https://video.foxnews.com/v/5977750216001/?#sp=show-clips

Dec. 11, 2018 – 10:52 – As federal and state agencies respond to the staggering rate of drug overdose deaths — primarily involving illegal opioids like heroin and illicit fentanyl — doctors who maintain they are responsibly prescribing opioids are getting caught up in the crackdown. This is their side of the story to the opioid crisis and how it has impacted — and for some ruined — their lives.

Notice Kolondy in the video… he states that he has treated/dealt with thousands of ADDICTS…  apparently he has NEVER TREATED the first chronic pain pt..  and this is one of the authors of the CDC opiate dosing guidelines ?

Dr. Stephen Nadeau received a warning from the Gainesville, Fla., hospital where he worked.

Their policy on prescribing opioids was changing, to go beyond federal guidelines aimed at the national overdose crisis that has claimed hundreds of thousands of lives.

The hospital would stop treating pain with opioids. And every doctor, including Nadeau, had to stop prescribing them. Doctors otherwise risked losing hospital admitting privileges – and perhaps even their medical license.

In Helena, Mont., Dr. Mark Ibsen was feeling heat from the state medical board – and the U.S. Drug Enforcement Administration (DEA), for the high-dose opioids he was prescribing to patients in severe, chronic pain. An allegation made by what he described as a disgruntled employee charged Ibsen was overprescribing.

As a result, the state medical board suspended his license. The DEA visited five times, Ibsen said, suggesting he was risking his livelihood and could end up in jail if he kept prescribing.

Both doctors complied and stopped prescribing, affecting roughly 230 of their patients. Tragically, among those were several who committed suicide, the doctors said, when they couldn’t find another health care provider to relieve the pain.

That’s a scenario playing out across the country, as government agencies respond to the staggering rate of drug overdose deaths, involving primarily illegal opioids like heroin and illicit fentanyl. Doctors who maintain they are responsibly prescribing opioids are getting caught up in the crackdown, according to dozens of medical care providers interviewed by Fox News, leaving little room to both play by the rules and properly treat huge numbers of patients who legitimately suffer chronic and intense pain.

Some doctors like Ibsen and Nadeau are opting to simply stop prescribing legal opioids, as insurers, pharmacies, and authorities warn them about overstepping guidelines issued in 2016 by the Centers for Disease Control and Prevention (CDC).

Meanwhile, other doctors, nurses and medical associations accuse the federal government of interfering in the physician-patient relationship, and pursuing simplistic, politically expedient solutions that put tens of millions of Americans at risk.

“Not only is the government legislating the way we care for chronic pain patients,” said Nadeau, a professor of neurology at the University of Florida College of Medicine, “they are substantially taking away our ability to do it.”

CDC GUIDELINES CONTROVERSY

Critics of the way the 2016 guidelines have been applied note they were not intended as law, but as a means to advise primary care physicians. The CDC specifically cautioned against abruptly stopping or forcibly tapering opioid treatment for patients already taking them, because of the danger of withdrawals, or debilitation.

More than 300 health care professionals, including former drug czars in the Clinton, Nixon and Obama administrations, have signed an as-yet unpublished public letter to the CDC, warning of a brewing crisis among pain patients, despite the “laudable goals” of the guidelines.

“Within a year of (CDC) Guideline publication, there was evidence of widespread misapplication of some of the Guideline recommendations,” said the letter, written by three doctors and a pharmacist. “Soon, clinicians prescribing higher doses, pharmacists dispensing them, and patients taking them came under suspicion.”

“Patients with chronic pain, who are stable and, arguably, benefiting from long-term opioids, face draconian and often rapid involuntary dose reductions,” the letter continued. “Often, alternative pain care options are not offered, not covered by insurers, or not accessible … Consequently, patients have endured not only unnecessary suffering, but some have turned to suicide or illicit substance use. Others have experienced preventable hospitalizations or medical deterioration.”

Others argue many authorities have misunderstood, or outright ignored, the CDC’s disclaimer. Health care providers who don’t drop opiate painkillers are setting strict limits on dosage limits, even for chronic pain sufferers who require more medicine because of serious conditions, or the way they hyper-metabolize opioids. Many who do so cite the CDC guidelines, saying they were told to follow them — or took them up as a kind of pre-emptive strike.

Not only is the government legislating the way we care for chronic pain patients, they are substantially taking away our ability to do it.

