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FDA Commissioner Scott Gottlieb is resigning
https://www.cnbc.com/2019/03/05/fda-commissioner-scott-gottlieb-is-resigning.html
Food and Drug Administration Commissioner Scott Gottlieb is leaving his post as the nation’s top health regulator after two years in the role.
Gottlieb, who’s waged a pitched battle against teen smoking in recent months, is resigning to spend more time with his family, people close to Gottlieb said Tuesday.
The physician has been commuting from his home in Westport, Connecticut, where he has a wife and three young daughters, the people said. His successor hasn’t been named yet, they said.
Gottlieb plans to stay on at the agency for another month.
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Exclusive: OxyContin maker Purdue Pharma exploring bankruptcy – sources
Exclusive: OxyContin maker Purdue Pharma exploring bankruptcy – sources
https://finance.yahoo.com/news/exclusive-oxycontin-maker-purdue-pharma-151955953.html
(Reuters) – OxyContin maker Purdue Pharma LP is exploring filing for bankruptcy to address potentially significant liabilities from roughly 2,000 lawsuits alleging the drugmaker contributed to the deadly opioid crisis sweeping the United States, people familiar with the matter said on Monday. You can check out bankruptcy attorneys from Benner & Weinkauf P.C. if you need the best attorneys!
The potential move shows how Purdue and its wealthy owners, the Sackler family, are under pressure to respond to mounting litigation accusing the company of misleading doctors and patients about risks associated with prolonged use of its prescription opioids.
Purdue denies the allegations, arguing that the U.S. Food and Drug Administration-approved labels for its opioids carried warnings about the risk of abuse and misuse associated with the pain treatments.
Filing for Chapter 11 protection would halt the lawsuits and allow Purdue to negotiate legal claims with plaintiffs under the supervision of a U.S. bankruptcy judge, the sources said. People can hire chapter 12 bankrupty attorneys, if they need the best bankruptcy attorneys.
Shares of Endo International Plc and Insys Therapeutics Inc, two companies that like Purdue have been named in lawsuits related to the U.S. opioid epidemic, closed down 17 percent and more than 2 percent, respectively, on Monday.
More than 1,600 lawsuits accusing Purdue and other opioid manufacturers of using deceptive practices to push addictive drugs that led to fatal overdoses are consolidated in an Ohio federal court. Purdue has held discussions to resolve the litigation with plaintiffs’ lawyers, who have often compared the cases to widespread lawsuits against the tobacco industry that resulted in a $246 billion settlement in 1998.
“We will oppose any attempt to avoid our claims, and will continue to vigorously and aggressively pursue our claims against Purdue and the Sackler family,” Connecticut Attorney General William Tong said. Connecticut has a case against Purdue and the Sacklers.
BANKRUPTCY FILING NOT CERTAIN
A Purdue bankruptcy filing is not certain, the sources said as there are some mistakes to avoid with bankruptcy which they would have not considered researching about it. The Stamford, Connecticut-based company has not made any final decisions and could instead continue fighting the lawsuits, they said. You can learn about bankruptcy and understand what you can do when it comes to your finances.
“As a privately-held company, it has been Purdue Pharma’s longstanding policy not to comment on our financial or legal strategy,” Purdue said in a statement.
“We are, however, committed to ensuring that our business remains strong and sustainable. We have ample liquidity and remain committed to meeting our obligations to the patients who benefit from our medicines, our suppliers and other business partners.”
Purdue faces a May trial in a case brought by Oklahoma’s attorney general that, like others, accuses the company of contributing to a wave of fatal overdoses by flooding the market with highly addictive opioids while falsely claiming the drugs were safe.
Last year, U.S. President Donald Trump also said he would like to sue drug companies over the nation’s opioid crisis.
Opioids, including prescription painkillers, heroin and fentanyl, were involved in 47,600 overdose deaths in 2017, a sixfold increase from 1999, according to the latest data from the U.S. Centers for Disease Control and Prevention.
Purdue hired law firm Davis Polk & Wardwell LLP for restructuring advice, Reuters reported in August, fueling concerns among litigants, including Oklahoma Attorney General Mike Hunter, that the company might seek bankruptcy protection before the trial.
