Your pain meds being reduce/cut: call their bluff with a certified letter ?

Posted on February 8, 2022 by Pharmaciststeve

I can’t count the number of times that I have heard from chronic pain pts that their prescriber is reducing their dose or eliminating their dose all together. Or the prescriber tells the pt that they must or must not do something because it is “the law ” when in fact it is now the policy of their practice or the healthcare system that they work for… has nothing to do any law.

Here is a chart that list the extensive effects that under/untreated pain has on various bodily functions and/or the pt’s comorbidity issues and this chart was composed almost TEN YEARS AGO… so it is not something that is new and most healthcare professionals should be aware of the issue that it contains.

When a pt gets this sort of edict of their medications are being reduced. Their time to act to get things rectified could be a rather short window of opportunity. The pt should not say anything when given this edict, but should contact an attorney, probably one that deals with civil rights & discrimination. If the prescriber is not reducing the pt’s other medications but just focusing on controls.

If I was a pt in this position, on my way out of the office, I would ask for a printout of the prescriber’s clinical notes for this visit. In healthcare there is this saying, “if it is not documented… it didn’t happen”. If the only documentation that shows is the reducing of the dose – without any clinical reason – or – just claims they are following cdc guidelines… or no reason at all because they are following some corporate edict that they have been told not to disclose.

I would also suggest that the pt start taking daily blood pressure readings and record them… Elevated blood pressure is one of the first visible side effects of the reduction of pain meds and the adjacent chart demonstrates what those adverse side effects are of HIGH BLOOD PRESSURE – which is also known as “THE SILENT KILLER”. If the pt dies of high blood pressure, their death certificate will probably be labeled as “natural causes” and the prescriber will get off with causing the pt’s premature death.

I am not an attorney and I may be way off base but what I am suggesting is a relative inexpensive initial step – a couple of hundred dollars.

This letter may end up being sent to a prescriber/healthcare corporation, pharmacy/pharmacist, insurance company, PBM.

My idea is just a letter to put those entities ON NOTICE that if the pt is harmed/dies from a reduction/elimination of controlled meds – especially they are intentional thrown into a cold turkey withdrawal. That there could be consequences for their actions.

If the entity claims that there are no studies that shows that opiates are beneficial to pts for long term use… here is a TEN YEAR study from the early 2000’s that documents otherwise

Opioid Treatment 10-year Longevity Survey Final Report

If the entity is just claiming that they are following the “law” in regards to max MME’s/day…

Here is a MME conversion program that I use for reference

https://globalrph.com/medcalcs/opioid-pain-management-converter-advanced/

and here is footnotes from the same prgm all MME conversion programs will have same/similar footnotes, basically these footnotes suggests that on a “good day” these MME conversion programs are JUNK SCIENCE.

Published equianalgesic ratios are considered crude estimates at best and therefore it is imperative that careful consideration is given to individualizing the dose of the selected opioid. Dosage titration of the new opioid should be completed slowly and with frequent monitoring.
Conversion ratios in many equianalgesic dosing tables do not apply to repeated doses of opioids.
The amount of residual drug in the patient’s system must be accounted for. Example: fentanyl will continue to be released from the skin 12 to 36 hours after removal of the patch. Residual effects from discontinued long-acting formulations should also be assessed before converting a patient to a new opioid.

If the entity states that 90 MME/day is the CDC guidelines and/or “it is the law”… here is quotes from the CDC 2016 opiate dosing guidelines:

https://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm

“The guideline is intended to ensure that clinicians and patients consider safer and more effective treatment, improve patient outcomes such as reduced pain and improved function.”

“Clinicians should consider the circumstances and unique needs of each patient when providing care.”

“Clinical decision making should be based on a relationship between the clinician and patient, and an understanding of the patient’s clinical situation, functioning, and life context.”

“This guideline provides recommendations for primary care clinicians who are prescribing opioids for chronic pain outside of active cancer treatment, palliative care, and end-of-life care.”

Then if the entity has not taken into consideration the pt’s CYP-450 opiate metabolism status, then all of the pt’s health issues has not been considered.

Here is a article about CYP-450 opiate metabolism rates .. this is just one of many articles available

https://www.practicalpainmanagement.com/treatments/pharmacological/opioids/making-practical-sense-cytochrome-p450

Here is a newer and more comprehensive DNA testing: Pharmacogenomics: What does it mean for your health?

In sending this letter to these various entities, the attorney should consider a statement that being discharged from the practice will be consider a act of retaliation and/or pt abandonment and may result in further legal action against the entity.

