1-ribboncryingeyevoteFirst 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 an 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

cpvotesvotersyourvote

CVS Specialty Pharmacy is the absolute worst Pharmacy I have been involved with since becoming Ill

cvshealthsignCVS Specialty Pharmacy is the absolute worst Pharmacy I have been involved with since becoming Ill

http://www.newsmandan.net/my-journey-with-msa—blog/came-up-short-on-the-drug-for-controlling-my-ortho-static-hypotension

Ortho-static Hypotension is a sudden drop of blood pressure from a known or unknown reason causing the pt to become anywhere from dizzy to a temporary black out.. causing the pt to collapse and putting them at risk of numerous possible injuries… depending what their body hits on the way down to the FLOOR.  Less severe cases will happen when a person suddenly changes positions… like getting up from a seated to standing position

I have had a difficult week mainly due to the inept people at CVS Specialty Pharmacy.  Because I can only receive a 30-day shipment at a time, I am reliant on CVS to call and arrange a shipment when I am down to 5-6 days of supply.
This is the third month I have had to get on the phone with the pharmacy reps at CVS and then with Northera to work on having another 30-day supply shipped.
I contacted CVS but did not receive a response, all operators were busy, I left a message.
After I had spoken to the Northera representative, they were going to call CVS and then call me back. You can guess this one, I did not receive a call back from Northera. With three days left I spread the Northera over 7 days. I take six tablets 3 x’s a day. I cut it back to 4 tabs 3 x’s a day. Missing those six pills a day sent my OH into steep dives. One minute I was working in the garage, next minute I am on the floor wiped out, BP was 70/50.
I recovered and started watching television. Around midafternoon I had a second episode. Lucky I was in a sitting position. I should have remained seated.  I knew there was a problem so I decided to go to my room and lay down. I lasted for 5 steps and went down, crashing to the floor.  The second episode in less than two hours was a marked change compared to  previous episodes of OH (Orthostatic Hypotension) that I have experienced. This evolution of OH was new to me. It came on fast and lasted longer than the current episodes.
Last Monday I had to overcome similar OH episodes and again Tuesday thru Thursday. I was also experiencing serious balance issues and fell twice this week. Compare that to zero falls in the previous 4 months. The lower dosage was not helping me. Finally Thursday night Northera made arrangements to ship a 15 day supply over night to my home. I specifically asked the representative to not require a signature. Unfortunately they did not follow my request and required the UPS driver to get a signature.  So at 10:05 AM the UPS driver rang the door bell waited 10 seconds,  stuck a sorry we missed you post-it note on my door and drove away. It takes me 10 seconds just to convince my body to rise and walk. After all my brother is 70 years old. After several calls to the UPS Service line my medicine finally arrived at 8:30 PM Thursday night. Not in time to save me from two more bouts with OH. I did start regular dosing Friday morning.  I have had OH issues Friday, Saturday and again today. Today’s episode was minor compared to the other seven days.
I still do not understand what is going on with CVS Specialty Pharmacy’s handling of my prescription of Northera going forward. I am hoping that they switch it over to Walgreen’s Specialty Pharmacy as I hear they take care of their customers much better.

Dan

Horror stories don’t create good laws… but.. they do create laws.

Cincinnati responds to 30 heroin overdoses in one day

http://local12.com/news/hooked-on-heroin/district-3-police-respond-to-20-heroin-overdoses-in-one-day

Obama’s first chief of staff Rahm Emanuel.. that this philosophy of how you could get done within the legislative process.

“Things that we had postponed for too long, that were long-term, are now immediate and must be dealt with. This crisis provides the opportunity for us to do things that you could not do before.”

Maybe I have not seen it… but.. I have not seen much of the DEA/law enforcement having press releases on much of this Heroin/Fentanyl mixture that has been confiscated and the people involved with its distribution arrested.  Likewise there has been little public announcements of oral doses/tablets of Fentanyl being sold on the street.  Keep in mind.. there is no legal commercially available oral Fentanyl doses made in the USA.

