Leaving the bench

Today I turned in my resignation as a certified pharmacy technician with CVS.

I’ve been working as a tech for the last 18 years and the changes that come down on us are getting worse and worse. I’ve lost hope that our patients will be taken care of. Last week was the worst shift of them all. A flood of people coming in for flu shots, phone lines lighting up, people piling up at the register, and stacks of prescriptions waiting to be filled. We were drowning with no relief in sight. As I looked at my overtaxed pharmacist all I could see was a mistake waiting to happen. She’s being pulled in no less than 5 different directions, while the flu shots are piling up and she’s suiting up for the task, the narcotic waiter she still has to count and verify is 40 minutes past the promised time. While the patient was extremely understanding after watching us for the last hour, it’s not fair to him or any of our patients to have our attention pulled away in different directions constantly. I went home after my shift, defeated, and really thought about why I was still working here. It most certainly wasn’t because of the money, I could make more working at a coffee shop or as a cashier at a grocery store, shoot a lot of them even got hazard pay during this time. No raises since my pharmacy was bought out 5 years prior and most likely none in the future even with minimum wage creeping up in my state. No hazard pay, no thank you for coming in, nothing but headaches and chest pains. Our patients are no longer patients but are treated as customers who should be up sold at every interaction. Do you need this or that, how about we call your doctors for refills you don’t need, what about auto filling, what about any of these 3-5 vaccines, do you have a rewards card…. Looking back over the years the best thing to happen to me was NOT going to pharmacy school where I would have been saddled with a mortgage in student loan debt and in a job market that’s over saturated. 12 hour shifts, no time for a bathroom break, let alone trying to have a lunch break and many working extra hours before and after their shifts uncompensated just to clear the work for their colleagues. It was bittersweet turning in my 2 week notice, I feel awful for the team I’m leaving behind but I’m glad the abuse will be over. I did not join the pharmacy team to become a used car salesman but that is what CVS has turned it into, minus the commission of course. It’s time to let go and focus on myself, my son has been counting down the days to my last pharmacy shift so he came have some more mommy time… life is too short.

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My state drivers license was suspended unknown to me, to make matters worse my great-grandson took nana’s d.l. for the picture of nana long story short he lost it. We were in the hectic throws of covid, dept of Licensing closed. I went and got veteran’s affairs outreach office to make me a copy of that Driver’s license also included my social security. Card. My pharmacist at took the copy for months (7) now they are refusing unless I have a original drivers license. Because of covid I don’t have a chance of getting a new one. I paid my fines but the drivers license dept is telling me because of covid they have to send it out of state using the picture off my old dl.picture.this will take 6 weeks. I am disabled on social security. My pain meds I have been on for 10 years. I cannot just stop. Pain is constant and I can function with my meds . I have implants that have gone wrong. I need to have surgery, I also have nerve damages, spinal stenosis, nerve damage in my back, Deep vein th. Thyroid disease. Have gone thru therapy, exercises, non-opiod meds. Nothing help. My dr. Had me classified as completely disabled, no Hope’s of going back to my job of 15 years. But also let me tell you when I became aware of my lost of license I did what I could to correct it. Can you advise me? My meds are due 10-19-20. I am afraid of what will happen if I cant find a way to get this copy to be accepted the GOVERNMENT gave me a copy of the original. My script has my photo on it I have my photo on my copy. What more can I do?? Please respond, thank you

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Inside Hunter Biden’s murky history of business dealings in China

https://nypost.com/2020/10/14/inside-hunter-bidens-murky-history-of-business-dealings-in-china/

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Opioid Prescribing for Cancer Care Drops

https://www.drugtopics.com/view/opioid-prescribing-for-cancer-care-drops

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Mallinckrodt files for Chapter 11 bankruptcy

https://www.beckershospitalreview.com/pharmacy/mallinckrodt-files-for-chapter-11-bankruptcy.html

Mallinckrodt has filed for Chapter 11 bankruptcy for all of its U.S. subsidiaries and some international subsidiaries, the company said Oct. 12. 

The bankruptcy restructuring will reduce the company’s total debt by about $1.3 billion and resolve opioid-related claims and litigation involving its drug Acthar.

