The Doctor’s Corner Show #43 “Pharmacist Steve” Ariens

Better to let 95% of surgery pts to suffer in pain during recovery than risk that MAYBE 5% become addicted ?

 

 

Summa Health eliminating opioids from surgeries

https://www.news5cleveland.com/news/local-news/akron-canton-news/summa-health-eliminating-opioids-from-surgeries

AKRON, Ohio — Summa Health System has drastically reduced the use of opioids in surgeries at all of its hospitals as a direct result of the opioid crisis.

In 2017, Summa used narcotics in 98 percent of procedures, but now that number stands at 20 percent.

By the end of the year, the goal is to use narcotics in 10 percent or less of all surgeries.

“My goal is to eliminate the opiates from what we do in the operating room completely,” said Dr. Thomas Mark, the chairman of the anesthesiology department at Summa Health.

Mark said studies show addiction can start with just one dose of an opioid during surgery for up to six percent of patients.

“That’s unacceptable. We do 20,000 cases here at Summa. That means just because somebody had the audacity to have surgery, 450 people potentially face addiction,” Mark said.

Instead of relying on opiates, Summa is using regional blocks with local anesthetic that can last 24 to 36 hours, a continuous peripheral nerve block that can deliver medication directly to an affected area of the body, or a combination of over-the-counter pills, therapy and a pain management approach.

Mark said he’s also stressing to surgeons to cut down on the number of pain pills prescribed to patients after surgery – a trend he believes must continue to reduce the number of people who get hooked on narcotics and overdose.

For many people, pain pill addiction becomes a gateway to more dangerous drugs like heroin.

Nicole, a 32-year-old woman from Stow, told News 5 she became hooked on pain pills about 10 years ago.

“I would get them off the street and basically buy scripts off people,” she said.

She overdosed once on heroin and a second time on carfentanil, but has been clean for more than two years.

“I basically have to take it one day at a time and work with others to keep my sobriety.”

Since the changes, Summa reports a a higher satisfaction rating and patients returning home much earlier due to quicker recovery times.

Cleveland Clinic Akron General Medical Center has reduced the use of narcotics in colorectal surgeries to 17 percent and has also decreased opioid use in breast and bariatric procedures.

On March 5, the city of Green, the drug task force and Summa Health will discuss pre-operative and post-operative non-opioid pain management at Green City Hall. The event runs from 6:30 to 7:30 p.m.

Law enforcement pushes back on Michigan civil asset forfeiture reforms

Law enforcement pushes back on Michigan civil asset forfeiture reforms

https://www.detroitnews.com/story/news/local/michigan/2019/02/19/law-enforcement-pushes-back-michigan-civil-asset-forfeiture-reforms/2913449002/

Lansing — Bipartisan legislation that would reform the state’s controversial civil asset forfeiture laws received pushback Tuesday from Michigan law enforcement.

The Michigan Association of Chiefs of Police voiced opposition in a state House committee to proposals that would require a conviction before police permanently forfeit up to $50,000 in property believed to be connected to a crime.

The association’s executive director, Robert Stevenson, said, by requiring a conviction, the legislation affords a higher level of protection for alleged drug dealers than others subject to civil proceedings or lawsuits.

“The federal government can seize your money for tax evasion without a criminal conviction,” Stevenson said. “Geoffrey Fieger has made a very good living seizing people’s money without any type of conviction. The state of Michigan can seize your property without a conviction. Any of you can go to small claims court today and get an order to seize somebody’s else’s property without a conviction.”

The bipartisan civil asset forfeiture reform plan would require a conviction before police could permanently seize or sell confiscated property worth less than $50,000.

The House Judiciary Committee heard testimony on the House-initiated legislation Tuesday as well as a similar package of bills that was passed last week by the Senate. The bills received the unique dual support of the left-leaning American Civil Liberties Union and the free-market-oriented Mackinac Center for Public Policy.

Rep. Graham Filler, chairman for the committee, said lawmakers are likely to consider the bills further next week. The DeWitt Republican said legislators are working with law enforcement to address some of the concerns with the proposed reforms.

The requirement of a conviction would reform long-debated civil asset forfeiture laws, which allow police to permanently confiscate cash, cars or other property that they suspect was involved in the commission of a crime or obtained through the commission of a crime.

The forfeiture proceedings occur in civil court, separate from the criminal process, and require a prosecutor to establish clear and convincing evidence rather than proof beyond a reasonable doubt.

More than $13 million in cash and assets amassed by drug traffickers was forfeited in 2017, according to a Michigan State Police report. 

The Legislature in recent years has increased the standard of evidence required to process forfeitures and eliminated a bonding requirement for citizens fighting to keep their property.

The $50,000 threshold would allow protections for people found with smaller amounts of money while acknowledging that larger quantities may indicate more serious dealers for which existing civil asset forfeiture laws may be more appropriate, said Sen. Peter Lucido, the Shelby Township Republican who introduced the Senate reform bills.

