Chronic Pain Sufferers Are Scared by Ohio’s New Opioid Rules

Chronic Pain Sufferers Are Scared by Ohio’s New Opioid Rules

http://www.nbcnews.com/storyline/americas-heroin-epidemic/chronic-pain-sufferers-are-scared-ohio-s-new-opioid-rules-n742951

Chronic pain sufferers fear they could become casualties in the war on Ohio’s opioid overdose epidemic.

They say recent moves by Gov. John Kasich to fight the plague by restricting how many painkillers can be prescribed will add to their anguish — and could force them to go underground to find the relief they need to make it through a day.

“We are being punished for being in pain,” said Amy Monahan-Curtis, 44, who has been living in agony since 1993 due to condition called cervical dystonia that causes her neck muscles to contract involuntarily.

 Congress: Fentanyl Crisis "No. 1 Drug Threat" In Opioid Epidemic1:51

Monahan-Curtis, who lives in Cincinnati, said limiting painkiller prescriptions for adults to just seven days at a time, as Ohio now does, means “an additional financial burden is being placed on the pain patient if a primary doctor will write a prescription to pay for multiple scripts.”

“What these regulations are doing is forcing pain patients out of terror and extreme pain to the street, to find something to control their pain,” she said. “Legislators are making the drug problem much worse.”

Monahan-Curtis said she already follows strict rules laid out in the “narcotic contract” she signed when she enrolled in a pain management clinic, including having to submit to random urine samples.

“I can be called into the office at any time in between my monthly appointments, asked to bring in my narcotics bottle for a count to see if I have an appropriate amount left and am not selling them or taking too many,” she said.

Image: Amy Monahan-Curtis, 44, of Cincinnati, Ohio, is among the many chronic pain sufferers who fear they will be hurt by painkiller restrictions imposed by politicians battling the opioid epidemic
Amy Monahan-Curtis, 44, of Cincinnati, Ohio, is among the many chronic pain sufferers who fear they will be hurt by painkiller restrictions imposed by politicians battling the opioid epidemic. Since 1993, she has been tortured by a condition called cervical dystonia which causes her neck muscles to contract involuntarily. Courtesy of Amy Monahan-Curtis

And if her meds are lost or stolen, Monahan-Curtis said, “they will not be replaced.”

Kasich, when he made his announcement last week, said the new rules don’t apply to patients who already take painkillers for things like cancer or to treat dying patients receiving hospice care.

“We have tried to make it as clear as possible that this is not aimed at chronic pain sufferers,” said Cameron McNamee at Ohio’s state Board of Pharmacy.

A guide put out by Kasich’s administration clearly states that “the limits only apply to the treatment of acute pain.”

“I suspect what may have caused some confusion is that two pieces of legislation that do address chronic pain dropped a day before Gov. Kasich made his announcement,” McNamee said. “I can tell you with 100 percent certainty that the rules proposed by the governor are not aimed at persons who suffer from chronic pain. Those individuals will still be able to get their appropriate medications.”

Monahan-Curtis said she doesn’t believe it. She said the online message boards for chronic pain sufferers lit up after Kasich unveiled the restrictions.

“Doctors are already feeling this pressure not to prescribe pain medications,” she said. “What I am hearing is people are already being turned away. They are not getting medications. They are not even being seen. “

Ashley Marie MacDonald, who has been living in constant pain since a falling bookcase crushed her foot in 2011, echoed those concerns.

 

“I understand that there is a drug epidemic, but by doing this it is affecting people like me,” said MacDonald, 28, of Cincinnati.

MacDonald suffers from a malady called complex regional pain syndrome, that she says makes her feel “like I’ve been lit on fire and have barbed wire around my skin.” Workers’ compensation pays for her visit with a pain management specialist every 28 days.

But under Kasich’s order, MacDonald fears patients like her will have to make more frequent visits and pay $150 out of pocket every time. She said she’s got barely enough money now to survive. But the alternative is a horror she knows all too well.

