OHIO MJ: $500+ per OUNCE

Posted on January 20, 2019 by Pharmaciststeve

Why are Ohio’s medical marijuana prices so high?

https://www.cincinnati.com/story/money/2019/01/20/why-ohios-medical-marijuana-prices-high/2602221002/

Moments after CY+ Dispensary sold some of the first legal medical marijuana in Ohio, the crowd of patients waiting outside for their turn to make state history wanted to know one thing: How much?

They weren’t happy with the answer: $50 cash for a small plastic container holding 2.83 grams of dried marijuana bud, or just under $500 an ounce.

“I’ll buy one today to say I did it, but I can get it a lot cheaper than that elsewhere,” said one man who declined to be named.

How cheap? Michigan dispensaries charge between $150 and $300 an ounce, depending on the variety, or strain. Patients say that’s similar to prices for illicit marijuana in Ohio. 

Dispensaries sold 8.7 pounds of marijuana on Ohio’s first day at an average price of$538 per ounce, according to sales figures released Thursday.

Why so much? There are a few reasons.

Regulated and tested

Marijuana sold in legal markets have a hard time competing with product sold on the black market for several reasons.

Legal marijuana businesses have to comply with regulations for pesticides, tracking every plant with sophisticated software, security and more. They also pay taxes, and because marijuana remains an illegal substance on the federal level, they can’t deduct expenses the way other businesses can.

Ohio law requires every medical marijuana product to be tested by an independent state-licensed lab. There are only two in operation. The labs test for pesticides, mold and other contaminants. They also test for amounts of various marijuana compounds including THC, which generates a high, and cannabidiol, or CBD, which doesn’t.

Ohio’s program allows individuals with one of 21 medical conditions to buy and use marijuana if recommended to them by a physician. Eligible conditions include AIDS, cancer and others where consumers’ immune systems could suffer from tainted marijuana.

Limited supply

The state has licensed 29 businesses to grow marijuana, but only 14 have finished building their facilities and been approved to start growing. None of the state-licensed processors are operating, so oils, lotions, patches, edibles and other products are not yet available. 

The four dispensaries that opened Wednesday sold only dried marijuana flower, or bud, from a handful of medical marijuana cultivators.

“If I wanted to open today, I had to buy it from them,” said Mike Petrella, who owns Ohio Valley Natural Relief dispensary in Wintersville.

Dispensaries set prices based on what they pay for the product; state regulators have no authority to limit or change prices. Most of the varieties sold Wednesday were priced the same. Officials from the first four open dispensaries say prices should go down as more cultivators harvest and compete.

Some dispensary owners plan to offer discounts to veterans, senior citizens and others. The Forest Sandusky offers a 20 percent discount to veterans.

More regulations

In Michigan and other states, flower can be packaged in the dispensary. Not in Ohio.
Growers and product manufacturers are the only ones who can package products, and dispensaries have to sell products in the original, sealed packaging.

Ohio has some of the highest marijuana business licensing fees in the country – $200,000 a year for large-scale growers and $70,000 every two years for dispensary owners. Businesses pay additional fees to the state to register employees and pay a $100 fee for each strain or dosage of a product.

“There’s a higher cost of production to adhere to all the regulatory requirements and to deliver that product to the consumer,” said Jason Erkes, spokesman for Cresco Labs, which operates CY+ Dispensary. Cresco also has an Ohio cultivation license and operates medical marijuana businesses in Illinois and Pennsylvania.

Prices in Illinois averaged $450 an ounce during the first week of sales in 2015. Current prices there range from $240 to $420 an ounce, according to dispensary websites.

Pennsylvania started selling flower in August 2018, and prices are now hovering around $300 to $480 an ounce, according to dispensary websites.

The ‘Ohio tenth’

One specific regulation sets Ohio apart from the 33 states that allow cannabis for medicinal use.

Rules set by the Ohio State Pharmacy Board, which oversees dispensaries, require marijuana flower and infused products to be packaged in certain amounts, called “whole day units.”

A unit of dried flower is 2.83 grams, or 1/10th of an ounce. Where did that number come from? State law limits patients to buying and possessing no more than a “90-day supply,” but didn’t define it in law.

The pharmacy board decided to set that number at 8 ounces of dried flower or an equivalent amount of THC in marijuana products. The limits came from a panel of pharmacists who reviewed clinical research about the marijuana compound. 