“It’s optically wrong not to give a person a day in court,” Lucido said. “…Once they’re found guilty, the civil asset forfeiture falls into place. But if they’re found not guilty, they should be returned their property.”

Democratic Attorney General Dana Nessel joined House Speaker Lee Chatfield, R-Levering, for the introduction of the House civil asset forfeiture plan in January.

She told lawmakers Tuesday that she supported the bills in concept, but believed some tweaks were necessary on provisions for defendants located outside the state, a potential standard for the initial seizure of assets, and the destruction of property that could constitute evidence.

“These legislators have nearly a full two years,” Nessel said. “While I want to see this issue addressed as quickly as possible, take the time to get it right.”

Stevenson said drug deals are often separate from a dealer’s cache of cash and assets. While law enforcement may be able to prove a drug deal or the proceeds from a drug deal officers, they aren’t always able to connect them in court.

He gave the example of a confidential informant who made a $10,000 buy from a home that police later raided only to find a “dry hole” that sold out of drug products, but was littered with scales, packaging materials and $49,000, including the $10,000 used in the controlled buy.

“We would have to give them back all that property,” Stevenson said. “This is like being pregnant; you either are or you aren’t. It’s drug proceeds or it’s not drug proceeds.”

The Prosecuting Attorneys Association of Michigan also recommended changes to the bills, including lowering the threshold to $25,000 and giving law enforcement more time than the proposed 28-day window to issue a warrant.

“That’s wholly unworkable,” said Livingston County Prosecutor Bill Vailliencourt. “Lab reports alone form the state police crime lab to determine if a substance is controlled or not takes much longer than 28 days.”

 

two PBMs charged $224 million more a year for drugs than they were reimbursing pharmacists – just in OHIO !

Attorney General Dave Yost seeks $16 million repayment from pharmacy middleman OptumRx

https://www.dispatch.com/news/20190219/attorney-general-dave-yost-seeks-16-million-repayment-from-pharmacy-middleman-optumrx

After nearly a year of investigating, Ohio is taking its first steps to recover money from pharmacy middlemen who do billions of dollars worth of business with state agencies.

Attorney General Dave Yost announced Tuesday that he is seeking repayment of nearly $16 million paid to pharmacy-benefit manager OptumRx by the Bureau of Workers’ Compensation. Yost intends to take OptumRx to nonbinding mediation, saying the company has overcharged the bureau since 2015. Such mediation is required under the contract between the bureau and OptumRx. If it fails, the dispute presumably will be taken to court.

“The state of Ohio and the BWC consider these matters of public significance and have calculated the following overcharges attributable to OptumRx’s failure to adhere to agreed discounts on generic drugs. …” says a copy of Yost’s Feb. 11 letter to OptumRx that was obtained by The Dispatch.

As part of its Side Effects investigation into pharmacy benefit managers, The Dispatch reported in May that the Bureau of Workers’ Compensation had performed an analysis of its prescription-drug spending and, in the words of former BWC pharmacy program manager John Hanna, “discovered we were being hosed.”

The firm that conducted the analysis, Healthplan Data Solutions, determined that OptumRx overcharged BWC by $5.7 million in 2017. That’s 6.5 percent of the $86 million in total agency spending on prescription drugs that year. The bureau fired OptumRx as a consequence of the analysis.

In his letter to OptumRx, Yost wrote that the pharmacy benefit manager overcharged the bureau by $6 million in 2015, by $2.7 million between the beginning of 2016 and the end of October 2016 and by $7.2 million between Nov. 1, 2016, and Oct. 27, 2018.

More such moves are expected against pharmacy benefit managers administering public dollars. OptumRx also is the pharmacy benefit manager for one of Ohio’s five Medicaid managed-care plans, while CVS Caremark is PBM to the other four. Together, the companies administer $2.5 billion in annual Medicaid drug spending.

The Dispatch conducted an analysis in June using confidential reimbursement data that showed the PBMs were charging taxpayers far more more for prescription drugs than they were reimbursing pharmacists. The Ohio Department of Medicaid then hired Healthplan Data Solutions to conduct an analysis using all reimbursement data.

That study found that the two PBMs charged $224 million more a year for drugs than they were reimbursing pharmacists. That was as much as $187 million above the typical cost of administering such programs in one year, the analysis found.

PBMs act as middlemen between drugmakers, insurers and pharmacies. OptumRx, CVS Caremark and ExpressScripts control 80 percent of the pharmacy benefit management business in the United States, according to filings in federal litigation over CVS’s merger with insurance giant Aetna.

Critics say PBMs use their size and a lack of transparency to drive up drug costs — and corporate profits. But the PBMs say they use their size and sophistication to achieve savings for consumers and taxpayers.

