More bureaucratic MICRO-MANAGING ?

Senate OKs bill allowing doctors to eat conference food paid for by drug companies

https://vtdigger.org/2017/02/25/senate-bill-allows-doctors-eat-conference-food-paid-drug-companies/

The Vermont Senate gave preliminary approval Friday to a bill that would allow doctors and other health care providers to eat food paid for by pharmaceutical companies.

The Senate approved S.45 in a voice vote, with a handful of voices dissenting. The bill is scheduled to be read the third time, and possibly passed, on Tuesday. The bill would then head to the House.

If S.45 is approved by the Legislature, Vermont would adopt federal rules to allow doctors to eat food provided at conferences, but require pharmaceutical companies to report more free food as gifts, according to Sen. Debbie Ingram, D-Chittenden.

Currently, lawmakers say state statute prohibiting certain gifts from pharmaceutical companies to doctors and other health care providers means that those providers cannot accept free food from pharmaceutical companies at conferences.

“Our highly restrictive laws, which are more stringent even than federal law, are inhibiting our physicians’ abilities to participating fully in continuing ed conferences,” Ingram said.

She said pharmaceutical companies sometimes embarrass Vermont physicians who go to their conferences by placing a sign in front of conference buffets saying Vermont practitioners are not allowed to eat the food.

Ingram read a letter on the Senate floor from a doctor in Burlington who said he attended a conference but had to take a taxi to a nearby restaurant to find food. The doctor, who was unnamed, said he missed presentations. The Vermont Medical Society asked Ingram not to disclose the doctor’s identity.

Jessa Barnard, a lobbyist for the Vermont Medical Society, said in an interview that S.45 was one of the organization’s legislative priorities this year.

“This is solving a fairly narrow problem of being able to accept food at a conference when the content that accompanies that food is either accredited (continuing medical education) or otherwise objective and free from influence,” Barnard said.

She described what happens at many national conferences: “There may be a lunch or some coffee in back of the room, but if that’s provided by a drug manufacturer, rather than the conference itself, they’re not able to accept that food.”

“Sometimes they’re not able to enter the room because that’s easier for the conference sponsor to just say, ‘You can’t even be in the same location so we don’t have to track if you’ve accepted the food,’” Barnard said.

She said the current law is “an impediment to obtaining continuing education.”

Even when voters SPEAK… bureaucrats have to MICRO-MANAGE ?

Ohio regulators propose strict limits for medical pot supply

http://www.charlotteobserver.com/news/article134950574.html

Ohio regulators have proposed restrictions on how much medical marijuana a patient could buy that would be among the strictest in the nation.

Under Ohio’s medical marijuana law, patients with 20 medical conditions can buy and use marijuana if recommended by a doctor. The state’s program is slated to become operational in September 2018.

The Ohio State Board of Pharmacy this past week released draft rules detailing the allowable amounts, Cleveland.com reported (http://bit.ly/2lCVI1T ).

Regulators are proposing limiting supplies by a product’s amount of THC, the psychoactive ingredient in marijuana. Ohio would be the first of the 28 medical marijuana states to calculate limits this way.

“I think this is the right approach because we’re in the middle of the pack of states that have adopted this,” Steven Schierholt, executive director of the State Board of Pharmacy, told the Ohio Medical Marijuana Advisory Committee. “We’ve benefited from what other states have done and have the benefit of their successes and failures.”

Patients could buy and possess up to six ounces of plant material or marijuana products containing the equivalent amount of THC in a 90-day period. Patients could mix and match products, but the amount could not exceed a total 90-day supply.

Chris Lindsey, senior legislative counsel for pro-marijuana group Marijuana Policy Project, said dosage and supply are tricky limits for the state to set because doctors can’t prescribe how much a patient can consume.

The proposed rules would impose a $100 fee on each strain or dosage of a product, which would likely be paid by the product manufacturer.

Public comment on the proposal is being accepted through March 10. The rules will go through two more stages of review and comment before being finalized.

