Bipartisan Senate Bill Takes Step Against Opioid Epidemic

Bipartisan Senate Bill Takes Step Against Opioid Epidemic

https://morningconsult.com/2017/04/13/bipartisan-senate-bill-takes-step-opioid-epidemic/

A bipartisan Senate bill unveiled Thursday would impose strict limits on some opioid prescriptions, a small tweak to federal law that is part of an ongoing effort in Congress to curb overuse of the drugs.

The legislation, introduced by Sens. John McCain (R-Ariz.) and Kirsten Gillibrand (D-N.Y.), would bar doctors from supplying more than a week’s supply of an opioid drug to patients suffering from acute pain. Refills for those patients would also be prohibited, but prescriptions to treat chronic illnesses and end-of-life care would not be subject to the rules. Several states, including New York and Arizona, have already enacted similar policies.

“We have a long way to go to end the scourge of drugs across our communities, but this legislation is an important step forward in preventing people from getting hooked on these deadly drugs,” McCain said in a statement.

The overuse of addictive prescription opioids has been an area of top concern for lawmakers in both parties. In the run-up to the 2016 election, Congress worked in rare, bipartisan fashion to pass legislation combating the nation’s opioid addiction epidemic by bolstering treatment and recovery efforts.

Most recently, the issue also appears to be a focus for Scott Gottlieb, the nominee to head the Food and Drug Administration, who said the opioid crisis would “require dramatic action.”

The senators are still working on a strategy to get the bill signed into law, a Gillibrand spokesman said in an email. Several legislative vehicles, including the Food and Drug Administration user fee reauthorization and government funding legislation, are possible options.

Fourteen billion opioid pills are now dispensed annually in the United States  https://www.durbin.senate.gov/newsroom/press-releases/durbin-sends-letter-to-dea-calling-for-stricter-limits-of-opioid-pills-

It was recently stated that we have 2.1 million serious opiate addicts. The question has to be asked … If the opiates are so HIGHLY ADDICTED and there are 14 billion opiate doses dispensed annually … why is there not more people abusing/addicted to opiates ?

If you notice that this proposed bill EXEMPTS Suboxone and the like from the bill/law… so it appears that these bureaucrats have been sold a “bill of goods” that it is better for a person to be DEPENDENT on a C-III than be DEPENDENT on a C-II

Here is the official definition of C-II & C-III… notice the similarities

Schedule II substances are those that have the following findings:

  1. The drug or other substances have a high potential for abuse
  2. The drug or other substances have currently accepted medical use in treatment in the United States, or currently accepted medical use with severe restrictions
  3. Abuse of the drug or other substances may lead to severe psychological or physical dependence.

Schedule III substances are those that have the following findings:

The drug or other substance has a potential for abuse less than the drugs or other substances in schedules I and II.
The drug or other substance has a currently accepted medical use in treatment in the United States.
Abuse of the drug or other substance may lead to moderate or low physical dependence or high psychological dependence.

 

filing complaints/grievances anonymously

A lot of pts are reluctant to file complaints or grievances against healthcare professionals for fear of some sort of retaliation … being discharged from practice and/or having their medications cut.

This is probably most appropriate where a corporate entity that hires prescribers and the corporation has implemented policies and procedures that are being applied only to a select group of pts… especially when many/most/all of those pts are covered by The Americans with Disability Act.

If a groups of pts that are being affected by a particular corporate policy, they need to hire an attorney to send a letter to the legal dept of the offending corporation, and the pts’ identity can be protected by attorney/client privilege.

The same would apply to medical licensing boards.

It has been reported that 90% of those families who have a chronic pain pt… are struggling financially because one spouse can’t work and/or the cost of medical treatments.

Those in control in corporate America, will push the envelope of what they can legally do and if they are dealing with a group of pts that they know that most are financially challenged… they could make corporate policies and procedures that are – in fact – illegal… figuring that they will never be challenged in the courts.

As well, if a pt challenges the prescriber directly.. they know that they can retaliate against the pt because again.. they will not be challenged in the courts and even if they are it will take years to get it resolved.

Challenging the corporate policy and or the prescriber’s actions anonymously can change the whole game.. one that they may not see them coming… not knowing how many pts are involved in hiring the attorney .. could force a change in corporate policies…

Having an attorney to send a letter to a corporation legal dept and/or medical licensing board will not cost a whole lot of money. If it gets a corporation to change their policies and procedures… could be money well invested.

