A CAMPAIGN OF INTIMIDATION STATE OF CALIFORNIA vs. Guven Uzun, MD (WALGREENS AT THEIR VERY BEST)
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A CAMPAIGN OF INTIMIDATION, STATE OF CALIFORNIA VS. GUVEN UZUN,MD., (WALGREENS AT THEIR VERY BEST)
Posted on November 20, 2023 by Norman Clement
Documentary: Take Care of Maya
Posted on November 20, 2023 by Pharmaciststeve
Take Care of Maya
This is video documentary available on Neflix and is about 105 minutes long. This family lived in Florida and the hospital involved is John Hopkins All Children Hospital in St Petersburg, FL https://www.hopkinsmedicine.org/all-childrens-hospital This story is apparently not that unusual where parents take their child to an emergency room and the parents are charged with child abuse abuse and one or both parents are charged with child abuse and possibly jailed and the kid(s) put into foster care. This appears to be a classic example of various parts of a “state’s system” – medical practitioners, judicial system, bureaucrats – with apparently good intentions – goes seriously off the rails.
Maya Kowalski sobs as jury awards family over $200M after hospital treatment led to mom’s suicide
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An estimated 24 veterans commit suicide EVERYDAY: substandard pain care?
Posted on November 19, 2023 by Pharmaciststeve
VA reduces number of Veterans prescribed opioids by 67% since 2012
https://news.va.gov/press-room/va-reduces-opioids-by-67-since-2012/
WASHINGTON — Today, the Department of Veterans Affairs announced it has reduced the number of Veterans with opioid prescriptions by 67% since 2012, from 874,897 Veterans in 2012 to 288,820 in 2023 — while continuing to provide comprehensive, world-class pain management to Veterans. Beating the opioid epidemic is a key pillar in President Biden’s Unity Agenda for the nation, and today’s announcement reinforces the importance of preventing opioid addiction.
VA has adopted a Whole Health approach to Veteran-centered pain care, which focuses on the Veteran as a whole person and provides evidence-based treatment via interdisciplinary pain management teams, rather than relying on one treatment. As outlined in VA’s Stepped Care Model for Pain Management, VA helps Veterans manage their pain by providing foundational services at each facility across the enterprise — including nutrition and weight management, movement and exercise, quality sleep, and relaxation techniques that are delivered through a personalized health plan and supported by whole health coaches.
“More than a third of Veterans who use VA live with chronic pain, so it’s a top priority for us to help them manage that pain safely and effectively,” said VA’s Under Secretary for Health Shereef Elnahal, M.D. “By providing comprehensive pain-management tools, we can often avoid the need for potentially addictive medications or invasive procedures. Our goal is to help Veterans live full, meaningful, pain-free lives — and we will continue to look for new ways to help Veterans do exactly that.”
This progress is largely due to VA’s Opioid Safety Initiative (OSI), which first launched in 2013. VA has achieved this reduction through significant investment in interdisciplinary pain management teams, a sustained focus on increasing access to proven therapies and treatments, and by updating opioid treatment guidelines and implementing best practices.
VA also reduced the number of patients receiving opioids and benzodiazepines together by 90%, from 162,444 in 2012 to 15,981 Veterans in 2023; reduced the number of patients on long-term opioid medications by 71%, from 569,207 in 2012 to 162,261 in 2023; and reduced the number of patients on high doses of opioids by 81%, from 76,444 in 2012 to 14,733 in 2023. The majority of Veterans who do receive opioid prescriptions from VA get them for short-term pain care, such as for surgery or an injury. For patients on long-term opioid therapy for chronic pain conditions, VA uses a patient-centered approach that treats and monitors each Veteran individually according to their needs.
VA has also decreased opioid prescription significantly since 2020, the last time VA publicly reported these numbers. Specifically, VA has reduced the number of Veterans prescribed opioids by 16% since 2020; reduced the number of patients receiving opioids and benzodiazepines together by 26% since 2020; reduced the number of patients on long-term opioids by 27% since 2020; and reduced the number of patients on high doses of opioids by 19% since 2020.
