently being treated with Suboxone received prescriptions for a total of 360 Hydrocodone pills from another MD "specializing" in pain management. I called her and she was very surprised to find out that I knew what she was prescribed. She tried to convince me that she only fills these scripts for "psychological reasons" but is not taking but hoarding them at home. I asked her to come to my office for a follow-up visit including drug testing but she never showed up. I suspect that she may sell, or share this medications with others.
I urge you to obtain your username and password and to incorporate this valuable tool into your practice.
Yours
Bernd

Medicaid and Suboxone

"The evidence does not support rationing buprenorphine to save money or ensure safety."

Attached you find a link http://content.healthaffairs.org/content/30/8/1425.abstract to a very interesting article from the recent edition of "Health Affairs" titled "The Evidence Doesn’t Justify Steps By State Medicaid Programs To Restrict Opioid Addiction Treatment With Buprenorphine" arguing that the evidence does not support rationing buprenorphine to save money or ensure safety.

ABSTRACT:

Many state Medicaid programs restrict access to buprenorphine, a prescription medication that relieves withdrawal symptoms for people addicted to heroin or other opiates. The reason is that officials fear that the drug is costlier or less safe than other therapies such as methadone. To find out if this is true, we compared spending, the use of services related to drug-use relapses, and mortality for 33,923 Massachusetts Medicaid beneficiaries receiving either buprenorphine, methadone, drug-free treatment, or no treatment during the period 2003–07. Buprenorphine appears to have significantly expanded access to treatment because the drug can be prescribed by a physician and taken at home compared with methadone, which by law must be administered at an approved clinic. Buprenorphine was associated with more relapse-related services but $1,330 lower mean annual spending than methadone when used for maintenance treatment. Mortality rates were similar for buprenorphine and methadone. By contrast, mortality rates were 75 percent higher among those receiving drug-free treatment, and more than twice as high among those receiving no treatment, compared to those receiving buprenorphine. The evidence does not support rationing buprenorphine to save money or ensure safety.

PDMP goes online!

Attached a link http://www.miamiherald.com/2011/09/01/2385732/fla-prescription-data-base-goes.html to an article from today's Miami Herald titled " Fla. prescription database goes into operation" highlighting the fact that as of September 1st Florida's prescription drug tracking system finally was up and running. That means that dispensers and pharmacies must upload their prescription data for Schedule II to IV to the database. Rebecca Poston, the system's program director in the Department of Health said that "Everything is working wonderful, I have not heard of any glitches related to the dispensers registering or uploading information in the system."
The Department of Health will not begin registering doctors and pharmacists until Oct 1, nor will they be able to get information out of the database until Oct. 17. In my opinion the registration and training process should start now and be phased in either by region, or other criteria to be determined by the Department to allow for a smooth transition and to motivate doctors to use the system. Its not too late to do that but leaving it until October 1st is cutting it too short.
Yours
Bernd

Pill Mills Under Pressure

Attached a link http://www.nytimes.com/2011/09/01/us/01drugs.html to today's New York Times front page article titled "Florida Shutting ‘Pill Mill’ Clinics."
The article highlights the accomplishments made despite the initial resistance by the current administration in Tallahassee.:

As of July, Florida doctors are barred, with a few exceptions, from dispensing narcotics and addictive medicines in their offices or clinics. As a result, doctors’ purchases of Oxycodone, which reached 32.2 million doses in the first six months of 2010, fell by 97 percent in the same period this year.
One indication that law enforcement officials are choking the supply of prescription drugs sold illegally in Florida is that the price of Oxycodone on the streets here has nearly doubled from last year, to $15 per pill from $8.
On Commercial Boulevard, a major street in Broward County, the number of pain clinics has fallen in the past year from 29 to one.
The fallout from the tougher laws may include an increase in pharmacy robberies, a problem that has been worse in Florida than any other state since 2007 (there were 65 armed robberies of pharmacies here last year).

As of today any health care practitioner who has dispensed a Schedule II-IV controlled substance, as defined in section 893.03, F.S. (i.e., OxyContin®, Percocet®, Vicodin®, Klonopin®, Xanax®, and Valium®), is required to report dispensing information to the Prescription Drug Monitoring Program’s database within seven (7) days after dispensing, in accordance with section 893.055, F.S. This includes pharmacies licensed under chapter 465, F.S., and dispensing health care practitioners licensed under chapter 458, 459, 461, 462, or 466, F.S
Now we must push to start educate physicians on how to use the PDMP and to encourage accessing the database to identify "doctors shoppers."
I am optimistic that we can achieve our goals.
Yours
Bernd

Drug Testing for Welfare Recipients

Attached some food for thought regarding the mandatory drug testing for welfare recipients:

When Florida Gov. Rick Scott (R) signed the law requiring welfare recipients to pass annual drug tests to collect benefits, he justified the likely unconstitutional law by saying it would save the state money by keeping drug users from using public money to subsidize their drug habits. Drug use, Scott claimed, was higher among welfare recipients than among the rest of the population.According to preliminary results from the state’s first round of testing, however, has seemingly proven both of those claims false. Only 2 percent of welfare recipients failed drug tests, meaning the state must reimburse the cost of the $30 drug tests to the 96 percent of recipients who passed drug tests (two percent did not take the tests). After reimbursements, the state’s savings will be almost negligible, the Tampa Tribune reports:
Cost of the tests averages about $30. Assuming that 1,000 to 1,500 applicants take the test every month, the state will owe about $28,800-$43,200 monthly in reimbursements to those who test drug-free.
That compares with roughly $32,200-$48,200 the state may save on one month’s worth of rejected applicants.
Net savings to the state: $3,400 to $5,000 annually on one month’s worth of rejected applicants. Over 12 months, the money saved on all rejected applicants would add up to $40,800 to $60,000 for a program that state analysts have predicted will cost $178 million this fiscal year.
This should serve as an example that our government in Florida seems to base its decisions on ideological assumption instead on rational thought and consideration.
Yours

Bernd


Bernd Wollschlaeger,MD,FAAFP,FASAM
16899 NE 15th Avenue
North Miami Beach,FL 33162
Phone: (305) 940-8717
Fax: (305) 940-8871
Web Site: www.miamihealth.com
Blog: http://floridadocs.blogspot.com
Twitter: http://www.twitter.com/dadedoc

Feds Crack Down on Pill Mills

Attached a link to an article published in today's Miami Herald http://www.miamiherald.com/2011/08/23/2371284/federal-authorities-announce-south.html
reporting that

" For the first time in Florida’s war on prescription drug abuse, investigators are pursuing pill mills as organized crime enterprises — and corrupt doctors as murderers. After a three-year investigation, federal authorities announced the details of Operation Oxy Alley, a sweeping indictment charging 32 people under racketeering statutes for their involvement in South Florida-based pill mills that doled out 20 million oxycodone pills and profited more than $40 million dollars from illegal sales of controlled substances. In a companion indictment, local authorities charged a doctor with first-degree murder in the death of a West Palm Beach man who died within hours of filling a prescription for a painkiller."

"The indictment brought Florida’s prescription medication abuse problem — described by investigators as a homegrown drug epidemic — into sharp focus. Last week, the state’s Medical Examiners Commission released its annual report showing deaths caused by prescription drugs in 2010 were up by about 8 percent. Oxycodone was the cause of death for 2,710 people, about a 28 percent increase since 2009. And about 85 percent of all oxycodone sold comes from Florida."

Its about time!!

Yours
Bernd

The Blues Treatment For Mental Health Providers

Attached a very troublesome article I just received today reporting that on July 27, 2011 Blue Cross Blue Shield of Florida began notifying ALL of their mental health providers (licensed social workers, licensed mental health counselors, psychologists, and psychiatrists) that effective November 30th, 2011 they would be terminated, without cause.
They were also notified that that if providers would like to join the new companythey are partnering with, New Directions, so that they can provide services to their patrons, they would need to complete a new contract (sent under separate cover) within 15 days and agree to significant cuts (35-55%) in reimbursement rates, as well as other disturbing clauses such as only being able to refer to in-network providers, etc.
Since BCBS is considered to be one of the largest providers of insurance for mental/behavioral health in Florida, this termination could potentially place hundreds/thousands of providers in a position of being underemployed and/or unemployed, and worse, leave thousands of patients without coverage or access to mental health/psychological treatment.


