Hon. John P. Flannery “It’s Time To Protect Our Pain Patients and Doctors”

A tired Pharmacist is a Dangerous Pharmacist ?

No automatic alt text available.

‘Worst drug epidemic in American history’: Durbin, Schneider discuss opioids with North Chicago pharmacy students

http://www.chicagotribune.com/suburbs/lake-county-news-sun/news/ct-lns-durbin-schneider-opioid-speech-st-0503-story.html

While pharmacists have the right to refuse to fill a prescription, a fear of being reprimanded or fired may be leading them to do it anyway, according to a student at Rosalind Franklin University’s College of Pharmacy.

The third-year pharmacy student was responding to a question posed by U.S. Sen. Dick Durbin Wednesday afternoon at the North Chicago school following some remarks by Durbin and U.S. Rep. Brad Schneider (D-Deerfield) about the opioid crisis.

“We’re in the midst of the worst drug epidemic in American history,” Durbin said. “Our opioid crisis, I have witnessed in every corner of our state. There’s no suburb too wealthy or town too small. It’s hit everywhere.”

Schneider told of his experience of receiving 120 Vicodin pills after complaining of pain from a kidney stone.

“Help me understand why I needed that kind of prescription,” he said. “As we talk to doctors, what I’m being told is they don’t they get the education in med school, they’re not getting the education in their residency and so we just need to make sure we’re providing the information as we learn more about addiction.”

Durbin asked the group of students and faculty, some practicing pharmacists, how a pharmacist would be trained to address a situation like that.

One pharmacist said they have the professional right to deny a prescription. She added she would advise her students to talk to the patient to better gauge the situation or call the doctor for more information.

“I wonder how often that happens, that a pharmacist says no,” Durbin said.

“Every day,” came one response.

Part of the problem is that pharmacists are evaluated on the number of prescriptions they fill, the third-year student said. Complaints from patients could also lead to reprimands.

“It’s really the struggle between obviously we know that we shouldn’t be filling this, but I need a job at the same time,” she said.

Some retailers are making changes to switch that incentive by not including opioid prescriptions in their quotas, another third-year student told Durbin.

It’s something all companies should start doing, he said.

“We have to get everybody on board,” Durbin said. “You can’t just look the other way at any level. Whether it’s the pharmaceutical companies, the distribution companies, the dispensers, the prescribers and the pharmacists.”

Durbin said he’s been working to get the Drug Enforcement Administration to lower the cap on the amount of opioids pharmaceutical companies are allowed to produce each year for domestic consumption.

Two years ago, the last reported period, the DEA approved the production of 14 billion pills, enough for every adult in the U.S. to have a three-week prescription, he said.

Durbin said he’s also introduced a bill that would allow the DEA to consider the risk of abuse and overdose when establishing the quotas.

More awareness training has to be done for various medical professionals to ensure they’re aware of the latest guidelines from the Centers for Disease Control and Prevention, he said, crediting professional associations that have made continuing education a requirement.

Another bill introduced by Durbin back in 2016 that he’s still pushing would require drug company representatives who promote opioids to be licensed and to undergo training.

He’s also suggested a tax on opioid medications that would fund take-back programs like the one in Lake County that allows people to turn in medications with no questions asked.

Schneider said he has also introduced legislation that would require three-hours of continuing education for doctors who prescribe opioids.

“There’s a lot for us to do,” Durbin said.

emcoleman@tribpub.com

Twitter @mekcoleman

“One pharmacist said they have the professional right to deny a prescription. She added she would advise her students to talk to the patient to better gauge the situation or call the doctor for more information.”

I find this statement very interesting… yes.. a pharmacist has the right to refuse to fill a prescription, but normally that involves a drug interaction with the pt’s existing medications and new medication, a allergy to a medication, dose is too high or TOO LOW or some other valid reason/fact that the new medication will harm the pt.

Apparently this woman is an instructor at the pharmacy school ( Rosalind Franklin University’s School of Pharmacy School ) where this Congressional meeting took place and I don’t know if it was intentional or unintentional.. but this instructor’s name was not mentioned in the article… Afraid to stand up for her beliefs ?  I just wonder how much her instructions to future pharmacists in her classes is more about “just saying no” to all pts with opiates and/or controlled substances.

