“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
Four states and more than a dozen cities and counties have filed lawsuits contending drug makers misrepresented the risks and benefits of opioid use, spurring an addiction crisis.
Some of the lawyers working on the suits were previously involved in lawsuits claiming tobacco companies misrepresented the health risks of smoking, the Wall Street Journal reports.
Among the lawyers is Michael Moore, who filed the first state lawsuit against tobacco companies in 1994 when he was attorney general of Mississippi. Soon after he left office in 2004, Moore got involved in lawsuits filed against OxyContin maker Purdue Pharma by patients who said they became addicted, despite taking the drug as prescribed. The suits settled for $74 million in 2007.
Now Moore’s law firm, based in Flowood, Mississippi, is helping represent the states of Mississippi and Ohio in their suits against drug makers. Missouri and Oklahoma also have also sued. Moore is also meeting with other lawyers representing government to coordinate arguments.
Another lawyer involved in the suits is Joe Rice of Mount Pleasant, South Carolina-based Motley Rice, who was outside counsel to two dozen states in the tobacco litigation. Rice notes that lawyers in the tobacco suits stayed in touch, and he expects communication among lawyers in the opioid suits.
Moore’s use of outside counsel while attorney general helped make the practice more popular, though some critics say the practice improperly gives law enforcement powers to law firms with an interest in profiting from the suits, the article points out.
In the Ohio case, the Journal reports that Moore’s law firm and five other firms have a fee agreement that gives them 25 percent of any recovery up to $10 million, and a smaller percentage for additional recoveries with a maximum fee of $50 million.
See also:
ABAJournal.com: “Drug firms knew opiates were being abused on Cherokee reservations but did nothing, lawsuit alleges”
Attorney General Jeff Sessions and the acting head of the Drug Enforcement Agency Charles Rosenberg have both been named in a new federal lawsuit challenging marijuana’s Schedule I status as unconstitutional.
The 89-page lawsuit was filed Monday in the Southern District of New York by attorney Michael Hiller on behalf of a former NFL player, two children who regularly use medical marijuana, an Iraq War veteran with post-traumatic stress disorder, and a nonprofit called the Cannabis Cultural Association.
The lawsuit challenges the constitutionality of the Controlled Substance Act, which designates marijuana as a Schedule 1 substance. Other drugs included in that classification include heroin and LSD, and Hiller argues on behalf of the plaintiffs the classifcation is so “irrational” it violates the U.S. Constitution.
“The record makes clear that the CSA doesn’t make any rational sense, and the federal government knows it,” Hiller said in a statement, adding, “if the federal government doesn’t believe in the rationality of its own statute, it’s unconstitutional to enforce it.”
Hiller doubts that the government has actually believed marijuana has ever met the three requirements for Schedule 1: (i) must have a high potential for abuse; (ii) must have absolutely no medical use in treatment; and (iii) cannot be used or tested safely, even under strict medical supervision.
“[T]he federal government has admitted repeatedly in writing and implemented national policy reflecting that cannabis does in fact, have medical uses and can be used and tested safely under medical supervision,” the complaint reads. “On that basis, the federal government has exploited cannabis economically for more than a decade by securing a medical cannabis patent and entering into license agreements with medical licensees.”
The Justice Department and DEA as a whole are also listed as defendants in the case.
Sessions has multiple times criticized marijuana, once calling it “only slightly less awful” than heroin.
Marijuana activists have been waiting for the attorney general to act on a Justice Department policy — the Cole memo — that allows states to set their own rules and regulations for the drug.
Currently, eight states and the District of Columbia allow recreational sales of marijuana, as well as medical. An additional 24 allow only medical marijuana use.
The Washington Examiner has reached out to the Justice Department for comment on the lawsuit.
A Gulf Breeze High School administrator is facing multiple charges, including prescription fraud and passing a forged prescription.
According to the Santa Rosa County Jail log, 43-year-old Sean Patrick Tomey was released on bond Thursday, July 20.
