For Profit Hospice and owner/account gave orders about which drugs patients should receive, how much, and when they should die ?

Posted on June 16, 2018 by Pharmaciststeve

Ex-Hospice Manager Pleads Guilty in $60M Fraud Scheme

https://www.nbcchicago.com/news/national-international/Ex-Hospice-Manager-Admits-Scheme-to-Drug-Patients-to-Hasten-Their-Deaths-485624571.html

A former manager of a North Texas hospice has pleaded guilty to health care fraud, admitting her role in a $60 million scheme that involved drugging patients to “hasten their deaths,” according to court documents.

Jessica Love was the registered nurse case manager and regional director for Novus Health Services from 2012 until 2014. She faces up to ten years in prison and a $250,000 fine.

Love is now expected to testify against Novus’ owner, Bradley Harris, and 13 others, including four nurses and five doctors who also were charged in the FBI investigation. Agents searched Novus’ Frisco offices in September 2015.

Love said Harris, an accountant with no medical training, gave orders about which drugs patients should receive, how much, and when they should die.

Love detailed her role in a court document known as a factual resume. She accused Harris of personally directing patient care.

“These directions included Bradley Harris instructing nurses to intentionally over-medicate beneficiaries with medications such as hydromorphone and morphine with the intent to hasten their deaths,” Love said. “Harris ordered these increases in medication because he wanted the beneficiaries to die.”

Medicare and Medicaid pay more for patients who are on 24-hour “continuous care,” but according to a complicated formula, hospice owners lose money if patients remain on continuous care too long.

Love explained how doctors she recruited participated in the scheme by signing blank prescription forms and falsely claiming they had seen patients face-to-face.

Love’s admission included quotes of text messages between her and another nurse who was known to “do it right” when Harris wanted a patient to die.

Love admitted her orders to the nurse included “turning off the beneficiary’s oxygen, increasing the Ativan and Morphine, and turning the beneficiary on their left side.”

Love said in a text message, the technique “works like a little charm,” the document said.

The patient died within five hours, according to Love’s admission.

The court document quoted the nurse texting Love: “Ya know, I was thinking, (patients) are sometimes on (continuous care) for days before I come in. And they almost always pass before my first shift ends. What does that say about me? Lol.”

Love responded: “That your (sic) a great nurse,” adding a symbol for a smiley face.

The court document also details how Harris and his wife Amy, who also is charged, kept blank “Do Not Resuscitate,” or DNR, forms, so they wouldn’t have to pay for an ambulance if someone called 911.

Love is the second defendant in the case to plead guilty. Just last month, former Novus operations director Melanie Murphy admitted her role.

The others have pleaded not guilty. A trial in federal court in Dallas is scheduled for January. Love’s sentencing date hasn’t been set. 

The FBI search warrant on Novus’ offices said Harris, the owner, once texted a nurse, “You need to make this patient go bye-bye.”

Filed under: General Problems | Leave a Comment »

A Bad Bill That Won’t Fight Opioid Addiction

Posted on June 15, 2018 by Pharmaciststeve

https://www.painnewsnetwork.org/stories/2018/6/15/bad-policy-in-the-name-of-fighting-opioid-addiction

(Editor’s note: Last month, PNN reported on the “Post-Surgical Injections as an Opioid Alternative Act,” one of dozens of bills Congress is considering to combat the opioid crisis. HR 5804 would raise Medicare’s reimbursement rate for epidurals and other spinal injections used to treat post-surgical pain. The bill – which was lobbied for by doctors who perform the procedures – has drawn little public scrutiny and was rushed through a congressional committee after one brief hearing.)

By Denise Molohon, Guest Columnist

Raising the reimbursement rate for post-surgical spinal injections would dramatically increase healthcare costs and disability rates. This is based on historical research and medical evidence.

A harmful procedure should never be considered a “standard of care” by the medical profession. Yet that is what has happened with epidural steroid injections (ESIs) and Congress is going along with it under the guise of preventing opioid addiction.

“In the United States, more than ten million epidural steroid injections are delivered each year, a number that makes them the bread and butter of interventional pain management practices,” wrote Cathryn Jakobson Ramin, author of “Crooked: Outwitting the Back Pain Industry and Getting on the Road to Recovery.” 

The National Health and Medical Research Council of Australia warned in 1994 that the risk of a dural puncture of the spinal cord during an injection was at least 5 percent. It also cautioned that “particular care must be taken if attempting an epidural injection in patients previously treated by spinal surgery.”

US Capitol.jpg

In such cases, an epidural steroid injection (ESI) carries a very high risk of direct entry into the subarachnoid space, which can have catastrophic consequences to a patient, including the development of Adhesive Arachnoiditis, a chronic, painful and disabling inflammation of spinal nerves. I live with that condition, along with a growing number of other patients.

“The incidence of arachnoiditis has risen about 400% in the past decade,” says Forest Tennant, MD, Editor Emeritus of Practical Pain Management.

