Docs warn that Medicare crackdown will hurt pain patients

http://www.politico.com/story/2017/03/docs-warn-that-medicare-crackdown-will-hurt-pain-patients-235917

A group of prominent pain and addiction specialists are pushing back against the federal opioid crackdown by asking CMS to withdraw a notice that would make it extremely difficult for Medicare patients to get painkiller prescriptions above a certain strength.

More than 80 physicians, including four who helped create the 2016 CDC guidelines on opioid prescribing, wrote to acting Medicare director Cynthia Tudor about the notice, which would require pharmacists to refuse prescriptions over 90 milligrams of morphine or its equivalent unless the patient first went through a complex, time-consuming review.

While the CDC guidelines caution that high doses create an overdose risk, they also state that physicians should have ultimate discretion on prescribing, and warn that it is not advisable for patients to be tapered off high doses of opioids involuntarily.

An estimated 5-8 million Americans use opioids to treat chronic pain. Many were started on the drugs before the risks were recognized. A 2008 study showed that half of non-cancer opioid patients in Medicaid and private insurance were getting doses above the threshold. While tapering off high doses is often advisable, pain doctors say it must be done carefully and with patient consent.

“CMS mandates will cause previously stable patients to suffer acute withdrawal with or without medical complications, including death,” says the letter, which states that the CMS rule, buried deep within a Feb. 1 CMS payment document, is “in tension with the spirit and the letter of the CDC Guideline.”

Pain and addiction specialists largely agree that doctors saddled too many patients with high doses of opioids in the decade before 2010. Yet some of these patients are medically stable on high doses, and others can’t access the complex care needed to wean them off without tremendous suffering.

“There’s little question that the license given to doctors to reduce pain … was too much,” said Jeffrey Samet, past president of the American Board of Addiction Medicine. “But the pendulum has swung too far in the opposite direction.”

To be sure, there were more than 20,000 deaths linked to prescription painkillers in 2015. Since 2012, though, opioid prescribing and deaths have gradually declined, while deaths from heroin and fentanyl, a powerful synthetic opioid, continue to skyrocket.

“What caused the epidemic and what sustains it today are not the same,” said Stefan Kertesz, a University of Alabama internist and addiction specialist.

The comment period for the CMS rate announcement rule, which takes effect April 3, ended last Friday. Asked to respond to the critique, CMS said its notice followed CDC expert guidelines.

CMS is not the only agency that is tightening the screws on high-dose prescribers.
Under new guidelines under consideration by the National Committee for Quality Assurance, health care providers who provide patients more than 120 milligram morphine equivalents daily over a three-month period would have points taken off from their quality scores.

Already, prescription drug monitoring programs are getting better at detecting patients who doctor shop and doctors who overly prescribe. Many doctors have cut doses or “fired” high-dose patients, and there are anecdotal reports of suicides and heroin deaths among patients who lost access to the medications they were using.

Some of these patients are in such pain that the “just lie in bed or watch TV all day,” said James DeMicco, whose Hackensack, N.J., pharmacy services a major pain clinic. About two-thirds of the opioid patients he serves get more than the CMS-proscribed dose, he said.

The CMS rule could inconvenience pain patients without having much impact on mortality, Kertesz said, because opioid fatalities are increasingly heroin-related.

Data from Birmingham, Ala., for example, show that since 2010, prescription opioid deaths have stabilized at about 50 per year, while heroin deaths surged from 3 in 2010 to 92 in 2016, and fentanyl deaths jumped from 0 to 92. In Cleveland, where 494 people died of opioid overdoses in the first eight months of 2016, 424 were from fentanyl. In Massachusetts, only 8 percent of those who died of overdoses over a three-year period had been prescribed opioids at the time of their deaths.

Though skeptical of the CMS rule, many pain and addiction specialists agree that most high-dose patients would function better if tapered down. They are also less likely to die of an overdose, notes Paul Hilliard, chairman of the Hospital Pain Committee at the University of Michigan health system.

