Top California doctors group seeks legislation to ensure pain prescriptions get filled

https://www.sacbee.com/news/state/california/article224581310.html

The California Medical Association is working to get legislation introduced — perhaps as early as this week — that will alleviate a problem with prescription forms that has pharmacists across the state rejecting patients who bring doctors’ orders for pain medications.

Many doctors say the problems began Jan. 2 after a new law went into effect the day before. That’s when they started receiving emails from pharmacies telling them that they had used an incorrect prescription form and that pharmacists couldn’t fill their orders until they received the correct form.

“I just got my new prescription pads (Monday) at a cost of several hundred dollars, and the change is trivial,” said Dr. Richard Buss, a family practice physician in Jackson. “At the hospital here, I was next to a doctor who was trying to send a patient home after knee surgery, and the pharmacy wouldn’t honor his prescription because they were old forms.”

The new law, known as Assembly Bill 1753, is intended to help keep opioid medications and other controlled substances out of the illicit drug trade. Carried by Assemblyman Evan Low, the measure allows the California Department of Justice to restrict the number of companies authorized to print prescription drug forms, and it requires that each form has a unique serialized number for tracking. Legislation in 2017 required other security measures for prescription forms.

Buss said the changes in the forms seem more like a change in format to him than an addition of meaningful new security measures. The old forms, he said, had serial numbers as well.

Gov. Jerry Brown signed the measure in September, but the California Medical Association told Attorney General Xavier Becerra in a letter dated Dec. 21 that updated forms were not available to physicians until the week of Dec. 17. The professional organization, which represents 43,000 doctors, said in the memo that it had concerns that doctors would not have enough time to acquire the new forms and implement the new protocols before the Jan. 1 deadline.

The Jan. 1 implementation “would result in a serious barrier to patients who must access necessary medications in a timely manner,” said Janus Norman, senior vice president for the CMA’s Center for Government Relations. He urged Becerra to work with the Medical Board of California and the California Board of Pharmacy to establish a transitional period allowing pharmacists to accept forms that do not comply.

Buss said he was frustrated because this is the second year in a row where he felt doctors were not given proper notification of changes needed in their prescription forms: “They’re just changing a prescription requirements, and then the doctors have to jump through the hoops suddenly, and I’m left with thousands of prescription blanks that are unusable, and that’s probably true for a lot of other doctors.”

No transition period was included as part of the legislation. In an email to The Sacramento Bee, Low stated that he is “committed to seeing that any legislative solution is signed into law immediately.”

On Tuesday, Anthony York, a spokesman for the California Medical Association, said the organization hoped to have legislation soon that would ensure a smoother transition to new prescription pads. He didn’t have details on the measure under consideration.

Buss said he believes that legislation affecting prescriptions should include a grace period in which pharmacists and printing companies alert doctors of the date on which their prior forms will expire.

The Medical Board of California said it tried to get the word out. On Dec. 28, it sent an email blast to all licensees notifying them of the new prescription form requirement for many controlled substances, and the agency posted messages that day about the new prescription form requirement on its Facebook and Twitter sites. On Jan. 10, it issued a joint statement with the Department of Justice and the pharmacy board.

In that statement, issued via email blast and the web, the agencies said none of them wanted to see patients denied access to necessary medications in the transition to new forms. To that end, the pharmacy board said in the statement, it would not make a priority of investigating pharmacists who determine it is in the best interest of a patient or public health to fill a prescription using last year’s prescription forms.

“Pharmacies have the option of accepting the (prescription forms) but people are so wary now of running afoul of the Board of Pharmacy that they’re just refusing them,” Buss said. “Even the prescription printers had no warning of this. There’s probably 20 to 30 organizations that print security prescriptions, and they were all rushing to get these things done.”

