Breaking: Supreme Court Rules ‘Red Flag’ Gun Laws Unconstitutional – should RED FLAGS used by DEA be UNCONSTITUTIONAL ?

In a recent lawsuit against Walgreens for their Pharmacists filling Rxs that the DEA claimed demonstrated RED FLAGS were being ignored https://www.pharmaciststeve.com/walgreens-priority-was-filling-drug-orders-fast-judge-told/

Catizone, who served as the executive director and CEO of the National Association of Boards of Pharmacy from 1988 to 2020, also submitted a 35-page declaration to the court. live testimony was given Thursday from Carmen Catizone, who said Walgreens did not meet the standard of care legally required of pharmacies. Among concerns, from 2003 to 2012, Walgreens had a policy passed on to pharmacists to merely call the doctor who issued a questionable prescription as opposed to doing any other due diligence. During cross-examination, Swanson took aim at the list of “red flags” or warning signs that suggest opioid abuse or diversion that Catizone said pharmacists are required to be on the lookout for.

“You don’t cite any federal or state statute that discloses each of these specific red flags you identify, do you?” Swanson asked, later noting that they also don’t appear in the Controlled Substances Act.

Does this suggest that the DEA is using RED FLAGS that does not exist in the Controlled Substance Act as part of their ALLEGATIONS that the practitioner, vendor (Pharmacy/Wholesaler) have violated the Controlled substance act. If RED FLAGS are unconstitutional involving the confiscating of guns, should they be EQUALLY UNCONSTITUTIONAL in using them in ALLEGATIONS that DEA license/permit holders have violated the Controlled Substance Act ?  What I have seen is that the DEA has observed what addicts, abusers, diverters have done over the years, certain combinations of meds that they had abused- disregarding the very large doses they were taking or other substances legal/illegal taken concurrently, paying cash for Rxs, traveling long distances to see prescriber or pharmacy to fill Rxs and coming to the conclusion – particularly with combo of meds legally prescribed and within recommended doses – that anyone being prescribed these meds – must be a diverter, abuser, addict… because that is what they casually observed being done by addicts, abusers, diverters.

I have heard numerous attorneys state that those people who are taken to FEDERAL COURT – that 90%+ ARE FOUND GUILTY…  With DEA/DOJ/FBI, is it all that they have to do in Federal Court to find a healthcare practitioner/vendor “guilty” is to produce some ALLEGATIONS,  based on some “unconstitutional opinions” and NO REAL FACTS ?  By getting a conviction of a practitioner on such unconstitutional “RED FLAGS”… could that be considered the confiscation of all the medical records of the chronic pain pts of the practice pain therapy, especially when the DEA ..that many have claimed that the DEA refused, declined, stalled off the pts getting copies of their medical records … making them having little/no chance of getting into another practice and getting their pain management reinstated ? Intentionally throwing all those hundred or thousands of pts into cold turkey withdrawal and at risk of premature death and or forced into using the only option that they have to end their unrelenting torturous level of pain – SUICIDE ?

Breaking: Supreme Court Rules ‘Red Flag’ Gun Laws Unconstitutional

https://americanmilitarynews.com/2021/05/supreme-court-rules-warrantless-home-gun-confiscation-is-unconstitutional-in-9-0-vote/

The Supreme Court ruled Monday that warrantless gun confiscation from Americans’ homes is unconstitutional, voting unanimously on the side of a Rhode Island man whose firearms were taken by law enforcement without a warrant after his wife expressed concerns that he might hurt himself.

According to Caniglia v Strom, a lower court had previously determined that police confiscating the guns without a warrant fell under the Fourth Amendment’s “community care taking” exception, but a 9-0 vote from the nation’s top court struck down that ruling.

Justice Clarence Thomas wrote the unanimous opinion for the Supreme Court, stating that law enforcement can execute “many civic tasks in modern society,” but there is “not an open-ended license to perform them anywhere.”

“The very core of the Fourth Amendment,” Thomas wrote, is the “right of a man to retreat into his own home and there be free from unreasonable search and seizure.”

