OHIO: legislation contributing to increase in overdose deaths ?

Drug War: Shutting down pill mills is only the start

https://www.newsandsentinel.com/opinion/editorials/2017/06/drug-war-shutting-down-pill-mills-is-only-the-start/

Buckeye State residents should, perhaps, take some pride in knowing the American Medical Association calls Ohio the top state in the country in terms of monitoring prescription drugs. The Board of Pharmacy’s Ohio Automated Rx Reporting System, established in 2006, has processed more than 24 million queries from doctors and other health professionals. In 2015, Gov. John Kasich had it integrated directly into electronic medical records and pharmacy dispensing systems.

According to the Board of Pharmacy, “OARRS collects information on all outpatient prescriptions for controlled substances dispensed by Ohio-licensed pharmacies and personally furnished by licensed prescribers in Ohio. Drug wholesalers are also required to submit information on all controlled substances sold to an Ohio licensed pharmacy or prescriber. The data is reported every 24 hours and is maintained in a secure database.”

By all accounts, it is a fantastic system, and one worth accolades from the likes of the AMA.

Some experts, however, believe Ohio did such a good job with that crackdown that it drove addicts to even stronger street drugs. And the number of drug — prescription or otherwise — overdose deaths in Ohio is increasing: 4,149 died last year (a 36 percent increase from the previous year); and coroners across the state says this year’s overdose fatality numbers are outpacing 2016.

Dr. Thomas P. Gilson, Cuyahoga County’s medical examiner, last month told a U.S. Senate committee studying ways to combat illicit drugs, “The opiate crisis is a slow-moving mass-fatality event that occurred last year, is occurring again this year and will occur again next year.”

Certainly the majority of more recent deaths are due to heroin, fentanyl, carfentanil and any number of deadly combinations and new ingredients.

Ohio officials did a remarkable job of locking down the pill mills that started this plague. It turns out that was just the beginning of their fight. It is time for them to focus the same common sense and resources that created OARRS into winning the next battle — and, eventually, the war.

Trial: ended in a hung jury.. DOCTOR pleaded guilty to health care fraud

State of Addiction: DEA program works to make sure doctors aren’t over prescribing pain pills

http://www.koco.com/article/state-of-addiction-dea-program-works-to-make-sure-doctors-aren-t-overprescribing-pain-pills/9980504

An Oklahoma City doctor was sentenced to prison three years ago after he was found guilty of second-degree murder for overprescribing drugs.

 William Valuck was convicted in the overdose deaths of eight patients, and Drug Enforcement Agency said he’s not alone.

“There are, unfortunately though, those who are basically a drug dealer with a lab coat,” said Lisa Sullivan, manager for the DEA’s Diversion Program. “(There are a) very small amount of them, but they’re absolutely out there. And they result in people being overprescribed.”

DEA officials said doctors are tough to prosecute.

Amar Bhandary, an Oklahoma City psychiatrist, was charged in 2012 with 53 counts of illegal distribution of controlled substances. Federal prosecutors claimed the over prescribing resulted in the deaths of five people.

The trial ended in a hung jury and mistrial. Bhandary eventually pleaded guilty to health care fraud.

“In this case, the jury was not going to convict a doctor because the doctor says, ‘I’m trying to help patients in pain.’ All you have to create is a reasonable doubt,” said Richard Salter, assistant special agent in charge of DEA Oklahoma.

The DEA’s Diversion Program regulates pharmaceuticals in Oklahoma and works to make sure they’re used for legitimate medical reasons. The program has almost a dozen people working for it — compared to the nearly 17,000 practitioners in the Sooner state.

Those practitioners are also supposed to use an online prescription monitoring program to help people who “doctor shop.”

“They’ll hit five different doctors in a day, go to five different pharmacies,” Sullivan said. “If those doctors were to look at the PMP, they’d see that individuals were doing that, and they’d know they don’t need these medications for a legitimate need.

“And if they don’t, then they’re contributing to the problem.”

DEA officials have stressed that most physicians are trying to provide the best care to its patients. They also said after Valuck and Bhandary went to trial, many doctors on the DEA’s radar left the state.

 

Suggests why abstinence/sobriety rehab programs have 95% failure rate ?

In Texas, Abstinence-Only Programs May Contribute To Teen Pregnancies

http://www.npr.org/sections/health-shots/2017/06/05/530922642/in-texas-abstinence-only-programs-may-contribute-to-teen-pregnancies

To understand why teen pregnancy rates are so high in Texas, meet Jessica Chester. When Chester was in high school in Garland, she decided to attend the University of Texas at Dallas. She wanted to become a doctor.

