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State wants to move Xanax from S4 to S2


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http://www.al.com/news/index.ssf/2017/04/pharmacists_fight_effort_to_in.html

So my state wants to be the first in the US to move Xanax from S4 to S2. Some highly intelligent doctors feel that this is necessary because Xanax is scary-bad-dangerous and people OD on it. Mind you, they don't want to move other benzos, just Xanax. I really don't see any benefit, other than street dealers are going to make a killing, because they're going to import it from neighboring states without the restriction. Those of us with legit prescriptions are just going to be inconvenienced and stigmatized with taking a S2 drug. I want to talk to my pdoc to get his opinion on this, because Xanax happens to be a drug that works extremely well for me, and I don't want to go through the annoying trial-and-error process again. I can see plenty of over-worked pdocs hanging up "NO XANAX" signs in their office because of the hassle it would cause them. This state already has a shortage of pdocs and other mental health professionals, and this is just going to make it harder for them and their patients.

I don't see what the endgame is for this. Who wins?

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That will really suck.  I bet with this they will limit how much a person can take at a time ... like go with the opiod guidelines ... vicodin, oxy, percocet, dilaudid, etc.

Also, it might not be able to be prescribed with refills.  It would be a temporary med like an opiod would be (in most cases).

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6 hours ago, dtac said:

they don't want to move other benzos, just Xanax.

I heard that they were thinking of moving ALL benzos as well as the nonbenzodiazepines (like Ambien, etc.) to CII... as well as Lyrica and tramadol. (Lyrica? REALLY?) I don't have the link to that, I was reading it with a friend of mine and forgot to get him to send me the link.

6 hours ago, dtac said:

I can see plenty of over-worked pdocs hanging up "NO XANAX" signs in their office because of the hassle it would cause them. This state already has a shortage of pdocs and other mental health professionals, and this is just going to make it harder for them and their patients.

2

I fear this as well. My pdoc used to prescribe me Xanax 3 times a day as needed.

4 hours ago, melissaw72 said:

I bet with this they will limit how much a person can take at a time ... like go with the opiod guidelines ... vicodin, oxy, percocet, dilaudid, etc.

Also, it might not be able to be prescribed with refills.

5

This would suck hard... as I said, my pdoc used to prescribe me Xanax 3 times a day prn, but my friend's gdoc refused to prescribe him his ongoing prescription from his previous doc at first, then gave him 15x 0.5 mg per month after he said he had been on 1 mg. The DEA I'm sure were already breathing down the necks of all prescribers... I mean, there are PAIN MANAGEMENT doctors WHOSE JOB IS TO PRESCRIBE OPIOIDS AND SUCH for people with chronic painful conditions having their licenses revoked because "they're prescribing too many opioids," at least around where I live anyway. It's not fucking fair for the people who legitimately need these meds to not have access to them because of the ones who abuse them and ruin it for the rest of us.

You can count on these meds to be required to be prescribed with no refills if this goes through. I saw my pdoc the other day and meant to ask her take on it and forgot to... I know she trusts me, but I have a feeling the DEA is watching her based on her prescribing habits lately with me (she got me to quit my Adderall and is lowering my benzos amount per month).

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10 hours ago, mikl_pls said:

I heard that they were thinking of moving ALL benzos as well as the nonbenzodiazepines (like Ambien, etc.) to CII... as well as Lyrica and tramadol. (Lyrica? REALLY?) I don't have the link to that, I was reading it with a friend of mine and forgot to get him to send me the link.

I fear this as well. My pdoc used to prescribe me Xanax 3 times a day as needed.

They were proposing that all other benzos, and Ambien be classified CIII, and wanted to reclassify Lyrica to CIV...  http://www.quarles.com/publications/alabama-closer-to-making-alprazolam-a-schedule-ii-drug/

BUT, have no fear folks, at least for now...This proposal has now been BLOCKED as of April 14th:

http://www.quarles.com/publications/alabama-battle-over-alprazolam-is-done-for-now/

Even though I don't take Xanax, I say YAY.!!!!!!!.........:D

Edited by CrazyRedhead
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5 minutes ago, CrazyRedhead said:

They were proposing that all other benzos, Lyrica and Ambien be classified CIII, from what I read about it.

