“The moral test of a government is how it treats those who are at the dawn of life, the children; those who are in the twilight of life, the aged; and those who are in the shadow of life, the sick and the needy, and the handicapped.” – Hubert Humphrey
passionate pachyderms
Pharmacist Steve steve@steveariens.com 502.938.2414
NCPA, along with the National Association of Chain Drug Stores and the Washington State Pharmacy Association have filed a legal brief in a case that involves changes to the way that state reimburses community pharmacies that serve Medicaid patients. The suit alleges that the state rule does not make required adjustments for prescriptions to Medicaid patients and threatens patient access. In addition, the brief argues that the state is violating federal and state laws by hindering Medicaid patient access to care.
With so many supplements on the market, it can feel overwhelming when trying to choose the right one for you. Brand, cost and dosage can all play a part but why does it matter? See my tips below for on what to look for when choosing a quality supplement.
1. Quality and efficiency
When it comes to vitamins and minerals, there are many different forms but not all brands use the same type in their supplements. Magnesium is a perfect example; this mineral can be sold in the form of magnesium chloride, sulphate, taurate and citrate to name a few.
Magnesium sulfate, commonly known as Epsom salts can be a great constipation aid but needs to be taken with caution due to its laxative effect. Although it is a common form of magnesium, research has shown it is rapidly excreted via the kidneys and therefore difficult to assimilate. The effects of a magnesium bath last longer when using magnesium chloride over magnesium sulfate, due to the effects of magnesium chloride being easily assimilated and metabolised in the body.
For fast acting use, magnesium chloride is highly recommended as it has an impressive rate of absorption, making it the perfect form for BetterYou’s Magnesium Oil sprays and flakes. As it is absorbed through the skin, it bypasses the digestive system providing a fast and effective dose whilst giving the digestive system a break. A trial by Watkins & Josling showed that transdermal application of magnesium in the chloride form will raise magnesium levels within the body over a relatively short period of time and also demonstrated a beneficial effect in preventing calcium build up in body tissues meaning that the calcium could be correctly utilised.
Magnesium oxide is the most common form of magnesium sold in pharmacies yet its absorption rate is poor compared to the above.
The sourcing of supplement ingredients is another factor to be mindful of when choosing supplements. Do they come from a non-toxic environment? Are they sourced ethically? BetterYou only use the most soluble and pure natural source of magnesium. It is mined from Northern European from deposits of an ancient seabed known as the Zechstein Sea, which now sits over one mile below ground. Due to the depth and location of this ancient seabed it has been naturally filtered and condensed for over 250 million years and is completely protected from man-made pollutants.
2. Tried and tested
As a practitioner, when choosing supplement brands to work with, I will always ask what research has been done and what type of clinical trials the company has used to prove its efficiency. I also ask the company for information and copies of the trials and look to see if they batch test their products to check the contents on the label are really in the product. These are guidelines that are strictly followed at BetterYou for whom quality and assurance is a number one priority. All of BetterYou’s products are batch tested and if a product fails any test, it is not sold. Unfortunately, not all brands follow such stringent testing as BetterYou.
3. Dosage and formulas
This is an important factor to take into consideration when supplementing. More isn’t always better and depending on the supplement, it can make more sense to choose a supplement with a lower dose that can be taken several times a day so there is a better chance of it being absorbed.
The ease of application is also another factor to take into consideration. Swallowing capsules is not ideal for everyone especially those with digestive issues or insufficiencies for example, so buying supplements in oral sprays, liquids and other topical methods can be an easier option. This is why BetterYou’s transdermal magnesium and oral vitamin spray ranges are ideal for supplementing, not only due to the absorption but the ease of delivery.
4. Genetically-modified organisms (GMOs)
Always avoid anything that has been genetically modified, including your supplements. Not only are GMO products bad for your health, they are not good for the environment and the community. They can require heavy use of toxic pesticides and herbicides including glyphosate which has been linked to many health conditions including cancer and digestive complaints. These are the best vitamin infused patches.
BetterYou uses the highest quality ingredients in their supplements and adheres to strict standards to ensure there are no GMO ingredients.
5. Additives, colourings and artificial flavourings
Look for clean and pure products with no added sugars, colourings, additives or artificial flavourings.
Keep an eye out for allergens too such as gluten, dairy and soy as these can often be used in supplements.
6. Not tested on animals
Many people are unaware that animal testing can play a major role in the testing of supplements. Look for products that are tested on humans, not animals.
7. Cost
Supplements need to be affordable but cheaper doesn’t necessarily mean better. Some cheaper brands do not use well researched ingredients which can mean their products are not as effective. Always do your research and take all of the above into consideration.
Choosing a supplement doesn’t have to be a daunting task if you follow these tips. By choosing a reputable company that uses top quality materials and has good ethical values, your body will reap the benefits and your mind will be at ease knowing that you are using a quality supplement.
A pregnant woman’s use of acetaminophen may be associated with an increase in her child’s risk for attention-deficit/hyperactivity disorder (ADHD), the authors of a large, prospective study report.
