“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
Some of our veterans gave their lives in defense of this country. It takes a very brave person to be willing to sacrifice themselves for their country.
Sadly, many veterans are not being treated very well by their country. The man you see in this photo is 76-year-old Peter A. Kaisen.
Kaisen served in the United States Navy from 1958 to 1962. He was standing outside the Northport Veterans Affairs Medical Center when he took his own life.
He was a recurring patient at the hospital but had been denied service.
Thomas Farley, Kaisen’s friend for 40 years, said Kaisen went there for help with depression.
Kaisen retired from the Navy and became a Long Beach Police Officer.
In the 1960s, he was in a car accident and was permanently disabled. Kaisen had gone to the ER for help and didn’t get any.
So, he went outside to his car and took his life. What kind of a hospital turns away someone who is asking for help with a mental illness?
Who dropped the ball? The hospital stated that Kaisen didn’t go to the ER for help.
Are we to believe that he just drove to the hospital and shot himself in the parking lot?
Kaisen’s family is hoping that by sharing this story, it brings awareness to how the VA is treating our veterans.
Something needs to change – now. The past several years has revealed that many VA hospitals are falling short in their treatment of veterans.
MedWatch – The FDA Safety Information and Adverse Event Reporting Program
A MedWatch Safety Alert was added to the FDA Recalls webpage.
TOPIC: Multiple Ophthalmic Products by Altaire Pharmaceuticals Sold at Walgreens Stores: Recall – Due to Potential for Non-sterility
AUDIENCE: Consumer, Health Professional, Risk Manager, Pharmacy
ISSUE: Altaire Pharmaceuticals, Inc., announced on July 3, 2019 that it is voluntarily recalling the Over-the-Counter (OTC) drug products sold at Walgreens during the time period as indicated below: • Lubricant Eye Drops Moisturizing Walgreens item #: 801483 NDC #: 0363-0185-13 Package Size: 15 mL. Lot Number 19095, Expiration Date: 04/21, Manufacturer Ship Date: 05/14/19. • Lubricant Eye Drops Moisturizing Twin Pack Walgreens item #: 801477 NDC #: 0363-0185-49 Package Size: 2 x 15 mL. Lot Number 19095, Expiration Date: 04/21, Manufacturer Ship Date: 05/14/19. • Sodium Chloride Ophthalmic Ointment, 5% Hypertonicity Eye Ointment Walgreens item #: 801482 NDC #: 0363-7500-50 Package Size: 3.5 gram. Lot Number TCI, Expiration Date: 03/21, Manufacturer Ship Date: 05/08/19. • Sodium Chloride Ophthalmic Solution, 5% Hypertonicity Eye Drops Walgreens item #: 801402 NDC #: 0363-0193-13 Package Size: 15 mL. (Two Lot Numbers) (1) Lot Number 19105, Expiration Date: 04/22, Manufacturer Ship Date: 05/24/19 and (2) Lot Number 19050, Expiration Date: 02/22, Manufacturer Ship Date: 05/23/19. • Lubricant Eye Ointment PF Soothing Walgreens item #: 801486 NDC #: 0363-0191-50 Package Size: 3.5 gram. Lot Number TBD, Expiration Date: 04/22, Manufacturer Ship Date: 05/24/19. The products are manufactured and labeled exclusively for Walgreens. Altaire ships the products labeled for Walgreens only to Walgreens. The products are distributed at the retail level by Walgreens. Altaire has also requested that Walgreens notify its customers.
Healthcare professionals and patients are encouraged to report adverse events or side effects related to the use of these products to the FDA’s MedWatch Safety Information and Adverse Event Reporting Program: • Complete and submit the report online. • Download form or call 1-800-332-1088 to request a reporting form, then complete and return to the address on the form, or submit by fax to 1-800-FDA-0178. Read Alert
When recovering opioid addict Jacob was called into court in Clinton County, New York, for violating a restraining order, the judge told him he had 90 days to quit using his addiction medication, Suboxone.
Jacob, whose last name Law360 is withholding for privacy reasons, said he was “heartbroken” and afraid of possibly relapsing. But his court-appointed lawyer didn’t object, so he figured he had no choice but to get off the medication he had used to treat his opioid addiction for 13 years.
“When [the judge] told me that, I was just devastated. I didn’t even know what to do, because I know how hard it is to come off of them,” Jacob said. “I had a court-appointed lawyer, and he didn’t even care. So I figured I was done. I had to do it.”