— Dr. Steve Nadeau, a professor of neurology at the University of Florida College of Medicine

Dozens of pain patients have told Fox News they were dropped or forcibly tapered down by doctors who long treated them quite successfully, but who became fearful about losing their license after being formally admonished, or hearing about other doctors who ran afoul of the government.

Meredith Lawrence, who lived in Tennessee with her husband, Jay, while he suffered decades of pain following a tractor-trailer accident, recalled the helplessness she felt watching him suffer, while his dosage of opioids was being sharply reduced.

Lawrence said the doctor who had treated him successfully for years was very clear about his decision to taper down the dosage.

“He said ‘My patients’ quality of life is not worth risking my practice or my license over,'” she told Fox News. “I’ll never forget that.”

“Jay felt like they gave up on him,” she said, recalling what finally prompted her husband to kill himself. “That was the day Jay gave up. He felt the doctor gave up – and he gave up.”

Dr. Stephen Nadeau

DEA TARGETING ‘WORST OF THE WORST’

Much of the opioid overdose epidemic in recent years stems from illegal drugs, not legitimate prescriptions. But more than a decade of overprescribing – out of ignorance for some, and for others the chance to rake in big profits – played a significant part, according to federal authorities and others who have studied the issue.

Assured by what some charged were deliberately deceptive pharmaceutical companies insisting opioids weren’t very addictive, some health care providers prescribed liberally, even for minor procedures such as a pulled tooth, or non-serious orthopedic injuries. Overprescribing led to greater daily dosages or easy-to-get refills – more than were needed. That, along with the theft and resale of opioids from people who had prescriptions, laid the groundwork for the crisis.

Most prescribers say they recognize many health providers were not prudent enough when prescribing opioids. And many doctors noted they were previously criticized for undertreating pain. Medical schools devoted little time to the study of pain and to opioids, they also say.

“Physicians and particularly medical school residency programs should have been taking more responsibility. Pain is the most common condition, and it’s one of the most difficult to treat,” said Nadeau. “And there [have been] pill mills that have relied on physicians to prescribe and many have done so very irresponsibly. But I think many are compassionate physicians … it’s a reflection of the inadequacy of their training that they basically had to learn the ropes on their own.”

John Martin, the DEA’s Administrator of the Diversion Control Division, said an overwhelming percentage of prescribers followed the rules. Of 1.6 million registrants, he said, less than one percent “operate outside the law.”

But there are still unscrupulous prescribers.

“Remember, with the opioid epidemic, just one practitioner that’s operating outside the law can really have a lot of serious consequences. In a small community, it can wreak havoc,” Martin said. “They’re really going after the worst of the worst of the criminal violators.”

Martin said most prescribers have nothing to worry about.

“Doctors are writing less prescriptions. And that goes down to education with the CDC guidelines,” he said. “There’s a new and different way of looking at using opioids for chronic pain.”

But that’s not what prescribers and patients see.

“Doctors around the country are terrified because of what happened to me and other doctors,” Ibsen said. “We don’t arrest car dealers if someone drives a car and gets into a fatal accident.”

“Standards of care are being decided by a jury of people without medical training,” Ibsen added. “It’s a very bad situation. We’re playing Whack-a-mole with the wrong mallet.”

Remember, with the opioid epidemic, just one practitioner that’s operating outside the law can really have a lot of serious consequences. In a small community, it can wreak havoc…[the DEA agents] are really going after the worst of the worst of the criminal violators.

— John Martin, DEA Administrator of the Diversion Control Division

THE CHALLENGE OF PAIN MANAGEMENT

For many medical professionals, treating pain patients has become a thankless task. The stakes are too high, they say, as even those who try to responsibly manage opioid treatment for their sickest pain patients find themselves hounded by authorities or pharmacists.

Many doctors say they view opioids as a last resort. They are very strong medicines, which often come with strong side effects, ranging from constipation, nausea, liver damage and respiratory problems. Many pain patients said in interviews they were reluctant to take them initially, and eventually did only after other treatments and surgeries failed.

“If we had a good alternative to opioids, every physician would be at the front line of it to prescribe that,” said Dr. Lynn Webster, vice president of PRA Health Sciences, and the past president of the American Academy of Pain Medicine.