Between 2000 and 2011, there was a staggering 665% increase in the rate of lumbar and sacral epidural injections among Medicare beneficiaries. The data also show that there were enormous increases in spinal injections performed by physical medicine and rehabilitation specialists.

“We are doing too many of these, and many of those don’t meet the proper criteria,” Dr. Laxmaiah Manchikanti told The New York Times in 2012.  Manchikanti runs a pain clinic in Paducah, KY and is chairman of the American Society of Interventional Pain Physicians – which lobbied for HR 5804 and gave campaign contributions to its sponsors. He told The Times about 20 percent of doctors who perform ESIs are not adequately trained.

The growing use of spinal injections has not resulted in better care. Dr. Richard Deyo, a professor of family medicine at Oregon Health and Science University, told the The Times that “people with back pain are reporting more functional limitations and work limitation, rather than less.”

HR 5804 is more bad policy piling on top of an already failed campaign of opioid legislation — much of it based on misinformation provided by the CDC — that will perpetuate the tsunami of needless pain and overdose deaths. 

It needs to stop. Today. 

When profit is one of the major motivating factors of those seeking new legislation, those creating the legislation and those lobbying for it need to be questioned. Profitability should never play a factor in any treatment plan. However, it now seems to dominate the American healthcare system from diagnosis to testing to medication. 

This needs to change.

Medicine needs to be removed from the hands of lobbyists, PAC’s, and politicians and put back into the hands of the personal physician and his or her patient. It should be as individualized and unique as the medical needs of each patient. 

It truly is that simple. 

Neither the FDA nor the founder (Upjohn) of the drug Methylprednisolone recommends this medication to be used in ESI’s.  And according to the 1994 Australia study…  and the number of ESI given every year… we can expect abt 500,000 new pts developing Adhesive Arachnoiditis… which results in the pt becoming a intractable chronic pain pts.. which is IRREVERSIBLE !!!  So Congress – in an attempt to address the pseudo opiate addiction crisis – is causing the potential of 500,000 pts to be in need of 24/7 opiate therapy…. just the opposite effect that Congress of what is the apparent attempt of Congress..

This is an election year… and one has to wonder how much money had to change hands to get this bill passed by the House ?

Just remember that all 435 members of Congress are up for re-election in November- except those that have chosen to not run and jump ship before it sinks 🙂

Hopefully, when the bill gets to the Senate… the Democrats… who have not agreed to vote with the Republicans… will continue on this bill… and it will fail to get passed

Filed under: General Problems | Leave a Comment »

CDC Report Ignores Suicides of Pain Patients

Posted on June 15, 2018 by Pharmaciststeve

https://www.painnewsnetwork.org/stories/2018/6/7/cdc-report-ignores-suicides-by-pain-patients

The suicide rate in the United States continues to climb, with nearly 45,000 people taking their own lives in 2016, according to a new Vital Signs report by the Centers for Disease Control and Prevention.

The suicide rate in the U.S. is so high it rivals the so-called “opioid epidemic.” The number of Americans who died by suicide (44,965) exceeds the overdose deaths linked to both illicit and prescription opioids (42,249).  The nationwide suicide rate has risen by over 30 percent since 1999.

“Unfortunately, our data shows that the problem is getting worse,” said CDC Deputy Director Anne Schuchat, MD. “These findings are disturbing. Suicide is a public health problem that can be prevented.”  

Contrary to popular belief, depression is not always a major factor in suicides. The report found that less than half of the Americans who died by suicide had a diagnosed mental health issue. Substance abuse, physical health problems, and financial, legal or relationship issues were often contributing factors. So was the availability of firearms, which were involved in nearly half of all suicides.

But while CDC researchers can go into great detail about the methods, causes, demographics, ethnicity and even the drugs used by suicide victims, they did not investigate anecdotal reports of a growing number of suicides among pain patients.

“Our report found that physical health problems were present in about a fifth of individuals as circumstances considered to lead up to suicide,” Schuchat said in a conference call with reporters. “That doesn’t differentiate whether it was intractable pain versus other conditions that might have been factors.”

CDC_site_pic.jpg

Asked directly if lack of access to opioid medication may be contributing to pain patient suicides, Schuchat said that federal agencies were “working on comprehensive pain management strategies,” but they were not investigating patient suicides, such as the recent tragic death of a Montana woman.

“We don’t have other studies right now. But I would say that the management of pain is a very important issue for the CDC and Health and Human Services,” she said.

PNN asked a CDC spokesperson if the agency was conducting any studies or surveys to determine whether the CDC’s 2016 opioid guideline was contributing to patient suicides, and what impact it was having on the quality of pain care. The boilerplate response we received essentially said no, and that the CDC was only tracking prescriptions. 

“Through its quality improvement collaborative and its work with academic partners, CDC is evaluating the impact of clinical decisions on patient health outcomes by examining data on overall opioid prescribing rates, as well as measures such as dose and days’ supply, since research shows that taking opioids for longer periods of time or in higher doses increases a person’s risk of addiction and overdose,” Courtney Leland said in an email.