“Blanket statements and policy should never substitute for sound clinical judgment,” said Hilliard. “I do, however, support the notion that any patient on high-dose opioids deserves a review of the medication and treatment strategy. “

“I just don’t see that many patients on high doses who are working full time, coaching the kids’ soccer team, or volunteering at soup kitchens,” he said. “And they continue to report high pain levels.”

Patients who benefit from high doses of opioids are “more the exception than the rule, in my practice,” said Jane Liebschutz, a Boston Medical Center physician. “But the ones who do need it I’d go to bat for. The rules CMS is putting out would make it more difficult for patients and doctors.”

Federal officials have been campaigning hard against prescription drug abuse but are beginning to show concern about unintended consequences.

In a New England Journal of Medicine article in December, Surgeon General Vivek Murthy noted that while prevention and increased treatment are needed to lower opioid abuse, “we have to do all these things without allowing the pain-control pendulum to swing to the other extreme, where patients for whom opioids are necessary and appropriate cannot obtain them.”

NIH officials are also wary of unintended consequences. Federal surveys show that roughly 80 percent of heroin users got started on opioids through prescription drugs.

There is no evidence that pain patients weaned off of opioids turn to heroin in large numbers, but it’s possible that street drugs can become an option “when their other drug of choice becomes unavailable,” and the issue needs more study, said Wilson Compton, deputy director of the National Institute of Drug Abuse.

Doctors who decide to taper off an addicted patient need to help find them treatment, he said. But treatment is expensive and waiting lists to get into decent programs are long in opioid epidemic-stricken regions of the country. A new law would vastly expand treatment, but first Congress has to fund it.

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North Carolina Drug Control Bill Seeks to Add More Restrictions on Doctors, Pharmacists

www.claimsjournal.com/news/southeast/2017/03/08/277262.htm

North Carolina lawmakers can save patients’ lives, spare their families and combat an ongoing opioid-abuse crisis by putting tighter controls on physicians and pharmacists who hand out powerful pain-killing medicines, supporters of a drug control bill said Thursday.

The plan announced by Republican lawmakers and new Democratic Attorney General Josh Stein would put new restrictions on medical providers who prescribe and dispense opioid drugs like OxyContin and morphine and limit their public supply. Such drugs carry a high risk of addiction and are often considered a gateway to the use of heroin and other illegal drugs. The bill also includes $20 million over two years for local substance abuse treatment and recovery services.

One of the chief sponsors, Sen. Tom McInnis, R-Richmond, said his stepson died in 2007 at age 22 after a fight with drug addiction he said intensified when he was prescribed an opioid following an automobile accident.

“We lost a beautiful vibrant wonderful son to this epidemic,” McInnis said at a Legislative Building news conference. “He was given a vial of these horrid, horrid addictive drugs and he started a downhill spiral that ended up with the loss of his life.”

Nearly 250 heroin deaths were reported in North Carolina in 2014, a more than five-fold increase from 2010, according to state health statistics. Four North Carolina residents die every day from drug and medication overdoses, backers of the bill said. Many more are hospitalized or go to emergency rooms.

“Opioids are tearing families apart all across our state. Too many of our neighbors, co-workers and family members are dying,” Stein said.

The measure would require physicians to log on to the state’s controlled substance database system and examine a patient’s prescription history to prevent overprescribing. Such information could show when abusers go to multiple physicians seeking prescriptions for their favored drug. Doctors would pay a $20 annual fee to keep up the system.

Pharmacists also would be required to register with the system and report controlled substance transactions within 24 hours. Pharmacy registration is essentially encouraged now and transactions now can wait 72 hours. Those who don’t file proper reports could be fined.

Doctors also would have to prescribe controlled substances electronically to reduce fraud. In most instances they would be limited to initially prescribing no more than a 5-day supply of a controlled substance for treatment of “acute pain.” This would stop 30-day supplies that bill supporters say can lead to addiction or unused pills left in medicine cabinets for young people to take. State health officials would audit prescriber records.

