“The moral test of a government is how it treats those who are at the dawn of life, the children; those who are in the twilight of life, the aged; and those who are in the shadow of life, the sick and the needy, and the handicapped.” – Hubert Humphrey
passionate pachyderms
Pharmacist Steve steve@steveariens.com 502.938.2414
The Drug Enforcement Administration has seized billions of dollars in cash from Americans never even charged with a crime, according to a report by the Office of the Inspector General.
The report should encourage lawmakers with any commitment to due process and constitutional rights to get behind reform of existing forfeiture and seizure practices.
The OIG, an independent office within the U.S. Justice Department tasked with investigating waste, fraud and abuse in the DOJ, discovered considerable causes for concern in the practice and oversight of asset seizures and forfeitures.
Although asset forfeiture is routinely justified by law enforcement as an important tool to take down criminal organizations, the OIG noted the DOJ doesn’t collect data enabling it to measure how forfeiture activity actually advances criminal investigations.
To get a sense of this relationship, the OIG gave particular attention to the Drug Enforcement Administration, which operates under the DOJ and is responsible for most cash seizures done in the name of the DOJ. From 2007 to 2016, the DEA seized over $4 billion in cash, $3.2 billion of it taken administratively, by the determination of a government agency, rather than a court, without regard to criminal charges or a conviction.
The OIG evaluated 100 cases involving cash seizures by the DEA. Of the 100 cases evaluated, the DEA could verify only 44 cases in which cash seizures either advanced or were related to criminal investigations. In other words, in the majority of the cases, no discernible connection could be drawn between seizure activity and even the advancement of a criminal investigation.
“When seizure and administrative forfeitures do not ultimately advance an investigation or prosecution, law enforcement creates the appearance, and risks the reality, that it is more interested in seizing and forfeiting cash than advancing an investigation or prosecution,” the OIG argued.
Given the tremendous financial incentives involved, in the absence of a criminal investigation, criminal charges or a criminal conviction, there is cause for concern about whether law enforcement can be trusted to resist placing a disproportionate emphasis on revenue generating cases.
Mounting evidence suggests law enforcement cannot be trusted to behave responsibly. According to “Policing for Profit,” a report by the Institute for Justice, between 1986 and 2014, deposits to the DOJ’s Assets Forfeiture Fund grew from $93.7 million to $4.5 billion.
Fortunately, there is now a growing bipartisan understanding of the problems of asset forfeiture. Last month, Sen. Rand Paul of Kentucky and Rep. Tim Walberg of Michigan introduced The FAIR (Fifth Amendment Integrity Restoration) Act. On March 29, Rep. Jim Sensenbrenner of Wisconsin and a dozen cosponsors introduced The DUE PROCESS (Deterring Undue Enforcement by Protecting Rights of Citizens from Excessive Searches and Seizures) Act.
Both bills shift the burden of proof from the property owner to the government, raise the standard of proof in civil forfeiture proceedings, provide legal representation for the indigent in proceedings and increase transparency. But whereas the FAIR Act would end the equitable sharing program in which the federal government splits forfeiture proceeds with state and local agencies to incentivize their participation in federal investigations, Sensenbrenner’s bill does not, an omission that should be corrected.
While it is arguable that the government should be able to take someone’s property or cash only following a criminal conviction, it is a welcome development that increasing numbers of congressmen are willing to put sensible limits on the practice.
The suicide rate does not peak during the holidays, and the media should stop saying it does, according to a report released Tuesday by the Annenberg Public Policy Center. In fact, the suicide rate is highest in spring and summer. The holiday suicide-spike myth persists because it has a convenient narrative: Lonely people become despondent around Christmastime. So why do people kill themselves in the spring?
