Providing highest quality of care to Medicare Advantage pts ??? NOT ???

Posted on November 30, 2016 by Pharmaciststeve

Cures Act would give pass to lowest-quality Medicare Advantage plans

http://www.modernhealthcare.com/article/20161129/NEWS/161129920?

If Congress passes the 21st Century Cures Act, the federal government would be barred from axing the worst performers in Medicare Advantage through 2018.

The provision, Section 17001 in the 996-page bill being floated in Congress this week, flexes the lobbying muscle of private health insurers that could face the chopping block if their Medicare Advantage quality ratings falter. The Cures legislation essentially would ensure the CMS stays on the sidelines.

“It’s a stay of execution for crappy plans, and that’s just bad policy,” said John Gorman, a former CMS official who now is a health insurance consultant in Washington. “This program works a lot better when there’s a level playing field.”

Current law allows the CMS to boot out Medicare Advantage plans—the private managed-care alternative to traditional Medicare—if those plans don’t attain at least three stars just once in three consecutive years. The system grades companies on a variety of clinical and care-management measures and dishes out a star rating ranging from one to five. Plans with four or more stars get bonus payments.

Nabbing three stars is a relatively low bar for insurers. Roughly 99% of the 18 million Medicare Advantage enrollees are in plans with three or more stars for 2017, according to CMS data.

In fall 2015, the CMS published its star ratings for 2016, and it said there were three plan contracts that were eligible for termination at the end of 2016. Those three plans were Windsor Health Plan, owned by WellCare Health Plans; Sierra Health and Life Insurance Co., owned by UnitedHealth Group; and Cuatro, a small plan based in New York City’s Queens borough.

In April, the CMS sent a letter to Cuatro CEO Dr. Juan Estevez notifying him the insurer was getting tossed out of the Medicare Advantage program because it “failed to achieve a … rating of at least three stars” in 2014, 2015 and 2016.

However, UnitedHealth and WellCare received no such letters, based on publicly available records. The latest Medicare Advantage data from the CMS show both plans had stable enrollment as of Nov. 1. The UnitedHealth contract in question has 3,426 members, and WellCare’s low-performing contract had more than 46,000 members—representing millions of dollars in Medicare revenue for those companies. Medicare’s annual enrollment ends Dec. 7.

However, a CMS spokesperson said in a statement that “none of the three plans mentioned will be operating in 2017.” UnitedHealth and WellCare, both publicly traded companies, did not immediately respond to interview requests.

Many lower-rated plans contend they have higher proportions of sicker, complex patients with socio-economic issues that are not easily resolved. But experts say lax or nonexistent enforcement on Medicare Advantage star ratings fails to hold insurers accountable, allowing them to skirt penalties and continue to gain financial rewards.

“If you’re below four stars, the incentives are exactly the same,” said Gretchen Jacobson, an associate director at the Kaiser Family Foundation who studies Medicare. She added that the government also wants to give plans enough time to turn their quality ratings around.

The Medicare Advantage provision embedded in the latest Cures legislation was not part of last year’s original bill. However, many other members of Congress previously introduced separate legislation that would delay the CMS’ authority to terminate poorly performing plans. Legislators on both sides of the aisle have framed the issue as preserving seniors’ access to their Medicare Advantage plans.

Including the provision in a growing bill that was primarily focused on reforms to regulatory approval of drugs and devices indicates Medicare Advantage insurers can “buy the best lobbyists ‘Gucci Gulch’ has to offer,” Gorman said.

“I just find it shocking that a Republican Congress that prides itself on competition in healthcare markets wants to issue squirt guns to Medicare’s firing squad for quality,” he said.

Updated: The story has been updated to reflect CMS’ response and the fact the three low-performing plans from 2016 will no longer be operating in 2017.

Filed under: General Problems | Leave a Comment »

OIG/DOJ : Oversight of DEA’s Confidential Source Program Report

Posted on November 30, 2016 by Pharmaciststeve

Image result for graphic thumbs downOversight of DEA’s Confidential Source Program

 

 

 

Oversight of DEA’s Confidential Source Program

Filed under: General Problems | Leave a Comment »

Palliative Care: The Role of the Pharmacist

Posted on November 30, 2016 by Pharmaciststeve

Palliative Care: The Role of the Pharmacist

http://www.pharmacytimes.com/publications/health-system-edition/2016/november2016/palliative-care-the-pharmacists-role

NOVEMBER 22, 2016
Jerry Barbee, Jr, PharmD, BCPS, CPh; Suzanne Kelley, BPharm, CPh; Jessica Andrews, 2017 PharmD candidate; Amanda Harman, 2017 PharmD candidate
Palliative care is defined as “an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems—physical, psychosocial, and spiritual.”1
 
Pharmacists are essential in developing an individualized treatment regimen for each patient. A treatment plan requires specific patient goals with pharmacologic and nonpharmacologic management to improve quality of life while reducing costs and unnecessary medications. Effective utilization of pharmaceutical options optimizes the care of active disease states, enhances individualized dosing regimens, and assists in reducing the adverse effects (AEs) of medications.2

Excessive Medication
Excessive medication use can lead to polypharmacy and AEs. In palliative care patients, AEs can be avoided by discontinuing inappropriate medications. Examples of interventions pharmacists can use to prevent and reduce polypharmacy include medication reconciliation, patient education, geriatrics consultation, and multidisciplinary team consults.3 In addition, resources such as the Beers List Criteria4 can be used as a guide for effective and appropriate medication de-escalation in elderly patients.

