TBI: counterfeit drugs are newest trend contributing to opioid epidemic

Posted on November 3, 2018 by Pharmaciststeve

TBI: counterfeit drugs are newest trend contributing to opioid epidemic

https://www.wjhl.com/top-news/regional/tbi-counterfeit-drugs-are-newest-trend-contributing-to-opioid-epidemic/1570683855

KNOXVILLE (WATE) – The Tennessee Bureau of Investigation is reporting a new trend contributing to the opioid epidemic: counterfeit drugs. 

The phenomenon involves drugs, specifically pills, made to look like prescription medications like Percocet or Xanax.

Using pill presses that can produce thousands of pills in an hour, the medications are manufactured to look real, but are made with a combination of other drugs. 

“Pharmaceutical manufacturers will tell you, when you take powders and try to mix them together, it’s one of the most difficult things that they do,” said T.J. Jordan, Assistant Director for the TBI, overseeing the drug division. 

Jordan says the growing trend is dangerous because the counterfeit drugs can be laced with more deadly combinations, like fentanyl, without the buyer knowing. One could talk to Renaissance Recovery de-addiction experts to get help with overcoming the issues.

The counterfeit pills are more increasingly sold online using the “Darkweb,” according to the TBI’s annual report, and cannot usually be traced as easily by law enforcement. 

“People think they’re buying hydrocodone, but they’re actually getting a pill laced with fentanyl. They think they’re getting a good pill, but actually, it’s counterfeit and it isn’t what it appears to be,” said Jordan. 

In Knoxville, a local pharmacist says his job changes weekly to stay up-to-date to new medications and prescription laws. 

 “I understand that people want to save money, i understand that money can be tight, but it’s not worth risking your life over saving $5 on the internet getting a medication that you may not know what you’re getting,” said Matt Windham, pharmacist in charge at Belew Drugs on Washington Pike in Knoxville. 

Windham says while he doesn’t think about counterfeit drugs everyday, he hopes to educate the community about the risks associated with some drugs, to help the community be safer. 

The TBI reports investigations involving counterfeit drugs are increasing statewide. 

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Chronic Pain in Adults on the Rise: A Potential Crisis

Posted on November 3, 2018 by Pharmaciststeve

Chronic Pain in Adults on the Rise: A Potential Crisis

https://www.medscape.org/viewarticle/904084

Clinical Context

All clinicians are aware of the mandate to reduce opioid use, but is awareness having an effect? Data from the Centers for Disease Control and Prevention suggest that the tide has shifted in the prescription rate for opioids.[1] Opioid prescription rates reached a peak in 2010 to 2012, but since then, there has been a steady decline. In 2012, the rate of opioid prescriptions per 100 persons in the United States was a staggering 81.3. That figure fell to 58.5 by 2017. Prescription rates for high-dose opioids have fallen by more than half from their peak in 2008.

Nonetheless, 17% of Americans received at least 1 opioid prescription in 2017, and these patients averaged 3.4 prescriptions over the year. There is wide geographic variability in the rate of opioid prescriptions, with rates generally higher in locations with larger proportions of non-Hispanic white residents and more primary care physicians and dentists.

While US healthcare practitioners grapple with the opioid epidemic, we still need to treat the many adults with chronic pain. How many are there, and what are the risk factors for chronic pain? Dahlhamer and colleagues address this subject in their current research.

Study Synopsis and Perspective

Chronic pain affects about 50 million US adults, and “high-impact” chronic pain, which interferes with life or work activities, affects around 20 million adults, new federal data indicate.

“Pain is a component of many chronic conditions, and chronic pain is emerging as a health concern on its own, with negative consequences to individual persons, their families, and society as a whole,” note the authors, led by James Dahlhamer, PhD, from the National Center for Health Statistics, part of the Centers for Disease Control and Prevention.

Their analysis of 2016 National Health Interview Survey data showed that 20.4% of US adults had chronic pain in 2016, and 8.0% had high-impact chronic pain. Both types of pain were more prevalent in women than men (20.8% vs 17.8% and 8.9% vs 7.0%, respectively).

