It has been six months since Tennessee enacted new laws to restrict the number of opioid prescriptions, but it still comes as a shock to patients.

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Oregon law keeps secret doctors over prescribing opioids

https://www.bluemountaineagle.com/capital_bureau/oregon-law-keeps-secret-doctors-overprescribing-opioids/article_2d7b30be-1504-11e9-88fe-d75b3dee0d05.html

State officials know of 160 doctors with suspicious prescribing patterns, but Oregon law shields those doctors from further scrutiny.

Legislators put little teeth into a 2018 law that requires doctors to register for a program that monitors drug prescriptions. Doctors, for instance, face no sanction if they don’t join, according to state officials.

Doctors identified as perhaps improperly prescribing opioids only get a letter from the state suggesting more education. Doctors can and do ignore even those mild letters with no fear of a sanction.

Under the program, retail pharmacists report prescriptions of controlled substances such as Oxycontin and Xanax to the state within 72 hours of dispensing them. The state maintains three years of prescription data.

The issue of prescriptions has been central to government efforts to reduce the number of overdose deaths attributed to opioids.

In 2016, Oregon doctors wrote 3.1 million opioid prescriptions at a rate 13 percent higher than the national average.

That year, 312 Oregonians died from an opioid overdose, a rate of about 7.6 per 100,000 people, according to the National Institute on Drug Abuse. Nationally, the rate was 13 people in 100,000.

Oregon legislators in 2017 revised the state’s prescription reporting system to flag doctors who prescribe high volumes of opioids or prescribe conflicting drugs.

State auditors examining the system found instances of Oregonians “doctor shopping.” Nearly 150 people were identified as each getting prescribed drugs from at least 30 different doctors.

That led auditors to question how the state deals with those doctors identified as improperly prescribing opioids.

“Questionable prescribing habits seen within the data, even those that are egregious, cannot be elevated to any regulatory or enforcement entities to directly look into those situations,” auditors said in their audit released in December.

Auditors recommended that a state review committee get authority to require prescribers to justify practices deemed “concerning” and to collaborate with licensing boards and police.

The state committee confidentially reviews prescriber, pharmacy and patient prescriptions, according to the Oregon Health Authority. It also developed criteria defining risky prescribing.

When the committee spots a suspicious pattern, it typically writes to the doctor. A sample letter that state auditors reviewed said it was an “invitation to explore” the state’s resources and “review your prescribing practice.”

The doctors don’t have to acknowledge the letter or take any more training or education, auditors said.

The information can’t be shared with medical licensing boards.

Those licensing boards can obtain the state’s information if they certify the information is needed for an investigation.

According to the Health Authority, state licensing boards in the last three months of 2018 requested drug monitoring information 109 times. Department officials couldn’t recall a time when they denied a request for such information from the board and said the requests are increasing.

Police can obtain the monitoring program’s data with a court order.

By the time Oregon legislators established the state’s prescription drug monitoring program in 2009, Oregon was behind dozens of other states already operating similar programs.

Rob Bovett, former Lincoln County district attorney who at the time lobbied on behalf of law enforcement groups, helped lead the charge to create the monitoring program.

The law was the result of “a lot of bargaining and compromise” between advocates and the ACLU of Oregon and the Oregon Medical Association, Bovett said.

Police and prosecutors wanted to tackle prescription drug abuse at the source, Bovett said.

“Oregon law enforcement doesn’t just want tools to go after people for drug abuse,” Bovett said. “They prefer that drug abuse drop because they’ve got plenty to keep them busy, and we just, quite frankly, don’t have enough of them.”

The Oregon District Attorneys Association plans to review the audit report at its board meeting Friday, according to the association’s executive director, Tim Colahan.

Gary Schnabel, the executive director of the state’s Board of Pharmacy from 1999 to 2014, said the board floated the idea of the state monitoring controlled substance prescriptions for years before the legislation was passed.

