Chronic pain sufferers applaud changes to opioid limits law

http://www.wcsh6.com/news/local/chronic-pain-sufferers-applaud-changes-to-opioid-limits-law/450683168

AUGUSTA, Maine (NEWS CENTER) — People taking opioid painkillers for chronic pain are breathing a little easier. A new state law that went into effect Friday is clearing up confusion about how much a patient can legally take.

The law used to require people taking opioids to taper down their daily doses to no more than 100 morphine milligram equivalents, with exceptions only for those under hospice or palliative care in connection with a serious illness.

Doctors knew they could prescribe more for patients treated for cancer or hospice care, but many didn’t think they could go over that limit for patients with chronic pain. This new law makes it clear that people with chronic pain can be exempt.

► Two Midcoast business owners notify state of intent to sue over opioid taper rule

Brian Rocket, a midcoast lobster wholesaler was one of those patients who was told by his doctor several months ago that he had to taper down his opioid dose to meet a new state law. He suffers from chronic pain from prior injuries and was worried he wouldn’t be able to run his business.

With the new law in effect, he says his doctor’s now confident that Brian is exempt from that 100-milligram limit and can accept a higher dose.

“I’ve certainly been reclassified under the palliative care back to where I was on medicine and I can function,” he said. “I can live to fight another day.”

► People prescribed opioids for pain seek changes to Opioid Rx Limits Law

Eric Wass, a roofing contractor, who for 20 years has been taking opioids to manage chronic pain, was also forced to taper down and is also now allowed a higher dose. He said it’s made all the difference.

“I can work all day and I have a vegetable garden over there now,” he said, “so it’s giving me my life back because it was being taken away from me.”

Both men went so far as to hire a lawyer to sue the state and then testified at public hearings about the need to change the law.

► VERIFY: Can people with chronic pain be exempt from Maine’s opioid RX limits?

Lawmakers heard those pleas and passed a bill the governor signed — offering relief for those who found themselves dependent on painkillers after having them legally prescribed by their doctors.

“It’s not much fun,” Wass said. “I’m not proud of it. I don’t like it, but I don’t have much choice.”

Maine DHHS expressed concerns about adding too many exemptions to the law, saying that excessive overprescribing of opioid painkillers is what led to this epidemic that Maine and the nation are now facing.

World Health Organization definition of palliative care:

Palliative care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual. Palliative care:

• provides relief from pain and other distressing symptoms;
• affirms life and regards dying as a normal process;
• intends neither to hasten or postpone death;
• integrates the psychological and spiritual aspects of patient care;
• offers a support system to help patients live as actively as possible until death;
• offers a support system to help the family cope during the patients illness and in their own bereavement;
• uses a team approach to address the needs of patients and their families, including bereavement counselling, if indicated;
• will enhance quality of life, and may also positively influence the course of illness;
• is applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life, such as chemotherapy or radiation therapy, and includes those investigations needed to better understand and manage distressing clinical complications.

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While this may seem VERY STRANGE.. In June of 1960.. I turned THIRTEEN … the above picture  was from the 8th grade “safety patrol”.. I am second row… third from right…  Thanks to my old time friend… standing to my immediate left… he saved all of these – some believe – embarrassing pictures and posts them on my Face Book page … but his birthday was 8 days ago !!! So he is actually OLDER than me 🙂  Only time that was significant is when we could get our driver’s licenses.

I capped off the 60’s by marrying my wife in June 1969 and  graduating from college in May 1970.

So today I turn 70’s and thus my travel thru the 60’s again… this time as a SENIOR CITIZEN.. rather than a TEENAGER

Both decades had their challenges… some I wish to remember and celebrate and others … I would rather forget 🙁

As I enter my EIGHTH decade on this earth quoting…  the movie character from Galaxy Quest…  Jason Nesmith  (Tim Allen) :Never give-up, never surrender.

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This isn’t easy for me but I would like to share a very upsetting and frustrating experience I have had with a doctor and ua lab results.
A little about me, I suffer from RSD/CRPS, Fibromyalgia, Occipital Neuralgia, I’ve had Thoracic surgery yrs ago which seems to be given me pain also, Cervical disc fusion 2-7, asthma and more. I feel I am a good patient, always following instructions and seeking out new treatments on my own, on the net and through all my Facebook groups. These groups have been extremely helpful in many ways.
I have a PCP, Neurosurgeon, Anesthesiologist for pain blocks, ENT, and Neurologist who treats my pain with some meds and once with Occipital blocks.

For the past year I’ve had sinus face and ear pain so my PCP set me up with a wonderful ENT. Due to the asthma/copd he wanted to do a balloon sinuplasty in office but insurance wouldn’t approve, but they did approve the OP Full in hospital sinuplasty. While waiting for surgery date I was put on 1 Rx of amoxicillin then 2 Rx of Amoxicillin-Clav. Almost 4 weeks of antibiotics.

