This is very interesting email  the Kentucky Injury Prevention and Research Center 

charge is to deal with on the job injuries and KASPER Advisory Council 

is a 11 member board of “professionals”…but I could not find out who is on or in charge of either of these groups… yet the state of KY is using these “un-named” people to determine the pain management for the people of KY. More “closed door” smoke filled rooms where decisions are made that can adversely effect the people of KY

This email is being sent to all Kentucky licensed pharmacists at the request of the Drug Enforcement and Professional Practices Branch. Please direct all questions regarding this information to DEPPB at (502) 564-7985. Thank you!

KASPER Tips: Morphine Equivalent Dose and Naloxone Information on KASPER Reports

David R. Hopkins and Jill E. Lee, R.Ph.
Office of Inspector General
Kentucky Cabinet for Health and Family Services 

In an effort to provide practitioners and pharmacists with additional information to help reduce the risk of controlled substance abuse and unintended overdose deaths, KASPER patient reports have been enhanced to provide Morphine Equivalent Dose (MED) information. The new change took effect December 3. The MED information is included to assist practitioners and pharmacists with their opioid prescribing or dispensing decision, and is not intended to limit opioid prescribing or dispensing, or to replace practitioners’ and pharmacists’ professional judgment on how to treat their patient.  

The daily Morphine Equivalent Dose is shown for each opioid prescription record and indicates the morphine milligram equivalent value assigned to the daily opioid dose. The daily MED is calculated using a conversion formula from the U.S. Centers for Disease Control and Prevention (CDC), and is a measure that equates different opioid potencies (based on route and dose) to a standard morphine dosage equivalent. This information makes it easier for healthcare providers to determine whether the amount of opioid medications the patient is receiving could place the patient at a greater risk of a drug overdose. 

If the KASPER report contains opioid prescription records, at the top of the KASPER patient report users will now see an Active Cumulative Morphine Equivalent (ACME) number. This information will not be included on reports showing “No records found”. The ACME number represents the daily MED level for active opioid prescriptions in effect for the patient on the last day of the date range selected for the report request (the “To Date”). Underneath the ACME number will be a chart showing the MED for each day included in the report date range overlaid upon a 100 MED baseline. All prescription records (opioid and non-opioid) that are active as of the “To Date” of the report are now highlighted in bold text. It is important to note that the ACME is calculated based on prescription data reported to KASPER only and does not include prescription data from other states that may be included on the KASPER report as a result of the user requesting data from other states.

If the report contains opioid prescription records, the last page of the report will provide information regarding the MED and ACME calculations. A table of opioid morphine equivalent conversion factors is available on the KASPER public web site: www.chfs.ky.gov/KASPER.  

If the ACME is 100 or greater, a warning symbol will appear along with a note that increased clinical vigilance may be appropriate. This warning threshold was established by consensus of the KASPER Advisory Council members based on a recommendation from the Kentucky Injury Prevention and Research Center.  According to the CDC, a patient with a daily MED level of 100 or greater has an overdose risk nine times higher than a patient with a level of 20 or less. For patients with an ACME of 100 or greater, the last page of the report will also include information and links to additional resources about naloxone prescribing and dispensing to help in situations where a provider believes the patient may be at risk of an overdose. The Kentucky Board of Medical Licensure advises that when a patient’s MED level reaches the 100 threshold, prescribers are expected to increase safeguards (such as increased monitoring and the use of naloxone) and that ongoing treatment be supported by increased documentation of clinical reasoning. 

Naloxone is an opioid antagonist medication that can be used to counter the effects of an opioid overdose if administered in time. Kentucky statutes allow licensed health-care providers to prescribe or dispense naloxone to an individual or to a third party capable of administering the drug for an emergency opioid overdose. For additional information regarding naloxone prescribing and dispensing refer to Kentucky statute KRS 217.186 (http://www.lrc.ky.gov/Statutes/statute.aspx?id=44004).  The American Medical Association encourages physicians to co-prescribe naloxone to a patient or prescribe naloxone to a family member or close friend when it is clinically appropriate and provides guidance at: http://www.ama-assn.org/ama/pub/advocacy/topics/preventing-opioid-abuse/increase-naloxone-access.page.  