Obama vs Trump AG :Army vet faces trial for posting flags at VA site

Army vet faces trial for posting flags at VA site, Sessions asked to intervene

http://www.foxnews.com/politics/2017/02/24/army-vet-faces-trial-for-posting-flags-at-va-site-sessions-asked-to-intervene.html

A 74-year-old U.S. Army veteran is set to go on trial next month for the ‘crime’ of posting two American flags on the fence of a Los Angeles VA facility — and the Justice Department is facing calls to drop the case. 

The criminal prosecution of Robert Rosebrock dates back to charges filed under the Obama administration, but conservative group Judicial Watch is hoping new Attorney General Jeff Sessions will take a second look. 

“Frankly, President Trump should ask why the VA and his Justice Department are trying to jail this American patriot,” Judicial Watch President Tom Fitton said in a statement. His group is now representing Rosebrock. 

“The federal government’s pursuit of these vindictive charges against Mr. Rosebrock is mind-blowing,” he added. 

Judicial Watch Director of Litigation Paul Orfanedes confirmed to Fox News they have reached out to Sessions with a request to intervene before the scheduled March 7 trial.

Rosebrock is facing one criminal charge for displaying an American flag without permission on the fence outside the Greater Los Angeles Veterans Affairs (GLAVA) facility during a protest of the VA’s treatment of homeless veterans.

The charge is related to a 1973 VA regulation that prohibits individuals from posting materials or placards on VA property except when authorized by the head of the VA facility or a designee.

Rosebrock faces a criminal count of violating that policy during a protest last Memorial Day and on June 12, 2016. In the second incident, Rosebrock was not even the individual who posted the flag. Orfanedes told Fox News the reason why the police chose to enforce the policy on those days remains unclear.  

Rosebrock is facing an two additional counts for allegedly taking unauthorized photos of a VA police officer on Memorial Day and during the second protest when conservative activist Ted Hayes was handcuffed and detained. Hayes is not being prosecuted.

Rosebrock, who served in the Army from 1965 to 1967, pleaded not guilty but faces up to six months in prison if found guilty.

Neither the Justice Department nor the Department of Veterans Affairs returned calls seeking comment.

The roots of the unusual case date back almost a decade, when Rosebrock held his first protest. Every Sunday since March 2008, Rosebrock and other veterans have placed flags on the fence as a means of drawing attention to what they allege is VA mistreatment of homeless vets.

For almost 66 weeks, he and other veterans placed their flags on the fences without any interference from police. It was only after some of the protesters started hanging the flag upside-down that the police became involved.  

Starting in June 2009, they began issuing citations for “unauthorized demonstration or service in a national cemetery or on other VA property,” according to the ACLU of Los Angeles, which represented him in a 2010 First Amendment lawsuit.

In May 2011, U.S. District Judge S. James Otero found the VA had violated Rosebrock’s First Amendment rights, and the VA eventually dismissed the citations against him.

While it would not grant him any damages, the 9th Circuit Court determined that VA enforcement only began “when protestors hung the American flag union down on the fence.” Orfanedes said the protesters haven’t hung the flag upside-down since 2010. 

Although the VA may view Rosebrock and his fellow vets to be a nuisance, the attention on the VA’s management of the Los Angeles properties has led to change.

For example, the ACLU of Southern California also filed a lawsuit in 2011 alleging the VA had illegally leased land, including to UCLA for its baseball stadium and to a parking service. The VA eventually settled in 2015 and subsequently unveiled a plan to improve its management of the Los Angeles campus.

Will the Trump Admin take a different stance on the abuse of CPP by the CDC ?

CDC: Withdraw Guidelines for Prescribing Opioids for Chronic Pain

http://petitions.moveon.org/sign/cdc-withdraw-guideline.fb49?source=s.fb&r_by=18051621

The CDC’s Guidelines are inappropriate, short sighted, and are more harmful than helpful to pain patients. Developed in violation of the Federal Advisory Committee Act’s (FACA) regulations with little to no evidence used in support, the Guidelines are blatantly discriminatory to existing pain patients, licensed pain specialists, and responsible users of opioid medication, and should be withdrawn.
There are currently 5,105 signatures. NEW goal – We need 7,500 signatures!
 
