I am going to be AWOL for a while

Posted on August 3, 2019 by Pharmaciststeve

Today we traveled from our Indiana home to our Florida condo… we had to travel in my 1999 F-150 because of the tools I had to bring to do repairs at the condo after Hurricane Michael took the roof of the complex Oct 10.2018..

We are zipping right along in Southern Alabama and all of a sudden the radio starts acting up… trying to get to work without any luck and then the blower on the AC seems to slow down and not really cooling… so I turn it off and was going to roll down the windows  – power windows of course – NOTHING…  then it started raining and the windshield wipers won’t work… luckily I had put RAIN-X on the windshield a couple of days before we left… very good stuff.. especially when your wipers won’t work … I grab my Iphone and tell SIRI  “FIND ME A FORD DEALER”… luckily one is 7.2 miles ahead… the trucks seems like it is mis-firing… and then all 6 dash instrument drop to ZERO… no speedometer, no tachometer, no oil pressure, no engine temp … you get the point…

It is now about 130 local time ON A FRIDAY as we roll into the dealership parking lot and the truck DIES… turn the key and it is DOA..  They have to push it into the work bay..

The gal who is service coordinator at the dealership… tells me that they have a whole list of jobs that have to be done TODAY…   I am 150 miles from the condo… a wife … a dog and a “dead truck”… doesn’t look like this is going to be a good day…  My trusty old truck that I bought new in 1999 and had only failed to start once in all this time – failed fuel pump… and it picks here and now to PLAY DEAD..

Luckily the shop manager took mercy on us… they quickly diagnosed the problem as a alternator failing – hell it was only 21 yrs old…. the original alternator on the truck from 1999 and that I had been running totally off the battery for god knows how long today…  The alternator was only putting out 9 volts and I think that it is suppose to put out 14 volts +/-

Abt 2 hrs later and a $500+ charge… for a new alternator and battery – the battery was 3 + yrs old… so I wasn’t going to argue about a battery..  I knew that because I keep a list of maintenance on my vehicles in my IPHONE   🙂  …  and we are back on the road…

Then we get to our condo…. remember Hurricane Michael took the roof off of the place Oct 10,2018 and the place is still not “open” and they are optimistically hoping that they will be able to start renting units again by Jan 1, 2020… Out unit is our second home and we don’t rent it… so we didn’t loose a year+ of revenue like the 90 odd units that do rent.

We were down here the last week of May and what drywall work that had been done… I was not very pleased with… but .. apparently a newer crew came in and fixed all the bad “mudding” work..  We knew that we had some work that we were going to have to do …. and had allowed abt 8-10 wks.. to accomplished…that may prove to be a gross under estimation… Both Barb and I are now in our 70’s and 12 hr days… are no longer a option.

On top of all of this… I was told last week that the Association’s insurance had not given them any money since April and payroll a week or so ago was not made… the general contract and all the people working on the building – WALKED….  the guy that maintain the grounds around here left sometime during the winter, the general manager left the end of May and after no paycheck two maintenance workers left…. so the entire staff… includes… a maintenance supervisor ( I think ), a receptionist, a bookkeeper and there was one of our regular security staff when we arrived tonight…

Other than that … everything is SUNSHINE, LOLLIPOPS and ROSES…

So if you don’t hear from me for several days… I have not died… although there is a chance that I may be in jail if I get my hands on some of the construction workers that have been in my unit working…

Over the next few days, I going to have all the doors re-keyed and there is a NEW SHERIFF IN TOWN… anyone who wants in my unit to work will be under my direct supervision…  and there is going to be two ways to do anything .. the WRONG WAY….. and… MY WAY !!!!

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Don’t be silent: Speak up about pain this September

Posted on August 1, 2019 by Pharmaciststeve

Don’t be silent: Speak up about pain this September

https://uspainfoundation.org/news/dont-be-silent-speak-up-about-pain-this-september/

Too often, due to broad misconceptions and a lack of understanding about pain, pain warriors are afraid or ashamed to speak up about their stories.

But the only way we can create change is if we start talking–to loved ones, coworkers, neighbors, clinicians, and even policymakers.

That’s why our theme for Pain Awareness Month 2019, which begins September 1, is “Let’s Talk about Pain.” We’ll be hosting numerous events, campaigns, and activities that center around this idea. In order to truly get the word out, though, we need your help.

