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Chronic pain pt asking LA of Senator Rubio to co-sponsor a bill reverse CDC guidelines
Posted on July 17, 2019 by Pharmaciststeve
A Visitor from the Past
Posted on July 17, 2019 by Pharmaciststeve
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Class Action Lawsuit Slams UnitedHealthcare for Denying Drug Addiction Treatment While Millions of Americans Die from the Disease
Posted on July 17, 2019 by Pharmaciststeve
Class Action Lawsuit Slams UnitedHealthcare for Denying Drug Addiction Treatment While Millions of Americans Die from the Disease
SANTA ANA, CA–On average, 130 Americans die every day from an opioid overdose.
In 2017 alone, California lost 2,196 lives to the opioid epidemic.
Drug overdoses now cause more deaths than either car accidents or guns.
There is now a critical need for access to treatment for substance use disorders. Addiction is recognized as a chronic, relapsing brain disorder characterized by compulsive drug seeking, continued use despite harmful consequences, and long-lasting changes in the brain. Timely access to life-sustaining and life-saving treatment and continuing care for substance use and mental health disorders is critical to preventing unnecessary deaths, and allowing people to achieve long-term recovery and return to their families, friends and communities as healthy, productive and contributing members of society. Without treatment and engagement in recovery activities, addiction is progressive and can result in unemployment, homelessness, disability and premature death.
Ryan S. recognizes the necessity of timely access to treatment and continuing care for successful recovery, and he has experienced the demoralizing effect of insurance company exclusions and limitations on coverage. That is why on behalf of all persons who have suffered with substance use and mental health disorders and were denied treatment, Ryan is suing UnitedHealthcare for engaging in what he alleges to be an unlawful, institution-wide, pattern and practice of delaying, denying and underpaying claims for substance use disorder and mental health treatment despite the UnitedHealthcare plans specifically providing for benefits. The class action lawsuit in the United States District Court for the Central District of California, entitled Ryan S. v. UnitedHealth Group, Inc., et al., Case No. 8:19-cv-01363, was filed on July 11, 2019, by Ryan’s attorneys, Callahan & Blaine of Santa Ana, California.
The lawsuit describes seven company practices by UnitedHealthcare that Ryan’s lawyers allege were designed to deprive patients access to essential health care benefits in violation of a number of federal laws, including the Patient Protection and Affordable Care Act of 2010 (“PPACA”), 42 U.S.C. §§ 18001, et seq.; the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA), 42 U.S.C. § 300gg-26; and the Employee Retirement Income Security Act of 1974 (“ERISA”), 29 U.S.C. §§ 1001 et seq. The plaintiffs are asking the court to order UnitedHealthcare to change its practices going forward in conformity with federal law, and to remedy the effects of its past wrongful conduct.
Traditionally, the lawsuit explains, insurers have covered treatment for mental health conditions, including substance use disorders, less favorably than treatment for physical health conditions, including higher cost-sharing obligations for patients, more restrictive limits on the number of inpatient days and outpatient visits, and more onerous prior authorization requirements. That was supposed to change with passage of the MHPAEA, but has not been the case as explained by Ryan Hampton, national addiction recovery advocate, author of American Fix, and opioid addiction survivor himself.
“Parity violations aren’t the exception, they’re the rule in our country. For too long, big insurance companies – like United Healthcare – have gotten away with nothing short of murder. The name of their game is to deny basic medical care for substance use disorders at all costs – even if that cost is a human life. Over the past four years, I’ve lost over two dozen friends to preventable overdoses, people I loved and cared about. Many of them sought treatment multiple times, using their UnitedHealthcare PPO plans, only to be told their condition wasn’t medically necessary for treatment. Big insurance is playing Russian roulette with our lives. It’s time to hold them accountable. This lawsuit represents a massive step forward in raising the curtain on these deadly violations and starts to hold them accountable.”
Damon Eisenbrey of Callahan & Blaine, an expert on legal matters impacting the treatment industry, explained what’s at stake with this lawsuit. “Substance use disorder treatment is difficult and oftentimes involves cycles of recurrence and remission before long-term recovery is realized. We’re seeing insurance companies like UnitedHealthcare imposing access barriers at the patient’s initial request for treatment authorization. For those lucky and persistent enough to receive authorization, they face further exclusions and limitations on coverage that essentially deny the patient the treatment needed to recover. We intend to expose UnitedHealthcare’s objective to deny and limit coverage, in violation of industry standards and in pursuit of profits.”
