The “SHOT ACROSS THE BOW” ?

Posted on February 16, 2018 by Pharmaciststeve

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

This BS about the “BNE staff assured that the goal of the letter was no intimidation, but education for these physicians regarding the CDC’s chronic pain guidelines”

Right off the bat, you get the impression that they are treating the “guidelines” as “law”…

I have seen this sort of thing in pharmacy.. normally around wanting to document fill errors… not for punitive action but to analyze how misfills happen and what can be done to prevent them in the future.

What normally happens is that it is discovered that there are parts of “the system” that is causing the errors, and to solve these errors changes has to be made to the system. It takes money that the employer doesn’t have or wants to put the money out to fix things… and all of a sudden this “collecting data” exercise turns into punitive actions against those who make errors.  They come to the conclusion that their system cannot be the cause of these misfills, it has to be a problem with the staff.

Who believes that the BNE is going to change their opinion of what/how the CDC guidelines are to be followed/observed ?  Just watch at some point in the future that those physicians that initially got these “educational letters” and they don’t bring all their pts in line with the CDC guidelines.. the next letter will either be a threat to have all pts conform to the CDC guidelines or else or they will just skip that step and go right to sanctions ? Because the first letter should have “educated them enough” for them to start reducing their pt’s doses to CDC guideline levels.

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proposals out their waiting for comments from the general public

Posted on February 16, 2018 by Pharmaciststeve

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The other opioid epidemic: Chronic pain patients in need of care

Posted on February 15, 2018 by Pharmaciststeve

Drug Database Oregon

http://www.philly.com/philly/health/the-other-opioid-epidemic-chronic-pain-patients-in-need-of-care-20180212.html

We have two epidemics related to misuse of opioids in America.  First: people with addiction and premature death from abuse of opioids.  Second: also devastating but getting far less attention, people suffering for years from chronic unrelenting pain losing access to needed medicine. They are in more pain and experiencing terrible deterioration of their quality of life – unnecessarily.

 Listen to a real patient I recently saw.  At 55, he has suffered from severe, but well-controlled, pain for 10 years. He told me he was relatively OK, until his doctor told him “that there were new regulations, that my pain medications had to be cut down.”  He was taking them as prescribed, without abuse or side effects.  They enabled him to live his life and enjoy his family, though he couldn’t work.

With his medicine decreased, his pain increased. He was mostly homebound and needed a cane.  Then it got worse.  He told me, “I was shocked, and scared when my doctor said I had to find a new doctor; he wouldn’t prescribe pain medicines anymore.”

 

I hear this type of story multiple times every day in my practice.  Fearful, teary-eyed patients, wondering what I, their new doctor, will be like.  Harsh, judgmental, rushed, uncaring? Or perhaps, understanding?

Here’s what I usually tell my patients (after a comprehensive history and exam, toxicology studies, reviewing questionnaires and databases which alert me to misuse): “There was no good medical reason to taper your medications. They were helpful and weren’t abused. There aren’t new regulations, rather, recommendations about not using higher levels of opioid medications unless there is a compelling reason. Chronic severe pain, and deterioration of quality of life, are significant compelling reasons, if the medicines help decrease your pain, and if no other treatments can accomplish this.”

Patients frequently breathe a sigh of relief after this.  As I begin to treat them carefully and act as their ally, most note decreasing pain and quality-of-life improvement.  There are few greater physician rewards.

 

Opioids are prescribed in different clinical situations.  In acute scenarios — tooth abscess, a bone fracture — a prescription should be limited. Overprescribing has frequently occurred in such cases. Patients with malignancies can develop severe pain, but for them, opioids are often underprescribed.

Then there are chronic-pain patients. Many have exhausted such options as physical therapy or had surgery without benefit.  Physicians are backing away from opioid medications in all these situations. Why?  Two reasons. First, with the harsh public spotlight, they are uncomfortable that they’ll come under professional and legal scrutiny.