But five attorneys working pro bono helped convince the judge to let Jacob stay on his medication — just one way in which attorneys and legal advocates around the country are stepping up to help people affected by opioid addiction.
One of Jacob’s attorneys, Sally Friedman, is among over 30 lawyers and advocates from across the country who have come together to work on an opioid task force convened by the Legal Services Corp., the federally funded nonprofit that distributes funds to over 130 independent nonprofit civil legal aid programs around the country.
The task force released a 53-page report on June 10, with a suite of recommendations about how legal aid providers and the judiciary can fight the opioid crisis by helping people with opioid use disorders tackle legal problems that interfere with recovery and by standing up for them when they do head to court.
“The change is far too slow, but there is change happening. I’m on numerous task forces that are seeking to educate the legal community and courts about this issue,” Friedman said. “That’s huge. I mean, none of that was happening three years ago even.” The Power of Legal Aid
In Jacob’s case, it was essential for the court to understand that forcing someone off Suboxone “dramatically increases the chance of relapse and possibly death,” said Friedman, who is vice president of legal advocacy at the Legal Action Center, a nonprofit that fights discrimination against people with addiction, HIV/AIDS or criminal records.
Jacob and others with opioid use disorders face the unique challenge that some of the medications that are prescribed to treat their addiction use opioid-based compounds, drawing the ire of judges and employers.
Fighting a Crisis
This month, a task force convened by the Legal Services Corp. released a 53-page report with numerous recommendations for how legal aid providers and the judiciary can fight the opioid crisis. Here are some of those proposals.
Legal aid providers should develop medical-legal partnerships with health care providers.
Legal aid providers should build other partnerships with local organizations that serve those affected by the opioid epidemic.
Legal aid providers should obtain training on the science of opioid use disorders and recovery.
LSC should work with legal ethics bodies and health law experts to develop policies and materials that address privacy and ethical issues related to helping clients impacted by the opioid crisis.
Courts should consider expanding alternate court options to assist people with opioid use disorders.
Correctional facilities should collaborate with civil legal aid attorneys to decrease obstacles facing people who are returning to society from incarceration.
Suboxone, for example, contains buprenorphine, a partial opioid agonist that binds to opioid receptors in the brain, preventing cravings and withdrawal syndromes without providing a full opioid effect, according to the National Alliance on Mental Illness.
Jacob, then 34 years old and the sole provider for an infant daughter, said he’d been taking his two Suboxone each morning to “live a normal life” and overcome an addiction to the opioid painkiller Percocet. That addiction started when he was prescribed the drug for roughly two years following an all-terrain vehicle accident in the early 2000s.
It’s an all too common story when it comes to the opioid epidemic burning across the country.
Regional legal aid providers have been making efforts to combat this epidemic through existing programs and new initiatives. The LSC’s task force was aimed at bringing the lessons learned through successful local efforts onto the national stage so they can be applied around the country.
One of the most prominent of these regional efforts has been the medical-legal partnerships pursued by civil legal aid nonprofit Indiana Legal Services, whose managing attorney, Jay Chaudhary, has become recognized as a national leader on the issue. Through these partnerships, attorneys are embedded with health care providers to help people fix various legal problems affecting their health.
“Civil legal aid in my view works best as a value-add to everything else, whether it’s mental health, health care, substance abuse treatment and recovery,” he said. “Legal aid is a necessary component, because barriers arise to whatever the end goal is, sobriety or living with recovery.”
A civil legal aid attorney can help someone keep their housing, reduce excessive child support obligations, negotiate a debt repayment plan, or get their driver’s license back so they can get back to work, Chaudhary said.
Even knowing how to craft a letter can make a difference in confronting the fallout from opioid addiction. Chaudhary recalled putting his writing skills to work to help convince a homeless shelter to take in people using opioid-based addiction medications like Suboxone.
For people who are trying to stay in recovery, homelessness can push them into relapse, but those who are evicted from their homes are unlikely to do the research to know if their eviction is legal, and don’t know how to fight it, Chaudhary said.
Most people with a substance abuse disorder, even when facing these issues, wouldn’t think to look to an attorney to help them in their recovery, said Brandon George, the director of the Indiana Addiction Issues Coalition.