Companies facing widespread lawsuits sometimes seek bankruptcy protection to address liabilities in one court even when their financial condition is not dire. California utility PG&E Corp filed for bankruptcy earlier this year after deadly wildfires raised the prospect of large legal bills even though its stock remained worth billions of dollars.
DECEPTIVE MARKETING
Massachusetts Attorney General Maura Healey in June became the first attorney general to sue not just Purdue but Sackler family members. Records in her case, which Purdue has asked a judge to dismiss, accused Sackler family members of directing deceptive marketing of opioids for years while enriching themselves to the tune of $4.2 billion.
Some other states have since also sued the Sacklers. The Sacklers are currently discussing creating a nonprofit backed by family financial contributions to combat addiction and drug abuse, a person familiar with their deliberations said.
The drugmaker downplayed the possibility of a bankruptcy filing in a Feb. 22 court filing in the Oklahoma case. “Purdue is still here – ready, willing and eager to prove in this Court that the State’s claims are baseless,” the company said in court papers.
Sales of OxyContin and other opioids have fallen amid public concern about their addictive nature, and as restrictions on opioid prescribing have been enacted. OxyContin generated $1.74 billion in sales in 2017, down from $2.6 billion five years earlier, according to the most recent data compiled by Symphony Health Solutions.
Purdue Chief Executive Officer Craig Landau has cut hundreds of jobs, stopped marketing opioids to physicians and moved the company toward developing medications for sleep disorders and cancer since taking the helm in 2017.
In July, Purdue appointed a new board chairman, Steve Miller, a restructuring veteran who previously held leadership positions at troubled companies including auto-parts giant Delphi and the once-teetering insurer American International Group Inc.
Mortimer D.A. Sackler no longer sits on Purdue’s board, according to a filing the company made with the Connecticut secretary of state late Monday.
The Oklahoma case and other lawsuits seek damages from Purdue and other pharmaceutical companies accused of fueling the opioid crisis. In addition to lawsuits consolidated in an Ohio federal court, more than 300 cases are pending in state courts, and dozens of state attorneys general have sued manufacturers, including Purdue.
Settlement discussions have not yet resulted in a deal.
Purdue and three executives in 2007 pleaded guilty to federal charges related to the misbranding of OxyContin and agreed to pay a total of $634.5 million in penalties, according to court records.
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Veteran Shoots ER Doctor At West Palm Beach VA
Veteran Shoots ER Doctor At West Palm Beach VA
www.disabledveterans.org/2019/02/28/veteran-shoots-er-doctor-at-west-palm-beach-va/
Reports of a veteran shooter late Wednesday night were confirmed by witnesses as is the FBI investigation into the incident.
A wheelchair-bound double amputee reportedly shot an ER doctor in the neck, a source told local CBS12 News. Early reports suggested two to six individuals were shot in the confrontation, though authorities have yet to confirm that number.
VA director Donna Katen-Bahensky issued the following statement:
An incident has occurred this evening at the West Palm Beach VA Medical Center. There is no danger to patients or staff at this time and the area has been secured. We are working with local law enforcement and the investigation remains ongoing.
The doctor is now stable following surgery at St. Mary’s Medical Center.
The Sun Sentinel reported a technician in the restroom saw the shooter loading his weapon. Witnesses say the patient had the weapon hidden within the seat of his wheelchair. The patient opened fire after the tech ran for help.
The patient was arrested and the facility is now operational.
I hope I speak for every veteran reading this article when I say violence against any VA employee is not the answer. Let’s be sure to pray for the ER doctor and the veteran who shot him.
Some pts can withstand only so much untreated pain until they “break” and strike out… Some have committed suicide in a VA parking lot and others strike out to “share their pain” with those who they believe are the source of them being forced to live in a torturous level of pain, when they know that there is medication that would improve their quality of life. I don’t know if this is the first, but doubt that it will be the last
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here is ONE WAY to cut your needs of opiate/pain meds ?
A Swimmer Saved by What She Lost
www.nytimes.com/2019/03/03/sports/morgan-stickney-swimming-amputee.html
Tormented by pain, Morgan Stickney made the agonizing decision to have her lower leg removed. The groundbreaking procedure may change the course of her life, and the future of amputations.
COLORADO SPRINGS — The last thing Morgan Stickney remembers from before her lower leg was amputated is lying on a hospital gurney waiting for the anesthesia to take hold. With a debilitating fear racing through her mind, she asked her surgeon to hold her hand. They talked about swimming until she passed out.