He got the idea while at a national conference and learned what other states were doing.

“It was the very beginnings of the opioid crisis, and it was a way to actually monitor opioid use,” Schnabel said.

The point was to identify people using more than a certain amount — whatever program administrators thought was appropriate — and let doctors know.

Pharmacists hoped that the program could prevent issues like doctor shopping by having doctors intervene when they found a patient had multiple prescriptions for the same or conflicting drugs.

But they didn’t want to share the database with police or investigators.

“The only people who (would have) access to that data were the patient themselves, or the patient’s physician,” Schnabel said. “Nobody else would have access to it.”

The state association representing doctors and the ACLU of Oregon resisted at first, Schnabel said.

The ACLU of Oregon worried the program would invade patient privacy and could be susceptible to data breaches. Some health care providers also voiced privacy concerns, legislative records show.

“They thought it was invasive,” Schnabel said of the Oregon Medical Association. “They thought it might get physicians in trouble, thought it might be punitive against the physician for prescribing. They just didn’t trust it.”

Courtni Dresser, director of government relations for the Oregon Medical Association, said the group never opposed the program.

The monitoring system was cumbersome at first, said Dr. Amy Kerfoot, an Oregon Medical Association trustee who represents the association at the governor’s Opioid Epidemic Task Force.

In recent years, the association urged reforms to make it easier for doctors to use the monitoring data, Dresser said.

In 2017, state lawmakers created the special committee to review prescribing practices of controlled substances.

The bill was sponsored by state Rep. Knute Buehler, R-Bend, a surgeon, and supported by the medical association.

The committee advises the Health Authority on interpreting prescription information and training prescribers. State law requires committee members be licensed health care practitioners with at least five years of experience prescribing controlled substances.

The following year, Gov. Kate Brown asked the Legislature to mandate registration in the prescription program.

Kerfoot testified in favor, as did other health care groups like the Oregon Primary Care Association.

“Requiring practitioners to register with the Prescription Drug Monitoring Program is another important step in the right direction,” Kerfoot told lawmakers in a letter. She said the program would be “a powerful tool to help providers rethink prescribing decisions that had been automatic in the past, but maybe should not have been for many patients.”

In an interview, Kerfoot acknowledged that the medical association was concerned that doctors would become more liable for their prescribing decisions.

“You never want to have a legislative body sending out what a physician is liable for when they don’t yet have the background on the patient, the indications, the rationale behind it,” Kerfoot said. “They want prescribing to be safe, but prescribing is a tool that should be available to the people who need to use it — qualified physicians and pharmacists.”

But that law created no consequence for not signing up and doesn’t require prescribers to access the database before prescribing a controlled substance.

State auditors cited a study from the National Bureau of Economic Research that found opioid misuse decreased in states that required health care providers to check such a database.

Dresser said requiring queries by law isn’t necessary.

“There’s no need to mandate it because it will just be part of the workflow as the integration project continues,” Dresser said.

Oregon’s program, auditors said, was “intended to be used for determining the course of treatment for a patient and should be rightfully protected,” auditors wrote. “Yet it is also intended to help ensure appropriate use of prescription medications.”

The ACLU of Oregon maintains that the monitoring program shouldn’t be used to punish or regulate doctors, but to help them improve medical care.

In 2017, roughly 40 percent of prescribers were registered with the program, according to the Oregon Health Authority. By late 2018, after state outreach efforts, 83 percent of prescribers were registered.

Additionally, only retail pharmacies must submit prescription data to the state. That leaves out pharmacies in long-term care facilities and residential treatment facilities, auditors said.

There are 143 institutional pharmacies licensed in Oregon, according to the Board of Pharmacy. Of those, 56 are pharmacies in long-term care facilities.

Those facilities often care for patients with chronic illnesses or disabilities, rather than patients with acute pain like a back injury.

