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Oklahoma Pharmacy Board Investigating Chain Pharmacies, Staffing Levels

https://www.news9.com/story/41694114/oklahoma-pharmacy-board-investigating-chain-pharmacies-staffing-levels

Preston Jenkins thought his pharmacist substituted a generic version of his insulin prescription last November.

“My life depends on the medicine I take,” Jenkins said. “Without insulin, I don’t exist.”

He has been dependent on the injections for 14 years.

“We got to checking and found out that it was not a substitute, that they have given me the wrong insulin,” Jenkins said.

The Oklahoma State Board of Pharmacy confirmed it is investigating chain pharmacies, like the one Jenkins went to, for inadequate staffing levels, creating a stressful work environment for pharmacists.

According to the New York Times, state pharmacy boards and associations in at least 24 states have received complaints from pharmacists.

“I talk with some of my pharmacist friends who work for chains, some of their staffing has been cut by 50 percent,” pharmacist Greg Clyde said. “More mistakes are going to happen.”

He believes staff reductions are being made in an effort to increase profit margins.

Clyde worked at a chain pharmacy for 10 years before opening his own store. He said many of his former colleagues are afraid to blow the whistle.

“When I talk to my pharmacist friends who still work in those environments, they describe the workload, they are working on things from a week ago instead of things today,” Clyde said.

CVS Pharmacy issued a statement responding to the Times investigation, saying in part,

“Patient safety is our highest priority. Everyone at CVS Health, including our more than 30,000 pharmacists, approaches this responsibility with the utmost seriousness and dedication. We work hard, every day, to earn the trust of our patients and customers as we help them on their path to better health.”

Clyde said things like over-the-counter immunizations, sicker patients, and more complex conditions, combined with aggressive staffing cuts, created a recipe for disaster.

Another issue of concern to Clyde is the rapid turnover of pharmacy technicians who help prepare medication for pharmacists.

“What I saw when I was in chain pharmacy, more errors are happening before they even get to the pharmacist,” Clyde said. “The more errors you see before the pharmacist gets it, the more likely there’s going to be an error that gets out of the pharmacy.”

In Choctaw, Jenkins and his wife were able to catch the error before he injected the medication.

“If I had taken the amount that I usually take of the (normal prescription), it would have probably put me in a diabetic coma,” Jenkins said.

Pharmacists like Clyde urge patients to be extra vigilant.

“Check your medication,” Clyde said. “If your tablet has changed from a white tablet to a green tablet, ask questions.”

Anyone who wishes to DUMP THE CHAINS here is a website that will help you find an independent pharmacy by zip code.

http://www.ncpanet.org/home/find-your-local-pharmacy

what have you got to loose… less chance of getting the wrong medication(s), having to wait for hours/days to get your prescription filled. The chains are just playing with your health and your life.  The vast majority of the boards of pharmacy are stacked with non-practicing corporate pharmacists that is not going to “bite” the hand that signs their paycheck.

Reality is that the cost of settlements for giving a pt the wrong med is less expensive than having the Rx dept properly staffed

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This is exactly what I have posted about OVER AND OVER… this is a clear example of a discrimination of pts because of their valid health issues and the valid need for one or more controlled substances to help the pt to properly manage the consequences of their disease issues.  As I read this, this is a CORPORATE DECISION and if they are going after “many of her meds” … it could have something to do about the overall cost of treating this pt.  Could this be a textbook example of a disabled person being discriminated against by a healthcare corporation because of the pt’s medication needs and be a civil rights violation, along with pt abuse, denial of care and pt/senior abuse — for starters…

This pt needs to reach out to a civil rights law firm and she is probably not the only pt that is being discriminated against… how many hundreds or thousands of pts of Community Health Network  are being mis-treated in a similar fashion.

My Doctor May Fire and Blacklist Me

https://medium.com/@ediebillhimercaito/my-doctor-may-fire-and-blacklist-me-827bc44441e7

Thursday, February 6th may become one of the most profound days in my life. This could destroy me, send me into a dark place from which I will never be able to escape. And it may just kill me.

Thursday was a day I knew could come. After all, it has happened to millions of people, just like me, all across the country. And this is the second time my doctor shared with me the threats thrust upon him by those who oversee his practice as part of a hospital corporation.

