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Frustrated opioid patients speak out: ‘I now buy heroin on the street’
Posted on November 27, 2019 by Pharmaciststeve
Frustrated opioid patients speak out: ‘I now buy heroin on the street’
One woman spoke of how her mother, at 72 years old, and in pain because of degenerative bone disease, saw only one way out after her opioids were tapered down. She committed suicide.
A husband whose wife of 50 years suffers from neurological and spinal diseases and who no longer can get a prescription for painkiller patches said, “A welcome death has become a discussion.”
Paul Wayman, a 69-year-old veteran, wrote: “The VA cut my pain meds cold turkey after over 25 years. I now buy heroin on the street.”
“You need to talk with veterans. My friend has more metal and screws in him than a robot, but no more pain meds. Suicide is the only light at the end of the battlefield,” Wayman said. “I used to do a lot of volunteer work, loved doing it with my wife. Now I get high so I can walk.”
AS DOCTORS TAPER OR END OPIOID PRESCRIPTIONS, MANY PATIENTS DRIVEN TO DESPAIR, SUICIDE
“All we’re asking is some relief. And some quality of life,” he said. “Ending life now is not on bucket list. I do think about it all the time.”
Wayman is among the hundreds who reached out to Fox News through emails and messages on social media, following the publication of a three-part series on the nation’s struggle to address its crippling opioid crisis, caused mainly by illegal drugs, and the unintended victims – chronic pain sufferers who have relied on prescribed opioids for relief – left in its wake.
U.S. Air Force veteran Herb Erne II, 76, of North Carolina, died by suicide in February 2018. On the right is the note to his wife, saying he could no longer stand the chronic pain.
The series showed the federal government’s approach to addressing the overdose epidemic by targeting the supply and prescribers of opioids has unwittingly led many doctors to cut down or cut off their patients’ pain medications altogether. The approach – bolstered by 2016 Centers for Disease Control and Prevention (CDC) guidelines for opioid prescribing that, despite the agency’s warning that they merely were suggestions, not to be enforced as law – has left many chronic pain sufferers undertreated, with some contemplating taking their own life.
Pain patients who shared their frustrations and desperation and, in several cases, questions about whether they could go on much longer included a wide range of mothers, fathers, executives, farmers, maintenance workers, doctors, nurses, law enforcement officials and veterans. All described their experience of being limited by their diseases and pain to being debilitated and bedridden, after being tapered down or denied continued prescription opioids.
“My wife lives in extreme pain,” wrote Tom Walker of Lousiana. “She has had countless epidural procedures, to no avail. And add one very invasive back surgery, to no avail. She suffers from three different neurological diseases as well.”
The only source of relief, transdermal fentanyl patches, was discontinued, he said.
“When I reminded the doctor about his Hippocratic Oath, he informed us that he was not going to lose his job over a patient,” said Walker, who has been married for 50 years. “She went thru [sic] a very painful ‘Cold Turkey’ process.”
Casting the restrictive policies on painkillers as a “mutant outgrowth of the CDC’s position on opioids,” Walker said, “I am afraid that this has become the cause du jour for too many law enforcement agencies and politicians.”
DOCTORS CAUGHT BETWEEN STRUGGLING OPIOID PATIENTS AND CRACKDOWN ON PRESCRIPTIONS
Julie McLeland wrote: “My mother hung herself in August after her ‘pain management’ doctor made some radical changes to her drug protocol.”
“She was only 72 and had degenerative bone disease in her back,” McLeland said. “She lived in misery and died in despair because it was politically popular to ignore patients who desperately need medication and paint them as addicts without moral compasses. She is loved and missed. Thank you for giving her a voice.”
Herb Erne III, a registered nurse, wrote: “My father was a victim of the opioid scare, he took his life because nobody would help him with his pain. He was 76 with several health problems, one being chronic leg pain that started about 18 month prior to his suicide. Nothing would help with the pain.”
“He was scheduled to have surgery this past January. The surgeon decided to postpone the surgery until my father had regained his strength, he was receiving Home Health at the time” Erne wrote. “He asked his primary MD for help with the pain but he would not write for narcs and nothing he tried was working for pain control.”
Erne continued: “The MD referred him to a pain clinic, with similar results. On February 10th of this year, my father put a gun in his mouth and pulled the trigger. My mother was out at the time and found him when she returned home. I arrived shortly after. He left a note saying he just could not take the pain.”
Erne says his father, a U.S. Air Force veteran and former employee of General Electric’s aircraft division, was one of the many pain patients who are the silent victims of the opioid crisis.
“As a nurse, I have seen addicts and the other end of opioid abuse,” he said, “but there is another side to this crisis that people are not talking about, those that actually need pain medications but cannot get them because of the ‘fear factor’” of running afoul of the anti-opioid – including legal ones taken safely under medical supervision – backlash.