In the case of the workers’ compensation bureau, Yost said OptumRx failed to manage the effective rate of the bureau’s maximum-allowable-cost list “to achieve the discounts against (the average wholesale price) promised by OptumRx, and OptumRx wrongfully increased prices charged to BWC.”

Last year, while he was state auditor, Yost released a critical analysis of the practices of the PBMs that serve the Medicaid program. It confirmed that they were charging far more than they were paying for drugs, and “various practices were identified as indications of potential conflicts of interest that could impact pharmacy services in the Medicaid program and other publicly funded health care.”

The same report said analysts didn’t have enough data from the Medicaid operations involving OptumRx and CVS Caremark to “provide a complete picture of pharmacy costs and PBM compensation.”

It added that “there are a number of additional factors that impact PBM revenues and pharmacy reimbursements that were outside of the scope of this report, such as rebates, additional plan fees, and pharmacy fees. The Ohio legislature should take steps to mandate the reporting of additional statistical and financial data that would provide a more complete understanding.”

Ohio has about 3% of the country’s total population … 16 million over charge by ONE PBM… handling the Rxs for one of the state’s Medicaid HMO’s.. There is 4 other Medicaid HMO’s in Ohio which is managed by CVS Health/Caremark PBM. 

Both of these PBM’s charged Ohio 224 MILLIONS than they reimbursed pharmacies.  Just on Medicaid pts in a state with just 3% of our total population…

Anyone question why YOUR PRESCRIPTIONS COST SO DAMN MUCH ?

Canadian study finds benzodiazepine use in patients drops 45 percent after medical cannabis treatment

Canadian study finds benzodiazepine use in patients drops 45 percent after medical cannabis treatment

https://www.thegrowthop.com/cannabis-health/cannabis-medical/canadian-study-finds-benzodiazepine-use-among-patients-drops-45-percent-after-medical-cannabis-treatment

Four in 10 patients who regularly consumed benzodiazepines stopped taking the medication within about six months of initiating and being monitored on medical cannabis, Aleafia Health Inc. reports in what it believes is the first study of its kind published in peer-reviewed journal.

Appearing in Cannabis and Cannabinoid Research, the observational study featured a cohort of 146 patients receiving physician-led treatment at Canabo Medical Clinic, which is wholly owned by Aleafia, a federally licensed producer and vendor of cannabis that operates medical clinics, cannabis cultivation and research and development facilities.

With an average age of 47 years, 61 percent of patients were female, 54 percent reported prior use of cannabis and all were referred to the clinics by practising physicians outside the clinic network. “A retrospective analysis was performed on a cohort of patients using medical cannabis. These data are part of an ongoing database gathered by Canabo Medical Clinic on medical cannabis patients,” the study notes.

Benzodiapines, a class of psychoactive drugs, include the most common sedatives and anti-anxiety medications. This class of medication is used to treat anxiety, insomnia and alcohol, seizure and spasticity disorders. “Complications of long-term use include lack of concentration, dependence, tolerance, overdose and addiction,” the research adds.

Findings indicate that after completing an average two-month prescription course of medical cannabis, 30.1 percent of patients had discontinued use of benzodiazepines, 44.5 percent at follow-up after two prescriptions, and 45.2 percent at final follow-up after three medical cannabis prescription courses. This shows “a stable cessation rate over an average of six months,” study authors suggest.

 

Conditions precipitating cannabis treatment

GettyImages 842130392 534x306 Canadian study finds benzodiazepine use in patients drops 45 percent after medical cannabis treatment
After three visits, 30.3 percent who discontinued benzodiazepines said their life was impacted by their medical condition ‘all the time krisanapong detraphiphat / iStock / Getty Images Plus

Reported primary conditions driving cannabinoid treatment were grouped into neurological, 7.5 percent; pain, 47.9 percent; psychiatric conditions, 31.9 percent; and other, 12.7 percent. “After three clinic visits, 45.0 percent of patients using benzodiazepines, and 30.3 percent of patients who discontinued benzodiazepines, reported that their life was impacted by their medical condition ‘all the time’,” the research reports.

“This study found no significant difference in the proportions of CBD and THC in the cannabis used by patients who continued and those who discontinued benzodiazepines,” the study goes on to say.

Beyond a decrease in the use of benzodiazepines, “these patients, following prescription cannabis use, also reported decreased daily distress due to medical conditions,” notes a press release from Aleafia.

Citing information from the Canadian Centre on Substance Abuse and Addiction—which reports that 10 percent of the Canadian population takes prescription sedatives—the Aleafia statement notes that the centre found “benzodiazepines may lead to serious long-term complications, including dependence, overdose and death.”

That is consistent with findings recently published in The British Medical Journal. The study, which looked at all Ontarians who died of an opioid-related cause from Jan. 1, 2013 through Dec. 31, 2016, reported that benzodiazepines consumption significantly increased the risk of opioid overdose.

