It would appear that the nomenclature surrounding the use/abuse of opiates is changing once again… They have seem to finally figure out that we don’t have a EPIDEMIC.. because addiction is not contagious. They have also seem to be moving away from using both terms addiction and dependency and now they are just using the term “substance use disorder”…

So anyone using/abusing opiates or controlled substances are now being labeled as having a SUBSTANCE USE DISORDER…

Is a “disorder” … a disease…. a mental health issue… or a moral failing ?

It would appear that the number of Face Book pages devoted to pain and/or disease issues with pain associated with it.. that keep expanding almost exponentially

The common thread among all those Face Book pages is a lot of whining, bitching and moaning and if anyone believes that anyone that are perpetuating this covert genocide are following any of these FB pages… and or cares what is said on these FB pages … are kidding themselves.

A handful or two have tried to be a lighting rod to organize some demonstrations across the country and/or collect facts about how the bureaucracy is harming the chronic pain community.

Maybe everyone should take a step back and look at the number of protestors that showed up this past week against Kavanaugh getting confirmed by the Senate.  Kavanaugh still got confirmed and all those hundreds of  people on the capital steps MAY HAVE changed the mind of TWO SENATORS to vote NO – MAYBE…

And just like the few people that showed up for the various demonstrations last month in various cities… some got some TV coverage and some got some unwanted notice with people setting up free needles and/or encouraging people to have Narcan handy. Then there was one TV station that included the piece about the denial of pain care… they included something about the opiate crisis and/or free needles and the use of Narcan.

If you cannot control the message…   because you can’t get the full attention of the messenger, you never know what is going to show up on the nightly news.

Is it time for pts to start filing complaints en mass ?

The American with Disability act is at the federal level and many states have a similar law.

If you are on Medicare or Medicaid then www.cms.gov or 800-Medicare

If you have other health insurance there is a state insurance commissioner. Every complaint filed against an insurance company gets posted on the insurance commissioner’s webpage – and STAYS THERE…  Seeing the number of complaints against an insurance company on the insurance commissioner’s website … does not make any insurance company happy.

If you have company insurance and it is a ERISA plan (company is self insured) .. the “insurance company” is just paying out the employer’s money and there is normally someone in the employer company who can tell the “insurance company” to just cover the service and PAY THE BILL.

Each state has a Pharmacy Board, Medical Board, Nursing Board or Dental Board or other such boards… and while they may dismiss your complaint.. they have to put in the healthcare practitioner’s file…

Having complaints en mass .. then it will be time for pts to take their issue to their state or fed legislators… they passed the laws that these agencies are refusing to enforce. Presuming that there is a volume of ignored or dismissed complaints … the legislators may not be very pleased with what is going on in regards of enforcement of the laws they passed.

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So, I am on hd opioids. My pharmacist, whom I’ve been with for years, won’t fill my prescription because 60 minutes spooked her. I get it filled weekly. She gave me one week. Is that abandonment? Any advice?

This isn’t a pharmacist practicing medicine without a license – where really is that line ? … and she called the BOP and they could not advise her one way or the other…  so apparently the BOP either has not addressed this issue… either because they could not come up with a “pair” or a backbone between the lot 🙂  Maybe they have had complaints and have ignored or just dismissed them because there was no law firm involved.  So much for the BOP’s primary charge to protect the health/safety of the general public.

Is this because NO PTS have filed complaints against any pharmacists in this state – not sure what state this pt lives in.

If this pt does decides to file a complaint against this pharmacist with the BOP… what is the pharmacist going to do… force the pt off of his opiates as a retaliatory reaction ?

Maybe it is time for pts to start filing complaints with the BOPs EN MASSE… force the BOP to make a decision that will apply to all pharmacists… if the BOP refuses to address the issue, then it is time to contact your state’s legislators.. they are the ones that passed the laws that the BOP is suppose to enforce…but.. failing to do so.

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“After using Walmart pharmacy many years to fill my opiod prescriptions, they will no longer fill any opiod prescription solely because my pain management doctor does not have me on a program to wean me off all opiod medications.”

Some people think that this is practicing medicine without a license, but in reality is that the pharmacist is trying coerce the prescriber to change the prescription.  If the prescriber “caves” to the request/demand of the pharmacist then the prescription order is being done by a legal prescriber.

