“The moral test of a government is how it treats those who are at the dawn of life, the children; those who are in the twilight of life, the aged; and those who are in the shadow of life, the sick and the needy, and the handicapped.” – Hubert Humphrey
passionate pachyderms
Pharmacist Steve steve@steveariens.com 502.938.2414
Many chronic pain sufferers are frustrated with how they are depicted in the media – often as lazy, whining, drug seeking addicts.
A new documentary called “The Painful Truth” is trying to change that narrative. It began airing on local PBS stations this month.
LYNN WEBSTER, MD
“I wanted to give a voice to people who live in the shadows. People in pain are often ignored and treated as outcast or druggies,” says co-producer Lynn Webster, MD, one of the world’s leading experts on pain management and past President of the American Academy of Pain Medicine.
“The film tries to demonstrate the lack of humanity that exists today towards people in pain. It also reveals some of flaws in our public policy that has contributed to the current pain and addiction crisis. I hope that the film will be a seed for a cultural transformation in attitudes and respect for the most hurting among us.”
The 30-minute documentary is the video version of Webster’s 2015 award-winning book, The Painful Truth, in which he shares the personal stories of chronic pain patients he treated for over 30 years in the Salt Lake City, Utah area.
Webster may be retired now as a practicing physician, but he’s determined to have pain sufferers treated with more compassion and respect, not only by the media, but by government, regulators, insurers and their own doctors.
“I’ve had patients who begged me for alternatives to opioids when their insurance wouldn’t cover anything else that would give them relief,” says Webster. “I’ve had patients who could not find a respite from their pain and chose to end their suffering by taking their own life. I’ve cried with, and comforted, the caregivers of my patients, people who are on the front lines every single day doing everything they can to help their loved ones regain the life they once knew.”
Webster and co-producer Craig Worth traveled over 70,000 miles gathering stories from patients and documenting their daily struggles. They also interviewed caretakers, doctors, patient advocates, addiction specialists and law enforcement officials.
The Painful Truth has already aired on KENW-TV in Portales, New Mexico and WXXI-TV in Rochester, New York. It will be broadcast later this week on WOSU-TV in Columbus, Ohio. For a listing of stations and air dates, click here.
Webster is encouraging pain sufferers to reach out to their local PBS stations and ask them to broadcast The Painful Truth. He says when documentaries air on local public television, it is common for the host station to include a panel discussion with community members.
“If your local public station decides to air this documentary and you would be willing to make yourself available for a panel discussion, I would encourage you to reach out to your station to offer your participation. It could be a great opportunity to discuss how important it is to transform the way pain is perceived, judge and treated,” Webster says.
“I am realistic about the film. It won’t be the solution, but it may open some eyes and more importantly some hearts that could result in better pain care in America.”
NEW YORK (CBSNewYork) — The Drug Enforcement Administration said Monday that New York City and the nearby suburbs are facing a heroin epidemic.
As CBS2 Political Reporter Marcia Kramer reported, law enforcement is seeing record overdoses and a sharp rise in street heroin mixed with chemicals so powerful that even a miniscule amount can be deadly.
“The heroin problem right now in New York City, and really the whole country, is in a crisis state,” said New York DEA Special Agent-in-Charge James Hunt. “It’s something that we haven’t seen in years if ever.”
Hunt is talking about a terrifying development in the war against drugs. More people in the area are turning into heroin as the drug of choice because it is cheaper and more powerful with a higher content of the drug.
“The heroin right now that users are buying could range from 30 to 40 percent; sometimes 50 percent,” Hunt said. “If you take it back 30, 40 years ago, it was in the single digits.”
And because the heroin is stronger, often mixed with chemicals such as fentanyl, it is much more powerful and much more dangerous that what was on the street a generation ago.
“Sometime the size of a couple grains of salt can kill you,” Hunt said.
In New York, overdoses are soaring.
“Last year, we had approximately 1,200 overdoses. Now, if you look at that versus our homicide rate – it’s 335. It’s almost four times as much,” said NYPD Chief of Detectives Robert Boyce. “So we’re very concerned about it.”
