https://www.politico.com/story/2018/08/28/how-the-opioid-crackdown-is-backfiring-752183

The former law enforcement officer was in constant pain after his doctor had abruptly cut off the twice-a-day OxyContin that had helped him endure excruciating back pain from a motorcycle crash almost two decades ago that had left him nearly paralyzed despite multiple surgeries.

“I came into the office one day and he said, ‘You have to find another doctor. You can’t come here anymore,’” Fowlkes, 58, recalled. The doctor gave him one last prescription and sent him away.

Like many Americans with chronic, disabling pain, Fowlkes felt angry and betrayed as state and federal regulators, starting in the Obama years and intensifying under President Donald Trump, cracked down on opioid prescribing to reduce the toll of overdose deaths. Hundreds of patients responding to a POLITICO reader survey told similar stories of being suddenly refused prescriptions for medications they’d relied on for years — sometimes just to get out of bed in the morning — and left to suffer untreated pain on top of withdrawal symptoms like vomiting and insomnia.

“I was pretty much thrown to the curb,” said Denise Pascal, 65, who had taken pain meds for decades after six back surgeries. Then her pain doctor cut her off and closed her practice without connecting her with another specialist.

Many of POLITICO’s respondents described being tapered off narcotics too quickly, or worse, turned away by doctors and left to navigate on their own. Some said they coped by using medical marijuana or CBD oil, an extract from marijuana or hemp plants; others turned to illicit street drugs despite the fear of buying fentanyl-laced heroin linked to soaring overdose death numbers. A few, like Fowlkes, contemplated suicide.

“I sat my wife down and told her life wasn’t worth it,” Fowlkes said after he had gone more than a month without pain relief while also suffering opioid withdrawal symptoms. “My pain exceeded my ability to handle it. We had a very frank discussion. … We even discussed what gun I would use.”

Fowlkes found another doctor willing to continue prescribe his medication. But he worries what will happen if the pills stop coming.

“Now there’s this ticking time bomb,” he said. “I don’t know when it’s going to go off again.”

That’s not an idle fear. Trump, who vowed during his campaign to combat the opioid crisis, has set a goal of cutting prescriptions by one-third over the next three years. He has also boasted of stepped-up prosecutions of doctors who prescribe inappropriately and sought tougher sentences for those who sell drugs illegally. While Trump has stressed a law enforcement approach — including broader use of the death penalty for traffickers — his administration has also invested billions in prevention, treatment and research, and last week authorized a respected science group to develop better guidelines for doctors about how to safely treat patients with severe pain.

Certainly, stories like Fowlkes’ and Pascal’s illustrate the unintended consequences of efforts to suddenly reverse years of loose prescribing practices that fueled an addiction crisis — and why so many of the estimated 25 million Americans suffering from chronic pain feel angry and forsaken. While studies suggest that other therapies are safer and more effective for many chronic conditions, large numbers of these patients are now hooked on the narcotics and on the relief they say they get from constant, grinding pain.

“I have a lot of anger, because I think there were a lot of things done wrong to all of us,” Pascal said.

Have you been treated for opioid abuse recently? Tell us your story.

Many doctors and pharmacists responding to POLITICO’s survey acknowledged such patients’ predicament. But they said they feel under enormous pressure to limit the powerful painkillers and fearful of consequences, such as losing their licenses or even prison time, for inappropriate prescribing.

The Justice Department has aggressively prosecuted doctors for improper prescribing or fraud — charging nearly 200 doctors and another 220 medical personnel for opioid-related crimes since January 2017, the DOJ said in a June press release.

Nonetheless, the toll of overdoses keeps mounting. Almost 70,000 people died of drug overdoses last year, according to the latest government numbers. About 49,000 were opioid-related, including legal and illegal painkillers, as well as street heroin and fentanyl.

“I will no longer treat chronic pain. Period,” said Sue Lewis, a primary care doctor who works in an urgent care clinic in Portland, Oregon. “There is too much risk involved,” she said, adding that if a patient doesn’t take the medications as she prescribes them, they could jeopardize her license.

Steven Henson, an emergency room doctor in Wichita, Kansas, described how his license was suspended after six patients illegally sold the medications he prescribed, without his knowledge.

“The DEA should be working with doctors when this happens,” as opposed to punishing them, Henson said.