If the Pharmacist just flat out REFUSED to fill the prescription without VALID FACTS to justify the denial. Then the Pharmacist could be guilty of denial of care and not following the prescriber’s orders.

Also under the Controlled Substance Act no one can prescribe/de-prescribe a controlled substance without doing in person physical exam of the pt and since Pharmacists do not have the education/training or legal authority to do a physical exam of the pt. So unilaterally changing a pt’s controlled med.. could also be a violation of the Control Substance Act.

Some Pharmacists believe that they can refuse to fill a prescription for ANY REASON… everyone is entitled to their own opinion BUT .. no one is entitled to their own FACTS… and refusal to fill a prescription should be based on facts that filling the prescription will harm the pt. Pharmacist seem to continue to believe this “I can deny anything” because no one has sued them for denying care without a valid/factual reason.

If the Pharmacist arbitrarily decided to changed the directions and quantities on the prescription without consent of the prescriber and decide that the pt was going to be weaned off the opiate(s).. then that would be practicing medicine without a license.

Normally, chronic pain pts collectively takes a “boat load of medications”, so if a Pharmacist is only having a concern about weaning a pt off of a controlled med and none of their other medications then one could argue that could be a discrimination.  Generally, the vast majority of pts being prescribed a controlled substance have one or more health issues that would qualify the pt as being part of the protected class under the Americans with Disability Act. 

Discrimination under that act is considered a civil rights violation, much like if a pharmacist refused to fill a prescription because he/she did like the color of the pt’s skin, sexual orientation or some other reason that has nothing to do with proper medical care.

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Waldoboro woman sues VA over death of father, 90, blaming change in meds

www.pressherald.com/2018/04/10/waldoboro-woman-sues-va-over-death-of-father-90-blaming-change-in-meds/

A Waldoboro woman is suing the federal government over the death of her 90-year-old father less than two weeks after a VA doctor took him off Vicodin, a prescription opioid painkiller he had taken in small doses for 40 years to deal with chronic knee pain.

The man suffered from gastrointestinal bleeding and died due to hemorrhagic shock and ulcers, the lawsuit alleges – side effects of the new painkiller he was prescribed by a doctor at the Department of Veterans Affairs medical center in Togus. The suit contends the ulcers and bleeding started only after Douglas C. Wallace’s painkillers were changed.

According to the suit, the change in medication was made in September 2014 when Wallace, a decorated World War II veteran, first saw his new primary care physician, Dr. Joseph J. Lienart, at the Togus VA medical center.

Wallace was in good health, according to his daughter, Donna Wallace, who said she accompanied her father to the appointment with Lienart. Wallace had been taking a small 5 mg dose of Vicodin and acetaminophen daily for four decades to manage pain in his knee, the lawsuit said. But Lienert, the suit contends, told the Wallaces there were risks in the use of opioids by the elderly and the VA had adopted a new policy of taking all patients off opioids.

A VA spokesman in Maine, Jim Doherty, did not respond to a Press Herald email Monday afternoon seeking information on that policy. He also declined to comment on the suit.

Two weeks after he saw Lienert, Wallace got a prescription in the mail for Diclofenac, his new painkiller, the suit said. Within 10 days, the suit alleges, he developed bleeding ulcers. Two weeks after he started taking the new drug, he was dead.

The suit alleges that when Lienert switched Wallace’s drugs, he never told Wallace or his daughter what drug he planned to prescribe to Wallace or the possible side effects.

Maine now has a strict law designed to limit the dosage of opioids doctors can prescribe to patients and the duration of the prescription. But VA doctors aren’t required to follow the state laws in all cases, and the measure was never intended to apply to the elderly, said Gordon Smith, executive vice president of the Maine Medical Association. Smith is a lawyer, not a doctor, but he worked with lawmakers in drafting the law, which went into effect in 2016, two years after Wallace’s death.

Smith said the 5 mg dose that Wallace was taking falls well below the dosage limit in the law, and he said the law is not intended to apply to the elderly. He said the medical association would be more concerned with a caretaker stealing opioid medications from an elderly person than someone in their 80s or 90s developing a dependence on the drug and taking higher dosages.

