Methadone not reported on prescription monitoring

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PikminOC

PikminOC

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New patient on liquid methadone from a clinic that dispenses it. This doesn't show up on the prescription monitoring site. Is this common? At least he told me he was on it.

He is asking for Adderall. Why on earth would he want to create another pill problem for himself? He is on methadone due to problems with opioids in the past (increased doses, tolerance, etc).
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Federally funded Methadone clinics don't report to the PDMP. HIPAA protected.

Lots of high dose patients want stimulants to off-set the somnolence of opioids. Just like laxatives and testosterone replacement.
 
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He is on 150 mg.
And then why are all the other people on the pdmp if it violates hipaa. Makes no sense at all.
 
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101N said:
Federally funded Methadone clinics don't report to the PDMP. HIPAA protected.

Lots of high dose patients want stimulants to off-set the somnolence of opioids. Just like laxatives and testosterone replacement.
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You think it's a good idea to give them stims?? Isnt Provigil a better choice?
 
Makes some sense - privacy & stigma - but dangerous. 150mg is a lot. Sounds like he's seeing you for the side-effects of his addiction.
 
GroverPsychMD said:
You think it's a good idea to give them stims?? Isnt Provigil a better choice?
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Better to treat the underlying disease: opioid addiction/& dose. Lower the opioid dose and watch the constipation, somnolence, sleep apnea, hypogonadism, OIH, get better.

Say that to the patient, put it in your note, fax it the the MTD prescriber and call them and give it to them as a formal recommendation. But don't touch the MTD as you are not a Federally Qualified Ctr.
 
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He's gonna relapse, if he hasn't already.
 
Titrate to QT > .5 then problem solves itself.

Addiction substitution. Methadone reduces risk from HIV, HEP C, OD due to unknown potency and purity.

Add a 12 step program.
 
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The information from methadone clinics is considered psychiatric treatment and is therefore protected under federal law CFR 42. with the advent of the prescription monitoring programs in conjunction with the massive opioid overdoses, the law needs to be changed however Congress has so far refused. It is no different than the Veterans Administration Hospital is refusing to input their data in the prescription monitoring programs.
 
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Wait you gave him clonidine for "withdrawal"? Seriously how the F could he be withdrawing at that dose? He is either lying to you/is full of ****, selling his daily liquid dose for street drugs, or feeding you a line so you would increase his methadone dose. No possible way he is withdrawing at that dose. What he is defining as withdrawing is probably him coming down from his morning high. This guy needs some serious substance abuse treatment.
 
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algosdoc said:
The information from methadone clinics is considered psychiatric treatment and is therefore protected under federal law CFR 42. with the advent of the prescription monitoring programs in conjunction with the massive opioid overdoses, the law needs to be changed however Congress has so far refused. It is no different than the Veterans Administration Hospital is refusing to input their data in the prescription monitoring programs.
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Not true. When I prescribe a benzo it shows up on the prescription monitoring site. What you are referring to is a different thing.
 
PainDrain said:
Wait you gave him clonidine for "withdrawal"? Seriously how the F could he be withdrawing at that dose? He is either lying to you/is full of ****, selling his daily liquid dose for street drugs, or feeding you a line so you would increase his methadone dose. No possible way he is withdrawing at that dose. What he is defining as withdrawing is probably him coming down from his morning high. This guy needs some serious substance abuse treatment.
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He didn't come to me for methadone. He came to me for Adderall. But I do see exactly what you are saying. He didn't make a follow up. I have requested records from the methadone clinic. Anything else I can do? I have seen him only once.
 
GroverPsychMD said:
He didn't come to me for methadone. He came to me for Adderall. But I do see exactly what you are saying. He didn't make a follow up. I have requested records from the methadone clinic. Anything else I can do? I have seen him only once.
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Decline controlled substance requests. Problem solved. How about no rx for him? Trll him to take otc stimulants. Consider provigil, amantidine, or strattera.
 
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I did give him straterra. He asked me exactly why I'm not giving addy. I'm thinking he wont be back.
 
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No stimulants. Treat the disease, not the symptoms. Let the dealer deal with the side effects of his work.
 
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On the phone when he called for the first appt, he had said that he had heard I was really helping patients so he wanted to see me. I guess I will need to drug test everyone I have on stims..
 
GroverPsychMD said:
I guess I will need to drug test everyone I have on stims..
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Yes! If it's a controlled substance - both benzo & stims - there should be a formal treatment agreement & UDS. Hopefully you aren't using benzo's chronically.
 
