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