American Pain Society Goes Belly Up

Opioid lawsuit costs prompt membership to approve bankruptcy filing

https://www.medpagetoday.com/primarycare/opioids/80777

Saying it is beleaguered by legal debt fighting lawsuits alleging that its policies contributed to the nation’s opioid crisis, the American Pain Society has voted to cease operations and on Friday, filed for bankruptcy protection under Chapter 7.

Numerous legal filings have accused the organization, along with other companies and associations, of acting as “front groups” for opioid drugmakers because many of them regularly contributed significant financial support to professional groups such as the APS.

In a statement emailed Friday afternoon, the 42-year-old organization said it had been “named a defendant in numerous spurious lawsuits related to opioids prescribing and abuse. The organization’s financial health has deteriorated as a result of the litigation” that constituted “a perfect storm” for the organization’s demise.

The statement added that the organization’s financial health had deteriorated as a result of litigation costs, but that declines in membership, sponsorship revenue, and meeting attendance also contributed to the decision.

“Our resources are being diverted to paying staff to comply with subpoenas and other requests for information and for payment of legal fees instead of funding research grants, sponsoring pain education programs, and public policy advocacy,” APS President William Maixner, DDS, PhD, said.

In late May, the APS board of directors had called for a membership vote to support bankruptcy action, but said it was doing so “with heavy hearts.” Results were supposed to have been announced the following week, but requests for a determination were not forthcoming. A decision required at least 10% of its 1,173 eligible members to vote; the APS statement posted Friday on its website said 93% voted to approve the bankruptcy filing.

APS spokesman Chuck Weber said on Friday the decision was made with only one round of voting, but he said he did not know the reason why the organization delayed announcing the ballot’s result.

The press release quoted several members lamenting the end of the APS.

Roger Fillingim, PhD, an APS past president and professor of psychology, University of Florida School of Dentistry, said the “APS has been advocating for increased investment in research for many years, and it is particularly ironic that APS’s voice will go silent at this critical time in our history, when increased investment in pain research has finally become a reality in an effort to combat the opioid crisis.”

APS President-elect Gary Walco, PhD, also noted the irony that a “professional organization best poised to provide the spectrum of science to improve the prevention and treatment of pain and related substance abuse is defunct.”

Walco, director of pain medicine at Seattle Children’s Hospital, added that “Now, more than ever, our nation needs the collective efforts of leading scientists and clinicians who hold patients’ well-being at the highest premium. The principal focus on punishing those in industry that may have contributed to the problem is shortsighted and far from sufficient.”

The Chicago-based organization said it filed for bankruptcy protection in the U.S. Bankruptcy Court for the Northern District of Illinois.

It is unclear what will happen to its monthly Journal of Pain, although Weber said last month that the journal, as well as numerous research grants, a young investors fund and the group’s annual scientific meeting, would disappear or be taken over by other organizations.

In brief remarks Friday afternoon, Weber said he expected that all of the organization’s endeavors and operations “will be gone,” and that there is no sign that any other organizations are willing to pick up any of its functions.

“The next steps are in the hands of the trustee,” he said. The APS statement also promised more information for members “in the next week or so.”

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Pa. might devise punishments for docs who give more than a week of opioid painkillers

https://www.pennlive.com/news/2019/06/pa-might-devise-tougher-penalties-for-docs-who-prescribe-long-term-opioid-painkillers.html

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We have treated the utility industry since the Sherman Antitrust Act was signed into law in 1890.  Until the 1990’s most health insurance companies were mutual companies … the were NOT FOR PROFIT businesses and their policy holders basically owned the company.  but starting in the 1990’s the healthcare insurance industries began “demutalizing” … they converted the companies into FOR PROFIT, PUBLICLY HELD COMPANIES and their focus change to their bottom line profits and price of their stock.   The people who were stockholders became more important to the insurance company and large group health insurance plans than the healthcare that they provided.

In the last decade or so… mergers having been happening and we are being left single companies that provide various services,, that can both self serving and “feed/refer” business from one component to another.