Jianguo Cheng, president of the board for the American Academy of Pain Medicine, said that besides being scared, many doctors are also fed up with time-consuming requirements, including pill counting, where a patient brings her prescribed medication to the clinic so the doctor can make sure they aren’t being misused. Doctors also have to order regular urine tests to detect abuse.

And few are trained how to safely wean someone off opioids. Some patients told POLITICO their doctors failed to treat their withdrawal symptoms, and they were sick for weeks after being tapered off their painkillers.

Any doctor can prescribe a powerful painkiller like Oxycodone, but a physician has to go through special training and licensing to prescribe some drugs used to treat addiction. Only about 5 percent of U.S. physicians have been certified to prescribe buprenorphine, one of the main treatments for addiction, according to an NIH study published last fall.

Few saw the approaching wave. The effort to overhaul opioid prescribing began with little fanfare in March 2016, when President Barack Obama’s CDC issued controversial, first-of-their-kind guidelines, advising primary care doctors to prescribe opioids only as a last resort for pain, and then, in the lowest effective dose.

The guidance suggested a three-day limit for initial prescriptions for acute pain and recommended avoiding prescribing increasing large doses for those complaining of chronic pain. It was aimed at primary care doctors in an outpatient setting, not at specialists treating people with complex, chronic conditions, or those with advanced cancer. The CDC specifically excluded active cancer treatment, palliative care and end-of-life care, as well as the use of opioids in surgical and trauma settings.

Nonetheless, groups including the American Medical Association and the American Cancer Society Action Network raised concerns about unintended consequences for certain chronic pain patients, including cancer survivors who often deal with lifelong pain. AMA also raised concerns about the evidence underlying the guidelines.

Since then, at least 32 states have enacted laws related to limiting opioid prescriptions with exceptions for cancer and palliative care patients, according to the National Conference of State Legislatures. Most center on acute pain, but Oregon is considering a 90-day prescribing limit on many chronic pain patients in Medicaid. Those patients would have to go off the drugs within a year.

The guidelines have also served as a template for insurers like Anthem and pharmacy chains including CVS Caremark, that have capped initial opioid prescriptions. The Trump administration has also finalized opioid prescribing limits for initial prescriptions in Medicare Part D to take effect next year.

Sally Satel, a psychiatrist, Yale University School of Medicine lecturer and resident scholar at the conservative American Enterprise Institute, said the guidelines have been “systematically misinterpreted” as a blanket ban on opioids.

“Policies are being written as if to be in compliance with some mandate that we don’t have,” she said.

That misinterpretation, coupled with the crackdown on doctors and pharmacists under Trump’s Justice Department and growing alarm about opioid overdose deaths, has caused some doctors to stop prescribing opioids entirely.

Now, though, some patients are beginning to fight back.

“We thought we should be the ones being consulted because you’re talking about taking our medicine,” said Lauren DeLuca, president of the Boston-based Chronic Illness Advocacy Awareness Group, formed last November by DeLuca and another chronic pain patient to lobby state and federal lawmakers on behalf of those with chronic pain.

Some doctors are also questioning guidelines that they say tie their hands when it comes to chronically ill patients.

Thomas Kline, a general practitioner in North Carolina specializing in chronic and rare diseases who has garnered a large social media following for opposing the guidelines, argued the CDC shouldn’t tell doctors how to treat their patients. “It dawned on me that the CDC was going to sit in my office and try to tell me how to prescribe pain medicines, instead of tracking Zika,” he said.

Kline said he has not tapered any of his patients off opioids because he doesn’t believe that’s the right approach. He wants Congress to create an independent board to review the prescribing guidelines to prevent further unintended consequences.

Such efforts may be having an effect.

The Trump administration stands by the CDC guidelines, but officials say they are in early discussions about “expanding” upon them by providing specific examples of what doctors should prescribe for certain procedures. The FDA recently awarded a contract to the National Academies of Sciences, Engineering, and Medicine to develop new guidelines for treating acute pain that build on the CDC’s guidance, but lay out treatment recommendations for specific conditions and procedures.