As an addict in long-term recovery himself, George is painfully aware of that reality for many the coalition tries to assist.
When George stopped using heroin and crystal meth, he had an enormous amount of credit card debt, was behind on child support payments and had a suspended driver’s license, he said.
“I thought I was just bad with money and had baby mama issues,” he said. “I had no idea that these were legal issues. My brain just did not connect the dots.”
When George was first asked in his role as coalition director to work with Chaudhary in an addiction treatment training project at Indiana University, he was skeptical. He said he thought the attorney “stuck out like a sore thumb.”
Once the group began handling case studies, however, George said he instantly realized how useful legal aid could be, from helping support people in their housing and financial situations to helping sort out child custody issues.
George also touted the key role attorneys can play by helping people obtain felony conviction expungements. “People pay lifetime sentences socioeconomically because of felony convictions,” he said, which in turn can hinder recovery.
Now, George is working on connecting recovery organizations to civil legal aid attorneys nationwide, establishing a model where people coming in to the recovery organization can have their legal problems identified and receive a referral to an attorney, or learn when an attorney will be available on-site.
On the Front Lines
In providing these services, legal aid attorneys have a first-hand look at how the courts’ response to the opioid crisis can impact those struggling with addiction.
Friedman said she saw another client go through “tremendous” pain when, like Jacob, she was ordered to stop using medication-assisted treatment and began tapering down the dose.
“They just slog through their days not knowing if they’re going to end up in jail in two weeks, or relapse and overdose,” she said. “The human toll is devastating.”
As they did in Jacob’s case, lawyers are turning to the Americans with Disabilities Act to keep people with opioid dependency from being ordered off buprenorphine, according to Melissa Trent, an attorney with Brooklyn Defender Services and another onetime member of Jacob’s legal team. The ADA requires the government to make “reasonable accommodations” to ensure people with disabilities have equal opportunities to access public services and benefits.
“You can’t be denied participation in a probation program because you have a wheelchair,” she said. “People who have opioid addiction are people who have a disability under the Americans with Disabilities Act. … The argument is that the reasonable accommodation would be their medication-assisted treatment.”
Groups like the Legal Action Center are also working to spread awareness and best practices in other ways.
This means suing employers that fire employees for using medication to treat their opioid dependence, lobbying for laws like 2008’s Mental Health Parity and Addiction Equity Act, which requires insurers to designate funding for treatment services, and creating informational materials so that other attorneys know how to defend their clients’ right to stay on opioid-based medication, according to Friedman.
That theme of education runs through several of the recommendations in the recent LSC report. Among other proposals, the task force calls for the development of new medical-legal partnerships, getting specialized training to aid attorneys, increasing education about opioid use disorders in the courts and improving collaboration between state agencies and treatment providers.
Of course, funding remains a pressing need, according to Chaudhary, who said more diverse funding could help spread legal aid programs to drug courts and community recovery organizations.
Legislation known as the Support for Patients and Communities Act, which targets the opioid crisis and was signed into law in October, made many federal funding streams newly available to support civil legal aid, according to Stefanie Davis, assistant general counsel in the office of legal affairs at the LSC.
However, Davis added, “the funding that we are able to get even as it increases is not nearly enough to meet the need that exists for legal aid.”
That funding matters for people like Jacob, who says that without the pro bono legal help he received, he might have ended up relapsing or in jail, instead of raising a family.
“It saved my butt, I know that. It saved my life pretty much. Who knows what would have happened?” he said. “It’s a happy ending for sure.”
As an advocate for social justice, NMMAA empowers the community through education and activism. With active NMMAA patient advocates throughout the country, informed citizens organize and protest injustices, raise awareness, educate, inform, and build coalitions.
In 2008, investigative journalist Katherine Eban started digging into the generic drug industry after hearing stories of patients whose generic drugs were not working properly for them. They had been stable on a branded drug, but then relapsed once switched to a generic version or experienced troubling side effects when switched between generics. She detailed her findings in a series of articles in the magazines Self and Fortune, and her new book, Bottle of Lies .
Katherine Eban. Robert Falck
The majority of generic drugs are manufactured overseas, and “the [US Food and Drug Administration] FDA was essentially regulating on an honor system,” Eban told Medscape Medical News. The agency would announce its inspections of overseas manufacturing plants weeks or months in advance, giving companies an opportunity to prepare to put on a good face and mislead inspectors with fabricated data.
