“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
Prescription drug monitoring programs (PDMPs) are state-based data banks that track opioid and other controlled substances prescribed by healthcare providers and filled by patients at pharmacies. They are supposed to cut down on the abuse and overuse of such substances by reducing the rate at which physicians prescribe opioids. While many policy makers think they’re a great idea, they may be actually contributing to the rise in opioid overdose deaths.
PDPMs have been operating in most states for several years, and although the number of opioids prescribed are indeed decreasing, the death rate from opioid overdoses keeps climbing at an alarming pace, with a reported 200 percent increase between 2000 and 2014. Indeed, the most recent data from the Centers for Disease Control and Prevention (CDC) is telling; it appears that overdoses from prescription opioids are stabilizing or even waning, while overdoses from heroin are dramatically increasing.
One reason may be that heroin is cheaper than ever on the black market. In 2015 the CDC reported a record high 33,000 opioid overdose deaths, the majority of which were from heroin. But another reason may be that physicians are reticent to prescribe opioids to those who legitimately need them, forcing their patients to turn to the black market.
And PDMPs likely share some of the blame, although they were created with good intentions. California established the first PDMP in 1939, and by 1992 10 states had PDMPs in operation. Different states had different designs in their programs and they varied in their methods of operation, even though they all shared the goal of diminishing drug abuse and diversion, i.e., the movement of prescription drugs from the patient population into the recreational user community.
Today 49 states have PDMPs at various levels of development. The only holdout is Missouri. There, legislators led by State Senator Robert Schaaf, a family physician, have obstructed the legislature’s attempts to establish a monitoring program on the grounds that it might risk patient privacy.
My state’s PDMP has been operated by the Arizona State Board of Pharmacy since 2008. All federally licensed narcotics prescribers must participate. Their prescribing data are kept in the monitoring program, inaccessible to the general public in order to protect patient privacy.
Providers receive quarterly “report cards” comparing them to their peers in their specialty with respect to the number of times per month they prescribe various opioids, benzodiazepines, and other controlled substances. They are classified anywhere from normal to outlier to extreme outlier.
At this point the report cards are for informational and educational purposes only. Starting in October, however, Arizona will join at least 16 other states in requiring providers to first check the PMDP database on their patient in most cases before being allowed to prescribe an opioid for that patient.
Yet, even before this policy takes hold, the PDMP has significant effect on prescribers. Aware that they are under surveillance, no provider wants to be seen as an outlier. There’s no telling what the long-term consequences might be for a provider with that label. I’ve spoken with practicing physicians across my state, and all of them agree that it’s disconcerting to have “big brother” looming over their shoulders in this manner.
The ensuing chilling effect on the prescribing of opioids has led doctors to cut off some of their patients who are honestly in pain — and some of whom may have developed a physical dependence, but not an addiction (there is a difference), leading some of them to seek relief in the illegal drug market. The CDC data showing an increase in the number of heroin overdoses and a slowing in those from prescription drugs appear to bear this out.
This calls into question the value and effectiveness of PDMPs. PDMPs might succeed in making healthcare providers more frugal prescribers of narcotics. But they may also be sending more patients, in desperation, to the illegal drug market where they obtain opioids that may be counterfeit, laced with dangerous and more powerful drugs such as fentanyl and carfentanil, and where they may opt for heroin because it is actually cheaper and easier to obtain than prescription opioids.
A study released in May 2017 lends credence to this theory. Researchers at the University of Pennsylvania and Pennsylvania State University used data from all jurisdictions, as well as from the Centers for Disease Control and the US Census Bureau, to examine the effect of all PDMPs from 1999-2014. They concluded that, “PDMPs were not associated with reductions in drug overdose mortality rates and may be related to increased mortality from illicit drugs and other, unspecified drugs.”
To be sure, PDMPs may serve a useful adjunct to the healthcare practitioner. Knowledge of a patient’s prescription drug history can be very helpful not only when deciding whether to prescribe a narcotic, but also whether to have a serious discussion with a patient about that patient’s possible drug dependency. But this should be at the discretion of the doctor.
There are many cases in which the provider knows the patient quite well, and a check of the database amounts to nothing more than a nuisance. And provider report cards that carry the risk of an outlier accusation probably only serve to exacerbate the opioid overdose problem.
If states want to continue with Prescription Drug Monitoring Programs they should convert them into useful databases for healthcare practitioners to voluntarily access, as needed, in the course of administering care to their patients. But big brother heavy handedness in these programs needs to end as it is only making matters worse.
NASHVILLE, Tenn. (WKRN) – A Tennessee District Attorney is offering a warning about a new, deadly mix of drugs – marijuana mixed with fentanyl.
DA Matthew Stowe told News 2 the drug is here in Tennessee and he can’t warn people fast enough.
“It’s absolutely being seen in Tennessee. It’s being seen in West Tennessee, it’s coming in in vast, vast quantities,” he said.
Fentanyl is a powerful synthetic opioid used in medical settings to treat chronic pain. On the street, it takes just a small amount for someone to overdose within minutes.
“It is very easy to move,” Stowe said. “It is very easy to transport and it’s hard to detect.”
He continued, “There are some marijuana dealers that will tell their clients that I have no doubt there is fentanyl in it and some of the more addictive folks, especially folks that also use other drugs, will get that marijuana laced with fentanyl in hopes of getting a better high.”