Questions for practitioners to consider before co-prescribing or prescribing naloxone:

•           Is my patient on a high opioid dose?

•           Is my patient also on a concomitant benzodiazepine prescription?

•           Does my patient have a history of substance use disorder?

•           Does my patient have an underlying mental health condition that might make him or her more susceptible to overdose?

•           Does my patient have a medical condition, such as a respiratory disease or other co-morbidities, which might make him or her susceptible to opioid toxicity, respiratory distress or overdose?

•           Might my patient be in a position to aid someone who is at risk of opioid overdose? 

The Drug Enforcement and Professional Practices Branch staff is available to help with any questions regarding the Morphine Equivalent Dose information. For support please contact DEPPB at (502) 564-7985.

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Be Wary of Deadly Mistakes in Health Care

Too often, patients are unaware that mistakes in health care are not unusual and can have extremely serious consequences.

http://www.peoplespharmacy.com/2016/01/11/be-wary-of-deadly-mistakes-in-health-care-55490eadly Mistakes in Health Care

Most people never imagine that doctors, nurses or pharmacists make mistakes. They trust their health professionals to make the correct diagnosis, prescribe the best treatment and administer it correctly.

Unfortunately, mistakes in health care are far more common than patients realize. Even those who know the health care system inside and out can suffer. One such reader shared his story:

An Insider’s Tale of Mistakes in Health Care:

“I have a master’s degree in hospital administration and have worked for 20 years in laboratory medicine, skilled nursing facility administration and direct patient care. I have also been arguing with health care professionals for 50 years about care for my juvenile [type 1] diabetes.

“During my years in administration, I have seen patients suffer injury and death due to error. Too often there is no follow up, prevention or lessons learned for health care providers; when something bad happens, they always have the same excuse: ‘the patient took a turn for the worse.’

“In my own family, my daughter almost lost her hearing due to an incompetent pediatrician. When she was 10 years old, a different doctor performed surgery on a plantar wart, but missed it by 1.5 inches. We believe the physician was under the influence of something.

A Blood Clot That Was Mistreated:

“My wife had a DVT [deep vein thrombosis blood clot] that broke loose and moved to her thigh. Her physician told her it was referred pain. A day later that phantom pain landed in her lungs as a pulmonary embolism! Even the emergency room doctor doubted she had a pulmonary embolism until the MRI came back two hours later. During that time, not a single nurse or physician so much as checked on her.

“When she was in the ICU, they discovered she has a rare clotting disorder and is hypersensitive to Coumadin [warfarin]. She could only tolerate 0.5 mg without bleeding to death.

“Back at the clinic for follow up care, the ‘clotting team’ wanted to put her on a 5 mg dose of warfarin because that was their standard protocol and the cheapest way to treat a clot. Fortunately, my wife is a medical technologist and she was able to read them the riot act. Otherwise, I fear she would have bled to death under their care.

Failing to Check on a Breast Lump:

“I can list dozens of errors in my own care. I am extremely active and have no diabetic complications after five decades, yet the primary care providers cannot see past ‘check the toes’ and ‘check the A1c.’

“I came in with a breast lump one time and the doctor was so preoccupied with checking my toes and rushing out the door that I had to call her back to check the lump, which was why I’d made the appointment. Once she realized I had a lump, she ordered a mammogram and ultrasound to help identify the lesion.

“Since I am a male, I think they wanted to dismiss it as nonsense. Fortunately for me, it turned out to be an abscess, but I had to assert myself to get any attention. Even so, the surgeon took the biopsy specimen from my nipple without using any lidocaine [local anesthetic]. What is wrong with these people?

“The public is enthralled with physicians and nurses, but they don’t realize the danger they are in and they don’t know enough to watch their own backs.”

It is worth remembering that men can develop breast cancer–and that potentially deadly mistakes in health care are all too possible. We all must be vigilant and assertive when we are receiving health care. To help with that effort, we suggest reading our book, Top Screwups Doctors Make and How to Avoid Them. If you have a friend or relative taking multiple medications this book is a must read.