The investigation first started on July 19 when the Neighborhood Walmart Pharmacy on Gulf Breeze Parkway contacted police.
The Gulf Breeze Police Department (GBPD) said a pharmacist technician found a prescription they filled was fraudulent. They said the tech received a call from an institution saying the prescriptions from Tomey were not given to him by them.
The tech also told police that Tomey passed fraudulent prescriptions on July 11 for 120 tablets of Tramadol 50 milligrams (mg) and another on July 5 for 90 tablets of Percocet 10 mg.
When police went to the institution to speak about the incident, they said Tomey initially tried to drop of the fraudulent prescriptions to a CVS Pharmacy before heading to Walmart on the 19th.
A CVS pharmacist told police they knew the prescription was fake.
CVS staff told police they confronted Tomey and that “he took the fraudulent prescriptions with him.”
Tomey was taken into custody without incident by police at his home. He has been charged with two counts of passing a forged prescription and one count of prescription fraud.
“Mr. Tomey stated that he did not understand why he was being placed under arrest and did not pass any fraudulent prescriptions to any pharmacy,” states the arrest report. Tomey told police he had received the prescriptions from the institution about two months ago.
After evidence was presented by police, Tomey admitted to creating the fakes on his laptop. He told police that his pain had increased over the years and doctors weren’t able to give him any help.
“He was desperate for relief of pain he was suffering from previous injuries,” according to the arrest report.
Superintendent Tim Wyrosdick said Tomey has been placed on paid administrative leave pending the outcome of the investigation. Wyrosdick told Channel 3 News per school policy, he will not have contact with students.
By Patrick Sullivan of The Law Offices of Salazar, Sullivan & Jasionowski posted in Doctor Errors on Thursday, October 1, 2015.
The Centers for Disease Control and Prevention has drafted proposed guidelines for prescribing opioids to prevent addiction and overdoses. However, this could have a troubling impact on doctors in New Mexico and across the rest of the country, because some medical professionals believe that the guidelines make prescriptions a priority over patient treatment, which could lead to medical malpractice.
Doctors are working toward an environment of treatment that redefines and reclassifies chronic pain conditions based on body systems. Nearly 100 classifications for pain levels exist for the musculoskeletal system alone, and all of them could potentially lead to long-term treatment. The health care system uses a concept of medicating patients to prevent conditions that cause acute pain from progressing to the level of disability or chronic pain. However, the long-term prescribing of opioids could have a negative impact on some patients.
A CDC review of injury and death data indicates that hospital or doctor care is the third-biggest danger to patients. These cases include wrong diagnosis, failure to rescue, improper surgeries, wrong prescribing, infections acquired in hospitals and other forms of medical negligence, all of which the patients have no control over. Overdose on prescriptions is not even one of the top 15. However, the drafted CDC guidelines recommend that patients with non-traumatic acute pain only be prescribed a three-day supply or less of opioids, which may not meet the individual needs of some patients. Not providing them enough prescriptions to treat their individual condition based on behaviors or characteristics that are unrelated to them could be tantamount to malpractice.
Sometimes a medical mistake is made because test results get mixed up or are not properly translated, leading to the patient receiving an improper diagnosis and treatment. When negligence is involved in the cause of these types of medical errors, the patient might want to meet with an attorney to explore the legal remedies for seeking compensation that might be available.
A Xarelto lawsuit filed on behalf of a Mississippi woman will head to trial next month, after the federal judge overseeing a massive litigation involving the blood thinner denied a defense bid for Summary Judgment on the plaintiffs’ failure-to-warn and design defect claims.
Xarelto Litigation Background
Xarelto is a novel anticoagulant that was first approved by the U.S. Food & Drug Administration (FDA) in October 2011. From its launch, the medication was touted as an improvement over warfarin, a decades-old blood thinner sold under the brand-name Coumadin. Among other things, Xarelto’s manufacturers promised that patients using their new drug would not be required to undergo regular blood tests to ensure proper dosage, a standard component of warfarin treatment.
