KY Senate OKs bill limiting some painkiller prescriptions

www.wtvq.com/2017/03/30/senate-oks-bill-limiting-painkiller-prescriptions/

FRANKFORT, Ky. (AP) – Kentuckians would be limited to a three-day supply of powerful prescription painkillers in most cases under a bill that has cleared the state Senate on the final day of the legislative session.

The Senate voted 29-9 to approve House Bill 333 on Thursday. The bill forbids doctors from prescribing more than a three-day supply of prescription painkillers but lists many exceptions including cancer treatment, chronic pain and end-of-life care.

The bill also defines “fentanyl” and “carfentanil,” two synthetic drugs similar to opioids but much more dangerous. Fentanyl accounted for 420 drug overdose deaths in 2015, up from 121 deaths in 2014, according to the most recent drug overdose report.

The Senate made a few changes to the bill. If the House agrees by midnight, it will go to the governor’s desk.

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State Law Enforcement Concerned About Growing Presence of Synthetic Opioid Carfentanil

http://www.kaaltv.com/article/stories/S4440562.shtml

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New rule limits narcotic painkiller prescriptions to seven days

http://www.dispatch.com/news/20170330/new-rule-limits-narcotic-painkiller-prescriptions-to-seven-days

Ohio doctors, dentists and some nurses will be unable to prescribe more than seven days of narcotic pain killers — five days for minors — under rule changes announced today by Gov. John Kasich.

Medical personnel who don’t follow the rules will be in danger of losing their license, Kasich said at a Statehouse news conference. The rules are not expected to take effect until this summer.

“You are going to have to abide by these rules or else you’re in serious trouble, whether you’re a doctor, a dentist or a nurse,” he said.

Kasich said tightening prescribing rules is part of Ohio’s multi-faceted approach to fighting a deadly scourge of drug abuse, which took a record 3,050 lives through overdoses in 2015.

According to this report http://www.cleveland.com/metro/index.ssf/2017/03/ohio_lawmakers_push_opioid_pre.html

Prescription drugs were responsible for about 22 percent of the 3,050 overdose deaths reported in 2015. Heroin and fentanyl were responsible for the majority of overdose deaths.

What was not apparently determined if any/all of those 22% prescription OD’s were or were not SUICIDES

“We’re paying the price now for a lot of the neglect we had in the past,” Kasich said of the state response to the drug epidemic.

“We’re winning the battle but we have a long way to go to winning the war … This is one of those issues that, thank God, supersedes party and philosophy.”

The new rules follow a series of restrictions on pain pills beginning in 2012. Overall, the previous restrictions cut down pills prescribed in Ohio by 20 percent, or 162 million doses, from 2012 to 2016.

Prescriptions now can be written for 30 to 90 days of painkillers.

Health experts say prescription opioids are most often the gateway to addiction, with three of four people who died from a drug overdone in 2015 previously having been prescribed an opioid pain pill, such as OxyContin. Many, especially young people, get their first narcotic pain pills from prescriptions unused by family and friends.

The rules will be enacted by the Ohio Board of Pharmacy, the State Medical Board, the Dental Board and the Board of Nursing. However, the process is expected to take several months because the rules must be reviewed by the Joint Committee on Agency Rule Review, a legislative panel.

Ohio officials have struggled to deal with the rising tide of overdose deaths. The total is expected to be much higher once 2016 numbers are tallied.

Dr. Mark Hurst, medical director of the state Department of Mental Health and Addiction Services, said Kasich’s idea is to dramatically reduce the number of pills prescribed unnecessarily.

“Every unused pill is an opportunity for someone to take that pill inappropriately,” Hurst said.

He said the state worked with medical organizations to avoid breaching doctors’ professional judgement about when to prescribe and not to prescribe painkillers. He said doctors will have flexibility to exceed the rule if they provide documented reasoning.

Kasich’s announcement comes a day after Republican lawmakers proposed legislation to require doctors to follow federal Centers for Disease Control guidelines limiting acute pain prescriptions to three days, or up to seven days if the doctor goes through training in alternatives and offers treatment options.

House Speaker Cliff Rosenberger, R-Clarksville, promised to forge a “partnership between the legislature and the governor” on the subject. “At the end of the day, it’s about the families of the state of Ohio.”

The Ohio State Medical Association, representing doctors, called the legislative proposal too rigid. An official said the association thinks Kasich’s rules offer doctors more flexibility.

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https://youtu.be/eQ1pLSTMFAU

Chris Christie has stated many times today in conjunction of being appointed to a new White House initiative on fighting the “opiate epidemic”.

He states that he is PRO-LIFE … from conception to grave… and that those with diseases need to be provided treatment…. “given a life”… so where does chronic pain pts and others with subjective diseases fit into this concept ?

