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When a chronic pain pt becomes over verbally abusive not liking my free advice
Posted on May 8, 2024 by Pharmaciststeve
the 1+ minute audio file below is from a chronic pain pt who reached out to me for assistance. Apparently, a Wags Pharmacist refused to fill this pt’s controlled Rx. This pt reached out to me via FB chat. It took me ~ 90 minutes just for the pt to tell me who the pt’s insurance company was. Finally abt 80 minutes in the back/forth in FB chat, the pt shared a copy of their medication insurance card. The card said Prime Therapeutics, and doing a little research online. I discovered that Walgreens and Prime Therapeutics had jointly created a new company https://www.alliancerxwp.com/ that is a PBM, mail-order pharmacy, and specialty pharmacy. At that point, it seem obvious to me that her PBM was owned by Wags and it was Wags that was refusing to fill her controlled Rx. I spent another 30-45 minutes talking to this pt on the phone about her issue, and another 30-45 minutes giving her a detailed suggestion that might get her controlled Rx filled.
Maybe I should have just told the pt that the letter could not be changed in any way to get that Wags Pharmacist to fill her controlled med.
This pt’s phone number was from the East Coast, but claimed they were living on the West Coast. The pt was also wants to have someone to find her a new doctor. I referred to a couple of people within APDF https://americanpaindisabilityfoundation.org/ who could possibly know more about doctors around the country who will possibly properly treat chronic pain pts and are pain refugees. The advocates were not aware of any prescriber in the pt’s area who the pt could be referred.
Then various verbal abuse started coming. I see ~ 20 emails sent from this pt. The APDF advocate that I referred to, has told me an untold number of calls to his home by this pt. Below is a voicemail that this pt left me. BE WARNED, the language used could be offensive to some.
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5 people arrested after surge of suspected drug overdoses in Austin: Police
Posted on May 8, 2024 by Pharmaciststeve
Here is a example of how our judicial system in VERY INCONSISTENT Pain Management Physician Convicted of Unlawfully Distributing Opioids
The Physician looks at the potential of 480 yrs in prison over prescribing 9 pts three different controlled meds over 6 yrs, BUT NO OVERDOSE DEATHS!
In the below article NINE OD DEATHS, Five people were arrested and charged with possession or delivery of a controlled substance! NO involuntary manslaughter or some degree of MURDER!
5 people arrested after surge of suspected drug overdoses in Austin: Police
Nine people are suspected to have died in connection with the overdoses.
Five people have been arrested after dozens of people overdosed in Austin last week, leading to nine suspected deaths.
The Austin Police Department said Marcellus Barron, 30; Denise Horton, 47; Gary Lewis, 50; Ronnie Mims, 45; and Kanady Rimjo, 32, were arrested and charged with possession or delivery of a controlled substance, according to local ABC News affiliate KVUE.
Police said they located the suspects by investigating the source of the narcotics used in the recent overdoses, KVUE reported. The drugs included marijuana and crack cocaine laced with fentanyl.
Fentanyl is a synthetic opioid that is 50 to 100 times more potent than morphine, according to the Centers for Disease Control and Prevention.
Most cases involving fentanyl-related harm, overdose and death in the U.S. have been associated with illegally made fentanyl, the CDC said. It is often sold through illegal drug markets and mixed with other drugs, such as cocaine or heroin, to increase its effects.
STOCK PHOTO/Getty Images
Starting around 9 a.m. ET on Monday, April 29, Austin-Travis County Emergency Medical Services (ATCEMS) said it received a surge of calls concentrated in the downtown area.
ATCEMS said it usually receives two or three overdose calls per day, but the number of calls equated to a 1,000% increase in call volume, Dr. Heidi Abraham, deputy medical director for ATCEMS, said last week during a press conference.
As of Monday, there were 79 reported overdoses and ATCEMS distributed 438 Narcan rescue kits. Narcan is given as a nasal spray and the active ingredient in the medication — naloxone — can quickly restore breathing if someone is experiencing an opioid overdose.
Police say a sixth person, 55-year-old Johnny Lee Wright, was arrested after surveillance video captured him delivering narcotics to Austin residents, KVUE reported. According to the APD, Wright has several previous felony convictions, including some related to narcotics.
APD did not immediately return ABC News’ request for comment.
