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DO NOT DISMISS pts from care… DO NOT ABRUPTLY DISCONTINUE or TAPER OPIATES
Posted on July 31, 2019 by Pharmaciststeve
Florida: Not all SUNSHINE & ROSES ?
Posted on July 31, 2019 by Pharmaciststeve
Florida Officials Successfully Withheld Pain Meds from Surgical Patients. Aren’t They Special?
Let’s congratulate the state of Florida. In its infinite wisdom, the state has jumped into the scrum of the “who can be tougher on drugs” match that is playing out all across America at the expense of pain patients, past, present, and future (1).
Could there be a better way to celebrate than by taking apart another crap study? Didn’t think so.
This one is called “Opioid prescriptions for acute pain after outpatient surgery at a large public university-affiliated hospital: Impact of state legislation in Florida” and was published online last month by a group of surgeons at the University of Miami Medical School. It’s a real beaut. Let’s take it apart…
“In response to the growing opioid crisis, Florida recently implemented a law restricting the duration of opioid prescriptions for acute pain.”
Aside from the fact that opioid use by pain patients (especially short-term) played approximately zero part in the fentanyl epidemic, this statement is fundamentally sound.
“Little is known about the impact of such legislation on opioid prescription practices at the time of discharge after surgery.”
Well, that’s not really true, is it? Plenty is known. Like this…
The number of opioid prescriptions by year (source: CDC) Between 2012-2017 there was a ~30% reduction in opioid prescriptions while during that same time period…
…deaths from any opioid more than doubled. Nice going.
“The objective of this study was to determine whether Florida’s new legislation changed opioid prescription practices for analgesia after surgery.”
Let me get this straight. This is a study to determine whether fewer post-surgical opioid prescriptions were written after a law was passed limiting opioid prescriptions? Duh?
“The proportion of patients receiving opioid prescriptions for longer than a 3-day supply decreased by 68% [after the law passed].”
How can we explain this marked decrease? Here is a section from Florida’s new law, HB 21 Section 456.44 – Controlled Substance Prescribing:
“HB 21 provides that a prescription for a Schedule II opioid for the treatment of acute pain may not exceed a three-day supply.” (2)
Not only does a law that prohibits prescriptions for more than three days decrease the number of prescriptions for more than three days, but it does so by 68%!
Everything I’ve discussed about the U Miami study so far has been merely stupid. But then it gets irresponsible…
“We observed no change in the number of postoperative emergency department visits before and after implementation of the law.”
This statement is one gigantic problem (3). Taken at face value it tells us that everything is fine and dandy – that strict restriction of post-operative opioid scripts has no adverse impact on patients, something that will no doubt be reported by the press. But here’s what it doesn’t address:
- Was there an assessment of post-operative pain?
- Were patients comfortable when the drugs ran out?
- Or did the law merely result in patient suffering?
- Did the law result in an increase in time of recuperation or in secondary complications?
- Is the number of emergency department visits an accurate proxy of patient pain? It is now common knowledge that you are just about as likely get opioids in an emergency department as at a Dairy Queen.
- Was there an increased use of NSAIDs after day 3?
- If so, was there an increase in adverse events due to the NSAIDs?
- Were there additional emergency room visits or hospital admissions for acetaminophen (Tylenol) poisoning?
- When, exactly, did it become acceptable for governments to tell doctors how to do their jobs?
“The legislation should significantly decrease the amount of unused opioid pills potentially available for diversion and abuse.”
…and significantly increase the number of deaths from street fentanyl, as the two graphs above clearly demonstrate.
“Secondary effects from the enactment of this law remain to be evaluated.”
Don’t hold your breath. This study will never be done, and the off-chance it is, it will never see the light of day if the results support anything other than the party line. Do you honestly think that any ideologically-driven academician or opportunistic politician is going to admit that there any downside to a law imposing mandatory limits on anything opioid-related?
No way.
“Whenever you find yourself on the side of the majority, it is time to pause and reflect.”
Mark Twain
Or, if you don’t like Twain, try Orwell…
“If you want a vision of the future, imagine a boot stamping on a human face – forever.”
George Orwell
NOTES:
(1) It is only a matter of time until any of us, our families, or our friends are going to require pain medication and be denied what they need. Given today’s climate of bullying and hysteria, this is inevitable. We are all one illness or accident from being in the same sinking ship that is already overloaded with millions of Americans. One can only hope that the Florida Legislature suffers a massive, collective kidney stone first. And let’s save one for Governor Rick Scott, who signed this atrocity into law in early 2018.