 

Petition Background

This petition is on behalf of all chronic pain sufferers, as well as their families and loved ones. For myself and those like me, the responsible prescription and use of opioid pain medication is all that makes it possible for us to function as productive members of society. The CDC Guidelines have been developed irresponsibly and without the patient in mind, focusing instead only on the potential for abuse. The prescription of pain relief medication should not be dictated by government decree, but instead should be responsibly managed by a licensed physician and pain professional.

60 percent of all the caregivers made errors when doling medication into a pillbox

https://youtu.be/HVuSC67-ljI

Third of Home Care Staff Make Medication Errors – What You Can Do

http://www.123trump.com/49805.html

A Northwestern University study has shown that more than one-third of paid home care staff had difficulty reading and understanding health-related information and directions. Sixty percent made errors when sorting medications into pillboxes.

Nearly 100 paid, non-family caregivers were recruited in the Chicago area and their health literacy levels and the health-related responsibilities were assessed, said Lee Lindquist, MD, assistant professor of geriatrics at Northwestern University Feinberg School of Medicine and physician at Northwestern Memorial Hospital.

Nearly 86 percent of the caregivers performed health-related tasks. Most were women, about 50 years old, foreign born or with limited education. Many made under minimum wage.
Despite pay, country of birth, or education level, 60 percent of all the caregivers made errors when doling medication into a pillbox.

Lindquist said. “If you really want to know if the caregiver is doing a good job and is taking care of the health needs of your senior, start by going into the home, observing them doing the tasks, and asking more questions.”

When evaluating a care provider ask if:

* they provide training for staff at orientation on medication management.
* they provide ongoing training to staff as medications change, come and go.
* use a licensed pharmacist on a consulting basis.
* they equip staff with smart-phone apps that staff can download that can help with medication identification and management.

“Most physicians and family members do not realize that while the caregiver is nodding and saying ‘yes,’ she might not really understand what is being said,” he said.

 

Woman Sues Pharmacy Claiming She Was Given Wrong Pills

Woman Sues Pharmacy Claiming She Was Given Wrong Pills

Says She Hallucinated, Had ‘Terrible Nightmares’

http://www.newschannel5.com/news/local-news/woman-sues-pharmacy-claiming-she-was-given-wrong-pills

This woman’s adverse effects of getting the wrong medication is that much different than a opiate dependent pts being intentionally thrown into cold turkey withdrawal by a healthcare professional ?  And an attorney is willing to sue the “guilty party” … WHAT IS WRONG WITH THIS PICTURE ?

GALLATIN, Tenn. – A woman was written a prescription for sleeping pills, but she went home with an anti-psychotic drug and said she almost lost her mind.

Now Donna Duncan, a Mid-State woman, has sued in federal court, accusing the pharmacist of making a big mistake.

Her case might make people think twice before assuming they’re always getting the right medication.

Consider this: nearly five billion prescriptions have been filled every year in the U.S., and two percent have been mistakes.

It may not sound like much, but that means millions of patients get the wrong pills. For Duncan, that was a big problem.

“I was praying to God let it pass, and the other prayer was take me home. I just wanted it to end,” Duncan said.

She has suffered from restless leg syndrome and went for her usual prescription — Ropinirole — at a CVS pharmacy in Gallatin.

Duncan said she took it home, swallowed three pills, and her nightmare began.

“I didn’t know what was going on,” she said. “I was hallucinating. My body felt like the limbs were detached from me. I had terrible nightmares.”

Then Duncan woke up talking crazy to her husband and daughter, Molly.

“I started telling the story of being two years old out to sea, and I witnessed a murder,” said Duncan.

“I was like, okay, something is not right,” Molly observed.

Duncan’s daughter immediately noticed her rational, sensible mother was talking out of her head, so she checked her pill bottle for the Ropinirole.

“It says this is a pink round tablet with the ‘HH’ on the back,” said Molly.

But the pills she found inside were not pink, and they were marked with the letter “M.”

“Wrong pills in the right bottle with the right name with the right dosage with the right patient,” said Clint Kelly, Duncan’s attorney.

Kelly has sued Tennessee CVS Pharmacy in federal court alleging his client was given the wrong pills.

“Clearly some safety protocols were bypassed,” Kelly said.

