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Mike Pence Wants Indiana’s Punitive Form of Medicaid to Become a National Model

https://truthout.org/articles/mike-pence-wants-indianas-punitive-form-of-medicaid-to-become-a-national-model/

Rhonda Cree has diabetes, significant vision loss, and high blood pressure. Cree, 61 years old, is one of 65 million Americans who relies on Medicaid to cover her prescriptions and other healthcare costs. But Cree lives in the town of Logansport in north-central Indiana. Unlike most states, Indiana requires her to pay monthly premiums for Medicaid.

Last November, Cree and her husband were going through a particularly difficult time financially, and she was unable to pay her full monthly premium. The state stopped her coverage and barred her from reapplying for six months. During that time, Cree was forced to skip prescribed injections, and suffered more vision loss as a result.

Mike Pence’s plan is working exactly as he hoped.

Before Pence ascended to the national stage as Vice President and he recruited his longtime ally Seema Verma to lead the Center for Medicare and Medicaid Services, they together crafted a unique Indiana approach to Medicaid. Their goal was to reshape the 54-year-old program into something far smaller and more punitive. The Healthy Indiana Plan, they promised, would demand “skin in the game” from enrollees like Rhonda Cree.

Medicaid works as a federal-state partnership, with the federal government paying most of the cost and the states agreeing to follow guidelines set at the national level. All U.S. states have agreed to the terms, and Medicaid accounts for almost one-fifth of the country’s personal healthcare spending.

The platform for Pence and Verma’s ambitious remodeling of Medicaid was provided by the Affordable Care Act of 2010’s invitation to states to significantly expand their Medicaid coverage. Under the ACA, all adults in households whose income is less than 133% of the federal poverty level, a little under $17,000/year for an individual, would be eligible for Medicaid. But, in 2012, the U.S. Supreme Court in the case of National Federation of Independent Business v. Sebelius ruled that Congress did not have the authority to demand that states expand Medicaid, although states could do so if they wished. For Republican state officials like then-Indiana governor Pence, the ruling created a dilemma.

On one hand, Pence was a vocal opponent of the ACA and Medicaid. “We are going to use every means at our disposal to oppose this (ACA) government takeover of health care,” he said. Of Medicaid, he pronounced, “The sad truth is that traditional Medicaid is not just broke, it is broken.” But the ACA included a tantalizing offer for Indiana and other states: if they expanded Medicaid coverage as the new law called for, the feds would pay the full cost of the initial expansion, and 90% of the cost after that. Pence’s constituents, most notably the well-connected leaders of Indiana hospital systems that would benefit from more of their patients being covered by Medicaid, pushed him to accept the deal.

Caught between his ideology and political pressure, Pence turned for help to Verma, a former Indiana hospital administrator who had launched her own consulting firm. Verma had already gained a reputation for taking a conservative approach to public healthcare systems, earning contracts from multiple state agencies and private companies. She earned praise for avoiding the “fatal mistake of making everything free,” as Pence’s predecessor Mitch Daniels put it.

At Pence’s request, Verma took the lead in crafting a version of Medicaid expansion that would look less like a government program than a high-deductible insurance plan offered by the for-profit insurance industry. The Healthy Indiana Plan, Pence promised, would be a “hand-up, not a hand-out.” It would demand healthy behaviors and personal responsibility from low-income Hoosiers, or they would face dire consequences.

Premiums, Lockouts, and Copayments

Under the Medicaid Act, the U.S. Secretary of Health and Human Services can waive some Medicaid requirements for states that wish to experiment with new approaches, as long as those approaches promote the objectives of the overall program. In 2014, Pence and Verma asked for a federal waiver to implement their reimagined version of Medicaid.

Indiana wanted to accept the ACA Medicaid expansion offer of near-total federal funding, they said, but only if the state could require enrollees to pay monthly premiums to private insurance companies that contract with the state, and terminate non-compliant enrollees like Rhonda Cree, and lock them out of coverage for failure to pay. Pence and Verma also wanted to demand copayments, even for emergency services and even from the lowest-income persons on Medicaid.