“[L]ong-term acetaminophen use during pregnancy is related to more than a twofold increase in risk for offspring ADHD,” after adjusting for genetic risk factors, indications for the mother’s acetaminophen use, use of the drug before pregnancy, and other potential confounders, lead author Eivind Ystrom, PhD, and colleagues write in an article published online today and in the November issue of Pediatrics.
Conversely, use of acetaminophen for less than 8 days during pregnancy was associated with a decrease in ADHD risk, suggesting its antipyretic effect “could be beneficial with regard to fetal development,” the authors add.
In an accompanying commentary, Mark L. Wolraich, MD, who was not involved in the study, cautions that these findings do not establish a causal relationship between prenatal acetaminophen exposure and ADHD risk, “but they do suggest the possibility and raise the need for further study and more cautious consideration of acetaminophen use during pregnancy.”
It is estimated that approximately 65% to 70% of pregnant women in the United States and approximately 50% to 60% of pregnant women in western and northern Europe use acetaminophen.
Data on More Than 100,000 Children
For the current study, Dr. Ystrom, from the Norwegian Institute of Public Health, Oslo, and colleagues analyzed data from the Norwegian Mother and Child Cohort Study, which includes information on 114,744 children born between 1999 and 2009, as well as on 95,242 mothers and 75,217 fathers throughout Norway.
Mothers and fathers alike completed questionnaires at 18 weeks of gestation. The mothers also filled out questionnaires later in pregnancy, after delivery, and when their children reached 6 months, 1.5 years, and 3 years of age. The researchers obtained information on ADHD diagnoses from records maintained by the Norwegian Patient Registry.
The parents’ questionnaires included questions about their acetaminophen use. To control for potential confounders, the mothers also answered questions regarding various medical conditions for which acetaminophen was indicated, as well as the duration of their acetaminophen use. Their children were followed to the time of their ADHD diagnosis or until December 31, 2014.
The final sample consisted of 112,973 children and their parents. Of those children, 2246 (2%) were diagnosed with ADHD, and 52,707 (46.7%) mothers reported some acetaminophen use during pregnancy. Compared with no acetaminophen exposure, the unadjusted hazard rate (HR) of ADHD in children after 1, 2, or 3 trimesters of prepartum exposure was 17%, 39%, and 46%, respectively.
Duration Makes a Difference
When the authors adjusted for parental ADHD symptoms, the risk associated with acetaminophen use declined slightly, from an HR of 1.26 in the unadjusted model to 1.20 (95% confidence interval [CI], 1.09 – 1.32). However, when calculated by amount of exposure, the rate rose from 1.13 (95% CI, 1.01 – 1.27) for any one trimester to 1.32 (95% CI, 1.16 – 1.50) for any 2 trimesters, and to 1.34 (95% CI, 1.05 – 1.71) for all three trimesters.
A fully adjusted model, which accounted for alcohol use during pregnancy, smoking during pregnancy, symptoms of anxiety and depression during pregnancy, maternal education, marital status, body mass index at the 17th week of gestation, maternal age, and parity, showed a similar trend for duration and increased risk, although not all points remained statistically significant. Specifically, use for any one, any two, or all three trimesters was associated with an HR of 1.07 (95% CI, 0.96 – 1.19), 1.22 (95% CI, 1.07 – 1.38), and 1.27 (95% CI, 0.99 – 1.63), respectively.
When analyzed by the total number of days the mother took acetaminophen while pregnant, the HR associated with 1 to 7 days of use for any indication was 0.90 (95% CI, 0.81 – 1.00) compared with no use of acetaminophen. Longer use generally was associated with a steady increase in risk, such that the HR for 29 or more days was 2.20 (95% CI, 1.50 – 3.24). However, when the indication was “fever and infections,” the HR associated with use for 22 to 28 days was 6.15 (95% CI, 1.71 – 22.05), although it dropped to 2.40 (95% CI, 0.34 – 16.78) with use of 29 days or more.
The authors also found no association between maternal acetaminophen use during the 6 months before pregnancy and ADHD in the child. However, “paternal use for 29 days or more was as strongly associated with ADHD (HR = 2.06; 95% CI 1.36–3.13) as the corresponding maternal prenatal use.” The reasons for the paternal association are unclear, but may be related to “male germ-line epigenetic effects as described in endocrine disruption effects of acetaminophen on the human testis.” Nevertheless, the authors caution that given this finding, “the causal role of acetaminophen in the etiology of ADHD can be questioned.”
Still, the possibility of a relationship between maternal acetaminophen use and ADHD “brings to mind the association between aspirin and Reye syndrome,” writes Dr Wolraich, professor of pediatrics at the University of Oklahoma, Oklahoma City. “Although the comparisons are far from perfect, given the serious morbidity and risk of mortality associated with Reye syndrome, it does illustrate how finding associations between drug and disease can improve health outcomes.”
He recommends longitudinal studies to explore the acetaminophen/ADHD relationship further.
Study limitations include the inability to adjust for the severity of the indications leading to maternal acetaminophen use, reliance on clinician diagnoses of ADHD and lack of validation in a research clinic, and underrepresentation of young parents or parents who smoked, “which may limit generalization of results to all children,” authors write.
The authors have disclosed no relevant financial relationships.
GRAND RAPIDS, Mich. (WOOD) — Alex Ostrowski has worked hard to control her pain. Now, she fears it will control her again.
