After years, pharmacy-middleman suit might finally come to trial

https://ohiocapitaljournal.com/2022/05/16/after-years-pharmacy-middleman-suit-might-finally-come-to-trial/

Since at least 2016, Ohio pharmacists have been accusing large companies acting as pharmacy middlemen of abusive practices, which they deny. And since 2019, the state has been accusing them as well, in the form of lawsuits.

Now, after years of wrangling in court, some of that litigation might be headed to trial.

The middlemen, known as pharmacy benefit managers, operate behind the scenes, but they’re part of some of the largest corporations in the United States. And the big three, which handle prescription transactions for more than 70% of covered Americans, are part of companies that also own major insurers.

Pharmacy benefit managers, or PBMs, negotiate rebates from drugmakers, in part by controlling which drugs are covered by insurance and at what level. They contract with networks of pharmacies and decide how much to pay them for the prescriptions they dispense.

In 2016, two of the big-three PBMs — CVS Caremark and OptumRx — were working for Ohio’s five Medicaid managed-care companies. Late that year, many Ohio pharmacists complained, the companies slashed their reimbursements and then CVS — which was also their biggest retail competitor — offered to buy them out.

CVS and OptumRx insist their reimbursements have been fair and that their actions have saved money for consumers and taxpayers. But amid a newspaper investigation and one by then-Auditor Dave Yost, the Ohio Department of Medicaid in 2018 commissioned an investigation that showed that in 2017, CVS and OptumRx charged taxpayers $244 million more for Medicaid drugs than they paid the pharmacies that dispensed them.

While that was a bombshell, big portions of the analysis were redacted. Under prodding from lawmakers and the press, then-Medicaid Director Barbara Sears moved to release an unredacted version. CVS and Optum sued on July 16, 2018 to block release.

That suit continues, even though The Columbus Dispatch was able to get behind the redactions and show that CVS in 2017 reimbursed big competitors such as Kroger and Walmart much worse than it did its own pharmacies.

The case has languished for almost four years, with Franklin County Common Pleas Judge Andy D. Miller most recently granting another delay last month.

But another, perhaps more substantive case, appears to be moving ahead.

After he became attorney general, Yost in 2019 sued OptumRx over its dealings with the Ohio Bureau of Workers’ Compensation. That suit claims that Optum defrauded the agency of $16 million by not providing guaranteed discounts and through other practices.

It’s slated for trial before Franklin County Common Pleas Judge Michael Holbrook on Oct. 24, and the parties seem to be getting ready for trial.

“We are in the discovery process and planning accordingly for our trial date in October,” Yost’s spokesman, Steven Irwin, said in an email on Tuesday.

A spokesman for OptumRx again denied that the company had done anything wrong.

“We are honored to have delivered access to more affordable prescription medications for the Ohio Bureau of Workers’ Compensation and Ohio taxpayers,” the spokesman, Andrew Krejci, said in an email. “We continue to believe these allegations are without merit and will vigorously defend ourselves.”

Yost also has sued another of the big-three PBMs, Express Scripts, on behalf of the Ohio Highway Patrol System. The suit seeks an unspecified dollar amount after Express Scripts “egregiously charged for services it didn’t deliver,” Yost said. 

Express Scripts also denied wrongdoing. The case now is slated for trial before Franklin County Common Pleas Judge Colleen O’Donnell in June 2023.

When he announced the workers’ comp suit, Yost said it was the start of a flurry of litigation against the pharmacy middlemen, and his office is said to be pursuing other claims.

He tallied a big win last year after he sued Medicaid managed-care provider Centene over dealings using its in-house PBMs. Centene didn’t admit wrongdoing, but it agreed to pay Ohio $88.3 million and set aside an additional $1 billion to settle similar claims in states that hadn’t even sued.