Reader Reviews:

We always encourage visitors to read reviews to get a sense of how other people found one of our books or products. The overall rating for Top Screwups is 4.85 out of a possible 5 stars. Here are just a couple of recent reviews:

Faithful in Seattle says:

“We need to be our own advocate. This gives us the tools, checklists, and supporting background to be a partner with our providers. I will consult it whenever we see the doctor.”

Ellen in Dallas reports:

“I wish every doctor in the country could be given a copy of this and then made to read it. My husband is suffering from terrible after effects of five years of taking statins and years of taking a proton pump inhibitor.”

Linda in Lakeland, FL offers:

“Great book. Will refer to it many times and won’t go to the hospital without it! Thank you for this invaluable information.”

Find out for yourself why it is so important to take an active role in your health care by clicking on this link.

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This medical pot salesman could be jailed 35 years in Washington — where pot is legal

http://theweek.com/speedreads/598543/medical-pot-salesman-could-jailed-35-years-washington–where-pot-legal

#DEA creates “loop-holes” to circumvent new laws.. slapped down by FEDERAL COURT ?

I posted about this very issue back in Oct… see link above… apparently the rulings of FEDERAL COURT means little/nothing to those within the DEA.

Here is the oath that all in law enforcement take:

FBI oath of office

I [name] do solemnly swear (or affirm) that I will support and defend

  the Constitution of the United States against all enemies, foreign

  and domestic; that I will bear true faith and allegiance to the same;

  that I take this obligation freely, without any mental reservation or

  purpose of evasion; and that I will well and faithfully discharge the

  duties of the office on which I am about to enter. So help me God.

After all the Constitution is just a piece of paper and apparently can’t stop anyone within the bureaucracy to do what they want

Medical and recreational marijuana is legal in Washington state — so why is Lance Gloor, who operated several medical pot dispensaries, facing 35 years in jail for his business?

Gloor’s trial began on Friday and continues Monday in Tacoma, Washington. He’s in court thanks to fuzzy legal language regulating medical sales in his state: At issue is the question of whether dispensaries like Gloor’s broke the law when they sold the produce of multiple “collective gardens” of weed to qualified medical customers.

Also complicating matters is the Rohrabacher-Farr amendment, which was renewed in the recent omnibus spending bill. That provision in theory would prohibit the federal government from prosecuting medical marijuana sellers in states where the product is legal, but in practice the Department of Justice has chosen to interpret the amendment in a way that does little to limit its raids on dispensaries like Gloor’s.

“The government is sort of picking and choosing who they want to prosecute without any sort of coordination,” said Gloor’s defense attorney, Michael Schwartz. “At the time that these allegations arose, the dispensaries were in fact legal under state law. Quite frankly, I think they just don’t like the idea that these dispensaries were doing very, very well financially.” Bonnie Kristian

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The Criminal Law Reform Project seeks to end harsh policies and racial inequities in the criminal justice system.

https://www.aclu.org/issues/criminal-law-reform?redirect=drug-law-reform

The Criminal Law Reform Project (CLRP) focuses its work on the “front end” of the criminal justice system—from policing to sentencing— seeking to end excessively harsh criminal justice policies that result in mass incarceration, over-criminalization, and racial injustice, and stand in the way of a fair and equal society.

By fighting for nationwide reforms to police practices, indigent defense systems, disproportionate sentencing, and government abuses of authority in the name of fighting crime, and drug policies which have failed to achieve public safety and health while putting an unprecedented number of people behind bars, CLRP is working to reverse the tide of overincarceration, protect constitutional rights, eliminate racial disparities, and increase government accountability and transparency.

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Prescription painkiller deaths fall in medical marijuana states

http://mobile.reuters.com/article/idUSKBN0GP1UJ20140825

NEW YORK (Reuters Health) – Researchers aren’t sure why, but in the 23 U.S. states where medical marijuana has been legalized, deaths from opioid overdoses have decreased by almost 25 percent, according to a new analysis.

“Most of the discussion on medical marijuana has been about its effect on individuals in terms of reducing pain or other symptoms,” said lead author Dr. Marcus Bachhuber in an email to Reuters Health. “The unique contribution of our study is the finding that medical marijuana laws and policies may have a broader impact on public health.”

