“The moral test of a government is how it treats those who are at the dawn of life, the children; those who are in the twilight of life, the aged; and those who are in the shadow of life, the sick and the needy, and the handicapped.” – Hubert Humphrey
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Pharmacist Steve steve@steveariens.com 502.938.2414
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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
Overdoses in the state from fentanyl-laced heroin may be on the decline, but the state is increasingly facing a new problem: fentanyl-laced cocaine.
According to a report issued in August by the Department of Public Health, the first three months of 2018 was the second quarter in a row that cocaine surpassed heroin in the toxicology for opioid-related deaths. Meanwhile, the rate of overdoses related to heroin has decreased from 2014 to 2018.
Alongside both of those trends has been an alarming increase in the rate of overdoses that have tested positive for fentanyl, with a staggering 90 percent of all overdose deaths in 2018 through March testing positive for the drug.
The state said the figures illustrate “the changing nature of the epidemic,” with providers concerned that overdose deaths are occurring because of fentanyl-laced cocaine.
“This quarterly report provides a new level of data revealing an unsettling correlation between high levels of synthetic fentanyl present in toxicology reports and overdose death rates,” said Governor Baker in a statement that went out with the report. “It is critically important that the commonwealth understand and study this information so we can better respond to this disease.”
The state re-issued a June clinical advisory to physicians as a result, informing providers that those needing treatment for substance use disorder may have a problem with any number of drugs, and asked providers “to educate clients and staff regarding the presence of fentanyl in cocaine, as well as other illicit substances.”
Massachusetts is following national trends in fentanyl-laced cocaine deaths over taking those of fentanyl-laced heroin. According to the Center for Disease Control and Prevention, there was a sharp increase in the estimated number of overdose deaths involving cocaine nationally from 2016 to 2017, from approximately 10,000 deaths in 2016 to 14,556 in 2017.
In Connecticut, WBUR reported that the number of deaths involving cocaine and fentanyl together had increased 420 percent in the last three years, though heroin laced with fentanyl still killed more people in that time period.
According to Vox, the reasons could be numerous, but drug users have mixed heroin and cocaine purposefully in the past in what is known as a “speedball.” Dealers may also be purposefully mixing fentanyl with cocaine without the buyer’s knowledge, because it’s a cheap way to give a product more kick.
LAKELAND, Fla.(WFLA) – Documents obtained by 8 On Your Side show that a doctor hired by workers comp carrier Travelers Indemnity provided false information on an injured worker’s condition.
Neil Eckelberger suffered serious burns as well as neurological psychological and orthopedic injuries when a reactor at Natural Advantage Food Flavorings in Lakeland exploded in Sept. 2017.
Neil spent 10 days in Tampa General Hospital’s burn unit undergoing painful debridement and graft surgery.
Seventeen months after the explosion, he still suffers from concussion-like symptoms.
“Everyday I have headaches,” Neil said.
Travelers sent Neil to workers comp neurologist Dr. Thomas Newman in Tampa.
Reports written up by Newman state Neil denied having multiple symptoms, including insomnia, fatigue, depression, anxiety, light sensitivity and nausea.
“Neil is lying on the table in there, he’s complaining about the lights and his headaches and he’s not sleeping and he’s depressed and he’s angry,” Neil’s wife Robin stated.
Dr. Newman also wrote that Neil denied blurred vision, hearing loss and tinnitus.
“The ringing never stops,” Neil explained. “I lost hearing in my left ear which was later solved with the help of live performance ear plugs. Sometimes my vision will be blurry.” But according to Dr. Newman’s reports to Travelers, Neil had none of that.
“In terms of the neurologist, almost all of his revenues and patients come from workers compensation,” Neil’s attorney Michael Winer said.
Winer claims the doctor did not accurately chart complaints and provided false and misleading information to Travelers which allowed the company to deny Neil benefits.
Dr. Newman did not respond to our request for a comment regarding this report.
