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Steve Ariens,P.D.
Chronic Pain Management Consultant
I asked this person the following question:
I got the email below on Jan 1, 2024. This pt’s story is not a unique issue. Another example of bureaucrats and politicians attempting to “solve” our fabricated opioid crisis by creating a “one size fits all” on pain management.
After having this blog for 12-13 yrs, I have developed a fairly sizeable network of chronic pain pts, chronic pain advocates, and numerous healthcare practitioners. I shared this woman’s email with a couple of select people that I believed might be able to STEP UP. And one did:
When everything seemed to start to fall into place for this young lady. This young lady’s pharmacist and the mid-level practitioner who was forcing her to reduce her pain meds had to step in to make sure that things were not going to change the way that this mid-level practitioner wanted things to happen. Here is a video this young lady sent that she personally explains what has happened.
Hi Steve,
I have sent you my story before. I am a single disabled palliative care sick patient in Maine. In September of 2021, my doctor and I were targeted by the assistant attorney general, Michael Miller. We think it was for 2 reasons-he was very effective at getting patients disability, testings, procedures, equipment, etc and because I require a high dose of opiates to physically and mentally function. Dr. Lommler believes Michael Miller made a deal with the insurance companies and profited somehow for taking him out. Michael Miller used at least 2 agencies to target, harass, and destroy us. They suspended Dr. Lommler’s license for going over the 100 MME limit on my prescription. However, Maine has a palliative care exemption that allows people (like me) to have access to opiates for pain control and disease treatment options. It also allows us to go over the 100 MME limit. They refused to lift the suspension unless he transferred to a “board approved” facility. He chose to retire because he wanted to stay at his independent office with his 200 complicated and unique patients. They gave neither one of us any due-process! They used backdoor methods and I believe they were illegal! There was a covering LNP seeing me for a year. We tried to find a doctor everywhere in Maine to see me but because of the Opiate Task Force and doctors getting red-flagged for going over the 100 MME limit and being dragged in front of the board, no one would see me. I was forced to transition to the hospital where all of my specialists are. You see, Maine and New Hampshire were the 2 states prescribing the most Opiates so they created a New England Opiate Task Force and sent them to work with the Governor Mill’s administration to red-flag doctors prescribing over the 100 MME limit and drag them in front of the board of medicine! They have forced independent providers to either retire or transfer to a “board approved” facility. These “board approved” facilities all have anti-opiate one-size-fits-all policies. The hospital that I am at has an anti-opiate provider masquerading as a “pain specialist.” She believes Opiates are life threatening and dangerous to everyone. She is force tapering me off all my pain medication! I am complicated and unique-I have multiple health conditions. I had an original medical nightmare that left me with life altering physical deformities and severe debilitating pain. I have Crohn’s disease, vitamin and bone deficiencies, and neuropathy-all of these cause malabsorption so I have to take double doses of all of my medication! I cannot have the conventional pain management treatments because I am allergic to everything and sensitive to anything and I have a prosthetic heart valve. I have Scoliosis and severe Osteoporosis with dangerously low Scores. I am 46 in an 86 year old’s body.
They are stereotyping anyone on opiates as addicts and forcing them off pain medication. The only option they give you is Suboxone-I cannot take this because the side effects would be catastrophic to my body. I had nothing but recovery and progress with my 8 1/2 year stable pain regimen. I was able to semi function independently with a decent quality of life. Since this provider has been force tapering me, I can no longer function independently at all and I have zero quality of life! According to Maine’s own definition and standards, what this facility and provider are doing to me is disability abuse! I tried to contact patient services for an advocate but was told there wasn’t one. The woman I spoke with for 2 minutes, asked me what my concerns were. I explained to her what was happening to me. 2 days later I received a letter stating my concerns were forwarded to the Medical Director and Operations Manager and they agree with the provider force tapering me. They also said there was no medical justification for my pain medication. I filed a public accommodation discrimination complaint with the Maine’s Human Rights Commission but haven’t heard a word since intake months ago! The letter gave an 800 number to call if you disagreed with their decision. It was the board of licensure telling you to submit a complaint. I already filed a complaint with the board of medicine and nurses months ago. So, you have to go to the same people that are red-flagging and harassing doctors going over the 100 MME limit. I won’t hold my breath! These are the same people that asked Dr. Lommler how he didn’t know that I was taking half of my pain medication and selling the other half! Dr. Lommler provided them with 7 1/2 years worth of passed urine screens and passed frequent random pill counts! I wasn’t even allowed to attend or participate into the investigation into my opiate use-I could’ve answered that question myself-I have never misused my pain medication! In fact, I did everything that I was supposed to do! How in the world can I trust they will help me!
