Walgreens: uncover new and innovative approaches to help improve outcomes for our patients

Posted on May 18, 2017 by Pharmaciststeve

Walgreens presents five clinical studies tracking pharmacy’s impact on adherence

http://www.drugstorenews.com/article/walgreens-presents-five-clinical-studies-tracking-pharmacys-impact-adherence

DEERFIELD, Ill. — Walgreens will present the findings of five recently completed clinical studies at the 22nd Annual International Society for Pharmacoeconomics and Outcomes Research Annual International Meeting, May 20-24 in Boston. Clinical abstracts from the studies being presented focus primarily on Walgreens efforts to improve medication adherence and patient outcomes through various pharmacy initiatives.
 
“We’re continually seeking to uncover new and innovative approaches to help improve outcomes for our patients,” stated Chet Robson, medical director, clinical programs and quality, Walgreens. “The research we are presenting at ISPOR demonstrates the impact and effectiveness of various pharmacy programs and services and how they can serve to benefit patients and payers.”
 
The studies to be presented at ISPOR include:

  • Analysis of 90-day prescription refill at retail programs, and their impact on improving adherence to medications included in the CMS Star quality measures, demonstrating significantly greater adherence among Medicare Part D patients;
  • A study that observes adherence rates among Walgreens Medicare Part D patients for whom pharmacists initiated late-to-refill reminder calls. Greater impact is shown among patients with 90-day medication fills than on 30-day fills;
  • An exploration of factors associated with medication self-synchronization (aligning multiple medications to be refilled on the same day), in which findings reveal medication self-synchronization is associated with age, copay amount, selected maintenance medication indicators, day supply indicators and total number of prescriptions;
  • Examination of the Universal Medication Schedule as a means of standardizing prescriptions that demonstrates UMS prescribing is associated with significantly higher adherence to oral diabetic medications for older adults with low education who receive a multi-daily regimen. Walgreens collaborated with Northwestern University on this research; and
  • A study exploring length of therapy and factors associated with HIV pre-exposure prophylaxis medication adherence, demonstrating significantly higher adherence among older age groups, males, users of HIV-specialized services, and those with private insurance. The study found that patients used PrEP on average for seven to eight months in the first year.

Isn’t it amazing that Walgreens is expressing a increased interest of pts taking their chronic  medication as prescribed…  because the more prescriptions they fill.. the more money they can make ?

CMS Star quality measures That will financially PENALIZE healthcare providers if they pts that they serve are not compliant with their medication to treat chronic pain diseases… right now CMS is focused on Hypertension, Cholesterol, Diabetes.

Does this suggest that Walgreens “Good Faith Policy”  regarding the filling – OR DENYING – the filling of controlled medication prescriptions by their Pharmacist is in conflict with their concerns about pts being compliant with their medications to treat chronic conditions ?  http://www.wthr.com/article/walgreens-secret-checklist-reveals-controversial-new-policy-on-pain-pills

Does this suggest that Walgreens is primarily interested in encouraging pts being compliant with their medication(s) where Walgreens stands to MAKE MORE MONEY ?

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Woman says CVS didn’t properly fill son’s seizure medication prescription

Posted on May 18, 2017 by Pharmaciststeve

Woman says CVS didn’t properly fill son’s seizure medication prescription

http://wvrecord.com/stories/511117429-woman-says-cvs-didn-t-properly-fill-son-s-seizure-medication-prescription

CHARLESTON – A Kanawha County woman is suing CVS Pharmacy after she claims it filled her child’s prescription with the wrong dosage, causing him injuries.

 

West Virginia CVS Pharmacy; CVS Pharmacy Inc.; CVS 6306 WV; Caremark; Jane Doe Pharmacist(s); and John Doe Pharmacy Technician(s) were all named as defendants in the suit.

Cliff McLean Collins maintained a prescription for 250mg of Depakote DR through his treating physician and, as prescribed, he would ingest three pills in the morning, two in the evening and three at bedtime, according to a complaint filed in Kanawha Circuit Court.

Connie Arteese claims on or before March 31, 2015, an unbeknownst to her, Collins’ treating physician had changed his prescription and sent it to CVS and, as prescribed, Collins was to receive his medication as taking two 250mg tablets at 6 a.m., two tablets at 2 p.m., and three tablets at 10 p.m.

