There has been some discussion in a few FB groups in particular about creating and funding a “legal defense fund”. To address the issue that many in the chronic pain community is dealing with is a multi-faceted problem. Federal rules/laws, state rules/laws and healthcare corporations (Insurance/PBM, healthcare corporations, chain pharmacies, CDC guidelines, and numerous interpretations and implementations of those guidelines.

Below is a very recent example of how some of these healthcare corporations are making policies that are going to adversely impacting the quality of life of many pts, many of whom are covered by the Americans with Disability Act.

What we are seeing a classic lawsuit tactics to force defendants into settling.  The first example was the tactics of several state AG’s against the company that first brought out Zohydro ER – a long acting Hydrocodone – no Acetaminophen – and did not contain an abuse deterrent.  The company was sued in a number of different states… forcing the company to hire law firms in each of those states to defend themselves.  This was a fairly young company and Zohydro was their only product… needless to say… the cost of defending themselves in all those states and paying for all those different law firms… caused them to file for bankruptcy.

We are seeing the same thing going on with the lawsuits against various pharmas, wholesaler and chain pharmacies over the opiate crisis.  Numerous cities, counties and states have filed lawsuits. I have seen where the number of plaintiffs being listed in the THOUSANDS.  It is all a “legal game” to encourage the plaintiffs to SETTLE .. rather than go thru all the costs of defending all of these lawsuits in all of these different states.  It is claimed that there is some 100 million chronic pain pts.. and that 80% are struggling financially… that leaves 20 million who are not struggling financially… and getting a $10/month donation from each of those represents a potential 200 million/month cash flow… even getting 5% to contribute would potentially generate 10 million/month.

The chronic pain community needs a law firm, PR firm and a lobbyist firm on the job. Since most/all chronic pain pts are considered a covered entity under the Americans with Disability Act and Civil Rights Act…

While you can’t sue the government, there is nothing that prevents the community from challenging the various laws/rules/regulations that are being passed by Fed/state legislatures. There is nothing in our legislative system that guarantees that any bill signed into law is constitutional, but our system is set up that as long as a law is on the books .. it can be enforced… until someone challenges the constitutionality in our court system and it is declared unconstitutional.

The DEA has its own PRESS RELEASE MACHINE  https://www.dea.gov/press-releases   shouldn’t the chronic pain community have it own PRESS RELEASE MACHINE…?  While it is great that chronic pain pts occasionally gets a some press, but occasional press in various markets around the country … is no more than a “flash in the pan”

The question has to be asked, why are all of these various entities discriminating against chronic pain pts ?  Could it be that they are being encouraged – or intimidated by the DEA – to do so… and to date … they have suffered no adverse consequences.  Some of these entities – Insurance/PBM/HMO – actually makes more profit from denying care and not having to pay for that care.  Prescribers and chain pharmacies are less at risk of running afoul of the DEA and avoiding potential fines.

I recently made this post  97% of Congress voted for this law designed to DENY CHRONIC PAIN PTS APPROPRIATE THERAPY       so this Congress has routinely voted for bills along party long, except when it came to voting on denying chronic pain pts adequate pain management and increase funding for the treatment of substance abusers.  If the chronic pain community had a lobbyist firm ON THE JOB in DC… this bill may have not gotten passed and signed into law.

Will the chronic pain community finally come together or remain on the side lines and continue to suffer ?

Filed under: General Problems | 9 Comments »

Filed under: General Problems | 1 Comment »

Often Mistaken But Never in Doubt. Dr. Debra Houry and CDC Guidelines on Opioid Prescription in Chronic Pain

https://www.acsh.org/news/2019/10/28/often-mistaken-never-doubt-dr-debra-houry-and-cdc-guidelines-opioid-prescription-chronic-pain-14363

What I have not seen – and I may have missed it – that no one has came out and questioned – or validated – that CDC actually had the statutory authority to generate and publish these guidelines. The CDC primary charge is to deal with communicable diseases and the treatment and/or prevention.  Subjective and/or mental health diseases or neither communicably nor preventable.