“It’s the last moment I had with two legs,” she said. “I was in the pool, the most happy place for me.”
Five years earlier, Stickney had dreams of becoming an Olympian. At 15, she ranked in the top 20 nationally in the mile, a freestyle event, and was a rising star out of Bedford, N.H.
But by the time she was wheeled into surgery last May, her Olympic dream had long since vanished. A relatively minor foot injury in 2013 had dragged her down a rabbit hole of five surgeries, numerous examinations and untold theories, none of which relieved — or even explained — the constant, excruciating pain that left her unable to walk by day and then, cruelly, stabbed her awake at night.
The only solutions offered by too many shrugging doctors were the prescription painkillers that, Stickney and her family knew, were turning a once cheerful teenager into a dreary, opioid-dependent 20-year-old pushing herself around her college campus on a kneeling scooter.
The worst moment came during a chemistry exam one day, when the only clear thought Stickney could summon was the note she wrote to her professor on the paper: “I’m too high to take this test right now.”
Not long after that, she made the agonizing, irreversible choice to have her lower left leg removed.
“Opioid addiction is an epidemic,” she said. “I didn’t want that to become my life. I want to have a family one day. I want to be able to do things with my life. This was the only solution anyone was giving me.”
Forced out of the pool by unrelenting pain, Stickney elected to have her leg amputated below the knee in a new medical procedure developed primarily by Matthew Carty, a specialist in limb restoration at Brigham and Women’s Faulkner Hospital in Boston.
The amputation procedure that Carty performs is designed to enhance the vitality and the possibilities for the portion of the limb that remains. Those possibilities include the potential of one day connecting the lower leg muscles to a futuristic robotic prosthesis currently in development across the Charles River at the Massachusetts Institute of Technology. The developers of the prosthetic hope it will operate much like a natural ankle and foot.
The operation is not yet perfect — Stickney will require at least one more surgical procedure — but it could forever change how amputations are performed. But in Stickney’s case, it has been transformative: Within weeks of her amputation last spring, Stickney, now 21, was back in the pool, swimming before she could even walk. By December, she had won the 400- and 100-meter freestyle races at the U.S. Paralympics national championships in Arizona. And while her experience has not been seamless, Stickney’s national team dreams, once abandoned, are flickering back into view.
Nathan Manley, the coach of the resident program of the U.S. Paralympic team in Colorado Springs, where Stickney trains, said she was a serious contender to make the American team for the 2020 Paralympic Games in Tokyo.
Perhaps most important, she is feeling like herself again — the “nonnarcotic Morgan,” in her words, is having fun again.
“Of course, I am,” she said. “When I’m in the pool it’s me, Morgan. It’s not Morgan the amputee.”
When Stickney was a healthy 15-year-old in 2013, and suddenly ranked among the best swimmers her age in the country, she saw a different future for herself. But a few months later, while jumping next to the starting blocks before a race, she broke a sesamoid, one of two jellybean-size bones under her left big toe. Ordered to wear a boot, she was told that in eight weeks all would be well.
It never was. Four surgeries followed, plus the seemingly endless prescriptions for painkillers and anti-inflammatories: Oxycodone. Tramadol. Meloxicam. Diclofenac. Stickney continued to swim for her club team, and she even earned a scholarship at Biola University, a private Christian college about 20 miles southeast of Los Angeles. But within a month of her arrival there in 2016, the pain grew more intense.
Another surgery revealed she had shattered the other sesamoid bone in the same foot, and it was removed in a rare — and perhaps ill-conceived, her family now believes — procedure. (The Stickneys lauded the care that Morgan had received from some of her physicians, but also described what they now view as incompetence from others.)
After yet another summer spent recuperating from surgery in her room in New Hampshire, Stickney hobbled back to Biola and resumed her studies, powering through her classes in an opioid-induced haze. “I would take about five Oxy at once,” she said. “I went to class high. There were times I took so many pills and I was scared that I had overdosed.”
In the fall of 2017, a staph infection related to one of the surgical procedures surfaced in her ailing foot, and her temperature spiked to 104 degrees. Her parents arranged for a flight back to Boston, and Stickney was on an operating table the next day. Around that time, the word “amputation” was first mentioned. She cried through the night.