On April 1, 2015, Arteese traveled to CVS in St. Albans to pick up Collins’ prescription and, upon arrival, she was directed that Collins should take the drug in the manner as prescribed on the bottle, however, CVS had negligently, carelessly and recklessly mis-filled his prescription, according to the suit.

Arteese claims believing the instructions to be correct, she permitted Collins to ingest the prescription in the manner prescribed on the bottle, which, instead of totaling 1,750mg, actually totaled 3,500mg.

Following the unknown, unauthorized and dramatic increase in Collins’ ingestion of Depakote, he initially showed signs of decreased energy and strength, followed shortly thereafter by a marked increase in the number of seizures, which would vary dramatically in number each day, according to the suit.

Arteese claims on April 27, 2015, she contacted CVS to request a re-fill and was advised there were no refills due to the prior dosage change, which perplexed her and she retrieved one of the bottles of the prescription, where a closer examination revealed that the instructions and the total amount of milligrams were not consistent.

When Arteese telephoned Collins’ treating physician to inquire about the incorrect prescription, the physician requested Collins be brought to Cleveland Clinic immediately for treatment and evaluation, according to the suit.

Arteese claims the defendants failed to correctly fill the prescription.

As a direct and proximate result of the breach of standard of care, and the carelessness, recklessness and negligence of the defendants, Collins ingested the incorrect dosage and sustained physical injuries; pain and suffering; mental anguish; increased costs of care, reasonable and necessary medical expenses; and annoyance and inconvenience, according to the suit.

Arteese is seeking compensatory and punitive damages. She is being represented by Robert B. Warner and Andrew D. Byrd of Warner Law Offices.

The case is assigned to Circuit Judge James C. Stucky.

Kanawha Circuit Court case number: 17-C-589

 

 

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PA fired: some of his patients were on high doses of opioids that exceeded clinic policy?

Posted on May 18, 2017 by Pharmaciststeve

Patients Allege Mistreatment at Montana Pain Clinic

www.painnewsnetwork.org/stories/2017/5/18/patients-allege-mistreatment-at-montana-pain-clinic

By Pat Anson, Editor

A Montana pain clinic is under fire from patients for abruptly stopping their opioid medication, forcing them to take expensive drug tests, and steering them towards invasive and potentially dangerous procedures.

Some former patients at the Benefis Pain Management Center in Great Falls also allege they have been unfairly labeled as addicts, which has made it difficult for them to find new doctors.

“I’ve never been treated so badly in my life as I have at Benefis, to the point that I terminated my care with them, because I couldn’t do it. I couldn’t be called an addict and a junkie anymore,” says Tami Duncan, a 50-year old woman who suffers from chronic back pain.

“I’m not going back. I am done with them,” says another former patient. “It’s like I was a junkie just looking for my next fix. And that’s not the case at all.”

“You become terrified of who you are going to see next and what they are going to say and do to you,” said a current patient. “The fear of losing my job and not to mention my sanity. The fear that I am going to be labeled an addict if I don’t do what they tell me to.”

“They do not care. They do not know their patients. They do not review the records,” another current patient said. “There is so much more. Billing errors, rarely treated like a person, the wait to see doctors, and then 15 minutes (with them) and you are gone.”

The Benefis pain clinic is part of Benefis Health System, a non-profit community-based health organization that operates a hospital and provides a wide variety of medical services in Great Falls, a city of over 58,000 people in north central Montana. With over 250 physicians and about 3,000 other employees, Benefis is the largest employer in the area outside of government.

“We have some of the finest nurses and Physician Pain Management specialists, with experience second to none. This experience combined with their compassion, provide a tremendous supportive atmosphere. Our pain management team aims to help people reduce and cope with pain,” Benefis says on its website.

Some patients disagree, saying Benefis doctors are quick to label a patient as non-compliant, which has led to patients being discharged from the clinic. In a rural state such as Montana, where options for pain care are limited, that is not a threat to be taken lightly.

“Any questions or requests can be seen as combative. To try and protect ourselves we were recording our appointments. Somehow it was found out and there are now signs everywhere stating no recording or photos,” a patient told PNN.

“We are not allowed to have anyone come into the appointment with us. I am being bounced around to different providers. There is no stability. I am still receiving meds but at a fraction of what they were. To say that I am hurting would be an understatement.”

“Our clinic does not suddenly discontinue opioid prescriptions for patients unless we feel it is unsafe to continue prescribing them,” said Katrina Lewis, MD, a Benefis pain management specialist. “We have patients that have been on pretty high doses of opioids for many years but are not experiencing much relief from pain anymore and their quality of life is suffering significantly.  