(2) HB 21 provides exceptions where a seven-day supply is permitted but only if certain conditions are met. And these conditions are determined by the prescribing physicians, who are themselves under pressure to stop prescribing. Fox. Henhouse.
(3) Thanks to former ACSH advisor Dr. Jack Fisher, a retired surgeon, for bringing this to our attention.
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we saw our first batch of fraudulent escripts for oxycodone and percocet at my pharmacy this week.
Posted on July 31, 2019 by Pharmaciststeve
Here’s an interesting one. With SureScripts knocking on the doors of all Boards of Pharmacy asking to mandate electronic prescriptions, has anyone else seen fake e-scripts, especially for controls? CP
Phrom a Phriend:
“Here is something to ponder CP. With regulations stating that all CII scripts be e-scripted by 2021,
we saw our first batch of fraudulent escripts for oxycodone and percocet at my pharmacy this week.
The infallible system failed! The Dr was contacted, he is a hospital anesthesiologist, he does not write scripts, yet between 3 stores we received a total of 15 scripts. Thoughts?”
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Chronic pain patients fear new opioid bill could cripple care
Posted on July 31, 2019 by Pharmaciststeve
Chronic pain patients fear new opioid bill could cripple care
BOSTON – A proposed bill is causing panic among those living with chronic pain.
Massachusetts Senators Edward Markey and Elizabeth Warren have not taken a position yet on a new bill in the United States Senate that would effectively limit the medical indications for use of long-acting opioids.
It is barely three pages long but packs a potent punch.
The Federal Drug Administration Opioid Labelling Accuracy Act was filed in the U.S. Senate earlier this month. If passed, advocates say it could have a profound effect on patients living with chronic pain.
Kari Hicks, from Weymouth, had knee surgery six years ago and has been in pain ever since.
“It’s just one more layer of the federal government overreach,” Hicks told Boston 25 News.
The bill, introduced by Senators Joe Manchin of West Virginia and Mike Braun of Indiana, would allow labeling for long-acting opioids only for use in cancer and end-of-life care. But it would also be up to a doctor’s discretion if opiates are considered the best choice for a given patient suffering from chronic pain.
“It’s all lip service,” Claudia Merandi suggests.
She is the founder of the organization “Don’t Punish Pain Rally” and formerly used opiates for pain and other symptoms of Crohn’s Disease.
She says the net effect of the Manchin/Braun bill if passed, will be to virtually end access to opioids for patients with chronic pain.
“No doctor in their right frame of mind will prescribe,” she said. “They see their colleagues being shipped off to prison and they’re not willing to take the chance.”
Hicks says her doctor tapered her off opioids last February, fearful of federal intervention in his practice.
She says she has been living with pain ever since.
“Every day at the end of the day I’m just done,” she said. “I just don’t want anybody around me. I’m grumpy. I want to be part of everything but the pain is just bigger.”
I was at a town hall meeting of Sen Braun on July 8th, 2019 and really couldn’t get him to talk much about the opiate crisis… He is a first term – first year – Senator and mainly wanted to talk about how his company in Jasper , IN .. because of the way they did things their premiums for employees didn’t increase for 10 yrs. Sounds like a case of HIGH COPAYS & DEDUCTIBLES in getting health care.
Sen Manchin, once was talking about introducing a bill that would put a tax/surcharge on pharma opiates to pay for treatment for people dealing with substance abuse.
Neither one of these senators have and medical background… so of course, they are HIGHLY QUALIFIED TO INTRODUCE SUCH A BILL..
So most clinical studies take TEN YEARS or so… and the 1000’s of years that opiates have been used to treat pain… is just a FOOTNOTE in medical history ?
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America Betrayed: Senator Marsha Blackburn (R-TN)
Posted on July 30, 2019 by Pharmaciststeve
Sen Marsha Blackburn Asst Kim Cordell 07-25-2019.wav
audio file above
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Around 25 countries have now removed criminal penalties for the personal possession of some or all drugs in a sign of the global shift toward decriminalization
Posted on July 30, 2019 by Pharmaciststeve
Why Malaysia’s New Proposal Could Change Southeast Asia’s Drugs Debate
Scientific reason broke through the dominant political rhetoric on drugs in Southeast Asia last month. Instead of the “war on drugs” narrative favored by the region’s populists, Malaysia’s government said it was time to put “science and public health before punishment and incarceration” as it proposed decriminalizing personal drug use.
The plan to remove criminal penalties for the possession and use of drugs in small quantities (as opposed to those involved in drug trafficking) is a bold move in a country that currently has some of the world’s most punitive drug laws.When it comes to knowing law and handling cases Tampa DUI lawyer has always great analysis as well as result.