CNN producer note
iReport -
On July 27, 2011 Blue Cross Blue Shield of Florida began notifying ALL of
their mental health providers (licensed social workers, licensed mental
health counselors, psychologists, and psychiatrists) that effective Nov 30,
2011 they would be terminated, without cause. That is, they will no longer
be providers for BCBS-FL. In this notice, current providers were also
instructed to notify BCBS subscribers/patients of this coming termination
directly and on behalf of BCBS-FL.

BCBS-FL also indicated that if providers would like to join the new company
they are partnering with, New Directions, so that they can provide services
to their patrons, they would need to complete a new contract (sent under
separate cover) within 15 days and agree to significant cuts (35-55%) in
reimbursement rates, as well as other disturbing clauses such as only being
able to refer to in-network providers, etc.

Interestingly, New Directions appears to be a subsidiary of BCBS-FL. So, as
if it isn't horrible enough that ALL of the mental/behavioral health
providers have been "fired" at the same time and patients will likely find
themselves with poor quality care or no care at all, it appears that they
(the same company-BCBS-FL) fired its contractors and then offered them the
oportunity to reapply for rehire within the same week, but only if they
agree to sign a new contract, with entirely different terms.

This action (termination of providers only in one area) also seems to be a
possible violation of the Federal Mental Health Parity Law which protects
against the discrimination of mental health services. It does not appear
that any of the other healthcare providers or "medical" providers had their
contracts terminated.

Since BCBS is considered to be one of the largest providers of insurance for
mental/behavioral health in Florida, this termination could potentially
place hundreds/thousands of providers in a position of being underemployed
and/or unemployed, and worse, leave thousands of patients without coverage
or access to mental health/psychological treatment.

The ripple effect of these actions by BCBS-FL could be deadly to the people,
communities, and businesses throughout FL. leaving many unable to make a
reasonable living and thousands (including Seniors with BCBS as a secondary
policy) unable to access and/or pay for mental health treatment and
psychological services.

--
Bernd Wollschlaeger,MD,FAAFP,FASAM
16899 NE 15th Avenue
North Miami Beach,FL 33162
Phone: (305) 940-8717
Fax: (305) 402-2989
Web Site: www.miamihealth.com
Blog: http://floridadocs.blogspot.com
Twitter: @dadedoc

Stoned Drivers

Attached an article http://www.sun-sentinel.com/news/nationworld/la-na-pot-drivers-20110703,0,7871314.story entitled "Stoned driving is uncharted territory" which was initially published in the Los Angeles Times highlighting the problem of impaired driving, especially as it pertains to the legal and illegal use of marijuana. The most recent assessment by the National Highway Traffic Safety Administration, based on random roadside checks, found that 16.3% of all drivers nationwide at night were on various legal and illegal impairing drugs, half them high on marijuana. The article clearly points out that "As the medical marijuana movement has gained speed — one-third of the states now allow such sales — federal officials are pursuing scientific research into the impairing effects of the drug. The issue is compounded by the lack of a national standard on the amount of the drug that drivers should be allowed to have in their blood. While 13 states have adopted zero-tolerance laws, 35 states including California have no formal standard, and instead rely on the judgment of police to determine impairment. Even the most cautious approach of zero tolerance is fraught with complex medical issues about whether residual low levels of marijuana can impair a driver days after the drug is smoked. Marijuana advocates say some state and federal officials are trying to make it impossible for individuals to use marijuana and drive legally for days or weeks afterward."
Several studies are underway to determine if marijuana can impair drivers and increases the risk for car crashes. A $6-million study in Virginia Beach, Va., is attempting to remove any doubt that users of pot and other drugs are more likely to crash. Teams of federal researchers go to accident scenes and ask drivers to voluntarily provide samples of their blood. They later return to the same location, at the same time and on the same day of the week, asking two random motorists not involved in crashes for a blood sample. The project aims to collect 7,500 blood samples to show whether drivers with specific blood levels of drugs are more likely to crash than those without the drugs, said John Lacey, a researcher at the nonprofit Pacific Institute for Research and Evaluation. In other projects, test subjects are being given marijuana to smoke and then examined under high-powered scanners or put in advanced driving simulators to gauge how it affects their brains and their ability to drive.
But questions remain: Does it mean that there is no amount of marijuana that a person can consume and drive safely immediately afterward? Can we determine whether it is possible to set limits on "safe" marijuana use with, or without, a combination of other substances such as alcohol? An open discussion is indicated to reach an evidence-based answer.

Yours
Bernd

Seroquel and Methadone

Attached a link to an article published in the New York Times (July 19th, 2011) http://www.nytimes.com/2011/07/19/health/19drug.html reporting that at the request of the Food and Drug Administration, AstraZeneca is adding a new heart warning to the labels of Seroquel, its blockbuster antipsychotic.
The revised label emphasizes that drug.Seroquel and extended-release Seroquel XR “should be avoided” in combination with at least 12 other medicines linked to a heart arrhythmia that can cause sudden cardiac arrest.The previous Seroquel labels had mentioned the risk of a prolonged QT interval, but had not identified other drugs to avoid, Stephanie Andrzejewski, a spokeswoman for AstraZeneca, said Monday. The new warning also is separated from other warnings and precautions on the label, she said, “to provide some additional guidance to physicians” treating patients ”who are already at risk of QT prolongation.”
The new label lists the other drugs to avoid as antiarrhythmic drugs like quinidine, procainamide, amiodarone and sotalel; antipsychotic drugs like ziprasidone, chlorpromazine and thioridazine; antibiotics like gatifloxacin and moxifloxacin; the anti-infective drug pentamidine; and synthetic opioids like levomethadyl acetate and methadone. The label also raises caution about use by the aged and people with heart disease. As addiction professionals we should know that Seroquel has a potentially deadly interaction with methadone in regard to the QT interval, even though the FDA is downplaying this risk!
Methadone use and deaths have increased drastically in recent years as more doctors prescribe it for chronic pain. The number of methadone prescriptions for pain in the United States rose to 4.3 million in 2010 from 2.2 million in 2006, IMS Health, an industry data firm, said Monday. The use for pain has surpassed that for heroin withdrawal and maintenance.

Yours
Bernd

Bath Salts Abuse Increasing

Attached a link to an interesting article http://www.nytimes.com/2011/07/17/us/17salts.html entitled "An Alarming New Stimulant, Legal in Many States" highlighting the growing abuse of bath salts containing  chemicals like mephedrone and methylenedioxypyrovalerone, or MDPV, also known as substituted cathinones. Both drugs are related to khat, an organic stimulant found in Arab and East African countries that is illegal in the United States. Bath salt users so agitated that they often do  not respond to large doses of sedatives.Poison control centers around the country received 3,470 calls about bath salts from January through June, according to the American Association of Poison Control Centers, up from 303 in all of 2010. 
At least 28 states have banned bath salts, which are typically sold for $25 to $50 per 50-milligram packet at convenience stores and head shops under names like Aura, Ivory Wave, Loco-Motion and Vanilla Sky. Most of the bans are in the South and the Midwest, where the drugs have grown quickly in popularity. But states like Maine, New Jersey and New York have also outlawed them after seeing evidence that their use was spreading. Law enforcement officials said they had been shocked by how quickly bath salts turned into a major problem. As addiction professionals we need to stay informed on how to diagnose and treat patients who are under the influence of these powerful synthetic drugs. We also should call for tough regulatory measures including, whether to make MDPV and mephedrone controlled Schedule I drugs like heroin and ecstasy, to stop the sale and consumption of these drugs.
Yours
Bernd

Heroin Use Surges

Attached a link to an article http://www.miamiherald.com/2011/06/30/2292618/as-poppy-fields-flourish-in-mexico.html#storylink=misearch published on the Miami Herald web site pointing out that that Mexico has surpassed Myanmar as the world's second-largest poppy cultivator and produces 7 percent of the world's heroin, mostly for the U.S. market. The State Department and the United Nations say that Mexican poppy production has nearly tripled since 2007, though Mexico strongly disputes that estimate. "They brought in experts, chemists, folks from Asia who taught them how to produce better heroin," said a U.S. law enforcement official based in Mexico City, who spoke only on the condition of anonymity for security reasons. "You saw purity levels climb from 40 to 50 percent up to 90 percent." He said Mexican heroin now might hold two-thirds of the U.S. market. "You're seeing it everywhere. It's cheap. The market base is teenagers. They are the target consumers," the official said. At about $15 a hit, heroin is a lot cheaper than prescription painkillers such as oxycodone (known by its brand name, OxyContin), which can cost $50 to $80 a tablet on the black market. Both opiates, they have similar highs and Heroin can be snorted and inhaled, too.
As addiction professionals we should get prepared for an avalanche of new opioid users who switch from prescription drugs to Heroin and teenagers who start their using "career" with Heroin.
Yours
Bernd

Drug Testing for Welfare Recipients

Drug Test Law May Face Costly Legal Challenges:

Attached a link http://www.orlandosentinel.com/health/os-drug-tests-welfare-20110630,0,5410762.story to an article published in today's Orlando Sentinel pointing out that a new state law requiring welfare applicants to be drug-tested goes into effect today.