There is another old saying within legislative circles….“Horror stories don’t make good laws… but… they do cause laws to be passed”

Is someone… some entity..  putting these two philosophies together to create some larger agenda.  On one hand we have various states that are making Naloxone – up until now can only be purchased by prescription – to be mostly purchased as a over the counter medication.  We have guidelines to restrict/limit the amount of opiates that someone suffering from documented chronic pain… but.. the number of time that a individual is revived with Naloxone is unlimited and – as a society – we provide little/no mental health therapy after a person is revived… and the failure rate of those that do get therapy is a high percentage.  It would seem to be like a revolving door and like a virtual ATM for those who operate rehab facilities.

Those with addictive personalities are suffering from a chronic disease… but.. like chronic pain.. our society does not seem to provide long term therapy… just short term fixes. Our “boat” is LEAKING and we are trying to plug the holes with  CHEWING GUM ?

CINCINNATI (WKRC) – Cincinnati emergency crews responded to 30 heroin overdoses in the course of one day Tuesday, August 23.

Officials said most of the overdoses were located in the west side of Cincinnati. The Cincinnati Police Department said in a statement Tuesday evening they were not sure of the exact cause of the increase yet. They warned anyone who may be using dangerous drugs to be aware of the increased danger.

Three people overdosed in one house and one man overdosed while driving through an intersection. Another overdosed with his child in the car at a gas station. Fire crews worked quickly to save as many lives as they could.

The Cincinnati Police Department was working to identify the commonalities in the overdoses in an effort to find the source of the dangerous drug being circulated.

The problem continues to plague cities across the country. In Charleston, West Virginia 26 people OD’d in four hours. All of them were revived. The same couldn’t be said for the Akron area. In a three-week span in July 2016, 173 people overdosed. Sixteen of them died.

The scary part was that it was not just heroin that was causing the deaths. The uptick in overdoses was being linked to a drug that was used to tranquilize elephants called carfentanil. Most people have no idea it’s mixed in with other drugs. Carfentanil is 100 times as powerful as fentanyl which killed hundreds in the Tri-State area in 2015.

Narcan no longer brings everyone back to life.

The coroner said about it earlier in August, “Bottom line, this would be a good time to get clean. Be a great time to get clean and stay clean. Because we are really afraid of what we are coming up against here.”

It was too early to tell if the spike in overdoses Tuesday night, August 23, had anything to do with carfentanil. But, it was found in several places throughout the city of Cincinnati in early August 2016.

Anyone with information that could be helpful to the investigation is asked to call Crime Stoppers at 352-3040.

 

If the chronic pain community gets their act together

Burning HouseTHE HOUSE OF REPRESENTATIVE

this is what the Representatives could be literally looking at if the chronic pain community comes together and VOTES THE BUMS OUT.

So far calls from constituents, letters from constituents , on line petitions has caused not much more than a “virtual pat on the back” that they understand…. BUT… they are concerned about the opiate epidemic. BUT.. they will remember your concerns when a law comes up for action.

Congress passed the Control Substance Act 1970 which created the DEA and they have the legal ability to amend or repeal that law.  After 46 yrs all Congress has done has allowed  – turned a blind eye/deft ear – the DEA to REINTERPRET that law to establish regulations that suits the DEA’s agenda for the immediate – or longer period.

No one may ever know what/who has influenced this agenda or process… is there lobbyists for certain companies “bending the ear” of  the members of the most appropriate Congressional committees. Undoubtedly, the “higher ups” of the DEA have fairly ready access to those same members of Congress.

It would seem that the only individuals that are not able to influence the members of Congress is the constituents that they are suppose to represent.

The question has to be asked.. if they are not listening to you… why are you voting them back into office ?

cryingeyevote

 

Woman DIES after being INTENTIONALLY thrown into COLD TURKEY WITHDRAWAL

Lawsuit: Indifference by medical staff at Forsyth jail led to woman’s death

https://triad-city-beat.com/2016/08/lawsuit-indifference-medical-staff-forsyth-jail-led-womans-death/

A lawsuit filed in Forsyth County court alleges that a private healthcare company and medical staff at the local jail displayed deliberate indifference, causing the death of a woman awaiting trial in 2014.

 

A lawsuit filed in Forsyth County court last week alleges that medical staff at Forsyth County jail acted with deliberate indifference, causing the death of a pregnant woman who was undergoing withdrawal from opiates while awaiting a hearing on charges of prescription drug fraud in 2014.