Asked why he has sued the $150 billion insurance giant, Ryan S. stated, “I am alive today, clean and sober, because I was able to access the treatment I needed to fight my addiction. But I had to not only fight the demons of my addiction on my road to recovery, but also my insurance company, UnitedHealthcare. When an addict finally becomes willing to seek treatment, that window of opportunity is barely open and only for a moment. That window shouldn’t be slammed shut by insurance companies like UnitedHealthcare. I’m taking on this multi-billion dollar insurance company to tear down the barriers they’ve constructed to block patient access to treatment.”
Unfortunately for too many, there is no way to remedy the fatal effects of denied access to treatment. Jodi Barber, community advocate and Executive Producer of “Overtaken” and “Overtaken 2: Where Are They Now,” explains.
“As a mother who lost her 19-year-old son and three of his close friends in the same year, I know the importance and urgency of providing affordable, long-term treatment when someone with substance use disorder wants help. I receive calls every day from parents and from young adults desperate for help and it’s not available because of the high cost of insurance coverage or the fact that insurance won’t cover their treatment. Addiction is a brain disease and should be treated like any other disease. Deaths are occurring because of the lack of coverage.”
Leading health care attorney, Rich Collins of Callahan & Blaine, added that, “Despite the obvious public health interests, UnitedHealthcare is blatantly refusing to follow the law. And they’re doing it in the middle of an opioid epidemic! With this lawsuit, we intend to hold them responsible for their conscious disregard for the health and safety of its members like Ryan S. and for placing profits over patient care in a life and death situation.”
For more information, contact: Laurali Kobal, Firm Administrator, 714-241-4444, Laurali@callahan-law.com
ABOUT RICHARD T. COLLINS: Mr. Collins is known for being an aggressive trial attorney who has been named to the list of Super Lawyers each year since 2015. Rich has been lead counsel in over 25 jury and court trials in federal and state courts throughout California and elsewhere. He is a litigator with extensive experience in the areas of insurance recovery, coverage and bad faith, and has recovered millions of dollars for his policyholder and health care provider clients through verdicts and settlements. 714-241-4444, rcollins@callahan-law.com
ABOUT DAMON D. EISENBREY: Mr. Eisenbrey is a Senior Attorney at Callahan & Blaine. He has extensive experience in complex business litigation involving unfair methods of competition and unfair and deceptive business acts or practices, and is regarded as an expert on legal matters affecting the substance use disorder treatment industry. Mr. Eisenbrey also represents insurance policyholders and health care providers in individual and class action insurance recovery, coverage and bad faith matters, and he prosecutes and defends cases in state and federal court. 714-241-4444; deisenbrey@callahan-law.com.
ABOUT CALLAHAN & BLAINE: Founded in 1984, Callahan & Blaine is California’s Premier Litigation Firm with record-breaking verdicts and settlements in all areas of complex litigation. With a current roster of more than 28 trial lawyers experienced and focused in virtually all civil practice areas, Callahan & Blaine offers civil litigants an impressive set of credentials and client service values. Our attorneys have more than 700 years of trial experience, and since 2003, our verdicts and settlements add up to over $1.0 billion. Our law firm represents consumers and corporate, professional and entrepreneurial clients of all sizes. https://www.callahan-law.com/
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Surgeon General Backpedals on Flawed Tylenol Study. Because of ACSH
Posted on July 17, 2019 by Pharmaciststeve
Surgeon General Backpedals on Flawed Tylenol Study. Because of ACSH.
Fireworks can be an awful lot of fun on July 4th, but not so much if they blow up in your face. Unfortunately for Surgeon General Dr. Jerome Adams, his face was in the wrong place on Independence Day because of a ridiculous paper in a ridiculous journal called Emergency (Tehran).
“Comparison of the Analgesic Effect of Intravenous Acetaminophen and Morphine Sulfate in Rib Fracture; a Randomized Double-Blind Clinical Trial” concludes that IV Tylenol works better (or as well) as morphine for patients who go to emergency departments for broken ribs – a notoriously painful injury.
Here are Dr. Adams’ Tweets from July 3rd and 4th. Pay special attention to the one from July 4th on the right. Dr. Adams tells us that he unquestioningly believes the study results and offers no doubt about its accuracy.
It appears that Dr. Adams didn’t bother to read the paper from which this conclusion was drawn. So I did. And it was a colossal mess, something I explained on July 8th (See Need General Surgery? Ignore The Surgeon General). The study was so bad that it was impossible to tell whether Tylenol worked better than morphine, morphine worked better than Tylenol, or either drug worked at all.
A few days later ACSH friend, Dr. Aric Hausknect, a New York neurologist and pain management expert, who has both written for and been interviewed by us) must have read the paper as well because his July 12th letter made what I had to say seem rather tame by comparison (See Dr. Aric Hausknecht Responds To SG Jerome Adams’ Tylenol Recommendation).