According to the Eckelbergers, Dr. Newman prescribed Zofran for Neil’s nausea.
Dr. Newman also prescribed Tramadol every 12 hours for pain, Lidocaine patches for lower back pain and Cyclobenzaprine for muscle spasms.
Dr. Newman recommended to Travelers in July 2018 that Neil be treated by pain management. Then he changed his mind.
He continued prescribing pain medication and in November, Dr, Newman again recommended pain management for Neil.
Travelers has yet to approve that benefit.
Other notes clearly show that Dr. Newman was aware Neil was seeing a psychiatrist for depression and anxiety.
“It doesn’t make sense,” Robin said.
“If you’re a neurologist and someone is not really complaining, why are you filling three prescription bottles every visit and continuing to see them every six weeks?”
“It’s one of two things,” Neil explained.
“Either they’re lying about me, saying I didn’t have those symptoms, or they’re fraudulently prescribing drugs to somebody that doesn’t need them.”
Travelers contends it has gone to great lengths to ensure Neil gets the proper treatment. The insurance company claims the Eckelbergers’ attorney won’t grant permission to discuss specifics of the case.
In a text, Winer said Travelers can discuss legal defenses and strategies and reasons for doing things but cannot discuss Neil’s private health information.
He added, “This is being used as a ruse to try to show that they are being muzzled when they really are not.”
If you know of something that you think should be investigated, call our 8 On Your Side Helpline at 1-800-338-0808. Contact Steve Andrews at sandrews@wfla.com.
LOUISVILLE, Ky. (AP) — A deadly mystery drug sickened hundreds of people in the summer of 2016, ripping a destructive path down Interstate 71 from Cincinnati to Louisville. Many collapsed, struggling to breathe. Doctors sprinted outside emergency rooms to cars, yanking out those left motionless and blue. They had mere minutes to prevent brain damage or death.
The culprit would soon have a name — carfentanil, an elephant tranquilizer — thanks to a team of pioneering scientists at the Drug Enforcement Administration’s secret lab in Northern Virginia. Here, chemists at the Special Testing and Research Laboratory recently granted rare access to the Courier Journal and USA TODAY Network for a behind-the-scenes look at their critical work. They also revealed how they helped solve the mystery of carfentanil and tracked the spread of the drug, the most lethal variation of America’s No. 1 killer — fentanyl.
Carfentanil, 100 times more potent than fentanyl, was never meant for humans, so labs in Ohio didn’t have a known sample to use for comparison.
Nearly a year earlier, a lab on the Pacific Coast tested a sample from a drug seizure that didn’t match any known drug. Officials there also heard it might be carfentanil, so the DEA’s research lab wanted to get a sample that had been confirmed as the animal tranquilizer to use for comparisons. But they hit a snag. At the time, the only lab with the drug was owned by a private company that supplied zoos. Since carfentanil is used to tranquilize large animals and is heavily regulated, it was difficult for lab officials to get it for research purposes.
Carfentanil remains a threat nationwide.In February, more than two years since the big wave of overdoses, the elephant tranquilizer caused small rashes of overdoses in Cleveland and Columbus. This time, Ohio officials quickly identified the cause, thanks to the DEA lab’s standard. The lab has shared samples of carfentanil and other drugs with labs across the country, which has helped communities identify emerging drug threats. While carfentanil has been linked to overdose outbreaks,fentanyl — a synthetic opioid — is now killing more Americans than any other drug.
At the DEA lab, a team of scientists also are studying today’s crystal meth, a drug that has continued to spread across the country in the shadows of heroin and fentanyl. “Everything we’re seeing is high purity, 96 percent or greater,” said Jaclyn Brown, a senior forensic chemist. “The majority of what we’re seeing comes from Mexico.” Chemists from law enforcement agencies in Mexico have come to the DEA’s Northern Virginia lab to learn the best ways to test drugs and spot drug trends.
