1-ribbonFirst they came for the mentally ill addicts, and I did not speak out—
Because I was not a mentally ill addict.

Then they came for the empathetic prescribers, and I did not speak out—
Because I was not a empathetic prescriber.

Then they came for the Pharmacists, and I did not speak out—
Because I was not a Pharmacist.

Then they came for me—and there was no one left to speak for me

pharmacists are more focused on filling a prescriptions ?

Feds step up drug enforcement of pharmacies


On July 13, 2012, a pharmacy technician ordered 1,000 hydrocodone pills through the San Diego pharmacy he worked for.

But it was not a sanctioned order. The highly addictive drugs were either meant for his own consumption, or to restock the pharmacy’s supply of pills he had already stolen, concluded the state Board of Pharmacy, which ultimately revoked his license after he was convicted of prescription forgery and burglary.

The incident helped spark a massive investigation into Medical Center Pharmacy, a collection of a dozen family-owned pharmacies that operate throughout San Diego County. What the U.S. Drug Enforcement Administration found was a system that lacked controls on the distribution of controlled substances, shoddy record-keeping and lax procedures on dispensing psuedophedrines, which can be used to make methamphetamine, the U.S. Attorney’s Office announced this month.

The investigation also found a total of 21,000 oxycodone and hydrocodone pills that were unaccounted for from four San Diego pharmacies over a two-year span. In some instances, the drugs are believed to have been delivered to a home used by pill seekers, authorities said.

The effort to combat the illegal flow of pharmaceuticals from legitimate businesses is intensifying as prescription drug abuse remains a top public health concern.

The DEA, which enforces pharmacy compliance with federal drug laws, has increased the amount of surprise inspections on businesses in recent years. And the state board that licenses pharmacists and similar workers is considering making it mandatory for pharmacies to inventory their drug supplies once every quarter to better stem the illicit flow.

Pharmacies are currently required to report when drugs go missing. Last year in California, 1 million dosages of pills were reported lost, said Virginia Herold, executive officer of the state board. The year before it was about 1.5 million.

“The problem is controlled substances are so valuable on the street compared to their value in the pharmacy,” Herold said. Some pills go for $30 each or more, she added.

Employees who divert pills are either addicted to the drugs themselves, or just selling them for the money, said DEA Supervisory Special Agent Thomas Lenox.

Besides pill diversion, other major problems that authorities look for is poor record keeping and pharmacists who are more focused on filling a prescription rather than doing their due diligence to make sure the prescription is legitimate and not stolen, forged or counterfeit.

“The one thing is, it’s all paper,” Lenox said of the stringent record keeping required of pharmacies. “You either have the documentation or not. If you don’t have them, you’re in violation.”

Investigators say the problems are seen just as much at large, chain pharmacies as at smaller mom-and-pop pharmacies. The only difference is volume: Missing pills are also sometimes spotted faster at the larger chains due to more stringent corporate policies in place, Herold said.

Earlier this year, CVS Pharmacies and the U.S. Attorney’s Office entered into a $22 million settlement after an investigation showed some pharmacies in Florida were knowingly filling illegitimate prescriptions for painkillers.

Authorities can go after offending pharmacies in various ways, from sending a letter of admonition to taking away the DEA registration that allows them to sell controlled substances to civil enforcement to criminal charges. The state board can also go after licenses of individual workers. Licensed workers do undergo background checks, Herold said.

In the Medical Center Pharmacy investigation, authorities went the civil enforcement route, resulting in a $750,000 settlement last week. The corporation, owned by Joseph and John Grasela, operates several storefronts under names such as Galloway Medical Center Pharmacy, Community Medical Center Pharmacy and Medical Center Pharmacy.

Besides the missing pills, authorities said the pharmacies also violated the Combat Methamphetamine Epidemic Act, which requires pharmacies to keep a logbook of sales of certain over-the-counter medications that can be used to make meth. The records must include the buyer and the product purchased, and are intended to prevent individuals from buying large quantities of the same drug.