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The roadmap details our three- pronged approach to combating the opioid epidemic going forward: 1) prevention of new cases of opioid use disorder (OUD); 2) treatment of patients who have already become dependent on or addicted to opioids; and 3) utilization of data from across the country to better target prevention and treatment activities.

Most/all of chronic pain pts – especially those dealing with intractable chronic pain – will be DEPENDENT on their opiate therapy, according to this CMS release all of those DEPENDENT ON OPIATES are now officially considered to be suffering from a OPIOID USE DISORDER – the NEW TERM for someone who is has been “using opiates (legally/illegally)” > 90 days.

This policy will affect Medicare patients who have not filled an opioid prescription recently (for example, within the past 60 days) when they present a prescription at the pharmacy for an opioid pain medication for greater than a 7 day supply.

does this mean that chronic pain pts – such as myself – who are able to control their pain most of the time with NSAIDS are going to keep being “reclassified as opiate naive” and only able to get a 7 days supply ?

If you get caught up in this BS… and you are forced to pay cash to get your opiate medication to avoid cold turkey withdrawal… be cautious of the pharmacist telling you that they can rebill the insurance company once a PA is approved… Ask them what the days limits are for rebilling.. most will not be able to do it after 7-10 days after the Rx was filled.. and the PA process – unless you insist on an EMERGENCY PA – which should take 24 -72 hrs – otherwise it make take a couple of weeks…  and you may have to submit your receipt directly to the insurance company for reimbursement and what you get reimbursed may be substantially LESS than the pharmacy’s CASH PRICE.

Just remember that a NO from an insurance company is NOT IN CONCRETE… they all have appeal processes and they don’t have to tell you what the process is – or that they have one – unless you ask, then they have to provide you the process of filing an appeal in writing..  TODAY.. it is probably now a webpage.  Following the directions and the days limits  when an appeal has to be filed by.

Here is a excellent tutorial about filing appeals  https://www.pharmaciststeve.com/?p=27887

 

 

 

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Judge dismisses opioid crisis lawsuits against drug makers

https://www.wtnh.com/news/connecticut/hartford/judge-dismisses-opioid-crisis-lawsuits-against-drugmakers/1694181747

HARTFORD, Conn. (AP) – A Connecticut judge has dismissed lawsuits against Purdue Pharma and other drug makers brought by 37 cities and towns in the state that blame the companies for the opioid crisis and sought to recoup millions of dollars spent responding to the crisis.

Judge Thomas Moukawsher in Hartford ruled Tuesday that the lawsuits were not allowed because they were not filed as government enforcement actions authorized by state public interest laws.

Lawyers for several municipalities said appeals are being considered. Bridgeport, New Haven and Waterbury are among the plaintiffs.

Purdue Pharma officials said the judge was right to conclude opioid manufacturers cannot be held responsible to municipalities for indirect harms from the opioid crisis.

More than 1,000 lawsuits against opioid makers by state and local governments remain pending nationwide.

 

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My name is Mary  and I am a stage 4 cancer patient. In 2007 I was Diagnosed with a primary Pertinal cancer,Stage 3 C ,Primary colon cancer,stage3 ,2005 Back fusion L 4 L5 S1. I have had 8 lower bow Blockages,1 of them had to have surgery,,Then I had a nother open surgery and lost my spleen ,and a nother to take half of my Pancreas,I have had 7 open Abdominal cancer surgerys.I pay 1638 dollars for my helth care. In 2007 I was put on Methadone and 1 or2 Oxy Codeine for Chronic pain,I had to try 8 drugs stores when I moved down to find one that would help me.My blue cross has been paying for my meds ,I have been on methadone since 2007 as it is one of the cheapest pain pills and one that has really work.Last month I was waiting for my medicine and it never came and I only take 1 for times a day total 40 mg.I called Walgreens mail order.I told them I only had 4 left and they said that they were stopping the methadone just like that, I went to CVS and ask the Pharmacist.if I could just stop methadone and she told me no way,Now my nose was running,I had the chills, sweeting, a severe body ache, Now my hole body is going thought a great deal of pain,I went 13 days with out my Methadone.My Doctor told them that they were to order the medication and were told that it is not for a cancer pt.and try something else,so he appealed it and they said no,I was in so much pain I called a Detox unit,and two doctor looked and my Medical history and was told that they cant beleave that they did this with my medical promblem and I should call a lawer.I called my Doctor and told them that I am going thought Servira pain, Sweating Profusely,and they called and told them that I need it now.After 2 weeks I got a Prescription from Walgreens but I had to pay cash for it and it was a one time deal,I would love to start a class action suit for all the cancer patients that have to go though this.Thank you for any help that you can ghb I’ve me.If a Doctor gives a cancer medication I should not have to be look at as a drug addict,and run from one drug store to another and another,This is not right

