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Democratic presidential candidate Kirsten Gillibrand proposes prescription drug crackdown, prosecution of pharma executives.
Posted on July 24, 2019 by Pharmaciststeve
MASS: Male Addicts are jailed for 90 days without charges
Posted on July 24, 2019 by Pharmaciststeve
Massachusetts’ contentious tactic to fight its opioid crisis: jailing addicts
State is placing persons who are involuntarily committed to treatment – the section 35 process – in jail or prison even though no charges have been levied against them
The scene plays out every day in Massachusetts, thousands of times a year.
A loved one is addicted to opioids. Their life is spinning out of control as they use more and more. Their family panics. Rehab can be unaffordable – and it may require waiting for a spot. But they need to get their loved one somewhere they can’t use before it’s too late.
It’s about now that they might consider section 35, a process in Massachusetts by which persons abusing drugs or alcohol can be involuntarily committed to treatment for up to 90 days after a family member, guardian, law enforcement officer or doctor petitions a judge. Many states have similar laws in place and have turned to them in battling the opioid crisis gripping the nation.
But in Massachusetts, involuntarily committed men can end up in jail or prison even though no charges have been levied against them.
That’s how Jim, a 29-year-old student, arrived at the Hampden county jail in the western Massachusetts town of Ludlow in March after overdosing on opioids. Despite being forced into jail with no charges, he told the Guardian he was glad to be there.
“I’ve never been in trouble with the law, but it was absolutely necessary for a cop to come to the house, put me in handcuffs and take me here,” he said.
Eight days into his stay, he said jail was “the best thing that’s probably ever happened to me”.
As Massachusetts struggles against an opioid crisis that kills five times as many people than automobile accidents every year in the state, the placement of civilly committed men in correctional facilities has emerged as one of the most controversial tactics to confront addiction in the state – and one not seen anywhere else in the nation where a detox facility is the preferred method.
To proponents, the section 35 process is seen as lifesaving, putting people in a place where they absolutely cannot get drugs and where they cannot simply walk out. But its detractors say that forced rehabilitation does not work, that putting men in correctional facilities is unconstitutional and that putting patients in prison settings is detrimental to recovery and increases the risk of relapse once patients are released.
Women were once held in correctional facilities in Massachusetts for addiction, but after an ACLU lawsuit, the state ended the practice in 2016.
But the state has ramped up its incarceration of civilly committed men. According to Prisoners’ Legal Services, a not-for-profit that has been a key opponent of the practice, Massachusetts places more than 2,000 men involuntarily committed for substance abuse in correctional facilities per year.
In March, PLS filed a lawsuit against the department of correction and department of public health on behalf of 10 unnamed patients being held at the Massachusetts Alcohol and Substance Abuse Center (Masac), a facility operated by the DoC in the town of Plymouth.
The lawsuit charges that holding the men in correctional facilities is unconstitutional, constitutes unlawful discrimination on the basis of gender and disability and is overall detrimental to recovery. They also describe an abusive environment where patients are “routinely” humiliated by correctional officers (COs) and where patients lack access to opioid substitution medications such as Suboxone.
“These people are being shamed and stigmatised on the basis of a disease that’s acknowledged as a disability,” said Bonnie Tenneriello, PLS staff attorney.
One of the unnamed plaintiffs said officers called patients pussies, bitches, junkies and crackheads while telling him that his “mother is a whore”.
Another plaintiff described how during detox, his roommate urinated and defecated on himself, but that nobody cleaned it up.
Others described being too afraid to call their employers or loved ones as all phone calls coming from the facility inform the person being called that they are receiving a call from a correctional facility.
PLS says patients have been sent to solitary confinement for seemingly minor offences like smoking a cigarette, not answering questions or taking extra milk with their meals.
“All of that is counter-therapeutic, all of that is traumatising, all of that is telling people you are not a full citizen, you are not to be trusted, you are a bad person,” said Tenneriello of placing patients in correctional facilities.
‘It’s a jail mentality’
Joel Kergaravat, 36, was hooked on heroin and crystal meth when his mother petitioned him to be sectioned last summer. They both thought that sectioning him would mean rehab, but instead he was put in restraints and loaded into a hot van for a long drive to Masac.