The law stipulates that parents with minor children who request temporary cash assistance must undergo a drug test. The average benefit check per family is $240 a month with a lifetime limit of 48 months.

About 4,000 Floridians each month may be affected by the new law. The 93,000 state residents already receiving such benefits would not be affected unless they reapply. In addition all parents who test positive for drugs — including legal drugs not prescribed for the parent — will be reported automatically to the state's abuse hotline. Applicants will have to pay for the drug tests themselves, though those who test negative will be reimbursed in the first benefit check they receive. Those who test positive also would have the chance to get a second, more-sophisticated screening — at their own expense of up to $100 — and have an official medical review of the testing (MRO) . It is still unclear whether those expenses would be reimbursed if the applicant is ultimately cleared. The law may violate the constitutional standard requiring that the government must have reason to believe an individual is using drugs before demanding a test. Michigan, the only other state to pass a similar law, had it struck down in court. Therefore, it most probably will face a costly legal challenge on taxpayers expense!! Furthermore, by implementing this policy the state government should have provided drug treatment options for those welfare recipients with children who test positive for drugs. The new law falls shot of this option, too.

In my opinion this new law is a bad idea which will face a long and costly court battle and will further divert scarce state resources from more important issues such as drug use prevention and treatment programs.

Happy 4th of July,


Yours

Bernd

New-Onset Psychosis and Synthetic Marijuana

Attached you find a link to a very interesting article http://www.familypracticenews.com/single-view/new-onset-psychosis-linked-to-use-of-fake-pot/99bbe3bc19.html reporting that synthetic marijuana may be associated with new-onset psychosis in patients with NO psychiatric histories. Synthetic marijuana is usually a mix of cannabinoid receptor agonists. They are generally full agonists, which distinguishes them from the active ingredient in actual marijuana, tetrahydrocannabinol (THC), which is a partial cannabinoid agonist. The chemicals originally were developed to help locate cannabinoid receptors and as experimental pain relievers – uses that did not pan out, he said. Plant material is dipped into the chemicals, or sprayed with them, and sold on the Internet or in drug paraphernalia shops as K2, Blaze, RedXdawn, and other brands. Spice is usually smoked, but is beginning to be sold as a crystalline powder. Users have no way of knowing how potent a particular product is. On March 1, the U.S. Drug Enforcement Agency temporarily designated five synthetic cannabinoids as Schedule I substances, pending further action, "because they pose a threat to public health," according to the order.

Yours
Bernd

Counterfeit-Proof Prescription Pads

Just want to remind all of you that as of tomorrow, July 1st, 2011, counterfeit-proof prescription blanks MUST be used by all physicians for prescribing of ANY controlled substances. A list of approved vendors of counterfeit-proof prescription pads can be found on the Department of Health web site at http://www.doh.state.fl.us/mqa/counterfeit-proof.html.It is also important o know that approved vendors are required to provide monthly reports to the DOH, documenting who purchased the prescription pad or blanks and how many were purchased.
Have spoken today with one of the vendors and was assured that they make every efforts to expedite deliveries of counterfeit-proof prescription pads.

Yours
Bernd

Synthetic Marijuana is back!!

Attached a link to today's Miami Herald article http://miami.pointslocal.com/story/miami/393245/incense-makers-thwart-bid-to-weed-out-fake-pot reporting that the clever manufacturers of synthetic marijuana have changed the chemical compounds just enough to skirt the ban by the U.S. Drug Enforcement Administration and a new Florida law. Mr. Nice Guy, once one of the main brands of the “incense” that authorities targeted, is no longer sold. But on its website, the manufacturer promotes the brand Barely Legal, announcing it is “Legal in all 50 states. ”Local police say Barely Legal is one of the new generation of synthetic marijuana products formulated to beat the ban. Synthetic marijuana is labeled and sold as incense or potpourri, but law enforcement officials say people know what it’s really for: smoking to get high. Its packaging says, “Not for human consumption.” Moreover, the new chemical formula is stronger than the old one, according to Mr. Nice Guy’s website and local police.

Legislation helps but isn’t the answer, said state Rep. Darryl Rouson, D-St. Petersburg, who co-sponsored the synthetic-marijuana bill.“They’ll always come up with a slightly different type of strain,” Rouson said. “The creator of this drug has over 100 different strains.“This problem will only be solved by education and prevention. Not legislation, not incarceration, not punishment. We can legislate, we can [impose] punishment and hopefully, by punishment, there’s deterrence.”
I look forward to your responses and comments.
Yours
Bernd

Governor Scott Suspends Drug Testing Order

Attached a link to an article from today's Sun Sentinel http://www.sun-sentinel.com/health/fl-scott-suspends-employee-drug-testi20110616,0,6797555.story reporting that Governor Scott has suspended the order he signed earlier this year requiring random drug tests of all state employees in light of an ACLU law suit. The governor had signed the order for so-called "suspicion-less" drug tests – so termed because all state employees would be subject to them, regardless of their job or whether they were suspected of using drugs – in March. He also successfully urged the Legislature to require drug tests of all new applicants for welfare assistance, which the ACLU is also expected to challenge.
I encourage all of you to speak up loudly against the mandatory drug testing of welfare recipients which will be challenged in court, too.
Yours
Bernd

The Big Rip-Off

In today's Miami Herald http://www.miamiherald.com/2011/06/06/2254083/prescription-for-healthcare-shopping.html#storylink=misearch John Dorschner points out a painful truth: healthcare consumers are being ripped off every day by healthcare service providers.
According to Alan Sager, a healthcare policy expert at Boston University,  “Anytime I’ve read reports of patients or journalists seeking comparison pricing, they’ve encountered the same inconsistency, confusion, frustration and often misleading information,” he said. “When we go into a big supermarket, we all pay the same price for a gallon of milk. In healthcare, there are multiple prices in the same place.”
I myself have a hard time to find out the REAL costs of my own healthcare needs. Recently my daughter had to do undergo laboratory testing for which I was charged a $900 co-pay. I tried to appeal and as a result my case was immediately referred to a collection department. I barely saved my credit rating and paid. Its outrageous! The profit margins are beyond belief exceeding 1000 percent!! The so-called "free-market" argument is a joke!! An article in today's Wall Street Journal points out that in a survey of 1,000 British Medical Association members - all doctors - 80% of those surveyed were "mostly or very unwelcoming" towards the idea of privatization of the National Health Service. Meanwhile, American doctors and politicians continue to support the private health care market model. There is NO health care market but an aggregation of monopolies suffocating the average health care consumers. 
Its time to fight back! We should demand a single-payer system with uniform and transparent pricing structure.
Yours
Bernd

Governor Scott Signs Pill Mill Bill into law

After initially fighting one of its key provisions, Gov. Rick Scott signed a bill Friday aimed at cracking down on clinics that frivolously dispense pain pills, feeding a nationwide prescription drug abuse epidemic. The bill tightens reporting requirements to the database from 15 days to seven days, a change critics said the program needed to make it more effective. The measure also increases penalties for overprescribing Oxycodone and other narcotics, tracks wholesale distribution of some controlled substances, and provides $3 million to support law enforcement efforts and state prosecutors. It also bans most doctors who prescribe narcotics from dispensing them, requiring prescriptions to be filled at certain types of pharmacies. Scott has been under pressure from elected officials throughout the country to do something about the proliferation of so-called "pill mills" in Florida that attract people from other states seeking easy access to highly addictive, powerful painkillers.
We should now urge the Department of Health to provide education and training programs for physicians and other healthcare professionals on how to use the Prescription Drug Monitoring Program and to fund those necessary efforts.

