Louisiana has more opioid prescriptions than residents.

"Louisiana is one of eight states that has more opioid prescriptions than it has residents. The state has the sixth highest prescription-per-capita rate at 1.03 pain-killer prescriptions written per Louisiana resident in 2015.

But Holcombe argues more can be done, like making better use of the Prescription Monitoring Program operated by the Louisiana Board of Pharmacy.
The database includes anyone in Louisiana that has been prescribed a controlled substance. The problem, Holcombe points out, is that it is not mandatory for every prescriber to check first.
“It has been hugely important, but curiously, it is required that pharmacists check it before administering the prescription but not physicians before prescribing,” he explained.
Changing that would be “a very, very simple thing that could be done to squelch the over-prescribing taking place,” Holcombe said."


Read more about it here.

These States Require Opioid Prescribers to Check for 'Doctor Shopping'.

http://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2016/05/09/states-require-opioid-prescribers-to-check-for-doctor-shopping



(Map does not includes recent addition of the state of California who enacted this law on 9/27/16)

'Doctor shopping' targeted in new law signed by California Gov. Brown.

On September 27, Governor Jerry Brown signed into law a bill that requires all prescribers to check the state-run prescription database (known as CURES 2.0) before prescribing opioid painkillers, sedatives or any other schedule II, III or IV drugs.

http://www.latimes.com/politics/essential/la-pol-sac-essential-politics-updates-gov-brown-acts-to-curb-epidemic-of-1475015236-htmlstory.html

Metairie, LA doctor arrested for threatening law enforcement.

"“As alleged, rather than doing no harm as a physician, Shannon Ceasar illegally dispensed Oxycodone into a community struggling with an epidemic of opioid addiction,” stated U.S. Attorney Polite. “Then, when the governing medical board and law enforcement dared to challenge his criminality, Ceasar threatened to kill them. This level of disregard for human life, particularly from a physician, is absolutely despicable.”"

http://www.wwltv.com/news/crime/metairie-doctor-arrested-for-threatening-law-enforcement/280900794

Inter-State Update

Good news for patient monitoring & diversion prevention professionals:

The Louisiana PMP has added Texas to the states accessible on it's site.
With the current access to Mississippi and Arkansas, this provides access to all adjoining states.

Comprehensive Addiction and Recovery Act (CARA)

An update from Shatterproof.org, on the recent passage of the CARA.
Read the entire post here.

"This bill is an important first step, addressing the opioid epidemic in several ways. It authorizes $181 million in spending for treatment, prevention and recovery programs, and it allows nurse practitioners and physician assistants to prescribe buprenorphine to help treat opioid addiction. Most notably, it is clear recognition by both Congress and the administration that addiction must be treated as a health issue, not a crime."

Excerpt from: "State Policies Regulating the Practice of Pain Management: Statutes, Rules, and Guidelines That Shape Pain Care", American Academy of Pain Management - August, 2016
( http://blog.aapainmanage.org/state-policies-regulating-practice-pain-management/ )

"Over the past 2 decades, pain management in the United States has increasingly come to rely on opioid analgesics as a primary treatment. As a result, there has been a sharp increase in opioid prescribing, with opioid analgesic prescriptions, by weight, quadrupling since 1999. Concomitantly, there has been a dramatic in- crease in overdose deaths involving prescription opioids, with those rates also nearly quadrupling between 1999 and 2008. Although virtually nothing more is known about the circumstances of these overdoses, numerous agencies led by the US Centers for Disease Control and Prevention have called for states to establish more stringent policies with respect to opioid prescribing. The inherent message is: Decreased prescribing is a principal way to achieve fewer overdose deaths."



See link:   http://www.sciencedirect.com/science/article/pii/S1932227516000112

From A Clinic Secure ~

One of the largest sources of illegal opioid use is from diversion; the intentional diverting of prescription drugs by those to whom it is prescribed. In many states, the first response to this problem is to close the clinic from which these prescriptions were written.

While there are cases of doctors over-prescribing or engaging in illicit distribution, my research shows that these are rare occurrences, especially compared to the amount of willful diversion by prescription recipients, and the acquisition of these prescriptions through illegal activity, including doctor shopping and fraudulent medical reports.

We have, in fact, seen a marked increase in the sale of forged MRI and/or X-Ray reports, and prescription printouts, designed to acquire narcotics via fraud.  There is even a black market for these forged documents, alone. This too, is becoming a cottage industry.

At A Clinic Secure, we provide constant, meticulous protection from these activities. While no one can promise to put an end to these practices completely, our initial success rate at uncovering these activities is in the high 90% range. Under our watchful eye, nobody gets away with it for long. We are simply too thorough.

Further, we can and do  provide an ongoing record of checks and balances, proving that the clinic, and the doctors who work there, have made every possible effort to stem this diversion, and are willing to pass these irregularities on to the necessary authorities when it is discovered.

At one clinic alone, we averaged as many as four patients per week who were positive for doctor shopping or violation of their pain contract, just by thoroughly reviewing the PMP of every patient returning for a follow-up appointment.