Some exceptions to the 4th Amendment do exist, including “exigent circumstances,” Forbes reported. For instance, if an officer sees an individual about to shoot another person through the window of a home, that officer has the right to enter the home to prevent the attack.

Another exception – the one on which this case was based – is called “community care taking.” The Supreme Court previously determined that police can bypass the warrant requirement to perform “community care taking functions, totally divorced from the detection, investigation, or acquisition of evidence relating to the violation of a criminal statute,” noting a situation when police took a gun from the trunk of an impounded vehicle without a warrant.

“In reaching this conclusion, the Court noted that the officers who patrol the ‘public highways’ are often called to discharge noncriminal ‘community care taking functions,’ such as responding to disabled vehicles or investigating accidents. But searches of vehicles and homes are constitutionally different, as the Cady opinion repeatedly stressed,” Thomas wrote in the court’s opinion.

In the case, Mr. Caniglia and his wife were arguing when he put an unloaded gun on their table and said, “shoot me now and get it over with.” Following the argument, Caniglia’s wife called the non-emergency police line, leading to a visit from law enforcement. The police convinced Mr. Caniglia to go to the hospital for psychological evaluation, despite disagreeing that his behavior was “abnormal” or “agitated.”

While Mr. Caniglia was on his way to the hospital, his wife told the police that he had two pistols in the home, at which point the officers searched the home without a warrant; however, Mrs. Caniglia couldn’t provide legal consent because the police lied, telling her that Mr. Caniglia had consented to the seizure of his firearms.

The officers subsequently located and confiscated the two handguns, prompting Mr. Caniglia to sue the police for allegedly violating his 4th Amendment rights.

Justice Samuel Alito wrote a concurring opinion for the ruling in which he addressed existing “red flag” laws that also call into question Fourth Amendment rights.

“This case also implicates another body of law that petitioner glossed over: the so-called “red flag” laws that some States are now enacting. These laws enable the police to seize guns pursuant to a court order to prevent their use for suicide or the infliction of harm on innocent persons,” Alito wrote.

“They typically specify the standard that must be met and the procedures that must be followed before firearms may be seized,” he continued. “Provisions of red flag laws may be challenged under the Fourth Amendment, and those cases may come before us. Our decision today does not address those issues.”

In March, the Biden administration urged the Supreme Court to uphold the lower court’s ruling, arguing the actions taken by law enforcement to confiscate the petitioner’s firearms without a warrant were “reasonable.”

“The touchstone of the Fourth Amendment is reasonableness,” the DOJ’s brief stated. “For criminal investigations, this Court has generally incorporated the Warrant Clause into the Fourth Amendment’s overarching reasonableness requirement, but it has not generally done so for searches or seizures objectively premised on justifications other than the investigation of wrongdoing.”

“The ultimate question in this case is therefore not whether the respondent officers’ actions fit within some narrow warrant exception, but instead whether those actions were reasonable. And under all the circumstances here, they were,” the brief added.

 

what happened behind the “COVID-19 epidemic curtain” ?

 

How many chronic pain advocates in the chronic pain community – are really interested in the community as a whole


AMERICAN PAIN AND DISABILITY FOUNDATION:
We are all set up to go and advocate for a child with a government representative from the State of Tennessee. I knew these kids were something from the beginning and they were willing to fight for themselves and for us! I put the time, money, sweat, and most of all the effort in because I saw no future on our current path.These kids have been an absolute blessing to APDF and the pain community and it turns out IMHO the only ones who can save themselves and maybe us too if they don’t mind😉! These awesome kids have fought and died like a soldier to save pain patients and if that government official doesn’t take this to heart 💔 they have no intention of doing so for us. I am so proud of these kids words can’t describe what part of my heart cares more for them. An accident brought us together but fate kept it going! Although, the ridiculous attacks in the pain community are very real and vicious. I knew only the pure of heart would rule the day! This couldn’t of came at a better time as their funding was cut by nastiness in our own community, but it shows there is a plan and a future for pain patients of any size and age. On their first fight for themselves hopefully they will show us how its done and come together immediately. I have total faith in these kids from the start and knew something brought us together. I’m excited and I believe this will be a battle of all CPP battles and even if its just for the kids, I’m okay with that too! I’m an adult and we can handle what we are dished out as wrong as it seems. But its even way more wrong when it’s your baby suffering. These kids don’t fight and argue and the only fighting they do is to stay alive! My only hope is they go into this battle and fight as hard as they can for the right reason’s and that reason is no more suffering for everyone! No republicans and no democrats and no pain groups just kids who are the most deserving people on earth and maybe we will get lucky in passing! 😘 GO FIGHT WIN GUYS! ❤❤❤❤
#americanpaindisabilityfoundation #CANCERSUCKS #rarediseaseawareness #treatoursolgers ##cppkids #fightstartsnow

