I have highlighted several sentences in this article that suggest that the people doing the study were making some  GUESSES …like this one…Patients who die of overdose may have more than one prescribing physician and may overdose on illicitly obtained drugs. Just in one sentence they used the WORD MAY… but these medial examiners are sending letters to docs that ONE OF YOUR PTS – OD/DIED FROM A BENZODIAZEPINE in their toxicology. They converted all benzodiazepine to a “diazepam mg equivalent”.  We all know how accurate all those MME comparison work out. What was the toxicology values of these pts… the typical OD… has 4 to 7 different substances in their toxicology, one typically be the drug ALCOHOL. This study reminds me of all the things  I heard during the COVID-19 primary epidemic … when pts were claimed to have died of COVID-19 … when they really died from their existing comorbidity issues BUT… had tested positive for COVID-19.

Letter on Patient’s Fatal Overdose May Curb Benzodiazepine Prescribing

https://www.medpagetoday.com/publichealthpolicy/healthpolicy/100343

Physicians who received a letter from a medical examiner notifying them of a recent patient’s fatal overdose prescribed fewer benzodiazepines, a secondary analysis of clinical trial data showed.

Daily 2-mg diazepam pill equivalents decreased more in an intervention group that received a medical examiner letter and injunction to prescribe safely compared with a control group (-3.7%, 95% CI -6.9% to -0.5%, P<0.05), reported Jason Doctor, PhD, of the University of Southern California in Los Angeles, and co-authors.

On average, 2.9 fewer 2-mg diazepam pills were dispensed per prescriber per month in the intervention group compared with controls, Doctor and colleagues noted in JAMA Internal Medicine.

“The results of this secondary analysis of a randomized clinical trial suggest that having medical examiners send out letters informing clinicians of a fatal scheduled drug overdose in their practice is a low-cost approach to curtailing the overprescribing of benzodiazepines,” they wrote.

“The observed moderate reductions that were associated with the letter seemed to concentrate among continuing prescriptions, which is what was associated with the increase in benzodiazepine prescribing from 2005 to 2012,” they added.

The report extends the trial’s earlier finding that showed physicians in San Diego County who were informed by the medical examiner of a patient’s fatal overdose from July 2015 to June 2016 prescribed 10% fewer opioids.

These notifications may be effective reminders of the potential harm of opioids and benzodiazepines, observed JAMA Internal Medicine deputy editor Mitchell Katz, MD, of NYC Health and Hospitals, in an editor’s note.

“It is important to understand that the prescribed drugs may have been appropriate and that the patients did not necessarily overdose on the drugs that were prescribed by the physician who received the notification,” Katz pointed out. “Patients who die of overdose may have more than one prescribing physician and may overdose on illicitly obtained drugs.”

“Nonetheless, when we prescribe opioids and benzodiazepines, the risks and benefits to patients should always be weighed,” he continued. “Even appropriately prescribed scheduled drugs may be associated with long-term use and abuse, purchase of illicit drugs, and death owing to overdose.”

In their analysis, Doctor and co-authors assessed the change in benzodiazepines dispensed 3 months before (pre-period) and 1 to 4 months after (post-period) the letters and injunctions were sent. The researchers measured benzodiazepine prescriptions in daily 2-mg diazepam pill equivalents.

Overall, patients of 743 prescribers (353 in the intervention group and 390 in the control group) filled a benzodiazepine prescription during the study period. Alprazolam and lorazepam were the most frequently dispensed benzodiazepines.

In the intervention group, an adjusted average of 76.0 pills monthly were dispensed in the pre-period and 72.3 were dispensed in the post-period. In the control group, adjusted mean monthly pills were 82.9 in the pre-period and 82.0 in the post-period.

There was no significant difference by group in new treatment initiations from pre- to post-period.

One limitation to the study was that it did not evaluate the clinical well-being of patients or physicians in the intervention group, Doctor and colleagues acknowledged.

Other localities, like Los Angeles County and Washington State, have adopted the practice of sending letters to prescribing physicians alerting them of patient overdoses, Katz noted.

“As physicians, we do not always know why patients are no longer coming to see us,” he wrote. “Follow-up information can help us to be better physicians.”