In a recent survey by the North Carolina Medical Board of its licensees, 43 percent of 2,661 respondents said they had stopped prescribing opioids. They attributed their decision to concern about getting into trouble.

Patients complained to the board doctors had cut them off, pointing to the CDC guidelines or an initiative by the board aimed at cracking down on health care providers who prescribed high doses of opioids, or who had two or more patients die of overdoses in a year.

And of 3,000 doctors responding to a recent nationwide survey by the SERMO physician network for BuzzFeed News, 70 percent said they had dramatically cut down or altogether stopped prescribing opioids. The main reasons were “too many hassles and risks involved,” “improved understanding of the risks of opioids,” and fear of “getting into trouble,” according to BuzzFeed.

Yet another survey, commissioned by The Physicians Foundation, showed about 70 percent of nearly 9,000 physicians nationwide were prescribing fewer opioids.

In Nevada, where so many doctors stopped taking pain patients after the state implemented strict opioid prescription rules – which increased required record-keeping – physicians like Dan Laird now have a six-month waiting list.

“We turn patients away every day,” said Laird, who last year could fit in patients soon after they called for an appointment. “It’s heartbreaking, but many can’t find doctors.”

Many pain patients told Fox News that after being forcibly tapered down or abandoned by their pain doctors, they have lost much of their ability to function. Many said they have made suicide plans.

“I have heard from — either through email or posts on my blogs — about 1,000 people over past two years who have been denied pain medicine or forced to dramatically reduce their dose who have expressed a desire to die or commit suicide,” Webster said.

Karen Nicholson, a former federal prosecutor who credits her opioid treatment with allowing her to function after years of being bedridden, said: “We’re looking only at the supply, and cutting off people who are not abusing the medication. It made all the difference in the world, I couldn’t sit or stand or walk because of nerve damage. I went from being bed-ridden and completely non-functional to doing my work as a prosecutor.”

WARNINGS, RAIDS AND ARRESTS

Health care providers who prescribe opioids, particularly to high-impact chronic pain patients, are finding themselves on the radar of any number of sources – pharmacists, state medical boards, insurers, and law enforcement.

In a speech about the national overdose deaths epidemic in March, President Trump said: “Whether you are a dealer or doctor or trafficker or a manufacturer, if you break the law and illegally peddle these deadly poisons, we will find you, we will arrest you, and we will hold you accountable.”

But the red line triggering disciplinary action often is inconsistent, and murky. The CDC considers an opioid’s benefits to outweigh risks if it improves pain and function by at least 30 percent. But, doctors say, those factors rarely are considered when authorities scrutinize prescribing patterns.

More often, it’s large amounts of opioids and high doses – statistics on a spreadsheet or chart, without the context of a patient’s medical condition — that can bring disciplinary action.

On Nov. 2, Dr. J. Julian Grove posted to Twitter a letter his Phoenix office had received from Walgreens. Grove said he wanted to provide chronic pain patients “an insight to the veiled threats” that health care providers treating pain are getting these days.

The letter said: “Walgreens has determined that you may have issued prescriptions for opioids that exceed the CDC guidelines.”

It said Walgreens had the right to refuse to fill a prescription that falls outside the guidelines, and added: “Walgreens pharmacists may notify appropriate regulatory agencies when prescriptions are refused.”

Grove blasted the letter.

“I am a double board-certified anesthesiologist and pain specialist, treating complex pain and cancer pain always w/comprehensive approach,” he said. “Insulting.”

Asked about Walgreen’s pressure on prescribers to follow the CDC guidelines, company spokesman Phil Caruso told Fox News in a statement: “As a key patient touchpoint in the nation’s healthcare delivery system, we regularly communicate with prescribers to help ensure the safe and effective dispensing of medications in the best interest of our customers … Fighting the opioid epidemic requires all parties, including leaders in the community, physicians, pharmaceutical manufacturers, distributors, pharmacies, insurance companies, PBMs (pharmacy benefit managers) and regulators to play a role and coordinate efforts.”

The U.S. Attorney’s Office in Atlanta announced in October that some 30 doctors were put on notice there for prescribing opioids in larger quantities and higher doses than others. Prosecutors enclosed the CDC guidelines with the warning letters.

U.S. Attorney B. Jay Pak called those doctors “outliers,” adding the warning letters were meant to point out “atypical practices.” Significantly, Pak said the doctors may not have done anything wrong.