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The clampdown on opioid prescriptions is hurting pain patients

https://www.latimes.com/opinion/op-ed/la-oe-nicholson-opioids-20190118-story.html

In the summer of 1994, I was working at my desk at the Department of Justice when my back started to burn. Moments later, my body seized up, and I fell to the floor. Suddenly, at the age of 30, I was no longer able to sit or stand. I could barely walk short distances. These limitations, related to a surgical mishap, would continue for almost 20 years.

After dozens of failed treatments, I reluctantly tried prescription opioids. The pain medication enabled me to work despite my condition. I argued cases in federal court from a foldable reclining chair, negotiated settlements by video teleconference and, working remotely, managed litigation in U.S. attorney’s offices across the country.

When medical advancements led to an improvement of my health, I went off opioids without incident.

I was, as it turns out, incredibly lucky. A report released last month by Human Rights Watch paints a cautionary and at times harrowing picture of what pain patients are experiencing today.

The CDC needs to revise its guidelines to recommend that physicians not abandon pain patients or engage in “forced tapering.”
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Because of well-intended efforts to address the overdose crisis, many doctors are severely limiting opioid prescriptions. Patients who rely on opioid analgesics are being forcibly weaned off the medication or seeing their prescriptions significantly reduced. Other patients are unable to find doctors willing to treat them at all.

One such patient, Maria Higginbotham, has had more than a dozen surgeries to correct the collapse of her spine. She suffers from a painful condition in which the spinal cord fuses with adjacent membranes. Last year, her physician cut her pain medication by 75%, explaining that the reduction was to comply with federal guidelines.

In the past, Higginbotham could function. Now she needs assistance just to get out of bed and go to the toilet.

The federal guidelines Higginbotham’s doctor cited were issued in 2016 by the Centers for Disease Control and Prevention. They were intended as non-mandatory recommendations for primary care physicians.

Increasingly, the guidelines are treated not as recommendations, but as one-size-fits-all mandates. They are being misapplied by physicians, state legislatures, insurers and Medicaid programs.

Some physicians told Human Rights Watch researchers that they had taken patients off opioids, or reduced patients’ prescriptions, against their better clinical judgment. “You set yourself up for a liability, even when you know they’re not addicted and they’re benefiting from opioids,” one physician said.

Other doctors said that they had stopped treating pain patients altogether — even patients who don’t use prescription opioids.

It’s true that opioids were prescribed liberally in recent decades. Doctors began doing this in the 1990s. There were some bad actors, such as “pill mills” and wayward pharmacies. Opioid medication too often fell into the wrong hands.

Moreover, prescription opioids are not the magic bullet we once believed them to be. The evidence about their efficacy across a broad population is limited. Even when their use is appropriate, opioids carry risks, and the risks increase at higher doses. The CDC was right to encourage judicious, responsible prescribing.

But chronic pain is a large umbrella category, encompassing a wide range of injuries and diseases, some of which are incurable. A one-size-fits-all approach to treatment does not work.

The recent clampdown has had harmful consequences. Some patients told researchers that they were forced to quit working or go on disability when their medication was denied. Others are now homebound. Many mentioned the possibility of suicide.

Patients also said that they were turning to alcohol or illegal substances to treat their pain.

What began as an effort to protect patients may be morphing into one that is harming them. The CDC’s National Center for Health Statistics estimates that 50 million Americans have pain every day and nearly 20 million have pain that limits major life activities. If the experiences that patients described to Human Rights Watch are common, the harm to patients could be widespread.
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The CDC’s own data show that fatal overdoses are driven largely by illegally produced fentanyl, its analogs and heroin — not by medically prescribed opioids.

For all these reasons, the CDC should address the misapplication of its guidelines, as the American Medical Assn. recently did. The agency needs to revise its guidelines to recommend that physicians not abandon pain patients or engage in “forced tapering.”

The CDC should also study and address any unintended consequences of its 2016 guidelines, as it promised to do.

Tackling the overdose crisis is a vital public policy goal. But chronic pain patients should not become casualties in that fight.