Tulsa mass shooter allegedly gunned down his doctor after asking for help with pain

The above incident happened about 10 days ago and one person who claims to be a chronic pain advocate made a few videos about this incident, some believed that this person stated that the doctor DESERVED TO BE SHOT,  others believed that it was implied, others stated that is was suggested.

After those videos were posted,  many in the chronic pain community basically went ballistic .. some who were chronic pain pts, some who were both chronic pain pts and healthcare providers and some who were just healthcare providers who deal with chronic pain pts.  Ir really doesn’t matter what was actually said, there is a old saying “what you perceive, is what you believe ..”

And what did this “advocate” do… stirred up the “tribe of minions” aligned with this “advocate” and they started attacking a advocate from APDF, who has been successfully advocating for pediatric chronic pain pts in Vanderbilt Hosp in Nashsville, Many of these kids are END STAGE CANCER PTS.   He even took Vanderbilt to court when Vanderbilt stated that he could not advocate for the kids…even with the parent’s agreement/consent.  Vanderbilt LOST !!!…  Vanderbilt had a “NO OPIATE POLICY” and didn’t want to change it  – even for pediatric chronic pain pts.  Here is picture (dressed up to go trick-treating last Oct ) of one of the “little angels” that got to enjoy her final months of life, because of better pain management during her last months.  Without this advocate intervention on this kid’s behalf, she would have spent Halloween in a torturous level of pain, unfortunately she has now passed .   This advocate does the majority of advocating ” off the radar” and doesn’t not seek the spotlight for doing good !
These minions came out besmirching this advocate’s good deeds and throwing out untruths and your basic “mud slinging”… that often happens within political elections. I suspect that this same group will come after me, once this post goes up on my blog…  I have INTENTIONALLY not mentioned any names – they know who they are – and if you see anyone “slinging mud” toward me after this post… you will know who they are as well.

 

 

Sooner or latter the healthcare providers FIGHT BACK to low ball reimbursement for services from insurance companies

Healthcare System Sues Cigna Over Emergency Care Reimbursements

https://www.lexology.com/library/detail.aspx?g=a1c5223f-0d66-40a1-8d43-078765fafa0a

Tenet Healthcare and nineteen of its hospitals filed a complaint against Cigna Health and Life Insurance Company in Connecticut Superior Court, alleging that Cigna had reimbursed its claims at unfair and unreasonable rates. The plaintiffs also allege that Cigna wrongfully denied claims for emergency medical services, although they are legally obligated to provide Cigna plan members with emergency medical care.

Cigna immediately removed the suit to Connecticut District Court, where it remains pending. The District Court has issued the standard scheduling orders for civil cases. Cigna has not yet filed its formal response to Tenet’s complaint.

In its complaint, Tenet claims Cigna reimburses its claims according to a unilateral payment methodology, resulting in steeply discounted payments. Tenet alleges that it did not agree to discounted payments, which bear no relation to the reasonable and fair value of the medical services provided to Cigna plan members. Tenet further alleges that Cigna has arbitrarily denied many claims of its members for emergency services rendered by Tenet and its hospitals.

