APS

Most all of us have heard Einstein’s opinion of doing the same thing over and over and expecting a different outcome.

My blog is getting ready to close out its fifth year and as I look at the stats on my blog.. I find that while the number of page views have remained virtually unchanged over last year… the vast majority of people finding their way to my blog is done so via a web search… I can count on one hand the number of people that routinely post comments.

Over the five years, I have made over 5000 posts and each posts have had a AVERAGE of 2+ comments. In the last 12 months ONE SINGLE POST … that I made last Aug, has viewed almost 50% of total number of page views.

I have seen all too many chronic painers and advocates that professed their intent to CAUSE CHANGE.. IMO, there has been no positive change and many of those advocating are no longer around.

Optimistically, five years ago maybe up to 20% of chronic pain pts were getting adequate pain management, today that number is probably in the single digits and decreasing.

Bureaucrats at both the Federal and State levels are taking tax money from the chronic pain community to sue manufacturers, wholesalers, pharmacies in an attempt to deny those in the chronic pain community of their medically necessary pain management medications.

One Senator (Manchin D-WV) has discussed imposing a tax on prescription opiates to help pay for treating people who are self medicating the demons in their heads and/or monkeys on their back with various opiates – a increasing majority using illegal opiates being imported from Mexico, China and India and because they are mixing potent illegal fentanyl analogs with Heroin…more and more are dying of a overdose, while the number of prescribed opiates have fallen up to 35% over the past four years… while opiate OD’s continue to dramatically increase.

Many of us have been discussing the lack of unity among those in the chronic pain community – if possible – is getting worse…   At some point – if we are not already there – it is going to be every person for themselves.

I just wonder how many family members of those who OD’s, joins some anti-opiate group… and those family members whose chronic pain family member dies from removed pain therapy and/or commits suicides … just comes away from the funeral saying “At least, they are not suffering any more…”  and they go on with their lives.

Weekly, I get numerous emails and phone calls about pts being denied their medically necessary medication…  I am going to devote my blog to publishing these and my suggestions in how they can deal with it.  So that hopefully that others with similar situations may develop some strategy that can help them.

I am leaving all 5000+ posts and existing comments on the blog for reference purposes…  In the future, I don’t see me making more than one “educational posts” per day…  as I have in the past.

 

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 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

How long before pain management will consist of getting PLACEBOS ?

1. I had my 6mo checkup with PCP.  He quit Rxing my pain meds July 2015.

 2.   Discussion of current meds led to him basically telling me all the CME he is getting locally is discouraging any use of opioids.  His wisdom, “yup, the momentum swings too far in one  direction when these things come about.”

  1.  Had my 1 month visit with pain management.  He said he just returned from a 3-day pain mgt. conference at Harvard. He said in 3 days of talks, only one physician spoke on how the  pendulum has swung too far in the other direction and patients are being adversely affected.
  2.  A friend of mine in Spokane, Wa (which I have heard has no pain management physicians and they have to travel to West side Washington for evaluation) is having a total knee replacement

     in Sept.   My friend was told by the surgeon his post op pain medications are,   wait for it……

     ta da,  Celebrex and Lyrica !    Really !

 

Check your Rx price on line before using your drug insurance card…

CBS DFW, a local television station covering the Dallas-Fort Worth (Texas) metro area, has documented yet another example of PBM clawback practices that are negatively impacting community pharmacy patients. One local pharmacist says he see examples on a daily basis of customers with insurance being charged a higher price for a prescription drug than those with no insurance at all, and he can’t recommend lower-priced alternatives because of contractual confidentially clauses that would prevent him from telling customers their copay is more than the drug price. In one example, a customer with insurance purchased a common generic drug. His copay for that drug was $125, but had the customer paid with no insurance the cost would have been just $55—a difference of $65. The station did point out that if patients bring up the question unprompted about how much a prescription would cost if they didn’t use their insurance, the pharmacist can tell them.

https://www.goodrx.com/

https://www.blinkhealth.com/

If you have Medicare part D and by checking the price of your prescription on the above two websites and ask the pharmacist before you get it filled the cash price and use your prescription insurance card.. Could both save you money and keep you from going into the “donut hole”  and save you more money.