Thunder Over Louisville – if you like fireworks

Thunder Over Louisville

http://www.whas11.com/

Those of us who live in the Louisville KY area – locally  known as Kentuckiana. This Saturday (April 22nd).. the beginning of the Kentucky Derby Festival is referred to as THUNDER OVER LOUISVILLE

It is promoted as the largest fireworks display in the country.. This is the 27th year.  For those of you who like fireworks… this is abt 30 minutes of nearly continuous fireworks.. They move about 10 barges into the middle of the Ohio river filled with fireworks.

THE FIREWORKS

To some, it’s the official kick-off to the Kentucky Derby Festival. To others, it’s the unofficial beginning of spring. But to all, it’s simply one of the largest annual fireworks shows in North America and the setting for some of the most memorable moments you’ll ever share.

Now in its 27th year, Thunder Over Louisville continues to deliver a pyrotechnics spectacular like no other. Created as the Opening Ceremonies of the Kentucky Derby Festival, it offers an explosive kick-off to three entire weeks of celebration in Louisville, Kentucky and Southern Indiana. With an estimated average attendance of half a million people, it has become the largest annual event in its region. The show continues to be the largest annual pyrotechnics display in North America thanks to the artistry of Zambelli Internationale and the production of Visual Presentations.

http://www.whas11.com/  this is the local TV channel that has the exclusive rights to broadcast the entire day.. which starts  at 3PM EDT for the air show and the fireworks start at abt 9:30 PM EDT.

Best viewed… get your large HD TV and turn out all the lights in the room… just like being there.. except it won’t take you hours to get to your car and deal with the traffic gridlock as anywhere from 0.5 – 1 million people try to leave the river front on both sides of the Ohio River to get home.

This sheriff believes that he can kill all the cock roaches AKA “drug dealers”

2 big drug busts after viral video warning from sheriff

http://www.fox35orlando.com/news/local-news/248698764-story

LAKE COUNTY, Fla. (WOFL FOX 35) – The Lake County Sheriff’s Office said undercover deputies led them to two big drug busts in a matter of only three days.

The first came on Tuesday in Eustis, where officers seized a number of street-ready drugs, including heroin and methamphetamine.  Deputies arrested five people who were in a house on Dewey Street on various drug charged. They are Kendra M. Williams, Shannon L. Puckelwartz, William D. Insco, Troy E. Fechtler, and Joseph C. Williams.

 Then on Thursday, deputies made another bust at an apartment in Groveland, where Perry G. Garrett III was arrested on multiple charges; the Sheriff’s Office referring to Garrett as a high-level narcotics dealer. In that incident officers seized drugs, money, and guns including a handgun that was reported stolen from a Citrus County Sheriff’s Deputy.

The Groveland arrest was made just down the street from an elementary school, adding to the charges against Garrett.

All of the arrests and the two busts came just days after Lake County Sheriff Peyton Grinnell posted a viral video on social media featuring himself and several masked undercover deputies warning local drug dealers that the office was preparing several warrants and would be “coming for them.”

That video had been viewed more than 1.3 million times on Facebook as of Friday and caught some heat from some viewers; several who claimed it too closely resembled an ISIS propaganda video.  

The sheriff told FOX 35 this week that the masks on the deputies were to protect their identities as undercover cops, and he stood by the video’s strong message.

On Friday deputies at the Sheriff’s Office said the busts this week were evidence that the department planned to keep their promise to go after drug dealers.

 

OPS ???

Afghanistan, Chaparh?r : An Afghan farmer harvests opium sap from a poppy field in the Chaparhar district of Nangarhar province on April 19, 2016. Opium poppy cultivation in Afghanistan dropped 19 percent in 2015 compared to the previous year, according to figures from the Afghan Ministry of Counter Narcotics and United Nations Oiffce on Drugs and Crime. / AFP PHOTO / NOORULLAH SHIRZADAColossal Bomb Targets Afghan Islamic State Stronghold in Top Opium-Producing Region

http://www.breitbart.com/national-security/2017/04/14/colossal-bomb-targets-afghan-islamic-state-stronghold-in-top-opium-producing-region/

The U.S. military, perhaps inadvertently, may have eradicated opium poppy crops when it dropped the “mother of all bombs” on Islamic State (ISIS/ISIL) jihadists in the Achin district of Nangarhar province in eastern Afghanistan.

Nangarhar province, located along the Pakistan border, is one of the top poppy-producing areas in Afghanistan, the world’s leading supplier of opium and its heroin derivative, according to the United Nations.

 

Meanwhile, Achin is one of the main opium-producing districts within Nangarhar.

