Reality and responsibility: A commentary on the treatment of pain and suffering in a drug-using society

While opioids are a necessary part of the armamentarium of pain management, there has been a growing trend toward prescription drug abuse and diversion in our society. Meeting the goal of treating pain while not contributing to drug abuse and diversion requires vigilance and education. Physicians and patients have been singled out as the main players in the societal problem of diversion of prescription drugs. In fact, the problem can only be overcome when not only physicians and patients but also healthcare practitioners, third-party payers, law enforcement agencies and regulators, the pharmaceutical industry, and the media finally work together to prevent it, instead of fingering any one party for the blame.

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Combating the Prescription Painkiller Epidemic: A National Prescription Drug Reporting Program

American Journal of Law & Medicine ◽

10.1177/009885881404000103 ◽

2014 ◽

Vol 40 (1) ◽

pp. 85-112 ◽

Cited By ~ 15

Author(s):

Joanna Shepherd

Keyword(s):

Drug Abuse ◽

Prescription Drug ◽

The United States ◽

Third Party ◽

Prescription Drug Abuse ◽

Drug Abusers ◽

State Governments ◽

Drug Problem ◽

Payment Systems ◽

Prescription Drug Monitoring Programs

Prescription painkiller abuse is the fastest growing drug problem in the United States. In the past year, approximately one out of twenty Americans reported misuse or abuse of prescription painkillers. Several factors contribute to the prescription painkiller epidemic. Drug abusers use various methods—such as doctor shopping, paying with cash, and filling prescriptions in different states—to avoid detection and obtain prescription painkillers for illegitimate uses. A few rogue physicians and pharmacists, lured by substantial profits, enable drug abusers by illegally prescribing or supplying controlled substances. Even ethical physicians rarely have adequate training to recognize and address prescription drug abuse, and as a result, prescribe painkillers to patients who are not using them for legitimate medical purposes. Similarly, although the majority of pharmacies have taken steps to combat drug abuse and reduce prescription painkiller dispensing, under current reporting systems, pharmacists lack visibility into several important indicators of drug abuse. As a result, even the most vigilant pharmacists find it extremely difficult to identify and detect drug abuse with certainty.While state governments have established prescription drug monitoring programs (PDMPs) to crack down on prescription drug abuse, these programs have proven to be inadequate. The programs currently suffer from inadequate data collection, ineffective utilization of data, insufficient interstate data sharing, and constraints on sharing data with law enforcement and state agencies. By contrast, third-party prescription payment systems run by pharmacy benefit managers (PBMs) or health insurers have been effective in detecting prescription drug abuse. This paper suggests that a national prescription drug reporting program building on existing PBM networks could be significantly more effective than existing state PDMPs in detecting prescription drug abuse.

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How Predictors of Prescription Drug Abuse Vary by Age

Journal of Drug Issues ◽

10.1177/002204260803800405 ◽

2008 ◽

Vol 38 (4) ◽

pp. 1027-1043 ◽

Cited By ~ 18

Author(s):

Jeremy Arkes ◽

Martin Y. Iguchi

Keyword(s):

Drug Abuse ◽

Prescription Drug ◽

Prescription Drugs ◽

Age Groups ◽

Prescription Drug Abuse ◽

Drug Abusers ◽

Age Group ◽

The Past ◽

Nonmedical Use ◽

Race Ethnicity

Previous studies that have identified the predictors of prescription drug abuse have either focused on a specific age group or pooled all age groups together into one sample. This approach constrains the predictors to have the same effect across age groups. In this study, we use the 2001 to 2003 National Survey on Drug Use and Health to estimate separate models across five age groups for the past year nonmedical use of prescription drugs. The results indicate that several factors (e.g., gender, race/ethnicity marital status, other substance use) have quite different correlations with prescription drug abuse across age groups. This suggests that more accurate profiles of prescription drug abusers can be obtained by estimating separate models for different age groups.

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Early Detection of Prescription Drug Abuse Using Doctor Shopping Monitoring From Claims Databases: Illustration From the Experience of the French Addictovigilance Network

Frontiers in Psychiatry ◽

10.3389/fpsyt.2021.640120 ◽

2021 ◽

Vol 12 ◽

Author(s):

Thomas Soeiro ◽

Clémence Lacroix ◽

Vincent Pradel ◽

Maryse Lapeyre-Mestre ◽

Joëlle Micallef

Keyword(s):