A SIGN POSTED AT THE BENEFIS PAIN CLINIC

A SIGN POSTED AT THE BENEFIS PAIN CLINIC

“We have to do what is medically responsible and safe for our patients. Opioids are incredibly powerful drugs. Given the choice between a patient potentially dying and a patient going into withdrawal, we have to pick withdrawal.”

In an age of opioid hysteria and misleading headlines about an overdose epidemic fueled by painkillers, pain patients around the country – including many who have been stable and compliant on opioid medication for years – are seeing their doses cutback or eliminated. Some have been discharged by doctors who are leery of scrutiny by the DEA and no longer want to treat chronic pain.

What sets the disgruntled patients at Benefis apart from everyone else is that they have formed a support group for each other. And some are speaking out publicly against a provider they feel has shamed and abandoned them. For this story, PNN interviewed over a dozen current and former patients, including some who asked to remain anonymous.

Physician Assistant Fired

Many of the problems at the Benefis pain clinic can be traced back to the firing of Rodney Lutes, a popular 68-year old physician assistant (PA) who – until he was let go — was treating as many as 1,000 pain patients.  

RODNEY LUTES, PA

RODNEY LUTES, PA

“I was thunderstruck. It totally blindsided me. I thought I was doing everything I could for the patients,” says Lutes about his firing in early March.

Lutes was told he was “no longer a good fit” at the clinic and that his position was being eliminated. He believes the real reason was that some of his patients were on high doses of opioids that exceeded clinic policy.

“They didn’t come to me and say, ‘Hey Rod, you need to fall in line here and start reducing these people.’ There was no warning whatsoever,” said Lutes. “The majority of the patients were doing very well. You always have some patients who aren’t doing well and you try to adjust their medications. I had a number of those. But otherwise I felt that the patients were doing very well on the doses they were on.”

“We respect our employees’ privacy rights and consequently cannot comment on the details of Rodney Lutes employment with Benefis,” says Keri Garman, Director of Corporate Communications at Benefis.

There is no record of any disciplinary action against Lutes by Montana’s Board of Medical Examiners. He has been licensed as a PA in the state since 1991.

“He’s compassionate and understanding. I’ve never met anybody else like him in my life,” says Tami Duncan, a patient of Lutes for 20 years. “And Benefis is crucifying that man, along with his patients.”

Duncan was on relatively high doses of oxycodone and MS-Contin for chronic back pain caused by herniated and bulging discs, arthritis and fibromyalgia. She’s also had as many as 60 epidural injections, nerve blocks and other “interventional” procedures, which not only failed to stop her back pain, but may have given her adhesive arachnoiditis, a progressive and chronic inflammation of spinal nerves that she was recently diagnosed with.

“Sometimes it feels like I’m standing in a pot of hot boiling water all day,” says Duncan. The first thing she was told by her new doctor at Benefis was that he was taking her off opioids.

“He comes in and didn’t even look at my files, didn’t even look at my record. And he told me, ‘Well Mrs. Duncan, the game plan is we’re taking you off all your medications and then we’ll terminate your care.’” she recalled. “He didn’t know anything about what was wrong with me. Didn’t know I had nerve conduction tests done to show all the nerve damage I have in both of my legs. He basically came out and said, ‘All you patients all need to go into treatment. You’re addicts.’”

“There are many scenarios that may warrant discontinuation of a particular regimen for the benefit of the patient.  Opioids can have many negative side effects for patients,” said Dr. Lewis in a lengthy statement for PNN prepared by Benefis. “We understand that this can be unsettling for patients who have been with a provider for a long period of time and who are accustomed to their care plan.”

Duncan started looking for a new pain doctor and immediately ran into problems. When she visited a pain clinic in her hometown of Havre, she was turned away without an exam or review of her medical records.

“The RN proceeded to tell me that I was a junkie, those are her words, that I was an addict and the only thing that was wrong with me is that I needed to go to treatment,” she said. “I’ve called all over the state trying to find a different pain doctor. Nobody will take me. Benefis has called every doctor in the state of Montana saying not to take any of Lutes’ patients.”

Duncan cites a letter she received from Benefis, which states: “All care providers in our community have been made aware of the changes in our clinic and with what is going on with PA Lutes’ patients.”

