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Addicted Oklahoma: How can Oklahoma combat doctor-shopping?

by Jaclyn Cosgrove Modified: April 7, 2014 at 10:44 am •  Published: April 7, 2014
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The Oklahoman's Jaclyn Cosgrove and Oklahoma Watch investigative reporter Warren Vieth chatted with readers Monday about Oklahoma's prescription drug abuse and overdose problem. The two media entities partnered together for a special report to raise awareness about this issue and persuade our leaders to find a better solution.

NewsOK 9:24 a.m. Hey everyone! We'll get started with our chat at 10 a.m., but you can start submitting your questions now.
NewsOK 9:27 a.m. We'll be discussing Oklahoma's prescription drug abuse and overdose problem.

If you picked up Sunday's paper, you probably read our coverage on the gaps in our system. If you didn't, you can read it online here: http://newsok.com/prescript...

We'll answer your questions about the coverage and take feedback.
Jaclyn Cosgrove 9:57 a.m. Keep the questions coming. We'll get started soon.
Jaclyn Cosgrove 10:01 a.m. We are getting some great questions. It looks like we can start now. I am the health and medical reporter at The Oklahoman, and I'm joined by Warren Vieth, associate editor at Oklahoma Watch.
Guest 10:02 a.m. My mother used to suffer from chronic ongoing pain. She took a lot of meds and I used to worry. She explained to me that if a person has chronic pain, the meds aren't addictive. Does this make sens?
Jaclyn Cosgrove 10:04 a.m. Looks like Warren will take that question.
Jaclyn Cosgrove 10:05 a.m. As he answers, I also want to share that the National Institute on Drug Abuse has a great guide about addiction works in the brain: http://www.drugabuse.gov/pu... It's a great read.
Warren Vieth 10:05 a.m. Most people will become physically dependent on opiod pain-killers if they take them long enough. Stopping abruptly can cause withdrawal symptoms, so tapering off is advised. But not everyone becomes psychologically dependent on these drugs. It varies from person to person.
Jaclyn Cosgrove 10:05 a.m. Data show that about one in 10 people are more likely to become addicted based on how their brain chemistry works.
twk1945 10:06 a.m. how do you get a script written in another state but filled in oklahoma
Jaclyn Cosgrove 10:07 a.m. Feel free to ask more questions. Warren will also answer that question as well.
Warren Vieth 10:08 a.m. An out-of-state medical professional can obtain a license from the Oklahoma Bureau of Narcotics and Dangerous Drugs to write prescriptions for controlled dangerous substances, and Oklahoma pharmacies will fill them.
Jean Williams 10:09 a.m. Hi, have to ask. What did you discover about the over lap between drug abuse and mental illness.
Jaclyn Cosgrove 10:10 a.m. Hi Jean, thanks for your question! I wouldn't say that was a primary focus of this specific investigation, but I know that Terri White, the state's mental health/substance abuse agency commissioner, has talked to the Legislature about the topic. This NIDA article does a great job of laying out the scientific thought behind that relationship: http://www.drugabuse.gov/pu...
Jaclyn Cosgrove 10:10 a.m. For example: "Is drug addiction a mental illness?

