“The moral test of a government is how it treats those who are at the dawn of life, the children; those who are in the twilight of life, the aged; and those who are in the shadow of life, the sick and the needy, and the handicapped.” – Hubert Humphrey
passionate pachyderms
Pharmacist Steve steve@steveariens.com 502.938.2414
1/? GM twitter! Let’s reset the discussion on pain management and opioid misuse. First, we must acknowledge/ I’ve always felt and said that we have a crisis of un and undertreated pain in the US, and it can lead to suicide, self medication w illicits, and other bad outcomes.
2/? We also have an overdose crisis in our country. It is NOW largely fueled by fentanyl, but there traditionally have been, and still are many people who first become dependent due to opioids prescribed to them – or diverted from others to whom they were over prescribed.
U.S. Surgeon General
@Surgeon_General
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3/? It both can be and is true that many people benefit from opioids, while others who are getting them are seeing more downside than upside. Not either/ or. Examples of the latter are many patients (especially peds) getting dental extractions, and most with migraines.
4/? Thats why I highlight opioid alternatives where evidence suggests they provide as good or better risk/benefit. Im NOT anti-opioids, but pro better pain management. I want to ensure those who benefit from opioids get them, & those who might benefit from other meds get those.
U.S. Surgeon General
@Surgeon_General
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5/? I understand many chronic pain patients feel unheard- I HEAR YOU- and I am appreciative for your feedback. Whenever I speak on opioids, I ALWAYS discuss the need to protect chronic pain patients/ not pull the rug out from under them. We must NOT target the wrong people!
U.S. Surgeon General
@Surgeon_General
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6/? We must stop swinging the pendulum to extremes, and find a better balance between getting opioids to those who most benefit from them, while minimizing them for those who don’t. Opioids are BOTH being overprescribed to SOME populations, and under prescribed to others.
U.S. Surgeon General
@Surgeon_General
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7/? Eg overprescribing is well documented in OR setting. Many don’t need/take all opioids prescribed & when not properly stored/ disposed of, they can be diverted. It’s why as an anesthesiologist I highlight opioid sparing anesthetics- because for many we CAN
periop opioids.
U.S. Surgeon General
@Surgeon_General
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8/? Ive also tried to respond to questions/ comments on twitter in real time- a risk as some may feel my entire position is based on 1 reference/ study that is a specific reply to a different person/ question. We review the totality of the data before taking official positions.
U.S. Surgeon General
@Surgeon_General
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9/ I hope we can work together to achieve better pain management for all- those acute and chronic patients who benefit from opioids, & those populations for whom there are reasonable and often better alternatives (both pharmacologic and non pharmacologic). #betterpaincontrol4all
Chicago Tribune reporter Katherine Rosenberg-Douglas is injected with anesthesia ahead of a spinal injection procedure on July 2, 2019, at PrairieShore Pain Center in Lincolnshire. Rosenberg-Douglas needs aggressive pain management after breaking her back while rollerblading years ago.
Maybe it would be easier if I looked like I was dying.
Easier for the pharmacists, doctors, impatient friends, well-meaning family and the suspicious people who eye me up and down when I use my handicapped parking placard. It wouldn’t be easier for me — I already feel like I’m dying.
I broke my back while Rollerblading when I was 21. After three surgeries beginning at age 30, I’ve recovered enough that I’ve gone on to what looks like a normal life. I’m a married mother of twin 4-year-olds, so I am relatively stressed, but fortunately, I’m otherwise relatively healthy.
I’m also on a fentanyl patch delivering slow and steady pain relief to keep me feeling like I can get out of bed, and morphine for breakthrough pain when life requires more of me than merely getting out of bed — and anyone who has ever had a 4-year-old knows each day is far more demanding than that. Just driving my kids to school or sitting for longer than 20 minutes at a time is a struggle. [Most read] Column: Put this Serena Williams quote on all the motivational posters. The world needs to hear it. »
So is driving to the pharmacy, or to my doctor, both of which I must do every 30 days. To obtain a controlled substance in Illinois, one must visit a pain specialist because family physicians can’t prescribe this type of medicine long-term. Chicago Tribune reporter Katherine Rosenberg-Douglas undergoes a spinal injection procedure on July 2, 2019, at PrairieShore Pain Center in Lincolnshire. Rosenberg-Douglas has faced increasingly onerous regulations in managing her pain amid the opioid epidemic. Chicago Tribune reporter Katherine Rosenberg-Douglas undergoes a spinal injection procedure on July 2, 2019, at PrairieShore Pain Center in Lincolnshire. Rosenberg-Douglas has faced increasingly onerous regulations in managing her pain amid the opioid epidemic. (Erin Hooley / Chicago Tribune)
When we moved to Illinois in 2016, I had been on prescription opioids for almost a decade. I actually called up doctors and asked receptionists if they were taking new patients, and if the doctor prescribed opioids. After what I took to be stunned silence, I was either told they didn’t give that information on the phone or they couldn’t say because it was on a case-by-case basis.
