Document… Document… Document

Had a interesting phone call today… from an employee of that infamous chain/PBM…

Apparently this Pharmacist was written up for getting to work at 14 minutes past the hour… per the store’s video system…

Apparently this Pharmacist is kind of lazy and pockets the printouts(credentials)  that are generated when they login to the pharmacy system and when returning home… tosses these pieces of paper into pile   .. and this Pharmacist was able to produce the credentials from the particular day.. showing that the Pharmacist logged into their pharmacy computer system at 04 minutes past the hour.

What is not known at this time… if the time on the video system is “off” either intentionally or unintentionally… or there is some way that the date/time stamp on the “snap shot” from the video was altered .

Of course, we know that from all the fines this company has paid over the last few years… while admitting no wrong doing… they must be a “honest company”.. just settling all of these claims to avoid all the cost of legal costs and the resulting on going bad PR.

Of course, there are those “Legacy Pharmacists” that are filing age discrimination claims with EEOC and winning in court…

The DEA claims they are not interferring BUT ?

This showed up as a comment on another of my posts and this could be a major impact on patient health & safety.. if it is true !

My manager just told a story of the DM saying. .. There’s a situation where once you exceed a DEA or manufacturer quota, you will forever have to check PDMP on every control your pharmacy ever fills again, staple the results to the hard copy, etc.  Has anyone ever heard anything like this??

Let’s run the numbers… taking a store averaging 30 Rx/hr with a 12 hr day..

Assumption:

1 tech hr/15 rxs  = 24 tech hrs/day

20% of total Rxs are controls.. = subtract 5 tech hrs/day – some of the major chains it has been reported that they are removing controlled Rxs from the computation of allowable tech hours  – to discourage pharmacists from filling controls ?

Now we have a extra 5 minutes for all the pharmacist time.. in the administrative requirements of Hydrocodone products to C-II.. presuming that 50% of the controls will now be C-II’s.. that is 3 more Pharmacist’s man hours/day for new administrative tasks.

Throw in having to run a PMP report on all controls… estimated times 5 minutes each … another 6 man hours devoted to administrative tasks.

If a pharmacy/Pharmacists fills 360 Rxs/12 hr day.. with no controls … he/she will have 36 man hours (12 Pharmacist/24 techs)

If a pharmacy/Pharmacists fills 360 Rxs/12 hr day with 20% controls… after subtracting lost tech hours and added administrative hours.. there would remain approx 22 man hours.. the Rx dept moves from 10 Rxs/man hour to 16 Rxs/man hour..

And pain pts wonder why the Pharmacist just wants to  JUST SAY NO.. to filling your controlled med Rxs ?

 

The war on drugs.. the “energizer dog “?

dogchasingtail

 

 

 

 

 

Heroin use on the rise in United States

http://www.cnn.com/video/standard.html?/video/us/2014/08/26/pkg-feyerick-gateway-to-heroin.cnn

In this four minute CNN news story.. there are a couple of VERY INTERESTING quotes.. IMO… they were mostly made “off the cuff” and given no real weight within the report.

The police officer stated that “the drugs are here to stay.. they are not going anywhere ”

The officer also stated that they have arrested the SAME PERSON… TWO HUNDRED TIMES …

The addict admitted to OVERDOSING … FIVE TIMES… wishing she was DEAD and stating that “she could not even OVERDOSE CORRECTLY (suicide)  ”

I am sure that if she would have succeeded that her death would have been classified as a ACCIDENTAL OVERDOSE… and used as another reason to continue funding the war on drugs

Chronic pain pts becoming more VISIBLE ?

New Revenue Stream – legal extortion ?

Caught shoplifting batteries from Rite Aid and today got a letter about a settlement offer of $265.99 can this get dropped or even reduced?

https://answers.yahoo.com/question/index?qid=20140825163658AAwv5Av

From the article?

I was caught stealing a 4 pack of AA Duracell Rechargeable Batteries priced at 15.99 at my local Rite Aid in Oregon I was walking out and was about 10 feet from my car when I was stopped by an employee asking me about the batteries I stole and that he was going to need them back and to follow him into the back of the store and he was going to fill out some paperwork.

Today I received a letter at the top saying a settlement offer and then states that they represent Rite Aid concerning its civil claim that happened in there store and then mention Pursuant to Or. Rev. Stat 30.875 “Shoplifting or taking of agricultural produce” Rite Aid may consider moving forward with a statutory civil damages claim against you. And then says that they ask that I settle this matter by making a payment of $265.99 withing 20 days of this letter being dated (date the 19th) is there any way I can get these charges dropped or lowered?

MJ not toxic ?

States with legalized medical marijuana had 25 percent fewer prescription OD deaths: study

http://www.rawstory.com/rs/2014/08/26/states-with-legalized-medical-marijuana-had-25-percent-fewer-prescription-od-deaths-study/

From the article:

States that allow legal use of medical marijuana have lower rates of fatal overdoses from prescription medications.

