There is more than enough way to solve these problems, but for some f'n reason there is no will...
Also ridiculous but only tangentially related: Psychiatrists (or similar functions) cannot send prescriptions for ADHD drugs (Adderall / Amphetamines etc) to pharmacies (by any method) [EDIT: at least in Washington State as of March 2020]. You need to pick up the physical prescription from the health care provider, then take it to any pharmacy. The pharmacy may not even have the medication, and certainly will need some time to fill it on the spot.
Of course this is a controlled substance. Somehow this process is imposed by the DEA perhaps together with the FDA (unsure). I know it's a running joke to throw out the term Blockchain, but this really is where Blockchain might be a good solution. Regardless I don't see how a physical piece of paper changes the potential for abuse or any tracking of the patient. The pharmacy doesn't exactly make me verify my identity any differently from normal prescriptions to be picked up.
Also, the prescription is generally only issued for a month. You may get a few prescriptions with different start dates into the future. So every month you will make your pharmacy scramble (and waste your own time) because they could not prepare for your prescription to be filled.
All of this is even more annoying in the time of COVID-19. I need to unnecessarily have in person interactions for things that can happen remotely or virtually.
Another post claims they've been getting it sent electronically for a few years: https://news.ycombinator.com/item?id=23215206
[0] http://lawfilesext.leg.wa.gov/biennium/2019-20/Pdf/Bills/Sen...
I’d assumed that was for all prescriptions, but it could just be controlled substances.
This is not true, at least in California. I take a certain ADHD medicine that’s a Schedule 2 drug. So I’m limited to 30 day prescriptions with no refills (so my doctor sends in 3 at a time), but my doctor can most definitely send them direct to my pharmacy.
So I looked it up because that is very perculiar, and my quick skimming of the laws seem to imply that Schedule II through V drugs can be sent electronically:[0]
> (1) Information concerning a prescription for a controlled substance included in Schedules II through V, or information concerning a refill authorization for a controlled substance included in Schedules III through V, may be electronically communicated to a pharmacy of the patient's choice pursuant to the provisions of this chapter if the electronically communicated prescription information complies with the following:
> ...
I think all of us agree that the paper prescriptions are ridiculous, especially at this time.
I have many friends in the medical field. This MD vs NP hatred needs to stop.
NPs can be specialized and have great knowledge and experience in their particular field.
And my NP visit is cheaper - absolutely worth it to me.
Sarcasm comes across poorly in online communication, so I should probably use it less :)
The focus should absolutely be on patient care.
Note, getting the scrip from my GP requires an annual HIPAA privacy waiver and random piss tests. Privacy waiver is because they share medical records of patients prescribed controlled substances with law enforcement or any other local or federal government agency that wants to take a peek.
So, how good is a regulation if you need to waive it for something as basic as getting your medication?
Makes me respect GDPR even more.
The American Medical Association, et al., sold out their patients in exchange for not being held accountable for the US opioid crisis. (my opinion of course.)
My doc didn't think it was any big deal, she said I was her first patient to question it. She thought the waiver had some limitations, I showed her that it did not have any limitations except that access had to be for official use (which is not much of a limitation.) The records are stored in an electronic registry that various local or federal government agencies can access without warrants or notice.
As a lawyer I cannot imagine voluntarily entering into such an agreement against the interest of my clients. I still find it shocking.
The rationale was, prior to getting a surgery once, I was asked in pre-op to review my EMR information by the nurse. The info was completely wrong and very dated. I asked the nurse where the info was from since I had never been to that hospital chain before. Her comment was an affiliated urgent care I went to years ago was in their medical system. But the brand name was different because they were acquired. I was pissed. What if I had been rolled in unconscious and that EMR record was meaningfully inaccurate against my wellbeing?
So now it raises eyebrows but I refuse to provide any nonlegally required info. And to OPs point the response is one of almost mocking surprise. But the counter argument is, why would I trust you to not sell my data going forward? What if I'm wheeled into a hospital unconscious and your medical records from 20 years ago somehow cause me harm? Absolutely no way.