More than 17,000 Xarelto bleeding claims have been consolidated in the U.S. District Court, Eastern District of Louisiana, before Judge Eldon Fallon. Plaintiffs involved in this litigation assert that promises of Xarelto’s superiority over warfarin were misleading, as internal bleeding associated with the older medication can be stopped via the administration of vitamin K. There is currently no approved antidote to reverse hemorrhaging that sometimes occurs with Xarelto. They also allege that Xarelto patients would actually benefit from a regular blood monitoring regimen.
Xarelto Gastrointestinal Bleed
According to her complaint, Dora Mingo began taking Xarelto in January 2015, after a deep vein thrombosis was discovered in her left leg. Mingo later developed a severe upper gastrointestinal bleed, which she alleges directly resulted from treatment with Xarelto. Mingo further claims that Xarelto was defectively designed, and accuses Bayer AG and Johnson & Johnson of failing to provide the public with adequate warnings of its risks.
In moving for Partial Summary Judgment, the defendants asserted that Mingo’s failure-to-warn and design defect claims were preempted by federal law. However, in an Order dated July 21st, Judge Fallon found that the question of preemption was not clear.
“The preemption of claims against name-brand drug manufacturers is not clear; neither Congress nor the Supreme Court has spoken directly on that issue. And until Congress or the Supreme Court does so, this Court is restrained to existing precedent,” Judge Fallon wrote. “The Levine Court held that a state failure-to-warn claim against a brand-name drug manufacturer was not pre-empted by federal law, finding that Congress had clearly intended for the judicial branch to work in concert with the FDA to protect against unnecessary risk.”
Next month’s trial will be convened in the in the U.S. District Court, Southern District of Mississippi. As a bellwether case, the outcome is expected to provide clues as to how juries might rule in similar Xarelto lawsuits.
Between May and November 2009, the teenager filled numerous prescriptions for Oxycodone and Oxycontin at a New Mexico pharmacy. The prescriptions were all valid, signed by a licensed physician.
If the teenager had been taking the opioids as directed, each prescription would have been sufficient for a certain number of days. But often the teenager arrived at the pharmacy with a new prescription before the last one should have run out. At least some of the prescriptions bore notations saying “OK to fill early” or words to that effect. Seven times over the course of four months the pharmacy filled prescriptions early.
The teenager’s prescriptions were covered by Medicaid, so she could get the pills for free – if she waited. Medicaid didn’t permit early fills. But that financial incentive wasn’t always enough to make her wait. In September, she paid $1,107 in cash to fill a script early. The next month, she again offered to pay cash, just three days before she would have received the same pills for free. That time, the pharmacy called the doctor to make sure the early fill was really okay.
On top of pain medication, the teenager was also filling prescriptions for Alprazolam, an anti-anxiety drug. According to WebMD, Alprazolam can slow a person’s breathing, an effect potentially magnified if the drug is taken with opioids. The Court of Appeals’ recent opinion in the case, from which I’m drawing these facts, is blunt: “When used in conjunction with other CNS depressants (such as Oxycontin and Oxycodone), Alprazolam can be toxic even at low concentrations.”
As you’ve probably guessed, this story doesn’t end happily. The teenager died of “multiple drug toxicity” on December 1, 2009, just 19 years old.
As the Court of Appeals notes, “The nation’s ongoing ‘opioid crisis’ (is) the subject of news reports and commentary almost daily.” The Journal of the American Medical Association reports that “the amount of opioids prescribed in 2015 [was] more than 3 times higher than in 1999.” 2015 saw 33,091 opioid-overdose deaths in the U.S., about half involving prescription drugs. With so much suffering, there is plenty of blame to go around. The teenager’s estate sued the doctor and the doctor’s clinic, and also added claims against the pharmacy.
