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Harvard Health Blog
Prescription monitoring programs: Helpful or harmful?
- By Stephen P. Wood, MS, ACNP-BC, Contributor
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A concern I have as a long-term tramadol patient is that this hypervigilence will eventually be applied to this medication as well. I have been on the max daily dose (400mg of immediate release) for 5+ years to treat diabetic neuropathy. Not once have I ever felt narcotic effects. The only time I was “bothering” a pharmacy about it was when one kept saying they had not heard back from my doctor for reauthorization, but my doctor’s office showed me proof that they had reauthorized AND they got on the phone with the pharmacy to expedite the issue. I transferred to a different pharmacy and have had no problems since.
Tramadol is a prodrug, which means it has to get bioactivated to produce the narcotic active metabolite. The other method of action is via SNRI effects which do not need this bioactivation.
To me, it stands to reason that I am among the 10% or so of the population of my ethnicity that does not bioactivate much, if any, of this medication and others that rely on the same enzyme (CYP2D6). That said though, insurance carriers will not cover the genetic testing to find out if this is the case. I am betting, however, that if a crackdown happens, they will be right there saying that this medication that I have used for years without ANY sort of misuse is suddenly not covered.
The irony here is an FDA-approved option for diabetic neuropathy is tapentadol, which was created from tramadol with the intent of making it not need bioactivation and removing the serotonin inhibition. Tapentadol is, of course, a brand drug vs. generic for tramadol, so the FDA approved choice would push me to something that could cause addiction AND would cost me a whole lot more, perhaps being unaffordable. All because this “crisis” is being approached with the idea that “if a person is taking an opioid, they are an addict waiting to happen”.
You fail to mention other problems about all these databases. First, this constant monitoring is making physicians afraid to prescribe opioids at all — even when they might be the best option. Second, how safe are these databases from hackers? For example, I am an Anthem member and have been included in both the big Anthem hack (80 million members) as well as a breach that happened at an Anthem business provider — which wasn’t discovered until a year after it happened. Third, what about patient privacy, the patient.s HIPPA rights? A doctor or someone in the doctor’s group could check the database claiming they intended to prescribe an opioid medication when in fact they were just curious. In that same category, I had an interesting experience at our county health center. I was there to get a vaccination that I could not get at my primary’s office. The nurse pulled up a screen and went through various medications that I had been prescribed over time (that is, some were current, others not) and asked me about them. When I asked where she was getting the information, I was told that the state had the database which included any medication that had been received through mail order. I think the danger to the privacy of law abiding, non-addicted medication users is huge. Thoughts on this topic?
Thank you for this important and well written article on a very important subject. Well balanced discussion about PMP is necessary to address each aspect of a very complicated problem. Well done
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