Kate M. Nicholson is a civil rights and health policy attorney. She served for 20 years in the Department of Justice’s civil rights division, where she drafted current regulations under the Americans With Disabilities Act. She gave a TEDx talk about chronic pain, “What We Lose When We Undertreat Pain.”

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Doc, my son, has been in jail snce June 26, 2018. He will have to remain there until August of 2019, when the trial will begin. The DEA raided his office, his home and my home and stole jewellery of mine, without leaving a receipt. I consider them nothing but thieves, low life’s and liars. He is in jail, not because of any false charges they came up with, but because he had put a photo of the DEA agents on his computer to find out who had been telling the pharmacists he was under investigation. They, the DEA agent, convinced the judge that because doc had this photo of them, they were in mortal danger of their lives. It’s sickening how they lie and twist everything to suit themselves. The main reason for the raid I am convinced was to take all llhis assets, which they did, and left him with no assets to even hire a lawyer. Of course, this was intentional on their part, so that they may have a so called legal interest in clearing out his bank and investment account. The first thing on DEA web site that is what they are after is asset forfeiture. It is they who should be serving time in jail for theft.

Maybe this is why the DEA runs want ads like this:

Forfeiture Financial Specialist Supporting the DEA

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Rite Aid pays $177K to settle improper drug-dispensing allegations

https://www.beckershospitalreview.com/pharmacy/rite-aid-pays-177k-to-settle-improper-drug-dispensing-allegations.html

Retail pharmacy chain Rite Aid will pay $177,000 to resolve allegations that it violated Massachusetts law by accepting cash payments from Medicaid recipients for controlled substances instead of billing the agency “in a limited number of instances,” according to The Boston Globe.

The lawsuit, brought by Massachusetts Attorney General Maura Healey, claims that in some cases Medicaid had denied a claim for a controlled substance like opioids, and a Rite Aid pharmacist dispensed the medication anyway for cash.

Rite Aid denied violating state law and told The Globe that the settlement  is to avoid the uncertainty and expense of litigation.

Under the settlement arrangement, Rite Aid also agreed to train all pharmacy staff about Medicaid regulations and require all pharmacists to consult the state’s prescription monitoring program before dispensing controlled substances.

A similar agreement was reached in 2016 and 2017 with CVS and Walgreens, which also were accused of violating controlled substance drug-dispensing rules.

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https://youtu.be/VrTbpHJucYM

Too tired & suffering too much pain fog to share or even describe this video explaining #Starburst🚀 & the importance of all Americans filing the Motions to Join. Plz watch & share far & wide as it is appropriately named

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Chitty Chitty Bang Bang!

Ohio is filed! Case #5:19-cv-133

Makes EIGHT in EIGHT STATES! How much longer can mass media ignore?

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https://www.wfla.com/1706691547

St. Petersburg, Fl. (WFLA) – 77 year old Ruth Jones was a patient at the Laurellwood Nursing Center in St. Petersburg for 3 years.

She suffered from Alzheimer’s.

Osteoporosis fractured vertebrae leaving her in constant and severe pain which can often be overcome by QC Kinetix (Shoney) clinic.

Her daughter Cindy Harris volunteered at Laurellwood until an illness in 2018 kept her away for a few months.

When she returned in August, patients she knew told Cindy that her mother cried all the time.

Cindy provided 8 On Your Side records that show, 2 months earlier, in May, a doctor at Laurellwood discontinued Ruth’s pain killing drug, Percocet, the only pain medication that really helped her.

“They never informed me that they were going to withdraw that medication,” Cindy said. “77 years old and they let her pain get so bad that she had to holler for an entire day and night, it’s inhumane.”

According to Cindy, Laurellwood insisted that she take her mother to a doctor where she could get a new pain medication prescription.

Unable to sit up, Ruth made what turned into a grueling trip by ambulance.

“She was crying all the way up to the office on the stretcher, she was in so much pain,” Cindy tearfully explained. “Every time I think about it, my heart hurts for her.”