Growing interest in cannabis

“The study results are encouraging, and this work is concurrent with growing public interest in a rapidly developing Canadian cannabis market,” suggests Chad Purcell, lead author of the Aleafia study, who has a BSc with honours in pharmacology, a BSc in pharmacy and will receive an MD degree from Dalhousie University in 2019.

Other study authors include Andrew Davis, who has PhD and M.A. in economics from the University of Rochester and a BSc from Memorial University of Newfoundland; Dr. Nico Moolman, a clinical assistant professor at the University of Saskatchewan who specializes in head and neck surgery; and Dr. Mark Taylor, currently a professor and interim head of the Division of Otolaryngology-Head and Neck Surgery at Dalhousie University, who has more than 150 peer-reviewed publications to his credit.

Emphasizing the need for caution, however, Purcell notes that study results “do not suggest that cannabis should be used an alternative to conventional therapies.”

Among other factors, patients were not tested for verification of reported benzodiazepine discontinuation, as well as sample size and retrospective observational methodology used “preclude an inference of a causal relationship between cannabis and benzodiazepine use trend,” the study points out. “Without dependable safety data and evidence from randomized trials for this cohort, cannabis cannot be recommended as an alternative to benzodiazepine therapy,” it notes.

“Our purpose is inspiring others to advance current cannabis understanding as we collect stronger efficacy and safety data that will lead to responsible policy and recommended practices for use,” Purcell emphasizes.

“This study’s results will not be surprising to many patients who have transitioned from prescription painkillers and sedatives with the help of physician-led medical cannabis therapy,” suggests Dr. Michael Verbora, chief medical officer at Aleafia.

Still, hurdles need to be cleared—including regulatory challenges and stigma—to satisfy the current shortage of medical cannabis research, Dr. Verbora notes. “At Aleafia, we will continue to leverage our IP and leading cannabis data to further advance patient care through advanced treatment methods and specialized product development.”

The study notes the observations made merit “further investigation into the risks and benefits of the therapeutic use of medical cannabis and its role rating to benzodiazepines use.”

 

Want to keep up to date on what’s happening in the world of cannabis?  Subscribe to the Cannabis Post newsletter for weekly insights into the industry, what insiders will be talking about and content from across the Postmedia Network.

DOJ sticking with CVS-Aetna merger pact despite negative public comments

https://www.healthcaredive.com/news/doj-sticking-with-cvs-aetna-merger-pact-despite-negative-public-comments/548601/

Dive Brief:

  • After reading 173 comments from the public — all expressing some opinion about the proposed settlement in the CVS-Aetna merger case — the Department of Justice said its agreement would remain unchanged.
  • The feedback reflected a “wide range of views,” the DOJ said in a response filed last week in the D.C. District Court. Of the 173 comments, 26 were in support of the settlement, which calls for Aetna to divest its Medicare Part D business, an action that has already occurred and was a critical component in clearing antitrust hurdles.
  • The “remedy fully addresses the competitive threat posed by the merger,” the DOJ said. WellCare, the firm that acquired the business, will be a “vigorous competitor” and preserve the state of the market that otherwise would have been lost in the merger.

Dive Insight:

The American Medical Association was one of several organizations to send in public comments critical of the DOJ’s settlement with CVS-Aetna in the nearly $70 billion deal. “The nation has learned the hard way that overlooking consolidation in health insurance markets is costly,” the group said in its comment.

AMA said the deal raises concerns about whether WellCare will be able to compete as well as Aetna because of its smaller size. “WellCare cannot negotiate the same deep discounts on pharmacy and other inputs costs as Aetna can because of its size,” it said.

Various state regulators also submitted their comments and analyses, including Dave Jones, California’s Insurance Commissioner. Jones and other state regulators held their own hearings and conducted their own review of the merger’s effects on their respective markets.

The blockbuster CVS-Aetna deal is still waiting final approval from D.C. District Court Judge Richard Leon, who has raised concerns about whether the settlement does enough to protect consumers from anticompetitive effects.

“I am concerned that your complaint raises anti-competitive concerns about one-tenth of 1% of this $69 billion deal,” Leon said during an earlier hearing, according to a transcript of the court proceedings. 

Leon previously ordered the pharmacy chain and payer to operate as separate units until he blesses the union and asked for a firewall between them to prevent the exchange of competitive information.

Still, CVS and Aetna have already closed the deal and CVS CEO Larry Merlo sought to assure investors last month, calling the company already “one.”

Just another example of part of the Federal bureaucracy having the required  public comment period and regardless of the large percent of comments that are NEGATIVE as to what the bureaucracy has proposed… IN THE END… whatever change that was proposed to happen…. happens just as originally proposed.  The bureaucrats have dotted their “i’s” and crossed its “t’s” as required by law…  but apparently the law does not require them to put any weight of the comments to the final outcome.