The 2012 and 2020 numbers below have been updated from the previous release due to a change in Centers for Disease Control and Prevention tracking measures:
| Tracking Measure | 2012 | 2020 | 2023 |
|---|---|---|---|
| Patients receiving opioids | 874,897 | 345,910 | 288,820 |
| Patients receiving opioids and benzodiazepines together | 162,444 | 21,828 | 15,981 |
| Patients on long-term opioids | 569,207 | 219,639 | 162,261 |
| Patients dispensed greater than or equal to 100 Morphine Equivalent Daily Dose (high dose morphine) | 76,444 | 18,343 | 14,733 |
Veteran pain care at VA is broadly divided into five categories, including medication, restorative therapies, interventional procedures, behavioral health approaches, and complimentary and integrative health.
Learn more about the VA Opioid Safety Initiative or VA pain management.
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Head of DEA lobbying Senator about our illegal street drugs?
Posted on November 19, 2023 by Pharmaciststeve
I wonder how many tens of thousands of email, calls, faxes a Senator would have to receive from constituents to nullify a one-on-one visit from the head of the DEA?
DEA Administrator Briefs Senator Collins on Illegal Chinese Marijuana Operations, Efforts to Combat Opioid Epidemic, and Increase of Meth Use in Maine
Washington, D.C. – On Thursday, U.S. Senator Susan Collins received a briefing from Drug Enforcement Administration (DEA) Administrator Anne Milgram on efforts to address illegal Chinese marijuana operations, combat the opioid epidemic, and fight the rise of crystal meth use in Maine.
“No community is immune from the opioid epidemic, and I commend the men and women of the DEA for their work to combat illicit opioid trafficking and distribution. While we continue to target deadly opioids, we must not lose sight of the need to protect our communities from other emerging threats. The significant increase of crystal meth seizures in Maine – from 3 kilograms in 2021 to 72 kilograms in 2022 – is incredibly shocking,” said Senator Collins. “Administrator Milgram and I also discussed the recent reporting on the illegal Chinese marijuana growing operations in Maine and the potential harm they pose to our public health and national security. We must put an end to these criminal enterprises that are flooding our State and infiltrating our rural communities. I will continue to push the Department of Justice, including the DEA, to work with state and local law enforcement and shut down these illegal operations.”
In August, Senator Collins and the Maine Delegation wrote to Attorney General Merrick Garland requesting information on what the Department of Justice is doing to shut down these illegal Chinese marijuana growing operations. Following an investigation by Maine Wire that uncovered more than 100 foreign-owned drug houses throughout rural Maine earlier this month, Senator Collins renewed her call for federal action.
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Trying to find a Medicare Part D plan – can be a minefield
Posted on November 19, 2023 by Pharmaciststeve
this is the website provided by Medicare.gov https://www.medicare.gov/plan-compare/#/?year=2024&lang=en
I found that this website and the content regarding comparing various Part D prgms that are being offered are lacking some information about what is covered, math is incorrect. Seems like whoever put these info pages together, either didn’t know what they were doing or intentionally putting out incomplete or confusing information. Remember, part D prgms are all being provided by FOR PROFIT INSURANCE COMPANIES.
From Silver Scripts Evidence of Coverage – basically the 99 page the Part D “policy”.
New prescriptions the pharmacy receives directly from your doctor’s office. The pharmacy will automatically fill and deliver new prescriptions it receives from health care providers, without checking with you first, if either:· You used mail-order services with this plan in the past, or · You sign up for automatic delivery of all new prescriptions received directly from health care providers. You may request automatic delivery of all new prescriptions at any time by continuing to have your doctor send us your prescriptions. No special request is needed. Or you may contact Customer Care to restart automatic deliveries if you previously stopped automatic deliveries.If you receive a prescription automatically by mail that you do not want, and you were not contacted to see if you wanted it before it shipped, you may be eligible for a refund.If you used mail-order in the past and do not want the pharmacy to automatically fill and ship each new prescription, please contact Customer Care. If you have never used our mail-order delivery and/or decide to stop automatic fills of new prescriptions, the pharmacy will contact you each time it gets a new prescription from a health care provider to see if you want the medication filled and shipped immediately. It is important that you respond each time you are contacted by the pharmacy, to let them know whether to ship, delay, or cancel the new prescription. Refills on mail-order prescriptions. For refills of your drugs, you have the option to sign up for an automatic refill program. Under this program we will start to process your next refill automatically when our records show you should be close to running out of your drug. The pharmacy will contact you prior to shipping each refill to make sure you are in need of more medication, and you can cancel scheduled refills if you have enough of your medication or if your medication has changed.If you choose not to use our auto-refill program but still want the mail-order pharmacy to send you your prescription, please contact your pharmacy 15 days before your current prescription will run out. This will ensure your order is shipped to you in time. To opt out of our program that automatically prepares mail-order refills, please log on to your Caremark.com account or contact us by calling Customer Care.