Possibly because they interact more. Doctors first observed in the 1820s that suicide rates spike during late spring. Researchers have since postulated and tested all sorts of explanations for the global phenomenon, making this one of the most studied questions in psychiatry. There’s still no consensus, but evidence suggests it has to do with so-called sociodemographic factors. During the winter, many people go into semihibernation: They work less, see fewer people, and are exposed to less frustration and conflict. That all changes in the spring, when increased interaction with others and the stress of work may trigger suicidal thoughts. The theory is based on a couple of observations. First, the spring suicide peak is more pronounced among people employed on farms or in factories who experience greater seasonal variation in the intensity of work and social interactions. In addition, developing countries with a higher proportion of agricultural workers see more seasonal change in the suicide rate than do developed countries. The magnitude of seasonal changes in the suicide rate is more than 10 times higher in Uruguay, for example, than in Belgium. Researchers have also detected a smoothing out of the seasonal variation in suicides in recent decades as more people move from farm to office. (There are smaller peaks in other parts of the year. Cubicle workers are more likely to commit suicide in the fall than in the spring, as are mothers who send their children off to school in September.)
Some psychiatric researchers believe that climatic factors are responsible for seasonal changes in the suicide rate. Some suggest that sunshine triggers suicidal thoughts, making self-harm more common in months with longer days. Temperature is also a suspect, with one study from South Korea showing a 1.4 percent increase in the suicide rate every time the mercury rises by one degree Celsius. Rain, barometric pressure, and even thunderstorms have been blamed. Although there are studies supporting each of these theories, the data are controversial. For every academic article correlating weather patterns or sunlight to suicide rates, there’s one debunking the claim with competing statistics.
Physical health issues that intensify in spring seem to correlate with suicide peaks, although the data are similarly tenuous. Doctors point out that allergens trigger the release of anxiety-producing chemicals, and studies have linked the pollen count to the number of people killing themselves. Air pollution levels, which surge in the late spring and summer in some cities, are also correlated with self-harm.
Setting the epidemiological data aside, clinicians say that people suffering from winter depression often lack the initiative to kill themselves. One woman told her psychiatrist that she went to the basement in January to commit suicide and even selected a pipe from which to hang herself, but she gave up when she couldn’t figure out how to tie a noose. Summer depressives, in contrast, are more likely to have a dangerous combination of energy and desperation.
Jenny Rellick was born with spinal muscular atrophy, a degenerative disease that causes muscles to waste away. Eight years ago, she was facing pain so severe that her doctors put her on a high-dosage regimen of two different kinds of opioids. One is a long-acting, time-released opioid called Kadian that delivers 100 milligrams of morphine or its equivalent (MME) throughout the day. The other is a short-acting dose of oxycodone, which she takes in 15 MME increments as needed. Today Rellick, 46, takes anywhere from 175 to 190 MME of these painkillers daily.
“Opioids give [her] the ability to think about something other than pain,’” said Ashley Carr, Rellick’s caregiver. (Rellick had a tracheotomy, which makes it difficult for her to speak, and Carr often helps translate for her.) “But that does not mean she is pain-free. Even on opioids, she is constantly in pain, but opioids reduce it enough that it’s not a constant thought.”
But Rellick, who lives in Alexandria, Virginia, may no longer be able to get the medication she’s become dependent on. Recently, her primary care physician decided she would only write one-time prescriptions for opioids for up to 30 days. Other pain specialists Rellick has seen have said they would cut her daily dose in half.
“If I have to cut down 50 percent, it won’t help my pain enough to warrant the side effects,” Rellick told me in an email.
Increasingly, chronic pain patients like Rellick who take high doses of opioids daily are confronting new restrictions on the strength of opioids or length of prescriptions that doctors can give. The aim of these new measures being implemented throughout the health care system is to curb the epidemic of opioid addiction and overdoses. (More than 22,000 overdose deaths in 2015 involved prescription opioids.)
But they’re creating a new conundrum: what to do about patients like Rellick who could be hurt by big cuts in their dosage.
“People have been on these high [opioid] doses for years, and [if] all of a sudden they’re reduced within a day, the potential unintended consequences are huge,” said Chinazo Cunningham, a professor of internal medicine at Albert Einstein College of Medicine who helped review the 2016 Centers for Disease Control and Prevention guidelines on opioid prescriptions.