“I was top of the class,” she says. “I had a GPA of 4.5, a full-tuition scholarship to UTD. I was not the stereotypical girl someone would look at and say, ‘Oh, she’s going to get pregnant and drop out of school.’ “

But right before her senior year of high school, Chester, then 17, missed her period. She bought a pregnancy test and told her mom to wait outside the bathroom door.

“I saw both lines came up,” Chester says. “I had tears and I remember just opening the door and she was standing there with her arms out and she just wrapped me up and hugged me. I just cried and she told me it’s going to be OK.”

Chester’s mother had also been a teen mom, and so had her grandmother.

Traditionally, the two variables most commonly associated with high teen birth rates are education and poverty, but a new study co-authored by Dr. Julie DeCesare, of the University of Florida’s OB-GYN residency program in Pensacola, shows that there’s more at play.

“We controlled for poverty as a variable, and we found these 10 centers where their teen birth rates were much higher than would be predicted,” she says.

DeCesare, whose research appears in the June issue of the journal Obstetrics & Gynecology, says several of those clusters were in Texas. The Dallas and San Antonio areas, for example, had teen pregnancy rates 50 percent and 40 percent above the national average.

Research shows teens everywhere are having sex, with about half of high school students saying they’ve had sexual intercourse. Gwen Daverth, CEO of the Texas Campaign to Prevent Teen Pregnancy, says the high numbers in Texas reflect policy, not promiscuity.

“What we see is there are not supports in place,” Daverth says. “We’re not connecting high-risk youth with contraception services. And we’re not supporting youth in making decisions to be abstinent.” The state needs to emulate more progressive policies found in other states, she says.

 

Chester with her then-boyfriend Marcus Chester and sons Ivory and Skylar. They have since married.

Courtesy of Jessica Chester

For years, California has invested in comprehensive sex education and access to contraception, Daverth says. There, the teenage birth rate dropped by 74 percent from 1991 to 2012. The teen birth rate in Texas also fell, but only by 56 percent.

In South Carolina, young women on Medicaid who have babies are offered the opportunity to get a long-acting form of birth control right after they give birth. They’re also trying that approach in parts of North Carolina. And Colorado subsidizes the cost of long-acting birth control. There, both abortions and teen birth rates are dropping faster than the national average.

Texas makes it hard for teenagers to get reproductive health care, Daverth says.

In Texas, if a 17-year-old mom wants prescription birth control, in most cases she needs her parents’ permission. “Only us and Utah have a law that if you’re already a parent, you are the legal medical guardian of your baby but you cannot make your own medical decisions without the now-grandma involved,” Daverth says.

That’s part of the reason, she notes, that Texas has the highest rate of repeat teen pregnancies in the country.

After Skylar was born, Chester wasn’t given contraception counseling and still wasn’t sure where to go for help. Three months later she was pregnant again. She and her then-boyfriend, now-husband hadn’t realized she could get pregnant so soon after having a baby. She was a full-time student at UT-Dallas at that point, double-majoring in molecular biology and business administration. But the education Chester never got, she says, was sex ed.

“In hindsight,” she says, “It’s like, ‘Dude, what were you all thinking? I came in 17, pregnant, why weren’t you all lining up the chart and showing me [my] options?’ “

Chester’s high school taught abstinence-only sex ed, and the majority of schools in Texas, either do that or don’t offer any sex education at all. But more districts do seem to be adopting “abstinence plus” — which still encourages abstinence but also includes information on other pregnancy prevention methods and sexually transmitted diseases. Still, abstinence-only education is king, and of course, some parents aren’t comfortable discussing sex with teens, much like Chester’s mother wasn’t.

Nicole Hudgens, a policy analyst with the socially conservative Texas Values public policy group, supports abstinence-only education and says there are plenty of options for young moms who become pregnant.

“There are so many places like crisis pregnancy centers that are able to help these girls that are in need,” Hudgens says.

Crisis pregnancy centers provide counseling and support for pregnant teens but don’t offer abortions or contraception.

Studies show access to contraception is key to reducing the teen pregnancy rate. And according to the National Campaign to Prevent Teen Pregnancy, teen pregnancies in Texas cost the state $1.1 billion each year. Gwen Daverth says the costs are due to lost wages and an increased reliance on social services.

“One of the things we know is that 60 percent of teen parents will not graduate from high school and only 2 percent will go on to graduate from college,” Daverth says.

Jessica Chester did graduate from college. Her mom helped her through it, and she did end up taking out loans for day care, but she got a degree and at age 30 now has a job doing community outreach and family planning.

“I have a lot of support with my mother alone,” Chester says. “I had the example in front of me of [that getting pregnant young] doesn’t have to derail your plans, it doesn’t have to stop you from getting an education and a career.”