The U.S. military identified Nangarhar as ISIS’s stronghold in the Afghanistan-Pakistan region soon after the jihadist group established its branch there, dubbed Khorasan Province, back in January 2015.

According to the latest U.N. estimate available for opium production in Achin, there were 1,090 hectares (ha), or about 4 square miles, under poppy cultivation there in 2015, making the area one of the top opium-producing districts in Nangarhar.

In 2016, the U.S.-backed authorities carried out virtually zero opium eradication operations in Nangarhar, in part due to the deteriorating security conditions in the province, primarily at the hands of ISIS.

That means farmers in Achin were likely able to keep growing opium last year in the 1,090 hectares identified in 2015.

In fact, the area under cultivation in all of Nangarhar increased by more than 40 percent in 2016, from 10,016 ha (about 37 square miles) to 14,344 (about 55 square miles), reported the U.N. without providing a breakdown by district.

The Pentagon and the U.S. military in Afghanistan did not immediately respond to Breitbart News’s requests for comment on the possible impact the massive bomb strike had on opium production in Nangarhar.

Officially known as the GBU-43/B Massive Ordnance Air Blast bomb (MOAB), the 21,600-pound bomb reportedly has the capability of demolishing everything within 1 square mile.

On Thursday, the U.S. military dropped the MOAB munition on a network of fortified underground tunnels in Achin district that terrorist group had been using to stage attacks on U.S.-backed Afghan forces and freely move back and forth across the Afghanistan-Pakistan border.

“US and Afghan forces had been unable to advance [in Achin] because ISIS — which has expanded into Afghanistan in recent years — had mined the area with explosives,” notes CNN.

The Pentagon has said the majority of ISIS fighters in the region are Pashtuns from Pakistan, former members of the Pakistani Taliban or Tehreek-e-Taliban Pakistan (TTP).

At least 36 ISIS jihadists were killed in the blast.

Achin lies right on the international boundary between Afghanistan and Pakistan.

Besides the movement of fighters, it is unclear whether the tunnels were facilitating other illegal cross-border activity on behalf of ISIS, particularly the movement of contraband such as weapons and opium.

Heroin from the Afghanistan-Pakistan region is smuggled into Europe and the United states through West Africa, home to ISIS’s West Africa Province and Boko Haram affiliate, reported the U.N.

The United Nations has linked Boko Haram to drug trafficking in West Africa.

American Gen. John Nicholson, the top commander of U.S. and NATO forces in Afghanistan, estimated late last year that the Taliban generates nearly 60 percent of its funding from the lucrative opium business.

The Taliban is believed to make millions from cultivating and trafficking the deadly drug, responsible for an overdose epidemic in the United States.

In an interview with Turkey’s state-run Anadolu Agency in December 2016, Zamir Kabulov, Russian President Vladimir Putin’s special envoy to Afghanistan, indicated that the Taliban is intent on spreading the evils of heroin on American soil.

“We will send this haram [forbidden by Islamic law] thing to the crusaders and make money out of that for the sake of the Muslim people,” Kabulov cited as the Taliban’s position on trafficking heroin into the U.S.

Some experts believe ISIS has tapped into the illegal opium enterprise.

The group’s stronghold in Afghanistan, particularly Achin district, being among the top opium-producing regions in the country supports that claim.

Russia’s Federal Drug Control Service (FSKN) predicted in 2015 that the terrorist group would generate billions in profits from trafficking opium.

Breitbart London learned from top terrorism experts that ISIS planned “to flood” the United Kingdom and other countries in Europe with heroin from Afghanistan.

ISIS is expected to adapt to the imminent collapse of its so-called caliphate in Iraq and Syria, in part, by continuing to expand its drug trafficking operations, suggested Joseph Micallef, a best-selling world affairs author, in a recent op-ed.

A 2016 report from the U.N. was unable to determine the extent to which ISIS is involved in drug trafficking.

Could Trump’s Administration policies make the “war on drugs” WORSE ?

Could Trump’s Administration policies make the “war on drugs” WORSE ?

Newton’s Third Law:

Third law:When one body exerts a force on a second body, the second body simultaneously exerts a force equal in magnitude and opposite in direction on the first body.

Definition of Addiction:

Public Policy Statement: Definition of Addiction

Short Definition of Addiction:

Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors.

Addiction is characterized by inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response. Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death.

 

All new laws have unintended consequences

IMO..  the Trump’s administration change in policies will cause increased crime and violent crimes

AG Sessions has reportedly stated that he wants to take the war on drugs back to the ’90’s. Does that mean that he is “going after” over half the states that have legalized Marijuana in some manner.

