Thursday, February 5, 2015

In Opiate Abuse Prevention, PMP Timeliness is Godliness

By Doug Brockway
February 5, 2015

PMP data are collected monthly, or at best in some states weekly.  This is not sufficient to capture diversion, which can be done intraday with patients getting prescriptions from multiple doctors and filling them at multiple pharmacies in very short periods of time.

An enterprising “patient” can visit a doctor and get a prescription for a pain in the back, leave that office, go to another doctor, perhaps just doors down the hall, and get a prescription for a pain in the leg, and so on.  Perhaps a more frequent situation is the phantom patient that approaches a series of emergency rooms and clinics in an attempt to gain medication for phantom pains?

Then, or alternately, the enterprising patient can visit many pharmacies; a Walgreens at 10:00 AM, a CVS at noon.  Each with a different prescription, and keep doing this for some time, at least a week, before being found out.

Even if one believes that the only role of PMPs is aiding physicians in properly advising patients regarding their use of opiates there is something of a functional gap in the systems.  By not collecting activity in real-time the PMPs are forced to assist doctors and pharmacists with incomplete and thus inaccurate data.

From a process engineering perspective the penalty we all pay for this is not that we miss the opportunity to stop that last attempt at diversion that allows a patient to take the fateful step into addiction.  That we allow any such attempts because we haven’t made data collection (and use) real time we have permitted a diversionary environment.  This helps make PMPs, as currently implemented, inadequate to the tasks of prevention of doctor shopping and diversion.

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