Tuesday, February 7, 2012

Rx for Drug Problem: FL and CO Examples

Florida's crackdown on "pill mills", HB 7095, signed into law June 3, 2011, banning physicians from dispensing drugs on Schedules II and III of the DEA's controlled substances list, is being credited by state lawmakers with drastically reducing the purchase of the painkiller by physicians last year and reducing its overall purchase by pharmacies by 14%.

According to a report issued last week by the U.S. Drug Enforcement Administration (DEA), the number of doctors appearing on its national list of the top 100 U.S. physicians ranked by the volume of oxycodone they purchase dropped from 90 in 2010 to only 13 in 2011.

The 2011 list of oxycodone-purchasing doctors, published through the agency's Automation of Reports and Consolidated Orders System (ARCOS), showed 21 doctors listed in the top 100 now practice in Georgia, and another 11 practice in Tennessee.

The DEA said monthly purchases of oxycodone by Florida pharmacies increased slightly during January, February and March of 2011, while HB 7095 was being debated, and then began to drop significantly.

In addition to banning doctors from dispensing drugs on Schedules II and III of the DEA's controlled substances list, except as samples and during periods following surgeries, HB 7095 required doctors to resell their remaining inventories to wholesalers or turn them over to the Florida Department of Law Enforcement.

The law also required the Florida Department of Health to launch the state prescription drug-monitoring program (PDMP) last fall.

Pharmacies are required to supply the PDMP database with the names and other information of all persons receiving controlled substances, the dates the drugs were purchased, the quantities purchased, and information on prescribing physicians.

Georgia, Kentucky and Tennessee seem to be absorbing the business that has left Florida, according to the DEA report, demonstrating the difficulty of containing prescription drug dispensation issues within state borders.

In the meantime, Colorado is jumping on the bandwagon with new medical treatment guidelines for chronic pain and complex regional pain syndrome that include a threshold above which physicians should closely monitor opioid prescriptions and a dosage that should not be exceeded.

The updated guidelines, which take effect on Feb. 14, recommend providers screen injured workers for a history of substance abuse problems and obtain a consultation from a pain specialist before starting treatment with opioids. Providers should also have a patient sign a treatment contract indicating knowledge about the risks of addiction and that results of mandatory urine tests can be made available to employers.

Colorado's guidelines have similarity to Washington's move on prescription drugs, setting 120 milligrams of morphine equivalents per day as a dosage threshold.

The American Journal of Industrial Medicine in December said that dosage amounts in Washington, which peaked at 144.7 mg per day in 2002 had dropped to 113 mg in the third quarter of 2009 and 105 mg by the end of 2010. The study also found the number of opioid-related deaths among injured workers dropped 57.1% from a 15-year high of 35 in 2009 to 15 in 2010.

Each of these state moves is encouraging, but really are only band-aids attempting to quell symptoms rather than treat the underlying problem. I've said it before, "follow the money." There are forces at work behind prescription drug black marketing that are bigger than guidelines and physician bans, which is why the DEA found migration in such business to other states when Florida made it harder to sell.workers compensation, work comp, injured worker 

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