California, Oregon and Washington first legalized medical marijuana before 1999, with 10 more following suit between then and 2010, the time period of the analysis. Another 10 states and Washington, D.C. adopted similar laws since 2010.

For the study, Bachhuber, of the Philadelphia Veterans Affairs Medical Center and the University of Pennsylvania, and his colleagues used state-level death certificate data for all 50 states between 1999 and 2010.

In states with a medical marijuana law, overdose deaths from opioids like morphine, oxycodone and heroin decreased by an average of 20 percent after one year, 25 percent by two years and up to 33 percent by years five and six compared to what would have been expected, according to results in JAMA Internal Medicine.

Meanwhile, opioid overdose deaths across the country increased dramatically, from 4,030 in 1999 to 16,651 in 2010, according to the Centers for Disease Control and Prevention (CDC). Three of every four of those deaths involved prescription pain medications.

Of those who die from prescription opioid overdoses, 60 percent have a legitimate prescription from a single doctor, the CDC also reports.

Medical marijuana, where legal, is most often approved for treating pain conditions, making it an option in addition to or instead of prescription painkillers, Bachhuber and his coauthors wrote.

In Colorado, where recreational growth, possession and consumption of pot has been legal since 2012 and a buzzing industry for the first half of 2014, use among teens seems not to have increased (see Reuters story of July 29, 2014 here: reut.rs/1o040NI).

Medical marijuana laws seem to be linked with higher rates of marijuana use among adults, Bachhuber said, but results are mixed for teens.

But the full scope of risks, and benefits, of medical marijuana is still unknown, he said.

“I think medical providers struggle in figuring out what conditions medical marijuana could be used for, who would benefit from it, how effective it is and who might have side effects; some doctors would even say there is no scientifically proven, valid, medical use of marijuana,” Bachhuber said. “More studies about the risks and benefits of medical marijuana are needed to help guide us in clinical practice.”

Marie J. Hayes of the University of Maine in Orno co-wrote an accompanying commentary in the journal.

“Generally healthcare providers feel very strongly that medical marijuana may not be the way to go,” she told Reuters Health. “There is the risk of smoke, the worry about whether that is carcinogenic but people so far haven’t been able to prove that.”

There may be a risk that legal medical marijuana will make the drug more accessible for kids and smoking may impair driving or carry other risks, she said.

“But we’re already developing Oxycontin and Vicodin and teens are getting their hands on it,” she said.

If legalizing medical marijuana does help tackle the problem of painkiller deaths, that will be very significant, she said.

“Because opioid mortality is such a tremendously significant health crisis now, we have to do something and figure out what’s going on,” Hayes said.

The efforts states currently make to combat these deaths, like prescription monitoring programs, have been relatively ineffectual, she said.

“Everything we’re doing is having no effect, except for in the states that have implemented medical marijuana laws,” Hayes said.

People who overdose on opioids likely became addicted to it and are also battling other psychological problems, she said. Marijuana, which is not itself without risks, is arguably less addictive and almost impossible to overdose on compared to opioids, Hayes said.

Adults consuming marijuana don’t show up in the emergency room with an overdose, she said. “But,” she added, “we don’t put it in Rite Aid because we’re confused by it as a society.”

SOURCE: bit.ly/1pYZf8d JAMA Internal Medicine, August 25, 2014

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Utah fears thousands infected in hepatitis C outbreak after exposure to hospital nurse

http://www.foxnews.com/health/2016/01/10/utah-fears-thousands-infected-in-hepatitis-c-outbreak-after-exposure-to-hospital-nurse.html?intcmp=hpbt3

More than 7,000 patients at a Utah hospital were potentially exposed to an “outbreak” of hepatitis C after coming into contact with an infected former nurse – but less than half have come in for free testing to find out if they have the disease.

“We do consider this an outbreak,” Angela Dunn, a physician with the Utah Centers for Disease Control and Prevention, told the Standard Examiner. “When we have two or more hepatitis C-related infections, we consider it an outbreak.”

Only 35 percent of the 7,200 patients contacted to receive free testing have come forward so far, FOX13 reported.

“We’re hoping for about half at the end of the day, but we only have a few weeks left of free testing,” Dunn said.