Nontraditional Administration Routes
Alternative administration routes for palliative care are vital to providing effective patient care. Many commonly prescribed drugs (eg, promethazine, morphine sulfate) may be used in nontraditional routes.5 Topical gels containing lorazepam, diphenhydramine, or metoclopramide can be effective for patients with refractory nausea and vomiting.6 Various dosage forms, including transdermal patches of scopolamine and depot injections of octreotide, are used to treat specific needs of individual patients.7 Many medications not manufactured in parenteral or suppository formulations can pose administration challenges in patients with an interruption in oral access. Commonly prescribed medications can have nontraditional uses and rectal bioavailability, such as carbamazepine tablets or suspension for convulsions; rectal use may allow rapid absorption and partially avoid first-pass metabolism.8 If necessary, drugs can be compounded into parenterals, solutions, creams, ointments, and transdermal dosage formulations to improve patient adherence and ameliorate AEs, such as constipation, nausea, gastrointestinal issues, and sedation.9
 
Individualized Care
Because palliative care regimens are highly individualized to meet each patient’s needs, integrating a pharmacist into the interdisciplinary team is vital to achieving a patient’s care goals. Body kinetics and volume of distribution are altered in patients in end-of-life care. Pharmacists have a unique knowledge base for optimizing patient care while reducing AEs and toxicity.10 Specific characteristics of a patient affect his or her pain. Patients in palliative care typically require higher doses of opioids. This results in greater stimulation of mu-receptors and, in turn, increases activation of delta and kappa receptors, contributing to increased AEs. In addition, fentanyl patches in patients with cachexia may provide less pain relief due to protein binding and low subcutaneous fat stores.11

Gastrointestinal Issues
Gastrointestinal issues may develop secondary to many chronic conditions (eg, advanced cancer, neurologic disorders).12 Constipation is one of the most common problems patients experience at the end of life. The cause can be as simple as dietary alterations or the inability to ambulate or exercise. Severe discomfort and pain from constipation may cascade into an unrelenting decline in a patient’s quality of life, requiring pharmacologic intervention.13 Privacy issues during toileting and the inability to complete defecation without assistance may progress as a chronic disease worsens.
 
Pharmacists can play an important part in preventing and managing the symptoms of constipation, such as bowel obstruction, dehydration, loss of appetite, mobility issues, and medication AEs.12 Many nonpharmacologic approaches (eg, dietary changes, avoidance of negative environmental stimuli, behavioral measures such as relaxation) may assist patients without adding to the pharmacologic burden.
 
Nausea and vomiting are frequently reported because medications and chronic illnesses stimulate different mechanisms and receptors in the body7 (Table 17,14).
 
Psychological Issues
As patients cope with their illness and chronic pain, anxiety and depression are often comorbid conditions. Distinguishing between grief and depression is essential in determining appropriate pharmacotherapy. Many pharmacologic options (eg, benzodiazepines, anxiolytics, antihistamines, antidepressants) are available to assist with symptoms of anxiety and depression. By carefully interviewing patients, pharmacists can delineate the most appropriate therapeutic class to use. Evaluation of life expectancy is critical because some medications take many weeks of use to produce the desired therapeutic effect, possibly resulting in minimal patient benefit.

The Interdisciplinary Team
In collaboration with the interdisciplinary team, the pharmacist must assess the needs of each patient, including family dynamics and spirituality, to select the best method of treatment.15 This team may include a spiritual counselor, nurses, physicians, caregivers, and volunteers.16
 
Tapering or Discontinuing Medications
Appropriateness of therapy should be evaluated in regard to a patient’s anticipated life expectancy.17 Research shows that discontinuing certain medications in elderly patients and those in palliative care does not worsen outcomes, but can actually reduce the risk of AEs and decrease patients’ overall costs.18 Pharmacists can de-escalate medications by eliminating long-term medications that do not show immediate benefit to elderly patients and those in palliative care. As treatments centered on comfort and quality of life become a greater priority, many common long-term medication therapies may require reevaluation for patients in palliative care 3 (Table 23,19). Antihypertensive medications, for example, can be lifesaving; however, for patients receiving palliative care, the AEs (ie, fatigue and orthostatic hypotension) should be considered on an individual basis. It may be more appropriate to taper or discontinue these medications than to continue them.19
 
Counseling by pharmacists can bridge the knowledge gap for patients and caregivers to prepare them for possible discontinuation of long-term medications. Pharmacists within the interdisciplinary team can help patients and their families understand the risks and potential dangers of these medications. Some drugs may not be beneficial for sustaining life or providing comfort at the end of life, but may increase AEs.
 