It tests for dozens of drugs, including THC.
All patients prescribed a controlled substance have to take it.
Here is a link to a random lab describing it: https://etd.paml.com/etd/display.php?id=8412
I was told that I "may need to" take this test at some point. I never have and have been taking adderall for many years.
I assume the drug testing requirements may depend on the state or the provider. It benefits the provider/health system by providing evidence they are taking reasonable precautions to limit abuse.
Also, I don't know if psychiatrists in WA are held to a different reporting standard than general practitioners. When I used a solo psychiatrist, no testing or privacy waiver required. When my insurance changed, I lost that psychiatrist and went to a regular doc in a large health system (UW Physicians). They require the testing and waiver.
But the law was changing when I made the change, so it may apply to psychiatrists now, too.
They are testing for abusive behavior to identify drug abusers, re-sellers, or negligent providers (over prescribing).
I have read some people complaining that their provider will not prescribe the drug they need if THC comes up in the test. That is not universal, it probably depends on the individual provider or the health provider system.
The best part is that law enforcement can review the records at will (as long as they can articulate an official reason which is a very low bar.)
True, but a positive test wouldn't be enough to arrest someone for drug possession. I doubt it would even be enough to get a search warrant with.
My gut says that a lot of this is because of all of the regulations around handling and amount-on-hand rules in MI. There is one not-terrible side effect to the resulting process however; Since typically you'd just wait to get it filled (or pick it up ASAP,) It limits the risk of an electronic fill sitting around and getting 'lost'.
Granted, when I was seeing an individual psychiatrist prior to having Kaiser, she said I could only get a 30-day supply as well and would just send 3 at a time too. I feel like there is a way to do a 90-day supply that many providers either don't want to do or don't know about.
Edit - It might be something that's possible with electronic scripts and not possible with paper.
Opioids are limited to a 3 day supply tho (with some tight exceptions, for those patients that can afford a PM Dr).
Some random pharmacy can't see the fulfillment history from other pharmacies. They only way they could see abuse would be after the fact. They don't want to set themselves up for a lawsuit or criminal investigation so they just limit their Rx amounts.
It's hard to tell what's a federal law, a state law, or my insurance company judging me as a likely junkie.
It was 2 months before I was able to finally get it, because I made the mistake of trying to change my pharmacy to one that had it in stock.
These are professions that still use fax machines. The concept of sending scrips between random doctors and pharmacies over electronic means is too daunting (HIPPA, privacy lawsuits, child protection laws etc). They would rather stick them in envelopes. Giving it to the post office won't get them sued.
If a government agent determines that the doc is over-prescribing they can get into big trouble.
It is because of the US Opioid crisis, but the regulations are directed toward all controlled substances, not just oxycodone.
it is somewhat ironic that you have to remember to take something that helps you remember to do things.
The whole system is just shockingly stupid.
During covid, my doc all of a sudden started sending electronically.
I’m not sure if my doc was wrong, or lying, or just didn’t understand the stupid regulations around some meds.
Lots of prescriptions that don't see "abuse" can be communicated to the pharmacy with a phone call. Amphetamines are not such a drug.
A centralized ledger database is the right solution sometimes.
Why so complicated? Most use cases for Blockchain could be solved by public-key cryptography, technically backed by using a national government issued, RFID capable ID card (drivers license, passport, whatever) and it's trust chain.
There is an e-signing program that I think lets the pharmacy watch the signature being made or something that is now fixing this issue, but I hear it is both expensive and rather difficult to use.
Look for a pharmacy that offers delivery, they can make the trip to your doctors office for you as again these regulations are ridiculous.
This would presumably be no worse than keeping people from forging paper prescriptions.
It would logically be based on a public private key pair like gpg.
There are more security requirements like what you describe, but much of this is about making a new standard comply with laws from the 70's.
This becomes far more problematic if I have to travel for work (which was very common pre-COVID) and I'd literally have to drive an hour to a 24hr pharmacy and wait until 12.01am on the day of my flight, then wait half an hour to get the prescription filled, drive an hour home, then leave at 5.30am to get my morning flight.