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laurendeluca19

Lauren Deluca

· 889 Followers

Executive Director, Chronic Illness Advocacy & Awareness Group a NonProfit Org.

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I just happened to stumbled on to this while looking for something else…  Maybe I am wrong, but to develop a whole system that comes to a conclusion that a particular person’s risk of being or become addicted when they are taking controlled meds, is based on just using the data on 1523 pts.  Back in the last of 2021, the company that owns Narxcare is Bamboo, which was sold to Equifax  https://apprisscorp.com/press-relea…nsights-llc-to-equifax-in-1-825-billion-deal/.  I have read that all the data collected and maintained by Narxcare has been moved and stored outside of the USA… so that our HIPAA law has no authority over the prohibition of sharing/selling our personal health information.

There is some 330-340 million in our country and it is claimed that abt 100 million are dealing with some sort of chronic pain and as a country we purchase about 4 billion prescriptions per year and I have seen statements that abt 20% of those 4 billion prescriptions are for controlled meds…   that is a sampling of 0.001523 % sampling of the estimated number of chronic pain pts. Ohio has been one of the states with a very high substance abuse and OD rates.

According to this https://www.scrapehero.com/kroger-store-locations/ Kroger has 242 stores in Ohio and 160 stores in Indiana. So the sampling was in < 5% of the Kroger stores in those two states.  There are 88 counties in Ohio and 92 in Indiana.

Peer-Reviewed Study Validates Bamboo Health’s NarxCare as Effective Patient Screening Solution for Opioid Risk

https://bamboohealth.com/news-pr/peer-reviewed-study-validates-bamboo-healths-narxcare-as-effective-patient-screening-solution-for-opioid-risk/

Research funded by NIDA and NIH evaluated Narx Score rating system as compared to World Health Organization ‘gold standard’ for substance screening

BOSTON, October 26, 2021 – Bamboo Health, formerly Appriss Health and PatientPing, a healthcare technology solutions company focused on fostering care collaboration and providing information and actionable insights across the entire continuum of care, has announced that a newly published peer-reviewed study concludes the company’s NarxCare solution is effective as an “initial universal prescription opioid-risk screener.”

The peer-reviewed study was conducted through the National Institute on Drug Abuse’s (NIDA) National Drug Abuse Treatment Clinical Trials Network (CTN) and funded by the National Institutes of Health’s (NIH) HEAL Initiative. The study’s goal was to evaluate the validity of the NarxCare Narcotic Score as a clinical measure of opioid misuse and substance use disorder. Researchers assessed NarxCare risk thresholds relative to the “gold standard” World Health Organization Alcohol, Smoking, and Substance Involvement Screening Test (WHO ASSIST).

“Prescription Drug Monitoring Programs (PDMPs) are critical for pharmacists and clinicians to identify risky prescription medication use, but before our study the association between the Narx Score and other indicators of opioid use or risk had not been externally evaluated,” said Dr. Gerald Cochran, associate professor of internal medicine and director of research for the Program on Addiction Research, Clinical Care, Knowledge, and Advocacy in the Division of Epidemiology at the University of Utah School of Medicine, one of the leaders of the study team. “Our research shows that Bamboo Health’s NarxCare metric is a useful initial screening tool for prescribers to determine whether a patient is at risk for opioid misuse.”

Researchers recruited 1,523 participants from 19 Kroger community pharmacies located in both urban and rural Ohio and Indiana who were picking up prescribed opioids. The study was led by Dr. Cochran. The researchers have no relationship with Bamboo Health.

“This independent peer-reviewed study confirms what we at Bamboo Health have known about NarxCare’s ability to provide prescribers with clinical decision support to assess a patient’s vulnerability to opioid use disorder and misuse,” said Rob Cohen, company president and general manager. “We’re proud of the role our technology plays in helping clinicians and pharmacists make more informed prescribing and dispensing decisions to improve patient safety and health outcomes.”

NarxCare is a clinical decision support tool and care management solution that helps prescribers and dispensers analyze controlled substance data from PDMPs and manage substance use disorder. NarxCare automatically analyzes a patient’s PDMP data and provides risk scores along with interactive visualizations of usage patterns of opioids, sedatives, and stimulants to help identify potential risk factors.