As PNN has reported, the CDC’s guideline may be contributing to a rising number of suicides in the pain community.  In a survey of over 3,100 pain patients on the one-year anniversary of the guideline, over 40 percent said they had considered suicide because their pain was poorly treated.

Most patients said they had been taken off opioids or had their doses reduced to comply with the  CDC guideline, which has been widely adopted throughout the U.S. healthcare system. Many patients say they can’t even find a doctor willing to treat them.

‘Making Plans to End This Life’

“I am scared to death as pain for me is unbearable. If I cannot get a prescription for relief I will probably be one of those (suicide) statistics because as far as I’m concerned, my quality life would be gone and no longer worth living. I will be sure to leave a note telling the CDC to go to hell too,” one PNN reader said.

“If my life is reduced to screams of agony in my bed while my father has to watch, if that happens and I can’t take anymore suffering, I will leave a note (probably a very long one), and in it I will say that the people who are making these guidelines into law, should be charged with my homicide,” another patient wrote.

“My suicidal ideation has increased exponentially. I have now resorted to cutting and punishing myself in order to distract from the physical chronic pain I suffer with,” said another patient. “I am struggling terribly and can’t even get sleep. I have been making plans to end this life and if the pain continues without treatment, it will not be hard to do.”

“My wife has been talking about suicide as the only option to escape her chronic pain and migraine headaches. I am starting to think the same thoughts,” wrote a man who also suffers from chronic pain. “Many chronic pain patients left without a doctor or opiate painkillers will commit suicide to escape the pain and suffering. My wife and I included.”

British Columbia Revising Its Guideline

The Canadian province of British Columbia was one of the first to adopt the CDC guideline as a standard of practice for physicians. In April 2016, British Columbia declared a public health emergency because overdose deaths from illicit fentanyl, heroin and prescription drugs were soaring. In response, the College of Physicians and Surgeons of British Columbia released new professional standards and guidelines that were closely modeled after the CDC’s.

Two years later, the British Columbia guidelines are now being revised because too many patients were being denied care or abandoned by doctors fearful of prescribing opioids.

“Physicians cannot exclude or dismiss patients from their practice because they have used or are currently using opioids. It’s really a violation of the human rights code and it’s certainly discrimination and that’s not acceptable or ethical practice,” college registrar Heidi Oetter told The Globe and Mail.

Under the old guidelines, British Columbia doctors were strongly encouraged to keep opioid doses below 90 milligrams of morphine a day – the same recommendation as the CDC’s. Now they’re being told to use their own discretion and to work with patients in finding an effective dose.

“Hopefully it’s clear to physicians that the college is really expecting that they exercise good professional discretion, that they are really engaging patients in informed consent discussions and that patients are really aware of the potential risks that are associated with opioids, particularly if they’re taking them in conjunction with alcohol or sedatives,” Oetter said.

Not only were the old guidelines harmful to patients, they were ineffective in reducing overdoses. British Columbia still has the highest number of overdoses in Canada, with 1,448 deaths last year.

Overdoses also continue to soar in the United States – mostly due to illicit fentanyl and other street drugs. Will the CDC change its guideline — as promised — because it is harming patients and failing to reduce overdoses?

“CDC will revisit this guideline as new evidence becomes available,” the agency said in 2016. “CDC is committed to evaluating the guideline to identify the impact of the recommendations on clinician and patient outcomes, both intended and unintended, and revising the recommendations in future updates when warranted.”

Today’s report on suicides indicates the agency has no plans to do either.

Filed under: General Problems | 4 Comments »

Here’s The Opioid Crisis the News Isn’t Talking About

Posted on June 15, 2018 by Pharmaciststeve

www.lifenews.com/2018/02/23/heres-the-opioid-crisis-the-news-isnt-talking-about/

We are members of Not Dead Yet, a national grassroots disability rights organization, and some of us are living with chronic pain ourselves. Based on our knowledge of the disability community through personal experience and through our work, we have not seen disabled people with chronic pain experiencing opioid use disorder. What we are seeing is many disabled people who are suffering due to the lack of access to opioid medication[2]  previously available as part of comprehensive strategies and approaches to address chronic pain. They are experiencing an increase in chronic pain and other symptoms associated with that pain. Disabled people and others with chronic pain are rarely the ones who are abusing opioids,[3] but they are the ones who are having to deal with chronic pain symptoms without access to medications that made this pain more tolerable.

That is not to say that some disabled people will not have opioid use disorder. However, from our observation, chronic pain is not a causal factor[4] in who has abused opioids. Instead, opioids are a mitigating factor in how independent those with chronic pain are able to be. Having to deal with chronic pain with no relief, when opioid medication prevented such pain, can greatly affect the quality of life[5] disabled people with chronic pain have. It can affect their ability to perform activities of daily living. It can affect their ability to sleep. It can affect their mood. It can affect their productivity. Those with chronic pain that is untreated or mistreated are more likely to be depressed,[6] and depression itself can also be linked[7] to physical pain. Being depressed and in pain can also make disabled people more susceptible to suicidal ideation,[8] especially when there is seemingly no relief to the long-term pain they experience.