End Note
Improving patients’ quality of life during the transition into palliative care is an essential goal of the interdisciplinary team. As the pharmacist’s palliative care role continues to evolve, pharmacists need to step out of their comfort zone. Patients need to be assessed and treated appropriately, which may require using dosages and medications to which pharmacists are unaccustomed.
 
Each patient’s dignity and comfort are always at the center of any care plan. As pharmacists, we should do what we can to make the last days of our patients lives as good as possible. There is never a more pressing time for palliative care pharmacists to advocate for their patients.
 

Filed under: General Problems | Leave a Comment »

Cigna Prescription Drug Fee Lawsuit Alleges Overcharging Scheme

Posted on November 30, 2016 by Pharmaciststeve

Cigna Prescription Drug Fee Lawsuit Alleges Overcharging Scheme

topclassactions.com/lawsuit-settlements/lawsuit-news/349864-cigna-prescription-drug-fee-lawsuit-alleges-overcharging-scheme/

A woman has filed a class action Cigna prescription drug fee lawsuit over allegations the health insurance company overcharged for medications.

Cigna is accused of collecting “clawback fees,” which are amounts collected by the insurance company when the insurance company requires pharmacies to charge a co-pay for a drug that could be purchased for less money directly from the pharmacy without using insurance.

The difference between the co-pay amount and lesser cost of the drug is “clawed back” to the insurance company, which reaps the profit.

For example, a patient paid a $20 co-pay to a pharmacy to purchase a prescription drug, which was 1,042 percent more than the fee paid by Cigna to the pharmacy. Cigna contracted to pay the pharmacy $1.75 for the prescription, but told the pharmacy to collect the $20 “co-pay” from the insured. Cigna then pocketed the $18.25 difference.

According to the Cigna prescription drug fee lawsuit, “The secret payment of the ‘spread’ to the Defendants and/or their agents is known as a ‘clawback.’”

When an insured person pays a co-pay, the co-pay should never be more than the amount paid the insurance company paid the pharmacy for that prescription.

Oftentimes, the pharmacy is contractually banned from informing customers that there are cheaper alternatives to paying the co-pays that enable clawbacks.

In some instances, pharmacists are unaware of the clawbacks until monthly reconciliations show evidence of these clawbacks after the drugs have already been dispensed to customers who have paid the inflated co-pay prices.

Cigna Prescription Drug Fee Lawsuit Alleges Fraudulent Activity

According to the Cigna prescription drug fee lawsuit, Cigna has secretly taken clawbacks from customers, an action opposed in its own policies.

In one quote taken from Cigna policies, the line states “In no event will the… Coinsurance for the Prescription Drug or Related Supply exceed the amount paid by the plan to the Pharmacy, or the Pharmacy’s Usual and Customary (U&C) charge.”

The U&C charge is defined as the pharmacy’s retail cash price, “less all applicable customer discounts that Pharmacy usually applies to its customers regardless of the customer’s payment source.”

Many patients don’t realize their insurance companies are obtaining clawbacks because the patients are unaware of the drug’s cost without insurance. Most patients pay the co-pay, unaware it could be more than the cost of the medication without insurance.

By definition, a co-pay should be a fraction of the true cost of the drug, not a charge that exceeds the true cost of the medication.

More than 80 million Americans might be victims of such prescription drug fraud by insurance companies overcharging for medications. The Cigna prescription drug fee lawsuit is only the tip of the iceberg.

If you have been overcharged for a prescription drug, denied coverage or overcharged for a service, you could be eligible for compensation through a legal claim.

The Cigna Prescription Drug Fee Lawsuit is Case No. 16-cv-1702 in the U.S. District Court District of Connecticut.

Join a Free Health Insurance Fraud Class Action Lawsuit Investigation

If you or a loved one were overcharged for a prescription drug, denied coverage or overcharged for a medical service, you may qualify to participate in a health insurance fraud class action lawsuit investigation. It’s absolutely free to participate, so act now!

Filed under: General Problems | 2 Comments »

Has the DEA shifted “the blame” of rescheduling Kratom on the FDA ?

Posted on November 30, 2016 by Pharmaciststeve

The Stakes Are High As DEA Reconsiders Waging War On The Herb Kratom

http://www.huffingtonpost.com/entry/kratom-dea_us_583d8a66e4b04b66c01bb424

The FDA works – makes decisions – from clinical trials which takes 10+ yrs.  Will the FDA not recommend rescheduling Kratom….BUT… say that it can no longer be classified as a supplement and in order to be sold, will have to go thru clinical trials. Basically, still making Kratom UNAVAILABLE for OTC sale as long as clinical trials moves forward at a “snail’s pace” and will be giving BIG PHARMAS their next “cash cow” ?