The pharmacy’s argument against legal liability was straightforward. The prescriptions it filled were signed by licensed physicians and in every way valid. It’s not a pharmacist’s job to second-guess a doctor’s treatment decisions. Imagine how obnoxious it would be if the person behind the counter said, “Well, I disagree with your doctor about this choice of medication. I’m not going to fill your prescription.” A pharmacist who did that would arguably be practicing medicine without a license, and that’s a felony offense. A pharmacist’s paramount professional responsibility is simply to fill legitimate prescriptions with scrupulous accuracy, which the pharmacy did.
The teenager’s estate argued that more is required of a pharmacy. Its argument was supported by the state Board of Pharmacy’s regulations. Under the regulations, a pharmacist is required to be alert for signs of “clinical abuse/misuse” of opioids. Specifically, pharmacists should be suspicious whenever a patient fills an opioid prescription early or pays cash despite the existence of insurance, two things the teenager in this case did repeatedly. Once suspicions are aroused, the pharmacist is required to obtain the patient’s prescription history (known as a PMP report). And then? The regulations require the pharmacist to exercise professional judgment to decide whether to consult with the doctor or counsel the patient, and to document the decision-making process. No more forceful intervention is required.
The Court of Appeals agreed with the teenager’s estate that the standard of care owed by all New Mexico pharmacists to their patients includes strict compliance with the regulations. And the record before it did not reveal whether the pharmacy had complied in this case. That’s because the trial judge decided the case before trial on an incomplete factual record. In reversing the grant of summary judgment, the Court of Appeals didn’t find the pharmacy liable but only sent the case back to the trial court for more evidence. Specifically, the trial court was to determine whether the pharmacy did, in fact, take the steps laid out in the regulations. Even if the pharmacy fell short, a serious question would remain whether the lack of a PMP report and follow-up documentation really contributed in any meaningful way to the teenager’s sad end.
While this particular case continues, New Mexico’s other pharmacies are reminded that strict compliance with the opioid regulations can be an effective antidote to claims of legal liability.
If there are topics you would like to see Joel Jacobsen cover in future columns, please write him at legal.column.tips@gmail.com
Lynn Frank, 64, of Northeast Philadelphia, a former records and information manager at a law firm, experienced a serious foot injury in a car accident 12 years ago and was later diagnosed with CRPS/RSD (Complex Regional Pain Syndrome/Reflex Sympathetic Dystrophy), a chronic neuro-inflammatory disorder.
If you have had a similar reaction to opioid painkillers – they provided clear relief for pain but have become difficult to obtain due to actions intended to prevent addiction – and want to publicly share your story, please email staff reporter Don Sapatkin.
The opiate crisis is finally getting the recognition it should. It destroys families, increases crime, and causes heartbreak. People in all socioeconomic groups legally and illegally obtain and use these drugs.
I cry when I hear about deaths that should have never happened. I weep when babies are born addicted. I mourn when I read about families forever destroyed by the loss of a teenager or young adult.
But there is another side to this problem that you have not read about and may not have considered. My side.
I stand with other chronic pain sufferers off in the shadows. We have been forgotten. No research. No treatment. Now there are laws and a movement of public outcry condemning opioid use. Our pain medicine is being taken from us. We have been treated without compassion, humiliated, stripped of dignity. People don’t understand that we are not abusers but simply seek temporary relief from our endless pain. We are always tired, often depressed, and feeling hopeless. We are just trying to overcome the obstacles our bodies have presented to us. We are made to feel shame because we need to use pain medicine to cope with everyday life.
I stand in the shadows, sit, and watch. I usually don’t have the energy to do much more than lie in bed. Every movement can cause pain. Bright lights can bring on a headache; any touch to my skin can cause pain. I often keep to myself because my illness is not understood and I don’t usually look ill. I’m told that I am a hypochondriac, drama queen, socially inept, not responsible for keeping commitments. People — especially those who are closest to me — don’t take the time to educate themselves and to understand my illness.