A record number of Americans have died from drug overdoses. In 2022, there were nearly 108,000 drug overdose deaths, according to provisional data from the CDC.
In Texas, drug poisoning-related deaths for 2022 sit at 15.4 per 100,000 people, which is the highest rate since at least 2011, according to provisional data from the Texas Department of State Health Services.
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Medicare Hospital Trust Fund to Stay Solvent Until 2036, Trustees’ Report Says
Posted on May 7, 2024 by Pharmaciststeve
Medicare Hospital Trust Fund to Stay Solvent Until 2036, Trustees’ Report Says
https://www.medpagetoday.com/publichealthpolicy/medicare/109997
Projection is 5 years longer than last year’s prediction
The Medicare Hospital Insurance Trust Fund is expected to remain solvent until 2036, 5 years longer than projected last year, the Medicare trustees said Monday in their annual report to Congressopens in a new tab or window, but they also expressed concern about low payment rates to physicians.
The longer hospital trust fund solvency is “largely due to greater income and lower expenditures than was projected last year,” a senior administration official said on a call with reporters. “Income was projected to be higher because the number of covered workers and average wages per worker were both projected to be higher than last year’s estimate.”
On the other hand, “expenditures were projected to be lower in the short-range period mainly as a result of a policy change to reduce Medicare Advantage spending,” the official said.
The long range actuarial deficit of the hospital trust fund is 0.35% of taxable payroll, “lower than last year’s estimate of 0.62%,” he said. “Two ways to reduce the deficit are to decrease outlays by 8% or increase the standard payroll tax rate” from 2.9% to 3.25%.
The trustees’ report covers two separate funds. The Medicare Hospital Insurance Trust Fund — also known as the Part A Trust Fund — pays for inpatient hospital care as well as hospice care and skilled nursing facility and home health services following hospital stays. The Supplemental Medical Insurance (SMI) Trust Fund pays for benefits under Medicare Part B — which includes physician services — and Medicare Part D, which is the prescription drug benefit.
The SMI Trust Fund is adequately financed into the indefinite future because it is financed by beneficiary premiums and federal funds that are automatically adjusted each year to cover costs for the upcoming year. In contrast, the Part A Trust Fund is financed by a variety of sources, including payroll taxes, a portion of the taxes on Social Security benefits, Part D state payments, Part B drug fees, and beneficiary premiums.
The Medicare board of trustees has six members: the secretaries of Labor, HHS, and Treasury; the Commissioner of Social Security; and two public trustees, although the public trustee positions have been vacant since 2015. The CMS administrator serves as the board’s secretary.
The Medicare trustees also found that Part B expenditures were $502.9 billion in 2023 and are expected to grow annually at an average of 7.7% for the next 5 years under current law. In 2024, the monthly Part B premium rate is $174.70 and is projected to increase to $185 in 2025, although that amount won’t be finalized until later this fall.
As for the Part D drug program, expenditures there stood at $131.1 billion in 2023 and are projected to grow at an average annual rate of 8.2% over the next 5 years, according to the report.
In comparison to the rosy overall forecast for the Hospital Insurance Trust Fund, the official warned that “uncertainty remains about adherence to current law payment updates, particularly in the long range,” adding that the concern “is more immediate for physician services, for which a negative payment rate update is projected in 2025, and updates are projected to be below the rate of inflation in all future years.”
In particular, the official told MedPage Today on the call, with a negative payment update anticipated for 2025 and 0.25% or 0.75% updates specified after that, which are “considerably lower than projected rates of inflation…, there’s a recognition that those updates are not going to meet up with expectations for provider costs, and that’s the concern that is raised.”
The trustees’ report includes an alternative scenario in which physician payment rates are raised in conjunction with the rate of increase in the Medicare Economic Index (MEI), a measure of healthcare inflation. Under that alternative — which likely would ease concerns about beneficiary access to physicians — “total Medicare expenditures would increase to 8.4% of GDP [gross domestic product] at the end of the long-range [75-year] projection period, as opposed to 6.2%” if current law doesn’t change, the official said. He noted that without changes to current law, “should payment rates prove to be inadequate for any service, beneficiary access to and quality of Medicare benefits would deteriorate over time.”
