Chronic Pain, Medical Research, Standards of Care, Government Policy, Guidelines and Regulations, Ethics in Medicine and Government
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New blog focusing on the bureaucrats and how they track data
Posted on February 21, 2019 by Pharmaciststeve
Patient Files a Complaint, Now What?
Posted on February 21, 2019 by Pharmaciststeve
YouTube’s Doctor Mike learns from his mistakes
Mikhail Varshavski, DO, (better known on social media as “Doctor Mike”) is a board-certified family medicine physician at the Atlantic Health System’s Overlook Medical Center in Summit, New Jersey. His YouTube channel educates over 3 million subscribers with two weekly shows covering everything from trending medical stories, to health myths, to reaction videos critiquing popular medical TV dramas. His goal is to expose medical misinformation and increase the health literacy of young adults.
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Your rights are at risk. The real opioid Epidemic EXPOSED
Posted on February 21, 2019 by Pharmaciststeve
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A New Documentary – Chronicling the Scary Truth about our Pain Problem
Posted on February 20, 2019 by Pharmaciststeve
There are no marathon runs for chronic pain, no walks for its cure. Yet chronic pain disables some 25% of the population in developed countries such as Canada and the U.S.A. This is no small disease. In Canada, chronic pain costs the economy an estimated 60 billion annually in treatment, lost wages & productivity; in the U.S.A. a staggering 634 billion.
Those who suffer with intractable pain in North America now outnumber heart disease, cancer & diabetes patients combined. The current media focus on “The Opioid Crisis,” a dramatic but not necessarily more serious issue – has unfortunately resulted in a profound loss of care for chronic pain sufferers who in many cases are being undertreated- with dire consequences. This burgeoning epidemic is largely ignored &underfunded.
Pain Warriors by award winning filmmakers Tina Petrova and Eugene Weis, examines with unflinching truth “the forgotten ones.” Long time pain patients denied life giving medications by government policies can be driven to suicide while some doctors who bravely fight to uphold their Hippocratic oath are threatened with loss of license, livelihood and even criminal charges that can lead to incarceration. Would we take away someone’s insulin, beta blocker or Warfarin because a small percentile of the population found a way to monetize those drugs and get high off them? Are the human rights of pain patients being sacrificed for politically expedient policies, and extreme cuts to patient care costs?
Pain Warriors serves up a plate of disturbing truth: chronic pain patients face a lifelong battle with no cure in sight. They build their lives around managing pain and struggle to perform simple every day functions like walking or shopping for food. Their demographic is invisible, shunned and disbelieved. And yet “they” “could be “us” in a flash. We are all a car accident, a surgery, or a degenerative condition away from this tragic outcome. This brave documentary shines a light on patients fighting for the right to manage severe pain, including an eleven-year old who draws his pain as long toothed monsters, as well as specialists prevented from helping their patients achieve a small degree of comfort and dignity through pain control. Tragically, when opioids and other medications are suddenly withdrawn because of a blanket “one-size-fits-all” legislation, doctors and patients alike are being left with nowhere to turn. From the somber spreading of ashes at Newport Beach Ca. to H.H. The Dalai Lama’s hospital in Zanskar India, viewers are swept up in a stunning cinematic journey featuring gripping stories from the trenches.
Pain Warriors~ enters into the desperate lives of pain patients fighting for their very survival, families torn apart by suicide, and the troubled worlds of compassionate doctors who stand up for them, risking reputations and licenses in doing so. Tina and Eugene bring a balanced view, to a timely issue. painwarriorsmovie@gmail.com/ www.painwarriorsmovie.com
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When a chronic pain wife gets her opiates cut off… what is a husband to do ?
Posted on February 20, 2019 by Pharmaciststeve
Twin Lakes police captain accused of illegally removing prescription medication from department
https://fox6now.com/2019/02/18/twin-lakes-police-captain-accused-of-illegally-removing-prescription-medication-from-department/
TWIN LAKES — Captain Dennis Linn, the second in command at the Twin Lakes Police Department, was placed on administrative leave amid an investigation into allegations he illegally removed prescription medication from the department.
In 2016, Captain Linn was awarded for 20 years of service, and on Monday, Feb. 18, FOX6 confirmed the Twin Lakes Police Department, along with the Wisconsin Department of Justice’s Division of Criminal Investigation (DCI) launched an investigation into allegations against him.
According to an affidavit, comments Linn made to a fellow detective in the evidence room raised “red flags.” Captain Linn told the fellow detective his wife was in “a lot of pain” and was recently cut off from her prescriptions by her doctor. This, as Linn and the detective processed medication collected through the “Drug Take Back Program.” The affidavit said the detective was about to leave to get supplies when Linn said “I wouldn’t leave me down here. I don’t want to be suspected of anything, especially after I just told you about my wife.”