Some PBM (Prescription Benefit Managers) apparently are charging pts a SURCHARGE for using their prescription insurance.  Just like auto insurers raise your premium if you have a accident and have to use your insurance.

They have “gagged” the Pharmacists from telling you about this form of ROBBERY.. unless you ask…

By checking your cash prescription prices with the above two websites.. you can beat the PBM at their own game 🙂

 

 

Doctors forced to abide by corporate pt care mandates or risks losing job ?

The prescriber himself is against this . He apologizes constantly but tells me because the fact that the office he works for made every doctor implement the guidelines to new and old patients , that his hands are tied because he doesn’t want to loose his job. Myself and 79 other patients all with different doctors but the same office have all been lowered to the CDC guidelines . The problem is that doctors offices and doctors themselves are reading the guidelines as law . Their afraid that if they don’t follow the recommendations ,that they will get into trouble and loose their jobs . That’s what I’m finding also with pain patients across the country. Patients are being lowered to the CDC recommended morphine equivalents or their being forced off their medications altogether . So it’s not been 
That their following the standard of care , their following the recommend highest dose or morphine equivalents even though they’ve been on higher doses that have worked for them for many many years

This is what I believe is a good example where a class action lawsuit would come into play. The corporation that employs these prescribers and claiming that they are going to follow the CDC guidelines for all 80 pts.  So they are basically stating that the CDC guidelines are the standard of care and best practices for all the employed prescribers.  Apparently this prescriber is not happy about the edicts from the corporation in how he is being FORCED to mistreat or under treat pts against what his experience and training guides him to how pts should be treated.

They are also just implementing small portions of the CDC guidelines… the most limiting part that INTENTIONALLY limits a pt receiving optimum care and quality of life. That would be the 90 mg/day ME.  IMO.. they are violating their own standard of care and best practices which meaning that they are in the malpractice arena, pt/senior abuse and discriminating against pts that are suffering from subjective disease which could be a violation/civil rights discrimination under the Americans with Disability Act and Civil Rights Act.

Canada: Is denial of care to chronic pain pts now a PANDEMIC ?

Jennifer Butcher feels 'legitimate' opioid users are being left to suffer after government crackdown on fentanyl.Doctors ‘gun shy’ to prescribe opioids hurting those in pain, say experts

http://www.cbc.ca/news/canada/windsor/doctors-gun-shy-to-prescribe-opioids-hurting-those-in-pain-say-experts-1.4163563

A Windsor, Ont. woman who relies on prescribed narcotics to help with chronic pain believes “responsible” opioid users are being unfairly victimized in the government crackdown on drugs like Fentanyl. 

Jennifer Butcher has been unable to find a physician who will refill her prescriptions ever since her family doctor retired last month. She’s not alone, according to medical professionals and other patients in Windsor who say a spike in deaths across the region and province has doctors reluctant to prescribe opioids.

“I don’t feel like a functioning, productive member of society anymore,” said Butcher. “I am looked down upon by 90 per cent of the people I talk to, including doctors and pharmacists, because of the types of drugs I’ve been prescribed.”

jennifer butcher2

Jennifer Butcher struggles to stand on her own without her pain medication. (Aadel Haleem/CBC)

Butcher, 46, suffers from fibromyalgia, carpal tunnel syndrome and arthritis. She has neck and back pain from a car accident when she was a teen and has difficulty standing for long periods of time.

She relies on her walker to get around and has been using pain medication for more than 20 years. Her pain has been compounded in recent weeks by the gnawing pangs of withdrawal.

“People like me are slipping through the cracks. I’ve talked to a few people in my situation that really feel there’s going to be an uprise in suicides because of this,” she said. “People don’t want to live in pain and suffering every day — it’s no way to live. If I had cancer, they wouldn’t say, ‘We’re not going to give you chemo because it might kill you.'”

