Controlled Substances - They're Watching

They're watching you...

At my first appointment with the pain management doctor, I was told that I would be put in a state Prescription Drug Management Program database and monitored. While this sounds scary, it’s not just to monitor patients for abuse of narcotics. It’s also used to track doctors who prescribe them and adds a lot of red tape for them as well. After doing some research, I found out that it doesn’t just track patients and doctors who prescribe and use opioids, but also any Schedule II, III, IV & V controlled substance.  Doctors have to register in the database and submit their DEA certification number. So, for me, little did I know, I’m already being monitored in it because I am prescribed Xanax for anxiety and depression and temazapam (restoril) for sleep. (And, for any of your freaks who are thinking of coming to my house to steal my medicine...Well, first you have to trick our alarm system, then make it past our vicious chihuahua attack dog, survive the booby-trapped house cluttered with toys that makes Home Alone look like a cake walk, then you will have to make it past my husband and his AR-15, or weapon of choice. And, break into a locked in a safe. Oh, and don't forget to not wake the neighbors! So, don't even think about it! And no, I am not accepting applications for housekeepers.) 

Currently, 49 states have their own prescription drug monitoring program database. To find information on your state’s program, find your state on National Association of State Controlled Substance Authoritieswebsite. Some states have stricter guidelines that other.

Apparently, in 2011, TN had the second highest per capita prescription opioid rates in the U.S.

This of course led to tons of unintentional overdose deaths, (actually more than people killed in car accidents, homicides or suicides), more babies born addicted to drugs, more people in substance abuse programs, etc. I’ll get to the dangers of opioids in another post. Hence, the need for a tracking system. In Tennessee, where I live, the Department of health monitors the Controlled Substance Monitoring database (CSMD).

Here is the purpose of the Tennessee CSMD, which is similar to many other states.

“The Tennessee Controlled Substance Monitoring Database (CSMD) is a prescription monitoring program designed to provide healthcare practitioners with a comprehensive view of a patient’s controlled substance prescription history. The purpose of the CSMD is to assist in research, statistical analysis, criminal investigations, enforcement of state or federal laws involving controlled substances, and the education of health care practitioners concerning patients who, by virtue of their conduct in acquiring controlled substances, may require counseling or intervention for substance abuse, by collecting and maintaining data regarding all controlled substances dispensed in this state.”

The prescribers (Doctors) are required to check the database before prescribing anyone an opioid or benzodiazepine for more than seven days, except under special circumstances. Then, the doctors have to report all of those prescriptions pills they have prescribed every seven days.

Prescribers and pharmacists can then look patients up in the system and see their controlled substance prescription history. Any healthcare person who suspects a patient is doctor shopping must report it within 5 days to local law enforcement agencies, but they don’t have to if they are treating them for a mental illness.

Here is a description of the Tennessee CSMD.

The CSMD contains prescription information from all dispensers of controlled substances in Tennessee and also those dispensers who ship to a patient residing in Tennessee. This includes mail-order pharmacies and some Veteran’s Affairs pharmacies as well. The CSMD collects and maintains dispensing data regarding all controlled substances in Schedules II, III and IV, and Schedule V controlled substances identified by the controlled substance database advisory committee as demonstrating a potential for abuse. Data is to be submitted at least once every seven (7) days for all the controlled substances dispensed during the preceding seven-day period. The following information is required to be submitted for each dispensing in ASAP 2009 (4.1) format:

• Prescriber DEA number;

• Dispensing date;

• Patient identifier,

• Controlled substance NDC number;

• Quantity dispensed;

• Strength of controlled substance;

• Estimated day supply;

• Dispenser DEA number;

• Date the prescription was written;

• Whether the prescription was new or a refill;

• Source of payment”

Any doctor treating patients with ongoing opioid therapy prescribing 120 Morphine Equivalent Daily Doses (MEDD) must consult a pain medicine specialist at least once a year.

And those are just the rules for any kind of doctor who prescribes those meds! Pain Management Doctors have a whole entire set of rules. 

In my next post, I will address the rules and red tape that Chronic Pain Management doctors have to go through in order to treat us. Seriously, it makes sense why a lot of doctors don't want to.