I understand now that amid a deadly opioid crisis I must have sounded like a drug-seeker, though I just wanted to avoid wasting time or money. I have been dealing with this pain close to half my life, and we move often. I know how hard it can be finding a new doctor and transferring records to receive continuous care. In my first few weeks here I visited nine doctors, including neurosurgeons, orthopedic doctors and pain management specialists. They all agreed I needed strong pain medicine but said they weren’t the correct doctor to help me. Relieving pain is a pain
The doctor I chose is about 30 miles from my home. He tells me it’s troublesome keeping up with his patient load as other area doctors leave the specialty. Thankfully, many pill mills have been shut down, but even good doctors have closed up shop as keeping up with ever-changing restrictions imposed by legislators has become increasingly arduous, my doctor told me.
Among the most asinine of guidelines pushed by various plans to end the opioid epidemic: A pain doctor’s records should show he or she is trying to reduce the number of medications and the dosage patients are on. If your formerly high cholesterol returned to a healthy level with a certain dosage, can you imagine your doctor cutting the dose in half on your next visit? [Most read] Kumail Nanjiani’s last-minute ‘Conan’ cancellation was a comedic ‘snow day’ for O’Brien »
It’s not clear to me what purpose the every-30-day visits serve, other than to pick up my written prescriptions — controlled substances can’t be called in. But just as these rules unnecessarily hurt those of us in real pain, they also won’t deter a junkie who wants a fix. A monitor shows pain management specialist Dr. Richard Caner performing a spinal injection procedure on Chicago Tribune reporter Katherine Rosenberg-Douglas on July 2, 2019, at PrairieShore Pain Center in Lincolnshire. Rosenberg-Douglas has needed opioids to control severe pain for more than a decade. A monitor shows pain management specialist Dr. Richard Caner performing a spinal injection procedure on Chicago Tribune reporter Katherine Rosenberg-Douglas on July 2, 2019, at PrairieShore Pain Center in Lincolnshire. Rosenberg-Douglas has needed opioids to control severe pain for more than a decade. (Erin Hooley / Chicago Tribune)
I also pee in a cup at the visit. I didn’t know the true purpose of the urinalysis until about a year ago. I thought it was to ensure I wasn’t taking anything other than what my doctor prescribed. But it’s actually to ensure I am taking my drugs, not selling my fentanyl and morphine.
There also are no refills allowed on controlled substances and no bulk prescription by mail. There are no early fill dates. Not even at 29 days instead of 30, not even if you will be out of town. And if you’ll be out of state? Better to rearrange that trip. An out-of-state pharmacy likely won’t fill your prescription.
Even if intending to pick up the medication after day 30, I can’t drop off the piece of paper in advance. I must turn it in and wait for it to be filled. If this sounds insignificant, remember, the people affected are in many cases dying, or living in so much pain that sitting an hour in a waiting room is excruciating.
Say the pharmacy has in stock only some of the 150 morphine pills I take each month, something that happens to me every few months, because pharmacies try to keep quantities low to discourage robbery by drug seekers. If I agree to accept 90 pills, for example, I can’t get the remaining 60 without another prescription. [Most read] Sauk Village man refuses to remove lawn signs that contain racial slurs »
My personal record for pharmacies visited in a single day is 14. Doctors don’t decide if you need it, pharmacists do
Last month, I dropped off a prescription before I started work at 7 a.m. on a Sunday, and the pharmacist said she’d need to speak to the doctor so I probably wouldn’t get it until Monday. I had my doctor paged at 6:30 a.m. Agonizing hours passed before I called and pressed for the reason. She told me there were “great distances involved,” between my address, the doctor’s office and where I was visiting my parents for the weekend — although they’re all about a 45-minute drive, pretty standard for Chicagoland.
“It’s suspicious,” she said.
The previous month a pharmacist told me she wasn’t comfortable with the combination of fentanyl and morphine because, “It’s a lot of pain medicine.”
She filled the fentanyl patches but would not fill the morphine. When possible, I’ve used the same pharmacy chain for much of the past 10 years so there would be an easily accessible log of my prescription history, so I implored her to look. She said she had.
“If anything were to happen to you, I would lose my license, not your doctor,” she told me. I mentioned that without the morphine I’d taken for so long, she was putting me in a more perilous situation than if she did. True, she admitted. “But I have the right to refuse to fill any prescription for any reason, and I choose not to fill this for you.”