Proposal would ease penalties under new Nevada opioid law

www.reviewjournal.com/news/politics-and-government/nevada/proposal-would-ease-penalties-under-new-nevada-opioid-law/

Tough proposed disciplinary regulations aimed at curtailing overprescription of opioid painkillers would be eased considerably under a recommendation approved Wednesday by a subcommittee of the Nevada State Board of Medical Examiners.

Instead of the strict rules contained in draft regulations made public after the Prescription Drug Abuse Prevention Act took effect on Jan. 1, the subcommittee will recommend that the consequences for violations of the law will be left to the board’s discretion, based on a prescriber’s “good faith attempts at compliance.”

The original draft created an uproar at a January workshop among doctors who said the law and regulations didn’t adequately define the types of conduct that could lead to penalties or even the loss of their medical licenses.

In response, the medical board created a committee of about 20 doctors, lawyers and health care leaders to look at possible amendments to the regulations, leading to the recommendation approved Wednesday.

The law, passed in the 2017 Legislative session, mandates added paperwork for doctors prescribing opioids. The original regulations said doctors could lose their licences after five violations, even if they were clerical, like forgetting to pull up a patient’s prescription history, and had no direct impact the patient’s safety.

Discipline not required

Both doctors and patients have said in the four months since its implementation, the law has prevented some doctors from prescribing opioids for patients at all, regardless of the legitimacy of their needs.

The proposed regulation adheres to the board’s existing disciplinary process for other laws governing prescribers and gives the medical board the option to abstain from disciplining a doctor if members deem it appropriate.

It also mandates that a doctor who violates the law perform continuing medical education coursework.

“I think what the Legislature tried to do was come up with a response to an obvious issue, but in doing so, they created another set of concerns and worries among the providers, and that was the fear they were going to somehow be held accountable for things beyond the control,” said Dr. Victor Muro, chairman of the subcommittee and a medical board member. “I think what the subcommittee tried to do was address the issues … because the reality of it is that one of the unintended consequences was the continuity of care was disrupted.”

 

In addition to the disciplinary regulation, the subcommittee plans to recommend to the Board of Pharmacy a regulation to simplify the informed consent and patient medication agreement forms required by the law. Doctors have expressed concerns that they’d have to create additional paperwork to switch a patient’s prescription from one opioid medication to another, but the regulation would create a blanket form for any opioid medication.

If the Board of Medical Examiners approves the recommended regulation at its June meeting, it will be discussed at a public workshop and a hearing before it heads to the state Legislative Commission for approval. Catherine O’Mara, a committee member and executive director of the Nevada State Medical Association, said she expects the regulation to be in place by early fall.

Still, the committee acknowledged at Wednesday’s meeting that while the regulation would clarify how doctors would be disciplined for violating the law, there would need to be changes to the legislation itself in the 2019 session, including clarification as to whether all controlled substance prescribing is regulated, or just prescribing painkillers.

“I think there’s a lot of things that have to be addressed probably in the next session,” Muro said. “I think what we’re trying to do here is try to provide a little guidance in the interim.”

Contact Jessie Bekker at jbekker@reviewjournal.com or 702-380-4563. Follow @jessiebekks on Twitter.

 

Requirements under the law

The Prescription Drug Abuse Prevention Act limits initial opioid prescriptions to two weeks and requires doctors to perform patient risk assessments before prescribing.

After one month of prescribing, doctors and patients must enter into written prescription agreements.

Three months in, doctors should have a diagnosis for the patient’s pain.

A doctor shouldn’t prescribe more than a one-year supply of a drug within 365 days, according to the law.

Prescribing Policies: States Confront Opioid Overdose Epidemic

http://www.ncsl.org/research/health/prescribing-policies-states-confront-opioid-overdose-epidemic.aspx

Responsible for 115 deaths each day, the opioid epidemic continues to devastate the nation. The death rate from these drugs has nearly quadrupled since 1999, and continues to rise. Nearly half of these opioid-related deaths—46 each day— were caused by a prescription opioid.

Prescription opioids (e.g., oxycodone, hydrocodone, methadone) are used to treat moderate to severe pain, and can provide effective pain management when prescribed and taken as directed. However, prescription opioids can also be misused and lead to addiction, death, job loss and a host of other problems, taking a significant human and financial toll on individuals, families, communities and states.

