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Georgia now tracking drugs to address abuse

Saturday, Aug 10, 2013 6:04 PM
Last updated Sunday, Aug 11, 2013 2:24 AM
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Sylvia Dunham starts to list the painkillers she once took to combat the pain in her feet, then stops.

“You name it, I’ve been on it,” she said. At one point, she was downing 20 to 30 pills a day. “It was just like eating candy.”

Eventually, she was referred to the Au­gusta Pain Center and found an alternative treatment in a spinal cord stimulator whose constant pulses block the pain signals and offer her drugless relief.

“That is one thing I never liked to do, is take pills,” Dunham said.

For thousands of other women, the drugs lead to a darker end. Prescription drug abuse is a “huge” problem that Georgia is only now implementing a system to monitor and curb, the second-to-last state to do so, an official said.

The U.S. is awash in painkillers – in 2010, enough opioid painkillers were sold to drug every adult every four hours for a month, said a report from the Centers for Disease Control and Prevention. Sales of those painkillers increased 300 percent during the past 11 years, and with that has come a dramatic increase in the rate of prescription drug deaths, particularly for women, the CDC found.

More men died from drug overdoses than women in 2010 – 23,000, compared with 15,000 – but the death toll for women was five times greater than what it was in 1999 and 3.6 times greater for men, the CDC report stated.

“The women are catching up, so to speak,” said Dr. Richard Epter, the medical director for the Augusta Pain Center.

In 2010, the rate of drug overdose deaths for women was four times the death rate from homicide, and since 2007 more women have died from drug overdoses than from car accidents, according to the CDC report.

Women are more likely to engage in what is called doctor shopping, going to several providers to get prescriptions, the CDC report said, and often those prescriptions will be filled at several pharmacies.

Having a system in place to catch that has been in Geor­gia for only a short time.

The Prescription Drug Moni­toring Program has been available to pharmacists a little less than a month and for physicians less than two weeks, said Rick Allen, the director of the Georgia Drugs and Narcotics Agency, which administers it.

“We were the next-to-last state to get it, but we’ve been trying to get it through the Leg­is­lature for 10 years,” he said. Missouri is the only other state without it, Allen said.

PHARMACISTS AND physicians can register with the system – about 2,000 have signed on so far – and submit prescriptions for patients. They can then check to see whether patients are getting prescriptions from more than one doctor and using several pharmacies, which some pharmacists in Georgia have already found, Allen said.

That is part of the due diligence that physicians should do with new patients, said Epter, who was part of a lobbying effort to get a national database, only to see it defunded and referred back to the states.

At the Augusta Pain Cen­ter, new patients are never given narcotics on the first visit and – in addition to other exams and record reviews – must undergo a urine analysis, Epter said. That analysis will turn up drug use the patient had not admitted to at first, he said.

It can be surprising what else it turns up, Epter said.

“Some people who have very good jobs, or who are teachers or who are bus drivers for some kids, that (test) will come out positive for THC, marijuana, cocaine and other illicit substances in addition to taking prescription medications that they don’t tell you about,” he said. “It’s not that it’s that rampant, but it does happen not infrequently.”

The pain center takes the extra step of having its own pain psychologist, who will do a risk assessment to see whether the patient fits a drug-seeking or addictive personality profile, Epter said.
“That’s a huge help to me as a practitioner,” he said.

PAIN CENTERS and law enforcement are up against increasingly sophisticated forces trying to divert drugs for illegal resale, Epter said.

“Some are professionals,” he said. “Some will come in knowing exactly what they need to say and knowing exactly how they need to behave on a physical exam in order for a physician to believe that they’ve got the problem.

“We’ve got people that have trunkloads of medical records, including X-rays,” Allen said. “They know what they’re doing.”

Because other states began monitoring programs years earlier, it was believed those patients would flock to Georgia.

“They did,” Allen said. “We know they did.”

The new monitoring program means “they’re going to think twice, anyway,” he said.

“They can’t come into Georgia, thinking, ‘They’re not going to pay any attention to us,’ ” he said. “They’re going to have to realize that their doctors and pharmacists are paying attention to what’s going on.”