Both types of chronic pain were also more prevalent among older adults, veterans, those previously but not currently employed, those living in poverty or rural areas, and those with public health insurance.

The study was published September 14 in the Morbidity and Mortality Weekly Report, in time for Pain Awareness Month.[2]

$560 Billion in Direct Costs

Chronic pain and high-impact chronic pain have been linked previously to restrictions in mobility and daily activities, dependence on opioids, anxiety, depression, and poor quality of life, the authors write.

Chronic pain contributes to an estimated $560 billion each year in direct medical costs, lost productivity, and disability programs, they note.

As reported by Medscape Medical News, the federal government’s National Pain Strategy, released in the spring of 2016, marked the nation’s first coordinated plan for reducing the burden of chronic pain.

The plan recognized the need for better data to inform action and called for better estimates of chronic pain and high-impact chronic pain in the general population.

Dr Dahlhamer and colleagues say their report “helps fulfill this objective and provides data to inform policymakers, clinicians, and researchers focused on pain care and prevention.”

The study had no commercial funding. Dr Dahlhamer has reported no relevant financial relationships. One author has received honoraria for serving as a member of a research grant review board for the American Pain Society and serves as senior editor for Pain Medicine. Another author has received grants from Pfizer Inc as an investigator of the use and misuse of opioids at Kaiser Permanente Washington Health Research Institute and from inVentive as coinvestigator for US Food and Drug Administration-mandated postmarketing surveillance studies of extended-release opioids.

Morb Mortal Wkly Rep. 2018;67:1001-1006.

Study Highlights

  • Researchers used data from the 2016 National Health Interview Survey, which features an in-home interview among community-dwelling adults. The current study focuses on results from respondents at least 18 years of age.
  • The survey contained questions about frequency of pain, as well as functional limitations associated with pain.
  • Chronic pain was defined by researchers as pain that occurred on at least most days during the last 6 months. High-impact chronic pain was defined by disability in life or work activities resulting from pain on most days during the last 6 months.
  • The main study outcome was the prevalence of chronic pain and high-impact chronic pain in 2016. Researchers also assessed sociodemographic factors that might affect the prevalence of pain.
  • The study analysis estimated that 50.0 million US adults, or 20.4% of the total adult population, had chronic pain, and 8.0% of US adults, or nearly 20 million individuals, had high-impact chronic pain.
  • Variables associated with higher rates of chronic pain included being a woman, unemployment, poverty, lower educational attainment, and residence in a rural area.
  • Rates of chronic pain were highest among non-Hispanic white adults compared with other racial/ethnic groups. However, there was no difference in rates of high-impact chronic pain based on race and ethnicity.
  • Similarly, veterans had higher rates of chronic pain, but not high-impact chronic pain, compared with nonveterans.
  • Another factor associated with higher rates of both chronic pain and high-impact chronic pain among adults younger than 65 years was public health insurance vs either private insurance or no health insurance.

Clinical Implications

  • Rates of any opioid and high-dose opioid prescriptions have fallen substantially in the United States from 2012 to 2017, but 17% of Americans still received at least 1 opioid prescription in 2017. Communities with higher rates of opioid prescriptions have higher concentrations of non-Hispanic white residents, as well as more primary care physicians and dentists.
  • Approximately 1 in 5 US adults has chronic pain, and the rate of significant disability resulting from pain is 8%. Being a woman, poverty, public health insurance, and non-Hispanic white race were associated with higher rates of chronic pain.
  • Implications for the Healthcare Team: The healthcare team should try to use local resources to present an effective and multidisciplinary approach to treating the many US adults with chronic pain.

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Indiana Pharmacist’s has VERY SICK LITTLE GIRL… raising money for special operation

Posted on November 2, 2018 by Pharmaciststeve

Shi would like you to support

Rose Recovery Journey
by making a donation and helping
spread the word.

I’m trying to raise $17,000
$9,400 RAISED / 38 SUPPORTERS / 18 DAYS LEFT

 

 

 

 

Dear Member,

One of our member is in dire need of the entire Indiana Pharmacists Alliance help to save her daughter who is critically ill and needs to be operated urgently. It will be appreciated if we all can join hands together as one family and save her daughter. A fundraising campaign has been created and we are relying on the entire family support to help her raise the funds needed. Below is the fundraising campaign, thank you for your support in advance. No amount is too small and any amount donated out of the kindness of your heart will be highly appreciated.