I am a black mark on society. I am a doctor’s worst nightmare. I am one of the patients doctors toss aside like garbage and whom they fear.

I am a chronic pain patient. And Thursday, my doctor told me he would have to forcibly taper me from a life-saving drug.

It’s bad enough that the over-blown, opioid “crisis” has forced my doctor’s hand, resulting in tapering of my pain medication. But now, they are going after more of my medication.

I lost it in the doctor’s office. My stomach dropped to my feet when he told me my medication had to be tapered down. I cried. I could see in his eyes, the pain, the frustration. I left the office angry and tired of the 6 years of the systematic destruction of my health and quality of life.

So I sat down and I crafted this letter…. Then I emailed it to every single board member and higher-up in the hospital corporation that oversees my doctor. It needed to be said. However, now, it’s very likely I won’t have a doctor and I will be blacklisted from every physician in my area and beyond.

I am hoping that in sharing this letter, far and wide, I will be able to defend myself and obtain some protection against what may come.

Here it is (and please feel free to share…. actually, my health and life may depend on it.)

“Good afternoon,
Today, I saw my doctor. And today, I am ready to contact every media outlet and investigative reporter I can find, as someone in the higher levels of management IS TRYING TO KILL ME.

I have been a patient of the Community Health Network since 2013 and have had related services through Community Health several years prior to that. I have been deemed medically fragile by the state of Indiana and suffer from several illness and medical problems.

And I am a LOWLY HIP Plan Plus member via Indiana Medicaid.

I have Fibromyalgia, small fiber neuropathy, peripheral neuropathy, irritable bowel syndrome, paroxysmal atrial tachycardia, premature atrial contractions, anxiety (free-floating and IBS related), severe hand eczema, osteopenia, pelvic organ prolapse and Ehler-Danlos Syndrome type H.

My illnesses are extremely painful and I do everything I can to work with my healthcare provider to achieve some sort of quality of life. I exercise, eat well, drink water, use Epsom soaks and muscle rubs and use a heating pad.

Since 2007, I have been tried on several SSRIs and other anti-depressants as well as anticonvulsants, Lyrica, Neurotin, Gabapetin, steroids, NSAIDs, Beta-blockers, Calcium Channel Blockers each and every one of those drugs had a horrific affect on me. I was either curled in the fetal position, crying and contemplating the best way to commit suicide or I was so strung out, I couldn’t eat, drink or sleep. I paced. I lost 20 pounds in a week.

Dr. SXXXX, my Community heart doctor told me, “You are that rare 1% of people who cannot tolerate many drugs.” He finally got my heart stabilized on Verapamil. But it didn’t help my other problems.

My former physician (Dr, DXXXX DXXXXX through Johnson County Hospital) was able to stabilize my health between 2007 and 2009. He placed me on Hydrocodone 10 mgs X 6 hours as needed. I usually got by on 10 mgs per day but only occasionally would take a second dose.

Additionally, he pulled me off the SSRI and placed me on 1 mg Lorazepam 4 times a day. My health stabilized. I gained weight back, I began sleeping, eating and living again.

I lost my doctor due to having to switch to Medicaid in 2012. I found my Community doctor in early 2013. And all was well until the “opioid crisis” took hold of Indiana and the Emergency Prescribing Law took effect; and in December 2013, my physician, following Community rules, began force tapering me.

I went from 10 mgs Hydrocodone every 6 hours as needed to 7.5 mgs 2x a day and 59 doses per month. Since then, I have been tapered to 5mgs am and 7.5 mgs pm. My pain is not managed; however, I have never expected my pain to go away. Lowering pain is all I expect.

My quality of life, since Indiana implemented one of the strongest opioid prescribing laws in the country, has changed dramatically. My quality of life has plummeted and my conditions have worsened. I understand why my doctor prescribes the way he does….he is FORCED to follow guidelines set forth by the hospital corporation. He wants to treat me, but cannot as someone else is treating me.

Someone on a board within Community is treating me. Though they have never met me, never examined me, likely never read through all of my medical records, they are dictating my treatment.

And today, word came down from higher ups that I am to be forced tapered from my anxiety medication. The one medication that keeps me from passing out, vomiting and defecating on myself due to severe irritable bowel syndrome and the one medication that keeps me from panicking so badly in the grocery store that I have to be escorted out by paramedics. Yes, my teeny-tiny 0.5 mgs 3 times a day, that I sometimes only take twice on a good day.