The lawsuit, filed on Aug. 17 by the estate of Jen McCormack, names Correct Care Solutions — a Tennessee-based healthcare company with extensive contracts in detention facilities across the country — as defendant.

McCormack’s unexpected death at Baptist Hospital after being found unresponsive in the jail in downtown Winston-Salem first came to light in a series of articles [1, 2, 3] published by Triad City Beat in 2015 that included details of her deteriorating health during the 16 days of her detention while calling into question an official narrative suggesting she died as a result of a hunger strike.

McCormack’s death certificate, which is cited in the lawsuit, notes an “uncertain contributory role of reported intent to starve self v. deficient pre-emptive custodial intervention.”

Meanwhile, on Aug. 18, the US Justice Department announced that it will gradually phase out contracts with private prison providers, noting among other factors that “they do not provide the same level of safety and security” as those directly administered by the government. A review of inmate medical records by the Nation that focused on 11 immigrant-only contract prisons, including one in west Texas where Correct Care Solutions was the medical provider, found “prison medical units repeatedly failing to diagnose patients correctly despite obvious and painful symptoms, as well as the use of under-qualified workers pressed to operate at the borders of their legal scope of practice.” The investigative report, published in February, also said the files showed “men dying of treatable diseases — men who very likely would have survived had they been given access to adequate care.”

The lawsuit filed in Forsyth County court last week by McCormack’s estate fills in critical gaps about her access to medication in the jail and about concerns raised by an obstetrics nurse at an off-site clinic as to whether her deteriorating condition warranted her hospitalization.

McCormack had received Subutex — a brand name for the opioid-withdrawal medication buprenorphine — during a stay at Forsyth Medical Center prior to her arrest, according to the lawsuit. She also received Zofran to treat nausea. McCormack had wanted to receive treatment for her addiction to prescription drugs at an inpatient facility, but because no beds were available she planned to go home and begin outpatient rehabilitation, according to the lawsuit. Instead, she was arrested for multiple charges of felony prescription-drug fraud and booked in jail.

McCormack experienced nausea and vomiting for much of her time in jail, complaining of dizziness and chest pain, and exhibited lethargy and disorientation that worsened over time. The lawsuit alleges that although Zofran was ordered to treat her nausea, it was only administered to her once. The complaint alleges, “As a result of her uncontrolled nausea, decedent was unable to take many of the medications that were prescribed for her symptoms of opioid withdrawal, anxiety disorder, depression, and prenatal vitamins for her unborn baby.”

The lawsuit alleges that Registered Nurse Miriam Cornatzer Hauser and Nurse Practitioner Emma Aycoth, who worked in the medical unit at the jail at the time of McCormack’s detention and who are named as individual defendants in the lawsuit, and other members of the nursing staff “failed to properly and adequately assess decedent’s signs, symptoms and her severely deteriorated condition.”

The complaint alleges that Cornatzer and Aycoth violated McCormack’s constitutional rights “by intentionally, willfully, maliciously and with conscious and deliberate indifference, failing to secure adequate and reasonable medical care for decedent when they subjectively knew or should have known that decedent had an objectively serious medical need and faced a substantial risk of harm, by disregarding such risk of harm and by failing to take reasonable measures that were readily available to avoid that risk.”

The complaint goes on to say that the two nurses “had actual knowledge that decedent had failed for several days to take in and retain amounts of food and/or liquid sufficient to sustain life, as a result was exhibiting a seriously declining physical condition, and required immediate medical attention and intervention.

“Decedent’s condition would have been diagnosed by a physician as mandating treatment and/or was so obvious that even a lay person would easily recognize the necessity of medical attention,” the lawsuit continues. “Defendants RN Cornatzer and NP Aycoth failed to notify physician staff or otherwise secure reasonable and necessary medical attention for decedent. Their failure to do so and deliberate indifference ultimately led to her death.”

The lawsuit charges that the company’s cost-cutting policies were “a moving force” in Jen McCormack’s death.

Aycoth declined to comment and Cornatzer could not be reached for this story.

The lawsuit accuses Correct Care Solutions of maintaining “policies, practices and/or customs” that constituted deliberate indifference to McCormack’s serious medical needs and that “were a direct and proximate cause” of the nursing staff’s conduct.