“The goal is to strike a balance,” Vanila Singh, chief medical officer at HHS’ office of the Assistant Secretary for Health and the chair of an interagency Pain Management Task Force, said during a public meeting earlier this summer to discuss how to treat pain amid the opioid crisis. “We know there is a drug epidemic, and we know there are overdose fatalities happening all the time. But that has to be balanced against the issue of treating acute and chronic pain.”

Some doctors say they are also seeking better training in pain management. “Medical school certainly did not provide a solid basis for pain management or addictions,” said Henson, the Kansas emergency room doctor who said he has sought that out.

Many say one of their biggest problems is the dearth of good alternatives to opioids. Congress is working on legislation that includes provisions to encourage development of non-addictive pain treatments, but that won’t help the millions currently suffering from chronic pain.

Non-opioid pain therapies like acupuncture, which helps some conditions, can be expensive, and not all insurance plans cover them. Some people use medical marijuana, but insurance doesn’t cover that either. And some medical professionals caution against marijuana because there’s not a lot of research about its effectiveness and long-term safety for pain control.

Pascal, the Virginia back patient, says she has spent more than $5,000 in the past year treating her pain and withdrawal symptoms with alternatives such as acupuncture and CBD oil. She chose to go that route instead of medication-assisted treatment with a milder opioid called Suboxone (the brand name for buprenorphine). Although the treatment is considered the gold standard by doctors, she said she worried about remaining addicted.

Others say going off opioids entirely isn’t an option.

“The medication controls my pain to the point that I can function independently,” said Drew Pavilonis, 56, from Durham, North Carolina, who has relied on methadone to address chronic pain that developed following surgery to remove a brain tumor that left him wheelchair-bound. “Without it, I’m bedridden and pray for death.”

He blames “opioid hysteria” for the barriers at certain pharmacies.

“The longest I had to go without medication was four days,” Pavilonis said, blaming pharmacy issues for the gap. “I bought a pill splitter, and I started to split my methadone pills in half so I would at least have some medication for the four days. I suffered a great deal of pain during that time.”

Stigma around painkiller use is also an issue.

“You go in to fill your prescription and you’re treated like a second-class citizen … like you’re a drug addict,” said Melissa Brown of Helotes, Texas, who takes daily doses of OxyContin to cope with rheumatoid arthritis. “It’s like, wait a minute, I don’t abuse my drugs. I’m 51 and I’ve never had so much as a speeding ticket.”

Brown, and other chronic pain patients who responded to POLITICO’s survey, say they feel as if they’ve been pushed to the side in the larger response to the opioid crisis.

“President Trump in 2016 made it his mantra to represent the forgotten men and women,” Brown said. “I speak for a lot of chronic pain folks when I say we are now feeling like those forgotten men and women.”

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https://www.vice.com/en_us/article/8qb4dg/the-feds-are-about-to-stick-it-to-pain-patients-in-a-big-way

Doctors are already getting spooked out of prescribing painkillers, and new rules could make life in some of America’s struggling communities even worse.

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Wіth аll thе unhealthy food people eat today, thе bоdу bесоmеѕ weaker аnd unhealthy. Adding mоrе health problems іѕ stress. Stress hаѕ bесоmе аn everyday problem thаt people hаvе tо suffer frоm. Stress frоm work саn exhaust thе mind аnd thе bоdу, whісh саn easily lead tо sickness аnd diseases. Thеrе аrе certain types оf jobs thаt саn аlѕо саuѕе physical pain аnd discomfort tо thе bоdу. People рut uр wіth thіѕ bесаuѕе thеу need tо earn money. Hоwеvеr, thеrе іѕ a solution tо treating bоdу pain instead оf just ignoring іt untіl іt gets worse. Whаt іѕ thе solution уоu ask?

Chiropractic care іѕ popular fоr treating bоdу pain. Mоrе importantly, chiropractic care іѕ vеrу successful іn treating bасk pain, neck pain, muscle pain, joint pain аnd еvеn repetitive-stress injuries. Neck pain stretches can be treated well by good chiropractor. Chiropractic treatment іѕ a natural treatment thаt wіll nоt require аnу surgery оr medication. Thіѕ means thаt chiropractic treatments аrе vеrу safe аnd thеrе wіll bе nо ѕіdе effects. Chiropractic nоt оnlу focuses оn pain alleviation but іt promotes overall health аѕ wеll. People whо experience physical pain tend tо bе moody аnd sad. Thеіr bоdу feels heavy аnd thеіr energy іѕ quickly depleted. If thеѕе people undergo chiropractic treatment in Singapore through the expert chiropractic doctor available, thеу wіll bе wearing big smiles tо work еvеrу day.

