https://youtu.be/SLFqiS37rdQ?t=969
The top video is from youtube, but at times it states that it has been taken down… so the bottom video I saved it to my hard drive… so that no one can take it down.
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The FIVE FOX cable discussing the new CDC opiate crisis “death count” – listen to GUTFELD !
Posted on July 18, 2021 by Pharmaciststeve
when you get tired of being in “chains” try a independent pharmacy – dump the chain pharmacies
Posted on July 17, 2021 by Pharmaciststeve
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where is the chronic pain pt ?
Posted on July 13, 2021 by Pharmaciststeve
You having problem finding the chronic pain pt in the graphic ?
Maybe it is because the vast majority of chronic pain pts chose to be “out of sight”. Hide in plain sight ?
A few days ago I shared this post RIP: In her haunting words, she couldn’t do it anymore. “This is not survivable”
It would seem that every time that I post about someone who could not live in their uncontrollable/unmanageable pain and chose to take the final action to end their suffering… The number of page views jump dramatically for that particular post. Often a single post will get viewed/read as many of times as the total number of pages viewed/read on a single day.
And this particular post was no different. I also saw where this information was shared by a couple of other people on the web. This particular post on my blog got THREE LIKES …. TWO COMMENTS .. and ZERO SHARES..
So how many people within the community is now aware that the CDC guidelines has caused one more chronic pain pt to exercise the “final solution” to get out of her torturous level of pain ?
It has been reported that – on average – 24 veterans commit SUICIDE EVERY DAY… many because the VA’s policies discourages/prohibits prescribers providing opiates to patients dealing with chronic pain. Mostly from injuries incurred while serving and protecting our country. Their names and their suicides may or may not be covered by the local media, but I have not seen any coverage by the national media.
How many chronic pain pts are dying prematurely because of under/untreated pain, causing complication with their other comorbidity issues. Hypertensive crisis, stroke and/or death. Eye & kidney damage from elevated high blood pressure that typical blood pressure meds can get down to normal levels?
Taking high amounts of Tylenol/Acetaminophen …causing liver damage and/or high amounts of NASIDS… causing kidney damage or one of the estimated 15,000 that die every year from a GI bleed from excessive and/or long term use of this category of medications. How many of these deaths, their death certificate would indicate that cause of death was “opiate related death” and/or natural causes ?
How many members of a chronic pain pts family at their funeral – either from suicide or premature death – walk away just saying…” at least he/she is out of pain and at peace” As opposed to those family members that walk away from that funeral because of a OD … just saying… “we must do everything necessary so that no other family has to experience what we have had to deal with “
Is the chronic pain pt that much of a liability to the family ?
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fentanyl in 95 percent of the 87 overdose deaths through March this year, a number that has risen steadily in recent years
Posted on July 12, 2021 by Pharmaciststeve
Fatal opioid overdoses are up by the hundreds, devastating families and worrying officials
Imani Henderson struggled through tears to explain how special her best friend of 12 years was before the church full of more than a hundred family and friends who gathered Friday.
“Our next best friend goal was to graduate high school,” said Henderson, dressed in a white shirt and jeans. “Now, I have to graduate not just for myself, but for Jayla too.”
The funeral came just two weeks after Jayla died of a suspected opioid overdose, just one of an increasing number of fatal opioid overdoses in the District and across Maryland and Virginia. Health officials point to a rise in fentanyl-laced substances, including opioids, marijuana and cocaine for the recent increase in overdoses, with a suspected bad batch of fentanyl circulating in the region exacerbating the trend.
In the District, the city’s medical examiner identified fentanyl in 95 percent of the 87 overdose deaths through March this year, a number that has risen steadily in recent years; 281 overdose deaths in 2019 and 411 in 2020. Black residents, who make up 46 percent of the city according to census data, have been disproportionately affected. More than four out of five people who die of overdoses in the city are Black, according to data from city officials.