Past Medicaid waivers had been granted to states seeking to make small tweaks to the program, but the Indiana terms were something far more sweeping. The Pence-Verma plan ran counter to decades of Medicaid practices, and to the research consensus that cost sharing for healthcare was often quite harmful, especially to persons with chronic illnesses. Imposing user fees on the poor has proven to be “a prescription for death,” says physician and Harvard Medical School instructor Adam Gaffney.

Now it was the Obama administration that faced a dilemma. After the Sebelius ruling, many other Republican-led states were refusing to expand Medicaid. Seventeen states still have not done so. Even the Healthy Indiana Plan’s restricted version would expand coverage to hundreds of thousands of people in the state. Indiana healthcare advocates did not like the punitive Healthy Indiana Plan approach, but told federal administrators that the Pence-Verma half-loaf was better than none. The Obama administration approved the waiver.

The Pence-Verma version of Medicaid fulfilled each side’s predictions. The Healthy Indiana Plan has covered as many as 400,000 persons, most of whom otherwise would not have healthcare coverage at all. But, in the first two years of the program, over 70,000 people who failed to make premium payments were either kicked off coverage or never able to start coverage at all. Amber Thayer, a homeless Indianapolis mother of an infant child, was removed from coverage after her premium payment went to the wrong insurance company. Thayer was forced to spend weeks buying her medication one dose at a time, a new purchase every day, because that was all she could afford.

Next week: In Part Two of two, Pence and Verma ascend to the national stage, and push their Indiana version of Medicaid to be the national model, adding in restrictive work requirements to an approach designed to undercut the Affordable Care Act their boss has vowed to destroy.

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My blog is now in its EIGHTH YEAR

Nearly every day I check “Memories” that FB posts on my page… and I see names of people who have “liked” my page and/or started following me… and many of the names I don’t have a clue who they are or they never interact with my FB page at all.

I see the same couple of dozen people posting on FB and I notice that many people “like” the comment but few SHARE…  or I see the same person posting the same thing on multiple FB pages… Nothing makes me more happy than go thru FB notices to only find the same post over and over from the same person.  To “like” a comment only allows FB to collect data points on you for their database… that they are selling to anyone who wants to put up the money.

Does this suggest that we have TOO MANY FB pages devoted to trying to deal with pain ?

Many of these FB groups are “CLOSED/PRIVATE” and they made a post and suggest that it be SHARED….YOU CAN’T SHARE FROM A CLOSED GROUP !!!

One chronic painer asked me the other night if we should post something about supporting some doc that is getting drug thru the DEA swamp…  and my immediate response is why aren’t the doctors financially supporting the defense of their colleagues ?

It has been stated that there are some 100 million chronic pain pts and that 80% are struggling financially because of their inability to work, the other spouse took off and/or the cost of their therapy.

So does that mean that there is 20% of the chronic pain pts may have a few dollars to spare… that would be 20 million ?  I see on TV a lot of non profit groups asking for JUST $19/month for their cause…  Doesn’t anyone realize just what JUST $10/month from 20 million could do for a legal defense fund ?

Start hiring a PR firm, Lobbyists and law firms to get the message out that our government is actively participating in a covert genocide and suiting those healthcare corporations that are supporting this genocide.

With our ingrained TWO PARTY SYSTEM… it would seem that if the current “BUM” is voted out… his/her replace is or becomes the NEW BUM.  According to this https://www.washingtonpost.com/news/wonk/wp/2017/04/14/somebody-just-put-a-price-tag-on-the-2016-election-its-a-doozy/  the total Federal 2016 election – all candidates was 6.5 BILLION.

There are other political parties besides Democrats and Republicans and it only takes about 65 million votes to get a person elected President…  abt HALF the number claimed chronic pain pts… not counting their spouses and kids old enough to vote.

IMO… the chronic pain community needs to get their act together… that includes their dollars and their votes…  In the EIGHT YEARS of my blog.. things have not gotten any better and in reality probably got a lot worse and we are near the end… because many of you are still breathing and having the healthcare system spend money on your treatments.