“It is our standard practice to send a note to referring physicians within our own health system and community to let them know of changes to the providers practicing in our clinic.  The letters never indicate the reason a person is no longer with our organization,” Kathy Hill, Benefis’ Chief Operating Officer said in the statement.

“Community providers had many patients calling with concerns about whether they would be able to get in with a new provider soon enough to avoid a lapse in their medications.

“Whether or not to prescribe opioids to any patient is at the discretion of the provider. Providers were not urged either way.”

‘Nobody Will See Pain Patients’

Regardless of the reason, many former patients of Lutes are having trouble finding new doctors, a not uncommon experience in rural areas where healthcare choices are limited.

“Nobody in Great Falls will see any pain patients. I’m just sitting here in limbo doing nothing but being in pain,” said a former patient who decided to leave Benefis after her opioid medication was stopped. The doctor who replaced Lutes persuaded her to have an epidural, a decision she now regrets.  

“They’re forcing everybody to get injections,” says Adrienne Barnoski, another former patient. She and her husband Joseph, who has severe back pain, had been treated by Lutes for years.

“I’m not going to have any injections on my back after what my husband has gone through. It sometimes makes things worse,” she said.

Epidural injections have been used for decades to relieve pain during childbirth, but in recent years injections of a steroid into the epidural space around the spinal cord have increasingly been used to treat back pain.  The shots have become a common and sometimes lucrative procedure at pain clinics, where costs vary from as little as $445 to $2,000 per injection. Critics say the injections are risky, overused and often a waste of money.

“An epidural steroid injection is an invasive procedure. It has its risks. And I think a patient always has the right to decline an invasive procedure,” says Lutes. “I’ve had a couple of patients tell me (that they were told) to do epidural steroid injections and if they didn’t do the injections they were no longer going to be prescribed any medications. To me, that’s kind of like blackmail.  

“My patients are being treated very, very poorly. It’s horrible. I’ve had calls from patients or their spouses, very concerned the patient was going to commit suicide. It just scares me to death. And these were patients that were functionally doing great. And now they’re being told, sorry, we’re taking your medication away from you.”

Benefis says it does not pressure patients into having invasive procedures, but admits there could have been communication problems between doctors and their patients.

“This is not a policy or an expectation in any way. While we expect patients to be active participants in getting better, there is never a mandatory procedure,” said Nikki Phillips, BSN, Clinic Office Manager at Benefis Neurosciences. “We do our best to care for our patients and regret that this transition has been difficult for some. We realize we have opportunities to improve our communication with patients and will be working on that as a team moving forward.”

“The decision of whether or not to prescribe opioids to a patient is in no way related to their decision to have or not have other interventional procedures,” said Dr. Lewis. “Unfortunately there are some patients who come into the clinic with a preconceived notion that opioids are the answer for them, whether because of past practice within the medical community or other reasons, and overcoming that preconceived notion can be challenging.”

A major challenge for the patients who remain at Benefis is paying for their urine drug tests, which can cost as much as $1,500 and are not always covered by insurance.  For the past two years, Benefis has been working with a drug laboratory over 2,000 miles away in Georgia, one with a questionable past and a very uncertain future. More on that tomorrow.

I am not an attorney but this statement  “doses of opioids that exceeded clinic policy”  suggests that “cookie cutter corporate medicine” is in full effect in this so called “healthcare system”. 

This is the type of “one size fits all medicine” is where a class action lawsuit is going to first take place. When administrators and/or executives of a corporation starts basically dictating medical care in this manner.. you can be guaranteed that some/many pts will be harmed.  You cannot administratively invalidate the “bell curve” and the individualization of healthcare that every person needs and expects from the prescriber that they have trusted their quality of live and – at times – life itself to.

This sort of corporate medical policy edict would appear on face value that they are attempting to overwrite or supersede the state’s medical practice act which grants the prescriber professional discretion in treating pts.  

A SIGN POSTED AT THE BENEFIS PAIN CLINIC

In the whole medical industry  SOP is … “if it is not documented…. it NEVER happened ” so it would appear that this healthcare corporation only wants documentation based on “one point of view” and that would be from the healthcare provider’s perspective.  Which is “guided” by “clinic policy” and perhaps fear of continued employment…  as  RODNEY LUTES, PA recently found out… having to deal with… Benefis is the largest employer in the area outside of government.

I don’t think that it would be much of a push for a law firm to review their pt care policies to easily find out that the “most strict/limiting” are directed at those whose medical conditions require controlled medications and the rest of the pt care policies – if they do exist – have edicts that are more “general” in nature as to treatments and expected pt outcomes.

