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Narcotic Therapy for Patients with Chronic Non-Cancer Pain
Published in Gary W. Jay, Chronic Pain, 2007
In August, 2005, the National All Schedules Prescription Electronics Reporting Act (NASPER) of 2005 was passed into law (92). This bill, also called NASPER, enabled the establishment of a national prescription monitoring program, but at the state level. The purpose of the program was to enable pain specialists to see what drugs their patients, old and new, were obtaining, and from where. This bill has created significant concern from the physicians prescribing pain medications that it can be used to investigate them. Proponents of the bill indicate that the states may only disclose information to law enforcement personnel if it is related to furthering a specific investigation. Worry about erosion of medical privacy has grown, as have the fears of physicians, in spite of reported statements that physicians will monitor the DEA and state agencies to be certain that they are not profiling physicians.
Opioid prescribing patterns and overdose deaths in Texas
Published in Substance Abuse, 2021
Tiffany Champagne-Langabeer, Renita Madu, Sharmila Giri, Angela L. Stotts, James R. Langabeer
We relied on multiple data sources for this study. Prescribing data were extracted from the Texas Prescription Monitoring Program public use data file, the statewide monitoring program administered by the Texas State Board of Pharmacy. This database represents all prescription data for Schedule II, III, IV, and V controlled substances dispensed in Texas or for Texas residents.24 Primary variables extracted include drug name, controlled substance schedule, patient gender, city, insurance type, frequency, and dosage. We collected population data by quarter and county from the U.S. Census Bureau and the Bureau of Economic Analysis. We extracted opioid-related drug mortality data from the CDC’s WONDER database.25 To identify opioid-related deaths, we queried detailed, multiple causes of death involving opioids using relevant ICD-10 codes specifically for opioids (T40.1–T40.4, and T40.6), combined with an underlying cause of death being unintentional (X40–X44), suicide (X60–X64), assault (X85), or undetermined intent (Y10–Y14). We extracted all death data matching these criteria for the years 2013–2017 (last year of publicly available data). Texas prescription data were extracted for the 12 consecutive quarters ranging 2015–2017. Data prior to 2015 were not available due to a change in statewide regulatory agency for the PDMP system.
From Dark Dens to Suburban Townhouses: Creating a Centralized System for Prescription Opiate Monitoring to Combat the Addiction Epidemic in the United States
Published in Journal of Legal Medicine, 2018
Each state allows multiple individuals to access PMP data.101See generally Compilation of Prescription Monitoring Program Maps, supra note 88. Forty-nine states and the District of Columbia, excluding Missouri, allow prescribers and dispensers to receive PMP data.102See id. at 24. However, 15 states and the District of Columbia explicitly provide that prescribers and/or dispensers have no obligation to access the PMP, whereas other states require access under certain circumstances.103See id. at 29 (including Alaska, Alabama, Georgia, Illinois, Indiana, Iowa, Kansas, Maryland, Minnesota, North Dakota, Oregon, South Carolina, South Dakota, Wisconsin, Wyoming, and the District of Columbia). In addition, a majority of states have laws that provide immunity for prescribers and/or dispensers.104Id. at 30 (including Alabama, Alaska, Delaware, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Maine, Minnesota, Montana, New Jersey, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, South Carolina, South Dakota, Tennessee, Vermont, West Virginia, Wyoming, and the District of Columbia).
Rapid buprenorphine microdosing for opioid use disorder in a hospitalized patient receiving very high doses of full agonist opioids for acute pain management: Titration, implementation barriers, and strategies to overcomes
Published in Substance Abuse, 2021
Jonathan P. DeWeese, James R. Krenz, Sarah E. Wakeman, Alyssa M. Peckham
Her OUD history revealed heroin IDU daily use for much of the past year, though before this she had been in sustained remission without MOUD. In the distant past, she had been on methadone maintenance treatment (MMT) but had to abruptly stop a dose of >100 mg/day due to incarceration. Citing her miserable experience of forced rapid withdrawal from methadone in the past, she was unwilling to consider MMT or methadone for pain and withdrawal management. She had briefly tried buprenorphine in the past, but due to intolerable headaches that she attributed to buprenorphine/naloxone, she only agreed to buprenorphine while hospitalized. Her last reported use of heroin was 3 days prior to presentation, and she received buprenorphine the day prior at an outside hospital. Her urine toxicology was positive for opiates, buprenorphine, cocaine, and amphetamines. The Prescription Monitoring Program for Massachusetts and her home state was unrevealing. At this time, the patient’s stated goals were: to complete as much medical treatment for her osteomyelitis as tolerable, to have her acute pain regarded seriously and treated aggressively, and to induce buprenorphine prior to discharge in preparation for outpatient buprenorphine treatment. Her future goal was to taper off buprenorphine to transition to intramuscular extended-release naltrexone, a goal she attributed to stigma/external pressure, an unfortunately common experience amongst those on buprenorphine or MMT but not naltrexone21 despite better outcomes with buprenorphine and MMT.22 She also reported occasional cocaine use but denied recent use and did not identify these drugs as primary.