Get you head out of the sand and quit all the whining… bitching .. and moaning…

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California’s cunning plan to bankrupt local pharmacies and keep drugs from AIDS patients

https://missionlocal.org/2019/10/californias-cunning-plan-to-bankrupt-local-pharmacies-and-keep-drugs-from-aids-patients/

Many years ago, Bay Area TV commentator Wayne Shannon — remember Wayne Shannon? — told us he supported the dumping of vast quantities of nuclear waste into the ocean just off San Francisco, into the Farallones National Marine Sanctuary. 

Offended viewers responded en masse. But they were missing the point. 

Shannon’s rationale was that someone had to be in favor of dumping nuclear waste into a wildlife sanctuary — because, you know, we did that. 

So, your humble narrator supports California’s cunning plan to bankrupt local pharmacies and, in the process, deprive patients of medications for AIDS, Hepatitis-C, psychotic disorders and other maladies  — leading to a potential humanitarian crisis and, likely, costing far more money than the state stands to save in the short-term. 

Someone has to be in favor of that. Because, you know, we’re doing that. 

On a recent weekday morning at Mission Wellness Pharmacy, all appears well. It’s a shade chilly, immaculately clean, and there is, understandably, a dry, medicinal odor in here befitting a place with prescription bottles stacked nearly eight feet high. 

Mission Wellness isn’t an old-school pharmacy in the soda fountain and Norman Rockwell sense, but it does offer anachronistically extensive counseling and individualized day-by-day packaging of patients’ complicated multi-drug doses. And it does it all in several languages for, on this day, a guy who looks like he stumbled in from street — because he probably did. 

This pharmacy has a contract with the Department of Public Health to provide patients — often indigent patients on Medi-Cal — with the complex and expensive drugs it takes to fight AIDS and Hep-C; Mission Wellness also provides mental health patients with injectable antipsychotic medications.

Separate and apart from basic human decency — helping people suffering from preventable and treatable diseases — there is a bottom-line, cost-saving motivation here. It’s cheaper to keep people healthy and treated than to deal with them, repeatedly, in the Emergency Room. 

And yet all is not well here. Mission Wellness is hemorrhaging money. Its proprietor, Maria Lopez, informs me that the state summarily sucked some $30,200 out of her account in May. This is money that isn’t going toward helping indigent patients or buying medications but paying back a debt the state claims Lopez — and scads of other independent pharmacists — now owe the government.  

“For a small business, that’s a big hit,” Lopez confirms. And this was just the first of many proposed payments to the state. 

Maria Lopez, Pharm.D, at Mission Wellness has been forced to subsidize AIDS, HIV, Hep-C, and other patients out of her pocket for months. This, she says, is not a tenable situation. Photo by Joe Eskenazi.

 

This is happening because, after two years of analysis, the state has determined it will reimburse pharmacies, like Lopez’s, at a lower rate than pharmacies pay for wholesale “specialty drugs” for complicated maladies. 

According to numbers provided by the California Pharmacists Association, an advocacy and lobbying group, a pharmacist providing a Medi-Cal patient with the HIV drug Atripla will now lose $123 a year, per patient. A pharmacist providing a Medi-Cal patient with the schizophrenia/bipolarity drug Ziprasidone will lose $533 per year per patient. And a pharmacist providing the injectable antipsychotic drug Aristada will lose $816 per year per patient.  

San Francisco General Hospital alone refers some 1,200 patients to Mission Wellness.

So this is — by design — a losing proposition. Pharmacists are clearly incentivized to cease carrying these drugs and/or providing them to Medi-Cal patients — which, in turn, makes it that much harder for people in need to obtain them. 

But wait, there’s more: The state, which has been mulling these changes since 2017, is demanding pharmacists retroactively pay back the higher reimbursement rates they received over that two-year period — hence that $30,200 clawback from Mission Wellness in May. 

When asked how much longer she can subsidize scads of AIDS, HIV, Hep-C, and mental health patients out of her own pocket, Lopez is frank: “Not much longer.” 