Rose is a 4 years old girl who was diagnosed with Neurofibromatosis type 2 when she was 3 years old. This illness affected her hearing and vision, it causes tumors to grow anywhere in her brain, along with the spinal cords and peripheral nerves. So far Rose have had 5 different surgeries to safely remove the tumors whenever needed to preserve her life.

A pioneering operation costing $17,000 is available privately and we have been able to raise $9,400. This operation will not only lasers all the tumors away, but it will also reduce the risk of Rose needing further treatment.

Rose wants to be a doctor when she grows up. Please help us raise the money for Rose’s operation so that she can live a normal, life and fulfill her dream.

Please share your prayers and financial support to encourage Rose in this battle. We understand money can be tight, but any amount you’re able to give will truly make a huge impact.

MAKE A DONATION

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23andMe to offer direct-to-consumer pharmacogenetics reports

Posted on November 2, 2018 by Pharmaciststeve

23andMe to offer direct-to-consumer pharmacogenetics reports

https://www.drugstorenews.com/pharmacy/23andme-to-offer-direct-to-consumer-pharmacogenetics-reports/

The Food and Drug Administration has granted consumer genetics and research company 23andMe de novo authorization to offer reports on pharmacogenetics, indicating how customers’ genetics may influence the way they metabolize certain medications.

This is the first authorization of a direct-to-consumer report on pharmacogenetics and came through the FDA’s de novo classification process. The FDA has classified these direct-to-consumer pharmacogenetic reports as moderate risk that have special controls to ensure safety, effectiveness and accuracy. This authorization enables 23andMe to report on numerous variants associated with pharmacogenetic response.

“We’ve continued to innovate through the FDA and pioneer safe, effective pathways for consumers to directly access genetic health information,” 23andMe co-founder and CEO Anne Wojcicki said in a statement. “Pharmacogenetic reports are an important category of information for consumers to get access to and I believe this authorization opens the door for consumers to work with their health providers to better manage their medications.”

23andMe had to demonstrate the accuracy of its testing and consumer comprehension of the testing information, including “treatment adherence” and whether or not a customer would continue their prescribed treatment of a medication, or change or stop treatment. Studies showed that more than 97% of users understood that they should not use the report to make any changes to treatment without consulting their doctor, the company said.

The authorization allows for the reporting of variants in multiple genes that impact how well an individual metabolizes certain medications, for example clopidogrel, which is commonly prescribed to prevent heart attacks and strokes. These genes are associated with response to more than 50 other commonly prescribed and over-the-counter medications. The authorization allows 23andMe to provide customers with information on whether they are predicted to be fast or slow metabolizers based on their genetics, and when supported by appropriate clinical evidence, whether they may experience reduced efficacy or have an increased chance of side effects from certain medications.

Finally, the company said that the decision continues the commitment made by 23andMe to return all the types of genetic health information to customers that it offered prior to an FDA warning letter in 2013. However, 23andMe has not determined when it will be able to make these new reports available to its customers.

Filed under: General Problems | 1 Comment »

OH: “Not only law enforcement, [but] the judiciary across the state,” against no jail, just treatment for substance abusers

Posted on November 2, 2018 by Pharmaciststeve

Ohio ballot measure seeks to reform drug laws

https://www.foxnews.com/politics/ohio-ballot-measure-seeks-to-reform-drug-laws

Heath Bechler has been treating addicts both in and out of prison for 25 years. Incarceration, he said, often gets in the way of real recovery.

“Historically, we’ve seen that prison doesn’t work,” Bechler explained.

In order to stay clean and sober, he believes that addicts need some form of treatment.

“The threat of punishment is good for a lot of people in society, an overwhelming majority,” Bechler told Fox News’s Douglas Kennedy, “but when it comes to addicts, they don’t think like average people think.”

Right now, Ohio prisons are 30 percent over capacity, and that’s just one of the reasons Bechler is supporting a ballot measure that would make low-level drug possession here a misdemeanor rather than a felony in the state of Ohio.