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Whаt does chiropractic care involve? Wеll, treating bоdу pain wіth chiropractic treatments wіll vary frоm оnе person tо аnоthеr. It wіll depend оn thе bоdу pain аnd condition оf thе patient. Usually, chiropractors perform spinal manipulations оr adjustments. Aside frоm thіѕ, chiropractors саn аlѕо uѕе different types оf therapy like ice оr heat therapy, electric stimulation оr massage therapies like one can have tantric massage in London tо reduce inflammation, swelling and feel better. Thе chiropractic treatment wіll highly depend оn thе evaluation оf thе patient. Nonetheless, аll treatment plans wіll bе mаdе especially fоr a patient.

Chiropractic care wіll greatly help іn уоur overall wellness ѕо іt іѕ a muѕt thаt уоu choose thе right chiropractor tо help уоu. Thе chiropractor ѕhоuld bе certified. Hе оr ѕhе ѕhоuld bе trained аnd experienced аt treating bоdу pain. Thе chiropractor ѕhоuld bе reputable аnd credible. If уоu аrе experiencing neck pain specifically, уоu саn look fоr a chiropractor thаt specializes іn treating neck pain. Chiropractic services аrе vеrу affordable аnd іt іѕ considered cheap whеn уоu start feeling thе benefits оf thе treatment. Aftеr аll, whеn health іѕ thе topic, spending money іѕ worth іt. Look fоr a qualified аnd certified chiropractor tо treat уоur bоdу pains ѕо уоu саn look forward tо аn energetic, happy аnd productive day аt work.

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http://www.drugtopics.com/article/new-opioid-pain-management-regulations-pharmacists-should-know

As federal and other regulations on opioid pain relievers are changing, NCPA presented a panel discussion on “Opioid Pain Management and Your Pharmacy” on October 9 at the group’s Annual Convention in Boston.

The discussion centered on three aspects of opioid pain management: federal regulatory updates, work flow best practices for filling opioid prescriptions, and evaluating the abuse prevention policies in the community pharmacy.

Presenter Ronna Hauser, PharmD, vice president, Pharmacy Policy and Regulatory Affairs, NCPA, says the group has several recommended solutions for the opioid crisis, including establishing limits on maximum day supply for certain drugs, expanding electronic prescribing for controlled substances, encouraging alternatives to opioids for pain management, enhancing prescription drug monitoring programs (PDMPs), and increasing use and access to medication-assisted treatment for opioid abuse and addiction.

Policy Changes Coming

The presentation occurred within days of Congress’ passage of sweeping changes to federal rules related to the opioid crisis in Medicaid and Medicare programs. Many changes will start in 2019, though some won’t come into effect until 2021. “The main thing, I think, for our members is we’re going to move to a mandated system of electronic prescribing for controlled substances in [Medicare] Part D starting in 2021,” Hauser told Drug Topics prior to her presentation. Electronic prior authorization will be required for Part D drugs starting then as well, she adds.

Another change is that there will be a new drug management program or “lock-in program,” for Part D patients, where plans lock patients into using one or more specific pharmacies or healthcare providers for their prescriptions of frequently abused drugs, Hauser says. However, she adds, “It’s really the discretion of the [HHS] Secretary to determine what a frequently abused drug is. And then it’s up to the discretion of the Secretary to determine how you identify patients eligible for a lock in.”

There will also be hard safety edits for opioids, with seven-day limits on initial opioid prescriptions for acute pain under Part D. There will also be a real-time safety edit at 90 morphine milligram equivalents (MME) per day, which could be triggered when a beneficiary reaches a cumulative level of 90 MME per day across all their opioid prescriptions, she notes. Patients in hospice care, long-term care facilities, who are receiving palliative or end-of-life, or are being treated for cancer-related pain will be exempt from these rules.

NCPA believes that only a small number of patients will be affected by the 90 MME per day requirement, she says. “Nevertheless it’s going to be in existence and, I think, potentially grow in scope and size over time.” More federal legislation on opioids is expected in 2019, Hauser says.
 