Bill sponsor Rep. Greg Murphy, R-Pitt and a physician, said some of the restrictions place more “bureaucratic hassle and paperwork” upon doctors, but it’s worth it.

“Our goal here is to save lives, to save families, to save businesses and it is an honorable and laudable and I believe attainable goal that we all must be willing to make sacrifices to achieve,” Murphy said.

The measure also would expand a 2016 law that created a statewide standing order at all pharmacies for access to a prescription drug that can reverse overdoses of opium-based drugs.

The bill would need House and Senate approval before going to Gov. Roy Cooper’s desk. Cooper’s proposed state budget includes $14 million to treat and combat opioid-related drug abuse and overdoses.

Stein said he would soon convene a task force of law enforcement officials to recommend new criminal charges for opioid drug dealers.

Ethan Buck of Greenville, who began using prescription opioids at age 12, advanced to heroin before becoming homeless and finally getting help. Now 20, Buck attended Thursday’s event and warned drug addiction can happen to anyone no matter their education or status.

“It’s not a disease that discriminates,” Buck said.

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Cadden Seeks Acquittal on All Charges

http://meningitis-etc.blogspot.com/2017/03/cadden-seeks-acquittal-on-all-charges.html

BOSTON, Mass.- The head of a drug compounding firm blamed for a deadly fungal meningitis outbreak is asking a federal judge to acquit him on all charges, including racketeering and 25 counts of second degree murder.
In a 38-page motion filed today in U.S. District Court, Cadden’s attorneys are charging that federal prosecutors failed to present adequate evidence of second degree murder though they conceded the evidence might support “at most” a manslaughter charge.
The motion, which was not unexpected, comes as federal prosecutors are about to call their last witness in a trial that began in January.
In testimony today a former employee described how she and a colleague created dozens of phony prescriptions to present to state officials in response to a complaint that had been filed against Cadden’s company, the New England Compounding Center.
Cadden has been charged in only 25 of the 76 deaths recorded in the 2012 fungal meningitis outbreak. He was one of 14 to be charged in late 2014 following a lengthy grand jury probe. Charges against two defendants have been dismissed, Two others pleaded guilty to reduced charges with the remaining facing trial later this year.
Cadden’s motion states that federal investigators, despite spending years on the case, still could not explain how vials of methylprednisolone acetate became contaminated with fungus.
“The fact that 25 (people) died is not in dispute,” the motion states, adding that federal investigators never found evidence at NECC of the specific fungus, exserohilum rostratum, that was found in the bodies of victims and unopened vials of NECC steroids.
“Despite calling over 50 witnesses over 41 days, the government has failed to prove what caused the contamination,” the motion states, adding that Cadden did not compound the steroids that caused the outbreak.
The government, the motion continues, “has provided no evidence that Cadden acted with the requisite intent to commit second degree murder.”
Calling the murder charges unprecedented for “a participant in a non-violent business,” the motion concludes, “The court should exercise its extreme discretion to grant the motion for acquittal.”
At the court session Beth Reynolds, who worked for NECC’s sales arm, Medical Sales Management, said that one of her duties was to ensure that pharmacists and technicians were properly licensed and registered.
A hesitant witness who spoke at times in whisper soft tones, Reynolds said she and another worker were assigned in 2012 to take patient names from a list at the Mass. Eye and Ear Infirmary and insert them on prescription forms.
According to previous testimony, the drugs in question already had been delivered to Mass Eye and Ear without patient specific prescriptions as required under state law. In fact the drug, a numbing agent, already had been administered to patients.
Reynold’s assignment followed a complaint the health facility had filed with the state Pharmacy Board against NECC. The complaint charged the drugs that didn’t have the required potency, prompting complaints from patients and doctors.
The witness identified a series of emails relating to the project.
“The labels have all been created, printed and proofed,” Reynolds wrote in one email.
She said that both she and her colleague, Michelle Rivers, thought the project was “out of the ordinary.”
She said she didn’t like another 2012 assignment from Cadden, which was to compile a list of states that allow prescriptions to be filled under certain circumstances without the name of a patient. Under so-called office use provisions set quantities of drugs can be dispensed for use in a hospital or doctor’s office in situations where the patient’s identity can’t be determined in advance.
She said the assignment made her feel uncomfortable and she did not know what was going to be done with the information.
An official of the Massachusetts Pharmacy Board later testified that there is no such exemption from the patient specific requirement for pharmacies, like NECC, licensed in Massachusetts.
Other witnesses provided additional testimony and evidence about the Mass Eye and Ear Infirmary incident including an email from Cadden with instructions on the need to insert patient names in each prescription.
Contact: wfrochejr999@gmail.com

