Future uncertain for Kansas prescription drug monitoring program

Pharmacist Michael Conlin of Topeka's Jayhawk Pharmacy logs onto the online system for the state's Prescription Monitoring Program, which also still allows reporting using paper forms.  The program allows the tracking of prescriptions that are controlled substances and is intended to safeguard against prescription abuse. The system is relatively new in Kansas but use of it has grown quickly. Future funding for it remains an open question.

Pharmacist Michael Conlin of Topeka's Jayhawk Pharmacy logs onto the online system for the state's Prescription Monitoring Program, which also still allows reporting using paper forms. The program allows the tracking of prescriptions that are controlled substances and is intended to safeguard against prescription abuse. The system is relatively new in Kansas but use of it has grown quickly. Future funding for it remains an open question. by Phil Cauthon

Since the launch of the state’s electronic monitoring program early last year, officials at the Kansas Board of Pharmacy have fielded more than 156,000 digital queries from a growing number of doctors and pharmacists who use K-TRACS to check on possible prescription abuse by their patients.

Despite its apparent success, the prescription drug monitoring program faces extinction as early as this fall when the federal grant money that has sustained it ends, said Christina Morris, the program’s director.

“If we don’t find funding,” she said, “we shut down.”

K-TRACS began with a two-year, $400,000 grant from the U.S. Department of Justice that ends in October. Morris said replacement funding hasn’t been identified.

The National Association of State Controlled Substance Authorities also provided about $32,000 for the program, but those dollars are dedicated to special projects.

The Kansas Legislature authorized the monitoring program in 2008, but it took awhile for the federal funding to materialize so it could be implemented.

Kansas doctors and pharmacists began querying the database in April 2011. Since then, the number of registered users has grown from about 850 to about 5,500. The system allows the medical providers to log on to the computerized database using a software called RxSentry and review the prescription histories of their patients. Without the K-TRACS system, it would be difficult for the doctors or pharmacists to know if the patients already had similar or the same prescriptions from other providers.

Kansas is one of 49 states to authorize a prescription drug monitoring program, according to the Alliance of States with Prescription Monitoring Programs. Missouri is the only state without one.

'Growing, deadly epidemic'

A primary purpose of the programs is to reduce what the U.S. Centers for Disease Control and Prevention has called the “growing, deadly epidemic of prescription painkiller abuse.”

Prescription painkiller overdoses killed nearly 15,000 people in the United States in 2008, according to the agency. That’s more than three times the number of people killed by those drugs in 1999.

The prescription drug databases track individual drug purchases, giving pharmacists, doctors and regulators a tool to see a patient’s complete pharmaceutical record.

The aim is to prevent so-called “doctor shopping,” when addicts obtain overlapping prescriptions from a number of physicians and fill them at various pharmacies.

Continue reading at khi.org/ktracs

Tagged: monitoring, ktracs, drug, k-tracs, kansas, addiction, prescription, abuse, system, controlled, substance, program

Comments

Alceste 2 years, 5 months ago

Piffle. More political correctness being foisted on the public and doctors making it more and more difficult to treat pain correctly. What? Accupuncture now? Yoga? Bert Nash sessions? Why is it "OK" to prescribe so many "happy pills" (Zoloft, Paxil, Prozac, etc.) and not pain medication?

There is a Pain Crisis in America. Its primary manifestation is the routine and widespread under-treatment of pain, especially chronic, non-cancer pain. Other manifestations include a severe and growing shortage of physicians willing to prescribe morphine and related opioid analgesics, the widespread use of more toxic and less efficacious classes of medications in an effort to avoid opioids, and the profound distortion of medical education and of the doctor-patient relationship.

How large a problem is under-treated pain in America? In a 2001 article in the Journal of the American Medical Society (JAMA), Brian Vastag reports on the work of Richard Brown and colleagues who stated, at a National Institute on Drug Abuse (NIDA) symposium in April 2001, that there was widespread acknowledgment that both acute and chronic pain are undertreated. Brown estimated that more than 17% of Americans have serious chronic pain and that many go untreated and many more are undertreated. [Vastag, 2001] This is the pain crisis in America.