The lawsuit charges that the company’s cost-cutting policies were “a moving force” in McCormack’s death, while alleging that “CCS has stated that it is committed to measures that minimize the need to transport inmates offsite.”

Jim Cheney, a spokesman, said Correct Care Solutions would not be able to comment because the case is under litigation.

The lawsuit alleges that “misconduct of nursing staff” at Forsyth County jail and other detention facilities served by Correct Care Solutions was “widespread,” adding that at least seven inmates, including McCormack, have died at the local jail “due to inadequate or improper medical care.”

Correct Care Solutions, along with the Forsyth County Sheriff’s Office, is currently defending itself against a lawsuit filed by the family of Dino Vann Nixon, a man who died in the jail in 2013. The lawsuit alleges that medical staff refused to provide Nixon with Xanax, an anti-anxiety medication also known as benzodiazepine. A report by a local medical examiner found that his death “was related to withdrawal from benzodiazepine.”

Despite the finding by the medical examiner, the defendants deny that Nixon’s death was related to withdrawal from the medication, while maintaining that he received appropriate care.

Correct Care Solutions also provides medical services in the Guilford County detention center. A woman named Ellin Schott who had been arrested for panhandling died at Cone Hospital after her health rapidly deteriorated during a brief stay in one of the jails in downtown Greensboro. A local medical examiners report chronicled medical staff’s apparent unwillingness to provide Schott with her prescribed anti-seizure medication and concluded that the immediate cause of death was “complications of prolonged seizure activity.”

According to the lawsuit filed in Forsyth County court last week, McCormack reported to the nursing staff on the fifth day of her detention that she was weak and dizzy, that she had been vomiting, and that the anti-nausea medication she had been receiving “is not sufficient.”

The lawsuit alleges that Dr. Alan Rhoades assessed that McCormack was apparently fainting, further concluding that she was exhibiting “drug seeking behaviors.” The complaint continues, “Decedent had been placed on Vicodin because CCS did not have access to Subutex. Dr. Rhoades ordered that Vicodin dose be decreased and ordered, ‘no change in management otherwise,” with the doctor emphasizing the first two words in all capitals.

Rhoades’ LinkedIn page identifies him as the medical director for the Forsyth County jail, along with the three Guilford County detention centers. Rhoades could not be reached for comment for this story.

The next day, according to the lawsuit, McCormack visited an OB/GYN at a clinic off site from the jail. “The obstetrical nurse contacted NP Aycoth expressing concern about decedent seeming drugged and drowsy and because decedent had vomited ginger ale she had been given,” the lawsuit alleges. “The obstetrical nurse questioned whether decedent should be hospitalized, and NP Aycoth instructed the obstetrical nurse to have decedent returned to the jail.”

Later that day, the lawsuit alleges that despite discovering that McCormack had vomited in her wash basin back in her cell and was struggling to eat, Aycoth failed to report those developments to physician staff.

“After September 9, 2014, nursing staff made no assessment of blood pressure or vital signs until September 13, 2014,” the lawsuit alleges. “Meanwhile, decedent was becoming more and more dehydrated due to continued nausea and vomiting. Nursing staff made no measurement of decedent’s food and water intake or output except for one notation of water intake that was made on September 13, 2014. Decedent was becoming at high risk for a serious and significant dehydration setting the stage for injury to her brain, kidneys and heart that did, in fact, cause a severe downward spiral in decedent’s condition, including changes in cognition, damage to her kidneys placing her at high risk for kidney failure, and culminating in a cardiac arrest that led to hypoxic brain injury and death.”

paybacks are hell ?

EpiPen price skyrockets 400%

spiderwebWhat I find interesting… Mylan’s President is the daughter of Sen Manchin (D-VA)… The Senator has proposed a OPIATE TAX and one of Mylan’s major products is Hydrocodone/Acetaminophen… which is taking a volume/profit hit because the DEA changed this product to a C-II a couple of years ago… So now that the only competitor to Mylan’s Epi-pen has had a voluntary recall.. they are “the only game in town”… Are they trying to regain the profits they believe that they have lost…. because of the actions or proposed actions of the FEDS.