Eventually, though, she secretly began researching prosthetics, and through that process came to learn about Carty and his new procedure. Named the Ewing amputation, after Jim Ewing, the initial patient, the procedure is thought to be the first significant change to amputations in hundreds of years, Carty said.
During standard below-the-knee amputations, the muscles in the back and front of the lower leg, which naturally work in tandem, are shorn of their connection. In the new procedure, Carty uses material from the discarded portion of the limb to reconnect those tissues and the nerves that serve them. Doing so preserves the natural connection of the two muscles and the communication with the brain, he said, and, in most cases so far, allows them to work in concert as before.
“This is an experimental operation, and I would never represent to anyone that it is signed, sealed and delivered,” Carty said. “But I believe in my soul of souls that we are on to something much better.”
Carty said he had been thinking of a better way to do amputations when the Boston Marathon bombings occurred in 2013. He and his colleagues treated dozens of victims after the attack, many of whom required complex reconstruction of their lower limbs. The family of one of the victims that day, Gillian Reny, donated $2 million to establish the Stepping Strong Center for Trauma Innovation, which has helped finance Carty’s research, in collaboration with Hugh Herr, the M.I.T. scientist who is developing the robotic ankle and foot that Stickney and other amputees have tested in his lab. The Department of Defense has since provided an additional $6 million to help develop more sophisticated approaches to amputation.
On Wednesday, Jason Souza, a staff surgeon who specializes in amputations at Walter Reed National Military Medical Center in Bethesda, Md., performed the first Ewing amputation by someone other than Carty.
“The nice thing about this surgery is that it is a relatively straightforward surgery in terms of the technical demands, and it is relatively low risk,” Souza said.
Before patients can elect to have the Ewing amputation, Carty mandates second opinions, along with visits to a pain specialist and to psychiatrists. Stickney had her surgery on May 14, a month before her 21st birthday.
Tony Stickney, Morgan’s father, initially opposed it, and even tried to dissuade his daughter as late as the day of the operation. But she was resolute.
“She wanted to be out of pain, and I didn’t know what else to do as a dad,” he said. “I knew we were losing her to the drugs. Dr. Carty’s surgery provided some hope.”
During the operation, Carty discovered that one of Stickney’s metatarsal bones — the five long bones in the foot — had died, probably as a result of the earlier staph infection. What he saw confirmed that any additional procedures to salvage the foot would have failed. Stickney’s decision to amputate only hastened the inevitable.
Complications led to a minor corrective procedure soon after. But within weeks, and with her father’s video camera rolling at a pool in Manchester, N.H., Stickney hopped to the edge, dived in and sliced through a lap of the pool before surfacing with her unmistakable smile brightening her face.
In that moment — her first venture into a pool in almost two years — a swimming career was reborn. At a para-swimming event in California in September, Morgan so dazzled scouts that she was invited to the U.S. Paralympic training program at Colorado Springs. She moved in last fall.
Stickney’s recovery is far from complete. She continues to endure phantom pain — a torment for many amputees — but Carty said that he believed the issue stemmed from a nerve complication, and from the fact that she does more extensive physical activity (training twice a day, six days a week) than any of his previous 12 patients.
He has told Stickney that a straightforward procedure should fix the nerve problem, but she said she would not consider it until after the Paralympics. If she makes the United States team, she has already asked Carty to join her in Tokyo.
That is the short-term goal. For the long term, Stickney has transferred to the University of Colorado at Colorado Springs. She is still on a track toward medical school, and perhaps even a career in limb restoration, just like Carty.
Because of everything she has been through, Stickney said, she would like to become a physician or a physician assistant.
“I think the world needs better doctors,” she said.
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Some People Still Need Opioids
Some People Still Need Opioids
https://slate.com/technology/2017/08/cutting-down-on-opioids-has-made-life-miserable-for-chronic-pain-patients.html
The crackdown on pain medication prescribing is intended to help the addiction crisis—but it’s leaving chronic pain patients in untenable situations.
On July 26, Todd Graham, 56, a well-respected rehabilitation specialist in Mishawaka, Indiana, lost his life. Earlier that day, a woman complaining of chronic pain had come to Graham’s office in hope of receiving an opioid such as Percocet, Vicodin, or long-acting OxyContin. He reportedly told her that opioids were not an appropriate first-line treatment for long-term pain—a view now shared by professionals—and she, reportedly, accepted his opinion. Her husband, however, became irate. Later, he tracked down the doctor and shot him twice in the head.