In an attempt to gauge the extent of the problem, these researchers developed a survey that measured the prescribing practices for benzodiazepines (Valium and related sedatives) and for opioid analgesics by different groups of physicians in response to variations of a single presented case. The physicians' prescribing decisions were then compared with recommendations from a panel of pain management experts. The findings were stark:

While the expert panel recommended that virtually all patients with [common idiopathic back pain] who do not respond to other treatments be given an opioid analgesic, only 20% of physicians said they would actually write that prescription... "It suggests there's a lot of unnecessary suffering," said Brown. To combat the problem, he called for increasing the amount of medical school education devoted to pain management, from the typical 2 to 4 hours to 16 or 20. [Vastag, 2001]

http://www.doctordeluca.com/Library/WOD/WOD-PCA060404cWeb.htm

Western European doctors are far more understanding of pain rather than USA trained doctors. "Learn to live with it". Good riddance to this Big Brother tracking program. Why is the USA such a backwards and judgemental place in so many instances? Guys like Rush Limbaugh can buy their way into as much oxycontin as he wants but a person, following....oh....say a tooth extraction.....can't even get Tylenol #3? Incredible......

Ryan Neuhofel 2 years, 5 months ago

"More political correctness being foisted on the public and doctors making it more and more difficult to treat pain correctly."

How does giving health care providers (doctors, nurses and pharmacists) access to a patient's accurate and up-to-date prescription information make it MORE difficult to treat pain correctly?

Alceste 2 years, 5 months ago

Do you not believe and/or trust your own patients, Doctor and their own self reporting? If you do not, Alceste respectfully suggests you leave the business/profession. Why not weigh in on the other data provided....that pain is UNDER treated in the USA....a good deal due to the value laden morality of the "doctor". "I know you're faking.". Too, why is "the system" set up that the patient has to personally go to Topeka to get a copy of the record? What happens when someone is residing in Garden City....and to top it off....an "appointment" has to be set up? Incredible. http://www.hidinc.com/assets/files/kansaspmp/Patient%20Request%20Form-v3.pdf

Alceste has read the Doctor's value opining relative to Whitney Houston. Bet money the good doctor would prescribe Zoloft or Lexapro in a New York second......just the next generation of "dope" to be banned.....as well it should be....so it probably won't be

Ryan Neuhofel 2 years, 5 months ago

Unfortunately, this is not strictly a matter of "trust" between patients and doctors. From my experience working in ERs, I (and any other doctor) can tell you it is not possible to develop 'trust' with a person based on a 10-15 minute isolated encounter. Also sometimes patients cannot remember the details of their medications and it's very helpful to verify them.

"Appropriate" treatment of chronic pain is a very debatable issue and many "experts" have wide-ranging opinions about opiate medications. There are entire journals and conferences dedicated to this topic, so it's too large of topic to debate on a message board.

Regarding KTRACs, I still fail to see how the doctor having MORE information is a bad thing. If we are going to give health care providers the authority to manage "controlled" substances, I believe we should give them every tool to do so in an open and transparent way.

Actually, I am very conservative when it comes to prescribing any psychoactive medications, including anti-depressants. My "Whitney Houston" article was a cautionary tale about a specific class of medications (Benzos), not an endorsement for widespread use of SSRIs.

Ron Holzwarth 2 years, 5 months ago

If you think that Zoloft, Paxil, and Prozac are "happy pills", you are sadly mistaken, and have obviously never used them.

Ron Holzwarth 2 years, 5 months ago

Zoloft = Sertraline is used to treat depression, obsessive-compulsive disorder (bothersome thoughts that won't go away and the need to perform certain actions over and over), panic attacks (sudden, unexpected attacks of extreme fear and worry about these attacks), posttraumatic stress disorder (disturbing psychological symptoms that develop after a frightening experience), and social anxiety disorder (extreme fear of interacting with others or performing in front of others that interferes with normal life). It is also used to relieve the symptoms of premenstrual dysphoric disorder, including mood swings, irritability, bloating, and breast tenderness. Sertraline is in a class of antidepressants called selective serotonin reuptake inhibitors (SSRIs). It works by increasing the amounts of serotonin, a natural substance in the brain that helps maintain mental balance.

