Operation 2020: influencing politicians’ position on chronic pain who are running for office

FROM:  Linda Cheek

I am seeking professional help from experienced writers to help with a BIG project for pain management.  I have sent out blind copies of this to 17 others, and I hope all of you will forward the request to everyone in your professional loop–ATIF, HP3, AAPS, USPF, etc., as I do not have the individual emails to all potential supporters.

 

I am trying to create a questionnaire to send out to state and federal legislative candidates, and presidential candidates to find out their positions on areas of our concern. By doing so, we also tell them those areas of concern, and hopefully get them to be vocal about their position on the campaign trail.  It’s time that the topic of the war on doctors and patients no longer be ignored by the political parties and their candidates. 

This is a major undertaking, of which I have no personal experience. We should get back thousands of replies, and this could go well for us in creating media attention. But I can’t do it by myself. So. PLEAZZZ, if you have any expertise or desire to help in this creation, let me know. 

 

We will need to have a data-evaluation service, which might be built in to the survey program. I think someone on this list has offered help in this area, but I would appreciate more detail.  

 

I also do not need personal recognition for this survey. In fact, I think it would be responded to better if a large, well-known organization was the name attached to the survey. Or any/all organizations helping could sign.  I’m open to whatever people think is best. So if you are a member of a large organization and want to use that name, just let me know.   If you think of an organization that you think might be interested in helping, send the suggestion to me. If they aren’t already included in this email, I will add them in the future.

 

It might be that some of the larger organizations in this email already have a database to communicate the survey to federal and state candidates.  If so, please let me know. If we don’t have that, I will enlist other help–CPPs, individuals, etc–to help get those contacts and send out the survey to their state candidates.  Like I said, this it BIG, and any and all help will be greatly appreciated.

 

This is being sent out on September 11.  I do respect the recognition and honor given to those who died that fateful day in New York. But I also hope someday, that recognition and honor will be given to all those who have died, or will die, as a result of the government’s failing war against drugs.

May the Lord bless you and keep you.

 

 

Linda Cheek <lindacheekmd@gmail.com>;

Teacher of The Seven Steps to Healing

Best Selling Author of Target: Pain Doc

www.sevenpillarstotalhealth.com

www.doctorsofcourage.org

nearly 2/3 of all illicit overdose deaths reporting combination of Fentanyl with benzodiazepines, cocaine, or methamphetamine.

nearly 2/3 of all illicit overdose deaths reporting combination of Fentanyl with benzodiazepines, cocaine, or methamphetamine

https://www.cergm.carter-brothers.com/2019/09/12/cdc-reports-illicit-fentanyl-appearing-in-nearly-all-overdose-deaths/

The CDC’s August 30, 2019 Morbidity and Mortality Weekly Report documents changes in opioid involved overdose deaths by opioid type combined in the presence of benzodiazepines, cocaine, and methamphetamine for 25 states, July–December 2017 to January–June 2018.

Overall they report about a 5% decrease in Prescription Overdose Deaths when compared to the time frame 2014-2017. Yet in this same time frame, overdoses from illegally manufactured Fentanyl are up 11% with 63% or nearly 2/3 of all illicit overdose deaths reporting combination of Fentanyl with benzodiazepines, cocaine, or methamphetamine.

The reader should note though, that when overdose deaths are counted, one individual who overdoses on a combination of hydrocodone or oxycodone and Fentanyl, is counted as both an illegal opioid and a prescription opioid death, even though the actual source of the hydrocodone or oxycodone may not be known and could have come from an illegal sources. Until States start cross referencing every opioid overdose death with Prescription Drug Monitoring Data, the real sources of these medication will not be known.

The CDC goes on to say, from 2013 to 2017, the number of opioid-involved overdose deaths (opioid deaths) in the United States increased 90%, from 25,052 to 47,600. This increase was primarily driven by substantial increases in deaths involving illicitly manufactured fentanyl (IMF) or fentanyl analogs† mixed with heroin, sold as heroin, or pressed into counterfeit prescription pills, some of which contain hydrocodone or oxycodone. Italicized and bold words are my own, not the CDC’s and are based on reports from Ohio law enforcement and exit interviews with street drug users coming out of treatment.

