Congress voted 407-5 to continue to practice medicine without a license.. guess who is going to get screwed ?

cryingeyevoteMedicare Drug Plans May Establish Pharmacy, Prescriber Lock-ins for Beneficiaries ‘at Risk’ of Rx Abuse 

The House last week overwhelmingly advanced multi-faceted legislation intended to address the nation’s opioid abuse crisis, moving the package to the Senate for an expected vote later this week. The measure, a House-Senate conference report that passed 407—5, contains a pharmacy and prescriber lock-in program for some controlled substances in Medicare Part D and Medicare Advantage drug plans.

The goal is to restrict the ability of Medicare beneficiaries to obtain prescribed narcotic painkillers if the patients are deemed to be at “high risk” of prescription drug abuse. Some 47 states have instituted similar restrictions for Medicaid enrollees. NCPA procured an exemption for long-term care patients.

If enacted—and there is partisan controversy that new funding was not included–the legislation would require stakeholder meetings, rulemaking, and a comment period—in all of which NCPA would be heavily involved. The effective date would be Jan. 1, 2019.

Also contained in the legislation are sections addressing prescription drug monitoring programs, disposal of controlled substances, and secure containers for controlled substances. In each of these cases, NCPA succeeded in ensuring there are no specific requirements for community pharmacies. 

Another provision would permit partial filling of Schedule II controlled substances prescriptions at either the request of the prescriber or patient. NCPA advocated to remove a burdensome requirement that would have called for physician notification each time a Schedule II drug was filled. NCPA will provide members with an analysis of all the relevant pharmacy provisions after the bill becomes law.

Those who have the “gold” and “pays the bills”… write the rules and withholds therapy ?

painedlifeInsurers restricting high-risk opioid users to select pharmacies

http://drugtopics.modernmedicine.com/drug-topics/news/insurers-restricting-high-risk-opioid-users-select-pharmacies?page=0,1

As the opioid epidemic continues to get worse, some health insurers are blocking patients identified as “high risk” from getting multiple opioid prescriptions filled at various pharmacies by restricting where they can fill prescriptions.

Editor’s Choice: How pharmacists should be fighting the heroin epidemic

Lisa Morris, AnthemMore people died from drug overdoses in the U.S. in 2014 than during any previous year on record, according to the CDC, with nearly half a million people in the United States dying from drug overdoses between 2010-2014. Notably, at least half of all opioid overdose deaths involve a prescription opioid.

Early into Anthem’s Pharmacy Home Program to prevent opioid abuse and polypharmacy, the insurer has already identified high-risk patients and plans to start curbing opioid scripts filled by those patients. In May, Anthem began notifying members identified as “high risk” for opioid abuse that they would be enrolled in the program, which limits drug coverage to one member-chosen home pharmacy.

These patients can select the pharmacy of their choice. However, after that selection is made the insurer will only pay for opioid prescriptions dispensed by the selected pharmacy. “We have sent hundreds of letters out. It won’t be until July that we will have the first group of pharmacy members [in place],” said Lisa Morris, Anthem’s vice president of clinical and specialty pharmacy.

According to Anthem, it has found that 24% of members identified as “high risk” had filled 10 or more controlled substance prescriptions during a 90-day period. Plus, 13% filled controlled substance scripts at five or more pharmacies and 19% filled scripts from five or more prescribers during a 90-day period.

Morris is optimistic that Anthem’s program will produce similar results as its opioid abuse-deterrent program that was designed to identify high-risk members with the Medicaid program in Maryland. “We experienced an opioid-related spending decrease of 12%, driven by reductions in inpatient services, reduced emergency department [visits] and non-opioid prescription drug spending in our Medicaid program in Maryland,” Morris said.

Plus, as members decreased or stopped opioid use, they also enrolled at much higher rates in substance abuse treatment. “The important issue is that we are helping to re-direct members to appropriate care and hopefully preventing unnecessary adverse events and deaths,” Morris said.

In May, Cigna also announced a multi-pronged plan to curb opioid abuse, with the goal of reducing members’ opioid use by 25%. Cigna will limit the quantity of painkillers and explore “additional controls for high-risk customers identified by Cigna’s data on its customers,” the insurer said in a statement.

Cigna is also supporting efforts to require prescribers to check state Prescription Drug Monitoring Program databases when prescribing more than a 21-day supply of a painkillers such as oxycodone or morphine, and is encouraging the rapid adoption of the new CDC guidelines on opioid use. Those guidelines include prescribing opioids for the shortest time possible to treat acute pain, and talking with patients about all options and risks before beginning long-term therapy.