http://www.ncpanet.org/home/find-your-local-pharmacy

 

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Scientists seek ways to finally take a real measure of pain

http://www.tribtown.com/2019/01/10/us-med-measuring-pain/

WASHINGTON — Is the pain stabbing or burning? On a scale from 1 to 10, is it a 6 or an 8?

Over and over, 17-year-old Sarah Taylor struggled to make doctors understand her sometimes debilitating levels of pain, first from joint-damaging childhood arthritis and then from fibromyalgia.

“It’s really hard when people can’t see how much pain you’re in, because they have to take your word on it and sometimes, they don’t quite believe you,” she said.

Now scientists are peeking into Sarah’s eyes to track how her pupils react when she’s hurting and when she’s not — part of a quest to develop the first objective way to measure pain.

“If we can’t measure pain, we can’t fix it,” said Dr. Julia Finkel, a pediatric anesthesiologist at Children’s National Medical Center in Washington, who invented the experimental eye-tracking device.

At just about every doctor’s visit you’ll get your temperature, heart rate and blood pressure measured. But there’s no stethoscope for pain. Patients must convey how bad it is using that 10-point scale or emoji-style charts that show faces turning from smiles to frowns.

That’s problematic for lots of reasons. Doctors and nurses have to guess at babies’ pain by their cries and squirms, for example. The aching that one person rates a 7 might be a 4 to someone who’s more used to serious pain or genetically more tolerant. Patient-to-patient variability makes it hard to test if potential new painkillers really work.

Nor do self-ratings determine what kind of pain someone has — one reason for trial-and-error treatment. Are opioids necessary? Or is the pain, like Sarah’s, better suited to nerve-targeting medicines?

“It’s very frustrating to be in pain and you have to wait like six weeks, two months, to see if the drug’s working,” said Sarah, who uses a combination of medications, acupuncture and lots of exercise to counter her pain.

The National Institutes of Health is pushing for development of what its director, Dr. Francis Collins, has called a “pain-o-meter.” Spurred by the opioid crisis, the goal isn’t just to signal how much pain someone’s in. It’s also to determine what kind it is and what drug might be the most effective.

“We’re not creating a lie detector for pain,” stressed David Thomas of NIH’s National Institute on Drug Abuse, who oversees the research. “We do not want to lose the patient voice.”

Around the country, NIH-funded scientists have begun studies of brain scans, pupil reactions and other possible markers of pain in hopes of finally “seeing” the ouch so they can better treat it. It’s early-stage research, and it’s not clear how soon any of the attempts might pan out.

“There won’t be a single signature of pain,” Thomas predicted. “My vision is that someday we’ll pull these different metrics together for something of a fingerprint of pain.”

NIH estimates 25 million people in the U.S. experience daily pain. Most days Sarah Taylor is one of them. Now living in Potomac, Maryland, she was a toddler in her native Australia when the swollen, aching joints of juvenile arthritis appeared. She’s had migraines and spinal inflammation. Then two years ago, the body-wide pain of fibromyalgia struck; a flare-up last winter hospitalized her for two weeks.