Ohio Issue 1 would also prohibit sending people to prison for non-criminal parole violations and would set aside a large percentage of a projected $100 million in savings for addiction treatment. It’s a proposal that’s getting a lot of pushback.

Many in law enforcement in Ohio are opposed to the measure.

“Not only law enforcement, [but] the judiciary across the state,” said Paul Pfeifer, a former state Supreme Court judge and the current executive director of the Ohio Judicial Conference. He called the proposal “devastating, reckless and dangerous.”

Pfeifer said judges and prosecutors oppose question 1 because it provides too much carrot and not enough stick.

“It removes punishment completely,” Pfeifer said. “First two offenses, no jail no prison. You can’t get an addict into treatment without the threat of punishment.”

Bechler disagrees with the position that addicts can’t get clean without punishment, or the threat of punishment.

“They can,” he said, “and they do.”

Bechler believes that prison, and the threat of prison, can actually make many addicts rebel from treatment.

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CDC Director: another powerful bureaucrat with a kid involved in drug abuse

Posted on November 1, 2018 by Pharmaciststeve

CDC director says they’re “poised” to do more gun research if Congress funds it

https://www.cbsnews.com/news/cdc-director-robert-redfield-says-cdc-poised-to-do-more-gun-research-if-congress-funded-it/

Dr. Robert Redfield, director of the Centers for Disease Control and Prevention, says the CDC is “poised” for additional research on the causes of gun violence if Congress chooses to give it additional funding. According to Redfield, how the CDC prioritizes its spending is largely driven by where “Congress puts the priority to want to fund us.”

“We have a program called the National Violent Surveillance System… and so, we currently are recording violent deaths from all causes, including firearms. And so that is, that’s ongoing,” Redfield said.

In 1996, Congress passed the Dickey Amendment, which prohibits using public health funds to “advocate or promote gun control,” but earlier this year, Health and Human Services Secretary Alex Azar said he would instruct the CDC to conduct research on the causes of gun violence.

Asked what kind of constraints the CDC faces from that provision, Redfield said, “I don’t feel we have any restrictions to do research. The issue will be if Congress can give us funding to expand the research that we’re currently able to do. … The secretary has also made it clear that we do not have a restriction to do research. Basically, what we need to do is get a funding mechanism for Congress to instruct us to do that research.”

Redfield also spoke about what he considers considers the public health crisis of our time: the opioid epidemic. Preliminary CDC data shows the number of deadly drug overdoses nationwide has plateaued for six straight months even though more than 72,000 Americans died last year from drug overdoses. A little over 48,000 of those deaths were from opioids. 

It’s a crisis that hits close home for Redfield.

“It’s personal to me. I think you know one of my six children almost died from cocaine that was contaminated with fentanyl,” Redfield told “CBS This Morning” co-host John Dickerson. “You know, my wife and I have a very supportive family. But my own son was in tears when he finally told us that he was using cocaine. And I didn’t understand, you know, why didn’t he come earlier? Well, because he was made to feel ashamed. … You know, who knows why he started using cocaine? 

According to Redfield, we now know that 2 to 6 percent of people who get a single prescription for an opioid for routine procedures  like wisdom tooth removal end up becoming chronically dependent.

“There’s a pathophysiological reason for addiction… and the more we can embrace that, not make people feel bad about it,” he said. “We don’t make people feel bad if they have cancer. We have to allow people to embrace the medical illnesses they have and help them get the best therapy treatment so that they can go on to a productive and happy life.”

Despite recent CDC numbers suggesting the rise in drug overdoses has leveled off, the CDC director said it is going to require “enormous effort” to get the epidemic under control.

“Well, I think, first and foremost, we have to recognize it for what it is. It’s a medical condition. It’s not a moral failing, right. And the second thing we have to recognize is it’s actually a chronic medical condition,” he said. “You know, I try to encourage people to support families like us that are trying to win the battle against opioid addiction. … Recognize that treatment success is possible. It should become the rule, not the exception.”