A growing number of insurers and health care organizations are moving to regulate opioid prescription strength
Last spring, the CDC published a first-of-its-kind guideline on prescribing opioids for chronic pain that has reverberated throughout the health care system. The recommendations questioned the effectiveness of opioids in managing chronic pain and raised serious concerns about long-term use.
And individual insurers, state and federal agencies, and national health care accreditation organizations have either proposed or put into effect policies ranging from limiting the number of days an initial opioid prescription can last to restricting the strength of the actual doses doctors can prescribe.
What NCQA has proposed would be far-reaching — it would penalize health care providers who prescribe patients more than 120 MME daily over a three-month period.
The NCQA cautioned Vox that the specifics of how the measure would work are still being discussed, and a final version won’t be released until July. What’s more, if the measure is implemented, the first year will be a test period to collect data and determine whether it merits being included in the accreditation program.
“The idea behind the safety measure is identifying what the risky situations are that we think health plans can help clinicians manage,” said Mary Barton, an NCQA vice president. “If I’m a doctor, I might not know a patient is fulfilling prescriptions at multiple pharmacies, but the health plan has access to that kind of data.”
Government health care plans have also considered introducing rules to regulate opioid prescription strength. The Centers for Medicare and Medicaid Services considered implementing its own opioid dosage limits, which would have denied coverage to Medicare patients seeking prescriptions of 200 MME or higher and required extensive case reviews for opioid prescriptions of 90 MME or higher.
Ultimately, the CMS decided to not enact them in 2018, because “prescribing physicians … are in the best position to identify and employ best practices … for enrollees using high dosage opioids,” the agency said in a statement.
Stefan Kertesz, a primary care doctor and researcher at University of Alabama Birmingham who specializes in pain management, told Vox that some Medicare and commercial insurance plans have already started to deny payment for opioids over a certain dose threshold, even though it is not currently required.
“Insurers have already been permitted to be more aggressive, saying patients have to be brought down or else we’re going to stop payment,” said Kertesz. “But much of the regulation is actually initiated through insurers or states, who may have a different approach.”
There’s limited evidence that opioids are effective for treating chronic pain
An estimated 5 million to 8 million Americans use opioids to treat chronic pain. And according to a 2013 study, the vast majority who take the drugs daily get 40 MME or less. But 15 percent are in the same category as Jenny Rellick, taking more than 100 MME.
Because there is such a wide range in the dose levels among people using opioids long term, some doctors say limits like 120 MME (what NCQA has proposed) seem arbitrary.
“I strongly agree with the principle that we need to limit opioid prescribing,” said Joanna Starrels, a professor at Albert Einstein College of Medicine and part of the group that crafted the 2016 CDC guidelines on opioid prescriptions. “However, we need to apply this principle where it makes sense — to prevent people from getting to high doses in the first place, and to reduce doses for patients who are not benefiting. Targeting all patients with blunt instruments like dose limits is likely to compound the negative consequences of this epidemic.”
One of the most contentious issues is whether opioids should continue to be prescribed for chronic pain at all. There is limited data on their effectiveness, and the evidence we do have raises serious concerns about using them long term.
Most trials to measure opioid effectiveness have lasted six weeks or less. The CDC was unable to find a study that analyzed opioid use for longer than one year, but the few studies that were longer than six weeks were not promising. Some studies even found that long-term opioid use might increase sensitivity to pain.
Which is one reason doctors fear the impact of the hard dose limits, which don’t include plans to gradually taper patients on higher doses to lower doses.
Some patients are pushing back against “one-size-fits-all rules”
When Rellick and I last spoke, she wasn’t terribly optimistic about finding a doctor willing to treat her at her current medication levels. She has one month left of her prescription, and says she’s afraid of the pain and withdrawal she may face if her dose is decreased rapidly.
And Rellick isn’t the only long-term chronic pain sufferer frustrated with the new limits. In Maine, two business owners, who like Rellick have taken high doses of opioids (over 100 MME) for years to manage a degenerative disc disease, are seeking an exemption to the state health department’s requirement that all long-term opioid users reduce their daily opioid doses to 100 MME by July 1.