This horrific story has been showcased to confirm that physicians who specialize in chronic pain confront real threats from patients or their loved ones, particularly regarding opioid prescriptions. But Graham’s death also draws attention to another fraught development: In the face of an ever-worsening opioid crisis, physicians concerned about fueling the epidemic are increasingly heeding warnings and feeling pressured to constrain prescribing in the name of public health. As they do so, abruptly ending treatment regimens on which many chronic pain patients have come to rely, they end up leaving some patients in agonizing pain or worse.
Last month, one of us was contacted by a 66-year old orthopedic surgeon in Northern California, desperate to find a doctor for herself. Since her early 30s, Dr. R suffered from an excruciating condition called Interstitial Cystitis (IC). She described it as a “feeling like I had a lit match in my bladder and urethra.” Her doctor placed her on methadone and she continued in her medical practice on a relatively low dose, for 34 years. As Dr. R told one of us, “Methadone has saved my life. Not to sound irrational, but I don’t think I would have survived without it.” Then a crisis: “Unfortunately for me, the feds are clamping down on docs prescribing opiates. My doctor decided that she did not want to treat me anymore, didn’t give me a last prescription, and didn’t wait until I found another pain doctor who would help me.” For the past 30 years, Dr. R has been an advocate for better treatment of IC and reports “many suicides in the IC patient population due to the severity of the pain.”
Thankfully, Dr. R found someone to treat her. Doug Hale, 53, of Vermont was less fortunate. On Oct. 11, 2016, he died by suicide.
“My husband Doug took his own life after being cut off abruptly from his long-term therapy for intractable chronic pain,” his wife, Tammi, wrote in a survey collected by a rehabilitation scholar. His pain was caused by interstitial cystitis, severe migraines, and a back condition. A doctor had prescribed methadone and oxycodone since 2001, according to Tammi Hale, but then “said he would not risk his [medical] license.” Her husband “lasted six weeks, all the while desperately searching for help” but he made a conscious choice not to pursue alcohol or illegal drugs. He said he wanted to live to see his grandchildren and to grow old with me, his wife wrote, “but the pain drove him to suicide as he could not bear a life of intractable pain.”
So, he waited until his wife was out running errands, went to the far end of their backyard, and shot himself. Doug Hale left a suicide note stating that no one but his wife had helped him and that “the doctors were all puppets who basically just wanted to cover their own backs well.”
In 2016, a physician wrote a searing personal account of losing his sister, a chronic pain patient, in the Journal of the American Medical Association. William Weeks of Dartmouth Geisel School of Medicine, described Hailey’s death. A “caring, devoted, and motivated woman,” Haley injured her back at 35 when she was thrown from a horse. Her back never got better, and she qualified for federal disability payments. Over 14 years she received opioids and sedatives from a single pain physician, reaching high doses of both. When illness struck her physician, he retired, leaving her with a one-month prescription and a list of doctors.
As Weeks wrote, “My sister made appointments with several of the physicians [but at] every appointment, she was told that the physician would be unwilling to prescribe her current medication regimen. At every appointment, she was told that she would need to dramatically reduce her use of opioids and benzodiazepines. At every appointment, she felt that the medical establishment, which had prescribed these medications for a decade and a half, had abandoned her. Having not found a physician to manage her medications, she tried to wean herself, if only to extend her medication supply.” She accelerated her alcohol use, wound up in an emergency room—and then a jail cell where she died, six weeks after her last prescription.
Finally there is the anguished report from Mark Ibsen, a doctor based in Montana. On Aug. 4, he posted a video of himself with a distraught patient. “This patient is suicidal due to sudden severe cuts in her medications,” reads the tagline. Ibsen, who is currently entwined in a legal battle over his own practice of prescribing opioids to people with chronic pain, explains the urgency:
This is Kirsten. She’s here for a cannabis card. And we’re going to approve her. She has been on chronic pain medication. And the reason I want to show you this is that she can’t move her neck. She is operating stiffly. She lost all her muscles in her neck, when she had hardware placed by a doctor and it got infected, and she has had chronic pain since then. She has been on opiates for 11+ years. She is suddenly weaning, due to her doctor’s insistence. Just see your scar back here. That’s her scar. And this lady is in agony… She is on a third of her morphine and a third of her oxycodone. She is suicidal. And she has been abandoned by the medical profession. … And we just talked about how if she were an animal, we would euthanize her for this kind of suffering… So I am sending out a plea. I don’t know what I am pleading for, except this lady is suicidal, and this is a preventable suicide. If she could get her opiates, she wouldn’t be trying to kill herself. …This is a crime scene… as this lady deteriorates and gets more and more suicidal. Senator Tester can you help us?