Now we have the head of the CDC and our Surgeon General – both medical doctors – that claims that addictions are mental/health issues but the DOJ is still functioning under their 1917 declaration that opiate addiction is a CRIME and not a DISEASE and the DOJ the only “treatment” that they have for treating addiction is jail/prison.

Yet today, and for several decades, the DEA has been licensing Methadone and Suboxone clinics to treat the CRIME of opiate addiction with medication(s).

Also since at least 1973 the DEA has claimed that Marijuana has NO MEDICINAL VALUE, but recently they have chosen to call for clinical trials to determine what medical benefits Marijuana could provide.  Does this suggest that DEA’s claims that Marijuana had not medicinal value back in 1973…was not based on any valid medical data ?

What else has the DEA based their actions on “opinions” and not FACTS over the past 45 years ?

It is common knowledge that the vast majority of illegal drugs on the streets is coming from Mexico and China and has contributed to tens of thousands of deaths each year. Is it time that Congress pulls in the reigns in on the DEA and refocus their actions – or limit their actions – to focus their actions on those cartels that are flooding our streets with illegal drugs ?

Filed under: General Problems | 3 Comments »

when opinions are treated as FACTS and FACTS are treated as LIES ?

Posted on November 1, 2018 by Pharmaciststeve

Andrew Mark Ho, MD

http://doctorsofcourage.org/andrew-mark-ho-md/

On April 19, 2016, Denver internist, Andrew Mark Ho MD’s life turned upside down. This was the beginning of a Board of Medicine/Federal government collusion to put another good, innocent doctor in prison. He was coerced to stop practicing as a result of the BOM’s investigation of six patients and his prescribing benzodiazepines in combination with opioids. He agreed to stop practicing in lieu of a summary suspension of his license by the board. Meanwhile, the board continued the investigation against him for his evaluation and treatment of patients.

So what does Dr. Ho’s patients say about his care? Dr. Ho had exemplary patient statements on various websites of healthcare professionals. Here are some of them:

Dr. Andrew Ho is not replaceable. He is the only doctor who patiently spends as much time as i need to answer any and all questions, sometimes up to 30 minutes per visit. He understands my challenges of travelling up to 9 months a year overseas and shows compassion in all aspects of work and family.

Exceptional doctor. Best doctor I have ever seen. He’s the best. Listens to your problems and does everything he can to help you. Don’t want to part with this doctor.

Dr. Andrew Ho is the best internist I’ve ever had and I’ve lived all over the world the past 30 years. His greatest qualities are deep knowledge of current and traditional medicine, bedside manner and that he spends however much time I need to answer all questions with a very relaxed demeanor. He understands the issues of a world-traveler (my two prior back surgeries) who spends up to 9 months a year (3 weeks a month) overseas and only one week back home in Denver.

DR Ho is most unusual…..HE cares ….he listens to your words and treats you like an important person. He helps with any needs, is most informed on latest drugs and treatments. I feel honored to call him “MY DOCTOR”. He is kind, friendly and ready to help you heal. May God ALWAYS keep him in His care.

So the attack by the BOM prevented Dr. Ho from making a living for over two years. Then, the icing on the cake. On October 25, 2018, the Feds indict him using the Controlled Substance Act illegally. The indictment states:

“Andrew M. Ho, practicing internal medicine in Denver, Colorado, has been charged with distributing or dispensing controlled substances illegally between September of 2014 and November of 2015 outside the usual course of professional practice and for a purpose other than a legitimate medical purpose.”

This statement was by U.S. Attorney Bob Troyer. Since the CSA states in §802(56)(c), that only the doctor can determine legitimate medical practice, then it would appear that Mr. Troyer is practicing medicine without a license making that statement.  He should be the one charged and put in prison, along with all the other US Attorneys that are doing the same thing for money and promotions.

Doctors in America should stop prescribing controlled substances altogether. This attack on Dr. Ho shows that anyone is a potential target. Don’t be naïve and think that there is any safe practice in pain management. If it is the US Attorney’s office that is determining what is legitimate medical practice, then it is just a matter of who they want to target, whether for money or for ethnic cleansing of the medical profession.

