substance-use disorder: what we are facing is a human problem

These Virginia counties are ignoring the real problem in the opioid crisis: Treatment

https://www.washingtonpost.com/opinions/local-opinions/these-virginia-counties-are-ignoring-the-real-problem-in-the-opioid-crisis-treatment/2019/04/19/b90e0788-57bb-11e9-9136-f8e636f1f6df_story.html

Kevin Doyle is an associate professor and chair of the education and counseling department at Longwood University, where he also teaches in the counselor education program.

Roanoke, Roanoke County and Salem are joining a legal battle over the opioid addiction crisis by filing civil suits against drugmakers, distributors and pharmacy benefit managers. These lawsuits are part of a national push to hold companies accountable for irresponsible practices in the sale, marketing and distribution of opioid-based medications.

While these lawsuits might help somewhat, the real debate raging in the world of addiction is how best to treat it and the incorporation of medications into other long-standing treatment methodologies.

As a licensed professional counselor in Virginia, I have worked with people from all walks of life over the past 34 years. I have had the privilege of being a part of the recovery process for several thousand people dealing with what we now call “substance-use disorders.” The public hears about “addiction,” “substance abuse,” overdose deaths and the opioid crisis, but what we are facing is a human problem.

While counseling, talk therapy and self-help groups are valuable, they cannot be the only answers for everyone. We now have effective, safe medications that, when combined with traditional approaches, can give individuals with opioid and other addictions a fighting chance in the desperate battle to overcome the life-threatening consequences that often ensue.

Traditionalists continue to advocate an abstinence-based approach and often seek to blame pharmaceutical companies as in these lawsuits. Traditionalists see true recovery as consisting only of complete abstinence from mood-altering substances. Though this approach is consistent with that of many self-help groups and has certainly been helpful for millions of people, it has many holes.

People clearly benefit from prescription medications for physical or psychiatric conditions, and others are given a pass from the abstinence mentality for their use of more societally accepted substances, such as nicotine and caffeine. Effective medications, which allow people with an opioid addiction to replace high-risk opioid use with safer, “medication-assisted” therapy or treatment, are frequently frowned upon by traditionalists who insist on an outdated, one-size-fits-all model that is inconsistent with research and developing approaches.

On the other side of the debate is the medical community, supporting the use of new and promising medications that can be both lifesaving and humane. Places such as Phoenix House Mid-Atlantic, based in Arlington, are successfully incorporating approaches such as office-based opioid treatment into their treatment strategies, with much success.

Medications such as suboxone and methadone allow people with an opioid-use disorder (addiction) to replace high-risk opioid use with safer, medication-assisted therapy or treatment, while naltrexone blocks the effects of opioids and can be administered either orally or via a monthly injection known as Vivitrol. Naloxone (or the brand name Narcan), which is better-known, provides a lifesaving response in the case of an overdose, reversing the opioid’s effects and saving countless lives. These approaches, however, are too frequently criticized by the abstinence community and some segments of the general public for not being a permanent solution or simply replacing one addiction with another.

We even limit the number of patients that physicians approved to prescribe suboxone may have on their caseloads, an unprecedented and even unfathomable reality when one considers the scope of the opioid crisis.

Of course, simply throwing medication alone at a problem of this magnitude will have only a minimal impact at best. People with the complex set of problems associated with substance-use disorders need effective, trained counselors and access to a wide variety of services to enable them to return to full health and functioning.

The question, then, is when will we embrace an approach that designs and provides specific care to meet the needs of the particular individual in question. Drawing from both arenas is the only way to meet the crisis, which is claiming more than 70,000 lives annually across the United States, including more than 1,100 in Virginia. A frank, no-holds-barred dialogue is needed and immediate action required to address this public-health emergency.

 

8 Things to Consider Regarding End of Life Pain Management

https://bkbooks.com/blogs/something-to-think-about/8-things-to-consider-regarding-end-of-life-pain-management-1#

8 Things to Consider Regarding End of Life Pain Management

There is so much confusion and fear regarding end of life pain medicines, morphine in particular, that I am addressing what I consider major issues. I have made the list simple, short, and to the point so that you can use this as a guideline when your loved one is receiving a narcotic.

* To be effective, pain medicine needs to be given on a regular, around the clock, schedule.

* Over time the original dosage may have to be increased.

* Everyone’s pain is different so everyone’s pain medicine and amount will be different.

* There is no standardized medicine dosage for pain. It takes time to find the correct pain medicine and the correct amount.

* The biggest fears about taking narcotics for pain management is fear of addiction and overdosing.

* Most medicines given by mouth can be given rectally. Some pain medicines can be made into creams and rubbed on the skin.

* Generally there isn’t a need for needles in end of life pain management.

* Pain doesn’t stop when a person is non-responsive. Continue the pain management schedule until death.

I am adding an additional caveat to the above knowledge: Dying is not painful. Disease causes pain. If pain has not been an issue during the disease process then just because a person is actively dying does not mean they are in pain. If pain has been an issue during the disease process that pain is present to the last breath.