For more information see http://www.miamiherald.com/2011/06/03/2249936/scott-signs-pill-mill-bill-into.html

ACLU Sues Governor Scott Over Drug test Rule

ACLU Florida has filed a lawsuit against Gov. Rick Scott over his executive order to force drug testing on state employees. The suit argues that Scott's order is an unreasonable search of the government that violates the Fourth Amendment of the U.S. Constitution.The ACLU maintains that the mandatory random drug testing Scott has ordered on about 100,000 workers is only allowed under special circumstances, such as workers who carry firearms or railroad workers involved in accidents.
I urge all medical professionals involved in federal workplace drug testing procedures to await the outcome of this lawsuit BEFORE deciding on their participation in the proposed state wide drug testing for state employees.


For more information and the complete text of the law suit see http://www.tampabay.com/blogs/the-buzz-florida-politics/content/aclu-sues-gov-scott-over-drug-testing-order

Physicians Challenge Florida Goverment

Attached an article highlighting an issue which is going to be resolved in court. Unfortunately, Governor Scott signed HB 155 into law which will bar physicians from asking patients about gun ownership. Florida is the only state in the nation to have such a law which was pushed by the NRA.
Sadly, the Florida Medical Association does not oppose the new law exposing its members to charges of harassment if they "dare" to provide their patients information about gun safety. Any alleged violation of the new law will expose physicians to disciplinary action and even license revocation!
Now its time to stop government intrusion into the patient-physician relationship.
I encourage doctors to pay attention to this issue and to take action.
Yours
Bernd












PalmBeachPost.com



By DARA KAM

Palm Beach Post Staff Writer

Updated: 10:58 p.m. Thursday, June 2, 2011

Posted: 8:19 p.m. Thursday, June 2, 2011

Three groups of doctors are suing Gov. Rick Scott over a bill he signed into law Thursday restricting health care workers from asking patients questions about guns.

Lawyers representing members of Florida chapters of the American Academy of Pediatrics, the American Academy of Family Physicians and the American College of Physicians asked Scott last week to veto the measure (HB 155) and threatened to sue if he signed it into law.

The Florida Medical Association does not oppose the new law.

Bruce Manheim of the Washington-based Ropes & Gray law firm said Thursday he would file the lawsuit immediately after Scott signed the law.

Doctors say the law infringes on their First Amendment constitutional right to free speech by barring them from asking about gun ownership, something they say is necessary to do their jobs.

It will "have a muzzling effect on doctors" who routinely ask parents and teenagers about swimming pools, dangerous drugs, bicycle helmets and car seats as well as about firearms in the home, pediatrician Tommy Schechtman said.

Under the law, doctors and other health care professionals will face sanctions including fines and losing their licenses if they ask patients about guns in the home without a direct belief that the inquiry is relevant to the patient's safety or health.

"It is my job. It is my responsibility. I have a moral obligation, an ethical obligation to be doing this," said Schechtman, who has offices in Palm Beach Gardens, Jupiter and Boca Raton.

But Scott spokesman Lane Wright said the first-term governor is confident he is on solid legal ground by signing the bill.

"Others would argue it would be an infringement of a citizen's rights who owns a gun to have a doctor ask those questions," Wright said. "Why should any law abiding citizen have to report to a doctor that they have a gun?"

Florida is the only state in the nation to have such a law, according to National Rifle Association lobbyist Marion Hammer, a former president of the gun rights organization.

Hammer said some health care professionals are pushing anti-gun messages to their patients under the guise of home safety questionnaires. The measure was prompted by complaints from gun owners following an incident this summer in which an Ocala-area physician told a couple to find another pediatrician after they refused to answer questions about whether they owned a gun and how it was stored.

The NRA and other supporters don't object if doctors routinely distribute safety brochures to all patients that give instructions on swimming pools, firearms or other safety-related issues, Hammer said.

"But doctors should not be spending the time that patients are paying for to talk to them about matters they're not there for. They come to doctors for medical care and medical treatment, not to have politics in the examining room and not to be lectured on firearms. They are medical doctors; they are not firearms instructors," she said.

But Mannheim said the new law is so vague about when questions are permissible that it would have a chilling effect on health care practitioners fearful of having to defend themselves before the Board of Medicine.

"Questions about firearm safety, as innocuous as they may be to the ordinary person, could be construed by someone as constituting harassment by a physician and simply on the basis of that judgment a physician could be taken through these disciplinary proceedings," he said. "It immediately chills the speech of our clients and their members and accordingly we intend to move very quickly with a lawsuit."

Schechtman said the new law won't stop him, however. More than 1,500 children die each year from household gun-related injuries, he said.

"Some of us won't shut up. Sometimes you have to decide to do the right thing which is what I will do. It's not going to stop me from doing anything," he said.

But other physicians may feel it's not worth the risk.

"It will have its intended effect. That's the thing that's scary to me. And that's why I think we have to take this off the books. I think it's sending a wrong message that people shouldn't have to worry about guns," Schechtman said.

PDMP Update

Attached an update regarding the implementation status of the Florida Prescription Drug Monitoring Program.
We are slowly but steadily moving forward.
Yours
Bernd

PDMP Update



Contract: On Monday, May 16, 2011 DOH delivered the contract to Health Information Designs, Inc. (HID). DOH will receive the customized off the shelf database within 90 days from the execution of the contract, approximately September 1, 2011. Although tested and operational when received, the users have to be notified and trained on how to register and download data to the database. The RFP allows an additional 30 days (120 days from the execution of the contract) for HID to provide beta testing for providers on how to register and download data.

The following is an estimated timeline for implementation:

· Contract execution date: June 1

· Delivery Database: September 1

· Go Live/Receive data: October 1



DSO: HB 7095 removed references to the Office of Drug Control and reassigns the duties of the Office of Drug Control to DOH and the State Surgeon General.



Funding: The PDMP is funded by three sources: (1) DSO, (2) Federal Grants, (3) Private Grants. HB 7095 prohibits the use of funds provided by prescription drug manufacturers to implement the program. The PDMP is currently funded through September 2012 with federal and private grants, and donations from the DSO. The PDMP projects to spend $485,965 in FY 12/13.



Grants: PDMP submitted its application for the 2011 Harold Rogers Prescription Drug Monitoring Program (PDMP) Enhancement Grant, to request funding to improve its existing PDMP. PDMP requested $398,287, under this grant application to implement the enhancements outlined below. This proposal is in response to a competitive grant announcement by the U.S. Department of Justice (DOJ), Office of Justice Programs (OJP), Bureau of Justice Assistance (BJA).



PDMP will improve its program by: (1) enhancing collaborations with law enforcement to establish a comprehensive PDMP strategy; and (2) enhancing the PDMP’s ability to analyze and use collected data to identify drug abuse trends, identify and address sources of diversion, and increase the number of PDMP users. These improvements will align Florida PDMP with the 2010 National Drug Control Strategy of establishing a balanced approach to drug use by expanding efforts for the 3 critical ways that the problem can be addressed: prevention, treatment, and law enforcement. Specifically, it will strengthen efforts to prevent drug use in communities by fostering collaboration between public health and public safety organizations.



In addition, our request to extend the project period by one year for Grant Award Number 2009-PM-BX-4004 has been approved by BJA.

Addicted Babies

Attached a link to an an article published in the 05/13/2011 edition of the Miami Herald http://www.miamiherald.com/2011/05/13/2216300/state-seeks-end-to-crisis-of-babies.html reporting that at St. Joseph’s Women’s Hospital in Tampa 15 to 20 percent of the babies admitted to the neonatal intensive care unit are treated for withdrawal from prescription drugs like oxycodone. Statewide, an estimated 1,300 babies were treated for withdrawal in 2010, a 30 percent increase from the previous year. These troubling data were presented at a roundtable discussion with top officials from BayCare Health System, AG Pam Bondi and Senate President Mike Haridopolos to discuss the enormity of the problem and what can be done to stop it. Babies born with prescription drugs in their systems often spend the first weeks of their lives in hospital NICUs getting weaned off their addiction. Mindy Young, a nurse and manager of St. Joseph’s NICU, said it’s a painful process that can take up to 30 days. We definitely need to do more to identify and treat pregnant opioid-dependent women to stop this epidemic. The article only refers to Methadone as a treatment modality and omits mentioning the use of Buprenorphine (SUBUTEX) as a treatment option.