Since this provider has been forcing me off my pain medication, I have had sky high blood pressures-202/129, severe bloody noses, I have been discharged from aquatic therapy-which I needed to get into my Crow Walker boot, I am completely dependent on my sons, I have had to quit tutoring for supplemental income, I can no longer walk on my crutches so I am trapped in my wheelchair, and I cannot mentally or physically function! My counselor and former providers have tried talking with this provider but she refuses to listen because she knows best. I had to spend my Christmas in the ER and I am now watching my right leg and foot do exactly what my left leg and foot did in my original medical nightmare. When my body is in severe stress, my multiple conditions play off of one another and wreak havoc on my body. Last time, the severe stress was an allergic reaction to hardware (we didn’t know why at the time, it took years to figure it out). This time, it is force tapering my pain medication! This time, it’s the providers choice to force taper me because of her personal feelings about a medication! Medical providers are supposed to do what is in the best interest of the patient, not what is in the best interest of their personal feelings! I have cellulitis in my right leg and foot with ulcers everywhere! I maintain my left leg and foot with Cuban for compression. I tried to wrap my right leg and foot but it’s not used to being wrapped, and I get continuous Charley Horses. They are intolerable with all of my pain medication being taken away! I have severe PTSD and zero trust in doctors from my original medical nightmare! I never ever wanted to go back to that sick person trapped in a wheelchair, I thought I left it behind for ever! This time, I don’t have a heart valve to lose! I am petrified and profoundly devastated because I worked so hard for 8 1/2 years to recover and progress and now that has been destroyed! I see people helping doctors that have been arrested but what about people, like me, who have been targeted, harassed, discriminated against, and literally going through disability abuse-who tells our story and helps us?
My counselor gave me a brochure for adult protective services and she told me to call because what they are doing to me is discrimination and disability abuse. I called and the lady said there is no process for this situation. She told me that it does qualify but the only thing I can do is file a complaint with the board of medicine and nurses because they are the only entities that have authority and jurisdiction over medical providers. I told her that I already filed complaints but it will take months because they only meet one day a month! I told her my body won’t make it that long and I asked her, “what if I die in the meantime?” She said, “let’s hope it doesn’t come to that but good luck!” WHAT? It’s like a nightmare that I cannot wake up from! I have contacted every politician in Maine and asked for their help. Crickets…I requested assistance from Governor Mills but she doesn’t even think she has to answer to her constituents. I have reached out to every volunteer lawyer’s projects and disability rights groups but they all claim no to have the resources to help me. I have documented, taken pictures, recorded videos, screenshot messages from my portal between her and I, audio recorded my video appointments exposing her discrimination and disability abuse! I cannot find an attorney in Maine to help me. This provider only saw me one time in person! She never looked at any areas causing my pain, she’s not monitoring my vitals or everything that is happening to me, she doesn’t even have the correct MRI’s-she’s going by a 2008 one when I was a normal person and could walk on my own, and she’s retaliating against me for filing a complaint! I need help and I don’t know where or who to go to! I even have an appointment with cancer care, January 23rd. I have MGUS and the blood work markers and symptoms all point to it turning into Multiple Myeloma. I asked her to please pause the force taper until I can get into my appointment. She said, “Oxycodone will not cure Multiple Myeloma so the force taper will continue!” How cruel is that!
I was hoping that you may have some direction or advice to help me. If I knew how to file a civil lawsuit against the hospital and provider, I would do it myself. Since September of 2021, I have had to be my own advocate, case manager, and attorney!