While I understand that since the “opioid crisis” (which I use quotations as we no longer have a PRESCRIPTION opioid problem but an illicit opioid problem) everyone is HYPER AWARE that benzodiazepines and opioids CAN be a deadly combination. And this has been the same danger since 2007 when I began this life-saving regimen.

However, I too, am hyper-aware of the potential of problems with respiratory depression and I am careful with my medications. I always have been. Additionally, there has been nothing in my health record to indicate that I am at risk for addiction, have shown an abhorrent behaviors, have never misused my medications, have never diverted, sold, given-away or been anything but DILIGENT with my medications, how they are stored and how they are used.

Yet someone feels the need to tell my doctor how to treat me. Someone who has never examined me and likely someone who doesn’t even have a medical degree.

While I understand that you want your hospital corporation to look good and be pillars of society that are doing things to help the opioid crisis, however, you are harming patients. Yes, the hospital that claims patient care is important and our treatment is your top priority….yes, I have read pages and pages on how you want to give patients the best care.

But is it top quality, compassionate care to force taper a STABLE patient from the very medications that are keeping them functioning? According to the CDC’s latest reports on the opioid crisis, it is NOT and it is a danger as well as a detriment to the patient.

My medical file and that of thousands of patients are different. As we are all humans that have conditions that vary. Therefore, our treatments will vary. Some need high doses of pain meds, while some are fine on low doses. Every individual patient is unique and different. You claim patient focused medicine that is catered to that individual yet you force across-the-board rules and guidelines.

I am just a number now….a pariah on society, a potential liability and a number that may make you look bad. I am being treated as if I am a junkie and someone incapable of knowing the risk of the medications that I take. And as with all medications there are risks.

If my medications are forcibly tapered, my health will decline further. I will give up my pain medications to keep my anxiety medication. Which will force me into unimaginable pain. I will spend the rest of my days curled into the fetal position, praying for death to come. The pain I feel from these diseases is unimaginable to ALL OF YOU as you have never lived a day in my body.

But Community Hospital will look good because that will be one more number in the “off those demonized medications” list. And that’s all that counts, right? Not my comfort, not my quality of life, not compassionate care, not my individualized care, but your numbers.

But this does make me question….is it about numbers, statistics and looking good or are there, as in many cases involving medicine, kick-backs? Rewards for good numbers? Or are you preparing to introduce patients like me to the next greatest treatment in pain: Naxolone and Suboxone as has other medical facilities are across the country? Addiction medication for pain control. What a novel and profitable idea.

I am angry and upset right now. And I am sitting here pondering what my life will look like in mere months and contemplating if I should wait until I am curled into the fetal position, unable to move before I pray or plan for death.
So, I am reaching out. I am telling everyone how it is. And I am PRAYING one of you will answer me, SEE ME and see that I am sick, I am unique and I deserve the care that keeps me stable and improves my quality of life DESPITE your shiny numbers and how good you look to others.

Look at my chart, examine me, see the hell I have been through, the medicines shoved down my throat causing me to nearly die and the relief I finally found. Talk to me. See I am an individual and not a statistic and THEN decide if taking away my medications is the RIGHT thing and patient focused, individualized, compassionate care.

I will wait for a response, though it’s likely I won’t get one. But I want you all to know that every person in this state and in this country needs to see what’s going on in the lives of patients just like myself. We are mere numbers to you and whether we lose our lives or take our lives, you don’t care.

Thank you for hearing me out. I beg of you to look at your policies and allow physicians to single out cases like mine that don’t fit into that tidy little mold you’ve created for patients. Allow them to choose their patient’s treatments on a case by case basis. And stop threatening good doctors who are TERRIFIED to treat their patients as they see fit. It’s wrong.

Respectfully,
Edwina L Caito”

As of today, Sunday, February 9th, I have gotten only 1 response and that was from the hospital patient complaint office; the people who are paid to coddle patients, tell them they will look into it, then quietly sweep the complaint under the rug.

To be honest, I don’t expect to hear from anyone at all. That is, until my next doctor’s appointment will likely be cancelled.