Drug overdoses are up in all five boroughs. Comparing the first six months of 2015 to the first six months of 2016, the Department of Health saw drug overdoses rise from 115 to 252 in the Bronx, 120 to 223 in Brooklyn, 115 to 145 in Manhattan, 104 to 144 in Queens, and 51 to 69 on Staten Island.
“It’s creating a big problem as far as people using it, even those who have been addicts for some time,” Boyce said.
“I think it’s of increasing concern for us, and just keep in mind that we attack this on many different levels –an international level, a regional level; each and every borough has a major case team,” said NYPD Commissioner James O’Neill.
Officials said Monday that the heroin comes from Mexico, and that even with Mexican drug lord Joaquin “El Chapo” Guzman in custody in New York, the Mexican spigot is hard to turn off.
“The border of the United States is so porous – it’s thousands of miles of border,” Hunt said.
Federal drug agents have seen heroin seizure soar, from 100 kilos a day five years ago to 1,000 kilos now. New York accounts for one third of all the heroin seized in the U.S.
Hunt said people are getting addicted because they start with prescription drugs and move to heroin because it is cheaper.
“Eighty percent of new heroin users started with prescription drugs – prescription opiates, specifically – Percocet, Vicodin,” Hunt said.
According to Hunt, part of the problem is the economics. You can buy a bag of heroin for about $6 to $10, while a pill such as Percocet or OxyContin could cost between $25 and $50.
A company that operates acute care hospitals around the country says it has fired a pharmacist whose license has been suspended by The Ohio Board of Pharmacy.
The pharmacy board says Ernest Perrin admitted he personally diluted intravenous medication for the drugs Cubicin and Tygacil so patients wouldn’t get the full dose. The drugs are antibiotics. If and how Perrin may have personally profited is unclear.
The board tells 21 News that Ernest Perrin admitted what he did and said he did it to cut costs.
We also don’t know how many received the drugs but the board did tell us from roughly January 1 through February 23rd of this year, nine vials of Cubicin where turned into 105 vials and other drugs were given to patients at about half their strength.
Perrin worked at Select Specialty Hospital which is located on the 7th floor of St. Elizabeth’s hospital in Boardman but is not affiliated with St. E’s.
Specialty Select operates more than 100 acute care sites across the country.
A spokesperson from Select Medical who we contacted stressed patient safety and later added Perrin had been fired and they couldn’t comment further because it’s now a legal issue.
So what about patients who may have been treated with the diluted drugs?
One pharmacist 21 News talked to says the drugs in question are extremely expensive and not giving the correct dose can clearly put the patient’s life at risk since they are high-risk patients to begin with.
“With something like an antibiotic if we’re diluting the dose and the patient is not getting the correct amount it’s possible it won’t enter into the therapeutic window and it’s not going to kill the bacteria like it’s supposed to and that bacteria can develop resistance,” said AJ Caraballo, Pharmacy Manager of Hometown Pharmacy in Youngstown.
The state board of Pharmacy is considered a law enforcement agency so they could consider criminal charges against Perrin once they finish their investigation.
Chris Christie wants to limit painkiller prescriptions. Will that cut back on opioid addiction?
New Jersey Gov. Chris Christie has called for emergency curbs on the prescription of opioids, a move that would mirror laws in several other states that have curtailed the length of first-time prescriptions.
ONCE AGAIN… politicians use EMERGENCY RULE MAKING to AVOID a public comment period. Since we have 45 million alcoholics and 35 million addicted to Nicotine and > 550,000 death associated with the use/abuse of those drugs… Maybe more deaths could be prevented if we limited Alcohol sales to ONE OUNCE SINGLES of liquor and single can of beer – like is found on airplanes and cigarettes be sold as “singles” and there has to be a national registry that would limit the number could be purchased in a single day or days in a row.
Gov Christie had to have “lap-ban” surgery in May 2013 to help him “deal” with is “addiction to calories” and if the above picture is recent… while it appears to have lost weight, but a recommended weight loss is ONE POUND PER WEEK.. it has been nearly 200 weeks since his surgery… 200 lbs lost ?
—Gov. Chris Christie wants to tackle New Jersey’s opioid epidemic with an emergency measure that would place the state between doctors’ prescription pads and their patients.