Seven weeks after the U.S. Drug Enforcement Administration officially withdrew its plan to ban kratom, the federal government is once again set to decide the fate of the herb and the people who rely on it for pain relief and other treatment.

The DEA had initially planned to use its emergency scheduling power to push through the ban without input from the public, despite concerns from lawmakers and scientists ― as well as kratom users ― that the move would do more harm than good. In October, however, the DEA opened a public comment period allowing individuals to weigh in on the agency’s decision to place mitragynine and 7-hydroxymitragynine, two active compounds in kratom, in Schedule I. Substances in this category include heroin and LSD and are considered to have no known medical benefit and a high potential for abuse.

With the comment period set to close on Thursday, the DEA will now have to take into account the nearly 9,000 submissions from people who wanted to voice their opinions about this proposed expansion of the war on drugs.

But kratom isn’t in the clear yet. The DEA is currently awaiting the results of a U.S. Food and Drug Administration analysis on the potential harms and health benefits of the herb, which will determine if kratom truly poses an “imminent hazard to the public safety,” as the agency initially claimed in August.

The DEA doesn’t know when it will get the results of the FDA’s review, Russell Baer, a spokesperson for the agency, told The Huffington Post.

“We’ve asked the FDA to expedite their analysis, but they’ve not given us any indication as to when that may be done, other than as soon as practical,” said Baer. “They’re involved in an exhaustive scientific review and evaluation, so these things do take time.”

Although Baer said he expects the DEA to wait for the FDA’s analysis before deciding on an appropriate schedule for kratom ― or whether it should be scheduled at all ― he noted that the agency could still proceed with emergency scheduling even in the absence of more concrete scientific evidence.

The DEA’s next steps will have huge implications for people like Joshua Levy. In the video above, Levy explains that he turned to kratom after struggling with dependence on the opioid painkillers he’d been prescribed following a hit-and-run accident. Like many kratom users, he says the herb gave him back the life that had been taken from him by addiction and other side-effects of narcotic painkillers.

“Since I started taking kratom, since I had gotten off of the pain pills, my life has basically opened up dramatically,” Levy told HuffPost. “I got a new job. I’m building a friendship up with my sister that I haven’t had in a long time. I’m not lazy anymore. I don’t want to isolate myself. I want to go out, I want to be out of the house.”

The kratom community is full of success stories like Levy’s. But together, they form only anecdotal evidence of the herb’s benefits, which is not enough to support a more official confirmation of its medicinal value.

Experts like Andrew Kruegel, an associate research scientist at Columbia University, hope the DEA will allow kratom to remain legal so they can keep working to unlock the herb’s potential.

Kruegel’s studies have shown that kratom can be used to alleviate mild pain, and that the plant’s negative side effects are relatively minor.

“As a scientist, I try to be as objective as possible and not overstate the promise of kratom,” said Kruegel. “We just don’t know that much about the plant yet.”

But Kruegel also has bigger hopes for kratom, which he believes can be used to aid in the development of safer alternatives to the prescription opioids that claimed more than 18,000 lives in the U.S. in 2014 due to overdose.

“Of course, if it’s in Schedule I, historically that greatly limits the ability to do research on it,” he said.

Filed under: General Problems | 5 Comments »

Who’s profiting from prescription overcharges?

Posted on November 29, 2016 by Pharmaciststeve

http://www.kare11.com/mb/news/investigations/whos-profiting-from-prescription-overcharges/347424661

Investigations

Who’s profiting from prescription overcharges?

MINNEAPOLIS – Internal pharmacy records obtained by KARE 11, along with two newly filed class-action lawsuits, raise questions about whether some popular insurance plans are overcharging customers for prescription medicines and pocketing the profits.

What’s more, documents obtained during KARE 11’s yearlong investigation reveal that so-called “gag clauses” often prevent local pharmacists from disclosing lower prices, effectively keeping customers in the dark about the overcharges.  

“I think if people really knew what was going on, there’d be an uproar,” says Tim Gallagher.

 Gallagher says he saw the insurance overcharges first-hand when he worked as a pharmacist.  Now, he’s with a company that advocates for independent pharmacies.

“Patients were actually paying more than they could otherwise have paid if they were paying cash,” Gallagher told KARE 11.

KARE 11 began investigating the issue last year after we told the story of Twin Cities resident Curt Burshem.

When Burshem tried to refill a prescription for a life-saving kidney drug, he discovered his insurance copay was almost twice as expensive as just paying cash for the same medicine.

His copay was $476. The cash price, without insurance, was just $259.

“It makes me insane,” Burshem told KARE 11.

How could that be? 

A WHISTLEBLOWER SPEAKS OUT

For nearly a year, KARE 11 has been investigating, uncovering evidence that what happened to Burshem is happening more often than you think.