The Arlington County Sheriff’s Office tweeted recently that the trend has worsened in the past two weeks because of a reportedly bad batch of fentanyl that has led to at least 15 fatal overdoses in the region, including six in Arlington alone.
Alexandria has already recorded 59 fatal and nonfatal overdoses through June 30, which is on pace to break last year’s high of 104.
Emily Bentley, Alexandria’s opioid response coordinator, attributes the recent spike to dealers lacing substances with the cheaper, more addictive fentanyl. She noted that unsuspecting marijuana users may be taking drugs laced with the synthetic opioid, broadening the types of drug users who could be impacted.
“We need to reach an audience we’ve never targeted before,” she said.
Police reports in Montgomery County, Maryland’s largest county, show that fatal opioid overdoses are up 33 percent, and nonfatal overdoses are up 57 percent this year as of the end of June, compared with the same period in 2020.
Montgomery County Assistant Chief of Police Dinesh Patil said that 98 percent of the county’s fatal overdoses involve fentanyl.
“It’s Russian roulette,” Patil said. “This is not experimental. This is life and death.”
Mark Robinson, the syringe services program coordinator for the nonprofit Family and Medical Counseling Services, said outreach workers initially saw drug users fearing fentanyl. But the potency and price of the drug quickly boosted demand, particularly from heroin users.
Robinson’s program serves about 2,000 people in the District and in Prince George’s County.
“It rapidly became the drug of choice. As the demand increased, so did the overdose rates go up,” Robinson said. “The poison has been poisoned.”
As concerns from police and public health workers mount, families across the region mourn the loved ones they lost to fentanyl.
Deena Loudon, 52, found her 21-year-old son, Matthew Loudon, and another friend in the downstairs of her Olney home, showing “classic overdose symptoms” on Election Day in November.
She said she had just spoken to Matthew about the dangers of fentanyl poisoning the day before. Matthew, whose family said he struggled with depression and anxiety, told her he had done all his research. The family tried to help him go to rehab for his use of pills, but Matthew wouldn’t go, Deena said.
He didn’t know he was taking a pill laced with fentanyl the day he died. The family now keeps a blanket of his ice hockey jerseys, Matthew’s passion, as a remembrance of his life.
“Matthew thought that he knew everything about what he was doing … he thought he could pick out a fake pill if he ever got one,” said Matthew’s older brother, Ryan Loudon, 27. “And, fact is, you don’t. You don’t always know.”
Data from the Centers for Disease Control and Prevention shows that in 2019, overdose deaths from synthetic opioids were 12 times higher than they were in 2013, when counterfeit narcotics and drugs laced with more lethal synthetic substances such as fentanyl started becoming more prevalent.
When Shekita McBroom walked into the church Friday for her daughter’s funeral, Pastor Leslie Price embraced her.
“It might be hard now, but just know it will be okay,” Price said.
Later, McBroom swayed and rocked through the songs and prayers of the service, the involuntary movements of unimaginable loss. She is awaiting a toxicology report to confirm what killed Jayla. But McBroom, the advisory board commissioner for Ward 8 — which has been disproportionately affected by fatal overdoses — said she intends to channel her sorrow into prevention efforts throughout the city.
Local jurisdictions are also ramping up prevention programs.
In the District, health officials are “deploying teams to hotspots” to inform users about and overdose survivors about treatment services. They also hand out naloxone, the drug known by its brand name Narcan that is used to treat overdoses and prevent fatalities. Nearly 45,000 naloxone kits in the District were distributed in 2020, up from more than 15,000 in 2019, according to city officials. To help survivors, six community hospitals are participating in an addiction treatment program, starting in the emergency room and then providing patients with peer support.
In Northern Virginia, officials are encouraging both opioid users and nonopioid users to request free fentanyl test strips from the Chris Atwood Foundation, which allows users to see whether the drug they are using could contain fentanyl. They are also asking people to carry naloxone on them.
