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Medical Forum / General / Pharmacy / May 2006

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Doctor Shopping/Diversion....

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Mahheyta - 07 May 2006 17:37 GMT
In the state I live in, doctor shopping is a form of diversion and is
considered a crime.  For those of you who don't know what that is (and
I'm sure most do) it's going to multiple doctors for the same
controlled substance without the knowledge of the doctors.  For
instance, you could be seeing Dr. Jones for back pain and he is
prescribing 10mg Lortabs and also be seeing Dr. Smith for the same
thing who is prescribing Vicodin ES.  That is illegal here and is
actually considered a class D felony.  People have been prosecuted and
sent to prison for this, it's considered no different than forging a
script.  I'm wondering if it's the same in every state.

I have a friend who calls it "tweaking the system," but I disgree.
This type of behavior should be prosecuted in my opinion.  Here, we
have a prescription monitoring service that keeps track of doctors,
pharmacists and patients by keeping track of all controlled substances
that are prescribed, filled and purchased, how many states have this?
Would it be possible to have a federal system?

I read about a guy locally (some dunderheaded jackass) who was seeing
10 different doctors for the same things, interestingly, it took the
computer that is responsible for keeping track of diversion 10 months
to catch up with him!
Pumbaa - 08 May 2006 18:09 GMT
> In the state I live in, doctor shopping is a form of diversion and is
> considered a crime.  For those of you who don't know what that is (and
[quoted text clipped - 18 lines]
> computer that is responsible for keeping track of diversion 10 months
> to catch up with him!

It should be easy to catch Doctor Shopping by anyone who is using either
private insurance, Medicade or Medicare.  If office visits and pharmacy
visits are paid with cash then it will be a problem.  If we had a federal
system then we would have to have some sort of federal medical account
number. I don't think most Americans really like the idea of one ID number
to access your whole life style.  The Social Security number of a person
causes enought problems when it is used by a person that it is not issued
to.  Prohibition did not work for booze and it certainly does not work for
drugs.  It does make for a lot of criminals and crooked police officers.
Paul Trusten, R.Ph. - 13 May 2006 22:01 GMT
I was told by a New Zealander friend of mine that all New Zealand pharmacies
are online with each other, without regard to insurance plans. So, for
example, a prescription filled in Auckland would be cross-referenced with an
actual or therapeutic duplicate in Christchurch.
> > In the state I live in, doctor shopping is a form of diversion and is
> > considered a crime.  For those of you who don't know what that is (and
[quoted text clipped - 28 lines]
> to.  Prohibition did not work for booze and it certainly does not work for
> drugs.  It does make for a lot of criminals and crooked police officers.
Mahheyta - 14 May 2006 03:29 GMT
Interesting, That's the type of system I was referring to in my initial
post.  Assuming your friend means that ALL pharmacies are connected
with each other, not just pharmacies who share the same name.  For
instance, here in the states, all Walgreens are connected but for
states without their own individual prescription monitoring service,
that does nothing to stem diversion because their are hundreds of
different stores that don't share information.
Pumbaa - 14 May 2006 15:53 GMT
> Interesting, That's the type of system I was referring to in my initial
> post.  Assuming your friend means that ALL pharmacies are connected
[quoted text clipped - 3 lines]
> that does nothing to stem diversion because their are hundreds of
> different stores that don't share information.

One thing is certain if you are a doctor shopper then you had better support
your local independent drug stores. They are not going to have access to
chain pharmacies customer databases until they are forced  by some
government agency.  In my small town, so far, Wally World is the only chain
outfit with a pharmacy that I am blessed with. I don't use them myself, but
two independent pharmacies in my town have closed since Mao Mark opened.
Mahheyta - 14 May 2006 21:06 GMT
Here in Kentucky, they have a system called KASPER that keeps track of
these things and even the mom and pop pharmacies are required to report
any controlled substance that is filled to the state, be it Valium or
OxyContin.  Other states have follwed suit, I know Indiana, Texas,
Illinois and a few other states have similar systems.  Again, if you
play by the rules you shouldn't have any problems, that should be
obvious (not directing this at you at all but there are some people who
are extremely paranoid).
karl1973@my-deja.com - 09 May 2006 22:24 GMT
I view trying to track people as a gigantic waste of time, effort, and
resources.  If some junkie wants drugs, they'll get them one way or
another.  Everyone else gets treating like a criminal all to catch
those relatively few who do this.

And while we're arresting a guy who got too much Valium, for example,
other folks are buying unlimited amounts of booze at the liquor store.

Which do you think is more dangerous: unlimited amounts of 190-proof
Everclear from the liquor store or unlimited amounts of Valium from ten
doctors?  It strike me that the Everclear is vastly more likely to
result in death by OD and in the long run heavy drinking will destroy
your liver, a problem you won't have with Valium.

Prohibition didn't work 80 years ago.  The DEA has been around 35 years
trying to win the drug war with no end in sight.  When will our
politicians figure out drug prohibition doesn't work.  Never has, never
will.
Mahheyta - 10 May 2006 02:45 GMT
> I view trying to track people as a gigantic waste of time, effort, and
> resources.  If some junkie wants drugs, they'll get them one way or
[quoted text clipped - 14 lines]
> politicians figure out drug prohibition doesn't work.  Never has, never
> will.