If Epidural Spinal Injections (ESI) are involved and the entity is mandating that the pt is required to get oral opiates they MUST SUBMIT to having ESI done.

Here is just one of many articles about the FDA’s https://livelovefruit.com/dangers-epidural-steroid-injections/ FDA Warns About Dangers of Epidural Steroid Injections for Back Pain

The side effects of epidural steroid injections are so severe that the FDA ruled that all injectable steroid must carry an updated warning that includes the above risks, as well as “arachnoiditis, bowel/bladder dysfunction, headache, meningitis, paraparesis/paraplegia, seizure, [and] sensory disturbances (6).”

The FDA’s website also warns that “the effectiveness and safety of injection of corticosteroids into the epidural space of the spine have not been established, and FDA has not approved corticosteroids for this use (7).” This is largely due to the fact that research into the risks of epidural steroid injections is still being conducted. Approved or not, Dennis Capolongo of the ENDC, a ground that has campaigned against epidural steroid injections for years, believes that warning labels need to be stronger, and more visible – not just confined to the small print.

Then there is the issue of if the entity states that “no ESI’s … no oral opiates” … there is a portion of the Sherman Antitrust Act called TYING COMMERCE

https://en.wikipedia.org/wiki/Tying_(commerce)

This law basically states that it is illegal for a vendor to force a customer to purchase something that they don’t want in order to purchase something that they do want.

If the pt gets little or no benefit from these ESI’s then there is the question of Medicare/Medicaid law on inducement to cause a pt to cause Medicare/Medicaid to be charged for services that are not medically necessary https://benkofflaw.com/practice-areas/federal-and-state-anti-kickback-and-inducement-laws/

Then there is possibly the final “notice” to the entity… if the pt becomes incapacitate, dies or commits suicide then there is a possible legal recourse by the spouse and children

This is probably the last thing that the entity will ever consider … being sued by the spouse and/or children of the pt.

Here is lawsuits settled last year for prescriber induced suicides https://www.wdrb.com/news/7-million-awarded-to-family-of-man-who-killed-himself-after-pain-medication-denied/article_92db6b14-09c0-11ec-b39b-7b711a46b1c7.html

https://www.13wmaz.com/article/news/local/deposition-reveals-va-doctor-reduced-veterans-drug-medicine-mistakenly-4/93-2d9dc181-1f28-4bcc-9d5a-a2e7a4b74b72

A good law firm may see that a single letter to one set of healthcare entities have the distinct possibility of turning into a large class action lawsuit, since it is unlikely that the healthcare entity is doing this to just one or even a handful of pts, but more likely all similar pts in the practice or when it comes to large healthcare corporations, chain pharmacies, insurance/PBM companies could be applying this to thousands and/or tens of thousands pts.

What I am suggesting is what prosecuting attorneys do to criminals… they “over charge” with the hopes that they will end up pleading guilty to one-two charges and/or if they go to trial… they will get a guilty verdict on one or two charges.

Any pt that attempts to talk to a law firm about being poorly treated for total denial of care… don’t talk to them about malpractice or let them go down that path… many states have caps on award for malpractice and each side hires a “expert” that will testify that who hired them was doing the correct thing… because of the award caps, most law firms will not even cover their expenses – if the take the case on a contingency basis – even if they win.

The look for a large number of people in a class action against a entity with deep pockets. IMO, sending the offending healthcare entity a letter of notice of the potential harm that could happen to a pt.. then they have been harmed and things may move from malpractice to known intent… Intentionally and knowingly throwing a chronic pain pts – particularly a intractable chronic pain pts into cold turkey withdrawal and the pt ends up with a heart attack, failing kidneys, stroke, suicide or death… the $$$ damages should be greatly increased and if their is a spouse and children left behind or required to care for a loved one who is no longer self reliant and has to be cared for… that is financial damages…

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Spinal Cord Stimulators An Analysis of the Adverse Events Reported to the Australian Therapeutic Goods Administration

Posted on February 7, 2022 by Pharmaciststeve

Spinal Cord Stimulators

An Analysis of the Adverse Events Reported to the Australian Therapeutic Goods Administration

https://journals.lww.com/journalpatientsafety/abstract/9000/spinal_cord_stimulators__an_analysis_of_the.98907.aspx

Abstract

Background

Spinal cord stimulators are used to treat intractable pain. Placebo-controlled trials of spinal cord stimulators typically involve short-term treatment and follow-up, so long-term safety and efficacy are unclear.

Aim

The aim of the study was to describe the adverse events relating to spinal cord stimulators reported to the Therapeutic Goods Administration of Australia between July 2012 and January 2019.