But, have no fear folks, at least for now......This proposal has been BLOCKED as of April 14th:

http://www.quarles.com/publications/alabama-battle-over-alprazolam-is-done-for-now/

Even though I don't take Xanax, I say YAY!!!!!!!!...........:D

This wasn't in the state I live in, but it is still great news because all it takes is one state to start something.

Thanks for posting!

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2 hours ago, CrazyRedhead said:

They were proposing that all other benzos, and Ambien be classified CIII, and wanted to reclassify Lyrica to CIV...  http://www.quarles.com/publications/alabama-closer-to-making-alprazolam-a-schedule-ii-drug/

BUT, have no fear folks, at least for now...This proposal has now been BLOCKED as of April 14th:

http://www.quarles.com/publications/alabama-battle-over-alprazolam-is-done-for-now/

Even though I don't take Xanax, I say YAY.!!!!!!!.........:D

This is great news! For once, the state government did something rational... 

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This is somewhat on-topic:

Last time I saw my pdoc we discussed her experience with different insurers, and she mentioned something that I found startling. One of the major insurers in my state started requiring prior authorizations for every benzodiazepine from January onwards. She said that her and the other practitioners in this group practice (which also literally runs the area's psych ward and so collectively has a massive patient caseload) literally could not handle that insane of a volume of additional prior authorizations on top of the number they already have to file routinely and the psych who owns/runs this group practice decided that they would just tell all of the patients on that insurer that they'd have to pay cash for their benzodiazepines as a result.

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14 hours ago, JustNuts said:

This is somewhat on-topic:

Last time I saw my pdoc we discussed her experience with different insurers, and she mentioned something that I found startling. One of the major insurers in my state started requiring prior authorizations for every benzodiazepine from January onwards. She said that her and the other practitioners in this group practice (which also literally runs the area's psych ward and so collectively has a massive patient caseload) literally could not handle that insane of a volume of additional prior authorizations on top of the number they already have to file routinely and the psych who owns/runs this group practice decided that they would just tell all of the patients on that insurer that they'd have to pay cash for their benzodiazepines as a result.

I tried to PM you but couldn't find the message link ... If you don't mind me asking (and please don't answer if not comfortable), what state is this happening in?

Edited by melissaw72
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23 hours ago, JustNuts said:

This is somewhat on-topic:

Last time I saw my pdoc we discussed her experience with different insurers, and she mentioned something that I found startling. One of the major insurers in my state started requiring prior authorizations for every benzodiazepine from January onwards. She said that her and the other practitioners in this group practice (which also literally runs the area's psych ward and so collectively has a massive patient caseload) literally could not handle that insane of a volume of additional prior authorizations on top of the number they already have to file routinely and the psych who owns/runs this group practice decided that they would just tell all of the patients on that insurer that they'd have to pay cash for their benzodiazepines as a result.

Don't get me wrong----this whole situation really sucks......But at least generic benzos are pretty cheap (at least in my area they are)......I checked Ativan, Valium, Xanax and Klonopin , and the cash price is very reasonable.

Most folks wouldn't have a huge financial problem with paying cash for benzos.....In fact  generic Klonopin is one of the cheapest meds I I get....Only my Trazodone is cheaper.......But that's not the point, really.

The point of it is, that the insurance company that's doing this is penalizing people just because they take benzos, and that's not right at all.

Edited by CrazyRedhead
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Just more fuel to add to my paranoid issues about refilling my prescription for Valium.   Laws by themselves might make some people feel better but if they don't change anything for the better whats the point?

I understand some genius got like 100 different doctors to prescribe him opiates and this was all with the written scripts no auto refills etc.   HAVE A POINT and test the system to see if it has any effect before making everything a giant pain in the ass.

Off topic wouldn't it be great if for every new law 2 old ones had to come off the books?   Wouldn't that improve things in the long run?  Can anyone say they know all the laws in your typical state?   Even CLOSE to knowing all of them?   Its just stupid.

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11 hours ago, melissaw72 said:

I tried to PM you but couldn't find the message link ... If you don't mind me asking (and please don't answer if not comfortable), what state is this happening in?

The message link is missing because the site mods massively overreacted to something extremely minor and decided that completely disabling my ability to send or receive private messages was a rational response.

The state is Illinois.