As the prescribing of opiates gets more and more interfered with, we are going to see increasing number of chronic pain pts turning to the street… resulting in more arrests, and OD’s.  Competing with the existing estimated 2.1 million addicts/substance abusers.

Tighter border controls… resulting in fewer illegal opiates coming into the country.. resulting in price increase in illegal drugs, and less availability… Resulting in an increase in pharmacy robberies , home break in’s and perhaps increase violence in these crimes.  On top of the already 2 million reported home robberies.

With potential of shortage of supply, increased costs and restricted prescribing… could the number of OD/suicides dramatically climb ?

The chronic pain community cannot count on any of the DEA’s licensees to take a stand against these new policies

Pharma Manufacturers – the DEA establishes annual opiate quotas that they can produce… Who doesn’t believe that if the Pharmas took a stand.. their production quotas could be reduced annually.. until there was no available quota to produce.

Doctors – all it takes is ONE perceived pt’s death from opiates for the DEA  to “go after” a practice and shut them down.. while they investigate to prove their “theory or probable cause”.  Many times it seems like the DEA will find justification their actions… even it appears to be fabricated.

Pharmacies – No one is PERFECT in recording keeping.. and all it takes is a few pieces of missing data for the DEA to impose fines in the hundreds of thousands or millions of dollars.

 

 

Time to Clean Up the Mess

Time to Clean Up the Mess

Clinical experts weigh in on what’s next for pain management.

http://clmmag.theclm.org/home/article/Time-to-Clean-Up-the-Mess?

It’s indisputable that society has recognized the overuse, misuse, and abuse of opioids since Big Opioid Pharma convinced prescribers, pharmacists, and medical schools that they would solve the pain problem.

The federal government took notice and responded via the Centers for Disease Control and Prevention’s formal declaration of an “opioid epidemic,” and later publishing of prescribing guidelines. Additionally, U.S. Surgeon General Vivek Murthy launched the #TurnTheTide initiative and sent a letter about the addictive nature of opioids to every doctor in the country. Individual states responded by legislating maximum day supplies, expanding access to naloxone, encouraging substance abuse treatment, and mandating the use of prescription drug monitoring programs. The media—mainstream and social—noticed and regularly publishes statistics and individual stories about the devastating impacts of opioids and other dangerous prescription painkillers.

So if the country knows that opioids are dangerous, how will non-malignant chronic pain (NMCP) be treated in this changing landscape?

There are a limited number of situations in which opioids are clinically appropriate for NMCP. These are cases in which the lowest possible dosage and number of drugs yield acceptable levels of activity and function with a manageable set of side effects. The general consensus is that opioids can improve function by about 30 percent in the best-selected candidates. That means opioids are not appropriate treatment for the majority of people with NMCP. So what’s next?

To get a well-rounded view, I surveyed several clinical experts around the country who are highly respected for having the proper approaches and consistently high-quality outcomes. The list included clinicians (six doctors, two psychologists, and three nurses) who directly help patients deal with pain, and three medical directors of workers compensation payers. 

While all of the respondents agreed that opioids have been overused for NMCP, not all of them made the same suggestions. It is entirely possible that some would even disagree with some of the recommendations. The bullet points below are a synthesis of respondents’ input and should be viewed as potential tools in the overall toolbox. Individualized treatment for NMCP can be complex, so the treatment provider needs to have access to as many options as possible to determine which ones work best for a person’s specific conditions at a given point in time. 

Here are the respondents’ answers to the following four questions. 

1.  What are the most appropriate prescription drug options for chronic pain in lieu of opioids?

Respondents’ Summary: There is no “magic pill,” and, increasingly, studies show that medications should not be the primary management tools for pain. That said, the following may be helpful in some circumstances and for certain types of pain:

•   Acetaminophen and NSAIDs like celecoxib, ibuprofen, ketoprofen, meloxicam, and naproxen.

•   Antidepressants, particularly tricyclic antidepressants and serotonin and norepinephrine reuptake inhibitors, like amitriptyline, duloxetine, and trazodone.

•   Anti-convulsants, like gabapentin, pregabalin, and carbamazepine.

•   Topicals that include ingredients like lidocaine, NSAIDs, and capsaicin.

•   Muscle relaxants for nocturnal use only, like cyclobenzaprine, baclofen, and tizanidine.

•   Tapentadol, which has much lower risks and side effects than tramadol or other opioids.

•   Buprenorphine (some respondents said this could be a maintenance medication; others thought it should only be used during the opioid tapering process).

•   Definitely NOT carisoprodol or any benzodiazepines like alprazolam, clonazepam, diazepam, lorazepam, or temazepam.