Grand Slam Article by Dr. Josh Bloom Shows True Opioid Stats

Grand Slam Article by Dr. Josh Bloom Shows True Opioid Stats

www.medium.com/@heatherzamm/grand-slam-article-from-dr-josh-bloom-shows-true-opioid-statistics-a83331e84161

Government Failure Unreported by Media; Meth Deaths Triple & Then Some Since ‘11

I checked in to the ACSH website as it has been almost a month, with holidays and whatnot, and I was blown away by the article Dr. Bloom had published on December 12, 2018.

I didn’t catch this and I am putting it up immediately because it is important and deserves to be read far and wide.

Why no one is talking about this? Well, of course we know why.

It is another bomb that blows the “opioid crisis” to shreds.

Every time we see another truth come out, no one cares.

It’s so frustrating to the point of parody now, folks.

Anyone who actually thinks the opioid crisis is a real, live epidemic of prescription pill misuse/overuse is not paying attention to a damn thing.

However, the media ignored the data Dr. Bloom exposed, because they have their story and they are sticking to it, come hell or high water.

It matters not what we prove. They are not ever going to report facts.

We need to understand that.

The frustrating issue is how entrenched the narrative they have promulgated is in the national consciousness.

Dr. Bloom’s article is titled:

“Dear PROP/CDC, Here’s What Happens When You Over-Restrict Pills: More Deaths. Nice Going.”

I am a fangirl of Dr. Bloom’s work.

I admit it.

Not in a creepy way, I swear.

I admire Dr. Bloom and respect the heck out of him.

I send links to my husband of all of his work and point out how awesome and personable his writing is.

That’s it.

He writes in a unique style that makes me laugh and also educates me.

For a scientist… that’s amazing.

In this article, Dr. Bloom shows the public just how ridiculous the CDC, media, and Dr. Andrew Kolodny’s group PROP (Physicians for Responsible Opioid Prescribing) is when they shriek regarding the “overprescribing” of opioid medication.

He uses science and facts, unlike the champions of opioid throttling, who use emotion and rhetoric.

He writes:

If Shakespeare were alive today, he would be hard-pressed to come up with a script that could match the tragedy that has been imposed on this country by self-appointed drug experts, bureaucrats, self-serving politicians, and various other fools. It’s that bad. And it was largely preventable.

So, let’s all congratulate the CDC for sticking its nose where it should not have been and the Physicians Responsible for Opioid Prohibition (1) for creating a mess that we will not be getting out of anytime soon. A new report from in the December 12th National Vital Statistics Reports (NVSR) confirms what patient pain advocates and I have been saying all along — that we’ve been fighting the wrong war (against prescription opioid analgesics) and, in doing so, managed to screw two things up at the same time.

“Pain patients are suffering”

More people, not fewer, are dying

One can only hope that the press, which has been pathetically inept in its coverage of the “opioid crisis,” which is really the “fentanyl crisis,” might pay attention to the new report and possibly start to get the story right. But don’t get your hopes up. To do so would entail not only reading the report but also, understanding what it says.

I’ll make it easy for them.

As I’ve written repeatedly, pills are not the real problem

(See No, Vicodin Is Not The Real Killer In The Opioid Crisis and The Opioid Epidemic In 6 Charts Designed To Deceive You);

it is the difficulty of obtaining them that is now. The NVSR makes this painfully obvious. Here’s why.

In 2011 (Table 1), there were 41,340 overdose deaths from all drugs — legal, illegal, prescription, and over the counter. Oxycodone was the primary cause of OD deaths (5,587, 13.5% of total). But a closer look at Table 1 reveals some interesting facts.


Table 1 -The 15 Drugs Most Responsible for OD deaths in 2011 as reported by NVSR and reproduced by Dr. Bloom with commentary on ASCH.org

— a closer look at Table 1 (I added the notes in color) reveals some interesting trends. Although oxycodone leads the pack with 5,587 deaths, illegal drugs, heroin, cocaine, and methamphetamine, killed twice as many people (and alcohol killed 80,000). The number for heroin is almost certainly too low, probably by a lot. This is because heroin is rapidly metabolized to morphine,

“so someone who died from a heroin overdose will also test positive for morphine.”

Since people on the street generally, don’t inject themselves with morphine, it is plausible that most of the morphine overdoses were actually from heroin.

Although two benzodiazepine sedatives, Xanax and Valium are on the list, this is somewhat misleading. Virtually all of these deaths are a result of concomitant use of alcohol or opioids.

“It is virtually impossible to kill yourself with Valium alone.”

In a case study, a woman who tried to commit suicide took 2,000 mg of the drug — the equivalent of 400 five milligram pills and walked out of the hospital two days later.

(See Can Valium Kill You?).

In high doses, patients may manifest coma, respiratory depression, hypotension, hypothermia, and rhabdomyolysis. Otherwise, benzodiazepines are remarkably safe as single agents.

TOXNET, Toxicology Data Network

Now, let’s take a look at the same data for 2016 (Table 2). The changes are startling.