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Clarence Scranage, Jr., MD

www.doctorsofcourage.org/index.php/2017/03/08/clarence-scranage-jr-md/

Clarence Scranage Jr., MD, 61, of Richmond, VA is the next doctor illegally persecuted by the government for money. He was indicted Feb, 2017 on a charge of conspiracy to possess controlled substances with the intent to distribute them and 18 counts of distribution of controlled substances.

All of the news media reported the exact same information, so it is obviously government propaganda that they copied from the indictment. The news media also brought out past government attacks to paint Dr. Scranage in as bad a light as possible. They should have nothing to do with the current situation and poor reporting like that makes a fair trial impossible. Also, the attacks mentioned are usually planned government attacks created for the purpose of leaving a paper trail.

Dr. Scranage meets all the criteria for doctors that are specifically targeted for attack by the government:

1. Older (so they can forfeit all assets—savings, property, etc) Yep—proven by the fact that the indictment seeks the forfeiture of $650,000 they base on these prescriptions
2. Minority,
3. Primary care who moved into pain management. Dr. Scranage was board certified in Emergency Medicine, but developed his pain management practice involving 3 clinics in the Richmond area.

According to the indictment, Dr. Scranage was in a conspiracy with Anthony Harper, who has pleaded not guilty to all 19 charges. Prosecutors claim Harper simply gave names of people to Dr. Scranage who then wrote prescriptions which Harper then paid for. Is anyone really gullible enough to believe that, in today’s pain management-attacking world?

And the charges are the standard illegal government maneuvering in order to charge a legitimate physician with criminal activity. From the media information, it can be gleaned that the people recruited by Harper did come to see Dr. Scranage as patients. They were evaluated and received legitimate prescriptions for their diagnosis. But because they acted fraudulently, the government uses that as an avenue to attack the doctor. If people present to a doctor fraudulently, THEY have committed a crime. But the government doesn’t get as much through attacking them as they do the doctor, so they ignore the illegal activity of the fraudulent patient, and instead, make deals with them for false testimony to use against the doctor.

The indictment accuses Scranage of repeatedly failing to individually assess the medical needs of the people for whom he wrote prescriptions. But if he saw the patient and prescribed medication, then he assessed the medical needs. It’s the government breaking the law by illegally misinterpreting the CSA.

I just hope Dr. Scranage also pleads NOT GUILTY!  I’m going to be at his trial and will give him support any way I can, hopefully through testimony. Please contact me, Dr. Scranage.

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UPDATED: KPD officer allegedly stole Fentanyl from woman

http://www.kokomotribune.com/news/local_news/updated-kpd-officer-allegedly-stole-fentanyl-prescription-from-woman/article_58a49e6a-0426-11e7-8890-0741438c76d7.html

KOKOMO – Kokomo Police Department officer Heath Evans was charged Wednesday with two felony drug counts and misdemeanor theft for allegedly stealing Fentanyl from a local woman in December.