He said Duncan was mistakenly given Risperdone, an anti-psychotic drug meant for schizophrenics.

“Serious mental patients in hospitals… everybody but Donna Duncan,” Kelly said.

“I didn’t know what was going on,” Duncan said.

She had to be hospitalized for taking the dose of Risperdone, which she did not need.

“They started pushing IV fluid to push it through me,” said Duncan.

She said the traumatic experience where she seemingly lost her mind has continued to haunt her.

Duncan added something like this could happen to anyone, so what does she do now if she needs a prescription?

“Every single time I fill a prescription, I see the pharmacist, we open the bag, and see the medication, and he must reassure me that it’s the medication it’s supposed to be,” said Duncan.

Attorneys for CVS have filed a response denying the allegations of negligence and recklessness.

They have been asking to have the lawsuit dismissed.

Light at the end of the tunnel – is not a TRAIN …

White House Opens Door To Crackdown On Recreational Marijuana

Trump pledged to respect states’ rights on marijuana during his campaign. This may signal a reversal on that promise.

http://www.huffingtonpost.com/entry/trump-recreational-marijuana-weed-states_us_58af3a8fe4b060480e05ef0e?

President Trump has stated that he was going to be a “law and order President”…  AG Sessions has also stated that he is going to enforce all laws.

As we have all noticed, President Obama was extremely discriminatory in enforcing some laws and likewise ignore or over looking the enforcement of many laws … particularly those involving people who have to deal with their subjective disease treatment.

How many times have we hear about Pharmacists discussing a pt’s health/medication issues in a load enough tone that many/all people around the Rx dept area could hear… can you say HIPAA VIOLATION ?

Likewise, how many times have we heard about Pharmacists “not being comfortable” about filling a pt’s prescription for some controlled medication. No reason given, just “not comfortable” and intentionally throwing dependent pts into cold turkey withdrawal.

Enforcement of the Americans with Disability Act was virtually non-existent…  under the Obama Administration … Let’s challenge the Trump Administration on its promise to be a “law and order administration”.

Obama/Holder told the DEA to not bother states where MJ had been legalized… they ignored them… Congress passed a law to tell the DEA to not bother states where MJ had been legalized.. they ignored Congress… a Federal judge told the DEA to not bother states where MJ had been legalized.. and they ignored him/her.

Here is the website to file a ADA complaint  https://www.ada.gov/filing_complaint.htm

If you are on Medicare/Medicaid/Medicare Advantage here is the website www.cms.gov  (800-MEDICARE) for denial of care or poor care by doctors, hospitals, pharmacies/pharmacists, insurance company, Part D provider.

Get your smart phone out and audio/video record denial of care by Rx dept staff.  The only way that you can guarantee that what was done/not done can’t be misrepresented by the Rx dept staff.

If you want proper treatment and want justice.. you have to STEP UP TO THE PLATE…

White House press secretary Sean Spicer suggested during a press conference Thursday that the federal government may crack down on states that have legalized recreational marijuana.

Spicer explained that President Donald Trump sees the legalization of medical and recreational marijuana as two distinct issues. When it comes to medical marijuana, Spicer indicated that the president understands the importance of the drug’s availability, especially to those facing terminal diseases. But when it comes to recreational use, Spicer had a very different take, connecting recreational marijuana use to the opioid crisis currently ravaging the nation.

“There’s a big difference between [medical marijuana] and recreational marijuana and I think that when you see something like the opioid addiction crisis blossoming in so many states around this country, the last thing we should be encouraging people ― there’s still a federal law that we need to abide by when it comes to recreational marijuana and other drugs of that nature,” Spicer said.

When asked if the federal government will take action around recreational marijuana, Spicer said, “That’s a question for the Department of Justice. I do believe that you’ll see greater enforcement of it. Recreational use … is something the Department of Justice will be looking into.”

Marijuana remains illegal under the federal Controlled Substances Act, despite statewide efforts to scale back on criminalizing the plant over the past few years. Legal recreational marijuana has been approved in eight states and Washington, D.C., which continues to ban sales, unlike the state programs. A total of 28 states have legalized marijuana for medical purposes. Former President Barack Obama’s Justice Department allowed states to forge their own way on marijuana policy with guidance urging federal prosecutors to refrain from targeting state-legal marijuana operations. But this guidance is not law and can be reversed by the Trump administration.