‘Distinct shift’

Angela Lambing has seen a “distinct shift” in how pain management is being addressed. The nurse practitioner believes physicians have become “gun shy” when it comes to prescribing opioids. She’d like to see medical professionals receive more pain management training.

“It’s like anything else, you have one patient that misused, you worry that another patient is going to do it too,” said Lambing. “Physicians are saying there’s going to be a higher rate of suicide because patients aren’t going to get what they need and they’re going to have significant pain, which is difficult to live with.”

angela lambing

Angela Lambing has seen a ‘distinct shift’ in how pain management is being addressed. The nurse practicioner believes providers are ‘very gun shy’ when it comes to prescribing opioids. (Aadel Haleem/CBC)

Reluctance on the part of physicians is no surprise, considering the provincial government in October announced what it called its first comprehensive opioid strategy.

The moves comes after a steady increase in opioid-related deaths and injuries for more than a decade, according to Public Health Ontario. The latest available statistics are for 2015, when the province recorded more than 730 opioid-related deaths, which is a 99 per cent jump from 2003 figures.

Numbers for emergency room visits are a little more up to date, with 4,420 patients showing up at ERs with opioid-related problems, compared to 1,858 in 2003. Those figures represent a whopping 137 per cent increase.

But as prescription medication dries up, Lambing, who has worked at Detroit’s Henry Ford hospital for 25 years, fears people in pain will turn to the streets.

“They’re going to be taking medicines off the street that are cut with who knows what, and then we’re going to have the same issue that we’re already seeing with that fentanyl,” she said.

Doctors are ‘being cautious’

Dr. Amit Bagga, the president of the Essex County Medical Society, acknowledged doctors are now more “cautious” about prescribing high-dosage opioids to patients with non-cancer pain.

“There are guidelines, and the College [of Physicians and Surgeons] is watching physicians and supervising the dosages that are being used,” said Bagga. “So one is being cautious, one is being careful.”

dr.bagga

Dr.Amit Bagga admits doctors are now more ‘cautious’ to prescribe high-dosage opioids in non-cancer pain. (Aadel Haleem/CBC)

He said doctors need to balance their responsibility to manage pain with the havoc being wrought on the streets by powerful opioids, which is being described by officials across the country as an epidemic. 

“There is appropriate use, but there is misuse. There’s people selling it on the streets, there are people using high doses getting into accidents,” said Bagga. “So at the societal level, physicians are a bit of a gate-keeper, and we have to kind of respect that they are in a tough position.”

Like Butcher, Marcie Porter feels like collateral damage in the battle against the opioid epidemic. She suffers from fibromyalgia and has been taking fentanyl patches and Percocets to ease the pain. Her family doctor shuttered his practice two months ago and now Porter only has enough medication to last another month. 

She said she has called 12 doctors, many of whom are taking new patients, but none will see new patients looking for pain medication. 

marcie porter

Marcie Porter is wearing two fentanyl patches. She returns used patches to the pharmacy before receiving next prescription. (Aadel Haleem/CBC)

“I feel like we’re being discriminated against because they don’t know us as a person,” said an exasperated Porter. “We’re being looked at as a different person because of the epidemic — and I get the epidemic — but it’s not fair to us that need [opioids] and actually don’t abuse it.”

Porter stressed she is a responsible opioid user in desperate need of pain medication.

“I would like to see doctors looking at people who are in pain more, not to look at us as a druggie or somebody that’s taking them on the streets because that’s not true,” she said. “I take mine back to the pharmacy every time that is needed and I’ve been tested every time when I go to the doctors.”

Refusals must be ‘in good faith’

In an email to CBC, the College of Physicians and Surgeons of Ontario says its Accepting New Patients policy states doctors must accept new patients “on a first-come, first-served basis.”

However, there are exceptions “if a patient’s medical needs don’t align with the physician’s clinical competence or scope of practice. This type of situation would be grounds for refusing a prospective patient. The policy also says that such decisions to refuse must be made in good faith.”