In the course of Eban’s reporting, she obtained 20,000 internal FDA documents that “revealed that the FDA’s investigators have grave doubts about the quality of the drugs being manufactured at these plants,” she said. But FDA officials minimized the investigators’ findings.
Eban spoke with Medscape Medical News about the implications of her findings for clinicians. The following is a lightly edited account of the conversation.
Medscape Medical News: What do you think doctors and other healthcare professionals need to know about the state of generic drugs?
Katherine Eban: In the book I feature several doctors from the Cleveland Clinic who struggled with this question of the quality of generics. A number of heart transplant patients suffered organ rejection after being switched to a generic tacrolimus. And also a number of patients who were followed by a cardiologist who became very intently focused on this question and felt he couldn’t stabilize them on certain generics.
He actually identified drugs that were particularly problematic, and after he identified them, lo and behold, the FDA went into the plants, found egregious conditions, and those drugs were recalled. So he was observing something that really is going on.
What I think physicians need to understand is, if their patient is not responding as anticipated from a medication, they need to consider the possibility that it is the medication that is the problem. So instead of just increasing a dose, or switching a patient to a different therapy altogether, I think they need to consider, is this the manufacturer of this generic? Is there a better generic that I can get the patient switched to? Or do I need to make a case to the patient’s insurance company that they should be on the brand? And it’s just a kind of category of thought that physicians need to have.
What role did physicians play in helping these issues come to light?
The doctors that I’ve talked to who have become aware of this, and have petitioned the FDA about this, I think [they] played a major role in having this come to light.
I think without their clinical vigilance, I’m not sure it ever would have come to light. But it’s no accident that it took me essentially 10 years of reporting to produce this book. It’s very complicated. And it requires a lot of connecting of the dots, from clinical symptoms, to the global drug supply, to regulatory failures, to what’s actually happening in these manufacturing plants. It’s a lot of data points to line up. And I think that’s one of the reasons why it hasn’t really come to light before this.
What discovery from your reporting for this book surprised you the most?
The level of data fabrication is really extraordinary. I’ll give you an example.
Because of some of the findings in the plants, the FDA ran a pilot program in India, from 2014 to mid-2015. They decided all the inspections were going to be unannounced or on very short notice, which obviously should be the standard. Once they started going into these plants completely unannounced, what they discovered was just staggering.
The plants operate data fabrication teams that come in in advance of FDA inspections. They alter data, they invent documents, they even invent standard operating procedures that don’t exist. One plant steamed them overnight to make the documents look old. They found out another plant was completely fabricating its testing to prove that the plant was sterile. There were no tests. The laboratory that was doing this was testing nothing, and all their data were perfect. So that’s an example of the kind of depth and extent of the fraud in these plants. It’s shocking.
Is there anything that doctors can do to help their patients avoid these poor-quality generic drugs?
Once doctors become aware of this issue, as their patients have symptoms, or as they have difficulty, I think [doctors] will find that there are certain manufacturers where they have repeated problems, and then when they switch to different manufacturers, everything is OK.
As difficult as it sounds, I think that doctors really have to get to know some of these manufacturers. I think the medical community and the patient community have taken it pretty much on faith from the FDA that all the drugs are interchangeable. That you can just switch from one brand to a generic or between generics and it’s all the same, except that’s really not the case. Once doctors become aware of that, I believe you’re going to find that drugs from certain companies are pretty reliable, and drugs from other companies are not, and that becomes a way to get to the bottom of this more quickly.
What is the role of listening to patients about their reactions after switching to a new generic drug?
Listening to patients is absolutely vital. In the first article I wrote about this, I interviewed this woman who was switched at the pharmacy from a brand name to a generic antidepressant, and had just a horrible set of reactions and side effects. [She] ended up going from doctor to doctor to try to treat all those side effects because she didn’t realize that it was her generic. She finally went online and began doing her own research and began to connect the dots and realize that the onset of her symptoms was at the point that she was switched to a new medication. She called her doctor’s office and the nurse at the doctor’s office said, “Yeah, we hear this from a lot of patients.” Had she had that information previously, she would not have been on this horrible medical odyssey.
Doctors can play a huge role in helping patients with this. Frankly, we need new legislation around this, but that’s not going to happen anytime soon, most likely. So until these problems can get addressed, doctors are really the front line in dealing with it.
What about the role of pharmacists?