Evans, who was the focus of an internal KPD investigation, was charged with a felony count of obtaining a controlled substance by fraud or deceit; a felony count of possession of a narcotic drug; and misdemeanor theft. A warrant was issued for Evans’ arrest today and bond has been set at $10,000.

Evans’ initial appearance is set for 9 a.m. March 16 in Howard Superior Court I.

According to a probable cause affidavit, Evans responded to a welfare check for a woman named “Nancy” on Dec. 22, after Nancy’s friend called police to say she was worried about Nancy’s wellbeing.

After speaking with Nancy and leaving the residence, Evans reportedly returned to the home to ask Nancy if there was anything further he could do for her.

Nancy told Evans that she needed her prescription picked up from a doctor’s office and then filled at the CVS Pharmacy located at Sycamore Street and Dixon Road, according to court documents. Originally, Evans told Nancy that he could drop off the prescription and Nancy could have a friend pick it up.

Approximately 30 minutes later, however, Evans returned to Nancy’s home, providing her with an unstapled pharmacy bag. Nancy found the situation to be “odd and peculiar” as her prescription bag of Fentanyl patches are always stapled and include two boxes, according to the affidavit.  

Only one box was in the bag given to Nancy.

After Nancy questioned Evans, he told her, “That’s what they gave me.”

Evans then sat down and began to question Nancy on how to apply Fentanyl patches, asking her where she puts them on her body, according to the affidavit. At Evans’ request, Nancy even changed her Fentanyl patch and applied a new patch. Fentanyl, a powerful synthetic opioid analgesic, is used to treat severe pain.

In an interview with KPD investigators, Nancy said that because of the theft “she is suffering both mentally and physically.” Nancy’s interview with police was conducted on Jan. 12.

On Jan. 13, KPD Detective Derek Root went to the CVS at Sycamore Street and Dixon Road and spoke with the store manager, who provided Root with video of the Dec. 22 incident.

Root also acquired the pharmacy label printout of Nancy’s prescription for Dec. 22 for two boxes of Fentanyl, 50 microgram patches, with five patches in each box.

Root also was given a CVS signature log and a copy of the prescription. A CVS Pharmacy tech later confirmed that Evans picked up two boxes of Fentanyl patches.

In the affidavit, Root says he made several attempts to meet and speak with Evans about the situation, but that Evans initially advised him to speak with his attorney. Despite speaking with Evans’ attorney, no interview or statement was given by early February.

On Feb. 21, Root received a sealed envelope from KPD Capt. Shane Melton, which contained lab results from Evans’ urine screens. The sealed envelope was given to Melton from Howard County Prosecutor Mark McCann. Root had previously completed a subpoena request for lab results of Evans’ urine screens.

The urine screen showed a positive test for the presence of Fentanyl, after which Root requested an arrest warrant.

Evans was put on administrative leave without pay following the reading of a memorandum from KPD Chief Rob Baker at Wednesday’s Board of Public Works meeting.

In a press release, McCann said “the case is still under investigation and anyone having information concerning this case should contact the Kokomo Police Department or the Howard County Prosecutor’s office.”

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Class action: Walgreens, CVS, Osco overcharging diabetics on Medicare for insulin pumps, supplies

http://cookcountyrecord.com/stories/511087986-class-action-walgreens-cvs-osco-overcharging-diabetics-on-medicare-for-insulin-pumps-supplies

A Geneva resident who says pharmacies are overcharging people with diabetes for medication is pursuing a class action complaint against some of the country’s largest retail drug stores in Chicago federal court, seeking at least $5 million. 

Robert Mayberry filed his complaint March 3, naming as defendants Walgreens, CVS Pharmacy and Osco Drug parents Albertsons and Supervalu. He accused each pharmacy of improperly processing claim payment and reimbursement of insulin pump supplies, which are supposed to fall under Medicare Part B, resulting in customers paying more than their intended share. 