State lawmakers are crafting innovative policies—engaging health, criminal justice, human services and other sectors—to address this public health crisis while also ensuring appropriate access to pain management. This report provides an overview of state legislation setting guidelines for, or limits on, opioid prescriptions. As of early April 2018, at least 28 states have enacted legislation related to opioid prescription limits.

$20 million in opioid funding advances in Senate with slight change

https://www.mprnews.org/story/2018/05/01/opioid-funding-advances-in-senate-with-slight-change

Study Finds 31% Use No Opioids After Surgery

https://www.clinicaladvisor.com/pain-information-center/study-finds-31-use-no-opioids-after-surgery/article/760164/

HealthDay News — Almost 63% of patients did not use opioids after having an elective procedure, according to a study presented at the annual meeting of the American Surgical Association, held from April 19 to 21 in Phoenix.

Cornelius A. Thiels, DO, from the Mayo Clinic in Rochester, Minn., and colleagues conducted a prospective survey of patients to investigate postoperative opioid use. In total, 2550 patients undergoing 25 elective procedures were asked to complete a 29-question telephone interview survey 21 to 35 days after being discharged; 1907 patients completed the survey.

The researchers found that 92.2% of patients received discharge opioids. These were converted into oral morphine equivalents (OMEs). After discharge, a median of 44 OMEs were consumed. On average, 62.7% of prescribed opioids were unused. Thirty-one percent of patients used no opioids, and 52.3% required <50 OMEs. The refill rates varied from 1.7 to 71.4% for laparoscopic inguinal hernia and lumbar fusion, respectively. Most patients (90.2%) were satisfied with their post-discharge pain control. More than one-quarter (28.2%) reported being prescribed too many opioids, while 8.3% reported not being prescribed enough. Remaining opioids were disposed of by only 7.5% of patients.

“This research provides a road map for physicians and surgical departments,” a coauthor said in a statement. “It shows there are certain surgeries and types of patients who are likely receiving significantly more opioids than needed.”

Evidence of dozens of deaths ‘irrelevant’ for meningitis jury, defendants argue

By Maria Cramer Globe Staff  May 01, 2018

Dozens of people died and hundreds of others fell ill during the 2012 fungal meningitis outbreak that began in a Framingham compounding pharmacy.

But should jurors in the latest trial against former pharmacy employees hear the devastating details of what is considered one of the largest public health crises ever caused by a pharmaceutical product?

Prosecutors and defense lawyers for nine pharmacists, technicians, and executives sparred over that question Monday at a hearing in US District Court in Boston.

The nine defendants are the lesser-known actors charged in the tragedy involving the New England Compounding Center during the summer of 2012, when prosecutors say contaminated, expired, and untested drugs were mislabeled and shipped to doctors, clinics, and hospitals across the country.They face charges that include mail fraud and racketeering in connection with the scandal and are scheduled to go on trial in October. But their lawyers contend they had no role in producing the batches of a contaminated steroid that caused the deadly outbreak. Some had worked for years at the company, while others had only been there a few months when federal officials launched their investigation.

“The outbreak has nothing to do with the charges against them,” said Dana McSherry, who is representing Joseph M. Evanosky, a pharmacist who worked at NECC from April 2011 to October 2012.

The nine defendants had filed a joint motion asking that US District Judge Richard G. Stearns bar testimony about the tainted vials of the steroid, methylprednisolone acetate, and the harm they caused.

The man responsible for compounding that drug, pharmacy supervisor Glenn Chin, was convicted last fall, defense lawyers argued. Chin began serving an eight-year sentence for racketeering and fraud in April. NECC’s former owner, Barry Cadden, was convicted of fraud and racketeering in March 2017 and was sentenced to nine years in prison.

“This is not Cadden-Chin, round three,” McSherry said. “These are different defendants, different charges.”

Cadden and Chin were both acquitted of second-degree murder charges.

Assistant US Attorney George P. Varghese said it’s critical that jurors know about the fallout of the steroid’s production so they can understand why the federal government launched a massive investigation into the pharmacy.

The remaining defendants may not have been responsible for production of the steroid, but Varghese said they used the same unsafe practices to produce and ship other drugs.

“We are not seeking to inflame the jury,” Varghese said. “We are trying to demonstrate the story of what happened in this case.”

Varghese said prosecutors plan to seek testimony from Centers for Disease Control and Prevention and Food and Drug Administration officials but will not call victims or their families as witnesses.