Epter said having the program will be “a huge thing.”

“We as practitioners are very, very happy that it is finally here, just being implemented,” he said. “I believe it will make a major impact, decreasing the number of deaths, decreasing obviously a number of other problems that patients have.”

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JRC2024
6955
Points
JRC2024 08/10/13 - 10:19 pm
3
0

The doctors play a big big

The doctors play a big big part in this addiction. They are used to giving out lots of drugs because the person says they need them.

Bodhisattva
4942
Points
Bodhisattva 08/11/13 - 06:08 am
6
2

Pain is subjective, and real.

Pain is subjective, and real. There is just as much of a problem of doctors under prescribing pain meds for fear of the state and feds making their lives a living hell with investigations as there is with overprescribing. In the end, it's the patient who suffers. There are criminals who make a living at scamming the doctors for meds. Go after them and don't treat patients who already suffer as some kind of wanna be drug king pins. Who cares if they have THC or marijuana (a little confused on that one) in their system. It's been proven to help alleviate pain and is a pretty darned safe adjunct to other pain meds. It's for sure a lot safer than gobbling acetaminophen all day and frying your liver. Take too much and you raid the cookie cabinet and nap. Take too much Tylenol and you get to take Acetylcysteine. Love that smell. While we're at it, stop treating the doctors like criminals too. I'd rather they spend time worrying about my health than the authorities that are constantly looking over their shoulders. It seems rather simple. If doctor X writes an abnormal amount of prescriptions for narcotics for one patient (especially if he/she isn't a pain management Doc) it wouldn't hurt to check on it. The same goes if Doctor X has an abnormal amount of patients on narcotics or writes them an abnormal amount at one time. "Why does Bob need 1,000 Oxycodone a month Doc?" would be an example. I'm not a big fan of the assume everyone is guilty and you have to prove your innocence approach.

shrimp for breakfast
5011
Points
shrimp for breakfast 08/11/13 - 07:00 am
5
1

I went to Dr. Epter

He's done good things for people in pain I hear but he didn't help me one bit. I had shots in my back that cost $16,000 and it lasted 2 days. He wanted me to have more. Yeah I can see why.
I have decided to give up trying to get help and just take the pain or only use over the counter medicine. I haven't smoked pot in many years but if it ever becomes legal here I want a prescription! You can't OD and from what I hear it 's great for pain relief. I bet the pharmaceutical companies will do everything in their power to keep pot illegal in the backwards thinking south.
I will only go to a Doctor now if I absolutely have to and I have insurance. Every one I've been to here in Augusta has treated my pain too conservatively which has resulted in a lousy quality of life.

shrimp for breakfast
5011
Points
shrimp for breakfast 08/11/13 - 07:13 am
4
1

Hippa laws

The Hippa laws have been thrown into the trash bin of history. It's just like the NSA. There is no privacy whatsoever in the medical profession anymore. I wonder how long it will be before attorney client privilege is done away with.

angedelune
215
Points
angedelune 08/11/13 - 08:07 am
3
3

hmmm

i don't understand how this violates HIPPA. The only people able to see this information are prescribers and the pharmacies. So, please explain your statement.
I work in the medical field and I LOVE LOVE LOVE this system. We can pull up what people have had filled and 70% of the time if someone is coming to me with a pain related problem they have had multiple narcotics filled from different pharmacies.

IBeDogGone
1773
Points
IBeDogGone 08/11/13 - 09:36 am
2
1

Get Educated

I work in the field of pain management in several states and I can tell you this is the one of the best act's passed for both the physcian and the patient. Their are many drugs that do not interact well together and can be fatal. The attending physcian does not know what all patients are taking because the do not always tell the truth. (Imagine that)

As far as drug testing this is a must, I do not care if a patient smokes pot, but I care if he is issued narcotics and he sells them to get street drugs. This happens more than most people would believe.