In an interview with the Portland Press Herald, the men’s attorney, Patrick Mellor, said the intentions of the state were good but the ruling was problematic because it was a “one-size-fits-all rule.”
“My clients, they are employers and business people who have never been in trouble and have been lawfully prescribed these medications for years to manage their pain. They don’t get high on these. They take them to function,” said Mellor.
I have been keeping up on your page for quite some time and now I need some help.
I have been a patient with the same doctor for 10 years. Over the years we have tried many different treatment plans, some holistic, some requiring narcotics. For the past 5 years I have been on varying strengths of Butrans (buprenorphine) patch, ranging from 20mcg to 15. For nearly 10 years I have been on Carisoprodol, and this past fall we decided to cut that amount to the minimum, as I don’t feel it’s 100% necessary. We also cut my Butrans patch from 15 down to the lowest dose, which is a single 5 mcg patch.
This sudden drop resulted in extreme anxiety, (on top of my clinically diagnosed anxiety and depression), and severe breakthrough pain. We decided on a treatment plan for the next few months to alleviate those symptoms so that ultimately by the end of May I will be okay on a single 5 mcg patch of bupe. I’d also like to mention this is not an addiction situation, it simply helps with my severe pain the best out of everything I’ve tried, and I feel more comfortable without taking tons of pills.
Our regimen as of December has been:
5mcg Butrans, change the patch once a week.
1 Carisoprodol per day as needed #30 (I rarely take this)
He added in 1 Tramadol every 8-12 hours, and
1 0.25 mg clonazepam every 6-8 hours as needed.
Each month on day 29 I send in my refill request, speak with the doctor monthly about how I’m doing, and fill my scripts on day 30. I’ve never asked for an early fill, I take my meds as prescribed, and less if I don’t need them.
This month I received a call from a new pharmacist at CVS (where I have always filled these prescriptions and have been going for years) saying he will not refill the Tramadol or clonazepam due to contraindications with the other two meds. I did look up the contraindications, and while I do see that this combination could cause issues, it’s a short term, well planned step discussed monthly between my physician and I.
Now I understand each pharmacist has the right to deny fills based on ethical reasons. I also trust pharm-D’s and appreciate their knowledge. But they’ve been filling them for me since December and can see that each month I’ve reduced my dosage. He marked my scripts as invalid and basically told me my doctor of 10 years was wrong. I’ve had no issues or side effects with these meds, and again, I take them responsibly.
Now it is Friday. My doctors office has closed for the day and I am faced with going four days without these medications which will certainly be torturous.
Is he right to do this? Basically override doctors orders, essentially cutting me off cold turkey? Why were they okay to fill a higher dose last month but not a lower dose now? I’m so confused and upset. Any advice is truly appreciated!
Typically the Pharmacists that works for the chain stores gets paid every week regardless if they fill your controlled prescription or not. The independent Pharmacist/owner is in business to fill legit/on time/medically necessary prescriptions… they don’t accept a prescription and start looking for a reason NOT TO FILL A PRESCRIPTION…
I owned my own INDEPENDENT PHARMACY for TWENTY YEARS… I know/understand the mindset of the typical Pharmacist/owner.
These young Pharmacists’ brains are crammed full of all kinds of “book smarts” .. except dealing with pts and their medication/therapy does not always follow the rules in “the books”… most is not Black/White…there is a lot of grey area.. that can take years of clinical experience of dealing with the exceptions to the rules and learn to sometime ignore “the rules” Pharmacists are there to make sure that pts get the medication that they need and avoid any valid conflicts.
This Pharmacist could have copied these prescriptions out to another store… the fact that he invalidated/destroyed/confiscated these prescriptions … IMO… stole/denied the pt the right to the prescriptions that belonged to the pt. The fact that this Pharmacist confiscated the prescriptions and told the pt that his/her PCP was WRONG … clearly demonstrates his ARROGANCE about the absoluteness of his medication knowledge… Hopefully one day in 5-10 yrs… he will realize how IGNORANT he really is.