Following the “money trail” is like tracing a spider web…

On Fox Business today they had the Mother of a son who died 3 yrs ago because of a food allergy.  Which has created a FOUNDATION to help make sure that no one goes without access to this necessary medication.. and no one loses someone to allergic reactions.

Perhaps the chronic pain community needs to take notice of what is going on around us… ONLY DEAD BODIES GET ATTENTION OF THE MEDIA !

The chronic pain community have DEAD BODIES… from pts being thrown into cold turkey withdrawal and dying because of that in combination with their co-morbidity issues… those who have committed suicide because their quality of life was flushed down the crapper because of reduced or eliminated pain medication.

As I have heard before with the media ” IF IT BLEEDS IT LEADS “… Your disease, your suffering is INVISIBLE … is our society making those who die from various reason associated with the inadequate/non-treatment of your pain … also INVISIBLE  ?

If you have a friend/relative that dies because of lack of adequate medical care committed suicide… please don’t stand around the casket saying ” at s/he is no suffering any more”… “s/he is now at peace”…  and other platitudes…  Where is the OUT RAGE that making sure than no one else has to go down that path ?

 

Target stores has lost “foot traffic” because CVS now operates their pharmacies ?

Customers: CVS Takeover Erased Everything Good About Target Pharmacies

Customers: CVS Takeover Erased Everything Good About Target Pharmacies

One of the reasons that Target gave for its poor performance during a recent earnings call was that stores may have lost some foot traffic because of “some disruptions” when the discount store sold its pharmacy business to CVS. We wondered what that meant, and asked if readers had experienced those “disruptions.” They had, but the bigger problem is something that Target’s executives may not have realized: people filled prescriptions there because they liked things that Target did differently.

The Bottles

Image courtesy of Eric Spiegel

The ClearRX system, which Target introduced in 2005, solved most of the annoying problems with the standard amber prescription bottle, even making it easy to tell which medication is which with bottles standing up in a drawer or box. For nearly all customers who contacted us, these bottles were the main reason why they chose the pharmacy.

targetbottle“Target had the best prescription packaging I’ve seen,” reader R. wrote. “Labels were easy to read and the color-coded bands made telling whose bottle was whose without glasses simple.”

The safety-minded packaging for prescriptions at Target drew many customers to the chain’s pharmacy counter over other options that might have even been in the same strip mall. A Target representative told Consumerist that the ClearRX patents were part of the sale of Target’s pharmacy business to CVS, and the drugstore giant now owns them, but is not using them.

It would be nice if CVS implemented them across the entire chain, but readers report that the red bottles have been discontinued since the changeover, and their meds are in classic CVS amber containers.

The People

Image courtesy of Mike Mozart

“My local pharmacy team was always very friendly, and even knew my name,” reader S. wrote. “Now, they are staffed with new people who are extremely rude.”

This was a common complaint of readers about CVS: whether it was because previous staff members left or because CVS brought its own people in, the familiar faces behind the pharmacy counter disappeared.

“Target Pharmacies were great,” G. wrote. “They were like your old-time neighborhood pharmacists.” He notes that he used to drive past about a dozen other pharmacies just to patronize Target, but will no longer be doing that.

The Cost

Image courtesy of Brittany Loubier

Reader G. shared her experience trying to use her discount card through GoodRX, a site that lets you compare prices at different pharmacies in your area. She used the company’s discount card on the mobile app just as she always had at Target…or she tried to.

“I used to use it at Target with no problems,” she wrote to Consumerist. “Since CVS took over, even though they are still listed in the GoodRX app, when I went to pick up two of my prescriptions I was told they do not honor it.”

Other customers mourned the end of the discounts they received from pharmacy rewards. In states where such programs are legal, customers would receive a 5% off certificate good or a whole Target shopping trip after filling five prescriptions at the store.

The Actual Drugs

Image courtesy of Edward Kammerer

M. takes a medication with a very specific extended-release mechanism, and she has found the generic version from one manufacturer to be the most reliable. Target used that one, but the new CVS inside Target stocks a version from a different manufacturer that she doesn’t trust. “So many recalls,” she notes.

The pharmacy was able to get the drug for her after a month of taking the less trustworthy version, but didn’t stock it consistently, leading to wasted trips. She gave up and switched her prescriptions to Walmart.