Suboxone: the methadone of the decade

Suboxone: the methadone of the decade

http://www.clinicaladvisor.com/your-comments/suboxone-the-methadone-of-the-decade/article/506524/

I work with many patients in family practice and mental health, but I also have many patients, as well as family and friends, who are in recovery from addiction. Suboxone is not the answer [Advisor Forum, May 2016]. Suboxone has become a crutch for many. What was supposed to be short-term relief to help opiate addicts withdraw from opiates has become a growing epidemic in and of itself. Many tell me that they have been on this drug for 3, 4, and even 8 years. They also tell me that this medication is harder to quit than the opiates it was supposed to help them stop using in the first place. Suboxone has become the methadone of this decade. I saw a 44-year-old patient yesterday who has been on methadone for 12 years because he had back surgery. We are always looking for a quick fix, and it just does not work. Suboxone can be injected, despite what we are told by pharmaceutical companies. There is no easy answer, but this is not it. It is trading one drug for another. It seems physicians at times have become legal drug dealers (this is opinion, not fact), charging $200 each visit to these patients because insurance does not cover their visits. I do not know what the answer is, but this certainly is not it. 

 Obviously, I have strong feelings about this issue due to the handling of the medications and the patients involved. Patients with chronic pain cannot get the medications they need in this country now. Addicts are dying more on the streets today than ever before, and people are also not getting the correct treatment they need.—SALENA STEADE, FNP-BC, Mobile, Ala. (213-2)

what is the war on drugs good for ??… ABSOLUTELY NOTHING !

Tonight I watch Bernie Sanders standing along side Hillary Clinton claiming that he was going to do his best to make sure that all American has what they need.  I am not sure that the bureaucrats in our Federal system can adequately determine what each of us needs.. I am concerned that they are incapable of make the distinction between needs and wants.

If we all need national health insurance, does that mean that everyone that suffers from recognized chronic disease states will get treatment ?  Including those who have various mental health disease issues and those that suffers from chronic pain ?

The above sound track was released in 1969, in the middle of the Vietnam war… another dozens of years at war… losing some  50 +K young soldiers.. in a war that we never won and just pulled out in the early 70’s. Much like what we have been doing for the past decade in the Middle East.

Barb and I were “raised” in the 50’s & 60’s .. actually the “sixties” was our teenage years.. I turned 13.. June of 1960,, and Barb turned 13 Jan 1962.. couldn’t have nailed that any better .. if we had planned it…

Looking at what is now considered what many – including the government – considers a “basic standard of living”… we were both “dirt poor” during our childhoods.

It has been stated that our “rules of engagement” in the middle east is so narrowly defined that our Air Force fly sorties and the planes return without dropping the first bomb because the people that we are “at war” with.. hide behind innocent women and children…  and we can’t take the risk of harming innocent civilians in order to kill the “bad guys”

Remember the last war that we have actually won was in 1945 (World War II) and it took TWO ATOM BOMBS.. SEVENTY YEARS of fighting wars both territorial and socially … the most powerful nation in the world and the only thing that we can do is DECLARE WAR … fight a war… and end up walking away…

It doesn’t seem to matter if we are fighting a war on civil rights, drugs, poverty, education (head start & no child left behind). we just continue to “keep on fighting” and never assessing if there is any progress to a goal… or if we even have a endpoint ?

Who believes that if/when we get national health insurance, all those with chronic diseases will be able to get appropriate therapy or will their continue to be rationing and/or denial of care to certain groups or certain disease conditions ?

Why is seemingly the only choice in politicians is “doves” or “hawks”.. isn’t there a politician that will build our military into such a formidable force.. that everyone else clearly understands …. “you pick on us.. we will KICK YOUR ASS.. and we won’t screw around doing it “

 

Sometimes THE TRUTH is hard to recognize

truthSometimes THE TRUTH is hard to recognize

Overdose deaths increased by more than one third in Western Pennsylvania, DEA says

http://triblive.com/news/allegheny/10781143-74/heroin-county-drug

This is a article mostly stating FACTS except they make one statement in the article  While good statistics aren’t available … the continue to include MAY… MIGHT.. and their GOAL is to HOPEFULLY stop the increase in deaths from drug overdoses… Really not clear which drugs are the real cause of the overdoses.  Having another 3400 drug overdose deaths in 2016 would be considered a VICTORY ?  Of course, most statements are being made by the DEA or a director for a Rehab center.

If they are administering more and more Naloxone and deaths are increasing… Naloxone is NOT PREVENTING OD DEATHS… it is just postponing it !

Why hasn’t those involved with the war on drugs.. look at it like we do terrorists… we have to be 100% correct to prevent a terrorist from killing some of us.. because the terrorist only has to be correct ONCE to kill innocent people.

The Naloxone prgm – to prevent OD deaths – have to be there 100% of the time.. and when you hear bureaucrats “glad-handing” each other when they have revived a single person from dying from a OD numerous times, sometimes in a single day.