Minnesota health care professionals dispensed about 9 percent fewer prescriptions for controlled opioid painkillers in 2016 than they did in 2015, according to the Minnesota Board of Pharmacy.
The data comes amid an opioid epidemic that continues to crescendo in Minnesota and the U.S. Between 2000 and 2015, opioid overdoses killed 2,273 Minnesotans, and nationally, they have contributed to more than 200,000 deaths since 1999.
For most drugs, the state wouldn’t expect to see a decline in prescriptions: Minnesota’s population is growing and getting older, which generally means a steady rise in drugs dispensed over time, said Cody Wiberg, the executive director of Minnesota’s Board of Pharmacy. But opioids are not most drugs. Among the most common versions of the drugs, Minnesota saw a decline in prescriptions of hydrocodone/acetaminophen (aka Vicodin) of 13 percent, while oxycodone (OxyContin) went down by one percent, tramadol (Ryzolt) by 6 percent and oxycodone/acetaminophen (Percocet) by 13 percent.
Altogether, filled opioid prescriptions tracked by the state dropped from about 3.87 million in 2015 to 3.53 million in 2016. (The number of filled prescriptions for some opioid painkillers are not available prior to 2015.)
Prescriptions filled in Minnesota for common opioid painkillers
The number of prescriptions filled for Hydrocodone/Acetaminophen, Oxycodone/Acetainophen, Tramadol HCl and Oxycodone HCl/Acetaminophen — the most commonly prescribed opioids — declined in Minnesota in 2016.
Number of prescriptins filled201420152016Hydrocodone/Acetamino…Oxycodone HClTramadol HClOxycodoneHCL/Acetaminophen0500k1 000k1 500k
Source: Minnesota Board of Pharmacy/Prescription Monitoring Program
The declines in Minnesota are consistent with declines reported nationally. IMS Health, an organization that tracks prescriptions, found a 12 percent drop in opioid prescriptions nationally from their peak in 2012 to 2016, according to The New York Times.
Raising awareness
With widespread media attention focused on deaths due to overdoses each year, awareness of the risks of opioid addiction has likely contributed to the drop-off in prescriptions, said Jason Varin, assistant professor in the Department of Pharmaceutical Care and Health Systems at the University of Minnesota’s College of Pharmacy.
Attitudes about prescribing opioids have also changed since the 1990s, when advocacy groups argued that their use was a more compassionate way to treat pain. Relying on a few small studies, they downplayed the risk of addiction to the drugs, said Dr. Bret Haake, a neurologist and clinical researcher at Health Partners.
Those risks were deemphasized by the pharmaceutical industry, too: Purdue Pharma, the company that manufactures OxyContin, once told doctors their extended-release formula carried less risk of addiction than shorter-acting opioid painkillers. (Purdue would eventually plead guilty to charges misleading the public on the claim, an admission that cost the company $600 million.)
Fewer downplay the risk of addiction now. “I would argue that there is very very limited pain diagnoses [they’re] appropriate for,” Haake said.
One reason opioid addiction can be so catastrophic is that some people who become hooked and can’t satisfy their addiction with prescription medication turn to heroin, often a cheaper fix than buying prescription opioids on the street. The number of deaths due to heroin in Minnesota has climbed in tandem with those due to opioids, according to Minnesota Department of Health data.
Opioid painkiller-related deaths in Minnesota, 2000-2015
The number of Minnesotans dying of overdoses related to opioid painkillers has increased since 2000.
Number of deathsOpioid painkillersHeroinAll drugs20002001200220032004200520062007200820092010201120122013201420150200400600
Source: Minnesota Department of Health
Monitoring prescriptions
Changes in the rules for prescribing some opioids could also be changing prescribers’ behaviors, Varin said. Hydrocodone, for example, an ingredient in some prescription opioids, was reclassified in 2014 in a way that made it harder to prescribe and disallowed refills.
Wiberg says he’d like to think there’s another factor in the declining number of opioid prescriptions being dispensed in Minnesota: the state’s Prescription Monitoring Program.