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CVS profit beats estimates; will hold off on new major deals

https://in.reuters.com/article/cvs-health-results/cvs-profit-beats-estimates-as-high-drug-prices-boost-pharmacy-business-idINKBN2062HL

CVS, which gets discounts and rebates from drugmakers in exchange for listing their products on its formularies of preferred drugs, in turn guarantees rebates to its PBM customers. Profits have diminished in the past few quarters as the rate of drug price hikes has slowed under intensifying pressure from politicians of both major U.S. parties.

The company played down the role of rebate guarantees on a conference call with analysts, and said it expects the issue to be immaterial to earnings as it heads into 2021.

“We’ve obviously been working hard to reverse our rebate exposure, and we’ve seen that exposure has lessened in our outlook for 2020,” said Derica Rice, head of CVS’ PBM unit, who plans to leave the company after February.

It would appear that Caremark is ADMITTING that they get discounts/rebates (kickbacks) from the pharmas’ and they “share” that those dollars with its PBM’s customers…

Anthem sues Express Scripts over prescription drug pricing

here is a article where Anthem sued Express Scripts – largest PBM in the country – for about 16.5 BILLION for allegedly charging too much for drugs to Anthem over a 5 yr period.

West Virginia kicked out their PBM for their Medicaid program and is saving 122 million/yr – JUST ON MEDICAID

Arkansas has investigate Caremark – part of CVS – on their state employee health insurance and a survey found that on abt 250 highly prescribed meds that CVS paid a average of $60 more when the prescription was filled  at a CVS store than filled at one of CVS’ pharmacy conpetitors

Ohio has found CVS/Caremark over charging on the HMO medicaid prgms they have in the state.

Kentucky’s legislature is now looking into the PBM handling their Medicaid prgm

Report: Kentucky middlemen reap $123 million from Medicaid at pharmacies’ expense

Last year, pharmacy benefit managers, or PBMs, took in $123 million through a practice known as “spread pricing,” the difference between what the pharmacy benefit company pays the pharmacist and what it bills the state Medicaid program, according to the report.

CVS Caremark, an affiliate of the drugstore chain, holds the majority of pharmacy benefit business in Kentucky.

There examples is just state Medicaid programs but 90% of the Rx in their country abt 3.6 billion/yr are handled by a PBM – and “they” wonder why prescription prices are so high ?

Other countries – like Canada – don’t have these “financial leaches” in their healthcare system and that could explain why Rx prices are less expensive in other countries

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Anatomical changes correlated with chronic pain

https://edsinfo.wordpress.com/2020/02/06/anatomical-changes-correlated-with-chronic-pain/#comments

Anatomical changes correlated with chronic pain in forensic medicine – Free full-text /PMC6197126/ –  Jun 2017

This article from the NIH has a good summary of physical changes that come about due to chronic pain, not just psychological “problems”, but numerous physical harms resulting from unrelieved pain.

This study was performed to determine the relationships between chronic pain and anatomic changes that may occur in the body.Autopsies were performed on fatalities that required death investigation in Linn County, IA, or adjacent and nearby areas.

Certain causes of death may also have been related to chronic pain. The heart, lungs, liver, spleen and kidneys were significantly heavier in persons with chronic pain; emphysema and pleural and abdominal adhesions were more common in persons with chronic pain.  

Diabetes, hypertension and depression were more common in persons with chronic pain.

There appear to have been diffuse changes in the body related to chronic pain. These changes may have been mediated by a number of systemic mechanisms that are involved with chronic pain, including cardiovascular activity, the immune system, the neuroendocrine system and others.

Results

Based on medical records and scene investigations, 54 persons had been diagnosed with chronic pain ante-mortem, and 320 had no known chronic pain.

The demographic data are summarized inTable 1.

The types of chronic pain encountered are listed in Table 2.

Systemic or widespread pain was the most common type, such as neuropathic pain, fibromyalgia, multiple sites of arthralgia or pain from disseminated carcinoma; musculoskeletal or site-specific pain followed, particularly chronic low back pain.

Table 1.
Subject data (case number).