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Medicare Advantage Versus Traditional Medicare

https://www.daily-remedy.com/medicare-advantage-versus-traditional-medicare/

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It appears that in FLORIDA Walgreens is being sued for “contributing” our fabricated opiate crisis and in CALF they are being sued for having their stores understaffed and putting pt’s safety at risk from mistakes Walgreens’ Priority Was Filling Drug Orders Fast, Judge Told

https://www.tobaccofreekids.org/assets/factsheets/0365.pdf     Florida got 10+billion out of the Tobacco settlement at the end of the last century. I don’t know if they were hoping to extend the “annual annuity payments” from the tobacco settlement with suing the pharma industry.  It appears that this settlement comes up short.

Florida may be returning to the pharmacy environment back in the mid 2010-2020 decade… when most chain pharmacists were SELDOM COMFORTABLE filling Rxs for controlled meds… the term was coined back then as the “Pharmacy Crawl”..where pts trying to get a controlled Rx filled may have to go to a dozen or so different pharmacies in trying to get a controlled Rx filled.  Can you imagine a chronic pain pts … having to drive around most of a day to find a pharmacy to fill their pain med Rx ?  Back then controlled Rxs were still “paper”, so the pt had a Rx in their hand. Today, most all controls are now sent to a pharmacy electronically. When a pharmacy/pharmacist can’t/won’t fill a C-II,  the Rx basically goes dead, because the pharmacy can’t do nothing but CANCEL the electronic Rx… and the pt is having to have to reach out to their prescriber to send it to another pharmacy. Of course, pharmacies will not tell a pt over the phone if they actually have a particular C-II in stock. When one of the early statements in the early part of the war on drugs was “JUST SAY NO”… may take on a new meaning for chronic pain pts trying to get their pain meds filled .

Walgreens reaches opioid settlement with State of Florida

DEERFIELD, Ill. — Walgreens announced Thursday that it has entered into an agreement with the State of Florida to resolve all claims related to the distribution and dispensing of prescription opioid medications across the company’s pharmacies in the state.

The settlement amount of $683 million includes $620 million to be paid out to the State of Florida over 18 years, as well as a one-time payment of $63 million for attorneys’ fees.

The settlement includes no admission of wrongdoing or liability by Walgreens.

“As the largest pharmacy chain in the state, we remain focused on and committed to being part of the solution, and believe this resolution is in the best interest of all parties involved and the communities we serve across Florida,” said Danielle Gray, executive vice president and global chief legal officer, Walgreens Boots Alliance. “Our pharmacists are dedicated health care professionals who live and work in the communities they serve, and play a critical role in providing education and resources to help combat opioid misuse and abuse.”

As one of Florida’s leading health care providers, Walgreens has taken a number of actions to prevent and respond to the opioid crisis, while continuing to serve patients, including:

• Providing patient education on safe opioid use
• Making life-saving Naloxone, the opioid overdose reversal medication, available in all Walgreens pharmacies nationwide
• Providing safe and convenient medication disposal kiosks available at 1,400 Walgreens stores, along with other safe disposal options at all other Walgreens locations
• Deploying technology to help pharmacists ensure they are dispensing prescriptions written for a legitimate medical purpose
• Stopping self-distribution of opioids and all pharmaceuticals to Walgreens stores in 2014

The settlement funds will be used by the State of Florida to support its efforts to combat and treat opioid addiction. The settlement is a result of unique facts and circumstances concerning the state of Florida. It should not be used to forecast or predict the value of any other litigation claims or future settlements, and is unrelated to any other opioid-related litigation in which Walgreens is involved and which the company will continue to defend vigorously.

Click to access 0365.pdf

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Walgreens’ Priority Was Filling Drug Orders Fast, Judge Told

A former Walgreens pharmacist felt pressured to “fill, fill, fill” prescriptions while working at a pace that made her fear making fatal errors, a California federal judge heard in recorded testimony Thursday in a multibillion-dollar bellwether trial over claims Walgreens and others illegally fueled San Francisco’s opioid epidemic.