Since the pts covered by the former policies are covered by either the Americans with Disability Act or/and the Civil Rights Act.. and it would be quite easy to PROVE discrimination… which is a CIVIL RIGHTS violation under those laws.

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Death linked to CVS robbery, police say

Posted on May 18, 2017 by Pharmaciststeve

Death linked to CVS robbery, police say

http://www.duluthnewstribune.com/news/crime/4269129-death-linked-cvs-robbery-police-say

The suspect in the robbery of a pharmacy earlier this week has died, Duluth police reported.

Police said they responded to a residence in the 600 block of North First Avenue East shortly after 1 p.m. on Tuesday to the report of a dead body. Investigators responded because of the deceased individual’s age and lack of medical history, they said.

At the scene, investigators noticed numerous items that appeared to have been stolen from the CVS pharmacy at 1215 E. Superior St. on Monday. They concluded that the deceased individual was the suspect in the robbery and said they were seeking no other suspects.

The death did not appear to be suspicious, police said.

The body was taken to Midwest Medical Examiners for an autopsy and results on toxicology are being awaited to determine the manner and cause of death, police said.

The dead individual’s name was not immediately released.

Since Pharmacies in general and chains in particular have been reluctant to created a more “fortified” Rx dept… so that Rx dept robberies would become more difficult, if not impossible.

Should  these pharmacies that have left their Rx dept “wide open” and more “inviting” to robbers… be charged with some sort of violation of being complicit with what goes wrong and/or people harmed because of this reluctance/failure ?

In this particular case, should CVS and their executives be charged in contributing to the death of this person?  I can assure you that if this person had gotten a prescription from a prescriber and OD’d… the DEA would be after the prescriber… Shouldn’t pharmacies be held to the same standard ?  Shouldn’t the Boards of Pharmacy take a more proactive stance in the how Rx depts are configured and be “less robber friendly “?  The Boards of Pharmacy primary charge is to protect the health/safety of the general public.  Since the majority of the Boards of Pharmacy are “stacked” with non-practicing corporate Pharmacists… working for the same pharmacy chains that are keeping their Rx depts “robber friendly”.  In general, are the Boards of Pharmacy being negligence ?

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SPEAK UP OR BEND OVER !

Posted on May 18, 2017 by Pharmaciststeve

Congress made all these contracts for themselves. Serving in Congress is an honor, not a career. The Founding Fathers envisioned citizen legislators, so ours should serve their term(s), then go home and go back to work.

TRUMP, in a recent interview with CNBC, offers one of the best quotes about the debt ceiling: “I could end the deficit in five minutes,” he told CNBC. “You just pass a law that says that anytime there is a deficit of more than 3% of GDP, all sitting members of Congress are ineligible for re-election”.

The 26th Amendment ( granting the right to vote for 18 year-olds ) took only three months and eight days to be ratified! Why? Simple! The people demanded it. That was in 1971 – before computers, e-mail, cell phones, etc.

Of the 27 amendments to the Constitution, seven (7) took one (1) year or less to become the law of the land – all because of public pressure.

Trump is asking each addressee to forward this email to a minimum of twenty people on their address list; in turn ask each of those to do likewise.

In three days, most people in The United States of America will have the message. This is one idea that really should be passed around.
If each person contacts a minimum of twenty people, then it will only take three days for most people in the U.S. to receive the message. It’s time!

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Sen. Chuck Grassley: IS DEA agents.. exaggerated their record of drug seizures “in order to obtain funding from Congress.”

Posted on May 17, 2017 by Pharmaciststeve

Leading Republican Senator Demands To Know If The DEA Lies To Congress

https://www.buzzfeed.com/danielwagner/leading-republican-senator-demands-to-know-if-the-dea-lies

 

BE SURE TO READ LETTER 

https://www.documentcloud.org/documents/3723725-Grassley-to-DEA-OIG.html

A top Republican senator has demanded that the Drug Enforcement Administration respond to allegations that agents exaggerated their record of drug seizures “in order to obtain funding from Congress.”

Sen. Chuck Grassley, who chairs the powerful committee that oversees the DEA and Department of Justice, raised the issue in a letter sent last week to Chuck Rosenberg, the DEA’s acting administrator, and to Justice Department Inspector General Michael Horowitz. It cites a BuzzFeed News report from earlier this month, about a DEA agent stationed in Sao Paulo, Brazil, who asked his girlfriend, Larissa Carvalho, to translate sensitive DEA memos. After she ended the relationship with him, the agent, Scott Nickerson, stalked and harassed Carvalho and her friends and relatives, BuzzFeed News reported.