Subject	Parameter/classify	Chronic (N = 54)	Control (N = 320)	Significance
Age (years old)	Mean ± SD	50 ± 13	44 ± 18	P = 0.020 4
Range	29–82	13–88	–
Sex	Men	34	224	–
Women	20	96	–
Race	Caucasian	52	269	P = 0.018 3
Other	2	51	–
Height (inches)	Mean ± SD	68 ± 4	69 ± 4	–
Range	60–75	55–77	–
Weight (pounds)	Mean ± SD	194 ± 66	180 ± 48	–
Range	101–422	55–375	–
Body mass index (BMI)	Mean ± SD	29.0 ± 9.0	26.9 ± 6.6	–
Range	15.8–52.7	10.2–57.1	–
Social	Caffeine	14	63	–
Tobacco	1	23	–
Alcohol	9	96	–
Marijuana	3	48	–
Medical	Diabetes	10	21	P = 0.006 2
Hypertension	18	52	P = 0.004 0
Psychiatric	Depression	28	60	P < 0.000 1
Bipolar affective disorder	3	8	–
Schizophrenia	0	5	–
Substance abuse	13	42	P = 0.005 2

Table 2.
Sites of chronic pain (N = 54).

Sites	Number
Systemic	20
Back	14
Abdomen	5
Neuropathic	6
Other musculoskeletal	5
Chest	2
Headache	2
Total	54

Death from natural causes was significantly more common among persons with chronic pain (chronic pain n = 28, control n = 109; P = 0.014 6).

The Cox analysis of survival showed no differences based on sex, race, height, weight and BMI.

Based on clinical factors (P = 0.000 4), systemic hypertension was significantly correlated (P = 0.000 8) with early mortality, while chronic pain, narcotic use, depression and diabetes mellitus did not appear to contribute significantly as covariates to overall survival.

This is good news: “narcotic use did not appear to contribute significantly”.

The Cox analysis using organ weights as the hazard is reported in Table 3. Chronic pain was identified as a significant covariate in heart weight

Chronic pain was also identified as a significant covariate in spleen weight, along with Caucasian race and increased body weight.

Anatomic findings from autopsy are summarized in Table 4.

All of the visceral organs were significantly heavier in the chronic pain group compared to the controls.

Table 4.
Anatomic findings.

Organs	Parameter/classify	Chronic (N = 54)	Control (N = 320)	Significance
Brain	Weight (grams)	1 340 ± 167	1 362 ± 156	–
	Cerebral oedema	11	61	–
Heart	All (non-surgical), weight (grams)	426 ± 87	389 ± 118	P = 0.032 4
	Normotension, weight (grams)	401 ± 81	366 ± 100	P = 0.046 4
	Hypertension, weight (grams)	476 ± 78	505 ± 135	–
	Cardiac hypertrophy	35	89	P < 0.000 1
	Atherosclerotic cardiovascular disease (ASCVD)	26	148	–
	Myocardial infarction (MI)	3	9	–
Pleural cavities	Adhesions	11	13	P = 0.000 1
Lung, right	All, weight (grams)	639 ± 193	569 ± 230	P = 0.036 3
	Pneumonia(−), weight (grams)	641 ± 201	555 ± 213	P = 0.012 1
	Pneumonia(+), weight (grams)	630 ± 156	848 ± 352	–
Lung, left	All, weight (grams)	557 ± 220	492 ± 197	P = 0.028 3
	Pneumonia(−), weight (grams)	568 ± 235	484 ± 189	P = 0.007 9
	Pneumonia(+), weight (grams)	501 ± 116	639 ± 283	–
	Pneumonia	9	14	P < 0.002 5
	Emphysema	21	82	P = 0.044 6
Abdomen	Adhesions	7	6	P = 0.000 7
Appendix	Present	35	250	P = 0.000 6
Liver	Weight (grams)	2 026 ± 568	1 769 ± 544	P = 0.001 9
	Weight range (grams)	1 200–3550	700–3910	–
	Steatosis	27	135	–
	Cirrhosis	4	14	–
	Hepatitis	13	62	–
Gallbladder	Present	38	283	P = 0.000 2
Spleen	Weight (grams)	245 ± 112	186 ± 107	P = 0.000 3
Kidney	All, weight (grams)	339 ± 78	310 ± 94	P = 0.037 3
	Normotension, weight (grams)	335 ± 76	301 ± 90	P = 0.033 9
	Hypertension, weight (grams)	346 ± 84	356 ± 99

 

Discussion

This study investigates whether a documented experience of ante-mortem chronic pain may have been related to anatomic changes in the body that could be observed at autopsy.