His experience at Masac appeared to mirror allegations laid out in the lawsuit.
Once he got to Masac, he did not have access to detox medications. “It’s barbaric not to give people that medication, because you’re basically vomiting and shitting yourself for six days,” he said. “That’s what happens. It’s not pretty.”
Inside, he said guards were abusive. He felt the place was unsanitary and unclean and worried about getting sick. Patients would get into fistfights.
“It’s a jail mentality,” he said. “They have you in a prison setting so people act accordingly.”
When he got out, he was traumatized. He got back on drugs and at one point tried to kill himself by overdosing – a result, he says, of his experience at Masac.
“If you’re going to force people into treatment, that’s fine, put them into treatment,” he said. “You can’t just rename a prison or a section of a prison and call it treatment.”
A sheriff champions section 35
The Hampden county sheriff, Nick Cocchi, might be the biggest proponent of section 35 in the state.
Cocchi views his mission as a rehabilitative one. His COs don’t carry weapons of any kind and those on the section 35 wing don uniforms consisting of polo shirts – an attempt to look less guard-like. He keeps a folded, ageing piece of paper in his pocket that lists the names of those that have died at the jail in the 26 years he has been working there. When western Massachusetts residents call him and send him Facebook messages pleading for advice about loved ones who have been trapped by addiction, he invites them to his office, even if it is a weekend. Men who have previously been sectioned call him up when they are relapsing.
Cocchi says that when done right, forced rehab works.
His enthusiasm about section 35 was born out of a desire to provide treatment closer to home for residents of western Massachusetts.
“You serve no purpose taking somebody two and a half hours from home, detoxing them and then saying ‘here’s a bus ticket to get back to where you’re going.’ Where’s the support?” he said. “There’s no support. And when there’s no support, there’s relapse.”
He said the kind of abusive treatment outlined against Masac in the lawsuit brought by PLS doesn’t happen at his jail. He said that there need to be reforms to the section 35 process, but that his facility is “second to none” in the state.
Recently the gregarious sheriff brought the Guardian into the section 35 wing, walking in with a five-month-old bull mastiff puppy named Brooklyn.
“What’s up guys?” he beamed at the patients – or “clients” as they are referred to in the jail administration’s parlance. “I don’t want anyone to panic – this is not a drug sniffing dog!”
The wing appeared clean and orderly. The patients wore a uniform of brown pants and yellow or blue T-shirts with inspiring mottos like “recovery works” and “one day at a time” on them. They appeared friendly with the sheriff and the COs, stopping them to share their thoughts and concerns about their time on the unit.
Several patients eagerly lined up to speak to the Guardian about their experience at the jail, all saying positive things. Many were optimistic that being closer to home, having counseling about their discharge plan and having access to advice after they were out would mean it would be easier to stay off drugs or alcohol once released.
Some had spent time at Masac in Plymouth and said their current surroundings were much better.
Jim, the 29-year-old student who was sectioned after an overdose, said: “The COs don’t treat you like inmates, they treat you like a patient essentially.”
The wing has only been receiving section 35 patients since May, but Cocchi says he is confident that statistics will eventually show that his program has a higher success rate than any other treatment facilities.
“There’s also a group out there that says forced treatment doesn’t work – when you force someone to go into treatment, it doesn’t work,” he said. “That is absolutely false.”
If people trying to put an end to correctional facilities holding civilly committed men are successful, Cocchi says “they will devastate the commonwealth of Massachusetts, specifically western Massachusetts right now … And I will not lay down on that.”
‘Setting them up to die’
But opponents of jailing section 35 patients say that even if the abuses laid out against Masac are not present at a correctional facility, keeping civilly committed men there is wrong and dangerous.
“No matter how well run any prison might be, we’re saying that it’s a disease,” said Tenneriello, the PLS attorney. “Putting people in prison because they have a disease is fundamentally wrong”
Leo Beletsky, an associate professor of law and health sciences at Boston’s Northeastern University is an expert on the opioid epidemic and sits on the state’s section 35 commission.
He points to studies, like one by the Massachusetts department of public health, that show that persons recently released from incarceration are 120 times more likely to die of an opioid overdose than members of the general public.
“By putting people in correctional settings, we’re essentially setting them up to die,” he said.