The district attorney told News 2 there is no way for someone on the street to know if the marijuana is laced.
“The bottom line is, anyone, anywhere could mix fentanyl and marijuana and there’s no way of knowing it until it’s too late,” Stowe warned.
Since fentanyl is so powerful, Stowe said that marijuana laced with it could kill more than just the user.
“Marijuana laced with fentanyl can be extremely deadly and to anyone who touches it, taste it, smokes it [or] anything else of that nature,” he explained. “If it’s laced with fentanyl, marijuana can be the deadliest drug there is.”
Stowe said agents have recovered the deadly mix of drugs from busts throughout Tennessee.
“I wanted to get an alert out right away,” Stowe said. “I didn’t want the community to have their first notice that we have this problem be someone’s child in the morgue.”
He continued, “Parents just need to know how deadly this is. Someone with marijuana laced with fentanyl could light up that joint, and not only would they be dead, but everyone who’s been around it inhaling the smoke could be dead as well in a matter of minutes.”
The dangerous mix of drugs has also caught the attention of the Commissioner of Safety and Homeland Security. The office confirmed fentanyl laced with marijuana is a concerning trend it’s starting to see.
News 2 also reached out to the Tennessee Highway Patrol. The agency said so far, no cases of marijuana mixed with fentanyl have been found.
A KNUTSFORD man who suffered decades of back pain took his own life with painkillers, an inquest has concluded.
Former baggage handler, Fred Sinclair, 67, was found dead in bed at his home at Longridge on February 22.
The inquest in Warrington on Monday heard that Mr Sinclair had been retired from his job because of the back pain.
His GP Tim Mallon told the inquest: “He wasn’t suicidal. I think he was rather frustrated and a bit angry at retiring at 45 with a bad back and it was hard for him to take.”
Dr Mallon told the inquest that to help relieve the pain Mr Sinclair had been taking Co-proxamol, but due to his prevailing heart condition, he had warned him of the dangers of overdosing.
The drug itself was withdrawn from general prescription because of its toxicity, but its removal left Mr Sinclair with the loss of what he believed to be the only effective drug to treat his pain, the inquest heard.
Dr Mallon added: “Over the years we have struggled to find other painkillers that were hitting the spot in dealing with the pain in his back.”
The last prescription he had for the drug was in March 2011.
His son Anthony told the inquest that his father was a proud man who would never have wanted to end up in a wheelchair.
“He wanted his distalgesic (Co-proxamol) back because he was in a lot of pain,” he said.
Anthony said that after his father’s death, two emails were found on his electronic tablet, which, in hindsight, indicated that he was hurting very much and was, in effect, saying goodbye to the family.
PC Andrew Walker had earlier told the inquest that the box of Co-proxamol, which had been prescribed in 2011, was found at the bedside.
West Lancashire coroner Claire Hammond said the cause of his death was “suicide as the result of an old prescription of Co-proxamol, with underlying heart disease, which had also contributed to his death”.
AS states grapple with increasing opioid abuse, policymakers would do well to consider if government has inadvertently played a role in fueling addiction. U.S. Sen. Ron Johnson, R-Wis., has gathered evidence suggesting this may be the case.
In a recent letter to the Health and Human Services inspector general, Johnson noted that opioid problems appeared much worse from 2013 to 2015 in states that expanded Medicaid under the Affordable Care Act than those that didn’t, based on Census data and statistics from the Centers for Disease Control and Prevention. In Maine, which didn’t expand Medicaid, there was a 55 percent increase in opioid overdose deaths. In nearby New Hampshire, which did expand Medicaid, there was a 108 percent increase. In Maryland, an expansion state, the rate surged 44 percent, but just 22 percent in non-expansion Virginia. In Medicaid-expanded Ohio, overdoses increased 41 percent, compared to 3 percent in Wisconsin, which didn’t expand its program.
Overall, overdose deaths per million residents increased twice as fast in Medicaid expansion states than in non-expansion states.
Correlation doesn’t automatically equal causation, but Johnson provides reason to think it exists in this case. Based on police comments, he reports someone with a Medicaid card can obtain up to 240 oxycodone pills for as little as a $1 co-pay. Those pills can then be resold for $4,000 on the black market.
It’s not unreasonable to think some people will exploit the system for fast cash, especially since others (taxpayers) foot almost all up-front costs.
Oklahoma is not among the Medicaid expansion states, and opioid abuse, while a major problem, isn’t as common here as in many other states — at least for now. But there have been Oklahoma cases that lend credence to Johnson’s theory.
In 2015, state authorities raided a south Oklahoma City pain clinic, Aria Orthopedics. Physician Harvey Jenkins and five former employees were eventually charged with Medicaid fraud and various drug offenses. Prosecutors called the Harvard-educated Jenkins “a drug dealer with a prescription pad.”
Jenkins had served hundreds of Medicaid patients. Prosecutors said he was known for writing large prescriptions and doing little to prevent diversion of narcotics, mainly opioid painkillers. A former clinic employee told investigators the clinic served “between 60 and 115 patients” every day.
Proponents of Medicaid expansion were quick to shrug off Johnson’s findings, and many countered that Medicaid expansion also pays for some people to obtain addiction treatment. The latter is true, but that doesn’t negate potential abuse of the system.