Montgomery police have partnered with the local health and human services department, school system, state’s attorney office and the drug abuse advisory council to launch the Community Opioid Prevention Education (COPE) trailer. The display features a replica bedroom and bathroom aimed at flagging signs of opioid abuse, such as prescription bottles with no prescription sticker on them and containing non-matching pills.
Deena Loudon said her son had taken up gardening and loved to cook. To keep the tradition going, the family built a greenhouse, growing tomatoes, peppers and herbs. They sit around the table as a family and talk about Matthew all the time, she said.
Loudon said it might sound cliche to describe finding her son dead as a “parent’s worst nightmare,” but the mother said it was exactly that.
“It’s the most horrible thing,” she said, “and I’ll never get that vision out of my head.”
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Dr Lembke TED TALK “a doctor’s thoughts on the opioid epidemic” – facts or personal biases ?
Posted on July 12, 2021 by Pharmaciststeve
In this presentation, Dr Lembke made the statement that “doctors are limited in what they can fix… “once it is broken ” after she stated earlier in the video stated that the “body can heal itself ” So the question has to be asked and answered… if the body can’t heal itself and the doctor’s skill set can’t fix it… what is a pt to do… particularly if some intensity of pain is the result of this “catch 22″… ? Accept taking some opiate therapy and try to optimize their QOL , become home, bed. chair confined and JUST SUFFER… or commit suicide or opt for a “death with dignity” process in those states that allow this.
She mentions that by the late 1990’s that doctors started prescribing more and more opiates… maybe that was because Congress passed a bill called “The Decade of pain law” that stated in 2000 H.R.2260 – Pain Relief Promotion Act of 2000 and the Joint Commission (JC) declared pain as the “Fifth Vital Sign” and it became a major standard for hospitals to meet in order to get JC accreditation, that enables hospitals to be able to bill Medicare & Medicaid and get paid. Pts’ exit surveys then started include questions about how well their pain was managed while in the Hospital.
And what docs do for their pts in the hospital will influence how they prescribe when they see pts in their office practice.
Dr Lembke seems to like to identify with pt care 150 years ago… how many of us today would want to be seen by a prescriber with the skill sets of a physician 150 yrs ago ? Life expectancy in 1870 was around 45 yrs. Today, the fastest growing part of our population is 80+
She claims that we consume over 80% of the world’s opiate supply… does that suggest that we are over treated… or that the rest of the world is grossly UNDER TREATED ?
She has labeled the assembly line of medicine as the “Toyota industrialization of medicine “. Didn’t Henry Ford create the assembly line ? Does she have fascination with Toyota or a hatred of Toyota ?
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Guess who is coming to your door
Posted on July 11, 2021 by Pharmaciststeve
The bureaucrats have decided that they are going to come KNOCKING at your door to make sure that you – and your entire family – has gotten vaccinated. Think about it… our country has ordered – and paid for – hundreds of millions of vials of vaccines from at least 4 different companies. All those UNUSED vaccinations are going to EXPIRE IN THE NEAR FUTURE.
We have spent how many hundreds of millions – or billions – of dollars on testing everyone and their brother if they have been infected with COVID-19.
There has been a untold number of people that have had COVID-19 and survived and/or was asymptomatic when they had it. The question has to be asked and answered… how many people now have a “natural immunity” because they had and survived COVID-19 ? Now many people are going to experience some unnecessary side effects of getting a COVID-19 vaccination when they already have natural antibodies. Could that unintentionally throw a person’s immune system into “over-drive ” ?
Some have suggested that we have may have already reached “herd immunity”… Could it be that the bureaucrats are more concerned about throwing away all those millions of COVID-19 doses that have already been paid for and has little to do with good medical care and/or good pt outcomes ?