Pain physcians are in a difficult position unless you can see a bulging disk from X-rays ect it is hard to caculate just how much pain a person is suffering. I have seen a patient walk with a cane and stooped over walking out the clinic and when you see them at CVS picking up their RX they are standing as straight as a Georgia Pine.

Alternative devices are good Tens Unit, Stimulators, and injections do give many patients relief of not having to take as much oral medication many times.

soapy_725
43306
Points
soapy_725 08/11/13 - 09:37 am
0
0

Pain management is like "talk therapy". Never ends. Never ends

Unpublished

Pain management is like "talk therapy". Never ends. Never ends

dstewartsr
20388
Points
dstewartsr 08/11/13 - 09:41 am
1
3

For once I agree with Bodhisattva.

Mark your calendar; those trapped in the infernal regions are having slushies. As the result of what might be called "an interesting life" I have had recourse to pain meds over the course of decades. Recently, I have had several surgeries and not only were the post-op prescribed pain medications one-half to one-quarter the strength, they were written for five days. The doctor said I must make another appointment because he couldn't write the amount I really needed without setting off alarms.

Bear - Lillian Smith
65
Points
Bear - Lillian Smith 08/11/13 - 09:56 am
3
3

Mixed feelings....

I have very mixed feelings about this, however, it's extremely naive to think only physicians and pharmacist will be able to see this "very" private information. In my opinion, it does violate the "intent" of HIPPA.

At the very least, it gives the government yet one more portal to unfettered access into the private life of its citizens. Can't image why that would make me nervous.

allhans
21955
Points
allhans 08/11/13 - 10:00 am
2
2

I hope this program works.

I hope this program works.

sdwells
6
Points
sdwells 08/11/13 - 10:11 am
2
3

People, it's HIPAA, not

People, it's HIPAA, not HIPPA.

shrimp for breakfast
5011
Points
shrimp for breakfast 08/11/13 - 10:15 am
4
0

angedelune

When I was written pain medication for my bulging disks, fracture it was never more than 30 5mg hydrocodone pills. What this meant for me was that I was granted 5 hours a day when I could live a normal life. I doctor shopped to find a doctor who would give me enough to make my life a little easier. Didn't work though. I tried steroid shots, every NSAID known to man among other things like physical therapy. If I was given a narcotic pain reliever it was always too little to help. I've tried everything. If you have any kind of advice you can give me to del with chronic pain I'd gladly accept it.
I've been given enough muscle relaxers. They do nothing for the pain I have but the Doc's always prescribe them even though they know they don't help at all.

IBeDogGone
1773
Points
IBeDogGone 08/11/13 - 11:01 am
0
0

sdwells

It is HIPAA, Health Insurance Portability and Accountability Act!

Follow this link it explains KY's Guidelines and I am sure GA will reflect closely.

http://chfs.ky.gov/os/oig/KASPER.htm

soapy_725
43306
Points
soapy_725 08/11/13 - 11:27 am
0
0

Defensive Medical Treatment. That is the new game for MD's

Unpublished

Defensive Medical Treatment. That is the new game for MD's

soapy_725
43306
Points
soapy_725 08/11/13 - 11:28 am
0
0

Half of all spine related surgery ends in more pain. Scar tissue

Unpublished

Half of all spine related surgery ends in more pain. Scar tissue

soapy_725
43306
Points
soapy_725 08/11/13 - 11:29 am
0
0

You get better odds of recovery from a plumber than a surgeon.

Unpublished

You get better odds of recovery from a plumber than a surgeon.

soapy_725
43306
Points
soapy_725 08/11/13 - 11:30 am
0
0

When your neurosurgeon says he wouldn't have surgery. WOW

Unpublished

When your neurosurgeon says he wouldn't have surgery. WOW

soapy_725
43306
Points
soapy_725 08/11/13 - 11:32 am
0
0

The Affordable Health Care train is about to leave the station.

Unpublished

The Affordable Health Care train is about to leave the station.

soapy_725
43306
Points
soapy_725 08/11/13 - 11:33 am
0
0
LBunnies32
101
Points
LBunnies32 08/11/13 - 11:34 am
0
0

I also saw Epter...