For some disabled people, opioids are the only medication or treatment that can help their pain. Now, those who have chronic pain are treated with suspicion,[9] as though they are abusing opioids, especially by medical personnel at doctors’ offices and hospitals when they seek out this medication. Doctors are increasingly afraid and unwilling[10] to prescribe opioids, so instead of continuing effective treatment for those who have seen great benefits from using these medications, too often doctors are essentially abandoning those who truly need access to opioids.

Opioid abuse is a problem, but it is not a problem for the overwhelming majority[11] of the disability community or others with chronic pain. It’s a problem for those who have already been abusing these medications. Those are typically not people who need these medications to handle long-term chronic pain.

Yet, as sometimes misguided approaches to addressing the opioid crisis are hastily undertaken across the country, the very individuals, who benefit greatly in terms of health and productivity from continued opioid use as part of a comprehensive pain management strategy, are the people who face the most scrutiny and harm by not having access to medically necessary and appropriate medication.

HHS/ACL must recognize the harmful effects of a misguided crackdown on the legitimate use of opioids for chronic pain, educate state governments and providers about research on this issue, and discourage federal, state and local programs that do more harm than good in addressing the opioid crisis.

Follow LifeNews.com on Instagram for pro-life pictures and the latest pro-life news.

[1] https://www.acl.gov/sites/default/files/about-acl/2018-01/Final_RFI_Opioid_Use_Disorder_PwD_Jan2018.pdf
[2] Andrew Rosenblum, et al., Opioids and the Treatment of Chronic Pain: Controversies, Current Status, and Future Directions (2008)https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2711509/
[3] Maia Szalavitz, Opioid Addiction Is a Huge Problem, but Pain Prescriptions Are Not the Cause (Scientific American, May 10, 2016)https://blogs.scientificamerican.com/mind-guest-blog/opioid-addiction-is-a-huge-problem-but-pain-prescriptions-are-not-the-cause/
[4] Michael A, Yokell, et al., Presentation of Prescription and Nonprescription Opioid Overdoses to US Emergency Departments (Jama Intern Med, Dec 2014)https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1918924
[5] McCarberg BH, et al., The impact of pain on quality of life and the unmet needs of pain management: results from pain sufferers and physicians participating in an Internet survey (Am J Ther 2008) https://www.ncbi.nlm.nih.gov/pubmed/18645331
[6] Bair MJ, et al., Depression and pain comorbidity: a literature review, (Arch Intern Med, Nov 2003) https://www.ncbi.nlm.nih.gov/pubmed/14609780
[7] Madhukar H. Trivedi, M.D., The Link Between Depression and Physical Symptoms (Prim Care Companion J Clin Psychiatry, 2004)https://www.ncbi.nlm.nih.gov/pmc/articles/PMC486942/
[8] Beverly Kleiber, et al., Depression and Pain (Psychiatry, May 2005) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3000181/
[9] Chronic pain patients say opioid crackdown is hurting them (Chicago Tribune, June 5, 2017) http://www.chicagotribune.com/lifestyles/health/ct-opioid-patients-backlash-met-20170603-story.html
[10] Kelly K. Daneen, et al., Between a Rock and a Hard Place: Can Physicians Prescribe Opioids to Treat Pain Adequately While Avoiding Legal Sanction? (Am J Law Med 2016)https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5494184/

[11] Nobel M, et al., Opioids for long-term treatment of noncancer pain (Cochrane, Jan 2010) http://www.cochrane.org/CD006605/SYMPT_opioids-long-term-treatment-noncancer-pain

Filed under: General Problems | Leave a Comment »

First-Ever Ketamine Guidelines for Acute Pain Management Released

Posted on June 15, 2018 by Pharmaciststeve

Evidence supports the use of intravenous (IV) ketamine for acute pain in a variety of contexts, including as a stand-alone treatment, as an adjunct to opioids, and, to a lesser extent, as an intranasal formulation, according to the first guidelines on the use of ketamine for acute pain management.

Ketamine has captured headlines recently for its potential role in treating severe depression and posttraumatic stress syndrome. Ketamine is also increasingly being used in inpatient and outpatient settings to manage acute pain.

One driving force behind this is the growing effort to reduce the risk for long-term opioid use after acute exposure and its subsequent complications, including addiction. Yet, to date, few recommendations have been available to guide this emerging acute pain therapy.

“The goal of this document is to provide a framework for doctors, for institutions and for payers on use of ketamine for acute pain, who should get it and who should not get it,” guideline author Steven Cohen, MD, from Johns Hopkins School of Medicine in Baltimore, Maryland, told Medscape Medical News.