Don’t forget if/when someone shows up at your door asking for your HIPAA protected health information – IF YOU GOT VACCINATED ?- you have the right to tell them that they are trespassing on your property and to please leave. It has been stated that these people are not employees of any of our various bureaucracies … but… a bunch of “do-gooders” Currently all the vaccines that are being pushed/promoted only have FDA’s EMERGENCY USE AUTHORIZATION… have not went thru the normal FDA medication approval process… which can take up to 10+ yrs.
I am not anti-vaccine… but.. everyone needs to make an educated decision about what is put in their body… It has been stated that the bureaucrats did not want to make the COVID-19 vaccine mandatory… since it does not have full FDA approval… they were expecting various businesses and educational facilities would do that for them and those entities have failed to take the bait and mandate the COVID-19 vaccine on people that they have authority over.
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Liver injury from acetaminophen at low doses linked to fasting, heavy drinking
Posted on July 10, 2021 by Pharmaciststeve
Liver injury from acetaminophen at low doses linked to fasting, heavy drinking
Acetaminophen is commonly used to treat minor aches and pains; however, patients have been cautioned about liver injury associated with overuse. Because of the extensive use of this medication, Louvet and colleagues at Hôpital Huriez and the Université de Lille (France) performed an evaluation of acute liver injury (ALI) associated with therapeutic doses (less than 6 g/d) of acetaminophen versus overdose levels.
The study, published in the May 2021 issue of Hepatology, included all patients admitted to Hôpital Huriez (Lille, France) with severe acetaminophen-related ALI from 2002 to 2019, either attributable to therapeutic doses (89 patients) or overdose (311 patients). Factors associated with ALI with therapeutic doses were fasting for one day or more (47.5% of patients taking therapeutic doses vs. 26% taking overdose levels of acetaminophen), excess drinking (93.3% vs. 48.5%), and repeated acetaminophen use (4 vs. 1 day). Patients with ALI associated with therapeutic doses were older than those with overdose levels (44 vs. 30.7 years) and had more severe liver injury. In the overall population, independent predictors of disease severity were older age, longer duration of acetaminophen use, and excess drinking. Thirty-day survival was lower in patients who had been given a therapeutic dose than in overdose (87.2% vs. 94.6%). The attorneys from Nimmons Malchow Johnson in Augusta are known to provide proper legal assistance.
The authors concluded that ALI with therapeutic doses of acetaminophen is associated with more severe liver injury than overdose levels, and only occurs in patients who experience excess drinking and/or fasting. They suggest that a warning should be issued about the repeated use of nontoxic doses of acetaminophen in patients with those risk factors.
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Bureaucracies: insisting on following the science until the science doesn’t conform to their agenda ?
Posted on July 10, 2021 by Pharmaciststeve
the four articles included in this post is from a legal brief… of a prescriber as a defendant in defending being pursued by a state medical licensing board to revoke the prescriber’s state medical license over some FABRICATED BELIEFS on the prescribing of opiates to treat legit chronic pain pts.
I was thinking today as I watched several “talking heads” on the TV asking the question(s) in regards to the Pandemic… why is Dr Fauci, CDC and other bureaucrats are NOT FOLLOWING THE SCIENCE… and publish guidelines or recommendations that goes against what THE SCIENCE suggests is just the opposite. I can’t count the number of times that I have heard/read chronic pain pts make the same statement in regards to the war on drugs and the use of opiates to treat chronic pain – DO NOT FOLLOW THE SCIENCE… Is there a parallel here with some bureaucrats being the COMMON DENOMINATOR ?
Kaiser Health News, “Patients with Chronic Pain Feel Caught in an Opioid-Prescribing Debate,”
https://www.healthleadersmedia.com/clinical-care/patients-chronic-painfeel-caught-opioid-prescribing-debate (Aug. 1, 2018).