Then she gave me directions to a rival pharmacy chain’s store. Chicago Tribune reporter Katherine Rosenberg-Douglas is helped to her ride from friend Courtney Holbrook with the help of medical assistant Mario Flores after undergoing a spinal injection procedure on July 2, 2019. Use of a fentanyl patch has helped to correct a pronounced limp. Chicago Tribune reporter Katherine Rosenberg-Douglas is helped to her ride from friend Courtney Holbrook with the help of medical assistant Mario Flores after undergoing a spinal injection procedure on July 2, 2019. Use of a fentanyl patch has helped to correct a pronounced limp. (Erin Hooley / Chicago Tribune) Pain you can’t see
I have a number of diagnoses. Failed back syndrome, a medical term that means just what it says and suggests surgery didn’t help. A “bone stimulator” was implanted during one surgery to encourage growth between pieces of cadaver bone and my own vetebrae, but too much bone grew in around my sciatic nerve, giving me sciatica, or a burning sensation from my rear down my left leg to my toes, which often are numb and tingling (I take another medication for nerve pain). My left leg has so much atrophied muscle that it drags behind my right and I had a pronounced limp, but the fentanyl patch largely has eliminated that by providing more steady pain relief. I am disabled, but no longer outwardly appear so, which, along with my age, probably accounts for the daily dirty looks people shoot me when I park in handicapped spaces.
I understand why police, politicians and many doctors want to combat the opioid epidemic, but I’m tired of people throwing around that term and lumping me in with a group of drug abusers.
I support the spirit behind their efforts, but can’t support any more regulation on controlled substances. We have now overcorrected, and anyone who requires pain medicine is looked upon as a criminal.
It was once hard to imagine being in more pain than I am, but the current regulations added a new layer of suffering. Please remember opioids exist for a reason, and don’t let it get any more difficult for those already in agony.
The legislation would improve patient care access and access to medication assisted treatment for opioid use disorder.
– Bipartisan legislation in the House of Representatives and Senate would abolish administrative barriers that keep some providers from prescribing medication assisted treatment, thus expanding patient care access and treatment for substance used disorder (SUD).
The Mainstreaming Addiction Treatment (MAT) Act would specifically get rid of requirements that state prescribers must obtain a waiver from the Drug Enforcement Agency (DEA) to prescribe buprenorphine, a key substance used in medication assisted treatment.
Additionally, the legislation would require the Secretary of the Department of Health & Human Services (HHS) to create a national provider education campaign informing providers of the change in medication assisted treatment policy and encouraging them to integrate addiction treatment into their care offerings.
The legislation has been introduced into both the House and Senate, gaining bipartisan approval. House bill co-sponsors include Representatives Paul Tonko (D-NY), Antonio Delgado (D-NY), Ben Ray Lujan (DNM), Ted Budd (R-NC), Elise Stefanik (R-NY), Mike Turner (R-OH). In the Senate, Congresswomen Maggie Hassan (D-NH) and Lisa Murkowski (R-AK) sponsor the bill.
“Medication-assisted treatment is the gold standard for treating substance use disorder, and we need to break down the barriers that prevent more health care providers from treating patients in need,” Hassan said in a statement on her website. “I urge my colleagues in the Senate to support this commonsense, bipartisan measure in order to expand access to buprenorphine and help more people get on the road to recovery.”
It is ironic that providers can prescribe opioids but cannot freely prescribe medications used to treat opioid use disorder, Murkowski pointed out in a statement.
“By removing barriers to life-saving medication-assisted treatments that have been clinically proven to help patients safely reduce or even end their dependence on opioids, we can ensure Americans struggling with substance abuse have access to the treatment they need to fully recover,” she said.
The bill will also have positive implications for patients living in rural regions who often struggle with geographic barriers in place between them and physicians.
“This bill also addresses some of the geographical challenges that many face in Alaska, by allowing community health aides and practitioners to offer MAT working with a provider through telemedicine. Overcoming addiction is already difficult enough,” Murkowski said. “I’m proud to support this effort to increase access to recovery services and save lives.”
Passing such legislation will be critical to quelling the nation’s opioid epidemic, according to Representative Paul Tonko. Over 70,000 people died from an opioid overdose in 2017, he reported in a fact sheet about the House version of the bill. Meanwhile, only about one in five individuals are receiving the opioid treatment they need right now.
“The devastation of America’s opioid crisis has touched every part of our country, and access to treatment is a matter of life and death,” Tonko said. “Our national response needs to rise to meet the unprecedented scale of this crisis.”