The detective stayed in the room and soon alerted the police chief when she noticed a bottle of oxycodone hidden inside a small garbage can.
According to the affidavit, a body camera was placed in the evidence room, which recorded Linn picking out an item from the garbage can at the end of his shift. The camera picked up sounds of “pills rattling.”
A search warrant executed at Linn’s home revealed three empty Walgreens prescription bottles, one for oxycodone and two for hydrocodone. The names on the bottles did not match Linn’s name or that of his spouse.
Marijuana concentrates and six twisted tissues with black material were taken — found in garbage cans at his home, according to the affidavit.
FOX6 News knocked on the door at Linn’s home Monday. No one answered. He has not been charged with a crime at this point, but the police chief said the investigation is ongoing — including a separate, internal investigation into whether Linn violated any department policies or procedures.
Linn has been a full-time member of the Twin Lakes Police Department since 2002.
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Prosecutor: will “turn on their own” JUST TO GET A WIN ?
Posted on February 20, 2019 by Pharmaciststeve
Attorneys for ex-DEA agent Chad Scott say prosecutors retaliated against defense witness
In a sharply worded new court filing, attorneys for indicted former federal drug agent Chad Scott are accusing federal prosecutors of improperly retaliating against a defense witness. They are asking the judge to dismiss the charges against Scott as a result.
The broadside, filed Tuesday in federal court, is the latest in a series of blistering motions filed by Scott’s attorneys, Matt Coman and Stephen Garcia. It comes less than three weeks after jurors were unable to reach a verdict on any of the seven counts Scott faced, forcing U.S. District Judge Jane Triche Milazzo to declare a mistrial.
In another motion, Coman and Garcia urge Milazzo to postpone the March 18 scheduled date for Scott’s retrial, arguing that they have crowded trial schedules and that it will be difficult to subpoena witnesses and experts for the second trial.
Coman and Garcia reserved their strongest language for their motion to dismiss.
Prosecutors ran afoul of the law when they “intimidated and retaliated against James ‘Skip’ Sewell after that witness testified and the first trial ended in mistrial,” Scott’s attorneys wrote. Their actions “must not be sanctioned by allowing this prosecution to continue.”
Sewell, one of three witnesses who testified for Scott, was a longtime, highly decorated DEA agent who had been Scott’s supervisor before Scott was suspended in 2016 as part of the investigation into the task force he led.
Sewell was also caught up in the probe. Although there were no allegations against him, he was put on light duty for more than a year while the investigation proceeded. He then retired — in good standing — from the DEA and went to work for 22nd Judicial District Attorney Warren Montgomery as an investigator.
During his time with Montgomery’s office, he was placed on a violent crime task force and was sworn in as a DEA task force officer in late 2018. But soon after his Jan. 30 trial testimony, he was notified by DEA brass that he was no longer on the task force. The government’s actions were ” ‘intentional and in bad faith,’ warranting the dismissal of the indictment with prejudice,” the defense filing says.
This is at least the second time that Scott’s legal team has accused prosecutors of misconduct. In June, they accused prosecutors of “framing” Scott and hiding evidence that supported his innocence. They asked Milazzo to toss out the indictment, but she refused.
In a separate filing, Coman and Garcia say that both of them have trial commitments in different parts of the country during late March and April, and that forcing them to reconvene to retry Scott at that time would place an undue burden on the defense. They also say they are trying to secure the testimony of an additional expert, which would be difficult given the quick turnaround of the trials. They suggest a trial date in September.
Scott faces 11 total charges, but last year, Milazzo split the counts into two trials. The first, on seven counts of obstruction, perjury and falsification of government forms, ended Feb. 4 in a mistrial. The trial on the remaining four counts is currently set for Oct. 1, though that date has been thrown into question by the status of the retrial on the first seven counts.
Scott and some members of the Metairie-based task force he led have been the targets of an investigation that began more than three years ago. Two task force members, former Tangipahoa Parish Sheriff’s Office deputies Johnny Domingue and Karl Newman, have already pleaded guilty to federal crimes. Both testified for the prosecution in Scott’s trial.
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Trump Administration Is No Friend to Pharmacy Benefit Managers Like CVS
Posted on February 20, 2019 by Pharmaciststeve
Trump Administration Is No Friend to Pharmacy Benefit Managers Like CVS
The usually business friendly Trump administration is not as amicably positioned for pharmacy benefit managers (PBMs) like CVS Health Corp. (CVS) .
Shares of the pharmacy, retail, and healthcare giant are slumping after its pre-market earnings report provided much weaker guidance than was expected.
A large degree of deceleration was noted in both PBM and long term care in the company’s report.
“In Retail/LTC and PBM, we expect our greatest level of year-over-year deterioration in Q1,” the company reported, while still holding out hope for pick-up in the latter half of the year.