Speaking at the State of the State address Tuesday evening, Mr. Christie called on New Jersey Attorney General Christopher Porrino to “use emergency rule-making and other regulatory reform to limit the supply of opioid-based pain medications,” hoping that a reduction in initial prescription length from the current 30-day supply limit to just five could prevent some patients from becoming addicted to the pills.
New Jersey isn’t the first state to propose drastic steps in response to the nationwide opioid crisis. States such as Massachusetts, Connecticut, New York, and several others have passed similar laws, arguing that the action could reverse the upwards trend of opioid-related deaths, which jumped to a record of 33,000 in 2015, according to the Centers for Disease Control and Prevention (CDC). But pharmaceutical companies and doctors object. Some note that opioid prescriptions have declined 12 percent since 2012, as The New York Times reported. And they maintain that prescription lengths should be a conversation that takes place between doctors and patients without the government’s input, and worry that the interference could discourage doctors from prescribing opioids at all.
Research has yet to determine the long-term benefits of these new, shorter limits, but growing support for the measures among policymakers does show an emerging consensus about how opioid addiction begins.
“When you see a state legislature or governor or attorney general put forward this type of intervention, what it demonstrates is an understanding of what’s been fueling the opioid crisis,” Andrew Kolodny, the director of the Opioid Policy Research Collaborative at Brandeis University’s Heller School, tells The Christian Science Monitor in a phone interview. “Until very recently, which is why I think the epidemic has worsened … policymakers didn’t understand that over prescribing was fueling the problem.”
For years, opioids were viewed through two distinct lenses: heroin, a dangerous and illicit substance used by drug abusers, and painkillers, medications given to relieve the pain of those who were injured or underwent a surgical procedure, or suffered from chronic pain. Pharmaceutical companies spent the past two decades urging doctors to issue looser, lengthier prescriptions, using targeted marketing campaigns to dismiss fears that the pills could lead to serious addictions and normalizing drugs that were previously doled out sparingly in extreme cases.
But as the number of overdoses and fatalities associated with the drugs rose, more began to see that many of the people who lost their lives in the ongoing epidemic began using prescription drugs for a minor injury and quickly became addicted to the highly potent pills, a revelation that changed the face of addiction.
Mr. Porrino said Wednesday he planned to submit Christie’s recommended rules to state regulators by the end of the month. The rules could be put into place within 30 days under the emergency law statutes.
“This allows us to take action very quickly,” Porrino told NJ.com.
Traditional legislative attempts to curtail the length of opioid prescriptions languished in the state, and a bill that would have placed a seven-day limit on the prescriptions died in committee last year, prompting Christie to seek alternative action. Christie says this issues is personal for him and made an impassioned speech about opioid addiction during a 2015 presidential campaign stop in N.H. that went viral on YouTube.
Additionally, on Tuesday, Christie called on Porrino to open “an investigation of the prescribing practices of our medical community and their interaction with the industry manufacturing these drugs,” a move that mirrors investigations in New Hampshire and Chicago that resulted in lawsuits against opioid manufacturers.
The prescription limit won’t have an effect on those who are introduced to the drugs through heroin, and likely will play little role to keep those addicted to pain pills from overdosing, Dr. Kolodny says, noting that such measures aren’t a cure-all for the crisis. But the rules could limit the number of new patients that go down the road to addiction, as well as others in their homes who could get hold of the leftover pills.
“If you supply someone a 30-day supply when they only needed two pills, the rest are in the medicine chest where they’re a hazard,” he says. “We do need much more cautious prescribing.”
Experts are scrambling to find solutions to the epidemic, but some doctors maintain that blanketed limits undermine the authority and expertise of medical professionals.
“Arbitrary pill limits or dosage limits are not the way to go,” Patrice Harris, chairwoman of the American Medical Association’s committee on opioid abuse, told Pew Charitable Trusts last year. “They are one-size-fits-all, blunt approaches.”
But others argue that for minor procedures, including many things from a tooth extraction to regularly-performed surgeries, opioids are often over-prescribed, leaving patients with leftover pills in the bottom of bottles that go unused — until they’re picked up for a nonmedical or unauthorized purpose.