Ron Holzwarth 2 years, 5 months ago

Paxil = Paroxetine comes as a tablet, a suspension (liquid), and a controlled-release (long-acting) tablet to take by mouth. It is usually taken once daily in the morning or evening, with or without food. You may want to take paroxetine with food to prevent stomach upset. Take paroxetine at around the same time every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take paroxetine exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

Shake the liquid well before each use to mix the medication evenly.

Swallow the extended-release and regular tablets whole; do not chew or crush them.

Your doctor may start you on a low dose of paroxetine and gradually increase your dose, not more than once a week.

Paroxetine controls your condition but does not cure it. It may take several weeks or longer before you feel the full benefit of paroxetine. Continue to take paroxetine even if you feel well. Do not stop taking paroxetine without talking to your doctor. Your doctor will probably decrease your dose gradually. If you suddenly stop taking paroxetine, you may experience withdrawal symptoms such as depression; mood changes; frenzied or abnormally excited mood; irritability; anxiety; confusion; dizziness; headache; tiredness; numbness or tingling in the arms, legs, hands, or feet; unusual dreams; difficulty falling asleep or staying asleep; nausea; or sweating. Tell your doctor if you experience any of these symptoms when your dose of paroxetine is decreased.

Ron Holzwarth 2 years, 5 months ago

Prozac = Fluoxetine (Prozac) is used to treat depression, obsessive-compulsive disorder (bothersome thoughts that won't go away and the need to perform certain actions over and over), some eating disorders, and panic attacks (sudden, unexpected attacks of extreme fear and worry about these attacks). Fluoxetine (Sarafem) is used to relieve the symptoms of premenstrual dysphoric disorder, including mood swings, irritability, bloating, and breast tenderness. Fluoxetine is in a class of medications called selective serotonin reuptake inhibitors (SSRIs). It works by increasing the amount of serotonin, a natural substance in the brain that helps maintain mental balance.

Ron Holzwarth 2 years, 5 months ago

Source for the above: 'U.S. National Library of Medicine - The World's Largest Medical Library'

Source for Alceste's opinions: Things that Alceste dreamed up.

Alceste 2 years, 5 months ago

The entire SSRI family of drugs, not to mention the SNRI group, are today's "happy pills". Over prescribed; dangerous.....far more so than the benzodiazapine family; addictive; and did I say dangerous: modifying brain chemistry on a FOREVER type of basis....

Let's just take a look...at....oh.....Lexapro, ummmm k? http://www.nytimes.com/2009/09/02/business/02drug.html

The insurance industry, along with greedy doctors have destroyed mental health services in the USA and there is no turning back. 7 psycho-therapy sessions and then a life time supply of "happy pills" ("happy pills" because the MASK symptoms.....they're not a "cure"...). Great. No thank you. Bring back psychoanalysis and psychotherapy, please.

Ron Holzwarth 2 years, 5 months ago

Lexapro? What netherworld did you dream that up from? That was not being discussed. Neither were Quaaludes either, for that matter.

Since you have the opinion that you are more educated than someone who has finished 4 years of college, 4 more years of medical school, a year of internship, followed by 2 more years of psychiatric school, followed by another year as an intern, you need to see a psychiatrist because you are wildly delusional.

Ron Holzwarth 2 years, 5 months ago

There is another, far greater issue involved here. Pain medications were being discussed, and Alceste suddenly threw a red herring into the stew when she suddenly switched the subject to psychotropic medications.

I am not a psychiatrist, but it's my opinion the tendency to do something like that is indicative of the Attention Deficit Hyperactivity Disorder (ADHD) syndrome. People with that problem jump from subject to subject, rarely complete a thought, and the points they think they are making make sense only to them.

There is help available, it's not a terribly serious condition.

Alceste 2 years, 5 months ago

Lexapro is pretty much the same as all the other poisons poster Ron Holzwarth listed. It's an SSRI. Did you read the report?

Certainly, back to the under prescribed drugs.....the pain medication family.....did you read the JAMA report on the very facts centering around the disinclination of the "professional medical provider" to properly provide opiod based medicine or did you just decide to shoot the messenger?