We’ve long supported efforts to require doctors to check the state’s prescription drug database every time they prescribe highly addictive drugs. Current law requires Oklahoma doctors to check it only on a patient’s first visit and then every 180 days thereafter. Imposing an every-time requirement would certainly be appropriate any time a doctor serves a Medicaid patient who is using taxpayer funds. There are likely other safeguards worth implementing.
Johnson’s observations justify careful review and reconsideration of state law. Policymakers in Oklahoma and elsewhere should take this critique seriously. State officials must ensure the expenditure of Medicaid dollars generates improved health outcomes, not an addiction crisis.
When the Commission on Combating Drug Addiction and the Opioid Crisis advised the President to declare a national emergency to deal with the overdose epidemic, HHS Secretary Tom Price wisely suggested that this step wouldn’t be particularly useful: “[T]he opioid crisis at this point can be addressed without the declaration of an emergency.” Price is, of course, a physician who understands the public health implications of opioid addiction. He is also a former congressman who knows what kind of mischief the federal government gets up to when “solving” a crisis. Price was in Congress when the “uninsured crisis” spawned Obamacare.
Sadly, President Trump listened to less sagacious counsel and declared an emergency after all. If the White House and Congress follow the other bad advice offered in the commission’s interim report, they will produce another disaster for doctors and patients while exacerbating the problem they ostensibly wish to resolve. The most pernicious recommendation offered by the commission involves what the report dubs “prescriber education.” It calls for doctors, dentists, and every other provider with a prescription pad to suffer through mandatory courses — under the watchful eye of the Drug Enforcement Administration — to learn the “proper” way to treat pain:
Mandate medical education training in opioid prescribing and risks of developing an SUD by amending the Controlled Substance Act to require all Drug Enforcement Administration (DEA) registrants to take a course in proper treatment of pain. HHS should work with partners to ensure additional training opportunities.
The primary result of this ill-conceived recommendation will be far fewer prescriptions for all types of medication. But isn’t the problem caused by too many doctors writing too many prescriptions? Nope. The authors of the interim report claim, “We have an enormous problem that is often not beginning on street corners; it is starting in doctor’s offices and hospitals in every state in our nation.” In order to reach this preposterous conclusion, the commission had to studiously ignore a widely-documented decline in the number of opioid prescriptions that began at least seven years ago. In July, the Centers for Disease Control and Prevention (CDC) reported:
From 2010 to 2015, the amount of opioids prescribed in the United States decreased from 782 to 640 MME per capita.… Nationally, opioid prescribing rates leveled off from 2010 to 2012, and then decreased by 13.1% from 2012 to 2015.
Despite this decrease in opioid prescribing rates, mandatory education and increased DEA surveillance will soon render providers wary of prescribing any kind of controlled substance. Doctors will be so afraid of violating DEA rules that they will err on the side of caution. Patients with no history of, or predisposition toward, addiction will suffer needlessly because lazy politicians on a presidential commission have eschewed critical thinking and embraced hyperbole. Ironically, most controlled substances are neither narcotic nor addictive, and few patients are in any real risk of addiction. As geriatric specialist Thomas F. Kline, M.D. writes:
Out of 100 people taking pain medicine, only a very few, perhaps three or four, will develop an addiction. Restricting pain medicine in the other 97 is not good medical practice.… Deaths from narcotic overdoses usually involve multiple, non-prescribed, street drugs, not pain medicines prescribed by caring doctors.
But the report rejects dull reality in favor of sensational factoids: “The average American would likely be shocked to know that drug overdoses now kill more people than gun homicides and car crashes combined.” The average American won’t be “shocked” to learn that this is hopelessly misleading. To support their claim, the commission lumps together deaths involving all drugs, including heroin and cocaine, and fails to differentiate between overdoses and deaths resulting from the ingestion of multiple contraindicated drugs. Finally, the commission ignores the role government has played in creating the “crisis.” Which brings us to its second worst recommendation:
Grant waiver approvals for all 50 states to quickly eliminate barriers to treatment resulting from the federal Institutes for Mental Diseases (IMD) exclusion within the Medicaid program. This will immediately open treatment to thousands of Americans in existing facilities in all 50 states.
This seems innocuous enough, at first glance, but disturbing data have emerged suggesting Medicaid is no panacea for this “epidemic.” Indeed, the program may well be driving the dramatic increase in opioid overdoses. A key provision of Obamacare involved coercing states into expanding Medicaid to able-bodied adults. The Supreme Court ruled that provision unconstitutional in 2012, permitting states to opt out of expansion. Since then, 19 states have done just that. What has all this to do with opioids? It turns out that the very real spike in overdoses seen in the Medicaid expansion states is absent from those 19 states. As Jon Cassidy wrote in this space in June:
Obamacare’s Medicaid expansion and individual insurance exchanges both went into effect in 2014. In just the next year, the fatal opioid overdose rate increased by 15.6 percent, CDC found.… The increase isn’t uniform. It’s clearly happening in 30 states, most of which accepted the Medicaid expansion. But overdose deaths have remained steady in 19 other states, according to the CDC.