My impression is that most pharmacists don’t really know about these issues, and that they also don’t really know where drugs are manufactured. It’s not their fault. What they know is what they have on the shelf at any given time, which is in these big bottles that they’re filling prescriptions from. I think a lot of states don’t even require pharmacies to maintain records of which manufacturer they dispense. The recalls often don’t even get down to the patient level because of that.
To the extent that they talk to consumers, I think [pharmacists] can play a key role in helping them. For example, there are manufacturers whose drugs I won’t take. And my pharmacist knows that I’m a bit of a pain when I go to fill a prescription, but there are just certain companies — because I know that they fabricated data, that their plants are not sterile, that they’ve gotten FDA warning letters — I won’t take a prescription filled with their medicines. And my pharmacist knows that. They let me switch to a different manufacturer. I often am requesting specific generic manufacturers that I trust more than others. But I think if the pharmacist doesn’t understand these issues, that’s going to seem like very strange behavior to them. So it’s something I think that they need to be educated about, too.
One thing that I know a lot of experts in this space really think is important is putting the country of origin, of manufacturing, on dispensing labels. Why shouldn’t consumers know where the active ingredient and the finished drug are made? Why isn’t that information passed along to patients? That is something that could be a sort of educational tool for everybody in this space.
In addition to your book, what are some other key resources to keep up to date on what’s happening with generic drugs at the FDA and which manufacturers have an issue?
On the FDA website there are links to warning letters and import alerts. There’s another site that I like a lot called FDAzilla, which has all of the documents related to FDA inspections on it. If your patient is reacting badly to a drug made by company X, you could go into FDAzilla and look up the inspection record of that company. But for busy physicians, it’s not so easy.
The category of findings related to falsification is called data integrity. The whole idea behind “good manufacturing practices” is that you can’t test the quality of a million pills in a batch. So consequently, good manufacturing requires a kind of minute-by-minute creation of data that accompanies each step of the manufacturing practice. And that data is considered the cornerstone of good manufacturing practices. Without that data, there’s no way to vouch for a drug’s quality. If a company has data-integrity issues, it’s a pretty scary world. It means that there is a real possibility that they’re committing fraud. Not a guarantee, because you can have data-integrity findings that are not necessarily fraud, but negligence, or just problems, but it’s kind of a red flag. And that’s something for doctors to be aware of.
Doctors who are inclined to be political about this should contact their lawmakers. Because it’s really a very difficult, almost intolerable situation that we’re in. I think there needs to be medical activism on this issue.
University Hospital nurse Alex Wubbels has agreed to a $500,000 payment to settle a dispute over her arrest by a Salt Lake City police officer after she barred him from drawing blood from an unconscious patient, her attorney said Tuesday.
Attorney Karra Porter said at a news conference that the agreement with Salt Lake City and the University of Utah covers all parties and takes the possibility of legal action off the table. “There will be no lawsuit,” she said.
The arrest drew widespread condemnation after Porter released police body camera and hospital security footage of the encounter on Aug. 31.
Wubbels will use a portion of the money to help people get body camera footage, at no cost, of incidents involving themselves, she said at the news conference. In addition, Porter’s law firm, Christensen & Jensen, will provide for free any legal services necessary to obtain the video.
“We all deserve to know the truth and the truth comes when you see the actual raw footage and that’s what happened in my case,” Wubbels said. “No matter how truthful I was in telling my story, it was nothing compared to what people saw and the visceral reaction people experienced when watching the footage of the experience that I went through.”
Wubbels said she also will make a donation to the Utah Nurses Association and will help spearhead the #EndNurseAbuse campaign by the American Nurses Association.
Porter said she hopes the discussion about the need for police body cameras continues and noted that the footage also protects law enforcement officers.
The July 26 encounter leading to Wubbels’ arrest began when she refused to allow Salt Lake City Detective Jeff Payne to draw blood from an unconscious patient who had been involved in a fiery crash in Cache County earlier in the day.
Wubbels pointed out that the crash victim was not under arrest, that Payne did not have a warrant to obtain the blood and that he could not obtain consent because the man was unconscious.
Payne insisted he had implied consent to get the blood and eventually arrested Wubbels. He handcuffed her and placed her in a police car outside the hospital, then released her after about 20 minutes. Charges were never filed against the nurse.