Often dying looks painful to the people watching. Dying is a struggle to get out of the body. There are sounds that ordinarily would indicate discomfort but, when a person is actively dying, are part of the struggle. Just as the little chick works to get out of its shell, a person works to get out of their body. It takes effort to release from our body. That includes rattling and gasping sounds, twitching, random hand and leg movements, picking the air, facial grimaces, and talking that doesn’t make sense. All of this is part of the natural struggle to get out of the body. Nothing bad is happening, nothing pathological. This is how people and other animals die.

What I have described in the paragraph above is generally interpreted as an expression of pain unless someone tells the watchers differently. That is where knowledge of end of life and the dying process comes in, that is where health care professionals can give important guidance IF they, themselves, understand the normal natural way people die. Sadly to say, all too often, even health care professionals do not know.

Something More about… 8 Things to Consider Regarding End of Life Pain Management

To educate families who have a loved one in the dying process, I encourage the palliative care team and the hospice team to give them Gone From My Sight (the hospice Blue Book) and show them the 25 minute film NEW RULES for End of Life Care.  To educate the palliative care and hospice team (social workers, chaplains, nurses and volunteers) I encourage agencies to watch THIS IS HOW PEOPLE DIE.  Both films check the boxes for continuous care of families and agencies with medicare and raise CAHPS scores.

 

digging into data on doctors and nurses who prescribe unusually large quantities of opiates

Colorado’s new U.S. attorney wants law enforcement to treat overdose deaths as homicides as he focuses on opioids

www.coloradosun.com/2019/04/15/jason-dunn-us-attorney-colorado-opioids/

Jason Dunn, appointed by President Trump, laid out some of his office’s redoubled tactics in an interview with The Colorado Sun — his most extensive remarks to the news media since taking office

 

Jason Dunn. (Provided by Brownstein Hyatt Farber Schreck)

Jason Dunn, Colorado’s new U.S. attorney, has made stemming the state’s opioid epidemic a top focus of his office, encouraging law enforcement in the state to investigate deaths as homicides. He is also digging into data on doctors and nurses who prescribe unusually large quantities of opioid painkillers, with an eye toward prosecuting those who are illegally diverting the drugs and, he feels, adding to the scourge of heroin.

“You have dealers who either know they are selling fentanyl instead of heroin or know that it has already caused death and continue to sell it,” Dunn said in an interview with The Colorado Sun Friday in his downtown Denver office, where he offered his most detailed remarks since taking office in October. “We think they’ve met the required element that they can be charged.”

The tactics mark a redoubling of efforts that began in Colorado’s U.S. Attorney’s Office under Dunn’s predecessors and amid growing efforts statewide to tackle an epidemic that killed 560 Coloradans in 2017. They also come after Dunn warned Denver against a proposal to allow a supervised drug consumption site where people could inject heroin under the watch of a medical professional in an effort to reduce overdose deaths.

“We created a task force within our office that’s both criminal and civil,” Dunn said. “The civil side is really interesting because it’s focused on the diversion of opioids — from doctors, pharmacies, nurse practitioners. Clearly, if we can get people to stop abusing prescription opioids, then we can have a huge impact on the heroin problem.”

Federal prosecutors in Colorado have been combing through Medicare and Medicaid databases, as well as the records of Tricare, the military health insurance program, to find out which medical professionals are prescribing the most opioids, including OxyContin, in the state. They are also looking to see if they have patients who are traveling long distances, an indication that a person might be seeking out drugs for illicit reasons.

“You can see, when you start charting it, where the top people are,” he said. “… There’s a three-drug cocktail of opioids that apparently enhances the opioid high. We look at, OK, which doctors are prescribing that three-drug cocktail the most. Because there’s really no reason you would do it other than for illegitimate purposes. So we’re using that data and we’re starting to see some success with that.”

In terms of what those successes are, Dunn said, “most of it, I can’t go into detail because they’re ongoing investigations.”

“While there are a lot of U.S. attorneys around the country that are doing that data mining, we’ve taken it to kind of another level,” Dunn said.

Dunn said his attorneys have been working to get access to Colorado’s state-level opioid prescribing database, which has far more information. But the information is only available via subpoena, which the federal prosecutor called a “hindrance.”

The tree of life at the Harm Reduction Action Center is dedicated to those who have survived an overdose. (Marvin Anani, Special to The Colorado Sun)

“There’s a state statute that says law enforcement can’t get access to that database without a subpoena and only in a specific investigation. So we’ve served subpoenas and gotten it on a specific case-by-case basis,” he said. “But we really would love to have that data, even if it’s anonymized initially to mine it and see where the statistical outliers are. We’ve had conversations with the state about that.”

State Sen. Brittany Pettersen, a Lakewood Democrat who is heavily vested in ending the opioid crisis, said she would like to see enforcement action focused on pharmaceutical companies and not on doctors and nurses. She said charging those medical professionals could lead to more problems.