The pressure on PBM specifically could intensify if proposals from the Department of Health and Human Services (HHS) are enacted.
Reading the Regulation
According to the department’s “American Patients First” proposal, released shortly after the State of the Union address earlier this month, it argues for a new “safe harbor” for prescription drug discounts offered directly to patients, as well as fixed fee service arrangements between drug manufacturers and PBMs would be created.
Under the proposed rule, prescription drug rebates, that are estimated to constitute up to 30% of the list price of drugs, may be passed on directly to patients in order to make transactions more transparent and streamlined.
“This proposal has the potential to be the most significant change in how Americans’ drugs are priced at the pharmacy counter, ever, and finally ease the burden of the sticker shock that millions of Americans experience every month for the drugs they need,” HHS Secretary Alex Azar said in a statement announcing the proposal.
The rule would offer prescription drug discounts directly to patients, as well as fixed fee service arrangements between drug manufacturers and PBMs.
If enacted, the deal would crush the preferred drug status offered to drug manufacturers in exchange for kickbacks to PBMs. The “kickback” rebates offered to PBMs provide a significant revenue stream to these providers, like CVS, especially for higher end drugs.
The rule could promote some bipartisan support as well.
Drug pricing has been a major platform for leading Democrats like Representative Elijah Cummings of Maryland and recently announced Democratic presidential candidate Bernie Sanders, though the aforementioned senators have narrowed their focus far more to manufacturers than the Trump administration has.
Erin Taylor, a health economist at the RAND Corporation, told the Pew Trusts that the largest PBMs – [UnitedHealth Group’s (UNH) ] OptumRx, [Cigna (CIG) owned] Express Scripts and CVS Caremark, are “practically oligopolists” with power that rivals that of the drug companies.
“They are the elephants going up against the gorillas, because they have so many covered lives,” Taylor said in the research report. “The concern has arisen that the PBMs are getting too big a piece of the pie and contributing to high prices.”
Considering a PBM like CVS has $47 billion up for renewal in 2019 in its PBM business, a clamp on this income is a key issue to follow in 2019 as the proposal is considered.
Rebuke of Regulation
The proposed rule provoked a strong reaction from CVS CEO Larry Merlo on Wednesday morning.
“We see the rebate rule taking us backwards, not forwards,” Merlo told analysts. “A small percentage of seniors may net out favorably…but as many as 70 percent of beneficiaries are going to be worse off.”
“We’re certainly weighing in during the comment period with our concerns with the rebate rule, but more importantly what we believe the appropriate solutions are to address the root cause,” he added.
Still, CFO Eva Boratto said that the company is well positioned to deal with the shifting regulatory environment.
“It is clear that the PBM industry is in the middle of an environmental change given the dialogue around rebate,” she acknowledged. “However, it is also clear that the PBM brings tremendous savings and value to the clients we serve. The importance of size, scale and customer relationship will continue to be paramount, and we remain focused on delivering the value our clients expect.”
The company has also worked to increase transparency independently, anticipating governmental requirements for the company.
This begins with the creation of a a new PBM contracting model that will maintain guaranteed costs and offer 100% of rebates to customers and seek to reduce costs overall.
Further, executive VP of pharmacy services and supply chain Kevin Hourican was bullish on the Aetna integration’s ability to mitigate regulatory and pricing impacts with the scale that Boratto cited.
“By owning a large insurer and owning the largest PBM, we can lead that change by structuring a contracting relationship that if we can lower overall health care costs, we can take some of the burden off the annual reimbursement reform,” he noted. “Where that will come from is the last thing I’ll say is we can prove through technology and clinical care programs that we can improve medication adherence.”
The rule, which would go into effect in 2020 if approved, was not optimistically observed by Merlo in terms of voter acceptance either.
He estimated the total cost of the legislation to the taxpayer at $200 billion over 10 years and would likely lead to many seniors leaving Medicare Part D coverage. He noted that this high cost signifies the proposal is not likely the best solution to bring forward.
As the presidential campaign season picks up and healthcare costs and drug pricing remains the number one issue in the mind of voters according to the Henry J. Kaiser Family Foundation, the progress of the proposal and the pushback from PBMs will be a pivotal issue to follow.
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The Doctor’s Corner Show #43 “Pharmacist Steve” Ariens
Posted on February 20, 2019 by Pharmaciststeve
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Better to let 95% of surgery pts to suffer in pain during recovery than risk that MAYBE 5% become addicted ?
Posted on February 20, 2019 by Pharmaciststeve
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.
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Law enforcement pushes back on Michigan civil asset forfeiture reforms
Posted on February 19, 2019 by Pharmaciststeve
Law enforcement pushes back on Michigan civil asset forfeiture reforms
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.”
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