CVS Health is a good example, first in the pharmacy business in 1964 with pharmacy depts in the then Consumer Value Stores. Today, they have some 10,000 community pharmacies,  Minute clinics in their stores, owns the largest long term care pharmacy (Omnicare), one of the largest Prescription Benefit Managers (Caremark), one of the largest Part D insurers (Silver Scripts) and currently trying to close a 60+ billion dollar deal acquiring Aetna insurance with some 43 million beneficiaries.  Their Minute Clinics which were originally suppose to deal with just acute health issues is starting to move into treating chronic health issues.

These health monopolies may or may not be able to “force” a pt to use all their services, but they can put into place financial incentives or disincentives to stay within their system and force pts to contribute to their bottom lines.

All of these insurance companies are exempt from Sherman Antitrust by the McCarran Ferguson Act.. So what is ILLEGAL for other business to do, these insurance companies can do without any concern of violating any law or suffering any consequence from the DOJ.

In the last year, Arkansas, Ohio, WV has caught PBM’s charging excessive costs for prescriptions (multiple millions in each state) they manage the bill paying for state employees and/or Medicaid pts. These are national PBM’s so it may not be long before other states start finding out that they are being “taken to the cleaner” by these PBM’s and taking some corrective action.

Personal experience, Barb had a chronic medication that our Part D/PBM wanted a prior authorization and a $600.00+ copay for her 90 day medication and I was able to find a big box store where I could purchase the same medication/strength/quantity for $44.00 – by PAYING CASH.  Saving abt $2,400.00/yr on JUST ONE PRESCRIPTION.  Maybe this is why they can charge pts about $30/month for premium… 

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What a dramatic difference between those on the stage the first night and the second night… the first night it was like a group of Type B personalities participating in a very “polite debate” The Second night was like a group of type A personalities in a “cat fight”.

They keep talking about “Medicare for all” …but when you listen to the real details that they are tossing out there is really should be called “Medicaid for all” or “VA care for all”… they are talking about no premiums, no deductibles, no copays… and they even want to provider “free healthcare” for illegal aliens.

Do you know what you get when all healthcare becomes “FREE”… you get lines out the door, around the corner and down the street.

They also claimed that “healthcare is a HUMAN RIGHT ”  does this mean that both chronic pain pts and those with various mental health issues – including additive personalities – deserve appropriate care ?

They talked about various discrimination…  Roe v Wade and women’s right, LGBTQ’s discrimination, discrimination with school busing … but discriminating against chronic pain pts and substance abusers… apparently NOT ON THEIR RADAR ?

As many of these 20 contenders start falling off, the remaining will start having meeting in many communities are the primaries start happening. Is this where the chronic pain should start having demonstrations and trying to get discrimination of chronic pain pts on the NATIONAL AGENDA ?

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Audit report raises concerns with effectiveness of prescription drug registry

https://helenair.com/news/state-and-regional/govt-and-politics/audit-report-raises-concerns-with-effectiveness-of-prescription-drug-registry/article_b406cb8f-f2d9-5885-8f5f-92669f47a180.html

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Opioid-related ER visits decline in Massachusetts

https://www.boston25news.com/news/opioid-related-er-visits-decline-in-massachusetts/961737773

BOSTON – A state panel says the number of emergency department visits by people with opioid-related issues dropped by nearly 6 percent in Massachusetts from 2016 to 2017.

The report released Wednesday by the Health Policy Commission is based on a state database of hospital discharges up to 2017, the most recent year available.

The HPC says even though opioid hospitalization rates are down the opioid epidemic is still hitting Massachusetts harder than some other states. And it may be hitting some unintended targets. 

Until recently, professional musician Ellie DeOrsey was able to perform with a Rhode Island Orchestra thanks to the use of oral fentanyl. 

But when she was forced to change doctors because hers moved away, her treatment changed. 

“It didn’t affect my judgment, my thinking, it just took my pain away,” Ellie told Boston 25 News. “And my first office visit with this doctor, his first thing was: I will not prescribe you fentanyl.”