No other state has calculated limits this way.

The only product sold Wednesday was little containers with one “Ohio tenth” of buds inside.

On Tuesday, pharmacy board spokeswoman Ali Simon said flower had to be packaged in 2.83 gram amounts. On Thursday, Simon clarified it can be packaged in greater amounts, as long as the total is made up of whole daily units.

Buckeye Relief, a large-scale cultivator in Northeast Ohio, planned to start packaging in larger quantities after the first day of sales.

“I’m sure we’re all trying to drive costs down for patients over the long haul,” Buckeye Relief CEO Andy Rayburn said.

 

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Failed spinal cord stimulator, Taken off methadone cold turkey.

Posted on January 20, 2019 by Pharmaciststeve

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What you probably never see nor hear about – behind the Rx counter

Posted on January 20, 2019 by Pharmaciststeve

Now that I just spent my LAST DAY working as a community pharmacist I feel like I can get some things off my chest.
You should probably be nicer to your pharmacy.
I know this doesn’t include everyone. I know there are nice, polite, patient, understanding people in this world but I also know that when you’re sick, tired, exhausted, and ready to go home…..sometimes it’s a lot harder to be kind but you should try anyways.
I spent four years studying biology, followed by another four years studying medicine. I studied what the medicine was made of, how it’s absorbed, how it’s broken down, how it’s excreted. I know what it will do to you, what it will do when taken with other meds, what happens when you abruptly stop it, what happens when you never stop it, you name it, I studied it and believe it or not, as a pharmacist, I am on your side.

When you told me today you quit taking your antidepressant because it made you feel funny when you forgot to take it and you have gained 10 pounds, I wrote down the name of one that you can get by skipping a couple days with (it has a half life of about 3 days- fun stuff) that may also lead to some weight loss. Hopefully your doctor can get you a script for that.

When you dropped off your script for Mobic 10 mg… I called the dr and asked if I could change it to something that actually existed…it took a second but we got you covered.

When the urgent care np called in a script for your 6 year old last night that ended up exceeding adult dosages because they used weight based dosing and didn’t bother to check the max limits…I called and changed it because I did check them and I can’t imagine the diarrhea your kiddo would have gotten. My tech told you it would be 10-15 minutes. That’s before we knew it was written incorrectly.

The titration pack your doctor called in for your anti-epileptic wasn’t ready on time. I know. It was $250. We got it changed to the old school pills and included an instruction sheet on how to take it. You ended up paying $5 but it took me a minute to make that happen.

When your doctor sent a script over for a blood thinner that was twice the normal dose, I called to make sure it was on purpose. It wasn’t. No biggie, I fixed it for you.

Medication errors are the third leading cause of death in the United States (following heart disease and cancer, in case you were wondering). Pharmacists in your community pharmacy are trying to make sure an error doesn’t happen to you. When they say it will take 45 minutes to fill your script, give them the courtesy you gave to the guy who just took your pizza order (I am
assuming you don’t ask “why so long” when they give you a time)….say thank you, be patient and remember the pharmacy is on your side. We do a lot more than apply stickers with your name on them. We care and we are doing our best and we are going as fast as we can. If you know your pharmacy is great, let them know too because by the end of a twelve hour shift, they almost never feel that way.

(Also, if you’re still reading this, for the love of god, give the pharmacy your new insurance card.)

Many times pharmacists do things that the pt never has a clue about what is going on… Can’t count how many times that I would tell the pt that there was something that was not clear on the prescription(s).  What was more often the case was that your prescriber wrote for something that was contraindicated with existing medications, you were allergic to, the dose was too high or too low… dozen different things that were “just not right”.

I would take the “hit” for being “too slow” to get the prescription filled rather than tell the pt that their prescriber make a serious error that could have caused the pt anything from an unnecessary inconvenient side effect… to something more critical or even fatal.. 

 

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Saving Money For Medicaid in WV

Posted on January 19, 2019 by Pharmaciststeve

http://www.theintelligencer.net/opinion/editorials/2018/12/saving-money-for-medicaid

In 2017, West Virginia was faced with growing Medicaid costs — particularly when it came to prescription drugs. So state government cut out the middlemen, pharmacy benefit managers, and turned to a streamlined system that utilizes West Virginia University’s School of Pharmacy to recommend drugs for patients, instead. The move saved the Mountain State $30 million in its first year.