Chester with Ivory (left), 11, Skylar (right), 12, and Kameron (center), 21 months.

Lauren Silverman/KERA

Chester and Marcus got married in 2010 and in 2014 planned to have another baby — Kameron, now 21 months.

Sitting in the couch at her home in Garland, Chester admits it can be tough watching friends graduate with medical degrees or who are further along in their careers. Sometimes, she says it can feel like she failed.

“Like I gave up on my goals and dreams or messed them up. But when I look at my children I don’t regret a thing. I’m not sad,” she says through tears. “It’s just the reality of knowing my life is completely altered because of decisions I made as a teenager.”

Then Chester hears her older boys laughing upstairs, wipes her tears and goes to cheer them on.

DEA Chief Chuck Rosenberg: “marijuana is not medicine”

With These 4 Words, the DEA Head Shut Down Any Hope of Legalizing Marijuana Anytime Soon

http://host.madison.com/business/investment/markets-and-stocks/with-these-words-the-dea-head-shut-down-any-hope/article_f21ee453-5b16-51d9-a666-3bd1c9afad4c.html

In recent years, growth in the marijuana industry has been phenomenal. In fact, you’d struggle to find an industry that could deliver comparable growth over an extended period of time, which is a prime reason why investors have flocked to marijuana stocks.

Last year in North America, according to cannabis research firm ArcView, net sales of cannabis were an estimated $53.3 billion. Of this amount, just $6.9 billion was conducted through legal channels. The remaining $46.4 billion stands as a pie-in-the-sky opportunity for the pot industry to attract new customers through legal means. This, along with record-high approval ratings for marijuana in Gallup’s and CBS News’ most recent polls, is what’s pushed many marijuana stocks higher by at least 100% over the trailing 12-month period.

Also noteworthy is the fact that our neighbors to the north and south could be readying to expand the use of legal marijuana. In Canada, where medical cannabis has been legal since 2001, Prime Minister Justin Trudeau introduced legislation that would make recreational weed legal for adult use by next summer. Meanwhile, legislation made it through Mexico’s Congress that would legalize medical marijuana throughout the country.

Where’s the U.S. while this is going on, you ask? Mostly stuck in neutral.

Federal scheduling of marijuana is holding the industry back

In terms of state-level legalizations, the U.S. has made marked progress in recent years. As of the end of 2016, more than half of all states (28) had legalized medical cannabis, and residents in eight states have voted to legalize recreational marijuana since Nov. 2012.

However, and this is the big “however,” the federal stance on marijuana remains the same today as it’s been for decades. Namely, cannabis is a schedule I substance, meaning it has no medical benefits and is entirely illegal — the same as heroin or LSD. This stance was considered acceptable to many back in the 1990s when, according to Gallup, just a quarter of respondents wanted weed legalized nationally. With approximately three out of five survey-takers wanting to see pot legalized nationally today, Congress’ view on marijuana isn’t all that popular.

In fact, categorizing marijuana as a schedule I substance has some pretty adverse impacts on companies that operate legally within the industry.

For example, most weed-based business have little to no access to basic banking services, ranging from obtaining a loan or line of credit to something as simple as getting a checking account. Since most financial institutions report to the Federal Deposit Insurance Corporation, a federally created entity, and the federal government lists cannabis as schedule I, any banking institutions that offers services to pot-based businesses could, under a strict interpretation of the law, be guilty of money laundering.One option is to check out the top information of different loan sources and see if there are options of your business.

Furthermore, businesses involved in the marijuana industry face some pretty stiff tax disadvantages. IRS tax code 280E disallows businesses that sell federally illegal substances, like marijuana, from taking normal corporate tax deductions. The result is pot-based businesses get stuck paying tax on their gross profits (should they be profitable), as opposed to net profits like normal businesses.

You can essentially kiss any chance of legalization goodbye under the Trump administration

Though the public is holding out hope that lawmakers on Capitol Hill will take notice of the shifting tide toward marijuana, the chances of that happening are slim-to-none, and commentary from the chief of the U.S. Drug Enforcement Agency (DEA) last week supported that view.

DEA Chief Chuck Rosenberg reinforced his previous view on weed in just four words last week, saying that “marijuana is not medicine” while speaking at the Cleveland Clinic in Ohio.

Despite acknowledging that medical marijuana has demonstrated some positive benefits in terms of treating childhood epilepsy, Rosenburg said, “If it turns out that there is something in smoked marijuana that helps people, that’s awesome. I will be the last person to stand in the way of that. But let’s run it through the Food and Drug Administration process, and let’s stick to the science on it.”