“That has not been our focus,” he said. “Elderly patients on very low doses have generally been allowed to continue.”

The suit doesn’t specify how much Donna Wallace is seeking in damages.

Her attorney, Taylor Asen, said he was unable to contact Donna Wallace on Monday to determine if she wanted to speak publicly about the suit.

According to his obituary, Douglas Wallace was a World War II Army veteran, serving in the Philippines and outer islands of Japan. His convoy was attacked by Kamikaze planes and Wallace was awarded a Purple Heart, the Philippine Liberation Medal with Bronze Star, the Victory Medal, the Asiatic Pacific Theater War Medal and a Good Conduct Medal. After the war he built wooden boats at a yard in Friendship and later became a lobsterman and an avid hunter.

Edward D. Murphy can be contacted at 791-6465 or at:

emurphy@pressherald.com

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There is a person running for Indiana’s 9th Federal district House of Representatives.

If you listen to what is being promised as what this candidate is behind and then crunch the numbers and/or pay attention to the words that are being used

The first promise is that everyone DESERVES a livable wage… now what is a “livable wage”

Mine and Barb’s family were very similar… Fathers were blue collar, union shift workers and our Mothers were stay at home “homemakers” and the standard of living when were kids would be considered very low standard by today’s standards, back then… it was fairly average.

The second major promise is that healthcare is a “RIGHT” and that it should be “AFFORDABLE”

On a national basis we spend abt $10,000 per person per year on healthcare. That comes out to about 3.2 TRILLION/YR… Currently the ENTIRE FED BUDGET is abt 4 TRILLION/YR.  Of course, some pts require more than $10,000/yr in medical expenses and some require less.

What is hard to determine is what part of that 4 + Trillion Federal budget goes to fund Medicare A&B, Medicaid and health insurance that the Feds pay for all federal employees, including military.  For the sake of arguement let’s presume that half of that 3.2 trillion cost is paid for out of the Federal budget. Leaving 1.6 Trillion that needs to be paid by someone.

If people expect that the definition of “affordable” is for a national health insurance that  is going to pay FIRST DOLLAR – no deductibles and/or copays. Then the feds are going to have to find 1.6 trillion dollars… if they confiscated all the assets of all the country’s BILLIONAIRES… that would pay for the first year… and if they confiscated all the assets of all the millionaires that would pay for the second year..

Close to 50% of households pay NO FEDERAL TAXES… so where is the money  going to come from ? How much should each family pay in a deductible and copay… what is considered affordable ?

We are already – and have been for nearly a decade – adding a trillion dollars/yr to our national debt… already at around 21 trillion total.

So the next time that a politician seeking election promises “affordable insurance is a right”.. try to find out the details of where the money is going to come from

If one takes a “conspiracy theory” approach to what is going on with what appears to be some sort of rationing of care for chronic painers and other who could be classified as the “sickest of the sick” and the ones that are consuming a large disproportionate share of our limited healthcare dollars. 

Policies that some consider causing a “covert genocide” could be a larger plan to make some sort of national health insurance more affordable… by eliminating the most costly people in our population.

Dr. Ezekiel Emanuel one of the people involved with the creation of ACA (Obamacare) suggested in 2014 that people should be willing to “walk away” from being a cost to society when they are 75. You stop contributing to society at 75 ?

After all it is claimed that about 80% of a person’s lifetime medical expenses are incurred in the last couple of years of their life

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For those who believe that it is beneficial to go to washington DC and protest… I am watching (not listening to) what is going on right now at the capital steps.  Just a couple of weeks ago the Senate vote 99-1 to approve 70 odd opiate related bills – all to basically harm chronic pain pts and “help” substance abusers – who most of them don’t want help.

Now the senate is pretty much divided along party lines on voting for Kavanaugh, except for one of the Senators from Alaska  Sen. Lisa Murkowski (R), who has stated she is going to vote “PRESENT”… apparently she doesn’t have the “balls” to make a decision so she is going to “sit on the fence” and refuse to vote at all.  She sure had the “balls” to vote for the 70 odd opiate bills a couple of weeks ago…  along with 98 other members of Congress.. the only Senator that voted against those opiate bills was a Republican from Utah. I think that it was Mike Lee.

What I am noticing is that many of the protestors are being lead away in “handcuffs” and many have one arm raised – much like the Nazis and Hitler did during Hitler’s reign.