The vast majority of electronic Rxs, sent by prescribers goes thru a “switch”, which is basically a electronic routing of any/all communications between pharmacies and prescribers. Now there is only ONE SWITCH since Sure Scripts & Rxhub merged with Rxhub being the “survivor ” of the merger and Rxhub is owned by CVS Health/Caremark and Express Script PBMs and those two PBMs, manage > 50% of all Rxs filled in pharmacies.
In the RED TEXT above from Silver Scripts, to me, suggests that Caremark may just divert any e-RX from a prescriber to your pharmacy of choice and send it to their mail-order pharmacy and they will contact pt if they want the mail order pharmacy to fill the new Rx. And apparently your only options once they contact you – let them know whether to ship, delay, or cancel the new prescription – if you don’t want them to fill it, you will need to contact your prescriber to send another E-Rx and hope that Caremark doesn’t snag it again.
I went to Caremark’s website looking for the place where I could opt-out of mail-order. Could not find anywhere to do it. So, I called their Customer Care and talk to their representative ( Lucy) who said that there was no OPT-OUT. If your prescriber designated your pharmacy of choice, your Rx will be sent to that Pharmacy.
Now choosing a Part D plan that is accepted by your pharmacy of choice. Normally with health insurance, there are providers in-network and out-of-network, but in the Medicare.gov site, Silver Scripts only show if a pharmacy in-network or out-of network, but when you get Silver Scripts pharmacy network guide – you find out that they have in-network and IN-NETWORK (preferred) pharmacies. The “preferred” pharmacies – you get lower co-pays than just in-network pharmacies. In the county where we live, the only “preferred” pharmacies are CVS, and big box or grocery store pharmacies. Missing from the “preferred group” is CVS’ largest community competitor – WALGREEN – that has more stores in my county than CVS!
If you use CVS mail order pharmacy – they promise – Usually, a mail-order pharmacy order will be delivered to you in no more than 10 days.
Now you go to their drug formulary. Notice under column Tier Requirements/Limits, the vast majority of meds -especially generics have the limits of MO – and MO stands for MAIL ORDER. On the Medicare.gov website, Silver Scripts didn’t mention REQUIRED MAIL ORDER. Back to my conversation with Customer Care Representative (Lucy), when I questioned mandatory mail order – according to Lucy – NOPE.
Back to the first section copied above from their 99 page policy explanation and in RED TEXT.. that if you never use their mail order it would appear that they are going to snag new e-Rxs and contact you if you want their mail order to fill it. If you routinely, tell them to delete the new order, will the time frame from when they get the next new e-Rx and they contact you.. get LONGER & LONGER ?