The pharmacies have had problems with the board before, Herold said. As part of the settlement, the owners have agreed to implement new inventory control measures, authorities said.

This case is just the most recent example of similar pharmacy misconduct in the county.

Last year, a Hillcrest pharmacist lost her Sixth Avenue Pharmacy over allegations of failing to account for 16,000 missing oxycodone pills, dispensing drugs with invalid or nonexistent prescriptions, exchanging drugs for services or advancing pills to customers, according to the U.S. Attorney’s Office.

In 2008, federal agents raided three San Diego pharmacies on allegations that several employees were diverting painkillers.

The DEA works closely with the pharmacy board to educate pharmacies on drug trends, how to spot theft, and security measures such as surveillance cameras, keeping addictive drugs under lock and key and keeping stocks of such painkillers low.


(619) 293-1391


Iowa’s alcohol addiction problem is TWENTY FIVE TIMES worse than their Heroin problem..


Pain pill addicts fueling Iowa’s heroin epidemic


Iowa claims to have a Heroin epidemic .. yet… abt 50% of those dealing with substance abuse treatment were dealing with a ALCOHOLIC addiction.



Ken McKim on explaining DEPRESSION

If you want a biased opinion.. you just have to follow the money trail

Accepting Pain More Important than Reducing Pain Intensity Because Opioids Are Harmful, Docs Write in NEJM Commentary


Apparently the best way to get something published in a normally respected medical journal is to based the article on the premise as if the article was written by the DEA. I especially like this very unscientific statement and the successful outcome prefaced with a MAY REDUCE ...“willingness to accept pain and engagement in life activities despite pain, may reduce suffering and disability without necessarily reducing pain intensity.”   Unfortunately, many who will read this will believe this “hogwash”

People suffering in chronic pain need to learn to accept it because “achieving a balance between the benefits and potential harms of opioids has become a matter of national importance,” wrote two influential doctors who advocate for changing opioid prescribing practices in a commentary for the esteemed New England Journal of Medicine.

Jane Ballantyne, M.D., and Mark Sullivan, M.D., authors of the commentary, wrote,

“Is a reduction in pain intensity the right goal for the treatment of chronic pain? We have watched as opioids have been used with increasing frequency and in escalating doses in an attempt to drive down pain scores — all the while increasing rates of toxic drug effects, exposing vulnerable populations to risk, and failing to relieve the burden of chronic pain at the population level. For many patients, especially those who have become dependent on opioids, maintaining low pain scores requires continuous or escalating doses of opioids at the expense of worsening function and quality of life. And for many other people, especially adolescents and young adults, increased access to opioids has led to abuse, addiction, and death.”

Dr. Ballantyne is President of Physicians for Responsible Opioid Prescribing (PROP), an organization that advocates for state and federal policies that promote cautious prescribing habits, proper enforcement of laws that prohibit marketing of drugs for conditions where risks of use outweigh benefits.

Dr. Sullivan is the Executive Director of Collaborative Opioid Prescribing Education (COPE), an organization that educates healthcare providers on how to safely treat and manage the care of people with chronic pain in order to improve patients’ lives and end the prescription opioid epidemic.

The authors framed the topic of opioids this way:

“For three decades, there has been hope that more liberal use of opioids would help reduce the number of Americans with unrelieved chronic pain. Instead, it produced what has been termed an epidemic of prescription-opioid abuse, overdoses, and deaths — and no demonstrable reduction in the burden of chronic pain.”

The reference cited for the above statement, The prescription opioid and heroin crisis: a public health approach to an epidemic of addiction. Annu Rev Public Health 2015;36:559-574, was authored by Ballantyne’s colleague, PROP Executive Director, Andrew Kolodny.

Reduce pain intensity, or suck it up?

“We propose that pain intensity is not the best measure of the success of chronic-pain treatment. When pain is chronic, its intensity isn’t a simple measure of something that can be easily fixed. Suffering may be related as much to the meaning of pain as to its intensity,” they wrote.

“Patients who report the greatest intensity of chronic pain are often overwhelmed, are burdened by coexisting substance use or other mental health conditions,” they added.