I visit the neurologist, get my Rx and do a ua. I mention to the lady that I was taking new meds (antibiotics) she says nothing and walks away.
Then the following Saturday I receive a certified letter in the mail. I open it, read it, and just started losing it. The stress brought on a bad asthma attack. Family wanted me to go to the hospital but I refuse. This letter was from the neurologist and said I tested positive for “cocaine”, and that after 6/16 he would no longer treat me as I breeched the pain contract. After I get my breath, I get ANGRY! WTF? I have NEVER EVER use cocaine or any other street drugs. I’m losing it. My family who doesn’t get how we chronic pain patients are being treated by drs, and pharmacist just thought the dr would fix it. We all know that doesn’t happen. You just get kick to the curb and that’s that. Those who know me would have never thought this would happen to “me”.
That night I contacted Pharmacist Steve and Dr Mark Ibsen for their help and knowledge. These two men are the most caring and helpful people who I have the pleasure of meeting through FB. Both explained that labs are NOT 100% accurate AND that there are other drugs/foods that CAN show a FALSE/POSITIVE for cocaine or other illegal drugs. WHAT? I had no idea about this. Their help and info pushed me into fighting to clear me of being red flagged. I spoked to my local pharmacist who was outraged, I called my PCP to request another ua but they didn’t think the dr would accept that. I also saw my ENT who confirmed what Dr Ibsen mention that ENT’s may use a cocaine substance in surgery as it’s a good dilator. (Surgery was after the us) He says he doesn’t use it in surgery but did say the spray used in office is Pontocaine & Tetracaine which was used prior to the ua. He wasn’t sure if these would cause the positive results.
So the following day after I see the ENT I go to this drs office and ask to speak to the dr about these results. First a lady comes out and has the test results & shows me the report. I practically start crying and she says she believes me when I say I never use but…. it’s the metabolites. I still don’t understand and the nurse comes out and says I can do another ua and I give her my ENT meds (only new meds) and all my OTC meds and she says she will call me with the results this week.
During this several day wait in hell I gather up all my meds, write everyone down and list all the OTC meds I have in the house that I may have used. This included vitamins, sinus spray/pills etc…. I go to the pharmacy as Pharmacist Steve suggested and get a printout of several months of everything I’ve been prescribed and then FAX all this to the dr so he would have this first thing Monday morning.

Everyone I spoke to and internet searches ALL said that the amoxicillin COULD produce a FALSE/POSITIVE for cocaine. In my mind that HAD to be the problem as that was the only new med I had taken. Oh the stress & frustration of this! Something like this the Dr SHOULD know this. The dr at the time did not know yet that I had been on amoxicillin or had had surgery. But dam, I’ve seen him for years and never had a positive ua. I would have appreciated a call into the office to discuss this instead of getting a shitty letter that nearly sent me to the hospital stressing out.
As we know, depression is a huge part of chronic pain and I could see this stress sending me down that deep dark hole…. But Pharmacist Steve, Dr Ibsen, and others gave me hope and the strength to fight this stigma.

Today I received a call from the drs office saying that after going over all the information I had faxed and the 2nd ua results the Dr WILL “continue” to see me. No apology of course. I will see him early next month and hope to have a SERIOUS discussion about this. I so understand the drs are under scrutiny by the DEA etc…. but this is no way to treat a long term “good” patient.

At the moment this has left me with the question, do I want to even continue to see this dr? (I liked him because he’s one of the “very few” drs that understand RSD/CRPS as his wife has this terrible disease). Could it happen again to me or someone else who doesn’t have the resources of professionals like I had to see me through this nightmare? I guess I will see him next month and see how the discussion goes.

I share my horrible experience and what I’ve learned hoping it never happens to you too.

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Steve my name is XXXXX I was told about you on a IC site another young women has taken here life this past weekend . I am 62 and on disability my husband decided 6 months ago he no longer wants to be married. On top of that my family Dr had her nurse call me and say she would be taking me off my pain meds. She wants to send me to a pain clinic. I feel like the other shoe just fell. I also have 2 knees that need replaced but due to my high white count due to my IC the dr will not due the surgery on top of diabetes. also had mri done am i’m in therapy for spine problems. I had 2 disc in my neck replaced 6 years ago and still deal with pain and weakness. how can I get help I was told you are trying to help people with chronic pain. Im scared and alone any help would be so helpful. thank  you

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Jeff Sessions is wrong about the War on Drugs

https://action.aclu.org/secure/sessions-war-on-drugs

Attorney General Jeff Sessions is spouting rhetoric and promoting policies that we’ve been working hard to put in the past. With near-consensus that the War on Drugs was a failure on all levels, the country is ready to move to smart and commonsense reforms to our broken criminal justice system.