“I had to recently go to court to fight for my medicine because workers comp got some doctor who never met me and said I don’t need my medicine,” she said. “So I went without for several days.”

What happened? “I could not get off the couch because the pain was unimaginable,” she said.

MacDonald said even before Kasich’s order pain patients were treated like criminals.

“You’re looked at suspiciously all the time,” she said. “You feel as if you are being treated like an addict. I don’t know how treating people like us like criminals will help stop the opioid epidemic. I’m not taking meds to get high, I am taking them to survive.”

 

“I do not believe that making it harder for people is going to solve this opiate crisis,” added 29-year-old Christa Whighstel of Columbus, Ohio, who suffers from the same syndrome as MacDonald.

Whighstel said the unintended consequence of Kasich’s rule is likely to be pain patients “jumping ship and getting addicted to the illegal stuff.”

“It will force people to go over to the other side,” she said. “They just want to live their lives without pain.”

While the deadly scourge of fentanyl-laced heroin cutting through Rust Belt states like Ohio has made headlines of late, the number of fatal overdoses from opioids that can be purchased with a prescription like oxycodone, hydrocodone, and methadone “have more than quadrupled since 1999,” according to the federal Centers for Disease Control and Prevention.

During that same time period, the amount of prescription opioids sold in the U.S. also quadrupled, according to the CDC.

In 2013 alone a quarter billion prescriptions were written, which equates to “enough for every American to have their own bottle of pills,” the agency reported.

Even if used correctly the CDC reported, “anyone who takes prescription opioids can become addicted to them.”

“In fact, as many as one in four patients receiving long-term opioid therapy in a primary care setting struggles with opioid addiction,” according to the CDC. “Once addicted, it can be hard to stop. In 2014, nearly two million Americans either abused or were dependent on prescription opioid pain relievers.”

Even before Kasich made his announcement, Ohio in January 2016 released new prescription painkiller guidelines recommending that people suffering short-term pain from surgery or injuries should be given alternatives whenever possible.

Among the alternatives suggested by Dr. Mary DiOrio, medical director for the state Department of Health, were ice, heat, wraps, stretching, massage therapy, acupuncture, physical therapy and non-addictive medicines like ibuprofen.

“Nobody wants to punish people with chronic pain,” Dr. Michael Kelley of the Ohio Health hospital system told NBC News. “But at the same time we don’t want to develop more addicts.”

Asked why the chronic pain community isn’t getting the message that they are not being targeted, Kelley said, “I don’t know for sure.”

“From the very start we were clear that doctors should responsibly treat people with chronic pain,” Kelley said. “But some doctors are starting to feel a little bit paranoid about the different laws. I think, sometimes, they’re over-concerned.”

Coming as early as September, Ohio will be able to offer chronic pain patients another alternative — medical marijuana.

“There is some evidence it works for chronic pain,” said Kelley. “There is also some evidence it may be a way to treat people who are addicted to opiates.”

The Money Trail: New medical marijuana fees in Ohio may exceed program costs

New medical marijuana fees in Ohio may exceed program costs

http://www.kansascity.com/news/article143510979.html

State regulators in Ohio acknowledge that proposed licensing fees for medical marijuana businesses could initially exceed the state’s costs of operating the program.

Missy Craddock, of the Ohio Medical Marijuana Control Program, told an advisory panel Friday the program is requested roughly $2.5 million a year for operational costs in each of the next two years. That doesn’t include a number of unknown costs, including setting up the program’s licensing, product tracking and payment systems and establishing a required toll-free hotline.

If the state issues all the licenses it’s making available — 24 to cultivators, 40 to product processors and 60 to dispensaries — fees as proposed would generate $10.8 million.

The state has also made application fees for the licenses non-refundable.

Several advisers pushed back against the idea that fees might be too high.

“I’m all for the state being properly funded,” said committee member Ted Bibart. “I’m just not for the patient bearing that weight.”

