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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…
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https://medicalxpress.com/news/2017-03-opioid-pain-areas-negative-side.html
(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.
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.
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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 code http://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”
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http://abc11.com/news/durham-va-makes-changes-after-troubling-waiting-room-photos/1783334/
Officials at the Durham VA hospital said Friday changes have been made after troubling photos of the facility’s waiting room were posted to Facebook.
CLICK HERE TO READ THE ORIGINAL STORY
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.
READ DIRECTOR DEANNA SEEKINS’ FULL STATEMENT HERE
The changes also came with an apology.
“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.”
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http://www.wral.com/here-to-help-attorneys-on-call/9207273/
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.
Attorneys on Call is part of the North Carolina Bar Association’s annual Statewide Service Day.
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A few months ago I made the post below
Now here comes the Senate Democrats with a new proposal to import drugs from:
Secretary Tom Price to issue regulations allowing drug wholesalers, pharmacies and individuals to import drugs manufactured at facilities inspected by the Food and Drug Administration and sold by FDA-certified Canadian sellers.
http://www.modernhealthcare.com/article/20170228/NEWS/170229911
Democratic senators have introduced a bill that would allow for importing of low-cost medicines from Canada and other nations.
Sens. Bernie Sanders (I-Vt.), Cory Booker (D-N.J.) and Bob Casey (D-Penn.) introduced legislation Tuesday that would instruct HHS Secretary Tom Price to issue regulations allowing drug wholesalers, pharmacies and individuals to import drugs manufactured at facilities inspected by the Food and Drug Administration and sold by FDA-certified Canadian sellers. Two years later, the secretary would be authorized to allow importation from certain countries that meet U.S. standards.
A companion bill was introduced in the house by Reps. Elijah Cummings (D-Md.) and Lloyd Doggett (D-Texas). The bill would not permit importation of controlled substances, anesthetic drugs inhaled during surgery, or compounded drugs, and sellers would be required to pay a fee to fund the importation program.
Drugs purchased under the act would have to have the same basic characteristics as the version of the drugs approved in the U.S., and HHS would be authorized to approve laboratory testing of the imported drugs to assess their chemical authenticity. Individuals would be barred from importing certain types of drugs, including some biologics, that could only be imported by wholesalers or pharmacies.
President Donald Trump advocated for the importation of drugs throughout his campaign and has chastised drugmakers for their U.S. pricing strategies. He’s also called for border taxes, including a proposed 20% tax on Mexican imports.
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https://youtu.be/EnLV7wH-_K4
http://www.wgnsradio.com/sgt-allegedly-kills-himself-on-va-campus—update-cms-36394
In Murfreesboro, a man found dead on the VA property this past week is the same man who said he asked for help, but did not get it.
Sergeant John Toombs recorded a video (ABOVE) just before committing suicide. He claimed, “I came for help and they threw me out just like a stray dog in the rain.” Toombs also stated, “The knew the extent of my problems.”
Sgt. Toombs served in Afghanistan with the US Army. He was said to have been kicked out of the VA just days before Thanksgiving, according to a phone call received by his father exactly two days before the holiday.
Sgt. Toombs later hung himself in a vacant building on the VA campus in Murfreesboro.
U.S. Department of Veteran Affairs’ Health System Director, Jennifer Vedral-Baron, released the following statement Monday afternoon:
A tragic incident occurred at the VA Tennessee Valley Healthcare System (TVHS) Alvin C. York campus in Murfreesboro, TN. At approximately 6:40 a.m., Wednesday, November 23, 2016, personnel arriving for work discovered Mr. John Toombs, an Army Veteran, deceased in an apparent suicide.
This is a heart wrenching tragedy for everyone involved. Out of respect for the Veteran and his family, we are unable to speak further about the specifics of his care and benefits in accordance with his privacy rights under HIPAA. Management and staff of TVHS offer our sincere condolences, and our thoughts and prayers are with Mr. Toombs’ family and friends.
Suicide is a tragic outcome and even one suicide is one too many. VA is committed to ensuring the safety of our Veterans, especially when they are in crisis. Veterans, Servicemembers, and their loved ones in crisis can call the Veterans Crisis Line at 1-800-273-8255 and press 1, send a text message to 838255, or chat online at VeteransCrisisLine.net to receive free, confidential support 24 hours a day, 7 days a week, 365 days a year, even if they are not registered with VA or enrolled in VA health care.
The Rutherford County Sheriff’s Office is assisting in the investigation into the death of Sgt. Toombs
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https://www.vice.com/en_us/article/the-feds-are-about-to-stick-it-to-pain-patients-in-a-big-way
Before she turned 18, Anne*, a nurse, had endured at least five major surgeries, all without the use of post-op medication stronger than ibuprofen. As a child in Birmingham, Alabama, she had been diagnosed with cerebral palsy, but eventually learned that she actually has primary generalized dystonia, a genetic disorder that causes frequent painful muscle spasms and rigidity. By 19, she says, she had tried pretty much every treatment available, including a spinal implant that made matters worse.
Then she was given a prescription opioid.
Here is where your typical American news story might turn into a parable of addiction and dysfunction, even though the evidence we have suggests the vast majority of pain patients don’t become addicted. But Anne’s story is different, and there are millions of patients taking opioids for pain whose voices are rarely heard.
Their ability to live and function well is now in danger because doctors and insurance companies have turned what were supposed to be voluntary guidelines issued last year by the Centers for Disease Control (CDC) into inflexible rules. Soon, Medicare plans to follow suit, with potentially massive implications for how pain is treated—or not treated—in America. This relentless focus on cutting medical use of opioids in the face of a real addiction crisis is starting to damage the middle- and working-class people it was intended to help. And because so many are also facing job loss and wage stagnation, we can’t really help until we recognize how economic, emotional, and physical pain are intertwined.