Except for one man: our top law enforcement official, Jeff Sessions.

Sessions has reversed an important charging policy that instructed prosecutors to avoid getting caught in the stranglehold of mandatory minimum sentencing. Mandatory minimums are widely understood as racist, destructive to families and communities, and fundamentally unfair. So why is our attorney general actively undoing policy in order to encourage the harshest possible punishments?

Jeff Sessions has a history of endorsing ineffective policies and positions based on political rhetoric. He wants to put as many people as possible behind bars. And not just anyone – the War on Drugs policies Sessions is rolling out target and harm Black and Brown people and communities.

This has to end. We need smart criminal justice reforms – not regressive, recycled policies. Add your name now to tell Jeff Sessions that no matter what he says, the War on Drugs must end.

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Supreme Court tightens rules on class-action lawsuits

https://www.washingtonpost.com/business/capitalbusiness/supreme-court-tightens-rules-on-class-action-lawsuits/2017/06/19/435260c6-550a-11e7-a204-ad706461fa4f_story.html#comments

The Supreme Court on Monday issued a ruling that makes it more difficult for plaintiffs attorneys to look for friendly locations for their lawsuits, a practice known as “court shopping.”

The court reversed a lower-court decision on class action lawsuits, ruling that hundreds of defendants who sued Bristol-Myers Squibb in California over injuries associated with the blood-thinning drug Plavix could not sue in that state because they were not residents.

The 8-1 decision led by Justice Samuel Alito rejects a liberal standard for where plaintiffs can sue, creating a hurdle for litigants. The majority decision said non-state plaintiffs had failed to establish a strong connection between their alleged injury and Bristol-Myers actions in California.

The plaintiffs had claimed the drug manufacturer misrepresented the risks of strokes and heart attacks due to Plavix.

The court, speaking specifically of the non-California residents who joined the class-action suit against the drugmaker, said those individuals “are not California residents and do not claim to have suffered harm in that State. . .It follows that the California courts cannot claim specific jurisdiction.”

“The non-residents were not prescribed Plavix in California, did not purchase Plavix in California, did not ingest Plavix in California, and were not injured by Plavix in California,” Alito said in his majority opinion. “The mere fact that other plaintiffs were prescribed, obtained, and ingested Plavix in California—and allegedly sustained the same injuries as did the non-residents—does not allow the state to assert specific jurisdiction over the nonresidents’ claims.”

In her dissent, Justice Sonia Sotomayor said she feared the consequences of Monday’s decision.

“The majority’s rule will make it difficult to aggregate the claims of plaintiffs across the country whose claims may be worth little alone,” she said in the dissent. “It will make it impossible to bring a nationwide mass action in state court against defendants who are ‘at home’ in different States. And it will result in piecemeal litigation and the bifurcation of claims. None of this is necessary.”

Andrew Pincus, a Supreme Court lawyer with the Washington office of Mayer Brown, said the ruling leaves open “two big questions:”

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What happens when lives are dramatically torn apart by chronic pain? The Painful Truth takes us behind the headlines of addiction and beyond the controversies of the war on opioids – and provides an intimate view of patients’ frustrations, setbacks, and goals as they deal with chronic pain. We hear patients tell us their stories … and we understand the social barriers and prejudices they face.

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Do you think the chronic pain community could get Michael Moore-the film maker to take his camera around the country and get our story out?

I am a retired federal social security examiner and a part of the story not being told is the millions of people who will now apply for social security disability due to severe pain that was controlled prior to these “new” rules.

www.michaelmoore.com/

Here is Michael Moore’s website

This person may have a point.. Michael Moore is most definitely ANTI-TRUMP and ANTI-REPUBLICAN and  PRO-LITTLE GUY..  He has a “bully pulpit” and a “bull-horn”.

         This battle for the chronic pain community has to be a personal battle.. since those in the chronic pain community are the ones that are suffering and being discriminated against.

I think that Michael Moore would have to be approached in a manner that he could “back hand” the Trump administration and/or Republican party in general…

The fact that CMS ,VA and others are adopting the CDC guidelines…. that were developed behind “closed doors” and leaks have indicated that this committee had some very well known anti-opiate advocates on it.  One that has financial ties to a group of rehab facilities.

For starters …AG Session has asked Congress to not renew the law that prohibits the DEA from going after entities within states that has made Marijuana legal https://thejointblog.com/ag-jeff-sessions-asks-congress-remove-federal-medical-marijuana-protections/   We have some THIRTY STATES that have legalized MJ and MMJ in some form.  Session appears want to ramp up the war on marijuana even though there is increasing evidence that it has certain medical benefits.