Note that all of these drugs have potential negative side effects, many should not be used long-term, and several have a risk for misuse, abuse, or addiction. In other words, everything should be done to limit or even eradicate the number of medications used to manage NMCP.

2. What is the easiest non-prescription drug option to implement in parallel with the reduction or elimination of opioids?

Respondents’ Summary: If they work, non-pharmaceutical options will always be better for a patient’s short- and long-term health. However, the term “easy” is relative, as it is easier to suggest treatments than it is to get patients to truly believe that they will work and to be consistently motivated to continue them for the rest of their lives. While some of the suggestions include temporary modalities to reduce pain, most revolve around making lifestyle changes that are lifelong and self-sustaining. Sometimes it is difficult to motivate patients because the suggestion seems foreign or even implausible and might require a switch from a dependence mindset to one of independence and resiliency. Everything listed is either supported by evidence or by clinicians’ personal experiences. Suggestions include:

•   Individual responsibility for maintaining one’s own health to move from injury mode to recovery mode.

•   Ice and heat.

•   Active exercise treatment plan for progressive aerobic and physical strengthening, which not only stimulates the body, but also the brain.

•   Healthy diet and nutrition plan, with a focus on anti-inflammatory and low-acid foods, daily hydration, moderate carbohydrate load, sugar avoidance, and limited caffeine and alcohol.

•   Physical therapy, including hydrotherapy and posture correction.

•   Psychotherapy, including cognitive and dialectical behavioral therapy (this was mentioned by all as the fastest and longest acting non-pharmacological method to deal with NMCP).

•   Mindfulness practices, meditation, and guided imagery.

•   Fear avoidance belief training.

•   Life coaches.

•   Deep breathing maneuvers.

•   Yoga, Tai Chi, Nia technique, and Qigong.

•   Relaxation response training and biofeedback.

•   Smoking cessation and weight loss.

•   Chiropractic treatment.

•   Massage therapy.

•   Acupuncture.

•   High-frequency neurostimulation.

•   Transcutaneous electrical nerve stimulation.

•   Low-level lasers and electromagnetic therapy.

•   Nerve blocks and injections, although these procedures are costly and success is highly dependent upon locating a specific pain site and the physician’s skills.

3. What is the most long-lasting, non-pharmaceutical option for managing chronic pain?

Respondents’ Summary: While the modalities listed previously are the tactics, there were some specific strategies that create some guiding principles, including:

•    Educating the patient on the best way to self-maintain the proper attitudes about NMCP and then finding the most appropriate treatment options that can be self-sustaining. The formula for each person varies, but it starts with the concept that pain may be the “new normal” and there is no quick fix. Patients also need to understand pain signaling, the role of deconditioning, and the importance of trying various modalities.

•    Establishing an ongoing lifestyle of activity and exercise, good nutrition and eating habits, and proper sleep hygiene. In other words, helping the patient consistently make better lifestyle choices to improve and maintain their health.

•    Developing resiliency and a determination to not allow pain to turn into suffering. Taking active control of the pain as opposed to having a passive expectation that someone or something else will eradicate the pain. Being happy, keeping busy, and not focusing on the pain. In other words, equipping patients with the ability to cope with the pain.

•    Establishing relationships with mentors and fellow NMCP patients for accountability and support.

4.  What do you anticipate doctors will do when opioids are no longer an option (for whatever reason)?

Respondents’ Summary: Doctors will gravitate towards what will be paid. In other words, the navigation towards different strategies largely will be dictated by the payers. However, it will also require teamwork with the medical community. Several respondents pointed out that many physicians either do not understand or do not want to treat NMCP because it’s challenging, individualized, and potentially requires an “all-of-the-above” trial and error approach that can be time consuming and not appropriately reimbursed. All hoped that the treatments listed above would not only be used, but also paid for in increasing measure to help foster a focus on functional restoration and recovery.

There was consensus among respondents on the majority of suggestions because evidence-based medicine confirmed the approaches. However, there were some unique perspectives. One respondent noted that there is an industry built on the continuation of pain, which may, in fact, be the biggest obstacle to properly treating NMCP. Two said that medical cannabis has evolving evidence (including recent research from the National Academies of Sciences, Engineering, and Medicine) that point to its benefits in treating chronic pain. One suggested that an educated consumer with money at stake through out-of-pocket payments would help focus choices. Another noted that workers compensation has been unwilling to fully embrace the biopsychosocial model because it could potentially bring with it the psyche diagnosis that opens up liability for even more costs and scope of services. All of those points certainly bear consideration.