“I would describe where I was at 10 years ago as a fog,” Ostrowski said.
Ostrowski, now 30, was first prescribed opioids at age 14.
“You’re controlling your pain, but at the price of normal interaction, at the price of normal quality of life,” she explained.
Ostrowski’s chronic back pain stems from injuries she suffered in a horrific accident on the Sparta lake where she grew up. Ostrowski was 12 years old when a boat ran over her Jet Ski on Camp Lake, pinning her body between its propeller and the wooden slats of the boat’s diving board.
“The propeller cut into the entire left side of my body, in to my stomach, into my intestines, completely crushed my hip and my pelvis,” Ostrowski said.
Incredibly, doctors were able to save not only her life, but also both of her legs. They used metal rods to rebuild her left hip and pelvis.
Photo: An X-ray shows Alex Ostrowski’s rebuilt hip.
But the extensive physical trauma led to excruciating chronic back pain and years of overmedication on opioids.
“It was a dark place. It was a very dark place,” Ostrowski said of her years on painkillers.
PATIENT COVERAGE CUTS “TERRIFYING”
Six years ago, Ostrowski found Javery Pain Institute in Grand Rapids, which helped her get off high-dose opioids and find a procedure called facet joint injections that provided the pain relief she desperately sought. In that procedure, small amounts of anti-arthritic steroids — not opioids — are injected into the patient’s spinal joints.
“It’s given you your life back,” Dr. Keith Javery, who is board-certified in anesthesiology and pain management, said during a recent consultation with Ostrowski at the clinic on Kenmoore Drive SE. “With those injections, you were able not only to get back to work, but get into a supervisory role.
“It kills me that the insurance company is no longer allowing us to do those therapeutic facet injections,” Javery said.
Photo: Alex Ostrowski undergoes injections to treat chronic pain.
Ostrowski is trying alternative procedures, but so far has nothing has worked as well as the facet injections.
“I feel like I’m being punished because I don’t want to take pain medications and that seems so backwards,” she said. “It’s terrifying. I feel almost pushed back into that place by them denying coverage of this procedure. They leave you no other options.”
According to Javery, new restrictions on the kinds of injections and the number of procedures allowed per visit are hurting hundreds of patients at his clinic alone.
DOCTOR: PAIN TREATMENTS ‘LITERALLY SAVE LIVES’
In late 2016, Blue Care Network, one of Michigan’s biggest insurers and a subsidiary of Blue Cross Blue Shield of Michigan, stopped covering the commonly used spinal joint injections for long-term pain relief — the kind of treatment Ostrowski was getting.
The change came after the insurer hired an outside benefits management company, South Carolina-based eviCore Healthcare, to handle interventional pain claims for members.
EviCore considers therapeutic facet injections “experimental, investigational or unproven,” according to its clinical guidelines.
“All these things that we can do to reduce the need (for opioids) are being rapidly in real time denied and not authorized by insurance companies that have been authorizing these for decades,” Javery explained.
“These treatments literally save lives,” he argued.
BLUE CARE NETWORK: NO HIGH-LEVEL EVIDENCE-BASED SUPPORT FOR INJECTION
Blue Care Network confirmed to Target 8 that its coverage guidelines on facet joint injections have changed.
“Blue Care Network’s current policies and coverage guidelines align with eviCore’s and are based on proven, clinical best practices,” Dr. Marc Keshishian of Blue Care Network wrote in an email to Target 8. “Our approach is to take responsible steps to eliminate unnecessary care and expenses in the health care system that drives up costs for our customers and members, by using clinically valid determinations that ensure our members get the most appropriate and effective care at the right time on their path to wellness.
“There’s no high-level evidence-based medicine supporting therapeutic facet joint injections,” Keshishian, the senior vice president and chief medical officer for Blue Care Network, continued.
Pain physicians themselves acknowledge there’s a lack of high-quality, large-sample studies on interventional pain procedures. They say that’s partially because it’s difficult to recruit subjects for double-blind pain studies in which some participants will receive placebos.
But Javery said he doesn’t need “high-level evidence” because he sees the results every day.
“The pain relief is drastic,” he said.
Many insurers still cover facet joint injections for long-term pain relief, though the number per year is limited, often to five sessions per region per year. Medicaid and Medicare are among those that cover the injections, though Michigan’s Medicare administrator told Target 8 supporting evidence for their use is “not strong” and that Medicare covers them simply because the procedures have been done for a long time.
It’s clear there’s no broad consensus across the health care industry on best practices for pain management.
In fact, Blue Care Network’s own medical director for behavioral health told Target 8 his experience supported the use of facet injections.
“Facet blocks have been around since I started practice,” Dr. William Beecroft of Blue Care Network said. “They’re very effective. They work very well with relatively low side effects, adverse reactions to them. There are some better procedures now looking at a treatment plan, but if they work for the individual and consistently work for that person, it’s illogical they would be stopped.”
Blue Care Network initially provided Beecroft for a sit-down interview with Target 8 because the insurer thought the story focused on opioids, not changes to pain treatment coverage, though Target 8 specified the latter in a prior email exchange.