The Justice Dept should be enforcing discrimination under the Americans with Disability Act and Civil Rights Act against the chronic pain community and those who have been diagnosed with other subjective disease and have a legit medical need for controlled medications.

Chris Christie just had the first meeting yesterday of some committee on drug abuse  http://www.washingtonexaminer.com/christie-to-lead-new-opioid-commission-under-trump-administration/article/2618751  It is common knowledge that Christie had a close friend from college OD…  that contributed to him  becoming a drug abuse crusader. We don’t know where this committee is going, but my money is on… that it will be in the direction of further restriction of access to opiates and other controlled medications that pts have a legit medical necessity.

Also all the state legislators that have passed opiate dosing guidelines … few – if any – legislators have a medical background and they are making medical decisions using a “cookie cutter” process and limiting pain management via edict

I did this post this other day about Cutting of pain management therapy.. turning a “maker” into a “taker”

a chronic pain pt that had moved from California to state of Washington and was being managed on 18 mg morphine equivalents and the WA doctor refused/declined to continue the therapy that was working… at such a low dose… and the person was in fear of losing his job..

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Our Mission

http://www.aarp.org/about-aarp/

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

It has been claimed that the “biggest enemy” of a chronic pain pt is their family and the local pharmacist.  Because neither really knows what is going on with a particular pt’s overall health.  All they know is the “large quantity” of medications that they take including those “bad opiates”.

Go to their website and search for “alcoholic” and you get 98 articles.. search for “opiate addiction” and you get 157 articles… search for “Nicotine addiction” and you get 57 articles..  The addiction (Nicotine) that kills the most people gets the least amount of “ink”… Alcoholism kills more than addiction and yet opiate addiction gets the MOST INK.

Type in “chronic pain” and you get 3030 articles and in reading the dozen or so articles.. it is all about “alternative therapies” including a article from the infamous DR.OZ.

It would appear that their MISSION STATEMENT of “fighting for what matters most to families “… HEALTH being one… that apparently they are aligning themselves with all those in the Federal/State bureaucracies that believes that prescribing opiates causes addiction.

In 2016 AARP spent  $8,710,000 on lobbying http://www.opensecrets.org/lobby/clientsum.php?id=D000023726&year=2016  If one looks at the articles that they have published… one can come to the conclusion that little/none of that nearly NINE MILLION DOLLARS was spent on the issue of better chronic pain treatment for the 38 million seniors that they claim that they represent.

The question has to be asked… so all those 50+ y/o “seniors ” who suffer from chronic pain… support an organization that appears to be SILENT on one of their most pressing personal health issues ?

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388,000 residents die each year of HAIs with infection control practices lacking, experts warn

http://www.mcknights.com/news/388000-residents-die-each-year-of-hais-with-infection-control-practices-lacking-experts-warn/article/668614/

Long-term care providers are falling behind when it comes to training for infection control personnel, leaving gaps that may be to blame for at least some of the 380,000 annual resident deaths linked to healthcare-associated infections, new research shows. 

Investigators with health departments in Tennessee and Washington set out to gauge nursing home providers’ infection prevention proficiency, a topic that has heated up following the release of the Centers for Medicare & Medicaid Services’ final rule for long-term care. That rule, published in September, includes provisions requiring providers to improve their infection prevention and control programs.

The results, presented Wednesday at the Association for Professionals in Infection Control and Epidemiology’s annual conference in Portland, OR, found that many of the infection control officers in the facilities surveyed lacked formal training and the foundational skills required for infection prevention.

“The findings presented here are concerning and should prompt immediate efforts to increase education and support for infection prevention programs in all types LTCFs,” said APIC 2017 President Linda Greene, RN, MPS, CIC, FAPIC. “Nursing home residents often have multiple, chronic diseases, transfer frequently between the hospital and the long-term care setting, and are overexposed to antibiotics, all of which place them at higher risk for developing infections with antibiotic-resistant organisms.” 

In Tennessee, 95% of facilities studied failed to meet the requirements or an antibiotic stewardship program, while 56% of providers had infection control programs managed by someone with no additional training. Many facilities also may have implemented competency-based training programs for hand hygiene and personal protective equipment, but failed to provide feedback on employees’ performance.

On average, long-term care facilities in Tennessee devoted only 12.5 staff hours per week to infection prevention efforts, researchers said.

In Washington, the researchers found that only 10% of infection preventionists had formal training. Many providers also failed to conduct annual reviews of their infection prevention policies or give ongoing feedback on employees’ competencies. On average, infection professionals in that state dedicated just 11 hours per week on prevention activities.

Researchers said the results of the surveys in both states showed “clear gaps” in infection prevention practices, as well as an “urgent need” to boost efforts within long-term care facilities.

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