Instead of opioids, the doctors say that an interdisciplinary and multimodal treatment coupled with coping and acceptance strategies are critical.  In addition, they conclude that a “willingness to accept pain and engagement in life activities despite pain, may reduce suffering and disability without necessarily reducing pain intensity.”

Comments on the New England Journal of Medicine’s website related to the article included:

“Intensity of pain is relevant mostly when pain limits the actions and abilities of the patient to live a life with any minute level of fulfillment. Humane treatment should be a goal in any medical plan, one dealing with pain should start there” – Kimberly Miller

“Chronic pain is an injury to central nervous system functions that profoundly impacts a cascade of measurable biological functions and associated adaptive behaviors which are rarely accounted for by the addiction or the interventional pain models and often discounted when reported, leading to increased disability. It does a disservice to patients to infer that chronic pain serves to maintain emotion and reward seeking behaviors or that the degree of experienced sensation is somehow illegitimate.” – Terri Lewis, Ph.D. (who is also a contributor to National Pain Report).

“Many patients are not much interested in learning behavioral strategies which may help them function better with chronic pain, nor changing their expectation of complete relief. They wish a simple pill to swallow or a procedure to be performed on them, and many do not want to stop doing things making their pain worse. While basic research continues, with a goal to finding improved treatments for chronic pain, we have a difficult task before us changing the population’s attitudes towards what is possible and practical for our patients in pain.” – Leo Martin, MD

“Thank you for your interesting article pointing out that the suffering associated with chronic pain is related to its meaning and not only to pain intensity and therefore treating it only pharmacologically with opioids does not work. … Without a philosophical/spiritual context no strategy will significantly ease the burden of chronic pain, no matter how biopsychosocial it is.” – Alberto Montoya, MD


The “VOICE” of the chronic pain community is not being heard ?


What the Internet Says About “Opioids” Says a Lot!



It’s safe to say that Google’s advanced search algorithms return search results that reflect the dominant content the globe is seeking on any given topic.  So, what do Google search results tell us about what the world thinks when it comes to opioids?

National Pain Report went to Google and asked that very question.  And, here is what Google tells us.

When you type in “opioids” into Google search, the search engine goliath returns 5,730,000 pages of content.  That’s a lot to cull through, so, thanks to Google’s algorithms, the browser makes calculations on which of those 5+ million pages are most relevant to you, the searcher.  Fewer than 15% of people ever even click the “Next” button to see results past the second page, so that’s where we focused our attention.

When we searched “opioids”, there were 24 results (non-advertisements) on the first two pages of Google.  We reviewed each of the results to determine if the content was:

  • “About Pain” (supported or reflected the proper use of opioids for the treatment of pain)
  • “About Abuse” (supported or reflected the misuse of opioids, addiction or death)
  • “About Both” (supported or reflected both proper and improper use of opioids)
  • “About Law” (supported or reflected content about arrests related to opioids)

Google search - opioids 150% of content related to “opioids” exclusively reflects abuse, addiction or death.

Only 4% of content related to “opioids” exclusively reflects the proper use of opioids to treat pain.

92% of content related to “opioids” includes abuse, addiction or death.

Only 46% of content related to “opioids” includes the proper use of opioids to treat pain.

That’s pretty telling.  The “Internet Machine” suggests that when the world thinks about opioids, it’s thinking addiction, abuse and death – not proper and legal use of opioids.  But, does this add up to the real numbers, or does it seem to reflect current trends in media, government and society (or big business)?

According to the CDC, about 12 million Americans abused or were dependent on opioids in 2013.  We used trusted Google to see if we could find the number of people who legally and properly use opioids in an effort to look at the size of this group (and we know it is HUGE).  With that number we would then be able to (however loosely) see if Google is exposing searchers to a reflective point of view on opioids.

Guess what?  That number (how many people legally and properly use opioids) is elusive.  And here’s why.

Ask Google a question, and you reliably get the exact answer you’re searching for, right?