Not only do these customers pay more out of pocket, the complaint continues, they also reach Medicare Part D limits faster, thereby incurring out-of-pocket expenses for other prescriptions that are supposed to fall under Part D, until they reach Medicare’s catastrophic coverage threshold. In 2016, Medicare participants were completely responsible for Part D drugs after reaching $3,310 in plan purchases until they’d spent $4,850 out of pocket. 

According to the complaint, Part B covers medical services required for people with diabetes as well as some preventive services for Medicare beneficiaries considered at risk for diabetes. Specifically, this includes external insulin pumps and insulin for those pumps. Part D covers anti-diabetic drugs, including insulin, and supplies needed for inhalation or ingestion. 

The distinction, per Mayberry’s complaint, is that “most health insurance plans, including Medicare and Medicaid” classify an insulin pump and supplies — which includes the drug itself — as durable medical equipment. He further alleges the pharmacies are motivated to misclassify these purchases in pursuit of profits because the Center for Medicaid Services has cut its rate of reimbursement for the products. The pharmacies make more money when patients pay out of pocket. 

Mayberry said he’s been on Medicare since 1996 and has had type 2 diabetes and used insulin to control blood glucose for about 35 years. He said for the last 15 years, he’s had a prescription for an insulin pump. On Feb. 23, 2016, his Part D coverage supplier, WellCare, sent him a denial of benefits notice regarding insulin, which is when he said he realized he’d been improperly paying out-of-pocket expenses for years. 

The complaint accuses the pharmacies of fraudulently concealing their claims reimbursement processes, depriving customers of the ability to learn they were paying too much and overextending their Plan D contributions. That concealment, Mayberry contends, tolls any statute of limitations defense. 

Formal allegations include a violation of the Illinois Consumer Fraud and Deceptive Business Practices Act, as well as similar laws of other states, common fraud by omission and unjust enrichment. 

The pharmacies, Mayberry alleges, “continuously and consistently failed to disclose to consumers … the defective claims process concerning insulin prescribed for use via pump (and) failed to make these disclosures despite opportunities through” employees, advertising, websites and sales literature. 

The class would include all Medicare or Medicaid plan participants who obtained an insulin pump from the named pharmacies from 2006 through the present. 

In addition to class certification and a jury trial, Mayberry’s complaint seeks restitution, compensatory damages, punitive, statutory and treble damages, as well as attorney fees and interest. He also wants the court to compel the pharmacies to establish a program to reimburse customers for Medicare claims related to insulin pumps that were previously denied or insufficiently paid. 

Representing Mayberry in the matter, and serving as putative class counsel, are attorneys with the Clifford Law Offices, of Chicago.

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My ER visit (May 23, 2015) was horrible.

On that day, I had fallen in a restaurant. I slipped in an unseen, unmarked puddle of water and fell, HARD, on my back down the entire length of my spine. I instantly froze, partly in shock, partly because I was terrified I had done some damage to either of the fused regions of my spine (C4-C6 and L4-S1). I was checked out by paramedics and eventually allowed to get to my feet. Not being able to tell how I felt (from the shock of the fall), and I wasn’t hurting any more than usual at the moment, so we declined the ambulance ride and stayed to eat the lunch we had ordered.

Throughout the meal, my pain started developing and increasing, so we decided to go to the ER to have me checked out, particularly to have imaging done to see if any damage was done to or around the hardware in my fusions.

I was triaged and taken back for assessment. I was passed off to a physician’s assistant who eventually agreed that I needed a full-spine CT. Once this was decided, I requested something for the pain, which had continued to escalate and spread up and down my spine. The PA grudgingly agreed to ordering a Percocet. At this point, she started treating me like a drug seeker. As time went by and no medication arrived, I asked a passing nurse if I could just take an oxycodone from my purse. The nurse obtained permission and I followed through.