“After many months of deliberation, negotiation and consideration of alternatives, Mallinckrodt’s management and board of directors determined that implementing a Chapter 11 restructuring provides the best opportunity to maximize the value of the enterprise and position the company for the future in light of the current challenges it faces,” said Mark Trudeau, Mallinckrodt’s CEO. 

Opioid claims against the company are to be channeled into one or more trusts which would receive $1.6 billion in structured payments. The company also agreed to pay $260 million over seven years to settle claims it knowingly underpaid Medicaid for Acthar. 

In the bankruptcy filing, Mallinckrodt listed both assets and liabilities in the range of $1 billion to $10 billion. 

The company will continue to operate as normal as it restructures for bankruptcy. 

Mallinckrodt had said in February that it would put its U.S. generics business in bankruptcy as part of a proposed opioid settlement. In August, the company said it was considering bankruptcy for the parent company and most of its subsidiaries. 

In early March, the U.S. sued Mallinckrodt, alleging it knowingly underpaid Medicaid hundreds of millions of dollars in rebates for Acthar. The U.S. Justice Department said the company had calculated its rebate payments to Medicaid based on the drug’s price in 2013, but it has raised the drug’s price by 20 percent since then. The company was ordered to pay $650 million to CMS. 

As part of its bankruptcy filing, Mallinckrodt said it would reset Acthar’s Medicaid rebate calculation as of July 1, and that state Medicaid programs will receive 100 percent rebates on Acthar Medicaid sales. The company said it will dismiss its appeal of the Justice Department’s ruling in the case. 

Read Mallinckrodt’s full news release here.

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In the USA – on average 7500 people die EVERY DAY… according to this. According to this, total USA deaths for 2020 is projected to be the LOWEST IN THREE YEARS and this number must include the reported 200,000+ COVID-19 deaths.

Makes one wonder before the pandemic… reportedly we had a death crisis of opiate OD’s and vaping deaths.

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US Blood Pressure Validated Device Listing

https://www.validatebp.org/

Blood pressure measurement devices that have been validated for clinical accuracy as determined through an independent review process.

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FDA flags 428 spinal cord stimulator patient deaths, urges more tests before implant

https://www.medtechdive.com/news/fda-flags-428-spinal-cord-stimulator-patient-deaths-urges-more-tests-befor/584714/

• FDA on Thursday published a letter to healthcare providers outlining hundreds of reports of deaths and thousands of injuries and malfunctions with spinal cord stimulators, reminding physicians to follow product labels calling for a simulation in patients prior to permanently implanting the SCS devices.
• Healthcare providers are supposed to trial the estimated 50,000 devices implanted each year from companies such as Abbott, Boston Scientific, Medtronic and Nevro to ensure they adequately relieve a patient’s pain. An agency review of 107,728 adverse event reports submitted in the last four years found 30,321 reports of unsatisfactory pain relief.
• The warning comes after a June report from Public Citizen called for FDA to tighten how it regulates the devices, including requiring original PMA submissions for all new models and reassessing whether any approved devices should be removed from the market. Device Events is also among the organizations that have highlighted dangers with spinal cord stimulators. 

Dive Insight:

The labels on spinal cord stimulators are clear on the need for trial simulation periods: Materials from Abbott, Boston Scientific, Medtronic and Nevro state their devices are only for use in patients who received effective pain relief during trial stimulation. The companies also provide information on how to carry out these trial periods. Nevro, for example, provides pages of information for physicians on two different approaches to trial-phase implantation.  

Yet, FDA is concerned about compliance with the trial-phase requirement. After its dive into the data found 28% of MDRs cite “pain relief, inadequate” as a problem, FDA said the review “highlights the need for patients to undergo and demonstrate an adequate trial.” The next two most frequently cited Patient Problem Codes — “pain” and “therapeutic effects, unexpected” — also point to the possibility that some physicians may be implanting SCSs without performing trial periods. 

FDA also looked at the most frequently reported Device Problem Codes but appeared less concerned by the findings. “Charging problems” was the most commonly reported code, leading FDA to state the reports “are consistent with those expected with battery-powered stimulation devices intended for longer-term implantation and therapy.”