Nationally, the number of doses of legal opiates being prescribed is DOWN DRAMATICALLY …however… the number of opiate related deaths are DRAMATICALLY UP.

In a recent article  http://www.cleveland.com/metro/index.ssf/2017/03/ohio_lawmakers_push_opioid_pre.htmlhttp://www.cleveland.com/metro/index.ssf/2017/03/ohio_lawmakers_push_opioid_pre.html

Ohio led the nation in opioid-related overdose deaths in 2014. Prescription drugs were responsible for about 22 percent of the 3,050 overdose deaths reported in 2015. Heroin and fentanyl were responsible for the majority of overdose deaths. 

Were those 671 deaths from prescription drugs – notice that they don’t claim –  only imply – that they were opiate related deaths – actually SUICIDES ?  We know that chronic pain pts are twice as likely to commit suicide.  Is the truth in these numbers being OBSCURED ?

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Payments by state malpractice fund dropping

A $1.2 billion state-run fund for large medical malpractice awards has seen a significant drop in payments to injured patients in recent years, contributing to a $813 million surplus that is more than twice what regulators recommend, a State Journal analysis shows.

The reduction in the number and amount of payments by the Injured Patients and Families Compensation Fund illustrates how hard it has become to win lawsuits against doctors in Wisconsin, said Mike End, a malpractice attorney in Milwaukee and former president of the Wisconsin Association for Justice.

“I think the medical complex has won the day,” End said. “They’ve beaten the lawyers down to the point that now when people are injured or relatives die because of medical errors, they just can’t find a lawyer.”

“We have high quality of care, so perhaps there are fewer negligence issues happening,” Grapentine said.

The fund, which started in 1975, pays malpractice awards of more than $1 million. Doctors, hospitals and some other health care providers must carry their own malpractice insurance up to $1 million and pay into the fund. At least 13 states have such funds.

Dan Rottier, a malpractice attorney in Madison, said the fund gives doctors and insurance companies less incentive to settle cases because they don’t personally risk losing more than $1 million. A $750,000 cap on non-economic damages in the state also makes it difficult to pursue malpractice cases, which typically cost at least $100,000, he said.

A case before the Wisconsin Court of Appeals, handled by Rottier, could lead to a ruling on the constitutionality of the cap. A jury awarded Ascaris Mayo, of Milwaukee, $16.5 million in non-economic damages after she lost all four limbs from an immune system reaction to an undetected infection. The award was reduced to $750,000 because of the cap.

“The cap punishes the people most seriously injured,” Rottier said. “The structure (of the fund) punishes the smaller cases that never get brought.”

According to a Legislative Audit Bureau reportin March, the fund had a surplus of $783 million a year ago, $406.4 million more than the upper end of a range of $86.4 million to $376.6 million recommended by regulators last year.

The  surplus grew to $813 million by March, the Wisconsin Office of the Commissioner of Insurance said last week.

The office has been reducing provider fees to the fund since 2013 to bring the surplus into the target range. Doctors now pay $606 to $3,998 a year, depending on their type of practice, 30 percent less than last year.

Over the past 20 years, the number of payments made by the fund has declined, and the total amounts paid in the past five years are considerably less than the previous five-year intervals, according to a State Journal analysis of data from the insurance commissioner’s office.

From fiscal years 1997 to 2001, the fund made 108 payments, or an average of 22 per year, worth a total of $138.5 million. In fiscal years 2012 to 2016, which ended in June, just 17 payments were made, or an average of three a year, for a total of $61.5 million.

In fiscal 2016, just two payments were made, including $2.75 million to Donna Disch, widow ofTravis Disch, a 37-year-old father of two who died after a routine endoscopy at St. Mary’s Hospital in 2013.

Though the fund and a version of the $750,000 cap have been around for many years, their cumulative effect, along with juries who tend to favor doctors, has led malpractice attorneys to become more selective in accepting cases in recent years, End said.

“There are fewer lawyers willing to take that gamble,” he said. “Patients are left out in the cold.”

Wisconsin ranked 49th among states in malpractice payments per capita from 2004 to 2014, according to the National Practitioner Data Bank.

However, a report this year by Zippia, a career guidance website, said Wisconsin ranked somewhat higher — 38th — in medical malpractice lawsuits filed per capita last year.

“The lawsuits are happening,” Grapentine said. “It just seems like they’re not winning in Wisconsin.”

Grapentine said that when doctors refuse to settle cases, it’s because they want to protect their reputations, not because of the fund.

“They don’t want to have a stain on their record that is not justified,” he said.

Even though the number and total amount of fund payments has dipped in recent years, the average payment has gone up. In 2012 to 2016, it was $3.6 million. In 1997 to 2001, it was $1.2 million.