A five-day limit, while slightly stricter than the seven-day limits found in several other states, sounds reasonable, Jonathan Chen, an instructor at Stanford University School of Medicine who has researched opioid abuse, says. Including a provision that allowed patients who did not receive adequate dosages to return to their doctors for additional pills would be key. And while that may be an inconvenience for some patients and busy doctors, it could cut back on the excess of pills lying around.
He also said drug-monitoring databases, which allow doctors to see what prescriptions patients have received from other physicians in the state, can help doctors to catch abusers who frequent multiple clinics.
“There’s no conflict between improving the quality of care for those with pain and reducing opioid use. What’s been set up is a false dichotomy: one of the pushes of the pharm lobby is to argue that any effort to rein in runaway prescribing is going to cause suffering and deprive people of necessary pain treatments,” Dr. Alexander said.
Still, Dr. Chen says, there’s also a societal shift that needs to happen alongside the law, changing how patients and doctors view painkillers and prompting them to use and prescribe them less.
“It’s tricky,” he says. “It’s really a cultural change that has to happen to readjust those parameters.”
Others point to medical marijuana as a possible, less-addictive substitute. In states where the substance has been approved widely for medical use, the number of deaths related to opioid abuse fell by 25 percent.
Government intervention in the medical sphere remains largely unwelcome by doctors and patients, who often feel their levels of expertise and private, personal cases may not fit neatly into legislation. Still, others aren’t sure how to reverse years of overprescribing that have come to define modern pain medicine, and think legal action could be the most effective solution.
“I don’t know if I want [the government] to be the one doing it, but they’re kind of in the position to be doing it,” Chen says.
Eleven West Virginia lawmakers have signed on as sponsors of legislation that would direct the state Board of Pharmacy to track reports of drugstores that order a “suspicious” number of highly addictive prescription opioids and other powerful narcotics.
The bill (HB 2735) also requires the pharmacy board to forward the reports to the Attorney General’s Office — a practice the board started in December.
The legislation follows a Gazette-Mail investigation that found the pharmacy board never acted on thousands of reports that flagged pharmacies for ordering unusually large quantities of pain pills and other controlled substances. Prescription drug distributors submit the reports to the pharmacy board.
“We asked the board why the reports were put in a shoebox, and their response was the Legislature hadn’t directed them what to do with the reports,” said Delegate Kelli Sobonya, R-Cabell, the bill’s lead sponsor. “We want to make sure there’s clear direction.”
For years, the pharmacy board didn’t investigate suspicious order reports, board administrators have told the Gazette-Mail. The agency never contacted the drug distributors or pharmacies. And the board didn’t pass the reports along to law enforcement authorities.
Instead, the board stored the reports in two banker’s boxes. The Gazette-Mail inspected the drug order reports in December. Nine months of reports from one company were missing. The board hadn’t counted the reports.
“What happened shouldn’t have happened,” Sobonya said. “It was an egregious oversight.”
The House bill requires the pharmacy board to keep a log of suspicious drug orders, including shipment dates, the names of companies that submit reports and pharmacies flagged for allegedly ordering too many narcotics.
“It would let the public know just how many suspicious shipments are coming into specific pharmacies and specific areas to see if there’s a pattern of misbehavior,” Sobonya said.
The pharmacy board also would have to disclose when it forwards the reports to the attorney general.
Under the bill, the Attorney General’s Office would review the reports and refer them to medical licensing boards, the U.S. Drug Enforcement Administration, law enforcement authorities or back to the pharmacy board for further investigation.
“Even though the attorney general doesn’t have prosecutorial powers, we felt there needed to be a clearinghouse to send the reports to the appropriate prosecutors and authorities,” Sobonya said. “It would add a second layer of accountability.”
The bill has been referred to the House Health and Human Resources Committee.
The West Virginia regulation that requires reports on suspicious drug orders — copied from federal law and on the pharmacy board’s books for more than a decade — was designed to keep in check the flow of prescription pills into the state.
The pharmacy board has acknowledged it didn’t start enforcing the reporting rules until December.
“When you have these shipments going into these communities — thousands of pills per resident — that should have been a red flag,” Sobonya said. “We have an addiction problem, and we have a duty as policymakers to try to help alleviate that.”