In response to a list of questions Target 8 submitted after the interview with Beecroft, Blue Care Network said the concerns regarding coverage cuts “appears to be an isolated complaint by a specialist and members.”
Michigan Pain Consultants is also frustrated by the reductions in coverage.
“Patients feel trapped,” said Lisa Pearson, executive director of Michigan Pain Consultants, one of the state’s largest networks of clinics.
“Limited on the injections. Limited on the narcotics. High co-pays and deductibles for physician therapy and behavior therapy, both important to treating chronic pain in a comprehensive fashion,” she wrote in an email to Target 8.
Pearson said the biggest issue for patients is the reduction in what injections they are allowed to get and how often they can get them, especially with facets and epidurals.
“Patients with whom our physicians have worked for months or years to dial in the best pain relief possible with the fewest side effects are told that despite the fact that we document the injections wear off at week 7 or 8 or 9 are told that they have to wait another 3 or 4 or 5 weeks in severe pain before they get treatment. If we could magically make depomedrol (an anti-inflammatory steroid) last longer than it lasts, we’d do so,” Pearson said.
“What is the point of even having physicians, if the insurance companies and companies like eviCore ultimately override the physician’s decisions? This is an extremely dangerous path that we are going down,” Pearson argued.
EVICORE: GUIDELINES “GROUNDED IN STRONGEST EVIDENCE-BASED MEDICINE”
For its part, eviCore told Target 8 in an email that its coverage guidelines are “grounded in the strongest evidence-based medicine published to date.”
“Pain complaints, most of which are attributed to musculoskeletal conditions, impact more than 116 million Americans annually, making it critical that we ensure these patients are receiving the type of evidence-based care that best positions them for successful outcomes,” wrote Robert W. Westergan, M.D., chief of musculoskeletal programs for eviCore.
“EviCore’s guidelines, first and foremost, reflect the most current, evidence-based criteria and peer-reviewed literature available. These guidelines are completely transparent and available for anyone to view,” Westergan wrote. “Our only goal is to ensure that the patient receives the most appropriate, evidence-based care for his or her situation. Evicore’s clinical reviews make determinations following the Evicore evidence-based clinical criteria, even if that results in a more expensive episode of care.”
PATIENT WILL ASK STATE TO REVERSE DENIAL
Meanwhile, Alex Ostrowski is trying alternative treatments, though none have worked as well for her as facet joint injections did.
The newly married marketing manager can’t afford to pay out of pocket for the four times yearly injections. One series of the treatments (she gets several shots at a time) would cost her more than $800.
Her appeal to eviCore and Blue Care Network has been denied, but Ostrowski has every intention of asking the state to review her case.
Michigan’s Department of Insurance and Financial Services conducts external reviews of cases that qualify under the Patient’s Right to Independent Review Act. DIFS can reverse a denial and order an insurer to cover the denied treatment, medication or device.
Here are the outcomes from PRIRA reviews from DIFS 2016 annual report:
Health Benefit Claims
New Requests for External Review: 887
General Insurance: 576
HMO/AFDS: 311
Commercial Insurers
Number of Orders issued and the Carrier’s Position was Upheld: 222
Numbers of Orders issued and the Carrier’s Position was Reversed: 78
Cases Resolved before issuance of an Order: 56
Not Accepted, Dismissed or Withdrawn: 193
Health Maintenance Organizations (HMO)/Alternative Financing Delivery System (AFSD)
Numbers of Orders issued and the Carrier’s Position was Upheld: 84
Number of Orders issued and the Carrier’s Position was Reversed: 42
This message is to inform you that The American Patient Defense Union is now open to receiving your personal complaints and grievances in interacting with Healthcare providers, insurers and drug/device companies.
Three categories of complaints will be considered by The Union:
Personal grievances about “process issues” at specific hospitals and practices.
Complications or allegations of harm at the hands of specific practitioners, hospitals or drug/device companies.
Personal financial difficulties, collection notices or bankruptcies caused by specific hospitals, practitioners or insurers.
Please limit your initial communication with The Union to a 500-word email submitted to complaints@patientrights.org. Please describe your grievance as concisely and specifically as possible. Following review and consideration of the information you provide, we will conduct a personal interview by phone in order to strategize with you. No communication with your providers or insurers will take place until we have conducted an interview and obtained your full consent to proceed. If you wish to communicate with us via a secure two-way encrypted email system, please create a free email account at protonmail.com and use it communicate with us.
Please note that The Union is strictly focused on individual patients’ specific and personal narratives of grievance or complication resulting from treatment by specific healthcare facilities, practitioners and drugs/devices in the United States. These can range from simple to complex matters.
The Union hopes to ultimately identify broad practices and policies that are causing financial or physical harm to individual patients across the United States — in order to address public policy issues on a larger scale. However, our strict starting point in all cases will be the individual American patient’s story of difficulties, conflict with or harm by specific practitioners, hospitals, insurers or drug/device companies.
The Union is NOT a law firm. However, in cases where we do believe negligence has occurred, we will recommend that you seek legal guidance.
We are aiming to defend your rights and voice, publicly —You, The American Patient.
The Union seeks to establish large-scale collective bargaining power capable of political lobbying at the state and federal levels with the goal of shifting medical practice in the United States away from a profit-driven corporate mode towards a patient-centered system. In achieving this goal, we need you to rise up and empower this union.