That is likely because attorneys are turning down more cases that are unlikely to result in a large payment, Rottier said.

Justice may be BLIND… but still “CONTROLLED” by the ALMIGHTY DOLLAR

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Topics with Trish – Chronic Pain, Medications vs Treatment, Doctors & Support 03/30 by YourVoiceRadio | Current Events Podcasts

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Ohio lawmakers push opioid prescription restrictions, online addiction counseling

http://www.cleveland.com/metro/index.ssf/2017/03/ohio_lawmakers_push_opioid_pre.html

COLUMBUS, Ohio — Prescription painkillers are responsible for the largest number of opioid overdoses in Ohio, and state lawmakers want to further restrict prescribing the highly-addictive pills.  

GOP lawmakers introduced companion bills in the House and Senate that would adopt national opioid prescribing guidelines, set dosage limits for opioids prescribed by dentists and primary care doctors and make addiction education and counseling available online.

Gov. John Kasich plans to announce on Thursday his own proposal to limit opiate prescriptions.

Ohio led the nation in opioid-related overdose deaths in 2014. Prescription drugs were responsible for about 22 percent of the 3,050 overdose deaths reported in 2015. Heroin and fentanyl were responsible for the majority of overdose deaths. 

Sen. Jay Hottinger, a Newark Republican, said the package of reforms will prevent more people from becoming addicted to opioids and later turning to more potent drugs. 

“We’re not going to be able to legislate our way out of this epidemic,” Hottinger said at a Wednesday news conference. “But this will save lives because it will slow the pipeline of addiction caused by overprescribing.” 

Hottinger co-sponsored the Senate bill with Sen. Bob Hackett, a Madison County Republican. Republican Rep. Jay Edwards of Nelsonville sponsored the House version.

Under Senate Bill 119 and House Bill 167: 

• Primary care physicians and dentists could only prescribe up to the equivalent of 50 milligrams of morphine per day in no greater than three-day supplies unless they complete several requirements. 
• To prescribe greater amounts and supplies, doctors and dentists would have to complete eight hours of training about opioids and addiction and doctors would have to provide treatment for addiction. Exceptions are made for hospice, nursing home, chronic pain and cancer patients.
• Addiction treatment centers or physicians treating patients for addiction must offer naltrexone, which blocks opioids’ effects on the brain, as an option. 
• State officials must make patient counseling and education available online. 

The Ohio State Medical Association, which represents thousands of physicians, supports efforts to address the opioid crisis, spokesman Reggie Fields said. But Fields said such guidelines shouldn’t be mandatory and doctors should have discretion to best treat their patients.

“While two individuals may have the same condition, what’s effective for one might not be for another,” Fields said. “We want to avoid locking physicians in a cookie cutter approach.”

Fields said Kasich’s proposal gives doctors flexibility to make a clinical diagnosis in  the best interest of the patient.

Opioid prescriptions have declined as the state has increased prescription reporting and cracked down on pill mills and doctor shopping. The Governor’s Cabinet Opiate Action Team, a panel Kasich established in 2011, released physician guidelines in 2013 and 2016 aimed at reducing overprescribing.

Between 2012 and 2016, the total number of opioid doses dispensed to Ohio patients declined by 20.4 percent — from a peak of 793 million pills to 631 million pills, according to the State Board of Pharmacy.  

Opioid prescriptions in Ohio down more than 20 percent over last 4 years

Fields said the state is turning a corner with prescriptions and should focus on making treatment more available.

A new law expanding addiction treatment options and limiting the amount of pills that can be dispensed to a 90-day supply takes effect April 6. 

The legislation is called the bill “Daniel’s Law,” after a Germantown man who died from an overdose. Daniel Weidle battled addiction for eight years before he died at age 30. Weidle had been seeking treatment, his father Scott said. 

“Ohio has the opportunity right now to take ownership of this issue and do everything in its power to become a leader in opioid prescription reform,” Scott Weidle said.

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As seen on another FB post

I had ALL of my teeth cut out today and was fitted for dentures which has led to EXCRUCIATING pain. Because I receive Tramadol from my pain management doc for my back, hips, etc., the oral surgeon and oncologist could NOT give me ANYTHING for pain after pulling all those teeth and fitting the dentures. All they could do was to give me extra shot

s of Novocaine which lasted about an hour. Both of them feel so bad that they keep calling me at home to see how I am doing and to apologize for not being able to prescribe anything for me. I “jokingly” told them I wish I knew where I could get something stronger since they are the only things that actually help with the pain but of course they couldn’t say anything but sheepishly laugh a little. Still, it was nice that they felt bad for me and at least wanted to check on me to see how I’m doing after that horrible ordeal. I was ok until I started waking up from the deep anesthetic then once the Novocaine started wearing off, that is when the shit hit the fan (They both knocked me completely out and gave me loads of Novocaine.) (I have pictures but they are disgusting as hell to post without specific request. There was a whole lot

of cutting and stitching done. I’m glad this forum is here. I may not be able to get any relief from my excruciating pain but at least I (sometimes) get a sympathetic ear and get to blow off steam and vent my frustrations from being in so much pain all the time.