Pain patient advocate Bill Murphy of New Hampshire said: “The voices of addiction recovery advocates have been very effective over recent years, and rightly so. The problem against which they fight is very serious and the funding they have received for addiction education and more effective rehabilitation facilities is outstanding.”
“But the chronically ill who do not abuse, who do not divert, have become the unintended victims of misguided and overzealous efforts by policy and regulation making bodies in the government,” he said. “Addiction does not seek managed care. Pain management returns and improves function. Our leaders need to understand this.”
HEALTH EXPERTS OFFER SOLUTIONS FOR UNINTENDED CONSEQUENCES OF OPIOID CRACKDOWN
Another veteran wracked by pain from battlefield injuries wonders where the appreciation of the country he risked his life for is as health care providers deny him the medical relief that long kept him functional and grateful to wake up each day.
“This has to stop” wrote Rick Campbell, a disabled veteran who lives in Alabama and describes being in pain three-fourths of his waking hours. “I have been on opiates for over 15 years and have not overdosed or had a medical emergency due to them, but am being forced off and left to suffer in pain.”
“It is insane and we are suffering,” he said. “It is sad our country cares more about illegal drug users than they do the veterans that served this country and need the medication and have documented proof of it.”
Asked by Fox News for a response to a complaint by many veterans that VA facilities are undertreating their pain, the VA said in a statement: “VA is recognized by many as a leader in the pain management field for the responsible use of opioids across the VA health care system. For instance, in January the department became the first hospital system in the country to release its opioid prescribing rates.
“Because some Veterans enrolled in the VA health care system suffer from high rates of chronic pain, VA initiated a multi-faceted approach called the Opioid Safety Initiative (OSI) to reduce the need for the use of opioids among America’s Veterans using VA health care. Since its launch, the program has resulted in 308,911 fewer Veteran patients – a 45 percent reduction – receiving opioids from July of 2012 to June of 2018.”
Dr. Stephen Gelfand, a member of the Physicians for Responsible Opioid Prescribing (PROP), which says that opioids for chronic pain harm people more than they help, said in an email: “The efforts of PROP should not be derailed by the one-sided, opioid industry efforts to disparage the CDC Guideline.”
Referring to a news item in South Carolina about a large drug-trafficking operation that was selling heroin, fentanyl, crack cocaine, among other drugs, Gelfand said: “I am sick and tired of hearing how there should be few limits to opioid prescribing, when the track record of widespread over-prescribing has led, not only to the staggering rising toll of opioid-related addiction and death, but also to the great expansion of this lucrative criminal illicit opioid drug trade which affects society and all of us.”
Gelfand said there are doctors and drug companies that overstate the negative impact of restricting prescription opioids because of “a financial stake in maintaining the volume of opioid prescriptions.”
“They have taken advantage of chronic pain patients on opioids, many of whom suffer from opioid use disorder or the disease of addiction, which is characterized by denial and withdrawal symptoms, including pain, and used as an excuse for opioids being ‘needed’ lest they are at risk for ‘suicide,'” he wrote. “In other words, the occurrence of withdrawal, which is an inevitable consequence or direct effect of chronic opioid use, is being used as a reason to disparage the CDC Guideline and reject important gradual opioid tapering regimens, especially at high doses, or the more difficult discontinuation of opioids in some patients, or the essential referral of others for needed addiction treatment services, including the use of buprenorphine.”
“We believe in careful, gradual tapering of opioids to avoid or significantly attenuate withdrawal, as well as in the imperative of the prevention of addiction initially, by avoiding opioids in the vast majority of patients with chronic non-cancer pain, while prescribing them only for a carefully screened and monitored select minority.”
Dr. John Swicegood, an Arkansas physicain who has been a pain specialist for 33 years, vehemently disagreed, and lamented “the harm brought about by this ‘opioid crisis’ narrative… throwing every legitimate patient suffering chronic pain, even cancer and palliative pain, under the bus.”
TOUGH NEW OPIOID POLICIES LEAVE SOME CANCER AND POST-SURGERY PATIENTS WITHOUT PAINKILLERS
“I went personally to all Arkansas congressional offices more than once explaining this, that a social narrative was replacing science. lt was curious to just see someone’s eyes glaze just over when I went on to explain this, I kept saying, the ‘opioid crisis’ is not your grandmother taking 3 lortabs per day,” Swicegood wrote in an email.
“We see about 4,500 encounters per year – and they are infirmed, sick, crippled, in wheelchairs, walkers, having either failed spine or orthopedic surgery or not candidates – this is the group in the shadows. It is not your young tanned rested male or female walking in with minor findings wanting disability and opiates (we screen them out – this BTW is the population of misuse, diversion and addiction, enabled by our failed culture).”