One recent morning, Sarah climbed onto an acupuncture table at Children’s National, rated that day’s pain a not-too-bad 3, and opened her eyes wide for the experimental pain test.

“There’ll be a flash of light for 10 seconds. All you have to do is try not to blink,” researcher Kevin Jackson told Sarah as he lined up the pupil-tracking device, mounted on a smartphone.

The eyes offer a window to pain centers in the brain, said Finkel, who directs pain research at Children’s Sheikh Zayed Institute for Pediatric Surgical Innovation.

How? Some pain-sensing nerves transmit “ouch” signals to the brain along pathways that also alter muscles of the pupils as they react to different stimuli. Finkel’s device tracks pupillary reactions to light or to non-painful stimulation of certain nerve fibers, aiming to link different patterns to different intensities and types of pain.

Consider the shooting hip and leg pain of sciatica: “Everyone knows someone who’s been started on oxycodone for their sciatic nerve pain. And they’ll tell you that they feel it — it still hurts — and they just don’t care,” Finkel said.

What’s going on? An opioid like oxycodone brings some relief by dulling the perception of pain but not its transmission — while a different kind of drug might block the pain by targeting the culprit nerve fiber, she said.

Certain medications also can be detected by other changes in a resting pupil, she said. Last month the Food and Drug Administration announced it would help AlgometRx, a biotech company Finkel founded, speed development of the device as a rapid drug screen.

Looking deeper than the eyes, scientists at Harvard and Massachusetts General Hospital found MRI scans revealed patterns of inflammation in the brain that identified either fibromyalgia or chronic back pain.

Other researchers have found changes in brain activity — where different areas “light up” on scans — that signal certain types of pain. Still others are using electrodes on the scalp to measure pain through brain waves.

Ultimately, NIH wants to uncover biological markers that explain why some people recover from acute pain while others develop hard-to-treat chronic pain.

“Your brain changes with pain,” Thomas explained. “A zero-to-10 scale or a happy-face scale doesn’t capture anywhere near the totality of the pain experience.”

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Attention Missouri Pain Patients

www.medium.com/@marycremer/attention-missouri-pain-patients-fc398bc34c8a

We are in need of YOUR personal story. Please email to…

mopainadv@gmail.com

What’s needed? We need to know what is happening in your pain control lives. These are some ideas.

• Are you still receiving pain meds?

• Have your pain meds been cut or threatened? If so, why?

• Has your original dr retired, quit prescribing, referred you to pain management or expressed concern or fear from government and/or employers?

• Did you sign a Pain contract?

• Are you periodically drug tested? Any problems with this?

• Has your insurance or pharmacy given you problems?

• Have you lost quality of your life?

• Have you contacted your elected officials?

• Do you have a loved one that also has problems with pain control?

• Have you had problems post surgery or injury?

• Have you been flagged as a dr shopper? Has this caused you problems?

• Has anyone you know taken their life, or have you thought about it? And why?

• Describe your pain and what pain control does for you?

• Include any additional information.

Please include your name, address and phone number.

If you want to remain anonymous, you may, just please provide what district in MO you reside (and the email should state that you want to remain anonymous). You can look up your district and state Representative and state Senator at the bottom of the page. Please try NOT to be anonymous, if possible. Elected officials need to understand we are REAL and problems are happening in MO.

Please share this with other people from Missouri because we want as many true stories to come in so that our elected officials hear our voices.

This is a pivotal time in this state and country. Currently, MO is the last state to not have a fully functioning PDMP (prescription drug monitoring program). But, it is being added to many counties. A flagging system is in place too. Also, elected officials are saying they are NOT hearing from us. So, they do not think the changes they are making are affecting us. So, now is your time to make a difference.

https://house.mo.gov/FrontPageMobile.aspx

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CVS Health and Aetna officially merged at the end of 2018.

https://www.businessinsider.com/cvs-health-reveals-plans-for-health-hub-stores-2019-1

The $70 billion merger combines a chain of nearly 10,000 pharmacies that also owns a drug benefits business with one of the biggest US health insurers. The result is an entirely new healthcare company that can wield a tremendous amount of power over how healthcare gets paid for and provided to patients.