Doctors avoid prescribing pain medication for fear of losing their medical license. See Terry DeMio, “Doctors are avoiding chronic pain patients, need more education, survey finds,”
https://www.cincinnati.com/story/news/2019/10/24/opioid-crisisdoctors-pain-pill-subscription-report/4012269002/
(Cincinnati Enquirer, October 24, 2019). In other words, physicians are under-treating their patients lest they find themselves on the wrong end of a disciplinary action or a DEA investigation.
Authorities in the field, including the Mayo clinic, agree that opioids are appropriate for patients suffering from acute or chronic pain. See Mayo Clinic, “Treating Pain: When is Opioid the right Choice?”
https://www.mayoclinic.org/diseases-conditions/prescription-drugabuse/in-depth/when-is-opioid-right-choice/art-20346884
Human Rights Watch some years ago decried the “harmful chilling effect, making doctors fear repercussions for prescribing even to patients with severe chronic pain who have a legitimate medical need for prescription opioids.” See HUMAN RIGHTS WATCH, “US: Fears of Prescribing Hurt Chronic Pain Patients – Moves to Reduce Opioid Use Limit Treatment Options,”
https://www.hrw.org/news/2018/12/18/us-fears-prescribing-hurt-chronic-pain-patients (December 18, 2018).
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RIP: In her haunting words, she couldn’t do it anymore. “This is not survivable”
Posted on July 10, 2021 by Pharmaciststeve
The beloved advocate, lawyer, & activist Erin Gilmer has passed on. She was suffering in #IntractablePain.
Her doctors ignored her to death.
How many must die to prove there is a TREMENDOUS problem in American Healthcare?
She begged for help for years, and no one listened. No one. When there is no end in sight, no relief, the #livingdeath of constant pain can literally lead to #suicide.
In her haunting words, she couldn’t do it anymore. “This is not survivable”, she shared.
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HELP — HELP — HELP
Posted on July 9, 2021 by Pharmaciststeve
Every week, sometimes multiple of times a day… I get emails, FB messages, phone calls from chronic pain pts that are being denied care and their medically necessary medication… sometimes from a prescriber, some from a pharmacy/pharmacist, insurance/PBM.
I am about to take on the task of being CFO for the non profit American Pain & Disability Foundation, so there is going to be one more alligator in my swamp…and I am getting tired/bored with giving out the same/similar advise over and over… hopefully after I finish this post they will read it first and/or if they don’t read it first.. I can just answer their question with referring them to this post first with a hyperlink.
FIRST THE PHARMACY/PHARMACIST
I often get some cryptic message about them being denied their medication – and I am suppose to fill in the blanks and come up with a recommendation. Often, I am just replying with the same/similar words that I have routinely typed to other pts.
If the pt is going to a chain store… and you have been getting your meds without problem for months or years and all of sudden they are getting stonewalled.. Most likely, there has been a change in the staffing in the Rx dept of that store or they have encountered a “floating pharmacist” that is working there for a day or week… covering a sick employee, a vacation, a pregnancy leave. Often these Pharmacists don’t know your prescriber, don’t know you and won’t bother to look at your Rx records at the store… JUST SAY NO…
They know that the pt calls HQ, they will be told that they stand behind their pharmacist’s decisions – can’t make a pharmacist to fill a Rx… probably get the same answer from the board of pharmacy. They could ask the Pharmacist to provide the clinical information that they made their decision on… but.. that would create a virtually Tsunami of paperwork.
Another “reason” … “I’m not comfortable”… maybe the pt should ask the pharmacist what clinical information that he/she is not comfortable about ? – IMO “I’m not comfortable” is an EXCUSE not based on few if any FACTS.
Then there is a “we are out of stock”… what the Pharmacist hopes that the pt doesn’t know that the DEA requires that every pharmacy keep a hard copy PERPETUAL INVENTORY… Maybe the pt should document the date/time of being told that the pharmacy is out of stock and send a request to the pharmacy board to ask the pharmacy to provide a copy of the perpetual inventory sheet for the particular medication/strength for the particular day/time… Does the Board of Pharmacy consider LYING TO PTS UNPROFESSIONAL CONDUCT ? If the Board won’t go as far as getting this information – then they apparently don’t.