The second reason is it’s complex and time-consuming to care for chronic pain patients.  Opioids must be prescribed with proper knowledge and attention, or they can cause severe side effects, including death.  When prescribed carefully to appropriate patients, they are commonly very helpful. If the goal is to adequately reduce pain and suffering, there are often no replacements.

The negative side of prescribing opioids, devastating and important, has been widely publicized.  A survey last year showed that two-thirds of primary-care physicians had cut back on prescribing, though one-third believed that this was causing harm.  Finding a new physician is becoming very difficult for chronic-pain patients.  Many pain physicians don’t participate in insurance plans.  Many pain patients are disabled and poor.

Opioids are double-edged swords, with potential for great harm and great benefit.  But will denying opioids to chronic-pain patients who have no other options solve the addiction epidemic?  Unlikely. The solution doesn’t lie here, and is only causing more suffering. These patients don’t typically become addicts or overdose on opioids.  The overwhelming majority of patients with chronic pain who are prescribed opioids by a trained, careful physician, do not abuse or sell their medications.

Do some physicians debate the efficacy of these medicines? Of course.  This is usually when opioids are prescribed inappropriately to the wrong type of patient.  For the observant physician treating pain, and for countless chronic-pain patients, there is absolutely no question that they can be beneficial.

There is great suffering brought about by the first epidemic of addiction and overdose.  We are compounding this by inappropriate undertreatment of bona fide chronic pain patients.  Physicians, and patients suffering from chronic pain, are caught in the crossfire.  Still, physicians owe it to their patients – and to fulfilling medical vows – to help those who suffer.

Ira Cantor, M.D., is an internal medicine physician specializing in pain management at Steiner Medical & Therapeutic Center in Phoenixville.

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They volunteer to keep us safe.. and we INTENTIONALLY INFLICT PAIN ON THEM ?

Posted on February 15, 2018 by Pharmaciststeve

Navy vet: Northport VA didn’t provide post-surgery pain meds

http://longisland.news12.com/story/37509107/navy-vet-northport-va-didnt-provide-post-surgery-pain-meds

SPEONK –

A Navy veteran from Speonk says the Northport VA Hospital failed to give him any post-surgery pain medication after his knee replacement procedure. 

John Fink says the operation went off without a hitch, but that he had to deal with “horrific” pain in the aftermath. 

“After my surgery, I was supposed to get a morphine drip and unfortunately, according to what they told me, the authorization was lost in the computer,” said Fink. 

He says he was without any pain medication for 3 ½ hours. 

Fink says a Northport VA doctor told him the computer glitch was part of a pattern that has affected other patients. 

“They blame it on a computer. I blame it on the administrator of the hospital for not addressing this issue and putting in a secondary protocol to prevent this from happening,” said Fink. “Especially knowing it’s happened to other veterans and not just myself.”

A spokesman for the Northport VA told News 12 that privacy restrictions prevent them from publicly discussing individual patients’ care, but said they will look into the case. 

Fink says he’s speaking out because he hopes what happened to him won’t happen to another veteran in the future.

“We served our country to support the rights and liberties of every civilian…we deserve more than we’re getting,” says Fink

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#Kolodny: opiate tax is a good way to increase treatment and put money in his pocket ?

Posted on February 15, 2018 by Pharmaciststeve

Minnesota renews push for tax on prescription opioids

https://www.reuters.com/article/us-minnesota-opioid-tax/minnesota-renews-push-for-tax-on-prescription-opioids-idUSKCN1FY2VR

(Reuters) – Citing rising opioid fatalities, Minnesota Governor Mark Dayton on Wednesday announced a renewed legislative proposal to tax prescription opioid pills to help fund treatment.

 Minnesota is one of at least 13 states to have considered an opioid tax in recent years to help pay for the fallout from the United States’ opioid epidemic, although none have passed, according to the National Conference of State Legislatures.

Dayton’s proposal would levy a one-cent tax on drugmakers for each milligram of active ingredient in a prescription pain pill, generating an estimated $20 million a year for prevention, policing, emergency response and treatment.