“In my opinion, it needs to stop,” said a working pharmacist. 

He spoke with KARE 11’s Jay Olstad on the condition we not reveal his identity.  He’s afraid of retaliation by insurance plans that, he says, are routinely overcharging customers.

Jay Olstad: “Consumers are paying more because they have insurance, in some cases?
Pharmacist: “It’s probably 20 to 25 percent of the claims.”
Jay Olstad: “A lot?” 
Pharmacist: “A lot.”

And there’s evidence it’s happening all across the country.

“These type of shell games go on all the time,” says Doug Hoey, CEO for the National Community Pharmacists Association.

He blames Pharmacy Benefit Managers, or PBMs, for price gouging. PBMs serve as the middle man between insurance providers and pharmacies. And, often, they set the price you pay.

“They dictate that price,” Hoey explained.

“COPAY” MORE EXPENSIVE THAN PAYING CASH?

Here’s how it works. When you use an insurance card, the pharmacist punches the information into the computer and the PBM spits out the amount you owe, the so-called insurance “copay.”

“They dictate what the pharmacy can sell it for,” Hoey said.

KARE 11 obtained rarely seen internal records from pharmacists. They were careful to block out private patient information. 

But you can still see how the insurance “copay” set by the PBMs was much higher than the cash price at the same pharmacy.

For example, the anti-depressant Venlafaxine:
– $67.13 with the insurance copay.
– $24.99 if you paid cash.

Another example:  Allopurinol, for kidney stones:
– $58.96 with the insurance copay.
– $40.52 if you paid cash.

We showed Doug Hoey other examples we found, including one for the common antibiotic Doxycycline.
The copay was $46.14.  The cash price was just $26.95.

“My son needed the exact same drug and the exact same thing happened,” Hoey told us. “Fortunately, I knew to ask, and I got the much less expensive price.”

But, too often, customers don’t know to ask.  And, believe it or not, pharmacists aren’t supposed to tell them.

“GAG CLAUSES” KEEP CUSTOMERS IN THE DARK

“They have these gag clauses that forbid them from talking to consumers,” Hoey explained.

Gag clauses like the one in a contract obtained by KARE 11 detail how pharmacists can get kicked out of an insurance network if they talk to the media or “sponsor’s members” – which means customers – “without prior consent.” 

That explains why pharmacists are frightened about speaking out about insurance overcharges.

“By me giving this information out, you know, I’m risking losing my contract,” said a pharmacist who agreed to speak to KARE 11’s Jay Olstad on the condition that we not use his name.

Jay Olstad: “What would happen if you were kicked out of the network?”
Pharmacist: “I mean it would literally shut the doors. It would be over.”

Those threats of retaliation even have Congress asking questions.

“If you make too much noise about this, your contract could be in jeopardy?” asked Congressman Doug Collins (R-GA) during a recent hearing. “That is not right.”

WHERE’S THE MONEY GOING?

So, if consumers are paying more for prescriptions, who’s getting the extra money?

That’s what KARE 11’s Jay Olstad wanted to know when he interviewed Doug Hoey of the National Community Pharmacists Association.

Olstad:  “Does it go to the local pharmacies?”
Hoey:  “It certainly does not go to the local pharmacies.”

In fact, Hoey says Pharmacy Benefit Managers (PBMs) and insurance companies use so-called “clawbacks” to pocket the extra money. 

He says “clawbacks” are when PBMs tell local pharmacies to collect a copay, but require them to return much of that money to the insurance plan.

A current pharmacist gave KARE 11 an example of how the “clawback” process works.

“A clawback is what they’re referred to,” he explained. “An insurance company may charge the patient, say, $20 in a copay.  But then they ‘clawback’ $16.  So the pharmacy ends up with a net $4.”

WHO’S PROFITING FROM CLAWBACKS?

So, who’s cashing in from prescription clawbacks?  Doug Hoey says two companies with Minnesota connections are.

“Optum and Catamaran are the two who most frequently use the consumer clawback tactic,” he said.

And who are those companies owned by?

“They’re owned by United Health, which obviously has a big presence here in the Twin Cities,” Hoey said.

In fact, KARE 11’s investigation documented examples in which customers purchasing prescriptions through UnitedHealth Group companies, to treat conditions including heartburn, depression and high blood pressure, were charged more in copays than they would have if they’d simply paid cash.

CLASS-ACTION LAWSUITS FILED

Two class-action lawsuits filed just last month accuse UnitedHealth Group of a “scheme to defraud” customers in connection with prescription copay pricing.

The lawsuits claim UnitedHealth Group and its related companies used “gag clauses” to try to keep its so-called “clawback scheme” secret.

KARE 11 asked to sit down with representatives from UnitedHealth Group for an on-camera interview about allegations that the company had overcharged customers.

UnitedHealth Group declined our request. In emails, the company said the lawsuit “has no merit.”