“I like shopping at Target, and now I have no built-in reason to go there every month,” she wrote to Consumerist. “Sad for them too, because I never, ever walked out of there with just a prescription bag. I probably spent anywhere from $25 to $75 every time I went in to get my refill.”

Depending on how many customers are like M., this is exactly the kind of news that Target CEO Brian Cornell won’t want to hear.

While they aren’t exactly drugs, reader D. noticed a really common medical supply missing from his local pharmacy in Florida after the transition to CVS. “Basic diabetic supplies, such as test trips and lancets – no longer carried, with or without insurance,” he observed. Let’s hope that isn’t a permanent change.

The Data Migration

Image courtesy of jsbn123

Patients had less information on this, but recounted that their prescriptions were assigned new numbers under CVS. That makes sense. However, this broke the auto-refill system, causing problems for customers.

N. reports that the transition didn’t go well in Target’s home state of Minnesota. “Once the new CVS systems launched there were a lot of issues with employees struggling to input prescriptions and complete pickups with the new computer system,” he writes, saying that lines were exceedingly long for the first two weeks after CVS took over.

C. had her prescription for a controlled drug disrupted: her doctor needs to authorize it for three months at a time, and the pharmacy had to contact her doctor to confirm it even though he had just done so the month before CVS took over.

“It was a one-time inconvenience,” she wrote to Consumerist, “but enough of an aggravation that I elected to move my prescriptions elsewhere, since Target no longer had the bottles that made me interested in filling prescriptions there in the first place.”

Take heed, CVS: people really, really, really like those bottles.

PREVIOUSLY:
Target Sales Are Down Because Customers Are Fixing Up Their Homes Instead

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The truth and all the truth that “the spin” will allow ?

daffydizzy (1)Report: Pills in Prince’s home mislabeled, contained fentanyl

http://www.cnn.com/2016/08/22/health/prince-pills-fentanyl/

It is amazing how some reporters have to spin the TRUTH to make a point.  It has been reported that the tablets found in Prince’s position was a “Watson 385”.  This tablet was a commercial product containing 7.5 mg of Hydrocodone and 500 mg of Acetaminophen.  But about 3 yrs ago, all production of opiates with more than 325 mg of Acetaminophen could no longer be legally produced in the USA.  This product was replaced with a 7.5 mg Hydrocodone and 325 mg of Acetaminophen.

To the best of  my knowledge there is NEVER BEEN a legally produced, commercially available Fentanyl in a tablet form in the USA.  So to suggest that the manufacturer “mislabeled” the product is so small a possibility it is virtually NON-EXISTENT. 

There have been reports of ILLEGAL produced tablets that resemble both NORCO and Xanax that contained Fentanyl.. One thing that they did not clarify is that the Fentanyl that is legally available in the USA is Fentanyl Citrate.. the illegal products contain Acetyl Fentanyl and a new variation coming in from China furanyl fentanyl. Both of which are less potent than the Fentanyl citrate.  That single determination would have clarified if the tablets that Prince took were legally manufactured in the USA.

The question has to be asked … was Prince one of those 1%-2% of chronic pain pts that became addicted. Could he not find a doctor to treat his chronic pain (hip ?) adequately and resorted to getting his hands on something to allow him to continue doing is job of preforming ?

IMO.. because this was a OD death of a high profile person.. most of the details of his death will be kept confidential. So the truthful facts may never be known… just the spin that the media can put on this story…

Image result for watson 385

(CNN)Pills seized inside Prince’s Paisley Park compound by investigators were labeled as hydrocodone but actually contained fentanyl — the drug that killed the singer — according to a source with knowledge of the investigation who revealed the information to the Minneapolis Star Tribune.

The revelation gives more insight into what may have caused Prince’s overdose. There are two likely possibilities: Either a pharmaceutical manufacturer mislabeled the pills, or the pills were illegally manufactured and obtained illegally.
However, according to the Star Tribune, investigators are working under the theory that the pop star did not know the pills contained fentanyl. Prince died on April 21 from an accidental overdose of fentanyl, according to the medical examiner.
Is Prince overdose a wake-up call for doctors?