The city of San Francisco has accused Walgreens, along with drugmakers Teva and Allergan and drug distributor Anda, of creating a public nuisance by marketing opioids with misleading messages about their safety and failing to prevent the ensuing flood of painkillers from being diverted for improper uses.

Thursday marked the second day of the bench trial in which the testimony focused on San Francisco’s case against the pharmacy chain. It included the recorded deposition of Rebecca Gayle, who worked at a San Francisco Walgreens as a staff pharmacist from 2012 to 2016, also holding the role of assistant store manager from 2014 to 2016.

“The most challenging part of working at Walgreens was I constantly felt there was the pressure to fill, fill, fill, and that was what the company cared about most,” Gayle said. “That’s the message I got.”

The demand to fill prescriptions quickly made it difficult for her to investigate suspicious prescriptions or talk to patients about their medications.

“I constantly got feedback to go faster, shave down on the things that were most important to me as a pharmacist like counseling patients,” Gayle said, later adding, “I ran into situations where I was afraid I made a lot of mistakes that could result in severe patient … harm or even death, depending on medication and the type of error.”

During Gayle’s cross-examination, a lawyer for Walgreens asked her if she believed she and her colleagues were doing their best on behalf of their patients and to make sure they prevented diversion.

“I feel like we, as pharmacists, could have had many more tools, and support from a staffing and time perspective, to do more due diligence to prevent diversion,” Gayle said. “We were doing our best, but it was limited given the volume of prescriptions we were filling and the pace at which we were expected to fill.”

Gayle said she would sometimes search doctors’ names on the internet if she felt something was fishy about them, as well as leave notes for her colleagues to warn them about doctors who appeared to be issuing excessive opioid orders.

If there was a strong red flag, Gayle said she and her colleagues would sometimes refuse to fill a prescription.

Brian Swanson of Bartlit Beck Herman Palenchar & Scott LLP, an attorney for Walgreen’s, asked Gayle if she was ever punished for refusing an order, and she said no.

Among doctors who had “fishy” prescribing practices was Collin Leong, Gayle said. He ultimately lost his license in 2013 and pled guilty to selling opioid prescriptions to homeless people with no medical justification, but not before Walgreens filled thousands of his prescriptions, according to a document the city filed with the court. 

An attorney for San Francisco showed Gayle a news article that said the homeless people would be given cash for the pills from a third party. Leong charged $80 to $150 for a prescription, taking in about $400,000, according to the news report.

“Did your district managers ever ask you to identify suspicious prescribers so they could warn others?” the attorney asked. Gayle said no.

Another former San Francisco Walgreens employee, Victor Lo, also testified that the store he worked at was inadequately staffed, making it difficult to do his job carefully.

“We always felt like we were behind, we always felt, at least I felt, I could potentially dispense something incorrectly,” Lo said.

Lo, however, testified that when he told his supervisor that he felt the pharmacy was dispensing a lot of narcotics from doctors who appeared to be “too free” in writing prescriptions, he was told the pharmacists couldn’t say no.

“We couldn’t categorically say flat out we’re not filling these prescriptions from a licensed prescriber. Those prescribers could sue Walgreens,” Lo said he was told.

In addition to Lo, 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.

“This is especially true when the prescriber may be assisting the patient to inappropriately use controlled substances,” Catizone said.

In 2013, Walgreens introduced a checklist for pharmacists to use when dispensing some drugs, but it didn’t cover some commonly diverted opioids. Until 2020 the checklists were maintained only in hard copy at each pharmacy, and not electronically, so they could be shared with other stores, Catizone said.

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.

Swanson also posed several hypothetical situations to Catizone that would result in a legitimate prescription being flagged. For example, if a patient obtained multiple opioid prescriptions from different prescribers.

“That would flag a patient who broke a leg and then gets an opioid script from the ER and then gets a second prescription from the orthopedist who treats them,” Swanson noted.

Walgreens’ lawyer also said pill volume wasn’t necessarily a red flag, for example, if a doctor was prescribing for an oncology patient or for pain management.