Epter treated me like I was a drug seeker, even though all I ask was for him to do something, anything to help my pain. I never once asked for any prescription. He stereo typed me due to tattoos. He gave me an injection that felt like pure torture, after I found out he gave all his other patients something to relax them but gave me NOTHING, I was left in more pain than I came in with and when I went to him to do something about it, like even soaking in hot tub...anything! He turned his back on me and called me a drug seeker. I do not take drugs. I do not like to feel high! I only take what I am prescribed when I am prescribed it. I have a high tolerance to medications, even my BP medication had to be doubled the highest strength to work on lowering my BP. There are other doctors in Augusta that actually do try to help!
I have seen people (that i personally know) in no real pain walk out with prescriptions for pain meds and I have seen pele in true horrible pain be stepped on. Doesn't make any sense to me. I hope this system helps the ones in real pain get enough pain meds to actually improve their life instead of just allowing a few hours a day to barely function!

soapy_725
43306
Points
soapy_725 08/11/13 - 11:34 am
0
0

Go to a nursing home to view the new Affordable Health Care

Unpublished

Go to a nursing home to view the new Affordable Health Care

soldout
1280
Points
soldout 08/11/13 - 11:41 am
0
3

eft

emotional freedom technique has been found to be very effective for pain. You can learn how to do it in 5 minutes and takes about two minutes to do. There are videos on youtube to show you how to do it. It is effective for lots of things besides pain and something everyone should know how to do.

nocnoc
30931
Points
nocnoc 08/11/13 - 12:35 pm
0
0

TENS units

do sometimes help for a short period of time.
Tens Patches are costly and not as cheap as the $4 copay drugs.

I guess maybe the insurance companies need to relook how they co-pay some things vs. others.

JENNPAT
217
Points
JENNPAT 08/11/13 - 06:20 pm
1
0

i have suffered

with back pain for years i have had two neck surgs. and two lumbar and the last time they done surg. on me they had to put a rod and screws plus i had some disk messed up and a frecture and i have wires in my neck now i know what pain is and i don't need any one but my doctor to be helping me with my pain as i have osto arth.in my spine and sometimes i am in so much pain i can not even stand to put my foot on the floor i have tried tens units and it only help so much plus the patches broke me out as for as the stemulators you have to pass a test before they will put them in you and my insurance would not pay for me go have this done and i sure don't have that kind of money.my doctor does drug testing on people but i am never worried because i never take any thing except the pain meds. he gives to me and sometimes it does take alots of pain meds. and relaxers to get me out of pain so i thank God for my doctor

lsmith
105
Points
lsmith 08/11/13 - 06:39 pm
0
0

The Patient privacy act is a

Unpublished

The Patient privacy act is a joke, long gone out the door. Now, and especially when obamacare kicks in everything about you will be open book.
I've noticed that the people who actually need pain relieving drugs are usually the ones who can't get it. Of course abnormal pain usually will hit after office hours and physicians on duty will instruct you to go to the emergency room at $200 co-pay. Pain is the one thing that humans have the least tolerance for and the least access to real relief. It's a pity that the effort to cut off the druggies cause practitioners to take it out on the real patients who have to got to extraordinary lengths to get relief.

corgimom
19268
Points
corgimom 08/12/13 - 04:56 am
1
0

I love the way that innocent

I love the way that innocent people are treated like drug addicts, when they are not, because some people are.

That would be like treating every person that drank alcohol as an alcoholic. We don't do that, but pain pills is the big story right now.

Pain is debilitating. It wipes you out. It makes life very, very difficult and greatly impacts your quality of life.

