DEPENDENCE VERSUS ADDICTION … AND OPIOID USE DISORDER

Posted on June 25, 2017 by Pharmaciststeve

DEPENDENCE VERSUS ADDICTION … AND OPIOID USE DISORDER

www.rallyagainstpain.com/2017/06/23/dependence-versus-addiction-and-opioid-use-disorder/

It’s no secret that things are changing day by day for chronic pain patients. The CDC guidelines have not been viewed as “guidelines”; rather they have been viewed as law, causing States to implement their own stringent restrictions on opioid prescriptions by legitimate physicians, regardless of the patients’ medical condition, their confirmed medical diagnoses, and past history of the “tried and failed” methods of conservative treatment. When there is no conservative treatment or even invasive procedures available to help, many people suffering from severe, chronic pain, must rely upon opioid treatment in order to attain and maintain the highest quality of life possible.

Many patients have gone years or decades on a successful pain management plan; a plan which many times includes opioid treatment. These treatment plans provided pain relief which would allow these patients to remain functional. Do these patients “depend” on this treatment to maintain their ability to function? Yes, of course. Do diabetics rely on medicine, in conjunction with lifestyle changes to maintain function? Yes, of course. Do diabetics always incorporate exercise, diet, and lifestyle changes to control their disease? Many times … not so much. The same scenario goes for a multitude of disease processes. Further, the prescription medication used to control these disease processes have side effects and some can be abused. So to be dependent upon medication which keeps the patient stable is not necessarily a bad thing, even if it includes opioids.

Most physicians and patients know that when one has used opioid therapy for years, decades or more, a sudden discontinuance of opioids can and does lead to severe consequences for the patient. In fact, it can be fatal. Does this mean that the patient is addicted? Of course not. The patient simply relies upon the medication to keep them functional. When taken appropriately, opioids are not necessarily a bad choice for patients. The CDC guidelines even state that opioids are to be used “when the benefits outweigh the harm”. Let’s take a look now at addiction.

Addiction is defined, according to the American Society of Addiction Medicine as follows:

“Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors. Addiction is characterized by inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response. Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death.”

By the very definition of addiction, it is clear that chronic pain patients who use their medication appropriately are NOT addicted. They are dependent on the medication necessary to maintain quality of life and avoid loss of function.

Our final area of discussion is relatively new, yet perhaps as important as understanding the difference between dependence and addiction … Opioid Use Disorder. This diagnosis is relatively new and this author could find no clear definition or criteria which defined the criteria used for diagnosis of this disorder. From what I could ascertain, the best, most clearly stated definition of Opioid Use Disorder is from the American Psychiatric Association. http://pcssmat.org/wp-content/uploads/2014/02/5B-DSM-5-Opioid-Use-Disorder-Diagnostic-Criteria.pdf

The American Psychiatric Association gives the following as criteria for use of the diagnosis “Opioid Use Disorder”:

A problematic pattern of opioid use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12-month period:

1. Opioids are often taken in larger amounts or over a longer period than was intended.
2. There is a persistent desire or unsuccessful efforts to cut down or control opioid use.
3. A great deal of time is spent in activities necessary to obtain the opioid, use the opioid, or recover from its effects.
4. Craving, or a strong desire or urge to use opioids.
5. Recurrent opioid use resulting in a failure to fulfill major role obligations at work, school, or home.
6. Continued opioid use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of opioids.
7. Important social, occupational, or recreational activities are given up or reduced because of opioid use.
8. Recurrent opioid use in situations in which it is physically hazardous.
9. Continued opioid use despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance.
10. Tolerance, as defined by either of the following:
a. A need for markedly increased amounts of opioids to achieve intoxication or desired effect.
b. A markedly diminished effect with continued use of the same amount of an opioid.

Note: This criterion is not considered to be met for those taking opioids solely under
appropriate medical supervision.
11. Withdrawal, as manifested by either of the following:
a. The characteristic opioid withdrawal syndrome (refer to Criteria A and B of the criteria set for opioid withdrawal).
b. Opioids (or a closely related substance) are taken to relieve or avoid withdrawal symptoms.