The pain management office Cindy and Ruth went to didn’t have a bed to accomodate Ruth.

Ruth was in such agony the doctor recommended she be taken to a hospital emergency room.

There, hospital staff discovered a bed sore.

“Nursing homes have an obligation to provide patients the best care possible,” Brian Lee, executive director of Families for Better Care said.

Lee, the former Ombudsman for the state of Florida points out that nursing homes must also make sure that patients do not endure hardships when seeking assistance.

If there was no bed at the pain clinic to accommodate Ruth, Brian Lee says it is obvious the nursing home did not help coordinate the visit and was not looking out for the patient’s best interests.

Earlier this month 8 On Your Side profiled Tonya Baker’s complaints about Laurellwood.

Tonya showed us pictures of her father’s bed sore.

She complained to the Department of Children and Familes, Florida’s Agency for Health Care Administration and Elder Abuse.

DCF confirms it is investigating Tonya’s complaints.

Once Ruth was stabilized at the hospital in August, she returned to Laurellwood for another two months.

On the day she was moved to hospice, Cindy says she learned that Laurellwood had run out of Percocet a week before.

“They didn’t notify me,” Cindy added. “I had no idea.”

I reached out to Laurellwood this morning.

The telephone rang and rang, no one picked up.

Later in the day I was told no one was available to answer my questions.

Ruth moved to hospice in November and passed away 3 days later.

“I told my sister, after what I saw, don’t ever let me go into one of these homes, don’t let it happen,” Cindy explained. “If I’m an Alzheimer’s take me down the street and let me walk into traffic. I would never want to go through what she went through.”

If you know of something that you think should be investigated call our 8 On Your Side Helpline at 1 800 338-0808.

Contact Steve Andrews at sandrews@wfla.com

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Who else attended the Webinar for the HHS today? I asked 3 questions-1. Are they going to address the DEA problem that is scaring the doctors’ so badly? 2-Can they ask the FDA & the CDC to study chronic & intractable pain patients who have successfully taken opioids for years because no one has studied us. & 3. Even though medical marijuana is legal is WA state, we are not allowed to use it if we go to a pain clinic. Are their other states with this problem? & this also goes to stigma-being treated like an addict-will they add this to their stigma section? Many people addressed the DEA question & the moderator said that the best response was to support the HHS report and work through your legislature and contact your Senators in WA DC by phone. The more noise we make as constituents (voters) the better chance we have at changing things. No answer on the other 2 questions-maybe they will address them later. I was unable to hear the moderator responding to questions after the webinar was ended so I don’t know what questions were answered. Anybody else hear that part of the broadcast? Anybody else submit questions?

I have posed this question before and it would seem like those on this HHS webinar today… has just confirmed my fear/suspicions… The DEA is/has been no where around when all these various Fed/State groups are trying to – at least – put up the front that they are trying to help the chronic pain community and getting some adequate pain management.

I just wonder if it is a indication that the DEA is going to keep on as business as usual… targeting innocent prescribers, raiding their offices and confiscating their assets.

Will the DEA be encouraged or discouraged if Louisiana Republican Senator Bill Cassidy proposed that money seized from Mexican drug cartels get signed into law to build “the wall” ?  https://www.wndu.com/content/news/GOP-senator-suggests-using-drug-cartel-money-for-border-wall-504325111.html

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A few days ago I made the following posts and since then the number of page views on my blog as jumped substantially and I have notice a few more people are sharing my posts.

Liking vs Sharing on FACEBOOK

I guess this means that I/we are getting more people “educated” on what is going on good (Robt Rose’s lawsuit) and the bad (suffering and suicides) in/around the chronic pain community.

I don’t make a penny off a page view, in fact… I may have to pay my ISP a few more $$$ per month to add RAM to the buffer on my blog to handle the increased internet traffic… NO BIG DEAL… if we educate more in what those in the chronic pain are dealing with and get more chronic painers to ADVOCATE.

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