Interestingly, after some research, I discovered that there are a few other cases across the country of health insurers (including certain state Medicaid plans) requiring blanket PAs for benzos immediately, or blanket PAs for benzos after/if certain criteria (like X number of benzo Rx fills) is met.

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1 hour ago, JustNuts said:

The message link is missing because the site mods massively overreacted to something extremely minor and decided that completely disabling my ability to send or receive private messages was a rational response.

The state is Illinois.

Interestingly, after some research, I discovered that there are a few other cases across the country of health insurers (including certain state Medicaid plans) requiring blanket PAs for benzos immediately, or blanket PAs for benzos after/if certain criteria (like X number of benzo Rx fills) is met.

Thanks for the state.  Fortunately my insurance covers the klonopin and xanax for me.  The health insurances are just getting stricter and stricter all the time.  All the extra PAs is more work on the insurance's end too, so it doesn't really make sense to add more work to something that was fine to begin with.

Sorry about the messaging.  Maybe you can ask staff to let you PM again, and to give you another chance.  IMO people deserve second chances.

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12 hours ago, melissaw72 said:

Thanks for the state.  Fortunately my insurance covers the klonopin and xanax for me.  The health insurances are just getting stricter and stricter all the time.  All the extra PAs is more work on the insurance's end too, so it doesn't really make sense to add more work to something that was fine to begin with.

To me, PAs are like the nuclear option -- no one wins. It's more work for providers, the patient, and the insurance companies. The reality is that providers will just stop writing for those drugs if the volume of PAs gets too high. It's not even a cost-savings principle for the insurance carriers for stuff like benzos, they're already pretty cheap.

The sleep center I am going to right now has a mandatory $20 fee for all PAs. I get that it's extra work for them to deal with the paperwork, but it sucks as a patient to get charged for the insurance companies imposed restrictions. 

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17 hours ago, JustNuts said:

The message link is missing because the site mods massively overreacted to something extremely minor and decided that completely disabling my ability to send or receive private messages was a rational response.

JustNuts, we didn't overreact at all. Let me jog your memory, and enhance the understanding of anyone reading this thread who might have doubts about why you can't PM any more.

You took the novel position that it's ok to commit a crime if no one knows you did it. We called bullshit on obvious bullshit. I strongly recommend you get over it. 

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16 hours ago, melissaw72 said:

Sorry about the messaging.  Maybe you can ask staff to let you PM again, and to give you another chance.  IMO people deserve second chances.

That would seem unlikely, as he makes it clear in his post above that he holds the reason for our decision in contempt, and we therefore have no reason to believe he would not repeat the behavior, which was, in fact, a crime. And unfortunately for him, melissaw, whatever your opinion, you are not a moderator.

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23 hours ago, CrazyRedhead said:

But at least generic benzos are pretty cheap (at least in my area they are)......I checked Ativan, Valium, Xanax and Klonopin , and the cash price is very reasonable.

But Serax I believe is more expensive... bout $50 for 30x 30 mg, which is my benzo of choice... so I'd have to change to something else. My pdoc used to write them 1 po tid prn but now only writes them 1 po qd prn. This would be asinine if it goes through.

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3 hours ago, Cerberus said:

That would seem unlikely, as he makes it clear in his post above that he holds the reason for our decision in contempt, and we therefore have no reason to believe he would not repeat the behavior, which was, in fact, a crime. And unfortunately for him, melissaw, whatever your opinion, you are not a moderator.

What?

Idk what he did, but I was just saying that think people deserved 2nd chances ... NOT him personally, but a GENERAL statement about it.  And I was NOT implying anything either.  Did I say anywhere in that post I wrote that "He" deserved a second chance?  No, I didn't. 

I know I'm not a moderator.  And this post was NOT directed towards you. 

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7 hours ago, dtac said:

The sleep center I am going to right now has a mandatory $20 fee for all PAs. I get that it's extra work for them to deal with the paperwork, but it sucks as a patient to get charged for the insurance companies imposed restrictions. 

Wow does that suck!  I've never heard of that before.  I would be paying a lot of money if it was like that here ... at least 5 of my meds need PAs.

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23 hours ago, Gearhead said:

JustNuts, we didn't overreact at all. Let me jog your memory, and enhance the understanding of anyone reading this thread who might have doubts about why you can't PM any more.