As a result of its action, Tenet accuses Cigna of violating its common law right to payment for the fair and reasonable value of its services. It also claims that Cigna violated the legal obligation of health insurers to cover emergency medical services for its members and pay reimbursements in the amount of the fair market value of those services. Finally, Tenet alleges that Cigna violated the Connecticut Unfair Trade Practices Act.

Tenet claims that Cigna also refuses to add its hospitals to its roster of in-network providers, leaving plan members with no place to seek in-network non-emergent medical care in their geographical areas. According to Tenet, this refusal allows Cigna to continue unilaterally defining the level of reimbursement for services that Tenet provides to Cigna plan members.

Tenet’s complaint details allegations specific to various hospitals in different states, including Arizona, Florida, Tennessee, Alabama, Massachusetts, and South Carolina. Each hospital alleges state law claims and violations of the Emergency Medical Treatment and Labor Act (EMTALA).

chuckle of the day 06/13/2022


Nuts. Fruit. Cookies and pound cake. Even potato chips. You don’t have to look hard to find things that are coated in chocolate. But people? Never. But that’s what happened last week in Lancaster County, Pa., at the Mars Wrigley plant. Two plant employees were rescued after getting trapped in a large tank of chocolate and were taken to a local hospital. Here’s a song about falling into a vat of chocolate.

Red flag laws have worked so well for chronic pain pts – just imagine when they are applied to our 2nd Amendment rights

I don’t normally step on the “third rail”… how many times have we seen practitioners “taken out” with the FACTS from the DEA that they violated some “red flags”… none of which are defined in the controlled substance act and more often than not… the DEA uncovered these “red flag violations” by data mining the various states’ PDMP ?

Just imagine, if the ATF starts down the path of the DEA.. after all they are also part of the DOJ..  and starts data mining Electronic Medical Records and/or all prescription records – after all the PBM industry pays for some 90% of all prescriptions and with pharmacies filling some FOUR BILLION Rx per year… the PBM’s have huge databases… and the PBM’s are all about generating revenues and profits…  just let the ATF to go on a “fishing expedition” thru their databases. Find a person who has meds prescribed by a Psychiatrist, has a anti-depressant or some other “mental health med” prescribed/filled,  someone who is a chronic pain pt and taking opiates…  RED FLAGS of potential “mental instability” … under the “influence of opiates”…  Compare those names with the national gun register and could a person find someone from the local law enforcement or ATF… at their front door wanting to confiscate their guns ?

Of course, those people in possession of guns, that they have obtained thru break-ins, robbery, bought off the street and the like – don’t have to worry… there is no record of them buying/owning a firearm.

Just look at this recent case Dr. Bauer reports to prison Thursday 85 y/o doctor sent to jail for 5 yrs on the ALLEGATIONS by the DEA of “not adhering to good medical practices”  which I have never seen the DEA DEFINE, and THOUSANDS of his chronic pain pts were tossed to the curb. All those pts having to suffer thru cold turkey withdrawal, committing suicide, having to live/exist in a torturous level of pain and a untold number of premature deaths from their untreated pain.   I guess that all those “bodies” left in the wake of the DEA actions, will be just unfortunate collateral damage.

Fortunately or unfortunately, my two INDIANA SENATORS are not part of the 10 Republican Senators that have abandoned the party’s platform, I have no one to write to hoping they will change their vote.  Probably most/all are not up for re-election this Nov and figure that “all will be forgotten” the next time they run for re-election.

Senate Republicans Betray Base, Join Democrats on Gun Crackdown

DEVELOPING STORY: While you were attending church this morning, a bipartisan group of U.S. senators were conspiring to take away your constitutional rights.

The lawmakers, including enough Republicans to overcome the chamber’s “filibuster” rule, on Sunday announced an agreement on a plan that would curtail the right to bear arms.

“This is the ultimate betrayal of conservative voters,” said nationally syndicated radio host Todd Starnes. “Senate Republicans are more interested in being accepted at Georgetown cocktail parties than they are keeping their word to constituents.”

The bill included support for state “red flag” laws, tougher background checks for firearms buyers under 21 and a crackdown on a practice called “straw purchases.”