Dayton last fall blamed “special corporate interests” for blocking a similar proposal in 2017.

“We must take decisive action in this legislative session to reduce abuses and to ensure that all Minnesotans suffering from these addictions receive the treatment and support they need,” Dayton, a Democrat, said in a statement.

The efforts come as a growing number of states and counties are suing opioid manufacturers to recoup costs of a worsening epidemic. In December, the U.S. Centers for Disease Control and Prevention reported that the U.S. rate of drug overdose deaths in 2016 grew 21 percent from the prior year.

 Minnesota had 395 opioid overdose deaths in 2016, an 18 percent increase over the previous year.

The Pharmaceutical Research and Manufacturers of America, a national trade association, said the proposal could divert money for developing new non-opioid painkillers and medication-assisted addiction treatments.

“It’s clear that this proposed tax ignores all the factors that led to this public health crisis, including the substantial influx of heroin, counterfeit fentanyl and other illegal drugs, and fails to recognize existing funding available for treatment, prevention and other important programs to help communities,” association spokesman Nick McGee said in a statement.

Dayton’s proposed measure, part of a larger effort to boost treatment, access to overdose medications and enforcement, will be debated in the legislative session starting Feb. 20.

 “I don’t see any reason why the taxpayers should have to pay to fix this. I believe (pharmaceutical companies) owe reparations,” State Senator Chris Eaton said Wednesday during a news conference, the Minneapolis Star Tribune reported.

Andrew Kolodny, an opioid policy researcher at Brandeis University, said the tax is a good way to increase treatment

“I don’t think we’re going to see overdose deaths start to come down until we do a better job of expanding access to effective outpatient treatment,” he said.

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this is just one of so many bad reviews of optumRx

Posted on February 15, 2018 by Pharmaciststeve

this is just one of so many bad reviews of optum.

Original review: Jan. 22, 2018
I have been taking ** for chronic pain for 10 years plus. In 2017 we were covered with OptumRx and Blue Cross thru my wife’s employment at Walgreens. I am totally disabled and also on Medicare. For the year 2017 never had a problem getting my prescription filled. It’s now January 2018 and the trouble begins! My Doctor sent my prescription for ** to the pharmacy to be filled on January 17th within 2 hours of my requesting it. I am required to request refills 3 days before my medication is gone. Within an hour my pharmacy called to say they couldn’t fill the prescription because OptumRx needed a Prior Authorization. My pharmacy also sent a request to my Doctor’s office on my behalf. The pharmacy also recommended I call my Doctor as well just to expedite the Prior Authorization. On Tuesday I had enough medication to last until Friday morning the 20th.

On Wednesday morning the 18th I stopped by the pharmacy to get my prescription because the pharmacy said they should have approval by then. Well, no approval from Optum. I called the pharmacy again that afternoon and still no approval. I then called Optum to ask why my meds hadn’t been approved. I was told that they could take up to 7 days to approve the Prior Authorization. I told the rude customer service rep that the medication was an ** and I couldn’t wait 7 days for it or I would end up in the Hospital Emergency Room with severe withdrawals. I was then told that if it was an ** I would have to contact my Doctor and have another P.A. sent marked urgent and could then get my meds within 72 hours instead of 7 days and if that wasn’t soon enough I could pay for it out of pocket and would be reimbursed within 30 days.

I told her the cash price for a month’s supply of my medication is 900.00 dollars and I don’t have that kind of money available to me. Why is Optum doing this since it has never happened before. I then told her again without my meds I would be in withdrawals on Friday. I was told that this was the new policy due to the ** Crisis. First I asked her what has that got to do with me? This is a legal prescription written by my Doctor and I’m not an ** Crisis’ but I’m going to be if I don’t get my medication in time. I explained that I’m not allowed to get my prescription far enough ahead to cover the number of days Optum is requiring. No Doctor is going to do that nor would insurance pay for a next month’s refill that many days ahead. By this time I’m dumbfounded, angry and about to have a stroke. The Rep tells me that if I get that new P.A marked urgent it would more than likely be done by Saturday the 21st.