With some States now having “involuntary commitment laws”, it is important that if your doctor places this diagnosis on your billing statement or on your medical records, unless you meet the criteria for this diagnosis, you may wish to consider discussing it with your doctor. Unless he has reason to believe that you meet the criteria for this diagnosis, it should be taken off your chart. Perhaps your doctor doesn’t fully understand or maybe he has another source of information from which he is basing his opinion.

In this time of ever-changing laws and “guidelines” with respect to the treatment of chronic pain, it is important to stay vigilant and be involved in the decision-making process of your medical care. Stay informed. Take the time to discuss things you don’t understand with your doctor. Let your doctor know of any decline in functioning and describe the things that you were formerly able to do which you now suddenly cannot do if your medicine is decreased, discontinued, or changed. Communication is the key to a successful approach to your illness or disability.

Author: Lana Kirby (317) 441-2888

#Veterans & Americans United for Equality in Medical Car

Filed under: General Problems | 5 Comments »

Prescribed Painkillers Didn’t Cause the Opioid Crisis

Posted on June 24, 2017 by Pharmaciststeve

Prescribed Painkillers Didn’t Cause the Opioid Crisis

https://tonic.vice.com/en_us/article/a3z98b/big-pharma-didnt-cause-the-opioid-crisis-most-pain-patients-dont-get-addicted

People who need pain meds aren’t usually the ones who get addicted.

A recent study published in the New England Journal of Medicine produced stark headlines:

“A 5-sentence letter helped trigger America’s deadliest drug overdose crisis ever.” (Vox)

“The One-Paragraph Letter From 1980 That Fueled the Opioid Crisis” (The Atlantic)

“1980 NEJM Letter the Genesis of the Opioid Crisis?” (Medscape).

But while it’s clear that this letter was grievously misused by pharmaceutical companies intent on selling opioids—the truth about the real risk of addiction among pain patients and the influence of the now-infamous “Porter and Jick” paper is far more complex. And it matters a great deal because if we continue to misunderstand the problem, we’ll continue to pursue harmful and ineffective solutions that so far have only increased the death rate.

The letter in question was entitled “Addiction Rare in Patients Treated with Narcotics.” It noted that the researchers had examined records of more than 10,000 hospitalized patients treated with opioids for pain and found only four new cases of addiction.

The new study tracked how the paper—which had no details about methodology whatsoever— was cited 608 times. It also found that citations increased dramatically at the time when the makers of Oxycontin were marketing the drug as being unlikely to cause addiction, which was no coincidence.

“I think the letter—more correctly, the way in which it was mischaracterized—played an important role in helping reassure doctors that opioids could be used safely over the long term,” says David Juurlink, lead author of the study and a professor of medicine at the University of Toronto.

The narrative is evil drug companies pushed greedy doctors to prescribe unnecessary drugs, which turned innocent pain patients into people with heroin addiction.

At the same time, the story of the 1980 Porter and Jick letter and what has now become an unprecedented opioid overdose crisis has been spun by the media and some activists into a simplistic and misleading narrative. The idea is that the overdose epidemic was caused by evil drug companies pushing greedy doctors to prescribe unnecessary drugs, which turned innocent pain patients into people with heroin addiction, who are now overdosing on street fentanyl.

That, however, is not exactly what happened. Yes, the drug companies irresponsibly and reprehensibly misused the legitimate concern that pain was being undertreated to sell massive amounts of product. Yes, Purdue Pharma inaccurately claimed that Oxycontin was a less addictive opioid—and that its effects lasted longer than they really did. Yes, salespeople pressured many doctors into prescribing far more than made sense.

“The simple story is that addiction happens all the time when people get opioids for pain and that simple story is clearly wrong,” says Stefan Kertesz, associate professor of preventive medicine at the University of Alabama.

The research actually shows that people who developed new addictions in recent years were overwhelmingly not pain patients. Instead, they were mainly friends, relatives, and others to whom those pills were diverted—typically young people. Among the older patients, many who appeared to be newly addicted had actually relapsed or never recovered from prior addictions: some faked pain to get pills from well-meaning doctors; others got them from pill mills where shady physicians wrote prescriptions for cash.