Catizone’s time on the stand was about 30 minutes, in keeping with Judge Breyer’s orders and a tight trial timetable, limiting direct witness examinations to written declarations with only a short live introductory summary.

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.

The Bay Area litigation is the first to rope together defendants across the pharmaceutical supply chain, from manufacturing to distribution and pharmacy dispensing.

San Francisco is represented by its city attorney’s office, Lieff Cabraser Heimann & Bernstein LLP, Robbins Geller Rudman & Dowd LLP, Andrus Anderson LLP, Weitz & Luxenberg PC, Simmons Hanly Conroy LLC and Levin Papantonio Rafferty.

Allergan and its affiliates are represented by Kirkland & Ellis LLP.

Teva and its affiliates are represented by Morgan Lewis & Bockius LLP.

Anda is represented by Foley & Lardner LLP.

Walgreens is represented by Bartlit Beck LLP and Gibson Dunn & Crutcher LLP.

The case is City and County of San Francisco et al. v. Purdue Pharma LP et al., case number 3:18-cv-07591, in the U.S. District Court for the Northern District of California. The MDL is In re: National Prescription Opiate Litigation, case number 1:17-md-02804, in the U.S. District Court for the Northern District of Ohio.

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https://www.newsweek.com/record-numbers-americans-are-dying-overdoses-instead-justice-we-get-theater-opinion-1706231

The Guggenheim Museum in New York City announced this week that it would be removing the Sackler’s nameplate off of their arts center in response to pressure from activists. “The Guggenheim and the Mortimer D. Sackler family have agreed to rename the arts education center,” a museum spokesperson said in a statement on Tuesday. The Guggenheim was not alone; the Metropolitan Museum of Art in New York also removed the Sackler name from a gallery, as did the National Gallery in London this week.

The Guggenheim’s effort is timely, coming on the heels of another devastating statistic: Nearly 108,000 people died from drug overdoses in 2021. And yet, the sad truth is, embarrassing members of the Sackler family will not bring justice to the victims of the opioid crisis and their families, who are once again being offered busy work as though it were meaningful reform. Scrubbing the Sacklers’ name from museums, like suing them in court, amounts to little more than kabuki theater—and everyone but the victims knows it.

Real justice could not be more urgent. America remains mired in a protracted drug-overdose crisis, with over half a million people dead in just a decade. The crisis is being fed by the ubiquity of dangerous fentanyl in the black market. Despite illegal drugs being the culprit in almost every case, the focus of the media and politicians has been on punishing pharmaceutical companies, in particular, members of the Sackler family who own Purdue Pharma, for which a major case of civil litigation is ongoing.

But the calls for justice for the victims of opioid addiction rarely rise above the symbolic, things like the Guggenheim or the Metropolitan Museum of Art removing the Sackler name from their nameplates. And this is a far cry from meaningful consequences that would help the victims of the opioid crisis.

But the lawsuit is a far cry from what real justice would look like. “The whole thing is kabuki theater,” says Richard Ausness, a legal scholar and renowned opioid litigation expert from the University of Kentucky Law. He told me that while there is a high emotional charge to these proceedings, the actual bearing on the case is minimal. “It ought to be about money,” Dr. Ausness explained. “About who pays what. And instead, they want to make the Sacklers listen to people complain about them.”

It may surprise you to learn that instead of trying to bring the Sacklers to justice, the Department of Justice has done anything but. On multiple occasions, the family agreed to multi-billion-dollar settlements, like a widely-criticized bankruptcy agreement from September of 2021 which mandated that the Sacklers would forfeit Purdue ownership and shell out $4.3 billion to litigants. But it granted the Sacklers sweeping immunity from opioid lawsuits brought against their company Purdue Pharma and its drug OxyContin. The plan was killed last December by U.S. District Judge Colleen McMahon, after the DOJ publicly announced they didn’t like how the Sacklers would be immune to further shakedowns lawsuits.