How to Respond

After Hauser’s talk, Jordan Ballou, PharmD, BCACP, clinical assistant professor of pharmacy practice at the University of Mississippi School of Pharmacy, discussed policies that pharmacies should have in place when dealing with controlled substances. Policies should include what information to require from the patient; whether there should be a geographic limit to prescriptions, such as not filling those from providers outside a given distance from the pharmacy; when the PDMP should be checked; and what to do when patients request refills too early or too often.

Then Zach Forsythe, PharmD, a pharmacist with Hurricane Family Pharmacy in Hurricane, UT, looked back on how his pharmacy changed some of its practices after an armed robbery of the store. In southern Utah, where his pharmacy is located, there have been more than 20 night burglaries of pharmacies in 2017 and 2018. One independent store was hit three times in two months.

His pharmacy has added cameras, increased its employee training and counseling, put defined protocols in place, and added GPS trackers. It also added a sign in the window stating that the store was monitored by cameras and that Oxycontin and oxycodone are kept in a time-locked safe.

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• https://www.facebook.com/sally.balsamo?fref=gc&dti=982163208603921&hc_location=ufi

ILLINOIS RESIDENTS:

Our Illinois advocate representative, Sally Balsamo, is helping to find Illinois patients for a potential story that NPR is considering.

The reporter is seeking Illinois residents who were or are being weaned off of opioids. If you would like more information or this applies to you, and you are interested, please private message – Sally Balsamo through her FB page.

Thank you for your help.

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http://www.ciproms.com/2018/12/new-joint-commission-pain-standards-take-effect-january-1-2019/

New and revised Joint Commission pain assessment and management standards will be effective January 1, 2019, for accredited ambulatory care facilities, critical access hospitals, and office-based surgery practices. These updates continue a Joint-Commission initiative that required new and revised pain assessment and management standards for accredited hospitals to be implemented beginning January 1, 2018.

As with the hospital standards, the new standards going into effect in 2019 are reflected in the Leadership; Medical Staff; Provision of Care, Treatment, and Services; and Performance Improvement chapters of The Joint Commission hospital accreditation manual.

Joint Commission pain assessment and management standards are designed to strengthen organizations’ practices for pain assessment, treatment, education, and monitoring. They were established based on literature review, public field review, and several expert panels.

Based on the new and revised standards, Joint Commission–accredited organizations will be required to do the following:

• Provide staff and licensed independent practitioners with educational resources and programs to improve pain assessment, pain management, and the safe use of opioid medications based on the identified needs of their patient populations
• Involve patients in developing their treatment plans and setting realistic expectations and measurable goals
• Facilitate clinician access to prescription drug monitoring program databases
• Conduct performance improvement activities focusing on pain management and safe prescribing to increase safety and quality for patients
• Ensure that the critical access hospital organized medical staff take an active part in pain assessment, pain management, and safe opioid prescribing through participating in the establishment of protocols, quality metrics, and reviewing performance improvement activities
• Monitor high-risk patients in critical access hospitals

Not all requirements apply to all settings in the ambulatory care program. The Joint Commission has a grid indicating which requirements are applicable, as well as documentation by setting showing which requirements are new, which are deleted, and which have been revised.

For more information about the new pain requirements, review the Joint Commission Prepublication Standards – Revisions for Pain Assessment and Management.

— All rights reserved. For use or reprint in your blog, website, or publication, please contact us at cipromsmarketing@ciproms.com.

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https://www.consumerreports.org/pharmacies/consumers-still-prefer-independent-pharmacies-consumer-reports-ratings-show/

When it comes to filling prescriptions, consumers still prize the friendliness, courtesy, and expertise of the local drugstore.

That’s according to Consumer Reports’ most recent ratings of walk-in pharmacies based on survey responses from more than 78,000 CR members. Independent pharmacies earned high scores on such measures as courtesy, helpfulness, and speed of checkout and filling prescriptions, as well as pharmacists’ knowledge and accuracy.

At the bottom: large national chain pharmacies.

Daniel Holt, 53, a CR member from New York City, calls his local independent pharmacy a “neighborhood gem,” and notes that “I’d rather give my money to small, local businesses who are part of my community.” 

But the big business of retail pharmacy is changing fast and could threaten some of the nation’s 22,000 independent pharmacies. And that may make it more difficult—and expensive—for you to get medications at your neighborhood drugstore.