Methods

Adverse events were coded by seriousness, severity, body system affected, type of event, action taken, and attribution of fault. Data on the number of stimulators implanted and removed were sourced from the Admitted Patient Care Minimum Data Set.

Results

Five hundred twenty adverse events were reported for spinal cord stimulators. Most events were rated as severe (79%) or life-threatening (13%). Device malfunction was the most common event (56.5%). The most common action taken in response to an adverse event was surgical intervention with or without antibiotics (80%). The ratio of removals to implants was 4 per every 10 implanted.

Conclusions

Spinal cords stimulators have the potential for serious harm, and each year in Australia, many are removed. In view of the low certainty evidence of their long-term safety and effectiveness, our results raise questions about their role in providing long-term management of intractable pain.

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How good intentions– can cause piss poor medical outcomes

Posted on February 7, 2022 by Pharmaciststeve

I have been trying to advocate for the chronic pain community for abt 10 yrs.. The community seems to either be functioning under Eistein’s definition of insanity or a very bad “ground hog day” scenario

There has been too many years between now and Biochemistry class for me.
Today, I tend to rely on observations and my common sense to see things that seem abnormal.
I see chronic pain pts making statements that when they have had their pain meds involuntarily/forced reduction that their blood pressure goes into what I would call “stroke territory” – many north of 200/100.
Pts state that they may be taking up to 4 different categories of BP meds and their blood pressure doesn’t change little or none at all.
Apparently some practitioners just ignore their elevated BP, and can’t see – or don’t want to see the relationship between cutting the pt’s opiates and elevated BP.
Even those pts being put on up to 4 different categories of BP meds, their pressure will not return to what is considered acceptable 135/85 range.
Apparently, there is some physiological process effecting their blood pressure that is totally separate and distinct from what all of those different categories of BP meds have been targeted by clinical trials in controlling hypertension.
Since most opiates are generic, and there seems to be a near mass hysteria over the fear of addiction. There is probably little chance of some pharma to look at this issue.
My common sense suggests that there has to be one or more measurable components of our blood or urine that is raised or lowered and would indicate that the pt’s intensity of pain is elevated, maybe even capable of indicating just how high/intense it is.

Just look at line one on this chart on the effects to the human body from under/untreated pain. many/most of those items involved with the Endocrine system should be able to be measures with a simple blood or urine test. It is – or should be – common knowledge that any pts dealing with under/untreated pain for an extended period of time will end up with Addison’s disease – basically the adrenal glands have “quit/failed” while trying to compensate for the body’s stress and Addison is a disease that should not be ignored and not treated.

Hypertension from under/untreated pain is very common – ideal target for BP is 135/85 – but often pts who have had their opiate meds involuntarily reduced/eliminated will have a hypertensive crisis – with pressure often times north of 200/100 and that is STROKE TERRITORY.

What is even worse is – pts have told me that their practitioners will either ignore their hypertensive crisis and/or put them on as many as 4 different categories of blood pressure meds – and often their blood pressure will be reduced little to none. There must be a whole separate physiological body function separate and distinct from what the blood pressure meds that we now have addresses.

Several years ago, Medicare/HHS/CMS started a program to monitor pt’s compliance with medications for blood pressure, diabetes, cholesterol. They put the Medicare Advantage & Part D providers in charge of enforcing this program. Here is how it apparently works… the practitioner writes a Rx for pt to treat one or more of those medications… Those insurance prgms start tracking the pt, the pharmacy and the practitioner … if the pt doesn’t refill the prescribed medications on a timely basis – based on the last fill/refill date submitted to the insurance program – the insurance program will send out notices to the pt, pharmacy, practitioner – that the pt is NOT IN COMPLIANCE… the pharmacy and practitioner can get “financially dinged ” if more than a certain percent of their pts are no in compliance.

The ELEPHANT IN THE ROOM is that the insurance providers are apparently working under the belief that the pt’s lab values for those three disease states are being kept within “normal range”… In the case of under/untreated pain pts… taking 4 different blood pressure meds but their BP is still in “stroke range”. As far as Medicare/HHS/CMS is concerned … all the “i’s” are being dotted and “t’s are being crossed, but the original intent of this program – lowering cost to medicare because the pt is being compliant with their medications is either a mirage or an illusion.

I have no idea how large this subset of chronic pain pts with hypertension, who have had their pain meds involuntarily/forced reduction or eliminated, and whose blood pressure in above recommended levels – especially those who are being prescribed- and regularly taking – blood pressure meds – that are not lowering their BP… HHS/CMS/Medicare is working under the false pretense that the practitioner has got the pt’s BP under control…

Perhaps this is a issue that is better about talking to your member of Congress about… Congress or HHS put this program together to help Medicare folks to optimize their QOL and OF COURSE – to save Medicare money ! After all, high blood pressure has always been referred to a the “SILENT KILLER”. With that subset of chronic pain pts there can be a lot of other compromising QOL issues that high pressure will compromise – and cost Medicare MORE MONEY – before it kills you.