The harassment continued for months despite numerous official complaints by Carvalho and others, Grassley noted in the letter. She received little response from either agency, it said.

In response to BuzzFeed News’s investigation, the DEA said it initiated an investigation into Nickerson’s conduct in June 2016, “but Nickerson is still employed by DEA and reportedly has remained free to continue to harass and threaten Carvalho and her friends and family throughout the course of that investigation,” Grassley noted in his letter.

Carvalho reported the questionable drug seizure reports to the Senate Judiciary Committee, which Grassley chairs, his letter said. In a WhatsApp conversation with Carvalho dated May 2014, Nickerson appears to describe how agents stationed in Brazil lied to Washington, falsely taking credit for drug seizures by local authorities in order to help justify the field office’s funding. DEA ”receives money by telling congress how much money and dope we seize,” he wrote. “In the US, everything is pretty accurate. here, however, the office in Brazil takes credit for everything the Brazilians do, even if they had nothing to do with it.”

Agents sometimes “will take newspaper articles and report it like dea assisted with the seizure,” Nickerson added. He called the actions “an insult to the agents that are busting their ass in the States, and I don’t want to do it.” He said that if he reported these actions to senior officials, that could influence the agency’s decisions about where to station agents when they returned to the US.

Spokespeople for the DEA did not respond to requests for comment, nor did Nickerson’s attorney. A spokesperson for the Office of the Inspector General declined to comment.

Nickerson, a married agent 10 years older than Carvalho, met her in 2014 and soon began dating her, BuzzFeed News first reported on May 5. He sent her at least five documents detailing the operations and associates of drug kingpins, including their phone numbers and mobile PINs. Strict rules govern the way details like that are handled, to protect the integrity of an investigation as well as the safety of innocent people. Passing sensitive documents to people who are not meant to see them violates DEA rules and can be grounds for firing; it is not clear whether Nickerson’s actions were unlawful. After BuzzFeed’s report, one of the memos was posted in full on Twitter by an anonymous account. Images of some of documents also appeared on an online message board.

Nickerson’s written communications with Carvalho include numerous references to additional misconduct by him and other agents, as Grassley laid out in his letter. He said he hired sex workers, which is a fireable offense for DEA agents; he said the tinted windows on his government-issued SUV were useful “for safety and blow jobs”; and he used government funds to help pay for travel with Carvalho — a practice he jokingly called “Obama pays.”

After Carvalho broke up with him in late 2015, Nickerson began a campaign of stalking and harassing her, her friends, and family that continued until earlier this month, BuzzFeed News reported.

Sen. Grassley’s letter concludes with 13 questions for the DEA and the Office of the Inspector General, an independent watchdog within the Department of Justice. They include what the agencies knew about about Nickerson, when they learned it, and what they did about it. It asks the DEA when it began investigating him and which allegations it focused on, whether Nickerson has been disciplined or stripped of his security clearance, what steps the agency has taken to prevent Nickerson’s stalking and harassment, and whether DEA has looked into other agents’ misreporting of drug busts in the manner Nickerson described.

Grassley also asked the Office of the Inspector General when it became aware of allegations against Nickerson, when it first acted, and whether it recommended any actions to DEA in response to the allegations.

The Office of the Inspector General has repeatedly criticized DEA for failing to adequately supervise agents working overseas, for rampant sexual misconduct including soliciting sex workers, and for failing to discipline employees after their misconduct is exposed.

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back surgeons on back pain: treating it – overcoming it – can be , if not impossible

Posted on May 17, 2017 by Pharmaciststeve

NBA Coach Steve Kerr: Bad Advice on Back Pain

http://www.acsh.org/news/2017/05/16/nba-coach-steve-kerr-bad-advice-back-pain-11287

Tuesday night marks the seventh straight NBA playoff game that Steve Kerr will miss due to debilitating back pain. It’s been more than three weeks since the head coach of the Golden State Warriors said he had to leave the team because of the intense discomfort, and to seek additional treatment.

Despite this being the most important time for his team, Kerr is not expected to return to the Warriors bench this season, even if his juggernaut advances to the NBA Finals in June, as expected. That’s how uncertain his situation is.