Take Amazon, which recently entered the $453 billion prescription drug business by purchasing PillPack, an online pharmacy, posing a new challenge to walk-in pharmacies.

And CVS Health and Aetna recently merged, combing the nation’s largest retail drugstore and pharmacy benefits manager company (a “middleman” in the drug business that works behind the scenes) with one of the country’s biggest health insurers.

The new combined company says that people insured through Aetna will still be able to fill prescriptions at other pharmacies, and that people with other insurance plans will continue to have access to CVS pharmacy and ther services.

But some experts remain worried that the mergers could make it harder for some people to fill prescriptions at independent pharmacies. People insured by Aetna may be steered—by lower copays, for example—to a CVS for their prescription drugs or even one of the chain’s in-house clinics for vaccinations and other basic healthcare needs, says Douglas Hoey, president and CEO of the National Community Pharmacists Association.

A separate merger in the works, between the pharmacy middleman company Express Scripts and the insurer Cigna, could similarly restrict consumers’ pharmacy options. 

And there’s another potential obstacle to finding an independent pharmacy: Last year some 4,000 of them refused to join “preferred networks” of pharmacies in Medicare Part D drug plans, says Adam Fein, CEO of the Drug Channels Institute, a market research and consulting firm.

That could be a problem because preferred pharmacies typically offer lower copay prices to consumers. And while independent drugstores have among the highest overall scores in CR’s pharmacy ratings, they don’t do best at cost, landing between Costco (with the lowest prices) and big chain drugstores (with the highest) on that measure.

Chris Antypas, Pharm.D., co-owner of independent Asti’s South Hills Pharmacy in Pittsburgh, says his pharmacy was among those that opted out of being a preferred pharmacy. While he acknowledges that people on Medicare may now have to pay more for their drugs at his pharmacy, he hopes the personal care and extra services, including same-day home delivery and individualized prescription packaging service will still set him apart from the big chains.

“People want to be treated as individual as possible,” he says, “so independent pharmacists are focused on the relationship.”

That seems to be important for more than half of those CR members who fill their prescriptions at an independent and who said their pharmacists knew them by name. By contrast, only 14 percent of people said pharmacists at chain drugstores knew them by name.

Working with your pharmacist should never be a chore, says Antypas. “If your pharmacist doesn’t know you, get a new one,” he says. “Consumers should hold their healthcare providers accountable, and that includes pharmacists.”

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https://katu.com/news/local/oregon-task-force-backs-controversial-opioid-plan

BEND, Ore. (AP) — An Oregon proposal to expand alternative treatments for certain chronic pain conditions while limiting the use of opioids has moved forward with minimal changes, despite outcries from chronic pain patients and criticism from pain experts across the country.

The Bulletin reports that the state’s Chronic Pain Task Force, an ad hoc committee providing recommendations on treatments for chronic pain under Oregon’s Medicaid program, backed a proposal Wednesday to provide coverage for five chronic pain conditions currently not covered by the Oregon Health Plan.

That would allow patients to receive services such as physical therapy, acupuncture and other types of treatment. Opioids would be covered in limited doses for some of the chronic pain conditions, but not for fibromyalgia or centralized pain syndrome, a central pain processing disorder that can heighten the response to painful stimuli.

The task force concluded that opioids are not beneficial and can be harmful for those conditions.

Overprescribing of prescription opioids has been blamed for the ongoing overdose epidemic nationwide.

Patients who are already taking doses above the opioid limits would be required to begin a taper of their medications at rate determined in conjunction with their doctor. Patients with fibromyalgia or centralized pain syndrome would be required to taper off opioids completely.

“This is basically more extreme and draconian than any approach in the country. It goes against all of the guidelines,” said Kate Nicholson, a civil rights attorney from Colorado and a chronic pain advocate. “And importantly, it does so without regard for any attempt to measure potential harms or benefits to patients.”

The proposal is the second try by the task force to craft the chronic pain coverage guidelines.

A previous proposal would have limited opioid coverage to 90 days and required patients to taper off painkillers within a year. After hearing from patients and providers, Oregon Health Authority staff reworked the proposal to soften the language and provide patients and their doctors more flexibility in the rate of tapering.