Physician Sarah Wakeman, an addiction medicine specialist and medical director of the Substance Use Disorders Initiative at Boston’s Massachusetts general hospital, said those leaving forced rehab are at particular risk for overdosing given they did not want to be there in the first place and have lowered their tolerance.
To Wakeman, more focus needs to be placed on making sure that voluntary treatment for substance abuse is more readily accessible.
“The reality is that tough love is not a useful intervention to help a person suffering from addiction,” she said.
Beletsky said the section 35 system remains popular as it is much easier to access than voluntary treatment programs.
“Section 35 in many ways is the path of least resistance for getting into treatment,” he said. “It’s immediate, it’s free, it requires no navigation.”
It “illustrates how broken our systems of care are,” he said. “In many ways it’s easier to put somebody away than have them access normal healthcare.”
Putting someone in jail and totally abstaining from their drug of choice.. when they are discharged, their opiate tolerance will be very near to what is normally considered a “opiate naive” person. When they go back to the environment from where they came and is influenced to go back using their drug of choice and if they try and use the same amount… they will most like OD because of little/no tolerance that they had when regularly using.
“abstinence rehab” has a 5% success rate because they were addicted in the first place. All likelihood, they had a legal prescription for a opiate for an acute pain episode and they abruptly stop the opiate because the prescriber gave them too many doses and when they stopped they had become “dependent” and start going into withdrawal… All they, their family and friends know is what the media reports every night that “those opiates” are HIGHLY ADDICTIVE.
So if the person took opiates and went into withdrawal when they stopped the opiates.. THEY MUST BE ADDICTED. So they go to rehab and after week or so… they have “dried out” have no desires to take opiates again, but they are now labeled as an “addict in recovery”. Which the person will never be able to eradicate from their medical records for the rest of their life.
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Sickle cell “flare” can be VERY PAINFUL
Posted on July 24, 2019 by Pharmaciststeve
https://www.cdc.gov/ncbddd/sicklecell/data.html
The exact number of people living with SCD in the U.S. is unknown. Working with partners, the CDC supports projects to learn about the number of people living with SCD to better understand how the disease impacts their health.
It is estimated that:
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- SCD affects approximately 100,000 Americans.
- SCD occurs among about 1 out of every 365 Black or African-American births.
- SCD occurs among about 1 out of every 16,300 Hispanic-American births.
- About 1 in 13 Black or African-American babies is born with sickle cell trait (SCT).
Since Sickle Cell disease is almost totally a health issues that affects people of color … could this particular physician being violating both the Civil Rights Act (1964) and the Americans with Disability Act (1990) ?
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When DEA NUMBERS… don’t always “reflect reality”
Posted on July 23, 2019 by Pharmaciststeve
Small-town America does have an opioid problem, but not in this Alabama town
Gilbertown welcomes you.
That’s the simple message greeting visitors to this picturesque town of about 200 people, delicately placed inside less than one square mile of southern Choctaw County and seemingly designed to make you feel as nostalgic as possible.
It’s that version of small-town America we all hope to find when we take a random right turn on the interstate. Gilbertown is like apple pie and white picket fences. The sort of place where you expect to see a lemonade stand in every neighborhood. It’s kids playing in streets against a backdrop of beautifully manicured lawns and American flags fluttering in the wind.
And of course, everyone’s doors are unlocked, so they say.
Gilbertown has, for now at least, retained a unique charm that cannot be said for so many similar sized towns across the country, apparent victims to the unique demands of 21st century life. When jobs leave, so do the people.
But this snippet of traditional southern life, nestled quietly on either side of state road 17 about eight miles from the Mississippi line, has managed to keep its mom-and-pop stores open against national trends. It still has a newspaper, if you can believe that. Hunting camps dominate the vast forests in the area, while a nearby paper mill provides jobs to a large number of locals.
Despite what it does have going for it, Gilbertown is unfortunately not immune to another increasingly familiar aspect of small-town American life: its recently reported relationship with opioids.
Over a seven-year span starting in 2006, a single pharmacy dispensed 1.3 million pain pills to patients, placing it retrospectively at the heart of the opioid crisis in Alabama, according to recently released federal data obtained by the Washington Post. The D&L pharmacy, which has been closed for about six years and is now an insurance business, later sold its dispensary business to the Hometown Pharmacy, located about 200 feet away.