And so depression will often seep in, along with a decreasing sense of self worth. I am a mother and a grandmother. Having to take a urine test in order to get a one-month prescription of pain medicine that my doctor agrees I need is embarrassing. Having to visit the doctor every month in order to get that prescription takes away the little energy I have. Not being able to physically pick up my grandchildren — or have the energy to visit with them — is a defeat that means I have lost. Pain affects everything: thought, relationships, sleep … every aspect of my life.
Now I need to speak up. Will you hear me?
I am the other side of the opiate crisis. I am not an addict. I take pain medication to function at a minimal level and not allow my chronic pain get the better of me. It lets me feel normal for a short time every day. I never feel “high” from taking it, just almost “normal.” It allows me to focus and to do simple tasks that I could not otherwise perform
There are other things chronic pain sufferers do to relieve pain. In an effort to distract ourselves we meditate, pray, and have hobbies such as knitting (my personal favorite) and reading. We do many things to take our minds off of our pain, We attempt to stay positive even when it feels impossible. A short relief from pain helps. Pain medicine helps us function, at least for a short time, in a way that most people take for granted.
Please acknowledge those of us who suffer from chronic pain. Recognize our need for these powerful medications. Understand that we are only trying to live our lives by managing the nonstop pain. We want to survive and overcome. We will.
As The Hill reported, the expected crackdown is one that “criminal justice reform advocates fear will link marijuana to violent crime and recommend tougher sentences for those caught growing, selling and smoking the plant.”
They further cited a memo that Sessions sent to U.S. Attorneys and component heads on the work of the task force at the Department of Justice (DOJ), which requested review of “existing policies in the areas of charging, sentencing, and marijuana to ensure consistency with the Department’s overall strategy in reducing violent crime with the Administration goals and priorities.”
“The task force revolves around reducing violent crime and Sessions and other DOJ officials have been out there over the last month and explicitely the last couple of weeks talking about how immigration and marijuana increases violent crime,” Inimai Chettiar, director of the Bennan Center’s Justice Program told the outlet.
“Our attorney general is giving everyone whiplash by trying to take us back to the 1960s,” California Democratic Representative Jared Huffman recently told The New York Times.
In March, Sessions called marijuana usage a “life-wrecking crisis,” calling it “only slightly less awful” than using heroin:
“I reject the idea that America will be a better place if marijuana is sold in every corner store,” the Attorney General said. “And I am astonished to hear people suggest that we can solve our heroin crisis by legalizing marijuana – so people can trade one life-wrecking dependency for another that’s only slightly less awful.”
Mirroring these assertions, the U.S. Drug Enforcement Administration (DEA) announced last August that it would not reschedule its classification of marijuana under the Controlled Substance Act, keeping the drug in the same class as heroin despite a majority of Americans favoring its legal use.
BUFFALO, N.Y. — After three defendants fatally overdosed in a single week last year, it became clear that Buffalo’s ordinary drug treatment court was no match for the heroin and painkiller crisis.
Now the city is experimenting with the nation’s first opioid crisis intervention court, which can get users into treatment within hours of their arrest instead of days, requires them to check in with a judge every day for a month instead of once a week, and puts them on strict curfews. Administering justice takes a back seat to the overarching goal of simply keeping defendants alive.
“The idea behind it,” said court project director Jeffrey Smith, “is only about how many people are still breathing each day when we’re finished.”
Funded with a three-year $300,000 U.S. Justice Department grant, the program began May 1 with the intent of treating 200 people in a year and providing a model that other heroin-wracked cities can replicate.
Two months in, organizers are optimistic. As of late last week, none of the 80 people who agreed to the program had overdosed, though about 10 warrants had been issued for missed appearances.
