Here comes Narxcare – to help manage your potential to abuse certain substances

Posted on August 9, 2018 by Pharmaciststeve

https://www.acsh.org/news/2018/05/11/big-brother-walmart-watching-your-meds-very-carefully-and-not-just-painkillers-12950

In the name of battling our misnamed “opioid epidemic,” (1) which has only resulted in making things worse (2) there is a casualty that is far worse than anything that could be caused by a drug – the loss of our right to make healthcare decisions with our own providers and the right to privacy. A whistleblower document from Walmart which I obtained discusses “scoring” patients based on their medical and prescription history. It should terrify you. And it will. Following are some passages from the seven-page document, which, despite its benign-sounding title, is anything but.

What you will read is not guidance. It is all but certain it will become a mandate, just like the CDC 2016 Opioid Prescribing Guidelines are now law or becoming law in most states. And it goes far beyond its alleged goal of helping to control opioid overprescription. Very far beyond. Here are some “highlights” that Walmart does not want you to know about.

Page 1: Pharmacist “guidance” for prescription drug users with different scores as determined by NarxCare (2), an algorithm designed to sniff out potential problems with the legal use of certain prescribed medicines.

Two things jump off the page here. First, the group that encompasses people with scores of 10-200 represents most of the people with a prescription. In the red circle on the right, it becomes obvious how badly Walmart is overstepping. Let’s get this straight. If I have a legitimate prescription for Vicodin from my doctor I do not want to “consider the risks/benefits of new prescriptions.” Here’s how healthcare works:

The doctor writes the prescription
The pharmacist fills the prescription.
There is no #3

You may wonder what it takes to get into the 10-200 scoring group. Not much. From page 2:

Out of the blue, we are no longer talking about painkillers. Walmart is now interested in other potential drugs of abuse. If you happen to be taking Vicodin for chronic pain, Valium as a muscle relaxant, and an ADHD drug – a legitimate combination for some patients, you are going to get a worse score, which will likely mark you as a higher risk.

Which may make you wonder about this:

Alcohol aisle in a Florida Walmart. Photo: Florida Politics

It would seem that Walmart wants to know if you are taking Valium, which kills (on its own) approximately zero people per year, or Ritalin, but will cheerfully sell enormous quantities of alcohol, which is responsible for 88,000 deaths per year. Does anyone believe that Walmart wants to limit your drinking? Unlikely:

“Walmart is already the nation’s largest beer retailer after tripling its total alcohol sales in the past 10 years. But one of the chain’s top executives told beer distributors this week that the company is just getting started…’I’m pleased but not satisfied,’ Chief Merchandising and Marketing Officer Duncan Mac Naughton said during a presentation at National Beer Wholesalers Association meeting in Las Vegas, noting that the company is still “under-shared” in beer sales compared with competitors.

Ad Age October 2013

It gets worse.

This is really awful. First, if you use an MME calculator it becomes quickly obvious that Walmart is not talking about addicts who are taking huge doses of opioids. But that doesn’t stop the company from treating people that way. And it doesn’t have to be much. Walmart calls 40 MME an “unsafe condition,” and is recommending tapering or discontinuing other drugs, such as Valium, which could potentiate the action of the opioid. How much is 40 MME? It’s equivalent to 26.6 mg of oxycodone – 2.7 10 mg Percocet pills – not even half the maximum recommended daily dose of 60 mg.

The maximal daily dose of Percocet. Source: RxList

It is perfectly clear that patients are going to get some kind of a grade from The Walmart Enforcement Agency and you’d better believe that there will be consequences if that grade isn’t good. Good luck getting a legal prescription filled there if you don’t make the grade. Pharmacies around the country are already arbitrarily deciding who does or does not get their scripts filled. Although is not explicitly stated it a pretty safe bet that patients could be refused prescriptions because of their score doesn’t meet Walmart’s “standards.”

What can make scores bad? All sorts of things. For example, if you:

See your doctor too often within a certain time period.
See more than five different doctors in one year. It doesn’t matter if they are dermatologists or cardiologists.
Use more than four pharmacies in a three-month period.
Take an average of more 40 morphine equivalents (less than three 10 mg Percocet) in one day
Take a total of 100 morphine equivalents (total) in a day. There are plenty of pain patients who need more than this just to get by.

Questions that need to be asked

Walmart sells lawnmowers to people who could run over their own own foot, yet it doesn’t claim the authority or ability to monitor and control how they are used. So, how can the company claim it is better equipped than doctors to determine what painkillers, stimulants, and antianxiety drugs you are permitted to buy?
Walmart sells ovens, but can’t teach you how to cook. How does this give it the right or ability to determine who should have their medicines tapered and at what rate?
What is Appris Health, the company that created the algorithm Narx Care, which does the scoring? How did it get so much information on and influence over our private, personal matters? Why and how did the State of Ohio decide to implement this program in 2017 despite the fact that it already has a Prescription Monitoring Program?
Why should Appris (and of course, Walmart) have access to our individual health histories? In what other ways will this information be used? What safeguards are in place to safeguard our privacy?
Why is Walmart lying? The CDC’s number, which itself is ridiculous, it 90.

