Just over two years ago, I met with my old friend Dr. Frederic “Skip” Leeds. We were just catching up on what was happening in our lives, and with our families. Skip mentioned that he was working on something pretty interesting.  In response to a growing problem with prescription drug abuse, various state and federal agencies were turning up the heat on prescribers. Skip and his peers were finding themselves squeezed between a rock and a hard place.

Prescription Advisory Systems & TechnologySkip had developed some protocols for primary care doctors to treat non-malignant chronic pain sufferers, and he wondered if I could help him found a business to use computers to operationalize parts of this protocol. Prescription Advisory Systems & Technology is the result.

It is a really complex landscape to enter.  There are quite a few actors in this play:

  • There are patients with legitimate need for pain management;
  • There are patients who have developed a tolerance or addiction, who need and deserve compassionate treatment for their addiction, and who might also still have real pain;
  • There are addicts who reject treatment, or simple drug dealers, who lie to doctors to get drugs for abuse or the black market;
  • There are family members who lie to doctors to get additional medicine for relatives who are tolerant or addicted to these drugs;
  • There are institutions who employ the prescribers, who are at risk if a patient is harmed by drugs their emergency room (for example) prescribed and/or dispensed;
  • There are pharmacies and pharmacists who are at risk if the medicine they dispense is abused or harms someone;
  • There are of course the prescribers themselves, who risk license revocation, lawsuits and even criminal prosecution if medicine they prescribe is abused or harms someone;
  • There are state and federal agencies (DEA, FDA, VA) interested in stopping the few corrupt doctors and pharmacies who recklessly dispense controlled substances, and protecting patients nationwide;
  • There are legislative bodies who are passing laws trying to stem the epidemic of abuse and death from prescription drug overdoses;
  • There are insurance companies who want to control the expense of treating their insured populations;
  • There are state databases called Prescription Drug Monitoring Programs, which track filled prescriptions for controlled substances;
  • There are electronic health record systems, and their vendors;
  • The National Institute of Health, and the Center for Disease Control both have databases about the controlled substance medicines;
  • The National Association of Boards of Pharmacies, and their membership the State Pharmacy Boards have various initiatives related to controlled substance abuse;

And I could actually go on and on…..

And now into this mix, here we come, with tools that will help prescribers quickly and accurately make the right choice in deciding what medicine or treatment to prescribe to their patients.  They can know when they don’t really have to worry about using scheduled medicines, when they should investigate further to see if treatment for addiction is called for, and when they should refer to a specialist.  And they can protect themselves and their institutions while practicing patient centered medicine and protecting the one suffering from pain.

More soon.


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The AAOS recommends the following tools, which have been shown to significantly reduce medication errors:

  • computerized physician order entry
  • computerized decision support systems
  • computerized monitoring of adverse drug events
  • pharmacist-assisted rounds
  • high-risk drug protocols

Overdose deaths are “just the tip of the iceberg”: that for every death there are many more hospital treatment admissions, emergency room visits, people who abuse or are dependent on prescription drugs and nonmedical users.

American Psychological Association

Effective monitoring systems [PDMPs] will augment clinical judgment, provide evidence of misuse, and facilitate prescription of the most appropriate analgesic for the situation…The Emergency Department is regarded as the nation’s safety net…the last bastion of around-the-clock access to care … Unfortunately, some of the solutions to opioid misuse [limiting ED physicians to 3-day opioid prescriptions] preempts judgments from trained emergency medical providers.

American College of Physicians, Annals of Internal Medicine, 9 April 2013
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