How you can participate

Below, please find a short list of ways you can participate right now in Pain Awareness Month. Many of these campaigns require involvement before September, so don’t wait!

Submit your video story! Share a 3-5 minute video about your pain journey with us by August 9. All participants will receive a limited-edition Pain Awareness Month bracelet and our new Living with Pain educational booklet–AND be entered to win a prize pack. A handful of individuals will be selected to have their videos featured online throughout September! Get started here. Questions? Email us.

 

Request a proclamation. Ceremonial proclamations from state and local representatives help bring awareness to pain at the government level. To get started, fill out this form by August 9. We have easy-to-use templates and tips to make the process easy and fun. Please note that proclamations can take time, so put in your request now! For questions, email us.

 

Host an information table. Hosting an information table at a local hospital, library, town hall, or even a retail store is a great way to educate your community about pain. We’ll provide all the materials you need, including table cloths, brochures, and giveaway items. Simply fill out the questionnaire here. Keep in mind we need two weeks’ notice to ship materials!

 

Shine Blue for Pain. Through this campaign, you can request a government, historic, or private building or landmark light up in blue–the designated color for pain–on September 13. To get involved, fill out this form or send us an email by August 15. We’ll give you all the tools you need to make your request. Be sure to take a photo so we can celebrate your hard work!

 

Organize a Wear Blue Day. New this year, we’re encouraging people with pain to host Wear Blue Days at their schools or workplaces! By rallying together and wearing the designated color for pain, people with pain can feel included and supported. And, it helps raise awareness about the issue of pain on a large scale. For information on how to get involved, send us an email.

 

Help Beautify in Blue. Through this visual campaign, volunteers display blue ribbons and flyers in public locations such as town halls, community centers, libraries, municipal parks, or grassy areas. We provide a template letter to request permission to display the materials, as well as the materials you need (at no cost to you). Get started here.

Let’s make it the biggest year yet

To learn more about all Pain Awareness Month 2019 activities, visit our website. And remember to keep an eye out for more details about our social media challenge and weekly events.

If you have any questions about getting involved, please email us at painawareness@uspainfoundation.org.

 

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FORTY (PBM) PATIENT HORROR STORIES

Posted on August 1, 2019 by Pharmaciststeve

Patient Horror Stories

PBMs have very real and negative impacts on patients with cancer and our entire health care system. Read for yourself just how horrific PBMs are in the following collection of real stories. While these stories are real, we changed personal details to protect the privacy of patients.

www.pbmabuses.org/horror-stories/

There are FORTY (HORROR)  STORIES on this website

 

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PAY ATTENTION: are you part of the problem or part of the solution ?

Posted on July 31, 2019 by Pharmaciststeve

 

 

 

 

 

 

 

 

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DO NOT DISMISS pts from care… DO NOT ABRUPTLY DISCONTINUE or TAPER OPIATES

Posted on July 31, 2019 by Pharmaciststeve

 

 

 

 

 

 

 

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Florida: Not all SUNSHINE & ROSES ?

Posted on July 31, 2019 by Pharmaciststeve

Florida Officials Successfully Withheld Pain Meds from Surgical Patients. Aren’t They Special?

https://www.acsh.org/news/2019/07/30/florida-officials-successfully-withheld-pain-meds-surgical-patients-arent-they-special-14191

Let’s congratulate the state of Florida. In its infinite wisdom, the state has jumped into the scrum of the “who can be tougher on drugs” match that is playing out all across America at the expense of pain patients, past, present, and future (1). 

Could there be a better way to celebrate than by taking apart another crap study? Didn’t think so.

This one is called “Opioid prescriptions for acute pain after outpatient surgery at a large public university-affiliated hospital: Impact of state legislation in Florida” and was published online last month by a group of surgeons at the University of Miami Medical School. It’s a real beaut. Let’s take it apart…

“In response to the growing opioid crisis, Florida recently implemented a law restricting the duration of opioid prescriptions for acute pain.”

Aside from the fact that opioid use by pain patients (especially short-term) played approximately zero part in the fentanyl epidemic, this statement is fundamentally sound. 

“Little is known about the impact of such legislation on opioid prescription practices at the time of discharge after surgery.”