The task can seem daunting, since chronic pain does not have a single clinical signature.

It has a number of causes and presentations, although they share a common experience of persistent distress that impairs one’s experience of life, activities of daily living, work and relationships.

Yet, in opioid studies, such persistent and impairing distress is completely discounted.

It is important to consider that chronic pain is a very diverse condition arising from many aetiologies, so to consider them as a single diagnosis would be inappropriate.

Yet all opioid studies assume that all chronic pain is alike. This seems li,e a gross scientific and logical error that would completely corrupt any such study and make it meaningless.

This study furthermore appears to find that the body may undergo changes that may be correlated with chronic pain.

While many organs had interacting covariates in their size at the time of death, the heart and spleen were specifically correlated with chronic pain at the time of death, and all of the other visceral organs in persons with chronic pain weighed more than controls as independent variables.

Systemic changes may suggest systemic mechanisms that cause the visceral organs to enlarge, such as those mediated by the

• central nervous system [2,7,8,15,17,18,20–26],
• peripheral nervous system [23],
• neuroendocrine system,
• endogenous opioids and cytokines [2,20,21,23,25,26,28],
• the circulatory system including blood pressure [8,10],
• serum factors [21,35–39], and
• the immune system [2,20,21,23,25,26,28].

Under the direction of these interacting systems, chronic pain may induce stress that leads to reactive enlargement of the organs.

For example, systemic mechanisms that could enlarge the organs may include fluid redistribution to the interstitial space due to endocrine stimulation; immune cells may evoke inflammatory reactions; the central nervous system may stimulate sympathetic reactions; and others.

The significant incidence of pneumonia in persons with chronic pain could be related to decreased mobility in persons who experience ongoing pain, or the higher incidence of emphysema that was found in the pain group.

Adhesions were more common in the pleural and abdominal cavities of the pain group, suggesting systemic inflammation. Conversely, there was no increased incidence of cerebral oedema, atherosclerotic cardiovascular disease, myocardial infarction, steatosis cirrhosis or hepatitis.

The anatomic changes with the corresponding clinical or demographic correlations found in this study suggest that differences in the body are possibly correlated with chronic pain in many ways, such as

• organ enlargement,
• pneumonia,
• depression and
• increased likelihood of abdominal surgery such as cholecystectomy and appendectomy

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How It Feels to Be Force Tapered Off Pain Medication for Chronic Illness

https://themighty.com/2020/01/force-tapered-off-pain-medication-chronic-illness/

It’s that time of the month again.

I’m headed to my pain management doctor (more like my PO or parole officer) for a monthly checkup and prescription refill.

It’s the same every month…I sit in an over crowded office for over an hour, after my actual appointment time. I’m called back by the nurse to a room where I am asked to leave all my belongings. I’m given a cup with my name, DOB and date on it to pee in. I go into the bathroom, clean “down there” with a sanitary wipe, open the cup, start peeing, catch the pee in the cup (sometimes I accidentally pee on my hand, gross!) close it up, wipe myself and place the cup within the little box in the wall.

I open the bathroom door to let the nurse know I’m finished. She comes in to look everything over, flushes the toilet and lets me know I can wash my hands. I’ve never been arrested or gone to jail, but I certainly feel like I have now. It’s like I’m visiting my parole officer monthly, instead of my doctor.

I go back to the room where the nurse originally had me leave all my belongings, and now I wait. My doctor comes in and doesn’t make eye contact with me any longer, goes straight to her computer and asks how I’ve been and if there’s any new symptoms or health issues since last visit. I tell her “my quality of life is slowly going down the drain since she started to force taper me off pain medication.”

I must have struck a nerve because she finally looks me in the eyes and states “it is not her fault and her hands are tied due to the CDC guidelines” and “there’s nothing she can do about it.”

I think about letting her know, I’m in on her little secret. No one is forcing doctors to taper their patients living with rare and painful diseases. Doctors have bought into the “Fear of Addiction” media, the US government, the Drug Enforcement Administration (DEA) and the Centers for Disease Control and Prevention (CDC) has sold us all on.