Ellie, like many patients with chronic pain, believes the opioid epidemic is forcing doctors to sometimes turn away from pain-killing drugs that work in favor of ones that won’t draw the attention of the DEA. 

The commission analyzed emergency department visits, and inpatient hospital stays, for people who have an “opioid-related diagnosis,” such as opioid dependence, misuse, or overdose.

Nearly 68,000 opioid-related hospital visits occurred in 2017, a little more than 2 percent of all discharges.

The drop came after years of increases.

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AG: Addiction Treatment, Trafficker Arrests Key To Fighting Wisconsin’s Growing Meth Epidemic

https://www.wpr.org/ag-addiction-treatment-trafficker-arrests-key-fighting-wisconsins-growing-meth-epidemic

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Using Opioids and Having a Job—It’s Not Easy

www.nationalpainreport.com/using-opioids-and-having-a-job-its-not-easy-8840192.html

By Denise Hedley

Those of us with chronic pain are well aware of the new laws that have labeled the opioid crisis and thus punished chronic pain patients. We are all affected in one way or another, and a good number of us have had our medications taken from us. Just today, I was told to take Advil for my pinched nerve and three herniated disks in my back – oh and from now on, I’m supposed to basically live on my heating pad.

Those of us who have lived with chronic pain for quite a while are well aware of what it takes to hold down a job with an invisible illness. Most of us hide it for as long as we are able to work. We are the ones who are not addicts, of course, but there is a new threat to the chronic pain community in the form of proposed legislation and other movements that want to punish those in pain who are still able to work.

The fear of abuse is so rampant, that they want to make pre-employment and random drug screens add opioids to their lists of banned substances for the workplace. In those jobs that have safety concerns this might be understandable that they might worry about impairment. This move, however, seems more like a witch hunt.

What is not understood by many of the parties proposing these actions is that those of us who function only because we have this one tiny tool towards some degree of relief do not find ourselves impaired. We are better able to focus. For some, this relief could be the only thing keeping them in the workforce where they can have a benefits package and better insurance.

It is now recommended that prescription pain killers be considered a violation of the drug-free environment. Employee Assistance Programs (EAP) have now been advised to recommend that any employee who is using prescription painkillers be referred for treatment.

Companies who have thus far avoided drug testing programs may soon be required to begin one. There is a large movement towards taking the war on opioids into the workplace. Companies are now requiring employees to notify their employers if they are placed on prescription painkillers. Most will be required to take leave for the duration of their pain treatment while others may lose their jobs. Ironically, the company does not have the right to ask what those employees are receiving their pain management treatment for.

There have been some moves, as a result of the recent HHS task force activities, to rewrite instructions to primary care physicians as to the prescribing of opioids to those chronic pain patients with a proven history of staying within guidelines. The right to continue treatment seems like it is being excluded for those patients who are still able to work. If all of this new legislation passes, then the war on opioids is taken too far and it seems like it officially becomes a war on chronic pain.

This gives us one more reason why those of us in the chronic pain community need to be more vocal. Even if it is only one person at a time, our voices must somehow be heard.

Denise Hedley

Denise Hedley was initially diagnosed with Fibromyalgia in 2009. Her condition has worsened, and was diagnosed with bilateral RSD in January, 2019. She also suffers from Osteoarthritis, 2 herniated discs, and Systemic Lupus Erythematosis

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The DEA has previously stated that a Pharmacist needs to “resolve” issues that the DEA considered RED FLAGS..  One of their RED FLAGS is a pt that travels long distances to get a controlled  Rxs filled… because that is what substance abusers/diverters do… so – according to DEA logic – anyone who does this must be a substance abusers/diverters.

So according to this pt, apparently some RED FLAGS are IMPOSSIBLE for the Pharmacist to resolve USING COMMON SENSE.  The fact that the pt’s insurance company has LOCKED the pt into this pharmacy – for some reason .. makes no difference to the war on drug mafia.

This may answer my concern about pts paying CASH for part or all of the cost of controlled substances because of QUANTITY LIMITS of their insurance companies or the fact that their insurance will no longer pay for a particular medication. This is another RED FLAG according to the DEA

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