“This was an opportunity for [insurance companies] to bail on opiate prescription coverage as well as to place public focus implying pain care was addicting everyone,” Swicegood said, “and this was the crisis, to the extent physicians were to blame, the government was not stopping bad doctors. For example, pill mills are mostly uncredentialed physicians that the DEA continues to re issue schedule 2 controlled substance permits -despite knowing they were selling RX for cash. This continues in our area.”
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A Year of Historic Action to Combat the Opioid Crisis… Has HIPAA protected data just become a OPEN BOOK ?
Posted on November 26, 2019 by Pharmaciststeve
A Year of Historic Action to Combat the Opioid Crisis
https://www.whitehouse.gov/articles/year-historic-action-combat-opioid-crisis/
One year ago this week, President Donald J. Trump declared the opioid crisis a public health emergency. Ever since, the Trump Administration has applied an all-of-Government approach to the epidemic, allowing each agency and department to do their part to help the cause.
This is a crisis that cannot be solved through Government action alone. Private-sector and nonprofit partners are stepping up and stepping in to make a difference. Today, President Trump hosted 21 of these organizations at the White House. Their work is innovative, groundbreaking, and promising for the millions of Americans who struggle with addiction or support loved ones who do.
Amazon
Mr. Brian Huseman, Vice President, Public Policy
Amazon will help first responders more efficiently access critical medical records and has programmed Alexa voice service to answer important questions about opioids and addiction.
Belden Industries
Mr. John Stroup, President, Chief Executive Officer and Chairman of the Board
Belden will expand their rehab and employment program to two additional U.S. facilities in 2019 and provide a Blueprint for companies to adopt to recruit and retain employees supporting recovery.
Blue Cross Blue Shield Association
Mr. Scott P. Serota, President and CEO
Blue Cross Blue Shield Association will launch Blue Distinction® Centers for Substance Use Treatment and Recovery and will establish a toll-free national hotline to provide all Americans a way to locate designated treatment centers.
Cigna
Mr. Alan Muney, Chief Medical Officer
Cigna will partner with the Veterans Health Administration to help veterans manage pain, improve access to opioid addiction treatment and improve mental well-being, and will work to reduce opioid-related overdoses in various communities by 25 percent within three years.
CVS Health
Mr. Thomas Moriarty, Executive Vice President, Chief Policy & External Affairs Officer, and General Counsel
CVS Health is committed to installing 1,100 additional permanent medication disposal units in communities and reaching 250,000 students and parents with its opioid abuse prevention program by the end of 2019.
Dispose RX
Mr. John Holaday, CEO
DisposeRx is committed to stopping opioid abuse, by contributing DisposeRx packets that can remove over 10 million opioids from our nation’s medicine cabinets.
Emergent BioSolutions
Mr. Mike Kelly, President US Operations
Emergent BioSolutions will offer Free NARCAN® Nasal Spray to all 16,568 public libraries and to each of the 2,700 YMCA locations in the United States.
Facebook
Mr. Kevin Martin, Vice President, US Public Policy
Facebook is committed to addressing the opioid epidemic through impactful public-private partnerships including: a link to SAMHSA’s Helpline in Search, and supporting the Ad Council PSA and DEA Takeback Day.
Global Teen Challenge
Mr. Ed DeShields, Board Member
Global Teen Challenge, the largest treatment center worldwide, is building a national Treatment Information System so its 250 U.S. treatment centers can understand which recovery programs are showing the most promise of success from addiction.
Google
Ms. Susan Molinari, Vice President of Public Policy and Government Affairs
Google has created a Locator Tool for National Take Back Day that they’ll promote on the Google.com homepage, and will launch a partnership with Walgreens to display permanent drug disposal locations on Google Maps.
Johnson & Johnson
Ms. Linda Murray, Senior Vice President, Consumer Experience and Global Editor in Chief, BabyCenter
Johnson & Johnson will continue educating America’s nurses and physicians to fight substance abuse and launched an opioid addiction awareness campaign that reached more than 2.5 million expectant parents via BabyCenter.
Leidos
Mr. Roger Krone, Chairman and CEO
Leidos is committing to an additional $3 million to opioid related causes, and furthering efforts to educate our workforce of 32,000 employees and launching a coalition of dozens of companies to address the crisis.
MyPillow
Mr. Mike Lindell, CEO
MyPillow employs workers directly after graduating from faith-based drug treatment and will soon launch the Lindell Recovery Network to bring hope, recovery and mentorship to thousands struggling with opioid addiction.
National Head Start Association
Mr. Damon Carson, Board Chairman
The Head Start community will expand training to all 245,792 staff in over 21,000 centers nationwide to address the far-reaching impacts of parent substance-use disorder on young children and families
National Safety Council
Ms. Debbie Hersman, CEO
National Safety Council will spread awareness of the crisis through the Prescribed to Death traveling Memorial, and will educate 1,000 more physicians on safer prescribing practices.