“Within the next 60 days, Walmart and Sam’s Club will restrict initial acute opioid prescriptions to no more than a seven-day supply, with up to a 50 morphine milligram equivalent maximum per day. This policy is in alignment with the Centers for Disease Control and Prevention’s (CDC) guidelines for opioid use.”

Walmart press release.

Take a good look in your rearview mirror. Most likely you’ll see your right to determine your own medical care growing steadily smaller.

NOTES:

(1) We are having a fentanyl epidemic, not an opioid epidemic. It should be called by its correct name.

(2) Numbers of prescription for opioid painkillers have declined by almost 30 percent since 2011. Total opioid deaths shot up during that same time. Big surprise.

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If you don’t like what they say… JUST CUT OFF THEIR HEALTHCARE AND HOPE THEY DIE ?

Posted on August 9, 2018 by Pharmaciststeve

Filed under: General Problems | 1 Comment »

Chicago limits opioid prescriptions for city employees

Posted on August 9, 2018 by Pharmaciststeve

Chicago limits opioid prescriptions for city employees

http://www.chicagotribune.com/business/ct-biz-chicago-limits-opioids-0807-story.html#

The city of Chicago is asking major employers to follow its lead and limit coverage of prescription opioid painkillers to seven days at a time for many workers.

Mayor Rahm Emanuel announced Monday that many city employees will now be limited to seven days worth of prescription opioid painkillers at a time, a move aimed at fighting opioid addiction in the city.

The idea of limiting opioid prescriptions to seven days isn’t a new one. The Centers for Disease Control and Prevention recommends prescribing opioids for short durations for acute pain, saying three days is often enough and more than seven days is rarely needed. A number of health insurance companies, pharmacy benefit managers, pharmacies and states already impose similar limits.

UnitedHealth Group companies impose limits in line with those recommendations, as does Blue Cross and Blue Shield of Illinois for members who use its pharmacy benefit manager, Prime Therapeutics. This year, pharmacy benefit manager CVS Caremark limited new opioid prescriptions for acute conditions to seven-day supplies, with clients who don’t want to participate opting out.

Walmart also announced this year it would impose a seven-day limit.

“One element that’s contributed significantly to the opioid crisis throughout the nation has been over-prescribing of opioids,” said Dr. Julie Morita, Chicago Department of Public Health commissioner. “It’s really to make sure there’s not an excess amount of prescription opioids available to individuals in the community.”

If city employees need more than seven days of opioids, they’ll have to get prior authorization, Morita said. Patients being treated for cancer pain, chronic pain, terminal illness or on palliative or hospice care may get longer prescriptions. The city has about 33,000 employees. Its pharmacy benefit managers are CVS Caremark and Prime Therapeutics, Morita said.

In Chicago, 741 people died of opioid overdoses in 2016, a 74 percent increase from 2015, according to the city.

Michigan, Florida and Tennessee recently passed laws limiting opioid prescriptions. Illinois lawmakers tried to pass a similar law that would have prohibited doctors from prescribing opioids for use outside of hospitals for more than seven days with exceptions for chronic pain management, cancer and palliative care. The bill, introduced in February, has not moved since April.

Some groups, such as the Illinois Pharmacists Association, have opposed such measures, saying they can hurt patients in pain.

“We’re erecting additional barriers for patients who are legitimately seeking pain management treatment,” said Garth Reynolds, association executive director. “We are continuing to increase the stigma and treat patients who have legitimate pain management concerns like they’re lower-class citizens or doing something wrong or criminal.”

Limits can mean more co-pays for patients who have to fill multiple opioid prescriptions and more time visiting doctors to get additional prescriptions, he said.

l schencker@chicagotribune.com

Twitter @lschencker

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I thought that cruel and unusual punishment was ILLEGAL ? Unless you are a CPP ?

Posted on August 9, 2018 by Pharmaciststeve

just the other day a man whom was in so much pain had went to the Main St over path of the 15 fwy and tried to jump ..They got him down safely but this is what pain can do to a person .I myself feel like doing the same thing at times well not that but to end my life due to pain .. it’s so unbearable

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Then They Came For My Xanax – Opioid Madness Metastasizes

Posted on August 9, 2018 by Pharmaciststeve

https://www.acsh.org/news/2018/08/08/then-they-came-my-valium-opioid-madness-metasticizes-13286#comment-4031015126

Self-righteous busybodies, apparently not content with the carnage caused by their magnificently inept mishandling of the fake opioid crisis (1) have taken up a new cause – one that will make many of you anxious. They are now concerned about an increase in the number of prescriptions written for another class of drugs – benzodiazepines, such as Xanax and Valium, which are used to treat anxiety. When the busybodies become concerned it’s time for patients to be concerned because those who are speaking out are usually agenda-driven, unqualified, or both.