The PA asked me some strange questions. She asked me if I was afraid and whether or not I felt safe. I thought this was odd, even understanding that perhaps it was a question regarding abuse? Knowing that I came to the ER after a fall in a public restaurant full of people, who called 911, I thought it was strange. Then at one point she had me sit up so that she could check my leg reflexes with her little hammer. While tapping, she asked when my knee replacements had been done. Again, very odd, considering that I have no surgical scars on my legs whatsoever. (The answer was that no, I had never had knee replacements.)

The CT was a bit of a nightmare that added to my pain. Halfway through the full-spine scan, I was abandoned without explanation. I eventually had to call out for help. It turned out that a child had coded and all hands were needed there, and thankfully the tech shut off the machine before he left. However, the scan had to be completely done over, extending my time on a hard, narrow table, increasing my pain.

Thankfully, the CT images showed no damage done from the fall. By this point, my pain level was very high (8 out of 10), and I knew the limited amount of pain medication I had (1 pill per day, for a severe chronic condition called Adhesive Arachnoiditis) would not be enough to bring my body out of the pain flare caused by the trauma of the fall and exacerbated by the long, long time spent on the CT table. I talked to the PA about this and requested IM morphine (liquid morphine injected into the muscle) to bring the pain down to at least what it was when I entered the hospital. She exploded and said “We do NOT give out prescriptions for pain medication!!!” I quietly told her I did not ask her for one, only for the IM morphine to reduce the pain.

This is where she looked me in the eye and LIED to me, telling me that morphine could NOT be given IM. I looked at her in silence for about a minute, and then told her, “That’s interesting, because that’s exactly what I was given last November when I came in with a scorpion sting. In fact, it was here in this hospital, you can you check my records.” I had to insist she look at my chart. She left the area and I never saw her again, and I was eventually given the morphine IM by a nurse, but never received the single percocet tablet that was ordered (I’m guessing they cancelled it correctly).

This was my first experience being treated like a drug-seeker. My words were twisted, and I was lied to. Years ago I probably would have meekly shut up and suffered, but I am so tired of the mistreatment that chronic pain patients receive at the hands of their doctors, their pharmacists, hospital workers, and people in general. How do I go about preventing this mistreatment from happening again?

I also had a bad experience (just not directly) with a rookie pharmacist in 2013. My husband had gone to pick up a new prescription at XXX, because I wasn’t allowed to drive yet. My lumbar fusion was in June of 2013, and my surgeon was carefully titrating me off my oxycontin after the surgical pain had passed. It was a Friday, and I was having my follow-up with my surgeon’s PA rather than with my surgeon. We decided to reduce the oxycontin from 80mg 2x daily to 60mg 2x daily. For some reason (it was the only time this ever happened to me), she took my bottle of pills (I don’t even know why I had them with me; it could be she called and requested that I do so, but cannot truly recall this detail), leaving me 1 or 2 tablets in case it took extra time for the pharmacy to fill the new script.

The pharmacist refused to fill the script because it was “too early” for a refill, not acknowledging it was a NEW prescription of a lower-strength medication. My husband pointed this out to her, but she said it didn’t matter, it was too early. When requested to call the doctor’ office (it was after hours, but they have an answering service), she complied, but when the doctor on call was not the PA who wrote the script, but actually MY DOCTOR, under whose license the PA wrote the script. She REFUSED to talk to him and told my husband she would not fill the script.

When my husband asked if he could send her the bill if he had to take me to the ER for withdrawal complications, she said it didn’t matter, she wasn’t going to risk her license to do her job. That was that.

Fortunately, I had just enough oxycontin of lower strengths to cobble together (along with the 1 or 2 tablets left to me by the PA) to get me through Sunday night. I called my doctor first thing Monday and he got the pharmacist straightened out, so I was blessed to have continuity in my medication until I could get help from my doctor, without having to suffer withdrawal, humiliation, and further torture in the ER.

The pharmacist was completely out of order and negligent in her duty as a pharmacist. She refused to fill a completely legitimate prescription and refused to talk to the doctor who could verify it for me. She put my health at risk with her profiling behavior. One of my biggest regrets is not reporting her infraction right away. Unfortunately, this happens a lot with chronic pain patients; we are so exhausted from our daily battles, that the non-essential ones slip by without prompt action (especially when recovering from major spine surgery).