So this March, the Sacklers made a new deal, with compensation coming to $6 billion—and immunity from further litigation. Once again, the DOJ pushed to have it overturned, though U.S. Bankruptcy Judge Robert Drain stood firm and overruled. (DOJ is still pushing for an appeal in the federal appeals court.)

Professor Ausness and others I spoke to believe the case will end up at the Supreme Court, and it’s anyone’s guess what happens then. But as it currently stands, the victims will never see a single cent from civil litigation. Unless specified otherwise by state law, litigation settlement funds are at the discretion of state attorneys general, who have historically allocated the vast majority of opioid litigation money to feed state budgets. What little funds go toward “anti-addiction” projects have been spent on ridiculous efforts that have very little do with addiction, like Michigan’s focus on helping new mothers or West Virginia’s emphasis on public education.

The media and prosecutors should have been honest with victims from the start and admitted that putting the Sacklers in jail was never an option. Remember, in the 1990s and 2000s, the hard push for prescribing opioids was at the behest of the federal government. These companies’ advertising strategies weren’t drastically different from those for any other drug. While Big Pharma’s behavior was unethical, that is not the same as it being illegal.

Meanwhile, Americans are still overdosing on illegal drugs in the hundreds of thousands.

Where are the calls for justice for them?

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If healthcare providers start/keep getting thrown in jail for medical errors, pretty soon there will be no one to care for people need medical care. Many lethal medical errors that I have read about, most all the “system” contributed to the problem. Some of that is when licensing boards fail to take actions against a practitioner’s license who is a “frequent offender”, other times..it can be grossly understaffed/overworked staff, other times it can be contributed to by automation systems that are not working as designed … either from poor design or malfunctions that have failed to be corrected/fixed.

Nurse Vaught Sentenced for Deadly Medical Error

https://www.medpagetoday.com/special-reports/exclusives/98706

Former Vanderbilt nurse gets 3 years probation for negligent homicide, adult abuse

RaDonda Vaught, the Tennessee nurse convicted after a medical error led to a patient’s death, was sentenced to 3 years of supervised probation, evading a possible prison sentence of up to 8 years.

Today’s sentencing caps a years-long process, including delays caused by the COVID-19 pandemic, that brought to light Vaught’s medical error, led to her prosection, and sparked a national outcry from the medical community.

Vaught, 38, was convicted on March 25 of negligent homicide and impaired adult abuse over the medication error, which resulted in the death of 75-year-old Charlene Murphey at Vanderbilt University Medical Center (VUMC) in 2017. Vaught received concurrent sentences of 3 years probation for the adult abuse charge and 2 years probation for the reckless homicide charge.

The fatal error happened when Vaught, a nurse at VUMC at the time, was preparing Murphey for a PET scan on the day after Christmas. Murphey had complained of feeling anxious ahead of the scan and was ordered 2 mg of IV versed. Vaught mistakenly administered 10 mg of vecuronium to the patient instead, according to a CMS report on the incident. Murphey was transported to radiology for imaging, coded in the scanner, and died shortly after.

Vaught was fired from VUMC on Jan. 3, 2018. The hospital negotiated an out-of-court settlement with the patient’s family, one that required them not to speak publicly about Murphey’s death or the error, according to a report from the Tennessean. An anonymous tipster eventually reported the error to state officials in October 2018, and Vaught was charged by prosecutors in February 2019.

The case has stirred up a national conversation around the implications of criminal persecution for medical errors, an uncommon punishment for what many medical societies consider to be accidents born out of high pressure and high-risk environments.

Vaught’s case has also become a symbol of the policy problems that several experts say can lead to these kinds of errors.

“This is an excruciating case for nurses, because it is so abundantly clear that the conditions under which this particular nurse was working made it impossible for her to practice in a manner that ensured patient safety,” Patricia Pittman, PhD, of the Milken Institute School of Public Health at George Washington University, told MedPage Today via email. “It is a tragic example of what happens when nurse-to-patient ratios are too low. There is over twenty years of research showing this relationship, but policymakers and some healthcare leaders still don’t get it.”