MORE: The opioid maker being sued by Colorado for fanning the overdose epidemic says everything it did was FDA-approved

“More people will die because they will be cut off from their prescriptions,” she said. “They will go to heroin to deal with their withdrawal.”

Dunn calls his plan to approach overdose deaths as homicides a “street-level” approach.

There’s currently a national debate about charging drug dealers in overdose deaths. Opponents worry that doing so would prevent people from seeking help in an overdose situation and question if it really serves as a deterrent.

Pettersen, whose mother has struggled with heroin addiction, cautioned against criminalizing the issue. She says she has nothing but hatred for the man who introduced her mom to heroin and would give the drug to her, even while she was in the hospital. But Pettersen said she recognizes that he, too, had a problem.

State Sen. Brittany Pettersen, D-Pettersen, talks to reporters about the introduction of the red flag gun bill on Feb. 14, 2019. (Jesse Paul, The Colorado Sun)

“It’s incredibly complicated,” she said. “A lot of people who are dealing drugs are also addicted and trying to feed their habit. They are doing desperate things to feed their disease. Throwing these people in jail is not going to solve the opioid crisis.”

Many states, Colorado not among them, either have specific laws on the books to use in those situations or are considering them. The federal government also has a distribution of heroin resulting in death charge.

Fifth Judicial District Attorney Bruce Brown, a Democrat whose territory covers Summit and Eagle counties and surrounding areas, has been using this tactic for years. His office has successfully pursued a number of cases against people who provided the heroin used in fatal overdoses, charging defendants with criminally negligent homicide, manslaughter or drug distribution offenses.

“Generally speaking, the law enforcement community customarily treated people who overdosed not so much as victims of crime, but maybe victims of their own criminality,” Brown said. “I have tried and worked very hard with our local law enforcement to convince them that they are homicides and the people who overdose have a health issue.”

Brown said Colorado’s safe-harbor law should prevent people who call 911 in an overdose situation from facing charges. But, he said, whether the tactic serves as a deterrent is a difficult question to answer, though he’s hopeful.

“Our goal is that the dealers think twice,” Brown said. “I do think that in some way there’s a likelihood that we’re saving lives. Can we definitely say that? No.”

Dunn said his office has set up a training program to encourage local law enforcement in Colorado to treat overdose deaths not as accidents, but as potential homicides with crime scenes.

He is urging law enforcement officers to check fatal overdose scenes for pill bottles or cellphones with information that might point investigators toward the drug supplier.

“We’re trying to encourage local law enforcement to actually contact us,” Dunn said. “We’re actually giving them the name of one of our attorneys here that, even in the moment at the scene, to call him and he can say, ‘Look, do this, this, this and this at the scene and treat it like a homicide.’”

Dunn’s office already has successfully prosecuted one Denver-area heroin dealer in a case involving an overdose and in which a woman’s body was dumped in an alley. A second person also has been charged in that case.

During the interview, Dunn re-emphasized his opposition to a supervised drug-consumption site in Colorado. That idea, an attempt to bring a first-in-the-nation program to Denver following a similar effort in Vancouver, Canada, has been shelved.

“I think a safe-injection site is a bad idea,” he said. “Again, we don’t weigh in on specific legislation or city ordinances, but I felt like it was important to let people know that we take that very seriously and that the Department of Justice takes it very seriously. I felt like the right thing to do was, working with the Drug Enforcement Administration, to let the city and the state and the public know that we will treat that seriously and that federal law enforcement will engage if such a facility were opened.”

Dunn said that if such a site were to open, there are a range of options he could take to push back. “It ranges from everything from asset seizure — seize the facility — to civil under the Controlled Substance Act all the way to criminal (charges) for individuals.”

A pamphlet at the Harm Reduction Action Center depicts a diorama of a booth at a safe injection site where IV drug users would inject heroin or methamphetamine. (Marvin Anani, Special to The Colorado Sun)
Whatever happened to our FOURTH AMENDMENT – probably cause and unreasonable search and seizure ?
Either the reporter who wrote this article misquoted this attorney or NOT …
He is also digging into data on doctors and nurses who prescribe unusually large quantities of opioid painkillers, with an eye toward prosecuting those who are illegally diverting the drugs and, he feels, adding to the scourge of heroin.
Does this mean that this attorney is “fishing” in one or more state’s controlled substances prescription database and using HIS OPINION as to who is prescribing unusually large quantities.
Here is a mini CV from his website:  http://jasonadunn.com/meet-the-attorney/

I graduated from Virginia Polytechnic Institute and State University with a double major in political science and environmental policy and planning. I then attended Tulane University Law School in New Orleans, Louisiana, where I graduated with a Juris Doctor in 2004. I was admitted to the Virginia State Bar in 2004 and I began my legal career as a public defender in Portsmouth, Virginia. In 2008, I was admitted to the United States District Court for the Eastern District of Virginia. In 2011 I was admitted to the United States Bankruptcy Court for the Eastern District of Virginia. In the following year, I was admitted to the United States Court of Appeals for the Fourth Circuit. In 2014, I opened my solo practice in Virginia Beach, Virginia.