“It is our plan to strategically reduce the impact of this crisis within our community by notifying outlier prescribers that their opioid prescribing habits are not in conformity with accepted standards, or the prescribing habits of their peers,” the agency said in a statement. “Through this initiative and others, it is the goal of the Department of Justice to reduce opioid prescriptions by one-third over the next three years.”

Prescribers particularly dread getting in the crosshairs of the DEA, which can revoke permission to manufacture, distribute and dispense controlled substances. The agency opens about 1,500 new opioid cases per year and makes more than 2,000 arrests. The arrests include DEA registrants, doctor-shopping patients, and prescription forgery rings.

Martin, the DEA administrator, said that actions against prescribers are not undertaken arbitrarily.

“When we are investigating something like a doctor that may be overprescribing, you know because we’re not doctors, in the course of our investigation we are going to solicit medical experts,” Martin said. “We’ll try to get what’s called prescription drug monitoring program information and that’s information that the states have at their level that shows how many prescriptions are being written by a doctor for a patient and being filled at a certain pharmacy.”

“So we’ll try to look at that stuff and then maybe go out to that pharmacy and do an inspection and look at their records and just see if there’s anything more there and then we’ll follow up with that,” he said.

Roughly 800 prescribers each year surrender their DEA registration – a kind of license – when the agency opens an investigation. DEA investigations can involve having assets and medical records seized. In some cases that can lead to bankruptcy, doctors said, prompting many to surrender their opioid prescribing rights, rather than fight a battle against a behemoth government.

Ibsen was an emergency room doctor in Montana when he became – as he puts it, an “accidental pain doctor,” taking “pain refugees” whose doctors had been arrested. Many patients were very ill and suffered severe chronic pain, said Ibsen, who added he was able to wean many patients down to lower doses.

Ibsen said he became a target of the state board of medical examiners after an employee he fired filed a complaint, saying he over-prescribed. His license was suspended but eventually reinstated – after four years. But he decided to stop prescribing opioids after five visits from the DEA.

“They were very vague,” he said of the DEA agents. “They said ‘You’re risking your freedom by prescribing to patients like these.’ I said ‘Patients like what?’ They said, ‘Patients who might sell the pills.’”

“Doctors are taking plea deals because they don’t want to go to prison,” said Ibsen, who was not charged. “Once they arrest a doctor, they seize all their medical records. A doctor can’t make any more income. They seize your assets, and can’t afford an attorney.”

Ibsen referred patients to a prominent pain doctor in California, Dr. Forrest Tennant, who became known for taking people cut off by other doctors. Tennant for years had been researching non-opioid alternatives.

Then the DEA raided Tennant’s office. The agency never charged him, but he, too, gave up prescribing opioids.

“It’s immoral and unsafe to forcibly taper down or abandon a patient,” said Tennant, whose patients included those with terminal illnesses. “Some doctors don’t give these patients any withdrawal medication. Who is the worst offender, then? The CDC, the DEA, the U.S. attorneys who are shutting down doctors, or the doctors who abandon patients?”

One Tennant patient, Jennifer Adams, a former Montana police officer who had been treated by Ibsen, died from a self-inflicted gunshot in April, after the California doctor’s office was raided by the DEA.

Tennant said he respects the idea “the DEA has a right and responsibility to investigate.”

“But since I used high doses, they said my patients were going to overdose and die,” Tennant said. “I’ve been practicing a long time, I’ve not had a single overdose. I’ve given patients thousands of opioid equivalents. I know how patients should be monitored.”

Dr. Lesly Pompy was one of a few pain physicians in a rural part of Michigan, serving as many as 1,500, the majority of them referrals from other doctors who could not treat their chronic conditions. A pain specialist since 1995, he kept long hours, sometimes going to hospital emergency rooms when he was summoned to help a patient in severe pain. Sometimes he would try nerve blocks, many other times opioids.

On Sept. 26, 2016, roughly 25 law enforcement officers raised Pompy’s office at the ProMedica Monroe Regional Hospital.

“There were DEA agents, county and local police, they had everybody in my waiting room and who worked in my office put their hands up. Children were crying. There was a helicopter over the building. It was like a scene from a Jason Bourne movie,” he said.