Instead, I smile and shake my head yes. Yes, I know she’s afraid that the DEA will barge into her office, take all her patient files and threaten jail time. Yes, I know she’s afraid to lose her career she’s worked so hard for. Yes, I know about the kickbacks doctors (maybe not her) receive now, if they lower their patients under a certain percentage off their pain medications. Yes, I know that she is no longer my doctor, the government now controls what medications I receive, how much I receive and how often I receive it.

My doctor stares at her computer monitor and asks me again, “do I have any new symptoms or health issues.”

I tell her it takes me longer to get going in the mornings. One of my major health issues is complex regional pain syndrome (CRPS) in my arms, upper body and head. My hands usually swell three times larger than normal every morning.

I let her know that my neck pain is getting harder to keep under control. I’ve broken it two times in two different car accidents, which led to five neck surgeries.

She tells me that my pain levels will go up as she tapers me, and then will start to lower once I’m completely tapered and my body adjusts to having no pain medication. She must be kidding?! I understand withdrawal. I’ve tapered myself several times off pain medication when preparing for ketamine infusions. My pain always did go up as I tapered, but it definitely didn’t “go down” or “go away” after my body adjusted to no pain medication in my system. Maybe she doesn’t believe the several diagnoses is accompanied with pain. Maybe she doesn’t believe I’m actually in that much pain?

She lets me know that I should prepare myself with the reality that she will completely taper me off all pain medications in the next few months.

I don’t say anything. I fight with myself on how to respond. I would love to give her a piece of my mind, but I know that will do nothing except give her a reason to dismiss me as her patient, immediately giving me a one way ticket out of the little care I still receive and probably red flagged for life on my medical records.

I decide to be the good and docile patient. I ask her if there’s any other medications or alternative therapies I can try? She smiles a little. She starts going through the different groups of medications I can try: gabapentin, different anti-depressants used for pain, blocks I can get in my neck, ketamine infusions, NSAID’s…I stopped listening at this point. I’ve tried what she’s suggesting at some point in my 25 year career as a patient.

I let her know I will research everything she suggested and next month we can go over these new options. She hands me my prescription and leaves with a “have a great day.”

I leave my appointment feeling helpless, hopeless and scared. How is it that as a United States citizen I am now treated as “junkie,” a criminal and a drug seeker? I’ve always taken my medications as prescribed. I don’t take illegal or street drugs. I’ve always been a great patient, following my doctors instructions and willing to try new medications and therapies when asked too.

Living with health issues for over 25 years, I’ve tried most medications and “alternative therapies.” I’ve always been realistic and careful when taking my pain medications. Pain medication will never take the pain away completely. It takes the edge off just enough to sleep and function throughout the day.

I’ve learned to use a combination of medications, therapies, diet and exercise in order to achieve the best quality of life. Taking away pain medication from patients living with constant and high levels of pain is barbaric and wrong!

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https://www.medicarerights.org/about-us

Another chronic pain senior citizen shared this with me… and indicated that they can be of great assistance for those on Medicare and having trouble getting appropriate services/care.

I am going to post a link to this post on the resources tab on my blog

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Moody, pharmacy chains tangle in opioid lawsuit

https://www.news4jax.com/news/2020/02/06/moody-pharmacy-chains-tangle-in-opioid-lawsuit/

TALLAHASSEE, Fla. – Castigating the tactic as a “publicity stunt,” Attorney General Ashley Moody is asking a judge to reject an effort by the nation’s two largest pharmacy chains to add 500 unidentified physicians to the state’s lawsuit against the pharmaceutical industry over the opioid epidemic.

CVS Pharmacy Inc. and Walgreen Co. filed what is called a third-party complaint against 500 “John and Jane Doe” doctors, alleging that the prescribing physicians — and not the drug stores — are to blame for faulty prescriptions.

The state’s lawsuit against the chains “is nothing more than unsupported speculation” that pharmacists “filled prescriptions for opioid medications that they should not have filled” despite the state’s “inability to support its claim with even one instance of an improperly filled prescription,” the pharmacies argued in the third-party complaint filed Jan. 22. By looking at The Law Offices Of Michael H. Pham Avvo Profile, it is better to get a consultation about this issue first with them. Then, they would study the case properly and will suggest some measures to clear this case and would eventually get it done with the order obtained at the court of law.