Buffalo-area health officials blamed 300 deaths on opioid overdoses in 2016, up from 127 two years earlier. That includes a young couple who did not make it to their second drug court appearance last spring. The woman’s father arrived instead to tell the judge his daughter and her boyfriend had died the night before.
City Court Judge Craig Hannah presides over Opiate Crisis Intervention Court in Buffalo, New York on June 20, 2017. AP file
“We have an epidemic on our hands. … We’ve got to start thinking outside the box here,” said Erie County District Attorney John Flynn. “And if that means coddling an individual who has a minor offense, who is not a career criminal, who’s got a serious drug problem, then I’m guilty of coddling.”
Regular drug treatment courts that emerged in response to crack cocaine in the 1980s take people in after they’ve been arraigned and in some cases released. The toll of opioids and profile of their users, some of them hooked by legitimate prescriptions, called for more drastic measures.
Acceptance into opioid crisis court means detox, inpatient or outpatient care, 8 p.m. curfews, and at least 30 consecutive days of in-person meetings with the judge. A typical drug treatment court might require such appearances once a week or even once a month.
“This 30-day thing is like being beat up and being asked to get in the ring again, and you’re required to,” 36-year-old Ron Woods said after one of his daily face-to-face meetings with City Court Judge Craig Hannah, who presides over the program.
Woods said his heroin use started with an addiction to painkillers prescribed after cancer treatments that began when he was 21. He was arrested on drug charges in mid-May and agreed to intervention with the dual hope of kicking the opioids that have killed two dozen friends and seeing the felony charges against him reduced or dismissed.
Drug overdose deaths in US jump 19 percent0:33
In addition to the Monday-through-Friday court dates, Woods attends daily outpatient counseling, submits to drug testing, works at his family paving business and, although they are not required, attends Narcotics Anonymous meetings.
“This court makes it amazingly easy. Normally I’d be like … ‘This is stupid,'” said Woods, who has been through programs before. “But for the first time I have an optimistic outlook and I wanted to get clean.”
Buffalo’s get-tough court is part of a nationwide push to come up with ways to use the criminal justice system to address the opioid crisis. In April, the National Governors Association announced that eight states — Alaska, Indiana, Kansas, Minnesota, North Carolina, New Jersey, Virginia and Washington — will together study, among other things, how to expand treatment within the criminal justice system.
The grant pays for the coordinator and case managers from UB Family Medicine, a University at Buffalo medical practice, who enforce curfews, do wellness checks and transport patients. Insurance is billed for treatment.
Judge Hannah hasn’t taken a day off since the program started, determined to show participants he is as committed as they are. Although he still carries a full City Court load, he meets unhurriedly and one by one with the people in the opioid program during prolonged sessions on the bench.
These are not interrogations about whether they’ve used drugs the previous night; they are chats about the weather, the weekend and work. Some have missed check-ins or otherwise slipped and are brought before him in handcuffs after being picked up by law enforcement.
“I don’t want to die in the streets, especially with the fentanyl out there,” Sammy Delgado, one of the handcuffed defendants, said. After his arrest for drug possession, Delgado left inpatient treatment after six days but wants another chance.
Hannah, as much counselor and cheerleader as judge, told him: “You have a lot of people pulling for you. We need you to pull for yourself.”
Later, in his office, Hannah described his philosophy as tempering justice with mercy. He said he’s willing to overlook defendants’ occasional lies and attempts to fool him, “because we’ve got them now. We’re just trying to save their life at this point and to stabilize them, get them back on track.”
Amidst concerns over a massive national increase in the use and abuse of prescription painkillers, health insurer Blue Cross Blue Shield of Massachusetts instituted a new policy to reduce pain medication addiction and misuse.
This week The Boston Globe reports that as a result of the new policy, Blue Cross has cut prescriptions of narcotic painkillers by an estimated 6.6 million pills in 18 months.