The US Attorney’s press release also shows how they are targeting doctors. They have formed the Colorado U.S. Attorney’s Opioid Working Group. The indictment states the following about this group:

“It is comprised of expert civil and criminal staff in the U.S. Attorney’s Office who use sophisticated data analytics to identify doctors and pharmacies unlawfully dispensing opioids.”

What that actually means is that the group is simply DOJ staff, some possibly even without a high school education, who go through the prescription monitoring program for the state and choose doctors based on the numbers or types of prescriptions written. And now with the passing of H.R. 6 becoming Pub. L. 115-271, more doctors will be targeted by simply using prescription numbers.

Filed under: General Problems | 2 Comments »

News 4 Investigates: How a major retailer was making personal information easily accessible

Posted on November 1, 2018 by Pharmaciststeve

News 4 Investigates: How a major retailer was making personal information easily accessible

https://www.kmov.com/news/news-investigates-how-a-major-retailer-was-making-personal-information/article_7f98db9c-dbe0-11e8-a0a3-fbc413d0ede0.html

ST. LOUIS (KMOV.com) – A major retailer was putting you at risk by making very personal information easily accessible.

Now a News 4 Investigation is getting results and a popular chain that you likely shop at all the time is making changes.

The retailer is Walgreens.

Lawsuit: Wrong Walgreens prescription led to suicide attempt
(Credit: AP Images)

If you enter your number at the cash register, you can earn Balance Rewards from Walgreens, points that can total up to cash.

Recently, though, Trey Forester, from St. Charles County, made a startling discovery.

“It’s just ridiculous to me,” he said.

On the Walgreens website, you could enter in anyone’s phone number, and, if they’re a member of the rewards program, you could see exactly what they bought, when, where and for how much.

“You just need their phone number. It’s simple. Just a phone number,” Forester said.

Forester looked up a few friends.

“I didn’t tell him, but he had bought Rogaine. That’s not information you want people knowing,” Forester said.

News 4 took the issue to consumer experts who say it’s a huge breach of privacy.

“It’s really crazy,” said Cara Spencer.

Spencer works for the Consumer’s Council of Missouri and is also an elected official.

“For me, my phone number is public, that’s true of almost anyone these days,” she said.

Spencer says our purchases say a lot about what’s going on with us, items like itch cream, lice shampoo or adult diapers for example.

“It may be something you wouldn’t want your employer to see, friends or neighbors to know that you’re experiencing some sort of medical situation,” she said.

Or personal items, like pregnancy tests and condoms, could show an ex you’re moving on.

“If you are having a domestic situation, this could wind up putting you in real danger,” she said.

She says nothing about the balance rewards program made it clear that your data might be out there.

“Do you think it should change?” asked Investigative Reporter, Lauren Trager.

“Absolutely, I don’t think this should be so freely and readily available to the general public,” Spencer said.

Forester says he never got a sufficient response and he wanted answers.

“Are they going to fix the problem? Are they going to apologize for allowing this to happen?” he asked.

So News 4 took the issue directly to Walgreens corporate offices and that’s exactly what they did.

Less than two days after our inquiry about it, the website changed.

A spokesperson politely declined to do an interview. But they provided the following statement:

We take the privacy and security of our Balance Rewards members seriously. A recent enhancement…. on Walgreens.com inadvertently also allowed the potential viewing of some additional purchase activity associated with that account. We have taken immediate action to correct this issue. We apologize for any inconvenience this may have caused. 

Forester is relieved it’s resolved.

“It’s all we could talk about,” he said.

Walgreens says the issue has gone on since July.

After we brought this to their attention, Walgreens.com now prompts you to put in a password to see your purchase history.

We checked with other retailers, they require the same thing.

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AG Sessions: statistics of number of doses prescribed determined “medical necessity” ?

Posted on October 30, 2018 by Pharmaciststeve

AG Sessions calls for state medical board ‘to be more aggressive’ in opioid crisis

Sessions says medical boards failed to act quickly

https://www.news5cleveland.com/news/local-news/investigations/ag-sessions-calls-for-state-medical-board-to-be-more-aggressive-in-opioid-crisis

WASHINGTON, D.C. – U.S Attorney General Jeff Sessions is calling on state medical boards across the country “to be more aggressive” when investigating and disciplining physicians engaged in overprescribing painkillers that contributed to an opioid crisis that has ravaged Ohio and the nation.