While the overall figure of opioids dispensed does appear alarming, the current owner of the Hometown Pharmacy told AL.com that the initial calculations made, apportioning as many as 928 pills to each of the 200 residents over the seven years, is misleading.
“The simple issue is that the pharmacy wasn’t just used by people who live in this town,” said Cole Floyd. “During that time the pharmacy was the only one in southern Choctaw County. While it’s hard to make accurate calculations, each of the three pharmacies in the county probably had as many as 4,500 people using them.
“That drastically changes the number of people per person receiving pills,” he added.
Based on Floyd’s rough number, each person using the pharmacy received about 41 pills a year over seven years. He admitted that some of those people could have had issues, but insisted that the volumes dispensed were not unusually high.
But Floyd also said that had the number of opioids dispensed been over any legal limit, the Drug Enforcement Agency would have likely visited D&L. “At the end of each day, our computer uploads data regarding the number of controlled drugs bought and sold by us in any given day. That includes opioids and other controlled drugs. If that number is above [a certain] percent of all controlled drugs [dispensed], not just opioids, then we would expect a visit from DEA.”
Floyd also said that the wholesale drug companies also had to report sales to the DEA and that his store policy was to not dispense drugs for people who are from outside of Choctaw County. Along with a database for each patient, the strict dispensary controls help his team prevent addicts who are “doctor shopping,’ which is when people visit multiple doctors to maximize the amount drugs they can obtain.
The former owners of the D&L Pharmacy continue to operate drug stores in Birmingham, according to Floyd.
While Floyd had read The Washington Post story, not everyone in Gilbertown was aware of the town’s top rank in state. Indeed, Gilbertown was the only town in south Alabama to make the top 10 list for opioid pills per capita. Most of the heaviest pain pill use in state occurred in the hills of north Alabama, especially in Walker County and other neighboring counties northwest of Birmingham.
In Gilbertown on Monday, Summer Turner, who was working a shift at Magnolia Traditions clothing store, said she had never heard of people abusing any kind of drug in the town. “I’ve been here for 20 years and I don’t remember any trouble like that here,” she said, adding that she doesn’t often lock her door.
Fifty feet away at the Heavenly Creations book store, which also sold flowers, gifts, rental tuxedos, and doubled as a small church, Minister Shirley Pearson said she was also not aware. “I’ve never felt like this is a place where that happens or where people feel fear,” she said. “I suppose I am upset that outsiders are suggesting we have a problem here. We have a lot of spirituality and people sometimes pull over while on road trips to come pray. We turn no one away.”
A stone’s thrown from Pearson’s church is a monument to one of Gilbertown’s past glories and a reasons tourists still visit the town. It was the first place in Alabama to successfully drill for oil all the way back in Jan 1944 and the reason the state started its oil and gas board. At the base of a tall drilling rig monument, which no longer works and was moved about a mile from where the original drilling began, two fresh faced teens diligently worked at a snow cone hut.
“What’s an opioid?” said Hudson Abston,18, while standing next to his colleague and fellow Southern Choctaw High School graduate Emily Phillips, 17. “We don’t get a whole lot of trouble around here. There was a couple of robberies about two years ago,” he added excitedly.
At the rear of the snow cone hut, next to a restored caboose and memorial fountain, and not far from the spotless public bathroom, you’ll find the mayor and police chief’s office. The police chief has two officers working under him and a third part-time officer due to start Tuesday, said Mayor Billy C. May, currently in his first term as mayor after being elected three years ago.
“The new cop isn’t being hired because of the drugs,” joked Mayor May. “I know that this country has problems with these drugs, but that’s not an issue in this town.
“We are a rural town, but we serve as a hub and a destination for thousands of people who live in other rural areas here in Choctaw County. We have people coming from as far as Philadelphia [Mississippi] to use our two medical facilities.”
May said that the downtown medical facility, Franklin Primary Health Center, receives about 25 to 50 patients a day. “They are packed five days a week and sometimes open on Saturdays,” he said, suggesting that the perceived high level of opioid dispensed in the town was due to the large numbers of people coming from out-of-state and other areas of the county.