Is the Naloxone prgm just a “catch or release” process… or is it more of just a mirage of something being done to save/help people who suffers from the mental health disease of addictive personality disorder ?

Overdose deaths increased by more than a third in most Western Pennsylvania counties last year with heroin and other opioids driving the numbers, according to a new government report.

More people are dying because more people are abusing drugs, said Dr. Neil A. Capretto, medical director for Gateway Rehabilitation.

“Nearly every day, there’s more people using opioids than there were the day before…,” he said. “It’s like a tsunami of addiction.”

Statewide, drug-related overdose deaths increase by about 23 percent to 3,383 deaths in 2015, according to an analysis by the Drug Enforcement Administration.

Fatal overdoses increased by 37 percent to 422 in Allegheny County and by 43 percent to 126 in Westmoreland County, according to the report.

Westmoreland County has implemented several programs in the last year such as a drug court and an early diversion program at the magistrate level, naloxone training and drug use prevention programs, said Tim Phillips, director of the county’s Drug Overdose Task Force.

“Once we get all these pieces in place, we hope to at least see it level off,” he said.

The continued increase in overdose deaths drives home the need to get naloxone, commonly sold under the brand name Narcan, in as many hands as possible, Phillips said. Rapid administration of naloxone can keep people from dying from an overdose.

While good statistics aren’t available, the increased use of naloxone by first responders has probably cut the number of overdose deaths in Allegheny County by more than 100 people, Capretto said.

In addition to an increased number of people using heroin and opioids, some of the factors driving the increase in deaths include the use of fentanyl as a cutting agent or, increasingly, as a substitute for heroin, he said.

Heroin comes from poppy plants, so drug cartels have to grow and harvest the plants before they can sell it. Fentanyl is both a stronger drug and a cheaper one that’s made in laboratories, Capretto said.

Autopsies statewide found heroin or an opioid in 81 percent of the people who died of an overdose in 2015, according to the DEA. The presence of fentanyl increased by 93 percent and this increase was “concentrated in several southwestern counties,” the report says.

“The abuse of illicit street drugs and diverted pharmaceuticals continues to take too many lives and destroys families across Pennsylvania and the nation at large,” said Gary Tuggle, special agent of the DEA’s Philadelphia Field Division, which covers the state.

The DEA is increasingly seeing fentanyl being passed off as heroin, said DEA spokesman Patrick Trainor.

While he hasn’t run into a dealer selling fentanyl as heroin, it’s frequently mixed with heroin, and there’s not much quality control in the drug trade, said Westmoreland County Detective Tony Marcocci.

Testing bags from the same batch will show that one stamp bag has a mix while another will be nearly pure fentanyl, he said.

For an individual stamp bag, “there no telling what percentage it is,” Marcocci said.

The rise of heroin and opioids is driven by peer pressure and myths, such as the mistaken belief that snorting heroin or opioids keeps people from getting addicted, he said.

“We see some individuals who begin snorting heroin, become addicted to it and start injecting it because it’s cheaper,” he said.

Injecting is cheaper because the user gets a stronger effect for the same dose, Marcocci said. Other people start on pain medications and switch to heroin for the same reason, he said.

“The sad reality is that it’s affecting more and more people from various lifestyles,” Marcocci said. “It knows no barrier.”

A focus in Allegheny County is gathering more information about the people using heroin and opioids to see how to prevent or break their addictions, said Dr. Karen Hacker, director of the county’s health department.

“What we’re trying to figure out is where the interventions are going to have an effect,” she said. A report on the issue should be coming out soon, she said.

While police departments have been reluctant to start carrying naloxone, an increasing number such as Monroeville, Pitcairn and Brentwood have done so, she said. A Pittsburgh police spokeswoman couldn’t be reached for comment.

The county is also trying to get doctors who prescribe opioids to include naloxone as a safety net, Hacker said.

Westmoreland and Allegheny counties have standing orders allowing pharmacies to sell naloxone to anyone without a prescription. Neither is sure how many people are taking advantage of that.

“Getting it out there to the people who need it is a challenge,” Hacker said.

Brian Bowling is a Tribune-Review staff writer. Reach him at 412-325-4301 or bbowling@tribweb.com.

 

Opiate tolerance: fact or fiction ?

Often  chronic pain pts’ need for increased pain meds is blamed on “tolerance” …  some believe that the pt’s increase needs has little/nothing to do with the concept of “tolerance”.

In all likelihood this concept came from the fact that those who have abused opiates quickly develop a “tolerance” to “getting high” and keep having to take more and more in hopes of reaching a “high”.  After 1-2 yrs of an addict trying to get “high” … they can’t get high any more…  they continue to use/abuse opiates to avoid withdrawal… which they call “dope sick”.

It would seems that those who have issues with substance abusers have tried to apply this tolerance to getting high to the chronic pain pt’s need for higher doses.