This chart pretty simply explains the potential adverse health consequences to a pt with long term high blood pressure. A stroke may not kill you … could make you bed confined, could make you a paraplegic and in a wheelchair, heart attack doesn’t have to kill you, can cause a lot of different disabilities and if you are on Medicare you are “too old” for a heart transplant.

Kidney damage and you will end up on dialysis and again if you are on Medicare, you are “too old” for a transplant

How would losing your eye sight affect your day to day living and QOL ?

And who is going to pay for all of these medical services that you need ? Medicare will only pay for so many days in a nursing home and then you will be liable until you only have $2000.00 and a car and if you have a house.. they may sell it for you to keep paying your nursing home costs and then you will get on Medicaid…. and the care that you received will be dictated by Medicaid

This is just one example of how good intentions by Congress, HHS. CMS, Medicare could be costing our healthcare system unnecessary costs and costing pts unnecessarily having their QOL compromised because all those involved are only looking at part of a pt’s health issues. It is also pathetic, that there could be all sorts of pt’s data points (lab tests) in Electronic Medical Records (EMR) that could verify and document a chronic pain pt’s intensity of pain.

Because NO ONE IS LOOKING at the data that is right under their noses !

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“In God we trust; all others cash.” -GoFundMe says they will “send all remaining funds- abt 10 million – to credible and established charities verified by GoFundMe.

Posted on February 4, 2022 by Pharmaciststeve

I am no attorney but in my short research, suggest that:

Definition of theft:1a : the act of stealing specifically : the felonious taking and removing of personal property with intent to deprive the rightful owner of it

Depending on the state or country… anyone involved in the theft of 10 million could be charged with a FELONY and could serve a number of years in JAIL.

Is this just another example of “tech companies”… doing what they damn please… because they disagree with something that some other entity has done or said. https://dennismichaellynch.com/breaking-gofundme-makes-shocking-move-on-canadian-truckers-fundraising-page/

I remember 22-25 yrs ago… all those tech companies promoting their companies’ stocks and all too many were running on “financial fumes” and shortly after the turn of the century… a huge chuck of all those tech companies went BELLY UP.. after the fact ..it was referred to as the “tech wreck” A whole lot people who had put their savings/retirement money into some/many of these “high flying” tech companies were financially ruined.

Yesterday, Meta Platforms Inc (FB) formerly known as FACE BOOK… their stock DROPPED in value 250 BILLION and Jeff Zuckerberg personally was worth abt 30 BILLION less at the end of the day yesterday than he was worth the day before when the stock market closed. The graphic below, is the last 5 DAYS of stock price value for (FB) We have seen FAKE BOOK, YOU TUBE, TWITTER and others have banned some very popular people, including some of our Federal Senators, Representatives and some celebrities.

While it is unlikely that any non-profit pain advocacy group… could raise that much money, but if they could be fortunate enough to amass a few million … would it be out of the question that some such entity – like gofundme – could confiscate/steal their $$$ because they had decided that advocacy for chronic pain pts is supporting the fabricate opiate epidemic ?

“In God we trust; all others cash.” -GoFundMe says they will “send all remaining funds- abt 10 million – to credible and established charities – of GoFundMe choice – verified by GoFundMe.

BREAKING: GoFundMe makes shocking move on Canadian truckers’ fundraising page

The GoFundMe site set up to support the Canadian truckers Freedom Convoy had raised over $10.1 million.

On Wednesday, GoFundMe announced, “This fundraiser is currently paused and under review to ensure it complies with our terms of service and applicable laws and regulations.”

Now, as of Friday, Feb. 4, the crowdfunding site has taken down the Freedom Convoy 2022 page entirely, claiming the peaceful demonstration has now become an unlawful “occupation.”

GoFundMe says they will “send all remaining funds to credible and established charities verified by GoFundMe.” They also provide an option for donors to request a refund – but only until Feb. 19.

Below is the full statement which GoFundMe has posted on the now-defunct fundraising page for the Canadian truckers’ Freedom Convoy:

UPDATE: GoFundMe Statement on the Freedom Convoy 2022 Fundraiser

GoFundMe supports peaceful protests and we believe that was the intention of the Freedom Convoy 2022 fundraiser when it was first created.
We now have evidence from law enforcement that the previously peaceful demonstration has become an occupation, with police reports of violence and other unlawful activity.