This comes after an exclusive 5 On Your Side investigation, “Prescription for Failure.”

In a rare, one-on-one interview in Sessions’ private conference room at the U.S. Justice Department in Washington, D.C., Sessions sat down with 5 On Your Side Chief Investigator Ron Regan to discuss the impact of the opioid crisis that led to the deaths of 72,000 Americans last year.

As part of our investigation, we reviewed three dozen of the highest profile cases involving pill mills and doctors across Ohio in recent years. We found 1 in 3 doctors had serious disciplinary histories, including felony drug convictions.

Even so, they were able to keep their medical licenses and later went on to be prosecuted for running pills mills across Ohio.

“It went on too long,” Sessions said. “For physicians to prescribe this extraordinarily high number of pills and nobody know about it is hard to believe.

“These medical boards and professional groups need to be more aggressive — I think in many cases they failed to pick up on information that should have been available,” he said.

In response to the opioid crisis, the Justice Department has launched an aggressive campaign to halt the spread of deadly opioids that includes:

  • New strike force to target drug trafficking and violent crime in Cleveland
  • Providing additional federal prosecutors in Ohio and seven other states
  • Awarding $320 million to combat the opioid crisis
  • Joined in a multi-district class action lawsuit against opioid manufacturers and distributors

The Justice Department’s action follows a directive from President Donald Trump who has declared the opioid crisis a “national health emergency.”

On Oct. 24, 2018, News 5 was invited to the White House where President Trump signed sweeping legislation providing $8 billion in funding to curb the opioid crisis.

You can watch the interview with Chief Investigative Reporter Ron Regan and Attorney General Jeff Sessions in the player above.

You need to watch the video on this piece, Session claims that DOJ has “convicted” some 250 physicians and then corrects himself that they are “charged’ some 250 physicians.  Does this suggest that those attorneys in the DOJ will “bend the truth” so bad that they can almost be assured of a conviction and/or they will get a plead agreement because they will charge the physician with a ” boat load” of fabricated charges… just to get the physician to agree to a plea of a few charges.

It would seem like the DOJ is using the number of doses that the prescriber writes as the primary criteria as to determine that the prescriber is writing high number of doses and thus medical necessity could not be met.  Does not look into how many pts are being cared for, the average number of doses/day or even the average number of mgs/day

What the DOJ and other bureaucrats are doing is tantamount to expecting a cardio vascular surgeon to do open heart surgery with a ‘electric knife” … much like the one a person would use to carve a turkey or ham.

Filed under: General Problems | 7 Comments »

OK: prescribers can prescribe as much MME for chronic pain as they want…as long as they don’t show up on monthly top 20 prescribers

Posted on October 30, 2018 by Pharmaciststeve

New opioid law aims to cut down on abuse, but some say it hurts those who need pain medication

https://www.tulsaworld.com/homepagelatest/new-opioid-law-aims-to-cut-down-on-abuse-but/article_3e2688ef-dd99-5275-bd75-c0413e694bd3.html

A state law that takes effect Thursday mandates new prescribing limits for opioids, but some worry it could end up hurting patients who suffer from chronic pain.

Senate Bill 1446 will limit initial opioid prescription terms and require providers to take extra measures when dosages exceed certain thresholds.

The new law has been hailed for its attempt to address opioid abuse in the state.

Oklahoma ranks No. 6 in the nation in opioid prescriptions dispensed per capita, according to the U.S. Centers for Disease Control and Prevention.

“This certainly does have the potential to curb a lot of abuse and even prevent some addiction, let alone help with some of those who might already be addicted, to slowly get them off of some of these medications much sooner than they would without it,” said Mark Woodward, spokesman for the Oklahoma Bureau of Narcotics and Dangerous Drugs Control.

However, state officials have been scrambling in recent weeks to answer questions from doctors, pharmacists and patients about the new law.

“There’s already a lot of confusion about this law,” said Dr. Blake Kelly, a pain management specialist.

One aspect of the new law limits initial opioid prescriptions to treat acute pain to a seven-day supply for patients.