Apparently, we hit the mark because in subsequent Tweets Dr. Adams was backpedaling like the bicycle scene from The Wizard of Oz played backward. Here are a few from July 13th…
Finally, there’s this…
What Dr. Adams did is no different than what PROP, certain members of the CDC, politicians, academic zealots, and various other self-serving individuals and groups have been doing for almost a decade – making up a story and backing it up with faulty (or non-existent) research to “prove” a point.
We just happened to catch him.
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(Illegal) fentanyl is now the leading cause of fatal drug overdoses claiming 49,000 lives in 2017
Posted on July 16, 2019 by Pharmaciststeve
Chinese fentynal dealer busted by the DEA
https://foxsanantonio.com/news/local/chinese-fentynal-dealer-busted-by-the-dea
SAN ANTONIO — Chinese fentynal dealer busted by the DEA as he shipped thousands of dollars worth of fentynal into South Texas.
The DEA tells Fox San Antonio how the Chinese government help to bust the dealer in this week’s On the Frontlines with the DEA.
It’s a case that was years in the making, but now a major fentynal dealer from China has been taken down after the DEA identified him as the person shipping fentynal to Texas. The tiniest amount of this drug has proven to be deadly all over the country. In fact according to the DEA, fentanyl is now the leading cause of fatal drug overdoses claiming 49,000 lives in 2017. So when a man in China was identified shipping a kilo of fentynal into Texas the DEA was quick to move.
“At that time a parcel was seized of a bout a kilogram of what is known as molly MDMA. An investigation was done and what started as a kilogram turned into a lot more. We found out that this company was sending this product all over the country and actually all over the world,” said Dante Sorianello, the assistant special agent in charge of the San Antonio district.
The seller was in China and he would coordinate the movement of MDMA, steroids and fentynal all over the world including to a buyer right here in Texas.
“We found out that this lone individual had received over the past several years over 52 kg of MDMA that makes a lot of stimulant getting out on the streets and that’s just one individual,” said Sorianello.
But this case could not have been closed according to the DEA without the help of the Chinese government who help find a hidden lab in operating in China.
“Ultimately with our Chinese partners the Chinese government was able to identify that laboratory, seize it, dispose of the laboratory and arrest that individual,” said Sorianello.
Is it illegal to ship via. Is it illegal to ship via the us postal service and is it also illegal via a private company like UPS or Fedex?” Yami asked. “You’re dealing with a controlled substance, so yes it’s all illegal,” said Sorianello.
The DEA says that if you are caught shipping drugs via the us postal service vs a private company there are laws that allow them file more charges against you.
In your neighborhoods, on the streets, Fox San Antonio and the DEA will keep you informed and safe.
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Insulin In Canada cost 10% of the USA price… Insurance/PBM industry is the reason but the Pharma industry gets the blame
Posted on July 15, 2019 by Pharmaciststeve
Family says 21-year-old son died rationing insulin
The price of insulin is costing some people who can’t afford it their lives.
RAMSEY, Minn. — Advocates say it is a sign of the growing problem of rising prescription costs in America.
Friday, friends and family said 21-year-old Jesimya David Scherer-Radcliff died as a result of rationing his insulin.
His father, David Radcliff Jr. III, said everyone called his son Jesy.
“The cost of insulin is ridiculous. It is hard for me to even go in there and look at his casket. He is gone now. I can’t say, ‘hey let’s go here,’” he said. ‘I just think this country is backwards and I am a veteran. I have seen other countries and how they operate.”
Jesy was 21. A service celebrating his life was held at the Lord of Life Church in Ramsey.
Friday, Jesy’s mom, Cindy, and other members of the family wore red and black.
Nicole Smith-Holt, an advocate for affordable insulin, stopped by to show her support.
Nicole’s son Alec was 26. He died trying to ration his insulin one month after losing healthcare coverage. Nicole was among the caravan of Minnesotans who traveled to Canada in search of insulin which is ten times cheaper there than it is in the U-S.
“We lost another Type 1 diabetic due to insulin rationing. This is something you know we hoped would never happen again,” she said. “After losing my 26- year-old son to the same situation and fighting so hard at the legislative level to pass the Alec Smith emergency insulin act and it going nowhere and telling them if they did not implement this law we were going to lose more lives this just goes to show we were right.”
But this is a time she wishes she wasn’t right.
“My son and Jesy, they were murdered. They were killed by big Pharma. The cause of death should actually be on their death certificates, corporate greed,” she said. “I want justice for all of their deaths.”