To ensure GoFundMe remains a trusted platform, we work with local authorities to ensure we have a detailed, factual understanding of events taking place on the ground. Following a review of relevant facts and multiple discussions with local law enforcement and city officials, this fundraiser is now in violation of our Terms of Service (Term 8, which prohibits the promotion of violence and harassment) and has been removed from the platform.

Organizers provided a clear distribution plan for the initial $1M that was released earlier this week and confirmed funds would be used only for participants who traveled to Ottawa to participate in a peaceful protest. Given how this situation has evolved, no further funds will be directly distributed to the Freedom Convoy organizers — we will work with organizers to send all remaining funds to credible and established charities verified by GoFundMe.

All donors may submit a request for a full refund until February 19th, 2022 using this dedicated refund form.

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Shark Tank: Mark Cuban’s Cost Plus Pharmacy – saving pts money — reality or MIRAGE ?

Posted on February 3, 2022 by Pharmaciststeve

I have spent some time today researching the buzz behind this new “Mark Cuban’s Cost Plus Pharmacy”.

And while I love Shark Tank and nothing makes me happier than cutting out the vampires that are pharmacy middlemen (PBMs), I feel there is an elephant in the room that is not being mentioned in any of the articles I have read:

LOCAL INDEPENDENT PHARMACIES HAVE BEEN DOING THIS FOR YEARS….and they do it better!

Example: “Mark Cuban’s Cost Plus Pharmacy’s” flagship low-priced item, Imatinib.

In every article and post Mr. Cuban’s pharmacy mentions that they will save patients $9,657 on this one product. Sorry, but THIS IS DISHONEST.

NOWHERE, not even the worst of the worst pharmacies, charge anyone anything NEAR $10,000 for 30 tablets of Imatinib 400mg.

The second photo on this post is a shot from GoodRx (which should prove how dishonest they are also) where you can see that no pharmacy’s price is near that estimate, but still much higher than the $47.40 that Mark Cuban advertises.

(-This is how customers are mislead into believing GoodRx does something. $127 is a lot better than $6,000, right?-)

Mark Cuban’s pharmacy chose Imatinib (Gleevec) because it’s a cancer medication and his team knew that it would get great press for them to be the savior of cancer patients…all while being dishonest about competitors prices.

So before you trust that a billionaire is truly out to help you, maybe just check with the store down the road?

Oh, and by-the-way, Golden Isles Pharmacy’s price for Imatinib is 40 cents cheaper than Mark Cuban’s price.

Last week, I got a new Rx med – a topical cream – and I am in my annual deductible… I didn’t pay much attention to the Rx receipt – until I got home… We have Humana Part D… but I started to filing the receipt away and notice that in the lower left hand corner of the receipt INSURANCE PAID $-7.00

this is the 2nd or 3rd year we have been using Humana Part D and I have seen receipts where it showed that Humana PAID NOTHING on a Rx.

The Rx was not a real cheap, a ONE OUNCE TUBE and the charge was $45.16… I called the pharmacy back and talked to the PIC.. if she could help me understand as to why Humana charged me $7.00 MORE … she told me that she could have charged me a lower CASH PRICE… but that it would not be applied to my Humana Deductible… so HUMANA UP CHARGED ME … about 18%…

I know how these things work- the pharmacy computer talks to the Humana computer and the Humana computer tells the pharmacy computer how much the pt – in this incident, that would be me – owes for the particular prescription.

I checked the tube of Cream and it is marked RX ONLY… and it was ONE OUNCE size

The only ingredient in the cream has been around FOREVER… and this tube was 3% strength….

So… I started doing some RESEARCH… and found out that I could buy at AMAZON – as a OTC … TWO – SIX Ounce tubes of the same active ingredient but it was 5%…

and Amazon wanted $44.99 for the TWO TUBES – total of TWELVE OUNCES.

For those of you… that math is not your strongest trait… the Rx cream was 45.16/Oz and the one coming from Amazon is $3.75/Oz and 66% MORE POTENT.

I think that I am going to talk to Humana tomorrow – and I doubt that I will get a accurate answer … nor my $7.00 back.

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FAKE BOOK (META) stock price DROPS 23.5% today

Posted on February 3, 2022 by Pharmaciststeve

Meta Platforms (FB) shares are trading (26%) lower after the company reported worse-than-expected Q4 EPS results and issued guidance.