Please note that you are filing your complaint with The Union voluntarily. After verifying the information you provide, The Union will initially use this to generate a professionally-crafted and adequately-measured signal to the healthcare or insurance entity causing the grievance. This signal will be in the form of a letter of warning from The Union, to the entity you are interacting with, requesting immediate action on your behalf. Should the provider/insurer not respond in an adequate or timely fashion, this letter of warning will be shared with the public, the press and all members of The Union in order to maximize public scrutiny/exposure.
Ultimately, as The Union acquires member-driven power, it will provide the litigation services necessary to create changes to the behavior of our healthcare establishment using the individual grievances provided by our members.
Every Patient and citizen/resident of the United States is invited to join The Union. Specific instruction to join, including member fees, will be provided at www.patientrights.org in the near future.
Let’s begin to develop the powerful backbone every American patient needs to defend against harm in seeking a healthier tomorrow.
Yesterday afternoon, President Trump declared America’s opioid crisis a public health emergency, and for good reason: the American Society of Addiction Medicine estimates that there’s nearly 2.6 million Americans with an opioid addiction, and the communities affected include some of our poorest and most vulnerable. The problem is becoming critical, and solving it goes beyond politics to become one of basic human compassion.
The only problem: current guidelines by the FDA and CDC are ineffective, based on a factually‐faulty premise unsupported by evidence, and will almost certainly increase suffering and death without significantly improving the numbers for opioid addiction.
Patients must be prescribed opioids only for durations of treatment that closely match their clinical circumstances and that don’t expose them unnecessarily to prolonged use, which increases the risk of opioid addiction. Moreover, as FDA does in other contexts in our regulatory portfolio, we need to consider the broader public health implications of opioid use. We need to consider both the individual and the societal consequences.
(For this, and all future quotes, all bolding is my own emphasis.)
The CDC goes further with its current guidelines, including a clinical “reminder” that “opioids are not first-line or routine therapy for chronic pain”. It recommends to use as low of a dose as possible for as short of a time as possible, frequently reconsider its upkeep, and to only start them as a last result.
Almost any statement made by public officials relating to the crisis is based on the same two premises: reducing the number of patients receiving long‐term opioid prescriptions is the most effective way to curtail the opioid epidemic, and most opioid addictions start as a result of use that began as legitimate.
Unfortunately, nearly all the evidence we currently have contradicts these foundations. If you’re interested in a detailed, academic look at the topic, there’s a fantastic article written by three doctors — including an Associate Professor at the University of Massachusetts Medical School — appropriately titled “Neat, Plausible, And Generally Wrong”:
Recommendations from the Centers for Disease Control and Prevention (CDC) for chronic opioid use, however, move away from evidence, describing widespread hazards that are not supported by current literature. This description, and its accompanying public commentary, are being used to create guidelines and state-wide policies.
These recommendations are in conflict with other independent appraisals of the evidence — or lack thereof — and conflate public health goals with individual medical care. The CDC frames the recommendations as being for primary care clinicians and their individual patients. Yet the threat of addiction largely comes from diverted prescription opioids, not from long-term use with a skilled prescriber in a longitudinal clinical relationship. By not acknowledging the role of diversion — and instead focusing on individuals who report functional and pain benefit for their severe chronic pain — the CDC misses the target.
We need to break some statistics down. According to the 2014 National Survey on Drug Use and Health, 74.9% of nonmedical opioid use happens as a result of people taking medication they were not prescribed, such as those obtained or stolen from a friend or drug dealer. A further 3.1% fraudulently obtained prescriptions from multiple doctors, a practice called “doctor‐hopping”. That’s a total of 78% of sources other than a relationship with a single doctor. That leaves 22% of those who were addicted who do receive their pills from a doctor, but we need to put that number into perspective.
The findings of this systematic review suggest that proper management of a type of strong painkiller (opioids) in well-selected patients with no history of substance addiction or abuse can lead to long-term pain relief for some patients with a very small (though not zero) risk of developing addiction, abuse, or other serious side effects.
Signs of opioid addiction were reported in 0.27% of participants in the studies that reported that outcome.
A scant 0.27% of patients prescribed long‐term opioids for chronic pain showed signs of becoming addicted. The doctors above found similarly‐low rates of addiction with other sources of data.
Responses of addicted patients significantly differed from those of nonaddicted patients on multiple screening items, with the two groups easily differentiated by total questionnaire score. Further, three key screening indicators were identified as excellent predictors for the presence of addictive disease in this sample of chronic pain patients.
It’s important to recognize that scripts written properly aren’t the cause of the epidemic, because — beyond being ineffective — this mindset can actually lead to reduced access to treatment for those with addictions.
Buprenorphine is an opioid that’s used as maintenance therapy, as it has a far lower risk of causing respiratory depression, the primary killer in opioid overdose. Its use as a maintenance therapy is associated with a significantly lower chance of death than leaving addiction untreated; inexplicably, however, the use of buprenorphine was stifled by a 2000 law stating that only 30 patients could be treated at any one time per physician to begin with, and only after jumping through numerous bureaucratic hoops that made it more difficult to prescribe treatment for opioid addiction than the opioids themselves.