Acute pain is obviously different than NMCP and requires different resources. Opioids could be part of that pain management process for a short time. As a potential model, one of the respondents explained her regimen for a recent hip replacement surgery. Three days after surgery, she took two ibuprofen 200mg pills every four hours, two acetaminophen 500mg pills two hours later, then alternated between them every two hours along with an opioid at bedtime (in lieu of the acetaminophen) to assist in restful sleep. She took a total of three opioid pills after that third post-surgery day. Unfortunately, that is often not the regimen seen in medical and claims files.

Clearly, what’s next for pain is thinking about it differently. Patients, clinicians, and payers need to be willing to try and pay for different treatments. Treating NMCP is complex, but the common theme among these clinicians was that a mindset of resiliency and recovery coupled with as few medications as possible is a better approach than what has evolved since the mid-1990s. In order to create that mindset, more time must be allowed in each office visit for the doctor to understand the person and utilize the options that actually work.

It would be patently unfair—in fact, it would be inhumane—to swing the pendulum to the other extreme of “no opioids” without providing access to other methods by which to manage NMCP. It is obvious that opioids are, in many cases, more dangerous and create more issues than the original source of pain. As the U.S. healthcare and workers compensation systems deal with how to #CleanUpTheMess, not being constrained by the old way of doing things is a necessary first step.

 

Mark Pew is senior vice president for PRIUM. He has been a CLM Fellow since 2011 and can be reached at mpew@prium.net, www.prium.net.

 

Congress “legalizing” Elder Abuse ?

https://nyti.ms/2oe6igy

G.O.P. Bill Would Make Medical Malpractice Suits Harder to Win

www.nytimes.com/2017/04/15/us/politics/republicans-health-care-bill-medical-malpractice-suits.html

Under the new House bill, the Congressional Budget Office said, doctors would slightly decrease the use of diagnostic tests, like X-rays, and other services that they perform to reduce their exposure to lawsuits. Credit Andrew Sullivan for The New York Times

WASHINGTON — Low-income people and older Americans would find it more difficult to win lawsuits for injuries caused by medical malpractice or defective drugs or medical devices under a bill drafted by House Republicans as part of their plan to replace the Affordable Care Act.

The bill would impose new limits on lawsuits involving care covered by Medicare, Medicaid or private health insurance subsidized by the Affordable Care Act. The limits would apply to some product liability claims, as well as to medical malpractice lawsuits involving doctors, hospitals and nursing homes. The Pasadena trust litigation lawyers welcome the decision made by the government as this will ensure that the compensation will be given only to those who are deserved and needy, as this decision can distinguish needy from frauds.

Sean Spicer, the White House press secretary, said the bill would limit “frivolous lawsuits that unnecessarily drive up health care costs.”

But Democrats and plaintiffs’ lawyers with Israel & Gerity, PLLC lawyers said it would take rights away from people served by federal health programs, including those harmed by horrific medical mistakes. Adults figuring out their properties and assets can read more about probate laws here.

In renewing their effort to devise a replacement for the Affordable Care Act, Republicans say one chief aim is to slow the growth of health spending. Representative Robert W. Goodlatte, Republican of Virginia and the chairman of the House Judiciary Committee, said the malpractice limits would reduce health costs, increase access to care and save taxpayers billions of dollars.

According to Raleigh probate attorneys, the nonpartisan Congressional Budget Office estimates that the bill would reduce federal budget deficits by almost $50 billion over 10 years. Under the bill, the budget office said, doctors would slightly decrease the use of diagnostic tests and other services that they perform to reduce their exposure to lawsuits. Doctors have long said such “defensive medicine” adds to the cost of care.

But Representative Jamie Raskin, Democrat of Maryland, said the bill would deny full restitution to many victims of medical malpractice. Representative Steve Cohen, Democrat of Tennessee, said the bill’s restrictions would apply even in cases of “egregious medical error,” such as when a foreign object is left inside a patient’s body or surgery is performed on the wrong body part.

Kimberly A. Valentine, a lawyer in Orange County, Calif., who has represented scores of nursing home residents, said the House bill “would make it much more difficult for victims of elder abuse to seek redress and would eliminate one of the most powerful tools we have to improve care in nursing homes.”

The bill would set a $250,000 limit on “non-economic damages,” which include compensation for pain and suffering, though states could set different limits.

California has long had a $250,000 cap on non-economic damages in medical malpractice cases. But under state law, elder abuse cases are exempt from the limit. Ms. Valentine said she had obtained verdicts and settlements exceeding $250,000 for relatives of many patients who had died because of infected bedsores, medication mix-ups, malnutrition, dehydration or a failure to provide care.