Industry efforts to address the opioid epidemic stretch beyond Congress. Earlier this week, United Health Foundation announced a partnership with the Helen Ross McNabb Center and the University of Tennessee Medical Center to expand patient access to behavioral health providers.
The $1.05 million grant will allow the Helen Ross McNabb Center to expand the University of Tennessee’s emergency department services catered toward substance use treatment.
Specifically, the grant will help the Center drive patient education among those presenting in the ED with substance use disorder, refer at least 250 patients to outpatient treatment centers per year, and hire addiction specialists to work within the ED to consult on patients.
“Every day we see the devastating effects of substance abuse and addiction on East Tennesseans,” said Jerry Vagnier, president and CEO of the Helen Ross McNabb Center. “We are grateful to have a partner like the United Health Foundation to help us expand the reach of our resources and services to meet the needs of our neighbors and their families. Together we will improve the lives of the people we serve.”
It’s a health problem that a Wisconsin lawmaker calls “staggering” and which is expected to get worse.
Two out of five people living in Wisconsin are expected to develop type 2 diabetes in their lifetime, a disease the Wisconsin Department of Health Services estimates costs $5.5 billion annually in health care and lost productivity.
“This is something that is going to be affecting us all and it is a train that has not been able to be slowed down,” Rene Walters, diabetes education supervisor for UW Health, told state lawmakers on Wednesday.
A bipartisan proposal which got a hearing before the Assembly Committee on Health would require the state’s Health Department to develop a “diabetes action plan” with data on prevalence and prevention compiled in a report for lawmakers every two years.
More than half the states in the U.S. have assess the burden of the disease and make policy recommendations under diabetes action plans, according to the American Diabetes Association.
“These issues are costly to our state and affect a lot of people and, for the most part, type 2 diabetes is preventable,” said state Rep. Tyler Vorpagel, R-Plymouth.
He said lawmakers should do “anything we can to saves the state money and makes their lives better.”
Rep. Melissa Sargent, D-Madison, called the costs “staggering” and noted that 1,300 people die from diabetes in the state every year.
Under the proposal, the state’s Health Department would receive $107,600 to gather and analyze data and prepare biennial reports for lawmakers.
Those testifying at the committee hearing had different views on why diabetes has been such a stubborn problem to solve.
Anand Iyer, who runs Welldoc, a company that produces health and wellness software, said the problem isn’t going away with traditional methods and needs to be addressed differently.
Walters said the nature of the problem leads to inaction. Common ways to combat diabetes — diet and exercise — are personal and require change, he said. That’s something many find hard to do.
WASHINGTON, D.C. — U.S. Senators Kamala D. Harris (D-CA), Dick Durbin (D-IL), Mike Lee (R-UT), Sheldon Whitehouse (D-RI), Amy Klobuchar (D-MN), Chris Coons (D-DE), Mazie Hirono (D-HI), and Cory Booker (D-NJ), all members of the Senate Judiciary Committee, sent a bipartisan letter to Department of Health and Human Services (HHS) Secretary Alex Azar about their concerns that the Drug Enforcement Agency (DEA) and Department of Justice (DOJ) have not adequately consulted with public health agencies in connection with the Trump Administration’s recent request that Congress legislatively place all “fentanyl-related” substances into Schedule 1 of the Controlled Substances Act (CSA).
“We are concerned that the failure to engage necessary health experts vests far too much authority to a law-enforcement agency and may result in action that will deter valid, critical medical research aimed at responses to the opioid crisis, including efforts to identify antidotes to fentanyl-analogue overdoses and improved treatment options. We are also concerned that by sweeping a broad set of substances onto Schedule 1, with no scientific consultation, we risk erecting unnecessary research barriers to drugs that may have great potential to society, and criminalizing substances that have no psychotropic effects,” the Senators wrote.
Walmart has terminated hundreds of pharmacists and technicians! But before addressing this action, let’s identify an extremely important event that has had a large influence on Walmart’s not being able to operate its pharmacies as profitably as it wants to. Walmart recently withdrew from the network of pharmacies participating in CVS-Caremark’s prescription plans because of its determination that the reimbursement it was being provided was too low. However, within just several days Walmart and CVS-Caremark reached an agreement. If Walmart insisted on appropriate compensation from CVS-Caremark and other health insurers and pharmacy benefit managers (PBMs), it would not have to be terminating pharmacists and technicians, and its customers would be much better served. If Walmart as the world’s largest retailer can’t successfully operate pharmacies because of the mandates/demands and inadequate compensation from PBMs and health insurers, can anybody?
Walmart caved in to CVS-Caremark, as did Target, another huge and otherwise successful retailer, several years ago when it sold its pharmacies to CVS. The PBMs and health insurance companies are destroying the quality and scope of health care, and by not challenging them, Walmart and Target are complicit in the responsibility for this debacle.