“We at OHA believe that health care delivery is really dependent on the trusting relationship between a patient and provider,” Dr. Dana Hargunani, chief medical officer at OHA, told the task force. “All of the proposal elements, particularly addressing the opioid tapers . including the timelines, the rates and the ultimate success in getting to zero, are intended to be flexible and to meet individual patient needs based on the patient and doctor relationship.”

Oregon Health Authority officials estimated that about 67,400 people would gain coverage to alternative pain treatments under the proposal and that between 600 to 1,200 patients would need to have their opioid treatments re-evaluated by their providers.

Filed under: General Problems | 25 Comments »

Hi, my name is Tom, I am using my wife’s account to write you. My wife, Jane, has been advocating for a long time now. Unfortunately, she fell during a doctor’s off, face first off of the exam table. That was the beginning of the nightmare that I now find her in today. She is unable to contact you herself, or she would be the one contacting you about my question(s) . I want you to know that she is not only a pain patient advocate, but also she is a medical researcher and was working for a large hospital system here in mid-west. She has POTS (Postral Orthostatic Tachycardia Syndrome) initial fall came during an appointment with a new cardiologist. She fell off the exam table, after the doctor asked her to stand up to see how orthostatic she was at the time. She also had Chiari, and has had multiple surgeries, none of which has helped her. During the hospitalization, She was put into an induced coma, it was to help her because she had major brain swelling due to the trauma caused by the fall. She fought hard and she was completely off of the ventilator for three days, then she developed pneumonia, she was put back onto the ventilator immediately. While in the coma, a doctor decided that she needed to have a routine urine test, and they also did a urine drug screening. They tried to say that she didn’t have the right levels of medication in her system. They forced me to leave her side for 4 days as they went through the cameras in the ICU. (I guess they thought I could have somehow get into the locked pump? Impossible, right?) After they re-tested, the results were the same, but she supposedly tested positive for “Norco.” The entire situation is ridiculous! How would they know what medication in that group it was specifically, and how in the world could she have taken it with a trachea in? Then things got worse. Suddenly, her palliative care provider decided that she was “too complex” and they dropped her. Then, her pain doctor (doctor that writes her prescriptions) was raided and all patients were dropped, if complex or needed high doses. And now she is still in the hospital without a pain management doctor to follow her after she gets home. I believe in my heart that she is a fighter, and will pull through this. But I don’t know how to fight this. I have talked to patient advocates, her close relative spoke with the president of the hospital (Her relative is an attorney and retired from the deanship at a Law School) and the hospital keeps maintaining that they cannot help, and there was no way the urine test could have been wrong. They are so corrupted! We requested an immediate blood test when we were told that she had “Norco” in her system, but it never happened. Then, yesterday, the head of the anesthesia department came to see her to see how she was doing. During this visit she informed her father and I that as of June or July of 2019, there will not longer be a diagnosis code for chronic pain. And that they will be placing a number of pills needed for any surgery someone may have. For example, they will only allow three days of low level opiates for a same day surgery. Possibly up to 7 days for back surgery, etc. I asked for any paperwork that she may have regarding this, and she said that she would bring it to me when she comes back next time. I was in such shock, I failed to ask if it was going to be a state or federal law. Jane would have known what to ask, but it comes naturally because of her training in medical school, and working for the hospital (different hospital system than where she is currently inpatient.)I apologize for my lack of all of the correct medical terminology, I am learning in the moment and I may have misspelled some or many of the medical terms. Do you have any advice you can offer me? Have you heard anything about this change in chronic pain diagnosis codes? She basically said that there will no longer be a classification for chronic pain. If you have any advice or information that may be helpful, please message me back! I have lost trust in anyone working in the hospital, they all join together as a corrupt group that will never correct anything that another doctor has said or done. I have heard over and over again that “If Dr. X said that, then it must be correct.” I have also been informed that the only medication that she will be able to go home with is Suboxone or Subutex. (sorry if I butchered the spelling) I have reached out to other people in the chronic pain community that knows her personality, and 4 out of 5 told me that you were the one to contact for advice and guidance. I apologize for reaching out to you on this platform, I wasn’t sure how to best contact you. I look forward to hearing from you! Happy Holidays!