Clearing patients before admitting has revealed ongoing criminal enterprises that include mass doctor shopping, forgery rings selling fake MRI and X-Ray reports, and those who “straw dog” the elderly, taking them to clinics with fraudulent information, and collecting their prescription drugs once the prescriptions have been filled.

Sadly, once discovered, many of these groups have left a trail of bodies, usually among high school and college aged kids, who died of opioid overdose from illegally available pain medication. This can and must be changed.

At A Clinic Secure, we provide a variety of programs to combat this epidemic, and at the same time, protect medical personnel from the back lash of illegal activity that usually goes on outside their sphere of influence, and far beyond their control.

These include full service contracts;

* Checking every single PMP for doctor shopping, conflicting drug use, early returns on refills, forged prescriptions and errors of record by participating pharmacies.

* Documentation of this work, with each PMP duly noted as having passed review or any notes required, should it not. Each and every PMP report is signed by the qualified staff member who reviewed it. You will know exactly who is responsible for your protection.

* Reports created and filed with the DEA, should the clinic or doctor of note find that necessary, or should it be required by law.

* Written or other personally provided testimony regarding any case in which we have been involved, whenever it is deemed necessary by the client. We are on your team.

* Clearing of any new patient to confirm and verify prescription lists and MRI/X-Ray reports, before admitting them to the clinic. This includes records from any state in the continental United States. If their hospital or medical facility exists, we will find it.

* HIPAA Certified & a Member of the Academy of Integrative Pain Management, all of our work meets the necessary guidelines required.

* We can provide basic patient questionnaires, HIPAA release forms & patient pain
contracts for this process.

Any and all of these services are available separately, or in various custom configurations, depending on the need of the individual clinic. This includes ongoing patient review or single PMPs pulled as necessary. Patients may be cleared in groups or as individuals.

We also train delegates for doctors who wish to do this in house.
Group seminars available. References and prices available by request.

For further information, contact:

A Clinic Secure
Office: 504 324-6258
Fax: 504 267-7992
Email: Secureclinic@cox.net
Web: aclinicsecure.com

Sincerely;
David Percival
HIPAA Certified ~ Member ~ Academy of Integrative Pain Management
(Formerly; American Academy of Pain Management)
( http://www.aapainmanage.org/ )

Beginnings.

When I began doing this work, in early 2013, there were just over two dozen states with a Prescription Monitoring Program (PMP) issuing a report of a patient’s prescription history of controlled drugs. Of those that did exist, none of them could network with each other.

It began for me with ‘clearing’ patients; pulling a PMP going back two years and checking it for inconsistencies or doctor shopping. I then contacted the facility where their MRI or X-Ray had been generated to verify its validity. I had to explain what I was doing and why, and was often refused, until I made clear I had a HIPAA ( http://www.hhs.gov/hipaa ) release form, signed and ready to fax.

In short order, it became apparent that some of these perspective patients had perfectly legitimate medical problems, the test records to back them up, and were still going from clinic to clinic, seeking multiple prescriptions for the same condition. This ‘doctor shopping’  could still easily occur even after they had been cleared and accepted.
( https://en.wikipedia.org/wiki/Doctor_shopping )

A ‘pain contract’ was implemented, between the doctor and patient, to let patients know this was both illegal and not to be tolerated by the clinic, or doctor of note. This agreement allowed for real pain management, rather than just the dispersal of pills. The use of non-emergency pain medication for other conditions (surgeries, dental work, broken bones) required a release form be signed by the patient and added to their file, complete with a new confirmation of these records. Patients agreed to random drug tests, both to prove they were not using illicit substances and to prove their prescribed medications were in their blood stream.

We began to pull a PMP for each patient, just before each follow-up appointment.
Today, I believe that 48 of 50 states now have a PMP program, and from here in Louisiana, we can access the PMP files of Mississippi, Arkansas, South Carolina and Connecticut.( http://www.deadiversion.usdoj.gov/faq/rx_monitor.htm )
 
An organization called Shatterproof ( http://www.shatterproof.org ) has begun working both to de-stigmatize addiction and subsequent treatment, and has released their own report on the use of PMPs to prevent addiction, going so far as to ask Congress to mandate the use for them by doctors prescribing opioid pain medication.

While I am unsure how that would work, I am unable to offer them support at this time, although I believe that this is a necessary path down which we all must eventually go.
 
I will, in future posts, describe the methodology with which we have achieved years of success in treating patients, kept clinics safe from many who would seek drugs illegally, done our due diligence in reporting those cases, and earned a reputation for both of these things.

As the founder of A Clinic Secure, a New Orleans based Patient Monitoring and Diversion Prevention consulting firm, it is my goal to both limit the exposure of society to illegally sourced prescription drugs, and to offer protective services to the thousands of doctors who prescribe these medicines in good faith, with no other goal than limiting the suffering of those in need of them. In the end, it is the legitimate patients who must come first.

David Percival
Patient Monitoring & Diversion Prevention ~ New Orleans, LA
Member ~  Academy of Integrative Pain Management
( http://www.aapainmanage.org/ )