Red Cross
Mr. Jack McMaster, President, American Red Cross Training Services
Red Cross will offer our online course, First Aid for Opioid Overdoses, to give all Americans the knowledge to respond to a suspected opioid overdose emergency and will integrate opioid education in over 3 million annual first aid trainings.
Rite Aid
Ms. Jocelyn Konrad, Executive Vice President for Pharmacy
Rite Aid is offering free DisposeRx packets with new opioid prescriptions. Its Foundation installed 312 medication disposal units and launched the Prescription Drug Safety Initiative for students across the country.
Ultimate Fighting Championship
Mr. Lawrence Epstein, Senior Executive Vice President and COO
UFC commits to launching a public service campaign to bring attention to the opioid crisis, using UFC athletes, its powerful social media platforms, and popular live events to educate millions of people on the dangers of opioid abuse.
Unshattered
Ms. Kelly Lyndgaard, Founder and CEO
Unshattered will expand their partnerships with recovery centers across the county and provide employment and job skills training to double the number of women that we serve by the end of 2020.
Walgreens
Mr. Rick Gates, Walgreens Senior Vice President for Pharmacy and Health Care
Walgreens is expanding its medication disposal program to all of its stores, and collaborating with Google to provide information about the location of disposal sites on Google’s platform.
Walmart
Mr. Paul Beahm, Senior VP of Health and Wellness Pharmacy Operations
Walmart will continue to limit initial, acute opioid prescriptions to a 7-day supply, use analytics to block illegitimate prescriptions, and require E-Prescriptions for all scheduled drugs by January 1, 2020.
Looking at this list of the 21 organizations at this White House meeting …. I see at least FOUR of the the major pharmacy chains, several of the major insurance companies and most of the major internet data collectors. All/most of these companies have access or in charge of protecting HIPAA data on all of us. Missing is all the DRUG WHOLESALERS and ALL THE PHARMAS with the exception of J&J.
This was ONE YEAR AGO… how much data has been collected, in the interim, on anyone legally being prescribed controlled substances ?
How many people dealing with chronic pain and other subjective diseases have to suffer, die or commit suicide because of this “gang of 21” KISSING UP to the administration ?
How much longer is those in the chronic pain community going to continue to act like a bunch of feral cats.. running in all directions and fighting among themselves. ?
These companies represents multiple TRILLIONS of dollars of net worth…
JUST TODAY AMAZON announced Amazon launches medication management features for Alexa As Amazon moves further into the healthcare market, the company today is rolling out a medication management feature for Alexa owners. The feature will allow customers to set up their own medication reminders and request voice refills using their prescription information
Over the eight years that I have been posting on my blog… I have seen advocates coming forward… eager to “right the ship”… and typically after 6-24 months… they become discouraged and “disappear”… Eight years of watching people contacting their members of Congress, dozens of media outlets, untold number of petitions and perhaps THOUSANDS of Face Book pages devoted to pain in some manner, making comments to various alphabet of federal/state agencies… which is not much more than a diversion… because the conclusion/outcome is preordained…
The number of legal opiate Rxs peaked in 2011-2012 and have been declining every year… how many have died from complication of their co-morbidity issues from under/untreated pain and the cause of death “NATURAL CAUSES”… how many have committed suicide from the unrelenting pain… I suspect that the number we know is much smaller than the REAL NUMBER.
With the technology that this “gang of 21” has… could be a modern day TROJAN HORSE… but with this TROJAN HORSE… the killing will be a very large COVERT GENOCIDE.
It may now be TOO LATE to create a legal defense fund… This David & Goliath battle may not turn out the same way as it did in the bible
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non-physician clinicians: are not trained to be substitutes of physicians
Posted on November 26, 2019 by Pharmaciststeve
15 Doctors Fired From Chicago-Area Health System
https://www.medpagetoday.com/publichealthpolicy/workforce/83576
At least 15 physicians have been fired from Edward-Elmhurst Health as the suburban Chicago-based health system moves to cut costs, sources told MedPage Today.
The doctors, who worked across its seven “Immediate Care” or urgent care sites, will be replaced by advanced practice nurses,
according to an email sent by hospital leadership that was shared with MedPage Today. The physicians were informed late last week that they would be terminated as of April 1, 2020.
A physician who spoke on the condition of anonymity said the doctors were “broadsided” by the news. While they harbored some concerns that a few of the slower urgent care sites might be turned over to non-physician clinicians, they weren’t expecting so many of the sites to be impacted and for such a large number of doctors to be let go.