Well, this is what Google tells us when we asked the question, “how many people legally use opioids?”Gogle search - opioids 2

Gogle search - opioids 3

Thanks Google.  You made our point.  We don’t blame you.  But, you are making things worse!

There is a major message that is being driven by government and media.  Just look at the first four Google search results above – all are US Government entities.  And, all of them are related to addiction, misuse, or the drug epidemic, something the government seems to believe is the only thing that opioids do.

And, the next two search results?  Big media with punishing headlines.

The Washington Post article titled, “The legal drug epidemic” leads off with this, “When is this country going to wake up — really wake up — to the catastrophe that prescription opioid painkillers have caused since they came into widespread use in the early 1990s?”  Thanks Google for answering the question about legal use of opioids with this.

CNN says that the FDA approval of a new pill to treat pain is… “Genuinely Frightening.”  When a new cholesterol drug gained FDA approval, CNN’s headline was, “FDA approves second in new class of cholesterol lowering drugs.”  When the FDA approved Addyi, CNN’s headline was, “’Female Viagra’ gets FDA approval.”

So, why is a new pill to treat pain “genuinely frightening?”

It’s because the “message” is that opioids are only about addiction and overdose and not about legal and proper use of important medicines.

Thanks Google.  Thanks government.  Thanks media.  You’re working very well together.

Another EPIDEMIC that you don’t hear about ?

 Antibiotics resistance blamed for 23,000 deaths annually


ATLANTA, GA (CNN) – According to the CDC, at least 2 million people a year in the U.S. become infected with bacteria that are resistant to antibiotics, leading to more than 23,000 deaths.

We all know “germs” are bad, but some disease-causing bacteria have the ability to develop resistance to the drugs created to destroy them.

The overuse, or misuse, of prescription antibiotics, and the use of antibiotics in the food we eat, like beef and pork, are some of the causes.

What does it mean when your body doesn’t respond to antibiotics?

“Antibiotic resistance occurs when organisms have been exposed to different types of antibiotics, and once they’ve seen antibiotics they can develop and evolve, as part of their living process, a resistance to some of the antibiotics,”says Emory University Pharmacist Steve Mok.

If you experience this resistance, does it mean the bacteria are resistant to that antibiotic forever?

“As we remove antibiotic pressure – they’ll become not so resistant anymore. So, it’s very important that we use our antibiotics judiciously to make sure we get the right dose, taking it for the right amount of time to attack those organisms, so it can’t come back and hurt you later on,” Mok said.

Are there ways to reduce your risk of catching a resistant strain of bacteria?

“It’s very important for people to remember to wash their hands. the other one is to make sure you don’t share things like towels, razors nail clippers.those sorts of personal products,”Mok said.

Could refusing to fill a pt’s Rx be a form of MALPRACTICE ?

Miami Pharmacy Malpractice Lawyers


If a Pharmacist sends a patient away without their necessary medication… is it the same/similar situation as mis-filling a prescription and sending the patient away with the wrong medication. Both can cause the patient HARM… is both of them MALPRACTICE ?

Florida Pharmacy Law And Miami Pharmacy Malpractice Lawyers

The Florida Pharmacy Act requires proper dispensation of a medication before it’s given to a patient. Pharmacists must interpret and assess every prescription for potential adverse effects. They must also determine whether the dosage seems appropriate and counsel patients about proper medication use. At the same time, the Pharmacy Act prohibits Miami pharmacists from altering prescriptions and diagnosing or treating any medical condition.

Pharmacist Duty Of Care

The Pharmacist Duty Of Care means that a pharmacist must be equipped to carry out the duties of the pharmacy profession. The pharmacist must demonstrate a level of skill, knowledge and expertise that’s comparable to that possessed by others in the pharmacy profession. The pharmacist must also be knowledgeable about prescription medications and have the ability to discriminate between them.

If Duty of Care is violated, the pharmacist may be liable for damages. Pharmacists must take all reasonable precautions when dispensing medications, and if the pharmacist suspects that a prescription may be illegal or harmful to a patient, that pharmacist is duty-bound to check the order with the prescribing physician.