How the commission missed the Medicaid connection is a mystery. Even the establishment media have taken notice. A headline in the Hill, for example, drew attention to the relationship thus: “Want to end the opioid epidemic? Start by freezing Medicaid expansion.” The author of that piece, Sam Adolphsen, points out that a patient covered by the program is 6 times more likely to die of an opioid-related death than someone with decent coverage. Adolphsen also points out that the Medicaid expansion in which Ohio governor John Kasich takes such pride has his state “on track to have more overdose deaths in 2017 than the entire United States had in 1990.”
All of this is lost on the President’s Commission on Combating Drug Addiction and the Opioid Crisis. Chairman Chris Christie and its other members clearly believe that government meddling will end the “epidemic.” The rest of their recommendations all involve increased federal surveillance of doctors and patients, throwing taxpayer money at failed programs, and adding to the regulatory morass that is already killing our health care system. Before President Trump and Congress take further action based on the commission’s advice, they would do well to remember Ronald Reagan’s admonition about the nine most terrifying words in the English language.
The kind of “help” offered by Governor Christie and his accomplices on the commission is exactly what Reagan found terrifying. It will give government more power over patients and doctors while making the “crisis” worse. Here’s a novel idea: How about getting together a few actual physicians, people who actually treat actual patients, and see what they suggest? We have had a lot of government help during the last eight or so years. Do we really want MORE?
You can view the I-Team story tonight on WCPO 9 On Your Side at 6 p.m.
As the nation’s opioid addiction grew out of control in the five years between 2007 and 2012, one Cincinnati company sold more than 4 million doses of highly addictive prescription pain pills to one county.
A county of only 200,000 people.
Omnicare, a big supplier of drugs to pharmacies, hospitals and nursing homes, is one of at least five Cincinnati-area companies now in the sights of states and counties fighting back against the opioid epidemic that is killing their residents, draining their budgets and stretching their resources to the breaking point
These companies played a key role in the epidemic, shipping millions of doses of addictive narcotics around the country, including to doctors’ offices and pain clinics that became known as “pill mills,” the lawsuits say.
Omnicare and other pharmaceutical wholesalers typically conducted business behind the scenes, supplying retail drug stores, hospitals and nursing homes with the pharmaceuticals they order for their patients and customers. But the tsunami of pain pills that washed over the country and, in particular, here in the nation’s heartland, would not have happened without their participation.
They are, essentially, drug dealers, selling prescription narcotics that are chemically akin to heroin and doing it on a massive scale. Whether they did so legally or not is the question.
A growing number of cities, counties and states claim they haven’t and are suing these drug middlemen, saying they precipitated the heroin and opioid epidemic that has cost so many lives and damaged so many others.
Many people began their journey into addiction with pain pills such as Oxycontin and Vicodin, which they often acquired from disreputable doctors or pain clinics. But when the street price of the pills became too high and states cracked down on the pill mills, many of the addicted turned to heroin, which was cheaper and even easier to get.
Five Cincinnati-area companies sued
On Tuesday, the city of Cincinnati became the latest jurisdiction to sue pain pill wholesalers when it targeted three major ones — Cardinal Health, McKesson Corp. and AmerisourceBergen. A day later, Hamilton County agreed to join that lawsuit.
In July, Clermont County declared the opioid epidemic a public nuisance and sued the same three wholesalers. Five other Southern Ohio counties, including Brown and Adams, have joined that lawsuit.
The state of Kentucky says it plans to sue distributors, and the state of Ohio is considering doing the same.
The Omnicare sales figures come from a lawsuit filed in March by the commissioners of Kanawha County, West Virginia, the home of that state’s capitol, Charleston.
It names 16 distributors, including five from the Cincinnati region: Omnicare, Kroger, Springboro-based Miami-Luken, Masters Pharmaceutical Inc. and Blue Ash-based Keysource Medical Inc.
All the companies are part of a previously obscure link in the chain that supplied doctor’s offices and consumers with pain medicine, and led — many experts agree — to addiction and heroin.
Carol Wagner’s son, Chad, died of a heroin overdose at the age of 37. His addiction started with the painkillers Oxycontin and Vicodin, which a doctor prescribed for his carpal tunnel syndrome.
Chad Wagner
“He was a wonderful kid,” said Carol, who lives in Fort Mitchell. “He went to the University of Kentucky, he played ice hockey for the university. He was handsome, he was charismatic, he was hard-working. He was all the things you would want in a child.”
By the time he overdosed and died in a Cincinnati halfway house on May 20, 2005, he had lost his marriage, his home and had filed for bankruptcy because of his addiction.
His mother says drug wholesalers and others should answer for the drug epidemic.
“We are in an opioid crisis,” she said. “People are dying. They need to be held accountable.”
But holding them accountable is not always easy.
At least two local wholesalers years ago attracted the attention of the U.S. Drug Enforcement Administration, which tried to shut them down.
One, Masters Pharmaceutical, has been under investigation by the DEA for nearly 10 years.
In 2008, the agency threatened to revoke the company’s license to sell controlled substances such as pain pills, saying it violated the law by selling the powerful narcotic hydrocodone to “rogue Internet pharmacies.”
Masters employees should have known that those orders were suspicious, the DEA said.