“But pharmacists do not write prescriptions and do not decide for doctors which medications are appropriate to treat their patients,” the chains’ lawyers wrote. “While pharmacists are highly trained and licensed professionals, they did not attend medical school and are not trained as physicians. They do not examine or diagnose patients. They do not write prescriptions.”

Pharmacists, “with limited exceptions,” are “bound to respect a prescribing doctor’s professional medical judgment about which medications are appropriate to treat a particular patient under the doctor’s care,” the companies argued.

The pharmacy chains deny they are “liable in any respect.”

But responding Wednesday to the third-party complaint, lawyers representing the state accused CVS and Walgreens of having “launched a publicity stunt attempting to deflect attention from their role in causing the opioid epidemic plaguing Florida.”

“CVS and Walgreens’ gambit is factually unsupported because both pharmacies have records concerning the prescriptions that the pharmacies dispensed, including the names of the doctors who wrote the prescriptions,” the state’s lawyers wrote.

The attorney general’s office filed the lawsuit in 2018 to try to recoup millions of dollars the state has spent because of the opioid epidemic. The lawsuit was filed against manufacturers, distributors and sellers of opioids and included a series of allegations, including misrepresentation about opioid use and filling suspicious orders for drugs. The state later added CVS and Walgreens to the lengthy list of defendants in the case.

In the third-party complaint, CVS and Walgreens lawyers wrote that if the chains can be held liable for filling prescriptions, “ultimate responsibility must rest with those who wrote the prescriptions: the prescriber defendants themselves.”

The chains will amend their complaint to identify the doctors “if plaintiff (the state) ever identifies the specific prescriptions it claims should not have been filled,” they wrote.

The state’s attorneys, however, wrote that the pharmacies have records of prescriptions, including the names of the doctors who wrote the prescriptions, but they failed to identify “a single prescriber.”

The pharmacies’ “tactic” is legally groundless “because Florida law treats such John and Jane Doe filings as a nullity,” the state’s lawyers wrote, adding “such a filing does not commence a legal action against any party.”

Retail pharmacies “are the last line of defense between dangerous opioids and the public,” the state argued, accusing Walgreens and CVS of failing to fulfill their obligations to adequately review prescriptions and ensure they were “effective, valid, and issued by a practitioner for a legitimate medical purpose” as required by law. If in Festus attorneys defending against drug charges issues are available in case of a problem.

Both pharmacy chains were the target of enforcement actions related to the opioid epidemic, the state argued.

CVS “paid millions of dollars to resolve allegations of malfeasance” at one of its stores in Sanford, and Walgreens “paid millions of dollars in connection with diversion and record-keeping problems” at its Jupiter distribution center and six retail stores, Moody’s lawyers pointed out.

A Walgreens in Pasco County “sold 2.2 million tablets in Hudson alone in one year,” the state added. The lawsuit is filed in the 6th judicial district, which encompasses Pasco and Pinellas counties.

The state asked the judge to strike or sever the third-party complaint, saying the John and Jane Doe pleadings were not proper and that any attempt to litigate the third-party claims along with the state’s complaint “would be unduly cumbersome for the parties and the court.”

In the third-party complaint, the pharmacy chains said the state has not sued health-care practitioners who wrote the opioid prescriptions. Over 60 percent of the opioids dispensed in Florida did not come from the chains, they argued.

“But in a misguided hunt for deep pockets without regard to actual fault or legal liability, plaintiff has elected not to sue any of these other parties,” the pharmacies’ lawyers wrote.

The pharmacies also denied the state’s allegations that a vast number of Florida doctors wrote an excessive volume of opioid prescriptions without legitimate medical purposes.

“Perhaps unsurprisingly, the state’s lengthy amended complaint against the Florida pharmacy chains fails to identify even one prescription that was supposedly filled improperly by any pharmacist for any of the Florida pharmacy chains. Not one,” the chains said.

Pharmacists who work for the drug store chains “are among the best, most caring, and most conscientious in the business,” their lawyers argued. One can follow the link here and get a good legal expert who can stand by you and help you with your case.

“They care just as deeply about their communities as anyone else and could not take more seriously the responsibility of dispensing of controlled substances, including prescription opioid medications. At the same time, they are committed to serving the legitimate needs of patients across the community who must have access to such medications, as prescribed by their doctors for conditions that can range from pain in terminal cancer patients to severe pain after surgery to disabling chronic conditions,” they added.

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