The bill would not limit a patient’s ability to recover economic damages, for medical expenses or lost earnings. If more than one defendant was responsible for an injury, the jury would award damages against each one in proportion to the share of responsibility.
Morning Briefing

   The bill says that a doctor who prescribes a drug or medical device “approved, licensed or cleared by the Food and Drug Administration” may not be named in a product liability lawsuit against the manufacturer or seller of the product. The bill provides similar protection for pharmacists who fill prescriptions. The bill would restrict contingency fees that lawyers can charge for representing plaintiffs in health care lawsuits.

The measure would limit claims related to coverage provided “via a federal program, subsidy or tax benefit.” Brian K. Atchinson, the president of the Physician Insurers Association of America, a trade group for insurers, said this meant that the House bill would apply to health insurance provided by employers, because the federal government provides a tax break for such coverage. The tax-free treatment of employer-provided health benefits is one of the largest tax breaks in the tax code, costing the government more than $150 billion a year in lost revenue, according to the Congressional Research Service.

The costs of the medical malpractice system have been hotly debated for years. Reliable, comprehensive data is not available. Several studies suggest that the costs, including damage awards, legal fees and the effects of defensive medicine, may represent 2 percent to 2.5 percent of national health spending.

The House bill is supported by the American Medical Association, the American Hospital Association and the American Health Care Association, a trade group for nursing homes. But manufacturers of medical devices have mixed feelings about it.

“We support the overall intent of the bill, to reduce litigation burdens on the health care system,” said Greg Crist, a spokesman for the Advanced Medical Technology Association, which represents device makers. “But some of our members are concerned that the bill could actually have the opposite effect and could increase burdens on manufacturers by insulating doctors and other health care providers from any liability related to devices.”

Several provisions of the House bill closely resemble legislation introduced by Tom Price, the secretary of health and human services, when he was a House member from Georgia. As a congressman, Mr. Price, an orthopedic surgeon, championed legislation that would set limits on damages and make it easier for doctors to defend themselves in malpractice lawsuits.

In a report on the latest Republican bill, the House Judiciary Committee referred to a “malpractice insurance crisis” and said that “no doctor is safe from lawsuit abuse.”

Paul A. Greve, who follows malpractice trends as an executive vice president of Willis Towers Watson, a benefits consulting company, said two factors slowed the growth of malpractice claims in the first part of the last decade. “Patient safety initiatives improved care,” he said, “and many states adopted tort reform laws.”

But, Mr. Greve said, in the last few years, malpractice insurance became less profitable because of the growing frequency of jury verdicts exceeding $1 million.

Placing this 250,000 cap on damages will basically discourage any/all attorneys from taking a lawsuit on a contingency basis (attorney doesn’t get paid unless they win).  and even if they do win … the cost of the lawsuit could exceed the 250,000 cap.  The law is directed at the two classes of pts that least afford to fund a lawsuit – low income & elderly. Is this another attempt to “thin the herd” and/or a form of legalized GENOCIDE.

Since abt 40% of the members of Congress are – by education – ATTORNEYS… they are fully aware of what they are doing. It is claimed that between 200,000 and 400,000 people die annually from medical errors.  Is this part of Congress’ dedication to lowering the amount of opiates that are prescribed… so now … could denying of care… be basically legal or no consequences to the healthcare provider doing so ?

Nevada city to use vending machines to provide clean needles for drug users

Nevada city to use vending machines to provide clean needles for drug users

http://nbc4i.com/2017/04/13/nevada-city-to-use-vending-machines-to-provide-clean-needles-for-drug-users/

LAS VEGAS, NV (KSNV) The Southern Nevada Health District is making sure people have access to clean needles to reduce the risk of spreading diseases.

Three new needle exchange vending machines are being installed to give drug users access to clean needles.

Once users register with the program, they’ll be given a card and a unique identifier code to access the vending machines.

In addition to clean needles, the vending machines also have kits for syringe disposal, wound care and safe sex.

The health district estimates that about 9 percent of new HIV diagnoses in Clark County are people who inject drugs.

The CDC says 1 in 10 people with HIV inject drugs. In 2015 only 1 in 4 people who inject drugs got all of their syringes from a clean source.

There is going to be a lot of people, including health care professional that will be opposed to any “needle exchange prgm”.  We all know that addicts will do whatever is necessary to get their next fix and avoid withdrawal that they call “dope sick”.  Sharing needles and taking the risk of whatever disease they will get by using a syringe/needle untold others have used.