[As of June 2017,] only 35,894 providers are currently eligible to prescribe buprenorphine for addiction. Of those 35,894 only about 1/3 actively prescribe the treatment; and these few are further limited by the patient caps.
Prescriptions, given to patients adequately screened by and in possession of a good relationship with the physician, and used by the patient for which they were prescribed, simply are not the cause of the majority of opioid use disorders — diverted prescriptions and irresponsible mass scripts from so‐called “pill mills” are. You may have heard the small West Virginian town of Kermit mentioned in the news recently due to one of their drugstores: “In just two years, drug wholesalers shipped 9 million opioid pills to a pharmacy in Kermit, WV, a town of just 400 people.”
Researchers logged nearly 1,000 cases of doctors being either charged or administratively reviewed for the inappropriate prescription of opioid drugs over an eight year period, and specific high‐profile cases have been the subject of numerous documentaries. Pill mills prey on those susceptible to addiction, and prescribe indiscriminately:
Like the other pain clinics in Portsmouth where Volkman had worked, the clinic only accepted cash — no insurance, no Medicaid. In exchange for $150, patients could expect to receive high doses of pain medications, anti-anxiety agents, and muscle relaxers. In September 2005, according to a search warrant, one Portsmouth Police informant stopped in to see Volkman and received prescriptions for 180 oxycodone pills, 180 Lorcet (a hydrocodone-based painkiller) pills, 120 Soma (a muscle relaxer) pills, and 90 Xanax. Two days later, another informant received a prescription for 270 oxycodone pills, 270 Percocet, 120 Somas, and 60 Xanax. Volkman’s clinics brought in thousands of dollars in cash and pumped out thousands of pills in a region that was already being described in the Portsmouth Daily Times as “The OxyContin Capital of the World.”
It’s an operation driven by profit from the top down, and it’s easy to see how backing the CDC’s position of cracking down on opioids entirely becomes tempting, but there are ways to curtail excessive prescriptions without creating a devastating case of throwing the baby out with the bathwater.
According to the American Pain Society, there are over 25 million Americans who experience daily chronic pain — pain that affects quality of life every single day. Conditions like lupus, fibromyalgia, Ehlers‐Danlos syndrome, various forms of arthritis, and many more cause pain that is not only severe, but unending. That’s an important number, because it’s just about ten times the number of patients with an opioid addiction.
I’ve made two separate claims: increased suffering, and increased deaths. I’ll start with suffering.
Invariably, you’ll find guidelines instructing doctors to tell patients to pursue “alternative” painkilling strategies first, as if there are myriad wells of untapped relief that chronic pain patients simply ignore.
There aren’t.
We can save time and start with the easy ones: acupuncture doesn’t work. There’s some evidence for massage being somewhat effective for some conditions, but the fact that it’s rarely covered by insurance and the need for ongoing treatment renders the cost/benefit ratio bad. Marijuana is still federally illegal, unavailable in many states, and its presence on a drug test still precludes many employment opportunities for pain sufferers who are able to work. Chiropractic is ineffective pseudoscience that hurts more than it helps. Supplements can cause harm, interact with real medicine, and extraordinarily few have any high‐quality evidence for any condition, including almost none for chronic pain.
That leaves the big one: exercise. “Exercise helps reduce chronic pain!” is repeated often and adamantly, as if it is long‐accepted fact that has a long, positive background in research. Does it?
As recently as April of this year, Cochrane looked over twenty‐one of their reviews of studies regarding exercise for chronic pain, and found that the evidence was generally insufficient:
The quality of the evidence examining physical activity and exercise for chronic pain is low. This is largely due to small sample sizes and potentially underpowered studies. A number of studies had adequately long interventions, but planned follow-up was limited to less than one year in all but six reviews.
There were some favourable effects in reduction in pain severity and improved physical function, though these were mostly of small-to-moderate effect, and were not consistent across the reviews. There were variable effects for psychological function and quality of life.
[…]
Additionally, participants had predominantly mild-to-moderate pain, not moderate-to-severe pain.
Beyond that, the correlation between chronic pain and chronic fatigue is massive, with everything from lupus and fibromyalgia to EDS, rheumatoid arthitis, and Raynaud syndrome causing heavy fatigue, and that in no way comprises a complete list. Despite what the CDC incorrectly insisted for years past being proven inaccurate, exercise invariably makes chronic fatigue, such as found in CFS, worse.
So strike all the chronic pain patients suffering from chronic fatigue. Of the remainder, what about the ones with a strong medical reason not to exercise? Chronic pain caused by physical damage, Ehlers‐Danlos patients unable to exercise or maintain yoga‐esque positions due to frequent joint dislocations, inflammatory conditions that forbid normal ranges of movement, those with heart conditions exacerbated by activity…
We’re left with a small slice of the pie chart for which exercise gets the chance to be effectively used at all, and I would posit that even if there was evidence for it, calling it a replacement for pain management and not something to do alongside it is an act of cruelty. This was stated earlier, but it necessitates repeating: chronic pain is daily. Chronic pain causes real suffering every day, and frequently every hour.