Demonstrating Patient Harm And Pharmacy Liability

Pharmacy errors have become increasingly common in Miami, and the frequency of medication errors has sparked a flurry of lawsuits throughout the U.S. When medication errors cause harm or death to patients, pharmacies can be held liable. Patients are seeking compensation for pharmacy errors while regulatory agencies are taking disciplinary action against pharmacists. When a pharmacist breaches Duty of Care by making a medication mistake that injures a patient, pharmacy malpractice lawyers can show that Duty of Care was violated and that pharmacists must be held responsible for any pain and suffering they cause.


Four in 10 say they know someone who has been addicted to prescription painkillers

Four in 10 say they know someone who has been addicted to prescription painkillers


When the average literacy rate of adult Americans, hovering around the SIXTH GRADE.. you want them to be the ones determining who is “addicted” to prescription pain killers. I wonder how many of these people could describe the difference between OPIATE DEPENDENCE and OPIATE ADDICTION ?  File this under JUNK SCIENCE

Nearly four in 10 people know someone who has been addicted to prescription painkillers, including 25 percent who say it was a close friend or family member and 2 percent who acknowledge their own addiction, according to a new poll.

The Kaiser Family Foundation survey released Tuesday also reveals that 16 percent say they know someone who has died from an overdose of prescription painkillers, including 9 percent who say that person was a family member or close friend.

[Thousands of drug users are rescuing each other with antidote naloxone]

“A surprising 56 percent of the public say they have some personal connection to the issue — either because they say they know someone who has taken a prescription that wasn’t prescribed to them, know someone who has been addicted or know someone who has died from a prescription painkiller overdose,” according to the poll of 1,352 people conducted from Nov. 10 to 17. Thirty-nine percent said they knew someone who has been addicted to the prescription medications, which include oxycodone, hydrocodone and morphine.

The United States continues to suffer from an epidemic of opioid addiction, with 16,235 overdose deaths from prescription medications in 2013 and another 8,260 from heroin. Experts say the surge in heroin use was sparked by its cheaper price and wide availability after authorities began cracking down on the abuse of prescription opioids.

The Kaiser poll, which has a margin of error of plus or minus 3 percentage points, shows that connection to prescription painkiller abuse is more common among whites (63 percent), the affluent (63 percent among people with incomes of $90,000 or more), the young and the middle aged (62 percent for people aged 18-29 and 61 percent for people aged 30-49).

[When life begins in rehab]

But it has not spared other U.S. racial or demographic groups: Fifty-six percent of people who earn less than $40,000 report a connection to the epidemic, while 44 percent of blacks and 37 percent of Hispanics say they have an association as well.

By a margin of 77 percent to 58 percent, those polled say it is easy to get non-prescribed painkillers than say it is easy for people who medically need the drugs to get them.

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‘Needless suffering and death, social and economic havoc’: Ebola report cites egregious failure by countries, WHO