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101N said:
Yes! If it's a controlled substance - both benzo & stims - there should be a formal treatment agreement & UDS. Hopefully you aren't using benzo's chronically.
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I have a formal agreement. I only do UDS if I feel there is a need. I do have a few benzo chronically. Less than five patients.
 
If they are on opioids from another feel there is a need.

I appreciate your willingness to post & ask questions here.
 
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I appreciate you guys helping me.
I do not give benzos to people on opioids. I check the pmp on everyone.
I know you guys are tight with your practices. That's also why I posted here.
 
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Methadone prescribrd by methadone clinics absolutely will not show up on prescription monitoring databases. Any information or medical record generated by a methadone clinic is CFR42 protected and these supercedes privacy issues. The question is interesting as to why any doctor in a methadone clinic would ever prescribe a benzodiazepine to those taking methadone given the 1000% increase in death rate.
 
algosdoc said:
Methadone prescribrd by methadone clinics absolutely will not show up on prescription monitoring databases. Any information or medical record generated by a methadone clinic is CFR42 protected and these supercedes privacy issues. The question is interesting as to why any doctor in a methadone clinic would ever prescribe a benzodiazepine to those taking methadone given the 1000% increase in death rate.
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Salary position with bonusfrom shortening the wait to get in.
 
algosdoc said:
Methadone prescribrd by methadone clinics absolutely will not show up on prescription monitoring databases. Any information or medical record generated by a methadone clinic is CFR42 protected and these supercedes privacy issues. The question is interesting as to why any doctor in a methadone clinic would ever prescribe a benzodiazepine to those taking methadone given the 1000% increase in death rate.
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Not true. I have patients who have gotten methadone from other physicians that have shown up on the pmp
 
101N said:
Federally funded Methadone clinics don't report to the PDMP.
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Indeed and that is potentially a dangerous 'glitch' with current regulations.

GroverPsychMD said:
Not true. I have patients who have gotten methadone from other physicians that have shown up on the pmp
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Perhaps the Methadone was prescribed for 'pain' purposes and not through an addition clinic?
 
I'm not understanding. All controlled subs should show up on the pmp. It shouldn't matter why. The point of the pmp is to help physicians make sure of the controlled subs a patient is getting. How would it help if methadone doesn't show up, the patient lies, I give benzos, and the patient dies?
 
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GroverPsychMD said:
I'm not understanding. All controlled subs should show up on the pmp. It shouldn't matter why. The point of the pmp is to help physicians make sure of the controlled subs a patient is getting. How would it help if methadone doesn't show up, the patient lies, I give benzos, and the patient dies?
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Methadone Clinics are not required to submit data to a states PMP as they are exempt by federal regulations (42 CFR Part 2)

http://www.ecfr.gov/cgi-bin/text-idx?rgn=div5;node=42:1.0.1.1.2#se42.1.2_11

If you have seen Methadone on a PMP then it is likely not for a Methadone treatment program.
 
The other thing I recently learned is that medication prescribed through the VA system will not show up on the state PMPs because they will fill in VA pharmacy.
 
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Methadone clinics for the most part, dispense methadone rather than prescribe it. Perhaps dispensed meds from methadone clinics will not be reportable but those prescribed are?
 
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Respect is earned. 101N feels it is appropriate to disparage me personally, any member of this board who dares disagree with his outlier viewpoint, as well as the National and internationally respected leaders of our field.

I will give you the benefit of the doubt, and assume your were unaware of the above. I would encourage you to review 101N's posted diatribes and screeds, and then decide for yourself if he is deserving of your respect.
 
algosdoc said:
The information from methadone clinics is considered psychiatric treatment and is therefore protected under federal law CFR 42. with the advent of the prescription monitoring programs in conjunction with the massive opioid overdoses, the law needs to be changed however Congress has so far refused. It is no different than the Veterans Administration Hospital is refusing to input their data in the prescription monitoring programs.
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I can't speak for all VAs but my VA Pharmacy now monitors PDMP and documents in EMR on a routine basis. I'm not sure if they enter info into the PDMP. VA has also lowered their target to 100 MEQ max daily. All pts above this, among other factors, are identified and focused on, as are their prescribers. VA Pharmacy nationally is getting aggressive and it's about time.
 
The VA was authorized to supply this data to the PMP years ago but have refused to comply, causing untold numbers of drug related deaths by their intransigence. There should be criminal charges brought against VA administrators because of this tragedy.
 
They've been complying in OR for the last year.
 
101N said:
Federally funded Methadone clinics don't report to the PDMP. HIPAA protected.
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This is not a HIIPPA issue. My identification of that was not a personal attack on 101N. He made it up. That's a fact, Jack.
 
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