The report goes on to say Methamphetamine-involved and cocaine-involved deaths that co-involved opioids also substantially increased from 2016 to 2017, confirming what law enforcement officials reported during that same period. All of which goes back to what has been reported for more than seven years, that enterprising black market individuals, are mixing Fentanyl into every street drug sold as a means of increasing profits due to its low cost and ready availability.

 

One veteran tells the story of his struggles trying to manage chronic pain

One veteran tells the story of his struggles trying to manage chronic pain

https://newschannel9.com/features/price-of-freedom/one-veteran-tells-the-story-of-his-struggles-trying-to-manage-chronic-pain

We have spent several weeks reporting on the crisis of drug and opioid related deaths and overdoses and what’s being done about it.

Tonight in the Price of Freedom we take a look at part of this crisis that many believe is overlooked. That is the people who suffer with chronic pain and now don’t have access to the pain medications they desperately need.

And many of those people who need help have worn our country’s uniform.

Scott McConathy enlisted in the Air Force in 1993.

He was 19 years old.

“I basically enlisted right after high school,” McConathy told us via Skype.

April 19, 1995 is a day many people in this country will never forget.

At 9:02 AM The Alfred P Murrah Building in Oklahoma City was bombed killing close to 170 people and injuring more than 680 others.

That morning Scott McConathy was 8 and a half miles away at Tinker Air Force Base. He was one of the many people who responded to the bombing.

“When I showed up it was such a big explosion that it actually had lit vehicles on fire that were down the road,” McConathy said. “There’s all these fires going on, and they didn’t know that it was a bomb at first.”

He spent the first two days at the site of the explosion then he volunteered to work with the U.S. Marshals.

“They would get bulldozers and load up dump trucks.” McConathy said. “They would take them out to this field and dump them, and me and other guys and Marshals would sift through. What it was it was evidence collection, and in that process. And I don’t want to get too much into it because it’s upsetting, but there was a nursery that was there. So there were things that you see that I thought actually was a doll part, but it turned out to be remains.”

Today Scott and his wife Emily live in Oregon.

Scott says for months he has struggled to leave his home.

He suffers from PTSD from the Oklahoma City Bombing. He has Crohn’s Disease and chronic pain from injuries to his back and knees from training incidents during his time serving in the military and several other health issues.

“It’s pretty bad. Just trying to survive every day hour by hour,” McConathy said. “Sometimes it feels like a minute will go by and it feels like three or four hours, and the days are just really, really long.”

He says a little more than a year ago he was feeling much better.

He was able to work and sleep and go on hikes with his wife so he says he asked to have his medication reduced by 50 percent.

Scott told me for 12 years he was prescribed 60 mg of Morphine 3 times per day.

He says after working with several doctors to find a level of pain management that would work for him medical records he provided us show he was eventually prescribed 40 milligrams of hydrocodone per day.

That is a fraction of what he was taking a little more than a year ago.

Not long after that he claims he was told the VA would no longer prescribe him any pain medication.

He says now he can’t manage his pain enough to work, sleep through the night, and he struggles to leave his home

“I can really see how other people that don’t have the support system that I do that this could actually cost lives in a couple of different ways,” McConathy said. “There is a lot of hopelessness in this. I do have a little bit of hopelessness when it comes to the medical system just not my life. I love my life.”

Scott McConathy says during all of this he asked to have his pain medication increased, but claims that request was denied several times by doctors at the VA.

He told us he took his complaints to the White House Veterans Crisis Line, and his local VA Medical Center’s Chief of Staff.

He claims not long after that conversation he was told the VA would no longer fill his pain medications.

He told me that he believes that was “retribution” for his complaints.

We reached out to that VA Medical Center in Oregon for comment. They have not specifically spoken about this veteran’s case, but they did defend the Administration’s practices on pain management.