Dad Says Albertson’s Sells Bad ADHD Drugs

Dad Says Albertson’s Sells Bad ADHD Drugs


 CHICAGO (CN) – Albertson’s-owned Osco pharmacies sell generic drugs that did not get FDA approval to treat ADHD like their brand-name “equivalent,” Concerta, a father claims in court.
     Alex Turetsky says his minor son J.T. was prescribed Concerta, an extended-release attention deficit hyperactivity disorder (ADHD) drug approved by the U.S. Food and Drug Administration in 2000.
     Turetsky tried to fill J.T.’s Concerta prescription at an Osco Drug Store in Evanston, Ill., on April 24 of this year, according to a class action lawsuit the father filed on Friday in Federal Court. He sued American Drug Stores LLC dba Osco Drug, along with its subsidiaries, American Stores Co. LLC, New Albertson’s Inc. and Albertson’s LLC.
     He “expected to receive either brand-name Concerta or a therapeutically-equivalent generic,” the lawsuit states. “Plaintiff’s expectations were objectively reasonable given the superior position of knowledge and expertise of the pharmacists.”
     But the Osco pharmacy sold Turetsky – for about $173 – generic tablets manufactured by nonparty Mallinckrodt Inc. in Ireland, which do not medically equate to Concerta, he claims.
     “While there are three manufacturers that purport to manufacture generic Concerta, just one form of generic Concerta is currently approved by the U.S. Food and Drug Administration as being therapeutically equivalent,” the complaint states. “In fact, the FDA has expressly found that the two other generic versions of Concerta are not therapeutically equivalent because their effectiveness wears off much more quickly and does not provide the consistent, long-lasting ADHD symptom control equivalent to Concerta.”
     The two subpar generics are manufactured by nonparties Mallinckrodt and Indiana-based Kremers Urban Pharmaceuticals Inc., or Kudco, according to the complaint.
     “The FDA adverse event reporting system database received reports of patients describing insufficient therapeutic effect, with nearly 200 reports about the Mallinckrodt product and over 100 reports about the Kudco product,” from May 2013 to June 2014, Turetsky claims.
     While Concerta releases into the body over a period of 10 to 12 hours, the Mallinckrodt and Kudco drugs have a “diminished” release between seven to 12 hours, according to the lawsuit.
     Even after the FDA found in late 2014 that those drugs did not live up to Concerta’s standard, Osco “nonetheless continued to substitute and dispense the Mallinckrodt products and/or Kudco products in lieu of Concerta to plaintiffs and the class,” Turetsky says.
     The two generics still “hold approximately 30 percent of market share for generic Concerta, with Actavis holding the remaining 70 percent,” as of May 2015, the complaint states.
     Turetsky says Albertson’s stores “hold their pharmacies and pharmacists out to the public as occupying a superior position of knowledge regarding prescription fulfillment.” He alleges Osco’s safety and trust is touted in advertisements.
     Turetsky seeks to represent all Americans who were prescribed Concerta or generic versions and received and paid for generic Mallinckrodt or Kudco drugs from Osco or Albertson’s between November 13, 2014, and the present.
     His lawsuit alleges consumer fraud under state law, breach of implied warranties and unjust enrichment. It seeks actual, statutory, punitive or treble damages and a jury trial.
     Turetsky is represented by Daniel Kurowski of Hagens Berman Sobol Shapiro in Chicago.
     Albertson’s and Jewel-Osco did not immediately return emailed requests for comment.
     Concerta is made by nonparty Janssen Pharmaceuticals Inc

They are changing the rules of the game


Will CDC Guidelines Promote Addiction Treatment?


People who take opiates … NO LONGER DEPENDENT OR AN ADDICT …but.. you now have a “OPIATE USE DISORDER “

By Alison Knopf, Editor of Alcoholism & Drug Abuse Weekly

The quick answer to the question “Will treatment providers be able to treat patients coming in addicted to opioids because they have been thrown off their pain medications next year?” is no. The treatment system can’t even treat all the patients who need help now. But this question is on the minds of federal policymakers as the federal Centers for Disease Control and Prevention (CDC) works on its forthcoming guidelines for physicians on prescribing opioids, due out next January (see ADAW, Nov. 16).

While the pain community is creating the loudest noise about the forthcoming guidelines, charging that they are not addicts and don’t want to be lumped in with them, the treatment community has on the one hand seen the benefits of decreasing the amount of prescription opioids available, but also seen the downside: patients who are dependent or addicted, who cannot successfully taper off the pain medications, will switch to heroin. Many started as legitimate pain patients.

But for some, when their doctors felt they no longer needed the pain medication, or thought the patient was doctor-shopping, or simply decided to go along with the calls to reduce the amount of prescriptions for opioids, it was difficult to stop, and they sought illicit sources of opioids.

The CDC confirmed to ADAW that there will be a guideline that “addresses treatment for opioid use disorder.” The draft guidelines leaked in September specifically recommended that an opioid agonist (methadone or buprenorphine) be arranged for patients who need treatment for an opioid use disorder. The CDC said the guidelines are continuing to be revised. Below is the wording of that recommendation from the September draft:

“Providers should offer or arrange evidence-based treatment (usually opioid agonist treatment in combination with behavioral therapies) for patients with opioid use disorder.