The ordeals of Dr. R, Doug Hale, Hailey Weeks, and Kristin are being replicated across the country. Every week, one of us receives notice of suicides and overdoses by patients across the country who are distraught in the wake of having their dosages reduced. Eighteen months ago, Kertesz cared for a patient who had shot himself in the hand in the parking lot of a local hospital after his primary care doctor stopped maintaining even stable patients on opioids. That doctor had bought into a fallacy that’s been circulating medical practices: that the Centers for Disease Control and Prevention said all prescribing should stop.
It is no secret that one contributing factor to the current opioid crisis is the overreliance on and, at least in retrospect, irresponsible use of opioid-based pain medication. Promiscuous prescribing by physicians gained momentum in the early 1990s and continued for much of the next decade. Aggressive marketing by makers of long-acting painkillers, along with unfounded reassurances that they were safe, played a role in the explosion of prescribing—as did the culture of medical practice which rewarded hospitals based on patient satisfaction ratings, hurried visits, and a dearth of ready insurance-covered alternatives.
It should be noted that the chief risk of liberal prescribing—that is, giving a month’s worth of pills when two days were needed; prescribing opioids when extra-strength aspirin and a heating pad would do—was not so much that the patient for whom painkillers would become addicted or overdose. That can happen, particularly when the patient is also depressed, chronically anxious, or has a history of substance abuse, but it is not especially common: “Rates of carefully diagnosed addiction have averaged less than 8 percent [of patients receiving prescriptions] in published studies,” a 2016 review in the New England Journal of Medicine found. Others offer figures of 0.7 percent to 6 percent, a figure cited by the CDC itself. While those figures are high enough to merit a serious doctor-patient conversation, the bigger danger has always been that excess medication was feeding the rivers of pills coursing through many neighborhoods, and that as more painkillers circulated, more opportunities arose for nonpatients to obtain them, abuse them, and die.
As the pill problem has grown, physicians, medical centers, and state health authorities sought to bring prescribing under better control with education, new norms, and prescription registries that pharmacists and doctors could use to detect patients who “doctor shopped” for painkillers and even forged prescriptions. To a welcome degree, this worked: Since 2010, when opioid prescribing peaked, painkiller-related overdose deaths have begun to decline. (Now, heroin and illicit fentanyl are responsible for most opioid-related deaths.) Seventeen states have passed laws or regulations that limit doses or duration for acute pain, and several federal bills are under consideration. Last year, the American Medical Association recommended that pain be removed as a “fifth vital sign” in professional medical standards, another attempt to limit the overprescribing of opioid pain medication.
The pendulum has swung back in the other direction. We are now experiencing the painful backlash to overzealous prescribing of opioid painkillers (that was itself a backlash to the undertreatment of unremitting noncancer pain). The bad news is that many patients treated with high opioid regimens have been caught in the crossfire. Amid regulations, pharmacy payment restrictions, and intimations that doctors are the major culprits in this epidemic, doctors are increasingly sensing pressure to reduce doses, even among patients who are benefiting from the medication and using it responsibly.
On Oct. 1, for example, Colorado’s Medicaid requirement on dose-lowering goes into effect. It requires physicians to reduce the number of painkillers already being prescribed to patients with chronic pain to a one-size-fits-all threshold. Exception clauses do exist but given the notorious inefficiency of state bureaucracy and the priming of physician anxiety lest they not act, more needless suffering may well be an unintended fallout.
What’s more, there is no consensus among physicians on the proper role of opioids in the management of chronic pain. There is a “civil war” between clinicians who treat pain, according to Daniel B. Carr, president of the American Academy of Pain Medicine. “One group believes the primary goal of pain treatment is curtailing opioid prescribing,” he explained. “The other group looks at the disability, the human suffering, and the expense of chronic pain.”