In their email, hospital system CEO Mary Lou Mastro, MS, RN, and Chief Medical Officers Robert Payton, MD, and Daniel Sullivan, MD, pointed to patient cost concerns as the reason for eliminating the jobs: “Patients have made it very clear that they want less costly care and convenient access for lower-acuity issues (sore throats, rashes, earaches), which are the vast majority of cases we treat in our Immediate Cares.”
“Beginning in the spring of 2020, we will move to a delivery model in which care is provided by Advanced Practice Nurses (APNs) at select Immediate Care locations,” they wrote.
Leadership also stated in the email that they are “working closely with these physicians to assist them with finding alternative positions within Edward-Elmhurst Health or outside our system,” but doctors noted that they face a saturated Chicago healthcare market and they’re likely to have to relocate.
Keith Hartenberger, a spokesperson for Edward-Elmhurst Health, confirmed the layoffs: “We continue to assess our care delivery models in the interest of providing cost-effective care to our patients. We shared with physicians that we have plans to change the model next year at some outpatient sites and are working with anyone affected to find alternative placement.”
The move is becoming a more familiar one as some health systems try to save money by relying more heavily on non-physician clinicians.
Last year, 27 pediatricians at a chain of clinics in the Dallas area lost their jobs and were replaced by nurse practitioners — even though the chain subsequently changed its name to MD Kids Pediatrics.
Rebekah Bernard, MD, wrote in Medical Economics that she spoke with three of the pediatricians who were fired: “They told me that they and their physician colleagues were completely shocked by the sudden firing. ‘We thought we were going to retire from this place,’ one told me.”
Also in 2018, Charlotte, North Carolina-based Atrium Health ended a nearly 40-year contract with a 100-member physician group, signing up instead with Scope Anesthesia, which says it’s dedicated to forming partnerships with certified registered nurse anesthetists. Atrium said it too was looking to reduce patient costs.
“This trend of shuttering hospital departments and firing physicians to save money is dangerous and short-sighted,” Bernard wrote.
Purvi Parikh, MD, of NYU Langone Health in New York City, and a board member of Physicians for Patient Protection, which advocates against other healthcare providers replacing doctors, said that
although non-physician clinicians “are vital members of the healthcare team, they are not trained to be substitutes of physicians and as a result diagnoses are missed and improper treatments and tests [are] prescribed.”
Parikh said patients “have the right to choose a facility that is physician-only or one with physician-led care. In Chicago, luckily there are other options among competitors.”
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what part of Palliative Care do you not understand
Posted on November 25, 2019 by Pharmaciststeve
Chronic pain patients and virtually anybody can copy this letter and use it to send to their legislators
Posted on November 25, 2019 by Pharmaciststeve
Chronic pain patients and virtually anybody can copy this letter and use it to send to their legislators.
Dear Congressman,
I am a chronic pain patient as well as an associate of the patient/doctor advocacy group Doctors (and patients) of Courage (doctorsofcourage.org). There are many people such as myself that are being denied proper pain treatment due to ignorance and misinformation about opioid pain management. Those of us who rely on opioid pain medications are being discriminated against. By preventing trained pain management professionals from doing their job, the government is forcing its own citizens to the street for self-medication, where they most probably will unknowingly receive illegal fentanyl laced pills. More and more suffering patients are forced off their medication and are committing suicide at alarming rates.
Since opioid prescriptions are declining, opioid-related deaths are rising rapidly each year. The government solution is not and will not fix the problem, it will only perpetrate it and more people will ultimately die. Most pain patients are not addicts. The opioids that are killing people and contributing to these horrific overdose deaths are not a result of pills diverted from pain management facilities, but are a result of illicit Fentanyl sold on the street. Arresting doctors and forcing people with severe intractable chronic pain to an early grave will not in any way stop the overdose rate from doubling the next few years.
Opioids are not the cause of addiction. Being dependent on a drug does not mean you are addicted. Addiction is caused by toxicity and not by direct exposure to the drug. What does the body do with excess toxins? They have to be stored in the cells. That is genetically determined, and thus you get the genetic propensity to certain diseases. The fact that more people are not addicted that require pain medicines for their diseases actually proves that the medicine itself is not the cause. Restricting opioids from patients with chronic pain has no effect on addiction rates. This is why even though prescriptions have declined deaths have risen and will continue to rise if this war isn’t stopped.
We need to make the DOJ accountable for not following Supreme Court decisions and committing professional misconduct convicting innocent people any way they can. Allowing innocent Americans suffering severe chronic pain to be denied relief will hurt our society. It will force countless of hard working Americans who could function and manage their condition with opioids into a life of misery. This opioid war does nothing to stop addiction. What this all means for those of us who suffer daily. Who will support these people who can no longer support themselves because they can no longer work, care for their kids? These are people who are now out of the workplace and confined to a bed because the pain is so great they can’t work. This so called solution will hurt our economy. SSI/SSDI claims will skyrocket and it will lead to the tax payers having to foot the bill and care for all these people who could have otherwise supported themselves with proper medical care and proper pain management. These laws do nothing to stop addiction. What these laws mean to people like myself. TOTAL DEVASTATION. Loss of job, home, children. I am now forced to live on government assistance. These policies are not good for America. We need to stop this now.