Walmart terminations
It is surprising that the Walmart terminations have not received more media attention. However, the coverage in Bloomberg News (Matthew Boyle; June 26, 2019 and updated on June 27) identifies pertinent information as well as the lack of transparency on the part of Walmart. The article quotes a Walmart spokeswoman as saying the company “is aligning our staffing with the demands of the business. I don’t have a lot to share right now, other than we are on a transformational journey on how we operate our pharmacies and serve our customers.” The spokeswoman would not specify the number of jobs being cut.
The Bloomberg News report identifies a source who is familiar with the decision as saying that the pharmacy cuts will represent less than 3% of all health and wellness staffers in the U.S. This statement appears highly deceptive. The number of “health and wellness staffers” at Walmart has to be much higher than the number of pharmacists and pharmacy technicians, thereby creating a larger denominator from which pharmacy cuts representing less than 3% is calculated. “Less than 3%” is seemingly intended to suggest that the number of individuals terminated is small. Walmart should reveal the percentage of pharmacy cuts based on the number of pharmacy staffers rather than health and wellness staffers. However, that would look bad and raise even more questions as to whether the significant reduction in pharmacy staff will increase the risk of errors and harm to customers.
The numbers of pharmacists and technicians who have been terminated or have had their hours reduced are more likely in the many hundreds and possibly thousands. Posts on social media and message boards suggest that the cuts may include as many as 40% of senior pharmacists.
The Bloomberg News report includes a comment of the Walmart CEO at a gathering of investors in October, at which he stated that the company wants to find ways to increase its “share of wallet” in the $3.5 trillion market for health spending in the U.S. My loose translation of that statement is: Get the money, even at the expense of our customers and employees.
Responses of Walmart pharmacists and technicians
Hundreds of comments from Walmart pharmacists and technicians have been posted on social media sites and message boards regarding the actions taken and the manner in which they were communicated. For understandable reasons, most are provided anonymously, and the following represent a very limited representation of the distress and anger experienced.
“I was called to the back by the district manager several hours into my shift He gave me the talking points, went back to the pharmacy, handed me my license, and I was on my way home in 10 minutes! I thought our store was doing well!”
“‘Accompanied’ out of the building in front of staff and customers, desperately trying to hang on to my dignity. Failed miserably.”
“I got laid off yesterday as a pharmacy tech after 25 years of loyal service.”
“My exit interview wasn’t honest. I was encouraged to reapply full well knowing no positions will be posted within the 2-month window so IF I ever went back to Walmart it would be at drastically reduced pay.”
“Has anyone got any kind of paperwork from being let go? I’m having a hard time trying to get any kind of paperwork with my name on it.”
“The corporate email sent out this week said all the layoffs and changes were done to benefit customers. Well, my pharmacy has no more cashiers, no more pharmacist overlap, and tech hour cuts, but the script counts aren’t going down. Customers used to 20 minute waits will start leaving when the minimum reaches 1 hour+. Benefits only the shareholders.”
“Now with all of the staffing shortages its only a matter of time when big mistakes will be made due to the rush and stress of vaccinations, 90-day adherence, and pushing to get scripts out fast! With no cashiers at our busy store, we have techs trying to be both techs and cashiers and still get things done. One pharmacist per day at our store, long hours, no breaks, and his license on the line if a mistake is made.”
“Mr. Sam Walton (the founder of Walmart) said ‘There is only one boss – the customer. And he can fire everybody in the company from the chairman on down, simply by spending his money somewhere else.'”
“I bet Sam Walton would be rolling over in his grave if he could see what his company has become.”
“Walmart was the company who started the $4.00 prescriptions years ago. If they would have only raised it over time, they would be able to pay for adequate staffing and keep long-time, loyal employees.”
“Walmart just paid $282 million to settle and try to silence an international bribery scandal.”
“I am not a young pharmacist. I have been doing this for 20+ years. It has taken a toll on my body – standing for 12 hours a day, with less breaks than are legally mandated – all have contributed to knee/back/joint problems. . . I am a single parent with kids. And no job. In a saturated market. I think I’m going to have to sell my house, and most of the things in it. This has dramatically impacted me and my children. I have no illusions that I will find another job anytime soon, or that we will even have a home to live in. Devastated!”
These comments and the hundreds of others are all important. However, the last comment above has such an disturbing impact that I had to interrupt my reading, and resume reading more comments at a later point. Walmart executives must be made to recognize that the actions they take because of their mistakes have devastating consequences for individuals who have served their company well. However, they avoid personal responsibility to the point that a number of the individuals terminated observed that the manager who informed them of their firing said that the decisions were made by computers.
