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
Wednesday, April 20, 2011
Sunday, April 17, 2011
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
* 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
Thursday, April 14, 2011
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
I urge you to continue pushing your legislators to support the House ( HB7095) and Senate bill (SB818).
The battle is not over yet !!
Yours
Friday, April 8, 2011
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
"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
Saturday, April 2, 2011
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
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
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