The simple story that addiction happens all the time when people get opioids for pain is clearly wrong.

How do we know this—and why is this story so different from the one we hear in the media? For one, the National Household Survey on Drugs has asked about the sources of misused opioids in recent years: this representative survey of tens of thousands of Americans shows that less than a quarter of people who start misusing these drugs obtained them directly from one or multiple doctors. Half of new users, in fact, say they got them from a friend or relative for free.

Secondly, an early study of people being treated for Oxycontin addiction found that 77 percent of them had also taken cocaine—and it’s hard to imagine that this was supplied medically or that these pain patients went out in search of a cocaine dealer once they found out how nice opioids are. In addition, only 3.6 percent of people who misuse prescription opioids ever even try heroin. Although 75 percent of heroin users start with prescription opioids these days, very few prescription opioid users actually go on to heroin addiction.

Read More: Heroin Has Never Discriminated

And this, again, speaks to the unlikelihood that many prescription pain patients became addicted to heroin without having had a prior history of drug problems.

Just think about it: you’re a middle-aged woman with a bad back who uses a wheelchair. You’ve never even tried marijuana—let alone bought it on the street from a stranger. You aren’t internet savvy, so you’re not going to buy from the Darknet. And you aren’t street savvy, so you’re hardly likely to seek out the nearest bad neighborhood and start asking the people you usually cross the street to avoid if they can get you some “Um, do you still call it smack?” If you do work up the courage to try this, you are extremely likely to get ripped off or worse.

So, what is the real risk to pain patients from being prescribed opioids? This is a hotly debated topic, with the Centers of Disease Control and Prevention and news media being fond of saying that “up to 26 percent” of people exposed become addicted. This is pretty much the scariest figure available, but note that this means that nearly three-quarters don’t get hooked.

But this number cannot possibly be accurate. Some 70 percent of the population is exposed to medical opioids during their lifetime. If 26 percent of these people became addicted, we’d expect to see tens of millions of people with opioid addiction and hundreds of thousands of overdose deaths. The true addiction figure is roughly 2.5 million, or about 1 percent of the adult population, and the actual number of fatalities is horrifying enough, but it was just around 33,000 deaths in 2015.

If opioids were highly addictive for pain patients, we’d expect to see tens of millions of people with addiction and hundreds of thousands of overdose deaths.

Nora Volkow, the director of the National Institute on Drug Abuse, and her colleague, Tom McLellan, the former deputy drug czar, reviewed the literature on addiction risk during opioid treatment for chronic pain for the New England Journal of Medicine in 2016. These authors would seem to have the most reason to exaggerate these numbers—since government agencies and research scientists tend to want the most money and attention to the problems they work on. However, they say that among people taking opioids long term, “rates of carefully diagnosed addiction have averaged less than 8 percent in published studies.”

Says Juurlink of this number, “I think it’s on the high side,” but he adds, “Here again, we don’t have good real-world [studies] following people from the start of therapy until addiction or not, and we have this bewildering inconsistency in how addiction is defined.”

Moreover, among patients who just take opioids short-term—such as those who have acute pain from surgery or dental work—studies find that the risk is even lower. For example, one study of more than 640,000 surgical patients who had never previously taken opioids found that few used the drugs for more than three months after recovery from surgery: rates varied from less than 0.12 percent for people who had C-sections up to 1.4 percent for those who had knee surgery. And keep in mind that most of this long-term use—as we can see from the other studies—isn’t addiction, just pain treatment.

The recent study that may be most comparable to Porter and Jick (though with better design and clearer methodology) was published in the Journal of Urology in May. It studied records from 675,000 people who had undergone urologic surgery, including treatment for painful kidney stones. The rate of either new opioid addiction or overdose? Just 0.09 percent or 1 in 1,111 cases. In other words, not far off from what was found by, yep, Porter and Jick.

Still, Juurlink cautions, “I’m wary of big data studies that try to ascertain subtle outcomes like addiction. I suspect coding for addiction is fairly specific but insensitive. The corollary of this is that the absolute risk will be higher than a database study suggests.”