“People like this town and we’re doing well. We’re growing,” said Mayor May. “We have a county museum, the old oil well, and we have a picture of a dinosaur that was dug up here years ago. It’s in the Smithsonian now. It was a fish dinosaur I think, about 85 feet long.”
But the excitement doesn’t end there.
“We have a Verizon tower coming soon,” he added.
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Overzealous use of the CDC’s opioid prescribing guideline is harming pain patients
Posted on July 22, 2019 by Pharmaciststeve
www.statnews.com/2018/12/06/overzealous-use-cdc-opioid-prescribing-guideline/#comments
During the recent Interim Meeting of the American Medical Association, the organization’s president, Dr. Barbara McAneny, told the story of a patient of hers whose pharmacist refused to fill his prescription for an opioid medication. She had prescribed the medication to ease her patient’s severe pain from prostate cancer, which had spread to his bones. Feeling ashamed after the pharmacist called him a “drug seeker,” he went home, hoping to endure his pain. Three days later, he tried to kill himself. Fortunately, McAneny’s patient was discovered by family members and survived.
This story has become all too familiar to patients who legitimately use opioid medication for pain.
Since the Centers for Disease Control and Prevention published its guideline for prescribing opioids for chronic pain in March 2016, pain patients have experienced increasing difficulty getting needed opioid medication due to denials by pharmacists and insurance providers.
More troubling are recent press reports, blog posts, and journal articles that describe patients being refused necessary medication or those dismissed by their treating physicians, who practice in fear of regulatory reprisal. At the interim meeting, the AMA responded to these developments, passing several resolutions against the rash of laws and mandatory policies that limit or prevent patient access to opioid painkillers.
The CDC designed its guideline as non-mandatory guidance for primary care physicians. But legislators, pharmacy chains, insurers, and others have seized on certain parts of its dosage and supply recommendations and translated them into blanket limits in law and mandatory policy. Today, in more than half of U.S. states, patients in acute pain from surgery or an injury may not by law fill an opioid prescription for more than three to seven days, regardless of the severity of their surgery or injury.
Although many of these laws exempt patients with chronic or cancer pain, in practice they often affect those with long-term pain, like McAneny’s patient. Some insurance companies and major pharmacy chains, like Walmart, Express Scripts, and CVS, also have mandatory restrictions on the opioid prescriptions they will fill. In addition to imposing supply limits, insurers and pharmacies are increasingly using the CDC’s dosage guidance (the equivalent of 50 to 90 milligrams of morphine a day) as the basis for delaying or denying refills for long-term pain patients, even though the CDC guidance is intended to apply only to patients who have not taken opioids before.
The Drug Enforcement Administration and some state medical boards are also using this dosage guidance in ways that were never intended, such as a proxy or red flag to identify physician “over-prescribers” without considering the medical conditions or needs of these physicians’ patients. As a result, some physicians who specialize in pain management are leaving their practices, while others are tapering their patients off of opioids, solely out of fear of losing their licenses or criminal charges.
The laudable goal of these laws and policies is to stem the tide of unprecedented overdose deaths and addiction in the U.S. But here are three interesting facts: Opioid prescribing is currently at an 18-year low. The rate of prescribing opioids has dropped every year since 2011. Yet drug overdose deaths have skyrocketed since then.
Recent data from the CDC suggests that illegally manufactured fentanyl, its analogs, and heroin are responsible for well over half of all overdose deaths. Stimulants like cocaine and methamphetamines are responsible for another third. Deaths related to prescription opioids come next in line, although many of those who died were not the intended recipient of the prescribed medication. In addition, most deaths involve multiple substances that are used in combination, often including alcohol.
The vast majority of people who report misusing prescription opioids did not get them from a doctor under medical supervision, and as many as 70 percent reported prior use of substances like cocaine and methamphetamines.
Conflating the misuse of opioids with their legitimate medical use, and treating all opioids — illegal or prescription — alike is stigmatizing patients for whom opioid painkillers are necessary and medically appropriate.
There’s no question that taking opioid medications carries risks: The CDC places the risk of addiction with the long-term use of opioids at 0.07-6 percent. The risk of addiction justifies judicious prescribing, trying other forms of treatment before prescribing opioids, and carefully screening patients for a history of addiction and mental health issues when opioids are being considered.