I wonder how many in Congress could pass the scrutiny of a FBI investigation … Congress would probably not have enough members to have a quorum to pass any bills.. I often wonder why after 242 yrs Congress still finds a need to pass some 200-300 bills every year.

Other Presidents have promised to have a transparent administration and none have come close until Trump with all his tweets… maybe he has taken transparency a bit to far… but is that worse than everything in washington being done behind closed doors ?

How many of us have not done something REALLY STUPID in our teen/college years.. I know that I did and I know that our daughter had a grade school/high school friend that those two were synergistic troublemakers when they were together.

Is our political system becoming so polarized that our country itself is suffering from being BI-POLAR.

Our country may end up like a spinning wheel that becomes “out of balance” and just starts flying apart because of the lack of balance and as soon as that first piece flies off.. the wheel becomes more out of balance and the integrity of the wheel quickly   disintegrates and can’t no longer functions as it was designed.

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Prosecutors notify 30 doctors about excessive opioid prescriptions

https://www.ajc.com/news/crime–law/prosecutors-notify-doctors-about-excessive-opioid-prescriptions/fXSbsKBg8XiMc9y7wj3wPN/

Federal prosecutors in Atlanta have put about 30 doctors on notice that they’ve been identified for prescribing opioids in significantly greater quantities or doses than their peers.

The doctors, who were not publicly identified but work in the metro and North Georgia area, were notified by letter. Some also were found to have prescribed opioids to patients who may have a high risk of abuse, the U.S. Attorney’s Office said Friday.

“Medical professionals have an obligation to the safety and well-being of their patients,” U.S. Attorney BJay Pak said in a statement. “Many opioid prescribers may not realize that they are over-prescribing opioids. We aim to make these medical prescribers — who are outliers — aware of their atypical practices, so that they can make informed decisions about whether their opioid prescriptions are for a legitimate medical purpose.”

The letters are part of an initiative by the U.S. Department of Justice to reduce opioid prescriptions by one-third over the next three years. The Department of Justice has not determined if the 30 doctors who were put on notice have broken the law, but federal authorities will continue to monitor prescribing habits, Pak said.

In the letters, prosecutors provided the doctors with specific information about their prescription patterns. The doctors were also given guidelines by the Centers for Disease Control and Prevention for prescribing opioids for chronic pain.

Neil Campbell, executive director of the Georgia Council on Substance Abuse, applauded the move.

“This is a really good thing,” she said. “There’s been such an abuse of prescriptions and it’s hurt a lot of people. Most doctors don’t want to give more painkillers than they need to, but unfortunately that’s not the case with everyone.”

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Life is full of these entities… be it the school yard bully… in a political race, in the world of manufacturing and sale, the animal kingdom..

The predator typically only picks on the prey that they believe that they can defeat because the prey has something the predator wants… be it money, a possession they covet or they want to EAT THE PREY.

The kid that the bully keeps picking on learns a martial arts and one day kicks the ass of the bully … the bully will find a easier prey in the future

The political fight is over exposure, hand-shaking, baby kissing and unfortunately how much ” political mud” you can sling at your opponent.

In the market place… entities like Walmart and Amazon have changed how/where we shop and get things we need.

In the animal kingdom prey learn how to run/swim/fly faster, improve their senses to be more aware when a predator is close, or learn how to hide and or camouflage themselves better.

In the “real world” some predators use the laws and our legal system to go after their prey and that forces the prey to engage an attorney to fight back and/or create obstacles or camouflage.

whatever the predator is after.

Right now we have cities, counties and states being the predator after drug manufacturers and wholesalers… the “prey” is being blamed for creating the “opiate crisis” and the predator wants the prey’s money to compensate them for the cost providing treatment to those who have been ensnared in the opiate crisis. Apparently the individuals have no personal responsibility for the place they find themselves in !

We have the DEA who seems much like the human eating plant in the “Little Shop of Horrors ”  always demanding  “feed me Seymour”.  Their original charge/mandate  back in 1973, was to PREVENT DIVERSION.  Most/many /all of the sources of diversion in our country is from cartel outside of our country and the DEA does not have the authority nor the cooperation of foreign governments to interfere/stop these cartels production and exporting illegal drugs into our country.