—
May the Lord bless you and keep you.
Linda Cheek
Teacher of The Seven Steps to Healing
Best Selling Author of Target: Pain Doc
www.sevenpillarstotalhealth.com
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How many FAKE DRIVER’S LICENSED are presented to healthcare practitioners EVERY DAY to get controlled meds ?
Posted on November 25, 2019 by Pharmaciststeve
Officials Seize 500 Fake Driver’s Licenses That Would Have Gone To College Students
https://dailycaller.com/2018/08/30/fake-drivers-licenses-customs-students/
U.S. Customs and Border Protection (CBP) agents in Philadelphia seized about 500 fake driver’s licenses that would have gone into the hands of college students.
The IDs were found Aug. 15 in international air cargo shipped from Canada, China and other South Asian countries, CBP reported Thursday. The shipment consisted of fake Nigerian driver’s licenses along with licenses from over 20 U.S. states.
Connecticut, New Jersey, Maryland and Florida were among the many states represented. Some of the licenses were obvious fakes while others could be scanned by barcode readers, CBP reported.
While counterfeit driver’s licenses can be used for obtaining alcohol illegally for underage minors, they can also be used for immigration fraud and theft, according to CBP Director of the Baltimore Field Office Casey Durst in the news release. (RELATED: Officials Strip Convicted War Criminal Of Citizenship After He Fraudulently Got Refugee Status)
Many of the licenses were given to university police and states for investigation while others will be destroyed.
CBP not only focuses on border security, but also enforcing legal trade. CBP in partnership with U.S. Immigration and Customs Enforcement (ICE) seized over 34,000 shipments that were deemed unsafe or counterfeit in fiscal year 2017, according to CBP data.
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We need to measure the opioid crisis differently
Posted on November 23, 2019 by Pharmaciststeve
In this counterintuitive talk, physician Stefen Kertesz outlines how efforts to reduce the prescription of opioids has had a negative impact on patients who rely on the drugs to combat ongoing pain. Stefan Kertesz is a physician in internal and addiction medicine at the University of Alabama at Birmingham and Birmingham Veterans Affairs Medical Center. His clinical work and published research focuses on tailoring care for people with addiction and homelessness. Over the years, Dr. Kertesz has become a national voice on behalf of patients with long-term pain whose care has been impacted by institutional efforts to reduce opioid prescribing. Dr. Kertesz continues to advance research on improving primary care, addiction, pain and overdose risk in vulnerable populations, and serves on teams to support the Governor of Alabama’s Opioid and Addiction Council. This talk was given at a TEDx event using the TED conference format but independently organized by a local community.
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Doctors, patients: Efforts to block opioid addiction are also blocking treatment
Posted on November 21, 2019 by Pharmaciststeve
https://fox6now.com/2019/11/20/1274427/
MILWAUKEE — Just walking up to a pharmacy window is enough to send Tina Kasten’s brain into overdrive.
“You freak out,” Kasten said, using words like “anxiety” and “stress” to describe how she feels when she tries to pick up her prescription.
Kasten, who lives in Manitowoc, takes Suboxone as part of her treatment for heroin addiction. She said she has experienced delays in filling her prescription a half-dozen times over the last year.
Thirteen other patients described similar experiences in Wisconsin to the FOX6 Investigators. They did not want to be identified, citing the stigma of addiction.
Doctors, counselors, and pharmacists in Wisconsin say efforts to fight opioid addiction are inadvertently making it difficult to get addiction treatment.
The ‘devil and the angel’
Suboxone is a medication that contains buprenorphine and naloxone. It is used in combination with counseling and behavioral therapy to treat opioid addiction.
Drugs like Suboxone work by partially acting like an opioid and binding to the same receptors in the brain.
“That’s what allows it to be so useful in addiction treatment,” Dr. Selahattin Kurter said. Kurter is the executive director of West Grove Clinic, which provides mental health and addiction treatment.
“[Suboxone] doesn’t give you the euphoria associated with opiates,” Kurter continued. “But it protects you from the cravings and withdrawals.”
Kurter is Tina Kasten’s doctor. Kasten credits the combination of Suboxone and therapy for her addiction recovery.
“I didn’t have the cravings all the time,” Kasten said. “It wasn’t constantly on my mind like, ‘OK, am I going to use? Am I not? Am I going to use? Don’t do it. Oh, but you should.’ It’s like the devil and the angel and Suboxone tells them to be quiet and go home.”