VA has been recognized by many as a leader in the pain management field for the responsible use of opioids, and the department is sharing its knowledge and experience with federal and local governments and across the nation’s health-care networks.

In 2017, VA released its top eight best practices for reducing opioid use.

These best practices are invaluable tools for others working to balance pain management and opioid prescription rates.

In 2018, VA became the first hospital system in the country to publicly post its opioid dispensing 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 make the totality of opioid use among America’s Veterans using VA health care visible at all levels in the organization.

Results of key clinical metrics measured by the OSI from Quarter 4, Fiscal Year 2012 (beginning in July 2012) to Quarter 2, Fiscal Year 2019 (ending in March 2019) demonstrate:

351,971 fewer patients receiving opioids (679,376 patients to 327,405 patients, a 52 percent reduction).

97,925 fewer patients receiving opioids and benzodiazepines together (122,633 patients to 24,708 patients, an 80 percent reduction).

252,295 fewer patients on long-term opioid therapy (438,329 to 186,034, a 58 percent reduction).

The overall dosage of opioids is decreasing in the VA system as 43,254 fewer patients (59,499 patients to 16,245 patients, a 73 percent reduction) are receiving greater than or equal to 100 Morphine Equivalent Daily Dose.

These results have been achieved during a time that VA has seen an overall growth of 255,431 patients (3,959,852 patients to 4,215,283 patients, a 6.5 percent increase) that have utilized VA outpatient pharmacy services.

We expect even better management of pain medications for Veterans when VA and the Department of Defense roll out new, integrated electronic health records.

The new records will give health care providers a full picture of patient medical history, enabling better treatment and better clinical outcomes.

It will also help us better identify Veterans at higher risk for opioid addiction and suicide, so health care providers can intervene earlier and save lives.

New York state plans major lawsuit against drug makers – Governor Andrew Cuomo accuses drug makers of causing ‘immeasurable’ damage; reaction on ‘The Five.’

New York state plans major lawsuit against drug makers

Sep. 11, 2019 – 6:37 – Governor Andrew Cuomo accuses drug makers of causing ‘immeasurable’ damage; reaction on ‘The Five.’

Neighborhood pharmacies, under siege

Neighborhood pharmacies, under siege

https://www.nydailynews.com/opinion/ny-oped-neighborhood-pharmacies-under-siege-20190909-gca6eanb2fb63psmxf2f6u22qa-story.html

I proudly represent hundreds of neighborhood-based pharmacists who stand at the front line of health care for families in their communities. Patients depend on their pharmacists for advice on medications, to ask general questions about their health and of course to get the medicine they need, when they need it.

Across New York State, neighborhood pharmacies play a big role in our economy. The National Community Pharmacists Association reported that the Empire State was home to some 2,400 community-based pharmacies in 2017. They generated approximately $8.4 billion in outlet-wide sales and employed more than 22,000 people that year.

But today, independent neighborhood pharmacies face a serious competitive threat. You may assume I’m referring to chain pharmacies, but I’m not. You might think chain drug stores pose challenges to us, but we’re happy to go head-to-head with them when it comes to the quality and intimacy of our services.

In fact, the primary threat to our survival comes from a cadre of greedy middlemen who occupy an obscure and exploitative stratum of the prescription drug supply chain. Called Pharmacy Benefit Managers, they’re a powerful force wreaking havoc on local drug stores.

The stealthy, all-but-extortionate impact of PBMs has surged in the past few years.

  

OK, so what do these PBMs actually do?

Originally designed to help insurers manage insurance claims paperwork and provide administrative support, PBMs have grown into an unwieldly, hydra-like beast. PBMs play the role of middlemen among insurers, drug makers and pharmacies, exercising control over which drugs your insurance will cover, drug prices and the reimbursement levels pharmacies receive when distributing medications. They can even dictate which drugs doctors can prescribe for you.

And they’ve consolidated. Today, the vast majority of prescriptions are processed by PBMs that own or are owned by major national health insurance companies – Cigna, United HealthCare and Aetna – and these three PBMs, all Fortune 25 corporations, collectively control nearly 80% of the market.