Actions Walmart should take
All of the comments posted by former and current Walmart employees should be compiled in a document titled, “How NOT to treat employees and run a business.” Every Walmart executive and manager should be required to read it in its entirety.
Walmart has attempted to operate pharmacies, and it has failed! It has placed its customers at risk, and treated its pharmacists and technicians horribly. Walmart, as a company should now get out of pharmacy before it makes things even worse for its customers, pharmacy staff, and the profession of pharmacy. Rather than doing what Target did in selling its pharmacies to CVS, Walmart should sell its pharmacies and first offer them for purchase to its current and former pharmacists.
North Dakota has it right!
North Dakota has a law that requires majority ownership of pharmacies to be held by licensed pharmacists. There have been numerous attempts to overturn or circumvent this law that have been led by Walmart, Walgreens and others (please see my editorial, “Voters in North Dakota Should Oppose the Challenge to the Pharmacy Ownership Law!” in the September, 2014 issue of The Pharmacist Activist). These challenges have failed, and residents of North Dakota are served well by this law.
Other states should enact similar laws for new pharmacies, and existing pharmacies when ownership is changed. To protect the safety of the public, state boards of Pharmacy should require Walmart and other chain pharmacies that are substantially reducing pharmacist and technician staffing to submit reports of errors that occur.
CARTERSVILLE, Ga. – A Cartersville mother has an important warning for others after she says a local CVS pharmacist filled her 13-year-old son’s prescription with the wrong medicine.
Susanne Epps Jones told Channel 2’s Alyssa Hyman that her son, Elijah, is on the autism spectrum and has been taking the same medicine for eight years.
“I was scared. I wanted to know how it was going to affect the other medications that he’s been taking, what were the side effects. I didn’t know anything about the drug,” Epps Jones said.
Epps Jones said the pharmacist filled her son’s prescription with medicine commonly used to treat Parkinson’s disease.
“I immediately took him to the emergency room,” Epps Jones said.
She told Hyman that fortunately, Elijah is OK and only had mild side effects.
Epps said when she picked up his prescription, she had no reason to think anything would be different
I do take my responsibility. I should have inspected it more, but they looked the same size, shape and color. I didn’t think anything of it,” Epps Jones said.
She told Hyman that the pills and the bottles were so similar, she didn’t notice that it was the wrong prescription until four days later.
The directions on the bottles are the same, and the names of the medicines look similar.
“I trust my pharmacist to be filling the right prescription,” Epps Jones said.
Hyman contacted CVS to ask about the medication mix-up. A corporate spokesperson sent her a statement that said:
“When Ms. Jones notified our pharmacy about her son’s prescription on Friday evening, our pharmacist apologized and attempted to contact the prescribing doctor, however the doctor’s office was closed for the weekend.
“Our district leader has been in touch with Ms. Jones multiple times since the incident occurred to apologize, follow up on her son’s health condition, and ensure that he receives the correct medication.
“Prescription errors are a very rare occurrence, but if one does happen, we do everything we can to learn from it in order to continuously improve quality and patient safety.”
As for Epps Jones, she wants to remind everyone to check their medication.
“You get into a pattern after eight years of taking the same medicine every single month. I will now, from this day on, and we’re changing pharmacies,” Epps Jones said.
David Lackey spent 40 years running his machine repair business, despite having a body wracked by arthritis, degenerative disc disease, bone spurs in his shoulders and fractures in his back and spine.
After the Drug Enforcement Administration raided his pain doctor’s offices in January, seized medical records and prohibited any more opioid prescribing, Lackey only lived 34 more days.
The Odessa, Texas man died of a heart attack in March, after a month-long withdrawal that left him in bed shaking or in the bathroom vomiting and with diarrhea, his daughter, Gina Bruton, said.
Facing a backlash from chronic pain sufferers nationwide, federal health officials are rethinking policies that led to abrupt cutbacks to those who legitimately need these painkillers to function.
Federal measures made a broad-based effort to cut opioid prescribing and slow an overdose epidemic that kills tens of thousands of Americans each year. However, the Centers for Disease Control and Prevention officials acknowledge the agency’s influential 2016 chronic pain guideline has been used incorrectly to justify harmful practices such as rapidly reducing pain pills or doctors abandoning patients.
The CDC plans to update and expand the guideline with new research and is coordinating with public safety officials to ensure patients such as Lackey aren’t discarded when a doctor’s office is raided or closed.
In April, the Food and Drug Administrationwarned about reports of serious harm from slashing or discontinuing medication for opioid-dependent patients, including withdrawal, pain, psychological distress and suicide.