– See more at: http://www.wvgazettemail.com/news/20170305/wv-lawmakers-back-bill-to-track-suspicious-opioid-orders-#sthash.MUSvSUg8.dpuf
Normally I find ZDoggMD’s youtube satire pretty right on… IMO.. this time he wanted to talk about the mental health disease of addictive personality disorder…. but he starts out talking mostly abt chronic pain pts… Nice try ZDoggMD… but your MESSAGE MISSED THE TARGET…
(Medical Xpress)—A team of researchers with the Free University of Berlin and Zuse-Institut Berlin has developed a type of opioid that was shown to target pain in rats without causing negative side effects. In their paper published in the journal Science, the team describes the new opioid, how well it worked in rats and the side effects that were eliminated.
Most everyone knows about the positive and negative attributes of opioids—they are used to dull pain but are also highly addictive and have side effects such as constipation and respiratory distress. In this new effort, the researchers have developed a type of opioid they have named NFEPP that is works only on the part of the body that is in pain, while not affecting other parts, thus averting side effects.
As part of their research, the group noted that the parts of the body that hurt typically result in inflammation as the body tries to repair itself. They further noted that body parts experiencing inflammation tend to be more acidic than other parts. Because of that, they set about developing an opioid that would bind only to nerve receptors that exist in acidic environments. Opioids binding to untargeted parts of the body are what cause side effects, after all—binding to nerve cells in the gastrointestinal tract, for example, causes constipation and binding to nerve cells in the brain is what leads to feelings of euphoria and addiction.
The researchers tested the new opioid on rats, and found that it was comparable to the commonly prescribed opioid fentanyl in relieving pain, but it did not cause constipation, addiction, breathing problems, heart rate increases or changes to blood oxygen levels. In short, it appeared the new opioid alleviated pain as well as current opioids, but did not cause any noticeable side effects.
More research is required to test both the efficacy and safety of the opioid in rats and other test animals before it can be tested in humans, but if the opioid turns out to work in humans the way it does in rats, it could mark a truly transformative moment in medical science—a true breakthrough in pain mitigation and management.
On March 1st 2017, I went to my local CVS on Lantana Rd and Military Trail in Lake Worth Fl to refill a prescription. It was a new script because the old bottle had no refills remaining.
I drove up to the window and handed the young man Ash the new script. He went into the back and a few minutes later stated it would be ready by 2pm that day. I asked the young man if I could have it sooner since I was expecting a DHL delivery at home that required my signature. (My wedding dress)
He then left the window, returned to the back and then returned to the window with the pharmacist Muneera Imam. She told me that she would now, not fill my prescription and I should “do the math”, stating that I should have 4 pills remaining and she would not fill it until the next day.
I have been on a low dose of Alprazolam 1mg 2xday for anxiety for years.
In my opinion, she should have asked me to come inside and talk.
According to the CDC and the DEA, this prescription can be filled a few days early. If the pharmacist did not feel comfortable filling it at least she could have, again according to the CDC and the DEA gave me a couple of pills then subtract that amount when filling the script.
But NO, she embarrassed me in front of the other employees, made me feel stupid and acted like I was abusing my medication.
According to the law, when filling a controlled substance the attending pharmacist is supposed to circle the quantity of pills and initial the bottle. Which was not done for the February 2nd 2017 bottle.
I have never abused my medication and she had no right to accuse me of such. I also, have never “run out” prior to this last bottle. How do I know that someone at CVS didn’t count incorrectly since the amount on the bottle was never circled and there was no initials on it?
Let me now tell you what I experienced as a result of not having my medication.
My feet and hands went numb and we’re tingling. My heart was racing and the heart palpitations were so extreme it was like I was having a heart attack. My brain hurt. My eyes were blurry. I couldn’t sleep. I couldn’t talk. I couldn’t move and I actually seen my muscles twitching under my skin. It was something that I had never experienced in my life and never want to again.
The next day my fiance had to lose a day of work to pick up my prescription since I couldn’t move. I took a pill and slept most of the day. The following morning a awoke with extreme chest pains and went to the emergency room. The nurse at the hospital said I could have died because Muneera Imam put my health at risk. Aren’t pharmacist properly trained on what could happen if a patient abruptly stops a benzo medication?
