EpiPen price skyrockets 400%

What I find interesting… Mylan’s President is the daughter of Sen Manchin (D-VA)… The Senator has proposed a OPIATE TAX and one of Mylan’s major products is Hydrocodone/Acetaminophen… which is taking a volume/profit hit because the DEA changed this product to a C-II a couple of years ago… So now that the only competitor to Mylan’s Epi-pen has had a voluntary recall.. they are “the only game in town”… Are they trying to regain the profits they believe that they have lost…. because of the actions or proposed actions of the FEDS.

Following the “money trail” is like tracing a spider web…

On Fox Business today they had the Mother of a son who died 3 yrs ago because of a food allergy.  Which has created a FOUNDATION to help make sure that no one goes without access to this necessary medication.. and no one loses someone to allergic reactions.

Perhaps the chronic pain community needs to take notice of what is going on around us… ONLY DEAD BODIES GET ATTENTION OF THE MEDIA !

The chronic pain community have DEAD BODIES… from pts being thrown into cold turkey withdrawal and dying because of that in combination with their co-morbidity issues… those who have committed suicide because their quality of life was flushed down the crapper because of reduced or eliminated pain medication.

As I have heard before with the media ” IF IT BLEEDS IT LEADS “… Your disease, your suffering is INVISIBLE … is our society making those who die from various reason associated with the inadequate/non-treatment of your pain … also INVISIBLE  ?

If you have a friend/relative that dies because of lack of adequate medical care committed suicide… please don’t stand around the casket saying ” at s/he is no suffering any more”… “s/he is now at peace”…  and other platitudes…  Where is the OUT RAGE that making sure than no one else has to go down that path ?

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Customers: CVS Takeover Erased Everything Good About Target Pharmacies

https://consumerist.com/2016/08/23/customers-cvs-takeover-erased-everything-good-about-target-pharmacies/

One of the reasons that Target gave for its poor performance during a recent earnings call was that stores may have lost some foot traffic because of “some disruptions” when the discount store sold its pharmacy business to CVS. We wondered what that meant, and asked if readers had experienced those “disruptions.” They had, but the bigger problem is something that Target’s executives may not have realized: people filled prescriptions there because they liked things that Target did differently.

The ClearRX system, which Target introduced in 2005, solved most of the annoying problems with the standard amber prescription bottle, even making it easy to tell which medication is which with bottles standing up in a drawer or box. For nearly all customers who contacted us, these bottles were the main reason why they chose the pharmacy.

“Target had the best prescription packaging I’ve seen,” reader R. wrote. “Labels were easy to read and the color-coded bands made telling whose bottle was whose without glasses simple.”

The safety-minded packaging for prescriptions at Target drew many customers to the chain’s pharmacy counter over other options that might have even been in the same strip mall. A Target representative told Consumerist that the ClearRX patents were part of the sale of Target’s pharmacy business to CVS, and the drugstore giant now owns them, but is not using them.

It would be nice if CVS implemented them across the entire chain, but readers report that the red bottles have been discontinued since the changeover, and their meds are in classic CVS amber containers.

“My local pharmacy team was always very friendly, and even knew my name,” reader S. wrote. “Now, they are staffed with new people who are extremely rude.”

This was a common complaint of readers about CVS: whether it was because previous staff members left or because CVS brought its own people in, the familiar faces behind the pharmacy counter disappeared.

“Target Pharmacies were great,” G. wrote. “They were like your old-time neighborhood pharmacists.” He notes that he used to drive past about a dozen other pharmacies just to patronize Target, but will no longer be doing that.

Reader G. shared her experience trying to use her discount card through GoodRX, a site that lets you compare prices at different pharmacies in your area. She used the company’s discount card on the mobile app just as she always had at Target…or she tried to.

“I used to use it at Target with no problems,” she wrote to Consumerist. “Since CVS took over, even though they are still listed in the GoodRX app, when I went to pick up two of my prescriptions I was told they do not honor it.”

Other customers mourned the end of the discounts they received from pharmacy rewards. In states where such programs are legal, customers would receive a 5% off certificate good or a whole Target shopping trip after filling five prescriptions at the store.

M. takes a medication with a very specific extended-release mechanism, and she has found the generic version from one manufacturer to be the most reliable. Target used that one, but the new CVS inside Target stocks a version from a different manufacturer that she doesn’t trust. “So many recalls,” she notes.