After the initial prescription, a practitioner may issue another seven-day supply of opioid drugs if necessary, following a consultation with the patient.

Patients must enter into a pain management plan with their provider if the second, seven-day supply is exhausted and additional opioids are to be prescribed.

Woodward agreed that the new law has led to some confusion among patients and providers.

“We’ve had some patients who have called and said they have been fired by their physician, because the physician can no longer prescribe the amounts they have previously been prescribing,” Woodward said.

Woodward said face-to-face consultations between the provider and the patient are recommended, but not required, under the new law.

Kelly said he has heard some pharmacists are not filling patient’s prescriptions “because they are saying you can only get a seven-day supply.”

The initial seven-day limit only applies to new patients, Kelly said.

The law also does not apply to patients receiving active treatment of cancer, hospice, palliative care or residents of a long-term care facility.

Woodward said the seven-day limit on an initial opioid prescription could help curb abuses of the powerful, addicting drugs.

“I think it certainly does have the potential, with the seven-day limit, in preventing some people from getting on the path that would lead to addiction,” Woodward said. “Because clearly the longer you are on any kind of prescription opioid the greater the risk.”

Tamera Stewart, a chronic pain sufferer, said the new law began affecting her prior to it becoming law, following a visit to her pain management doctor’s office.

“In April of this year, the PA (physician assistant) walked in and said ‘not because of anything you have done, but I have to reduce your pain medicine in part because of a new law coming out in Oklahoma,’” Stewart said.

Stewart is national administrator of the Facebook group Coalition of 50 States Pain Advocacy Group.

A two-time cancer survivor, Stewart has undergone 13 surgeries.

The 37-year-old said she first tried steroids and other alternative therapies before turning to opioids about 10 years ago to manager her pain.

Stewart, who is also active in the Don’t Punish Pain Oklahoma advocacy group, said she has heard concerns from others who are worried they will lose their pain medications as a result of the law.

“I got involved (in advocacy) when I started hearing about older residents in my community being told they were not going to get their pain medicine,” Stewart said. “Because I am also a pain patient, it scared me.

“People are being literally abandoned by my doctor,” Stewart said.

Woodward confirmed that patients are reporting that their providers have dropped them or cut back their opioid dosages due to language in the law dealing with opioid dosage levels.

The new law requires providers to document and consult with patients when they are prescribed daily opioid dosages that are equivalent to or greater than 100 milligrams of morphine, abbreviated to 100 MME.

Many doctors already consulted with patients and documented when they exceeded the 100 MME dosage levels, Woodward said.

Still the threshold has prompted concerns.

“There’s some misunderstanding by some who think that the law says that you cannot prescribe pain medicine that would be more than 100 morphine equivalent or MME,” Woodward said.

The law clearly says doctors can continue to write as high a dosage as they believe is needed, Woodward said.

Those who do will have to maintain a written policy and engage in informed consent with the patient if they want to prescribe opioids that exceed the 100 MME, Woodward said.

“But there is no restriction that says anywhere that patients have to be at or under 100 morphine equivalent doses,” Woodward said.

Stewart said providers are fearful if they don’t reduce opioid dosages that they prescribe, they could end up on a state list that identifies them as a top prescriber.

“It’s an environment where everybody is afraid to write prescriptions because of the stigma,” Stewart said.

At issue is a list of top 20 prescribers of opioids that is generated monthly by the OBNDD.

The agency has been providing the list for years to state medical regulatory boards, Woodward said.

“That’s some of the concerns we are trying to get physicians to understand, if they are over 100 MME and they are on a list because they are one of the top prescribers, that doesn’t mean they are under investigation,” Woodward said. “It is simply a list that is generated by law.”

Kelly said everyone agrees that opioid dosages need to come down.

“But the concern is if someone is at three, four or five hundred MMEs and we wean them down to the 150 or 200 range and they are suffering, do we continue to wean them down, or is it understandable to leave them there understanding that they are on half the dosage that they were on for 10 years and they are barely able to get off the couch or out of bed at this level,” Kelly said.

“If we take them down lower what kind of quality of life are they going to have?” Kelly asked.

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