Spicer’s comments Thursday came moments after he addressed the White House’s controversial decision to rescind federal protections barring schools from discriminating against transgender students as a matter of “states’ rights” ― a philosophy that Trump appeared to support with regard to marijuana during his campaign, when he repeatedly said he would respect states’ positions on the issue. But following his election, Trump’s selection of Jeff Sessions as attorney general alarmed many drug policy reformers. 

That’s because Sessions has long held retrograde views on marijuana and the war on drugs. During a Senate hearing last year, Sessions spoke out against weed and urged the federal government to send the message to the public that “good people don’t smoke marijuana.” He went on to criticize Obama for not speaking out more forcefully against the drug, saying that “we need grown-ups in Washington to say marijuana is not the kind of thing that ought to be legalized.” In separate comments last year, Sessions also called the legalization of marijuana “a mistake.” 

Either the President is flip-flopping or his staff is, once again, speaking out of turn.” Rep. Jared Polis (D-Colo.)

Earlier this year, during Sessions’ confirmation hearings, the former Alabama senator offered only vague answers about how he might approach the drug. While he didn’t appear to suggest there would be any radical changes to federal enforcement, he left the door open for increased federal interference.

Drug policy reformers have raised concerns that Sessions could use the FBI to crack down on marijuana operations nationwide, or direct the Drug Enforcement Administration to enforce federal prohibition outside of the jurisdiction of the U.S. Court of Appeals for the 9th Circuit. The court ruled in August that a federal rider blocks federal officials from prosecuting state-legal marijuana operators and patients. But that rider must be re-approved annually, and if it’s allowed to expire, Sessions could then order the DEA to enforce federal law nationally. He could also sue the various state governments that have set up regulatory schemes.

Spicer’s comments Thursday are also in opposition to statements from Rep. Dana Rohrabacher (R-Calif.), a vocal proponent for reforming marijuana laws, who told The Huffington Post in November that Sessions would not interfere with states that have legalized marijuana, a position that he characterized as consistent with Trump’s.

Rep. Jared Polis (D-Colo.), a vocal proponent for reform of federal marijuana laws, said Spicer’s comments suggest that Trump may be “flip-flopping” on the issue. 

“The President has said time and again that the decision about marijuana needs to be left to the states,” Polis said in a statement to HuffPost. “Now either the President is flip-flopping or his staff is, once again, speaking out of turn, either way these comments leave doubt and uncertainty for the marijuana industry, stifling job growth in my state. The public has spoken on recreational marijuana, we’ve seen it work in Colorado, and now is the time to lift the federal prohibition.”

Rep. Earl Blumenauer (D-Ore.), who launched the congressional Cannabis Caucus earlier this month along with Polis and two other congressmen, said he was “deeply disappointed” by Spicer’s remarks.

“The national prohibition of cannabis has been a failure, and millions of voters across the country have demanded a more sensible approach,” Blumenauer said. The Cannabis Caucus is a group of lawmakers dedicated to protecting the burgeoning legal weed industry.

A federal crackdown on states that have legalized marijuana is in direct opposition with what American voters have said they want. A new survey from Quinnipiac University released Thursday found that a strong majority of American voters ― 71 percent ― want the federal government to respect state marijuana laws. Majorities of Republicans, Democrats, independents and every age group polled agreed: the feds should not enforce prohibition in states that have legalized medical or recreational marijuana. 

The trend of state-level legalization also reflects a broader cultural shift toward acceptance of marijuana, the most commonly used illicit substance in the United States. National support for the legalization of marijuana has risen dramatically in recent years, reaching historic highs in multiple polls just last month. States like Colorado have established regulated marijuana marketplaces, and successes there have debunked some lawmakers’ and law enforcers’ predictions that such polices would result in disaster

Recreational use … is something the Department of Justice will be looking into.” White House press secretary Sean Spicer

Drug policy reformers blasted Spicer’s Thursday remarks.