Now Ohio is struggling under the $2.5 billion its Medicaid system must spend on prescription drugs, through its managed-care plans. State officials are looking for a solution. They may not have to look any farther than across the Ohio River.

At WVU, there are “clinical, well-informed individuals who make appropriate clinical decisions,” according to a report in the Columbus Dispatch, and they are interested in the best health outcomes, not corporate profits.

Of course, there is resistance to this idea from the pharmacy benefit managers, who have had the luxury of operating in a remarkably layered and opaque environment. One tactic is pointing out that Ohio has a much larger population than West Virginia’s.

True, the system in place in West Virginia would have to be scaled up. Dr. Robert Weber, chief pharmacist and assistant dean for medical center affairs at Ohio State, acknowledges there would have to be an increase in resources to duplicate the Mountain State model. But it is possible.

“Our committee is focused on how we can improve quality of care,” Weber told the Dispatch. “We do not have any influence from the drug industry, no significant conflict of interests, we do not allow manufacturers to come into the institution, and the cost of the drug is the last thing we consider.”

Vicki Cunningham, West Virginia Medicaid’s director of pharmacy services, agrees Ohio could take advantage of West Virginia’s model. “You have to provide the same things if you have one person or 100,000,” she said.

There are, as is always the case when bureaucrats dig in, other factors. Ohio might also need to look at unbundling other services provided by the benefit managers to provide greater transparency (which almost always leads to saving more money). West Virginia has done that, too.

Assuming careful analysis of the plan shows the West Virginia model can be scaled up and will save Ohioans money, Ohio’s Department of Medicaid should consider following the Mountain State’s lead.

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why it takes so DAMN LONG to get your prescription filled at a chain pharmacy

Posted on January 19, 2019 by Pharmaciststeve

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How to find a local independent pharmacy/Pharmacist

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They say you can’t buy a politician.. what about a LONG TERM LEASE ?

Posted on January 19, 2019 by Pharmaciststeve

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study, could not differentiate between overdose deaths involving painkillers that are prescribed versus illicitly acquired

Posted on January 19, 2019 by Pharmaciststeve

Study Links Drug Maker Gifts for Doctors to More Overdose Deaths

www.nytimes.com/2019/01/18/health/opioids-doctors-overdose-deaths.html

WASHINGTON — A new study offers some of the strongest evidence yet of the connection between the marketing of opioids to doctors and the nation’s addiction epidemic.

It found that counties where opioid manufacturers offered a large number of gifts and payments to doctors had more overdose deaths involving the drugs than counties where direct-to-physician marketing was less aggressive.

The study, published Friday in JAMA Network Open, said the industry spent about $40 million promoting opioid medications to nearly 68,000 doctors from 2013 through 2015, including by paying for meals, trips and consulting fees. And it found that for every three additional payments that companies made to doctors per 100,000 people in a county, overdose deaths involving prescription opioids there a year later were 18 percent higher.

Even as the opioid epidemic was killing more and more Americans, such marketing practices remained widespread. From 2013 through 2015, roughly 1 in 12 doctors received opioid-related marketing, according to the study, including 1 in 5 family practice doctors.

The authors, from Boston Medical Center and New York University School of Medicine, found that counties where doctors received more industry marketing subsequently saw an increase in both the number of opioids prescribed and opioid-related overdose deaths.

In response to the study, Dr. John Cullen, president of the American Academy of Family Physicians, said, “A limitation of the study, as acknowledged by the authors, is the many unknown variables that prevent drawing a direct causal link between pharmaceutical marketing and opioid-related deaths.”

He added, “We’re very much aware of the critical and devastating impact of the opioid epidemic and work every day, with every patient interaction, to fight it. At the same time, we must protect the physician’s ability to provide adequate pain management.”

The authors acknowledged several caveats in the study, including that it could not differentiate between overdose deaths involving painkillers that are prescribed versus illicitly acquired.

“We acknowledge that our work describes only one part of the very complex opioid overdose crisis in this country,” said the lead author, Dr. Scott Hadland, a pediatrician and researcher at Boston Medical Center’s Grayken Center for Addiction. “Even still, prescription opioids remain involved in one-third of all opioid overdose deaths, and are commonly the first medications that people encounter before transitioning to heroin or fentanyl. It is critical that we take measures now to prevent marketing from unnecessarily exposing new people to opioids they may not need.”