I already have heart issues and all she had to do was to talk to me like a human being.
Now I am REQUIRED to see my primary doctor and my cardiologist to see if I have any damage to my heart as a result of the extreme withdrawals.
I uploaded the last prescription bottle as proof that there was NO circle and NO initials. Maybe CVS made the mistake. But Muneera Imam actions almost costed me my life. I am a mother and a grandmother and I want to be around for a very long time!
In case you haven’t figured this out by now this is from the GREAT STATE OF FLORIDA… Here the FL Board of Pharmacy Regulation that went into effect Dec ,2015 where a Pharmacist is suppose to NOT start looking for a reason NOT TO FILL a prescription http://floridaspharmacy.gov/latest-news/validate-pain-medication-prescriptions/
The cold turkey withdrawal can be more lethal/fatal than that of a opiate.
I have this pt’s name and pictures of the CVS labeled prescription bottles, but as usual.. I don’t divulge that information that is sent to me.
This is another example of a Pharmacist that will get her paycheck regardless if she fills prescriptions or not and apparently does not try to see if there are some extenuating circumstances.. just “DO THE MATH” … that is what healthcare is all about “DOING THE MATH”…
Once again, I suggest that pts that receive such treatment from a chain pharmacist, that they go looking for a independent pharmacy (Mom & Pop)… here is a website where you can find them via zip codehttp://www.ncpanet.org/home/find-your-local-pharmacy
Where you will be dealing the Pharmacist/owner.. who doesn’t get paid unless they fill legit/on time/medically necessary prescriptions. If they participate in your insurance company’s network, normally your copay will be the same.
Pts with chronic health conditions should not be expected to BEG a healthcare professional to take care of their needs. In this case there was “financial damages” incurred by the pt and her spouse… so an attorney might be interested in seeking restitution to “make them whole”
The couple that posted the photos said they witnesses older vets being mistreated and ignored during lengthy waits for service. One photo showed a veteran in pain lying on the floor.
Director Deanne Seekins told reporters video from the waiting room has been reviewed and it has been determined that three things could have been done better.
“Veterans come to us in their most vulnerable moments – when they are sick and at times in excruciating pain,” Seekins explained. “They deserve a safe and comfortable place while waiting for care and to be treated respectfully at all times. Our review of the incident has brought to light some additional steps that we will take to improve the comfort of the Emergency Department.”
Seekins said they’re going to add recliners to the waiting room and improve their “surge plan” when things get busy to include juice and snacks.
“I’m also committed to ensuring that if we have failures in performance that we address them properly and with the vet’s well-being at the center of our decisions. I personally apologize for a breakdown in customer service this past weekend,” offered Nurse Executive Dr. Greg Eagerton.
The investigation also turned up rude behavior by a nurse. We’re told that person has been disciplined, but we haven’t been told how.
The veteran who brought the allegations, Steve McMenamin, says he’s not satisfied with the changes announced.
“It’s something to show the public, to quiet the public down, but I think there are still a lot of changes that need to happen,” McMenamin said. “They listened to us because they had to. The way things were going at first, they really, really wanted to shut us up. Now that they can’t, I think they’re trying to appease the people more or less.”
McMenamin said the changes announced Friday don’t address root causes of problems, but rather treat the symptoms.
“This is more of a bandaid over the cut and we need to treat the cut,” he said.
“The doctors that we got treated by that night were top notch,” McMenamin said. “We got everything we needed once we got there, but the wait time, seven hours for us was pretty substantial for about a 5 minute visit with the doctor. What’s in question here is not the doctor, it’s what happened before the doctor, with the nursing staff and the wait times. I mean, guys laying on the floor because it’s their only option. It’s not a good option.”
Do you have a legal question? WRAL is Here to Help with Attorneys on Call.
On Friday, March 3, more than 150 local lawyers will be live in WRAL’s studio, waiting to take your calls and offer free legal information about topics including family, employment, housing and debt issues.
Phone lines are open from 7 a.m. to 7 p.m.
Spanish-speaking lawyers will be also available.
The expertise is absolutely free and completely confidential.
Volunteer attorneys staff five call centers across the state, including WRAL. The attorneys will only take questions over the phone.