The debate would recede if only there were reliable data to guide physicians. But the wisdom of involuntary reduction is not backed by evidence, according to a recent review in the Annals of Internal Medicine titled “Patient Outcome in Dose Reduction or Discontinuation in Long Term Opioid Therapy.” Comprehensive longitudinal data regarding opioids’ benefits in chronic pain patients is mostly lacking, as is the case for nearly all alternatives.
The 2016 Guideline for Prescribing Opioids for Chronic Pain from the CDC was introduced to provide general principles for how to treat people with chronic pain. It does not endorse mandated reduction. Instead the guideline indicates, correctly, that opioids should rarely be a first option for chronic pain. Indeed, some patients now on chronic treatment might have been successfully directed toward alternative remedies, such as physical therapy, anti-convulsant drugs, localized injections, or electrical stimulation when they first became ill, diverting them from opioids in the first place.
The guideline also recommends that doctors carefully weigh the risks and benefits of maintaining the current doses of opioids in patients already on them. This means, to us, that
doctors should discuss reductions with patients on long-term opioids, offer other options, and proceed with very slow tapering if the patient is interested. It turns out, in fact, that some patients welcome the chance to reduce the dose and even feel more alert once this is done. Nonetheless, there exists a contingent for whom only opioids work and who seem to benefit at a stable dose.
We seem to have come, in a tragic way, full circle. Doctors, in particular, have been open in acknowledging their role in the opioid crisis and are trying to balance appropriate prescribing with a duty to treat pain in an effective and compassionate way. Their challenge today is the mirror image of the balancing act they tried to perform back in the 1990s, when efforts to compensate undertreatment of pain gained momentum and led to overcorrection.
Everyone is trying to do the right thing, but the system sometimes fails patients who need opioids to manage chronic pain. As physicians negotiate this uneasy terrain, they need more data, less ideology—no matter how well-intentioned—and a case-by-case mentality. Until then, the clinical anecdotes that are accumulating should serve as powerful cautionary tales
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Walmart: moto “save money, live better” just don’t ask us to fill your controlled meds with us
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CVS Caremark Silver Script: charge of $2,373.56 copay.. Walmart $447.84 CASH PRICE
Letter: Prescription plan’s charge higher than Walmart’s
https://www.dispatch.com/opinion/20190302/letter-prescription-plans-charge-higher-than-walmarts
I am a retiree with the Ohio Public Employees Retirement System. I am a diabetic who needs to take injectable insulin. I am covered by CVS Caremark Silver Script for my prescriptions through OPERS. I ordered 18 vials of Novolin N insulin and was “assessed” a charge of $2,373.56 because that is what the plan stated it paid. However, I found that I could buy the same quantity from Walmart for $447.84!
I request that Gov. Mike DeWine, the Ohio Department of Insurance and OPERS investigate how this could happen.
I will not be buying insulin anymore from CVS Caremark until this despicable disparity is resolved and neither should readers. To me, this is unconscionable and wrong if one can buy it from Walmart, a retailer, at five times cheaper.
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Legal Foundation of Washington
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The practice of medicine has been stolen
The practice of medicine has been stolen.
https://www.physiciansrise.com/
It’s time for physicians to reclaim responsibility for the patient-physician relationship.
Third-party payors, government, hospitals, and non-physician staff disrupt the patient-physician relationship, once considered sacred. Productivity demands, shorter appointments, and one-size-fits-all algorithms rob patients of physician time.
Political funding schemes limit expansion of graduate medical education. Graduating physicians are left jobless while inadequately trained mid-levels are being used to fill the void. Soaring debt fuels physician exploitation by administrators resulting in abusive leverage over physicians in both employed and private practice settings.
The results are devastating:
- 51% of physicians are burned-out/abused
- 84% of healthcare costs are unrelated to patient care
- Less than ½ of physicians own their own practice
- 25% of physicians would choose a different career path
- 1 in 3 medical residents are depressed
- 400 physicians commit suicide each year leaving 920,000 Americans without their doctor
- $190,000 is the average medical school debt
- 24 states allow nurse practitioners to practice unsupervised without a medical license
We demand,
- The right to practice medicine without third-party intrusion
- Complete removal of any law disrupting access between patients and physicians
- Restoration of physicians as the head of the medical team
- Adopting fiscal policy that defines and respects the patient-physician relationship
- Physician autonomy as a professional right
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