Reduced Need for Opioids

Development of the guidelines on use of ketamine for acute pain was a joint effort spearheaded by the American Society of Regional Anesthesia and Pain Medicine and the American Academy of Pain Medicine, which approved the document, as did the American Society of Anesthesiologists’ Committees on Pain Medicine and Standards and Practice Parameters.

The guidelines state that subanesthetic ketamine infusions should be considered for patients undergoing painful surgery and may be considered for opioid-dependent or opioid-tolerant patients undergoing surgery.

Ketamine may be considered for opioid-dependent or opioid-tolerant patients with acute or chronic sickle cell pain. For patients with sleep apnea, ketamine may be considered as an adjunct to limit opioids, the guidelines note.

The use of ketamine in subanesthetic doses has “exploded and there definitely seems to be a strong signal that ketamine is effective for acute pain, and a lot of patients don’t have other options,” Cohen commented.

On dosing, the guidelines recommend that ketamine bolus doses do not exceed 0.35 mg/kg and that infusions for acute pain generally do not exceed 1 mg/kg per hour in settings without intensive monitoring. The authors acknowledge that individual pharmacokinetic and pharmacodynamic differences, as well as other factors, such as prior ketamine exposure, may warrant dosing outside this range.

The guidelines also state that moderate evidence supports use of subanesthetic intravenous ketamine bolus doses (up to 0.35 mg/kg) and infusions (up to 1 mg/kg per hour) as adjuncts to opioids for perioperative analgesia.

Ketamine should be avoided in people with poorly controlled cardiovascular disease, those with active psychosis, and pregnant women.

For hepatic dysfunction, evidence supports that ketamine infusions should be avoided in individuals with severe disease and used with caution, with monitoring of liver function test results before infusion and during infusions in surveillance of elevations in individuals with moderate disease. Ketamine should be avoided in individuals with elevated intracranial pressure and elevated intraocular pressure.

“Powerful, Inexpensive” Tool

The guidelines state that intranasal ketamine is beneficial for acute pain management; it provides not only effective analgesia but also amnesia and procedural sedation.

Scenarios in which this should be considered include individuals for whom IV access is difficult and children undergoing procedures.

For oral ketamine, the evidence is “less robust, but small studies and anecdotal reports suggest it may provide short-term benefit in some individuals with acute pain,” the authors say.

They found only “limited” evidence to support patient-controlled IV ketamine analgesia as the sole analgesic for acute or periprocedural pain. However, there is moderate evidence of benefit of the addition of ketamine to opioid-based IV patient-controlled analgesia for acute and perioperative pain management, the authors note. When a person receives an IV drip therapy, they’re receiving a liquid mixture of vitamins and minerals through a small tube inserted into a vein. This allows the nutrients to be absorbed quickly and directly into the bloodstream, a method that produces higher levels of the vitamins and minerals in your body than if you got them from food or supplements. This is because several factors affect our body’s ability to absorb nutrients in the stomach. Factors include age, metabolism, health status, genetics, interactions with other products we consume, and the physical and chemical makeup of the nutritional supplement or food. Higher levels of the vitamins and minerals in your bloodstream lead to greater uptake into cells, which theoretically will use the nutrients to maintain health and fight illness.

They conclude that “despite its drawbacks, ketamine remains a powerful and inexpensive tool for practitioners who manage acute pain. We believe its use will continue to expand as more institutions treat increasingly challenging patients in the perioperative period as well as those with painful disease exacerbations while trying to combat the opioid epidemic.”

They say more research is needed to “refine selection criteria for the treatment of acute pain and possible prevention of chronic pain, to determine the ideal dosing and treatment regimen to include coadministration of ketamine with opioids and adjuvants, and to better understand the long-term risks of ketamine in patients who receive serial treatments for frequent acute pain exacerbations.”

This research had no commercial funding. The authors have disclosed no relevant financial relationships.

Reg Anesth Pain Med. Published online June 7, 2018. Abstract

 

Filed under: General Problems | 7 Comments »

Doctor has DEA license suspended because he didn’t have access to computer

Posted on June 15, 2018 by Pharmaciststeve

Doctor at opiate treatment center in Limestone loses license

http://www.bradfordera.com/news/doctor-at-opiate-treatment-center-in-limestone-loses-license/article_031e44d6-7046-11e8-bcb0-af8b955a5884.html

A doctor who had been operating an opiate treatment center for several months in the Town of Carrollton Municipal Complex in Limestone, N.Y., has voluntarily surrendered his license to prescribe narcotics to patients at the facility.

Dr. Reed Haag confirmed that he had his license recently suspended by the New York Division of the Drug Enforcement Administration (DEA). Haag said he lost his license due to a technical issue.  

Haag, who also has an office in Wellsville, had decided to open the office in Limestone last year to better serve patients from communities that include Limestone, Olean and Salamanca, as well as Bradford, Smethport and Warren in Pennsylvania.

Edward Orgon, resident agent in charge with the DEA in Buffalo, said agents conducted “enforcement action” May 31 at Haag’s office in Wellsville, resulting in the license suspension.

He said Haag can reapply for his license, but the decision of reinstatement would likely be up to the Medical Board of New York State.