But most patients who use opioid medication for pain do not become addicted, although they may develop physical dependence. Addiction is the compulsive use of a substance despite adverse consequences. Appropriate medical use is just the opposite, use on a set schedule as prescribed with benefits to health and function.
Nearly 18 million Americans currently take opioids long-term to manage pain; many of them have complex medical conditions. When appropriately prescribed opioids are denied, patients whose pain has been well-managed by them may experience medical decline, lose the ability to work and function, and resort to suicide. Denying opioids to patients who have relied on them — sometimes for years — may cause some to turn to street drugs, thereby increasing their risk of overdose.
Dr. Terri Lewis, a researcher and rehabilitation specialist, recently conducted a nationwide survey of 3,000 pain patients. More than half of those surveyed (56 percent) reported disruptions in care or outright abandonment by their physicians. Among those reporting disruption or abandonment, many experienced adverse health consequences (55 percent) as well as hopelessness or thinking about suicide (62 percent) as a result. In other surveys, physicians said that they were prescribing fewer opioids or ceasing treatment of pain patients altogether because of regulatory scrutiny, even in cases where they believed that doing so would harm their patients.
The CDC guideline and its progeny of laws and policies have created chaos and confusion in the medical community. Some physicians are telling their patients that changes in the law are the reason they are tapering them to a preset dosage of opioids or off of opioids altogether. Yet the specific dosage thresholds in the CDC guideline were never intended to apply to patients currently taking opioids. Indeed, nothing in the current legal or regulatory environment justifies forcibly tapering a patient off of opioids who is doing well, and there is no solid evidence to support such a practice.
Some physicians are also using the CDC’s dosage thresholds, or simply their patients’ use of opioids, as a reason for abandoning them. Abandoning pain patients out of fear of regulatory reprisal may violate a physician’s ethical duty to place a patient’s welfare above his or her own self-interest. If serious harm results from abandoning a patient’s care, it may also serve as a basis for discipline or malpractice claims. In addition, physicians and pharmacies have responsibilities under the Americans with Disabilities Act not to discriminate on the basis of a patient’s condition, including chronic pain, or a perceived condition, as when a person with pain is erroneously regarded as a person with opioid use disorder or addiction when there is no clinical basis for that perception.
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CHRONIC ILLNESS & RELATIONSHIPS
Posted on July 21, 2019 by Pharmaciststeve
CHRONIC ILLNESS & RELATIONSHIPS
https://www.youtube.com/watch?v=wYXEJN_ozM8&feature=youtu.be
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Having HEALTH INSURANCE is NO GUARANTEE of actually getting HEALTHCARE SERVICES
Posted on July 21, 2019 by Pharmaciststeve
Study: 40% of Doctors Refuse New Chronic Pain Patients Using Opioids
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Many/most of the people who are running in the Democratic primary claim that healthcare is a RIGHT…. They are promoting “Medicare for all” but what they are describing is “Medicaid for all” because they are talking about services covered from “first dollar” which describes MEDICAID and no one is mentioning monthly premiums, deductibles and co-pays to be paid by the pt which is the norm for Medicare.
Shouldn’t these potential Presidential candidates be pressed to answer if they will make the DEA do their job of stopping illegal drug traffic because the illegal drugs (illegal Fentanyl, meth, cocaine) is what is causing the majority of the OD’s. They should also go after the diverters conning prescribers and does “healthcare for all” include that all substance abusers are entitled to treatment ? What they are promising – in generalities – has a lot of components that should be inclusive. Should those who are making these promises … should their feet be held to the fire to expand the details of what their version of “Medicare for all” really means ?
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Study: 40% of Doctors Refuse New Chronic Pain Patients Using Opioids
Posted on July 21, 2019 by Pharmaciststeve
Study: 40% of Doctors Refuse New Chronic Pain Patients Using Opioids
“Insurance status and whether the clinic provided for treatment of (opioid use disorder) were not associated with willingness to accept the new patient taking opioids,” according to the study, published in the online Journal of the American Medical Association.
In the national fight against opioid abuse, policymakers and politicians have deployed a range of strategies, including curbing access to the powerful prescription drugs. The logic: Stop addiction before it starts by restricting the amount of painkillers a patient can take.