“Our pharmacy offerings will help customers and consumers save billions in prescription drug costs this year alone. Pharmacies should always charge our members the lowest amount outlined under their plan when filling prescriptions,” UnitedHealth Group said in a statement.

They added, that customers should never pay more than the cash price. But the email didn’t explain why some copays did cost more than just paying cash.

Retired pharmacist Tim Gallagher thinks consumers should demand changes.

“People are getting taken advantage of, pharmacies are getting underpaid, and the PBMs are laughing all the way to the bank,” he said.

Here’s the tough part for insurance customers. Paying cash may not always save you money because experts say those purchases generally don’t count toward your insurance deductible.

HOW TO COMPARE PRICES

If you do want to consider paying cash, consumer advocates recommend shopping around.

Consumer Reports posted an article earlier this year with tips about finding the best prescription drug prices.  

They recommend always asking your pharmacist, “Is this your lowest price?”

In addition, there are a number of private websites that allow you to check prescription prices and to find discount coupons at pharmacies in your area. Two of them are GoodRX.com and Lowestmed.com.

If you discover your insurance copay is more expensive than the cash price for the same prescription, we’ll like to hear about it. You can email us at investigations@kare11.com.

Filed under: General Problems | 1 Comment »

In the debate over opioid addition, there’s one group we aren’t hearing from: chronic pain patients, many of whom need to use the drugs on a long-term basis

Posted on November 29, 2016 by Pharmaciststeve

War on prescription drugs: what if you depend on opioids to live a decent life?

https://www.theguardian.com/us-news/2016/jul/12/prescription-drugs-what-if-you-depend-on-opioids-chronic-pain

The US is facing what many are describing as an opioid crisis, with growing numbers of deaths associated both with opioid medications and overdoses on heroin – 19,000 in 2014 linked to opioids alone. But in the swirl of debate over the subject, there’s one group of Americans we aren’t hearing from: chronic pain patients, many of whom need to use opioids on a long-term basis to control their pain effectively.

Unlike patients with acute, short-term pain or pain associated with terminal illnesses such as cancer, they’re looking at a lifetime of living with conditions such as Ehlers-Danlos syndrome, fibromyalgia and endometriosis, along with many other disorders associated with chronic pain. Others are dealing with persistent pain from injuries.

Many have conflicted relationships with the medications they need to enjoy a good quality of life, and they fight an tough battle against negative public perception and cultural attitudes. They’re struggling with issues that aren’t being accounted for in conversations about dependence, addiction and the safe use of opioids for long-term pain management.

Heather Ace Ratcliff, who has Type 3 Ehlers-Danlos, a connective tissue disorder characterized by hypermobility which allows her joints to dislocate and subluxate easily, says uninformed views can stigmatize chronic pain patients who are struggling to access relief. “I am regularly treated as if I am overreacting, a hypochondriac, or a drug addict for wanting an increase in pain management,” she says, illustrating the consequences of misinformation about opioids and pain.

But those attitudes are internalized as well. Even though many patients recognize that opioids help them manage pain effectively, some still fear them, worrying that their relationship with their medication may be sliding into addiction. At the same time, they’re dealing with side effects like fatigue, “brain fog” and gastrointestinal stress. In an environment where physicians who aren’t extensively familiar with pain management and opioids can leap to conclusions, it can be difficult for patients to have honest conversations with their doctors about their concerns, as they may fear being chastised or cut off.

Shayla Maas, another patient with Type 3 Ehlers-Danlos who also has an autoimmune disorder, says that the conversation surrounding opioids sometimes makes her paranoid about her medications. “Maybe I’m just blowing it out of proportion,” she says, “looking for attention, looking for meds.” She can hardly be blamed for her self-doubt, as that’s precisely the kind of messaging she receives as a chronic pain patient, and it’s easy to internalise the fear, she says, that you might become a “dope fiend”.

Anna H, a patient with fibromyalgia, shares these worries. “I’ve been taking relatively small doses of pain meds every day for about six years, but I’m still afraid that taking a certain amount of pills – even if I’m in a lot of pain – will send me down the path of addiction.”

Their fears are to some extent grounded in reality: opioid medications can have an addicting effect. But the real story is more complicated.

“Opioids are the cornerstone of the treatment of pain,” explains doctor Anita Gupta, a board-certified anesthesiologist, pain specialist, pharmacist and vice-chair of Drexel College of Medicine’s division of pain medicine in Philadelphia. Among her many roles, she also serves as vice-chair of the American Society of Anesthesiologist’s ad hoc committee on prescription opioid abuse and has a vested interest in addressing the misuse of opioids. But she also has concerns about inadequate information that harms both patients and providers.

Gupta makes an important distinction between dependence and addiction, cutting to the heart of one of the greatest misunderstandings in the conversation about pain management. “If you’re on opioid medication for a long period of time, you become dependent,” she explains. “When a need becomes a want, that is really an example of when someone can become addicted. When you want it and you can’t live without it, can’t survive without it, it interrupts your day to day life, that’s addiction.”