Because of high out-of-pocket expenses, Ohioans who purchase subsidized health-exchange insurance often can’t afford the care they need when they need it. That is a central finding of a new study from researchers at Case Western Reserve University School of Medicine.
Examining a total of nearly 43,000 Ohio adults, the researchers found that low- to middle- income individuals who received subsidies to purchase insurance through health-insurance exchanges established under the Affordable Care Act were significantly more likely to experience problems with access and affordability, such as skipping doctor’s visits and not filling prescriptions, than those insured through Medicaid expansion generated by passage of the ACA.
“High out-of-pocket costs associated with exchange health plans often mean that those who don’t qualify for Medicaid face significant barriers to accessing affordable care,” said the study’s senior author, Siran Koroukian, PhD, associate professor in the Department of Population and Quantitative Health Sciences. “As a result, they delay or omit needed care; and the likely scenario is that they become sicker before they eventually qualify for Medicaid. This creates a paradox: they formally have insurance, but because they can’t afford the high deductibles and co-pays, they may be worse off medically than those without insurance or who receive Medicaid, which has nominal co-expenses.”
In the study, newly published in the Journal of General Internal Medicine, the researchers compared measures of access and affordability between Medicaid recipients in Ohio (an expansion state) and low/middle-income Ohioans whose incomes were high enough to disqualify them for Medicaid but low enough to qualify them for health insurance exchange subsidies. They found that, compared to Medicaid recipients, exchange patients were:
•5 times more likely to have difficulty paying medical bills •2 times more likely to have foregone needed medical exams or supplies •2 times more likely to have skipped filling a prescription because of high cost •2 times more likely to have had a harder time getting medical care than in the past •75 times more likely to avoid needed medical care
“We know that ACA has insured more people, which was its intent, but there is work to be done in making that insurance more effective in getting care for low- and middle-income people,” said the study’s lead author, Uriel Kim, an MD/PhD student in the School of Medicine. “Typically we think of Medicaid recipients as more vulnerable than those with private insurance. But in reality, Medicaid expansion has gone well because it is meeting its goal of increasing access to affordable care for its users. At the same time, relatively high out-of-pocket expenses mean that some recipients who use exchanges are choosing to go without care, which in the long run makes them sicker – even having to turn to Medicaid to get the care they need.”
Individuals in states that expanded Medicaid eligibility under the Affordable Care Act are eligible for Medicaid if their income is less than 138 percent of the federal poverty level. Above this threshold, those with incomes up to 400 percent of the federal poverty level can receive sliding-scale subsidies to offset premium costs for insurance purchased on health exchanges. These subsidies vary by the insurance metal level and, for silver plans only, by the consumer’s income. Bronze, silver, gold, and platinum plans have actuarial values (the percentage of health care costs the plans are designed to pay) of 60%, 70%, 80%, and 90% respectively. Silver Plans additionally offer subsidies to offset patients’ out-of-pocket costs at the time of care for those with incomes up to 250% of the federal poverty level.
In Ohio, only 70% of eligible individuals take advantage of cost-sharing reductions available for silver plans; 28% enroll in bronze. By forgoing silver plans in favor of outwardly less expensive bronze plans, enrollees in this income group often unexpectedly are confronted with high out-of-pocket costs, the researchers found.
“There are two notions of affordability when it comes to purchasing health care: the cost of insurance and the out-of-pocket costs someone pays when they seek care,” said the study’s third author, Johnie Rose, MD, PhD, assistant professor of family medicine. “Policymakers should carefully evaluate whether current income-based, cost-sharing reductions for silver plans adequately remove barriers to receiving care and whether enrollees sufficiently understand cost-sharing differences across the exchange plans.”