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Physicians’ legal duty to relieve suffering

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1071521/

The evidence that physicians and nurses do not treat pain adequately began to appear in the medical literature nearly 30 years ago.¹ In the following decades, the accumulated data showed that many types of pain—acute pain, cancer pain, and chronic nonmalignant pain—were being undertreated.² The reasons offered for undertreatment, usually characterized as “barriers” to effective pain relief, were remarkably consistent across the literature. These included insufficient knowledge among clinicians about the assessment and management of pain; the failure of health care institutions and professionals to make pain relief a priority; a lack of accountability for providing effective pain relief; physician concerns about regulatory scrutiny of their prescribing practices; and the persistence of myths and mis-information about the risks of addiction, tolerance, and adverse side effects associated with opioid analgesics.³

Despite numerous calls to educate health care professionals about pain management, only the rhetoric has expanded.⁴ Between 1995 and 2000, unrelieved pain has remained a significant problem.⁵ During these same years, state and national organizations were urging physicians to make pain relief a priority in patient care.⁶ Perhaps the outcome of 2 legal cases—the James case and the Chin case—might finally persuade the medical community that its duty to relieve pain and suffering is not only an ethical one but is enshrined in law.

In 1991, a North Carolina jury awarded $15 million in compensatory and punitive damages to the family of Henry James, a nursing home patient who died a painful death from terminal metastatic prostate cancer.⁷ The jury found that a nurse’s refusal to administer the opioid analgesics necessary to relieve Mr James’s pain, on the rationale that he would become addicted, constituted a gross departure from acceptable care. Significantly, no disciplinary action was forthcoming for either the nurse or the facility. Perhaps because the named defendants were a nurse and a nursing home, and no physician’s care was at issue in the case, the implications of the jury’s verdict largely escaped the attention of the medical community.

In 1998, William Bergman was admitted to Eden Medical Center in Castro Valley, California, in severe pain. Dr Wing Chin became his physician. Important details surrounding his 5-day hospitalization are in dispute between the Bergman family and those who cared for him. The hospital records indicate that at some point each day Mr Bergman’s pain was rated between 7 and 10 on a 10-point pain intensity scale, 10 being the worst pain imaginable. On the day of his discharge, a pain level of 10 appears in the medical record. Although a definitive diagnosis was not reached, a chest radiograph, combined with a long history of smoking, was strongly suggestive of lung cancer. Mr Bergman declined further tests, wishing to go home and receive hospice care. He died within a week of discharge.

Disturbed by what they perceived to be an inappropriate response to Mr Bergman’s pain, his family sought assistance from the national patient advocacy organization, Compassion In Dying. Based on an expert review, Compassion in Dying assisted the Bergmans in filing a complaint against Dr Chin with the California Medical Board. The board’s expert concurred that the pain management of Mr Bergman was inadequate, but the board declined to take any action against Dr Chin.

Compassion in Dying then assisted the Bergmans in filing suit against Dr Chin and Eden Medical Center.⁸ To recover damages for Mr Bergman’s pain and suffering once he had died, the action had to be brought under California’s elder abuse statute. To prevail under that statute, the Bergmans needed to prove that the care was not merely negligent, but grossly negligent or reckless. Eden Medical Center settled before trial. On June 13, 2001, the jury returned a verdict against Dr Chin of $1.5 million.

The nature and magnitude of the verdicts in James and Chin highlight a disturbing disparity between health care professionals and the lay public regarding the importance each attaches to undertreated pain. It is a disparity, however, that physician Eric Cassell noted almost 20 years ago: “The relief of suffering, it would appear, is considered one of the primary ends of medicine by patients and lay persons, but not by the medical profession.”⁹

Another message to physicians implicit in these verdicts is that there is a standard of care for pain management, a significant departure from which constitutes not merely malpractice but gross negligence. Even if professional boards might not hold their licensees to that standard, juries will. With the implementation of the new pain standards by the Joint Commission for the Accreditation of Healthcare Organizations, which recognize the right of patients to the appropriate assessment and management of their pain, public expectations will likely increase exponentially.¹⁰ To match these expectations, physicians will need to urgently improve their knowledge, skills, and attitudes toward pain relief.

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