“Our plan saves lives while also protecting the constitutional rights of law-abiding Americans,” the group, led by Democrat Chris Murphy and Republican John Cornyn, said in a statement. “We look forward to earning broad, bipartisan support and passing our commonsense proposal into law.”

Ten Republicans signaled their support for the preliminary deal, indicating the measure potentially could advance to a vote on passage and overcome roadblocks by other Republicans who oppose most gun control measures.

The senators include: Chris Murphy, John Cornyn, Thom Tillis , Kyrsten Sinema, Richard Blumenthal, Roy Blunt, Cory Booker, Richard Burr, Bill Cassidy, Susan Collins, Chris Coons, Lindsey Graham, Martin Heinrich, Mark Kelly, Angus King, Joe Manchin, Rob Portman, Mitt Romney, Debbie Stabenow, and Pat Toomey.

President Biden specifically thanks Sen. John Cornyn (R-TX) and Sen. Thom Tillis (R-NC) for their help in weakening the Second Amendment.

I want to thank Senator Chris Murphy and the members of his bipartisan group—especially Senators Cornyn, Sinema, and Tillis—for their tireless work to produce this proposal. Obviously, it does not do everything that I think is needed, but it reflects important steps in the right direction, and would be the most significant gun safety legislation to pass Congress in decades. With bipartisan support, there are no excuses for delay, and no reason why it should not quickly move through the Senate and the House. Each day that passes, more children are killed in this country: the sooner it comes to my desk, the sooner I can sign it, and the sooner we can use these measures to save lives. 

White House

Biden had called for banning the sale of assault weapons and high-capacity magazines, or, if that were not possible, raising the minimum age to buy those weapons to 21 from 18. Biden also pressed for repealing the liability shield that protects gun manufacturers from being sued for violence perpetrated by people carrying their guns.

A New Injectable Gel May Greatly Reduce Chronic Low Back Pain

A New Injectable Gel May Greatly Reduce Chronic Low Back Pain

https://neurosciencenews.com/hydrogel-back-pain-20785/

Summary: Hydrafil, an experimental injectable hydrogel appears to be safe and effective in reducing chronic lower back pain associated with degenerative disc disease.

Source: Society of Interventional Radiology

An experimental formulation of a hydrogel, injected into spinal discs, proved safe and effective in substantially relieving chronic low back pain caused by degenerative disc disease (DDD), according to new research to be presented at the Society of Interventional Radiology Annual Scientific Meeting, in Boston.

Hydrogels have been used for a number of years to treat DDD, but the current study is the first test of this particular gel in humans.

After six months, all participants in this small study reported significantly less low back pain—declining from an average self-reported pain level of 7.1 down to 2.0 on a scale of zero to 10. They also experienced greatly improved physical function, with average scores falling from 48 to 6 on a questionnaire to gauge the impact of low back pain in preventing patients from the ability to perform normal activities.

“If these findings are confirmed in further research, this procedure may be a very promising treatment for chronic low back pain in those who’ve found insufficient relief from conservative care,” said lead author Douglas P. Beall, MD, FSIR, chief of radiology services at Clinical Radiology of Oklahoma. “The gel is easy to administer, requires no open surgery, and is an easy procedure for the patient.”

The gel used in this study, Hydrafil™,  is a second-generation hydrogel developed by ReGelTec, Inc. In 2020, it received FDA’s breakthrough device designation, which allows expedited review when early evidence suggests an experimental product may provide more effective treatment than current options for treating a serious condition. Dr. Beall is a medical advisor to the company.

The research team enrolled 20 patients, aged 22 to 69, with chronic DDD low back pain. Each described their pain as four or higher on the 10-point scale. None had found more than mild relief from conservative care, which includes rest, analgesics, physical therapy, and back braces.

Patients were sedated for the procedure, and the gel was heated to become a thick liquid. Guided by fluoroscopic imaging, researchers used a 17-gauge needle to inject the gel directly into the affected discs, where the gel filled in cracks and tears, adhering to the disc’s center and outer layer.