And also, as we can see from the higher numbers above, chronic, long-term exposure is linked to a higher addiction risk than acute exposure—up to 8 percent compared to less than 1 percent. That means it was never appropriate for drug companies to use the 1980 letter to assess risk of addiction in chronic pain treatment. But they did.

Watch more on pain treatment from Tonic:

Nonetheless, the idea that patients who take medications as prescribed are the cause of this problem is inaccurate. While the media loves to highlight “innocent victims” who became addicted through medicine, the fact is that this group is a minority. Medical use surely increased access to the drugs—but the people who got hooked tended to do so while using medication that was either prescribed for someone else or otherwise distributed illegally.

And this has clear implications for what needs to be done. The first is to stop thinking that simply cutting the medical supply will work. People who start opioid use illegally are not going to have problems finding substitutes for prescription medications on the illicit market—indeed, shunting them away from medical sources will increase their risk of dying.

This is why the current crackdown is failing hard: it’s increasing harm by pushing people from drugs of known dose and purity to those with unknown dosages, filled with impure and deadly stuff like fentanyl and its derivatives.

That’s not to say that prescribing practices shouldn’t change: research finds that 67 percent of surgical patients do not take all of the opioids they are prescribed. Limiting initial prescriptions to several days with refills only as needed will help dry up this supply, with little harm to patients. Similarly, ensuring that chronic pain patients have been given appropriate access to alternatives before starting long-term opioid use makes sense—as does making sure patients are benefiting.

But what we’re doing now goes much further than this. Thousands of pain patients report that their doctors have either cut them off entirely or involuntarily tapered them to doses that aren’t sufficient—due to increasing scrutiny from medical boards, insurers, and police. This is inhumane and does nothing to prevent addiction. In fact, more than 90 percent of all addictions start when people are in their teens or early 20s: the people we need to be most careful with when prescribing opioids are not typically older folks in chronic pain, but youth.

American drug policy tends to make irrational swings from being too relaxed about opioid prescribing to being too harsh. Perhaps if we actually tried to understand how and why people really become addicted we could find a happy medium.

Filed under: General Problems | 7 Comments »

Did the CDC exceed its legal authority in releasing opiate dosing guidelines ?

Posted on June 24, 2017 by Pharmaciststeve

By the very definition of the CDC’s name Center for Disease Control… that typically involves the dealing with the treatment of diseases.. including the guideline of when/what vaccines should be given and the ability to treat or quarantine people who are contagious with a communicable disease that could cause a epidemic or pandemic. Think potential of EBOLA outbreak in Africa and a few people that came to the USA with it.

Giving vaccines and/or treating contagious disease is typically a ONE TREATMENT PLAN FITS ALL…

PAIN IS NOT A DISEASE it is a SYMPTOM OF A DISEASE … and ONE TREATMENT PLAN WILL NOT TREAT ALL…

So did Tom Frieden.. the former head of the CDC, over step the authority of the Federal CDC in establishing and publishing opiate dosing guidelines ?

Although the committee chosen by Frieden met behind closed doors and its members were supposedly to be kept anonymous… many names have leaked out and the committee was seemingly stacked with those who are “opiophobic” and/or had a financial vested interest in the rehab industry.

Again, since this committee seem to focus on the treatment of the mental health disease of addiction.. which is not a contagious disease and requires highly individualized treatment… once again did the CDC over step its legal authority to act ?

Did Frieden and the committee members know or should have known that they were outside of their legal authority and published these guidelines in hopes that many entities would adopt these guidelines and they would become – by sheer adoption – common practice and be considered best practices and standard of care and if anyone challenged the constitutionality of the CDC authority to issue these guidelines and was successful.. that the guidelines would be so ingrained into majority of medical practices that they would remain in place… since a prescriber can establish whatever rules they wish for their practice and if the pt is not happy with the practice’s rules they can find a another healthcare provider to take care of the pt’s needs ?

Filed under: General Problems | 4 Comments »

Harmful effects of UNTREATED PAIN

Posted on June 24, 2017 by Pharmaciststeve

Filed under: General Problems | 14 Comments »

Another reason to DUMP THE CHAINS ?

