Category: PDMP

House passes PDMP

On: By: topdog

PDMP is a law enforcement tool being sold as Doctor tool.

Surveillance is the purpose and not just opioid usage.  St. Louis County PDMP killed more people than ever before and they don’t tell you, see chart.  Citizens should note this day in history, When a slim majority of Republicans, made up of House leadership who owe the Health care lobby political favors and freshman who have no institutional knowledge on the issues of this bill, voted with the Democrats to seize your private health information as well as details that identify you personally, which are coveted by hackers for identity theft, medicare and medicaid fraud and blackmail.  Not surprisingly, no amendments were allowed that the bill sponsor admitted would make the bill better..  The most notable would have required the Doctors and Pharmacists to actually use the database prior to prescribing or dispensing opioids.  Every claim that the proponents spout as the need for the database are 

,for all practical purposes negated without 100% participation. It is counter intuitive for the health care lobby to require the bill sponsor to withdraw the bill if required to use the database.   Perhaps the Doctors know that the opponent claims are true.  The Health care lobby are talking out of both sides of their mouth.  Kill the bill if made mandatory, support it if not.  All best practices say that it has to be mandatory.  So what is really up?  Put your thinking caps on folks.  Forty-nine states have PDMP and no state has experienced a sustained decrease, in fact no state is lower today than before they implemented PDMP.  The sponsor of the bill touts a study that a newly implemented robust PDMP reduces opioid related deaths by 1.12 deaths per 100,000 people.  The study evaluated data from 1999 to 2013 comparing 32 states that implemented PDMP during that time period and the two remaining states that had not, Missouri and New Hampshire.  What she didn’t  say is they had to throw out West Virginia data in order to make that claim.  Fast forward to 2017 with 4 more years of data available.  New Hampshire implemented a robust PDMP in 2014, in 2013 the year of the study their opioid related death rate was 7.1 deaths per 100,000.  CDC data shows that the year it implemented 2014, their opioid related death rate jumped to 17.5 and as of 2017 a whopping 30.9 opioid related deaths per 100,000 population.  You don’t have to believe me read New Hampshire’s scathing

audit report of 2017 or this news summary.  This study was so fatally flawed it begs the question, Why was a federal grant used ?  Was it to put pressure on Missouri?  One co-author is an Associate Professor at Vanderbilt University located in Tennessee and another is an official of Tennessee Dept. of Health who used Federal funds for the study and then sited the study to apply for additional federal PDMP Funding.  By the way, Tennessee’s death rate was 9.9 in 2013, 2017 death rate 16.1.  You tell me sounds like the fix is in.  The Feds are desperate to complete the nationwide database network that contains drugs not just associated with the opioid epidemic, but drugs such as anti-anxiety, and anti-depressants some which are considered mental health drugs.  Put your thinking caps on and ask why track those?  Watch for follow up articles as this bill enters the state senate.  If you think that PDMP is not good for Missouri, contact you state senator by going to https://www.senate.mo.gov/LegisLookup/Default.aspx

PDMP

On: By: topdog

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Before retiring from SWBT I did root cause analysis of operational data. Interpeting data and understanding how data can be misrepresented or misinterpeted was part of my job. I’ve studied the CDC data and can find no reason to believe that a PDMP of any current state is effective at saving lives. Since Missouri without a PDMP tracks closely with the National Average death rate of 49 that have a PDMP. Clearly, PDMP has no real effect on the OD death rate and may well contribute to increased deaths as an unintended but documented consequence of increasing the OD death rate in states that implement PDMP.

There are many reasons why PDMP’s are ineffective and since we limited in time I’ll focus on just one glaring example. It starts with Medical community, they are the only ones that can prescribe these dangerous drugs. One question you should be asking every medical lobbyist and the sponsor of this bill. That question centers around the fact that all the key players say the best practice requires prescribers and dispenses to actually use the Database. They all clamor to have the database created, but balk at the idea of being required to use the database before prescribing. I was shocked while listening to the debate of this bill, when a representative who was a doctor complained that it it would increase his day by 1.5 hours to follow common sense procedures to insure their patients did not abuse the very RX they issued. The attitude displayed was his time was more important than his concern for the possible addictive effects of the drugs he giving his patients. I liken it to giving a child a loaded gun and say go outside and play. So lets, examine the result of not requiring our professionals to use the database before prescribing and dispensing. HB90 and 68 both grant no liability for using or not using the database, much like the majority of the states with PDMP.

However, in the vast majority of states, PDMP participation by prescribers is extremely low, and the effectiveness of this clinical tool is therefore compromised. A 2015 study of primary care prescribers found that while a majority reported having obtained data from their PDMP at some point in time, prescribers consulted PDMP data in fewer than one-quarter of instances when they prescribed opioids to patients.

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In a recent review of 2015 prescribing data in a sample of states where participation in the PDMP is voluntary, prescribers checked the patient history in the PDMP only 14% of the time before prescribing an opioid.

Refer to table 3 from Florida 2016 annual report of PDMP progress. Remember that this is 5 full years after they implemented their legislation for PDMP.

Please note that only 23.69% of their medical professional’s are registered to use it. Only 17.86% of MD’s, 34.53% of DO’s and 54.5% of Pharmacists. It’s no wonder PDMP are not effective.