I already missed about 6 years of my sons’ lives because of my original medical nightmare! I can do no physical activity without my pain medication! I really don’t think my body will make it through this force taper! Opiates are literally life saving for me! They knew that I wouldn’t be able to find another doctor to see me and Michael Miller and the board of medicine took 2 doctors from me! The provider force tapering me filed a complaint against the LNP that saw me for a year. In it, she said that she felt compelled because Kaye endangered my life by prescribing these life threatening and dangerous medications. She also accused me of bribing Kaye in her complaint. That is ludicrous-I have never bribed anyone! Kaye made it very clear in her response that no one forced or bribed her. She also made it clear that I was the only patient she ever prescribed narcotics for in her entire medical career! I have been accused of selling half of my pain medication and bribing doctors! I am a law abiding Mainer and American just trying to live my life!
Thank you for taking your time to read my email. You can reach me any time at xxx.xxx.xxxx
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Some believe our country is on the verge of a Civil War, they may be right, but it won’t be a bilateral war like our last Civil War.. Our society has voluntarily divided itself in – for lack of a better description – TRIBES.
The chronic pain community is not all that different from our country of as a whole.
Recently a fellow chronic pain pt who had been advocating for end stage pediatric pts in a large hospital system that has a “no opiate” policy. All of a sudden the advocated was told that he was no longer permitted to advocate for these end of life pediatric cancer pts. I suppose that this major hospital system will return to treating these pediatric pts with NSAIDS and Acetaminophen and let them live the rest of their lives in a torturous level of pain.
There are rumors as to who said what and to whom… I am not going to elaborate. However, they know who they are and what was said to cause this to happen. One can only imagine the deprived mental status of those who have been involved in this.
Some have told me that this tribe of malcontents have monetized chronic pain pts’- personal information and several other covert processes. I started my blog in 2012 and have tried to motivate and educate chronic pain pts in some ways that they can navigate their way to getting their pain management back. Some chronic painers have told me that I should charge for my advice. My Pharmacy degree, license and career has provided for Barb and myself a comfortable retirement.
After this issue with these end of life pediatric pts, Going forward… I am going to ASK of people that want my advice to make a contribution to one of the four national charities listed below, these are all about THE KIDS… and charities we support. Maybe in some small way, my advice can help more than just one person/family.
https://www.stjude.org/ St. Jude Children’s Research Hospital – deals with kids dealing with cancer and/or life threatening health issues
https://lovetotherescue.org/ Shriners Hospital – deals with kids, born with “broken bodies” and birth defects
https://rmhc-kentuckiana.org/ Ronald Mc Donald House – this is near us and just a few blocks from a very large regional pediatric hospital ,3 other major hospitals within blocks, one being a teaching hospital and having the only LEVEL ONE TRAUMA CENTERS for 100 miles and part of a medical university and helps provide housing for families with kids in the hospital
https://t2t.org/ Tunnel to Towers Foundation – helps get handicapable housing for veterans, first responders with “broken bodies” , families with spouse/parent killed in the line of duty and Gold Star Families
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https://www.cato.org/events/pain-refugees-collateral-damage-war-drugs
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Next year, Medicare folks are going to get a break when they pay $2,000 out of pocket for medications and get ZERO COPAY after than point.
Have you ever squeezed a balloon? What happens, one part gets smaller and the other part gets LARGER?
I went out to www.medicare,gov website to see what was being offered. I just looked at premiums and deductible. That is the only thing that I can be comfortable that won’t change during 2025.
Come to find out, in 2024 our 12 monthly premiums and annual deductible was LESS than our DEDUCTIBLE WILL BE IN 2025
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There is also a old saying, with age, comes wisdom. – or is it common sense and many figure out that friendship is more important than some political beliefs?
Typically, good friends will have your back, politicians will lie to your face!
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If you’ve been living under a rock for the past few years, take note that there are very effective medications used to treat obesity and type II diabetes. They include products with glucagon-like peptide (GLP-1) activity.