You took the novel position that it's ok to commit a crime if no one knows you did it. We called bullshit on obvious bullshit. I strongly recommend you get over it. 

I could use a little bit of clarification here. What crime was committed? 

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On 4/20/2017 at 9:10 PM, melissaw72 said:

Thanks for the state.  Fortunately my insurance covers the klonopin and xanax for me.  The health insurances are just getting stricter and stricter all the time.  All the extra PAs is more work on the insurance's end too, so it doesn't really make sense to add more work to something that was fine to begin with.

Sorry about the messaging.  Maybe you can ask staff to let you PM again, and to give you another chance.  IMO people deserve second chances.

PAs generally save insurers money, or rarely, they may not save them money but may lead to improved care. Of course in this case I have no idea what they were thinking but not having to pay for benzos may have saved them money? Idk.

The staff here aren't reasonable about stuff like that, so it's pointless.

On 4/21/2017 at 10:15 AM, dtac said:

To me, PAs are like the nuclear option -- no one wins. It's more work for providers, the patient, and the insurance companies. The reality is that providers will just stop writing for those drugs if the volume of PAs gets too high. It's not even a cost-savings principle for the insurance carriers for stuff like benzos, they're already pretty cheap.

The sleep center I am going to right now has a mandatory $20 fee for all PAs. I get that it's extra work for them to deal with the paperwork, but it sucks as a patient to get charged for the insurance companies imposed restrictions. 

I'm not sure why they'd do it for benzos but in other situations it's generally to save the insurer money in the long run - PAs aren't free to process but they do allow the insurer to avoid paying for some care and avoid overuse of expensive things.

On 4/21/2017 at 1:35 PM, Gearhead said:

JustNuts, we didn't overreact at all. Let me jog your memory, and enhance the understanding of anyone reading this thread who might have doubts about why you can't PM any more.

You took the novel position that it's ok to commit a crime if no one knows you did it. We called bullshit on obvious bullshit. I strongly recommend you get over it. 

 

On 4/21/2017 at 1:36 PM, Cerberus said:

That would seem unlikely, as he makes it clear in his post above that he holds the reason for our decision in contempt, and we therefore have no reason to believe he would not repeat the behavior, which was, in fact, a crime. And unfortunately for him, melissaw, whatever your opinion, you are not a moderator.

Yeah once again you guys didn't get any of my points from that thread and clearly have no experience with the DMCA. I have extensive experience moderating on a far larger site than this (actually one of the largest forums on the internet and by far the single largest IPB one at the time) where we took much less restrictive approaches and would never have removed a member's ability to access the PM system even for far more severe infractions of this type. We had far more realistic fears over being subject to the DMCA than this little site does for numerous reasons and yet our policies were entirely different - which was not due to our size, but simply due to the fact that the site was actually ran by people who actually understood requirements for DMCA compliance and didn't unnecessarily overreact to minor issues. I mean Jesus Christ the level of overreaction and unprofessionalism you have compared to how we handled things is utterly batshit insane.

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a) we are all batshit insane, @JustNuts

b) because we talk about meds this site has been the subject of higher than average scrutiny than in the past

c) we are all volunteers, and 

d) as such have no desire to police the PMs of a member who said they would do something that threatens the site for all users

e) if you don't like it here, feel free to leave

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The thing is, @JustNuts, you're not a Moderator here. So your experience with 4-Chan or Reddit or wherever else you were tooling around has no meaning to this site or its standards. Butting heads with the site Moderators here is a sign of sheer unadulterated stupidity, but we make allowances for lunacy here at Crazyboards - on a limited basis.

 And you've just spent your allowance.

 

Cerberus
Moderator

 

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20 hours ago, Wooster said:

a) we are all batshit insane, @JustNuts

b) because we talk about meds this site has been the subject of higher than average scrutiny than in the past

c) we are all volunteers, and 

d) as such have no desire to police the PMs of a member who said they would do something that threatens the site for all users

e) if you don't like it here, feel free to leave

18 hours ago, Cerberus said:

The thing is, @JustNuts, you're not a Moderator here. So your experience with 4-Chan or Reddit or wherever else you were tooling around has no meaning to this site or its standards. Butting heads with the site Moderators here is a sign of sheer unadulterated stupidity, but we make allowances for lunacy here at Crazyboards - on a limited basis.