The study found that opioid-related spending on doctors was most highly concentrated in counties in the Northeast; the Midwest had the lowest concentration.

Areas with large numbers of payments and high overdose rates included four cities in Virginia — Salem, Fredericksburg, Winchester and Norton — as well as Cabell County, W.Va., which has one of the highest overdose death rates in the nation. Lackawanna County, Penn., which includes Scranton, also ranked high in both measures, as did Erie County, Ohio.

The authors said they were particularly struck by the fact that the number of marketing interactions with doctors — such as frequent free meals — was more strongly associated with overdose deaths than the amount spent.

“Each meal seems to be associated with more and more prescriptions,” Dr. Hadland said. He added that while pharmaceutical company payments to doctors seem to have started dropping, the practice of companies buying meals for doctors “remains alive and well.”

The study noted that while some states have sought to limit the total amount drug companies spend promoting their products to doctors — New Jersey, for example, recently adopted a new regulation limiting such spending to $10,000 per doctor, per year — what may matter more is for states or health systems to limit the number of interactions.

“I think what seems to be less important is the amount of money spent,” Dr. Hadland said, “compared with the number of interactions.”

The study linked information from 2013 to 2016 across three national databases: the Open Payments database, which includes all payments made by pharmaceutical companies to physicians, which companies are required to report under a section of the Affordable Care Act; drug overdose data from the Centers for Disease Control and Prevention; and C.D.C. data on opioid prescriptions dispensed at pharmacies.

It measured opioid marketing in three ways: the total dollar value of marketing received by doctors; the number of payments made by the pharmaceutical industry; and the number of physicians receiving any marketing.

The study builds on another that Dr. Hadland and his co-author, Dr. Magdalena Cerda, an associate professor of population health at the NYU School of Medicine, published earlier this year. It found that for every meal a doctor received related to an opioid drug in 2014, there was an increase in opioid claims by that doctor for Medicare patients the following year.

As the opioid epidemic reached crisis proportions over the past few years, more than 30 states have responded by passing laws that restrict opioid prescribing. Critics say these policies are misguided because most overdose deaths now are from illicit opioids like synthetic fentanyl, and because the restrictions hurt patients with chronic pain.

But the policies may be having an impact, as opioid prescribing rates overall have been falling. Still, Dr. Hadland pointed out, prescribing rates remain uneven, with some regions still seeing widespread prescribing of opioids.

One company, Purdue Pharma, the maker of OxyContin, announced last year that it would stop marketing its painkillers to doctors, including by no longer sending salespeople to medical offices to talk about the drugs. According to a newly public filing in a lawsuit brought by Massachusetts against Purdue, a member of the Sackler family, which owns the company, had boasted in 1996 that “the launch of OxyContin tablets will be followed by a blizzard of prescriptions that will bury the competition.”

An analysis last year by ProPublica found that payments to doctors related to opioid drugs dropped significantly in 2016 — a sign that public pressure on the companies in the wake of the opioid epidemic had begun having an effect. ProPublica found that in 2016, drug makers spent $15.8 million on doctors in the form of speaking and consulting fees, meals and travel related to opioid drugs. That was 33 percent less than in 2015, when they spent $23.7 million, and 21 percent less in 2014, when they spent $19.9 million.

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Top California doctors group seeks legislation to ensure pain prescriptions get filled

Posted on January 19, 2019 by Pharmaciststeve

 

Top California doctors group seeks legislation to ensure pain prescriptions get filled

https://www.sacbee.com/news/state/california/article224581310.html

The California Medical Association is working to get legislation introduced — perhaps as early as this week — that will alleviate a problem with prescription forms that has pharmacists across the state rejecting patients who bring doctors’ orders for pain medications.

Many doctors say the problems began Jan. 2 after a new law went into effect the day before. That’s when they started receiving emails from pharmacies telling them that they had used an incorrect prescription form and that pharmacists couldn’t fill their orders until they received the correct form.

“I just got my new prescription pads (Monday) at a cost of several hundred dollars, and the change is trivial,” said Dr. Richard Buss, a family practice physician in Jackson. “At the hospital here, I was next to a doctor who was trying to send a patient home after knee surgery, and the pharmacy wouldn’t honor his prescription because they were old forms.”