Rosenburg’s commentary may refer to GW Pharmaceuticals’ (NASDAQ: GWPH) Epidiolex, an oral cannabidiol solution that wowed during multiple phase 3 trials in two rare forms of childhood-onset epilepsy, Dravet syndrome and Lennox-Gastaut syndrome. With statistically significant reductions seen in seizure frequency, Epidiolex is on track to potentially gain FDA approval, partially debunking Rosenburg’s thesis on medical marijuana (i.e., it’s cannabinoid-based, not smokable marijuana).

The DEA’s scheduling of cannabis, however, makes FDA-approved clinical trials of medical marijuana very difficult to run. It’s the ultimate Catch-22: the DEA needs more clinical evidence to consider altering marijuana’s scheduling, but the FDA keeps a tight lid on the number of clinical trials that can be run on medical cannabis.

Marijuana stocks could struggle

 With the DEA’s chief having a negative view of marijuana, and the federal government unlikely to suggest a rescheduling with ardent opponent Jeff Sessions as attorney general, legal sales growth could all be for naught for marijuana stocks.

 

 

Christopher Miller Plans To Challenge Legality of Kratom in Tennessee

Christopher Miller Plans To Challenge Legality of Kratom in Tennessee

www.inquisitr.com/4263043/christopher-miller-plans-to-challenge-legality-of-kratom-in-tennessee/

Clarksville native Christopher Miller was recently arrested in Nashville, TN for attempting to sell kratom. Kratom is an herb that recently faced up against a possible DEA ban. Luckily for the thousands who use kratom for pain, depression, anxiety or even to wean off of opiates, bipartisan support of congress and medical doctors, ethnobotanists, pharmacologists and even one of the foremost addiction specialists, Johns Hopkins professor Dr. Jack Henningfield, the DEA was forced to back down, a literally unprecedented occurrence in the history of the agency. Unfortunately, due to a great deal of misinformation, some of which comes from sources that are questionable at best, Nashville’s Metro PD were misinformed about the plant.

Metro PD’s release was made public by WZTV after a deluge of comments from Reddit users who were concerned with the inaccurate material in the original article. Kratom is listed as a synthetic substance and an opiate. The southeast Asian plant, related to kratom, is actually a perfectly natural substance that has been used in folk medicine for hundreds of years and has dozens of clinical studies related to its potential benefits for conditions as disparate as depression, anxiety, PTSD, chronic pain, addiction as well as being a more potent antioxidant than green tea that stimulates the immune system.

A Gofundme account was set up by a friend of Chris’ also in the kratom community. Jacky Ross said the following.

“Christopher miller is extremely passionate and knowledgeable about our beloved plant and has been catapulted into the spotlight by news agencies demonizing our plant. Now, he has an oppurtunity that our community has never had before, he has an opportunity to raise awareness for our plant in a very, very large way.”

Culpepper Botanicals is sponsoring a 5 kilo giveaway for donations currently and several other kratom vendors, such as Clean Kratom have been stepping out to support him and his cause.

According to the Affidavit, Miller is accused of attempted sale of a controlled substance analogue. There are some issues with this though. By definition, kratom is not an analogue. Unlike opiates, there is no overdose potential and it’s chemical structure is completely different. As far as it having an “opioid like effect” the same has been said of cheese, caffeine and bacon.

Christopher Miller kratom
[Image Christopher Miller]

Nashville’s WKRN news had previously reported the headline, “Man charged with selling synthetic opiate Kratom in Nashville.” I contacted WKRN news and finally got a response this week. News director Elbert Tucker in an email explains, “The Metro Nashville police department identified Kratom in this case as ‘synthetic.’ In our follow up with them, they told us it is considered synthetic because, in state law, it is included with synthetics. The spokesperson told us that even though it is naturally occurring, it is considered a synthetic by law.”

A rose by any other name, most likely would smell as sweetly and botanically speaking, regardless of how the Tennessee law books view kratom it is an organic, plant substance.

The affidavit is further evidence that the Metro PD are unfortunately misinformed. Both the affidavit and the press release that WZTV published after the Reddit comments came pouring in refer to it as “an opiate synthetic substance.” There is even some possible gray area in the law itself. I contacted the State Attorney General’s office 2 years ago to bring up the fact that the “kratom bill” references only the constituents of kratom and does so in a bill that is specifically and solely (in title and language) related to synthetics. I had asked governor Haslam if this meant that I would be able to sell kratom as a raw herb. He said he would forward my concerns and questions and get back to me. As of this writing, Governor Haslam never responded and hasn’t responded to an attempt to get a comment on the current case here.

Christopher Miller Facebook
[Image Christopher Miller Facebook]

“I don’t believe kratom is illegal in the state of Tennessee,” Christopher Miller told us in conversation online.