This fall, the FDA is expected to finalize plans to add warning labels to opioid medications about the risks of abruptly stopping the drugs. The FDA also proposed in May that drugmakers be required to offer limited-count blister packs of pills as an option to patients. These packs could be in low, medium or high-dose packs or be tailored to different procedures, such as hernia operations or appendectomies.
And a Department of Health and Human Services advisory task force in May reported on how to weigh the needs of 50 million chronic pain sufferers while tightening prescribing to prevent opioid addiction. The Pain Management Best Practices Inter-Agency Task Force recommended ways to allow pain sufferers to function and improve their quality of life.
Total U.S. opioid prescriptions have declined each year since 2012, a trend that accelerated after the CDC guideline issued in March 2016. Still, overdose deaths have continued to climb as pharmacies dispensed fewer pain pills, largely driven by illegal drugs such as heroin and fentanyl.
Vanila Singh, who chaired the HHS task force, says it could take time for state medical boards, doctors and others to bring nuance to prescribing opioids.
“I am not advocating we go and mindlessly prescribe,” says Singh, chief medical officer of the HHS office of the assistant secretary of health. “It has to be where the stigma of being the patient or the doctor or clinician who is prescribing is lessened. It is still a hard ship to turn.”
‘Doctors are afraid of the DEA’
Bruton believes pain patients and doctors have been unfairly targeted.
“Sure, the warning labels should be there,” says Bruton. “But in my opinion, they are fighting the wrong war.”
The CDC’s clarification is that its guideline was intended for primary care doctors, who increasingly are turning away pain patients.
“Doctors are afraid of the DEA and worry their livelihood will be lost, so they are trying to protect themselves,” says Bruton.
Like her father, Bruton’s husband, Vernon, works in heavy machinery repair and was a patient of Carl D’Agostino, a pain doctor who was disciplined by the Texas Medical Board in June 2018 for failing to maintain paperwork that showed he monitored patients through urine drug screens, pill counts and medical histories. D’Agostino did not return calls from USA TODAY.
Vernon Bruton now has to travel 700 miles round-trip to a new pain doctor in San Antonio, Texas. She says there are only four or five pain management doctors in an area of about 200,000 people.
He takes a small dosage of opioids to treat his degenerative disc disease and neuropathy, some of which stems from a car crash when he was young and drove off a bridge, landing in a creek bed upside down in his truck. He was found six hours later.
“Every day he worries his will be the next doctor raided,” says Bruton.
Because he couldn’t get copies of his medical records from the FBI, no new doctor would take Lackey on as a patient. The 74-year-old was still working part-time for his business and needed his 60 milligrams of hydrocodone a day to “be functional,” says Bruton.
“He was never completely out of pain,” says Bruton. “He just wanted to be able to participate in life.”
‘At the end of my rope’
The CDC acknowledged that there may have been unintended consequences from its 2016 guideline. Officials emphasized that the CDC is not a regulatory agency and its guideline is voluntary. Nevertheless, state health departments, insurers and other cited the guideline as reason for implementing opioid limits.
A common restriction: Limiting daily opioid intake at 90 morphine milligram equivalents per day – equal to two 30-milligram oxycodone pills.
“A lot of groups have taken that number and said, ‘We need to either taper [patients] down to that amount or we need to stop them,’” says Sharon Tsay, a medical officer with the CDC’s division of unintentional injury prevention. “That was not the intention. Some individuals need higher levels. People have physical dependence, whether or not they have addiction. So it’s actually very unsafe.”
Along with the federal Agency for Healthcare Research and Quality, the CDC is collecting new data to update and expand its pain guideline. The agency described the research as a priority but would not say when it expects to publicly release the information.
41% refuse new pain patients
Other research shows one consequence of the prescribing crackdown is that doctors are reluctant to take on new pain patients. A University of Michigan study published Friday in the Journal of the American Medical Association found that 41% of 194 primary clinics surveyed refused to take new pain patients.
Rebekah Leonard knows the difficulty of finding a pain doctor. A bulging disc, nerve damage and a botched back surgery have put the Reidville, South Carolina woman in constant pain since the late 1980s.
She says a fentanyl skin patch provided steady relief for years. But when her primary-care doctor retired five years ago, it took six months to find a pain specialist who put her on a strict, tapering regimen. When Leonard failed to take off one pain patch before putting on another, the pain doctor refused to continue to treat her, she said.
She’s been without pain medication for more than three years and spends 23 hours a day on her bed or sofa. She rarely leaves the house.
“I’m at the end of my rope,” Leonard says. “There are many people in this situation. You don’t seek any solutions. After awhile, you don’t have the energy for it.”