Posted on June 24, 2017 by Pharmaciststeve

Hi there I have a question I’m disabled I’m on disability I have disability Medicaid but Walgreens making me pay cash for my insurance I believe their discriminating against me they even made me change psychiatrist which I did last month I had him for ten years but I changed to local psychiatrist so they would fill my anxiety medication even though I had refill on it from my old one I didn’t transfer it but now this month they insist for me to pay cash for my prescription s from my chronic pain dr all 5 of them being on disability my income is challenging enough having to pay for my medication s is putting me in tough spot my insurance will pay for it but they said my dr is cash dr but there are no chronic pain drs that except my disability Medicaid is it illegal to pay for visit and use my insurance for prescription Walgreens is telling me it is I’m crying as I write this I’m so confused thank you for any help you can provide with this issue

There are some details missing from this email.. but.. WTF… a Pharmacist telling a pt that they have to change doctors… from one the pt has been seeing for TEN YEARS and then forcing the MEDICAID PT to PAY CASH for FIVE PRESCRIPTIONS ?

A person has Medicaid because they are POOR…

A person in such a situation should file a GRIEVANCE/complaint with www.cms.gov 800-MEDICARE against the Pharmacist and their employer

Then there is the boards of pharmacy here is a link to all the BOP’s websites where most/all have a complaint form https://nabp.pharmacy/boards-of-pharmacy/

I would expect the local news media would be interested into looking into this situation… because if there is one pt that it has been done to.. there has is most likely more have had it done to them..

If you want to DUMP THE CHAINS… here is a link to a website that will help find a independent Pharmacy by zip code

http://www.ncpanet.org/home/find-your-local-pharmacy

Some Pharmacists consider themselves healthcare providers… others apparently see themselves as REVENUE GENERATORS for their employer without concern for the overall welfare of the pt.

Filed under: General Problems | 3 Comments »

Healthcare: Nothing more than a FOR PROFIT INDUSTRY ?

Posted on June 24, 2017 by Pharmaciststeve

Landmark New England Journal of Medicine Study: “Spinal Fusion Surgery – The Case For Restraint”

https://drkevinpauza.com/blog/2016/06/28/landmark-new-england-journal-of-medicine-study-spinal-fusion-surgery-the-case-for-restraint/

Spinal fusion rates continue to increase dramatically in the United States. Oddly enough, this landmark study shows the rise is related financial incentives and other variables not associated with the patient’s well being. This respected journal states that the annual number of spinal fusions rose by 77% within 5 years. This is confirmed in this publication: NEJM Spinal- Fusion Surgery-The Case for Restraint

Why do you think so many unnecessary spinal fusions are happening?

FOLLOW THE MONEY TRAIL ….

Filed under: General Problems | Leave a Comment »

GREED AND LIES ?

Posted on June 23, 2017 by Pharmaciststeve

While my little blog only touches a very small portion of the chronic pain community… lately I am seeing a disproportion of incidents that are very disturbing to me.

I have always had this “strange talent’ of picking up on social/bureaucratic developing patterns long before others see things coming together.

I am seeing a pattern of prescriber practices using URINE TESTING to summarily discharge pts from the practice…

These practices are treating urine tests like a guillotine.. once the lever is pulled.. there is no DO-OVERS…

No prescriber – worth their salt – would start treating a pt for a non-life threatening life condition based on a single lab test. Lab tests are a “snap shot in time”… if you want to see how bad a snap shot in time can be pull out your driver’s license and see if your picture on your license is a good representation of you ?

Pts who have never had a UA problem all of sudden has a negative test or some illegal substance in their UA.

One very suspicious incident… pt’s UA tested positive for the appropriate medication..but.. the prescriber sent it to a OUTSIDE LAB .. where it showed – NEGATIVE… the pt is told that the prescriber could no longer provide opiates – even though the pt was on a very low dose – but would be happy to keep the pt into the practice and provide ESI (Epidural Spinal Injections)… so instead of the prescriber getting paid $100 for a office visit to write a prescription… the prescriber would be generating THOUSANDS for giving ESI’s… the question is why would a prescriber test the pt’s urine TWICE after the first was POSITIVE and why keep the pt in the practice that – in theory – failed a UA ?