The two dominant players in the industry are Novo Nordisk and Lilly.
Novo Nordisk distributes semaglutide: Ozempic for Type 2 diabetes; and Wegovy, a higher-dose product, approved for weight loss.
Lilly distributes tirzepatide: Mounjaro for Type 2 diabetes; and Zepbound, a higher-dose product, approved for weight loss. Tirzepatide works by mimicking two gut hormones: GLP-1 and glucose-dependent insulinotropic polypeptide (GIP).
Normally, when a drug is approved, the pharmaceutical sponsor has monopoly rights to distribute. The branded pharmaceuticals of Novo Nordisk and Lilly are not cheap. A one month supply is typically $1,000. Or more. And depending upon the patient’s insurance, it may not be covered.
Because of such high demand, patients HAVE been able to obtain what they want. Actually, it’s more accurate to say because of limited supply, patients HAVE been able to obtain what they want.
When drugs are in shortage, compounders are permitted to sell versions of those medications ostensibly to ensure patients can continue receiving care. By outsourcing to compounding pharmacies, companies and medical spas have been able to circumvent Eli Lilly and Novo Nordisk’s exclusive hold on GLP-1 drugs.
Many medications are currently on the FDA’s shortage list. As of October 2024, for example, clonazepam tablets and cis-platinum injections are in short supply. Most patients are not rushing to compounders to fill that need.
Presumably there’s a common manufacturing pathway for the compounded medications and branded medications.
Patients who have been accessing compounded GLP-1 drugs have been paying as low as $100/month.
This sets the stage for Novo Nordisk and Lilly to ramp up manufacturing capacity to serve anticipated demand.
On October 2, 2024, FDA sent out a press release.
The U.S. Food and Drug Administration has determined the shortage of tirzepatide injection, a glucagon-like peptide 1 (GLP-1) medication, has been resolved. Tirzepatide injection has been in shortage since 2022 due to increased demand.
FDA confirmed with the drug’s manufacturer that their stated product availability and manufacturing capacity can meet the present and projected national demand. Patients and prescribers may still see intermittent localized supply disruptions as the products move through the supply chain from the manufacturer and distributors to local pharmacies.
FDA reminds compounders of the legal restrictions on making copies of FDA-approved drugs
Compounded drugs are not approved by FDA. FDA-approved drugs go through FDA’s rigorous review for safety, effectiveness, and quality as part of the premarket approval process. Compounded drugs must meet conditions to qualify for exemptions under sections 503A and 503B of the Federal Food, Drug and Cosmetic (FD&C) Act. Among the conditions are:
- Section 503A of the FD&C Act includes restrictions on compounding drugs that are essentially copies of a commercially available drug. When a drug shortage is resolved, FDA generally considers the drug to be commercially available. Certain amounts are permissible under the law as long as the compounding is not done “regularly or in inordinate amounts.”
- Section 503B of the FD&C Act restricts outsourcing facilities from making compounded drugs that are essentially a copy of one or more FDA-approved drugs. Among other things, this means the compounded drug may not be identical or nearly identical to an FDA-approved drug unless the approved drug is on FDA’s drug shortage list.
Current shortage status of GLP-1 products (as of October 02, 2024):
- Tirzepatide injection: Shortage resolved.
- Dulaglutide injection: In shortage.
- Semaglutide injection: In shortage. Manufacturer has reported all but one of the presentations are available.
- Liraglutide injection: In shortage. Manufacturer has reported 2 presentations are available, and three have limited availability.
The agency will continue to work with manufacturers to help resolve the current shortages, and, as shortages resolve, will closely monitor the situation and provide any assistance we can to help manufacturers ensure an adequate supply. Before determining that a shortage is resolved, FDA considers a variety of factors, including the company’s ability to meet current and historical demand, the amount in a manufacturer’s stock, affected market share, ability of alternate manufacturers to cover the demand, and confirmed market stabilization. Please visit FDA’s Drug Shortages Database for the most recent information on the status of GLP-1 medicines and other drugs in shortage.