“Malaysia is about to embark on a significant game-changer policy,” Health Minister Dzulkefly Ahmad said in a statement. “An addict shall be treated as a patient (not as a criminal), whose addiction is a disease we will like to cure.”
That the plan was jointly put forward by the health minister and the home affairs minister sent a powerful message of the government’s intent, said Professor Adeeba Kamarulzaman, dean of the Faculty of Medicine at the University of Malaya in Kuala Lumpur.“For decades people who use drugs, whether recreationally or those who have developed an addiction, have been placed within the criminal justice system,” said Kamarulzaman, known for pioneering a harm reduction program among injecting drug users during Malaysia’s HIV epidemic in the 2000s. It’s a “paradigm shift,” she says, to treat rather than punish addiction.
The announcement comes at a time experts are amplifying calls for Asia’s governments to radically rethink their approach to drugs. Data shows the so-called war on drugs has failed. A recent report from the International Drug Policy Consortium (IDPC), reviewing the last decade of drug policies in Asia, said draconian laws and the misplaced pursuit of a “drug-free world” had failed to reduce the scale of the drug market. Instead drug usage had surged, with a devastating impact on people and communities. The greatest increases were observed, IDPC said, for amphetamine-type stimulants — in 2016 they were used by 17.45 million people in Asia, up from 8.74 million in 2011.
By contrast, the evidence that backs up the case for decriminalization seems to be growing stronger. Evidence from around the world suggests that treating problematic drug use as a health issue rather than a criminal one is a more successful model for keeping communities healthy and safe. To take one specific example, since Portugal decriminalized the possession of drugs for personal use in 2001, drug-related deaths have decreased. Analysis by the Transform Drug Policy Foundation also suggests that removing the criminal penalties did not cause an increase in levels of drug use, as had been feared by some.
Malaysia’s proposed decriminalization would move the nation in the direction endorsed by the United Nations, the World Health Organization, and multiple health, legal, and rights experts. Around 25 countries have now removed criminal penalties for the personal possession of some or all drugs in a sign of the global shift toward decriminalization.
Portugal’s success holds important lessons for Malaysia, says Professor Kamarulzaman, pointing to the country’s investment in treatment and support alongside the legal change. “It’s equally if not more important than the actual decriminalization,” she said, adding that Malaysia will “have to train a whole cadre of health professionals and support staff to cope with the demands of different drug users.”
Waiting on the Details
There are several important questions about the shape Malaysia’s proposed reforms would take. It’s still unclear, for instance, what impact changes to the law would have on those presently incarcerated for the personal use of drugs. Disproportionate punishments have led to massively overcrowded prisons in the region. People jailed for drug crimes, many for nonviolent behavior such as drug use and possession, form the majority of prison populations in many Asian countries.
Another major concern surrounds the use of compulsory “rehabilitation” in detention centers, says Gloria Lai, IDPC’s Asia director, who is waiting for more detail on what Malaysia’s reforms would mean for those forcibly detained.
“While we really welcome moves to take a health-based approach to drugs we want to emphasize that this shouldn’t lead to forced rehabilitation,” Lai said. The IDPC estimates that over 450,000 people in Asia are detained in such centers including in Malaysia, Thailand, Cambodia, the Philippines, and China.
Much is still being discussed, according to close observers, about the nature of the proposed reforms. Malaysia is already treading carefully given the sensitivities that can surround decriminalization. The coalition government, which came to power last year on a reform agenda, is particularly taking great pains to emphasize that decriminalization is not legalization. It knows the importance of keeping the broadly conservative public informed on an issue that has the potential for political opponents to launch attacks.
Other Southeast Asian nations have also taken steps toward changing their drug policies in recent years. Thailand, which is still debating decriminalization, has made important health-based reforms. And Myanmar has also moved toward decriminalization for drug use, but still retains prison penalties for possession.
The region at large, however, persists with some of the world’s most draconian drug policies. Nowhere has this been more evident in recent years than in the Philippines. Activists say that at least 27,000 people have been killed since President Rodrigo Duterte took office in 2016 on a platform of crushing drugs. The violent campaign has had reverberations across the region. Neighboring Indonesia is thought to have borrowed Duterte’s language to refuel its own drug wars while rights groups have also observed subsequent emboldened anti-drugs campaigns in Cambodia.
In this landscape, Malaysia chartering a health-oriented path could offer a breakthrough of sorts in the regional discourse surrounding drugs. The fact its ministers are talking about the evidence “instead of resorting to the usual scaremongering about drugs” is significant, said Lai, the regional IDPC director. “It definitely helps to open conversations about alternative approaches to drug use.”