The truth is that medicine does a lousy job of treating pain. And when you are in a pain cycle, the longer it goes, the worse it is.

angedelune
215
Points
angedelune 08/12/13 - 08:11 am
2
0

narcotic medication...

is only to be used for short term. One should not be on it for a long time at all, it is not a fix, it is not a solution. What helped me when I had problems was A). i replaced my bed B). i did yoga and tai chi along with stretching exercises C). don't smoke most of all it cuts off the small vasculature to the areas of your body that need healing and especially your periphery D). lose weight and don't eat processed foods with preservatives all of these contribute to pain and so-called Fibromyalgia. Most people are so caught up in the whoa is me I hurt that they begin to see themselves as a victim instead of getting up and doing something about it. Then you do have the people who go from ER to ER to ER and Doctor to Doctor just to get pain medications and mainly to sell. I have found so many people filling prescriptions at multiple pharmacies and numerous times a month, it's then i point this out and politely tell them they will be receiving absolutely nothing.

sportswriter1
14
Points
sportswriter1 08/12/13 - 12:37 pm
0
0

Dr. Epter has an answer, not necessarily THE answer.

Like several others have written here, I also tried Dr. Epter for my chronic back pain. His results on my case were not what we had hoped for.

My insurance provider and I paid for an initial consultation, x-rays, imaging and two additional office visits, along with an injection procedure at Dr. Epter's clinic. No problems with all that. Everybody has to get paid and the good doctor has people and equipment he must pay for.

My issue is the four different muscle relaxers he tried just didn't give me the temporary relief we hoped for before my first procedure. Then, the procedure itself helped--but for only about five days versus the up to 30-days--or more--Dr. Epter had anticipated.

Wen I called to advise the procedure was wearing off too quickly, Dr. Epter suggested I schedule another procedure very soon. In the meantime, both the costs involved and my chronic pain were rolling along with no real relief in sight.

I told Dr. Epter the meds were not giving me relief. His immediate plan to get the pain under control between the injections was to increase my muscle relaxer intake from 12 to 15 pills a day(sorry, don't recall the medication).

That was almost 7 years ago. My pain forced me to seek out a second opinion. I actually found Dr. Yagnick of Advanced Pain Management through my primary provider.

After explaining my situation, Dr. Yagnick did include opiate medication in my immediate treatments. Which led to some immediate pain relief in my case. But, my regimen is strictly controlled and my use of the meds are only as prescribed.

I got relief from my pain as a result of my first visit there. In addition, the costs both to me and my insurer were much less.

My individual situation doesn't allow me to simply have one of the new electronic simulators installed in my back and call it a day. I've also had 5 shoulder surgeries and chronic issues there as well.

In my case, narcotic medication has been the only source of reliable relief to allow me to live a pain-managed, not pain free, life for the past seven years.

I'm only 54 now and my plans are to continue to enjoy my grad-kids and get up and about for many more years to come.

To those in the medical community who have written on here that narcotics are only good as a temporary measure and have no long-term value, myself and many thousands of other chronic pain suffers disagree.

I've never doctor shopped, I've never sold a single pain pill and I have no issue with random drug testing by my doctor or the DEA--as long as they will pay for it when it comes back clean--to assist in keeping drug dealers and abusers from obtaining prescriptions.

I'm not saying I have THE answer as Dr. Epter and some others appear to be. What I am saying is I--and thousands of other chronic pain patients--have an answer that works for us. An answer that our medical provider isn't billing us over $2,500 for a single 45 minute visit each month or so. Amazing how the most touted "answer" often equals more money to the provider.

Lastly, please don't throw away thousands of people who use our medicine properly in a rush to try stemming drug abuse. Making us or our health professionals feel like criminals because we can't or wont jump on the alternative bandwagon is a troubling thing to me.

I'm all good with Dr. Epter's approach on patients it works for. But, he ain't batting a thousand here. Properly used narcotics still have a place in helping make life a little less painful for many people. If you want my help in showing I do it right, I'm all in--as long as the additional cost burden for testing is only charged to those who test guilty.

BamaFanNGa
67
Points
BamaFanNGa 08/13/13 - 12:56 am
0
0

Hooray for this System!!!

As one that suffers from chronic pain, I am thrilled to see Georgia implement this program. It will make it so much easier for the Doctors to recognize the seekers from the ones that truly need medical attention. As far as the medical marijuana debate goes; I would much rather use the THC than opioids. However, as long as marijuana is illegal, I will not touch it.

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