What illegal drugs the DEA has seized has no monetary value to them… it is more a liability… to search/seize, inventory, warehouse and destroy. The assets of these cartels are outside of our borders and untouchable.

Besides, these cartels and their street dealers distribution system seem to have little concern about protecting their turf and willing to shoot/kill anyone who tries to interfere with their business plan.

The DEA is a PREDATOR ! they have shown that they are going after the weakest prey that will provide them the largest financial gain.  That is the prescribers.

Historically, doctors/prescribers have been poor business people.  Their focus is to treat/heal pts.  So they have become the primary prey of the DEA Predator. The typical process of the DEA is to raid a prescriber’s office… convince them to surrender their license, close their practice and confiscate all the pt’s medical records and then confiscate/seize all the prescriber’s assets.

Their PROBABLE CAUSE is more like an opinion based on some raw number of prescriptions or doses that the prescriber has prescribed over some period of time… sometimes as far back as TEN YEARS.

If you notice the vast majority of prescribers that the DEA goes after are at the end of their career 50-55+… Those that have assets to seize…they are a not going to go after younger prescribers who have six figure student loans and probably floating in debt for a house and a couple of cars… The DEA can’t seize and liquidate a asset that has a large loan balance against it.

Then there has been numerous times that the DEA has closed multi location practices and TOSSED tens of thousands of chronic pain pts out into the streets and everyone knew that the local medical community did not have the capacity to even begin to absorb and treat these chronic pain pts. There has been information shared that more chronic pain pts committed SUICIDE within weeks of the practice being closed…. often more “bodies” than the practice was accused of having OD’d

I have been told that the DEA puts up “road blocks” to the pts of a practice they raided in getting copies of their medical records, which makes it nearly impossible to find a new prescriber to accept them as a pt. Increase the risk that a chronic pain pt will commit suicide.

I am concerned that the prescribers have not started protecting themselves from this PREDATOR…  It seem quite obvious that the DEA is after the prescriber’s assets .. even the most casual observer should be able to come to that conclusion.  If this is the case, the prescribers can divest themselves of their assets in a irrevocable trust… in fact they would have to make two.. because  the grantor of a trust cannot be the beneficiary of a trust… so one created by the husband for the wife and the wife creates one for the husband.

Personally, they basically becomes financial paupers … if it is done before the vultures start circling…  the trust can be set up to pay their day to day expenses, even legal expenses, but prohibit the trustee of the trust to allow the monies/assets to be confiscated.

The DEA PREDATOR is just like a robber/burglar… they look for easy targets and – IMO – they have little concern about the “dead bodies” attached to a particular practice/prescriber from the perceived OD of a person.

These, so called, OD’s from a particular practice that the DEA claims to be a result of the prescriber’s prescribing habits. where are the lawsuits from the surviving families toward these prescribers ?

Where is the actions against these prescribers by the state Medical licensing boards for improper prescribing before the DEA shows up on the prescriber’s doorstep ? No media coverage of all the complaints from pts from the Medical Boards’ records about a particular prescriber for unprofessional conduct, malpractice. Could it be that their file is basically “empty”. Does it boil down that only the DEA believes that the prescriber is a “bad prescriber” ?

I often wonder what some law firm has not set up and promoted creating such irrevocable trusts for presribers. Is it because it may be frowned upon by fellow attorneys that they are working AGAINST the judicial system?  Prescribers doing this in mass could have a chilling effect on the business/revenue of prosecuting/defense attorneys and the the DOJ/DEA would have fewer – if any – prescriber that they could “go after”.

Just think about it, when is the last time that you have heard of an attorney suing another attorney ?  So, is there a unwritten rule within the legal profession that you don’t sue another part of the judicial system ? and the DEA is part of that same system.

One would think that if doctors are concerned about their chronic pain pts and the care that they get and hopefully will continue to get.. that docs would be looking for ways to put obstacles between them and the DEA, instead of just ignoring the warning signs of what is happening or just stop caring for chronic pain pts or just walking away from the practice of medicine.

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America is more accepting of torture than most other countries

https://www.weforum.org/agenda/2016/12/america-accept-torture-survey-red-cross-2016/

Image: ICRC

Image: ICRC

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