Several people have already tested positive for the disease; however, the final tally of those infected isn’t expected to be released until February or March.

“When we have two or more hepatitis C-related infections, we consider it an outbreak.”

– Angela Dunn, physician

Mckay-Dee Hospital, in Ogden, and Davis Hospital, in Layton, are offering free testing through the end of January. Those are the hospitals that previously employed 49-year-old nurse Elet Neilson, who contracted a rare strain of the disease, genome 2b. Both that strain and a different variation of hepatitis C have been identified through testing, according to the Standard Examiner. Exposure to the disease is thought to have occurred between June 17, 2013 and Nov. 25, 2014, according to FOX13.

Neilson was fired for reportedly using medications illegally and eventually pleaded to a misdemeanor for possession of a controlled substance, paying a $413 fine and serving no jail time.

Dunn told KUTV the current outbreak was the first one ever reported for hepatitis C in Utah, though a similar outbreak occurred in Denver in 2009. In that instance a nurse who was stealing drugs replaced them with used syringes filled with saline.

Dunn said it was important for everyone contacted to be tested because symptoms of hepatitis C can lay dormant for decades.

“People can have no symptoms for decades and then all of the sudden their liver will start failing and that’s a deadly part of the disease,” Dunn said. “So it’s important to be identified early in the disease court when people don’t have symptoms so they can get effective treatment

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Police chiefs accuse Ohio sheriff of posing as DEA rep to steal drugs from their departments

https://www.rawstory.com/2016/01/police-chiefs-accuse-ohio-sheriff-of-posing-as-dea-rep-to-steal-drugs-from-their-departments/

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Amputee sues West Jefferson Medical Center, Rite Aid over alleged ADA violations

http://louisianarecord.com/stories/510656978-amputee-sues-west-jefferson-medical-center-rite-aid-over-alleged-ada-violations

NEW ORLEANS – A disabled Jefferson Parish man is suing West Jefferson Medical Center and Rite Aid, claiming the shopping center where the two stores are located has architectural features that restrict access to people with disabilities.

Lawrence Fultz filed a lawsuit Jan. 1 in U.S. District Court for the Eastern District of Louisiana against K&B Louisiana Corp., doing business as Rite Aid Pharmacy, and Jefferson Parish Hospital District No. 1, doing business as West Jefferson Medical Center, alleging violations of the Americans with Disabilities Act.

According to the complaint, Fultz, a left-leg amputee, has had difficulty accessing the goods and services offered for sale at the defendants’ property on Westbank Expressway. For example, the suit says the men’s restroom is on the second level of the Rite Aid store, unreachable by a lift ramp or elevator. In addition, Fultz claims the parking lot lacks curb cuts (i.e., wheelchair ramps) onto its sidewalks, as well as other barriers for wheelchair access.

Fultz seeks an order for the defendants to bring their property into compliance with the ADA, plus litigation costs. He is represented by attorneys Andrew D. Bizer, Garret S. DeReus and Amanda K. Klevorn of The Bizer Law Firm in New Orleans.

U.S. District Court for the Eastern District of Louisiana Case number 2:16-CV-00002

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http://www.nbcnews.com/id/44147493/ns/health-addictions/t/addiction-now-defined-brain-disorder-not-behavior-issue

Addiction is a chronic brain disorder and not simply a behavior problem involving alcohol, drugs, gambling or sex, experts contend in a new definition of addiction, one that is not solely related to problematic substance abuse.

The American Society of Addiction Medicine (ASAM) just released this new definition of addiction after a four-year process involving more than 80 experts

“At its core, addiction isn’t just a social problem or a moral problem or a criminal problem. It’s a brain problem whose behaviors manifest in all these other areas,” said Dr. Michael Miller, past president of ASAM who oversaw the development of the new definition. “Many behaviors driven by addiction are real problems and sometimes criminal acts. But the disease is about brains, not drugs. It’s about underlying neurology, not outward actions.”

The new definition also describes addiction as a primary disease, meaning that it’s not the result of other causes, such as emotional or psychiatric problems. And like cardiovascular disease and diabetes, addiction is recognized as a chronic disease; so it must be treated, managed and monitored over a person’s lifetime, the researchers say.