Jesy’s godfather, Ianin St. James holds memories in his heart and hands. He said Jesy would transport him to and from the Mayo Clinic when he was undergoing chemotherapy treatments.
As he shared memories about the 21-year-old, he held a thank you note he received from Jesy soon after his high school graduation.
“One of the last things he wrote was, ‘I love you and everything about you.’ Don’t ever stop being you,” he said. “He accepted everybody and everything. That is all he ever did he just gave of himself.”
Earlier this month I made this post When POLITICIANS don’t know their “APPLES” from their “ORANGES”
Where I think that I clearly explained why there is a difference in prices of prescriptions and it is all due to GREED…but they have been pointing the fingers at the wrong industry and the industry that is really to blame…. it is apparently very happy with everyone blaming the wrong industry.
I expect to see the PBM industry to attempt to confiscate as much money out of community pharmacies until the bureaucrats finally get their act together and stop being influenced on the HUGE PILE OF MONEY that the PBM industry has to lobby Congress. Collectively, the entire Lobbying industry spend 9+ million/day to influence members of Congress. The above story is just how LETHAL the GREED of the insurance/PBM industry can be to some people who can’t afford to pay “rack rate price” of some/many life sustaining medications.
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Our society discourages proper treatment of pain and mental health… which disease state is next ?
Posted on July 15, 2019 by Pharmaciststeve
How Did We Come to Abandon America’s Pain Patients?
https://filtermag.org/2019/07/15/abandon-americas-pain-patients/amp/
Overdoses—not those involving prescription opioids, but of heroin and illicit fentanyl, often combined with benzodiazepines—continue to go up. But opioid prescribing continues to go down. Pain patients are untreated and suffering. Pharmaceutical companies are being sued and settling. Law enforcement is cracking down on providers. And many physicians, caught in the middle, have stopped prescribing because they don’t want to get in trouble and possibly lose their livelihood.
This situation is continuing despite the Centers for Disease Control and Prevention (CDC) emphasizing in a commentary published this spring that their guideline on prescribing for chronic pain, released in 2017, is being misapplied.
The CDC authors wrote in April:
Clinicians might universally stop prescribing opioids, even in situations in which the benefits might outweigh their risks. Such actions disregard messages emphasized in the guideline that clinicians should not dismiss patients from care, which can adversely affect patient safety, could represent patient abandonment, and can result in missed opportunities to provide potentially lifesaving information and treatment.
So what has gone so terribly wrong? Because it has.
The Victims
Ian Lewis, who lives in Ohio, having grown up in Tennessee, is 37 years old. He had his most recent surgery on July 8.
His pain started in middle school. He began suffering in seventh grade, but nobody believed that he was in pain. His serious congenital spine problems were discovered when he was 12 years old. He had two blown-out discs, 16 fractures, and a cut durum bleeding into the spinal cord.
Ian’s mother, Terri Lewis, PhD, who teaches for the Rehabilitation Institute at Southern Illinois University in Carbondale, has been his caretaker throughout.
“Up to this point everybody had denied the pain that he was expressing,” said Lewis. He then got excellent care at Vanderbilt in Tennessee, she said, but in 2003 his pain increased. He had two more surgeries, but never healed. For 10 years, he got along on opioids, a “combination of legal and street,” said Lewis. “Cannabis was also pretty helpful, he discovered.”
The problem was the opioid crackdown. After it happened, medical providers “went all around the block to try not to label this as chronic pain, to call it trouble sleeping, or anxiety, but what he was given—antipsychotics—didn’t help,” said Lewis. “Why didn’t they label it as chronic pain?”
Ian had received nothing at all as a child, when nobody believed that he was in pain. “I can speculate it’s because we don’t recognize pain in kids,” said his mother.
The images below show the fractured Harrington rods that were removed from Ian’s back during his latest surgery, and his back after the operation.
Photos courtesy of Terri Lewis
According to the National Institutes of Health, nearly 50 million American adults suffer chronic pain. They typically face onerous and invasive requirements to obtain repeat opioid prescriptions, and live with the constant threat of being cut off—if they can get them in the first place.
Unfortunately, there is no way to assess the number of patients who have been subject to opioid dose reduction of an informal nature, said Stefan Kertesz, MD, professor of medicine and addiction scientist at the University of Alabama at Birmingham School of Medicine. “Neither is there a there a formal survey to assess the number of patients who have been discontinued, either voluntarily or against their will.”
The situation is difficult because nobody can tell how large the problem is if no data is collected, and because a major policy chance is being enacted with no entities reporting outcomes, Kertesz told Filter. (This study came close in terms of looking at outcomes, but not overall prevalence.)
The suffering caused by denial of opioids sometimes becomes unbearable, and numerous suicides for this reason have been reported.