SUCKERBBERG is not going to get any sympathy from me… after his “opinionated ” FACT CHECKERS – took a untold number of complaints from Richard Mark and his harem/tribe of minions falsely reported my blog as a SPAMMER. With SUCKERBERG’S estimated net worth he may have LOST some TWENTY FOUR BILLION in net worth.

Maybe SUCKERBERG saw this coming, since he changed FAKE BOOK’S name to META and is taking the company in an entirely new direction… and dropped his attempt in creating his own cryptocurrency (DIEM) https://www.businessinsider.in/cryptocurrency/news/mark-zuckerbergs-controversial-crypto-project-diem-is-looking-to-repay-investors-by-selling-its-assets-report-says/articleshow/89138561.cms

Be the end of the day (02/03/2022) META (FB) company LOST 250 BILLION in value !

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APDF: advocating for 9 y/o cancer pt – Intractable chronic pain pt – another SOLID HIT for APDF advocate Bob Sheerin

Posted on February 2, 2022 by Pharmaciststeve

Today we advocated for a 9 year old boy named Tony. Tony suffers from BLS ,chronic pancreatitis, and severe low back pain from cancer related problems. “Today was a win for American Pain and Disability Foundation’s team as they pulled together to advocate for kids who suffer in chronic intractable pain,” said Bob Sheerin.

Bob Sheerin, APDF’s VPO stated that “Today I learned a valuable lesson, this lesson came to me in 3 different parts. One, doctors are obviously under contract with certain types of owners and insurance companies who breed policies. Two, by the end of this advocating session it came to my attention that it almost always takes an entity like APDF to allow these doctors to go to their administration in order to not get a bad name for themselves or their practices. Lastly, this doctor was more than willing to work with us to get this child the medicine he needs to manage the great pain he was in!”

The doctor from Methodist Hospital referred him to Vanderbilt to ask if their policies are going to change soon. It felt like he was hopeful they would. The doctor wrote the child’s prescription and asked me out to lunch where we discussed many issues like pain care in America. “I have 3 more children to see this doctor over the next 3 weeks. After today when we are through with Methodist we will move onward and upward with the children’s program and continue to take action like this wherever and wherever action is needed.”

Bob Sheerin and the APDF team!

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Next Tuesday, the Colorado Pharmacists Society is holding a board meeting

Posted on February 2, 2022 by Pharmaciststeve

Next Tuesday, the Colorado Pharmacists Society is holding a board meeting and will be discussing burnout and workplace issues! They are inviting pharmacists to attend and to share our perspectives.

I’m thinking we have their support

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Chapman Law Group Wins for Doctors & Patients

Posted on February 2, 2022 by Pharmaciststeve

Chapman Law Group Wins for Doctors & Patients

https://www.chapmanlawgroup.com/

https://doctorsofcourage.org/chapman-law-group-wins-for-doctors/

Kendall Hansen, MD, 66 y/o pain management specialist in Crestview Hills, KY, was indicted Nov 18, 2021. But in the course of time since the raid on his office Feb 9, 2019, he was smart. He hired Chapman Law Group.This is something all medical professionals need to understand. Don’t waste your money with standard white collar lawyers in your area. Reach out to Ron Chapman, II from the word go. This is a case to show you why. In general, doctors who have been attacked visit Doctorsofcourage.org, but do not consult us. So they get snookered into hiring a standard white collar lawyer who has no idea how to approach the federal attack for prescribing opioids. They pay a lot of money to these lawyers who do nothing to prepare the case, and then pressure the professional to take a plea. What we see is that, after losing all their money to these worthless lawyers, they then come to us asking for help. But by then it is too late. If they went straight to the Chapman Law Group, like Dr. Hansen did, then the work is done in preparation, and they are ready to fight whenever the government decides to proceed.

Check it out

When Dr. Hansen’s office was raided Feb 6, 2019, He was reported to say

“We welcome the scrutiny, we do a good job.”

As most practicing physicians do, he believed that once investigators got a look at his records, they’d realize he hadn’t done anything wrong. But he was smart enough to get a lawyer so that when the government struck, he was ready. It generally takes 2-3 years from the raid to the indictment, as in this case. Most doctors think, if the indictment doesn’t happen right away, that they are safe. But that is not the case.

As part of the DOJ investigation of doctors, you are probably aware of the Narx score algorithm used against doctors and patients. Dr. Hansen was identified through the PDMP as a high prescriber of controlled substances. Obviously—he’s a pain management doctor. When the DOJ approached local pharmacies in their investigation, CVS decided to not fill any of Dr. Hansen’s prescriptions. Ron Chapman immediately took CVS to trial and won.