Raising physician payment rates in line with the MEI was also discussed by the Medicare Payment Advisory Commission (MedPAC) in its March report to Congressopens in a new tab or window. “Given recent high inflation, cost increases could be difficult for clinicians to continue to absorb,” the reportopens in a new tab or window said. “Yet current payments to clinicians appear to be adequate, based on many of our indicators. Given these mixed findings, for calendar year 2025, the commission recommends that the Congress update the 2024 Medicare base payment rate for physician and other health professional services by the amount specified in current law plus 50% of the projected increase in the MEI.”
“Based on CMS’s MEI projections at the time of this publication, the recommended update for 2025 would be equivalent to 1.3% above current law,” the report continued. “Our recommendation would be a permanent update that would be built into subsequent years’ payment rates, in contrast to the temporary updates specified in current law for 2021 through 2024, which have each increased payment rates for one year only and then expired.”
American Medical Association president Jesse Ehrenfeld, MD, MPH, said in a statementopens in a new tab or window Monday that “This report continues the drumbeat of recommendations that all point out that the payment system is failing patients and physicians. When physicians face a set of facts, we respond to improve the situation. It would be political malpractice for Congress to sit on its hands and not respond to this report.”
“Medicare trustees and MedPAC have teed up the issue for members of Congress who, no doubt, have heard from constituents about problems accessing healthcare under Medicare,” he added. “The AMA has plenty of reform ideas to permanently solve the problem and end this annual cycle of payment cuts and patches.”
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CDC Admits Its Opioid Prescribing Guidelines Have Hurt Chronic Pain Patients
Posted on May 7, 2024 by Pharmaciststeve
The CDC guidelines were not created by the CDC but by a dozen or so of “so-called experts” If these people on that committee were “experts” should they not have known that what they created -2016 CDC guidelines -potential to do harm? Could they be financially liable for all the harm that was caused directly & indirectly? I don’t know if the CDC paid those people on the committee – or they just volunteered to have the chance to put “their stamp/beliefs” on the chronic pain community. If they were paid… many were DOCTORS… The CSA states that no one can prescribe a controlled med without doing an in-person exam… While probably none on the committee directly treated pts, they used the perceived creditability of the CDC to convince the DEA, and VA to implement the guidelines as a standard of care and best practices and > 50% of our state legislators to codify these guidelines into law.
CDC Admits Its Opioid Prescribing Guidelines Have Hurt Chronic Pain Patients
https://themighty.com/topic/chronic-pain/cdc-opioid-guidelines-hurt-chronic-pain-patients/
On Wednesday, the Centers for Disease Control and Prevention (CDC) issued a clarification regarding the federal guidelines for opioid prescriptions that were put into place in 2016. The paper, published by CDC researchers in the New England Journal of Medicine, stated that many of the guidelines have been misapplied, causing serious harm to chronic pain patients.
The original prescribing guidelines were intended for primary care physicians treating adults with chronic pain (pain that lasts more than three months) outside of active cancer treatment, palliative care and end-of-life care.
“The guideline is intended to ensure that clinicians and patients consider safer and more effective treatment, improve patient outcomes such as reduced pain and improved function, and reduce the number of persons who develop opioid use disorder, overdose, or experience other adverse events related to these drugs,” the CDC wrote.
While many medical and health policy communities embraced the guidelines, CDC researchers said some clinicians and policy-makers have misinterpreted them, taking the recommendations too far.
The paper published this week reported that some physicians have encouraged “hard limits and abrupt tapering of drug dosages, resulting in sudden opioid discontinuation or dismissal of patients from a physician’s practice.” The guidelines have also been mistakenly applied to patients with pain associated with cancer, surgical procedures or sickle cell crises – patients who were not included in the original recommendations.
CDC researchers offered several examples of the ways in which their guidelines had been wrongly implemented. They wrote:
For example, the guideline states that ‘Clinicians should…avoid increasing dosage to ≥90 MME [morphine milligram equivalents]/day or carefully justify a decision to titrate dosage to ≥90 MME/day.’ This statement does not address or suggest discontinuation of opioids already prescribed at higher dosages, yet it has been used to justify abruptly stopping opioid prescriptions or coverage.