” I plan to challenge the legality of the plant in the state of Tennessee.”

What if we talked about physical health like we do mental health ?

ACLU has a Reproductive Rights Attorney but no pain management attorney ?


Albuquerque pharmacist accused of not filling birth control prescription

http://krqe.com/2017/06/02/albuquerque-pharmacist-accused-of-not-filling-birth-control-prescription/

ALBUQUERQUE, N.M. (KRQE) – An Albuquerque Walgreens is under fire, after a mother said a pharmacist wouldn’t fill her teenage daughter’s prescription because it was related to birth control.

What was supposed to be a typical prescription pick up at the Walgreens Pharmacy on Coors and Montano, turned into a mother’s fight for her daughter’s rights.

“A mother and her daughter who were discriminated against when they attempted to pick up a prescription related to the daughter’s birth control at a Walgreens pharmacy here in Albuquerque,” said Erin Armstrong, an ACLU Reproductive Rights Attorney.

It’s led to the ACLU filing a complaint against Walgreens. According to the complaint, in 2016 that mom tried to pick up a prescription of Misoprostol for her daughter. It’s a drug used to prepare patients for getting an IUD, a form of birth control.

However, when she tried to get that prescription filled, the pharmacist on duty denied her, stating personal reasons.

“None of us should have to worry when we go into a pharmacy that we might be turned away because of someone’s personal beliefs and not because of a medical reason,” said Armstrong.

It’s an incident that’s all too familiar to Susanne Koestner. She said it happened to her in 2012, at the Walgreens Pharmacy at Eubank and Central when she tried to get her birth control prescription filled.

“He said he wouldn’t fill it because of his religious beliefs,” said Koestner.

The ACLU also filed a complaint in 2012. Walgreens, at the time, said if filling a prescription went against an employee’s belief, another pharmacist would step in. Koestner said she’s disappointed that’s still not happening.

“It’s not about what our intent is with the medicine. That’s for our doctor and the patient to decide,” she said.

KRQE News 13 did speak to the pharmacist accused of not filling the teen’s prescription. He told us he did not want to comment. He was only filling in that day, and works at the Walgreens in Espanola.

Walgreens sent a statement addressing the situation:

Our policy is to allow pharmacists and other employees to step away from completing a transaction to which they may have a moral objection, and requires the pharmacist or other employee to refer the transaction to another employee or manager on duty to complete the customer’s request.

The policy’s objective is to ensure that in these rare instances, patients – both male and female – are offered reasonable alternatives to access legally prescribed medications.

We have expressed our desire to work closely with the ACLU of New Mexico to address its concerns, and also as we review our policies and evaluate other services to help meet the needs of patients and customers.

Additionally, we have taken the opportunity to retrain all of our pharmacists and store leadership in New Mexico on policies and procedures relating to conscientious objection, to ensure that we’re providing the highest level of patient care and service.

Amazing… the ACLU has a HIGH PRIORITY on a teenager on getting birth control…or not getting it, but … to date .. it appears that no matter how many chronic pain pts have contracted the ACLU about denial of care when it comes to controlled meds.

They seems to have little interest… in all the suffering by chronic pain pts… being denied getting their legit/on time/medically necessary medication… by Pharmacists who are “not comfortable”.

Notice Walgreen’s policy …   Our policy is to allow pharmacists and other employees to step away from completing a transaction to which they may have a moral objection, and requires the pharmacist or other employee to refer the transaction to another employee or manager on duty to complete the customer’s request.

The only problem with that policy when there is ONLY ONE PHARMACIST ON DUTY.. there is NO ONE to refer the transaction to… The Pharmacist is the only one that can approve/dispense the medication..  Walgreens and the other chains have cut back on Pharmacist staffing so much that the majority of the time there is only one Pharmacist on duty.. So when it comes to prescriptions… their policy is pretty much MEANINGLESS !!!

The Other Victims of the Opioid Epidemic

The Other Victims of the Opioid Epidemic

http://www.nejm.org/doi/full/10.1056/NEJMp1702188#t=article

I’d seen Jerry in pain before, but never like this. He lay prostrate on the gurney in the emergency department, his hands clenched in silent prayer. I laid an apologetic hand on his shoulder and told him we would do what we could to help. Then I logged in to the bedside computer to order his pain medication.

When I clicked the “sign” button, a message appeared on the screen.

“This patient has a documented history of substance misuse. Are you sure you want to order this medication?” Two options appeared below the query: “Yes, continue with this order” and “No, cancel this order.”