 And you've just spent your allowance.

 

Cerberus
Moderator

As I've explained already, your site is nothing special when it comes to the DMCA, the forum I was involved with had literally orders of magnitude higher risk at stake with far more actionable circumstances and yet they didn't resort to immature and irrational overreactions. The forum was also almost exclusively volunteer-ran, with approximately 110-130 active volunteer moderators and admins combined at any point in time and only a single paid staff member in charge of broad-scale community management. It also happened to be owned/controlled by a major company that would be extremely sensitive to DMCA issues for a number of reasons and yet didn't give a shit because they knew that the community was already clearly complying with their obligations under the DMCA via appropriate enforcement actions.

My point once again is that you have completely mishandled the situation, you have the most ridiculous views about what's actually appropriate or what's actually happened, and whenever it's brought up you revert right back to the same poorly-thought-out (and refuted) arguments combined with outright ad hominem attacks and thinly-veiled threats while flat-out ignoring, dismissing, or otherwise brushing aside everything any other forum member says.

"Batshit insane" or not, there's no excuse for acting like this. It's not the right way to run a community. It's not professional.

Let me remind you that I was not the one to bring this topic back up in here, I merely briefly summarized the reasons why nobody can send me private messages when a member asked why the private message button wouldn't show up on my profile. You guys are the ones who decided that this conversation deserved to be resurrected again beyond that point. So don't even try to blame me for that.

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@JustNuts Why do you continue to beat a dead horse? The word of the moderators is final, and this is particularly true in questions regarding board policy. As far as being unprofessional, where have we ever said we are professionals? This is a peer site ran by crazy people for crazy people. The moderators are all volunteer. Your continual actions of posting insults and taunting the moderators shows that you don't appreciate just how much on thin ice you are.

Also, taking away your ability to PM was not an overaction. It was a measured step to prevent us from having to police your PMs for criminal activity.

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8 hours ago, JustNuts said:

Let me remind you that I was not the one to bring this topic back up in here, I merely briefly summarized the reasons why nobody can send me private messages when a member asked why the private message button wouldn't show up on my profile. You guys are the ones who decided that this conversation deserved to be resurrected again beyond that point. So don't even try to blame me for that.

And by doing that, you brought the topic back up. And now you should drop it. Forever. 

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2 hours ago, mcjimjam said:

Here in Australia Xanax has been a schedule 8 drug (same as CII, basically) for a long time. Few people seem to use it and it has a very bad rep. Valium and Restoril are very widely used, however.

Interesting........What about Klonopin and Ativan?.....How widely are they used in Australia?

Just curious......:)

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  • 1 month later...
On 4/20/2017 at 2:12 PM, HAL9000 said:

 

I understand some genius got like 100 different doctors to prescribe him opiates and this was all with the written scripts no auto refills etc.   HAVE A POINT and test the system to see if it has any effect before making everything a giant pain in the ass.

 

I say we have a government database of people and their doctors and their prescribed medications, that pharmacists, doctors, and the government can look at to make sure people are behaving themselves with their meds. Then there'd be no need for this nonsense.

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17 hours ago, Alien Navel Cord said:

I say we have a government database of people and their doctors and their prescribed medications, that pharmacists, doctors, and the government can look at to make sure people are behaving themselves with their meds. Then there'd be no need for this nonsense.

If a patient got opiates from 100 different docs, that sounds like what's called "doctor shopping", and it is a crime in all 50 states if I remember correctly..........Some people have done jail time for doc shopping, depending on the state laws.

The term "doctor shopping" means that a drug-seeking patient goes to multiple docs, who don't know about the other docs the patient has seen, and said patient gets the same or similiar "Scheduled" med prescribed multiple times...........Then usually, they try and fill each script at a different pharmacy.

However, all 50 states now have in place a Prescription Monitoring Program, or PMP, to track all patients who fill Scheduled meds, such as stimulants, benzos, or opiates, etc........The PMPs don't track non-scheduled meds such as anti-depressants or anti-psychotics.

This means that any doc or pharmacist that's treating you, or filling meds for you, can pull up your PMP record, and see exactly when and where you filled your last "Scheduled" med, and also they can see who prescribed the meds to you.

If a doc or pharmacist sees that you've been filling the same Scheduled med multiple times from different docs, they can get the DEA and/or law enforcement involved, again depending on the state.........Some states have stricter laws than others.