So by this time on Wednesday my Doctors office is closed. I was at my Doctors at 8am on Thursday to get the new Urgent P.A. sent. The new P.A. was sent within the hour. I waited all day Friday to hear from the pharmacy that I could come get my Prescription. Finally my Pharmacist called to say they still did not have approval. I call Optum again and was told that the approval Dept would be open Saturday and it should be done by then. I waited till 3pm Saturday and still no approval. Called Optum and told that they closed at 3pm and I was lucky that the Rep had even answered the phone but there was nothing they could do!

It is now 2:30 am on Monday and I’m in extreme pain and having horrible withdrawal symptoms. Fever, vomiting, diarrhea and just waiting for my Doctor’s office to open. Can’t go to the Emergency Room because Blue Cross won’t authorize the visit because I could have paid for the Medication but choose not to. I am so angry and hurting and just plain disappointed that OptumRx thinks what they’re doing is OK. If at all possible I will beg and borrow enough money to hire a Lawyer to stop OptumRx from continuing their horrible and damaging behavior! Please, Please don’t ever sign-up for coverage by these Monsters!

OptiumRX is part of UNITED HEALTH… and UNITED HEALTH is ENDORSED BY AARP..  I wonder how many millions of dollars that AARP gets from United Health for that endorsement.

Here is AARP’S MISSION STATEMENT FROM THEIR WEBSITE https://www.aarp.org/about-aarp/

Our Mission

AARP is a nonprofit, nonpartisan, social welfare organization with a membership of nearly 38 million that helps people turn their goals and dreams into real possibilities, strengthens communities and fights for the issues that matter most to families — such as health care, employment and income security, and protection from financial abuse.

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End the Epidemic – AMA

Posted on February 15, 2018 by Pharmaciststeve

Treatment Toolkit – February 2018

Treatment

The nation’s opioid overdose and death epidemic will not end without increased access to comprehensive, multidisciplinary care for pain, as well as enhanced access to high quality, evidence-based treatment for substance use disorders. Please use the tools below to add your voice in calling for increased treatment.

www.end-opioid-epidemic.org/digital-toolkit/treatment/

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DEA is emailing doctors recommendations on how to safely prescribe opioids.

Posted on February 14, 2018 by Pharmaciststeve

http://www.kristv.com/story/37509369/dea-advises-precautions-when-prescribing-opioid-medications

CORPUS CHRISTI – According to the CDC, more than 100 people die every day from an opioid overdose. The epidemic has been a nation-wide topic of conversation, but healthcare workers and the government are making efforts to lower the amount of opiate prescriptions. Some changes are already happening.

Doctors at the forefront of this epidemic have to make the tough decision of prescribing the pain medicine, or not.

But now, the Drug Enforcement Administration, or the DEA, which is in charge of fighting drug abuse in the country, is emailing doctors recommendations on how to safely prescribe opioids.

Dr. Justin Hensley, President of the Nueces County Medical Society, said until this week, he has never gotten a notice like this from the DEA.

When KRIS 6 asked why he believes the recommendations just came out, Dr. Hensley said, “Because there’s news about 60,000 people dying a year from them.”

The misuse and abuse of opioids can present a challenge for doctors to prescribe the appropriate medication to their patient. Dr. Hensley says regardless, doctors do what’s in their patients’ best interest.

“We don’t want to make people hurt,” Hensley said, “but we don’t want to make them addicted to pain medicine all of their lives.”

As a doctor, Hensley says he and his colleagues were always aware of the possible consequences linked to prescribing opioids. He believes it’s a positive sign the government has issued recommendations like this.

“Look at all this data, look at how drug companies are decreasing what they’re spending,” Dr. Hensley said. “Look at what the government is doing.”

The state of Texas also requires a special prescription to get schedule two medications, which include opioids like hydrocodone and oxycodone. Those prescriptions make it even more difficult to get ahold of schedule two drugs. The impact has already been seen at a Corpus Christi pharmacy.