This shows a cartoon of a woman rubbing her back
After six months, all participants in this small study reported significantly less low back pain—declining from an average self-reported pain level of 7.1 down to 2.0 on a scale of zero to 10. Image is in the public domain

“We really have no good treatments for degenerative disc disease, aside from conservative care,” said Dr. Beall.

“Surgery is statistically no more effective than conservative care and can potentially make things worse; nerve ablation is appropriate for only a few patients; and existing hydrogels are inserted through an incision as a soft solid, which can pop out of place if you’re not highly skilled in placing it.”

“Because this gel is injectable, it requires no incision, and it augments the whole disc, restoring its structural integrity, which nothing we have currently can do,” he said.

Degenerative disc disease is the leading cause of chronic low back pain, one of the world’s most common medical conditions. Healthy discs cushion the spine’s vertebrae, facilitating movement and flexibility. With normal aging, though, they can become dry, thin, cracked or torn, causing pain or loss of motion. By age 60, most people have at least some disc degeneration.

 

Should those in the chronic pain community pay attention to this

About 40,000 people showed up in D.C., according to organizers, and protests were also planned through the day in major cities including New York, Chicago, Las Vegas and Los Angeles. About 300 people showed up to protest in West Melbourne, Florida, and some 400 people marched through Old Town in Fort Collins, Colorado.
The March for Our Lives events come four years after the organization was founded by teens who survived the 2018 Marjory Stoneman Douglas High School shooting that killed 17 people in Parkland, Florida. That year, more than 1 million people rallied in Washington.

This is suppose to be a picture of a protest TODAY (06/11/2022) in DC… estimated 40,000 showed up and their first protest, FOUR YEARS ago … claimed to have ONE MILLION people to show up.  This protest is about gun violence..  In the years between the first protest in 2018 and today… I have not seen anything done about gun violence.

The largest protest/demonstration by any chronic pain group – anywhere in the country – amounted to about SEVEN DOZEN people showing up. If a MILLION PEOPLE show up and there is no real change in anything that will compromise our 2nd amendment.

In our country’s nomenclature the killing of 4 or more people is considered a MASS SHOOTING..   So those four that were murdered and one suicide in St Francis Healthcare in Tulsa, was considered a MASS SHOOTING… but more than four people are shot/killed in Chicago each weekend, but because they are mostly individual shooting/killing… Chicago has very few mass shooting, but in 2021, Chicago had 797 homicides.

It is just my opinion, but I think that members of Congress can be more likely to be influenced by $$$ into their re-election campaign fund… Maybe that is why the lobby industry spend more than NINE MILLION PER DAY to influence the 535 members of Congress to get them to pass bills that will favor those who hire those lobbyists.

Maybe we need to look and follow what the “rich cats do”   Zuckerberg’s election spending was ‘carefully orchestrated’ to influence 2020 vote: ex-FEC member

A former federal election official on Thursday called the $400 million-plus that Mark Zuckerberg spent to help finance local elections a “carefully orchestrated attempt” to influence the 2020 vote

Monetary deception ?

This appeared to really starting to happen with the Tobacco settlement in 1998… in which 46 state AG’s and some law firms suited the 4 major tobacco manufacturers and 4 states settled outside of the lawsuit and in the first 20 yrs there was abt 135 BILLION dollars shared with those states.. I tried to read the details of the settlement and the details are so convoluted that at the end of 25 yrs of the settlement, the states are to share 9 BILLIONS/yr in perpetuity – think ” until hell freezes over”  The states didn’t put any taxpayers’ money at risk, the private law firms took all the fiscal risks.  The various states could only WIN or NOT WIN… they could NOT LOSE ANYTHING.