This misapplication can have major consequences for people with chronic pain. Researchers explained that forcing patients to abruptly taper their dosages can lead to opioid withdrawal, increased pain or other adverse psychological and physical outcomes. Too little is known about the benefits and harms of reducing high dosages of opioids in physically dependent patients for researchers to recommend this strategy to physicians.
Mighty contributor Chris Jolley was one of many people with chronic pain adversely affected by these misimplemented guidelines. In his essay “When a Doctor Forced Me to Taper Off Pain Medication,” he wrote:
I was with my pain doctor on the same medication for 20 years when the medications that control my chronic pain were stopped without my consent. …
I live in unbearable pain 24/7. I’m one of the many people in pain whose doctors have abandoned us and ignored our pleas for help. Many pharmacists profile us based on their perception of our appearance. Some will not even fill prescriptions from cancer patients.
I have disability benefits awarded by my government for intractable pain, yet I suffer discrimination and cannot get treatment for that pain. Until our government admits the epidemic is about street drugs like fentanyl and heroin and stops persecuting people in pain, there will be more and more deaths by overdose from street drugs and more pain patients suffering.
Since the CDC’s guidelines were published in 2016, the number of opioid prescriptions has decreased. In May 2018, SERMO, a social network for physicians, conducted a study of 3,000 physicians and found that seven out of 10 said they cut back on prescribing opioids or stopped prescribing them entirely in the last two years. When SERMO conducted the same study in 2016, six out of 10 doctors said they were cutting back.
Among doctors who had cut back, 22 percent said it was because there were “too many hassles and risks involved,” while 34 percent said chronic pain patients have been hurt by the reduction in opioid prescriptions.
Research has shown that limiting opioid prescriptions does not have an effect on the rates of death and addiction in the U.S. According to reports from the CDC, opioid deaths in the U.S. are rising, with a 9.6 percent increase from 2016 to 2017. But this increase is due to fentanyl, not prescription opioids.
Researchers said the CDC is examining the impact its 2016 guidelines have had on pain patients and will update them when new evidence is available. “Until then, we encourage implementation of recommendations consistent with the guideline’s intent,” they said.
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Doc Blows Whistle on Cigna
Posted on May 5, 2024 by Pharmaciststeve
Doc Blows Whistle on Cigna
https://www.medpagetoday.com/special-reports/features/109910
Cigna increased efforts to speed up claims denials using new software and performance measures that pressured medical directors to close cases without a full review, according to a ProPublica investigationopens in a new tab or window.
The insurance company reportedly pressured medical directors who fell behind in reviewing cases, and even threatened to fire them if they failed to work faster, according to Debby Day, MD, a medical director who worked at Cigna for more than 15 years.
Often, the company encouraged doctors to “cut and paste the denial language that the nurse had prepared and quickly move on to the next case,” according to Day. This practice became so common that Cigna employees took to calling the approach “click and close.”
The company reportedly measured the pace and total number of cases that each medical director closed, which involved a productivity dashboard that tracked performance. Day told ProPublica the only way to keep up with expectations was to “deny, deny, deny.”
But Day told ProPublica that she believed her work was too important to speed through. Medical directors at Cigna were given the responsibility to approve or reject payment requests for critical care such as complex surgeries. And while the insurance company was pressuring doctors to work faster, Day said the work of the nurses “was getting sloppy,” which made reviewing claims harder and more meticulous.
Cigna told ProPublica that medical directors are not permitted to “rubber stamp” nurse denials and the company expects case reviewers to “perform thorough, objective, independent, and accurate reviews in accordance with our coverage policies.”
Longevity Scientist Faces Blowback
A Harvard geneticist who became the face of the longevity movement has drawn increasingly harsh criticism for claiming his products can reverse aging, according to the Wall Street Journalopens in a new tab or window.
Last year, David Sinclair, PhD, faced backlash for posting on social media that a gene therapy invented in his lab and developed by his company, Life Biosciences, had successfully reversed aging in monkeys. He also claimed the therapy had restored vision in the monkeys.
Earlier this year, Sinclair reportedly said another company he co-founded had developed a supplement that had reversed aging in dogs, according to WSJ.
However, other longevity science experts called this an empty promise. There isn’t an accepted standard for measuring aging, let alone a definition of what it means to “reverse” it, they said. The criticism was paired with the resignations of scientists from the Academy for Health and Lifespan Research, a group that Sinclair co-founded and led. Of the roughly 60 members who resigned, one posted on social media that Sinclair was a “snake oil salesman.”