Prosecutors have described NECC as a “fraudulent criminal enterprise” that produced substandard drugs and marketed them as the safest in the country. They say many of the remaining defendants conspired with Cadden and Chin to carry out the scheme, but defense lawyers say the government went too far in charging their clients for what are essentially civil regulatory violations.

In 2012, investigators from the CDC and the FDA found that NECC sent out vials of mold-tainted steroids that were injected into the spines of patients, many of whom suffered strokes. Those who survived continue to be afflicted by pain, headaches, and memory loss. Many now rely on canes and wheelchairs.

In 2014, prosecutors indicted 14 people in connection with the outbreak, which authorities said caused the deaths of 64 people and infected about 800 patients.

Stearns seemed to agree with defense lawyers that it could be problematic to include evidence of the deaths and illnesses at a trial for defendants who were not accused of producing the deadly steroid.

But he said prosecutors have a strong argument for why the jury may need the context of the outbreak to understand why the pharmacy was investigated in the first place.

McSherry countered that it is not necessary to tell the jurors of the deaths and illnesses that occurred, since the defense does not plan to argue that there was no reason for federal agencies to investigate the pharmacy.

“That’s fair,” Stearns replied.

But Varghese said prosecutors need that background to counter the likely defense argument that they overreached in charging the defendants with racketeering or conspiracy.

He alluded to the second-degree murder acquittals of Cadden and Chin to show that jurors in those trials, who were shown photos of the victims and heard wrenching testimony about how they died, were still able to assess the evidence objectively.

The government is seeking almost $74 million from Cadden in restitution for the victims.

Besides Evanosky, the remaining defendants are Gregory A. Conigliaro, a former owner and director of NECC; Sharon P. Carter, former director of operations; Scott M. Connolly, a pharmacy technician; and five other pharmacists: Chin’s wife, Kathy; Gene Svirskiy; Christopher M. Leary; Alla V. Stepanets; and Michelle L. Thomas.

Maria Cramer can be reached at mcramer@globe.com. Follow her on Twitter @globemcramer.

Are restrictions on opioids a threat to human rights?

https://www.washingtonpost.com/opinions/are-restrictions-on-opioids-a-threat-to-human-rights/2018/04/30/42c7ac32-4c86-11e8-af46-b1d6dc0d9bfe_story.html

Fatal overdoses of prescription opioids were rare before 1999. Then doctors, influenced by pharmaceutical industry marketing, began prescribing them for chronic non-cancer pain. By the end of 2016, prescription opioids — not illicit heroin or fentanyl — had claimed 200,000 lives.

Now, at last, the opioid wave has crested. Per capita usage declined for the sixth straight year in 2017, according to IQVIA Institute for Human Data Science , a health-care consulting group. Changes in public policy, including long-awaited prescribing guidelines issued by the Centers for Disease Control and Prevention (CDC) in March 2016, promise to sustain this life-saving progress.

Or maybe they’ll lead to human rights violations. Believe it or not, that’s the premise of a new investigation by the New York-based nonprofit Human Rights Watch (HRW), known for its exposés of war crimes around the world.

HRW is seeking evidence that the CDC guidelines and other efforts to modulate opioid prescribing result in patients being cut off from vital medication, in violation of their right to appropriate health care.

The group “is looking for testimonials from chronic pain patients who have been forced or encouraged to stop their opioid medication by physicians or pharmacists,” the Pain News Network reported in March.

 

“The CDC clearly knows what’s going on and they haven’t taken any real action to say, ‘That is not appropriate, involuntarily forcing people off their medications. That’s not what we recommended,’ ” Diederik Lohmann, director of health and human rights for HRW, told the network, which says two-thirds of its readers take opioids, mostly for chronic, non-cancer pain. “When a government puts in place regulations that make it almost impossible for a physician to prescribe an essential medication, or for a pharmacist to stock the medication, or for a patient to fill their prescriptions, that becomes a human rights issue.”

Human Rights Watch is not alone; a recent cover story of the libertarian magazine Reason denounced “America’s war on pain pills.” And, of course, patients who have become dependent on opioids must be treated compassionately.

But even after the recent decline in prescriptions, the U.S. opioid rate of consumption in 2017 — 676 morphine milligram equivalents per adult — was five times the 1992 rate. It’s double or triple that of other advanced countries. People who really need them can get licit opioids in the United States.