I began my career as a public defender in the City of Portsmouth, Virginia, and briefly practiced with local firms before opening my solo practice in Virginia Beach in 2014. My practice is primarily focused on collections, civil litigation, personal injury and criminal defense. I specialize in real estate litigation and have collected delinquent real estate taxes for almost 15 years, over seven different jurisdictions.

After reading this CV several times… I see nothing that would suggest that this attorney has any  medical training/experience nor a degree in any medical field. One must wonder where “his feelings” are coming from… LOWER POSTERIOR ORIFICE ?

Patient Privacy in the Pharmacy (HIPAA)

Patient Privacy in the Pharmacy

https://www.managedhealthcareconnect.com/content/patient-privacy-pharmacy

April 18, 2019

Patient privacy in the pharmacy made the headlines recently when a man sued a large chain drugstore for revealing to his wife that he had a prescription for an erectile dysfunction drug.

The Case

The plaintiff, MF, brought a prescription for eight 100-milligram sildenafil citrate (Viagra) pills into his regular CVS pharmacy to be filled. According to the plaintiff, he gave specific instructions to the pharmacist that he did not want his insurance billed for this prescription and that he would pay with cash. The pharmacist agreed and MF left.

Several days later, MF’s wife called the same pharmacy to check on one of her own prescriptions, and the chatty pharmacy employee on the other end of the phone decided to mention to her that her husband’s Viagra prescription had not gone through the insurance.

The plaintiff is claiming that this disclosure of the erectile dysfunction prescription to his wife caused a breakdown in his marriage. In a lawsuit filed against the drug chain, MF claims that the pharmacy violated his privacy under HIPAA. The lawsuit alleges that the pharmacy employee “without solicitation, improperly informed MF’s wife that his prescription for Viagra was not being covered by insurance.” In the court papers, MF refers to his wife as a “third-party” who had no right to be informed about the drug.

Does MF Have a Case?

The HIPAA Privacy Rule, part of the Health Insurance Portability and Accountability Act of 1996, was enacted to protect personally identifiable health information while allowing the flow of information necessary to provide quality healthcare. It requires covered entities, including pharmacies, hospitals, health plans, and healthcare providers, to treat protected health information (PHI) as confidential.

It’s important to understand that a HIPAA violation does not give rise to a private cause of action to sue. A patient cannot sue for a HIPAA violation. (This misperception is very common in the general public, however).

Patients do have a recourse in the event of a HIPAA violation. A patient can file a complaint with the Department of Health & Human Services (HHS). HIPAA provides both civil penalties and criminal penalties for the mishandling of PHI.  It’s the purview of HHS and states’ attorneys to enforce the penalties and to decide to fine the offender, prosecute or jail the offender (if it was criminal), or to order the entity to institute HIPAA training for employees.

So, if prior legal precedent holds, MF will have a hard time succeeding if he is trying to argue a violation of HIPAA. It is, however, possible to sue and obtain damages for violations of state laws (provided the patient can prove damages).

This case is currently inching through the court system. It may be dismissed or settled before it ever goes to trial (most cases are), but it will be an interesting one to follow.

Your Risks with a HIPAA Violation

If the HIPAA rule is violated, your biggest risk is not getting sued, it is losing your job. The odds of a lawsuit are slim, and when it does happen it is generally the employer (in this case the drug chain) that is sued, not the pharmacist/employee. However, the employee is likely to be fired.

Most large entities – hospitals, pharmacies, medical practices – have strict guidelines about HIPAA and are required to provide some training for employees. Employees are often required to sign documents acknowledging their understanding of patient privacy issues. Breaches of privacy are treated very seriously, and companies will fire employees in order to reassure investigators that the situation has been handled.

Protecting Yourself

In the pharmacy, the best way to protect yourself is to remember to disclose only the minimum amount of information necessary to achieve the purpose of your communication. Never share protected health information. This is where the pharmacy employee in MF’s case when wrong – when MF’s wife called to ask about her prescription, the employee should have answered only that question, and not volunteered any extraneous information.

This “minimum information necessary” holds true if you are calling a patient or leaving them a message to let them know a prescription is ready. It is not necessary to volunteer the name of the medication, its use, or personal information about the person getting it. Always use the minimum information necessary to convey your message.  

The Real Headline From The CDC Report On Kratom Being Detected In Medical Examiner And Coroner Reports

The Real Headline From The CDC Report On Kratom Being Detected In Medical Examiner And Coroner Reports

https://www.ptcommunity.com/wire/real-headline-cdc-report-kratom-being-detected-medical-examiner-and-coroner-reports

WASHINGTON, April 18, 2019 /PRNewswire/ — The American Kratom Association (AKA) released a response to the CDC report on kratom being detected by medical examiners and coroners in 91 toxicology records.  The rebuttal to the CDC report was authored by 5 independent experts who are recognized for their work in substance abuse and addiction issues, and each affirmed that the media headlines reported in the CDC analysis misstated the actual conclusions of that report.