It was true, of course. Jerry was the first to admit that he had used cocaine in the past, before his cancer diagnosis. In fact, it was one of the first things he told me when we met in the palliative medicine clinic, shortly after his escalating back and abdominal pain led to a diagnosis of widely metastatic cancer. During the same appointment, he told me how opposed he was to using any sort of controlled substance for his pain. Over the next few months, he submitted gamely to any nonopioid therapy I could offer, from nerve blocks to adjuvant analgesics to reiki and massage. Finally, when the pain became so bad that he couldn’t travel for his chemotherapy infusions, he agreed to start an opioid.

Jerry knew that he was dying. He hoped that the chemotherapy would allow him a little more time with his young daughter and teenage son. But each infusion left him weaker and more debilitated, and his staging imaging did not offer good news. The tumor spread rapidly, threading its way through his liver, lungs, and spine. As his tumor burden increased, so did his pain, and he required increasing doses of opioids just to get out of bed. We both knew that time was short.

His progressive debility, combined with side effects of chemotherapy, meant that Jerry had to come in to the hospital a lot. He hated it. For Jerry, the hospital meant repeated questions about his past, looks of disbelief when he described his home opioid requirements, assumptions about why he was asking for so much medication, and long nights of undertreated pain. When he’d arrived at the hospital with vomiting the previous night, he’d been given doses of intravenous medications that were only a fraction of the dose of the oral equivalent he’d been taking at home. He’d spent the night in escalating pain, so that by morning he was reduced to the mute agony in which I found him.

I clicked “Yes, continue with this order” and went to find his nurse.

She was understandably apprehensive about the dose I had ordered; anyone would be. I agreed that the dose was high, described his home regimen, explained the need for equianalgesic dosing, and agreed to review the dose with our pharmacy staff, but nothing I said seemed to assuage her apprehension. Finally, she voiced her real concern.

“You know he’s an addict,” she said.

I let the silence grow. We were standing outside the open door to his room. I knew he could hear us. “I know he has used cocaine. His tumor is spreading. He has a reason to have pain, and we should try to control it.”

She turned away and spoke loudly enough for both me and Jerry to hear. “This is how we make monsters.”

When I turned back to Jerry’s room, he and I locked eyes. He was weeping.

Jerry is not innocent, nor does he claim to be. His vilification, however, is the result of an all-or-nothing approach to pain management under which the pendulum has swung from one unsustainable end of the spectrum to the other in the past two decades.

Early in my training, the nursing station on our main hospital floor was home to a bucket of lapel pins that depicted a lion tamer in circus gear, encouraging us all to “Tame the Pain.” The hospital’s initiative mirrored national campaigns. The American Pain Society supported a campaign to consider pain the “5th Vital Sign” in 1995.1 The Joint Commission’s Standards on Pain Management were released in 2000, and although they never explicitly recommended opioid prescribing, they did include recognition of the right of patients to appropriate assessment and management of pain, as well as incorporation of pain management into health care organizations’ performance measurement and improvement programs.2 Multiple national organizations, as well as vendors of the Hospital Consumer Assessment of Healthcare Providers and Systems survey, fell in line.3 Over time, for many clinicians, opioids became the treatment of choice, regardless of the cause of a patient’s pain or the likelihood that it would respond to therapy.

Now we have swung dangerously close to the other end of the pendulum’s arc. The “opioid epidemic” has captured the attention of lawmakers, the media, and the public. We have placed the blame for the tragic losses of so many lives in so many communities on the drugs themselves rather than on the complex interplay of factors that has led to the current crisis. The role of opioid analgesics has been distorted to the point where the word “oxycodone” uttered in front of a patient in my palliative medicine clinic is met with raised eyebrows, and some patients choose a bedbound existence as they near the end of life rather than risk the possibility of addiction. Many patients with a history of substance misuse who now only want to control their pain face additional challenges — they are subject to discontinuation of their opioid treatment even when they exhibit no behavior suggesting addiction.4 Should the bar for these patients be higher, or should we focus on the uniform application of careful practice standards to everyone?

The opioid epidemic is a national crisis that should not be underestimated. But its solution will require careful thought, consideration, and most important, development of meaningful interventions to improve both pain management and substance-misuse prevention. These interventions should not come at a cost to the epidemic’s other victims — hospice patients who are too afraid to take the medications they need to control their symptoms5; people whose history of substance abuse, no matter how remote, determines whether their pain will be treated; patients like Jerry, who, dying from cancer, his body containing more tumor than anything else, was told he is a monster.

He, too, is a victim of this epidemic.

Bad service/care at the chain pharmacies… a accident ?

How CVS Gets Away with What Walmart Can’t

https://hubpages.com/business/How-CVS-Gets-Away-with-What-Walmart-Cant

Walmart has been at the forefront of labor disputes, and the focus of well deserved righteous consumer indignation, for years now. However, it is hardly the only company failing to take care of its employees. Another enormously successful retail giant, CVS Health, isn’t treating its employees (or customers) particularly well either, but the lack of public attention means that those practices go largely unchallenged.