Gail Groves Scott, an opioid use disorder policy researcher,and doctoral student in health policy, told Filter about a relative of hers who killed herself. The relative had been a urologist, but had switched to prescribing buprenorphine. She developed a pain disorder and probably a substance use disorder as well, and was most likely going to lose her license.
“She was ashamed,” said Scott. “She didn’t have staff, and was probably really struggling financially.” She put fentanyl patches all over her body and died that way.
As for her patients on buprenorphine, “They had nowhere to go, but luckily there were fewer than 20.” She was in Tennessee, where registration requirements deterred new clinics and resulted in a reduction of patient slots.
In general, “Doctors are really nervous about taking a new patient who is on a controlled substance,” said Scott. Asked why, she listed concern about substance use disorder, concern about whether a patient’s previous doctor had been prescribing appropriately, and fear of oversight and potential sanctions.
Why Is the CDC Being Misinterpreted?
Deborah Dowell, MD, MPH, chief medical officer at the CDC’s Injury Center, told Filter that the 2017 guideline was meant to help “primary care clinicians work with their patients to consider all safe and effective treatment options for pain management,” and that “CDC encourages clinicians to continue to use their clinical judgment, base treatment on what they know about their patients, maximize use of safe and effective non-opioid treatments, and consider the use of opioids only if their benefits are likely to outweigh their risks.”
Dowell also referred to the recent CDC commentary, noting that it highlighted “the misapplication of the CDC guideline” and raised “awareness about issues that could put patients at risk.”
Dowell went on to say that the guideline did not apply to anyone but primary care clinicians treating chronic pain for patients 18 and older. It was not intended, she said, for patients in cancer treatment, for example, patients with post-surgical pain, or patients with acute sickle cell crises.
Yet the guideline has been applied—or misapplied—to all of these groups.
What’s more, Dowell said, there was nothing in the guideline’s dosage recommendation that should have resulted in hard limits for cutting off opioids. The guideline states: “When opioids are started, clinicians should prescribe the lowest effective dosage. Clinicians should… avoid increasing dosage to ≤90 MME/day or carefully justify a decision to titrate dosage to >90 MME/day.”
Yet this is what is happening. “High dose prescriptions, which overwhelmingly accrue to long-term recipients, have fallen 61 percent according to [pharmaceutical consulting company] IQVIA,” said Kertesz.
The details of the CDC guideline are not objectionable. Yet neither is it particularly encouraging to doctors who prescribe opioids needed for pain.
Dowell noted that that 2017 guideline also does not support abrupt tapering or sudden discontinuation of opioids, which can result in severe withdrawal symptoms, leading some patients to “seek other sources of opioids.” In addition, she said, “policies that mandate hard limits conflict with the guideline’s emphasis on individualized assessment of the benefits and risks of opioids given the specific circumstances and unique needs of each patient.”
Yet these policies are abundant, even prevalent. Abrupt tapering and discontinuation is happening, far too often.
Dowell also noted that patients receiving medication-assisted treatment (with methadone or buprenorphine, both opioids) for opioid use disorder (OUD) do not fall under the guideline, which concerns only chronic pain, not OUD. In fact, the guideline recommends offering these medications to patients with OUD.
The details of the CDC guideline are not objectionable. Yet neither is it particularly encouraging to doctors who prescribe opioids needed for pain. And the guideline’s widespread misinterpretation gives reason to question whether it puts too little emphasis on the importance of opioid prescribing to relieve suffering—and too much on the possibility of opioid prescriptions leading to OUD.
The CDC acknowledges the rarity of this latter scenario. When I asked Dowell how many patients who take opioids as prescribed actually develop OUD (as opposed to becoming physically dependent, which every long-term opioid user does), she replied in an email:
“One [2014] study* found that, among patients prescribed opioids for pain, rates of opioid use disorder diagnosis ranged from 0.7% with lower-dose (≤36 MME) chronic therapy to 1.3% for medium dose chronic therapy to 6.1% with higher-dose (≥120 MME) chronic therapy (versus 0.004% with no opioids prescribed).”
So for addiction rates of 0.7 -6.1 percent across all doses, virtually all pain patients are now either suffering in untreated pain or under threat of it? How did this happen?
“The guideline has been institutionalized to forcibly change patients’ care.”
By issuing the recent comment, the CDC basically admitted that misapplication of its guideline has had a chilling effect on prescribing. But it’s also important to acknowledge the limits of the CDC’s influence.
The CDC doesn’t regulate doctors. After the guideline was released, many in the addiction field did not think doctors would reduce prescribing, as there was no enforcement behind it.