Filed under: General Problems | Leave a Comment »

From: opioid-safety-and-naloxone-network@googlegroups.com <opioid-safety-and-naloxone-network@googlegroups.com> On Behalf Of Daniel Raymond
Sent: Monday, October 28, 2019 2:49 PM
To: OSNN <opioid-safety-and-naloxone-network@googlegroups.com>
Subject: [OSNN] Fwd: Responses Due by COB Wed., 10/30: CSOO Letter to E&C Re CARE Act of 2019

Hi everyone –

Kelly Corredor with the American Society of Addiction Medicine is asking for organizational sign-ons to the attached letter, encouraging the House Energy & Commerce Committee to move forward the Comprehensive Addiction Resources Emergency (CARE) Act. The CARE Act would provide $100 billion to address the overdose epidemic over the next 10 years, along with a provision for direct federal price negotiations with naloxone manufacturers to broaden access to and availability of naloxone.

Rep. Elijah Cummings introduced the CARE Act in the House and was its primary champion on the House side (Sen. Warren introduced the Senate version); with his untimely passing, there is a need to ensure that the CARE Act remains on the agenda for Congress.

If your organization can sign on to this letter, please contact Kelly directly at kcorredor@ASAM.org by 5 pm ET on Wednesday, 10/30.

Best,

Daniel

Daniel Raymond
Deputy Director of Planning and Policy
Harm Reduction Coalition
22 West 27th Street, 5th Floor
New York, NY 10001

Direct: (212) 377-9121
Mobile: (646) 283-8929
Fax: (212) 213-6582
raymond@harmreduction.org
www.harmreduction.org

October __, 2019

Dear Chairman Pallone and Ranking Member Walden,

The undersigned organizations in the Coalition to Stop Opioid Overdose (CSOO) and other undersigned organizations are writing today to voice our support for the Comprehensive Addiction Resources Emergency (CARE) Act of 2019. With the recent and tragic passing of its lead House sponsor, Representative Elijah Cummings, only with your leadership, can we keep the ideas in this legislation alive.

CSOO is a coalition of diverse organizations united around common policy goals to reduce opioid overdose deaths. CSOO members aim to elevate the national conversation around opioid overdose and work to enact meaningful and comprehensive policy changes that support evidence-based prevention, treatment, harm reduction, and recovery support services.

As we know too well, the morbidity and mortality statistics related to addiction, and in particular addiction involving opioid use, are astounding. In 2017, there were a record 70,237 drug overdose deaths in the United States, two-thirds of which have been linked to opioids.ⁱ Moreover, for three years in a row, life expectancy in the United States declined largely because of rising drug overdose deaths.ⁱⁱ While preliminary data indicates that drug overdose deaths may have slightly declined last year,ⁱⁱⁱ drug overdose deaths remain at historic highs, and synthetic opioids continue to pose a significant threat to life.^iv Given these alarming statistics, we need your leadership to pass legislation like the CARE Act of 2019, which provides bold actions that would help to turn the tide of our country’s addiction and overdose epidemic and save lives.

Modeled directly on the Ryan White Act, the CARE Act of 2019 would provide $100 billion in federal funding over the next ten years to states, local governments, and other organizations and institutions to support federal research and programs to prevent drug use while expanding access to prevention, harm reduction, addiction treatment, mental health services, and recovery support services. This level of authorized funding is critical in order to build comprehensive systems that are both effective and sustainable. The CARE Act would also incent systemic changes to facilitate adoption of evidence-based

practices and grow our mental health and addiction services workforce. For example, the bill would facilitate the implementation of nationally recognized level of care standards for addiction treatment

programs and new standards for recovery residences and improve training for healthcare professionals who care for patients with mental health and substance use disorders in communities across the US.

These provisions, among the others in the bill, are urgently needed and will move us closer to a future where all Americans living with mental health and/or substance use disorders are able to receive the high-quality care they need and deserve.

We would like to thank you for considering the CARE Act of 2019, and we look forward to working with you to secure its passage or the passage of substantially similar legislation.

Sincerely,

American Society of Addiction Medicine

*Not a CSOO member 

Filed under: General Problems | 3 Comments »

Filed under: General Problems | 3 Comments »

23 Seniors Died After Receiving Flu Shot Sold by Pharmacies

https://healthimpactnews.com/2013/23-seniors-died-after-receiving-this-years-flu-shot-sold-by-pharmacies/

Package insert for Fluzone flu vaccine marketed to seniors reveals 23 seniors died during drug trial

The annual marketing campaign pushing people to receive flu vaccinations is in full force. CVS Pharmacies is offering a 20% off shopping pass if you purchase a flu vaccine.