The 107,728 MDRs received by FDA in the four-year period following July 27, 2016, include reports of 428 individual deaths of patients implanted with SCSs between 2005 and 2020. Almost one-third of cases where times to event were available happened in the 30 days after implantation. Many of the patients had comorbidities and the average age was 69 years. FDA said MDRs often lack “enough information to establish a causal relationship between the device and the reported event.”

For now, FDA has limited its response to the data to a reminder of the need to trial SCS implants and recommendations for physicians about discussing the risks with patients and creating individualized follow-up plans for each recipient of a device. It also said it continues to evaluate the devices via mandated postmarket studies, medical literature and other sources.

But FDA’s steps don’t meet critics’ demands. Public Citizen’s June report detailed what it called FDA’s “dangerously lax oversight of high-risk implantable medical devices.” Public Citizen accused FDA of granting premarket approval to SCSs on the strength of studies of other devices, rather than prospective clinical trials of the implants being submitted for review.

In light of that evidence, Public Citizen called for FDA to move SCSs devices to a higher risk class. The Public Citizen report did not specifically mention the potential for harm due to a failure to follow the requirements on trial periods.

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Coronavirus: Health experts join global anti-lockdown movement

https://www.bbc.com/news/health-54442386

Thousands of scientists and health experts have joined a global movement warning of “grave concerns” about Covid-19 lockdown policies.

Nearly 6,000 experts, including dozens from the UK, say the approach is having a devastating impact on physical and mental health as well as society.

They are calling for protection to be focused on the vulnerable, while healthy people get on with their lives.

The declaration has prompted warnings by others in the scientific community.

Critics have pointed out:

• a more targeted approach could make it difficult to protect vulnerable people entirely
• the risk of long-term complications from coronavirus mean many others are also at risk

But the movement – known as the Great Barrington Declaration – mirrors some of the warnings in a letter signed by a group of GPs in the UK.

Sixty-six GPs, including TV doctors Dr Phil Hammond and Dr Rosemary Leonard and a number of medics who have held senior roles at the British Medical Association, have written to the health secretary, saying there is insufficient emphasis on “non-Covid harms” in the decision-making.

What is the Great Barrington Declaration?

The movement started in the US.

And the declaration has now been signed by nearly 6,000 scientists and medical experts across the globe as well as 50,000 members of the public.

The UK-based experts who have signed it include:

• Dr Sunetra Gupta, an epidemiologist at Oxford University
• Nottingham University self-harm expert Prof Ellen Townsend
• Edinburgh University disease modeller Dr Paul McKeigue

They say keeping the lockdown policies in place until a vaccine is available would cause “irreparable damage, with the underprivileged disproportionately harmed”.

The health harms cited include:

• lower childhood vaccination rates
• worsening care for heart disease and cancer patients

And they point out the risk from coronavirus is 1,000 times greater for the old and infirm, with children more at risk from flu than Covid-19.

As immunity builds in the population, the risk of infection to all – including the vulnerable – falls, they say.

And this would be a much more “compassionate” approach.

The declaration recommends a number of measures to protect the vulnerable, including regular testing of care-home workers, with a move as far as possible towards using staff who have acquired immunity.

Retired people living at home should have groceries and other essentials delivered, it says.

And when possible, they should meet family members outside rather than inside.

Simple hygiene measures, such as hand washing and staying home when sick, should be practised by everyone.

But:

• young low-risk individuals should be allowed to work normally
• schools and universities should be open for in-person teaching
• sports and cultural activities could resume and restaurants reopen

• TESTING: How do I get a virus test?
• SYMPTOMS: What are they and how to guard against them?
• LOOK-UP TOOL: How many cases in your area?
• YOUR QUESTIONS: We answer your queries
• THE R NUMBER: What it means and why it matters
• TREATMENT: How close are we to helping people?

What do other experts say?

While clearly “well intentioned”, the declaration has profound ethical, logistical and scientific flaws, University of Leeds school of medicine associate professor Dr Stephen Griffin says.