Second very suspicious incident… a long time pt was told UA was negative for prescribed medication… could not do another test… would not accept a outside lab test, hair test … nothing… ONE STRIKE AND YOU ARE OUT… It is common knowledge that these pee in the cup UA have a 20% +/- false positive/negative results. Even tests sent out to outside labs … could not have been stored/handled properly or some other issue that could cause a false reading. In this particular incident.. the clinic had CHANGED OWNERSHIP… first UA after ownership change – comes up NEGATIVE ??? Could it be that the pt’s insurance pays too slow or too low … could be that the pt’s daily opiate dose is higher than the clinic wishes to now prescribe ? THINNING OF THE HERD ???

Then you have prescribers who are seemingly unaware of what foods or OTC meds can cause false UA outcomes… one pt showed COCAINE in UA… pt asked me.. a simple web search and the Amoxicillin/Augmentin that the pt had been taking could cause a FALSE POSITIVE for COCAINE… pt won the argument on this one 🙂

A second similar case… pt had a opiate show up in UA… again the prescriber is ready to discharge the pt.. come to find out the pt was recovering from a cold and had been taking Robitussin DM..and DM (dextromethorphan) and DM… can cause a UA to throw a false positive for a opiate …

The really DOWN SIDE to all of this.. is once a pt is discharged from a practice for negative UA and/or because of illegal/non-prescribed meds in their UA… you might as well draw a BIG RED “A” on their forehead. No other presciber/pain clinic will treat them.

Here is a link to the common or OTC medications that can cause UA’s to come up with false outcomes:

http://www.keystosaferschools.com/drug-testing/drug-testing-false-positives-for-urine-testing

Filed under: General Problems | 8 Comments »

AARP support of senior health issues – VERY SELECTIVE ?

Posted on June 23, 2017 by Pharmaciststeve

AARP warns senators against supporting GOP healthcare bill

http://www.washingtonexaminer.com/aarp-warns-senators-against-supporting-gop-healthcare-bill/article/2626877

Have you notice that AARP has been VERY QUIET when the CDC came out their opiate dosing guidelines and entities like the VA started implementing PORTIONS of the guidelines – while 22 veterans a day commit suicide… and the DEA raids a constant flow of prescriber’s offices throwing hundreds or thousands of chronic pain seniors to
“the curb” quickly going into cold turkey withdrawal and causing their other co-morbidity health issues to be compounded. When AG Jeff Session recently came out wanting to turn the war on drugs back several decades and over-ride the state laws that have made Marijuana and/or Medical Marijuana legal. Someone must have forgotten that we are the UNITED STATES…not the 50 DISTRICTS of the Federal District of Columbia. Has the AARP LOST THEIR FOCUS , THEIR WAY and their MISSION STATEMENT ?

AARP doesn’t want any senator to support the Republican healthcare proposal introduced on Thursday.The organization dedicated to lobbying for older Americans over 50 years old took issue not only with some of the cuts the legislation would make but also the circumstances in which it was devised.

“This new Senate bill was crafted in secrecy behind closed doors without a single hearing or open debate—and it shows,” AARP Executive Vice President Nancy LeaMond said in a statement. The Senate bill would hit millions of Americans with higher costs and result in less coverage for them. AARP is adamantly opposed to the Age Tax, which would allow insurance companies to charge older Americans five times more for coverage than everyone else while reducing tax credits that help make insurance more affordable.”

The group also complained that the bill would make cuts to Medicare and Medicaid.

“AARP is also deeply concerned that the Senate bill cuts Medicaid funding that would strip health coverage from millions of low-income and vulnerable Americans who depend on the coverage, including 17 million poor seniors and children and adults with disabilities. The proposed Medicaid cuts would leave millions, including our most vulnerable seniors, at risk of losing the care they need and erode seniors’ ability to live in their homes and communities,” LeaMond said. “The Senate bill also cuts funding for Medicare which weakens the programs ability to pay benefits and leaves the door wide open to benefit cuts and Medicare vouchers. AARP has long opposed proposals that cut benefits or weaken Medicare.”