“The case is also a horrifying example of how moral injury works — a situation in which health workers feel betrayed by those in authority and forced to practice in ways that violate their professional ethics,” added Pittman, who is also director of the Fitzhugh Mullan Institute for Health Workforce Equity. “This leads to shame and a sense of helplessness and is a major driver of nurses’ resignations.”

The nurse community has reacted with strong opposition since the verdict in late March. Both the American Nurses Association and the Tennessee Nurses Association released statements following the verdict questioning the original decision to prosecute medical errors.

“Health care delivery is highly complex,” the statement said. “It is inevitable that mistakes will happen, and systems will fail. It is completely unrealistic to think otherwise. The criminalization of medical errors is unnerving, and this verdict sets into motion a dangerous precedent.”

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Missouri bill bars pharmacists from questioning Ivermectin effectiveness

https://www.kansascity.com/news/politics-government/article261400142.html

Missouri lawmakers this week passed legislation that appears to bar pharmacists from questioning doctors who prescribe the controversial off-label drugs ivermectin and hydroxychloroquine for patients. The measure, which passed the House on a resounding 130-4 vote this week, was tucked into a bill related to professional licensing. After passing both chambers, the bill now heads to Gov. Mike Parson’s desk. According to its language, the bill would prevent state medical licensing boards from punishing or taking away the medical licenses of doctors who “lawfully” prescribe the two drugs. And it prevents pharmacists from contacting a doctor or patient “to dispute the efficacy of ivermectin tablets or hydroxychloroquine sulfate tablets for human use” unless the doctor or patient asks about the drugs’ effectiveness. Sen. Rick Brattin, a Harrisonville Republican, told The Star Thursday he added the amendment after he spoke with doctors who worried they would lose their medical licenses for prescribing the drugs. Brattin, who said he previously bought ivermectin for COVID-19 but has never taken it, described the drug as “politicized.” “Unfortunately, because of the politicization of those two drugs, [doctors are] being targeted,” he said. “I wanted to protect them from that.” The bill, specifically Brattin’s amendment, swiftly drew criticism on social media from people who pointed to the fact that the Food and Drug Administration has not approved ivermectin for treating COVID-19. The drug is authorized for humans to treat infections caused by parasitic worms, head lice and skin conditions like rosacea. The agency has received multiple reports of people who have been hospitalized after taking ivermectin intended for livestock, according to its website. “The Missouri legislature has chosen to ‘own the libs’ by issuing a gag order against every pharmacist in this state from offering their medical opinion on taking either one of those medications—even if it could kill their patient,” former U.S. House candidate Lindsey Simmons wrote on Twitter. Rep. Patty Lewis, a Kansas City Democrat who served on the committee that handled the bill, told The Star Thursday that Democrats agreed to the language in the bill to satisfy a group of hard-right conservatives in the Senate. She said the parts of the bill relating to the two drugs will not change anything in the medical community. She said medical licensing boards already would not punish a doctor for prescribing a drug lawfully. “This language, with a few buzzwords, is to keep some difficult, obstinate, conservative senators quiet,” she said. “It’s not necessary, it’s not needed. It’s ‘do nothing’ language only to make sure the bill does not fail in the Senate.”

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One of the basics of the practice of medicine is the starting, changing/limiting , stopping a pt’s therapy. So besides these Pharmacists violating the American with Disability Act & Civil Rights Act… which both makes it illegal to discriminate against disabled people. It would seems that these Pharmacists are practicing medicine without a license.

I wonder if an attorney would file a complaint with the state’s board of Pharmacy and the Medical licensing board on behalf of all the pts being involved in this class action lawsuit, could be ignored by those licensing boards.  Some states allow complaints against state licensing boards to be filed directly with the state’s Attorney General.