On first blush, it appeared the “party was over” for those seeking inexpensive compounded tirzepatide.
Semaglutide was still in short supply, and available via compounders at low price. But even that could change quickly.
Then, a lawsuit was filed in Fort Worth, Texas federal court by the Outsourcing Facilities Association claiming the FDA failed to follow proper procedures in making the change.
The FDA did not give the public a chance to weigh in on its decision and trusted assurances from Lilly, “the company that is self-interested in monopolizing the market,” that it could meet projected demand, the lawsuit said.
It called the FDA’s action “arbitrary, capricious and contrary to law.”
Then, the FDA agreed to reconsider its decision; staying the lawsuit.
The agency said in a court filing it would now allow compounding pharmacies and facilities to keep providing the drugs while it reviews whether there is a shortage of their active ingredient. Outsourcing Facilities Association Chairman Lee Rosebush said in a statement the group was “greatly relieved, for our members and the many patients that they serve, that the FDA has agreed to reconsider its decision.”
The Outsourcing Facilities Association claimed in its lawsuit the FDA removed tirzepatide from its shortage list even though it remained in short supply.
Lilly in August began sending cease-and-desist letters to telehealth companies, wellness centers and medical spas selling compounded versions of Zepbound and Mounjaro. The company has also filed lawsuits against sellers falsely claiming to sell FDA-approved versions of the drug.
Is there a shortage of tirzepatide? Dunno. How is current supply/demand calculated? How is projected supply/demand calculated? Given the number of drugs on the shortage list, one would think that there are standard metrics for making such conclusions. But perhaps it’s a judgment call, and there’s flexibility.
So, what’s next?
I think the GLP-1 compounding party will soon be over. But I think other options will open up.
There will be tremendous pressure for the pharmaceutical companies to lower their prices. The drug does not cost much to manufacture, and they can still make their top line revenue numbers, and continue to make a fortune.
New competitors will be coming on line soon, putting more price pressure on established players.
Next carriers will be under pressure. Carriers can also push for price concessions from pharma. Given the health benefits, carriers should be motivated. Because they’re on the hook for costs associated with obesity and diabetes.
There may be options for individual patients to import from Canada or other countries.
And Congress can act. Or can it?
Anyway, the country got used to low cost GLP-1 medications, and given that such medications are intended for chronic use, it’s hard to see how the country will make nice and go back to accepting expensive medications with the supply constrained by limited insurance coverage. The US is a noisy country. And this issue may get a lot more attention than some of the other political issues in the news.
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Why does a woman have a “A fundamental freedom to make decision about their own body” when it comes to the health issue of pregnancy, but when it comes to the treatment of both acute and chronic pain, she seems to have less – or no – right to make a decision about her own body?
Our Founding Fathers declared in our
We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.
Who believes that our Founding Fathers intended that their successors would create definitions for and micromanage what the meaning of our unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness are?
Our Founding Fathers – in their 18th century vocabulary and mindset – stated that ALL MEN ARE CREATED EQUAL. 250 yrs later, there is so little equality or equity in our society. Are “we” too segregated into too many “tribes” to get our society back on the track our Founding Fathers initially put us on?
Based on the search results provided, there is no specific statistic given for the exact number of women in the USA dealing with intractable chronic pain who are being denied adequate or no pain management. However, the search results do provide some relevant information about chronic pain in women:
1. Women are disproportionately affected by chronic pain compared to men. According to a CDC report, 21% of women reported chronic pain, compared to 19% of men. Additionally, 8.5% of women reported high-impact chronic pain (pain that frequently limits life or work activities), compared to 6.3% of men[1].
2. Women are more likely to experience chronic pain conditions compared to men. Some conditions that are more common in women include migraine, musculoskeletal pain, fibromyalgia, rheumatoid and osteoarthritis, irritable bowel syndrome, and neuropathic pain[2].
3. Women often face challenges in having their pain recognized and taken seriously by healthcare providers. They are more likely to encounter skepticism regarding the severity or legitimacy of their symptoms due to gender biases and cultural norms[2].