Here is a link  https://www.cagw.org/thewastewatcher/smoke-what-happened-tobacco-master-settlement-agreement-money and especially a quote from that link

The Tobacco Master Settlement Agreement simultaneously represents one of the most egregious examples of a government shakedown of private industry and offers a case study of the problems that stem from big government and big business scratching each other’s backs. It has turned the largest tobacco companies into an indispensable cash cow for politicians and bureaucrats, enabled irresponsible state spending, and, amazingly, has resulted in less money for public health and tobacco control while propping up a declining industry. As is the case with discriminatory tobacco taxes, the incentives of the MSA are perverse: the more people smoke, the more money the government gets to spend on whatever it wants. The biggest losers are those with tobacco-related diseases and smokers trying to quit.

Apparently the lesson learned by the various state AG’s from this lawsuit – over suing companies that manufactured a legal product…  and we are seeing now with the lawsuit over the fabricated “opiate crisis”…is that they did not sue not only the manufacturers, but also the wholesaler and retailers.  Apparently they realized that they left a lot of money on the table with the tobacco lawsuit that they were not going to let them happen again as they proceeded to sue companies who manufacturer and sell a legal product.

Civil Asset Forfeiture act.  It has been stated that some city/state bureaucracies are able to cover up to half of their annual budget with the $$ collected using this law.   Anyone questioning this just do a web search on “Civil Asset Forfeiture Act ” and/or here is very interesting website  https://ammo.com/articles/civil-asset-forfeiture-policing-for-profit

Then there is social security…the first check was sent out the first of Feb 1940 – for $22.54 and when SS was started there was abt 25 employees for every recipient and in 1940 < 50% of all people would die before reach 65 y/o and draw the first penny from SS.  When I graduated in 1970, SS was 4.3% on the first 10,000 of income – which the employer paid an equal amount. In 2022 the income limit subject to SS & Medicare is 147,000 and combined tax is 7.65% and employer contributes the same.

In the last week or so it was announced/stated that if the COLA/CPI had been properly calculated from 2000 the average SS check would be $500+ more per month. This week it was announced that SS & Medicare would be unable to meet full promised commitment in the later part of the next decade.  Just as Gen-X become eligible for SS & Medicare and the last of the baby boomer generation will be entering their 70’s. Medicare & SS really doesn’t have much of a cash reserve, it depending entirely on cash flow to pay the bills and it is estimated that required payments in the latter part of next decade. Cash flowing into Medicare & SS will be LESS than what has to be paid out.  There has been estimates that all benefits will be reduced some 20%-25% when this happens.

the cost of treating pain is claimed to be second to the cost of treating Diabetes, however… there are 3-4 times more chronic painers than the number of diagnosed/undiagnosed diabetic  Does this suggest how GROSSLY UNDER TREATED CHRONIC PAINERS ARE ?

We have seen the DEA raid a office practice and confiscate all the prescriber’s assets and throw all the pts in the practice to the curb and confiscate all the pt’s records and some pts have reported to still be trying to get a copy of their medical records – THREE YEARS after the office was raided. it is well known that pts are less likely to be accepted in a practice without existing medical records.  So what is the game plan, the DEA doesn’t really know which pts that they claimed were being treated without valid medical necessity – because it is all done with data managing – so they CYA themselves because it might be uncovered that there were no pts in a practice that didn’t have a valid medical necessity ?

It is pretty well known that all the pts in a practice will be thrown into cold turkey withdrawal <30 days of the office being raided.  They could suffer a stroke or heart attack while going thru withdrawal.  Without medical records, pt is unlikely to find a new provider, end up being in a hypertensive crisis which could cause stroke, heart attack, kidney/eye damage, premature deaths and/or suicide.

Now we have hundreds or 1000+ pts who can’t get accepted to a new practice, the DEA has at least clawed-back all the monies paid to Medicare or Medicaid for medical services that were claimed not medical necessity.  Pt that will not incur little/no charges to Medicare going forward, because no office practice will accept them.  And may end up dying from complications of under/untreated pain. How many hundreds or millions of dollar is Medicare/Medicaid not going to not expend on these pts going forward ?

 

Bump in Non-Opioid Pain Prescriptions Following CDC’s 2016 Guidelines – pt outcomes of no concern ?