The vulnerable come from all walks of life and deserve to be “treated equally”.

And “long Covid” is reported to have left even people mild infections with problems such as fatigue and joint pain for months.

University of Reading cellular biology expert Dr Simon Clarke, meanwhile, says whether herd immunity is even achievable remains unclear.

“Natural, lasting, protective immunity to the disease would be needed,” he says.

“And we don’t know how effective or long-lasting people’s post-infection immunity will be.”

Some say the most likely scenario is immunity is not long-term but future reinfections then become milder.

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obviously this reporter and/or the person she is talking to… seems to believe that there is only ONE FENTANYL but according to Wikipedia… there is some 1400 different analogs of Fentanyl and one analog Fentanyl Citrate is a C-II med approved for human use.  All other analogs are ILLEGAL OPIATES.

This article bounces back and forth between legal and illegal fentanyl analogs… as if there is only ONE FENTANYL ANALOG

Too bad that truth is not a ideal that many in public office and many reporters

Local officials seeing increase in fentanyl-related crimes, deaths

https://www.owensborotimes.com/news/2020/10/local-officials-seeing-increase-in-fentanyl-related-crimes-deaths/

Local law enforcement officials said they have seen more fentanyl across Owensboro and Daviess County in recent months, while the Daviess County Coroner’s Office said fentanyl-related deaths have also increased in 2020.

Officials said fentanyl — a substance used to treat severe pain — is being cut into fake prescription opioid pills, causing those who ingest them to overdose and in severe cases die.

According to National Institutes of Health Order Publications, fentanyl is a powerful synthetic opioid analgesic that is similar to morphine but is 50 to 100 times more potent. It is a Schedule II prescription drug.

County Coroner Jeff Jones said his office has seen a definite uptick in fentanyl-related deaths this year.

“We’ve had 3-4 cases this past year that have been fentanyl-related,” Jones said. “Compared to previous years, that’s an increase.”

Meanwhile, Owensboro Police Department Public Information Officer Andrew Boggess said OPD has been seeing an increase of fentanyl use and possession for five months straight.

Daviess County Sheriff’s Office Chief Deputy Major Barry Smith said his department saw a small increase of fentanyl — mainly due to a methamphetamine supply decrease stemming from COVID-19 and travel restrictions — earlier in the year.

“The danger continues of counterfeit pain medicine that could contain fentanyl and fentanyl-laced illicit drugs,” he said.

Unlike other drugs, fentanyl isn’t normally taken by itself. Instead, other drugs such as heroin and methamphetamine are often laced with trace amounts of it. According to Foundation for a Drug-Free World, a dose of fentanyl is considered to be lethal at 3 milligrams, compared to 30 milligrams of heroin.

Now, pills are being altered with the deadly substance, Boggess said. When OPD first noticed the increase of fentanyl and other similar drugs in the area, a press release was sent out to local news outlets warning the community about the issue.

“We have multiple cases open and ongoing pertaining to overdoses,” Boggess said. “There are a lot of investigations going on right now with overdoses where a person may have taken pills and not known what they were made of. It’s concerning because these overdoses can be fatal.”

Jones said the vast majority of toxicology reports pertaining to those who’ve died of a fentanyl overdose have contained multiple drugs.

“It’s hard to know if they’re laced with fentanyl, if it’s a combination of drugs,” he said. “Fentanyl is the primary cause of death in all of these cases.”

Boggess said OPD officers have begun carrying naloxone nasal spray, or Narcan, and it has prevented a number of overdoses from turning deadly.

“With overdoses, timing is extremely crucial,” he said.

Boggess also said OPD isn’t sure at this time where the fentanyl-laced pills are coming from. In Owensboro and Daviess County, methamphetamine laced with fentanyl has been believed to have been primarily manufactured by the Mexican cartel.

Though OPD has not seen a significant decrease in fentanyl-laced meth, the primary concern this time around is the frequency in which fentanyl has been discovered across the community.

“An important distinction here is, these pills are being purchased on the street level, not at the pharmacy,” Boggess said. “You don’t ever know what you’re really getting. It’s extremely potent in small quantities.”

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