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CALL to action to contact specific Federal Representatives
Posted on July 29, 2019 by Pharmaciststeve
Representatives Bill Foster ( 11th district IL) & Mike Kelly (16th district PA) has introduced an amendment to HR 2470 (Amendment 20) that will require a “unique number” to all pts getting controlled substances. Don’t we already have a unique number called Social Security, some of us have a unique number as in DRIVER LICENSE… some of us have a unique number as in MEDICARE NUMBER.
It has been shown time and again that our unique number has been stolen, duplicated, forged to use our identity for illicit reasons.
We have three unique identifiers that can’t be stolen, duplicated or forged… it is called facial digital recognition, retina scan, digital finger print.
Here is a system that the FAA/TSA is using for IDing people to help them expedite their getting thru the TSA system and to their plane. https://www.clearme.com/
What if our healthcare system adopted such a system to register people within our healthcare system. First encounter with a healthcare provider. The pt is registered with the system and the unique number is shared with the healthcare system EMR (Electronic Medical Record) system. The pt is not provided the unique number, but each time a pt goes to a healthcare provider for service.. they use the same type of kiosk to register at the facility.
When the pt registers at the facility, if there is a PMP record on the pt, a report for the previous 12 months would automatically sent to the provider.
No matter who the pt tells the system that they are on the first encounter.. they will ALWAYS be that person in our healthcare system.. no matter what healthcare provider they go to see.
This is probably what Reps Foster & Kelly have in mind.. they are just don’t know what they really want or need…
Federal Reps will only accept correspondence from people in their district… if you are .. or know someone who is in their district… they need to reach out to convince them that they may have a good idea… just that their implementation is probably won’t work..
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Senior Moment ?
Posted on July 29, 2019 by Pharmaciststeve
An elderly Florida lady did her shopping and, upon returning to her car, found four males in the act of leaving with her vehicle.
She dropped her shopping bags and drew her handgun, proceeding to scream at the top of her lungs, “I have a gun, and I know how to use it! Get out of the car!”. The four men didn’t wait for a second threat. They got out and ran like mad.
The lady, somewhat shaken, then proceeded to load her shopping bags into the back of the car and got into the driver’s seat. She was so shaken that she could not get her key into the ignition.
She tried and tried, and then she realized why. It was for the same reason she had wondered why there was a football, a Frisbee and two 12-packs of beer in the front seat. A few minutes later, she found her own car parked four or five spaces farther down.
She loaded her bags into the car and drove to the police station to report her mistake.
The sergeant to whom she told the story couldn’t stop laughing. He pointed to the other end of the counter, where four pale men were reporting a car jacking by a mad, elderly woman described as white, less than five feet tall, glasses, curly white hair, and carrying a large handgun.
No charges were filed.
The moral of the story?
If you’re going to have a senior moment… make it memorable.
Share this with all your friends to give them a good laugh 😁😁
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Pacific Legal Foundation is a nonprofit legal organization that defends Americans’ liberties
Posted on July 29, 2019 by Pharmaciststeve
https://pacificlegal.org/about/
About Pacific Legal Foundation
Pacific Legal Foundation is a nonprofit legal organization that defends Americans’ liberties when threatened by government overreach and abuse. We sue the government when it violates Americans’ constitutional rights—and win!
Each year, PLF represents hundreds of Americans, free of charge, who seek to improve their lives but are stymied by government. We give them their day in court to vindicate their rights and set a lasting precedent to protect everyone else
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There are rumors that Facebook is going to implement some sort of censorship
Posted on July 29, 2019 by Pharmaciststeve
Facebook’s Implementing New Rules and Processes to Stop the Spread of Harmful Content
Some of my followers/readers have expressed concerns about this and not seeing what I post.. .or what I post get censored/deleted by FB.
Apparently no everyone realizes that what shows up under my name or FB or twitter originally appears on my blog ( www.pharmaciststeve.com) and is automatically copied to FB and twitter.
My WordPress blog has a place on the front page, right column to receive a email when a new post appears on my blog… by simply entering your email address in the appropriate input block.
Also by going to my blog and looking at the left hand column and there is list and links to the recent comments, recent posts, and top posts.
I will have no control over what FB or twitter will do with my posts, but my BLOG is MY BLOG and totally under my control.
Everyone is capable of copying the hyperlink of any single post and share it to where ever they wish to
“liking” a post on FB or twitter only lets FB or twitter to collect more information about your mindset/personality… SHARING – or retweeting – is what makes a idea/concept potentially go viral and make others aware of what is going on or happening.
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