“I put the work in to deal with the emotions and deal with everything that led me to be a drug addict,” Kasten added. “The Suboxone didn’t do that work. I did. But the Suboxone helped.”
But there is a danger patients could abuse Suboxone or illegally sell it for its opioid-like qualities; it is a Schedule III drug, which the U.S. Drug Enforcement Administration says could lead to “moderate or low physical dependence or high psychological dependence” if abused.
“It can be used to help somebody get rid of the addiction to opiates, it itself can be addictive,” Dr. Hashim Zaibak, pharmacist and CEO of Hayat Pharmacy said. “So the pharmacist has to balance between the risk and benefits of Suboxone and that can be a challenge.”
Red flags
As the opioid crisis spread, there was a push for Medicated-Assisted Treatment (MAT): The combination of drugs like Suboxone and therapy.
The Director of Wisconsin’s Prescription Drug Monitoring Program says the state has seen a 66% increase in Suboxone dispensations since 2016. A federal rule change expanded the number of patients that providers can treat with MAT, and gave more providers the ability to use MAT.
The Department of Health Services has also been facilitating training to give health providers the ability to prescribe buprenorphine, the active ingredient in Suboxone. Data from the Department of Health Services says one year ago, there were 850 available buprenorphine prescribers in Wisconsin; now, there are 1,117.
While these measures made it easier to have initial access to drugs like Suboxone, other measures made it more difficult to take the medication home.
To curb opioid abuse, pharmacists are guided to turn patients away if there are too many “red flags.” Examples include cash payments, returning too frequently for refills, signs of doctor shopping, family members receiving prescriptions from the same prescriber, and driving long distances to fill prescriptions
The U.S. Drug Enforcement Administration says it is a felony offense for a pharmacist to deliberately ignore a questionable prescription when there is reason to believe it was not issued for a legitimate medical purpose.
Dr. Kurter says these measures are important to prevent opioid abuse, but also says it’s easy to forget that one patient’s “red flag” could be another patient’s reality.
“So many patients actually need to travel distances because there’s no provider in their rural communities,” Kurter said.
‘Sometimes, that voice is a scream’
Wisconsin has more than 1,000 in-state, actively licensed pharmacies. The northern part of the state has fewer pharmacies; not all of them carry Suboxone.
Nine of the 14 patients the FOX6 Investigators spoke to said they have to drive 20 miles or more to their pharmacy; eight said at least once, a pharmacist has cited the distance as a reason to turn them away from filling their Suboxone prescription.
Others, like Kasten, say they’ve been turned away because the pharmacy did not have the medication available.
“If they have it, great,” Kasten said. “If not, you’re SOL.”
The measures to prevent opioid abuse make it difficult to get the prescription quickly switched to a different pharmacy. Those same efforts are the reason patients receive just enough Suboxone to last until they can fill their next prescription; they get turned away if they attempt to refill too early.
As a result, Kasten says she has gone up to five days without her medication.
“It totally takes them off their tracks of recovery,” Dr. Kurter said. “Because they’re so focused on the withdrawal, and their physical pains of withdrawal, and the emotional pains of withdrawal, oftentimes, patients will likely relapse with the drug that they were offending in the first place.”
“It’s definitely not a, ‘Oh shuckey, darn. Let’s wait until next week or tomorrow,'” said Jaimie Hauch, licensed professional counselor. “It’s usually ‘I need this medication today.'”
Hauch works at West Grove Clinic and says the emotional impact of not being able to access treatment medication is just as important as the physical impact.
“Here, these people are trying to make positive changes, and then there’s a bump in the road that derails those positive changes,” Hauch said.
“You have one day that you’ll be OK because it’s still in your system,” Kasten said, describing what it feels like when she has to wait to get her Suboxone prescription filled. “But after that, I mean, you have sweats, headaches. You sneeze all the time. You’re throwing up.”
“There’s that little voice since you don’t have your safety net, that little voice like, ‘Well, if you just do this, you’ll feel better. You’ll get your homework done. You’ll get your kids taken care of,'” Kasten added. “And sometimes that voice is a scream.”
Getting answers from pharmacies
Kurter says he supports efforts to prevent doctor shopping and pharmacy hopping, but he’s concerned that inconsistencies will negatively affect his patients’ treatment if they continue to have difficulty getting their medication.
“I think it’s important for pharmacies to identify what their rules are and what their protocols are,” Kurter said.
The FOX6 Investigators asked CVS, Walgreens, Walmart, Pick ‘N Save, Costco, Aurora, Meijer, and Hayat pharmacies about their policies related to opioids, specifically dispensations for drugs like Suboxone.