In Anne’s case, opioids seemed like a godsend. Thanks to this class of drugs, she says, she was able to complete nursing school and become a hospice nurse. And even when her disease progressed and she could no longer work, opioids allowed her to live independently. When she decided at one point for herself to go for months without them, Anne tells me, she lost the use of her hands.
In a letter to a local medical board explaining why access to these medications matters, Anne wrote that during six months without opioids, “I was in the worst shape of my entire life—reliant on a power wheelchair, losing weight rapidly, with severe rigidity… unable to sit without support, with clenched fingers that rendered my hands useless.”
Now 36, Anne fears she will be forced to go back to that straitened way of life. Over the past few years, doctors who prescribe high doses of opioids for patients like her have been increasingly targeted by law enforcement and medical boards, leaving some physicians terrified that any unusual prescribing pattern will put them at risk of losing their license or going to prison. And interviews, news stories, blog entries, and emails from numerous pain patients—as well as surveys and social media posts—suggest Anne’s case is far from unusual.
After one of Anne’s doctors stopped prescribing, she says, she called more than 60 physicians before finding one willing to prescribe the medication that works for her, despite a documented medical history without signs of addiction. But the CDC guidelines—which were supposed to be flexible and to be used by primary care doctors (not specialists)—have increasingly taken on the air of law. To protect themselves, some pain specialists have stopped prescribing any opioids at all or cut back patient doses to fall within the guidelines, regardless of whether their current doses are helping their patients.
Worse, just this month, the Center for Medicaid and Medicare Services (CMS) announced that it will soon apply the CDC guidelines to everyone insured via Medicare, which means that patients on high doses may find themselves cut off without much—or any—notice.
Doses outside the guidelines—except in end-of-life care—could soon trigger a process that prevents pharmacists from filling prescriptions. Yet that process for other exceptions is not yet clear, according to Stefan Kertesz, associate professor of preventive medicine at the University of Alabama, who has corresponded with the agency. (VICE reached out to CMS for comment, but the agency did not provide one prior to publication.)
“If a doctor could anticipate the need for special approval, and if he or she could obtain it in a rapid fashion, this process might not cause serious harm to patients,” Kertesz says. “However, we have no basis for expecting that kind of fluid rapid and clear communication in the history of managed care… I’m worried that the mechanics of how this will be implemented would result in patients being thrown into acute withdrawal, which would be medically risky.”
The Medicare plan seems to be based, at least in part, on a white paper written in collaboration between insurance companies and academic researchers. And according to Kertesz, insurers often extend policies that originate in Medicaid and Medicare to their private patients. What this means is that soon, anyone—either on Medicare, Medicaid, or privately insured—who takes a dose of opioids that is outside the CDC’s acceptable range may be pressured to cut down or stop the medications entirely, even if the same meds are keeping him or her functional and productive.
“It’s like a runaway freight train,” says Pat Anson, a journalist who covers these issues for a specialist publication, the Pain News Network.
Indeed, in every other area of medicine, “personalization” and “individualized care” are the buzzwords—but not when it comes to opioids.
Meanwhile, the crackdown isn’t curing people with addiction, even if it does seem to be shifting them to heroin. The result, among other things, has been more death: Just this past week, in fact, the CDC released data showing yet another jump in the overdose death rate, even though prescribing has continually fallen since 2012. According to the study, the proportion of overdose deaths involving heroin has tripled since 2010, while those involving prescription opioids have fallen. It’s not really in dispute at this point that being cut from medical opioids can send people in search of of riskier street drugs, sometimes cut with the super potent fentanyl and its derivatives.
But in the regions hardest hit by opioid problems—yes, these are some of the same areas that fell unexpectedly hard for Trump—opioid deaths are not the only kind of mortality on the rise. Deaths from suicide and alcoholism have risen, too—and the rise has been so large for whites that it has paused what once seemed like inevitable increases in lifespan in successive generations. Neither of these causes of death can be blamed solely or even mostly on increased opioid supply; instead, the trend points increasingly to an underlying common cause: the slow-motion economic collapse of these communities.
“These tend to be places that were once dependent on manufacturing or mining jobs and then lost a chunk of those,” explains Shannon Monnat, assistant professor of rural sociology at Penn State, who has published research on the Trump-voter-death-rate connection. “They tend to have experienced a decline or stagnation in median income. They have higher rates of poverty. It’s really that these are downward-mobility counties.”
Check out our interview with director Barry Jenkins, whose film Moonlight won Best Picture at the 2017 Academy Awards.
Opioids seem to be hitting these communities hard for the same reason crack was so devastating in black neighborhoods in the 1980s and early 1990s. Basically, not only did the drugs themselves provide escape and relief from distress, but they also offered one of the few avenues of economic opportunity: jobs in the drug trade.
Overwhelmingly, these rural addictions do not start with medical use, which reflects national patterns. However, a critical factor in their stories is childhood trauma, according to Khary Rigg, assistant professor in the Department of Mental Health Law and Policy at the University of South Florida. “These are folks who primarily are using painkillers, but also heroin,” he says before describing how the interviews he conducts with participants involve telling their stories chronologically. “They start talking about really, really intense traumatic experiences: rape, things like child abuse, molestation, witnessing someone die.”
Traumatized people seeking emotional relief are not going to be fixed by cutting off one source of their drug supply. Nor are patients like Anne. To wit: When yet another doctor recently stopped prescribing and she was forced to lower her dose to near the CDC-recommended levels, Anne fell out of her wheelchair and broke two crowns she’d just had placed on her teeth.
“My whole body was like, one shaking, jerking mess,” she says.
The Medicare changes are open for public comment until March 3 at this email address.
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https://youtu.be/aQO-xOntmEo
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