“He can reapply, but he’ll have to go through a procedure,” Orgon said of Haag. “It will probably be a lengthy process — he could get it back, but he could never get it back.”

Special agent Erin Mulvey, who serves as the public information officer for the DEA, also confirmed that Haag had voluntarily surrendered his license following the agents’ visit.

In commenting on the issue, Haag said that while working at the Limestone center one day a week, he didn’t have access to a computer in that office.

“What I would do is call the nursing manager (at the Wellsville office) and she would electronically (process) the prescription,” Haag said, claiming the nurse kept well-documented records for the prescriptions. “The DEA found out I was in one place, but the prescriptions were coming from another and they said that was a no-no. They did pull my ability to prescribe narcotics.”

Haag said when he explained the situation to the DEA, he was told he had made a “stupid mistake” and let him reapply for his license a couple of weeks ago.

“How long it’s going to take (for a new license) I’m not sure,” Haag said. “But what I’m also doing is trying to find another provider to work with me.”

He said if another professional did come on board, he would hope to work in collaboration with the individual, who could electronically process prescriptions after he reviewed the patient’s history, physical information and urine/blood screens.

“I’ve been calling the patients and (conveyed) that things are still up in the air and that I’m not 100 percent sure” of the outcome, he added. “I don’t know what’s going on with regard to my reapplying for my ability to prescribe.”

Haag said if all goes well, he is hopeful to receive a new license within two to three weeks.

“There are so many physicians who have lost their licenses for stupid reasons, like diverting drugs to other people or taking drugs themselves,” he continued. “The only thing I did was I didn’t have access to a computer, so I called my nurse (in Wellsville) to take care of the prescriptions.”

Haag noted he didn’t lose his physician’s license, therefore he could see patients for other maladies, such as high blood pressure or other medical issues.

“The only thing I can’t do is prescribe controlled substances like oxycontin, valium or things like that,”  he explained.

Haag said he didn’t visit the Limestone center this week and instead called his patients and cancelled the appointments.

“There is a website and a phone number I’m giving (the patients) where they can find providers near them,” Haag added, noting the website is www.insupport.com. When the individuals provide a zip code they will learn of providers near them. Haag said there are several area physicians who have indicated they can accept his Pennsylvania and New York state patients.

On a final note, Haag said that until he receives a new license, he’s just sitting and waiting “and being very frustrated.

“I went up to that area (in Limestone) because it was a small town and a physician-depleted area,” Haag lamented. “I was trying to be a nice guy, but because I didn’t have a computer they’re slapping me on the wrist.”

Filed under: General Problems | 1 Comment »

With More People Killing Themselves – What to Do?

Posted on June 15, 2018 by Pharmaciststeve

www.nationalpainreport.com/with-more-people-killing-themselves-what-to-do-8836496.html

By Geralyn Datz, Ph.D.

(Editor’s Note—The recent CDC report on suicide was alarming. Suicide rates have increased in nearly every state over the past two decades, and half of the states have seen suicide rates go up more than 30 percent. While the CDC didn’t release any data about what’s happening in the chronic pain community, most observers believe that the increased suicide rate is at least partially due to an increase in more chronic pain patients taking their own lives. We asked Dr. Geralyn Datz, a psychologist and former head of the Southern Pain Society to share a few thoughts.)

The topic of suicide itself has a huge taboo around it. The challenge in discussing suicide is always to acknowledge the vulnerability of the individuals that suffer from this type of thinking, as well as to address mischaracterizations of these individuals as weak, selfish, or simply “crazy”. In the life of a mental health professional, suicide is an occupational hazard that is haunting and challenging. While all suicides cannot be prevented, the number of them can be reduced through education.

Geralyn Datz, PhD

For people who suffer with pain, suicide may be viewed as an escape from the unsolvable problem that is chronic pain. Depression and anxiety also often co-occur with chronic pain, further adding to the mental obstacles in the life of pain patient, and making escape from reality, and suffering, all the more tempting. Finally, access to adequate pain treatments, including opioids, is very challenging, adding to the pressure and anguish that exists for pain patients today.

When applied to the problem of chronic pain, for a large subset of people with pain and suicidal thinking the issue is not that they want to die, it’s that they don’t want to feel pain and suffer any more. And suicide can unfortunately seem like a reasonable option.

One common myth that surrounding suicide is the thought that the person wants to die and can’t be helped.  One study that explored the desire to escape suffering vs the will to live is a famous study of individuals who jumped off the golden gate bridge in attempt to commit suicide. More than 3,000 people have leapt to their death from San Francisco’s Golden Gate Bridge, but out of the 26 people who survived the jump, all 26 reported that the moment they leapt from the bridge, they regretted their action and wanted to live.

Another myth is that asking about, or talking about suicidal thinking with the person experiencing it, increases the likelihood suicide will happen. The vast majority of suicide-related research—including a very well done study in 2014—suggests that open conversations about suicide are unlikely to increase suicidal ideation and may actually decrease it.