SAMHSA Working With CDC

But how the primary care physician determines whether a patient has an opioid use disorder is unclear. The Substance Abuse and Mental Health Services Administration (SAMHSA) expects there to be a change in prescribing practices — that’s the whole point of the guidelines. But according to Robert Lubran, director of the Division of Pharmacologic Therapies at SAMHSA’s Center for Substance Abuse Treatment (CSAT), it’s up to the physicians who are prescribing the medications to come up with a referral plan for their patients.

“I go back to what Westley Clark always said,” Lubran told ADAW, referring to the former director of CSAT. “He said the physician has to have an exit strategy for a patient he isn’t going to be prescribing opioids for anymore.” The physician has to determine if the patient is dependent on or addicted to the medication. Dependence is a normal result of regular opioid intake, addiction is pathological, but both will result in withdrawal symptoms when opioids are stopped suddenly. Someone who is dependent can be slowly tapered off the opioids and endure the craving that ensues. Someone who is addicted cannot stop and will seek opioids from another source.

“There has to be a place where the doctor can refer someone when the doctor determines that the patient can’t be safely tapered down because they are addicted,” said Lubran. A treatment provider specializing in opioid use disorders, such as an opioid treatment program (OTP) or office-based opioid treatment (OBOT), would be a good solution, he said. “We’re working with the CDC to make sure the guidelines include information on where to refer these patients,” Lubran told ADAW.

“We’re already struggling on the traditional medicine side with how a patient goes from being a pain patient to being an addict,” said Lubran. “They discharge them, but what about referrals? More states and counties need to be involved in recommendations for care,” said Lu, adding that insurance companies need to be involved as well.

Guidelines Not Mandatory

Mark Parrino, president of the American Association for the Treatment of Opioid Dependence (AA-TOD), said that as far as he knows, OTPs have not been involved in the development of the CDC guidelines. However, he expressed skepticism about the effect of the guidelines. “Will there be a reaction by physicians? Will this really change their practice patterns? Will there necessarily be a wholesale dumping of patients who are getting pain medications? I would hope not. But if that is the result, I would ask how we are going to know whether these patients will show up in treatment, or go into the street for drugs?”

Furthermore, said Parrino, these are just guidelines from the CDC. “Doctors aren’t even required to read the stuff,” he said. “They’ll issue a big press statement, yes. But it’s like package inserts. Do you really think every physician will be watching their computer for the guide-lines, saying ‘Now I need to change my medical practice?’”

The CDC itself says as much. “It is important to note that, like other CDC guidelines, including prevention and treatment of sexually treated diseases, the guidelines are intended to support informed clinical decision-making but are not mandatory (that is, physicians are not required to follow these guidelines),” according to Courtney Lenard of the CDC’s press office. The CDC’s guide-line is meant to “help primary care doctors provide safer, more effective care for patients with chronic pain” and at the same time “help reduce use, abuse and overdose from these powerful drugs,” the CDC’s press office told us last week. “The guideline is intended for primary care providers who treat adult patients (age 18 and older) for chronic pain in outpatient settings, and is not intended for patients who are in active cancer treatment, palliative care or end-of-life care.”

Asked if restrictions on prescription opioids will lead to increased use of heroin, however, the CDC continued to stick to the federal official answer, which is: No. “There is no robust evidence that recently enacted policies regarding prescription opioids are responsible for large-scale shifts to heroin,” said Lenard, adding that only 1 in 25 people who use prescription opioids nonmedically start using heroin within five years. However, she added that this “translates into a major and growing epidemic of heroin use given how widespread the misuse of prescription opioids has become.” Stopping the misuse of prescription opioids is the best way to stop the heroin epidemic, according to the CDC.

This article is republished with permission of Alcoholism & Drug Abuse Weekly, which provides news and analysis of federal and state public policy developments, private sector business developments, and provider issues and innovations in addiction treatment.

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