The pharmacy was able to get the drug for her after a month of taking the less trustworthy version, but didn’t stock it consistently, leading to wasted trips. She gave up and switched her prescriptions to Walmart.

“I like shopping at Target, and now I have no built-in reason to go there every month,” she wrote to Consumerist. “Sad for them too, because I never, ever walked out of there with just a prescription bag. I probably spent anywhere from $25 to $75 every time I went in to get my refill.”

Depending on how many customers are like M., this is exactly the kind of news that Target CEO Brian Cornell won’t want to hear.

While they aren’t exactly drugs, reader D. noticed a really common medical supply missing from his local pharmacy in Florida after the transition to CVS. “Basic diabetic supplies, such as test trips and lancets – no longer carried, with or without insurance,” he observed. Let’s hope that isn’t a permanent change.

Patients had less information on this, but recounted that their prescriptions were assigned new numbers under CVS. That makes sense. However, this broke the auto-refill system, causing problems for customers.

N. reports that the transition didn’t go well in Target’s home state of Minnesota. “Once the new CVS systems launched there were a lot of issues with employees struggling to input prescriptions and complete pickups with the new computer system,” he writes, saying that lines were exceedingly long for the first two weeks after CVS took over.

C. had her prescription for a controlled drug disrupted: her doctor needs to authorize it for three months at a time, and the pharmacy had to contact her doctor to confirm it even though he had just done so the month before CVS took over.

“It was a one-time inconvenience,” she wrote to Consumerist, “but enough of an aggravation that I elected to move my prescriptions elsewhere, since Target no longer had the bottles that made me interested in filling prescriptions there in the first place.”

Take heed, CVS: people really, really, really like those bottles.

PREVIOUSLY:
Target Sales Are Down Because Customers Are Fixing Up Their Homes Instead

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Report: Pills in Prince’s home mislabeled, contained fentanyl

http://www.cnn.com/2016/08/22/health/prince-pills-fentanyl/

It is amazing how some reporters have to spin the TRUTH to make a point.  It has been reported that the tablets found in Prince’s position was a “Watson 385”.  This tablet was a commercial product containing 7.5 mg of Hydrocodone and 500 mg of Acetaminophen.  But about 3 yrs ago, all production of opiates with more than 325 mg of Acetaminophen could no longer be legally produced in the USA.  This product was replaced with a 7.5 mg Hydrocodone and 325 mg of Acetaminophen.

To the best of  my knowledge there is NEVER BEEN a legally produced, commercially available Fentanyl in a tablet form in the USA.  So to suggest that the manufacturer “mislabeled” the product is so small a possibility it is virtually NON-EXISTENT. 

There have been reports of ILLEGAL produced tablets that resemble both NORCO and Xanax that contained Fentanyl.. One thing that they did not clarify is that the Fentanyl that is legally available in the USA is Fentanyl Citrate.. the illegal products contain Acetyl Fentanyl and a new variation coming in from China furanyl fentanyl. Both of which are less potent than the Fentanyl citrate.  That single determination would have clarified if the tablets that Prince took were legally manufactured in the USA.

The question has to be asked … was Prince one of those 1%-2% of chronic pain pts that became addicted. Could he not find a doctor to treat his chronic pain (hip ?) adequately and resorted to getting his hands on something to allow him to continue doing is job of preforming ?

IMO.. because this was a OD death of a high profile person.. most of the details of his death will be kept confidential. So the truthful facts may never be known… just the spin that the media can put on this story…

 

 

Investigators have not said whether Prince ingested those pills or whether he knew the pills contained fentanyl.

Star Tribune sources said Prince’s toxicology report, which has not been released, also revealed the presence of lidocaine, alprazolam and Percocet in his system.

CNN’s Dr. Drew Pinsky said the combination of fentanyl, (which is an opioid based drug), and alprazolam (which is a benzodiazepine) could be the key to why Prince died.

“It is all too common for people to overdose if they are taking a combination of a benzodiazepine and an opioid,” Pinsky said. “This is what I’ve been warning was a likely possibility.”