Well, that’s not really true, is it? Plenty is known. Like this…

The number of opioid prescriptions by year (source: CDC) Between 2012-2017 there was a ~30% reduction in opioid prescriptions while during that same time period…

…deaths from any opioid more than doubled. Nice going.

 

“The objective of this study was to determine whether Florida’s new legislation changed opioid prescription practices for analgesia after surgery.”

Let me get this straight. This is a study to determine whether fewer post-surgical opioid prescriptions were written after a law was passed limiting opioid prescriptions? Duh?

 

“The proportion of patients receiving opioid prescriptions for longer than a 3-day supply decreased by 68% [after the law passed].”

How can we explain this marked decrease? Here is a section from Florida’s new law, HB 21 Section 456.44 – Controlled Substance Prescribing:

“HB 21 provides that a prescription for a Schedule II opioid for the treatment of acute pain may not exceed a three-day supply.” (2)

Not only does a law that prohibits prescriptions for more than three days decrease the number of prescriptions for more than three days, but it does so by 68%!

 

Everything I’ve discussed about the U Miami study so far has been merely stupid. But then it gets irresponsible…

“We observed no change in the number of postoperative emergency department visits before and after implementation of the law.”

This statement is one gigantic problem (3). Taken at face value it tells us that everything is fine and dandy – that strict restriction of post-operative opioid scripts has no adverse impact on patients, something that will no doubt be reported by the press. But here’s what it doesn’t address:

  • Was there an assessment of post-operative pain?
  • Were patients comfortable when the drugs ran out?
  • Or did the law merely result in patient suffering?
  • Did the law result in an increase in time of recuperation or in secondary complications?
  • Is the number of emergency department visits an accurate proxy of patient pain? It is now common knowledge that you are just about as likely get opioids in an emergency department as at a Dairy Queen.
  • Was there an increased use of NSAIDs after day 3?
  • If so, was there an increase in adverse events due to the NSAIDs?
  • Were there additional emergency room visits or hospital admissions for acetaminophen (Tylenol) poisoning?
  • When, exactly, did it become acceptable for governments to tell doctors how to do their jobs? 

 

“The legislation should significantly decrease the amount of unused opioid pills potentially available for diversion and abuse.”

…and significantly increase the number of deaths from street fentanyl, as the two graphs above clearly demonstrate. 

 

“Secondary effects from the enactment of this law remain to be evaluated.”

Don’t hold your breath. This study will never be done, and the off-chance it is, it will never see the light of day if the results support anything other than the party line. Do you honestly think that any ideologically-driven academician or opportunistic politician is going to admit that there any downside to a law imposing mandatory limits on anything opioid-related?  

No way. 

 “Whenever you find yourself on the side of the majority, it is time to pause and reflect.”

Mark Twain

Or, if you don’t like Twain, try Orwell…

“If you want a vision of the future, imagine a boot stamping on a human face – forever.”

George Orwell

NOTES:

(1) It is only a matter of time until any of us, our families, or our friends are going to require pain medication and be denied what they need. Given today’s climate of bullying and hysteria, this is inevitable. We are all one illness or accident from being in the same sinking ship that is already overloaded with millions of Americans. One can only hope that the Florida Legislature suffers a massive, collective kidney stone first. And let’s save one for Governor Rick Scott, who signed this atrocity into law in early 2018.

(2) HB 21 provides exceptions where a seven-day supply is permitted but only if certain conditions are met. And these conditions are determined by the prescribing physicians, who are themselves under pressure to stop prescribing. Fox. Henhouse. 

(3) Thanks to former ACSH advisor Dr. Jack Fisher, a retired surgeon, for bringing this to our attention.

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we saw our first batch of fraudulent escripts for oxycodone and percocet at my pharmacy this week.

Posted on July 31, 2019 by Pharmaciststeve

Here’s an interesting one. With SureScripts knocking on the doors of all Boards of Pharmacy asking to mandate electronic prescriptions, has anyone else seen fake e-scripts, especially for controls? CP

Phrom a Phriend:
“Here is something to ponder CP. With regulations stating that all CII scripts be e-scripted by 2021,

we saw our first batch of fraudulent escripts for oxycodone and percocet at my pharmacy this week.

The infallible system failed! The Dr was contacted, he is a hospital anesthesiologist, he does not write scripts, yet between 3 stores we received a total of 15 scripts. Thoughts?”