Filed under: General Problems | 12 Comments »
Denial of care… continuing and growing ?
Posted on November 21, 2019 by Pharmaciststeve
Dear Steve,
I have pudendal neuralgia (on my right side) and interstitial cystitis. I’ve been following your work for awhile and I was one of the patients who spoke to the Department of Health & Human Services Pain Task Force in DC last year. I also follow Red Lawhern, (along with other excellent researchers on this topic), and have been an advocate on behalf of myself and others for the last 3 years or so.
I’ve been fortunate that I’ve been able to maintain a good medical team, though I must admit I live in fear of my pain management doctor being raided by the DEA even though he does all the due diligence possible.
I ran into an interesting problem the other day and I’m not sure if I have any recourse. I would appreciate it if you can weigh in. I’ve been taking 2 schedule 3 pain medications along with a very, very low dose of Klonopin daily. I’ve been taking this combination for awhile with no concern expressed by my doctors office or pharmacy. In fact, all of the doctors on my team are supportive of my protocol.
My doctor tried to call my Klonopin in to Wegmans pharmacy last week, as we have in the past. My doctor was told that they will no longer fill a benzodiazepine with an opioid pain reliever. My 3 doctors were surprised and I decided to call the pharmacist myself. After talking with the pharmacist at length to reassure him about my medical condition and explain that I’m one of the patients that takes my medication as prescribed… he acquiesced that they could continue to fill them as long as I kept my dose low.
He told me that the pharmacy had been harrassed by the medical board and were all in fear of losing their license if they filled a benzodiazepine and pain medication together. He also cited the CDC guidelines that discourage (but do not entirely prohibit) the combination.
Red Lawhern provided me with some research from UNC Chapel Hill that proved that the drug combination was generally safe when used as directed, but the pharmacist was not swayed. They simply had too much fear of the regulatory bodies that could take their license. My pain management doctor showed the pharmacist research that suggested that my incredibly low dose could not possibly cause an overdose, but again, the pharmacist was not swayed.
Do I have any recourse? I felt uncomfortable when I realized I needed to disclose my diagnosis in order for him to fill the prescription. I also felt uncomfortable that my pharmacist was allowed to question the sound judgment of 3 different doctors who know me well. I certainly don’t mind my pharmacist asking questions and verifying things with my doctor, but I think that creating an overall rule that they will not fill this combination of medication goes too far.
However, they seem to be embolded by the current CDC recommendations. I am having a hard time understanding this when those guidelines were only created for primary care doctors and not meant to be used by specialists or pharmacists.
Can you give me some advice? I do understand my pharmacist feels stuck in the middle of a regulatory mess. I am trying to be empathetic but I think I need to report the situation if you think it would help other patients.
Best regards,
This pt has been going to a grocery store chain pharmacy and it would seem what they are running into is that the corporate HQ has been intimidated by some part of some bureaucracy and/or they are concerned about being drug into the law suits that are currently going after the pharmas and wholesalers. I suspect that the chain pharmacies and the insurance/PBM industry can’t be far behind in the law firms going after more money ..because they will claim that they facilitated the opiate crisis by providing and/or paying for opiates for pts who had a valid medical necessity.This seems to confirm what I have suspected for some time, some corporations have went so far as to turn their employee pharmacists into nothing more than puppets to the corporate demands on what meds or combinations of meds will or will not provide to certain pts. Has these corporate demand being instigated by the DEA or by their legal council ?
From what this was stated by this pt… this corporation has taken upon itself to basically revoked the professional discretion of their employee pharmacists and impose their opinions, Which since the corporation can only have a permit to operate a pharmacy not the practice of pharmacy they have appeared to exceed their legal authority.
However, we have a very serious and growing Pharmacist surplus and it is claimed that the 140 odd pharmacy schools are graduating 15,000 new pharmacist each year and there are MAYBE 10,000 open job slots to be filled. Many of these new Pharmacists having SIX FIGURE student loans hanging over their heads.
So those Pharmacists who have a job, know that they can be easily replaced by young and eager – in debt – Pharmacists may accept a lower hourly rate.
To date, the corporations that are taking such actions have no reason to fear pts being denied care… no one has sued them… Actions that have no consequences, typically are repeated until there are consequences.
Here is a website to help pts find independent pharmacies http://www.ncpanet.org/home/find-your-local-pharmacy where they will be dealing with the Pharmacist/owner and unlike the corporate pharmacist that collects a paycheck every couple of weeks… regardless if they deny filling valid Rxs or not … only get paid when they fill legit prescriptions for pts with valid medical necessity. The over whelming majority don’t have “deep pockets” … so there is nothing for the bureaucrats to fine… if they do fine the independent it would probably mean a closing of the store because they cannot afford to pay the fine.
Filed under: General Problems | 2 Comments »