Powerful painkiller

At the beginning of the investigation into Prince’s death, sources told CNN that painkillers were found inside his Paisley Park compound and they could not find a valid prescription for the medication. The Star Tribune now reports that their source said no prescription for fentanyl has been found in the months since Prince’s death. So, a burning question remains. How did Prince acquire the drug?

Fentanyl, the most powerful painkiller on the market, is normally prescribed to cancer patients in extreme pain. It’s also used to ease the pain of someone who is dying or as part of anesthesia during surgery.

But illegally manufactured fentanyl pills are readily available across America.

 

Just last month, the Drug Enforcement Administration published a report saying counterfeit pills are fueling the fentanyl and heroin/opioid crisis in the United States, which has become an epidemic. The DEA issued a national health alert over the rise in fentanyl overdoses in 2015.

That year, the DEA said its National Forensic Laboratory Information System showed “there were approximately eight times as many fentanyl exhibits (confiscated drugs that tested positive for fentanyl) in 2015 as there were during the 2006 fentanyl crisis, clearly demonstrating the unprecedented threat and expansion of the fentanyl market.”

 

Prince’s death at 57 years old shocked the world. For months fans mourned the musical genius by showing up by the hundreds to pay their respects. Many left purple mementos on the fence that surrounds the Paisley Park Compound where Prince died.

He was discovered dead inside of an elevator in the complex.

Dosage would have killed anyone

Officials never revealed the amount of fentanyl that was in Prince’s system. But the Star Tribune reported that a source said the amount of fentanyl in his system was so high it would have killed anyone, no matter their size.

 

It has been four months since Prince died and the investigation into his death is still ongoing. The DEA began working the case alongside the Carver County Sheriff’s Office from the very early stages. But no one knows exactly why Prince was taking strong painkillers or how he obtained them.

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Some of my readers seem to have the same mental concept as some of the legislators that pass many of the laws that are impaling many in the chronic pain community.

PALLIATIVE CARE is a process not a structure.

Yes palliative care is normally associated with cancer care and end of life Hospice, but it is not a process restricted to Hospice or caring for terminal or end of life pts.

Hospice is a structure that is regulated by – who else – the government.  Normally, when a person enters Hospice.. their doc will confirm (guess) that the pt has less than 6 months to live.  In the case of a pt on Medicare/Medicaid, they relinquish their Medicare/Medicaid and the Hospice organization gets paid – normally a per diem amount – to provide all the services that the pt needs for the balance of their life.

Their goal is to “comfort” both the pt and their family and make the pt comfortable and do nothing that will extend their life.. Again it is about saving money for the system… paying for heroic procedures that may add hours or days to the pt’s life.

If you read the WHO’s definition of palliative care in this post  what would happen if ?

It is about helping a pt and the family deal with the pt’s life threatening disease… be that diabetes, hypertension, heart failure… whatever disease that if not properly addressed could impact both the pt’s quality of life and life expectancy.

How many pts’ quality of life have been compromised by the reduction or elimination of their pain medication therapy ?  How many chronic pain pts have committed suicide because their medication was reduced or eliminated.

Is providing a pt with physical therapy, a cane, walker or wheelchair to improve the pt’s quality of life, part of  palliative care ?

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I hear from pts .. nearly daily.. about their medications being pulled back, dropped altogether and/or discharged from a practice.  I read in a lot of state laws and CDC guidelines the word “PALLIATIVE” which is often aligned with the clause that exempts terminal/cancer pts from any limitations on their opiate/pain management therapy.

If you look to WHO (World Health Organization) as to their definition of Palliative care you get the following

WHO Definition of Palliative Care

Palliative care is 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. Palliative care:

http://www.who.int/cancer/palliative/definition/en/

• provides relief from pain and other distressing symptoms;
• affirms life and regards dying as a normal process;
• intends neither to hasten or postpone death;
• integrates the psychological and spiritual aspects of patient care;
• offers a support system to help patients live as actively as possible until death;
• offers a support system to help the family cope during the patients illness and in their own bereavement;
• uses a team approach to address the needs of patients and their families, including bereavement counselling, if indicated;
• will enhance quality of life, and may also positively influence the course of illness;
• is applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life, such as chemotherapy or radiation therapy, and includes those investigations needed to better understand and manage distressing clinical complications.

Palliative care seems to have a very broad definition and while normally associated with treating pts with cancer…there seems to be the potential to apply to pts with a large array of chronic disease states.