Wubbels is heard on footage of the incident asking a University police officer to protect her because Payne had threatened her with arrest. The U. officer informed the nurse that if she interfered with Payne’s investigation, she would be obstructing justice and he would not prevent the detective from arresting her.
The footage shows that as Payne moves to arrest Wubbels — grabbing and chasing her — she screams and backs into the U. police officer. The officer places a hand on Wubbels’ shoulder, apparently assisting Payne. (Other hospital employees appear to try and talk Payne down as the arrest is taking place.)
On Sept. 13, Salt Lake City Mayor Jackie Biskupski announced an internal affairs investigation had found Payne and Lt. James Tracy violated several department policies during their interaction with Wubbels. A review by the city’s independent Police Civilian Review Board also found the officers violated department policies.
Wubbels said Tuesday she hopes the disciplinary measures are upheld. “I will be very disappointed if they aren’t,” she said.
The patient at the center of the controversy was 43-year-old William Gray, a full-time truck driver and a part-time reserve officer with the Rigby, Idaho, police department. He was severely burned on nearly half of his body in the July 26 crash and died Sept. 25.
A man in a pickup truck who was fleeing from the Utah Highway Patrol collided head-on with Gray’s semi on U.S. 89/91 near Sardine Canyon, according to Logan police, who investigated the crash. The pickup’s driver, Marcos Torres, 26, died at the scene.
After the crash, Logan police requested that Salt Lake City police obtain a blood sample from Gray.
Greg Skordas, Payne’s attorney, has said a federal regulation requires a blood sample when a driver with a commercial driver license (CDL) is involved in a fatal accident, and that by getting a CDL, a driver is assumed to have consented to a blood draw. Gray had a CDL and Payne wanted the sample so the injured man could keep that license, according to Skordas.
Porter has countered that the CDL regulation covers what an employer — not a law-enforcement officer — is supposed to do after an employee is in an accident. Another CDL regulation adopts states’ implied consent law but Utah’s statute specifically requires reasonable suspicion that a person was intoxicated before a sample can be taken, she said.
A criminal investigation into the arrest — which involves the Unified Police Department, the FBI and the Salt Lake County District Attorney’s Office — continues.
Congress has approved of lifting a ban on giving medical patients a unique identifier as part of an effort to prevent the practice of doctor shopping for addictive painkillers and reduce medical mix-ups.
Congressman Bill Foster, a Democrat from Naperville, Illinois, introduced the amendment that was approved earlier this month as part of a $99.4 billion United States Department of Health and Human Services appropriations bill.
He said the measure would go a long way to fight the practice of doctor shopping for more prescription pain pills amid a deadly opioid crisis. Doctor shopping involves visiting multiple doctors to obtain multiple prescriptions for pills.
“This would not only guard against doctor shopping by those who are struggling with substance abuse disorder, but could also prevent those in recovery from accidentally being given prescription opioids after an injury, surgery, or childbirth, triggering a relapse,” Foster when he introduced the amendment.
Specifically, assigning a unique number to a patient would give doctors a way to immediately identify a patient’s medical history.
Pennsylvania Republican Mike Kelly said it would lower the cost of medical mix-ups due to misidentification.
“Lives have been lost and medical errors have needlessly occurred,” he said, sharing a story about his elderly father nearly being given the wrong medication during a hospital stay.
“These are situations that could have been entirely avoidable and patients would have been able to have been accurately identified and matched with their records,” Kelly said.
Opponents of an identifier have said it opens up health records to unwanted surveillance or privacy breaches, suggesting biometric identifiers would have the same benefit without assigning a number to people. Others have said it is the first step to nationalizing the private healthcare industry.
Each of us have a few unique identifiers… all digital FACIAL RECOGNITION, digital Finger Prints, digital optical scan… we don’t need any FRIGGIN UNIQUE NUMERIC IDENTIFIER… They need current digital technology… instead of playing a “number’s game”
Drug-related deaths have continued to climb in King County, with fatal overdoses involving methamphetamine and fentanyl on the rise, according to Public Health — Seattle & King County.
Last year, 415 King County residents died from drug or alcohol use — up from 379 in 2017, according to a report released Tuesday by Public Health. Of those who died, 20% to 25% had been drinking alcohol but mostly in combination with other drugs.