The bill introduced Thursday follows the passage of the healthcare reform bill passed by the House, which aims to partially repeal and replace Obamacare care, the signature healthcare law of former President Barack Obama. AARP says that like it did with all the members of the House, it will hold all 100 senators “accountable” for their votes on this “harmful” bill.

“Our members care deeply about their health care and have told us repeatedly that they want to know where their elected officials stand. We strongly urge the Senate to reject this bill,” LeaMond concluded.

50 GOP votes are needed to pass the bill under the process of reconciliation, with a tie-breaker vote from Vice President Mike Pence. Already four of 52 Republicans, Sens. Ted Cruz of Texas, Ron Johnson of Wisconsin, Mike Lee of Utah and Rand Paul of Kentucky, have said they are “not ready” to support the bill in its current form. It is expected that all Democrats will oppose its passage. President Trump chimed in on Twitter on Thursday to say he supports the Senate bill.

Filed under: General Problems | 8 Comments »

Indiana crackdown on opioids sparks more pharmacy robberies

Posted on June 23, 2017 by Pharmaciststeve

Indiana crackdown on opioids sparks more pharmacy robberies

http://www.startribune.com/indiana-crackdown-on-opioids-sparks-more-pharmacy-robberies/430364733/

Newton’s Third Law: As described by the third of Newton’s laws of motion of classical mechanics, all forces occur in pairs such that if one object exerts a force on another object, then the second object exerts an equal and opposite reaction force on the first.

INDIANAPOLIS — As the nation’s opioid epidemic intensified, Indiana cracked down on over-prescribing doctors and “pill mills” catering to people with addictions. The state also took aim at doctor-shopping — the practice of visiting multiple physicians to score more painkillers.

The measures had an impact, but not what officials hoped for.

While making opioid prescriptions harder to get, the crackdown also helped spur a twofold increase in robberies of pharmacies that exacerbated the state’s standing as No. 1 in the nation for those crimes. Between 2009 and 2016, Indiana had 651 pharmacy robberies — the most in the U.S. and more than the 597 recorded by No. 2 California, which has six times the population, U.S. Drug Enforcement Administration records show.

The frequent holdups reflect a grim reality: With each regulation or law enforcement tactic, the opioid crisis quickly shape-shifts to evade new obstacles. Dealers and those struggling with addictions adapt, and the epidemic continues with little interruption.

“They’re always looking for wherever they can get their foothold. And once they do, they’re going to take advantage,” said Tom Prevoznik, a deputy chief of pharmaceutical investigations with the DEA in Arlington, Virginia.

Pharmacies and law enforcement agencies in Indianapolis, where most of the robberies have occurred, are fighting back. Pharmacy chains have installed time-release safes that won’t open for several minutes, forcing robbers to risk arrest by waiting. Signs so far are positive. Robberies in Indianapolis numbered only eight through early June, compared with 55 for all of 2016.

But some criminals responded to those efforts by traveling from Indianapolis to small suburban towns to rob pharmacies, including one in January in Elwood, about 40 miles from Indianapolis, where two robbers herded frantic employees into a bathroom after threatening them with a handgun.

Indiana’s economic makeup has made it a likely breeding ground for opioid addiction for years.

The 2008 financial crisis hit the state’s manufacturing economy hard, causing waves of layoffs. And physically demanding jobs in heavy industry have long left workers prone to injuries that could lead to prescriptions for painkillers.

“They get a legit medical prescription — and then all of a sudden it gets out of control,” said Jason Hockenberry, an Emory University professor of health policy who has studied opioid addiction. He said the state already had outsized opioid woes, related in part to its location along Interstates 65 and 70 — two major corridors for illicit drugs.

Opioid addiction was behind the state’s worst-ever HIV outbreak, in 2015, an epidemic that infected more than 200 people in a rural county north of Louisville, Kentucky. Most had shared needles while injecting a prescription painkiller. That year, Indiana ranked 17th in the nation in heroin and prescription opioid overdose deaths, with 1,245 deaths per 100,000 people.