The Academy’s remaining board members called for Sinclair to step down as president, which he eventually agreed to do.
Sinclair made a name for himself by promoting scientific claims about his work that garnered interest from top-tier scientific journals as well as praise in the news and on social media. But he has increasingly drawn criticism for hyping his own research or promoting unproven products, especially when he stood to benefit financially.
“The data is not good, you’re calling it the wrong thing, and then you’re selling it,” Nir Barzilai, MD, the new president of the Academy and the director of the Institute for Aging Research at Albert Einstein College of Medicine in New York, told WSJ. “The selling is a step too far.”
Fertility Clinic Accidents
The growing fertility industry has been plagued by an opaque system that frequently hides major errors and accidents, according to a Washington Post investigationopens in a new tab or window.
Many fertility centers are not required to report errors or accidents, including lost or damaged embryos, to any government or professional oversight organization, the report found. The industry relies largely on self-policing, which means patients are rarely informed immediately after something has gone wrong.
The Post highlighted two accidents that resulted in the loss of thousands of eggs and embryos belonging to hundreds of individuals and couples. One accident in San Francisco involved the implosion of a cryopreservation tank that contained 4,000 eggs and embryos. Another incident in Cleveland resulted in the loss of 4,000 eggs and embryos after a similar storage tank failed.
Both incidents occurred over the same weekend in March 2018, the Post reported.
Industry representatives insisted that error rates are low, and experts told the Post that fertility practitioners are regulated similar to other medical disciplines. Patients are also able to use the courts to address mismanagement of genetic material, experts said.
In fact, the Alabama Supreme Court ruling that frozen embryos are children came during a dispute over the mishandling of human embryos. But experts claim that most lawsuits end in settlements with nondisclosure provisions reinforcing the secrecy around the fertility industry.
Still, Adam Wolf, a prominent attorney for fertility plaintiffs, told the Post that the “vast, vast supermajority of mistakes in fertility clinics, the public doesn’t even know about.”
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In Re: National Prescription Opiate Litigation transcript
Posted on May 3, 2024 by Pharmaciststeve
In Re: National Prescription Opiate Litigation
(Exhibit B – 3.28.24 hearing transcript)Related document(s)
It is only 160+ pages
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R.I.P. Robert Charles Foster: suicide by cop
Posted on May 3, 2024 by Pharmaciststeve
R.I.P.
Robert Charles Foster
Robert Charles Foster
Robert Charles Foster, a male from Oregon died by suicide. ‘(or as he phrased it, “suicide by cop”). Foster told the police during a previous suicide attempt, “I had been in chronic, constant pain, and was for whatever reason, not able to get the medication he needed for it.” He was 65 years old. He came out of a building with a gun, and would not drop it, on the command from the police. They shot and killed him – this was his intention.’
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Pain Management Physician Convicted of Unlawfully Distributing Opioids
Posted on May 3, 2024 by Pharmaciststeve
Notice in this DOJ press release, that they stated that individuals traveled hundreds of miles to obtain prescriptions for opioids and other controlled substances – one of those DEA RED FLAGS. Generally, RED FLAGS are policies that the DEA adopts from observing what many/addicts/diverters do. Let’s look at the simple math. Over a ~ 6-year period of time, Romano prescribed 137,000 doses of three controlled substances to 9 pts. 137,000/6 yrs = 22,833 doses given to 9 pts = 2,537 doses to each pt which equals ~ a total of 7 doses of those three meds daily – on average. That could break down to, 2 opioids a day, 4 muscle relaxants a day, and a benzodiazepine at bedtime for sleep. Not knowing the mgs of each med, this could be appropriate for many pts dealing with intractable chronic pain!
I noticed that there was no mention of any of his pts ODing/dying, and the pts were addicted to these medications. Do they know the difference between addiction and dependency when these categories of meds are appropriately prescribed long-term? It took 3 attorneys from the Criminal Division’s Fraud Section, “gin-up” 24 counts against Romano. Of course, each count could be worth 20 yrs in prison for Romano. Given Romano’s age (73 y/o), one count could end up being a LIFE SENTENCE, let alone the 480 yrs Romano is potentially looking at.