 
If the manufacturer mislabeled the pills, there would have likely been a recall, as fentanyl is an extremely potent opioid medication and a controlled substance. It would be a serious health hazard if a batch was mislabeled and given to the public.
Fentanyl is 50 times more potent than heroin and up to 100 times more potent than morphine.
Unintended consequences: Why painkiller addicts turn to heroin

 
Investigators have not said whether Prince ingested those pills or whether he knew the pills contained fentanyl.
Star Tribune sources said Prince’s toxicology report, which has not been released, also revealed the presence of lidocaine, alprazolam and Percocet in his system.
CNN’s Dr. Drew Pinsky said the combination of fentanyl, (which is an opioid based drug), and alprazolam (which is a benzodiazepine) could be the key to why Prince died.
“It is all too common for people to overdose if they are taking a combination of a benzodiazepine and an opioid,” Pinsky said. “This is what I’ve been warning was a likely possibility.”

Powerful painkiller

At the beginning of the investigation into Prince’s death, sources told CNN that painkillers were found inside his Paisley Park compound and they could not find a valid prescription for the medication. The Star Tribune now reports that their source said no prescription for fentanyl has been found in the months since Prince’s death. So, a burning question remains. How did Prince acquire the drug?
What you need to know about fentanyl
Fentanyl, the most powerful painkiller on the market, is normally prescribed to cancer patients in extreme pain. It’s also used to ease the pain of someone who is dying or as part of anesthesia during surgery.
But illegally manufactured fentanyl pills are readily available across America.
Why do so many pop stars die young?

 
Just last month, the Drug Enforcement Administration published a report saying counterfeit pills are fueling the fentanyl and heroin/opioid crisis in the United States, which has become an epidemic. The DEA issued a national health alert over the rise in fentanyl overdoses in 2015.
That year, the DEA said its National Forensic Laboratory Information System showed “there were approximately eight times as many fentanyl exhibits (confiscated drugs that tested positive for fentanyl) in 2015 as there were during the 2006 fentanyl crisis, clearly demonstrating the unprecedented threat and expansion of the fentanyl market.”
Feds seeking answers on how Prince got fentanyl, the opioid that killed him

 
Prince’s death at 57 years old shocked the world. For months fans mourned the musical genius by showing up by the hundreds to pay their respects. Many left purple mementos on the fence that surrounds the Paisley Park Compound where Prince died.
He was discovered dead inside of an elevator in the complex.

Dosage would have killed anyone

Officials never revealed the amount of fentanyl that was in Prince’s system. But the Star Tribune reported that a source said the amount of fentanyl in his system was so high it would have killed anyone, no matter their size.
Opioids and overdoses: 4 things to know

 
It has been four months since Prince died and the investigation into his death is still ongoing. The DEA began working the case alongside the Carver County Sheriff’s Office from the very early stages. But no one knows exactly why Prince was taking strong painkillers or how he obtained them.

Palliative care – revisited

Some of my readers seem to have the same mental concept as some of the legislators that pass many of the laws that are impaling many in the chronic pain community.

PALLIATIVE CARE is a process not a structure.

Yes palliative care is normally associated with cancer care and end of life Hospice, but it is not a process restricted to Hospice or caring for terminal or end of life pts.

Hospice is a structure that is regulated by – who else – the government.  Normally, when a person enters Hospice.. their doc will confirm (guess) that the pt has less than 6 months to live.  In the case of a pt on Medicare/Medicaid, they relinquish their Medicare/Medicaid and the Hospice organization gets paid – normally a per diem amount – to provide all the services that the pt needs for the balance of their life.

Their goal is to “comfort” both the pt and their family and make the pt comfortable and do nothing that will extend their life.. Again it is about saving money for the system… paying for heroic procedures that may add hours or days to the pt’s life.

If you read the WHO’s definition of palliative care in this post  what would happen if ?

It is about helping a pt and the family deal with the pt’s life threatening disease… be that diabetes, hypertension, heart failure… whatever disease that if not properly addressed could impact both the pt’s quality of life and life expectancy.

How many pts’ quality of life have been compromised by the reduction or elimination of their pain medication therapy ?  How many chronic pain pts have committed suicide because their medication was reduced or eliminated.