You could see this one coming years ago. Although opiates were, of course, the main focus of the intifada against controlled drugs, there were also whisperings by clueless academics and assorted other Percocet Puritans with too much time on their hands. “Oh, my! There are so many drugs out there that are being abused or might be. And we all know how well prohibition of drugs and alcohol works, right? So, let’s get busy.”

Can there possibly be a better (or more ironic) way to make anxious people even more so than to talk about restricting benzodiazepine anxiety medications? Let’s express this mathematically:

Life = Stress
Stress + People = An Unknown Number of Anxious People
An Unknown Number of Anxious People + Xanax* = Fewer Anxious People
Fewer Anxious People + A Bunch of Idiots Threatening to Restrict Meds = More Anxious People
More Anxious People + Idiots = More People Needing Meds
More People Needing Meds + Fewer Meds = Suffering + Alcoholism + Street Drugs + Unintended Consequences

* Benzodiazepines, such as Valium and Xanax, should not be dispensed like candy nor should they be demonized. They are safe when used appropriately. So safe, in fact, that it is just about impossible to kill yourself with Valium alone (See: Can Valium Kill You?).

Today’s train-wreck-in-waiting comes to us courtesy of an article from The Pew Charitable Trusts entitled “These Pills Could Be Next U.S. Drug Epidemic, Public Health Officials Say,” which features some really awful propaganda. Here is some of it:

“We have this whole infrastructure set up now to prevent overprescribing of opioids and address the need for addiction treatment…we need to start making benzos part of that.”

Dr. Anna Lembke, a researcher and addiction specialist, Stanford University

“No, we don’t.”

Dr. Josh Bloom, not an addiction specialist, American Council on Science and Health

And there’s more:

“What we’re seeing is just like what happened with opioids in the 1990s.” (Dr. Lembke)

No, it’s nothing of the sort. To even compare the addiction potential of Xanax or Valium and OxyCodone is ignorant, disingenuous, and just plain nuts. And to imply that an increase, even a substantial one, in prescriptions of benzodiazepines, will have anything even remotely close to the impact of truly addictive drugs is jaw-dropping.

in case you’re in the mood for zealous overstepping, there’s this:

“Doctors need to be informed that the medications should be prescribed for no more than two to four weeks. They were always meant to be short term.”

Dr. Christy Huff, co-director Benzodiazepine Information Coalition, Utah

Doctors need to be informed? Really? Tell me that this language doesn’t sound vaguely familiar to the CDC government-speak in the now-infamous “CDC Guideline for Prescribing Opioids for Chronic Pain.”

Guidelines, my arse. Guidelines do not include forcibly tapering (or cutting out entirely) the dose of medication given to chronic pain patients. Nor do they involve sending threatening letters to physicians who have the gall to exceed the “guidelines,” even for a single patient for a single month. Or the DEA busting down doors of the few pain management physicians who are brave enough to put their livelihood and freedom on the line to care for their patients. Sure, let’s have Christy Huff informing doctors.

Informing doctors? Original Photo: “Of Russian origin: The GULAG” Russiapedia (Translation: Bad doctors!)

If this all sounds vaguely familiar it is no accident. Remember PROP (2), the geniuses who spoon-fed their “guidelines,” to the CDC which then turned them into deeply flawed policies and shoved them down Americans’ collective throats? It remains unknown why the “guidelines” were enacted, especially since the FDA trashed the flimsy evidence used to justify them. A letter from Dr. Janet Woodcock, the director of the FDA’s Center for Drug Evaluation, to Andrew Kolodny, the head of PROP at that time makes this clear (3).

In the end, PROP and the CDC got their way. How’d that work out? Let’s see…

Source: (Top) AP News (Bottom) National Institute on Drug Abuse

Not so well, really. Far more people are dying than in 2011, and this is no coincidence.

So that fact that we’re seeing both of the photos below in the same 2018 article cannot be a huge surprise.

“There’s clowns to the left of me, Jokers to the right, here I am, Stuck in the middle with you.” Stealer’s Wheel, 1973. Photo credits: Clarion Ledger.

Because…

…just like Jason Vorhees, They‘re ba-ack!

Haven’t these meddlers done enough damage? Apparently not, since they now want to put their collective feet down on another class of drugs – one which is very much safer – despite the fact that they screwed up royally the first time around.