Yes, because addiction changes the brain in fundamental ways, disturbing a person's normal hierarchy of needs and desires and substituting new priorities connected with procuring and using the drug. The resulting compulsive behaviors that override the ability to control impulses despite the consequences are similar to hallmarks of other mental illnesses."
Corey Lambrecht 10:10 a.m. More of a comment than question. I think there needs to be legislation requiring law enforcement and the ME's office to check the PMP report for suspected overdose cases. Currently, its optional and rarely looked into.
Jaclyn Cosgrove 10:11 a.m. Thanks, Corey. Now would be an excellent time to shamelessly plug how to contact your lawmaker: http://www.oklegislature.go...
Corey Lambrecht 10:13 a.m. I will do so, thanks.
Jennifer B 10:13 a.m. The same could be said about doctor's offices being required to check the PMP. Write your lawmakers about that too.
Warren Vieth 10:13 a.m. A bill pending before the Oklahoma Legislature, SB 1821, would require physicians to check the Prescription Monitoring Program every time they write a narcotic prescription. It has been endorsed by Gov. Mary Fallin.
Guest 10:14 a.m. Isn't it also true that the body will build a tolerance to these drugs which causes someone who is addicted to use more of the drugs in order to get the same affect? And also these drugs are used on the street for recreational purposes.
Warren Vieth 10:16 a.m. Yes, people who use opiod painkillers and benzodiazepene anxiety drugs for long periods of time will build up a physical tolerance to them, which means they will require larger doses to achieve the same effect. And yes, many addicts buy prescription drugs on the street when they can't get them elsewhere.
Jean Williams 10:16 a.m. I appreciate attention to this issues. Did you discover how long the waiting list for a rehab facility is? Public vs private?
Jaclyn Cosgrove 10:18 a.m. We haven't looked at rehab facilities yet, but that's a great question, especially comparing public and private and who can access/afford which options. I know that in Oklahoma, an estimated 70 percent of adults in Oklahoma (40 percent of youths) who need mental health treatment don’t receive it. And every day, 600 to 900 Oklahomans who need residential substance abuse treatment are turned away for lack of beds.
Jaclyn Cosgrove 10:19 a.m. This is a great time to mention our Facebook group Oklahoma's Addiction and Mental Health Community: https://www.facebook.com/gr...
Jaclyn Cosgrove 10:20 a.m. Join that group, and let's have ongoing discussions about these topics. Both addiction and mental health are still seen as "taboo" topics in our culture. But we know that by talking about the issues that Oklahomans face and educating each other, we can help make change happen.
Jean Williams 10:20 a.m. I like the idea of Doctors having to check on the paitents prescription history before writing a script.
Jaclyn Cosgrove 10:22 a.m. It's definitely a debated topic. Some states have already mandated that.
Jaclyn Cosgrove 10:22 a.m. This map breaks down which states have implemented which laws to combat prescription drug abuse: http://healthyamericans.org...
Warren Vieth 10:23 a.m. Jean, last year Oklahoma pharmacies filled 9.7 million narcotic prescriptions, but doctors checked the PMP only 1.2 million times. Although some of those PMP checks might have covered two or three prescriptions at once, it's clear that doctors aren't using it routinely.
Guest 10:24 a.m. As a pharmacy student, I strong agree. The PMP is something we are required to check in my pharmacy. But you get patients going to different doctors (ERs, dentists, etc) and seeking out controlled pain medications and the prescribing physicians do not always look at the resources they have available. The pharmacy being the front lines for catching these patients and reporting back to the doctor, which is unacceptable.
Jaclyn Cosgrove 10:24 a.m. Thanks for your insight on that!
Jaclyn Cosgrove 10:24 a.m. We talked to pharmacists who said similar. You can see those comments, I believe, in this story: http://newsok.com/article/3... There's a video interview.
Jaclyn Cosgrove 10:25 a.m. We are getting great comments, questions and commentary. Keep 'em coming :)
Warren Vieth 10:26 a.m. Pharmacies are required by law to enter every narcotic prescription in the PMP within 5 minutes of filling it. But under current law, doctors are not required to check it. They have resisted efforts to make it mandatory, citing the time and expense involved. But we had doctors run demonstration PMP checks for us, and it only took about 90 seconds each.
Eric 10:26 a.m. However, checking a Prescription Monitoring Program, does NOT ensure that a patient is going to appropriately take a medication. Where is the personal responsiblity? If a patient received medication AND abuses the medication, when is it the patient's fault and NOT the prescriber?
Jaclyn Cosgrove 10:28 a.m. Eric, I think that question is one of the questions at the heart of this debate. I think in our investigation, we found that there are some physicians prescribing higher than average amounts of CDS, and when we spoke with addiction specialists, they said there are prescription guidelines that could help but aren't generally being followed.
Guest 10:29 a.m. It's hard to understand why prescribers aren't using the PMP any time they prescribe. As a Student Nurse Practitioner, I have witnessed my preceptor (a practicing Nurse Practitioner) pull a patient's PMP with ease-- its a matter of logging into the website and searching for the patient.
Eric 10:31 a.m. How many unintentional durg overdoses, are by persons that did not receive a prescription, but purchased the medication from the blak market>?
Jaclyn Cosgrove 10:32 a.m. We don't have specific data because state agencies aren't collecting that data in the same way across the board. What we do know, though, is more than half of the people who overdosed in Oklahoma in recent years had a prescription from their doctor. That's not to say that people aren't getting them off the streets. That absolutely happens, and we heard that echoed in our interviews with people in recovery.
Jaclyn Cosgrove 10:33 a.m. Here's a story that references recent data from the CDC on that very topic: http://articles.latimes.com...
Guest 10:33 a.m. The PMP is about restricting the quantity of narcotics the patients can get legally by filling prescriptions. If the pharmacy enters the proper days supply for the medication based on the prescriber's directions, then the patient should be stopped from receiving more pain medication (or other controlled prescriptions) before they are due to be out (regardless of whether they took as prescribed or not.)
Warren Vieth 10:35 a.m. The PMP also enables physicians and pharmacies to spot people who are "doctor shopping" by obtaining multiple prescriptions from more than one doctor at the same time. But if doctors and pharmacists don't check, it doesn't do any good.
Debbie Shipman 10:36 a.m. Wouldn't it make sense to legalize cannabis for medicinal use to reduce prescription opiate and benzo abuse? Since many opiate and benzo abusers use begins with an actual medical need, it seems to me that cannabis, which is much less addictive and non-toxic, should be an option for doctors to prescribe first.
Jaclyn Cosgrove 10:37 a.m. Hi Debbie, thanks for your question. I am personally interested to see how legalization plays out in Colorado over the next five years. I just visited Denver for a work conference, and there was legal marijuana on just about every corner. So it will be interesting to see what research is published about pain management and/or prescribing narcotics and whether there are any correlations of decrease in Colorado with -- more people using marijuana, and fewer people taking CDS for pain management.
jean Williams 10:38 a.m. Plug for My Mind Matters Day at the Capitol . Come to the Capitol and visit your representative and to tell them that support of substance abuse and mental health are important to you. April 14th. 10:00 am - 2 pm. 4th Floor Rotunda Booths, Speakers and awards too.
Jaclyn Cosgrove 10:39 a.m. Thanks, Jean. And thanks to everyone who asked questions. Please feel free to e-mail us -- Jaclyn at jcosgrove@opubco.com and Warren at wvieth@oklahomawatch.org.
Jaclyn Cosgrove 10:39 a.m. We are happy to answer any questions you might have that we weren't able to address. Also, we are planning to write several other stories, so we will keep your questions and commentary in mind.
Jaclyn Cosgrove 10:40 a.m. And I will make one more plea for you to join our Facebook group, although I would ask you to read over our community guidelines :) https://www.facebook.com/gr...
by Jaclyn Cosgrove
Medical and Health Reporter
Jaclyn Cosgrove writes about health, public policy and medicine in Oklahoma, among other topics. She is an Oklahoma State University graduate. Jaclyn grew up in the southeast region of the state and enjoys writing about rural Oklahoma. She is...
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