Will our erstwhile mayor forsake us?

Why do this? In a word: “savings.” The state stands to save some $60-odd million by reimbursing druggists less for these drugs. 

Now, $60 million is a good amount of money. But, in the context of the California budget, which is about $209 billion, there’s a term for savings like this: Budget dust. 

Saving $60 million off a $209 billion budget is akin to saving a quarter off a $1,000 purchase. 

But, as noted above, this is a dubious way to save money. Psychotic people acting out in the street and being hospitalized (or worse) or AIDS and HIV patients suffering healthwise will, invariably, result in increased expenditures (though — and this is key — likely not at the state level). 

Despite the term “specialty medications,” by the way, these are not extravagant or cosmetic drugs. “These aren’t luxury medications; this isn’t your expensive weekend Viagra,” says Dr. Annie Leutkemeyer, an infectious disease specialist at San Francisco General Hospital and UCSF. “These are life-saving medications which you cannot interrupt. If a patient misses even one dose, it could be catastrophic.” 

People’s lives will be ruined and the back-end costs will soar. And places like Mission Wellness will struggle to stay in business, which is also a net loss for the community. 

And while San Francisco often advocates for twee, independent businesses for emotional and altruistic reasons, that doesn’t apply here. Independent pharmacies are often the only ones willing to accept indigent people’s health plans — hence the Mission Wellness contract with the Department of Public Health. “My patients don’t go to Safeway,” says Leutkemeyer, who works out of General Hospital. “They have to go somewhere that accepts their insurance.” 

And this leaves Sen. Scott Wiener troubled. Gov. Gavin Newsom recently signed into a law a Wiener-penned bill that enables Californians to buy HIV-prevention drugs without a prescription. It is, simply, both the humanitarian choice and cost-beneficial to get these drugs into people’s hands. 

So Wiener is confused why, under that same governor’s watch, a move is underway to render it more difficult for people to get HIV medications — and bankrupt local pharmacies to boot. 

“What the state is doing here is terrible,” he says. “It’s going to harm people and it needs to change. This is not rational.” 

Mission District Supervisor Hillary Ronen agrees: “This is so bizarre. This is so weird. There is no scenario under which this decision makes any sense.” 

Ronen and Wiener likely also agree with one another that it’s a bad idea to mix beer and wine or drive on the railroad tracks (or both). But, by and large, they don’t agree on all that much. 

So, if Ronen and Wiener both tell you something is a bad idea and you should stop — it’s probably a bad idea and you should probably stop. 

If Hillary Ronen and Scott Wiener both tell you something is a bad idea and you should stop — it’s probably a bad idea and you should probably stop.

Again, why is this happening? Nobody thinks it’s a conspiracy to bankrupt the local pharmacies or deprive Medi-Cal patients from their life-saving drugs. That’s not the intent. Yet that stands to be the outcome. 

Under Gov. Jerry Brown, the state began searching for ways to save money. A consulting firm was contracted to undertake a survey that would help determine Medi-Cal reimbursements. 

That survey was faulty, complains the California Pharmacists Association (CPA), which filed suit against the state in May. That legal action froze the retroactive “clawbacks,” like the $30,200 appropriation Maria Lopez experienced earlier this year.  

Arguments are complete regarding that suit, according to CPA executive director Jon Roth; a judge’s ruling could come any day. Either the state will be forced back to the drawing board or it could begin once more demanding dollars from affected pharmacies. 

In the meantime, Roth is hoping Newsom can intervene. “If he were inclined to direct the Department of Healthcare Services to make the change, that would presumably happen,” Roth says. “They work for him.” 

Ronen agrees. And, again, so does Wiener. 

“This was a move by the Brown administration, so we’ve been waiting to see if the Newsom administration keeps with that same approach,” he says. But it may be time to stop waiting. 

“I think the LGBT caucus will get involved. The last thing we need is for community pharmacies that serve people with HIV to either go under or stop providing HIV medication. It’s really upsetting to me that the state has taken this approach.” 