Table 2. Overdose deaths from the 15 most common drugs. Note that adding the percentages results in a number considerably higher than 100. Likewise, adding the number of deaths gives a number greater than 63,632. This is because when multiple drugs are involved they are all counted. The term “fentanyl deaths” almost always means “illicit fentanyl and its analogs, not prescriptions patches — As posted by Dr. Bloom on ACSH.ORG

In Table 2, the damage of six years of bad policy becomes evident.

Despite a 25% reduction in opioid prescriptions during that time, 22,292 (54%) more people died from drug overdoses, despite the fact that the number of OD deaths from oxycodone (Percocet) and hydrocodone (Vicodin) remained essentially unchanged.

“And there’s more (and it’s really crazy). Note that the number of deaths from diphenhydramine (Benadryl) isn’t terribly different from the number from Vicodin.”

“Are we having a ‘Benadryl Crisis?’”

And even crazier — look at gabapentin (Neurontin, yellow arrow). Neurontin is being used like crazy (mostly off-label) as an alternative to opioids. Except it doesn’t work. But it managed to creep into the Top 15 list.

I’m speechless.

So, here’s the report card:

“Restricting prescriptions of opioid analgesics had approximately zero effect on overdose deaths from the pills.”

But it did result in incalculable suffering of pain patients.

And it also caused more deaths as oxycodone users switched to heroin, something we’ve known since 2010.



“This switch created a huge heroin market, which was filled by fentanyl starting in 2014 (Figure 1).”


Figure 5.Deaths from illicit fentanyl and its analogs 2014–2017 (blue hatch line). The red circle shows that fentanyl overdose deaths were rare before 2014 but were by far the major cause of death (green circle) in 2017. Source: National Institute on Drug Abuse. Sourced from Dr. Josh Bloom at ACSH.ORG

“If this is not an example of an abysmal policy then nothing is.”

Yet, despite this overwhelming evidence, we still hear crap like this:

  • When you talk about opioid pain medicines, we’re essentially talking about heroin pills — Dr. Andrew Kolodny

No, Andrew, we’re not. Read this article and then try to make that same statement with a straight face.

The false narrative of prescriptions doing the killing persists despite overwhelming evidence to the contrary. The longer it persists, more pain patients will suffer and more people will die. These charts are not lying.

Too bad I can’t say the same about others.

NOTE: (1) I changed the name of the group to something more accurate. So sue me.

— — Written By Dr. Josh Bloom, PhD.


(Author’s note — the tables show up so much better on the mobile app than on desktop- plus zoom is available. Huge apologies, but if I make them any larger for desktop, the data blurs badly and then it’s moot. Sorry, all.)

I want to point out before anything else that while the oxycodone number relatively stable from 2011–2016 (it didn’t even increase 800 people) …

… did anyone notice what number tripled & then some?!?!?!?

METHAMPHETAMINE.

Does anyone care whatsoever?

Of course not.

They can’t monetize meth addiction.

I have been working on an article around this for three months.

The curtain should drop on this Act now, people.

However, it hasn’t and it won’t.

Have you heard a whisper about any of this?

Of course you haven’t.

You still are being told to report on your neighbor to the state if you think he or she may be using too many Vicodin for their arthritis.

We know those people are the ones driving the opioid crisis, right?

That is what all the data has proven, correct? {insert eye roll}

When I visit politicians and staffers to speak to them about the opioid crisis and its impact on incurable painful disease patients, just pain care across the country, I am amazed at the rank ignorance and misinformation stridently believed by people.

It reflects how successful the media, driven by the architects of this crisis, have been in this crisis in frightening people and completely confusing them about opioid medication and addiction.

They have done a great job, I have to hand it to them.

If I had the billions that Soros and Mendell do, I would launch a counter campaign of true, factual information.

But, unfortunately, I do not.

I have been successful, at least in the moment, in correcting the blatant lies and fears I encounter.

However, I know once I am out of sight and out of mind, the machine slips back into place and I am forgotten.

It’s hard to beat that.

People are convinced they will become addicted to opioids after a few days exposure.

People are convinced that others are harming their cats and dogs to get opioids from veterinarian offices.

People are convinced that doctors are handing out pills like candy, first line, to patients for pain, and it needs to end now.

It is astounding to me to encounter the gross misinformation I have.

Especially the veterinarian yarn…

I asked one person who breathlessly insisted this was true, to think with me for a moment about it logically.

If one was desperate for “drugs”, how would a dose of Tramadol meant for a 7 pound cat or a 20 pound dog do anything at all for a 150 pound adult?

(This is setting aside the ridiculous notion of anyone that deep in the throes of addiction spending hundreds of dollars at the vet for this proposal).

The crumbling of the theory was fascinating to watch.

They didn’t want to let go of this “truth”, but they had to because it just wasn’t logical, it just didn’t make any rational sense whatsoever.

It was very hard.

The vast majority of pet owners do not own pets that weigh as much as they do.