We live in a value laden, moralisitic, backwards hillbilly state which has far too many gate keepers and even far too many Dream Police. The defunding of this centralized reporting joint is a good thing. It was established to create "do nothing" jobs in the pharmaceutical industry. It has no oversight; does as it pleases; and Alceste believes quite possibly is a violation of the basic civil rights of every Kansan. Good riddance.

Alceste 2 years, 5 months ago

PS: And codeine is available over the counter in Canada? Yup, sure is.....

Ron Holzwarth 2 years, 5 months ago

Everyone should listen to their doctor or psychiatrist before taking Alceste seriously. Many years of medical training, followed by two years of internship, trumps any opinion that a layman might have.

Alceste: "Bring back psychoanalysis and psychotherapy, please."

That really sums it up. She's stuck in the 1950s, but possibly all the way up into the early 1960s, school of Freudian psychoanalysis. Sigmund Freud died in 1939, and almost all of his psychoanalytic methods have been thoroughly discredited.

Ron Holzwarth 2 years, 5 months ago

This is a repeat of a posting I made on this same topic a couple weeks ago, with a possible minor error corrected:

I used to know a person that had a problem with abusing prescription pain killers. He also had a drinking problem. One time, he was less than 5 minutes from death. See my comments following this article for the details of that exciting event:

He had the most excellent job possible for someone with a prescription drug habit. It was his job to collect the medications for deceased patients at a large hospital, flush them, and sign that they had been disposed of.

Yes, they certainly were disposed of, but not quite the way they were supposed to be. He had a fantastic collection, I saw it once. They were all different colors, many dozens of colors, hundreds of pills, and they were actually quite pretty scattered all over the black and white linoleum tile. The picture was completed by his passed out body on the kitchen floor, and his dog gingerly stepping over him to go get a drink of water.

I thought to myself, '(TOS violation), not again! I've got to move out of here!'

That was after the time he almost died, I think. He did something amazing once. There is a extremely powerful painkiller called Fentanyl. It is available in a transdermal patch, to administer a very low dose over a period of time. He used a scissors to cut off one end of the patch, and licked the jell while he was drinking. He lived.

Then, quite a long time after I had moved out, I was told he had moved a long ways away, over 1,000 miles, and was now off the painkillers, didn't handle the disposal or handling of them, and so there wasn't a problem anymore.

The next thing I heard, he had lost his job and license, for swiping pills. Now he is a bartender. I am sure that his present income has necessitated a severe change in his lifestyle.

The Moral Of The Story: Do not trust the fox to guard the hen house.

Alceste 2 years, 5 months ago

Lexapro is pretty much the same as all the other poisons poster Ron Holzwarth listed. It's an SSRI. Did you read the report?

Certainly, back to the under prescribed drugs.....the pain medication family.....did you read the JAMA report on the very facts centering around the disinclination of the "professional medical provider" to properly provide opiod based medicine or did you just decide to shoot the messenger?

We live in a value laden, moralisitic, backwards hillbilly state which has far too many gate keepers and even far too many Dream Police. The defunding of this centralized reporting joint is a good thing. It was established to create "do nothing" jobs in the pharmaceutical industry. It has no oversight; does as it pleases; and Alceste believes quite possibly is a violation of the basic civil rights of every Kansan. Good riddance.

Ron Holzwarth 2 years, 5 months ago

I didn't have to read the report to know that Prozac was one of the worst possible drugs for me. I was given that for clinical depression, later my diagnosis was changed to bipolar. For me it was a terrible drug, but for other people, it is an excellent choice.

A competent psychiatrist will select from a large number of medications that are now available. I am quite sure there will be others in the future that are more effective, but for the time being, the doctors have to use what is available.

Earlier I was wondering if Alceste has ever tried to reason with a person with full blown schizophrenia, and tried to convince someone with that condition that their delusions are not real. I have done that. It does not work.

And, I wondered how much time Alceste has spent in a psychiatric ward with members of the military who have come back with Post Traumatic Stress Disorder (PTSD). I am quite sure that the time she has spent with such patients is very small, unlike me. I have seen them, and it is obvious that psychotherapy does not work.

If Alceste would spend about three weeks in a psychiatric ward, listening to the problems that many people have to deal with on a daily basis, I think that it's possible that she would realize that not everything is found in some dusty book that no psychiatrist has ever seen.