A copy of the report can be found at http://www.americankratom.org/images/Reply_to_CDC_-_Unintentional_Drug_Overdose_Deaths_with_Kratom_Detected.pdf

“The CDC report supports the AKA position that more regulations need to be in place to deny market access to unscrupulous bad actors who spike natural kratom with dangerous adulterants, including fentanyl, heroine, and morphine,” stated Dave Herman, Chairman of the AKA.  “The CDC report also supports the AKA position that medical examiners and coroners are reporting ONLY that they have detected kratom in toxicology reports, and they often incorrectly report that kratom was involved in or the actual cause of death.”

The five independent experts concluded in their report that the CDC data does not report whether the decedents ingested pure, unadulterated kratom in conjunction with dangerous substances or used an adulterated kratom product. The National Institute on Drug Abuse (NIDA) has documented that polydrug use or adulterated kratom product deaths are properly attributable to the toxicity of the multiplicity of co-consumed drugs or adulterants present whether intentionally consumed as a consequence of an individual’s addiction or the result of unknowingly using a product adulterated with a toxic dose of a dangerous substance.

“It grossly misleads the public and the millions of kratom users in the United States,” said Herman.  “We need evidence to document the danger of any substance, and right now the FDA is inflaming anti-kratom rhetoric with false information, deliberate overstatements of the facts, and conclusions about kratom that are unsupportable with any credible science.”

The independent report concluded that the consequences of inaccurate data on kratom-associated deaths clearly has contributed to the FDA’s persistent attacks on kratom; the decisions of 6 states who have banned kratom; the decision by some local jurisdictions to impose local bans on kratom; and the rampant misinformation disseminated to the public about the alleged risks of kratom use.

“The AKA is working hard with the states to enact responsible regulation to prevent adulteration and ensure kratom consumers have good labels, so they know they are purchasing a pure kratom product,” concluded Herman.

ABOUT AKA
The American Kratom Association (AKA), a consumer-based non-profit organization, is here to set the record straight about kratom and give a voice to those who are suffering and protect their rights to possess and consume kratom. AKA represents tens of thousands of Americans, each of whom have a unique story to tell about the virtues of kratom and its positive effects on their lives. www.americankratom.org

View original content to download multimedia:http://www.prnewswire.com/news-releases/the-real-headline-from-the-cdc-report-on-kratom-being-detected-in-medical-examiner-and-coroner-reports-300834810.html

SOURCE American Kratom Association

Prior Authorization Bill Expected in Congress This Summer

Prior Authorization Bill Expected in Congress This Summer

Two House Republicans and a Democrat working on a draft

https://www.medpagetoday.com/practicemanagement/reimbursement/79314

WASHINGTON — Bipartisan legislation to ease the burden of prior authorization is expected to be introduced in the House this summer, a Republican staffer said.

“We’ve been working with [Reps.] Mike Kelly (R-Pa.) and Suzan DelBene (D-Wash.) on prior authorization,” said Charlotte Pineda, healthcare advisor to Rep. Roger Marshall, MD (R-Kan.), an ob/gyn, during a conference on free-market healthcare here earlier this month.

“It’s important to work across the aisle because you can actually get stuff done,” she continued. “It’s one thing to introduce a bill and another thing entirely to introduce it with members of the committee on which the bill has jurisdiction. So the three members hopefully will be introducing that later this summer.” Kelly and DelBene are remembers of the House Ways & Means Committee, which would likely have jurisdiction over any prior authorization bill.

Naida did not say what the bill might contain, and she was unavailable for comment at press time. However, during the last Congress, Kelly introduced the Prior Authorization Process Improvement Act, which was referred to the Ways & Means committee but got no further. That bill required the Secretary of Health and Human Services to submit a report to Congress within a year “on the feasibility of Medicare Advantage organizations and providers and suppliers of services … using certain technologies to facilitate the administration of prior authorization requirements under Medicare Advantage (MA) plans offered by such organizations.”

The bill called for the secretary to consult with an advisory panel of MA organizations, providers and suppliers of services, beneficiary representatives, and technology vendors in preparing the report. Among other things, the report would include “recommendations on how to improve the administration of such requirements through the use of technology.”