Carlos Salinas, a pharmacist at Deleon’s Clinic Pharmacy, says within the last year, he’s seen a large decrease in the number of opioid prescriptions.

“The U.S. government along with other healthcare professionals are really, really trying to get control of the chronic opioid epidemic in our country.”

Texas has also provided recommendations on how to prescribe opioids. Those guidelines were enforced this month.

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Minnesota governor proposes penny-a-pill fee on opioid prescriptions

Posted on February 14, 2018 by Pharmaciststeve

http://www.fox9.com/news/mn-penny-a-pill-opioids-fee

ST. PAUL, Minn. (KMSP) – Minnesota Gov. Mark Dayton is proposing a “penny-a-pill” paid for by drug companies to fund an opioid stewardship program for addiction prevention, treatment and recovery efforts in Minnesota. The governor estimates the program would raise $20 million each year.

Minnesota Department of Health data shows the state had 395 opioid deaths in 2016, an 18 percent increase over 2015. Of those 395 deaths, 194 were linked to prescription opioids.

CHANGING GUIDELINES: Last December, Minnesota announced new guidelines to change how physicians are writing prescriptions for painkillers. These new guidelines were the product of 18 months of planning by a group of physicians on both sides of the aisle. 

 Part of the opioid prescribing work group are two state lawmakers, Rep. Baker and Senator Chris Eaton, who both have lost children to opioid overdoses. Their goal is to curb the number of opioids being prescribed across the state. Statistics from the CDC show 47 opioid scripts are written for every 100 Minnesotans.

The new guidelines include:

1. Prescribing the lowest effective dose and duration of opioids when used for acute pain.  
2. Monitoring the patients closely, including prescribing opioids in multiples of seven days.
3. Avoid initiating chronic opioid therapy, make it so long term prescriptions would include face-to-face visits with the provider at least every three months. 

“To our patients already on these pain medications, we are not abandoning you,” said Dr. Chris Johnson leading the group.

Johnson emphasized the focus will be on educating and guiding physicians, patients and their families. Minnesota is currently the fifth lowest state in the country when it comes to prescribing opioids, but everyone involved in this effort points out doing better is vital. 

“One opioid prescription can start the downward spiral in the right person,” said Dr. Rahul Koranne, Chief Medical Officer for the Minnesota Hospital Association. 

LAWSUITS AGAINST DRUG COMPANIES: Multiple Minnesota counties have filed lawsuits against pharmaceutical companies, accusing the drugmakers of using an aggressive marketing campaign to change the culture of prescribing opioids. A lawsuit filed by Anoka County last month claims pharmaceutical companies convinced doctors that it was safe to prescribe opioids to treat not only severe and short-term pain, but also for less severe and longer-term pain, such as back pain and arthritis. 

“The defendants knew, however, that their opioid products were addictive, subject to abuse and not safe of efficacious for long-term use,” the lawsuit says. 

In 2016, the Food and Drug Administration recognized opioid abuse as a public health crisis. Despite this, the lawsuit says pharmaceutical companies have maintained that prescription opioids are not dangerous and have continued to sell the drugs. 

About 20 other Minnesota county attorneys filed similar lawsuits in November, led by Washington County Attorney Pete Orput. 

Only a BUREAUCRAT/POLITICIAN would believe that they could impose a “tax” on a business and/or their product and it will not be passed along to the final customer. The problem may be that pharmacy may end up taking the blunt of this new tax.. PBM (Prescription Benefit Managers) control what pharmacy gets paid… Pharma passes the cost to the wholesaler… wholesaler passes the cost to the pharmacy.. but.. the PBM refuses to reimburse the pharmacy for the additional cost.  Independents will probably get hit the worse, because the typical independent 95% of their revenue is from the Rx dept and the contracts that the pharmacy has with the PBM.. prohibits the pharmacy from collecting anything additional from the pt.. above what the PBM states is owed by the pt. Since >50% of independent pharmacies are located in towns <20,000… so those people living in rural Minnesota will get hit the hardest.  Losing maybe their only local pharmacy and the next closest pharmacy being miles away…  Since Minnesota is in “snow country” … how many pts may be forced to be out of their medication(s) for chronic conditions.. because of this whole fiasco ?