Drug Abuse ◽

Early Detection ◽

Prescription Drug ◽

Prescription Drugs ◽

Best Practice ◽

Illicit Drugs ◽

Opioid Analgesics ◽

Outcome Data ◽

Prescription Drug Abuse ◽

Doctor Shopping

Opioid analgesics and maintenance treatments, benzodiazepines and z-drugs, and other sedatives and stimulants are increasingly being abused to induce psychoactive effects or alter the effects of other drugs, eventually leading to dependence. Awareness of prescription drug abuse has been increasing in the last two decades, and organizations such as the International Narcotics Control Board has predicted that, worldwide, prescription drug abuse may exceed the use of illicit drugs. Assessment of prescription drug abuse tackles an issue that is hidden by nature, which therefore requires a specific monitoring. The current best practice is to use multiple detection systems to assess prescription drug abuse by various populations in a timely, sensitive, and specific manner. In the early 2000's, we designed a method to detect and quantify doctor shopping for prescription drugs from the French National Health Data System, which is one of the world's largest claims database, and a first-class data source for pharmacoepidemiological studies. Doctor shopping is a well-known behavior that involves overlapping prescriptions from multiple prescribers for the same drug, to obtain higher doses than those prescribed by each prescriber on an individual basis. In addition, doctor shopping may play an important role in supplying the black market. The paper aims to review how doctor shopping monitoring can improve the early detection of prescription drug abuse within a multidimensional monitoring. The paper provides an in-depth overview of two decades of development and validation of the method as a complementary component of the multidimensional monitoring conducted by the French Addictovigilance Network. The process accounted for the relevant determinants of prescription drug abuse, such as pharmacological data (e.g., formulations and doses), chronological and geographical data (e.g., impact of measures and comparison between regions), and epidemiological and outcome data (e.g., profiles of patients and trajectories of care) for several pharmacological classes (e.g., opioids, benzodiazepines, antidepressants, and methylphenidate).

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Uncensored journalism in censored times: Challenges of reporting on Azerbaijan

Journalism ◽

10.1177/14648849211036872 ◽

2021 ◽

pp. 146488492110368

Author(s):

Arzu Geybulla

Keyword(s):

Law Enforcement ◽

News Media ◽

Authoritarian Regime ◽

Criminal Offence ◽

Law Enforcement Agencies ◽

Authoritarian Rule ◽

Media Environment ◽

The Media ◽

Media Systems ◽

The Impact

Azerbaijan is an authoritarian regime, whose government maintains a tight grip over the media landscape. Independent and opposition media are regularly persecuted, with journalists and their family members intimidated by law enforcement agencies via arrests, beating, threats and other forms of persecution. Defamation is considered a criminal offence. This paper addresses the impact of this restrictive media environment on reporting about Azerbaijan. As scores of journalists have fled the country in search of safety, a community of exiled journalists has emerged and a number of news media websites operate in exile. Together they continue reporting on Azerbaijan with the help of a handful of journalists remaining on the ground. This paper explores how reporting on Azerbaijan continues despite a highly restricted media environment and what this means for other media systems facing authoritarian rule.

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Lynching as an indicator of destructive processes in modern Russian society

Psychology and Law ◽

10.17759/psylaw.2020100107 ◽

2020 ◽

Vol 10 (1) ◽

pp. 84-91

Author(s):

A.M. Smirnov

Keyword(s):

Law Enforcement ◽

Community Development ◽

Criminal Policy ◽

Russian Society ◽

Law Enforcement Agencies ◽

Psychological Determinants ◽

Legal Psychology ◽

The Media ◽

Destructive Processes ◽

High Level

The article updates the issue of the prevalence of vicious punishment of harm-doers in Russian society, since the presence of this ancient practice at this point of community development indicates destructive processes in it. The following socio-psychological determinants of this phenomenon are designed and highlighted: the growth of social aggressiveness, feelings of hatred or enmity, defects in legal psychology caused by the development of legal nihilism, disappointment in the effectiveness of law enforcement agencies against the backdrop of a high level of crime in the country, rejection of the humanism of domestic criminal policy, mindset and the criminalization of Russian society, the formation of addiction to revenge and lynching, cultivated by the media. The catalyst for lynching harm inflicted primarily by affect, frustration, stress and resentment caused by a crime or other offence, which nullify the restraining imperatives of behaviour. The author concludes that it is necessary to develop appropriate measures that are proposed in the work to eliminate this negative phenomenon in Russian society.

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7. Sectoral aspects of data protection

Information Technology Law ◽

10.1093/he/9780198830559.003.0007 ◽

2020 ◽

pp. 114-137

Author(s):

Ian J. Lloyd

Keyword(s):

Law Enforcement ◽

Data Protection ◽

Law Enforcement Agencies ◽

Media Processing ◽

Electronic Communications ◽

The Media

This chapter considers the application of data protection principles within the media and electronic communications sectors. In both areas, the operation of data protection principles has been contentious. Data protection issues are principally concerned with the application of what might be regarded as ‘traditional’ data protection principles in the context of activities where different priorities might legitimately be identified. In some respects, media processing might be compared with law enforcement agencies. Digging out the truth about the unsavoury activities of powerful elements in society might well require the use of tactics and techniques that would be regarded as unfair in more general contexts.