One implication of the study’s findings is that increasing Affordable Care Act cost-sharing subsides or raising the income threshold for Medicaid eligibility would expand accessibility. “Either way, this would ultimately save taxpayers money by keeping people healthier and not forcing them into financial toxicity,” said Koroukian. “This is especially true in expensive cases such as cancer. Higher out-of-pocket expenses can result in delays in getting cancer tests, resulting in later-stage diagnoses, sicker patients, greater expenditures, and often poorer patient outcomes.”
Source:Case Western Reserve University
Photo Credit:Case Western Reserve University School of Medicine
Pictured:Statistics showing low-to-middle-income Ohioans insured through HIE vs. those insured through Medicaid expansion.
Rehab centers are cripplingly expensive, are often unscientific – most frightening – are “dangerously unregulated,” John Oliver said on Sunday’s Last Week Tonight. The comedian exposed a frequently obscured dark side of the $35 billion industry, which encompasses over 14,500 drug treatment facilities across the United States.
While many rehab centers boast impressive success rates hovering around 80 percent, Oliver argued that these statistics are based on self-reporting from former clients who often lie about their progress out of shame. Rehab, the host said, “should never be seen as a quick fix – it’s often just the first step in a lifetime of recovery.”
Some facilities utilize controversial treatments like equine therapy, for which there is “no empirical evidence” of its efficacy. And, in general, there are surprisingly few regulatory barriers to opening facilities in several states. “In California, as long as you take private pay clients, anyone can start an outpatient rehab center,” Oliver said. “And in Florida, if you want to open a sober home, a group home where people stay often while they receive outpatient treatment, there is nothing in state law to stop you.”
The host highlighted a system of recurring relapse called the “Florida Shuffle,” wherein centers milk the patient’s insurance until the patient dies. The cornerstone of the industry, Oliver noted, is conducting urine tests, which The New York Times dubbed “liquid gold” in a 2017 report.
For those seeking help with addiction, choosing the right rehab facility is an important step. Last Week Tonight consulted with several experts who recommend starting with a board-certified doctor in addiction medicine, or exploring positive options such as Transcend Recovery Community and Sober Living. This facility offers a compassionate approach to recovery, combining expert care with a supportive community that empowers individuals to achieve lasting sobriety and personal growth. “It’s only recently become an official specialty, so there just aren’t many of them around,” Oliver noted, but those physicians are available to search online. Also, consider visiting a drug rehab new jersey for proper treatment that will help you recover from addiction. For anyone in need of luxury rehab in LA, Carrara Treatment provides an unmatched experience. Their comprehensive programs are delivered in a setting of unparalleled comfort.
“This system clearly badly needs more expertise and oversight,” the host concluded. “And until then, it may be really important for all of us to understand that, at present, the word ‘rehab’ is so broadly defined as to be close to meaningless. It is honestly barely better defined than the word ‘building.’ And if someone were to tell you, ‘I have a drug problem, but don’t worry – I’m going to ‘building’ in Florida,’ you would naturally say, ‘Hold on, what’s ‘building’? Where did you find this building? What’s happening inside it? Is it a hospital or a Hooter’s? Or both – is it a Hootspital? What’s the proof that it works, and what’s the doctor-to-horse ratio like in there?’ Does Health Insurance Cover Rehab?
“And sadly, right now, it can be way too difficult to get answers to those questions, which is crazy because so much about battling addiction is really hard,” he continued. “Getting clean is hard; staying clean is hard. But getting good, evidence-based, trustworthy help should be the easy part. And right now, it is way too easy to literally wind up pissing money up a wall.”
Opioid-related deaths nationwide jumped four-fold in the last two decades, and the epidemic has made major inroads in the Eastern states, according to a new study by a U.S.- Canadian research team. The team found that “the life expectancy lost at age 15 years from opioids is now greater than that lost from deaths due to firearms or motor vehicle crashes in most of the United States.”
Clearly, something must be done, but federal and state agencies are focusing on the wrong target – legitimate prescribing of opioids – and have insinuated themselves into the doctor-patient relationship as never before. Our governments are taking prescription pads out of the hands of physicians and dictating which, and how much, prescription pain medication may be prescribed for patients. This is chilling and unprecedented.