Yours

Bernd

Pill Mills in the News

Attached a link to an interesting article published in today's (05/15/2011) Sun Sentinel http://www.sun-sentinel.com/news/broward/fl-pillbillies-crime-20110516,0,1515459.story reporting that “ out-of-state travelers called 'pillbillies' who are visiting South Florida to score prescription drugs are doing not only that, they're also adding to the local criminal population.” This adds additional workload to an already overburdened judicial system and the costs for jailing those criminals are mounting, too. Once the prescription drug monitoring program is up and running drug dealers and doctor shoppers will realize that Florida is not open for their business anymore. Therefore, we have to make sure that doctors are receiving the training to use the program and to fight for continuous funding for the PDMP.
Lets make it happen!

Yours

Bernd

Gun Law and Physicians

The new gun law makes Florida the first state in the nation to prohibit doctors from asking patients if they own guns. HB 155 entitled "Privacy of Forearm Owners" passed the Florida House and will be signed into law by Governor Scott. NPR featured this law in a recent story http://www.npr.org/2011/05/07/136063523/florida-bill-could-muzzle-doctors-on-gun-safety. Having read the entire bill http://www.flsenate.gov/Session/Bill/2011/0155/BillText/er/PDF I am trying to understand what I am allowed to ask my patients and how I can protect myself from those who exercise their constitutional right to carry guns. Here are the some of the problems the bill presents us with:

* The bill states that “A health care practitioner licensed under chapter 456 or a health care facility licensed under chapter 395 may not intentionally enter any disclosed information concerning firearm ownership into the patient's medical record if the practitioner knows that such information is not relevant to the patient's medical care or safety, or the safety of others."

Question: How do I know whats relevant to the patients safety? Actually, I was taught to be concerned about "anticipatory guidance" — teaching parents how to safeguard their children against accidental injuries. Like pediatricians family doctors ask about bike helmets, seat belts, and GUNS. That means I cannot counsel a parents how to secure a gun to prevent accidental injury and death? Shall I delete those questions from my patient intake form? Shall I NEVER ask those questions? Will I be disciplined if I dare asking those questions?

* But in the next paragraph the bill also states that " Notwithstanding this provision, a health care practitioner or health care facility that in good faith believes that this information is relevant to the patient's medical care or safety, or the safety of others, may make such a verbal or written inquiry."

Question: So what is correct and prevents my exposure to disciplinary action? Shall I adhere to a don't ask, don't tell policy?

* The bill contains other confusing language such as " A health care practitioner licensed under chapter 456 or a health care facility licensed under chapter 395 shall respect a patient's legal right to own or possess a firearm and should refrain from unnecessarily harassing a patient about firearm ownership during an examination."

Question: What if a gun owner claims to feel "harassed" by a doctor and files a complaint with the Board of Medicine then a physician has to answer and file a response. That requires legal advice and consultation which costs $$$. Facing such a dilemma precludes ANY questions about guns. That's what the NRA wanted, the legislators did and the FMA endorsed!

* The bill goes further stating " A health care provider or health care facility may not discriminate against a patient based solely upon the patient's exercise of the constitutional right to own and possess firearms or ammunition."

Question: What if the patient has a concealed weapon permit and carries a concealed weapon in the medical office and I discover such a weapon during the exam? It happened to me several times!! Can I ask the patient to leave and return without the weapon without him/her claiming that I harass them? Can I establish a policy prohibiting patients to carry guns on my premises?

* Furthermore, the bill contains an entire paragraph about patients rights BUT NOT a single sentence about physicians rights and safety!! That's what the NRA wanted, the legislators did and the FMA endorsed!


Yours
Bernd

Mandatory Drug Testing

The Miami Herald reports in today's edition http://www.miamiherald.com/2011/05/06/2204093/welfare-drug-test-bull-heads-to.html that a measure requiring the mandatory drug testing for all welfare recipients is headed to Gov. Rick Scott for signature , who called it one of his legislative priorities.

HB 353 requires all adult recipients of federal cash benefits — the Temporary Assistance for Needy Families program — to pay for the tests, which are typically around $35. The screen would be for all controlled substances and applicants would have to disclose any legal prescriptions. Recipients who test positive for drugs would lose their benefits for a year. If they fail a second time, they lose the benefits for three years. Parents who test positive must designate another adult to receive benefits on behalf of their children. Those who pass would be reimbursed by having their benefits increased by the cost of the test.

Personally, I consider this as an intolerable government intrusion which far exceeds all previous measures to reduce the demand for illicit drugs and controlled substances.!!

As a Medical Review Officer I am also concerned that the bill does not contain ANY references to formal written drug testing policy, standards of training for drug testing, or provisions for self-referral to treatment. Furthermore, the bill does not differentiate between regulated and non-regulated testing, procedures regarding verification testing to determine and to exclude false-positive or false-negative testing, and cut-off values for substances tested.

It also fails to take into consideration that gas-chromatography testing is required to verify the drug test results which can add additional costs exceeding the estimated $35 per test. For example, an synthetic opioid panel costs at least $85.

In addition the bill contains NO reference to the role of a Medical Review Officer (MRO) who makes the final and definitive verification decision for each drug test results and should report the results.

In summary: this bill must be challenged in court and will not hold up legal scrutiny.


Yours


Bernd

Controlled Substances

In an interesting article entitled “US Seeks To Rein in Painkillers” http://www.nytimes.com/2011/04/20/health/20painkiller.html the authors report that the Obama administration seeks legislation requiring doctors to undergo training before being permitted to prescribe powerful painkillers like OxyContin. This appears to be the most aggressive step taken by federal officials to control both the use and abuse of the drugs. Among the drugs that would most probably fall under a stricter licensing measure are OxyContin, fentanyl, hydromorphone and methadone. They are considered critical to pain treatment. But they also have been associated in recent years with a national epidemic of prescription drug abuse and addiction and thousands of overdose-related deaths. Proponents of the training argue that it would help doctors better identify patients who would benefit from treatment with long-acting narcotics, and help them unmask patients feigning pain to get drugs they then abuse. Opponents say a training requirement will reduce the number of doctors prescribing pain drugs and hamper patient care. The F.D.A. released new regulations on Tuesday that would require the makers of long-acting or extended release painkillers to provide training to doctors but would not require doctors to take such courses. This proposal is similar to the one rejected as too weak in last year’s debate. Dr. Janet Woodcock, who heads the F.D.A. Center for Drug Evaluation and Research, indicated that the new agency rules were effectively a placeholder until legislation was passed or were to be used if a relevant bill failed.

In my opinion additional education and training requirements for controlled substances prescribing are long overdue! Most physicians have no, or very limited knowledge, of the appropriate indication, pharmacology and adverse drug interactions of controlled substances. I often see patients who were prescribed Methadone, a long-acting opioid, at a four-times daily dosage schedule. These physicians seem to be clueless about the fact that Methadone metabolism rates vary greatly between individuals, up to a factor of 100! These metabolism rates can range from as few as 4 hours to as many as 130 hours, or even 190 hours. This variability is apparently due to genetic variability in the production of the associated enzymes. Ignoring these pharmacological facts can lead to accidental overdose and death.

Additional training requirements should be implemented to protect our patients and our families.

Yours

Bernd

Prescription Drug Monitoring Program Update

Attached links to several interesting articles regarding the so-called "pill mill database:

* A Sun Sentinel Editorial entitled “ Opposition to pill mill data base dissolves” http://www.sun-sentinel.com/news/opinion/editorials/fl-pill-mills-editorial-dl-20110417,0,5137083.story correctly points out that the latest change to HB 7095 includes support for a prescription drug monitoring program and restores tough regulations on pain management clinics that House leaders had threatened to strip from the bill. Thew new bill is far from perfect! Small pharmacies complain that the new version puts them at a disadvantage to the larger big-box drug chains where most medications are prescribed. More importantly, people who need these medications may find the bill creates new hurdles to getting them. Lawmakers should take the greatest care to make sure that that is not the case.
* Another article published in today's Sun Sentinel “ Why, and how, South Florida pill mills must be shut down” http://www.sun-sentinel.com/news/outlook/fl-nscol-pill-mills-prosecute-sanadi-20110417,0,5970691.story written by Nabil El Sanadi,MD points out that the newly formed pill mill" Multilateral Task Force should mandate that: That said, the task force should mandate that:
* The Board of Medicine exercise its power on licensees — physicians — to register as pain management specialists and to monitor each prescriber's activity to ensure compliance with 64B 9.013.
* The prescription drug database should be used to track doctor-shoppers and to detect over-prescribers, so that the attorney general, local law enforcement and the DEA can get these criminals off the streets.
* Physicians should be mandated to report suspected doctor-shopping and possible drug diversion, just like we have to report child abuse and certain communicable diseases.
* Physicians and pharmacists should be required to use the database when prescribing or dispensing narcotics.