And if the refill date occurs when I am away, I'm SOL - CA won't take a prescription from WA for a controlled substance. I usually have to ask my wife to go in early to pick it up, then spend a ton of money to overnight the medicine to my hotel.
There needs to be a system that allows for people who have been taking the same stuff for years to have SOME kind of buffer or slight flexibility. The current system is bullshit.
This is an utterly absurd situation - surely the people coming up with this stuff must realise this?
If anything, stupidity like this could actually cause more people to go to the black market.
What is genuinely enraging however, is when my son runs out and we can’t get him his medicine. His symptoms are honestly pretty bad and he is aware of them but can’t do anything about it. Hearing him ask “daddy, why can’t I have my medicine?” is both heartbreaking and enraging.
In the end, we asked the doctor, who agreed to issue us a slightly different prescription for him a few days after we filled the first one. This let us get the second prescription Refilled immediately so we thankfully have a small buffer for him now.
Laws like this are bullshit.
We aren't opioid addicts abusing the system and putting a strain on tax payers, we need this stuff to be a functional and contributing member of society because our brains don't produce enough dopamine for myriad reasons. Why subject us to this hell every 30 days, we need medical reform NOW!
Most other prescriptions he could call in, but I think in WA there's a special system you have to get set up with to do it yourself.
Now my wife doesn't need to physically pick it up anymore. If it would be useful to you, I can find out from my doctor's office what system they had to be part of to allow them to call in prescriptions like that.
https://www.addcenterofbellevue.com/ If you’re interested in a new doc.
There is actually a way to e-prescribe, but there are strict security requirements and I think it varies by state. IDK why blockchain is needed though, an ordinary digital signature ought to be enough and that's what the e-prescribing rule requires.
Short of overhauling personal identification in the U.S., I don’t see a simple solution. Making unemployment benefits more tedious to claim is politically risky.
Any change (resulting in potentially reduced benefits) to any social service results in the following headlines in the next days news:
"President X yanks benefits for the nation's most vulnerable"
https://www.google.com/amp/s/www.vox.com/platform/amp/2019/8...
Why? Because cutting benefits is popular with his supporters.
Callously cutting benefits for a miniority of the populat is populist for the selfish majority.
The beauty of this argument is that it works for any level of welfare at any given time. Dems could award unemployment benefits of 100K per year and when Reps point out this is crazy, unsustainable, and unfair to tax payers you can trot out the "Callously cutting benefits". Is there any form of welfare reduction you wouldn't call callous? What about the "Callous theft of the incomes from hardworking taxpayers"?
-"Poor minority" demand free medical care ? Steal it from the middle class -"Poor minority demand" ..paid vacation, paid sick leave, paid maternity leave, 4 day work week, free childcare, free whatever.... Steal it from the middle class
And before you say "The middle class gets to benefit from it too!!!" Thats a bunk argument because if they wanted those services they would pay for them like every other service. All of this is just wealth redistribution from those are creating value to those who arent for the market.
IMHO implementing a 2FA or a ID verification wouldnt be a burden on anyone but the bumbling bureaucrats. This problem isnt limited to UI, its a major problem (10's of billions) at the IRS. Who will send a refund before they even check the return or the income.
They send the refund to the first filer, with no verification! But when it comes to collecting the funds, they will hunt you down if your EIN doesnt match your entity name on the most obscure forms...
Source: have personally done it twice
Public airport or private?
"Retail" or privately hired pilot?
I would call that ‘more efficient’.
Besides, they apparently have ‘hundreds of millions of dollars’ to spend on it.
Not defending the practice, but the supposed reason for this is because pseudoephedrine can be used in cooking methamphetamine [1], and supposedly the 'cooks' had mules going around buying up stock everywhere to use in their labs.
The 'check' was supposedly to catch the mules buying large quantities across plural pharmacies/states to use in the cook's labs.
Sadly the unintended consequence is every time one has a head cold and buys original formula Sudafed, some government tracking database somewhere knows one bought that product.
https://web.archive.org/web/20120301155008/https://heterodox...