There are no “good days” where you don’t have pain, just days that are “somewhat better than usual”. Imagine this: every day, anywhere from “many parts” to “every part” of your body hurt; unrelenting, bone‐deep aching, nerves that light themselves on fire, jabbing pain coursing through your muscles upon the slightest activity.
If your pain levels average out to 7/10 on a daily basis, would you intentionally up the pain to 9/10 numerous days a week just to — after weeks and months of agony — potentially bring that daily average down to 6/10? Would you feel like you got good value on that proposition? Would you consider it worth it? Would you have the will to keep it up every week until your death, forever? It doesn’t matter if we assume the unsubstantiated claims of notable improvement are true; would you not want pain relief for the days in which your suffering was greatly increased?
Pain needs to be managed, and there are, unfortunately, limited ways to effectively do so. The single most efficacious non-pharmaceutical treatments involve mental mechanisms, such as mindfulness meditation and CBT, which do nothing to reduce the pain itself — merely one’s perception of it. They help, but they can take months to see improvement, and will always leave you with a certain baseline of pain that needs to be treated through some other avenue.
Depression affects up to half of all chronic pain patients. According to studies, risk of suicide is at least double that of controls, with up to 14% of CPP attempting suicide and around 20% of them experiencing suicidal ideation. Causes and levels of chronic pain can be disabling and prevent patients from maintaining gainful employment, or from participating in the hobbies and activities that were once important to them.
Chinese water torture is a process in which water is slowly dripped onto a person’s forehead, allegedly making the restrained victim insane.
The comparison might seem trite, but it’s apropos: the worst part of chronic pain is not the “pain” — it’s the “chronic”. Relentless pain dominates your life in a way few healthy people appreciate. It demands schedules to be built around it; it demands plans to be canceled en masse when it unexpectedly flares; it holds you as a hostage in your own body and taunts you with its permanency. Make no mistake that even with opioids, it makes it more manageable, not absent; completely eliminating pervasive pain is nearly impossible.
If relief is taken away from chronic pain sufferers indiscriminately and under faulty pretenses, the question is not whether it will result in increased disability and suicide — the question is only by how much.
The opioid crisis needs solutions, and quickly, but it also needs those solutions to be factual, effective, and compassionate, and our current theories for how opioid addiction starts and how it needs to end are none of the above.
An expert in treating chronic pain testified for most of Thursday in the trial of former Florence physician Chris Christensen, describing the various options for patients and the many steps needed before prescribing opioids.
In his opening statements, Deputy County Attorney Thorin Geist portrayed Christensen as a doctor who asked few questions and wrote plenty of opioid prescriptions, with some patients receiving the powerful drug within hours of entering his clinic, and others being given a list of opioids from which to choose. Christensen is charged with two counts of negligent homicide, nine counts of criminal endangerment, and 11 counts of distribution of dangerous drugs.
Dr. Patrick Danaher with the Advanced Pain and Spine Institute in Missoula testified that no one who walks into their clinic walks out with opioids that day. He said that after an exam and diagnosis, if opioids are part of the treatment plan the patient needs to see a psychologist, visit https://www.riverfronttimes.com/stlouis/erase-my-back-pain-reviews-2021-whats-new/Content?oid=34768096 if you are looking for a natural and harmless chronic back pain treatment.
“They take the patient through a battery of tests and do a pretty thorough interview. It takes two or three hours,” Danaher said, adding that they look for red flags, such as a history of substance abuse. Patients also can undergo the Minnesota Multiphasic Personality Inventory test so doctors can form a conclusion on whether the patients are goods risk for chronic opioid therapy.
Christensen’s attorney, Josh Van de Wetering, asked how expensive those tests are, having previously noted that Christensen didn’t accept insurance for his patients because of the plethora of paperwork. Danaher said he wasn’t sure, but in cases with low-income patients without insurance, his clinic will either set up a payment plan or forgo payments altogether.
“If they can’t pay we have a program where we can assist them or forgive the debt on a needs basis,” Danaher said. “We don’t advertise it, but we offer it.”
Danaher noted that opioids are quite dangerous, and can cause “respiratory depression” that gradually slows and ultimately stops a person’s breathing, which leads to death.
So instead, his clinic tries to treat chronic pain patients with other drugs that seek to address the cause of the pain, like anti-inflammatories, anticonvulsants, anti-depressants, muscle relaxants, usually most pain conditions are linked to overweight, check these meticore reviews.
“Opioid treatment is just one of the tools,” Danaher said. “There’s so many other things we have to offer.”
His testimony came on the same day that President Donald Trump declared the opioid crisis across the nation a public health emergency. (See related story.)
Danaher said he suspects that 30 years ago, doctors were under treating pain patients. With the creation of sustained-release opioids like OxyContin in the 1990s, the pendulum swung to over-prescribing, leading to an opioid epidemic.
“I think that is making its way back to what will be the middle,” Danaher said.
The trial continues today.
Doctor has no idea what the cost to the pt on a mandatory psychological testing that takes 2-3 hrs. No reference as to how many pt or per-cent of pts taking the test show a tendency of having a mental health disease of addictive personality… could that be because a very low per-cent fall into that category and it would suggest that the making the test mandatory is wasting a lot of money and expense for pts. Most Psychologists charge a minimum of $100 – $125/hr. There is a much more simplistic test SOAPP-R https://www.opioidrisk.com/node/1209 and takes 10 -15 minutes.