Someone has to be in favor of the common-sense, decent, and bottom-line beneficial thing to do. Because, you know, we’re not doing that. 

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SAY WHAT YOU WANT? MAYBE NOT IN THE PHARMACY

The chain pharmacies fear “bad press” or “bad word of mouth” …  The “service” that you are provided may be part reality… part illusion or mirage at the pharmacy counter. Unless your insurance has you locked into a particular pharmacy… you are going to pay the same price at any store so any “bad press” could cause pts to move their prescription(s) to a competitor.

Filed under: General Problems | Leave a Comment »

On Oct 12, 2019, at 2:13 PM, mark ibsen <markmusheribsen@gmail.com> wrote:

Dear Mr Harrington:

I could not post in the comments section of the Sandusky register,

So

I am responding in the email. 

Would you kindly ad this to the comments,

Or use this as an OpEd?

Thanks 

I have followed Dr Bauer’s case with interest,

As he courageously stands by his patients. 

In his original indictment,

You reported:

“According to the indictment from 2007 to this year, Bauer repeatedly prescribed powerful painkillers — including fentanyl, oxycodone, hydrocodone and morphine — without a legitimate medical purpose.

“It’s a terrible betrayal of the public-trust when professionals like Dr. William Bauer are engaged in corrupt practices, to include the diversion of controlled substances,” said Acting Special Agent in Charge Keith Martin.

The indictment lists 200 times between 2015 and 2018 that Bauer allegedly improperly distributed controlled substances to seven patients.”

Several things to point out:

In one paragraph DEA says he’s been a criminal since 2007.  My question would be: if he is such a heinous criminal, What Took DEA so long to indict him?

Next question: who decides what IS a legitimate medical purpose? A neurologist with 55 years of experience, or an agent who may or may not have graduated from college, let alone medical school, residency and a lifetime of practice without any legal trouble? Are they proposing this 82 year old grandpa suddenly “broke bad”?

And 

If there are 200 charges regarding 7 patients, does that equate to 28.7 charges per patient? The only way that could be is if they charged him with one felony for every Rx over a period of 29 months, right?

Again, if he’s been committing crimes over 12 years, why only 7 patients? According to the interview, he was seeing 4,000 patients, 1500 on opiates. So, law enforcement believes the 3,993 other patients were treated appropriately? How could that be? If 7 patients were inappropriately treated, would that not be best looked at by his licensing board ( his peers)?

And, if his Rx was legal in 2007, or 2015, (filled by pharmacist, taken by patient, who returned an average of 28 times for another Rx, how can they be illegal, suddenly, now?)

The constitution prohibits ex post facto laws. It calls for due process. If DEA knew he was doing this, and failed to stop him, how indeed are they keeping the citizens of Ohio safe? Is this not a form of entrapment? Or complicity? How were the 7 patients harmed? And, if they were harmed, why did they keep coming back every month?

The new charges just added to inflate the implausible number of felonies, are not equated to a number of patients, but based on previous ratios might equate to less than 10. How were these new crimes discovered? By actual deaths, or by data mining by matching a list of patients of Dr Bauer to a list of crimes by his patients? Did some of Dr Bauer’s patients commit crimes, and did they accept plea deals by lying about the legitimacy of their Rx?  This is the formula DEA has been using since 2004 and the conviction of William Hurwitz. Same techniques used against 1500 doctors over the last 15 years. (See the book 3 Felonies A Day, by Harvey Silverglate). 

We all need to look at the elephant in the room: agencies are thinking very simplistically about the epidemic of heroin/illicit fentanyl, as if doctors prescribing to the 20 million legitimate pain patients who need the medication are the cause. In other words, there is this myth:Johnny, the star high school quarterback breaks his collarbone, gets 20 Percocet, and dies 7 years of heroin OD, and we must blame someone, so let’s blame the doctor. Regarding cars, diabetic meds, air traffic control, and AIDS, we have always engaged in harm reduction, much more successful than prohibition, which has never once worked. 