Of those pet owners, how many of them are opioid addicts who would actually go to the veterinarian on a regular enough basis to forge a relationship well enough to be able to “score” those kinds of medications for their pet anyway?

The fantastical leaps that must be achieved here are… outrageous, however, in the world today, we seem to believe all kinds of things.

Except that incurable painful disease patients don’t misuse their prescriptions.

That is just unbelievable, apparently.


I appreciate Dr. Bloom’s straightforward and logical articles.

I hope you do too.

Please go to his website, linked above and spend some time reading his articles.

As an advocate, educated in science and health, fighting in the trenches, so to speak, and looking over this data, two things immediately become clear to my mind:

  • It appears that patients have turned to Benedryl to replace some of their schedule sleep aids they were abruptly cut off (for no good reason, I might add) and we are seeing the horrible side effect of that. With no real guidance, and mixing it with other prescriptions, they are accidentally killing themselves (or doing it on purpose, in some cases, to get out of the hellish life they have been given by the CDC and Kolodny).
  • It appears that an anticonvulsant, which has absolutely NO BUSINESS being used as a pain reliever, has meandered its way into the top twenty as a death agent. Why? Because recreational users will abuse anything, that’s why.

This proves to me that when someone wants to abuse a drug, they will abuse a drug.

It also proves that when patients are desperate, they will take larger than hell doses of these crappy drugs to try to help their severe intractable pain, hoping and praying to God somehow it will work!!

Both of these observations are totally heartbreaking to me.

What I wish was possible to see, and what we will never, ever be able to see, is what these charts would look like if Henny Penny hadn’t been somehow given the power he was to destroy pain management and gotten his way.

If nothing had been “done”.

If doctors would have been left alone to trust their judgment, training, licenses…

…they would have been able to correct this on their own without Big Pharma and Big Government in their faces.

Most of them were doing so.

The Pharma companies had sued them to prescribe the huge doses to everyone and anyone to begin with, and Kolodny knew it.

That information is scrubbed — extremely difficult to find online now.

I vow to each and every single person that these statistics would look so much brighter and better if everyone had simply let doctors sort this out themselves.

But… we will never know now. The damage is done and it is real.

Will we ever be back to any kind of normalcy again?


Filling so many prescriptions so fast that a pharmacist’s biggest concern is the ability to use the bathroom

 

Filling so many prescriptions so fast that a pharmacist’s biggest concern is the ability to use the bathroom. Our study showed compliance with dispensing laws to be around 20%…so any wonder as to how the apetite for drug use amongst our citizens grew? Look to the insurance contracts and the chains that willingly signed them.

 

 

Using opioids to treat addiction is considered the gold standard. So why aren’t more doctors prescribing them?

Using opioids to treat addiction is considered the gold standard. So why aren’t more doctors prescribing them?

https://www.heraldmailmedia.com/news/nation/using-opioids-to-treat-addiction-is-considered-the-gold-standard/article_429a001f-a7ab-5cca-8c50-b0a49df8989f.html

PHILADELPHIA — Doctors need no special training to prescribe the opioid pain pills widely blamed for fueling a national addiction crisis.

But prescribing the medicine considered the gold standard for addiction treatment is another story entirely.

Opioid-based medications that help curb cravings, prevent overdoses, and allow drug users to get through the day without the fear of painful withdrawal have been proven to help people achieve lasting recovery far more reliably than quitting without medical help.

But, doctors say, federal regulations surrounding these treatment medications — and the special physician training and monitoring required to dispense them — have deterred many of their colleagues from obtaining the license needed to prescribe the drug.

Just 3 percent of doctors in Pennsylvania and 4 percent of those in Philadelphia have the waiver needed to prescribe the treatment medicine buprenorphine, according to the U.S. Drug Enforcement Administration. And the problem is worse in rural areas: Nearly 30 percent of rural Americans live in a county without a buprenorphine provider, according to new research from the Pew Charitable Trusts.

Methadone, the most heavily regulated opioid-based treatment drug, can only be dispensed at specially licensed clinics, and often requires users to visit daily for the drug and for counseling. Buprenorphine can be taken in one’s own home, and is available in pill form, as a longer-acting shot, and as the brand-name drug Suboxone, which combines buprenorphine with the overdose-reversal drug naloxone.

There are differences between the two opioid-based medicines, but both are longer-acting and don’t produce the peaks and troughs associated with short-term opioids, like heroin, making them useful for people in treatment.

Physicians who want to prescribe buprenorphine need a license commonly known as an x-waiver from the DEA and the U.S. Substance Abuse and Mental Health Services Administration, after taking an eight-hour training course.

The American Society of Addiction Medicine’s eight-hour training course, one of several on offer on the Substance Abuse and Mental Health Services Administration’s website, identifies its “learning objectives” as teaching doctors how to apply for the waiver, to identify patients who’d benefit from buprenorphine and to recognize other illnesses associated with opioid addiction.