The danger of a layman with no training spouting off opinions that are based upon no medical science whatsoever is that people who really need help will remember that they saw a newspaper commenter with no medical training at all giving them advice which is contrary to what any competent psychiatrist will ever give them.

Ron Holzwarth 2 years, 5 months ago

This is a posting I made on this forum on June 19, 2012:

I'm from St. Francis, Kansas, the small town, population about 1,500, that made national news in 1992, and there is even a 'History' episode titled 'American Justice: A Questionable Doctor' about the event. I have it on both VHS and DVD.

Synopsis: Dr. Stan Naramore gave a dose of morphine to Mrs. Ruth Leach, one of his terminal cancer patients, because she complained of horrible pain. At the time, her life expectancy was perhaps 2 days.

Her son, Jim Leach, was a paramedic and present at the time.

He thought that she was being given too much morphine, and stated: “I’d rather my mother lay there and suffer for ten more days than you do anything to speed up her death.”

After that, Dr. Naramore decided he did not want to continue with Mrs. Leach’s care, and arranged for her transfer to another hospital. She received additional morphine at the new hospital, and died a few days later.

Some of the townspeople became very upset, partly because of that, and also because a lot of people didn't like him very much, and put Dr. Naramore on trial for the death of Mrs. Leach and also because he shut off the mechanical ventilator of a patient that he and another physician had already pronounced dead.

He was convicted of two counts of 1st degree murder, and ended up in prison for a while.

On appeal, there was not another trial, instead the three appellate court judges chose to dismiss the charges altogether.

Then, Dr. Naramore's medical license was reinstated.

Later, there was new legislation passed in Kansas that requires a medical review by professionals before small towns can convict physicians of murder for prescribing pain medication.

Ron Holzwarth 2 years, 5 months ago

There's an error there: Dr. Naramore was convicted of attempted murder, not murder, because his script for morphine was not administered. So, Mrs. Leach lived a few more days.

Ron Holzwarth 2 years, 5 months ago

It is a fine line between sufficient pain relief and too much, which might be subject to abuse or diversion.

But, this problem will be solved by our society in general, and not on a newspaper forum. It is certainly worth discussion, and that should be done at much higher levels than where it is being done now.

Ron Holzwarth 2 years, 5 months ago

I could tell quite a story here about a man who was not given nearly enough pain medication for an extremely serious problem. It was horrific, and I think he had reached the point of suffering withdrawal symptoms if he didn't get more than the doctor prescribed.

What had happened was that he overused the pain medications at first, and then later, when he really needed them, they were not as effective as they were before.

So, there was a great deal of running around, and quite a large expenditure of money, all to chase down some pills that he was sure he needed. It wasn't that difficult to line them up, because a terminal cancer patient was given more pills than I could believe, but finding money, and then finding him while he still had some pills left was the problem.

So, about street drugs, I know all about it. I could write a book.

Ron Holzwarth 2 years, 5 months ago

(Judging from the sheer number of comments I have made on LJWorld and Wellcommons, I already have.)

Ron Holzwarth 2 years, 5 months ago

And doctor shopping, yeah I know one doctor shopper. Sorry, I'm not going to give a name though.

Alceste 2 years, 4 months ago

Wm. S. Burroughs noted the 'script writers were croakers. Who needs to "doctor shop" when these "croakers" are all over the place, poster Ron Holzwarth? http://www.themonthly.com.au/nation-reviewed-gail-bell-croakers--1854

People who want to get high are going to get high irrespective of any "tracking system" anywhere; anyplace, anytime, anywhere. Moralists stand in the way of those in pain and that's all there is to it. shrug

People who ain't got the dough to pay croakers go to the back alleys and, evidently, several types of people poster Ron Holzwarth seemingly has chosen to have had regular contact with and even lived with.....not to mention what's on the world wide web. Judge away....use of pain medication will be with us until the sun stops rising in the east and setting in the west. The moralism and judgemental actions of the few (including the maniacal anecdotes of poster Ron Holzwarth) only make the matter all the more complicated. Nobody.....and Alceste does mean nobody.....should have to experience pain of any sort simply because some gatekeeper believes "....aches and pains are a part of everyday life.....". No. They're not.

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