As you can see in the screen shot above, taken from the CVS website, senior citizens over the age of 65 are being targeted to get the “high-dose” flu vaccine.

The FAQ at the CVS website defines the “high-dose” flu vaccine: “Containing four times the amount of antigen (the part of the vaccine that causes the body to produce antibody) in regular flu shots, high-dose flu shots, along with the additional antigen produced, are intended to create a stronger immune response.”

The name of this flu vaccine that is marketed for seniors is called “Fluzone.” You can find it being marketed to seniors at all the major pharmacies in the United States.

Package inserts for flu vaccines show a multitude of side effects, including death, and yet they are marketed the same as over-the-counter drugs with no prescription needed. Why?

Because in the United States vaccines enjoy complete immunity from lawsuits in the market place. If you are injured or die from a vaccine, you or your family cannot sue the manufacturer of the vaccine. This law enacted by Congress, was upheld by the U.S. Supreme Court in 2011.

Therefore, they are marketed with the same marketing techniques as any other high-profit product. With the baby boomer generation moving into their senior years, today’s seniors are seen as an especially lucrative market.

So financial incentives like discounts on other products, as CVS is doing, is quite common in order to boost vaccine sales.

Walgreens has a different program that especially boosts sales of vaccines:

While vaccine rates in the U.S. among children are close to 90%, rates in other parts of the world (where pharmaceutical companies do not have immunity from the law for adverse effects) are much lower. So, in partnership with Walgreens, a non-profit organization (Shot@Life) buys up the vaccines and sends them to these countries for free (who doesn’t want something for free, especially when you live in a poor country??)

This is a brilliant marketing plan for the pharmaceutical companies, as the U.S. government gives the organization buying the vaccines non-profit status, allowing them to receive tax deductible donations to pay for the vaccines. Walgreens is probably a contributor to the program as a tax write off.

With legal immunity to market dangerous products, don’t expect those doing the marketing and making the profits to warn you of the side effects. You need to find this information yourself, usually from the Internet.

For those pro-vaccine forces that warn people how dangerous it is to get information from the Internet, the information we are about to share is directly from the FDA website (at least at the time of this writing – they have been known to remove items from their website if it gets too much publicity and makes them look bad), and you can look it up yourself.

The high-dose Fluzone vaccine being marketed this flu season to seniors, which has four times the amount of antigens that the regular flu shot has, as well as the non-high dose version, had 23 seniors die during drug trials.

The package insert for the high-dose Fluzone flu vaccine is found here (for now).

In the section documenting adverse effects, this is what is written:

Within 6 months post-vaccination, 156 (6.1%) Fluzone High-Dose recipients and 93 (7.4%)  Fluzone recipients experienced a serious adverse event. No deaths were reported within 28 days post-vaccination. A total of 23 deaths were reported during the period Day 29–180 post-vaccination: (0.6%) among Fluzone High-Dose recipients and 7 (0.6%) among Fluzone 1 recipients. The majority of these participants had a medical history of cardiac, hepatic, neoplastic, renal, and/or respiratory diseases. No deaths were considered to be caused by vaccination.

This statement stating that 23 seniors died, which really should be headline news but is buried in a package insert on the FDA website, begs several questions:

1. By what basis can they conclude that “No deaths were considered to be caused by vaccination”??

2. If, as it is implied, the majority of these 23 deaths were caused by pre-existing conditions, why were there no deaths in the first 28 days? Shouldn’t the deaths, if not attributable to the vaccine but pre-existing conditions, be equally spread out through all time periods?

3. How does the medical history for these 23 seniors compare to the medical history of those who did not die? Were there any significant differences? The range of symptoms given in the package insert can very well cover almost all seniors during the flu season. And what about those who died that were not among the “majority” who had these pre-existing conditions? A majority could simply be 12 out of the 23.

Besides death, which is just one “serious adverse event,” there were 226 other “serious” adverse events, for a total of 249 serious adverse events, out of only 3,833 participants.

If this does not constitute a dangerous drug that should probably not even be on the market, then I don’t know what does. And yet, it is sold to unsuspecting seniors and others like candy at these drug stores.