Butcher has been taking pain management drugs for more than two decades now, starting with Tylenol 3s and moving on to Percocets, Oxycontin and finally fentanyl patches. 

She has gone through five physicians since her family doctor retired and none of them will refill her prescription. She is living in pain and fears what may happen to others who may seek solace in the streets. 

“The people that are getting addicted now and that are dying, a lot of times it’s because they can’t get what they’re used to being prescribed,” she said. “Then they turn to the streets and they either go towards heroin, which can be cut with anything, or these new fentanyl patches. They don’t realize that the liquid inside — you cannot drink, lick, smoke or shoot. You have to wear the patch.”

 

Mitch McConnell … got some ”xplainen” to do ?

People protesting outside Mitch McConnell’s office, some in wheelchairs, removed by police

http://wsbt.com/news/connect-to-congress/people-protesting-outside-mitch-mcconnells-office-some-in-wheelchairs-removed-by-police

 

WASHINGTON (Sinclair Broadcast Group) – People upset about the Senate’s proposed health plan protested outside of Senate Majority Leader Mitch McConnell’s office Thursday afternoon, prompting Capitol Police to escort them out of the building.

Dozens were arrested.

 Authorities were seen on tape dragging some of the protesters – who were in wheelchairs – out of the hallway.

Shouts of “no cuts to Medicaid!” were heard from the crowd as police cleared a path.

“Save our liberty!”

Some held signs objecting to the new bill, stating “Capping Medicaid = Death 4 disabled.”

Some of the protesters were escorted individually. Others are much more reluctant to leave and it’s taking four or five officers to carry them out.

One protester said he’s with the disability rights group ADAPT. Phillip Corona said he traveled from Wisconsin to make his voice heard. Corona said Medicaid helps his son Anthony get out of bed every morning. Phillip Corona fears that changes to the program “would possibly mean putting him in a nursing home.”

Alison Barkoff — director of advocacy for the Center for Public Representation — helped organize the protest. She says the protesters rely on Medicaid to help them live and she says the health bill amounts to “tax cuts for the wealthy on the backs of people with disabilities.”

Click here to read more about the GOP’s proposed bill to reform healthcare.

Please take the survey

https://www.surveymonkey.com/r/reportpainmanagement_prescri…

Please take the survey

Dr. Terri Lewis. Out of our conversation, we discussed the fact that Stats got us here and Stats are what will get us out. Dr. Lewis is analyzing info that will very likely be published in medical journals. We need stats from all different areas, insurance sources, Veterans, ethnic background, etc. The survey does take some time … maybe 15-30 minutes to complete. But isn’t it worth it? Please take the survey when you can (if you haven’t alrerady) and please enourage everyone you know to do so. Undisputable evidence pulished in medical journals could make a big difference. Please share and encourage others to share & encourage.

They volunteer to protect us… they come back broken.. and we deny to care for them ?

Robert D. Rose Jr. to Vets Fight Back

Tom from CBS is very interested in our stories and reached out to me again this morning. Please contact Tom at CBS – investigativeunit@cbsnews.com – Subject Genocidal Policies.

Here is the address to another reporter and my story. PLEASE send him your stories AND if you know someone else interested in sharing the truth, give them my story.   Robert — Teufelshunde

Dr. Red Lawhern – lawhern@hotmail.com

Pissed off Marine!

I was pain med compliant for 15+ years. Never popped positive on any mandatory drug screens or messed up a pill count. I was able to continue teaching, sponsoring a club, coach soccer, basketball, and little league baseball. While working full time as a school teacher and sponsoring a high school very involved in community service, I returned to a Christian college, Milligan College for my Masters in Education. I graduated with a 3.95 GPA; all while taking pain medication for injuries sustained in the Marines. I was able to take my sons fishing and hiking all because of pain meds… Unfortunately, my spine did not stop deteriorating and the VAMC has done nothing to fix the damage… instead I have been refused repeatedly for surgery as the damage and scar tissue is too severe and too old. The Mountain Home VAMC doc I had was awesome as we worked together to manage the pain meds with my pain and other medications. Then he retired and after a series of kooks, I ended up with a nurse practitioner, Christina Craft, state of Tennessee License Number #21419, who told me that I had the normal back of any other 50 year American male and that the VA had adopted the new “opioid safety initiative” and would be denying 90% of veterans being served there all pain meds. She did this by phone!!! No discussion with other physicians, pharmacists, psychologists, physical therapists (even Senator Corker’s request for new PCP was denied). I have been through every pain management program offered to include chiropractors, acupuncturists, yoga and even aroma therapy for my spine before this NP decided to deny pain meds without even bothering to read my chart (for which I have evidence).