“If the administration is looking for ways to become less popular, cracking down on voter-approved marijuana laws would be a great way to do it,” said Tom Angell, chairman of Marijuana Majority. “On the campaign trail, President Trump clearly and repeatedly pledged that he would leave decisions on cannabis policy to the states. With a clear and growing majority of the country now supporting legalization, reneging on his promises would be a political disaster and huge distraction from the rest of the president’s agenda.”

National Cannabis Industry Association executive director Aaron Smith said it would be a “mistake” for DOJ to “overthrow the will of the voters and state governments” who have set up regulated adult-use programs.

“It would represent a rejection of the values of economic growth, limited government, and respect for federalism that Republicans claim to embrace,” Smith said.

Mason Tvert, director of communications for Marijuana Policy Project, said that while Spicer claims there’s a difference between medical and recreational marijuana, the “benefits and need for regulation” apply equally to both.

“This administration is claiming that it values states’ rights, so we hope they will respect the rights of states to determine their own marijuana policies,” Tvert added. “It is hard to imagine why anyone would want marijuana to be produced and sold by cartels and criminals rather than tightly regulated, taxpaying businesses.”

When asked for details on Spicer’s remarks, Department of Justice spokesman Peter Carr said that DOJ didn’t have “anything more to provide than what [Spicer] said at today’s briefing.”

Kevin Sabet, president of anti-legalization group Project SAM, said the current split between federal and state laws is “unsustainable” and that he was hopeful that the Trump administration’s enforcement priorities are pursued in a safe and healthy way.

“This isn’t an issue about states’ rights, it’s an issue of public health and safety for communities,” Sabet said.

A dose of reality

The upside of opiates: How drugs taken properly are saving lives

fox6now.com/2017/02/16/the-upside-of-opiates-how-drugs-taken-properly-are-saving-lives/

KENOSHA COUNTY — Michael Weirich, 51, rarely leaves his Kenosha County home.

Michael Weirich

Michael Weirich

When he does, he makes sure wherever he’s going has a bathroom and that he can get to it quickly.

Using the bathroom presents two major problems for the Air Force veteran.

 

 

 

Michael Weirich

Michael Weirich

The first is because of a condition called Autonomic Dysfunction, he is not in charge of his bowels which is why he wears a colostomy bag. The bigger problem is that every time he digests a meal, he’s in a great deal of pain. If you want an adjustable hernia belt, you can get it here, either online or offline. 

“It’s in my intestine. That’s where 90 percent of my pain is and it’s from multiple surgeries,” Weirich told Fox6 recently from his home. “From the time I get up to the time I go to bed, I’m in constant pain. I’ve been hospitalized 30 times in the last six years for that.”

Michael Weirich

Michael Weirich

Because of that, Weirich only eats enough to survive and each meal is topped off with a prescription opioid to help combat the intense pain that comes as his food is being digested.

 

 

 

prescription-painkillers3

Weirich is on disability and he watches a lot of television. He’s seen many of our Dose of Reality reports about the epidemic of opioid abuse and he’s worried that people abusing prescription pain killers are tainting the way the public looks at people using the drugs responsibly.

 

Michael Weirich

Michael Weirich

“I just want to let people know that not everyone who takes these drugs is a drug addict. There are actually people who take them who need them like I do. If I didn’t have them, I couldn’t eat at all,” said Weirich.

Doctor Scott Hardin of Aurora Health Care, is well aware that medications have been abused but too knows the quality of life they can add to patients when taken properly.

Dr. Scott Hardin

Dr. Scott Hardin

“There are very few to zero patients who died taking their prescriptions the way they are supposed to,” said Dr. Hardin.

Dr. Scott Hardin

Dr. Scott Hardin

Hardin says pain doctors and patients need to work together to make sure most patients are on them for a short time only.

“When we begin our patients on opioids we also have a plan to get them off — an exit strategy — so they’re on there for a short period of time compared to the past,” Hardin said.

The reason for the increase in opioid overdoses is that patients don’t realize how strong the drugs are and often take more than they should or physically alter the pills in an attempt to get a high. This is often a fatal mistake.prescription-painkillers2

As for Weirich, he wants people to know how careful most patients are.