  

Not only can PBMs determine what drugs a patient uses; they can also determine where a patient gets their drugs. PBMs will frequently self-refer patients to mail order or chain pharmacies that are in their network, resulting in a greater return for the PBM even though this may not be the most affordable option for the patient.

Last January, a survey of more than 500 New York City neighborhood pharmacy owners conducted by the New York City Pharmacists Society showed how deeply PBM abuses are jeopardizing the viability of “mom-and-pop” pharmacies. Seventy percent of the owners were forced to reduce store hours or lay off employees last year because of PBM abuses. Ninety-two percent have contemplated similar curtailments this year for the same reason.

One nefarious PBM practice is called “spread pricing,” which usually pertains to the pricing of generic drugs. Under spread pricing, PBMs charge their sponsor-client one price for a drug, then most often pay the dispensing pharmacy a much lesser amount (frequently below the pharmacy’s cost), pocketing the difference for themselves.

 

This is contributing to the closure of family pharmacies. And it cost the state’s Medicaid managed care organizations at least $300 million in overcharges in 2018, according to the Pharmacists Society of the State of New York.

PBMs often force neighborhood pharmacies to sign onerous, take-it-or-leave-it contracts that dictate reimbursement rates. As small mom-and-pop businesses, we’re in no position to go up against some of the country’s largest corporations.

A recent state Senate report found that PBMs often demand patients to fill prescriptions using PBM-owned mail order pharmacies, further impairing the viability of local pharmacies.

  

Fortunately, lawmakers are now recognizing the damage caused by PBM misconduct and are starting to reel in their power. For example, while “spread pricing” continues in the private sector, Albany recently banned its use in the state’s Medicaid program. And, taking a cue from several other states, both houses of the state Legislature recently passed a PBM reform package that will help protect patients, taxpayers and neighborhood pharmacists from our broken prescription drug system.

The bill would mandate the licensing and regulation of PBMs, require disclosure of the details of “spread pricing” in both private and public insurance plans, and require disclosure of information on discounts, rebates and other kick-backs they receive from drug manufacturers — and make sure those savings are passed on to consumers.

Now, it’s up to Gov. Cuomo to sign this bill. The time has come to neuter the deleterious impact of this industry.

Chronic Pain Suicide: as seen on the web 09/11/2019

My close friends brother-in-law committed suicide last Sunday, he wasn’t found until tuesday. He suffered chronic pain, would run out of his meds early and use alcohol in between time. He isolated himself.

This last refill, he took them all and left a 3 page letter. His name is Mark Apple. He leaves behind 2 brothers (one is a twin) and his mother. He was unmarried and had no children.

This is so sad. I hate this so much. There is just no reason this should happen, that people lose hope simply because they can’t get relief.

“Narcan is as useful for me as a screen door on a submarine”

DEA proposes lowering opioid production quotas by 30% , expanding marijuana research

DEA proposes lowering opioid production quotas, expanding marijuana research

https://www.washingtontimes.com/news/2019/sep/11/dea-proposes-lowering-opioid-production-quotas-exp/

The Drug Enforcement Administration on Thursday proposed reducing the manufacturing quotas for the five most frequently abused opioids by an average of 30 percent in 2020.

Simultaneously, the DEA announced it would triple the amount of marijuana grown for research.


The moves signal the Trump administration is cracking down on opioid abuse while softening its hard-line stance on marijuana as a number of states continue to legalize its use.

DEA takes seriously its obligations to both protect the public from illicit drug trafficking and ensure adequate supplies to meet the legitimate needs of patients and researchers for these substances,” DEA acting Administrator Uttam Dhillon said in a statement.

The anti-drug agency said will reduce fentanyl production by 31 percent, hydrocodone by 19 percent, hydromorphone by 25 percent, oxycodone by nine percent and oxymorphone by 55 percent.

Combined with a reduction in morphine, the proposed quota would decrease opioid production by an average of 53 percent since 2016.