While the three lawmakers work on that bill, other activities related to prior authorization are continuing. In March, the eHealth Initiative, a coalition of provider and healthcare industry organizations, issued a paper on “Considerations for Improving Prior Authorization in Healthcare.” The document included four central points:

  • Transparency of payer policy and evidence-based clinical guidelines available at the point of care may, in many cases, reduce the need for prior authorization and minimize care delays.
  • Reducing the overall volume of services and drugs requiring prior authorization could decrease administrative burdens and costs for all stakeholders.
  • Payers, healthcare professionals, and vendors should use existing, industry-endorsed standards whenever possible and explore incorporating new electronic standards that have the capability to improve the prior authorization process.
  • Payers and healthcare professionals should explore alternative payment models that promote bundled authorization for procedures, medications, and durable medical equipment that are associated with a particular episode of care.

Over at the Centers for Medicare & Medicaid Services (CMS), the agency is participating in two different workgroups for its Document Requirement Lookup Services Initiative, which is aimed at making it easier for Medicare fee-for-service providers to find out what documentation is required in order for Medicare to approve a particular service for coverage.

“One workgroup is a private sector initiative hosted by Health Level Seven International (HL7), the Da Vinci project,” the agency explained on the initiative’s webpage. “The second workgroup, convened by the Office of the National Coordinator for Health Information Technology (ONC), is the Payer + Provider (P2) Fast Healthcare Interoperability Resource (FHIR) Taskforce.” FHIR (pronounced “fire”) is a common programming interface that is used in many health information technology applications.

Through working with those two efforts, “CMS is helping define the requirements and architect the standards-based solutions,” the agency said. “In parallel, CMS is preparing to support pilots testing the information exchanges for Medicare fee-for-service programs and possibly coordinate pilots with volunteer participants to verify and test the new FHIR-based solutions.”

On the insurer side of the equation, America’s Health Insurance Plans (AHIP), a trade group here for health insurers, is coordinating a demonstration project to automate prior authorization. “We expect to launch the demonstrating project later in 2019 in a manner that is scalable and as integrated as possible with provider workflow,” an AHIP spokeswoman said in an email to MedPage Today. “We will engage an independent organization to evaluate the impact of automation and release a final report in early 2020.”

She noted that only about 15% of healthcare services require prior authorization, which she said was “an important, safe care tool adopted by health plans and government-sponsored health care programs to help ensure patients receive the best results, better outcomes and better efficiencies.”

Specifically, prior authorization “prevents the overuse [of care], misuse [of care], or unnecessary (or potentially harmful) care and offers consistency and value to the patient, when there could be a wide variation provider performance, cost of the drug, and/or utilization within a clinician’s practice,” the spokeswoman said. “[It also] ensures care is consistent with evidence-based practices.”

But there is still work to be done to improve the process, she said, adding that AHIP “supports legislation that is designed to streamline and standardize electronic prior authorization, improve transparency, and encourage best practices that improve care coordination and reduce provider burden.”

Please do not take this final act! National Suicide Prevention Lifeline PLEASE CALL: 1-800-273-8255

In recent days there have been a series of coordinated attacks against me. I don’t know or understand why but they are making some very serious allegations. Please take a moment to hear me out and if you still have questions, please call me: 423-794-8241 “And now these three remain: faith, hope and love. But the greatest of these is love.” 1 Corinthians 13:13

DOJ/DEA/SWAT and their theatrics when they raid a prescriber’s office

A year ago I left a review  I was shocked to find a reply after a year. The patient who replied to my review replied with her very detailed description of the DEA raid IN HER DOCTOR’S OFFICE. Read and learn for if or when it happens to you.

https://www.facebook.com/DEAHQ/

This is the reply to my review:

This is slightly lengthy but it tells of the RAID by the FBI & DEA at my pain clinic. It is my unofficial deposition. Remember this was done when the government was shut down. I’m 61 and the youngest patient I have noticed is approximately 45ish. Some have canes and others have portable oxygen. Far cry the crack head pill mill they thought they would find!