 

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As Opiate Rxs decline …DEA agents predicts increased OD’s

Posted on February 14, 2018 by Pharmaciststeve

Getting worse before it gets better: DEA agent predicts deepening opioid epidemic

TEMPE – The opioid crisis in Arizona is likely to grow, a DEA agent warned Wednesday, adding that it’s time to stop playing the blame game.

“For right now, unfortunately, it looks like the problem is getting worse before it gets better,” said Doug Coleman, a special agent for the Drug Enforcement Administration in Phoenix.

Coleman framed the war on opioids as a series of front-line battles that have not yet reached peak casualties.

He was among the law-enforcement and health-care officials who met at the second annual Arizona Opioid Summit to discuss solutions to an epidemic that has led to nearly 900 deaths and 5,810 drug-related overdoses in the state since mid-June, according to state health officials.

Last month, Gov. Doug Ducey signed the Opioid Epidemic Act into law. The measure provides $10 million in treatment for underinsured or uninsured patients, restricts the number of opioids that can be prescribed at one time and protects people from drug-related prosecution if they call for emergency help during a drug overdose.

In his presentation, Coleman praised the new law, saying Arizona is “forward thinking” and “a leader” in the national opioid crisis, which claims an estimated 115 lives every day, according to the National Centers for Disease Control and Prevention.

Doug Coleman, a DEA special agent, said everyone wants someone to blame for the opioid crisis — whether doctors or the drug industry — but that’s a waste of time and effort. He spoke Wednesday to law-enforcement and health-care workers at the second annual Arizona Opioid Summit in Tempe. (Photo by Fortesa Latifi/Cronkite News)

But the connections that led to the epidemic are intertwined and deep, he said, meaning there’s no magic medicine to cure the crisis.

Everyone is trying to figure out who to blame, he said, adding that the true answer is everyone is to blame: Doctors, pharmacists, patients.

“We have to get past the idea of who’s to blame because there’s not one entity that’s to blame,” he said. “We all, as citizens of the United States, demanded these products to ease our pain, and that’s what led to this.”

First, he said, patients demanded opioids to combat their pain. Then, doctors started prescribing more painkillers. In turn, pharmaceutical companies manufactured more drugs. They provided the building blocks for a tragedy.

“We have to stop blaming each other,” Coleman said. “We have to figure out a solution.”

Janice Morrison agrees. Her son, Brett, battled heroin addiction after he was prescribed opioids following a snowboarding accident. She shares Coleman’s concern that the Arizona opioid crisis hasn’t hit its peak.

“Because of shame and stigma and fear of prosecution, people don’t reach out for help,” Morrison said. “It’s just a big mess.”

Morrison thinks law enforcement and government officials need to work with people who have experienced addiction in order to reach solutions.

Most of the conference at the Tempe Mission Palms Hotel centered on sessions to discuss law-enforcement work, pain management and treatment options.

In other ways, it was similar to other industry conferences, with a lobby of vendors offering free pens, candy and other giveaways. A rehab center marketed treatment options, such as $11,000 for a six-week outpatient program and $65,000 for a six-week inpatient program.

As this chart shows, the number of opiate Rxs in 2016 was slightly less than in 2006, but the red line indicates the number of overdose deaths. Of course, the way that the CDC collects data in this OD chart is all drug overdose deaths or just opiate OD deaths. We also don’t know how many of the drug OD deaths are in fact SUICIDES.

Why does the chart start in 2006, when many blame Purdue Pharma for the opiate crisis when they introduced it in 1995. Shouldn’t the chart cover the entire time frame that seemingly everyone is blaming ?

As for the old saying goes, figures never lie and liars always figure

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