The study used narcotic scores to divide participants into three groups representing low-, moderate- and high-risk for misuse; the thresholds proved clinically useful as a universal screen to advise providers on next steps with the patient, such as further review of the data or an additional screening with the patient.

“Pharmacists and physicians can use the thresholds as calls-to-action to further review details in the patient’s prescription history in conjunction with other relevant patient health information as they attend to the patients,” added Cohen. “The analysis, thresholds, and associated scores are not intended to work as sole determinants of a patient’s potential risk. We instruct our customers and clinician users that the purpose of NarxCare and the PDMP is to support their clinical decisions, not displace them.”

A Narx Score is a set of three-digit numbers that correspond to dispensing information for three different types of controlled substances (prescriptions). A separate score exists for narcotics, sedatives, and stimulants. The scores range from 000 to 999. The third number in the score indicates the number of current dispensations. The first two numbers are calculated based on data from the PDMP, including number of prescribers, number of pharmacies where prescriptions were dispensed, strength of the prescriptions, and overlapping prescriptions. More recent prescriptions and changes are weighted more heavily than older prescribing patterns.

Bamboo Health’s PDMP solutions are used in more than 40 states and territories and are leading the nation in prescription data monitoring.

About Bamboo Health

Bamboo Health, formerly Appriss Health and PatientPing, is a healthcare technology solutions company, focused on fostering care collaboration and providing information and actionable insights across the entire continuum of care. As one of the largest, most diverse care collaboration networks in the country, our technology solutions equip healthcare providers and payers with software, information, and insights to facilitate whole person care across the physical and behavioral health spectrums. By serving 2,500 hospitals, 7,800 post-acute facilities, 25,000 pharmacies, 37 health plans, 45 state governments, and over one million acute and ambulatory providers through more than 500 clinical information systems electronically, we impact over 1 billion patient encounters annually in provider workflow. Health systems, payers, providers, pharmacies, governments, individuals, and other organizations rely on Bamboo Health to improve care and reduce cost. Visit www.BambooHealth.com to learn more.

Study published in Drug and Alcohol Dependence journal

https://www.sciencedirect.com/science/article/abs/pii/S0376871621005627

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In ancient Greece, Socrates had a great reputation for wisdom. One day someone came to meet the great philosopher and said:

Let’s improve our individual life for good and society will change too.

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When I first started working in a pharmacy – in the summer of 1967 – while I was a student. There was NO PBM’s… 95%+ was brand name meds and everything was CASH… The average Rx price was $4-$5.  The PBM industry was created by the national UAW contract in the fall of 1969 – that covered the big three auto makers, John Deere & International Harvester. You could say that I had a “front row seat” to watching the PBM industry evolve since the beginning.

Here is graphic that demonstrates where the $$$ you pay at the Rx dept register really goes. Looking back, as the PBM industry starting controlling more and more of all prescriptions filled … the faster the wholesale price from the pharmas went up. Today, abt 85% of all Rxs are filled with generics and  the PBM’s control the price for 80%-90% of the 4 billion Rxs that we fill every year.  Today the average Rx price is pushing $70.00.

The PBM now are able to DEMAND a kickback/rebate/discount from the pharmas for any med that the pharma doesn’t want to require a prior authorizations.  It has been reported that money from the pharma can be up to 75% of the AWP (average wholesale price)

The new Inflation reduction act, that now laws Medicare to negotiate prices for Medicare covered medications… the Insurance/PBM industry was not included as a entity that should be included in the negotiation of Rx prices. Perhaps that we are having a national election in Nov, maybe a lot of money was put into some re-election campaigns by the insurance/PBM industry to make sure that they were not included in that new law. If you have a family, a business, or others who depend on you, visit here to get life insurance.

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I have been maintaining and adding to my blog for over 10 yrs .. I have actually lost count.  There has always seem to be some infighting within the chronic pain community.  Over the last few years, the in fighting has been escalated from in fighting to attempting to be down right DISRUPTIVE.

The community is – and been for decades – dealing with bureaucrats/politicians that regardless of what facts and studies that contradict their “facts” and their “agenda”  they are not going to change their policies and procedures.  They are going to continue to prevent people who have a valid medical necessity for being prescribed opiates and controlled substances from getting their needed medications.