From Vicodin to kratom
Tucson, Arizona resident Jacqui Gerschefske still has lingering back pain from an auto accident six years ago caused by a drunk driver. Her primary care doctor prescribed 5 milligram dosages of Vicodin and oxycodone, which allowed her to stand for 8-hour shifts as a convenience store clerk.
“She knew I was stable and she knew I was not abusing,” Gerschefske says.
Her doctor retired and her new doctor refused to prescribe her the same regimen, so Gerschefske began taking a herbal product, kratom. The FDA has warned consumers to avoid kratom because of risk of addiction, abuse and dependence.
The CDC says kratom, an herbal supplement, was a cause of deaths in 91 fatal overdoses in the United States from July 2016 to December 2017. USA TODAY
Gerschefske says because she no longer has access to a doctor willing to prescribe opioids, she will stick with kratom despite the FDA warnings.
“My new doctor doesn’t prescribe pain pills,” Gerschefske says. “This was my solution, and I’m thankful that I have it.”
Feds want to prevent new cases of addiction
Public comments on the FDA’s blister pack proposal have been largely negative so far, with suggestions that regulators focus on illegal drugs and look for solutions that don’t make it harder for people with painful conditions to open their pill packs.
Dr. Yngvild Olsen, a Baltimore addiction medicine physician, notes the proposed blister pack rules are targeted at patients with acute pain, such as after injuries or surgery. She doesn’t expect it will help or hurt chronic pain patients much. But it could help prevent some addictions from starting.
“Certainly there is a percentage of people who get started on opiods for acute pain and continue to use and may go on to misuse,” she says.
Olsen, co-author of “The Opioid Epidemic: What Everyone Needs to Know,” said the CDC guideline was applied in ways it was never intended.
It “was really never meant for people already on opioids,” she said. “Unfortunately, that’s what happened.”
Dr. Douglas Throckmorton, deputy director for regulatory programs in FDA’s Center for Drug Evaluation and Research, says the agency has “never lost sight of the needs of pain patients.”
“We know that every action we take could have a big impact,” he said.
Although doctors still routinely give 30-day prescriptions to opioids for procedures that rarely require more than a couple days, Throckmorton says he believes they can “change in response to conditions and education.”
“The goals that the CDC has mirror our goals – education and to reduce inappropriate prescribing of opioids,” said Throckmorton. “As we work to educate prescribers, we will continue to keep the pain patient in mind.”
Two U.S. Senators introduced a piece of legislation Thursday which would prohibit the Food and Drug Administration (FDA) from allowing opioids to be labeled for intended use of “around-the clock, long-term opioid treatment.”
The FDA Opioid Labeling Accuracy Act, introduced by U.S. Sens. Joe Manchin, D-W.Va., and Mike Braun, R-Ind., would prohibit such labeling until a study can be completed on the long-term usage of opioids.
“In the United States, we consume 80 percent of the world’s opioid production and in 2017, one single year, over 70,000 people died due to drug overdoses,” Manchin said in the release. “These statistics are unacceptable. As one of the hardest hit states, West Virginia has been on the front lines of the opioid epidemic, which is why I have introduced this bill today with Senator Braun to address how the FDA approves opioid prescriptions for treating different types of pain.”
In 2001, the release said the FDA updated opioid labels to indicate use from “moderate to severe pain where use of an opioid painkiller is used for more than a few days” to “management of moderate to severe pain when opioids are needed for an extended period of time.”
With this change, opioids began to be prescribed as a first line of treatment for long-term chronic pain that surpassed the original intended use for cancer pain or short term post-surgical pain and definitively contributing to the heightening of the opioid epidemic.
The FDA Opioid Labeling Accuracy Act would prohibit opioids from being labeled for intended use to treat long-term chronic pain, except for cancer pain, end-of-life care or when a prescriber has determined that all non-opioid treatments are inadequate or inappropriate.
This past Monday, Senator Braun had a “town hall meeting” in Corydon IN. At one point he was talking about “Medicare for all”.. which apparently he was not in favor of. I tried to point out to him that what “they” are talking about is “MEDICAID FOR ALL” because it would seem that they are talking about paying for FIRST DOLLAR for everyone’s medical care.. I pointed out that Medicare required premiums, deductibles, co-pays and it was MEDICAID that may have minimal copays … mostly on prescriptions… otherwise the pt has “no skin in the game” … He went right back to talking about “MEDICARE FOR ALL”
Senator Manchin, in the last Congressional session, proposed a “opiate prescription tax” to get money from group of pts (chronic painers ) to pay for the treatment for another group of pts (substance abusers).
My personal record for pharmacies visited in a single day is 14.