That program, in use since 2010, tracks all controlled substance prescriptions for drug schedules II through V in Minnesota, and the number of queries to the system by medical providers has seen a steady increase.
Last year, in the hopes of preventing doctor shopping by opioid abusers, the Legislature passed a bill requiring all prescribers and pharmacists to establish accounts with the registry. The hope was that the professionals would use those accounts to check the prescription monitoring system for patients’ prescription histories, though prescribers are not required to do so under the law.
Legislating opioids
Rep. David Baker, R-Willmar, one of the most vocal legislators on the subject of opioids at the capitol, says he’s encouraged that the number of opioid painkiller prescriptions appear to be dropping. For him, the issue is personal. His son Dan was prescribed Vicodin for a back pain when he was a junior at St. Thomas University. He became addicted to painkillers and died of a heroin overdose in 2011 at age 25.
Baker and a group of legislators from both parties, including Sen. Chris Eaton (DFL-Brooklyn Center), who lost her daughter to a heroin overdose in 2007, Rep. Debra Hilstrom (DFL-Brooklyn Center) and Sen. Julie Rosen (R-Vernon Center), have proposed legislation that Baker hopes could lead to further declines in opioid prescriptions in Minnesota.
Among other things, language included in the health and human services finance bill, debated in the House of Representatives Friday, would limit the terms of opioid prescriptions prescribed by dentists to four days, and propose requiring pharmacists to give patients information that explains the addictive potential of the drugs, as well as instructions on how to properly dispose of the drugs.
Baker said he’s optimistic that this session will bring about reforms, but said there’s still work to be done — especially in raising more awareness. “We’ve got more work to do, but this is a good starting point,” he said.
The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) requires group health plans and health insurance issuers to ensure that financial requirements (such as co-pays, deductibles) and treatment limitations (such as visit limits) applicable to mental health or substance use disorder (MH/SUD) benefits are no more restrictive than the predominant requirements or limitations applied to substantially all medical/surgical benefits. MHPAEA supplements prior provisions under the Mental Health Parity Act of 1996 (MHPA), which required parity with respect to aggregate lifetime and annual dollar limits for mental health benefits.
Since everyone who takes a opiate for > 90 days is now classified as suffering from a “opiate use disorder” this law would seem to apply to many/most/all chronic pain pts.
Is all the activity around putting opiate dosing limits in place by various entities… in violation of this FEDERAL LAW ?
This morning I got a call from a physician on the east coast, who part of his/her practice is treating addicts with Suboxone. Not every Physician can prescribe Suboxone, a physcian has to take special training and gets a distinct DEA number.
This physician practices is a rather rural part of this state and apparently all of a sudden the Pharmacists at the local BIG BOX STORE… informed the physician that they were no longer “professional comfortable” filling any of the physician’s controlled prescriptions.
I am not going to mention the name of this BIG BOX COMPANY that is based out of Bentonville, Arkansas. But this is not the first time that I have heard about this company doing similar things. Several months ago I was contacted by one of this company’s Pharmacist/PIC who had diligently grew a pt base of legit chronic pain pts. This store was in a state on the Gulf of Mexico. This PIC was told by District Manager/HQ that the pharmacy had TOO HIGH a percent of controls and that the corporation was MANDATING that the Pharmacist “eliminate” a certain percent of the pts that had been getting their pain control meds from this particular store. If fact, the Pharmacist’s ability to order controlled meds was limited at the warehouse/wholesaler level.
No matter which group of pts that you are talking about, both are trying to maintain their quality of life and trying to be a good spouse, parent/grandparent, employee and/or member of the community. Apparently the management at the HQ of this BIG BOX STORE could care less about these pts’ quality of life.
Personally, I consider it a disgrace that this company who promotes itself as a “great American company” and mistreats pts in such a manner. I am only aware of these two locations that have done this to pts, but where there is smoke there is FIRE.