Walmart’s new wage minimum is what CVS pays its Pharmacy Techs

Over the past year, there have been labor protests in several industries, predominately fast food and retail, pushing for an increase of the minimum wage. Earlier this year Walmart announced an increase in its minimum pay rate to $9 an hour. One group that you haven’t heard from is Pharmacy Technicians- specifically, CVS Pharmacy Technicians. These are the people that handle the medicine that may very well determine if you live or die, and their take home from what can be an incredibly stressful job is that same $9 an hour- roughly $1,000 a month after taxes. CVS techs can receive a modest pay increase by obtaining national certification, but that isn’t something that can be done overnight, and it’s still well below the national average (according to glassdoor.com)- this despite the fact that CVS is one of the two largest and most profitable pharmacy chains (along with Walgreens) in the country, and had a net profit of 4.63 billion dollars in 2014. Oh, and those Techs you’re so familiar with that have been working there for years and actually make the place run? They may have started at a time when the company was paying a more livable rate, but they’ve likely had their pay rate frozen for years in the name of an artificially imposed maximum.

CVS Pharmacy Techs do not receive the breaks workers in other industries take for granted

If you work at just about any retailer or grocer, including Walmart, you are likely accustomed to receiving a half hour lunch off the clock as well as two paid 15 minute breaks per eight hour shift. This is not federally mandated, and only a few states have labor laws that require them, but workers in most industries are granted them as part of company policy. Yet, despite what is, again, a very stressful job, CVS pharmacy technicians never receive anything more than their half hour lunches (the pharmacists don’t even receive that, but their pay scale is, umm, different). That is something Wal-Mart simply can’t get away with because it has a history of labor disputes and is being watched closely by, well, everyone, and it has labor unions waiting to pounce, but very few Walmart employees ever miss their fifteen minute breaks.

 The under staffing is largely intentional

Most CVS customers have at some point experienced long waits in line to receive their prescriptions, and have noticed that their simply are not enough people working to do everything that needs to be done (it’s also possible that you did not notice the last part, and decided to mistreat someone horribly instead, but I digress). Not surprisingly, the poor pay and overall stress of the position do often leave CVS pharmacies with fewer Technicians than they actually need, but in most instances the reason that your CVS is understaffed at a given time is because that is the way the company wants it to be. In an effort to further minimize their payroll (underpaying people was of course the first step in that process), CVS hired efficiency experts and developed computer programs to calculate the minimum number of technicians they could use at various times of the day. Of course, those formulas don’t account for sporadic rushes as opposed to slow, steady streams of customers, extended transaction times due to an elderly clientele, or the 50 million different problems that can pop up randomly and monopolize the staff’s time, so the pharmacy staff often finds itself understaffed and overwhelmed. Walmart attempted to do the same thing; unlike CVS, however, the problem largely blew up in Walmart’s face, creating ridiculous numbers of out of stocks that alienated customers and killed sales in the process. CVS has suffered no such repercussions because customers may very well have no other choice of where to go due to their insurance (more on that later), many of them have become accustomed to the long waits, and, well, people do have to have their medicine.

Human Resources has been outsourced

If a CVS employee has a problem with their pay or benefits, or if they have some sort of complaint to file (say, a problem with a supervisor, for instance), the company’s Human Resources number (888-MY-HR-CVS) connects to a foreign call center. Can you believe a company would even begin to consider doing that? Is there any way a company could more clearly indicate just how little it cares about its employees? By contrast, Walmart actually has a two person human resources department in each Supercenter.

CVS never fixes anything

CVS creates new problems for its pharmacy staff to deal with all the time, and it never fixes any of them. The most troublesome is the automated calling system, which if you’re a CVS customer you know calls far too often and gives misleading or erroneous information. It is the most common cause of confrontation with, and undeserved mistreatment from, customers. That system leaves poorly worded messages implying that refills are ready when it’s really seeking permission to refill, and at other times it legitimately tells people that there prescription is ready when there is actually nothing in the system to be processed at the store. The staff can do nothing but apologize and suffer the consequences of something that is completely beyond their control. It seems like something that would be an easy fix, but no.

More recently, there was an attempt to synchronize customer’s 30 day refills so that they would only have to make one trip to the pharmacy each month, and, shockingly, it worked horribly. The program used abbreviated fills to line up the pick up dates that, depending on how your insurance company sets up its copays, may have cost you a full copay for the alignment fills. The fill amount also did not automatically revert to the original fill number, meaning that you may have received additional abbreviated alignment fills that would have taken your prescriptions out of alignment again. CVS will correct those problems never.