4. Women are more likely to receive prescriptions for sedatives rather than pain medication for their ailments. One study showed that women who received coronary bypass surgery were only half as likely to be prescribed painkillers compared to men who had undergone the same procedure[3].
5. Women wait an average of 65 minutes before receiving an analgesic for acute abdominal pain in the ER in the United States, while men wait only 49 minutes[3].
6. 70% of people impacted by chronic pain are women, yet 80% of pain studies are conducted on male mice or human men[3].
While these statistics don’t directly answer the query about the number of women denied adequate pain management, they do suggest that there are significant disparities in how women’s pain is perceived, diagnosed, and treated in the healthcare system. This implies that many women may indeed be receiving inadequate pain management, though the exact number is not provided in the search results.
Citations:
[1] https://medicine.yale.edu/news-article/for-many-women-pain-is-still-a-problem/
[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10937548/
[3] https://www.health.harvard.edu/blog/women-and-pain-disparities-in-experience-and-treatment-2017100912562
[4] https://pmc.ncbi.nlm.nih.gov/articles/PMC8119594/
[5] https://www.iasp-pain.org/advocacy/global-year/pain-in-women/
[6] https://journals.lww.com/jbjsjournal/Fulltext/2020/05201/Sex_and_Gender_Issues_in_Pain_Management.7.aspx
[7] https://www.cdc.gov/mmwr/volumes/72/wr/mm7215a1.htm
[8] https://www.washingtonpost.com/wellness/interactive/2022/women-pain-gender-bias-doctors/
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Being a native Hoosier, I have always considered Indiana to be a fiscally conservative state. Apparently the PBM’s “dog and pony show” pull the fiscal wool over those who work for the state to sign up with a PBM who is known to have rather opaque financial disclosures. One of the PBMs that Indiana signed up for was the infamous Optum Rx that is owned by United Health.
From www.perplexity.ai:
Medicaid Programs
For Indiana’s Medicaid programs:
INDIANAPOLIS — Indiana lawmakers are calling for more oversight of “pharmacy benefit managers,” or “PBMs” for short, following a report presented to the Health Care Cost Oversight Task Force this week.
PBMs act as middlemen between drug manufacturers and insurance companies and play a huge role in deciding what Americans pay at the pharmacy.
Due to concerns over rising prescription drug costs, the General Assembly passed a bill this year calling for an audit of the state’s plans with PBMS—an audit some lawmakers said demonstrates PBMs aren’t working in the state’s best interests.
“If the PBMs were by design to be saving the state money, they have failed miserably,” State Sen. Andy Zay (R-Marion) said.
According to that preliminary report, Indiana paid $7 billion to administer prescription drug benefits for Hoosiers enrolled in the state’s Medicaid program and state employee plan through FY 2017 through FY 2022.
”To put that into maybe a more human perspective, $1,000 out of every Hoosier’s hands is given to the state to pay for these folks and these drugs over the past five years,” State Sen. Zay said.
The company behind the report, RxConnection, LLC, said a contractual loophole called “off-setting language” allows PBMs to keep more money they’re supposed to pay back to the state.
”Indiana is one of the few states that allows this to even happen to begin with, and so that’s an area that definitely needs to be addressed,” State Sen. Andrea Hunley (D-Indianapolis) said.
”That [off-setting] language makes no sense to me,” State Sen. Ed Charbonneau (R-Valparaiso) said.
State Sen. Zay recommended creating a state-run PBM, eliminating rebates, or ensuring all pharmacies are in network to address the issue. A date for the task force’s next meeting has yet to be released.
Although an addendum to the report is expected to be released in the next few weeks, lawmakers expressed frustration that the final report may not include certain proprietary information about PBMs—information they said could be crucial for them to lower prescription drug costs effectively.
”There are many ways for them to embargo information and release that, I mean that is a practice that is done all of the time, and the fact that they couldn’t figure that out ahead of our meeting, I’m going to call B.S. on,” State Sen. Hunley said.
