New Mexico where we now have the highest death rate in the nation from accidental painkiller overdosage. While the causes of the problem remain complex, the solution, or at least a part of the solution, is obvious: oversight.
Unlike illegal drugs, prescription drugs come from known manufacturers, pass through known distributors to known pharmacies where they are dispensed as prescribed by known prescribers to patients. So how then are these drugs ending up being so widely abused?
There are several ways:
Prescription Monitoring Programs are State-funded online databases that are designed to catch over-prescription and doctor shopping by placing ALL controlled substance prescriptions into a readily visible web-site that can be accessed by prescribers, pharmacists and law enforcement. This means that if "Patient X" is doctor-shopping and has received ten prescriptions for Oxycontin from different doctors over the last two months, the eleventh doctor can learn this simply by looking the patient up on the database. In theory, this should work perfectly... IF every prescriber actually checks the PMP BEFORE writing a controlled substance prescription. And that is the problem... they don't always check. In fact, many physicians still don't have accounts on the State PMP and therefore cannot look patients up. All that is about to change in a big way here in New Mexico.
Starting August 10, 2012, all New Mexico physicians are required by law to register with and most important, to actually use the New Mexico State PMP. Specifically this means that every one of us is REQUIRED to perform a PMP search on EVERY new patient to whom we issue a controlled substance prescription. This rule should , at least in theory, bring "doctor shopping" to a halt by exposing patients engaged in the practice.
Will it work?
I think that it will work. It will make it virtually impossible to doctor-shop and it will expose rogue prescribers. That is all very, very good, but there may be troubling consequences as well. They include several issues:
So far I have been writing about prescription pain-killers, drugs like Vicodin, Morphine, Oxycodone and so on. But the PMP covers ALL controlled substances including those that are not narcotics and including drugs like phentermine, phendimetrazine and diethylpropion. In other words, nearly all of the medications that we use in bariatric medicine must be reported to the PMP. This raises several issues that I want to address.