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7. Sectoral aspects of data protection

10.1093/he/9780198787556.003.0007 ◽

2017 ◽

Author(s):

Ian J. Lloyd

Keyword(s):

Law Enforcement ◽

Data Protection ◽

Law Enforcement Agencies ◽

Media Processing ◽

Electronic Communications ◽

The Media

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The Influence of Prescription Monitoring Programs on Chronic Pain Management

January 2018 - Pain Physician ◽

10.36076/ppj.2009/12/507 ◽

2009 ◽

Vol 3;12 (3;5) ◽

pp. 507-515

Author(s):

Paul J. Christo

Keyword(s):

Health Care ◽

Drug Abuse ◽

Law Enforcement ◽

The State ◽

Prescription Medications ◽

Law Enforcement Agencies ◽

Prescription Practices ◽

Prescription Monitoring ◽

Monitoring Programs ◽

The U.S

Background: Abuse of prescribed controlled substance has become a serious social as well as health care issue over the past decade. A particularly alarming trend exists among patients aged 12 to 17. Common abuse behaviors include doctor shopping, drug theft, feigned pain symptoms to gain health care access, drug sharing, prescription forgery, and improper prescription practices. In response to this epidemic of abuse, many states have adopted prescription monitoring programs (PMPs). Such programs first originated in the early twentieth century. As of 2006, 38 states had such programs, many of which are supported by federal grants. As PMPs become more widespread, they have also increased in sophistication. By keeping a record of the prescription and dispensing of narcotics, these programs are able to build a comprehensive data network for tracking prescription medications. These databases aid law enforcement agencies in investigations of narcotic trafficking; they also help state regulatory boards to monitor improper prescription practices. Objective: This manuscript examines the basic structure of a PMP, including the way the data are collected and the way these data are stored and used. It also looks at the organizational differences amongst state programs. NASPER and Harold Rogers are two federal programs that provide funding to the state PMPs, and the current study examines the differences as well as similarities between these 2 programs. This study also compares the results of 2 reports: the U.S. General Accounting Office Study and the Twillman study. Both studies have evaluated the efficiency of the PMPs. Discussion: The U.S. General Accounting Office Study showed that while considerable differences exist among the state PMPs, these programs not only reduce the time and effort for law enforcement agencies to conduct investigations, but also cut the supply of prescription medications. However, the Twillman report suggests that prescription programs caused a shift in prescription practice, while the actual rate of abuse may not have been reduced. These 2 studies both point to the challenges the PMPs face. However, more recent data suggest that proactive use of the PMPs results in the decreased growth of prescription medication sales. Finally, a number of states have also begun to objectively evaluate the efficiencies of the system. Conclusion: Many states have developed PMPs to help regulatory agencies as well as physicians detect prescription drug abuse. Limited data so far suggest that such programs reduce abuse practices. In addition, proactive usage of the data further prevents abuse. Key words: Prescription monitoring programs, drug abuse, National All Schedules Prescription Electronic Reporting Act, Government Accountability Office, Health Insurance Portability and Accountability Act

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Does early onset of non-medical use of prescription drugs predict subsequent prescription drug abuse and dependence? Results from a national study

Addiction ◽

10.1111/j.1360-0443.2007.02015.x ◽

2007 ◽

Vol 102 (12) ◽

pp. 1920-1930 ◽

Cited By ~ 153

Author(s):

Sean E. McCabe ◽

Brady T. West ◽

Michele Morales ◽

James A. Cranford ◽

Carol J. Boyd

Keyword(s):

Drug Abuse ◽

Prescription Drug ◽

Prescription Drugs ◽

Early Onset ◽

National Study ◽

Prescription Drug Abuse

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DRUG ABUSE IN ADOLESCENCE

PEDIATRICS ◽

10.1542/peds.44.1.131 ◽

1969 ◽

Vol 44 (1) ◽

pp. 131-141

Author(s):

Robert W. Deisher ◽

Albert J. Schroeder ◽

V. Robert Allen ◽

Harry Bakwin ◽

Victor Eisner ◽

...

Keyword(s):

Drug Abuse ◽

Law Enforcement ◽

Young People ◽

Children And Adolescents ◽

Young Person ◽

Drug Problem ◽

Factual Information ◽

Law Enforcement Agencies

The pediatrician can be useful to the young person with a drug problem if he: (1) is aware of the different motivations for drug abuse by adolescents and how to approach them, (2) recognizes the need for confidentiality, (3) provides factual information in a non-authoritarian manner and listens and counsels as indicated, and (4) manipulates the environment-to relieve school and family pressures and to help youngsters find better challenges. Drug abuse in children and adolescents is a major source of concern to parents, educators, law enforcement agencies, and physicians. For the pediatrician as well as the others, a challenge exists to find more appropriate ways of help for young people who turn to drug abuse for the answer that is not there.

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