b) Pharmacies licensed by the Virginia Board of Pharmacy located outside of the Commonwealth of Virginia that ship covered substances to Virginia residents.a) Pharmacies located within the Commonwealth of Virginia (they must be licensed by the Virginia Board of Pharmacy).If you have received a covered substance from any of the following, these covered substances will be included on your PMP report. A: The types of individuals/establishments listed below must report to the Virginia PMP.Q: Who must report to the Virginia PMP?.Oh, wait… You didn’t know that? OF COURSE, YOU DIDN’T KNOW THAT!! YOU READ A DOCUMENT LIKE THIS FAQ FROM THE COMMONWEALTH OF VIRGINIA: You all are totally reliant on the honesty of the patient. You can’t see it as the patient’s Primary Care Doctor. It is a federal law! None of the patient’s Methadone is listed in your state PMP or any PMP. The family member responds: “Of course not, you stupid idiot! Didn’t you know the person is in a Methadone Clinic?”That’s when you learn that, much to your surprise, Federally Funded Methadone Clinics cannot report their prescriptions to the PMP. Second, your patient is clean in the PMP database. You delegated that to the hapless Pain Management Nurse Practitioner. Then, a family member calls you: “WHY ARE YOU PRESCRIBING NARCOTICS FOR A DRUG ADDICT ALREADY ON METHADONE?!?!?!!? ARE YOU TRYING TO KILL YOUR PATIENT?!!!?”First, you defensively proclaim, you’re not the one handing out opioids. Yet, as you watch things unfold, you know deep down, no procedure will fix this pain. Maybe, some sort of nerve block is considered. Pain Management goes through the same struggle. Is it possible your bias is interfering with the proper care of the patient? So, you follow the coward’s way out: You refer them to a Pain Management Specialist. They are now getting stronger in their requests as they sit in the exam room, facing you. You check it for the states surrounding you. You check your state’s Prescription Monitoring Program (PMP). Maybe they don’t do it at the initial visit, but they are back a week later pushing for “something stronger.” This person is definitely looking like an opioid seeker. Yet, they are definitely pushing for a controlled substance. The person seems like a reasonable person, though. The pain seems to have some odd features. You have a relatively new patient who is complaining of what appears to be legitimate pain. But there are also unknown unknowns, the ones we don’t know we don’t know.” We also know there are known unknowns - that is to say, we know there are some things we do not know. “There are known knowns - there are things we know we know. In October 2008 prescription processor Express Scripts had their database stolen and offered US$1 million for its safe return.In February 2002, Defense Secretary Donald Rumsfield made an interesting observation: This is not the first time that medical databases have been held for ransom. The case raises long term questions for businesses holding large amounts of data on customers, and their liability should a hacking attack occur. And indeed, any decent backup system will only allow you to backup the data or read it – only the backup administrator should be able to delete the backups.” “Without knowing more details we can't say if the web application was good or bad (maybe the hacker got access through a different vulnerability), but one thing that should never happen is ability for a hacker to delete your backups. “If this all is correct, it indicates that several protection layers failed at the PMP,” said Bojan Zdrnja of the SANS Internet Security Center in a blog posting. The FBI and state police are reportedly investigating. The message then lampoons the FBI’s practice of not paying out ransom for information and gives an email for response. They say that they may not find a market for the prescription data but should be able to sell basic identity information such as social security numbers and driver’s license details. The message continues that if payment is not received in seven days then the hackers will offer the information to the highest bidder. The site has now been taken down and PMP representative are not returning requests for information from the media.
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