I am concerned that mandated reporting and the required use of the database may trigger significant political backlash from physician organizations and Republican legislators. I suggest focusing instead on allocating funds to educate physician on how to use the database and on how to identify doctor-shoppers. Subsequently, physicians will recognize that the exclusion of doctor-shoppers is good business.
* An additional article published in today's Sun Sentinel “ New Database Blocks Sales of Cold Medications” http://articles.sun-sentinel.com/2011-04-16/health/fl-cold-medicine-database-20110416_1_meth-labs-ephedrine-products-pain-pill-database highlights the success of the National Precursor Log Exchange database which went live in January, and through late March, has blocked more than 40,000 illegal ephedrine sales in Florida. lorida joined 11 states last year in passing legislation that forces pharmacies to track ephedrine products in a database. "It has been among the most successful laws we've had in reducing meth production," said Jim Hall, director of the Center for the Study and Prevention of Substance Abuse at Nova Southeastern University in Fort Lauderdale.The system has been compared to the pain-pill monitoring system that's been under fire in Tallahassee, which aims to crack down on pain-pill trafficking across Florida. Both systems track consumer information to show patterns of abuse, and both aim to stop people from doctor shopping or pharmacy hopping. Police and sheriff's associations pushed for the ephedrine database after reporting an alarming number of meth lab explosions in North Florida in 2009. Several people, including a baby, were severely burned. The rising popularity of the "shake and bake" meth-making method is largely to blame, authorities said. People have discovered how to make the narcotic in a 2-liter soda bottle, which builds with pressure and often erupts into flames. Although meth labs are more prevalent in North and Central Florida, a surprising number of blocked ephedrine sales in South Florida indicates that "smurfers" have been driving south to stock up, Beasley said. A smurfer is an individual who find and/or gather the raw materials for their dealer to make more drugs.FDLE launched the database as a pilot program in 2008 in North Florida. In one year, law enforcement agencies reported that it contributed to 133 arrests. The system flags people who try repeatedly to buy ephedrine over the legal limit, and police use those leads to open drug investigations. Investigators with the South Florida High Intensity Drug Trafficking Area use it to help local police find possible "smurfers." They look through the system for suspicious activity and alert respective agencies.

Yours
Bernd

Fla. House panel OKs compromise pill mill bill

Finally, the future for a prescription drug monitoring program is looking better every day. According to an April 12th Miami Herald article http://www.miamiherald.com/2011/04/12/2163473/fla-house-panel-oks-compromise.html compromise legislation designed to combat "pill mills" that supply prescription painkillers to drug dealers and addicts cleared a House committee Tuesday after the panel took out Gov. Rick Scott's proposal to repeal Florida's prescription monitoring system. The revised bill (HB 7095) instead would strengthen the database by giving pharmacies only seven days rather than 15 to submit prescription information to the state. Unchanged from the original legislation is a ban on dispensing controlled drugs by most doctors. That means patients would have to get prescriptions filled only at pharmacies. Doctors who violate the ban would face up to five years in prison. The House Appropriations Committee unanimously approved the revised bill. It next goes to the House floor. House Speaker Dean Cannon, R-Winter Park, also pushed for the database repeal, arguing that a ban on dispensing by doctors would be more effective, but Bondi said he's also supporting the compromise and helped bring it about. Bondi and Senate President Mike Haridpolos, R-Merritt Island, have been strong supporters of the tracking system, and the Senate's pill mill bill (SB 818) did not include the repeal.
I urge you to continue pushing your legislators to support the House ( HB7095) and Senate bill (SB818).
The battle is not over yet !!
Yours

Green Light for Prescription Drug Monitoring Program!!

Attached a link to an article http://www.miamiherald.com/2011/04/08/v-fullstory/2157716/span-classboldprescription-drug.html reporting the long awaited launch of the prescription drug monitoring program. The article highlights that:

"The Department of Health on Friday issued a final order in a months long bid dispute between two vendors, giving the program a green light... with the program mandated by statute, there is little opponents can do to stop it now that the legal issues surrounding it have been resolved."

This is indeed good news and I want to thank all of the many activists who invested so much time and efforts to support this noble cause.
Yours
Bernd

Governor Scott and Mandatory Drug Testing

Governor Scott and Mandatory Drug Testing:

A recent article published in the Miami Herald http://www.miamiherald.com/2011/03/27/v-fullstory/2137314/gov-rick-scotts-drug-testing-order.html reports that Governor Scott signed an executive order last week that requires drug testing for many current state workers and job applicants. According to the article “Scott’s order applies to all employees and prospective hires in agencies that answer to the governor, and could affect as many as 100,000 people. Scott also supports a state Senate bill that requires all cash-assistance welfare recipients over the age of 18 to pay for and receive a drug test, a policy that could affect about 58,000 people.”

But is this executive order legal?

* In April 2000 U.S. District Court Judge Kenneth L. Ryskamp ruled that governments cannot require prospective employees to take drug tests unless there is a “special need,’’ such as safety. Ryskamp’s ruling led other South Florida cities, such as Pembroke Pines, to abandon their policy of drug testing all job applicants.
* Random drug-testing of current government workers also has been limited to those in jobs that affect public safety and to cases where a reasonable suspicion of abuse exists, according to a December 2004 federal court ruling in a case that involved Florida’s Department of Juvenile Justice. In that case, U.S. District Court Judge Robert Hinkle ruled that the DJJ violated the Fourth Amendment in ordering random drug-testing of all the agency’s 5,000-plus employees.
* State agencies already are allowed, but not required, to screen job applicants for drugs, under the Florida Drug-Free Workplaces Act. The law allows state agencies to test employees if there is a reasonable suspicion that workers are on drugs. But that suspicion must be well-documented and employees must be informed of the policy prior to testing.
* Howard Simon, executive director of the ACLU of Florida, said Scott is taking a “simplistic” approach to the law, pitting the public’s expectation of a “right to know” against each individual state worker’s right to privacy.

The article concludes that though no legal challenge to the governor’s order has been filed, one will be forthcoming.
I urge all of you to support the ACLU of Florida in their efforts to fight back against government intrusion into our lives camouflaged in the shroud of transparency.

Yours
Bernd

Pill Mill Issue

Attached a link to an article http://www.tampabay.com/news/health/gov-rick-scott-announces-plan-to-combat-pill-mills/1160274 reporting that Gov. Rick Scott on Monday launched his own initiative to fight the problem. At a news conference where he was flanked by Attorney General Pam Bondi and a handful of law enforcement officers, Scott announced a statewide drug trafficking "strike force." Florida Department of Law Enforcement Commissioner Gerald Bailey will lead the effort, coordinating with local law enforcement agencies. Scott directed the FDLE to use $800,000 in unspent federal grant money to help pay for overtime and other costs associated with the effort. State Senator Fasano, a strong supporter of the Prescription Drug Monitoring Program, said he found it curious that the governor was able to come up with $800,000 for the law enforcement effort but not for the database. AG Bondi, who supports the database, acknowledged that she and the governor have a difference of opinion. But she praised the governor for taking action on the law enforcement front. "We need more tools for all these people standing behind us," she said. Later, Bondi said she considers the database one of those "essential" tools.
Further legislative update regarding the PDMP:
The state House of Representatives, at the urging of Speaker Dean Cannon, has proposed eliminating the database. But Senate President Mike Haridopolos has said that proposal won't make it through his chamber. In fact, fellow Republican Sen. Rene Garcia got nowhere in a Senate committee Monday with a bill amendment that would have killed the database. The amendment was dropped without even being put up for a vote.

Yours
Bernd

Florida gets the profits, Kentucky gets the problem

“We’ve got more people dying of prescription drug overdoses than car accidents,’’
U.S. Rep Hal Rogers.