Sometimes suicidal thinking is the result of interactions of factors. Genetic factors, like a personal or family history of psychological diagnosis, or of attempted suicide or completed suicide, can influence a person who has come to the point of contemplating suicide. Childhood trauma, of any sort, physical, emotional, sexual, and parental neglect, can also affect the development of suicidal thinking.

However suicidal thinking has developed, and the circumstances that surround it, it must be confronted. The following are some recommendations for dealing proactively with suicidal thinking:

  1. Don’t isolate, reach out. Be it talking to a friend, family member, faith community member, medical provider or calling a therapist, break the silence and shame feelings that are often present with severe depression and anxiety.
  2. Call or text a crisis hotline. Suicide Prevention Lifeline (1-800-273-8255) or Crisis Text Line (text HOME to 741741).
  3. If you feel you are in immediate danger, call 911, go the ER or local 24-hour psychiatric facility for admission.
  4. Safety first. If you are feeling like a threat to yourself, remove any harmful means from your home, and ask someone to help you monitor or co-administer your prescription medications to reduce the likelihood of overdose.
  5. Develop a safety plan. Write out your plan for action in a crisis. Also, the My3 app is a safety planning and crisis intervention app that can help develop these supports and is stored conveniently on your smartphone for quick access. It is difficult to plan and think clearly when in crisis, and having a plan can give you support.
  6. Get help. Suicidal thinking is a sign of severe depression and also anxiety. Schedule a consult with a mental health provider, psychologist, psychiatrist, counselor or primary care doctor. If you are without insurance, find your community mental health center that offers low cost assessments. Consider psychotherapy to develop coping skills for navigating this difficult period in your life. Medications can also be helpful for addressing mood disturbances, sleep difficulty, and panic attacks that often accompany suicidal thinking.

Filed under: General Problems | 4 Comments »

DEA: nearly 50 yrs of FAILED programs and Congress keeps giving them more money

Posted on June 15, 2018 by Pharmaciststeve

When DEA Cracked Down on Opioids, Abusers Moved to Black Market

https://consumer.healthday.com/bone-and-joint-information-4/opioids-990/when-dea-cracked-down-on-opioids-abusers-moved-to-black-market-study-734885.html

FRIDAY, June 15, 2018 (HealthDay News) — Illegal opioid sales on the internet have surged in the wake of U.S. government crackdowns on prescriptions for the highly addictive painkillers, a new study shows.

In 2014, the U.S. Drug Enforcement Administration reclassified the opioid hydrocodone (Vicodin). The change made the drug harder to prescribe and banned automatic refills.

Not surprisingly, the number of such prescriptions plunged by 26 percent between mid-2013 and mid-2015.

Yet a team of international investigators also found that since the new regulation took effect, more people have turned to purchasing opioids online without a prescription, using software-encrypted online portals that permit illegal sales and elude regulators.

Exhibit A: Since 2014, dark web opioid sales have increased their share of all online drug sales by an estimated 4 percent per year.

“This [DEA] action did have the hoped-for effect of reducing the number of prescriptions issued for these products,” said study author Judith Aldridge, a professor of criminology at the University of Manchester in England.

“[But] our team found that sales on the so-called ‘dark net’ of opioid prescription medications increased following the DEA’s initiative,” Aldridge added. “And this increase was not just observed for medications containing hydrocodone. We also saw increased dark-net sales for products containing much stronger opioids, like oxycodone [OxyContin] and fentanyl.

“Our study cannot definitively rule out that something else caused these rises in illicit sales of prescription opioid medications,” Aldridge acknowledged. “However, the fact that the rises happened only after the DEA scheduling change — and happened only for dark-net sales in the U.S.A. and no other countries — is strongly suggestive.”

To get a handle on the dark web drug market, the study investigators used “web crawler” software to peek behind the curtain of 31 so-called “cryptomarkets” that were in operation both before and after implementation of the DEA regulation

The team found little, if any, change in the sales records of sedatives, steroids, stimulants or illegal opioids (meaning opioids never prescribed by doctors).

In contrast, sales of prescription opioids on the dark web had spiked as a percentage of overall drug sales by 2016, accounting for nearly 14 percent of all such sales.

In another twist, the investigators found that although prescription opioid sales were up as a whole, fewer dark web purchases were for oxycodone, and more were for the far stronger prescription opioid fentanyl.

In fact, while fentanyl had been the least most popular prescription opioid in terms of dark web sales back in 2014, by 2016 it had become the No. 2 seller.

That alone is concerning, the investigators said, given that fentanyl is now the No. 1 cause of opioid overdoses in the United States.

But the bigger concern, they noted, is that the more people turn to the dark web for illicit prescription opioids, the more difficult it becomes to monitor and treat opioid addiction.

The findings were published June 13 in the BMJ.

“Solutions here are not simple,” Aldridge said. “However, we know very well that our results were entirely predictable. Solutions must combine cutting supply and tackling demand at the same time. This requires making prevention and treatment grounded in good science available for all.”