These bureaucrats probably feel very emboldened about continuing to  curtail the prescribing of opiates and controlled substances, because some within the community is trying to just tear the community apart.  They have little concern about the community attempting to change the path that the bureaucrats/politicians are one… because the community is too busy destroying itself from within.

They are going to use such number as within this decade, illegal drugs/substances from cartels will kill MORE OF OUR CITIZENS… than all our soldiers that were killed in all the years of wars in the LAST CENTURY.  Recently, I have read where “they” are admitting that the vast majority of OD/poisoning are from illegal fentanyl analogs… but… they still use their 5 decade old fact “all addicts stated with Rx opiates”

Only those within the community can put a end to this disruptive behavior… If those in the community continue to support, align and otherwise condone the actions of those who are doing this… things will not only remain… it will most likely get worse and those doing the disrupting will only get  more aggressive, until the community has self destructed.

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Is it just me… or according to this ––Jennifer Lofland, Field Intelligence Manager for DEA Washington division, says pills have been seized in and around D.C. for at least the last 18 months. – what other major shift happened in our country 18 months ago ?  In the article this is stated She said they’re increasingly finding animal tranquilizers added to pills as well  Are they talking about  carfentanil which is about 100 times more potent than most fentanyl analogs and according to this article methamphetamine is also in these tablets.  Does it really matter who is creating all of these illegal substances, some say it is China, other suggest India and still others claim that the drug cartels themselves are concocting these illegal substances…  It appears pretty plain that the Mexican cartels are targeting OUR CHILDREN and GRANDCHILDREN.

As I remember, when we first declared the war on drugs, elite teams of our armed services would go to those clandestine labs and blow them up – DESTROY THEM.  With the number of illegal substances and fake tablets looking like real Rx meds and now with the appearance of “candy” that are being confiscated… either none of those clandestine labs are being destroyed or the cartels are able to create new ones quicker that we can “take them out”.  

During the 20th century, our county lost 600,000 kids in four different wars ( WW I, WW2, Korea, Vietnam). At the current rate of poisoning of mostly 20-45 y/o people from illegal substances ( opiates, meth, cocaine, crack, etc)… we may reach or exceed the number of soldiers killed in all the years of wars in the last century by the END OF THIS DECADE.

I recently watched a video debate between 4 gentlemen about the opiate crisis and one gentlemen put out a educated guess that the illegal substance OD/poisoning will reach 150,000/yr before the end of the decade.  IMO, we may hit that number by the middle of this decade and this could become more of a likelihood now that our CHILDREN ARE BEING TARGETED BY THE DRUG CARTELS.  Especially, if they are mixing in animal tranquilizers (Carfentanil ?),  OD/poisoning could accelerate quite rapidly.

And if the politicians/bureaucrats follow what they have done historically… they will continue to reduce the supplies of legal opiates and deprive all those people who have a legit medical necessity for those medications.

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If you haven’t heard,,, Youtube removed this video of our song Take a Knee..My Ass!! After 5.4 million viewed it. Doesn’t fit their guidelines. Hope you’ll watch it and find it in your heart to Share!!! #KAG

This video is now SAVED on my hard drive…. it is not going to get taken down from my blog !

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All of these lawsuits seem somewhat similar to the Tobacco Lawsuit… with ONE MAJOR EXCEPTION… the Tobacco lawsuit was solely against the manufacturers.  With the opiate crisis lawsuit… they are suing the manufacturers, wholesalers, retailers…  why weren’t they including in these lawsuits – all the prescribers who wrote these prescriptions and all the Pharmacists that filled these prescription and they only sue the MAJOR CHAIN PHARMACIES… The pharma, wholesaler, corporate pharmacy chains – are not at the deciding point to write or fill a prescription. It does not appear that smaller chain pharmacies and independent pharmacies, hospital pharmacies or major nursing home pharmacies nor prescribers and chain pharmacy employee pharmacists.   Could it be that JUSTICE can only be served on entities that have DEEP POCKETS ?

Also notice that all these various bureaucratic entities are not putting any taxpayers’ money at risk, they are employing law firms that will put up their money – taking these cases on a contingency basis… the law firms only get paid if they WIN.