Attached a link to a great article published in today's Miami Herald http://www.miamiherald.com/2011/03/27/v-fullstory/2135476/kentucky-the-other-end-of-the.html again focusing on the unresolved pill mill issue in Florida.
The sobering facts speak for themselves:

* As far back as 2002, early in the epidemic, one fourth of all OxyContin-related deaths in the country took place in eastern Kentucky.
* According to a study by the Substance Abuse and Mental Health Services Administration, there was a fourfold increase nationally in treatment admissions for prescription pain pill abuse during the past decade. The increase spans every age, gender, race, ethnicity, education, employment level and region. Nearly every family in eastern Kentucky has been touched by prescription-drug addiction and death.
* In Kentucky some harbor a deep resentment at Florida’s unwillingness to crack down on pill sales, for instance, at its refusal to set up a prescription database similar to those in other states to ensure that customers are not “doctor shopping’’ – scooping up some pills here, more pills there – by dealing with multiple physicians.

Meanwhile, dozens of people die every day in Florida and Kentucky but Governor Rick Scott and many of his political friends are stonewalling.



Yours,

Bernd

Florida is Open for (Drug) Business

Attached a link to a Miami Herald article from Friday, March 11th http://www.miamiherald.com/2011/03/10/2107891/house-kills-plan-for-drug-monitoring.html  reporting that with little debate Thursday morning, the House health and human services committee voted to eliminate the state’s plan for prescription drug monitoring database.Before the vote to eliminate the database, the committee passed a bill that would prohibit doctors from dispensing narcotics, making the drugs largely available only at pharmacies. It would  would require wholesale distributors of narcotics to report who they are selling the drugs to so law enforcement officials can identify unusually large purchases. The bill calls for appropriating $1.5 million to track down the large, non-pharmacy dispensaries and return the drugs to wholesalers.
Our legislators also decided to eliminate registration and inspection of pain clinics, and a ban on felons owning pain clinics.
Obviously, the committee chairman,Robert Schenck (R-Spring Hill) and his fellow legislators believe that our already burdened law enforcement officers will do a better job to crack down on drug dealers in white coat and the OxyCartel. But even Broward County Sheriff Al Lamberti pointed out that we cannot arrest ourselves out of the problem! Meanwhile, the drug dealers can rest assured that Florida is wide open for their business and that no one will bother them anymore to ask for clinic registration or  physician ownership verification. Maybe we should post a sign at the state border: Felons welcome!
Something is rotten in the state of Florida.
Yours
Bernd

DOH wins PDMP Bid Protest

Attached you find a link to the Recommended Order by an Administrative Law Judge regarding the Prescription Drug Monitoring Program (PDMP) bid protest.
Let me explain briefly the circumstances for or those who may not know all the details:
The Department of Health (DOH) issued a Request for Proposals (RFP) for companies interested in bidding for the PDMP contract. The loosing bidder (Optimum Technology ) protested TWICE the DOH decision to award the contract to a competitor (Health Information Design).
An administrative law judge recommended today that the DOH enter a final order dismissing the Formal Written Protest.
That means the DOH WON the bid protest and may move ahead with the PDMP implementation.
I would expect that the DOH follows state law, awards the contract and moves to implement the PDMP. The only obstacles are the Legislature and the Governor who at this point in time defy state law!
Yours
Bernd


http://www.doah.state.fl.us/internet/search/docket.cfm?RequestTimeout=500&CaseNo=11-000257&Petitioner=OPTIMUM%20TECHNOLOGY%2C%20INC%2E&Respondent=DEPARTMENT%20OF%20HEALTH&URLString=Count%3D1%26BPCount%3D1%26DWH%3D1%26Pet%3DOptimum

Pill Mill and PDMP Issue

In the last 2 days a series of articles were published in the Miami Herald and Sun Sentinel focusing on the "pill mill" and PDMP repeal issue.
I am hopeful that the heightened publicity will put pressure on our legislators to act.
Yours
Bernd


Drug monitoring program worth saving, By Al Lamberti and Marcelo Llorente
Read more: http://www.sun-sentinel.com/news/opinion/fl-prescription-drug-forum-20110305,0,2826266.story

"On behalf of Floridians, we are pleading with Gov. Scott, Attorney General Bondi and legislative leaders not to sacrifice vital initiatives such as the PDMP in an effort to achieve a balanced budget. Too many lives are at risk, and the consequences are too great to eliminate the PDMP."

Sons and daughters, lost to a pill epidemic FRONT PAGE STORY
Read more: http://www.miamiherald.com/2011/03/05/2100118/sons-and-daughters-lost-to-a-pill.html#ixzz1FqNyNtUh
http://www.miamiherald.com/2011/03/05/2100118/sons-and-daughters-lost-to-a-pill.html

Florida pill mills: Different drugs, same faces
http://www.miamiherald.com/2011/03/05/2099419/florida-pill-mills-different-drugs.html

"Felons can’t get a license in Florida as a pest-control operator. Colangelo can’t be a private detective or paramedic or title insurance agent or bail bondsman or labor union business agent. He can forget about employment with the Florida Lottery. Or qualifying as a notary.
“In Florida, this guy couldn’t own a liquor store,” said Broward Sheriff Al Lamberti. Yet according to the DEA, Vincent Colangelo, who couldn’t kill bugs, serve cocktails or tail a cheating husband, could operate seven pain clinics and a pharmacy in Broward and Miami-Dade counties. His pill mills peddled more than 660,000 doses of oxycodone in just two years. The feds calculated Vinny’s proceeds at $22,392,391."



Drug epidemic: Monitoring program a necessity, by Bruce Grant
http://www.sun-sentinel.com/news/opinion/fl-drugs-oped0306-20110306,0,6995046.story

"It's time to quit posturing and doing nothing while people die. If there is a better solution to the monitoring program, then let's hear it. Currently, 38 other states have an operational program, and another five have passed the law and are awaiting implementation. What do they know that we don't? Worse yet, Florida now has other states chastising us over our deadly inaction.
Florida must implement the monitoring program now. It is the single most-effective mechanism we have to stop the epidemic of prescription drug abuse. Inaction on the program or its repeal is an option that would only result in further deaths, greater human suffering, and tremendous human and economic costs we cannot afford. Let's put aside rhetoric and put this program into operation. Lives depend on it."

Governor Scott and the PDMP: Accusations replace Facts

Unfortunately, Governor Scott pulls out all the stops to attack the supporters of the PDMP including the PDMP Foundation.
These are indeed groundless accusations without factual evidence to support the arguments made.


http://www.palmbeachpost.com/opinion/editorials/scott-makes-it-up-again-accusations-against-group-1276631.html?sms_ss=email&at_xt=4d6663c1bb07e380%2C0

Excerpt from the article above:

Gov. Rick Scott is inventing another excuse for opposing a statewide prescription pill database.

Without offering any evidence, the governor this week accused the private foundation that is raising money for the database of wasting donations. "It's come to my attention that thousands of dollars have been spent on lawyers, travel, meals for board members," Gov. Scott told reporters on Tuesday. "I believe it's an invasion of privacy. And right now with that database, it appears that the money's been wasted."

In fact, board members of the Prescription Database Monitoring Program haven't charged a single expense to the foundation. A private company started by the former chairman of the foundation's board has picked up most of the legal expenses. "The first communication from the governor's office to our foundation was a baseless accusation. It's desperate," said foundation Vice Chairman Rene Bruer. He is a financial analyst who worked for the director of Florida's drug control office under Gov. Jeb Bush. "We're rising up above the politics. We just want to deal with the problem."

http://www.palmbeachpost.com/news/state/fla-drug-database-fund-raiser-disputes-gov-scotts-1273905.html?page=2&viewAsSinglePage

Excerpt from article above:

Scott's attack on the foundation took Bruer [Vice-Chairman of PDMP Foundation] by surprise, he said.

"We've never ever had anybody from Rick Scott's office ask us questions, join one of our phone calls. Nothing. Ever. There has been no dialogue between us. We welcome that," he said.

The foundation is caught in the middle of a political battle of wills, Bruer said.

"The PMDP Foundation is not here to play political ping-pong. We're strictly here to look at the overarching issue which is people dying from prescription drug abuse and doing what we can within the letter of the law to make sure that one of Florida's worst public health epidemics is dealt with," he said.