Is providing a pt with physical therapy, a cane, walker or wheelchair to improve the pt’s quality of life, part of  palliative care ?

what would happen if ?

I hear from pts .. nearly daily.. about their medications being pulled back, dropped altogether and/or discharged from a practice.  I read in a lot of state laws and CDC guidelines the word “PALLIATIVE” which is often aligned with the clause that exempts terminal/cancer pts from any limitations on their opiate/pain management therapy.

If you look to WHO (World Health Organization) as to their definition of Palliative care you get the following

WHO Definition of Palliative Care

Palliative care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual. Palliative care:

http://www.who.int/cancer/palliative/definition/en/

  • provides relief from pain and other distressing symptoms;
  • affirms life and regards dying as a normal process;
  • intends neither to hasten or postpone death;
  • integrates the psychological and spiritual aspects of patient care;
  • offers a support system to help patients live as actively as possible until death;
  • offers a support system to help the family cope during the patients illness and in their own bereavement;
  • uses a team approach to address the needs of patients and their families, including bereavement counselling, if indicated;
  • will enhance quality of life, and may also positively influence the course of illness;
  • is applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life, such as chemotherapy or radiation therapy, and includes those investigations needed to better understand and manage distressing clinical complications.

Palliative care seems to have a very broad definition and while normally associated with treating pts with cancer…there seems to be the potential to apply to pts with a large array of chronic disease states.

The CDC guidelines and/or any guidelines – while don’t carry the weight of law – they do bear the weight of creating a “standard of care”  and/or “best practices”.  To establish a MINIMUM OF CARE for pts but not to exclude care provided to the pt above and beyond the MINIMUM care.

It is common knowledge that chronic pain pts typically suffers from depression and anxiety and is at twice the risk of committing suicide.

A pt’s medical records is clinical proof of what has been tried and what has been successful.  When a prescriber start changing/reducing the pt’s medication therapy.. could that be considered a form of pt abandonment or a form of malpractice because they are deviating from what has been proven clinically successful for a particular pt.

Currently Barb’s pain management is – IMO – at a optimum level, but like everyone else… she/we are at risk of various changes that could impact that situation… PCP retiring, dying… the teaching hospital where her pain clinic is located could have a change in policies and procedures.

If her pain management is reduced.. it is obvious that her quality of life goes in the same direction… and to the same degree it has an impact on my quality of life..

There is a part of the law:

http://www.legalmatch.com/law-library/article/limits-on-damages-for-loss-of-society-companionship–consortium.html

What is Loss of Companionship and Consortium?

Loss of companionship and consortium also called the loss of society, loss of conjugal fellowship, and loss of marital compatibility are all different names for the same thing. Essentially, these terms refer to the emotional sadness one goes through when an immediate family member (spouse or child) has been injured or killed. It can include the grief from the loss of sexual relations or the loss of the ability to have children. 

Under these circumstances… deviating away from therapy that has proven to optimize her quality of life… we could have a pt that is being placed at a higher risk of suicide and loss of companionship on my part..

Personally, I would have my attorney send the physician a certified letter that the palliative care provision of the law applies to Barb… that there is clinical evidence of what amount of medication that she needs to optimize her pain management and quality of life… so do anything less would constitute a failure to meet ‘best practices” and “standard of care”… a form of malpractice and pt abandonment … and if the prescriber’s actions/in-actions contributes to her committing suicide that I will file charges that he contributed to/assisted in causing her to take that action.

This could paint the prescriber into a corner … “CHECK MATE”… if he discharges her… then there is the issue of retaliation, pt abandonment and I am sure that a good attorney can think up a few other charges.

One has to ask, if a prescriber can be charged with the death of a pt that OD’s for prescribing opiates to them… why can’t they be charged equally if a pt – who the prescriber knew or should have known was at risk of  a deepening depression – if their medication was reduced or eliminated.

What I think would be quite interesting is the spouse suing the prescriber for lost of companionship because of their actions/in-actions.  This would probably only work if the pt’s pain management had been stable and went downhill because of reduction of pain management meds.

 

Professional moral responsibility to treat pain ?

I have started this presentation in the middle and you need to listen to about 7 minutes of it. The entire presentation is abt ONE HOUR and can be viewed in its entirety on www.youtube.com

 

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