In October 2016, I was at 180mg Morphine Sulfate (60mg tablet 3x daily) and by December 29, 2016 I was completely cut off. Since 12/29/2016, I have had nothing but Tylenol and Motrin I have had to purchase myself… I am going CRAZY because of the pain and burning up with ANGER at the VA, the CDC and DEA for what they are doing to so many Americans and veterans. Occasionally (my wife says all the time for the last thirty years), I am an obnoxious asshole. A title I proudly hold and whenever I see injustices, I get upset and the asshole rears its ugly head. When I am attacked or someone I care for such as veterans or the American people, I strike back with the speed of a rattlesnake and the ferocity of a Devil Dog! Please visit FB page Vets Fight Back for more important information for CIVILIANS and VETERANS.

Teufelshunde

Respectfully,

Robert D. Rose Jr.,
BSW, MEd., USMC
Semper Fidelis

We defended your freedoms…
Will you help defend ours?

four.of.hearts@comcast.net

denial of care at chain pharmacies EXPANDING ?

I recently saw your website and read your views on how to file a complaint. However, Im in Louisiana and have a friend that was denied a narcotic medication refill because it was after 2 days since it was prescribed from the emergency room. She  was still in pain and wasn’t able to get it filled because she had not received her paycheck. She also did not have insurance to pay for it. What are we supposed to do or can we do about this?

 

 

 

 

This was an interaction at the local large chain pharmacy – one that has their “good faith filling policy”

Part of that policy is that the pharmacist is not suppose to fill controlled prescriptions for pts wishing to pay CASH..

It is reported that some 30 million Americans DO HAVE HEALTH INSURANCE… so it would appear that those 30 million pts  ( close to 10% of the USA population ) need not come to this chain pharmacy if they need a controlled prescription filled…

Once again my recommendation to pts in need of getting controlled prescriptions filled is DUMP THE CHAINS !!!

Here is a link to help you find a independent pharmacy by zip code http://www.ncpanet.org/home/find-your-local-pharmacy 

The chain store pharmacist gets paid every week … regardless if they fill your prescription(s) or not… at a independent pharmacy you will – most likely – be dealing with the Pharmacist/owner who only gets paid if they fill legit/on time/medically necessary prescriptions.. They typically understand that the world is not perfect and some people can’t afford insurance and or that don’t have the money to get prescriptions filled when they need them.

The money you spend in a locally owned independent pharmacy STAYS IN YOUR COMMUNITY.. profits aren’t sent off to some corporate HQ in another state or another country.. It is one way to BUY USA !

 

Remember… healthcare is a FOR PROFIT BUSINESS… influences decision on pt care ?

Well I’ve been going to the same PM Dr for the past 8 years.

Always had a good relationship.

I’ve used only the same pharmacy for well over 15 years.

Always took my meds as prescribed.

2 oxycodone 5/325 per day.

Never had them lost or stolen.

No matter how unbearable at times, I’ve never called in between appts.

Just one of the most honest/compliant patients she’s had IMO.

Anyway the bottom line is she alleged me to be negative on my urine 3 times so she cut me off last month.

She said I’m still a patient for now and can go back for injections if I wish.

I have access to my records via the Patient Portal and for every accused negative it shows positive and I know I was positive because I certainly took them.

I’m assuming this positive is from the cup.

They then send the urine to a lab.