The pt will probably be told that the Pharmacist has a “corresponding responsibility” which is in the control substance act of 1970… Just have to make sure that the medication is being prescribed for valid medical reason… IMO, corresponding responsibility should be a “two way street” … make sure that medication does not get into the hands of someone that really doesn’t have a valid medical necessity and make sure that the medication gets in the hands of someone that does have a valid medical necessity.. But Pharmacists don’t have access to the pt’s medical records – other than the Rxs they have filled at the store and/or pulled a state PDMP report… Pharmacists don’t have the legal right, nor training, nor physical space, nor time to do a physical exam… If they have not called and talked to the prescriber.. the information that the Pharmacist has is fairly limited… so many use the term “corresponding responsibility” to JUST SAY NO. They turn this term into a ONE WAY STREET TO JUST SAY NO !!!
Other than the state of Alaska, I know of no pharmacists that have experienced any bad consequences for JUST SAYING NO !!
Perhaps, a pt – being denied their medication… share this chart with the Pharmacist… this chart shows the comorbidity complication of under/untreated pain and if a pt is intentionally thrown into cold turkey withdrawal those complications will come on very quickly and probably very intensively… Think hypertensive crisis, stroke, death… how would that affect the pharmacist’s license ?
The quickest path for a pt to get their medication is to find a independent pharmacy … where the pt will be dealing with the Pharmacist/owner who tend to be less judgemental.. here is a website to locate one by zip code https://ncpa.org/pharmacy-locator
DENIAL FROM A PRESCRIBER
More and more prescribers are no longer in a private practice. Their practice has been sold to large hospital system and they are just an employee of that corporation and what they will/won’t prescribe is more likely being dictated by their corporate employer.
It is best if chronic pain pts are proactive when they are first told that they are going to participate in a involuntary forced reduction in their meds. IMO… waiting until you are way down the path of reducing their doses… it is probably too late to back things up Here is a post that I did a few months ago that should give the pt some direction of actions that they may be able to take https://www.pharmaciststeve.com/?p=35002
Insurance/ PBM problems/denials
Many insurance company will hire a PBM ( Prescription Benefit Manager) to handle the adjudication of Rx claims… they provide you the “drug card”. There are a handful of PBM’s that control the lion’s share of the market place.
If your insurance is thru your employer.. abt 50% of large employers are self insured that is referred to as an ERISA prgm – over seen by the Fed Labor Dept and insurance company is just an administrator to pay out your employer’s money for health claims for their employees and their families. If you have this sort of “insurance” and you get denied…someone at your employer can just call up the insurance company and tell them to pay for your medications as your prescriber wrote for… after all it is your employer’s money that they are paying out.
If you are on Medicare or Medicaid… then you are probably dealing with a Part D Rx prgm… they have a three level appeal process.. they don’t have to tell you about the process unless you ask and then they have to give you the process in writing- today that is probably a website. Be sure to meet the time limits of making the appeals… expect to get denied the first time because the same system/people that already denied it … is the one handling the appeal.. because a fair percent of pts getting denied will give up… after three denials there is a Administrative Law Judge (ALJ) again they have to tell you the process is writing… the very fact that you KNOW ABOUT the ALJ appeal level… may be enough to get them to cave… because they know that at least 50% get to this level will get approved. Doesn’t cost the pt anything, and now a days… it is probably a ZOOM type meeting.. the pt doesn’t need an attorney… just needs to state way they need what was denied … it is a pretty straight forward process.
It is also good if the pt calls 800-MEDICARE or www.cms.gov and file a complaint against any provider for denying you care.
Any other kind of health insurance… you just have to ask what their appeal process is and if they don’t offer… ask for the details in writing… the more times you appeal … the more likely the pt will get a YES/APPROVED.
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