The CDC guidelines and/or any guidelines – while don’t carry the weight of law – they do bear the weight of creating a “standard of care”  and/or “best practices”.  To establish a MINIMUM OF CARE for pts but not to exclude care provided to the pt above and beyond the MINIMUM care.

It is common knowledge that chronic pain pts typically suffers from depression and anxiety and is at twice the risk of committing suicide.

A pt’s medical records is clinical proof of what has been tried and what has been successful.  When a prescriber start changing/reducing the pt’s medication therapy.. could that be considered a form of pt abandonment or a form of malpractice because they are deviating from what has been proven clinically successful for a particular pt.

Currently Barb’s pain management is – IMO – at a optimum level, but like everyone else… she/we are at risk of various changes that could impact that situation… PCP retiring, dying… the teaching hospital where her pain clinic is located could have a change in policies and procedures.

If her pain management is reduced.. it is obvious that her quality of life goes in the same direction… and to the same degree it has an impact on my quality of life..

There is a part of the law:

http://www.legalmatch.com/law-library/article/limits-on-damages-for-loss-of-society-companionship–consortium.html

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I have started this presentation in the middle and you need to listen to about 7 minutes of it. The entire presentation is abt ONE HOUR and can be viewed in its entirety on www.youtube.com

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LIFE Before Death Opium: Sinner or Saint

Our healthcare system has evolved to a point where now they label many things as “PRE”… pre-hypertensive, pre-diabetic, pre-cancerous  each of us has a finite number of days, weeks, months years to be on this earth..  let’s admit it.. everything after BIRTH is PRE-DEATH !

When I was born.. my life expectancy was 65.. since I have passed that “bar”… my life expectancy is now in the late 70’s – early 80’s .. Every birthday that I manage to make.. my life expectancy extends somewhat.

Over those decades, I have become “dependent” on many things… food, drink, sleep, air.. and now certain medications that keep what medical science considers “normal ranges”  trying to extend my life expectancy and hopefully my quality of life.

We are seeing more and more of those suffering from subjective diseases …specially chronic pain … as their medications are being pulled back and or they are dropped all together.. if their “quantity of life”/life expectancy is worth much without a optimized quality of life that their medications use to provide them.

I have been told by friends, relatives and doctors of people who are suffering so from their untreated pain.. have exercised their final and only option to finally stop their torturous level of pain.  

Have those deaths been intentionally mis-classifed as “opiate related death” and not the real cause… basically hidden from view and/or swept under the rug. There seems to be little indignation by the relatives that their loved one was forced down that path.  Unlike those who have lost a loved one who OD’d because they suffered from addictive personality disorder and for whatever reason… their death spiral could not be stopped.

Only the chronic pain community and their relatives can stop this INSANITY that is centered in Washington DC and many state capitals. The solution is not as tragic as what some in untreated pain are having to do…  but is would be a sort of  SHARING YOUR PAIN

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Is the use of medications like methadone and buprenorphine simply replacing one addiction with another?

https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/frequently-asked-questions/use-medications-methadone-buprenorphine

In treating substance abuse… are we trying to replace an ADDICTION to a C-II opiate by creating a DEPENDENCY on a C-III medication ? Is this an admission that substance abuse is NOT CURABLE… just TREATABLE… but still involves a controlled medication.. with – according to the DEA – still  has an abuse potential.. since it is a controlled (scheduled) medication.

No. Buprenorphine and methadone are prescribed or administered under monitored, controlled conditions and are safe and effective for treating opioid addiction when used as directed. They are administered orally or sublingually (i.e., under the tongue) in specified doses, and their effects differ from those of heroin and other abused opioids.

Heroin, for example, is often injected, snorted, or smoked, causing an almost immediate “rush,” or brief period of intense euphoria, that wears off quickly and ends in a “crash.” The individual then experiences an intense craving to use the drug again to stop the crash and reinstate the euphoria.

The cycle of euphoria, crash, and craving—sometimes repeated several times a day—is a hallmark of addiction and results in severe behavioral disruption. These characteristics result from heroin’s rapid onset and short duration of action in the brain.

As used in maintenance treatment, methadone and buprenorphine are not heroin/opioid substitutes.

In contrast, methadone and buprenorphine have gradual onsets of action and produce stable levels of the drug in the brain. As a result, patients maintained on these medications do not experience a rush, while they also markedly reduce their desire to use opioids.