The PMPs have cut down on "doctor shopping" quite a bit, but it's still out there to a certain degree.

Edited by CrazyRedhead
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29 minutes ago, CrazyRedhead said:

If a patient got opiates from 100 different docs, that sounds like what's called "doctor shopping", and it is a crime in all 50 states if I remember correctly..........Some people have done jail time for doc shopping, depending on the state laws.

The term "doctor shopping" means that a drug-seeking patient goes to multiple docs, who don't know about the other docs the patient has seen, and said patient gets the same or similiar "Scheduled" med prescribed multiple times...........Then usually, they try and fill each script at a different pharmacy.

However, all 50 states now have in place a Prescription Monitoring Program, or PMP, to track all patients who fill Scheduled meds, such as stimulants, benzos, or opiates, etc........The PMPs don't track non-scheduled meds such as anti-depressants or anti-psychotics.

This means that any doc or pharmacist that's treating you, or filling meds for you, can pull up your PMP record, and see exactly when and where you filled your last "Scheduled" med.

The PMPs have cut down on "doctor shopping" quite a bit, but it's still out there to a certain degree.

You also have agreements with EHR vendors and SureScripts to provide data sharing between pharmacies and providers. If you fill a med a pharmacy that participates in SureScripts' network, controlled or not, it's visible to any platform that interfaces with SureScripts. Not all pharmacies participate, especially smaller ones, but all of your big retail chains are part of it, and most modern EHRs will pull data from SureScripts. I can't directly speak to it, but I suspect Allscripts has similar functionality for their interface. It also tends to integrate directly into the EHR, whereas the PMP database is a separate website.

Between the the data sharing and PMP databases, providers have tools to cover the majority of abuse cases -- they just don't bother to check. 

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47 minutes ago, dtac said:

 Between the the data sharing and PMP databases, providers have tools to cover the majority of abuse cases -- they just don't bother to check. 

Currently, 34 states have circumstances in which the doctor, pharmacist, or both, are required by law to check the PMP database:         http://www.namsdl.org/library/14D3122C-96F5-F53E-E8F23E906B4DE09D/    (page 2)

Are they really checking  everything they should?......I would say in a lot of cases, probably not..

This is just my opinion, but I believe they scrutinize patients getting Schedule 2 meds a lot more than patients getting Schedule 3-5 meds..

Edited by CrazyRedhead
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10 minutes ago, CrazyRedhead said:

Currently, 34 states have circumstances in which the doctor, pharmacist or both, are required by law to check the PMP database:         http://www.namsdl.org/library/14D3122C-96F5-F53E-E8F23E906B4DE09D/    (page 2)

Are they really checking  everything they should?......I would say in a lot of cases, probably not..

This is just my opinion, but I believe they scrutinize patients getting Schedule 2 meds a lot more than patients getting Schedule 3-5 meds..

I know my pdoc checks. I couldn't remember all the sleep meds I've taken, so he pulled up the database and started looking at benzos and z-drugs I was prescribed. He also scrutinized my benzo history before prescribing Xanax. If he's that interested in my CIV history, then I suspect he watches his CII patients as well. I don't take it personally, I'm honest about everything (including my OD attempt), and he's never declined to write for a med based on my rx history. In fact, he's the one that suggested Xanax for my anxiety, and told me he wasn't worried about me abusing it, he's just cautious. 

The only time I got questioned by a pharmacist was when I filled a rx for Sonata a week after I had filled one for Lunesta (I was alternating sleep meds at the time.) He just wanted to make sure I wasn't taking them together. He wasn't concerned beyond the possible synergistic effect of the meds.

I've never been on CII meds for a period of time (only one-off short-term fills for Lortab/Norco due to dental work, sinus infection, etc.) so I can't speak to how much the scrutiny increases, but only Xanax seems to have raised any eyebrows from CIV.

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14 minutes ago, dtac said:

I know my pdoc checks. 

My p-doc checked my fill history when I was a new patient.

Since I've been with her now for 4 years, she probably checks it occasionally, since she does still prescribe Klonopin for me.....That's the only controlled med I take right now.

I've never personally had any problems with a pharmacist about filling the Klonopin.

Edited by CrazyRedhead
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