February 23, 2019
To Whom It May Concern,
I am a chronic pain patient and have been one in excess of 15 years and on permanent disability for 8 years. Prior to Dr. Ronald Moon I had to use Family Medical Care. That clinic became my primary care center. I was able to use the clinic for my routine medications such as hypertensive medication, anxiety medication well as my pain medication. I was able to use the clinic for approximately 3 years until their policy changed and they were no longer allowed to practice as a primary care doctor and chronic pain patient were no longer to be seen. I was forced to find a PCP and a Pain Specialist. I was given a list of primary care doctors as well as some pain clinics.
• I have been a patient of Dr. Moon for over 7+ years. My chronic pain is as follows: I have fibromyalgia, M.E., diabetic neuropathy in my feet and intention tremors in both hands. In addition I also have degenerative disc disease in my spine, spinal arthitis and buldging discs. I have had spinal surgery with metal rods and cadaver bone in my spine. The pain in my lower back travels down my right leg. I continue to experience chronic lower back pain. Severe headaches and at least once every 2-3 months I get blinding migraines. I have stiffness in my neck radiating down across both shoulders and extending up my neck to the base of my head. I do have PTSD, anxiety, depression, panic attacks and social anxiety which are being handled by another doctor that specializes in those areas.
• When I first came to Dr. Moon is as barely mobile even using my cane. I was homebound with the exception of my doctor visits. I was apprehensive of seeing another doctor due to the fact unless an medical issue can be visually seen or proven by diagnostic tests it did not exist. Dr. Moon through a system of questions, blood work, urinalysis and my presented systems gave me hope. Did he say he could cure me? NO. He told me that there were medications that could help make my chronic pain tolerable. Throughout the years with Dr. Moon I have had CT scans, MRIs, nerve conduction tests, nerve blocks, and a few other tests. I firmly believe that he is a conservative doctor than tries to locate the cause or root of the pain and DOES NOT hand out pain medication on a whim. In my experience he is careful to prescribe pain medication at the lowest dose that he believes will help the pain become manageable. Next visit if it’s not producing the desired results he reevaluates the situation and adjusts medication aa he sees necessary. Random urine drug screens are not uncommon. There seems to be no pattern in the randomization of the tests. Also if I am seen my another doctor or dentist for any reason and I am prescribed and narcotics I must have that prescribing doctor complete a Medical Disclosure Form. It has been this way since day one. Dr. Moon is a very caring, supportive, compassionate doctor that “talks TO me and not AT me.” There is a huge difference! Just as there is a difference between being dependent on pain medication and being addicted to pain medication. Even today I am unable to walk or stand for any length of time. If I have to go anywhere that requires walking or standing I have no choice but to use my wheelchair.
When he had to discontinue accepting BCBS insurance because of how the they wanted him to run his client and record keeping from what I could figure out.
• That Tuesday (Feb. 5th)morning at 6 a.m. while my husband and I were in the exam room waiting to be seen we both heard a loud commotion in the hall. All of a sudden my room door bursts open and 3-4 heavily armed agents entered the room. The red laser dot from the rifle was placed on my forehead and quickly to my husband’s forehead. They were loudly yelling “Search Warrant” as they burst into the room. This scared me to death! Having PTSD, anxiety and anxiety attacks this was extra stressful for me. I am so grateful my husband was with me to help me remain as calm as possible. Glen saw me begin to panic and he was able to keep me calm and thus avoiding a full blown panic attack.
• To my best guess there were +40 agents from multiple government agencies present. It was extremely intimidating! We each had to give our full name, address, date of birth, social security number and if relevant our work information. The FBI and DEA agents went through the office and each exam room like they were raiding a crack house.
• An FBI agent told me to follow him. We walked into an exam room followed by a DEA agent. I sat on the exam table, DEA agent sat at the small desk while the FBI agent stood in front of the only door to the room. I felt boxed in. I was asked approximately 6-7 typed pages of predetermined questions. I have very poor memory recall due to the fibromyalgia, brain fog and at that point increased anxiety. I answer their questions the best to my ability and informing them both I have had 2 small strokes and my memory wasn’t the best. I also let them know that my husband was out in the lobby and I asked if he could come in the room and help fill in the missing pieces of memory information they needed. I mentioned that on 3 separate occasions and I was told “no” and that I was “ answering the questions just fine.” I no concept of time and my best guess the 3 of us were in the small exam room for about an hour.
• Later I found out that the interview I had just finished was voluntary. At no time was I informed that I didn’t have to go with them and answer all of those questions. It was presented to me as mandatory that I follow them and answer their questions while the FBI agent standing with his back against the door. Yes I felt trapped and intimated. In found out that every patient chart was removed from the office. My private medical history was taken without my consent or prior knowledge. The results of my bone density scan is in my chart. Dr. Moon has not reviewed the results or gone over it with me. My latest blood work and test results are now gone. Yes I do feel my right to privacy have been violated. I do not have any idea as to who is looking at my private records or personal information.
• Having the agents burst into the exam room where we were with their automatic rifles pointed at me has caused my anxiety level to remain high. I have an increased difficulty falling and staying asleep. My prescription medication for sleep does very little to help. The bursting into the exam room so heavily armed and traumatizing me replays over in my head.
This was completely unnecessary. Dr. Moon follows the guidelines and gives me as well as his other patients no choice but to follow the rules. I appreciate the way he looks for the cause of the pain, attempts to remedy the root cause via tests and referrals to other doctors when needed while trying to keep my pain at a tolerable level. I truly believe he has my best interest in mind with every visit. I trust him completely and yes I have referred him to others and I will continue to do so.

Thank you for your time.

When reading this… mental images of  gestapo tactics that I have heard about under Hitler’s dominance of Germany and other parts of Europe that he attempted to conquer.  I would hope that all of the S.W.A.T. theatrics, those police officers had their guns on locked and just using the red laser target lights were just for EFFECT…  “scare the shit out of people in the waiting room effect”  

I am not an attorney, but as was stated in the article all of the theatrics was totally just that – THEATRICS – and the pt did not have to conform with what was going and and being demanded.