Public Health found that 77 percent of people who died had multiple substances in their system. Fatal overdoses from prescription opioids and heroin have remained stable in recent years, while fentanyl-related deaths doubled since 2017, climbing to 66 last year. Illicit opioids were involved in the most deaths overall, but methamphetamine became the most common drug associated with overdose deaths for the first time, as The Seattle Times reported last month.
Question- I am a 65 year old disabled female. Have dealt with pain for past 20 years. My opioid dose was cut in half in 2014 along with so many others. I have taken the same amount, 70 mg (85meq) for worsening conditions, cervicalgia, dystonia, as well as joint hyper mobility since 2014. Life is painful every day regardless. There isn’t much left to my life. I can’t travel well, my mobility has decreased, most all items are delivered, my life is confined to my home for most part.
Yesterday, I had surgery to (1) re-sect margins on a malignant melanoma on my back and (2) do a nipple biopsy on my breast. I was told that since I already take pain meds, the surgeon was ‘between a rock & a hard place’ with being able to prescribe any additional meds. I had received pre-op forms explaining that pain meds would be prescribed for all surgery patients, so I was confused, but tried to be understanding- Until the drugs from surgery wore off yesterday afternoon.
The dr explained to my husband right after surgery that my breast would be very painful for several days. No joke. I cried most of the night. I am tolerant, obviously, to the amount that I am accustomed to taking for fibromyalgia & degenerative issues, labral tear in hip, subluxation shoulder causing unbelievable thoracic pain in back left shoulder blade area. The amount of medication that I have is not enough to cover post surgical pain as well. I will run out before time for my next fill because of the surgery.
The surgery center called this a.m. to see how I was feeling. I explained I had been awake most of the night, hurting all night, having to take something every hour and a half, and still burning, stinging pain within my breast. The nurse said, “well, you have pain meds to take, correct?” I replied that I do, but I am shorting myself later in the month. If she understood, she was unfazed.
Steve, I need a sanity check- am I being unreasonable? Should I have to suffer through this after surgery just because I am already in an amount of pain that is being barely managed? By the way, my family dr manages my pain, conservatively. He stated before the procedure that he could write more meds offering me a tramadol prescription but I probably wouldn’t be able to have it filled. He convinced me I definitely need the surgeries, to go forward with them, and if I run out, he will try to figure something out. Am I missing something? Is this not what pain meds were designed to do? My pain during the winters keeps me bed-bound. My doctor has also said he would have my knees redone but he wouldn’t be able to control my pain?
This is way beyond discouraging. It’s been hard enough to accept that the medical community can do no more than barely keep me comfortable. I like my primary care doctor. And have no ill feelings toward surgeon, hospital, or anyone, except those who have laid out unrealistic limits for patients who are suffering already. I have been disabled for nearly 10 years. During my working career, I carried a top secret clearance with the same government that has me categorized as opioid tolerant. I might as well be on the street corner looking for drugs. I have been misjudged by pharmacists among others in healthcare. I have never asked for my med early, I have never failed a drug test, and am fully compliant with everything my dr has asked. This practice is discouraging future health procedures based on past pain experiences and i feel a form of discrimination. How can this be happening?
Is this average? I will make it thru this somehow, but God forbid, should I need another preventative procedure, I won’t be able to. Tell me others are not having to suffer like this.
Thank you for reading.
Just imagine in days.. months to come… how many “regular people” are going to go under surgery or have a accident that at the very least causes them some substantial pain.. According to thishttps://www.answers.com/Q/How_many_surgeries_are_done_in_the_us_every_yearthere is an estimated 40 million elective surgeries in the USA EVERY YEAR… that is 110,000 surgeries PER DAY.
How many of these surgery pts don’t experience some sort of on going/long term pain before their surgery and they wake up from surgery to be told that they will be given TYENOL/ACETAMINOPHEN to help them deal with their pain. How many of these pt and their family going to “go ballistic” about how they or their family member has been allowed to suffer post surgery ?
How much is their pain and/or frustration is going to be calmed by being told that the healthcare system “don’t want them to become addicted” and that is why they have to just “suffer thru for a few days or a week” ?
Not all surgeries produce “excellent outcomes” and how many pts end up with worse pain or end up with chronic pain post surgery ? All of these new little/no pain management post surgery pts & family going to be “more active” in filing complaints with various agencies over how they or their family were treated poorly or allowed to suffer in pain. The existing chronic pain community may be acquiring new and more active & vocal allies.