The company reached a settlement with the DEA, but by 2013, the feds again threatened to revoke its license. Employees were still failing to detect and report suspicious orders of oxycodone, better known by brand names Oxycontin and Percocet, it said. The company had filled orders of millions of doses of those drugs to eight “illegitimate pharmacies” in Florida and Nevada, the DEA argued.
Prescription OxyContin was widely diverted, sold on the streets and abused.
Federal regulations require wholesalers to report to the DEA suspicious orders of narcotics. These can include orders that are unusually large or are made too often. The agency requires the wholesaler to investigate suspicious orders and refuse to fill them if they are suspect.
But “Masters employees frequently simply brushed suspicion under the rug by deleting orders or paring them down and shipping them without reporting them to DEA,” federal judge Susan Dlott ruled in a 2011 lawsuit.
Masters employees also accepted “half-baked or implausible explanations its customers supplied,” the judge wrote.
Still selling, even as DEA investigates
Masters has fought the DEA’s enforcement at every step and continued to sell opiates while its case has been under appeal. The company operates distribution centers in Fairfield and Forest Park. Last week, a federal appeals court judge in Washington, D.C. ruled against the company, clearing the way for the DEA to suspend its license.
But the company will stay in business because the DEA approved a license for a new Masters facility in Mason in December 2016, even as the previous case worked its way through appeals.
Keysource Medical is a relatively small, independent drug supplier operating out of just one facility in Blue Ash. But DEA investigators paint a portrait of a company that played an outsized role in the pain pill wave that inundated the country.
Keysource specialized in generic hydrocodone and oxycodone, which the DEA calls the most widely abused pills in the country. Although it is a relatively small supplier, Keysource became one of the top wholesalers of pain pills to Florida pharmacies, the DEA said.
In a two-year period, Keysource sold more than 59 million doses of oxycodone to customers in 40 states, the DEA said. The vast majority of that — 78 percent — was sold to pharmacies in Florida, which was known as a haven for pill mills, the DEA said.
Some of those pills made their way back to Ohio and Kentucky via what DEA officials called the “Florida Pipeline” or the “Oxycontin Express.” Drug traffickers would hire people to drive to pill mills in Florida every two weeks or so, buy oxycodone for $40 a bottle, drive it back to Ohio or Kentucky and sell it on the black market for $1,500 a bottle, according to a DEA narrative.
A pharmacy raided by the DEA in Miami, Fla. in 2011. The “Florida Pipeline” stretched from Ohio and Kentucky to pain clinics like this in Florida, where narcotics were illegally bought and brought back to the Midwest, the DEA says. (Photo by Joe Raedle/Getty Images)
In 2011, the DEA raided Keysource’s Blue Ash office and seized sales records, emails and letters. It suspended the company’s license to sell narcotics “to stop KMI from adding any more fuel to the flame of what is an imminent and serious public health problem.”
Keysource “was sending tens of millions of pills of oxycodone into Florida, the national epicenter of the pill problem,” a DEA investigator said in court documents.
The company “was the number one independent distributor in the country for sales of oxycodone in 2010 and in the first three months of 2011,” the investigator said. “No other single-facility distributor distributed more oxycodone during that period.”
Like Masters Pharmaceutical, Keysource and its employees are accused of manipulating records to hide unusually large orders from pill mills.
Keysource Medical in Blue Ash Wholesaler-supplied pill mills were the drug dealers for many like Amy Parker, who got addicted and then turned to heroin after first being prescribed narcotics by a doctor.
More than 10 years ago, Amy saw a doctor in Hamilton for back and knee pain. After waiting hours to see him — a line of patients stretched down Route 4, she says — he prescribed her the powerful painkillers Opana and Oxycontin in an appointment that lasted just minutes. She ended up addicted, and when she could no longer get the pills, she turned to heroin.
Amy, who lives in West Chester now, survived pain pills and heroin and has been in recovery for nearly five years.
Amy Parker
Many more have not survived.nIn Ohio alone, at least 19,449 people died from drug overdoses between 2005 and 2015.
Who is ‘financially responsible’?
Now, cities, counties and states in need of money to clean up the ongoing carnage are suing these companies, accusing them of knowingly fostering the gross overprescription of painkillers. And they are seeking compensation.
“These community-based problems require community-based solutions which have been limited by budgetary constraints at the state and federal levels,” the West Virginia lawsuit says. Cincinnati wants to hold the distributors “financially responsible for … the hazards to public health and safety” they caused.
Both Cincinnati and Clermont County officials are seeking damages to compensate for the costs of medical care for overdose patients, the costs for treatment and rehab, costs for babies born addicted and increased costs of law enforcement. They’re also seeking punitive damages.
The Cincinnati-area distributors had little to say about the lawsuits or the DEA actions.
Keysource Medical’s CEO, Todd Szewc, would not comment on the lawsuit or the DEA action.
An attorney for Masters Pharmaceutical did not comment on the charges, but emailed briefs filed by three pharmaceutical trade associations that said the DEA changed its reporting requirements without enough notice.
Omnicare is now owned by pharmacy giant CVS. An official there said, “We believe the allegations have no merit.” She also emailed a general statement that said “CVS Health is committed to the highest standards of ethics and business practices, including complying with all federal and state laws governing the dispensing of controlled substance prescriptions, and is dedicated to reducing prescription drug abuse and diversion.”
Kroger would not comment or even provide information about its affiliates that supplied its pharmacies.