Let’s stop scapegoating kind old doctors and do our best to reduce harm- in patients, cars, airplanes, infectious diseases, diabetes and all things health related. God Bless Dr Bauer, honoring the Oath of Hippocrates 

MarkIbsenMD 

Helena Mt

https://latterly.org/pain-killer/

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Deadly fentanyl smuggled across the southern border is quickly spreading nationwide

HIDALGO, Texas. (SBG) — China has long been a major supplier of deadly fentanyl to the United States. But law enforcement agencies including the, Drug Enforcement Administration, say a new player is quickly taking its place. Mexico has picked up the slack in the production of the lethal drug, with

smuggling across our southern border becoming an increasing problem as the fentanyl enters the States and quickly spreads nationwide.

Evidence of the growing fentanyl problem was on display earlier this year at the Nogales, Arizona, Port of Entry operated by U.S. Customs and Border Protection. On a table guarded by an armed officer sat a massive load of fentanyl and methamphetamine. At the time, CBP called it the largest fentanyl seizure in agency history, with millions of dollars worth of the synthetic drug uncovered during an inspection. The fentanyl, found in both pill and powder form, had been smuggled in the hidden compartment of a tractor-trailer, driven by a Mexican national who had hidden the drugs beneath a load of cucumbers. Nogales Area Port Director Michael Humphries said, “We’re organized as well and we’ll use all our resources to prevent the entry of dangerous narcotics into the United States.”

Officials with US Customs and Border Protection announce the agency’s largest fentanyl bust in January 2019 (Photo: US Customs and Border Protection)

Fentanyl is considered so potent and dangerous that just a few grains are enough to kill. And the drug has become a nationwide killer. According to government statistics, more than 28,000 of the nation’s 70,200 overdose deaths in 2017 could be attributed to fentanyl. Now Spotlight on America has learned the source of deadly fentanyl is even closer to home, with the DEA citing a massive increase coming in from Mexico.

“It’s a significantly bigger problem,” said Will Glaspy, Special Agent in Charge of the DEA’s Houston division. “Five years ago, we didn’t know how to spell fentanyl in South Texas because we didn’t see it.”

Fentanyl has historically come into the U.S. from China, with some exploiting loopholes in the United States Postal Service as they imported the drug. But now Glaspy says drug cartels just over the border in Mexico have become major players in this deadly game, manufacturing fentanyl and smuggling it in. Often, he explained, it’s disguised as counterfeit pills that look like standard prescription painkillers. Once it’s stateside, it spreads like wildfire.

“That fentanyl can be on the street in South Texas, that very day. It can be on the streets in New Orleans in under two days,” Glaspy said. “And in three days, deadly doses of fentanyl can be on the streets of Atlanta, Chicago and New York.”

The problem is well-known to lawmakers and law enforcement. In July, the shift in supply was discussed at length during a hearing in the House Energy and Commerce Committee with the DEA’s Regional Director Matthew Donahue saying, “Mexican TCOs (Transnational Criminal Organizations) remain the greatest criminal drug threat to the United States. These Mexican poly-drug organizations traffic heroin, methamphetamine, cocaine, marijuana, and now more than ever illicit fentanyl and synthetic opioid analogues, which are responsible for so many deaths over the last several years throughout the United States using established transportation routes and distribution networks.”

In the last three months, Glaspy says his agents in the Houston division have seized more than 20,000 counterfeit pills containing fentanyl. And he told us authorities in Mexico have shut down at least a half dozen clandestine labs in the last six months. One of those labs, he said, had a load of chemicals so huge it could produce enough fentanyl to kill 113million Americans if it made its way across the border.

CBP officers do an initial screening of a car passing through the border checkpoint in Hidalgo, Texas (Photo: Joce Sterman, Sinclair Broadcast Group)

That’s where U.S. Customs and Border Protection comes in. Spotlight on America got an inside look as agents at the Hidalgo Port of Entry in Texas, ran cars through the border checkpoint and then funneled some into a deeper seven-point inspection, screening for illegal items being smuggled into the country.