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Chronic pain patients fear new opioid bill could cripple care

Posted on July 31, 2019 by Pharmaciststeve

Chronic pain patients fear new opioid bill could cripple care

https://www.boston25news.com/news/chronic-pain-patients-fear-new-opioid-bill-could-cripple-care/969841486

BOSTON – A proposed bill is causing panic among those living with chronic pain.  

Massachusetts Senators Edward Markey and Elizabeth Warren have not taken a position yet on a new bill in the United States Senate that would effectively limit the medical indications for use of long-acting opioids.

It is barely three pages long but packs a potent punch.

The Federal Drug Administration Opioid Labelling Accuracy Act was filed in the U.S. Senate earlier this month. If passed, advocates say it could have a profound effect on patients living with chronic pain.  

Kari Hicks, from Weymouth, had knee surgery six years ago and has been in pain ever since. 

“It’s just one more layer of the federal government overreach,” Hicks told Boston 25 News. 

The bill, introduced by Senators Joe Manchin of West Virginia and Mike Braun of Indiana, would allow labeling for long-acting opioids only for use in cancer and end-of-life care. But it would also be up to a doctor’s discretion if opiates are considered the best choice for a given patient suffering from chronic pain.  

“It’s all lip service,” Claudia Merandi suggests. 

She is the founder of the organization “Don’t Punish Pain Rally” and formerly used opiates for pain and other symptoms of Crohn’s Disease.

She says the net effect of the Manchin/Braun bill if passed, will be to virtually end access to opioids for patients with chronic pain.  

“No doctor in their right frame of mind will prescribe,” she said. “They see their colleagues being shipped off to prison and they’re not willing to take the chance.”

Hicks says her doctor tapered her off opioids last February, fearful of federal intervention in his practice. 

She says she has been living with pain ever since.

“Every day at the end of the day I’m just done,” she said. “I just don’t want anybody around me. I’m grumpy. I want to be part of everything but the pain is just bigger.”

I was at a town hall meeting of Sen Braun on July 8th, 2019 and really couldn’t get him to talk much about the opiate crisis… He is a first term – first year – Senator and mainly wanted to talk about how his company in Jasper , IN .. because of the way they did things their premiums for employees didn’t increase for 10 yrs.  Sounds like a case of HIGH COPAYS & DEDUCTIBLES in getting health care.

Sen Manchin, once was talking about introducing a bill that would put a tax/surcharge on pharma opiates to pay for treatment for people dealing with substance abuse.

Neither one of these senators have and medical background… so of course, they are HIGHLY QUALIFIED TO INTRODUCE SUCH A BILL..

So most clinical studies take TEN YEARS or so… and the 1000’s of years that opiates have been used to treat pain… is just a FOOTNOTE in medical history ?

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America Betrayed: Senator Marsha Blackburn (R-TN)

Posted on July 30, 2019 by Pharmaciststeve

 

Sen Marsha Blackburn Asst Kim Cordell 07-25-2019.wav

audio file above

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Around 25 countries have now removed criminal penalties for the personal possession of some or all drugs in a sign of the global shift toward decriminalization

Posted on July 30, 2019 by Pharmaciststeve

Why Malaysia’s New Proposal Could Change Southeast Asia’s Drugs Debate

https://thediplomat.com/2019/07/why-malaysias-new-proposal-could-change-southeast-asias-drugs-debate/

A move to decriminalize personal drug use and possession could help to shift the regional discourse on drugs.

Scientific reason broke through the dominant political rhetoric on drugs in Southeast Asia last month. Instead of the “war on drugs” narrative favored by the region’s populists, Malaysia’s government said it was time to put “science and public health before punishment and incarceration” as it proposed decriminalizing personal drug use.

The plan to remove criminal penalties for the possession and use of drugs in small quantities (as opposed to those involved in drug trafficking) is a bold move in a country that currently has some of the world’s most punitive drug laws.When it comes to knowing law and handling cases Tampa DUI lawyer has always great analysis as well as result.

“Malaysia is about to embark on a significant game-changer policy,” Health Minister Dzulkefly Ahmad said in a statement. “An addict shall be treated as a patient (not as a criminal), whose addiction is a disease we will like to cure.”