If an individual treated with these medications tries to take an opioid such as heroin, the euphoric effects are usually dampened or suppressed. Patients undergoing maintenance treatment do not experience the physiological or behavioral abnormalities from rapid fluctuations in drug levels associated with heroin use. Maintenance treatments save lives—they help to stabilize individuals, allowing treatment of their medical, psychological, and other problems so they can contribute effectively as members of families and of society.

How effective is drug addiction treatment?

https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/frequently-asked-questions/how-effective-drug-addiction-treatment

In addition to stopping drug abuse, the goal of treatment is to return people to productive functioning in the family, workplace, and community. According to research that tracks individuals in treatment over extended periods, most people who get into and remain in treatment stop using drugs, decrease their criminal activity, and improve their occupational, social, and psychological functioning. For example, methadone treatment has been shown to increase participation in behavioral therapy and decrease both drug use and criminal behavior. However, individual treatment outcomes depend on the extent and nature of the patient’s problems, the appropriateness of treatment and related services used to address those problems, and the quality of interaction between the patient and his or her treatment providers.

Relapse rates for addiction resemble those of other chronic diseases such as diabetes, hypertension, and asthma.

Like other chronic diseases, addiction can be managed successfully. Treatment enables people to counteract addiction’s powerful disruptive effects on the brain and behavior and to regain control of their lives. The chronic nature of the disease means that relapsing to drug abuse is not only possible but also likely, with symptom recurrence rates similar to those for other well-characterized chronic medical illnesses—such as diabetes, hypertension, and asthma (see figure, “Comparison of Relapse Rates Between Drug Addiction and Other Chronic Illnesses”)—that also have both physiological and behavioral components.

Unfortunately, when relapse occurs many deem treatment a failure. This is not the case: Successful treatment for addiction typically requires continual evaluation and modification as appropriate, similar to the approach taken for other chronic diseases. For example, when a patient is receiving active treatment for hypertension and symptoms decrease, treatment is deemed successful, even though symptoms may recur when treatment is discontinued. For the addicted individual, lapses to drug abuse do not indicate failure—rather, they signify that treatment needs to be reinstated or adjusted, or that alternate treatment is needed (see figure, “Why is Addiction Treatment Evaluated Differently?”).

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There is a anti-opiate group having a rally/protest in DC next month… The initial gut reaction by some in the chronic pain community is to show up and have a counter protest.

But this group is just patting all those in Congress and the bureaucracy to continue doing what they are doing… a counter protest could give them just that credibility and attention that they don’t deserve or would otherwise get.

Over the last decade, especially during this administration, the war on drugs has taken a definite change in direction, focused on pts, pharmacies/Pharmacists, drug wholesalers and prescribers.  Not really sure why the dramatic change.. Could it be in the same time that 25 states have decriminalize/legalize MJ/MMJ in that time frame and the DEA could stand to loose all states as more have it on the ballot this fall… that means that the DEA stands the possibility of losing a lot of funding unless they find another reason to keep their funding.  Could it also be part of this administration’s promise to fundamentally change America.

Congress creates laws and fund governmental agencies via the Federal budget process.  Congress also has the ability – although seldom uses it – the ability to revoke/rescind existing laws that are no longer appropriate.

They can even pass new laws – which they do 300-400 times a year – that are in conflict with existing laws on the books and/or makes existing laws on the books unconstitutional.

Congress works on a “seniority system” .. the old guard/establishment dictates the entire process.  As has been proven over the time, nothing has changed for the positive in the chronic pain community. Congress has turned a deft ear/blind eye to the medical needs of about 1/3 of our population.

In fact, they have seeming done things that are harming/killing and/or causing people to commit suicide because of the Federal agencies’ activities.

Is it time for the chronic community to SPEAK UP… and do it at the voting booth.  We don’t know what visible or invisible groups have the ear of those in Congress and to date have seemingly been successful in influencing the direction of the war on drugs/pts.  Lobbyists spend NINE MILLION/DAY trying to influence Congress… THREE BILLION + /yr.  They are not spending that kind of money… without getting the results that they want.

The chronic pain community’s votes could have MORE VALUE than all those BILLIONS that are being spent to influence Congress. How much is your health worth ?

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