Here is a page out of Silver Scripts formulary
Drug Name Drug Tier Requirements/Limits
NSAIDS
celecoxib capsule 400mg 4 QL (30 EA per 30 days) MO
celecoxib capsule 100mg, 200mg, 50mg 4 QL (60 EA per 30 days) MO
diclofenac potassium tablet 50mg 2 QL (120 EA per 30 days) MO
diclofenac sodium dr 2 MO
diclofenac sodium er 2 QL (60 EA per 30 days) MO
diclofenac sodium/misoprostol tablet delayed release 50mg; 200mcg 4 QL (120 EA per 30 days) MO
diclofenac sodium/misoprostol tablet delayed release 75mg; 200mcg 4 QL (90 EA per 30 days) MO
diflunisal 2 QL (90 EA per 30 days) MO
ec-naproxen tablet delayed release 375mg 2 QL (120 EA per 30 days)
ec-naproxen tablet delayed release 500mg 2 QL (90 EA per 30 days) MO
etodolac er tablet extended release 24 hour 600mg 4 QL (30 EA per 30 days) MO
etodolac er tablet extended release 24 hour 400mg, 500mg 4 QL (60 EA per 30 days) MO
etodolac capsule 300mg 2 QL (120 EA per 30 days) MO
etodolac capsule 200mg 2 QL (90 EA per 30 days) MO
etodolac tablet 500mg 2 QL (60 EA per 30 days) MO
etodolac tablet 400mg 2 QL (90 EA per 30 days) MO
FENOPROFEN CALCIUM CAPSULE 400MG 4 QL (240 EA per 30 days) MO
fenoprofen calcium tablet 600mg 4 QL (150 EA per 30 days) MO
flurbiprofen tablet 100mg 2 QL (90 EA per 30 days) MO
ibu 1 MO
ibuprofen tablet 400mg, 600mg, 800mg 1 MO
ibuprofen suspension 2 MO
ketoprofen extended release capsule 200mg 4 QL (30 EA per 30 days) MO
ketorolac tromethamine tablet 10mg 2 QL (20 EA per 30 days) PA MO
meloxicam tablet 1 MO
nabumetone 2 MO
naproxen sodium tablet 275mg, 550mg 2 MO
naproxen tablet 250mg, 375mg, 500mg 1 MO
naproxen suspension 4 MO
naproxen tablet delayed release 375mg 2 QL (120 EA per 30 days) MO
naproxen tablet delayed release 500mg 2 QL (90 EA per 30 days) MO
oxaprozin 2 QL (90 EA per 30 days) MO
piroxicam capsule 20mg 2 QL (30 EA per 30 days) MO
What is a pt to do?
what I may end up doing is to use the discounted cash price that the independent pharmacy that we patronize offers. If we stayed with the Humana Part D that we have had for the last 3-4 yrs, as opposed to signing up with Silver Scripts. The difference between premiums and annual deductible would be abt $2100 for a year. Both Part-Ds are not paying for two meds each of us take. By, paying cash, we don’t have to deal with prior authorizations, daily dose limits, step therapy, and other PBM’s BS. Our prescriber will not have to deal with getting prior authorizations on your meds. Our pharmacy will not have to pay the PBM a charge per Rx submitted electronically and they will not get any claw back in DIR fees ( direct and indirect remuneration fees). https://www.pharmacytimes.com/view/white-paper-dir-fees-simply-explained. The first week of Jan, 2024, I am going to request a refill on what should be a fairly inexpensive med, that one of us takes, to see if Silver Scripts rejects payment because mail order is mandatory.
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PERSECUTION OF DR. ASHOK JAIN, MD CLINICAL PSYCHIATRIST “IN HIS OWN WORD”
Posted on November 18, 2023 by Norman Clement
DR. ASHOK JAIN, MD FORENSIC AND CLINICAL PSYCHIATRIST
Filed under: Coming to a town near you, General Problems, Medication withdrawal | Leave a Comment »
54 surgical procedures over 14 yrs on this earth
Posted on November 17, 2023 by Pharmaciststeve
ADHD drug maker suing DEA over ‘effectively shutting down’ manufacturing
Posted on November 15, 2023 by Pharmaciststeve
ADHD drug maker suing DEA over ‘effectively shutting down’ manufacturing
OMAHA, Neb. (WOWT) – During an ongoing national shortage for drugs used to treat attention-deficit-hyperactivity disorder (ADHD), one manufacturer is suing the federal government.
A New York-based law firm representing Ascent Pharmaceuticals, Inc. said the Drug Enforcement Administration is keeping its client from manufacturing generic prescriptions to treat ADHD.
“At the very time that there is a federal government-recognized scarcity of ADHD medications, the government has elected to effectively shut down the company that was making 20 percent of the generic forms,” said Jim Walden, managing partner at Walden, Macht and Haran.
Walden said the DEA’s basis for the move is over alleged record-keeping violations by Ascent—assertions Walden said are wrong.
Hanging in the balance was Ascent’s application for a production quota.
“They were supposed to decide Ascent’s quota for manufacturing in July of ‘22,” Walden said. “Over the course of the last year-and-a-half, DEA has been conducting this audit of Ascent’s record keeping, and Ascent has cooperated. It provided all the documents when DEA expressed some concerns about documents.”
He said over that year-and-a-half, Ascent had been falling back on its stockpile of raw materials for making ADHD drugs, but that it has since run out.
He said the DEA finally denied Ascent’s quota application only after the company asked a judge to speed up the agency’s decision on it in late September.