“I don’t care what PBM attorneys think or don’t think,” State Sen. Chris Garten (R-Charlestown) said. “And I don’t care what lawsuits may or may not come. I care about getting this under control for Hoosiers…if the AG’s Office has had to issue a civil investigative demand, that’s pretty damning in my opinion.”
The Indiana Attorney General’s Office said it cannot comment on the matter until the report is completed.
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https://www.clinicaladvisor.com/features/failure-prescribe-pain-medications-suicide/
Mr M was a 48-year-old married man with 3 children. He had been seeing his primary care physician (PCP) regularly since 2005 for chronic, debilitating cervical pain. The patient had been diagnosed with multi-level degenerative disc disease and cervical radiculopathy stemming from injuries he sustained in a car accident in his 20’s. The patient was prescribed opioid medications for pain management by his previous PCP, starting in 2005.
Mr M took his medication as prescribed and showed up for his medical appointments. By 2017, the patient was on a combination of medications to manage his pain including morphine sulfate (60 mg 3 times a day), oxycodone/paracetamol (5/324 mg every 4 hours, as needed), and zolpidem (10 mg/d),
In late February 2017, Mr M was told that his PCP was retiring in a few weeks and he should find a new primary care provider. He set up an appointment to establish care at another clinic but his first appointment was not until May. In early April, Mr M filled his final prescription from his PCP. By early May, the patient had run out of medication but was unable to get an earlier PCP appointment.
In severe intractable pain, Mr M went to his local emergency department (ED) in mid-May, the day before his new PCP appointment. He told the ED providers that his morphine sulfate prescription had lapsed the previous day. He explained that his physician had retired and he was unable to get an appointment with a new primary care provider until the next day.
Mr M was given 1 dose of morphine sulfate in the ED and was then sent home with instructions to follow up with his primary care provider. The next morning, he went to his appointment at the new clinic. There he was assigned to a physician associate (PA). The PA examined the patient but did not refill Mr M’s opioid prescriptions. Because the PA did not take thorough notes, there was no mention in the patient’s record of why he refused to refill the prescriptions, or whether he consulted with any of the 4 supervising physicians at the practice.
What is known is that the PA did not renew the existing prescriptions and sent the patient home without pain medication. Mr M experienced severe withdrawal from the morphine, and, feeling hopeless, died by suicide the following day. He was survived by a wife and 3 children.
The patient’s widow hired an attorney who sued the PA and all 4 of the supervising physicians at the clinic. Discovery began, and the plaintiff’s attorney retained an expert physician to go over Mr M’s medical records.
The expert physician concluded that there was evidence of medical negligence in the treatment of Mr M. Specifically, the expert noted that the care provided by the PA and his supervisors fell below the appropriate standard of care required in such a case. The expert’s report alleged that the PA and his supervisors had:
The expert’s list of the clinicians’ failures was extensive and blamed the supervising physicians as well for failing the patient.
The case was settled out of court for an unpublished amount. It is unclear why the family did not sue the original PCP who retired and left his long-time patient without any direction.
We cannot tell from the facts in this case why the PA declined to renew Mr M’s prescriptions. The doses of opioids may have been higher than the PA was used to seeing in a primary care practice.
There were many mistakes in this case. The retiring PCP left his patient without clear instructions or referral to a pain specialist. He should have helped Mr M find a new provider who would continue the opioids, or he should have helped the patient to taper off his medications before he left his practice. Instead, the PCP retired and left his patient with no continuity of care.
It is not clear whether the PA had access to Mr M’s previous medical records at the time of their meeting. However, not treating a patient who is opioid-dependent is negligent. Mr M was not offered anything to help with his pain or offered medical management of his opioid withdrawal, a short prescription for pain relief, or a referral to a pain specialist. He was sent home in physical pain with no recourse.
We are all aware of the opioid “epidemic” in this country and the hazards that these medications can bring, but that should never be an excuse to deprive a patient of desperately needed help.
Ann W. Latner, JD, a former criminal defense attorney, is a freelance medical writer in Port Washington, New York.
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Should Clinicians Be Liable for Patient Suicide After Failing to Prescribe Pain Medications?
Another person made the following comment on that blog post