One of these other adverse side effects (besides death) is Guillain-Barré syndrome, which has symptoms similar to polio. If you are brought into an emergency room with the paralyzing effects of Guillain-Barré syndrome (GBS), the first question the doctors will ask you is if you just received the flu shot. Read one story here of how one man went from being able to bench-press 275 pounds to struggling how to walk after receiving last year’s flu shot: Miami Man Contracts Guillain-Barré Syndrome, Nearly Dies After Getting Flu Shot. Also, if you look at the majority of damages being paid out to those damaged from vaccines in the U.S. Vaccine Court, Guillain-Barré syndrome from the flu vaccine is #1, and almost equals all other awards for damages combined. (See: Flu Shot Causes Polio-like Guillain-Barré Syndrome: Are Rates Higher Than the Government Admits?)

The CDC would like you to believe that the risk of GBS from the flu shot is only one out of one million. But if that is the case, why is there a warning on package inserts of flu vaccines, and why is it the first question EMTs ask when dealing with GBS emergencies?

The package insert for Fluzone states: “If Guillain-Barré syndrome (GBS) has occurred within 6 weeks of previous influenza vaccination, the decision to give Fluzone High-Dose should be based on careful consideration of the potential benefits and risks.”

I wonder how many vaccine sales people at these pharmacies give “careful consideration” to this adverse side effect, or any others, before injecting you?

Be informed this flu season! Educate yourself before vaccinating!

Thanks to ExperimentalVaccines for pointing out this package insert information on YouTube.

Leaving a lucrative career as a nephrologist (kidney doctor), Dr. Suzanne Humphries is now free to actually help cure people.

In this autobiography she explains why good doctors are constrained within the current corrupt medical system from practicing real, ethical medicine.

One of the sane voices when it comes to examining the science behind modern-day vaccines, no pro-vaccine extremist doctors have ever dared to debate her in public.

Filed under: General Problems | 4 Comments »

My Story: Why Isn’t My Pain Covered?

http://nationalpainreport.com/my-story-why-isnt-my-pain-covered-8841427.html

My chronic pain treatment has not been covered since the CDC guidelines were published.

But the reasons my pain is not covered are different. It’s because of what I am. I’m an older white female.

Let me explain.

I have arthritis all over the place, yes; and this is the most common debilitating pain problem in the United States. I’ve had knee replacement surgery; my hands have had multiple surgeries for they are awash in stage IV arthritis. My spine, hips, SI joints, hips and left knee all have arthritis.

I have gone to extraordinary lengths to protect my bones and joints from both arthritis and osteoporosis. I strength train rigorously every week—as I have for 30 years. I also upholster furniture, alone, with my hands. If you saw my hands you would never suspect I have severe arthritis.

I am a psychotherapist. I specialize in treating professionals with dual diagnoses: professionals with substance use disorders. I understand addiction pretty well. I also understand professionals pretty well. And I have to say today I am ashamed to be part of my profession. Not because I am like those that precipitate these feelings in me. Because I am not like them. I am a pain patient and my pain is not being covered and I am furious and terrified about it.

My pain is literally killing me. Not lessening my will to live. Not making me depressed or anxious. MY PAIN IS KILLING ME.

Since my pain stopped being properly treated, I have been incapacitated between 24-36 hours a week, every week. It is as though I entered a time warp. I am aging at an astonishingly rapid rate. It is abnormal. Since my pain has not been adequately treated my level of functioning has declined beyond any other experience with illness that I have had. I have not been able to do my taxes in four years! Never before have I been unable to do my taxes.

I believe that one of the reasons chronic pain patients have been vilified is so that addictions professionals can have more patients and make more money. And that they are currently doing just that at the same time they fail to properly treat pain. The greed that accompanies a human being’s willingness to lay claim to a patient and keep her in pain in treatment in order to make more money is pretty repulsive to me. But I believe that is one part of the puzzle. If I was not an addiction specialist, I probably would not believe this. Imagine how popular I am in my field.

I also believe this is happening because it makes the DEA feel like they have some sort of handle on the problem identified as increased death due to opioid use. In other words, DEA agents and other people in positions of responsibility for drug control blame treating pain patients for changing the social mores, the social tolerance of opioid use. If our society had not become so lax, we would not have all these overdoses. People would not dream of using heroin laced with fentanyl if the stigma had not been altered by treating pain patients with opioids.