“We had been strung along, believing that we were going to get approved any day. After we filed that lawsuit, DEA filed its final denial two days after.”
So Walden has filed an emergency motion to restore Ascent’s ADHD drug manufacturing.
This comes during a time when prescriptions used to treat ADHD have been in short supply, which local pharmacies have been feeling.
It started with Adderall, then expanded to other medications like Focalin, Ritalin, Concerta, and Vyvanse.
Because of that, Walden said it’s a bad time for the government to put a muzzle on Ascent Pharmaceuticals’ manufacturing efforts.
“It used to make roughly 47 million pills that were used for ADHD treatments,” he said. By August of this year, it was only producing about 100,000 of them. Now, it’s producing none.”
6 News reached out to the DEA for comment but has not heard back.
The agency has said pharmaceutical companies have more than enough raw ingredients to make ADHD drugs.
Walden said he wouldn’t be surprised if the U.S. Court of Appeals for the Second Circuit makes a decision on Ascent’s lawsuit in the next couple of weeks.
42 USC 1395: Prohibition against any Federal interference
https://uscode.house.gov/view.xhtml
From Title 42-THE PUBLIC HEALTH AND WELFARE CHAPTER 7-SOCIAL SECURITY SUBCHAPTER XVIII-HEALTH INSURANCE FOR AGED AND DISABLED
§1395. Prohibition against any Federal interference
Nothing in this sub chapter shall be construed to authorize any Federal officer or employee to exercise any supervision or control over the practice of medicine or the manner in which medical services are provided, or over the selection, tenure, or compensation of any officer or employee of any institution, agency, or person providing health services; or to exercise any supervision or control over the administration or operation of any such institution, agency, or person.
(Aug. 14, 1935, ch. 531, title XVIII, §1801, as added Pub. L. 89–97, title I, §102(a), July 30, 1965, 79 Stat. 291 .)
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Clinical Context of Suicide Following Opioid Transitions
Posted on November 13, 2023 by Pharmaciststeve
Clinical Context of Suicide Following Opioid Transitions
CSI:OPIOIDs (Clinical Context of Suicide Following Opioid Transitions) is a scientific research study to closely examine suicides that happen after prescription opioid dose reductions in patients with long-term pain. Beginning as a pilot study supported by UAB Heersink School of Medicine’s Department of Medicine, today it’s supported by a Veterans Administration grant under the title “CSI:OPIOIDs-V“. The study’s purpose is to increase knowledge of the demographic, societal, and clinical factors that have led and may lead patients with pain to die by suicide after opioid reduction or stoppage.
Our work was inspired by the attention and tracking of Ms. Anne Fuqua, who noticed that many suicides of pain patients were reported by families online, but not followed up by health authorities or policymakers.
Results from the CSI:OPIOIDs study will help families, clinicians, and policymakers understand when and why patients with pain die by suicide after opioid reduction or stoppage. The results will help identify ways to improve health care and assure positive outcomes for patients with pain.
Why It Matters
Since 2012, many doctors have been reducing or stopping opioid medications in their patients with pain. While some patients have tolerated this change in medication, others have been harmed gravely, with suicidal events found in several research papers and news reports. Right now, no one fully understand what personal factors or life circumstances differentiate patients who tolerate change in their opioid medications well from those who are harmed by that change. Until we look closely at the individual tragedies, we cannot expect the kind of systematic changes in healthcare that will reduce negative outcomes for similar patients in the future.
What Will This Study Do
The CSI:OPIOIDs team will:
- Compile a registry of individuals who have died by suicide following a reduction or stoppage in their opioid medication
- Perform in-depth, one on one interviews with survivors of individuals who have died by suicide after opioid transition to understand what led their loved-one to commit suicide
- Identify factors common to these individuals prior to their death and suggest ways to reduce likelihood that future patients will commit suicide under similar circumstances
There are many reasons that no other team has attempted to study these deaths closely. But one is that any form of research that reaches out to members of the public who have suffered such a loss is hard to do. A research team must surmount logistical challenges and establish trust across communities of patients, families, experts and policy makers. See our briefing on Youtube to learn more.
Research Team
The CSI:OPIOIDs research team is led by Dr. Stefan Kertesz, Professor of Medicine at UAB Heersink School of Medicine and physician at the Birmingham VA Medical Center. See Our Team for more information.
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