A very controversial approach to prescription drug diversion and abuse that is used in at least fifteen states, and being considered in several others, is a prescription medication monitoring program.  One reason they are so controversial, and often lobbied against, are issues of privacy and doctor-patient confidentiality.  If handled properly, there is a positive healthcare related reason for endorsing these programs—they can help people as you saw in Part One.

Unless specific provisions for intervention and treatment are included in a monitoring system, many more people will be punished instead of helped.  The most significant opposition to the prescription monitoring system centers around the fear that big brother will use law enforcement to target people who, through no fault of their own, become addicted to the medication they were given to treat a legitimate medical condition.  In fact, many of them are not even addicted, but are on high doses of medication because after years of living with chronic pain, they have built up a high tolerance to it.

The other major concern is that unauthorized personnel might gain access to these monitoring records and use that information against them.  One documented case occurred in Nevada when a law enforcement officer, who was using OxyContin for an appropriate medical condition, was turned into his supervisor and subsequently fired.  There have also been reports insisting that in over 20 years there have not been any breaches of confidentiality in the fifteen states that currently have prescription monitoring programs.  Even so, there must be very stringent safeguards built into any prescription monitoring program to protect innocent people from unfairly targeted and harmed.

The solutions to the problem of prescription medication diversion are complex and need to be addressed not only by law enforcement, but also the healthcare industry.  With the quantity of Schedule II and Schedule III drugs continuing to increase significantly, the problem is only going to worsen.  Collaboration between law enforcement and healthcare providers is crucial.

Only by working together can appropriate solutions be found to use an effective tool like the monitoring program without it leading to the frightening predictions of the factions that oppose such measures.  In addition, healthcare providers and law enforcement personnel need to be trained to look for the early warning signs of both drug diversion and addiction.

This can be accomplished by using strategic research-based training protocols that educate healthcare providers and law enforcement professionals about discovering which patients are illegally diverting medication for profit, as well as focusing on prevention, intervention, and appropriate treatment strategies for legitimate addiction issues.  It is very important to have a strong focus regarding the ways in which healthcare providers and law enforcement can best collaborate when there is obvious criminal drug diversion activity.

I realize this is only a partial solution, but it is one that is desperately needed.  Each state should also form multi-disciplinary task forces that include all the segments of law enforcement and healthcare who are working together to combat this problem and save lives.  Educating the public, especially young children, about how to avoid an addiction trap is critical. 

In addition, we need to remember that although the vast majority of people with chronic pain may safely use pain medication.  Unfortunately, as many as 8.6 million people in 1999, to 11.7 million people in 2003, who used prescription drugs also suffered from coexisting abuse or addiction problems—these people need help, not incarceration.  However, people who are illegally diverting prescription medication for personal profit and greed need to be tracked down and prosecuted to the full extent of the law.

Unfortunately, prescription drug abuse or addiction is only one obstacle so to better understand the importance of overcoming obstacles to effective chronic pain management please check out my article, Overcoming Obstacles for Effective Pain Management, that you can download for free on our Ariticles page.

For an additional resource regarding medication management please go to our Publications page and check out my Addiction-Free Pain Management® Module Two: Examining Your Potential Medication Management Problems. To purchase this module please Click Here.

In Module Two you can explore the reasons people start developing problems with potentially addictive pain medication and define some often misunderstood terms. You can also examine the Red Flags Checklist to determine if there are any challenging medication management problems.  There is also a suggested APM Medication Management Agreement and information about how denial could prevent someone from following this plan.  Finally there is a safety plan designed to help people adhere to their Medication Management Agreement.  This safety plan includes developing a personalized craving management plan.

To read the latest issue of Chronic Pain Solutions Newsletter please Click here. If you want to sign up for the newsletter, please Click here and input your name and email address. You will then recieve an autoresponse email that you need to reply to in order to finalize enrollment.
To check out my upcoming trainings you can check out our Calendar page.

I want to start by sharing a medical intervention I participated in a with a California pain clinic.  Bob had been treated by the clinic for the over two years with no apparent problems.  The first indication that something was wrong when the patient’s family members called saying they were upset because of Bob’s bizarre behaviors that included falling asleep in the middle of dinner and becoming emotionally volatile for no apparent reason. 

The family was concerned that Bob was over-medicated, but the quantity and type of medications being prescribed to him by the pain clinic could not account for his extreme behavior.  This raised a red flag for us and as part of our assessment of the situation we asked for a pharmaceutical printout from the state’s prescription monitoring agency. 

We discovered that Bob was receiving similar medications from three other providers filled at three different pharmacies.  We initiated a medical intervention and Bob was eventually referred to medical detoxification, addiction treatment, and concurrent integrated pain management.  Both Bob and his family now believe that this intervention saved his life.  Unfortunately, he could easily have been arrested and even incarcerated instead of focusing on his legitimate healthcare condition and treating it effectively.  This was a humane and effective use of the prescription medication registry system but sometimes this system is neither humane nor effective.