“I hope they know there are people who take them like they’re supposed to and I go to the doctor every month like I’m supposed to and that there are people who take them and need them,” said Weirich.

Michael Weirich

Michael Weirich

Dr. Hardin says he can’t stress enough how important it is to follow directions, this is where you come in even if you’re not the patient. Keep tabs on how often, and how, a loved one is supposed to be taking painkillers. For example, if a 20-day supply is gone after ten days, there’s a problem and the prescribing doctor needs to know about it.

TV NEWS: Baby Dies Due To Medication Error at Seattle Children’s Hospital

TV NEWS: Baby Dies Due To Medication Error at Seattle Children’s Hospital

http://www.mensbroad.us/tv-news-baby-dies-due-to-medication-error-at-seattle-childrens-hospital

Q13 FOX – It was just last year that another patient at Children’s suffered a similar fate. Tammy Jarbo-Blakenship lost her son Michael on day after a routine visit for dental work. The family’s lawyer Chris Davis says the drug should have never been given to Michael.

“With respect to Michael who was given an overdose of a drug called Fentanyl pain patch that his dentist had prescribed for the first time in her career,” said Davis.

Davis says after Michael’s death Children’s Hospital promised the Blakenships it would establish new guidelines to prevent accidental overdoses.

“We were assured at the beginning of the lawsuit that they had taken changes, implemented changes to make sure this type of thing wouldn’t happen again. I’m absolutely shocked. It’s very tragic of course and absolutely unfortunate,” said Davis.

The nurse who caused this latest overdose death is on leave while the hospital investigates. The Blankenship’s lawyer Chris Davis says he doesn’t want to alarm the public, but after dealing with Michael’s death he’s learned getting to the truth in these types of cases may be difficult.

“The number of deaths and errors you see really hasn’t declined in my experience because the hospitals and medical profession goes to great lengths to keep it confidential,” said Davis.

The Blankenship Family just settled their lawsuit against Children’s as part of the deal; they’re not allowed to talk specifically about the settlement. As for changes the letter from the hospital says from now on only Pharmacists and Anesthesiologists can draw up doses of calcium chloride unless there’s a life-threatening emergency.

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VA & DOD: just avoid prescribing opiates ..There is no absolutely safe dose of opioids

Opioids for chronic pain: a new clinical guideline from the VA and Department of Defense

http://www.clinicaladvisor.com/pain-management-information-center/clinical-guideline-for-opioids-and-chronic-pain/article/639780/

A new clinical practice guideline regarding the use of opioids for chronic pain has been released by the Department of Veterans Affairs (VA) and Department of Defense (DoD).

The evidence-based recommendations are intended for practitioners throughout the DoD and VA Health Care systems and were developed by the Opioid Therapy for Chronic Pain Work Group. The revised guideline serves as an update to the 2010 guideline by the VA and DoD.

The guideline “is intended to assist healthcare providers in all aspects of patient care, including, but not limited to, diagnosis, treatment, and follow-up,” according to the work group. “The system-wide goal of this guideline is to improve the patient’s health and well-being by providing evidence-based guidance to providers who are taking care of patients on or being considered for long-term opioid therapy.”

The work group developed 18 recommendations and graded each as “strong for” or “strong against,” with the exception of the use of multimodal pain care in Recommendation 18, which was graded as “weak for.”

A summary of the work group’s recommendations is as follows:

Initiation and continuation of opioids

1. Avoid initiation of long-term opioid therapy for chronic pain. Use alternatives to opioid therapy such as self-management strategies and other nonpharmacologic treatments. When pharmacologic therapies are used, initiate nonopioids over opioids.
2. If prescribing opioid therapy for patients with chronic pain, a short duration is recommended. Note: Consideration of opioid therapy beyond 90 days requires reevaluation and discussion of risks and benefits with the patient.
3. For patients currently on long-term opioid therapy, the VA and DoD recommends ongoing risk mitigation strategies (see Recommendations 7-9), assessment for opioid use disorder, and consideration for tapering when risks exceed benefits (see Recommendation 14).
4. Avoid long-term opioid therapy for pain in patients with an untreated substance use disorder. For patients currently on long-term opioid therapy with evidence of an untreated substance use disorder, the VA and DoD suggest close monitoring, including engagement in substance use disorder treatment, and discontinuation of opioid therapy for pain with appropriate tapering (see Recommendations 14 and 17).
5. Avoid the concurrent use of benzodiazepines and opioids. Note: For patients currently on long-term opioid therapy and benzodiazepines, consider tapering one or both when risks exceed benefits and obtaining specialty consultation as appropriate (see Recommendation 14 and VA/DoD Substance Use Disorders CPG).
6. Avoid long-term opioid therapy for patients younger than 30 years of age secondary to higher risk of opioid use disorder and overdose. For patients younger than 30 years of age currently on long-term opioid therapy, we recommend close monitoring and consideration for tapering when risks exceed benefits (see Recommendations 14 and 17).

 

Risk mitigation

7. Implement risk mitigation strategies after initiation of long-term opioid therapy, starting with an informed consent conversation covering the risks and benefits of opioid therapy as well as alternative therapies. The strategies and their frequency should be commensurate with risk factors and include: Ongoing, random urine drug testing (including appropriate confirmatory testing), checking state prescription drug monitoring programs, monitoring for overdose potential and suicidality, providing overdose education, and prescribing of naloxone rescue and accompanying education.
8. Assess suicide risk when considering initiating or continuing long-term opioid therapy and intervening when necessary.
9. Evaluate benefits of continued opioid therapy and risk for opioid-related adverse events at least every 3 months.

 

Type, dose, follow-up, and taper of opioids

10. If prescribing opioids, prescribe the lowest dose of opioids as indicated by patient-specific risks and benefits. Note: There is no absolutely safe dose of opioids.
11. As opioid dosage and risk increase, the VA and DoD recommend more frequent monitoring for adverse events including opioid use disorder and overdose. Note: Risks for opioid use disorder start at any dose and increase in a dose-dependent manner. Risks for overdose and death significantly increase at a range of 20 to 50 mg morphine equivalent daily dose.
12. Avoid opioid doses greater than 90 mg morphine equivalent daily dose for treating chronic pain. Note: For patients who are currently prescribed doses greater than 90 mg morphine equivalent daily dose, evaluate for tapering to reduced dose or to discontinuation (see Recommendations 15 and 16).
13. Avoid prescribing long-acting opioids for acute pain, as an as-needed medication, or on initiation of long-term opioid therapy.
14. The VA and DoD recommend tapering to reduced dose or to discontinuation of long-term opioid therapy when risks of long-term opioid therapy outweigh benefits. Note: Abrupt discontinuation should be avoided unless required for immediate safety concerns.
15. Individualize opioid tapering based on risk assessment and patient needs and characteristics. Note: There is insufficient evidence to recommend for or against specific tapering strategies and schedules.
16. Use interdisciplinary care that addresses pain, substance use disorders, and/or mental health problems for patients presenting with high risk and/or aberrant behavior.
17. Offer medication-assisted treatment for opioid use disorder to patients with chronic pain and opioid use disorder. Note:See the VA/DoD Clinical Practice Guideline for the Management of Substance Use Disorders.

 

Opioid therapy for acute pain

18. Use alternatives to opioids for mild-to-moderate acute pain. The VA and DoD suggest use of multimodal pain care, including nonopioid medications as indicated when opioids are used for acute pain (weak strength). If take-home opioids are prescribed, the VA and DoD recommend that immediate-release opioids are used at the lowest effective dose with opioid therapy reassessment no later than 3 to 5 days to determine if adjustments or continuing opioid therapy is indicated. Note: Patient education about opioid risks and alternatives to opioid therapy should be offered.

 

“This guideline is not intended as a standard of care and should not be used as such,” stated the work group. “Standards of care are determined on the basis of all clinical data available for an individual case and are subject to change as scientific knowledge and technology advances and patterns evolve. Today there is variation among state regulations, and this guideline does not cover the variety of ever-changing state regulations that may be pertinent. The ultimate judgment regarding a particular clinical procedure or treatment course must be made by the individual clinician, in light of the patient’s clinical presentation, patient preferences, and the available diagnostic and treatment options.”