I have had some pts tell me recently that a CVS pharmacist told them that NO CVS PHARMACY will fill a particular controlled med in the immediate area.  I have also been told that ordering of stock for CVS Rx depts is now managed by the pharmacy computer system.  So it would seem that someone at CVS HQ could put a ZERO inventory to be maintained on certain meds at certain stores. Some state Pharmacy Practice Act, require a pharmacy to maintain inventory of meds routinely prescribed in their area. So if CVS HQ is prohibiting a CVS Rx dept to stock certain meds – even though the Pharmacist is regularly  being presented prescriptions to be filled.  Compounding the problem, C-II electronically sent, if they are not filled by the pharmacy/Pharmacist, basically become DEAD… because all paper C-II Rxs MUST BE SIGNED BY THE PRESCRIBER. I have read where the DEA has changed regulations that allows Pharmacist/Pharmacies to electronically transfer such electronic C-II to another pharmacy – HOWEVER – states would have to change their state control rules to allow this and pharmacy computer software would have to be changed.  I do not know  if any states and computer software companies have implement this.

This refusal to fill a pt’s controlled med Rx, seems that many different rules/regulations are being ignored and/or violated.

Here is a recent published article that shows that the MME SYSTEM has NO SCIENCE nor DOUBLE BLIND CLINICAL STUDIES behind it and/or supporting it.  Also, I have not seen any FDA professional prescribing information that mentions the MME SYSTEM regards to prescribing opiates. https://www.acsh.org/news/2022/03/01/true-story-morphine-milligram-equivalents-mme-16154  So what science or double blind clinical studies is CVS using in establishing this limiting pt’s opiate Rxs to 90 MME/day.  I was always told/taught that all clinical decisions has to be based on CLINICAL FACTS

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Survey: Unsafe pharmacy conditions put patient safety at risk, spark resignations among pharmacy techs

https://drugstorenews.com/survey-unsafe-pharmacy-conditions-put-patient-safety-risk-spark-resignations-among-pharmacy-techs

The survey shows that a significant percentage of pharmacy technicians are leaving their roles due to poor working conditions that are creating concerns for patient safety.

Sandra Levy

Senior Editor

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Aspirin, ibuprofen and other pain-relieving drugs may actually make agony WORSE, study warns

https://www.newsbreak.com/news/2599808451704/aspirin-ibuprofen-and-other-pain-relieving-drugs-may-actually-make-agony-worse-study-warns

Taking aspirin and ibuprofen as painkillers could be completely pointless, a study suggests.

Experts have now warned the cheap drugs may actually leave patients in agony for longer.

The findings call into question the conventional practice of treating pain with anti-inflammatory drugs, taken by millions around the world.

Researchers today praised the ‘excellent’ study, which was based tests in the lab on human cells and mice.

However, they have urged people not give up their painkillers overnight because the drugs are proven to be effective in the short-term.

The study by researchers in Canada and Italy suggests inflammation may not be the nemesis after all.

Instead, it could be protective in the long-term. One researcher said that it ‘may be dangerous to interfere with it’.

Popular anti-inflammatories include diclofenac, naproxen, and piroxicam.

The research, in the Science Translational Medicine journal, also looked at steroids like dexamethasone, which works in a similar fashion.

Anti-inflammatory drugs work by blocking neutrophils, white blood cells which help the body begin the healing process.

Experts analysed blood samples, taken on three occasions, from 98 people battling lower back pain.

Patients whose pain eventually went away had significantly more neutrophils in their blood, compared to those still struck down.

This inspired the researchers to test blocking neutrophils in injured mice with anti-inflammatory drugs dexamethasone and diclofenac.

HOW AMERICA GOT HOOKED ON OPIOIDS AND IS THE SAME HAPPENING HERE?

Research has shown hospital admissions for opioids has soared 50 per cent in the last decade in England adding to fears the UK could be facing a similar opioid crisis to the one in the US which has devastated thousands of families.