When you consider that HIV, Hep B&C are very common and each person that catches these disease by sharing needles… it will cost upwards of $750,000 to treat each of those, and since addicts have no financial resources.. guess who gets to pick up the cost of that treatment… Taxpayers/Medicaid.

 

John 8:32 32Then you will know the truth, and the truth will set you free.” UNLESS OPIATES ARE INVOLVED

No, Vicodin Is Not The Real Killer In The Opioid Crisis

http://www.acsh.org/news/2017/04/12/no-vicodin-not-real-killer-opioid-crisis-11123

CNN has just figured out something that we at the Council have been saying for more than a year. The narrative that opioid pills, such as Vicodin (hydrocodone) and Percocet (oxycodone) are causing addicts to drop dead left and right is absolutely false. (See: American Council On Science And Health — FDA Science Board Meeting Testimony On Opioids).

The network just acknowledged that the pervasive and convenient belief about pills is wrong. As we have written numerous times, it is fentanyl—an “opioid on steroids”—that is the culprit.

About 75 percent of the state’s men and women who died after an unintentional overdose last year had fentanyl in their system, up from 57 percent in 2015. It’s a pattern cities and towns are seeing across the state and country, particularly in New England and some Rust Belt states.

Martha Bebinger writing for CNN. April 11, 2017

The evidence has been clear for years. When pills become scarce, addicts turn to heroin, which now often contains fentanyl (see Fig. 1). A 2014 study found that 94 percent of heroin users said that they switched to heroin because the pills became “far more expensive and harder to obtain.” (1) 

Fig. 1- Once OxyContin – the primary driver of opioid addiction – was finally reformulated in 2010 to make it much harder to abuse, it’s use plummeted, while at the same time, heroin use soared.

 

 

 

Nowhere is this trend clearer than in New Hampshire

Overdose deaths in New Hampshire, 2011-2016. Source: Office of the medical examiner

The picture above shows what is really happening. In 2011, only three percent of overdose deaths in the state were due to fentanyl alone, and another eight percent were from fentanyl plus another drug (other than heroin). Heroin, either alone or in combination with drugs other than fentanyl was responsible for 28 percent of overdose deaths.

But in 2016, the story was very different. Fentanyl (alone) caused 27 percent of overdose deaths, and when combined with other drugs, that number became 70 percent. During this same time, the incidence of heroin-related deaths (excluding fentanyl) plummeted from 28 percent to three percent. Within just five years, the two drugs traded places. The magnitude of this change reflects the extent of penetration of fentanyl into the US. At least in New Hampshire, fentanyl has essentially wiped out the heroin market.

Even though the incidence of pill-only deaths (17 percent) is relatively low, this number is nonetheless inflated. Forty-three percent of opioid pill deaths nationwide are due to a combination of the opioid plus a benzodiazepine, such as Valium (2). So the actual incidence of pill-only deaths (assuming that the national figures apply to those of New Hampshire) would be 9 percent, and probably less (3). This is shown in Figure 2. 

Fig. 2 Total national overdose deaths from opioid pills (left). The involvement of benzodiazepines in opioid deaths (right). Source: NIH

 

The “pills kill” narrative we constantly hear is false. At least in New Hampshire, pills are not the main problem (4). Fentanyl is, which became popular only after the pills were harder to get—as good an example of the law of unintended consequences as you’ll ever see.

Which makes me wonder if the state should change its motto: Live Pill Free or Die?

The false narrative about the dangers of opioid pills has us looking at the wrong villain, and the consequences of this error are terrible. People with a legitimate need for pain drugs are terrified about being cut off from their medicines, while the real monster just sits and laughs at us.

Next: The second false narrative – the myth of addiction from legitimate use of prescribed opioid drugs.

Notes:
(1) See:  Cicero TJ, Ellis MS, Surratt HL, Kurtz SP. The changing face of heroin use in the United States: a retrospective analysis of the past 50 years. JAMA Psychiatry. 2014;71(7):821–826. doi:10.1001/jamapsychiatry.2014.366.Notes:

(2) The combination of an opioid plus a benzodiazepine is not only more dangerous than either alone, but is more so than a simple addition of each drug’s independent risk. There is a pharmacological synergy between the two.

(3) Opioid pills are also consumed with other drugs, such as alcohol and cocaine. It is all but certain that the 9 percent figure for opioid-only deaths is inflated.

(4) Very similar numbers can be found in Department of Health reports from a number of states, including Florida, Ohio, Pennsylvania, and Massachusetts. This is not a New Hampshire problem.