Pompy was charged with unlawful distribution of prescription drugs and health care fraud from 2012 to 2016. A federal jury indicted him this summer on 37 counts. The indictment maintained Pompy illegally prescribed some 10 million dosage units of controlled substances that fell outside the realm of standard practice. He was also accused of inappropriately filing claims to insurers.

Pompy denies the charges and claims that because he prescribed large quantities of opioids, some to severe pain patients who require high doses, he became a target.

“The damage that the proliferation of opioid distribution has done to our community, like many across the United States has been devastating,” U.S. Attorney Matthew Schneider said, according to published reports. “It’s particularly disturbing when the distributor is a medical professional.”

Pompy’s former patients and some former employees have stood by him, saying he is being scapegoated. Former patients have held rallies and started a Facebook group in support of him.

Janet Zureki, a former patient of Pompy, said that — as often happens after a prescriber’s arrest — patients were left in limbo, having to scramble to find another pain doctor. “After the raid and he could no longer prescribe, everyone was dangerously cut off of their medicines, including me,” she said. “It took me three months to find another pain doctor and they put me on a lower dose of medicine. During that three month period, I had to go without medicine and go through withdrawal.”

Zureki defends Pompy.

“As a doctor, I found him to be very compassionate and he also ran a tight ship,” she said. “I have been in his office and have heard him address someone who wasn’t taking their medicine properly, so I know he didn’t stand for that. He worked tirelessly to help the people in our community,” she said.

DOCTORS LAMENT WALKING AWAY

Nadeau is bewildered over having to stop treating his pain patients, at least one of whom died by suicide. And he said his hospital’s decision to stop working with opioids is by no means unique.

Hospitals increasingly see opioids as a liability; an overdose can land them in a lawsuit, he said. But he wrestles with the fact there are people he can no longer help.

“I can’t provide comprehensive care for my patients, meaning treatment of pain, depression, sleep problems, anxiety, and other problems,” Nadeau said. “In patients with chronic pain, there nearly always are a lot of problems.”

Nadeau reached out to fellow physicians to see if they would take his pain patients.

“It’s been extremely difficult to find physicians to provide comprehensive pain therapy,” he said. “I don’t blame physicians for being scared to death and for prescribing to CDC guidelines, but I do blame [some of] them for treating patients badly.”

For his part, Ibsen is treating patients with medical marijuana. Ibsen said he always strived to get patients on opioids to agree to taper down, and about 80 percent did, often using medical cannabis. For the others, opioids were the best treatment, Ibsen said. He understands the threat of the overdose epidemic all too well.

“My nephew died of a heroin overdose” in the summer, he said. “But incarcerating doctors is not going to solve the addiction crisis.”

“There are two things doctors do – we save lives and we relieve suffering. If we’re not willing now to relieve suffering, then what are we about?”

Filed under: General Problems | 3 Comments »

Police search for suspects in armed robbery of CVS Pharmacy

https://www.wndu.com/content/news/Police-search-for-suspects-in-armed-robbery-of-CVS-Pharmacy–502374401.html

Police are searching for three suspects in the armed robbery of a CVS Pharmacy in Michigan City.

It happened around 3:30 a.m. Monday at the store on Franklin Street.

An undetermined amount of money and narcotics were stolen.

The three suspects are described as black males, either juveniles or young adults. They were wearing all black.

If you have any information about the suspects, please contact Detective Corporal Michelle Widelski at 873-1465 ext. #1088 or email mwidelski@Emichigancity.com

The robbers became very agitated and nervous when the time delay safes wouldn’t open. The pharmacist, her name, ironically, is Patience. They threatened her and physically hurt her.
She has a possible broken rib, wrist, and a large cut on her head.
The District Leaders have refused to tell the other pharmacists what happened, standing by the company’s time delay C2 safe protocols.
I’m so pissed. I know these pharmacists. How do they dare not to let others know to be on alert!?!

Many pharmacies – mostly chains – are putting in “timed safes” to store their controlled substances… Pharmacist entering the combination and when the safe will actually open is highly variable.  This time – at 3 AM – the Pharmacist on duty was harmed because the safe would not readily open…  You notice that the MEDIA did not mention that anyone was harmed…  These timed safes were suppose to discourage robberies, apparently not do their job in this incident… how long before a CUSTOMER is held hostage – or threatened with harm – to get the pharmacist to open a save that they have no control over when it will open.

Filed under: General Problems | Leave a Comment »

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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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.

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