It turned out, they were wrong. Still, scaremongering politicians’ pronouncements, law enforcement crackdowns, Pharma lawsuits and relentless media “opioid epidemic” coverage have all played their part.
Kertesz supported the initial CDC guideline, but became concerned about its interpretation. “Over the last three years, I have seen patients harmed,” he told Filter. “I have written repeatedly about the fact that the CDC’s guideline was good but was misapplied. Broadly speaking, it was a reasonable document, but it has been institutionalized to forcibly change patients’ care.”
This March, he, along with other experts and Human Rights Watch, submitted a letter making this point to the CDC. It caused distress at the agency, which did not believe it had caused the denial of pain medication.
“I asked them how difficult would it be for the CDC to issue a defense of the guideline, with a little clarification?” Kertesz said. That day, a CDC official told him it was very difficult. But on April 24, in the New England Journal of Medicine, that clarification came.
“That’s courage in action,” said Kertesz, who is somewhat of a hero to pain patients across the country.
Why Physicians Are Frightened
Regardless of what the CDC says, it’s doctors who do the prescribing—and they’re the ones who don’t want to do it any more.
Scott, now an opioid use disorder policy researcher, previously worked as a pharmaceutical representative, selling many drugs for addiction and pain. Even then—well before the CDC guideline—she saw doctors’ hesitancy to prescribe.
“Doctors were becoming more aware,” she said. “We know that there was overprescribing. There was also an increase in electronic health records and prescription drug monitoring programs, which made everyone more aware of who was an outlier. This impacted physicians’ comfort level in prescribing opioids.
“They say that they want to know who has addiction and who doesn’t, but the real reason is they are terrified, of administrative and legal problems.”
“Nobody saw what was going to happen,” Mark A. Weiner, MD, representing the American Society of Addiction Medicine, told Filter. “Pain doctors are coming to me and my colleagues to answer the question of who’s who”—meaning which patients on opioids for pain have pain, and which are addicted.
This has been going on for years, according to Weiner. “They say that they want to know who has addiction and who doesn’t, but the real reason is they are terrified, of administrative and legal problems.” Weiner supports law enforcement, but “do they think everybody’s an addict?” He believes that prescription drug monitoring programs can help—but only if they are used properly. Used improperly, they just contribute to the problem.
Like many, Weiner cites the “pendulum”—one of his presentation slides has a moving pendulum in it. “On one side is 1985-2000, where people said we need to treat all the pain we can,” he said. “Then the pendulum started moving, through the middle part—the rational approach.”
But now, it’s swung too far to the other side. Weiner helps move it back toward the middle by reassuring physicians who provide palliative care for cancer and hospice that “it’s okay” to prescribe opioids. “I’m an addiction doctor, not a pain doctor, so I they listen,” he said. “But I often hear they’re not happy with it.” That’s because it’s their livelihoods on the line.
“The focus on prescribing is not unimportant,” said Richard Saitz, MD, professor at Boston University Schools of Medicine and Public Health. “Yes, exposure to opioids is a factor in developing opioid addiction, but it isn’t the sole factor, and focusing on prescribing of opioids is a bit like looking for the keys under the lamppost because that is where the light is.”
Rather, he told Filter, it’s important to focus on appropriate prescribing for the individual. Of course, nobody would argue with that medically. “But instead, PDMPs and insurance regulations focus on what is easily countable and set population goals to reduce and eliminate. As a result clinicians want less and less to do with opioid prescribing, even for acute pain.”
What the CDC guideline did, said Saitz, was give clinicians who were already uncomfortable prescribing opioids back-up to just taper or not prescribe.
Pharma Lawsuits’ Chilling Effects on Prescribing
A string of high-profile lawsuits against opioid manufacturers—the first in Chicago in 2016, the most recent in Oklahoma—have further impacted prescribing by adding to physicians’ discomfort, although the chill started before then. State medical boards and the American Medical Association, too, seem more concerned about overprescribing than patient abandonment.
The lawsuits definitely had a chilling effect on Pharma itself, and on the organizations Pharma supported. As for cancer and other conditions, pain patient advocacy often comes from the treatment field.
Loss of Pharma funding for pain advocacy groups has been significant. Lawsuits have alleged that Pharma used organizations like the American Pain Society, which is now disbanding, to promote their products.
In 2016, about the same time that Pharma companies started getting sued, they cut off the American Pain Society and others, said Bob Twillman, PhD, former executive director of the Academy of Integrative Pain Management and current clinical associate professor at the Department of Psychiatry, University of Kansas Medical Center. They no longer took booths at conferences. And they started reserving their cash for settlements. “Pain is still a valid specialty, but now, everybody’s too scared to prescribe.”