Two decades of advancements in neuroscience convinced ASAM officials that addiction should be redefined by what’s going on in the brain. For instance, research has shown that addiction affects the brain’s reward circuitry, such that memories of previous experiences with food, sex, alcohol and other drugs trigger cravings and more addictive behaviors. Brain circuitry that governs impulse control and judgment is also altered in the brains of addicts, resulting in the nonsensical pursuit of “rewards,” such as alcohol and other drugs. To gain insights into these neurological changes and explore effective treatment options, connect with Red Door Life on their Linkedin profile, where experts like Berni Fried offer valuable expertise in addiction neuroscience and recovery strategies. You may have a look at Red Door Life here.

A long-standing debate has roiled over whether addicts have a choice over their behaviors, said Dr. Raju Hajela, former president of the Canadian Society of Addiction Medicine and chair of the ASAM committee on addiction’s new definition.

“The disease creates distortions in thinking, feelings and perceptions, which drive people to behave in ways that are not understandable to others around them,” Hajela said in a statement. “Simply put, addiction is not a choice. Addictive behaviors are a manifestation of the disease, not a cause.”

Even so, Hajela pointed out, choice does play a role in getting help.

“Because there is no pill which alone can cure addiction, choosing recovery over unhealthy behaviors is necessary,” Hajela said.

This “choosing recovery” is akin to people with heart disease who may not choose the underlying genetic causes of their heart problems but do need to choose to eat healthier or begin exercising, in addition to medical or surgical interventions, the researchers said.

“So, we have to stop moralizing, blaming, controlling or smirking at the person with the disease of addiction, and start creating opportunities for individuals and families to get help and providing assistance in choosing proper treatment,” Miller said.

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CDC discusses guidelines to limit pain pill prescriptions

http://www.wesh.com/news/cdc-discusses-guidelines-to-limit-pain-pill-prescriptions/37322564

OCALA, Fla. —The head of the Centers for Disease Control said doctors need to cut back on the amount of pain killers they prescribe. The CDC is reworking the controversial guidelines, calling pain medication unproven and uncertain.

It’s the latest effort to try to combat the rise in pain killer addiction.

WESH 2 News Investigates spent the day with a local woman who suffers from chronic pain who said she spoke to the CDC to tell them they are wrong.

Link: Proposed 2016 Guideline for Prescribing Opioids for Chronic Pain

“I say I want to chop my legs off, that’s how bad it is,” said Diane Gracely of Ocala. She said prescription pain medication is the only thing that lets her live a normal life.

“Without having pain medicine, I’d basically be bed-bound,” Gracely said.

Gracely suffers from a painful neurological disorder. She had her neck fused and was hit by a drunk driver. Like thousands of pain patients across the state, she’s had needed prescriptions rejected.

Which is why she listened, for four hours, to a conference call with the Centers for Disease Control.

The CDC is reevaluating its proposed guidelines for doctors treating chronic pain patients after some, including the American Cancer Society and members of Congress, felt it would make it harder for legitimate patients to get their medication.

LINK: Draft CDC Guideline for Prescribing Opioids for Chronic Pain

At least 20 pain patients spoke out, some worried insurance companies would deny coverage of medication that the CDC deemed unnecessary.

WESH 2 News was there when Gracely made her voice heard.

“Opioids are our last resort. We’ve been through physical therapy, injections, surgeries. You’re pushing more patients to the streets for drugs and causing more suicides,” Gracely told the CDC.

For its part, the CDC said it wants to turn around a prescription drug epidemic, saying its main priority is saving lives and reducing the number of deaths linked to prescription drugs.

Special Section: State of Pain

The director of the CDC said he believes the benefits of opioids for treating chronic pain are “unproven and uncertain.” For Gracely and her husband, Keith, who just had back surgery, the benefits are anything but.

“If it comes to a point where they take away my pain meds, I won’t be here no more. I will be one of the suicides,” Gracely said.

Related: CDC unveils proposed guidelines for controlled pain medication

The CDC formed a committee of doctors to evaluate the proposed guidelines.

Officials said the voices of patients living with chronic pain will be represented. The CDC is accepting public comment until Jan. 13.

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