Maybe the chronic pain community needs to pay attention to this…  JUSTICE seems to be centered on suing corporate entities with DEEP POCKETS. There is all too many healthcare corporations that are limiting or denying “you” medically necessary therapies.  Various bureaucracies are using our laws and our judicial system (law firms & courts) to pad their individual budgets while constructing a barrier between you and your medically necessary therapy. They bankrupted Purdue pharma and blamed them for the entire opiate crisis – whose opiate meds account to only 4% of all opiate Rxs – and put them out of business… a couple of other pharmas has or in the process of some sort of bankruptcy.

Judge: Pharmacies owe 2 Ohio counties $650M in opioids suit

https://www.marketbeat.com/articles/judge-pharmacies-owe-2-ohio-counties-650m-in-opioids-suit-2022-08-17/

CLEVELAND (AP) — A federal judge in Cleveland awarded $650 million in damages Wednesday to two Ohio counties that won a landmark lawsuit against national pharmacy chains CVS, Walgreens and Walmart, claiming the way they distributed opioids to customers caused severe harm to communities and created a public nuisance.

U.S. District Judge Dan Polster said in the ruling that the money will be used to abate a continuing opioid crisis in Lake and Trumbull counties, outside Cleveland. Attorneys for the counties put the total price tag at $3 billion for the damage done to the counties.

Lake County is to receive $306 million over 15 years. Trumbull County is to receive $444 million over the same period. Polster ordered the companies to immediately pay nearly $87 million to cover the first two years of the abatement plan.

In his ruling, Polster admonished the three companies, saying they “squandered the opportunity to present a meaningful plan to abate the nuisance” after a trial that considered what damages they might owe.

Walmart and Walgreens both said they will be appealing the ruling. CVS did not immediately respond to a request for comment.

Trumbull County Commissioner Frank Fuda praised the award in a statement, saying “the harms caused by this devastating epidemic” can now be addressed.

Lake County Commissioner John Hamercheck said in a statement “Today marks the start of a new day in our fight to end the opioid epidemic.”

A jury returned a verdict in November in favor of the counties after a six-week trial. It was then left to Polster to decide how much the counties should receive from the three pharmacy companies. He heard testimony in May to determine damages.

The counties convinced the jury that the pharmacies played an outsized role in creating a public nuisance in the way they dispensed pain medication into their communities.

It was the first time pharmacy companies completed a trial to defend themselves in a drug crisis that has killed a half-million Americans since 1999.

Attorneys for the pharmacy chains maintained they had policies to stem the flow of pills when their pharmacists had concerns and would notify authorities about suspicious orders from doctors. They also said it was doctors who controlled how many pills were prescribed for legitimate medical needs not their pharmacies.

Walmart issued a statement Wednesday saying the counties’ attorneys “sued Walmart in search of deep pockets, and this judgment follows a trial that was engineered to favor the plaintiffs’ attorneys and was riddled with remarkable legal and factual mistakes. We will appeal.”

Walgreens spokesperson Fraser Engerman said “The facts and the law did not support the jury verdict last fall, and they do not support the court’s decision now.

“The court committed significant legal errors in allowing the case to go before a jury on a flawed legal theory that is inconsistent with Ohio law and compounded those errors in reaching its ruling regarding damages.”

CVS is based in Rhode Island, Walgreens in Illinois and Walmart in Arkansas.

Two chains — Rite Aid and Giant Eagle — settled lawsuits with the counties before trial. The amounts they paid have not been disclosed publicly.

Mark Lanier, an attorney for the counties, said during trial that the pharmacies were attempting to blame everyone but themselves.

The opioid crisis has overwhelmed courts, social services agencies and law enforcement in Ohio’s blue-collar corner east of Cleveland, leaving behind heartbroken families and babies born to addicted mothers, Lanier told jurors.

Roughly 80 million prescription painkillers were dispensed in Trumbull County alone between 2012 and 2016 — equivalent to 400 for every resident. In Lake County, some 61 million pills were distributed during that period.

The rise in physicians prescribing pain medications such as oxycodone and hydrocodone came as medical groups began recognizing that patients have the right to be treated for pain, Kaspar Stoffelmayr, an attorney for Walgreens, said at the opening of the trial.