Ohio’s medical marijuana law went into effect in June, with a target date to be operational of September 2018. It allows people with 21 medical conditions, including cancer, Alzheimer’s disease, AIDS and epilepsy, to purchase and use marijuana after getting a doctor’s recommendation. The law doesn’t allow smoking.

Ohio has set some of the highest fees of any medical marijuana state: a $20,000 application fee and $180,000 license fee for larger growers, and a $2,000 application fee and $18,000 license fee for smaller growers.

Craddock said that some guess work is involved in setting up a new program, but that having surplus revenue is better than being underfunded.

“It’s much easier to reduce fees down the line in the future than it is to increase them,” she told the Medical Marijuana Advisory Committee. She said the program looked to the example of the Ohio Casino Control Commission in setting initial licensing fees.

She added that high fees will weed out those businesses that might not be positioned to survive.

“It is important for us to make sure that we’re attracting industry that is capitalized enough to get through those cold winters,” she said. “And that is part of the reason for wanting to set some of these fees, to make sure that we have people who are serious enough.”

Anticipated expenses for the medical marijuana program include:

— About $845,000 for 10 positions at the Ohio State Board of Pharmacy;

— About $690,000 for 7 positions at the Department of Commerce;

— $611,500 for Pharmacy and $428,000 for Commerce for office overhead, training and travel;

— $175,000 for operation of the patient registry.

“It’s not cheap,” Braddock said. “I would be remiss if I didn’t note that.”

Chris Lindsey, senior legislative counsel for the Marijuana Policy Project, medical marijuana programs in the East and Midwest have placed more emphasis on fees than those in the West. Most argue that the fees are “reasonably related” to offsetting the costs of operating the program.

“The fees for these types of program shouldn’t be money-makers for the programs, and I don’t think states generally look at them like that,” he said.

Mounting evidence suggests law enforcement cannot be trusted to behave responsibly

Tougher rules needed on asset seizure; these bills create them

http://www.dailynews.com/opinion/20170407/tougher-rules-needed-on-asset-seizure-these-bills-create-them

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.

Tune in to Pain Patient Radio Day

The Season of Renewal and Suicide

The Season of Renewal and Suicide

Why are people more likely to kill themselves in springtime than during the holidays?

http://www.slate.com/articles/news_and_politics/explainer/2012/12/suicide_rate_season_there_more_suicides_in_spring_and_not_during_the_holidays.html

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.

Got a question about today’s news? Ask the Explainer.

The crackdown on opioid prescriptions is leaving chronic pain patients in limbo

The crackdown on opioid prescriptions is leaving chronic pain patients in limbo

http://www.vox.com/science-and-health/2017/4/7/14738292/crackdown-opioid-prescriptions-chronic-pain

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.

In the state of Maine, for instance, the health department is requiring all long-term opioid users to reduce their daily doses to 100 MME by July 1. The National Committee for Quality Assurance (NCQA), a leading accreditation organization of health insurers and physicians, is moving to enact opioid dosage limits too.

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.

Chart showing the average daily opioid prescription doses for chronic pain patients

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.

why don’t I get complaints like this about independent pharmacists – just the chains ?

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! 

 

Thanks, 

Here is a website that will help people find a independent pharmacy by zip code  http://www.ncpanet.org/home/find-your-local-pharmacy

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.

Opiate prescribing DOWN… opiate OD’s UP .. do you think that they will put 2+2 together ?

Amid opioid crisis, Minnesota sees significant decline in painkiller prescriptions

https://www.minnpost.com/politics-policy/2017/04/amid-opioid-crisis-minnesota-sees-significant-decline-painkiller-prescriptio

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

2016, Hydrocodone/Acetaminophen: 1,083,662 prescriptions filled
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.

A little Federal law that has been on the books for NINE YEARS

Mental Health and Substance Use Disorder Parity

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.

https://www.dol.gov/ebsa/mentalhealthparity/

https://www.dol.gov/sites/default/files/ebsa/about-ebsa/our-activities/resource-center/fact-sheets/fsmhpaeaenforcement.pdf

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 ?

 

I’m professionally UNCOMFORTABLE

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