Recently, after careful analysis I found they do still make it (or they make it again), but it was a definite bait-and-switch.
Phenylephrine Is No More Effective Than Placebo for Nasal Congestion https://www.jwatch.org/na39054/2015/09/17/phenylephrine-no-m...
The difference here is that one system has federal “war on drugs” muscle behind it, and the other... very much doesn’t.
It's not as if any of us are unclear on why sudafed is controlled.
The earlier comment is pointing out that it’s “ridiculous” that the government isn’t able to solve the problem from the article, given that they’ve clearly been able to build a system to track pseudoephedrine sales. They don’t seem to be making any claims about it being ridiculous that they need to talk to a pharmacist to get it, which is what your reply implies they said.
Make a few grams of meth? Go to jail. Launder billions in drug money at a major financial institution? Get a small fine and probably keep your job.
The current president of the United States is a borderline white collar criminal, though most of his past scams are of the "greasy" sort that are just barely on the right side of the law.
It's basically all about the social class of the criminal. The word "villain" comes from the same root as "villager" and means a person of lower social class.
https://www.etymonline.com/word/villain
A while back I found a fascinating crime map of white collar crime. It showed the inverse of what you see for street crime, with huge white collar crime hotspots in richer more upscale neighborhoods. In Compton (Los Angeles area) you are more likely to have your wallet stolen. It's safer to walk around in Santa Monica or Newport Beach, but the person you pass on the street is more likely to be stealing your pension.
I feel like there's just so much in the state now, we need mandatory sunset on anything like this.
Review of legislation and rules/regulation should be routine, rather than boutique, and each time we should be called upon to make a positive case for each rule.
Huh??? Reference?
Furthermore, apparently the firearm used in the shooting that prompted this sweeping ban was never sold on the Canadian market. It was illegally purchased, illegally smuggled into Canada, and you know, illegally discharged to kill people.
There is no connection between the Canadian domestic market for semi-automatic rifles and the shooting, and yet the resultant rules target only the Canadian domestic market for semi-automatic rifles.
https://nationalpost.com/news/trudeaus-gun-ban-appeared-to-b...
The recent CA gun rules are a knee jerk reaction that will not make anyone safer. It will however further Trudeau's goal of disarming law abiding citizens.
If anything would help it would be heavily restricting access to ammo. I don't understand how people with illegal handguns can even find the ammo for them.
Even assuming you could make it such that criminals only get ahold of small subsonic ammunition, that would not have a marked effect on the lethality of criminal acts committed with firearms, and likely would have no impact on the rate of wrongful homicide.
> I don't understand how people with illegal handguns can even find the ammo for them.
Manufacturing and/or smuggling ammunition is easy, and most criminals do not go through a lot of ammunition. In places where smuggling is restricted successfully, criminals find other ways to kill and intimidate people, including manufacturing firearms and explosives; which, it may surprise you, is pretty easy, and pretty easy to do without getting caught. If you want to commit the resources to monitor every machine shop in the Americas and build a trillion dollar system of fences and surveillance outposts between jurisdictions, be my guest though.
> Legal or not there is no need in Canada for a person to own a semi-automatic rifle
Why do you think you know that?
In a free society, the law should not be concerned with defining what is permitted, but with determining what is impermissible. To determine what the law should prohibit, it is not sufficient to ask yourself whether the law would inconvenience you.
When you make laws, you have to be ready to put people in prison for disobeying them, you have to be ready to look their families in the eye and say “I think your father/son/mother/daughter should not be free for the next ten to fifteen years because he possessed the wrong shaped metal object”.
There are many, many people in Canada who are guilty of no malum in se conduct, yet illegally possess firearms simply because they would rather risk the legal ramifications of keeping them than destroy them simply to satisfy the law.
You're going to have to tell me that every time the law sends such a peaceful person to prison and destroys their property, it is worth it. It is no more just to imprison people who possess firearms for their own lawful purposes than it is to imprison people who possess drugs for the same.