Prescription drug abuse and drug diversion is a big crisis in our country.  Some of the problem is because patients are lying to their doctors and/or going doctor shopping to make easy money.  Some people acquire extra cash by forging prescriptions or going pharmacy shopping:  They do this with an actual prescription that they alter and/or duplicate, then have it filled at different pharmacies.

Contrary to popular belief, a large percentage of prescription drug diversion for financial gain is done by healthcare providers, pharmacy employees, and others with access to medications. There are also people who have an addiction to prescription medication or other drugs (including alcohol) that use doctor or pharmacy shopping to manage their addiction.  And then there are the chronic pain patients who become addicted to their medication and end up either doctor or pharmacy shopping in an attempt to manage their pain.  The illegal diversion for financial gain obviously needs to include strong law enforcement interventions, but diversion by people who have an addictive disorder should be addressed primarily as a medical or public health issue. I’ll cover this in Part Two.

To learn more about ways to deal with the prescription drug abuse/addiction problem please check out my article Addressing the Problem of Prescription Drug Abuse-Addiction, that you can download for free on our Ariticles page.

You can learn more about the Addiction-Free Pain Management® System at our website www.addiction-free.com. If you are working with people undergoing chronic pain management and want to learn how to develop a plan for managing their chronic pain and coexisting psychological disorders including depression, addiction and other coexisting psychological disorders effectively please consider my book Managing Pain and Coexisting Disorders: Using the Addiction-Free Pain Management® System. To purchase this book please Click Here.

To learn about my upcoming trainings you can check out our Calendar page.

To read the latest issue of Chronic Pain Solutions Newsletter please Click here. If you want to sign up for the newsletter, please Click here and input your name and email address. You will then recieve an autoresponse email that you need to reply to in order to finalize enrollment.

Today effective chronic pain management systematically approaches the treatment of pain at all three levels (bio-psycho-social) simultaneously.  This means using physical treatments to reduce the intensity of physical (biological) pain.  It also means using psychological treatments to identify and change the thoughts, feelings, and behaviors that are making the pain more intense and replacing them with positive thinking, as well as feeling and behavior management skills that can reduce the intensity of the pain. 

Finally, effective pain management must involve not only the pain patient, but also the significant people in their life who can help them to develop a social and cultural context in which to experience their pain in a way that will reduce suffering.

Biological Pain is a signal that something is going wrong with the body.  The biological, or physical, pain sensations are critical to human survival. Without pain we would have no way of knowing that something was wrong with our body. So without pain we would be unable to take action to correct the problem or deal with the situation that is causing our pain.

Psychological Pain results from the meaning that the brain assigns to the pain signal.  The psychological symptoms include both cognitive (thinking changes) and emotional (uncomfortable feelings) that lead to suffering. Most people are not able to differentiate between the physical and psychological. All they know is “I hurt.” For effective pain management you need to learn all you can about your pain.

Social and Cultural Pain, results from the social and cultural meaning assigned by other people to the pain experience, and whether or not the pain is recognized as being severe enough to warrant a socially approved sick role.  These three components determine whether the signal from the body to the brain is interpreted as pain or suffering. 

Imagine the Following Vignette

Bob is his college’s star football player.  In last week’s homecoming game Bob scored the winning touchdown but broke his arm in the process.  This week Bob is sitting on the bench with a cast on his arm that everyone has signed.  This cast and how he earned it are seen as an honorable reason for him to be sitting on the bench.  In that same game Karl, a big hulking lineman, “tweaked” his back and was also sitting on the bench this week.  Unlike Bob, Karl doesn’t have an observable injury and people were asking him why he wasn’t out on the field helping his team.  Karl is much more apt than Bob to experience shame/guilt, which will probably amplify his pain symptoms.

To learn more about effective chronic pain management—especially when other coexisting disorders are present—please check out my article The Need for Multidisciplinary Chronic Pain Management, that you can download for free on our Ariticles page.

You can learn more about the Addiction-Free Pain Management® System at our website www.addiction-free.com. If you are working with people undergoing chronic pain management and want to learn how to develop a plan for managing their chronic pain and coexisting psychological disorders including depression, addiction and other coexisting psychological disorders effectively please consider my book Managing Pain and Coexisting Disorders: Using the Addiction-Free Pain Management® System. To purchase this book please Click Here.

To learn about my upcoming trainings you can check out our Calendar page.

To read the latest issue of Chronic Pain Solutions Newsletter please Click here. If you want to sign up for the newsletter, please Click here and input your name and email address. You will then recieve an autoresponse email that you need to reply to in order to finalize enrollment.