Then on November 18, 2021, indictments were filed against Kendall Hansen, MD and his associate, Michael Fletcher, MD in two separate cases. The indictment charges Dr. Hansen with one count of conspiracy to distribute controlled substance and two counts of distribution of a controlled substance. He is accused of getting other doctors to prescribe him controlled substances. They also accuse him of writing a prescription to his employees and instructing them to bring the pills back to him. The prescriptions were for 480 doses of tramadol in 2016 and 30 doses of phentermine in 2018. Both tramadol and phentermine are schedule IV drugs which are defined as drugs with a low potential for abuse and low risk of dependence.

Five days later on Nov 23, the Kentucky Board of Medical Licensure (KBML) restricted his license, prohibiting both doctors in the practice from prescribing controlled substances. Because they were already informed on the case, Chapman Law Group asked the KBML for a hearing to explain the number of patients relying on Dr. Hansen, but the board denied it, based on their rule that indictment meant automatic license withdrawal.

So Ron Chapman immediately took action by filing an appeal. On January 4, 2022, The Hon Audra Eckerle of the Jefferson Circuit Court, Div 7 ordered a temporary injunction against the Kentucky Board of Medical Licensure, telling the board it is time to change their restriction policy in these types of cases. She basically stated that the KBML applied an incorrect rule of law. That rule of law was that Dr. Hansen’s license could be suspended simply based on an indictment. Instead, the court states that the KBML must carry out its burden to establish that Dr. Hansen’s practice constitutes a danger to the health, welfare, and safety of his patients or the general public. So Dr. Hansen, due to the work of the Chapman Law Group, was again permitted to begin prescribing controlled substances at his Crestview Hills clinic, and that ruling should now apply to all cases that go before the Kentucky Board of Medical Licensure. Following that decision, the medical board should set a date for a hearing to determine if Hansen can continue prescribing while his case is pending. The injunction by the judge allows him to prescribe until that hearing is over.

The Rest of the Story

The battle isn’t over. While the KMBL matter was playing out, prosecutors attempted to utilize bond conditions to prevent Dr. Hansen from prescribing. At arraignment, Ron was successfully able to convince the judge that such a restriction should not be put in place because it would endanger the community and leave patients untreated. The judge agreed, refusing to advance the Government’s proposed restriction. So, the Government issued a superseding indictment with stale allegations and tried again. A hearing was recently held at which the judge took the matter under advisement but still has not restricted Dr. Hansen’s prescribing. 3000 patients in that clinic would be affected by any prescription restrictions and could go through withdrawal and end up seeking street drugs. It’s an interesting fact that the Cincinnati area, where Crestview Hills is located, is the nation’s No. 1 opioid overdose hot spot as of May, 2021 study by the University of Cincinnati.

So Dr. Kendall has the best lawyer for the job. We will keep informed on the status of this case

Filed under: General Problems | 2 Comments »

Imagine this: Federal Decade of pain law … could have contributed to our perceived “opiate crisis”

Posted on February 2, 2022 by Pharmaciststeve

Here is a conclusion of this study on opiate OD’s

The study also found a correlation between fatal overdoses and mental and physical distress using surveys of physically and mentally unhealthy days. Mental distress increases the relative risk of dying from a drug overdose by as much as 39%.

Here is a chart on all the comorbidity issues aggravated or caused by under/untreated pain. Pay particular attention to line THREE CARDIOVASCULAR and the LAST LINE – QOL could under/untreated pain be a underlying issues of ODing?

Here is another poignant fact… At the beginning of the epidemic it was heroin. By 2010 it switched to prescription opiates.”

Does anyone remember what changed in 2010 ? the Decade of Pain Law expired and was not renewed. So after 10 yrs of pain being referred to as the 5th VITAL SIGN and practitioners being encouraged to treat pain and the Joint Commission making it a MAJOR STANDARD for hospitals to get credentialed.. each pt when discharged was asked on a survey “how was your pain treated” ?

The Joint Commission quickly disclaimed any ownership of THE FIFTH VITAL SIGN and was no longer a major standard for hospitals to meet.

In Jan 2009, we had two new attorneys in the White House and a new Governor & AG in Florida. All seemed to have an intent to tackle the “opiate epidemic ” Florida was well known as having – it is claimed – a couple of hundred “Oxy docs”.

At the beginning of the epidemic it was heroin. By 2010 it switched to prescription opiates.” The ” pharma opiate epidemic ” had a 10 yr run up. Over the next 5 yrs we had bureaucrats trying to – at least – slow down the prescribing of opiates and Rx opiates peaked in 2011-2012… The DEA started reducing the pharma opiate production quota.. eventually reducing the opiate production quotas by 50%+. Then in 2016, the CDC published their opiate dosing guidelines and the DEA and Veterans Hospitals jumped on those GUIDELINES with BOTH FEET and making statements that the GUIDELINES were ACTUALLY LAWS… and that 90 MME/day was the LIMIT FOR EVERYONE… even though there was provisions in the guidelines that exempt many chronic health issues from those daily limits.