The lean and trim 51-year-old, whose undergone two failed back surgeries, cannot even manage sitting or standing – or a combination of both – in order to coach and travel to games, which is why Kerr stepped aside.

But during his announcement last month about his specific physical condition, he included some ill-advised medical advice for those in situations similar to his own.

“I’m not going to go into details on the symptoms. It’s just discomfort and pain and it’s no fun,” Kerr said on April 23. “And I can tell you if you’re listening out there, if you have a back problem, stay away from surgery. I can say that from the bottom of my heart. Rehab, rehab, rehab. Don’t let anybody get in there.”

Considering the amount of pain he’s experienced since first going under the knife in 2015 to repair a ruptured disk – also called a herniated or slipped disk – it’s understandable why Kerr said what he did. However, given his celebrity status and high visibility, he should have never offered medical advice of any kind, especially because every back problem is different, and no one approach is appropriate for every patient.

“We really don’t understand the spine very well, particularly the mechanics of the back. We apply a mechanical solution to what’s not necessary a mechanical problem, given that there are nerves and muscles involved,” says Charles Dinerstein, M.D., a Senior Medical Fellow at the American Council and retired vascular surgeon. “That said, while Kerr may have felt let down after two operations with no sustained relief, he should not have directed others with chronic back pain to stay away from surgery.”

The Wall Street Journal reported this week that “[r]esearch has shown the procedure is more successful than nonsurgical treatment for patients whose pain has persisted for several months,” and according to “Hyun Bae, a professor of orthopedic surgery at Cedars-Sinai Medical Center in Los Angeles, ‘When you look at the data, it clearly shows the patients who had surgery had a faster and more reliable recovery.’ “

Yet as many a back specialist will tell you, locating the source of back pain can be a very difficult thing to do. And even if it’s located, coming up with a plan to treat it – and overcoming it – can be just as difficult, if not impossible. Unless it’s under rare circumstances, even back surgeons won’t recommend back surgery from the start, since it’s often not the best approach – and the last option. 

“While sufferers are often desperate, and they are experiencing neuropathic pain,” adds Dr. Dinerstein, “in general it is almost never the first choice.”

For those who have experienced a herniated disk and the pain “has not resolved within a few weeks, your doctor may suggest physical therapy. Physical therapists can show you positions and exercises designed to minimize the pain,” according to the Mayo Clinic. Medications – including muscle relaxers and cortisone injections – WHICH THE FDA DOESN’T RECOMMEND… can also be prescribed. 

For Kerr, with enough time passed after recuperating from his first surgery, he began working out daily and incorporating yoga into his regimen to battle headaches, to help keep the pain at bay – which worked for awhile. But then he was afflicted by a rare complication from the original surgery: leaking spinal fluid, also called a cerebrospinal fluid leak, from a dural tear. That condition was addressed in his second operation in October 2015, but his awful pain has returned.

It’s this complication that makes Kerr’s situation even more unique, given that the cerebrospinal fluid leak occurs in roughly 1 in 20 disk operations. Just more reason for Kerr to have avoided telling the public to run from back surgeons. 

 

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FDA Adds Boxed Warning to Canagliflozin (Invokana, Invokamet, Janssen) for Amputation Risk

Posted on May 16, 2017 by Pharmaciststeve

FDA Adds Boxed Warning to Canagliflozin for Amputation Risk

http://www.medscape.com/viewarticle/880059

The US Food and Drug Administration (FDA) has issued a new boxed warning to the label of canagliflozin (Invokana, Invokamet, Janssen) to describe the risk for leg and foot amputations.

This heightened warning follows a May 2016 safety alert based on interim data from one of two ongoing trials in which the risk had been seen in one but not the other. Now, final results from both trials ― CANVAS (Canagliflozin Cardiovascular Assessment Study) and CANVAS-R (A Study of the Effects of Canagliflozin on Renal Endpoints in Adult Participants With Type 2 Diabetes Mellitus) ― indicate an approximate doubling of the risk for both leg and foot amputations in canagliflozin-treated patients compared to those randomly assigned to receive placebo.

The amputations were most commonly of the toe and middle of the foot, but some also involved the leg, below and above the knee. Some patients underwent more than one amputation, and some of those involved both limbs.

The European Medicines Agency has been investigating this phenomenon since April 2016, and in February 2017 issued a requirement that the labels of all drugs of the sodium glucose cotransporter 2 (SGLT2) inhibitor class carry the amputation warning.