That thought was seconded by Dr. Scott Hadland, an addiction expert with the Grayken Center for Addiction at Boston Medical Center, and author of an accompanying journal editorial.

“That dark web opioid sales rose afterwards is not surprising, given that amidst this policy change the demand for opioids was unchanged,” he said. “So, people began looking for opioids elsewhere, including online.

“The way to durably reduce demand for opioids is to ensure strong prevention, treatment and harm reduction throughout the country,” Hadland said. “Tightening access to prescription opioids like hydrocodone [common brands: Vicodin, Lorcet, Norco] will simply drive people who use opioids to look elsewhere for them if demand is not also reduced at the same time.”

More information

There’s more on the U.S. opioid overdose crisis at the U.S. National Institute on Drug Abuse.

SOURCES: Judith Aldridge, professor, criminology, School of Law, University of Manchester, England; Scott Hadland, M.D., M.P.H., pediatrician and addiction expert, Grayken Center for Addiction, Boston Medical Center; June 14, 2018, BMJ

Filed under: General Problems | Leave a Comment »

Empathy at the ER ? or “healthcare” at a comedy club ?

Posted on June 14, 2018 by Pharmaciststeve

Filed under: General Problems | 17 Comments »

Healthcare … is all about the money ?

Posted on June 14, 2018 by Pharmaciststeve

Hospital facing loss of federal money asked nurses to falsify records, inspectors say

https://www.kansascity.com/news/business/health-care/article213180824.html

Blue Valley Hospital offered employee discounts on weight-loss surgery and asked workers to falsify records to try to pump up its inpatient numbers enough to continue getting Medicare money, according to inspectors.

So far, it hasn’t worked.

U.S. District Judge Julie Robinson this week dismissed Blue Valley Hospital’s lawsuit against the agency that runs Medicare. Robinson wrote in her dismissal ruling that the court system can’t intervene every time a hospital is dinged financially for not following Medicare rules and, given what inspectors found during an initial inspection in November and a followup in April, this is not a case that warrants intervention.

“BVH was tagged with numerous deficiencies in both surveys, including compromise of patient care,” Robinson wrote. “As such, the government interest in protecting patients through an expeditious provider-termination procedure is quite strong.”

Blue Valley Hospital, a four-bed facility at 12850 Metcalf Ave. in Overland Park, is now set to lose its Medicare reimbursements starting Friday.

The hospital, which mostly does bariatric procedures, has said that could cripple it financially. Its lawyers filed a last-ditch appeal this week and asked that the reimbursements keep flowing until the appeal is heard.

“There has been no effect on existing patients and the hospital is still accepting new patients,” Blue Valley Hospital attorney Curtis Tideman said via email. “Blue Valley Hospital is still very hopeful that this entire issue will be resolved quickly and appropriately.”

Blue Valley Hospital filed suit after the Centers for Medicare and Medicaid Services pulled its certification. The agency cited an inspection that found the facility didn’t treat enough patients and wasn’t performing enough surgeries that require long stays to qualify for the higher Medicare reimbursements it had been receiving as an inpatient hospital.

Hospital officials have said that the loss of Medicare certification is due only to a technical change in the way federal rules are interpreted. They say the quality of care that patients receive is not an issue.

But Robinson wrote that inspectors found several patient care red flags when they made a followup survey after the lawsuit was filed.

“The re-survey found that BVH ‘failed to use safe practices for medication administration,’ ” Robinson wrote, “and cited examples of failing to document or properly monitor medication administration, including medications that BVH routinely allowed patients to bring from home, leading to ‘the potential for medication errors, drug overdose, adverse drug reactions, and ineffective medication management.’ ”

Robinson also wrote that Blue Valley Hospital’s leaders knew the facility wasn’t following federal rules and took extraordinary measures to try to pump up its patient load and average length of stay to get in compliance.

During the followup survey in April, two nurses told inspectors they rebelled after they were asked to falsify records to include complications that would justify keeping patients longer.

The chairman of the hospital’s board also told the inspectors the facility offered to absorb all out-of-pocket costs for employees and family members who medically qualified for a “gastric sleeve” surgery. According to inspection records, the chairman told inspectors it was something the staff had requested for years.

“Unfortunately, I have a lot of obese employees and they wanted this surgery,” the records quoted the chairman as saying. “So it was something that could help us both. We have done about 50-60 employee/family surgeries to date with about 70 more that want it.”

Robinson wrote that Blue Valley Hospital’s lawyers called the followup inspection “a sham” but didn’t provide any details to back that up.

Tideman didn’t immediately respond to a request for comment on the followup inspection Thursday.

Blue Valley Hospital officials have said that the loss of Medicare money could force it to close.

Federal attorneys essentially said that’s not the government’s problem, writing in a court filing that it “is the risk BVH has assumed in basing its entire business model on government reimbursement.”

Filed under: General Problems | Leave a Comment »

« Previous Page — Next Page »