They were suing companies for dishonestly marketing products that relieved pain, so it wasn’t convenient to acknowledge the value of these products.
A combination of finance and politics motivates the lawsuits, Twillman told Filter. “There’s money there.” There is the money that Oklahoma, for example, will receive—but also a motive for prosecutors who may want to get elected to higher office.
But Kertesz said that the prosecutors are doing their job. “They have one goal, which is to secure as much money as possible, not to worry about people who aren’t getting pain medication,” he said. “That’s not their department.”
And Kertesz, like Scott, is skeptical of all Pharma marketing. “I view it as a public menace,” he said. “I don’t think it’s wrong to get money out of the pharmaceutical companies.” But he does think the money should go to treating people. “I have a concern about significant portions of the settlement money going to pay scholars,” he said, referring to academic appointments.
“The other thing that concerned me about the attorneys general,” Kertesz said, “is they seem to want to preserve a pristine, simple, one-directional narrative, and anything that acknowledged the value of pain care was a threat to the lawsuit.”
So they left that part out. They were suing companies for dishonestly marketing products that relieved pain, so it wasn’t convenient to acknowledge the value of these products. And that directly hurt pain patients.
None of this is black-and-white. But the attempt to make it so has demonized pharmaceutical companies, prescribers and patients.
“Callous paternalism will be a poor substitute for care, resulting in promoting harm, suffering and a contempt for the healthcare delivery system.”
“There is no question that prescription opioids have been mis-prescribed and over prescribed,” H. Westley Clark, MD, JD, dean’s executive professor with Santa Clara University, told Filter. “There is no question that a few opioid prescribers devolved into being quasi-drug dealers. There is also no question that some patients have developed opioid use disorders as a result of imprudent opioid prescriptions.”
“However, in our zeal to curtail the excessive prescribing of opioids for the treatment of pain, we have trampled on the clinical needs of those individuals who have benefited from the use of opioids for the treatment of pain, said Clark, a former director of the Center for Substance Abuse Treatment at the federal Substance Abuse and Mental Health Services Administration.
“Those living with chronic non-cancer pain need to be heard,” he continued. “Their opinions need to a part of the dialogue for treatment. Those experiencing intractable pain are stakeholders in the discussion about the appropriate treatment of pain, but their opinions have been dismissed and their input trivialized. It is time to return to a rational approach to pain management, an approach that takes into consideration of input of those who suffer from pain, making sure that they are a part of the treatment team.”
“Otherwise,” he concluded, “callous paternalism will be a poor substitute for care, resulting in promoting harm, suffering and a contempt for the healthcare delivery system.”
Moving the Pendulum
“I certainly see liberal prescribing as playing a role,” said Kate Nicholson, a civil rights attorney who advocates for pain patients, of the overdose crisis. “I think people can become addicted, of course.”
Nicholson, who has a pain history of her own, and does most of her advocacy work for free, cites the National Institute on Drug Abuse/CDC incidence range of 0.7 to 6.1 percent.
Andrew Kolodny, MD, is co-director of Opioid Policy Research at the Heller School for Social Policy and Management at Brandeis University and a leading advocate for much stricter controls on opioid prescribing. He did not want to be quoted in this article but his testimony was instrumental in the Oklahoma lawsuit.
Rather than the NIDA-CDC figures, Kolodny instead uses a cross-sectional OUD prevalence figure, which includes people who had a history of misuse and in general were not well-screened before being prescribed opioids, said Nicholson. One article Kolodny cites gives figures of 3.5 percent for severe OUD symptoms and 58.7 percent for “no or few symptoms.”
“What I find difficult is that the treatment of pain is being framed as responsible for spawning a crisis.”
“We know that most who misuse did not receive medications directly from a doctor and already had a developed history of using other strong substances,” Nicholson said. “But, sure, some people undoubtedly got hurt from liberal prescribing. What we need is a return to nuance. What I find difficult is that the treatment of pain is being framed as responsible for spawning a crisis—and so patients in pain are beleaguered and disregarded.”
Amid the suffering, there have been rays of hope. The CDC’s April comment was one of them. And in New Hampshire this month, one physician was reprimanded for cutting back on a patient’s painkillers.
Pain patients—for all the stigma, lack of funding and other obstacles they face—are continuing to speak out. If we want the pendulum to swing back to somewhere rational, we have to hear them.
* Edlund MJ, Martin BC, Russo JE, DeVries A, Braden JB, Sullivan MD. The role of opioid prescription in incident opioid abuse and dependence among individuals with chronic noncancer pain: the role of opioid prescription. Clin J Pain 2014;30:557–64.