The new law, known as Assembly Bill 1753, is intended to help keep opioid medications and other controlled substances out of the illicit drug trade. Carried by Assemblyman Evan Low, the measure allows the California Department of Justice to restrict the number of companies authorized to print prescription drug forms, and it requires that each form has a unique serialized number for tracking. Legislation in 2017 required other security measures for prescription forms.

Buss said the changes in the forms seem more like a change in format to him than an addition of meaningful new security measures. The old forms, he said, had serial numbers as well.

Gov. Jerry Brown signed the measure in September, but the California Medical Association told Attorney General Xavier Becerra in a letter dated Dec. 21 that updated forms were not available to physicians until the week of Dec. 17. The professional organization, which represents 43,000 doctors, said in the memo that it had concerns that doctors would not have enough time to acquire the new forms and implement the new protocols before the Jan. 1 deadline.

The Jan. 1 implementation “would result in a serious barrier to patients who must access necessary medications in a timely manner,” said Janus Norman, senior vice president for the CMA’s Center for Government Relations. He urged Becerra to work with the Medical Board of California and the California Board of Pharmacy to establish a transitional period allowing pharmacists to accept forms that do not comply.

Buss said he was frustrated because this is the second year in a row where he felt doctors were not given proper notification of changes needed in their prescription forms: “They’re just changing a prescription requirements, and then the doctors have to jump through the hoops suddenly, and I’m left with thousands of prescription blanks that are unusable, and that’s probably true for a lot of other doctors.”

No transition period was included as part of the legislation. In an email to The Sacramento Bee, Low stated that he is “committed to seeing that any legislative solution is signed into law immediately.”

On Tuesday, Anthony York, a spokesman for the California Medical Association, said the organization hoped to have legislation soon that would ensure a smoother transition to new prescription pads. He didn’t have details on the measure under consideration.

Buss said he believes that legislation affecting prescriptions should include a grace period in which pharmacists and printing companies alert doctors of the date on which their prior forms will expire.

The Medical Board of California said it tried to get the word out. On Dec. 28, it sent an email blast to all licensees notifying them of the new prescription form requirement for many controlled substances, and the agency posted messages that day about the new prescription form requirement on its Facebook and Twitter sites. On Jan. 10, it issued a joint statement with the Department of Justice and the pharmacy board.

In that statement, issued via email blast and the web, the agencies said none of them wanted to see patients denied access to necessary medications in the transition to new forms. To that end, the pharmacy board said in the statement, it would not make a priority of investigating pharmacists who determine it is in the best interest of a patient or public health to fill a prescription using last year’s prescription forms.

“Pharmacies have the option of accepting the (prescription forms) but people are so wary now of running afoul of the Board of Pharmacy that they’re just refusing them,” Buss said. “Even the prescription printers had no warning of this. There’s probably 20 to 30 organizations that print security prescriptions, and they were all rushing to get these things done.”

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The clampdown on opioid prescriptions is hurting pain patients

Posted on January 18, 2019 by Pharmaciststeve

The clampdown on opioid prescriptions is hurting pain patients

https://www.latimes.com/opinion/op-ed/la-oe-nicholson-opioids-20190118-story.html

In the summer of 1994, I was working at my desk at the Department of Justice when my back started to burn. Moments later, my body seized up, and I fell to the floor. Suddenly, at the age of 30, I was no longer able to sit or stand. I could barely walk short distances. These limitations, related to a surgical mishap, would continue for almost 20 years.

After dozens of failed treatments, I reluctantly tried prescription opioids. The pain medication enabled me to work despite my condition. I argued cases in federal court from a foldable reclining chair, negotiated settlements by video teleconference and, working remotely, managed litigation in U.S. attorney’s offices across the country.

When medical advancements led to an improvement of my health, I went off opioids without incident.

I was, as it turns out, incredibly lucky. A report released last month by Human Rights Watch paints a cautionary and at times harrowing picture of what pain patients are experiencing today.

The CDC needs to revise its guidelines to recommend that physicians not abandon pain patients or engage in “forced tapering.”
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Because of well-intended efforts to address the overdose crisis, many doctors are severely limiting opioid prescriptions. Patients who rely on opioid analgesics are being forcibly weaned off the medication or seeing their prescriptions significantly reduced. Other patients are unable to find doctors willing to treat them at all.

