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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Prescribing or dispensing to an abuser, diverter, misuser or ‘doctor shopper’ puts the provider, their practice and or institution, as well as the patients at high risk.

Although relieving pain and reducing suffering are primary emergency physician responsibilities, there is a concurrent duty to limit the personal and societal harm that can result from prescription drug misuse and abuse.

ACEP Annals of Emergency Medicine 525

When a clinician is prescribing a controlled substance, readily available information about the drugs that a patient is receiving from other providers can be a critically important component of the decision-making process…Increasingly, these [PDMP] programs have evolved into a useful tool for the clinician who must incorporate careful risk management into the prescribing of opioid analgesics or any other controlled substance.

Increasingly, these programs have evolved into a useful tool for the clinician who must incorporate careful risk management into the prescribing of opioid analgesics or any other controlled substance Prescription Drug Monitoring Programs Serve a Vital Clinical Need.

Editorial  Pain Medicine, The American Academy of Pain Medicine; 2011;12:845
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