And there is another reason, perhaps the most significant reason why this is happening. Two social groups that suffer from chronic pain the most are aging white females and people of lower Socio-Economic-Status. two social groups are comprised of human beings that are not wanted, not valued by our society. Aging white females and people of lower SES are getting bullied by the amendment and administration of the pain policies in the United States today.

I have spoken to physicians who treat pain and their response to my challenges is pretty interesting. Upon approaching one physician with a sterling reputation for treating pain with the questions I have about the failure to treat my pain properly (I have extenuating circumstances, by the way) and he made no effort whatever to answer my questions. He met me with bristling hostility. Now, I did not approach him in the manner I am writing this article. I approached him as a humble patient suffering with pain that I do not believe is being properly medicated. I asked questions articulately and perhaps without the level of meekness he would have liked. But he just bristled with hostility. There was no way IN THE WORLD he was going to address my points. Because he couldn’t. There is no justification for the way my pain is mismanaged. And he hated me for making that clear.

My pain is not being covered because I am an aging white female being put in my place.

Filed under: General Problems | 2 Comments »

If you don’t compare your med costs under Part D – YOU MAY BE VERY SORRY !

Few days ago I make the above post …

Since then I had 5 prescriptions filled for Barb and myself at the local independent pharmacy that we patronize… currently and for the last 13-14 yrs we have had Silver Scripts Part D .. .which is part of CVS Health and Caremark is the PBM… which is also part of CVS Health..  Those five (generic) prescriptions we were charged abt $130 total for all five…

I looked up the price under the website https://www.medicare.gov/plan-compare/#/?lang=en as to what the costs would be when we switch to a new Part D program as of Jan 1, 2020.

Most/many/all of the Part D prgms in 2020 will have a deductible… Those same five prescriptions under the new Part D prgm would be abt $80 during the deductible period and abt $30 after the deductible has been met.

I knew that we were paying more using our local independent pharmacy than going to a CVS pharmacy when we had the Silver Script insurance.. the closest CVS store was 8-12 miles away…while our independent is about ONE MILE AWAY and will deliver if we need it.

Sure we could use mail order to have meds delivered to our door, but have you ever looked at the label and storage requirements of any medication – including OTC’s ?  Most have a temperature storage requirement by USP, NF & FDA in the 60 F – 80F range.  The manufacturer, wholesaler and pharmacy are legally required to maintain these storage temperatures … BUT… when your prescriptions are handed off to a commercial delivery service… they have no obligation to maintain those temperature storage requirements.  When is the last time have you seen a air-conditioned USPS, Fed-X or UPS delivery truck ?

I am not disclosing which new Part D prgm we are going to because savings may very… in fact … I could have saved a few dollars by signing up for a different Part D prgm than Barb, but chose not to because I did not want to have to deal with two different programs.  The part D prgm that we signed up for indicated that I would not even have enough Rx cost to even meet the annual deductible.  No such luck with Barb’s necessary medications 🙁

Filed under: General Problems | Leave a Comment »

Ohio’s largest Medicaid provider cuts ties with Walgreens

https://www.dispatch.com/news/20191025/ohios-largest-medicaid-provider-cuts-ties-with-walgreens

More than half of Ohio’s Medicaid recipients will lose access to Walgreens pharmacies on Jan 1. CareSource, Ohio’s largest Medicaid provider, is cutting ties with the state’s second-largest pharmacy retailer.

Walgreens, Ohio’s second-largest pharmacy retailer, will no longer service the state’s largest Medicaid provider as of Jan 1, raising concerns about creating pharmacy “deserts” in parts of Ohio.

The news, which wasn’t announced by the Ohio Department of Medicaid, comes a week before open enrollment in the insurance program is to begin.

It also raises worries about access for Medicaid patients and about the health of the marketplace. And it raises questions about how well the administration of Gov. Mike DeWine has reformed the way the state Medicaid department reimburses Ohio pharmacies as it spends $3 billion a year on drugs.

“CareSource has decided to move forward with a network that does not include Walgreens for Ohio managed Medicaid patients in 2020,” Walgreens said in an email Friday, referring to Ohio’s largest Medicaid managed-care organization, which serves more than a million recipients. Walgreens remains in the networks of two other managed-care plans: the UnitedHealthcare Community Plan and Paramount Advantage.