One such patient, Maria Higginbotham, has had more than a dozen surgeries to correct the collapse of her spine. She suffers from a painful condition in which the spinal cord fuses with adjacent membranes. Last year, her physician cut her pain medication by 75%, explaining that the reduction was to comply with federal guidelines.

In the past, Higginbotham could function. Now she needs assistance just to get out of bed and go to the toilet.

The federal guidelines Higginbotham’s doctor cited were issued in 2016 by the Centers for Disease Control and Prevention. They were intended as non-mandatory recommendations for primary care physicians.

Increasingly, the guidelines are treated not as recommendations, but as one-size-fits-all mandates. They are being misapplied by physicians, state legislatures, insurers and Medicaid programs.

Some physicians told Human Rights Watch researchers that they had taken patients off opioids, or reduced patients’ prescriptions, against their better clinical judgment. “You set yourself up for a liability, even when you know they’re not addicted and they’re benefiting from opioids,” one physician said.

Other doctors said that they had stopped treating pain patients altogether — even patients who don’t use prescription opioids.

It’s true that opioids were prescribed liberally in recent decades. Doctors began doing this in the 1990s. There were some bad actors, such as “pill mills” and wayward pharmacies. Opioid medication too often fell into the wrong hands.

Moreover, prescription opioids are not the magic bullet we once believed them to be. The evidence about their efficacy across a broad population is limited. Even when their use is appropriate, opioids carry risks, and the risks increase at higher doses. The CDC was right to encourage judicious, responsible prescribing.

But chronic pain is a large umbrella category, encompassing a wide range of injuries and diseases, some of which are incurable. A one-size-fits-all approach to treatment does not work.

The recent clampdown has had harmful consequences. Some patients told researchers that they were forced to quit working or go on disability when their medication was denied. Others are now homebound. Many mentioned the possibility of suicide.

Patients also said that they were turning to alcohol or illegal substances to treat their pain.

What began as an effort to protect patients may be morphing into one that is harming them. The CDC’s National Center for Health Statistics estimates that 50 million Americans have pain every day and nearly 20 million have pain that limits major life activities. If the experiences that patients described to Human Rights Watch are common, the harm to patients could be widespread.
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The CDC’s own data show that fatal overdoses are driven largely by illegally produced fentanyl, its analogs and heroin — not by medically prescribed opioids.

For all these reasons, the CDC should address the misapplication of its guidelines, as the American Medical Assn. recently did. The agency needs to revise its guidelines to recommend that physicians not abandon pain patients or engage in “forced tapering.”

The CDC should also study and address any unintended consequences of its 2016 guidelines, as it promised to do.

Tackling the overdose crisis is a vital public policy goal. But chronic pain patients should not become casualties in that fight.

Kate M. Nicholson is a civil rights and health policy attorney. She served for 20 years in the Department of Justice’s civil rights division, where she drafted current regulations under the Americans With Disabilities Act. She gave a TEDx talk about chronic pain, “What We Lose When We Undertreat Pain.”

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He is in jail.. he had put a photo of the DEA agents on his computer… the DEA agents.. in mortal danger of their lives

Posted on January 18, 2019 by Pharmaciststeve

Doc, my son, has been in jail snce June 26, 2018. He will have to remain there until August of 2019, when the trial will begin. The DEA raided his office, his home and my home and stole jewellery of mine, without leaving a receipt. I consider them nothing but thieves, low life’s and liars. He is in jail, not because of any false charges they came up with, but because he had put a photo of the DEA agents on his computer to find out who had been telling the pharmacists he was under investigation. They, the DEA agent, convinced the judge that because doc had this photo of them, they were in mortal danger of their lives. It’s sickening how they lie and twist everything to suit themselves. The main reason for the raid I am convinced was to take all llhis assets, which they did, and left him with no assets to even hire a lawyer. Of course, this was intentional on their part, so that they may have a so called legal interest in clearing out his bank and investment account. The first thing on DEA web site that is what they are after is asset forfeiture. It is they who should be serving time in jail for theft.

 

 

Maybe this is why the DEA runs want ads like this:

Forfeiture Financial Specialist Supporting the DEA

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