Top photo by Ryan Park on Unsplash
The author wishes to dedicate this piece to “all of the physicians who bravely treat pain patients with opioids, and to the patients who have been suffering through this nightmare.”
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Retail Pharmacist Beware
Posted on July 15, 2019 by Pharmaciststeve
DEATH on the Battlefield is Preferable
Posted on July 15, 2019 by Pharmaciststeve
DEATH on the Battlefield is Preferable
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Trump WH Seeks To Monitor The Disabled To Ensure They Aren’t “Too” Happy
Posted on July 14, 2019 by Pharmaciststeve
Trump WH Seeks To Monitor The Disabled To Ensure They Aren’t “Too” Happy
A new policy proposal by the Trump administration calls for the surveillance of disabled people’s social media profiles to determine the necessity of their disability benefits. The proposal, which reportedly aims to cut down on the number of fraudulent disability claims would, monitor the profiles of disabled people and flag content that shows them doing physical activities. When it comes down to it, the policy dictates that disabled people shouldn’t be seen living their lives for fear of losing vital financial aid and, possibly, medical care.
The administration has been working closely with the Social Security Administration in an effort to reduce false claims believing that social media holds a cache of information regarding eligibility of Social Security Disability Benefits. They believe that by monitoring the social media accounts of disability benefit recipients, they can root out false claims and reduce the overall amount of money spent on the programs.
The proposal, like many of its policies regarding disabled people, shows a fundamental misunderstanding of disability and takes advantage of how social media operates in order to cut them off from the support they need. Disabled people don’t all function in the same way, and disability is not a set of stereotypes like taking selfies staring longingly at the world. They live lives while managing their energy for the activities they can handle and trying to make those they cannot more accessible.
Additionally, studies have shown that a majority of social media users show only the good in their lives, not the hardships or difficulties. Disabled people should be allowed to share the full scope of their existence without fear they’ll be accused of lying—and even fraud—by the United States Government which will likely reason that if a disabled person is seen going to the mall or taking time to swim or jog, they can be working.
The truth about disability is that it isn’t a series of down moments but both highs and lows that comprise the lives of the disabled. Simply because disabled people are seen exercising, dancing or shooting hoops does not mean that they have the ability to sustain that level of energy all day. This type of policy also plays upon the assumption that people with disabilities all function and move about in the world in the same way, which is entirely untrue. There are wheelchair users who can walk, people with cerebral palsy that can run and amputees that are bionic. It is just as dangerous to assume that disabled people should have to “overcome” their disabilities to do what they love as it is to assume there is nothing they want to do. One person’s body should never be considered a prescription for another.
Another thing that the general public does not understand about disability and the internet is that attention to disability issues often operates within an economy of “Inspiration Porn.” Abled people often film, post, share and circulate photos and videos of disabled people doing extraordinary things as a litmus test to how “poor” life could be with a disability and how disabled people achieve “in spite of” their disabilities (quite often, this type of posting occurs without the disabled person’s permission). And, while many disability advocates disdain this type of media representation and are vocally calling for an end to inspiration porn, there’s a not-so-often talked about number of disabled people who play upon these stereotypes for their advocacy and to further their own quest for disability rights.
Quite often, in order for disabled people to be seen as needing help, nondisabled people need to see them as pitiful, helpless and ripe for a nondisabled person to swoop in and play hero. Without the ability to do so, a great many nondisabled people would not pay attention to disability issues. Disabled people know that, and it would appear the U.S. Government does as well. Public sympathies rarely side with disabled people who appear confident and comfortable in their own bodies. Therefore, there will be little outrage for cuts to disability benefits for active disabled people.
Aside from the cruelty it takes to cut necessary funds from a disabled person’s life because of a moment of activity, it seems willfully ignorant. Many in society already see disabled as “fakers” trying to take money from unsuspecting people, and this policy would only raise those tensions among the public. Disabled people are people, and as such, lead complex lives with ups and downs like the rest of the population. Relying upon a reductive narrative of disability is dangerous and will cost lives. Due to this, the administration should look inward and learn how to #BeBest.
Imani BarbarinContributor
I am a disability representation and inclusion advocate born with cerebral palsy. As a communications professional, public speaker, writer and blogger, I explore disability culture as well as society and business’s perceptions of disabled people from the perspective of a disabled black woman. A graduate of the Masters in Global Communications program at the American University of Paris, I use my skills to advocate for the representation, inclusion and empowerment of disabled people at the intersections of race and feminism both in the United States and globally. Familiar with the ways in which stereotypes and preconceived notions isolate disabled people and dictate the ways in which we interact with the world, I seek to break every single one of them.
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