State Sen. David Burke, R-Marysville, chairman of the Senate’s Health, Human Services and Medicaid Committee, said the move sends a “very strong signal” that serving Medicaid patients is a money-losing proposition for Ohio pharmacies.

Burke said he has known for weeks that Walgreens was departing.

In a Friday email, state spokesman Kevin Walter said, “Ohio Medicaid has been made aware of a potential change in the CareSource contract, but the change is still under evaluation.”

Dayton-based CareSource serves 1.2 million of the 2.2 million Ohioans who are enrolled in Medicaid managed-care plans. The company also serves Medicaid patients in Indiana, Kentucky, West Virginia and Georgia.

Despite promises by CareSource earlier this year of transparency, the company didn’t say whether Walgreens was departing its pharmacy network. It also wouldn’t say how many of its Ohio clients use Walgreens as their pharmacy. Nor would it say whether Walgreens was leaving its networks in other states.

“CareSource continuously evaluates our provider network to ensure we are offering members excellent access to quality care,” Stephen Ringel, president of CareSource’s Ohio Market, said in an email after news of Walgreens’ departure broke. “We are in the process of reviewing our future plans with Walgreens with the Ohio Department of Medicaid and remain committed to meeting and exceeding all network-access standards while also being good stewards of taxpayer dollars.”

Since last year, The Dispatch has written numerous stories raising questions about whether CareSource’s current pharmacy-benefit manager, CVS Caremark, was providing lowball reimbursements to the corporation’s retail competitors, including Walgreens. In April, CareSource announced that it was dumping CVS Caremark in all the states where it operates and instead was hiring Express Scripts to provide pharmacy benefit manager services such as billing for drugs, reimbursing pharmacies, establishing lists of covered drugs and negotiating rebates from drugmakers.

Despite long-standing complaints that Medicaid reimbursements were so low that they were driving independent pharmacists out of business, Express Scripts in June sent out proposed contracts offering to pay them a dispensing fee of only 15 cents per prescription. The state’s own surveys showed that pharmacists needed $10 to break even. Express Scripts quickly withdrew the proposed contracts. The company declined to comment for this story.

A study commissioned by the state determined that in 2017, PBMs CVS Caremark and OptumRx billed the state $244 million more for Medicaid drugs than they paid to pharmacists.

Time is short to notify patients that they need to find a new pharmacy home, and the Medicaid population can be difficult to contact; some are homeless, some move frequently, some frequently switch phone numbers, and some have no phone, said Antonio Ciaccia of the Ohio Pharmacists Association.

And Sen. Burke, who is a pharmacist, said Medicaid patients tend to be sicker than the general population, so if they stop taking their medicines, they are likely to end up in the emergency room or a hospital bed, which can cost orders of magnitude more than their medicines.

“Those people will be blindsided” by Walgreens’ departure, Burke said.

It’s unclear what might have caused the rupture between Walgreens and CareSource. But if it’s because CareSource’s new PBM, Express Scripts, isn’t offering what Walgreens wants in dispensing fees, that’s an ominous sign for pharmacy access in Ohio, Burke said. Community pharmacies, particularly those with a large Medicaid clientele, have been closing in recent years, often blaming reimbursements that are so low that they’re losing money.

As pharmacies with lots of Medicaid patients close, pharmacists fear that those patients will move to surrounding pharmacies, plunging them into the red and causing a cascade that will result in pharmacy deserts — places where people with transportation challenges would find it difficult if not impossible to see a pharmacist. With Walgreens no longer serving most of its Ohio Medicaid patients, the problem will become far worse, Ciaccia said.

“The patients don’t disappear; they go to other pharmacies,” he said. “My fear is that the independents are taking on too much water and are about to get hit by a tidal wave.”

Because of network-adequacy rules, Burke said that Walgreens’ departure from CareSource might also leave CVS in a position to dictate the prices it wants for Medicaid drugs.

“I don’t know where we’re going to be five years from now,” he said.

Filed under: General Problems | 2 Comments »

New Florida bill could require a prescription for most sunscreens

https://www.pharmacist.com/article/new-florida-bill-could-require-prescription-most-sunscreens

Filed under: General Problems | 2 Comments »