You know, I'm on Klonopin, Vicodin and Ambien (albiet not all of them
on a regular basis) and I live in the most rigid state in the country
and I've never encountered a problem.  You won't, if you play by the
rules, why would you?

Remember, there wouldn't even be a system in place if not for the
crooked doctors who run pill mills and their patients who either wolf
down 200mg's of Oxy a day or sell their scripts to pay the rent.  When
OxyContin became available it wasn't long before if became a major
problem here, pharmacies were getting robbed, doctors were running
illegal pill mills and people were seeing multiple doctors to get the
same type of medication (be it Oxy or Hydrocodone).  Something had to
be done, it was and it has been relatively successful and will continue
to improve.  Even surrounding states joined in to prevent people from
border hopping to see different docs.

The same system also keeps track of the products that are sold in drug
stores used to make meth.  Since these cold medicines were put behind
the counter and people had to sign them out, meth lab seizures have
gone down 70 percent.  And it doesn't work?  BS.

As far as booze is concerned, I don't drink but I agree that alcohol is
more dangerous than many drugs, inluding marijuana.  As long as there
are parking lots at bars people will be driving drunk, a whole other
issue there.  Bottom line, I completely disagree that it's a "waste of
time" to track illegal pill poppers, quacks and crooked pharmacists.
karl1973@my-deja.com - 10 May 2006 09:24 GMT
You talk about the Oxy problem.  It was in large part a creation of the
media.  The evening news tells everyone that Oxy is "Hillbilly Heroin".
Before it made the news few people outside the medical community and
pain patients had ever heard of this drug.  And then the next day a
pharmacy is robbed at gunpoint and they ask for OxyContin by name.
Golly, I wonder where the junkies ever got this idea?  It's almost as
if they'd seen it on TV.  After making OxyContin a household name and
effectively telling the junkies what to ask for when they rob
pharmacies, then the media reports on the pharmacy robberies that they
played a clear role in.  They actually helped to make the news they are
reporting.

And one of the reasons junkies turned to Oxy was because the DEA was
squeezing their heroin supply.  Can't get heroin, so switch to
prescription drugs.

Capitalism is the most powerful force known to man.  As long as
somebody is willing to pay for drugs, there will be a supply.  The only
thing the DEA and other law enforcement can do is cut down on supply.
That raises prices and creates additional crime.  If a junkie steals
your car or robs you at gunpoint to pay for their expensive drug habit
(a habit that is only expensive due to prohibition) will you send the
DEA a thank you note telling them how safe they make you feel?

Milton Friedman estimated that drug prohibition results in 10,000
additional homicides each year in the US.  Do you wish to disagree with
a Nobel Laureate?  Every war results in death and the War On Drugs is
no different.
Pumbaa - 10 May 2006 15:07 GMT
<Snip>
> Milton Friedman estimated that drug prohibition results in 10,000
> additional homicides each year in the US.  Do you wish to disagree with
> a Nobel Laureate?  Every war results in death and the War On Drugs is
> no different.

Just how bad was the drug problem in the US before the Harrison Narcotic Act
was passed?  At one time a person could just walk into a pharmacy and buy
morphine or codeine.  There was Tincture of Opium, Paregoric, Cocaine (even
in Coca-Cola)TM etc.  I remember in the State of MS when I could buy
Paregoric without a Rx.  Sometimes the cops would find a junkie in a local
motel filtering it and removing the alcohol and shooting it IV.

However they were NOT! shooting people over it, robbing people, etc., and
the cops were not getting paid to look the other way.  If grandma wanted her
Tincture of Opium she could just go to the drug store and buy it.  Sure some
people were addicted to drugs way back then but today they are addicted to
drugs and called criminals.

Some places like Washington DC have tried firearm prohibition. It is now
illegal to own a handgun in DC. Yet DC has one of the highest, if not the
highest, murder rates in the entire US.  The government never learns from
history.
Mahheyta - 12 May 2006 22:09 GMT
Well, first of all, trying to compare todays society with the 1800's
and early 1900's doesn't make any sense.  Legalizing all scheduled
drugs in todays society would be an absolute train wreck.  The poor sod
busters who ran this country in those days simply didn't know any
better.  I'm not saying that there are not any flaws in the system but
until someone comes up with something better, I think we need to stick
with what we have and try to improve on it.  Legalizing all drugs is
not the answer. IMO

However, I don't see the need to keep marijuana illegal simply because
it's not a dangerous drug, provided the individual that's using it is
not driving or operating heavy machinery.  I think we could at least
make it easier for an individual to access the drug if he/she truly
needs it for medical reasons.  Be it MS, Cancer or AIDS.  It's my
understanding the Marinol is totally unreliable and has some nasty side
effects.  Perhaps someone with more knowledge about that paticular drug
can elaborate.

There have been some obvious benefits as a result of the system that's
in place here, it's nearly impossible for an individual to get away
with diversion on a large scale, especially for an extended period of
time.  Ask any doctor or pharmacist about the benefits of a tracking
system and I'm sure the vast majority would agree that it's a good
thing.

As far as the DEA being too rigid, it's going to happen.  You're always
going to have over zealous cops out there, whether they're traffic cops
or DEA agents.
 
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