There’s no doubt that prescription drug abuse is a major problem in America, and it’s escalating in epic proportions. Prescription drug abuse affects men, women and teens. Concerning trends include older adults, adolescents and women.
Sometimes in this job you just get lucky. You have an elusive and/or dangerous diagnosis just dropped in your lap. Something devastating that you would never have been able to tease out otherwise just gets handed to you by the patient. There’s a catch, though: you have to be smart enough to know when to listen to the patient, when not to blow off their crazy talk as just crazy.
So it was recently when I saw a guy with back pain. From the chart, it didn’t sound like anything complex: a middle-aged to older guy, maybe 60 or so, with a history of chronic back pain and multiple surgeries for the same. He was on Oxycontin 80 mg three times daily (a very high dose, and a red flag for an ER doc naturally suspicious of drug-seeking behavior). I went to see him, and it was clear in seconds that this dude was JPN: Just Plain Nuts. Read more »
*This blog post was originally published at Movin' Meat*
I’m becoming an amateur archeologist. The hilltop where we live is strewn with arrowheads and bits of Native American pottery shards. I have slowly, surely, trained my eye to find them. There is little flint here; so most of the pieces I find were made of quartz. (Hard to work with, but remarkably beautiful and almost always a brilliant white.)
My kids and I walk the red-clay paths and look down for bits of stone protruding up, especially after a good, soaking rain. Elijah, my youngest boy, was the first to find one. ‘Is that an arrowhead, Papa?’ ‘Yep, good eye son!’ He had found what was probably the point of an atlatl (a kind of mix between arrow and spear).
We look for rocks that seem shaped by human hands. That’s the ticket; look for something that seems to suggest a purpose or a history. Things with no shape, no marks from being worked, are probably not worth our time. Read more »
Methamphetamine (also known as “speed” or “meth”) is a fairly common drug of abuse in this country. The National Institute on Drug Abuse estimates that as many as 3% of 12th graders have tried the drug, and about 0.3% of the population actively abuses it. Meth stimulates the release of dopamine in the brain, which produces a feeling of intense well being, as well as increases in wakefulness, respiration, heart rate, blood pressure, and hyperthermia. It is very addictive, and its tragic, long-term effects include permanent brain damage, personality changes, psychosis, hallucinations, and impaired learning and memory.
While most meth is produced by “superlabs” in foreign countries, there are a substantial number of small, illegal labs in the US that produce it. Meth can be created by extracting pseudoephedrine (found in many cold and allergy medicines like Sudafed) and transforming it into meth via a chemical process that creates toxic environmental waste.
In order to clamp down on local production of meth, it is critical to control the diversion of pseudoephedrine from local pharmacies into illegal labs. The US government introduced a “Combat Meth Act” to improve the tracking of pseudoephedrine purchases, but some believe that this approach doesn’t go far enough. One successful anti-meth program in Australia (called the MethShield) is now being piloted in Kansas. I spoke with Shaun Singleton, the creator of MethShield, to learn more about how we can reduce meth production and sales in the US.
Dr. Val: Tell me about the Combat Meth Act and why it dovetails nicely with MethShield.
Singleton: The Combat Meth Act was introduced in 2005 and it has substantially reduced the number of meth labs in the US. The Act limits consumer purchase of pseudoephedrine to 3600mg of active ingredient per day (or 9000mg in a 30 day period). In order to purchase pseudoephedrine, you have to present a form of government-issued I.D. (like a driver’s license) and the pharmacist records that information and keeps it in a log book. However, since this information is not electronic, pharmacies don’t share information with other pharmacies, and so meth producers are able to present fake I.D.s and travel from one pharmacy to the next without anyone realizing that they’re over their legal limit. So unfortunately, people found a way to circumvent the Combat Meth Act and local production of meth continues to be a problem.
The MethShield is a real-time tracking program for pseudoephedrine sales. Instead of keeping paper records, it allows pharmacists to enter information into a secure online database. This makes it much more difficult for people to travel from pharmacy to pharmacy, purchasing their maximum allowed dose at each one. With MethShield the pharmacist knows exactly how much product the client has purchased in the past (from any participating pharmacy), and whether they’re eligible to purchase more or not. The information in the database is aggregated and made available for law enforcement to review.
Dr. Val: How do you protect patient privacy?
Singleton: First of all, you have to realize that we’re not interested in people who have a sinus infection, or use 50 Sudafed tablets per year. We’re talking about the 1% of people who are purchasing 20 packs of Sudafed in a day. Those people are the ones who are flagged by the MethShield system and are investigated by law enforcement.
The MethShield database offers superior privacy to current methods – which basically involve hand-writing peoples’ names in a binder and keeping it open on the counter top at the pharmacy (not very secure at all). MethShield was originally conceived and developed by the Pharmacy Guild of Australia and took great care to engineer the database in the most secure way possible. We ask for informed consent from clients and train pharmacy staff in how to maintain the database. In Australia we processed several million transactions during our pilot and did not receive a single privacy complaint. Most people are quite willing to give their driver’s license number to their pharmacist, understanding that the process might help to catch meth lab criminals.
Dr. Val: Can’t people just use fake I.D.s?
Singleton: We can’t stop people from using fake I.D.s, but the system renders them useless very quickly. Once you’ve entered one I.D. in the system to purchase 9000mg of pseudoephedrine, you generally can’t use it to buy more for another 60 days.
Dr. Val: Couldn’t the MethShield check the I.D.s against the DMV records to identify fake I.D.s more rapidly?
Singleton: Law enforcement officers can do this manually, but for privacy reasons the MethShield database does not connect to any other databases. Also, MethShield was designed to support pharmacists – so they can sell pseudoephedrine products safely – and it’s not really their role to be checking peoples’ I.D.s against a DMV database.
Dr. Val: What inspired you to create the MethShield?
Singleton: I’m married to a pharmacist and we live in Queensland, the once meth capital of Australia. I head a team that has devoted itself to creating IT solutions that make life easier for pharmacists, since they spend a lot of their time filling out forms to comply with government and insurance regulations instead of dispensing drugs and counseling people. We wanted to try to automate some of those processes to help pharmacists like my wife do what they’re really skilled at. We applied innovative thinking to kill two birds with one stone – to address the meth problem and free up pharmacists from some of their overly burdensome administrative tasks.
MethShield launched in November, 2005 and within the first 6 months of the program we were able to reduce the number of illegal meth labs detected by law enforcement by 23%. After 18 months we reduced the number of meth lab detections by 37%, and also had an increase in arrests and a number of charges raised. It’s really exciting to see such a visible impact.
Dr. Val: How are you planning to quantify the success of the program in Kansas?
Singleton: There will be 128 pharmacies in the pilot (as opposed to the 950 that we had in our Australian pilot program) and the success of the program really depends on the participation rate of the pharmacies. If they are careful to process all their transactions through the database we’ll get some meaningful data. Ideally we’d like to establish clear patterns of use and help the law enforcement agents to discern where the products are being abused. Law enforcement detected 97 illegal meth labs last year in Kansas, and we hope that the MethShield will further assist in the crackdown. If we can demonstrate the cost effectiveness of the program, we hope that Kansas will implement it state-wide.
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