The DEA is requesting more than 3.2 million grams of marijuana to be grown legally in 2020, up nearly a third from the 2.4 million grown this year. The increased haul will be used for scientific research.

Both proposals are part of the DEA’s annual quota for manufacturing controlled substances to meet the nation’s medical, scientific, research and industrial needs.

800,000 GMS increase in MJ for RESEARCH… that is abt 1750 lbs.. or about 5 lbs/day.

Cut the availability of opiates for legal therapy, and increase MJ for RESEARCH… meaning that it could take 10-15 yrs before that research could get a meaningful MJ product for treating various health issues… NO GUARANTEES that anything will prove to be useful for treating any health issue.

So the DEA is determining the level of therapy that both acute and chronic pain pts require… without examining the FIRST PATIENT ?

Human Rights Watch Accuses Tennessee Of Over-Regulating Pain Management

Human Rights Watch Accuses Tennessee Of Over-Regulating Pain Management

https://www.nashvillepublicradio.org/post/human-rights-watch-accuses-tennessee-over-regulating-pain-management#stream/0

A report from Human Rights Watch accuses Tennessee of regulating opioids to the point of depriving patients in pain. Along with Washington State, the analysis focuses on Tennessee because of its new prescribing regulations, which are considered some of the strictest in the nation.

In its 109-page report, Human Rights Watch interviewed patients who were involuntarily weaned off of high-doses of powerful painkillers. Tennessee’s new law doesn’t directly impact so-called chronic pain patients, but it seems to have had a chilling effect. Several tell the advocacy organization that their doctors feel pressure to lower everyone’s dosages.

Gail Gray of Celina, Tennessee, tells HRW that her primary care physician cut her pain medication nearly in half but still felt like he could get in trouble. So Gray was forced to a clinic an hour away, which she worries might be a “pill mill” since they only take cash.

“I’m not comfortable with this. I feel like he [my primary care doctor] has pushed me into doing something that’s not right, and I don’t want to break the law,” she said.

More: Tennessee Doctors In Training Mode As Nation’s Tightest Opioid Restrictions Take Effect

HRW also interviewed clinicians, like a nurse practitioner from Vanderbilt’s hematology department who tells of her difficulty with insurance companies denying heavy prescriptions for a sickle cell patient.

A doctor in Knoxville describes how a new state law requiring physicians to try alternatives before turning to opioids has resulted in risky decisions. At times, he’s recommended surgery as a first course of action, just to avoid flack from regulators.

“It’s really against everything I was trained to do, but it’s the will of the legislators and regulators,” Dr. Joe Browder said.

The state did not respond to the study, which was funded by the U.S. Cancer Pain Relief Committee, a nonprofit with ties to pain management and the pharmaceutical industry. But Human Rights Watch says its top recommendation is for states to just limit the unintended consequences of cracking down on opioid prescribing.

Calling all CPP group leaders and CPP advocates

Calling all CPP group leaders and CPP advocates:
We are developing a questionnaire to send out to House, Senate, and Presidential Candidates to find out their positions on areas of our concern. By doing so, we also tell them those areas of concern, and hopefully get them to be vocal about them on the campaign trail. It’s time that the topic of the war on doctors and patients no longer be ignored by the political parties and their candidates.

This is a major undertaking, with hopefully 1000+ replies. We will need to have a data-evaluation service or some manner of organizing and reviewing the replies.

Are you willing to help? If so, reply on the Contact form on https://doctorsofcourage.org/communication-campaign/.
Right now, please give us questions you think are pertinent to be answered by the candidates. Tell us if you are willing to work on a panel to construct the questionnaire. If you know of anything like this that has been done before, please share. And last, but definitely not least, tell us if you have access to a data-evaluation program, or could get your hands on one. This is way over my level of IT capability. But computer data-crunching would be so much more time-effective than the old-fashioned way.
This is something that we can all do together with the greatest impact to make a difference in the War Against Doctors and Patients. I hope that all leaders get involved in one way or another. Please re-post to your own group as well, to spread the word. Share by email to all advocacy groups.