I struggle with statements like this. I’m in the prairies. You know what semi-automatic rifles are great for? Predator control. As an easy example from two weeks ago, a pack of coyotes came into my in-laws farm yard and started attacking the sheep. Would a bolt action rifle work? Sure, but significantly less effectively.
> Even with the guns there is no need for supersonic bullets and large grain/large mass bullets.
Are you referring to the 10kJ rule? Or just in general? It’s always tough to tell where someone’s actual understanding of these things is, versus misconceptions. Supersonic bullets are absolutely necessary for hunting game, as are “large mass” bullets (although 10kJ is not generally necessary for the game you’ll encounter around here).
The vast majority of the rifles that were recently prohibited fired low-mass high-velocity bullets. In many provinces, those bullets were not allowed for hunting because they did not have sufficient energy to reliably kill wild game.
> If anything would help it would be heavily restricting access to ammo. I don't understand how people with illegal handguns can even find the ammo for them.
You’re talking about people who are already in possession of a smuggled handgun, and you can’t conjure up a way for them to get ammunition?
Ammunition is currently regulated the same way firearms are: you have to have a firearms license, after having taken a course and been vetted by the RCMP. The people who are causing the vast majority of (non-suicide) firearms death in this country are not people who give a crap about the firearms licensing regime.
As for separating pseudo and acetaminophen? Right here: https://www.erowid.org/archive/rhodium/chemistry/thecure.htm...
Legit large scale meth labs have actual chemists on their payroll. It's not some junkies with a couple high school chem classes under their belt.
Because the point of the unemployment bureaucracy is to prevent the utilization of unemployment insurance. The easiest and cheapest way to do that is to just make the whole thing suck, which also, as a side-effect, makes it vulnerable to malicious actors.
In fact, the worst case scenario for the political class is a well-functioning society with no urgent-seeming problems to be solved because in a situation like that people will start to wonder why we need the political class at all.
It's pretty straightforward. Most people are simple-minded or dishonest enough that they can't understand or admit that policies they like can be inefficient or flawed. In the case of pseudoephedrine, the public conversation doesn't have too many advocates for meth dealers or trivially inconvenienced shoppers. By contrast, any inkling that a government program could be run more efficiently is immediately met with howls of outrage that reform proposals are just cover for the real goal of forcing poor people to starve.
Once you know what to look for, you'll see this for _almost literally every topic_ of this type, from infrastructure to public schools.
https://www.pbs.org/wgbh/pages/frontline/meth/
I have no idea whether or not to trust frontline because they've seemed on the wrong side of things for certain topics I know more about but, at least that made it clear to me why that stuff might be a controlled substance
Not kidding here.
In some jurisdictions there may be 1000s of non-voting registered voters who have moved away, died, or never voted at all (automatically registered voters, etc.)
Interestingly, vote by mail may be more secure than polling stations, because vote-by-mail often requires signature matching (matching signature on ballot cover with signature on registration). But the ACLU is fighting tooth and nail against signature matching.
https://www.heritage.org/election-integrity/heritage-explain...
It's rather strange that they left out the most recent and egregious instance of fraud. It just happened in NC. Funny how quiet the right gets when its one of their own...The GOP busted for fraud. Election invalidated. Just more projection from the party of projection. You can do better.
Ballot harvesting is a practice celebrated and embraced by progressive democrats. Recent changes in California law make ballot harvesting easier and more susceptible to fraud. Now, according to headlines at least, the GOP is ramping up their efforts to get more into the ballot harvesting game too.
The NC case is described in some detail herein: https://www.heritage.org/election-integrity/report/vote-harv...
>In some jurisdictions there may be 1000s of non-voting registered voters who have moved away, died, or never voted at all (automatically registered voters, etc.)
The database you mentioned consists of a grand total of 1,285 proven instances of voter fraud over 4 years. Nearly all of them are for single individuals voting twice, usually by submitting a absentee ballot, then voting in-person. There are vanishingly few instances of someone manipulating an election on a significant scale, by tens or hundreds of votes.
So which is it? Are there thousands of instances in multiple jurisdictions per election that we've completely failed to detect, or just a few thousand nation-wide over multiple elections and four years?