UC opioid study identifies at-risk populations in America

Fatal overdoses are linked to high rates of mental distress

https://www.uc.edu/news/articles/2021/05/uc-opioid-study-identifies-at-risk-populations-in-america.html

The opioid epidemic is taking a deadly toll on people in disproportionate clusters, according to a new national study by the University of Cincinnati.

Fatal opiate overdoses are most prevalent among six states: Ohio, Pennsylvania, Kentucky, West Virginia, Indiana and Tennessee. But researchers identified 25 hot spots of fatal opioid overdoses nationwide using data from the Centers for Disease Control and Prevention.

Published today in the journal PLOS One, the study demonstrates how both widespread and localized the problem of substance use disorders can be, UC assistant professor and co-author Diego Cuadros said.

Epidemiologist Diego Cuadros is director of UC’s Health Geography and Disease Modeling Lab where he has studied HIV, malaria and COVID-19. Photo/Andrew Higley/UC Creative + Brand

Cuadros is director of UC’s Health Geography and Disease Modeling Laboratory, which applies geographical information, perspectives and methods to the study of health, disease and health care. As an epidemiologist, he studies the impacts of diseases such as malaria, HIV and COVID-19.

“Not everyone is similarly at risk,” Cuadros said. “We wanted to identify characteristics that put people at higher risk of a fatal overdose.”

Health interventions for opiates have focused largely on treatments such as the distribution of naloxone and other lifesaving remedies. But Cuadros said prevention could be effective if vulnerable populations can be identified. To that end, researchers found that white males ages 25 to 29 were most at risk of fatal opioid overdose followed by white males ages 30 to 34. The study also identified an increasing risk to black males ages 30 to 34.

What’s happening now is we’re more than a year into a pandemic. Mental health has deteriorated for the entire population, which means we’ll see a surge in opiate overdoses.

Diego Cuadros,UC’s Health Geography and Disease Modeling Lab

“We saw a strong association with mental health and substance abuse disorders, particularly opiates,” Cuadros said. “What’s happening now is we’re more than a year into a pandemic. Mental health has deteriorated for the entire population, which means we’ll see a surge in opiate overdoses.”

Researchers are trying to understand why men are more likely than women to suffer a fatal overdose and what it is about the period of life between age 30 and 45 that makes people more susceptible to the epidemic.

“Maybe you have more responsibilities, financial responsibilities or stress at that time. Maybe there are physiological changes or changes in our brain that we don’t know yet,” Cuadros said.

A map of the contiguous United States shows the spatial distribution of relative risk for fatal overdoses from substance use disorder in 25 identified clusters. Graphic/UC

“This is a complex epidemic. For HIV we have one virus or agent. Same with malaria. Same with COVID-19. It’s a virus,” Cuadros said. “But with opioids, we have several agents. At the beginning of the epidemic it was heroin. By 2010 it switched to prescription opiates.”

Now states are seeing more overdoses from synthetic opioids such as fentanyl.

The study also tracked the migration of overdoses between 2005 and 2017 from Southwest states to the Northeast. Many of the clusters UC identified in the Southwest and Northeast had comparatively higher levels of physical and mental distress.

UC College of Arts and Sciences graduate Andres Hernandez identified national clusters where the opiate epidemic has had a disproportionate impact. Photo/Jay Yocis/UC Creative + Brand

Co-author Neil MacKinnon, former dean of UC’s James L. Winkle College of Pharmacy, said the analysis could help health policymakers and clinicians by identifying individual and community-level factors associated with an increased risk of death due to substance use disorder. He is provost now at Augusta University, Georgia.

“We hope the risk factors we identified in this analysis will be used by agencies like RecoveryOhio to plan proactive strategies and allocate resources to address this epidemic,” MacKinnon said.

Previously, UC researchers identified 12 regions in Ohio that had disproportionately high rates of fatal overdoses from opioids.

“We started in Ohio. We know that in this state we’re suffering one of the highest burdens of the problem,” Cuadros said.

Likewise, he said it would be worthwhile to study populations in the United States where opioids are not exacting a horrible toll on families to understand the problem.

“Sometimes we focus too much on where the problem is focused. It’s useful to look at the areas where the problem is not as pressing,” Cuadros said.

Filed under: General Problems | 1 Comment »

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