What they seem to ignore the fact that as everyone ages… things stop working as well as they use to… the disease state that is causing your pain has probably deteriorated or gotten worse.

Aging also tends to slow down your stamina … you may have to push harder to get the same things done as 5-10 yrs before.. which will cause activity induced pain.. trying to gets the same/similar tasks done.

There are many factors that contribute to a pt’s need for larger doses in treating their pain as times goes by… throwing the label of TOLERANCE on that need is probably more fiction than fact.

Obama administration: more help to save the addicts… CPP… don’t bother ?

D.C. Week: HHS Eases Buprenorphine Prescribing

http://www.medpagetoday.com/Washington-Watch/Washington-Watch/58977

WASHINGTON — The Obama administration raised the cap on the number of individuals for whom prescribers can prescribe buprenorphine and the FDA approves the first bioresorbable stent for coronary artery disease.

HHS Eases Buprenorphine Prescribing

The Obama administration announced a new rule that could lower the death toll from opioid overdoses, but the changes will be mostly meaningless without additional funding, officials said.

The Department of Health and Human Services (HHS) officially raised the limit on the number of individuals for whom prescribers can order medication assisted treatment, specifically buprenorphine, from 100 to 275.

“In the absence of congressional action, we’re taking every step forward that we can,” said HHS Secretary Sylvia Burwell, referring to the stalemate in Congress over appropriating adequate funding for opioids.

 

FDA Chief Criticizes Industry for Inaction on Opioids

The new head of the FDA accepted some blame for the agency’s role in the growing opioid epidemic, while also chiding drug manufacturers for failing to take action.

“[W]e are all sinners,” said FDA Commissioner Robert Califf, MD, recalling the words of his Baptist grandfather.

“I think in this case, there’s a lot of sin to go around.”

Califf spoke to provisional members of a newly formed committee charged with advising his agency on how best to balance the needs of legitimate pain patients with the societal issue of opioid addiction. At the meeting, held at the National Academies of Sciences, Engineering, and Medicine on Wednesday, Califf said he’s spoken with R&D directors at most of the big drug companies and none have shown interest in investing in research on new non-addictive painkillers.

CDC Warns:Don’t Use Oral Liquid Docusate (Colace) Stool Softener in Any Patient

Don’t Use Oral Liquid Docusate Stool Softener in Any Patient, CDC Warns

http://www.medscape.com/viewarticle/865957

US health officials are continuing to investigate a multistate outbreak of infections caused by Burkholderia cepacia complex possibly linked to contaminated oral liquid docusate stool softener products.

In its July 8 update, the Centers for Disease Control and Prevention (CDC) advised against treating any patient with oral liquid docusate products.

According to the CDC, as of July 8, 47 B cepacia complex cases have been confirmed by molecular typing to match one of two outbreak strain types identified from healthcare facilities in five states. The CDC is also looking into reports of possible cases from additional states.

The CDC has confirmed that two samples of unused oral liquid docusate product received from one of the affected hospitals have tested positive for B cepacia complex. Further testing is underway to determine whether bacteria from these samples match the outbreak strains.

In addition, the US Food and Drug Administration is conducting tests on multiple liquid docusate products that are epidemiologically linked to reported B cepacia complex cases. To date, the CDC has confirmed one product as having B cepacia complex growth.

In a preliminary update on June 24, the CDC noted that these infections have occurred primarily in ventilated patients without cystic fibrosis (CF) who are being treated in intensive care units. At that time, and again in its June 29 update, the CDC recommended that facilities not use any oral liquid docusate products for patients who are critically ill, ventilated, or immunosuppressed.

In its July 8 update, the CDC expanded this recommendation to all patient populations. “If an oral liquid docusate stool softener is medically necessary, alternative medicines should be used,” the CDC says.

The agency urges healthcare providers and laboratories to remain alert for infections caused by B cepacia complex occurring among non-CF patients and to inform infection prevention staff immediately when these infections are identified.

In addition, although infections caused by B cepacia complex are known to occur among patients with CF, any clusters of such infections should be reported. “Cases and clusters should be reported to state or local public health authorities,” the CDC advises.

Facilities that identify infections caused by B cepacia complex among non-CF patients or clusters of these infections among CF patients are asked to sequester and save all docusate products used in the facility.‎‎

 

The CDC said it will update the situation by July 14. More information on the outbreak can be found on the CDC website.

Weekly meeting Fibromyalgia and Chronic Fatigue 8 PM EDT

!cid_logoWeekly meeting Fibromyalgia and Chronic Fatigue 8 PM EDT

 


Goto https://www.livesupportgroup.com/ to register for the live webinar

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EXTRA…EXTRA… we don’t have a MENTAL HEALTH PROBLEM

suicideepidemic