But a new paper published Friday presents strong evidence that opioid users who take the drug for chronic pain — but show no signs of addiction — are suffering harmful, potentially deadly consequences of the crackdown, and are at risk of becoming “opioid refugees.”
Slightly more than 4 in 10 doctors’ offices refused to take on new patients who need opioids to control pain, according to the analysis, published in the online Journal of the American Medical Association.
That reluctance, the paper argues, could lead patients who use the drug responsibly as well as those who are addicted to seek out other ways to manage their condition — including illegal potentially dangerous substances like heroin — and increases their risk of suicide.
The results “are concerning not only because they demonstrate how difficult it may be for a patient with chronic pain to find a new primary care physician, but it also raises questions about what happens next,” says Dr. Pooja A. Lagisetty, an internist and researcher at the University of Michigan Institute for Healthcare Policy and Innovation. Lagisetty was the lead author of the paper, “Access to Primary Care Clinics for Patients With Chronic Pain Receiving Opioids.”
“Where will these patients find relief for their pain? Will they turn to more dangerous illicit opioids?” says Lagisetty. If those patients can’t get a primary care doctor, she adds, “who will manage their other medical problems such as their diabetes and hypertension?”
The situation is likely due to “a combination of factors,” Lagisetty says, including “new regulations (on opioid prescriptions) that are time-consuming (for doctors) to comply with” as well as medical liability, and “stigma against patients with chronic pain.”
Looking to examine whether medical practitioners were willing to take on patients who use opioids — and continue writing prescriptions for them — researchers contacted more than 190 doctor’s offices and clinics in Michigan between June and October of last year.
Following a script, the callers told the medical-care provider that they were the child of a woman who needed a primary-care physician, but “before we get too far, is it OK if my mother takes opioids for pain?”
Of 194 clinics, “40.7% stated that their practitioners were not willing to provide care for new patients taking opioids,” compared to 41% who were willing to schedule an initial appointment, according to the study. Seventeen percent of the clinics wanted more information before deciding whether to accept the patient, but after receiving the information only one agreed to treat her.
“Insurance status and whether the clinic provided for treatment of (opioid use disorder) were not associated with willingness to accept the new patient taking opioids,” according to the study. “However, larger clinics with more practitioners and community health centers were more than willing” to take on an opioid-using patient.
The results could reflect “practitioners’ discomfort with managing opioid therapy for chronic pain or treating patients with OUD as a result of pressures to decrease overall opioid prescribing,” the study says. Further, “our study found that a low number of clinics provided any medications for treatment of” opioid addiction, “and a large number of front-desk staff at clinics … did not know whether their clinic offered OUD treatment.”
Lagisetty found the results surprising “because I expected it to be around 25%” of clinics who wouldn’t take on opioid-using patients. “Forty percent was much higher than I thought it would be.”
For patients, “I think that is still really problematic,” she says. “It’s hard to build a trusting relationship with your doctor to treat your other medical conditions if you feel like your doctor is not willing to address your pain.”
“As a primary care physician, I will often see new patients who say that their previous doctor just stopped prescribing opioids for them,” Lagisetty says. “When I ask why, many will say that the doctor said it was a new ‘policy.’ We see stories about abandoned patients all over the news, and I also think we talk a lot about stigma against patients with addiction, but there is also stigma against patients with pain.”
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FDA warning: non-aspirin nonsteroidal anti-inflammatory drugs (NSAIDs) increase the chance of a heart attack or stroke
Posted on July 21, 2019 by Pharmaciststeve
FDA Drug Safety Communication: FDA strengthens warning that non-aspirin nonsteroidal anti-inflammatory drugs (NSAIDs) can cause heart attacks or strokes
The U.S. Food and Drug Administration (FDA) is strengthening an existing label warning that non-aspirin nonsteroidal anti-inflammatory drugs (NSAIDs) increase the chance of a heart attack or stroke. Based on our comprehensive review of new safety information, we are requiring updates to the drug labels of all prescription NSAIDs. As is the case with current prescription NSAID labels, the Drug Facts labels of over-the-counter (OTC) non-aspirin NSAIDs already contain information on heart attack and stroke risk. We will also request updates to the OTC non-aspirin NSAID Drug Facts labels.