Tip of the Iceberg

Attached an article from today's Miami Herald highlighting the arrest of several oxycontin dealers, wrongly called "doctors", Unfortunately, they represent just a tiny sample of the hundreds of drug dealers in white coat in South Florida who make millions in ill-gotten profits.
Meanwhile, the Oxy-Cartels are reinventing their business model and open "life style enhancement" and " wellness" clinics.
We have to stop them now!
Yours
Bernd



The Miami Herald
Posted on Wed, Feb. 23, 2011
Pill-mill arrests hit right target: doctors

Fred Grimm
fgrimm@MiamiHerald.com
Law enforcement tested a promising antidote for Florida’s oxy epidemic Wednesday – doctors in handcuffs.

Arrests of so many drug-addled users and low-rent street dealers hardly matters. Not compared to that ignominious image of Dr. Zvi Harry Perper led out of a “pain management clinic” in Delray Beach Wednesday. That stuck at the very nub of the pill-mill industry. In tan scrubs and steel cuffs. Dr. Perper on a perp walk.

Fifteen pill mills were raided in Broward, Miami-Dade and Palm Beach counties. A few oxy street dealers and a handful of clinic employees were arrested, all replaceable entities in the pill-mill business model. But five doctors were busted. Seven others “voluntarily” surrendered their federal license to prescribe narcotic medicines. Doctors, cranking out oxycodone prescriptions for phantom pain and fake injuries, are the essential elements.

While a doctor may be a crucial to a pill mill, actual doctoring is just a bother. Undercover agents, posing as patients, were prescribed hundreds of oxycodone pills without so much as an examination by Dr. Jeffrey Lipman at Midtown Pain Management in Miami-Dade, according to Lipman’s arrest warrant.

It was easy to see why the DEA might have been suspicious of Lipman’s bedside manner. In the first six months of 2010, he ordered up 288,560 oxy pills for his patients. (There are more prolific oxy docs in the United States. All 39 of them work out of South Florida pill mills.)

The agents told the doc of prior drug abuse and taking oxy with alcohol. They described only minimal pain. In Dr. Lipman’s waiting room, another patient, who said he planned to sell his pills in North Carolina, asked an agent (who he thought was from Tennessee), “How easy was it to sell up there?” The doctor even discussed the “street value” of the oxy he was dispensing with the undercover agents. He figured $8 to $16 a pill.

Medical experts cited in the arrest warrant described Lipman’s clinic as “consistent with those of the usual pill mill, where cash is the only form of payment, patients often travel from long distances and sell prescribed controlled substances , physical examinations are not performed . . . and controlled substances are prescribed in excessive dosages and potentially fatal combinations.”

The raids came the day after Gov. Rick Scott reiterated his fervent, ideological opposition to a drug database, designed to prevent oxy shoppers from filling multiple prescriptions, moving from one pill mill to another – circumstances captured nicely by the pain clinics raided Wednesday.

The warrants noted how the pill mills flourish in Florida with minimal regulations, without the tracking system used in most states. “Consequently, individuals have been able to obtain unlimited and unmonitored quantities of controlled substances from multiple pain clinics for either personal consumption or resale in Florida and elsewhere.”

The raids only reinforced the notion, widely held by law enforcement and most of the state’s medical associations, that without a monitoring system, Florida invites criminal operations in the guise of medical clinics.

But after Wednesday, the pill mill industry will be forced to limp along with a dozen fewer doctors.


© 2011 Miami Herald Media Company. All Rights Reserved.
http://www.miamiherald.com


Read more: http://www.miamiherald.com/2011/02/23/v-print/2082013/pill-mill-arrests-hit-right-target.html#ixzz1EqMoYvC7

The Stubborn Rejection of Common Sense

Rick Scotts decision to derail the Prescription Drug Monitoring Program (PDMP) is either based on ideological rigidity, or plain simple ignorance.

The attached articles and editorials clearly highlight the absolute necessity to declare a public health emergency and to implement the PDMP immediately!


1. More babies born addicted to pain drugs http://articles.sun-sentinel.com/2011-02-12/health/fl-prescription-drugs-born-addicted-20110211_1_newborns-prescription-drug-winnie-palmer-hospital



a. In 2009, nearly 1,000 babies born in Florida hospitals were treated for drug withdrawal syndrome. The most recent data show no signs of a slowdown. During the first half of 2010, 635 cases were reported.

b. From 2006 to 2009, there was a 173 percent increase in newborns treated at Florida hospitals for drug withdrawal syndrome, according to Agency of Health Care Administration records obtained by the Orlando Sentinel.

2. Why does Gov. Scott oppose Florida prescription drug database? http://articles.sun-sentinel.com/2011-02-12/news/fl-rick-scott-pills-mayocol-b021311-20110211_1_pain-clinics-prescription-drug-pill-mill-epidemic



a. “Scott's move to scrap a prescription narcotic database intended to temper the excesses of South Florida's rogue pain clinics makes no sense. Unless the governor somehow likes the drug tourism, overdoses and other human wreckage spawned by our pill-friendly culture. If it's not government's role to monitor controlled substances, then why bother monitoring anything? Let's just do away with driver's licenses, vehicle registrations and concealed weapons permits too, since cars and guns are legal. The database had support from just about everyone — legislators, law enforcement, responsible doctors and pharmacists and legitimate pain clinics.”

3. Pill mills: Scott, legislators undermining efforts, by Mike Fasano and Nan Rich http://www.sun-sentinel.com/news/opinion/fl-pills-oped0213-20110213,0,3980383.story

a. “Legislature is essentially allowing unneeded deaths to continue. It is, therefore, imperative that the legislature get out of the business of approving rules for bills that it has already passed. In the case of the Board of Medicine's rules, lives are at stake. Finally, the governor has eliminated the Office of Drug Control, which provides an important focus on the problem of drug abuse, and coordinates the numerous state agencies affected by this issue. State agencies across the board must deal directly or indirectly with the consequences of drug abuse, including our courts, law enforcement, prisons, foster care system, Veterans' Administration, health departments, mental health programs and even port security agencies. That's why the work of the ODC to coordinate the drug control efforts of each of these agencies is imperative, and why we're disappointed to see Gov. Scott unilaterally shut down this agency by laying off its entire staff. We therefore hope our legislative colleagues will consider taking immediate action to put our tough new pill mill regulations into action, and that the governor will put the Office of Drug Control back to work, and preserve the Prescription Drug Monitoring Program. This issue isn't about bureaucracy or the size of government — it's literally a matter of life and death.”



We should not ponder the question why our new Governor is not getting it. Instead, we should take action and develop a collaborative network of allies and supporters across the political spectrum to push back. Now its time to act! You can follow me on Twitter www.twitter.com/dadedoc or at http://floridadocs.blogspot.com



Yours truly,



Bernd Wollschlaeger.MD

Governor Scott and the PDMP

Governor Scott and the PDMP:



The Governors proposal to eliminate the Prescription Drug Monitoring Program (PDMP) surprised many supporters of this project. Currently, the PDMP implementation has been stalled by a protest from a software company, which bid for the contract and lost.

The PDMP would require doctors and pharmacies to enter and report each and every prescription for controlled substances. With the help of the database healthcare professionals and, under very restricted and monitored circumstances, the police could then crosscheck the database for anyone who has received multiple prescriptions of narcotic drugs from multiple sources, a common practice among addicts and drug dealers who amass large quantities of drugs from so-called “pain clinics.”

The law establishing the PDMP clearly stipulated that it to be financed without tax dollars. It would be run with more than $500,000 raised from drug makers, foundations and federal grants, which would have to be returned.

Without a functioning PDMP unscrupulous pill-mill owners and their drug dealer cronies in white coat can obscure and conceal the dispensation of millions of prescription narcotics taking place behind the pain-mill walls.

Governor Scott argues, "That program has not been working," even though is has yet to be implemented! The fact that NO tax dollars have been or will be used for developing and deploying the PDMP one is left to ponder the question what is driving our Governor to make such a foolish decision?

The reason is clear: ideological blinders prevent him from realizing that seven (7) Floridians die every day from prescription narcotic overdose. He firmly believes that government can do only harm and that regulations will prevent business to thrive and prosper. That includes drug dealers, fraudsters and thieves too!!

The time has come to stand up and speak up. We cannot allow him to dismantle the product of years of hard work. Lets not waste this opportunity to protect our public health and safety.



Yours truly,

Bernd