And the drugs still killed 46 people a day in 2016, according to the CDC.

In any case, alleged unintended consequences of justifiable and, indeed, moderate public-health policies just do not belong in the same moral conversation as deliberate human rights violations such as police brutality or torture.

Article 12 of the International Covenant on Economic, Social and Cultural Rights does indeed exhort governments to guarantee the “highest attainable standard” of health; in that sense, there is a human right to health. Whether it can be defined with sufficient objectivity for this situation is another story. Assuring health is exactly what the CDC is trying to do — not through “regulations,” but through evidence-based recommendations.

To be sure, HRW acknowledges that opioids have been overprescribed in the past, in part due to deceptive industry marketing; a key focus of its current research is ensuring non-opioid alternatives for patients weaned off the drugs, Lohmann told me.

 

One ought not to prejudge the HRW report, due later this year, even if Lohmann’s comments to the Pain News Network implied that the CDC is blameworthy, and even if the organization funding the study, the U.S. Cancer Pain Relief Committee, is headed by a five-member board of pain specialists who are well-known advocates of opioid use for chronic non-cancer pain.

Two of them, Russell Portenoy and Richard Payne, have received financial support from opioid manufacturers. In late 2015, Payne spoke out against the CDC guidelines in a government advisory group’s deliberations before they were adopted. (Efforts to reach board members were unsuccessful.)

Note that the CDC guidelines specifically address opioid use for non-cancer pain only. The government encourages palliative care for cancer and hospice patients.

The U.S. Cancer Pain Relief Committee has previously underwritten HRW reports on the developing world, the theme of which is that AIDS and cancer patients are being denied access to morphine due to international and national rules intended to prevent opioid misuse. Palliative care in poor countries is a legitimate concern — among the many urgent health-care deficits that such countries face.

Here’s another legitimate concern: Poor and middle-income countries may be vulnerable to the same kind of pro-opioid campaign that wreaked such havoc in the United States.

Mundipharma, a network of companies controlled by the same closely held family business that introduced Purdue Pharma’s OxyContin to the United States, is engaged in aggressive opioid marketing in China, Colombia, Egypt, Mexico and the Phillipines, according to a recent Los Angeles Times report.

As Keith Humphreys, Jonathan P. Caulkins and Vanda Felbab-Brown write in the May/June issue of Foreign Affairs, the U.S. experience shows that “legal drugs pushed by corporations can bring death on a scale vastly surpassing the effects of illegal ones.” And no human right is more important than the right to live.

Pts have a responsibility for abusing opiates & addictive behavior ?

On opioid lawsuits, powerful Texas Republican says there is blame to go around

https://www.lmtonline.com/local/texas-politics/quorum-report/article/On-opioid-lawsuits-powerful-Texas-Republican-12875964.php

AUSTIN — As Texas House lawmakers investigate what the state’s response should be to the growing opioid crisis here and around the nation, tort reformers are growing concerned that trial lawyers are “unethically” recruiting clients to go after big pharmaceutical companies.

Chairman of the Select Committee on Opioids and Substance Abuse, state Rep. Four Price, R-Amarillo, was asked about “ambulance chasing” attorneys by Jay Leeson, host of the Other Side of Texas Radio Show based in Lubbock.

In response, Price pointed out that the committee’s study of the issue – as laid out by retiring Speaker Joe Straus – does not include looking at litigation.

That’s even though some counties around the state including Upshur, Bexar and Harris have filed suit against manufacturers of opioids seeking to recoup uncompensated care costs.

 Price noted that at least $350 million in opioid overdose-related costs have been racked up at local emergency rooms.

“If you really study these issues, there’s a shared level of responsibility up and down that spectrum from the manufactures to the prescribers to the distributors to the patients themselves,” he said.

Price said the committee will take its time in coming up with recommendations by November for the next Legislature to consider. “Not all of big pharma’s going to love our recommendations. I’m sure not all prescribers or patients will love our recommendations,” he said.

The full story can be found in the Quorum Report. Copyright 2018, Harvey Kronberg,http://quorumreport.com/index.cfm, All rights are reserved. This story is presented as part of the Houston Chronicle’s collaboration with Quorum Report. For inside information on Texas politics and government and to sign up for real-time updates, go here.