Personally, I refuse to BEG any company to allow me to patronize them and give them my money. If they want me to BEG… they don’t deserve my patronage
I am sending you this letter in regards to how I have been treated while trying to get my meds filled. Just about EVERY time I go to Meijer pharmacy in , Michigan I’m harassed by one or more of the pharmacist on duty. I’m asked why do I need the pills, what’s my diagnoses, how long will I be taking the meds, have my doctor ever thought about giving you something else? it was a time the pharmacist told me the meds was not in stock and I would have to find another store. I fussed so bad she told me they would be ready in a hour but 5 seconds ago they wasn’t in stock. I can’t allow this anymore something needs to be done. Can you send me in the right direction. Ive called corp office and it seems like nothing is being done. Ive even asked for the store manager to express my concerns but nothing helps so now its time to file some complaints. If you can help please email me or call thanks.
Here is a websitehttp://www.ncpanet.org/home/find-your-local-pharmacythat will help locate a independent pharmacy by zip code where you will be dealing with the Pharmacist/owner and unlike these chain pharmacists who gets paid every week regardless if they fill controlled prescriptions or not… the independent Pharmacists are in business to fill legit/on time/medically necessary prescriptions and don’t start looking for a reason to refuse to fill a prescription. Personally, I refuse to beg any company to let me spend my money and patronize them… I had my own independent pharmacy for TWENTY YEARS… I know the mindset.
It seems like every entity that believes that they have some authority to interfere with the practice of medicine and opiate dosing… are attempting to put in their two cents and enacting some guidelines, laws and/or threatening some healthcare providers with having their accreditation withdrawn if they exceed a certain amount of MME/day on pts.
One group National Committee for Quality Assurance (NCQA),which is a agency that accredits different healthcare providers is putting forward daily MME and if prescribers exceed this arbitrary limit… the provider will have their accreditation revoked.
The Center for Medicare and Medicaid Services is coming forward with daily MME limits and is shifting some of the responsibility to enforce those limits to community pharmacists. Perhaps they approached this in this manner… so that they could wash their hands of any consequences caused by decisions of Pharmacists not to fill and deny care and override the prescriber’s wishes.
The CDC only put forth GUIDELINES… which did not bear the weight of law, but in fact has become de-facto standard of care and best practices for untold number of healthcare entities and providers.
Many states have passed laws that has MME/day limits and most are focused on those pts being treated with ACUTE PAIN…NOT CHRONIC PAIN.
This is a similar tactic that various state’s AG’s used against the company that brought a Hydrocodone ER (Zohydro) to the market. Because the company had to go to court in each state they were sued by the AG… and the company ended up in bankruptcy because of all of this nonsensical legal actions.
Those in the chronic pain community needs to make themselves of the various laws and guidelines… many of which can be in conflict or contradicting each other.
I am sure that a number of prescribers will tell pts that he/she is “forced” to comply with this-that law or guidelines. Many times these “limits” will be STATE LAW and I suspect that the prescriber will be misrepresenting what the context of the law really is. They may be observing their interpretation of the law and not the letter nor intent of the law.
I spoke with a chronic pain pt recently from Colorado. This pt’s prescriber was an employee of some corporation and that corporation was sold or merged with another corporation in FLORIDA… the FL corporation came down with a edit that NO OPIATES were to be prescribed. The prescriber started to wean down his pts… there was a edit from the FL corporation that all opiate pts were to be DISCHARGED IMMEDIATELY… cut off COLD TURKEY… I am not sure if the prescriber was fired and/or he quit… but.. he is no longer working for this corporation.
IMO, this is just the first of many such corporate decisions/mandates in how pts are provided care. This is where a class action law firm could be interested in pursuing… since a single corporate entity with “deep pockets” that he causing harm to hundreds or thousands of pts.
Unless chronic pain pts are aware of the rules/laws/guidelines that is being used to dictate their care… they will not be able to take legal action against the entity that is doing harm to them.
Remember, anytime that someone tell you that they are following some law/rule/regulation… simply ask them to furnish you with a copy of what they are following or the state statue number – so that you can look it up on the web… if they are unwilling/unable to provide you that information… It probably DOESN’T EXIST.
There should be consequences to those who violate our laws.