In a presentation on Tuesday at the JPMorgan Healthcare Conference in San Francisco, CVS CEO Larry Merlo outlined for the first time how the combined company will provide healthcare differently. The main goals are: keeping patients healthier and out of the hospital, caring for patients at less-costly locations (such as CVS’s clinics instead of emergency rooms), and pioneering new methods of caring for devastating chronic diseases like cancer and heart failure.

Achieving those goals will help CVS boost its profits. Since it now owns is a health insurer, the company will spend less on medical care if it can keep customers healthier, or care for them at clinics instead of hospitals.

Read more of Business Insider’s coverage from the J.P. Morgan Healthcare Conference here

A big component of the strategy is providing more healthcare in CVS stores, both at the pharmacy counter and via the company’s MinuteClinics. To make space, CVS is removing some products from the front of the stores where it’s piloting the new approach.

“We can open a new front door to health that is both easier to use and less expensive, while at the same time, providing convenient access to high-quality health care,” Merlo said during the presentation.

The strategy also helps CVS find new use for the floor space in its 9,800 locations, as customers increasingly shop for everyday goods on Amazon. And providing more care in stores can help CVS counter forays by rivals like Amazon into healthcare. Amazon, for its part, acquired the pharmacy startup PillPack last year, marking its entry into the drug-delivery business.

To start, CVS is opening up its first “health hub” in a redesigned store in Houston in February. On Tuesday, the company revealed what that store will look like. You can see that there’s a lot more store space devoted to providing healthcare, including at the clinic and pharmacy.

The MinuteClinics in the pilot stores will offer more services, including disease screenings and blood draws. CVS already has about 1,100 MinuteClinics across its stores. They’re usually staffed by nurse practitioners or physicians’ assistants, and now provide basic checkups and care for minor illnesses and ailments.

The stores will also have a “care concierge,” who might help individuals understand how their health insurance works, or help them use health and wellness devices and technology.

CVS is also testing several other initiatives to improve how its customers get healthcare, using the resources of the combined company.

In one program, CVS pharmacists will call Aetna members who the company thinks could be at high risk of a negative health event, and counsel them on how to improve their health. A second outreach program will focus specifically on Aetna members with heart disease.

Another focuses on Aetna customers who’ve been in the hospital. To make sure they get the care they need after leaving the hospital and prevent them from having to go back, Aetna care managers will schedule followup visits for them at MinuteClinics, if they can’t get in to see their usual doctor.

At the MinuteClinic, healthcare providers can make sure the patients understand their disease and how to manage it. They’ll also check that patients have the right prescription drugs and know how to take them.

“Helping people on their path to better health has been a cornerstone of our purpose at CVS,” Merlo said. “As we zoom out and look at the broader health care market and the savings that can be achieved by more effectively managing chronic conditions, the opportunity here is massive”

If CVS uses the same format that they use for the Silver Scripts Part D prescription program… they will put financial incentives/disincentives on copays and deductibles to “encourage” pts to use only CVS’ array of care thru one of their programs.  I have seen statements from they  – in regards to the Aetna merger – that they would not “force” Aetna policy holders to use CVS services.

Will CVS’ Minute Clinics become the triage for Aetna policy holders before they will be “allowed” to go to a ER ?  There are numerous ways that CVS can put financial incentives/disincentives in place that will very persuasive to pts to go down that path… Hopefully, none of these pts will be more ill than they believe they are and there “condition” is much more severe and life threatening than the pt believed it to be and “waste” critical time getting treatment in a ER because they were trying to take the “less expensive route” ?

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