Because the lab shows negative, I guess that’s all that matters to her.

I could see if I was negative on the cup AND the lab I wouldn’t have much of an argument, even though I took them as prescribed. But I’m positive and negative which makes no sense to me.

At my last appt, I called her out on this and told her to “stop trying to convince me that I was negative, it’s like me trying to tell you that you didn’t wear shoes to work this morning, sounds silly doesn’t it?”

She said she believes me but can no longer prescribe because of the lab results.

She printed out the lab results and gave me copies.

As you’ll see, it was collected the day of my appt. 

The lab receives it 3 days later and possibly didn’t test it for yet another week.

I do believe I have a fast metabolism because I’m 56 and weigh the same as I did in high school. I’ve never been able to gain weight.

So my questions are:

1) did the time it took for the lab to process the urine have any effect on the outcome?

2) do you feel she should have based her decision on the fact that the cup was positive for every one?

I will leave it as this for now although as you can imagine I have a ton of questions.

I feel completely blindsided and this couldn’t have happened at a worse time as on top of my chronic pain I’m also in a bad flare of diverticulitis and scheduled for a colectomy on July 10.

Thank you very much for your input and time!

It seems strange to me that a physician would send out a urine sample to a outside lab when the office’s testing shows the medication that the pt is prescribed shows up in the test…

I am not very knowledgeable on urine testing procedures, but common sense would suggest that tests on a sample that is not stored properly or mishandled.. could allow the medication being tested for to deteriorate until it was at such a level that it could not be detected.

I found this website that discusses mishandling and other issues effecting false urine test outcomes http://www.brighthub.com/science/medical/articles/71492.aspx

I also find it strange that the physician is willing to continue treating the pt with ESI’s… it is common knowledge that ESI’s are MUCH MORE PROFITABLE for a practice than getting a office visit charge for writing a prescription.

For a pt to have their pain managed on such a low dose of Oxycodone  – a total of 10 mg/day – seems so benign. Could this physician have figured out how to improperly store or mishandle urine samples being sent to outside labs so that the sample will deteriorate to a point that it will test negative for the medication that the pt is on .. so that there is “proof” of a negative test ?

Is this how the REPUBLICANS are going to get LOWER PREMIUM RATES ?

Image result for cartoon survival of the fitist

White House says diabetics don’t deserve health insurance

http://shareblue.com/white-house-says-diabetics-dont-deserve-health-insurance/

Donald Trump’s budget chief again revealed the Republicans’ callous approach to health care, arguing that some diabetics simply do not deserve health insurance, because of how they may have developed the illness.

Donald Trump’s budget director specifically called out people suffering from diabetes as a group of Americans who do not deserve the protection of health insurance.

Mick Mulvaney, director of the Office of Management and Budget (OMB), weighed in on the issue at the Light Forum at Stanford University. He was asked if families should be denied medical care because they can’t afford it, a standard Sen. Bill Cassidy (R-LA) had termed “the Jimmy Kimmel test,” after the late night comedian’s recent emotional call for improved health care.

Mulvaney said he believed in helping to provide “a safety net so that if you get cancer you don’t end up broke,” but separated those situations from others he termed “ordinary healthcare,” what he described as the heart of the debate.

He continued, “That doesn’t mean we should take care of the person who sits at home, eats poorly and gets diabetes. Is that the same thing as Jimmy Kimmel’s kid? I don’t think that it is.”

As of 2014, 29.1 million Americans suffer from diabetes, which is about 9.3 percent of the population.

Under Mulvaney’s standard, an examination of their eating habits and how their disease was triggered would have to be undertaken before it could be determined whether they are deserving of health insurance or not. In the meantime, people will suffer and possibly die from their illness.

The Affordable Care Act mandates coverage for people with pre-existing conditions like diabetes, without casting about for blame or applying some kind of litmus test to discern if they are deserving of treatment.

The system championed by Trump, House Speaker Paul Ryan, and the Republican Party would upend that safety net and contribute to ill health and death, in order to justify their sanctimonious attitude.

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