Dr Christensen was originally OVER-CHARGED with 400 charges… and were reduced to 22 for the trial two counts of negligent homicide, nine counts of criminal endangerment, and 11 counts of distribution of dangerous drugs.
Does this suggest that the prosecuting attorney just pulled the rest of those 378 charges out is his ass when the charges were just made ?
The pain specialist stated that: opiatescan cause “respiratory depression” that gradually slows and ultimately stops a person’s breathing, which leads to death.
Just about anything CAN CAUSE under desirable outcomes.. like drinking too much WATER can cause DEATH, but don’t hear about anyone suggesting that we should suggest limiting access to water.
WASHINGTON — In an unusually close vote, an advisory panel to the Centers for Disease Control and Prevention on Wednesday recommended the use of a new vaccine to prevent shingles over an older one that was considered less effective.
The decision was made just days after the Food and Drug Administration announced approval of the new vaccine, called Shingrix and manufactured by GlaxoSmithKline, for adults aged 50 and older. The panel’s recommendation gives preference to the new vaccine over Merck’s Zostavax, which has been the only shingles vaccine on the market for over a decade and was recommended for people aged 60 and older.
The panel also recommended that adults who have received the older vaccine get the new one.
According to the C.D.C., almost 1 of every 3 people in the United States will contract shingles,
a viral infection that can result in a painful rash and lasting nerve damage.
The disease, also known as herpes zoster, can range in severity from barely noticeable to debilitating. It is caused by the varicella-zoster virus, which also triggers chickenpox.
President Trump has now declared the nation’s opioid crisis a “public health emergency.” This important step follows the recommendation by a White House commission, led by New Jersey Governor Chris Christie, to “act boldly,” to stem the crisis.
As this epidemic of drug abuse becomes a growing problem for many states across the country, details of a White House strategy remain unclear. But as a recent Wall Street Journal editorial noted, the “horrors of opioid addiction come from many dysfunctions, including too many prescriptions, a decline in work, heroin and fentanyl, easy access from Medicaid, and others.”
Understandably then, as reported by a joint task force of the National Association of Counties and the National League of Cities, many communities are already cooperatively bringing together health care professionals, drug makers and distributors, regulators, law enforcement officials and social service providers “to break the cycles of addiction, overdose, and death” as they work through “partnerships across … local, state and federal levels.”
But having let themselves be convinced that communities can somehow sue their way out of complex opioid abuse problems, some state and local prosecutors have taken a more adversarial approach. Not coincidentally, those doing the convincing are many of the same private-sector personal injury lawyers who got rich beyond their wildest dreams with contingency fees two decades ago when they convinced state attorneys general to let them run lawsuits against cigarette makers.
So no one should be surprised that the personal injury lawyers’ national trade group here in Washington hosted in September a “Rapid Response: Opioid Litigation Seminar” to teach attendees how they too might cash in on such litigation. One of the breakout sessions was even titled, “Opioids: The Next Tobacco?”
Never mind that prescription opioid pain-relievers are not like cigarettes. They were developed to address a legitimate medical need. They require Food and Drug Administration approval and stark warning labels about the potential for addiction, and their lawful distribution is closely regulated by the Drug Enforcement Administration. Of course, as we’ve all learned in recent years, what may begin with doctors’ thoughtful prescriptions of lawful medicines for patients’ terrible pain can in some cases end in the streets with overdoses on illegal and deadly drugs such as heroin and fentanyl.
Not to be deterred by facts or nuance, much less the public interest, though, self-interested personal injury lawyers have talked a coalition of 41 state attorneys general into issuing subpoenas for five drug manufacturers that seek information about how prescription opioids were marketed and sold. Several state AGs have already gone further, filing multi-count lawsuits against drug makers and distributors, with dozens of county and city prosecutors following suit. And most of these prosecutors have hired private-sector lawyers to consult or run their lawsuits.
The prosecutors assert that hiring outside counsel on a contingency-fee basis saves taxpayers money since counsel only gets paid if litigation is successful. This simple rationale, however, overlooks the conflicts of interest and corruption to which such arrangements have often led. A litany of these types of abuses has been chronicled for more than a decade by the Wall Street Journal’s editorial board and a Pulitzer Prize-winning New York Times series.
This reporting has revealed that politically influential plaintiffs’ lawyers frequently shop their ideas for potentially lucrative lawsuits against corporate defendants to friendly state prosecutors who then hire the lawyers, expecting generous pay-to-play campaign contributions later.
Thus the American Tort Reform Association (ATRA) urges all policymakers to insist that the public interest in health and safety is never compromised by private interests. This principle has animated ATRA’s efforts for more than a decade to push commonsense reform statutes — successfully in 18 states so far — that promote accountability and transparency when public authorities choose to hire outside counsel on a contingency-fee basis.
Too many Americans are suffering serious drug abuse problems, and our leaders must work together to find good-faith solutions. They ought to be relying for guidance on caring and knowledgeable experts inside and outside of government. Because to rely on trial lawyers instead is to invite other problems that neither policymakers nor their constituents need.