In the early 2000s, the FDA and CDC started to notice a steady increase in cases of opioid addiction and overdose. In 2013, they issued guidelines to curb addiction.

However, that same year – now regarded as the year the painkiller epidemic took hold – a CDC report revealed an unprecedented surge in rates of opioid addiction.

Overdose deaths are now the leading cause of death among young Americans – killing more in a year than were ever killed annually by HIV, gun violence or car crashes.

In 2019, the CDC revealed that nearly 71,000 Americans died from drug overdoses.

This is up from about 59,000 just three years prior, in 2016, and more than double the death rate from a decade ago.

It means that drug overdoses are currently the leading cause of death for Americans under 50 years old.

The data lays bare the bleak state of America’s opioid addiction crisis fueled by deadly manufactured drugs like fentanyl.

Most control mice stopped feeling pain within two months.

But rodents on the anti-inflammatory drugs experienced for pain for twice as long on average, with some in pain for 10 times longer than the control group.

Replicating the experiment with painkillers that don’t target inflammation, such as paracetamol (acetaminophen), did not produce the same extended pain response.

This suggested inflammation played a role in healing injuries and resolving pain, the authors said.

The findings were supported by a separate analysis of 500,000 people that showed that those taking anti-inflammatory drugs to treat their pain were more likely to have pain two to 10 years later.

Professor Jeffrey Mogil, author of the study from McGill University in Canada, said by interfering with this initial painful period medics could be doing more harm than good.

‘Neutrophils dominate the early stages of inflammation and set the stage for repair of tissue damage,’ he said.

‘Inflammation occurs for a reason, and it looks like it’s dangerous to interfere with it.

‘For many decades it’s been standard medical practice to treat pain with anti-inflammatory drugs.

‘But we found that this short-term fix could lead to longer-term problems.’

He added that while ibuprofen was not studied explicitly in the experiments, it would have been reflected in analysis of 500,000 Britons.

‘It is highly likely that a large percentage of those in the UK Biobank who reported taking non-steroidal anti-inflammatory drugs were in fact taking ibuprofen,’ he said.

Fellow author, Dr Massimo Allegri, from Monza Hospital in Italy, argued the findings could mean medics need to treat painful injuries differently.

‘Our findings suggest it may be time to reconsider the way we treat acute pain,’ he said.

‘Luckily pain can be killed in other ways that don’t involve interfering with inflammation.’

Experts called for further trails comparing anti-inflammatory drugs to other painkillers that don’t disrupt inflammation.

Chronic pain, and the medications prescribed to counter it, are one of the drivers of the prescription painkiller addiction crisis in both the US and Britain.

Dr Franziska Denk, an expert in chronic pain from King’s College London, said the study was a ‘wonderful start’.

But she claimed further research needed to be done before changing how medics treated patients.

‘It would most definitely be premature to make any recommendations regarding people’s medication until we have results of a prospectively designed clinical trial,’ she said.

‘In my opinion, this study should not generate a debate around the use of NSAIDs in low back pain – much more research is needed to confirm these findings first.’

Professor Blair Smith, an expert on pain from the University of Dundee, said the latest study was an ‘excellent’ piece of research but people should continue to take their medications as advised until further scientific work is completed.

‘It is also important to note that anti-inflammatory drugs are effective in short-term pain management,’ he said.

‘There is good quality evidence to back this up and they should not be withheld unnecessarily.’

Ongoing chronic pain has been blamed for fuelling a painkiller addiction crisis in both the UK and the US which has blighted thousands of lives.

A London School of Economics study published in February found hospitalisations for opioid overdoses in England have soared by 50 percent in a decade.

Experts have also warned prescription painkiller use is likely on the rise as millions of patients suffer in agony while trapped on record-high waiting lists for surgeries like hip replacements on the NHS.

In the US the opioid addiction crisis has resulted in 600,000 deaths from overdoses since 1999.

Around 5million people a year in England are given prescription opioids, and more than half-a-million taken them for at least three years, according to a 2019 Government report.

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