Wednesday, January 24, 2018

Salting a Bird's Tail

When I was a little boy, my mother convinced me that if I could put salt on a bird's tail then I would be able to catch that bird. I believe she took several pictures of me with the salt shaker hustling after various birds. Never did it occur to me that if I could get that close to a bird then I should be able to put out my hand and catch it without the salt shaker.

In the early 70's, here in Tallahassee, I was working on a measure referred to as the Triplicate prescription bill. The essence of the bill was that the Department of Business Regulation would sell triplicate prescriptions to all physicians. Anytime that they Rx'd a schedule II (C-II for Class II)  prescription it would have to be written on a triplicate form. Those forms were to be created by the DBPR and sold to all physicians. Their cost was 10 cents per Rx. One copy would be kept in the physicians office, another with the dispensing pharmacist and another in the office of DBPR here in Tallahassee. That way auditors could access the Rx'ing tendencies of all physicians who wrote for narcotics and other C-II drugs and they could detect tendencies of those physicians who over prescribed them. This was 20 years before the internet grew legs and was accessible to anyone who wanted to purchase a computer. I worked for a manufacturer of a C-II pain reliever that was and still is very popular. If physicians had to purchase those forms from the state then they would just Rx something else for pain that was not scheduled. However that meant that many, many patients would be left suffering from post surgical pain, kidney stones, cancer, etc. It was not all that hard to defeat that legislation with a couple of well heeled lobbyists aimed at it. Also organized medicine was against it and they themselves were a formidable lobby. The measure died in committee after some effort was taken to defeat it. Thus the bird of a budding opiate over-prescribing community avoided the salt shaker of bureaucratic interference.

Ten years later we found ourselves in the same discussion. This time it was a 48 hour waiting bill. Any patient who had a C-II drug Rx'd was going to have to wait ( and hurt ) for 48 hours before the prescription could be filled. It did not take a whole lot of effort to kill that bill as dead as the proverbial hammer. What sort of mercenary mindset would put patients into a position of enduring major and extreme pain for 48 hours before intervention could be prescribed? The bird continued to be as elusive as ever. All of this effort was and is driven by communities, usually south of Tallahassee, where pill mills pump out all sorts of opiates into the community.

Now we come to today and to the current session of our legislature. We see that the bird has turned into a mammoth creature that all the politicians like to refer to as the opioid crisis. Our Governor has set his noble chin into a clamped and forward thinking point and has made the opioid, really it is opiate, crisis his primary plank in his platform into the 2018 Florida legislative session. Of course as he completes his final run in his two terms as Governor and looks wantonly at one of the Senate seats in Florida, this measure would look really good hanging on his wall. The bird has been pumped into really bad shape by this crisis. The news media and all politicians from school board to President have convinced us that it must be dealt with. Heck, the salt shaker is not even necessary in the current environment. All the drug addicts and drug dealers who have put the bird on steroids are responsible for making the effort a no brainer. Remember, our Guv comes from the world of health care and knows how to work the beads on most health measures. He sat upon the throne of Columbia healthcare and guided it through the rapids of one of the nastiest Medicare fraud scams of the century.

House Bill - 21 and its companions are sailing through all committees unscathed and is looking like Secretariat approaching mid furlong. This bill will limit the number of tablets, capsules, pills prescribed by the medical practitioner to seven days worth. If you hurt beyond that then you have violated the law effective July 1, 2018. Other means will need to be sought to alleviate your pain. Admit it, that guy who got elected to the house in south Florida knows a lot more about treating your pain than your physician who has 16 years of education and training post high school. They know best.

So what are alternative measures? A Motrin tablet the size of a watermelon? Accupuncture? Wait, could it possibly be medical marijuana? This bill passes and becomes law it could jettison the newly created medical marijuana industry in Florida beyond imagination. Our fat little bird has been caught and morphed into the Phoenix of euphoria by blood levels of THC instead of opiates. Jaded and cynical am I? We will just have to wait and see.