From there, a doctor can treat up to 30 patients in their first year with the license, 100 in their second year, and are capped at 275 in their third.

Another irony: These restrictions apply only to doctors prescribing these medications for a substance use disorder. There’s no special license required to prescribe methadone for pain. And though buprenorphine is not FDA-approved for pain, some providers are prescribing it off-label without an x-waiver.

The DEA’s local spokesman, Pat Trainor, said the x-waiver “allows doctors to help people to get medication-assisted treatment in their communities — and not have to go to a narcotic treatment program, so as to avoid the stigma of that,” he said, and added that primary care doctors not accustomed to treating addiction need training to do so.

But doctors who treat people with addiction say the regulations themselves create stigma, and discourage more doctors from seeing substance use disorder as a disease that they can treat.

“Doctors have basically been taught and raised and are functioning in a system where addiction is always someone else’s job,” said Priya Mammen, an emergency physician and public health advocate from South Philadelphia. “The regulations treat these medications as qualitatively different from any other medication we prescribe. It gives off the impression that addiction is a specific kind of illness — but from all the literature, all the data we know, it’s a chronic disease. But it’s not treated like that in the system.”

(EDITORS: BEGIN OPTIONAL TRIM)

Jeanmarie Perrone, the director of the division of medical toxicology in the University of Pennsylvania’s emergency department, has worked to expand her system’s buprenorphine program.

She believes doctors should still get some kind of training before beginning to prescribe buprenorphine, and has helped implement classic behavioral incentives to get more doctors into training.

The university paid for x-waiver training courses for its physicians, and allowed them to take the course online. They sent emails telling stories of Penn patients’ success on Suboxone. “Each week they got an email sort of nudging them along in the process, saying, ‘It’s not too late to sign up, you still have time to finish this — and look what your colleagues are doing (with buprenorphine),” Perrone said.

About 75 percent of Penn’s full-time emergency department staff now have x-waivers. Perrone said her goal is to create “a culture of buprenorphine in the whole city.” She is pinning her hopes largely on newer doctors and medical students whose training increasingly includes addiction medicine.

Most physicians who obtain an x-waiver will likely not hit their prescribing cap. Many doctors who get the x-waiver don’t even use it, said Leo Beletsky, an associate professor of law and health sciences at Northeastern University’s law school.

“It’s not enough to get people waivered,” he said. “You still have these issues around stigma. People don’t want to submit themselves to periodic DEA audits. They just don’t want to deal with this element of their practice.”

Where the caps can present challenges, Beletsky said, is in larger clinical settings. In Philadelphia’s men’s prisons, a just-launched Suboxone program has been paused because the prisons’ doctors have already hit their prescribing caps, WHYY reported last month.

Bruce Herdman, the prisons’ chief of medical operations, said his doctors will be able to expand their prescribing caps to 275 patients each by midsummer. Until then, new inmates with substance use disorder are being directed to an abstinence-only treatment program that includes cognitive behavioral therapy.

The prison is also looking to hire doctors with higher buprenorphine caps in the meantime.

“We have a great treatment to provide, and I don’t understand the logic behind this federal regulation,” he said.

Woman’s estate blames medical care providers for her death

Woman’s estate blames medical care providers for her death

https://wvrecord.com/stories/511741378-woman-s-estate-blames-medical-care-providers-for-her-death

HUNTINGTON — An administrator is suing a medical providers, citing alleged negligence and vicarious liability.

Kateland McCreery filed a complaint in Cabell Circuit Court against the defendants alleging that they deviated from acceptable standards of medical care.

According to the complaint, McCreery alleges that on Aug. 15, 2016, Teresa Ann Watts was presented to St. Mary’s emergency room and was misdiagnosed with heroin abuse. The misdiagnosis remained in her record and likely caused the negative effects on the medical care she received on subsequent visits, including after a motor vehicle accident on Sept. 6, 2016, when they failed to indicate that she was suffering from pulmonary hypertension and again on Oct. 28, 2016, which revealed yet again a severe pulmonary hypertension that led to her collapsed and death on Oct. 31, 2016, just seven minutes after being discharged despite the significant abnormal vital signs. Thus, the decedent’s family has and will suffer from sorrow, mental anguish, loss of solace, companionship, comfort, guidance, care and assistance because of her death. 

The plaintiff holds Dr. Tarun Popli, St. Mary’s Hospitalist Services LLC, et al. responsible because they allegedly denied Watts adequate treatment, failed to re-intubate after her endotracheal tube had become dislodged during the ambulance ride and denied her the opportunity to be resuscitated.

The plaintiff requests a trial by jury and seeks judgment against the defendants for general and special damages, punitive damages, interest, attorney’s fees, costs and other relief that the court may deem just. She is represented by David H. Carriger and L. Dante diTrapano of The Calwell Practice LC in Charleston.

Cabell County Circuit Court Case number 18-C-638