Miami-Luken declined to comment.
Although these lawsuits have the potential to bring milions to budget-strapped communities, it’s unlikely they will be settled anytime soon. Attorneys expect such cases to last about two years.
.This is a good example of a author writing and not researching accurate background information. This author is claiming that OMNICARE is part of the opiate epidemic, however, Omnicare only services institutional pts ( Nursing homes and the like) where if medication are not sent to the facility to conform to the prescriber’s orders… the nursing home is at risk of being cited by the state for failing to follow prescriber’s orders and PT NEGLECT.
Pts in these facilities DO NOT have access to their medication. They are provided to the pt per the prescriber’s medication orders.
Many of the pts in these facilities are in “skilled beds” which means that they are “high acuity pts” and require care similar to what is found/provided in a hospital. They tend to be very sick and require multiple medications.
The end of my pharmacy career was working in a Omnicare pharmacy… for about 6 yrs. I am very familiar with the LTC pharmacy operation.
ORANGE CITY, Ia. — Thirty-two years ago, a vehicle accident left Todd Mouw a quadriplegic, unable to feed himself and needing a ventilator to breathe.
Yet for decades he was able to live at home with the help of family, aided by medical staff who visited him daily to help provide 24-hour care.
That care abruptly ended when a for-profit company that Iowa hired last year to manage the state’s Medicaid program announced that some of the staffers who had attended to Mouw all those years weren’t qualified, and it wouldn’t pay for the cost.
As he and his wife Cyndi futilely searched for qualified help, Todd’s health dissipated. He had to leave his home for care, and on July 8 he died at age 53.
Now, Cyndi Mouw is speaking out, blaming her husband’s death on Iowa’s decision to turn over its Medicaid program to for-profit companies she believes are unilaterally denying or revoking medical services to potentially thousands of other disabled or elderly Iowans.
“If they’re trying to do this because they need to save money? Well, find other places,” Cyndi Mouw said. “And, yeah, I’m sure he’s not the only one.”
Her criticisms have echoed those of other families who complain that the private companies now managing the state’s Medicaid program are denying care that the state once approved.
And the state’s long-term care ombudsman said she has received hundreds of complaints from Medicaid recipients who are appealing decisions of the private managers hired by the state.
A lack of care
Todd Mouw’s problems began in March.
That’s when Amerigroup, one of three companies hired in 2016 to manage Iowa’s Medicaid program, notified the family that it was terminating a longtime waiver that allowed some of Mouw’s in-home workers to assist in such tasks as tracheostomy care.
Although some of the health provider firms and their employees had for nearly two decades provided Mouw’s care and equipment, Amerigroup said they no longer considered the workers qualified.
Amerigroup instead required registered nurses to provide some of the services that had for years been provided by home-health aides.
The requirement for higher-qualified staffing left the family scrambling for months to find workers Amerigroup would approve for payment.
When Cyndi Mouw thought she had identified potentially qualified workers, she said weeks of administrative delays resulted in repeated missed care for her husband.
In the months that followed, Todd Mouw would sometimes go unsupervised because no staff had been approved to provide care for him, Cyndi Mouw said.
When she had to go to work, she would monitor her cellphone in case her husband alerted her to an emergency care issue.
Several times, she said, she found her husband nearly unresponsive because the passageway of his trachea tubes needed to be cleared of mucus buildup.
“When I got the calls, I’d put on my hazard lights and I’d fly home,” she said, describing calls where all she could hear were the background sounds of his vent alarm system blaring warnings about her husband’s dropping oxygen levels.
“There were a couple times when he was blue when I got home. But we had no other option.”
In May, Todd Mouw developed pneumonia and was hospitalized.
Although he initially improved, he was never able to return home for lack of in-home workers.
Instead, he was sent to a facility in Sioux Falls, S.D., that specialized in respiratory ailments. He died at the facility about six weeks after he arrived.
Cyndi Mouw said her husband was happier at home. She believes he was provided better care there because his longtime workers were acutely aware of his needs.
“I do believe with all my heart this could have been prevented,” Cyndi Mouw said of Todd’s death.
Complaints, lawsuit follow Iowa’s money-saving plan
Iowa’s government for decades had managed the state’s Medicaid program, which serves more than 568,000 poor or elderly Iowans.
That changed last year when then-Gov. Terry Branstad decided to move the state’s Medicaid management to three private companies, saying health care would improve and the state would save tens of millions of dollars each year. The companies help decide which health procedures Medicaid will pay for.
Three companies — AmeriHealth, UnitedHealthcare and Amerigroup — began managing the program in April 2016. The three companies were paid $1,041 to $3,313 a month for each Medicaid patient they oversaw.
Cyndi Mouw gets emotional as she looks at the video that was played at her husband’s funeral Wednesday, July 19, 2017, at her home in Orange City, Iowa. Mouw’s husband, Todd Mouw, died after moving from in-home health care to an assisted living facility. Michael Zamora/The Register
In June, six Iowans with disabilities filed a federal lawsuit against Gov. Kim Reynolds, accusing the state of depriving thousands of Iowans that are part of the $4 billion program the legal right to live safely outside of care facilities.