Though organizations like the American Academy of Chronic Pain Management, US Pain Foundation and the American Chronic Pain Association engage in patient advocacy work, it can be a struggle. Even with the weight of patients, family, and medical providers behind these groups, they aren’t always treated as stakeholders in processes like developing new guidelines for opioid prescription and use.

“There’s a saying that goes something like: ‘We are all one drink or pill away from addiction,’ and I know this is meant to destigmatize what addicts go through, but I feel like I’ve been seeing variations on this ‘common knowledge’ more and more lately being used (on social media) as a cudgel to remind patients to not overdo it,” Anna says, speaking to the dual-edged sword of awareness. A motto designed to humanize the experience of addiction has been turned into a weapon that targets people who rely on opioids for pain management, and that translates to real-world stigma.

“When other people find out that I’m on opioids,” Maas explains, “depending on how close they are and how well they know me, I might get an ‘it sucks that your pain is so bad’ to a slightly narrowed side eye.” The judgmental comments she receives make her feel like people think she’s taking opioids for the fun of it.

“Believe me,” she says, “this is not for fun.”

“I haven’t really experienced the stigma personally other than some ill-informed comments from acquaintances,” says Anna. “But the media coverage of the ‘opiate epidemic’ as driven by pill pushing-doctors and by pain patients worries me a lot, and I think it is already being used to forward the idea that people in chronic pain should not have access to relief from their pain.”

Both Maas and Anna articulate worries that chronic pain patients are being “thrown under the bus”. Doctor Jerrold Winter, professor of pharmacology and toxicology at the University at Buffalo, tends to agree, and is concerned that new CDC guidelines and other efforts to address opioid use could actually make the situation worse.

“I think [the CDC guidelines] go much too far and a) will leave many in pain and b) will drive some seeking pain relief into the illicit market with all its hazards,” he says. “Indeed, two NIDA officials recently pointed out that the rate of deaths from prescription opiates between 2011 and 2013 were stable while heroin-related death rates rose dramatically. I fear that this trend will only worsen under the CDC guidelines.”

The ability to be open about these symptoms along with concerns about degree of dependence on opioid medication will help patients make sound decisions about their care.

That requires both clinician and patient education, as well as listening to the fears of chronic pain patients like Maas and Ratcliff as they attempt to balance chronic pain, fears about forming addictive habits and frustration with public perception. Both doctors and patients need to be playing a more prominent role in the unfolding conversation about how to deal with a very real American public health crisis.

Filed under: General Problems | 11 Comments »

CDC previously reported a rise in new hepatitis C infections

Posted on November 29, 2016 by Pharmaciststeve

A syringe is pictured in downtown Austin, Indiana, in this photo. Drug epidemic stalls HIV decline in whites who shoot up

http://www.foxnews.com/us/2016/11/29/drug-epidemic-stalls-hiv-decline-in-whites-who-shoot-up.html

NEW YORK –  The long decline in HIV infections among white people who inject drugs has stalled, another grim side effect of the nation’s drug abuse epidemic.

Health officials released the news Tuesday, as part of a call for more use of needle exchange programs.

“We really risk stalling or reversing decades of progress on HIV transmission,” said Dr. Tom Frieden, director of the Centers for Disease Control and Prevention.

The report comes as the nation is facing an ongoing epidemic of opioid and heroin use that has led to an increase in drug overdose deaths, particularly among white people. The increase in drug abuse is also hampering efforts to slow diseases carried in the blood that can be spread when injection drug users share needles.

1 IN 7 PEOPLE WITH HIV IN EU UNAWARE THEY HAVE THE VIRUS

The CDC previously reported a rise in new hepatitis C infections, which is tied largely to injection drugs.

Most cases of HIV, the virus that causes AIDS, are transmitted through sex — only about one in 11 HIV infections diagnosed each year are among people who inject drugs. But sharing dirty needles can spread HIV much more quickly.

More than 100 injection drug users were infected with HIV in early 2015 in rural Scott County, Indiana. The state’s governor at the time — Mike Pence, now the vice president-elect — declared a public health emergency and authorized a limited need-exchange program to prevent the virus from spreading further.

Until recently, HIV cases in injection drug users had been falling for all racial groups. Cases still are falling in blacks and Hispanics. But for whites they stopped falling in 2012.

NEW HIV VACCINE TRIAL TO START IN SOUTH AFRICA

In 2014, for the first time, a larger number of white inject drug users were diagnosed with HIV than injection drug users in any other racial or ethnic group. Traditionally, far more cases were seen in urban blacks.

At least part of the reason is that white injection drug users are often younger and more likely to share needles, according to a 22-city CDC study of people who inject drugs. Nearly half of white injection drug users shared needles with other addicts in 2015, compared with a third of Hispanics and a fifth of blacks.