Patients taking NSAIDs should seek medical attention immediately if they experience symptoms such as chest pain, shortness of breath or trouble breathing, weakness in one part or side of their body, or slurred speech.
NSAIDs are widely used to treat pain and fever from many different long- and short-term medical conditions such as arthritis, menstrual cramps, headaches, colds, and the flu. NSAIDs are available by prescription and OTC. Examples of NSAIDs include ibuprofen, naproxen, diclofenac, and celecoxib (see Table 1 for a list of NSAIDs).
The risk of heart attack and stroke with NSAIDs, either of which can lead to death, was first described in 2005 in the Boxed Warning and Warnings and Precautions sections of the prescription drug labels. Since then, we have reviewed a variety of new safety information on prescription and OTC NSAIDs, including observational studies,1 a large combined analysis of clinical trials,2 and other scientific publications.1 These studies were also discussed at a joint meeting of the Arthritis Advisory Committee and Drug Safety and Risk Management Advisory Committee held on February 10-11, 2014External Link Disclaimer.
Based on our review and the advisory committees’ recommendations, the prescription NSAID labels will be revised to reflect the following information:
- The risk of heart attack or stroke can occur as early as the first weeks of using an NSAID. The risk may increase with longer use of the NSAID.
- The risk appears greater at higher doses.
- It was previously thought that all NSAIDs may have a similar risk. Newer information makes it less clear that the risk for heart attack or stroke is similar for all NSAIDs; however, this newer information is not sufficient for us to determine that the risk of any particular NSAID is definitely higher or lower than that of any other particular NSAID.
- NSAIDs can increase the risk of heart attack or stroke in patients with or without heart disease or risk factors for heart disease. A large number of studies support this finding, with varying estimates of how much the risk is increased, depending on the drugs and the doses studied.
- In general, patients with heart disease or risk factors for it have a greater likelihood of heart attack or stroke following NSAID use than patients without these risk factors because they have a higher risk at baseline.
- Patients treated with NSAIDs following a first heart attack were more likely to die in the first year after the heart attack compared to patients who were not treated with NSAIDs after their first heart attack.
- There is an increased risk of heart failure with NSAID use.
We will request similar updates to the existing heart attack and stroke risk information in the Drug Facts labels of OTC non-aspirin NSAIDs.
In addition, the format and language contained throughout the labels of prescription NSAIDs will be updated to reflect the newest information available about the NSAID class.
Patients and health care professionals should remain alert for heart-related side effects the entire time that NSAIDs are being taken. We urge you to report side effects involving NSAIDs to the FDA MedWatch program, using the information in the “Contact FDA” box at the bottom of the page.
Drug Safety Communication (PDF- 84KB)
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Calling all civil rights and personal injury attorneys
Posted on July 20, 2019 by Pharmaciststeve
This office practice seems to be making a public statement that they are going to segregate the care that all pts with chronic health issues are dealing with.. EXCEPT those who are dealing with chronic pain.
So are the prescribers in this practice … when dealing with a pt that has a health issue where chronic pain is part of the disease… think Lupus, MS, RA and other serious.. even life threatening diseases and these health issues are NOT CURABLE… at best .. they can only be managed and part of that management should be the pain associated with those health issues. Whеn a person hаѕ experienced аn injury duе tо thе negligence оf аnоthеr party іt іѕ a vеrу good decision tо speak wіth a lawyer whо specializes іn personal injury. Personal injury lawyers like the ones at personal injury law firm Schaumburg аrе available tо assist thеіr clients whо hаvе bееn injured аѕ a result оf carelessness оf аnоthеr person оr business. For professional and experience attorney visit to Brasure law firm. Edinburg personal injury lawyer is best for your case.
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Whoever came up with this policy did not consult any attorney – or consulted an attorney that has little/no knowledge about the Americans with Disability Act or the attorney advised the practice that no pt would file a complaint or file a lawsuit… as if the pts are NOT THAT SMART ?
I hope that the pts that patronize this practice that the practice is fairly large or owned by a large hospital corporation… because both of those entities are likely to have DEEP POCKETS .. and that is what attorneys look for… DEEP FINANCIAL POCKETS.
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