Iowa’s Medicaid system had for years granted hundreds of “exceptions to policy” that allowed people like Todd Mouw flexibility to hire specialized care and — in some cases — spend more money than is allowed for a standard Medicaid patient.
But under management by the for-profit companies, those exceptions disappeared.
Medicaid recipients can challenge the companies’ decisions. And in hundreds of cases, recipients have sought help to resolve the disputes from the state’s long-term care ombudsman — an independent agency within the Iowa Department on Aging that investigates complaints.
Todd Mouw’s death is significant because he is an example of a disabled Iowan who had to be institutionalized following a for-profit company’s decision, said Deanna Clingan-Fischer, the state’s long-term care ombudsman. Mouw had contacted her office weeks before his death.
Clingan-Fischer said her office doesn’t know the number of people it has helped who were institutionalized because of a decision by one of the private companies. It’s part of a larger issue of reported service deficiencies that her staff finds concerning.
“It’s unfortunate they couldn’t maintain his level of care,” Clingan-Fischer said of Mouw, noting her office is no longer reviewing the case because of his death.
Serious claims have also been made against the companies in other states.
Multiple health providers claim in a lawsuit filed in Los Angeles federal court that WellPoint, which is a part of Amerigroup, orchestrated a scheme to reduce reimbursement payments. Portions of the lawsuit, first filed in 2009, have been dismissed, but others are still being litigated.
Among the plaintiffs are medical groups from California, Connecticut and Georgia.
A Des Moines Register investigation in 2015 found that each of the three managed-care companies operating in Iowa has been accused in other states of serious service and administrative errors, including denial of medical services to poor residents.
Starting in July, the Register made multiple attempts to ask Amerigroup representatives questions about Todd Mouw’s case.
Cyndi Mouw signed waiver forms requested by Amerigroup to allow the company to speak about her husband’s care.
But on July 31, Amerigroup said it additionally needed records showing Cyndi Mouw as the executor of her husband’s estate. Cyndi Mouw said she had no need to be appointed executor, since her husband had no assets, and she couldn’t afford the court costs.
An Amerigroup employee assigned to work with the family did make several attempts to help resolve the issues linked to her husband’s care, Cyndi Mouw said. She is left uncertain whether the problems lie mostly with Amerigroup or the state.
Amerigroup spokeswoman Denise Malecki said other members would testify that they wouldn’t have been able to obtain the health services they needed if it wasn’t for her company.
“It has seemed as if distaste for the new Iowa Medicaid managed-care program is the popular opinion, but we are seeing otherwise,” Malecki said. “There are a lot of people who have been helped and willing to share their stories to let others know that help is available.”
The Register requested the names and contact information of the people Malecki referenced. She did not respond.
“Medicaid modernization improves access, gives patients more choices and brings accountability to the program,” Reynolds said in her statement.
J.D. Power declined to identify who paid the company to use its survey results. Brenna Smith, a spokeswoman for Reynolds, said it wasn’t the state.
Community living vs. institutions
Department of Human Services spokeswoman Amy McCoy said she couldn’t speak to specifics about Mouw’s case, partly because of the pending class-action litigation filed against the state by the advocacy group Disability Rights Iowa.
But McCoy said “cost neutrality” plays a part in Medicaid care decisions.
The term is used to describe federal rules that say the aggregate cost of providing healthcare to a Medicaid member will not exceed the cost of an institutional placement.
In other words: If it’s cheaper to institutionalize a person, that’s generally the care that must be provided.
“Our goal is to successfully and appropriately serve Iowans with mental health and disability needs in the least restrictive setting possible while remaining good stewards of taxpayer resources,” McCoy said.
Cyndy Miller, an attorney for Disability Rights Iowa, said McCoy’s response does not consider federal laws such as the Americans with Disabilities Act and the Olmstead mandate.
That’s a law and a court ruling that have determined that people with disabilities have a right to live in the community, rather than in institutions.
Miller said there are questions about data the state uses to calculate “average aggregate costs,” specifically whether the data is too old to properly set rates.
“Institutionalization has been increasingly disfavored by the courts, giving states a greater incentive to pursue waivers and keep individuals with disabilities in their communities,” Miller said.
Cyndi Mouw hasn’t reviewed all their bills, but she said she’s confident her husband’s care was far cheaper at home than in the long-term hospitalized setting he lived in during the last weeks of his life.
Mouw said her goal is not to file a lawsuit or make Amerigroup and the state look bad. Rather, she said, she wants her husband’s death to serve as a wake-up call about serious problems in Iowa’s privately managed Medicaid system.
She recalled her husband’s “food ministry,” in which he planned meals and directed his family to regularly cook and serve needy families in his community.
“Don’t get me wrong, his death was inevitable,” Mouw said. “But I do believe with all my heart this could have been prevented and he would have lived longer.”
Marijuana: it was once a taboo topic, but is no longer.
According to a newly released study from national pollster Gallup, more Americans than ever have tried marijuana.
Gallup has been sporadically asking Americans if they had tried cannabis over the past 48 years. Back in 1969, just 4% of respondents claimed to have tried the drug. By 1999, just a few years after California became the first state to legalize medical cannabis for compassionate use, about a third (34%) of respondents had claimed to have tried marijuana before. However, between the mid-1980s and 2010, this figure was essentially static, give or take a few percent. According to Gallup’s July 2017 survey, 45% of Americans have now tried marijuana, an all-time high. If Gallup’s profile is consistent with that of America, then, utilizing data from the U.S. Census Bureau in 2016, more than 112 million adults have tried marijuana at least once in their lives.