Bump in Non-Opioid Pain Prescriptions Following CDC’s 2016 Guidelines

https://www.medpagetoday.com/painmanagement/painmanagement/99183

Non-opioid pain medication prescribing increased after the CDC published guidelines on opioids for chronic pain in 2016, according to a cohort study using insurance claims data.

Among over 15 million individuals, logistic regression models showed that the odds of non-opioid pain prescriptions were higher following the release of the “Guideline for Prescribing Opioids for Chronic Pain” compared with pre-guideline pattern-based estimates:

  • 3% higher in the first year (95% CI 2.6-3.3)
  • 8.7% higher in the second year (95% CI 8.3-9.2)
  • 9.7% higher in the third year (95% CI 9.2-10.3)

“This finding aligns with language in the 2016 CDC guideline advising caution when initiating opioids and avoiding their use as a default first-line therapy,” wrote Jason E. Goldstick, PhD, of the University of Michigan in Ann Arbor, and colleagues in JAMA Network Open.

The magnitude of the post-guideline differences from the pre-guideline pattern varied by several clinical characteristics, including chronic pain, recent opioid exposure, anxiety disorder, and mood disorder, the authors noted.

Of note, there were greater increases in odds of non-opioid prescribing over the post-guideline years among those with opioid exposure versus those without exposure:

  • Year 1: OR 1.06 (95% CI 1.05-1.06) vs OR 1.02 (95% CI 1.02-1.02), respectively
  • Year 2: OR 1.11 (95% CI 1.10-1.12) vs OR 1.08 (95% CI 1.08-1.09)
  • Year 3: OR 1.12 (95% CI 1.11-1.13) vs OR 1.09 (95% CI 1.09-1.10)

Similarly, those with chronic pain, anxiety disorder, and mood disorders showed larger relative increases in prescribing odds of non-opioids compared with those without these factors, Goldstick and team said. For instance, those with chronic pain had a 14.9% higher prescribing rate during the third year compared with the pre-guideline pattern estimates.

In addition, non-opioid medications were more likely to be prescribed for women versus men, and those with Medicare Advantage compared with those with commercial insurance plans.

Across the study period from 2011 to 2018, opioid prescription rates notably decreased throughout the full cohort, from 23.1% in 2012 to 17.6% in 2018. Non-opioid prescriptions were steady through 2015 (20.1%), but increased in each following year, rising to 22.2% by 2018.

“Identifying the best way to tailor treatment options and delivery to the individual is a new area of investigation. Innovations in clinical research, including pragmatic and adaptive clinical trials; stepwise treatments; responder analyses; and machine learning approaches to predictive modeling of the interaction of biopsychosocial factors in response to various treatments are poised to revolutionize the field,” noted Stephanie A. Eucker, MD, PhD, of Duke University School of Medicine in Durham, North Carolina, and colleagues, writing in an invited commentary. “Until we collectively prioritize pain management to include comprehensive multimodal, person-centered treatments, the problem of chronic pain will continue to grow.”

For their study, Goldstick and colleagues constructed seven annual cohorts using claims data from the Optum Clinformatics Data Mart Database for January 2011 through December 2018. The cohorts included adults with commercial insurance or Medicare Advantage plans, no cancer or palliative care claims, and 2 years of continuous insurance enrollment. Patients were allowed to be included in more than one cohort, and each cohort covered a 2-year period.

The first year in each cohort was considered the baseline period, used to measure opioid exposures and other clinical characteristics, while the second year was the follow-up period in which prescribing outcomes were measured. Out of the seven cohorts, four were studied before the 2016 guideline was published, and three were studied after.

Goldstick and team acknowledged some limitations to their study. The requirement of continuous enrollment in an insurance plan meant that participants likely fell within a particular socioeconomic range. The study was also unable to account for pain management for those without insurance, those on Medicaid, those using over-the-counter medications, and those with a secondary insurance plan.

In addition, any comorbidities prior to a participant’s insurance coverage, as well as specialty clinic care, were not included. Some non-opioid pain medicines, such as skeletal muscle relaxants and lidocaine, were also left out of the study, they noted