 
Medicare and Medicaid don’t make backroom deals with pharmacies, and some smaller chains specialize in Medicare Part D coverages.

CVS/Caremark, and the backroom deals made between pharmacies and health insurance companies, represent a vertical monopoly

As many consumers are becoming increasingly aware, health insurance companies and pharmacies reach agreements each year establishing what insurance copays will be at each pharmacy chain. In many ways it’s similar to the movie studio system that was broken up under antitrust laws by the Supreme Court’s Paramount decision in 1948. At the time, the movie studios handled their own distribution, and, more importantly, owned the movie theatres themselves. So, if you lived in a town that had a Paramount theatre, the only movies that you would get to see would be the ones produced by Paramount Studios. It was rare for a town to have more than one theatre at the time, so the result was very limiting for consumers. The Paramount decision consequently forced the major studios to separate themselves from the theatre chains they controlled. In this case, your choices as a consumer are also being made for you by these agreements, as you may have very little choice than to go to your insurance company’s “preferred providers” (only one of which may be in your immediate geographic vicinity); however, it may be costing you a great deal more than just being unable to see the best movies available. This lack of choice also eliminates competition between pharmacies, allowing them to keep prices artificially high, and, as was mentioned before, further allowing them to treat consumers in whatever manner they see fit in order to enhance their own bottom line. While deals between health insurance companies and pharmacies affect every pharmacy chain, CVS’s purchase of Caremark, technically a Pharmacy Benefit Management company, is particularly egregious in that they are now very much part of the same company. However, presumably for reasons that are largely political, the Federal Trade Commission stopped its antitrust investigation of CVS several years ago.

 
To be clear, this is roughly the same thing.
To be clear, this is roughly the same thing.

CVS deserves much of the same evil empire treatment that Walmart has received for years; however, you’re not going to hear about protests from Pharmacy Technicians anytime soon. A work stoppage simply isn’t a possibility, as there’s a huge difference between people not being able to get their favorite brand of fast food and people not being able to get the medicine they may very well need to survive. A strike of that type could easily be characterized as morally reprehensible, and almost no one working in CVS pharmacies would even begin to consider it. Still, when you make Walmart seem like the Shangri-La of employers by comparison, maybe you need to treat people better.

If anyone is interested in finding a independent pharmacy near them and DUMP THE CHAIN …

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

 

APS

Most all of us have heard Einstein’s opinion of doing the same thing over and over and expecting a different outcome.

My blog is getting ready to close out its fifth year and as I look at the stats on my blog.. I find that while the number of page views have remained virtually unchanged over last year… the vast majority of people finding their way to my blog is done so via a web search… I can count on one hand the number of people that routinely post comments.

Over the five years, I have made over 5000 posts and each posts have had a AVERAGE of 2+ comments. In the last 12 months ONE SINGLE POST … that I made last Aug, has viewed almost 50% of total number of page views.

I have seen all too many chronic painers and advocates that professed their intent to CAUSE CHANGE.. IMO, there has been no positive change and many of those advocating are no longer around.

Optimistically, five years ago maybe up to 20% of chronic pain pts were getting adequate pain management, today that number is probably in the single digits and decreasing.

Bureaucrats at both the Federal and State levels are taking tax money from the chronic pain community to sue manufacturers, wholesalers, pharmacies in an attempt to deny those in the chronic pain community of their medically necessary pain management medications.

One Senator (Manchin D-WV) has discussed imposing a tax on prescription opiates to help pay for treating people who are self medicating the demons in their heads and/or monkeys on their back with various opiates – a increasing majority using illegal opiates being imported from Mexico, China and India and because they are mixing potent illegal fentanyl analogs with Heroin…more and more are dying of a overdose, while the number of prescribed opiates have fallen up to 35% over the past four years… while opiate OD’s continue to dramatically increase.

Many of us have been discussing the lack of unity among those in the chronic pain community – if possible – is getting worse…   At some point – if we are not already there – it is going to be every person for themselves.

I just wonder how many family members of those who OD’s, joins some anti-opiate group… and those family members whose chronic pain family member dies from removed pain therapy and/or commits suicides … just comes away from the funeral saying “At least, they are not suffering any more…”  and they go on with their lives.

Weekly, I get numerous emails and phone calls about pts being denied their medically necessary medication…  I am going to devote my blog to publishing these and my suggestions in how they can deal with it.  So that hopefully that others with similar situations may develop some strategy that can help them.

I am leaving all 5000+ posts and existing comments on the blog for reference purposes…  In the future, I don’t see me making more than one “educational posts” per day…  as I have in the past.