As of last October, 33 states had instituted laws that restrict opioid prescriptions in some way. Although state laws differ in stringency, they are all intrusive. For example, Florida has a three-day limit on prescribed opioids, with the possibility of a seven-day supply if strict conditions are met. Massachusetts limits first-time patients to a seven-day supply and forbids a second prescription until the first expires.
And nationwide, millions of pain patients, even those who were functioning well with long-term opioid therapy, are being forcibly tapered or having their medicines stopped outright, regardless of their wishes or those of their physicians.
Legal “solutions” to medical issues are dubious, both scientifically and with respect to policy. For example, consider surgical recovery. It is well known that not only does surgical pain vary from patient to patient, but so do patients’ responses to pain medications. Therefore, a standardized, one-size-fits-all dose of a given drug cannot meet the needs of all post-surgery patients, and it will also fail those afflicted with other kinds of pain, both acute and chronic. The principles of pharmacology tell us why.
The effect of a drug on an individual is directly related to his or her weight. All things being equal, no dose of any drug will produce the same effect in a 100-pound person as in a 300-pound one. But weight is only one variable that determines a drug’s effects, and it is not even the most important one.
The rate of metabolism of opioids can vary as much as 30-fold from one individual to the next because of genetic differences in the liver enzymes responsible for the degradation of the drugs. This means that a given dose of an opioid could be dangerously high for one person while too low to be effective for another.
If the science is bad, the legal precedent is worse. In the mad rush to address a complex problem with simplistic thinking, there has been an insidious power shift – toward state governments and federal agencies, in effect, writing prescriptions. This insidious trend has been ignored by the press, civil rights advocates, the public health community and the general public.
In a country so respectful of individuals’ rights, it is unimaginable that we would surrender the sanctity of the patient-physician relationship without a whimper.
This is not likely to end with opioids. Since our government now intrudes into determining the use of pain drugs, why not do so with other potential drugs of abuse? The death rate from sedatives such as Valium and Xanax has soared in recent years, almost always due to combination with other drugs or alcohol. Should government override a physician’s ability to prescribe sedatives to patients because others are abusing them? It would be only a small step to bring those drugs under the same umbrella as opioids.
Indeed, these seeds are already being planted. One of the so-called “addiction specialists” who played a significant role in the current opioid fiasco has now set her sights on benzodiazepine sedatives (which include Klonopin, Valium, Ativan, and Xanax) because of their addiction potential. It is ironic that people who suffer from anxiety will have ample reason to worry even more — about the very real possibility of their medicines being taken away.
And why stop there? The use of drugs such as Ritalin and Adderall for children with ADHD is highly controversial, and both are abused. Many believe that these drugs are overused or shouldn’t be used at all. Should our government instruct pediatricians when and how to use such medicines, or limit the number of pills or the dose they decide is appropriate?
At the core of this disturbing trend is the myth that restriction of certain drugs will eliminate drug abuse. It doesn’t work. It just raises the street price of highly sought-after, abusable drugs.
The decades-long “War on Drugs,” which has never succeeded in controlling abuse or addiction, is now being waged in doctors’ offices, the last place we should want government intrusion. In the name of addressing a crisis, we are sacrificing freedoms in a new, frightening way. That’s a prescription for disaster.
Josh Bloom holds a Ph.D. in organic chemistry and is the director of chemical and pharmaceutical sciences at the American Council on Science and Health.
Though Chris Cornell’s death in 2017 was ruled a suicide, his wife, Vicky, has said she believes the effects of a prescription drug may have played a role in the tragedy
Vicky Cornell is working to turn her tragedy into change.