But Daniel P. Alford, MD, an associate professor of Medicine and director of the Safe and Competent Opioid Prescribing Education (SCOPE of Pain) Program at Boston University School of Medicine and Boston Medical Center, calls the policy “flawed and irresponsible.” Here’s Alford’s response:
By Dr. Daniel P. Alford
Guest Contributor
The Blue Cross Blue Shield of Massachusetts opioid management program was implemented to provide members with “appropriate pain care” and reduce the risk of opioid addiction and diversion.
In a recent Boston Globe report they claim “very significant success” with this program after 18 months because they have cut opioid prescriptions by 6.6 million pills.
Dr. Dan Alford
Is this really a measure of success and if so, for whom? It likely saves Blue Cross money but has it successfully achieved their program’s stated goals? Does decreased opioid prescribing mean more appropriate pain care? Does decreased opioid prescribing reduce the risk of addiction or diversion, or does it decrease access to a specific pain medication (opioids) for treating legitimate chronic pain? Is the observed decrease in opioid prescribing evidence that opioids have been overprescribed, as Blue Cross claims, or is it proof that instituting a barrier to opioid prescribing (prior authorization) will decrease prescribing even for legitimate need? Are patients with chronic pain really benefiting from this program? I doubt it.
Adding yet more paperwork for physicians will not improve pain care, decrease addiction or the numbers of accidental overdoses from prescription opioids. Those physicians who are unwilling (or ambivalent) to prescribe opioids even when indicated will use the prior authorization requirement as an excuse to continue not prescribing. Those who are overly liberal in prescribing will figure out the most efficient way to satisfy the insurance requirements for approvals. Physicians who responsibly prescribe opioids – that is, prescribing them only when the benefits outweigh any risks — will be saddled with more administrative burdens to justify their well thought-out treatment decisions.
Some physicians may ultimately decide that prescribing opioids isn’t worth the trouble despite known benefits for some patients.
Some physicians may become overwhelmed and burned out with the large number of desperate patients seeking a doctor willing to consider prescribing opioids for chronic pain.
The Blue Cross program ignores an important principle highlighted in the 2011 Institute of Medicine’s blueprint for transforming pain care in the US — chronic pain is a chronic disease. As opposed to acute pain — that is, a symptom that resolves — chronic pain persists and often gets worse over time. By requiring prior approvals to prescribe any opioid for more than 30 days, Blue Cross is assuming that chronic pain will resolve by 30 days. This is a false assumption.
As a primary care physician who manages a large number of patients suffering from chronic disabling pain, I appreciate the complexities of balancing appropriate pain management with the safe use of opioids. I understand the clinical challenges of the subjective determination of whether a patient on opioids is benefiting (i.e., improved pain control and function) or being harmed (i.e., addiction). In addition I understand the difficulties of distinguishing the patient who is inappropriately “drug seeking” due to addiction, from the patient who is appropriately pain-relief seeking, as they both can present as equally desperate for help.,
However, if Blue Cross were serious about improving my ability to manage chronic pain safely, they would increase access to new, yet more expensive, abuse-deterrent opioids (e.g., reformulated OxyContin, Opana and Embeda) rather than continuing to prefer (Tier 1) easily altered and abused opioids such as methadone and morphine.
I worry about this flawed and irresponsible policy, and that while Blue Cross congratulates itself on a job well done — decreasing the number prescriptions of opioids — we are swinging the pendulum unnecessarily too far back to the days of under-treating chronic pain in a patient population that is too often stigmatized and lacks a unified voice.
Each year 16,000 to 18,000 pts die because they have acquired a “bug” that is resistant to all available antibiotics because antibiotics are – and have been – prescribed too often and inappropriately. That is a similar number to the pts that they claim die of a prescription opiate overdose – and we don’t know how many actually obtained them legally… YET.. we don’t see any entity saying that we should be prescribing less antibiotics across the board.
Lawyer who targeted tobacco companies encourages state suits against drug makers for opioid crisis
Cops: High school administrator ‘desperate for relief’ arrested for prescription fraud