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Nadeau_Neurology 2015   <— click here to read

ABSTRACT

The recent American Academy of Neurology position paper by Franklin, “Opioids for chronic
noncancer pain,” suggests that the benefits of opioid treatment are very likely to be substantially
outweighed by the risks and recommends avoidance of doses above 80–120 mg/day morphine
equivalent. However, close reading of the primary literature supports a different conclusion:
opioids have been shown in randomized controlled trials (RCTs) to be highly effective in the
treatment of chronic nonmalignant pain; long-term follow-up studies have shown that this effectiveness can be maintained; and effectiveness has been limited in many clinical trials by failure to
take into account high variability in dose requirements, failure to adequately treat depression, and
use of suboptimal outcome measures. Frequency of side effects in many RCTs has been inflated
by overly rapid dose titration and failure to appreciate the high interindividual variability in side
effect profiles. The recent marked increase in incidence of opioid overdose is of grave concern,
but there is good reason to believe that it has been somewhat exaggerated. Potential causes of
overdose include inadequately treated depression; inadequately treated pain, particularly when
compounded by hopelessness; inadvertent overdose; concurrent use of alcohol; and insufficient
practitioner expertise. Effective treatment of pain can enable large numbers of patients to lead
productive lives and improve quality of life. Effective alleviation of suffering associated with pain
falls squarely within the physician’s professional obligation. Existing scientific studies provide the
basis for many improvements in pain management that can increase effectiveness and reduce
risk. Many potentially useful areas of further research can be identified. Neurology® 2015;85:1–6

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Family says cancer-stricken toddler died after hospital medical mix-up

http://www.ctvnews.ca/canada/family-says-cancer-stricken-toddler-died-after-hospital-medical-mix-up-1.3313954

A Quebec hospital has launched an investigation after a toddler who was being treated for cancer died in their care late last year. The parents of Ghali El Amrani, who died at 23 months, believe they lost their son after he was mistakenly given an extra injection of potassium.

Last June, Ghali El Amrani was diagnosed with neuroblastoma, a form of cancer that had spread to the child’s bone marrow. He was taken to CHU Saint-Justine Hospital, where he underwent six rounds of chemotherapy, followed by a bone marrow transplant.

“He was supposed to do five more days and go home,” his mother Hadil told CTV Montreal.

A shot of potassium was prescribed following the procedure and the nurse was supposed to give him two injections: one potassium, one saline solution, said Hadil.

But the nurse injected her son with two shots of potassium, she added.

The alleged overdose sent her son into cardiac arrest. Ultimately, Ghali suffered four heart attacks as medical workers tried to save his life.

“His heart came back after 25 minutes. He was transferred to another department and unfortunately he did (have) three heart attacks after the first one,” Hadil said.

In a preliminary report, the coroner stated as a probable cause of death that the child received care for a neuroblastoma “in which a solution of potassium and phosphate was administered by mistake.”

CHU Sainte-Justine has admitted that medication did play a role in the child’s death but say at this stage in the illness, they cannot place blame on any member of the care team.

The family’s lawyer, Jean-Pierre Menard, told CTV Montreal hospital nurses are supposed to follow a clear-cut protocol while treating patients. “Normally, there is a double-checking process to make sure that everything is properly identified. So the only way by which such a situation can occur is because somebody, somewhere, hasn’t complied with the protocol,” Menard said.

He added medical mix-ups are far too common. “Every year, we’re handling between at least five to 10 cases of medication error that have caused death or serious physical impairment … damage to a patient.”

Hadil said that her family doesn’t “have the real story” because the nurse doesn’t “remember anything.”

The family is planning to file a claim against the hospital but Hadil said more than financial compensation and an apology from the hospital, she wants answers.

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