A new study published in JAMA Internal Medicine found the 13 states where medical marijuana is legal had 24.8 percent fewer annual opioid overdose mortality rates.

The results indicate alternative treatments may be safer for patients suffering from chronic pain, researchers said.

I have noticed recently that “they” are now using the figure that 16 K -17 K die from accidental drug overdoses whereas previously “they” were promoting the number as 36 K – 39 K people dying of a accidental overdoses..

For years, there has been those that have stated that >50% of those who have died of a drug overdose was actually a suicide… Have “they” decided to report the actual number of those with a accidental overdose.. BUT… basically BURYING 20 K suicides.. because it doesn’t support the DEA war on drug agenda ?

I have also seen report after report that Heroin deaths are skyrocketing… but.. I don’t remember seeing many relaying REAL NUMBERS … Are those numbers becoming so high that it shows where the DEA is failing to attain their mission.. Is it worse for people to abuse ILLEGAL drugs… or abuse LEGAL drugs ?

After all it is perfectly legal to abuse the legal drugs ALCOHOL & NICOTINE !

Pain in America – have you noticed ?

Have you ever pay attention to the commercials on TV… unless you are watching all your TV from a DVR/Tivo or you are addicted to ROKU/HULU or some other such service… approx 20 minutes of every hour is COMMERCIALS.

If you pay attention to these commercials.. there as several each hour advertising some sort of pain medications.. most over the counter… topical creams, ointments, sprays, patches, NSAID, APAP, Cox-2 inhibitor and even a CONTROLLED MED ( Lyrica) – but they warn you if you have addiction issues.. you could have a problem.  Yes, it is a C-V, but you don’t see Synalgos DC (also a C-V)being advertised DTC.

We even see some of these “pain meds” being marketed in combination with Diphenhydramine … for pain and sleep.

Does anyone believe that all the money being spent on advertising these “pain meds” .. if they were not selling tons of these products..

Granted, these are for mild – mild/moderate pain.. but .. isn’t it a indication that we have a epidemic of pain – or perceived pain – in this country?  Doesn’t it make sense that pain will tend to increase as a person ages?

Too many attorneys or too big of budget defecit ?

Chicago and 2 California Counties Sue Over Marketing of Painkillers

http://www.nytimes.com/2014/08/25/us/chicago-and-2-california-counties-sue-drug-companies-over-painkiller-marketing.html?_r=0

From the article:

The City of Chicago and two California counties are challenging the drug industry’s way of doing business, contending in two separate lawsuits that “aggressive marketing” by five companies has fueled an epidemic of addiction and cost taxpayers millions of dollars in insurance claims and other health care costs.

Remember the big tobacco lawsuit ?… http://www.npr.org/2013/10/13/233449505/15-years-later-where-did-all-the-cigarette-money-go

Basically, numerous states went after the tobacco industry for health cost that the use of this legal product caused.. after these same bureaucracies had collected taxes on these same legal products for decades.

While tobacco products have no known medical benefit.. can’t say the same about the medical benefit when prescribed appropriately .. I guess they were afraid of suing the drug cartels !

Bureaucratic DOUBLE- SPEAK ?

http://www.deadiversion.usdoj.gov/fed_regs/rules/2014/fr0822.htm

c. Impact on Drug Availability

Two commenters suggested this rule will result in limited drug availability because wholesalers are limiting distributions to community pharmacies. These commenters assert that if a pharmacy goes over a pre-determined amount, they cannot obtain the needed pharmaceuticals until the following month. The commenter asserted that this practice may have particularly adverse impacts in rural areas where a pharmacy may only be serviced by one distributor. Another commenter suggested there will be local shortages of HCPs because of the cumbersome and slow schedule II ordering process. Two commenters were concerned that limited availability may result from delays associated with manufacturer production due to annual production requirements for schedule II controlled substances.

DEA response: DEA registered distributors are required to provide effective controls against diversion of controlled substances. However, the DEA does not limit the quantity of controlled substances that may be legitimately distributed to pharmacies. Any arbitrary limits placed on community pharmacies by distributors are the result of a business decision of that distributor.

The DEA does impose requirements for distributors to operate a system to disclose suspicious orders of controlled substances. 21 CFR 1301.74(b). Suspicious orders include orders of unusual size, orders deviating substantially from a normal pattern, and orders of unusual frequency. Id. Part of the due diligence associated with that requirement, as well as the general requirement under 21 CFR 1301.71(a) for registrants to “provide effective controls and procedures to guard against theft and diversion of controlled substances,” is to “know your customer.” While order volume may be one indicator of a suspicious order, the totality of circumstances must be used in making a determination. Generally, no single indicator is independently a suggestion that a given order is suspicious. Order volume should be examined not only on an industry-wide comparison level, but also on a local level. For example, a pharmacy located near an oncology clinic may be more likely to regularly order higher volumes of certain controlled pharmaceuticals than one that is not.