Image source: Getty Images.
Along those same lines, Gallup also asked its respondents if they were current marijuana users. In 2013, just 7% affirmed that they used marijuana on a somewhat regular basis. However, in the 2017 poll, 12%, or roughly one out of eight Americans, admitted to regularly smoking cannabis. Interestingly, this was down 1% from 2016, albeit still well within the standard margins for error in polling.
Five likely reasons why more Americans than ever are trying marijuana
So, this begets the question: Why are more people experimenting with marijuana than ever before? The answer probably lies with a confluence of factors.
For starters, we’ve witnessed a notable shift in the way the American public views marijuana over the past two decades. Gallup, which has also polled Americans on their views regarding legalization for the past 48 years, has shown that favorability toward legalization has soared recently. After just 25% of the public favored its nationwide legalization in 1995, 60% were in support of such a move in its 2016 survey, an all-time high.
The expansion of medical cannabis and recreational weed in select U.S. states, along with the end of the war on drugs, has also likely encouraged experimentation with the drug. Since 1996, 29 states have legalized medical cannabis, including Ohio and Pennsylvania last year, which did so entirely through the legislative process (i.e., without putting the measure on a ballot for residents to vote on). Eight states have legalized recreational weed since November 2012. Expansion gives Americans a legal means to try pot or, in rarer instances, become a regular legal consumer.
Image source: Getty Images.
Select state governments could also be behind higher experimentation rates. It’s no secret that certain states struggle to balance their budgets, thusly legal cannabis acts as a new stream of tax revenue and fees that can help close or ebb budget deficits. States like Nevada, which only recently opened their doors to recreational marijuana, are counting on tax revenue from the sale of legal weed in order to make ends meet.
We can probably also point to politicians for increasing the experimentation rate. Even though marijuana is entirely illegal at the federal level, this past November was the first presidential election cycle where marijuana was a mainstream topic for the candidates. It cemented the idea that pot was no longer a taboo topic that could be avoided by our nation’s lawmakers.
Lastly, the advancement of medical cannabis and cannabinoid-based drugs in clinical trials has probably cast a more favorable view on marijuana. GW Pharmaceuticals (NASDAQ:GWPH) is attempting to bring the very first cannabis-derived drug to market next year. The cannabidiol-based oral drug, known as Epidiolex, breezed through multiple pivotal-stage studies in two rare types of childhood-onset epilepsy, Dravet syndrome and Lennox-Gastaut syndrome. Clinical studies from GW Pharmaceuticals, along with more informal research studies from universities, have painted a picture that suggests marijuana could be helpful, not harmful, in treating certain diseases.
Despite weed’s growing popularity, the federal government has dug in its heels
However, it’s also worth pointing out that in spite of more Americans than ever having tried marijuana, any chance for change in the federal government’s scheduling of the drug still seems to be a ways off.
Image source: Getty Images.
One issue is Attorney General Jeff Sessions, who is among the most ardent opponents of marijuana. It was uncovered in June that Sessions had sent congressional leaders a letter in May requesting that they repeal the Rohrabacher-Farr Amendment, which protects legally operating cannabis businesses in legal states. In other words, Sessions requested permission from Congress to trample states’ rights and go after medical marijuana businesses.
Another issue is that Congress has far too much on its plate to concern itself with marijuana legislation. Republicans have been working on healthcare reform for more than five months, while tax reform talks have been progressing at a snail’s pace. Of the multitude of things that President Trump wants to accomplish as president, legalizing marijuana isn’t remotely on the list as of now.
The U.S. Drug Enforcement Agency (DEA) is probably of little help, too. Last year, the DEA had an opportunity to review two petitions that requested the scheduling for marijuana be changed. The DEA declined to do so, citing a lack of clinical evidence on the benefits and risks of the drug, as well as a lack of proper usage oversight.
There’s a Catch-22 as well. Most lawmakers, along with the DEA, want more clinical data to pore over in order to make an educated decision about weed’s scheduling. Unfortunately, its restrictive scheduling also makes running the studies that are needed very difficult. You could almost say that red tape is ensuring that marijuana remains an illegal substance.
Image source: Getty Images.
Investing in marijuana is a highly risky venture
Even with a record number of people experimenting with pot, and legal sales expected to grow by a double-digit percentage for the next five to 10 years, investing in marijuana stocks will remain a risky venture at best.
There are a number of concerns with marijuana companies that simply aren’t going away anytime soon. For example, weed companies have little or no access to basic banking services, such as a line of credit or even a checking account. This forces marijuana companies to deal solely with cash, which is a big security risk and an inhibitor of growth.
Also, the Internal Revenue Service doesn’t look too kindly on profitable pot companies. U.S. tax code 280E disallows businesses that sell an illegal substance, like marijuana, from taking normal corporate income tax deductions. Thus, if a weed business does turn a profit, it’s likely handing over far more in taxes than a “normal” business.
The result for most marijuana stocks is steady losses with no chance of really thriving until the federal government changes its stance on pot. Unfortunately, it’s unclear when, if ever, that’s going to happen.
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