The problem, he said, was “pharmaceutical manufacturers tricked doctors into writing way too many pills.”

The counties said pharmacies should be the last line of defense to prevent the pills from getting into the wrong hands.

The trial before Polster was part of a broader constellation of about 3,000 federal opioid lawsuits consolidated under the his supervision. Other cases are moving ahead in state courts.

Kevin Roy, chief public policy officer at Shatterproof, an organization that advocates for solutions to addiction, said in November the verdict could lead pharmacies to follow the path of major distribution companies and some drugmakers that have reached nationwide settlements of opioid cases worth billions. So far, no pharmacy has reached a nationwide settlement.

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Boards of Medicine Accountability

https://doctorsofcourage.org/boards-of-medicine/

One of the arms of attack on doctors treating pain and the patients they treat is the state board of medicine. They need to be held accountable for their inexcusable actions over the last 20 years.

The state boards of medicine are attacking doctors treating pain more than any other reason. And most of their attacks are unwarranted. So what is their purpose?  I contend that their purpose is purely monopolistic—to cull out the independent/minority physicians in competition with the hospital/large medical group practices. I also contend that the medical boards are in collusion with the government to eliminate those doctors treating the populations of citizens that the government would rather see dead—the elderly, uninsured, government insured, disabled, minority, or poor.

So how are they getting away with this, and what can we do about it?  First, we have to understand the purpose of the medical board. As stated by the AMA in their Journal of Ethics,

“State medical boards are the agencies that license medical doctors, investigate complaints, discipline physicians who violate the medical practice act, and refer physicians for evaluation and rehabilitation when appropriate. The overriding mission of medical boards is to serve the public by protecting it from incompetent, unprofessional, and improperly trained physicians, ensuring that only qualified physicians are licensed to practice medicine and that those physicians provide their patients with a high standard of care.”

The medical board evaluates a physician’s professional conduct or ability to practice medicine by reviewing complaints from patients, malpractice data, information from hospitals, and reports from government agencies. The state statute commonly known as the medical practice act defines unprofessional conduct in each state. Although laws vary by jurisdiction some examples of unprofessional conduct include:

• physical abuse of a patient,
• inadequate record keeping,
• not recognizing or acting on common symptoms,
• prescribing drugs in excessive amounts without legitimate reason,
• impaired ability to practice due to addiction,
• failing to meet continuing medical education requirements,
• performing duties beyond the scope of a license,
• dishonesty,
• conviction of a felony,
• inappropriately delegating the practice of medicine to an unlicensed individual.

Medical boards are supposed to focus on protecting the public, not on punishing physicians. Most problems can be resolved with additional education or training in appropriate areas. In other instances, it may be more appropriate to place physicians on probation or place restrictions on a physician’s license. This compromise allows the public to be protected while maintaining a valuable community resource in the physician. Probation and restrictions of a medical license can also be in place while a physician receives further training or rehabilitation.

I have researched the actions of the Virginia Board of Medicine over the last 20 years. And what I’ve found out is that, for the most part, doctors investigated for prescribing opioids have their abilities to do so taken away from them and eventually lose their license. The information is available HERE.

Comparing the actions of the Virginia Medical Board with the above stated purpose, I have identified the following:

Although there are ten reasons for investigation or censure, two (prescribing controlled drugs and impaired ability to practice due to addiction) involve over half of the board actions. And about half of those (the doctors addicted), don’t get their licenses suspended until they fail the PHMP, which all of them eventually do because conventional treatment doesn’t cure addiction.  So the group of doctors affected most are those prescribing controlled drugs, especially opioids. And the reasons behind the censure isn’t because the prescribing has harmed the patient in any way, but simply because the government propaganda against opioids gives the Boards of Medicine a door through which they can eliminate doctors of their choice.

Doctors and patients need to understand this problem and help rectify it. You can do so by doing what I have done for the state of Virginia—create a data sheet similar to the Complete list on Virginia Board of Medicine Attacks and send it to us.

As doctors from each state see how their medical board is constructed to eliminate them from the profession, we should have good justification for taking legal action.  So be a part of the solution and help, not a part of the problem.

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