Needle exchange programs give out clean syringe needles in exchange for used ones. Medical experts have found that such programs cut down transmission of HIV and do not cause increases in drug use.

Congress, though, has gone back and forth on allowing the federal government to fund the programs. For now, federal funds can be used for some program costs, but not for the purchase of sterile needles or syringes.

 

Filed under: General Problems | Leave a Comment »

Survey Of ER/Trauma Health Care Professionals Finds No Evidence Of Either Kratom Deaths Or Epidemic Of Abuse

Posted on November 29, 2016 by Pharmaciststeve

Survey Of ER/Trauma Health Care Professionals Finds No Evidence Of Either Kratom Deaths Or Epidemic Of Abuse

military-technologies.net/2016/11/29/survey-of-ertrauma-health-care-professionals-finds-no-evidence-of-either-kratom-deaths-or-epidemic-of-abuse/

WASHINGTON, Nov. 29, 2016 /PRNewswire-USNewswire/ — If the DEA is correct in suggesting that there is a kratom epidemic going on in America, then it is somehow happening without our nation’s front-line medical professionals knowing a thing about it. A random online survey of 115 emergency room (ER) and trauma health care professionals across the U.S. found zero reported cases of deaths related to kratom. The new poll also uncovered precisely 0 percent support among those surveyed for a Drug Enforcement Administration (DEA) ban on the coffee-like herb kratom.

 

Available online at http://bit.ly/kratomdocpoll and conducted via SurveyMonkey, the American Kratom Association (AKA) poll was carried out between November 23-28. 

AKA is submitting the survey findings as a formal response to the request for kratom-related comments from the DEA, a process that closes at 11:59 p.m. on December 1st.

American Kratom Association Founder Susan Ash said: “We conducted this survey after ER doctors and other medical professionals told us the notion there is some kind of kratom epidemic going on in America is a hoax. In fact, our totally random online survey found no evidence of kratom-related deaths and zero support among America’s front-line medical professionals for a ban on kratom. We are not going to stand idly by and let the DEA or anyone else whip up a phony panic about a nonexistent epidemic to try and ban a legal product that’s being consumed responsibly, with no major problems, by three-five million Americans.”

Key survey findings include the following:

The random online survey conducted via SurveyMonkey focused on panel of ER/trauma doctors, surgeons, nurses, related health care professionals, and EMTs/paramedics. Invitations to participate in the survey were extended directly through LinkedIn groups (including EMS Leadership and Administration, Emergency Room RNs and Management, Emergency Medicine and EMS World) and Facebook groups (including Paramedics on Facebook, FRCS Trauma & Orthopedic Surgery, First Responders, Trauma, Critical Care, and Acute Care Surgery, and Emergency Medical Technician). The full results and the complete text of the survey instrument are available online at http://bit.ly/kratomdocpoll.

ABOUT AKA

The America Kratom Association, a consumer-based non-profit organization, is here to set the record straight, giving voice to those suffering and protecting our rights to possess and consume kratom. AKA represents tens of thousands of Americans, each of whom have a unique story to tell about the virtues of kratom and its positive effects on their lives. www.americankratom.org

Filed under: General Problems | Leave a Comment »

NO GOOD DEED… goes unpunished ?

Posted on November 29, 2016 by Pharmaciststeve

PA Dumpster Divers Arrested For Helping Their Community

http://www.huffingtonpost.com/zac-thompson/dumpster_divers_arrested_b_13209010.html

The average person creates an incredible amount of waste on a daily basis and the average grocery store is even worse. The amount of perfectly good food that goes to the garbage is far too high now that we’re living in an era of convenience. The United States throws away 165 billion dollars of food a year, which means over 30% of the food purchased in the US ends up in the trash. So next time you think about throwing out food, don’t. Make a sauce with those musty old tomatoes.

You can also combat food waste by getting inside a dumpster. Dumpster diving is a popular form of modern salvaging that helps environmental activists reclaim food waste. While you might cringe at the idea, It’s a great way for people to prevent good food from heading to the landfill. Don’t believe us? Check out our previous coverage on Rob Greenfield.

Rob Greenfield has launched a new campaign raising awareness around Tony Moyer and Sam Troyer, brothers-in-law who were recently arrested for diving in a dumpster at a CVS store in Hershey, PA. Although the dumpster is located in an open enclosure in a parking lot in plain sight, with no “No Trespassing” signs or locks, the men were charged with loitering and prowling at night as well as criminal trespassing.

 The video above shows that the pair have collected thousands of dollars worth of edible food from dumpsters and donate it all to people in need, with donation receipts to prove their intent.

Dumpster diving prevents food waste, plain and simple. It’s not something we should punish but it is something we should reward. Help spread the word about Tony and Sam and together we might be able to change the dialogue surrounding dumpster diving to the actual issue at hand: food waste.

Filed under: General Problems | 3 Comments »

« Previous Page — Next Page »