Pain Management Physician Convicted of Unlawfully Distributing Opioids
https://www.justice.gov/opa/pr/pain-management-physician-convicted-unlawfully-distributing-opioids-0
A federal jury in the Southern District of Ohio convicted an Ohio physician today for unlawfully distributing opioids from his clinic.
According to court documents and evidence presented at trial, Thomas Romano, 73, of Wheeling, West Virginia, owned and operated a self-named pain management clinic in Martin’s Ferry to which individuals traveled hundreds of miles to obtain prescriptions for opioids and other controlled substances. Romano charged $750 for an initial visit and $120 for subsequent monthly visits. The prescriptions Romano issued for opioids and other controlled substances greatly exceeded recommended dosages and were in dangerous, life-threatening combinations that fueled the addiction of the individuals to whom he prescribed. Between October 2014 and September 2019, Romano prescribed over 137,000 pills, including opioids, benzodiazepines, and muscle relaxants, to nine individuals.
The jury convicted Romano of 24 counts of unlawful distribution of a controlled substance, outside the usual course of professional practice, and not for a legitimate medical purpose to nine individuals. He faces a maximum penalty of 20 years in prison for each charge. A sentencing date has not yet been set. A federal district court judge will determine any sentence after considering the U.S. Sentencing Guidelines and other statutory factors.
Acting Assistant Attorney General Nicole M. Argentieri of the Justice Department’s Criminal Division, U.S. Attorney Kenneth L. Parker for the Southern District of Ohio, Special Agent in Charge Orville O. Greene of the Drug Enforcement Administration (DEA) Detroit Division, Special Agent in Charge J. William Rivers of the FBI Cincinnati Field Office, and Special Agent in Charge Mario M. Pinto of the Department of Health and Human Service Office of the Inspector General (HHS-OIG) made the announcement.The DEA, FBI, and HHS-OIG, as well as the Ohio Bureau of Worker’s Compensation and Ohio Board of Pharmacy, investigated this case.
Assistant Chief Alexis Gregorian and Trial Attorneys Devon Helfmeyer and Danielle Sakowski of the Criminal Division’s Fraud Section are prosecuting the case.
The Fraud Section leads the Appalachian Regional Prescription Opioid (ARPO) Strike Force. Since its inception in late 2018, ARPO has partnered with federal and state law enforcement agencies and U.S. Attorneys’ Offices throughout Alabama, Kentucky, Ohio, Virginia, Tennessee, and West Virginia to prosecute medical professionals and others involved in the illegal prescription and distribution of opioids. Over the past four years, ARPO has charged over 115 defendants, collectively responsible for issuing prescriptions for over 115 million controlled substance pills. To date, more than 60 ARPO defendants have been convicted. More information can be found at www.justice.gov/criminal-fraud/health-care-fraud-unit.
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Equal Protection Clause- another law on the books to protect chronic pain pts
Posted on May 2, 2024 by Pharmaciststeve
Equal Protection Clause
https://en.wikipedia.org/wiki/Equal_Protection_Clause
The Equal Protection Clause is part of the first section of the Fourteenth Amendment to the United States Constitution. The clause, which took effect in 1868, provides “nor shall any State … deny to any person within its jurisdiction the equal protection of the laws.” It mandates that individuals in similar situations be treated equally by the law.[1][2][3]
A primary motivation for this clause was to validate the equality provisions contained in the Civil Rights Act of 1866, which guaranteed that all citizens would have the guaranteed right to equal protection by law. As a whole, the Fourteenth Amendment marked a large shift in American constitutionalism, by applying substantially more constitutional restrictions against the states than had applied before the Civil War.
The meaning of the Equal Protection Clause has been the subject of much debate, and inspired the well-known phrase “Equal Justice Under Law“. This clause was the basis for Brown v. Board of Education (1954), the Supreme Court decision that helped to dismantle racial segregation. The clause has also been the basis for Obergefell v. Hodges which legalized same-sex marriages, along with many other decisions rejecting discrimination against, and bigotry towards, people belonging to various groups.
While the Equal Protection Clause itself applies only to state and local governments, the Supreme Court held in Bolling v. Sharpe (1954) that the Due Process Clause of the Fifth Amendment nonetheless requires equal protection under the laws of the federal government via reverse incorporation.
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