“as of June or July of 2019, there will not longer be a diagnosis code for chronic”

A year or two ago the diagnosis coding system ICD9 was replaced with a new and revised ICD10 codes and the number of diagnosed codes were DRAMATICALLY INCREASED.  Here is an example of the number of ICD10 codes referencing pain https://www.icd10data.com/ICD10CM/Codes/G00-G99/G89-G99/G89-/G89

Putting a pt on Suboxone or Subutex will virtually automatically have someone put a ICD10 code of  “opiate use disorder” on her list of health issues.  Would almost guarantee that a pt will not get a opiate for pain in the future.

Here is a article that I authored about the reliability of urine tests http://nationalpainreport.com/when-the-urine-test-lies-8833834.html

No blood/urine test is guaranteed absolutely accurate and reproducible, it is claimed that with a urine test that you can expect a 20% +/-  false positive/negative.  And urine tests are defined as “qualitative test” the substance that you are looking for is either there are not… it is like a pregnancy test – you are either pregnant or you are not based on the presence or absences of a single hormone. For the hospital to say that “the right quantity” did not show up in a urine test is  PURE BULL SHIT !

Blood tests are “quantitative tests… the come back with “how much” of a substance is in the blood. They can also vary from one test to another.. it just depends on what you are looking for because the body has numerous biological cycles and values can/will vary given the time of day that the sample is taken, taken on empty stomach or not … etc…etc…

The best non-medical reference I can give is to ask a person to take out their driver’s license and ask them to make a comment on the pic on their license and is it a good reflection of how you look or have looked in other photos ?

I do not know if this hospital is just one large hospital in the mid-west or a teaching hospital, if the all the healthcare professionals are independent practitioners or JUST EMPLOYEES of this corporate healthcare system… but I don’t think that this story and this pt’s issues concerning her pain management will have some more things coming to light.

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Why states might start taxing opioids

The next wave of state actions against the opioid crisis may focus on taxing them — depending on the outcome of an industry lawsuit against New York, the first state to try it.

Between the lines: Most of the bills that have been proposed would tax opioid painkillers and use the money for addiction treatment and prevention. But the health care industry argues that they’re bad policy and, at least in the New York law’s case, illegal. That case will be tested when oral arguments in the lawsuit begin Monday.

More than a dozen states saw the introduction of bills to tax opioids last year, but only New York’s made it into law.

• The New York law will collect $600 million over six years from drugmakers and distributors and use it to fund addiction treatment and prevention. These industry groups have responded with three different lawsuits arguing that the law is unconstitutional. Oral arguments for each lawsuit will be heard on Monday.
• Some groups are also arguing that the law is bad policy. “The fee itself could force a generic company, which is making a very low margin, to leave the market. And so a potential policy consequence is that patients are only left with the brand-name, high cost opioids when they have medical needs,” said Jeff Francer of the Association for Accessible Medicines, one of the plaintiffs.

Why it matters: If the industry is successful in its attempt to kill the law, that could influence whether other states follow New York’s lead or how they write legislation.

• “I think that the states see what’s going on in litigation,” Francer said. “No legislator wants to pass a law that a court finds to be unconstitutional.”

One state to watch is Minnesota, where Governor-elect Tim Walz has said he’s supportive of a fee on opioid prescriptions to help pay for treatment and prevention.

• Legislation that would have created such a fee failed to pass last year, but lawmakers have said they want to try again, per Kaiser Health News.
• Other states to watch include California, Delaware, Iowa, Kentucky, Maine, Massachusetts, Montana, New Jersey, Tennessee and Vermont, per KHN.
• Here’s a list of state opioid tax legislation that was introduced in 2018, as compiled by the National Conference of State Legislatures.

Proponents of opioid taxes argue that their value goes beyond just raising money. “If the actual price for these products reflected their true costs, I think we’d see a greater emphasis on reducing opioid use and encouraging use of pain treatments that are much safer and more effective,” said Andrew Kolodny of Brandeis University.

The other side: Opponents say these taxes could make it harder for people to get the pain medication they need. “We do not believe levying a tax on prescribed medicines that meet legitimate medical needs is an appropriate funding mechanism for a state’s budget,” said a spokeswoman for Pharmaceutical Research and Manufacturers of America.

The bottom line: It’s a unique new approach to the fight against the opioid crisis — but a ruling against New York could easily shut it down.

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