Four years ago, the Legislature directed the state’s Medical Licensing Board to draft rules requiring patients to visit their doctors periodically to keep getting prescription refills. The changes included requiring doctors to use an online database to check patients’ use of controlled substances.

But stemming easy access to opioids probably contributed to the binge of 168 robberies in 2015, more than twice the previous year’s total, as more people addicted to prescription opioids robbed stores seeking painkillers and other potent drugs, said Greg Zoeller, who was Indiana’s attorney general at the time.

The holdups — sometimes more than five a day in Indianapolis — flooded the black market with nearly 200,000 pills, primarily painkillers.

“We knew full well that if you reduce easy access, you’re going to have these kinds of consequences,” Zoeller said.

Lt. Craig McCartt, who oversees robbery investigations for the Indianapolis Metropolitan Police Department, said 85 percent of Indianapolis’ pharmacy robberies in 2015 were committed by juveniles enlisted by adult dealers offering cash and gifts to rob the stores.

Amid that crime spree, Indianapolis police teamed up with the DEA, FBI and federal prosecutors for a multi-agency approach that’s led to the indictments of 35 people, including six juveniles, in 62 of the robberies.

The state’s two largest drugstore operators, Walgreens and CVS, have also installed time-release safes at their roughly 180 Indianapolis pharmacies and added armed guards at some stores in recent years.

Indiana’s pharmacy robberies dropped to 78 in 2016, but the state still ranked second in the U.S., behind California. The latest effort targeting the robberies is a law taking effect in July that will lead to longer sentences for people who threaten violence or injure anyone during pharmacy robberies.

Ken Fagerman, a former South Bend pharmacist who wrote a book about the robberies, said the pharmacy industry should not have tolerated the heists for years and shares some blame.

“It’s regrettable that more wasn’t done sooner,” he said.

Filed under: General Problems | 1 Comment »

How long before pain management will consist of getting PLACEBOS ?

Posted on June 22, 2017 by Pharmaciststeve

1. I had my 6mo checkup with PCP. He quit Rxing my pain meds July 2015.

2. Discussion of current meds led to him basically telling me all the CME he is getting locally is discouraging any use of opioids. His wisdom, “yup, the momentum swings too far in one direction when these things come about.”

Had my 1 month visit with pain management. He said he just returned from a 3-day pain mgt. conference at Harvard. He said in 3 days of talks, only one physician spoke on how the pendulum has swung too far in the other direction and patients are being adversely affected.
A friend of mine in Spokane, Wa (which I have heard has no pain management physicians and they have to travel to West side Washington for evaluation) is having a total knee replacement

in Sept. My friend was told by the surgeon his post op pain medications are, wait for it……

ta da, Celebrex and Lyrica ! Really !

Filed under: General Problems | 4 Comments »

« Previous Page — Next Page »

passionate pachyderms

Pharmacist Steve steve@steveariens.com 502.938.2414

Top Posts & Pages

Phil Mypockets – PBM – this is your life

Recent Posts

Recent Comments

Archives

Categories

replica rolex

Arachnoiditis Hope

Genocide in America updated 02/04/2016

Being Denied Meds – how to file complaints updated 11/12/2015

Pay Attention

Subscribe to Blog via Email

License to lie

Will Pill Control “Fix” Our Problem?: The Allure of Simple Solutions to the Opioid Crisis

What Pharmacist Steve is reading

DEPENDENCE VERSUS ADDICTION … AND OPIOID USE DISORDER

Share this:

Like this:

Prescribed Painkillers Didn’t Cause the Opioid Crisis

People who need pain meds aren’t usually the ones who get addicted.

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

Share this:

Like this:

FOLLOW THE MONEY TRAIL ….

Share this:

Like this:

Share this:

Like this:

AARP warns senators against supporting GOP healthcare bill

Share this:

Like this:

Indiana crackdown on opioids sparks more pharmacy robberies

Newton’s Third Law: As described by the third of Newton’s laws of motion of classical mechanics, all forces occur in pairs such that if one object exerts a force on another object, then the second object exerts an equal and opposite reaction force on the first.

Share this:

Like this:

Share this:

Like this:

Calendar

Blogroll