That the plan was jointly put forward by the health minister and the home affairs minister sent a powerful message of the government’s intent, said Professor Adeeba Kamarulzaman, dean of the Faculty of Medicine at the University of Malaya in Kuala Lumpur.“For decades people who use drugs, whether recreationally or those who have developed an addiction, have been placed within the criminal justice system,” said Kamarulzaman, known for pioneering a harm reduction program among injecting drug users during Malaysia’s HIV epidemic in the 2000s. It’s a “paradigm shift,” she says, to treat rather than punish addiction.

The announcement comes at a time experts are amplifying calls for Asia’s governments to radically rethink their approach to drugs. Data shows the so-called war on drugs has failed. A recent report from the International Drug Policy Consortium (IDPC), reviewing the last decade of drug policies in Asia, said draconian laws and the misplaced pursuit of a “drug-free world” had failed to reduce the scale of the drug market. Instead drug usage had surged, with a devastating impact on people and communities. The greatest increases were observed, IDPC said, for amphetamine-type stimulants — in 2016 they were used by 17.45 million people in Asia, up from 8.74 million in 2011.

By contrast, the evidence that backs up the case for decriminalization seems to be growing stronger. Evidence from around the world suggests that treating problematic drug use as a health issue rather than a criminal one is a more successful model for keeping communities healthy and safe. To take one specific example, since Portugal decriminalized the possession of drugs for personal use in 2001, drug-related deaths have decreased. Analysis by the Transform Drug Policy Foundation also suggests that removing the criminal penalties did not cause an increase in levels of drug use, as had been feared by some.

Malaysia’s proposed decriminalization would move the nation in the direction endorsed by the United Nations, the World Health Organization, and multiple health, legal, and rights experts. Around 25 countries have now removed criminal penalties for the personal possession of some or all drugs in a sign of the global shift toward decriminalization.

Portugal’s success holds important lessons for Malaysia, says Professor Kamarulzaman, pointing to the country’s investment in treatment and support alongside the legal change. “It’s equally if not more important than the actual decriminalization,” she said, adding that Malaysia will “have to train a whole cadre of health professionals and support staff to cope with the demands of different drug users.”

Waiting on the Details

There are several important questions about the shape Malaysia’s proposed reforms would take. It’s still unclear, for instance, what impact changes to the law would have on those presently incarcerated for the personal use of drugs. Disproportionate punishments have led to massively overcrowded prisons in the region. People jailed for drug crimes, many for nonviolent behavior such as drug use and possession, form the majority of prison populations in many Asian countries.

Another major concern surrounds the use of compulsory “rehabilitation” in detention centers, says Gloria Lai, IDPC’s Asia director, who is waiting for more detail on what Malaysia’s reforms would mean for those forcibly detained.

“While we really welcome moves to take a health-based approach to drugs we want to emphasize that this shouldn’t lead to forced rehabilitation,” Lai said. The IDPC estimates that over 450,000 people in Asia are detained in such centers including in Malaysia, Thailand, Cambodia, the Philippines, and China.

Much is still being discussed, according to close observers, about the nature of the proposed reforms. Malaysia is already treading carefully given the sensitivities that can surround decriminalization. The coalition government, which came to power last year on a reform agenda, is particularly taking great pains to emphasize that decriminalization is not legalization. It knows the importance of keeping the broadly conservative public informed on an issue that has the potential for political opponents to launch attacks.

Other Southeast Asian nations have also taken steps toward changing their drug policies in recent years. Thailand, which is still debating decriminalization, has made important health-based reforms. And Myanmar has also moved toward decriminalization for drug use, but still retains prison penalties for possession.

The region at large, however, persists with some of the world’s most draconian drug policies. Nowhere has this been more evident in recent years than in the Philippines. Activists say that at least 27,000 people have been killed since President Rodrigo Duterte took office in 2016 on a platform of crushing drugs. The violent campaign has had reverberations across the region. Neighboring Indonesia is thought to have borrowed Duterte’s language to refuel its own drug wars while rights groups have also observed subsequent emboldened anti-drugs campaigns in Cambodia.

In this landscape, Malaysia chartering a health-oriented path could offer a breakthrough of sorts in the regional discourse surrounding drugs. The fact its ministers are talking about the evidence “instead of resorting to the usual scaremongering about drugs” is significant, said Lai, the regional IDPC director. “It definitely helps to open conversations about alternative approaches to drug use.”

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