CBP Public Affairs Liaison Phil Barrera told us, “We’re the first line of defense. We’re the front door to your house.”

It starts with officer intuition, Barrera explained, but the agency also uses specialized tools. That includes something called a Gemini, which can speed test unknown powders and pills that could potentially be fentanyl. When officers place a small amount of the drug into a testing vial, the machine can identify human-made chemicals in a matter of seconds, which is crucial not just to prevent drug smuggling but also to preserve officer safety. Fentanyl has been problematic for law enforcement and first responders because breathing in a small amount of the drug can create health issues.

A machine called a Gemini helps CBP officers speed test unknown substances (Photo: Alex Brauer, Sinclair Broadcast Group)

Barrera said the machines, which he indicated cost approximately $85,000 each, have become a vital tool during border screenings, “It’ll tell us with pinpoint accuracy what we’re dealing with.”

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Roadside Drug Testing Program Starts in Michigan Today

Read More: Roadside Drug Testing Program Starts in Michigan Today | https://banana1015.com/roadside-drug-testing-program-starts-in-michigan-today/?trackback=fbshare_mobile&utm_source=tsmclip&utm_medium=referral

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https://www.hhs.gov/opioids/sites/default/files/2019-10/Dosage_Reduction_Discontinuation.pdf

https://www.hhs.gov/about/news/2019/10/10/hhs-announces-guide-appropriate-tapering-or-discontinuation-long-term-opioid-use.html

oday, the U.S. Department of Health and Human Services published a new Guide for Clinicians on the Appropriate Dosage Reduction or Discontinuation of Long-Term Opioid Analgesics – PDF. Individual patients, as well as the health of the public, benefit when opioids are prescribed only when the benefit of using opioids outweighs the risks.  But once a patient is on opioids for a prolonged duration, any abrupt change in the patient’s regimen may put the patient at risk of harm and should include a thorough, deliberative case review and discussion with the patient. The HHS Guide provides advice to clinicians who are contemplating or initiating a change in opioid dosage.

“Care must be a patient-centered experience. We need to treat people with compassion, and emphasize personalized care tailored to the specific circumstances and unique needs of each patient,” said Adm. Brett P. Giroir, M.D., assistant secretary for health. “This Guide provides more resources for clinicians to best help patients achieve the dual goals of effective pain management and reduction in the risk for addiction.”

Clinicians have a responsibility to coordinate patients’ pain treatment and opioid-related problems. In certain situations, a reduced opioid dosage may be indicated, in joint consultation with the care team and the patient. HHS does not recommend opioids be tapered rapidly or discontinued suddenly due to the significant risks of opioid withdrawal, unless there is a life-threatening issue confronting the individual patient.

Compiled from published guidelines and practices endorsed in the peer-reviewed literature, the Guide covers important issues to consider when changing a patient’s chronic pain therapy. It lists issues to consider prior to making a change, which include shared decision-making with the patient; issues to consider when initiating the change; and issues to consider as a patient’s dosage is being tapered, including the need to treat symptoms of opioid withdrawal and provide behavioral health support. For more information, go to: www.hhs.gov/opioids.

About the Office of the Assistant Secretary for Health

The Office of the Assistant Secretary for Health (OASH) oversees the U.S. Department of Health and Human Services’ key public health offices and programs, a number of Presidential and Secretarial advisory committees, 10 regional health offices across the nation, and the Office of the Surgeon General and the U.S. Public Health Service Commissioned Corps. OASH is committed to leading America to healthier lives.

Follow the Assistant Secretary for Health on Twitter @HHS_ASH , and sign up for HHS Email Updates.

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102.3 degrees. this is the temp of Brice’s rejection medication from CVS CAREMARK. It clearly states on the shipping papers for it to be kept at room temp (66 to 77) degrees. we have asked before for them to include gel cooling packs. we have to be home and sign for this. this is straight off the UPS truck. share the heck outta this and shame the big insurance companies . we have been forced to use mail order. we never had problems before that , when we could use our local pharmacy. the insurance compaines have way to much power.

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