The DEA does not find evidence to support the claim that the ordering process for schedule II controlled substances will result in limited availability of HCPs. A DEA Form 222, or its electronic equivalent–the Controlled Substance Ordering System (CSOS), is required for all distributions of schedule I or II controlled substances, with specific exceptions, 21 U.S.C. 828(a); 21 CFR 1305.03, which enables the DEA to monitor the flow of these controlled substances from their point of manufacture through commercial distribution. It takes approximately an hour to complete each order using the paper DEA Form 222. It takes approximately three minutes to complete an order using CSOS. (The DEA Form 222 permits ten line items per form; electronic orders are not subject to the same requirement and may contain an unlimited number of transactions (line items)). While CSOS transactions are faster, the paper DEA Form 222 orders are also able to be processed quickly through the system. In 2013, 109,632 registrants ordered schedule I or II controlled substances. About 4.8 million orders were processed on Form 222s and 924,257 were processed electronically via CSOS (approximately 16% of all orders). The paper orders represented roughly 27.7 million transactions (or about 6 per order); the electronic orders represented roughly 21.2 million transactions or slightly more than 23 per order.

There should be no impact on availability due to schedule II annual production requirements (i.e., manufacturing quota). Registrants that manufacture hydrocodone are already required to obtain an annual quota in order to manufacture hydrocodone because it is a schedule II controlled substance unless and until it is formulated into dosage form HCPs.

 

So all the “rationing” that we are hearing about with the drug wholesalers is a BUSINESS DECISION and the DEA has no mandate for them to restrict distribution ?  Tell that to Cardinal Wholesaler with their central Florida distribution center that had it DEA licensed suspended for TWO YEARS and ended up with fines and legal fees in the multiple million of dollars… because they legally sold controls to two  legally licensed  CVS pharmacies in central Florida… in quantities that was later determined by the DEA were not for patients with a legal medical need.

If all the drug wholesalers are rationing to all pharmacies.. isn’t that COLLUSION ?… isn’t that RESTRAINT OF TRADE ? Isn’t that a violation of R.I.C.O. ?

Our mission is more important !

This appeared in the Federal Register .. the DEA response to comments on the rescheduling of  Hydrocodone products. The previously statements of DEA spokesperson about how the DEA will not interfere with legit pts getting their needs therapy – IMO -  seems to be inconsistent with this current response.

8. Responsibilities of Pharmacists

The DEA received many comments, from pharmacists, physicians, ultimate users, and the general public, who were concerned that the increased administrative burden on pharmacists that might occur as a result of moving HCPs into schedule II would cause pharmacists to devote time to the administrative burdens rather than on patient counseling and safety. Commenters stated that the administrative burden would be greatly increased in the pharmacy setting because: separate prescriptions would have to be entered for every HCP; pharmacists would have to count the prescriptions, as technicians are not legally allowed to do so in some States; inventories would be required of all HCPs; and increased workload associated with recordkeeping requirements (i.e., DEA Form 222).

DEA response: The processes and procedures associated with dispensing a controlled substance are not relevant factors to the determination of whether a substance should be controlled or under what schedule a substance should be placed if it is controlled. See 21 U.S.C. 811 and 812.”

boa

We have a agency.. in fact two agencies working together – DEA & FDA .. and is making criminals out of people with mental healths issues that are self medicating their demons by abusing some substance, discouraging healthcare professionals from providing optimum treatment to those with subjective diseases and interfering with how healthcare professional practice medicine. All of these people could represent 125 – 150 million of our population…

There are some 11 K – 12 K people working for the DEA at the Federal level and they are the ones that are manipulating the lives of all of these people. A recent survey indicated that 90% of the people in this country believes that the war on drugs is a failure. Apparently the 10% that believe it is successful are those that derive their paycheck from this war in one way or another.

It is claimed that we spend 51 BILLION dollars annually on fighting this war and have spent over ONE TRILLION since the war officially began in 1970 with creation of  the BNDD.

Today we have 535 people that control the continued funding of this war.. 435 in the House of Representatives and 100 in the Senate.

There are abt 200 million eligible to vote in this country and about 120 million will vote in the next Presidential election… and elections are usually decided by a 1%-2% difference.. that means that 2.4 million will decide not only the next President but 435 in the House and 33-34 in the Senate. That is just 2% of the people whose lives are being adversely affected by the DEA.

After this next election.. is it time .. to work with politicians that will commit to DEFUND THE DEA and the war on drugs ? The first one to commit gets the support of those opposed to continuing the war on drugs…  You cut the head off of the snake…it will die.. You don’t cut the head of the snake off.. it may eventually kill you.

 

 

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