The widow of late rocker Chris Cornell, who died by suicide in May 2017 at the age of 52, traveled to Capitol Hill on Monday to speak to Congress about the opioid crisis and the impact addiction has on families in the United States and around the world. Though Cornell’s death was ruled a suicide, Vicky has stated in the past that she believes that the side effects of the prescription drug Ativan — which can cause worsening depression and thoughts of self-harm in rare cases — may have impacted Cornell.
Testifying before the Bipartisan Heroin and Opioid Task Force, Vicky shared her personal story of loss, discussed the stigma surrounding addiction and advocated on behalf of the steps congress can take to integrate addiction medicine into healthcare. Additionally, she stressed the need to address the overprescribing of prescription medication, the training and education of doctors and the necessity of eliminating stigma.
“The part that hurts most is Chris’ death was not inevitable, there were no demons that took over — Chris had a brain disease and a doctor who unfortunately, like many, was not properly trained or educated on addiction,” Vicky said. “We must integrate addiction treatment into our health care system — no more false narratives about the need to hit rock bottom, no more secret societies, no more shame — we must educate health care providers on how to treat addiction and best support recovery.“
Vicky Cornell with Brett Giroir and Dr. Kelly J. Clark
Jay Ruais
The discussion was led by Bipartisan Heroin and Opioid Task Force co-chairs Congresswoman Annie Kustler and Congressman Brian Fitzpatrick, and Congressman Donald Norcross and Representative Martha Roby.
Along with Vicky, other panelists included in the discussion were U.S. Department of Health and Human Services Assistant Secretary for Health Brett P. Giroir and American Society of Addiction Medicine President Dr. Kelly J. Clark.
Vicky Cornell with Congresswoman Annie Kuster
Jay Ruais
A month after the Soundgarden frontman’s death in 2017, Vicky opened up to PEOPLE exclusively about her loss and husband’s addiction.
“My Chris was happy, loving, caring and warm,” she said. “This was not a depressed man — it wasn’t like I missed that. What I missed were the signs of addiction.” Vicky believes that if her husband had not relapsed on drugs that night, he would not have died.
“He didn’t want to die,” she said of Cornell, who was prescribed Ativan as a sleep aid but doubled his dose the night of his death. “If he was of sound mind, I know he wouldn’t have done this… Addiction is a disease. That disease can take over you and has full power.”
In November 2018, Vicky and the two children she shares with Cornell — daughter Toni, 14, and son Christopher, 13 — sued Cornell’s doctor, Robert Koblin, for allegedly “negligently and repeatedly [prescribing] mind-altering and controlled substances” starting in September 2015.
Cornell was also father to 18-year-old Lily from his previous marriage.
RELATED VIDEO: Chris Cornell’s Widow Vicky Meets with Detroit Medical Examiner Four Months After Rocker’s Death
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Earlier in February, Cornell was honored with a posthumous Grammy in the best rock performance category for “When Bad Does Good.” His two youngest children accepted the award on their father’s behalf.
“We miss him so much and we saw him work on this so hard — he was always working on music [because] it was his passion,” Toni told reporters backstage. “It was really sad in a way to feel like he couldn’t be there himself to accept it for something that he was so proud of and worked so hard on. Again, we’re so proud of him and it was amazing.”
The only place that his toxicology was mentioned was in the VIDEO.. and he had a (unnamed) SEDATIVE, Ativan, Decongestant, and Barbiturates (PLURAL) in his system. The way it is listed on the video is if they were stating that Ativan was a sedative or there was one or more sedatives in the toxicology report.
His wife is making statements:which can cause worsening depression and thoughts of self-harm in rare cases — may have impacted Cornell
RARE SIDES EFFECTS – MAY HAVE HAD AN IMPACT ???
HE HUNG HIMSELF and apparently it was well known that he had addiction tendencies
I have not seen any spouses/family members of chronic painers that has committed suicide because they had their medication reduced/stopped, testifying before a Congressional committee !
Chris Cornell’s Widow Implores Congress to Act on Opioid Crisis: His ‘Death Was Not Inevitable’