I have seen some attorneys who have legally challenged law enforcement when they are “playing games” … all you have to ask is “Am I being detained ?” That is a simple YES/NO question… if they don’t say YES… then you politely tell them that “we are thru here and I am leaving”

If they say YES… ask them what they are charging you with and that you need to talk to your attorney … and don’t say another word or do anything that they request.

 

Andrew Kolodny Rips National Pain Report For Unfair Reporting

Andrew Kolodny Rips National Pain Report For Unfair Reporting

www.nationalpainreport.com/andrew-kolodny-rips-national-pain-report-for-unfair-reporting-8834556.html

Dr. Andrew Kolodny has criticized the National Pain Report for what he calls “its unfair and false reporting” on him.

He said it is “absolutely false” that he is “aggressively pushing the idea of restricting or eliminating opioid usage” as we indicated this week.

“I have never pushed for a policy that would restrict or eliminate opioids,” he said. “I believe opioids play an important in both the treatment of pain and addiction.”

What he is for, he said, is responsible prescribing.

Kolodny also believes we should avoid referring to the crisis as an epidemic of drug abuse.  As he said on the Brandeis University website: “Calling it an abuse problem suggests the cause is bad behavior—people abusing dangerous drugs to get high. While it’s true that some people got addicted from recreational use, many also became addicted taking opioids exactly as prescribed by doctors. Once addicted, people aren’t using heroin or pills because it’s fun. They need to keep using opioids to avoid feeling awful.”

Kolodny, who in addition to his work at Brandeis University is also executive director of Physicians for Responsible Opioid Prescribing, started working on the issue about 15 years ago for New York City’s health department.

Kolodny has been in the news recently urging the Trump Administration to move faster to address the issue of overprescribing and addiction.

“There really isn’t anything this (federal) commission is going to figure out that we don’t know already,” Dr. Andrew Kolodny, told the New York Times. “What we need is an enormous federal investment in expanding access to addiction treatment, and for the different federal agencies that have a piece of this problem to be working in a coordinated fashion.”

“Policymakers wanted to stop so-called ‘drug abusers’ but were ignoring the problem of overprescribing. It was all focused on preventing kids from getting into grandma’s medicine chest, but no one was looking at why every grandma now had opioids in her medicine chest.”

Kolodny indicated he would think about writing a column talking about opioids and chronic pain for the National Pain Report but said, “Had you approached me before you did this false reporting, I might have been more inclined to do it.”

 

See the source image

The day has come when I AGREE with Andrew Kolodny  Kolodny also believes we should avoid referring to the crisis as an epidemic of drug abuse. 

On JUST ONE THING… substance abuse/addiction is not a EPIDEMIC… because the word EPIDEMIC suggests that something is CONTAGIOUS and substance abuse/addiction is a mental health problem, not a moral issue and both our current and previous Surgeon General and new head of the CDC agrees with that statement.

Doesn’t anyone really wonder that only 5% of so called “addicts” that go to a sobriety clinic  stay “clean” ?  Maybe that is because they were never really addicted but was prescribed opiates and was not properly weaned off and had become dependent and experienced withdrawal symptoms and when they are properly weaned off… SURPRISE … no longer addicted.

I read this article several times and not ONCE did Kolodny mentioned that substance abuse/addiction is a MENTAL HEALTH ISSUE.

I had a Logic professor in college whose favorite quote was , “.. never say never and never say always… because someone will always prove you wrong… because there is no absolutes in life “

So this statement is patently UNTRUE  It was all focused on preventing kids from getting into grandma’s medicine chest, but no one was looking at why every grandma now had opioids in her medicine chest.”

I hope that Ed Coghlan will not let him make any posts… this statement shows he is interested in the liberal distribution of controlled substances:  “I have never pushed for a policy that would restrict or eliminate opioids,” he said. “I believe opioids play an important in both the treatment of pain and addiction.”

Since the medications that are used in a chemical rehab are both controlled substances  a C-II Methadone and a C-III Suboxone.  So apparently Kolodny and the members of his Physicians for Responsible Opioid Prescribing are very supportive of the prescribing of controlled substances/opiates… but mostly limited to those who are dealing with substance abuse/addiction.  Apparently a pt being dependent on one of those meds is perfectly fine, but .. those suffering from chronic pain should only get “responsible doses”  Whatever in the hell that is ?

Asked to pass this along – 04/17/2019

Please join our state pain advocacy groups and work together at the state and federal level to facilitate real change. We have members going to Town Hall meetings right now before they return to Congress to pass health care legislation soon. Members are meeting with policy makers and media in each state and creating real change. We have advocates, patients and medical personnel meet in with policy makers – home bound patients can call in to take part and we have a team of medical personnel to call in and share their side and what’s happening to their patients. They have to see people with 5, 10 or 20 different conditions, as many think we bumped our elbows and hopped on medication.

 

Tamera Stewart, the new C-50 Director has killed bad bills and gotten good ones passed in Oklahoma. We are losing our window, please work with others in your state before it’s too late


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