 

Before prescribing canagliflozin, the FDA advises healthcare professionals to consider factors that may predispose patients to amputations, including a history of prior amputation, peripheral vascular disease, neuropathy, and diabetic foot ulcers.

Patients taking canagliflozin should be monitored for signs and symptoms of those conditions. The drug should be discontinued if these complications occur.

Healthcare professionals and patients are encouraged to report adverse events or side effects related to the use of these products to the FDA’s MedWatch Safety Information and Adverse Event Reporting Program:

Complete and submit the report online: www.fda.gov/MedWatch/report.

Download the reporting form or call 1-800-332-1088 to request a form.

 

 

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more than 500 pharmacy robberies in Illinois and Indiana since 2012

Posted on May 16, 2017 by Pharmaciststeve

As the nation’s heroin epidemic continues to claim lives at a rapid rate, the search for the heroin high is creating a dangerous situation for pharmacies. Police have responded to more than 500 pharmacy robberies in Illinois and Indiana since 2012, according to statistics compiled by the Drug Enforcement Administration. Chris Coffey investigates.

(Published Monday, May 15, 2017)

http://www.nbcchicago.com/investigations/Pharmacy-Robberies-a-Nasty-Side-Effect-of-Nations-Opioid-Crisis-422408144.html

As the nation’s heroin epidemic continues to claim lives at a rapid rate, the search for the heroin high is creating a dangerous situation for pharmacies. Police have responded to more than 500 pharmacy robberies in Illinois and Indiana since 2012, according to statistics compiled by the Drug Enforcement Administration.

In many security camera videos, pharmacists and their staff members can be seen being threatened, pushed or held at gunpoint by robbers who are demanding opioids and anti-anxiety medications. Opioid painkillers are known to ease heroin withdrawal while anti-anxiety pills can be used to mellow a high.

Glenn Kosirog was working at his family-owned pharmacy in Chicago in February when an alleged robber displayed a gun and forced him to hand-over thousands of prescription pills. Most of the incident was captured by Kosirog’s security cameras.

“He had ripped the narcotic cabinet off the wall,” Kosirog said. “He didn’t take everything. He just took the Xanax and hydrocodone.”

Chicago police said no offenders are in custody and the investigation is still ongoing.

Prescriptions for hydrocodone dropped by 350,000 in Illinois, as tighter controls on painkillers are putting fewer pills in the hands of users. The resulting street value of the drugs increases because they are in more demand.

“If you can’t get your painkiller any more, you’re either going to move to heroin or in some cases you’re going to rob a pharmacy to get those drugs that’s harder to get from your medical provider,” said DEA Chicago Special Agent in Charge Dennis Wichern.

According to Mt. Prospect-based National Association of Boards of Pharmacy (NABP), violent pharmacy robberies may end up having the harshest effect on the real patients who need prescription painkillers.

“One of the unintended consequences of all of this is they will simply quit carrying these products and when they do, these patients don’t have access to the medication they need,” said NABP executive director Carmen Catizone.

The number of opioid overdose deaths in the U.S. skyrocketed to more than 33,000 in 2015, according to the Centers for Disease Control and Prevention.

The February robbery wasn’t the first targeting Kosirog’s pharmacy.

“You’re always taken by surprise,” Kosirog said. “You try to hope and pray that they leave quickly.”

Police continue to investigate a violent robbery at a Wauwatosa, Wisconsin pharmacy that occurred in December. Security video of the incident, which was reported by NBC 5, showed robbers knocking down pharmacy staff members and threatening them at gunpoint. A spokesperson for the Wauwatosa Police Department said suspects in the case have been identified, but criminal charges have not yet been issued in the case.

Wichern said in some cases children under 17 are given “shopping lists” by an older person to rob pharmacies of prescription pills. He said children are used to conduct the robberies because it makes it more difficult to prosecute the cases.

 

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Teen dies from OD on the drug CAFFEINE… more “drug” restrictions coming ?

Posted on May 16, 2017 by Pharmaciststeve

Coroner says teen died from too much caffeine

http://www.cbsnews.com/videos/coroner-says-teen-died-from-too-much-caffeine/

|A South Carolina coroner says too much caffeine caused the death of a healthy teenager. Davis Cripe, 16, collapsed last month at his high school and died at the hospital. He had consumed a large soft drink, a latte and an energy drink over a short period. Tony Dokoupil reports.

 

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