Or maybe we could leave physicians alone and let the good ones – the vast majority of them – do their jobs without incompetents and tyrants breathing down their necks. Enough.

NOTES:

(1) As I have written before, we are not having an “opioid crisis.” We are having a fentanyl crisis, which, ironically was partially caused by the coining of the term “opioid crisis.”

(2) PROP is an acronym for Physicians for Responsible Opioid Prescribing, a self-appointed group of experts that had undue (and unexplained) influence with the CDC when the agency was formulating its disastrous “Guideline” document in 2016.

(3) “FDA has evaluated concerns pertaining to the serious risks of misuse, abuse, hyperalgesia,41 addiction, overdose, and death associated with opioid use. The Agency acknowledges that the available data demonstrate an association-though not necessarily a causal relationship-between opioid dose and certain serious risks of opioid use. However, FDA also agrees that more data are needed regarding the relationship between opioid dose and adverse effects, and the relationship between opioid duration of use and adverse effects, before the Agency can determine whether additional action needs to be taken. More data are also needed on the point at which the risks of opioid use at escalating doses and longer durations of treatment may outweigh the benefits of opioid analgesic therapy.”

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The cuts to a major disability program in Trump’s budget

Posted on August 8, 2018 by Pharmaciststeve

The cuts to a major disability program in Trump’s budget

https://www.cbsnews.com/amp/news/the-cuts-to-a-major-disability-program-within-trumps-budget/?__twitter_impression=true

When Budget Director Mick Mulvaney assumed the podium in the White House briefing room last week and previewed the administration’s 2018 budget, Heather Block’s fears quickly turned to outrage.

Block, a 54-year-old former international aid worker from Lewes, Delaware, listened with growing anger as Mulvaney promised to slice $72 billion from Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) over the next ten years. The cuts are among $1.74 trillion in social welfare cuts proposed by the Trump administration, a sweeping plan that could kick people like Block off a program, known as SSDI, that keeps her financially afloat.

“Where are the morals of the people going after people dealing with Stage 4 cancer?” recalled Block, who has been on disability for five years after her cancer spread to her liver and lungs. “The people I know, like me, with advanced cancer — we’ve wanted to be in the workplace, but we don’t have that ability now, so this is our income.”

Disability insurance ensures benefits for American workers in the case of life-altering illness or disability. At the moment, roughly nine million Americans like Block depend on disability insurance, which includes an average annual benefit that hovers right above the poverty line. Supplemental Security Income, known as SSI, provides a basic standard of living for low income seniors and low income children and adults who meet the disability eligibility standard.

Trump budget proposal has massive cuts to social programs

Mr. Mulvaney struggled to explain why exactly the administration was targeting disability benefits as part of its proposed cuts. But he strongly suggested that some beneficiaries are not actually disabled, and are therefore scamming the government out of money that could be spent elsewhere. Pushing beneficiaries back into the labor force, he argued, could save the government billions of dollars.

“Shouldn’t it be up to the government to make sure we can look folks who are paying the taxes in the eye and say, you know what, we did everything we could to make sure that everybody on SSDI is really disabled,” Mr. Mulvaney said.

In briefings with reporters last week, while Mr. Trump was overseas, asked if people currently on SSDI would receive less as a result of this budget, Mr. Mulvaney responded that he hoped so – “if there are people who are getting SSDI who should not be,” he quickly added.

The goal of the cut – the largest proposed cut to disability programs in the budget — is to “test new approaches to increase labor force participation.” The line item calculates that weaning disabled beneficiaries back into the workforce will save a total of $49 billion dollars.

Mr. Mulvaney did not elaborate on how new work requirements would be phased in or how the administration would weed out the “people who are getting SSDI who should not be getting it,” as he put it, again suggesting that freeloaders are milking the system.

The Office of Management and Budget did not respond to a request from CBS News for additional information on the Trump administration’s plan to promote workforce participation. Previous administrations have attempted, unsuccessfully, to implement programs to funnel disability beneficiaries back into work. The Heritage Foundation, an influential conservative think-tank, advocates for “time-limited” benefits paired with incentives to encourage re-entry, offering a clue as to what Mr. Mulvaney’s plan may look like.

Mr. Trump’s proposed 2018 budget also reduces retroactive disability insurance benefits from twelve months to six months prior to the date of application– resulting in $9.9 billion dollars in cuts and costing individuals an average of $7,000 in disability-related expenses, according to the Consortium for Citizens with Disabilities’ Social Security Task Force.

Mr. Trump drew criticism from disability-rights advocates for his budget, which proposes major cuts to Medicaid and social safety net programs.

To disability insurance lawyers and experts, Mulvaney’s presentation demonstrated a fundamental misunderstanding of SSDI, which does not cover partial or short-term disability, as the budget director claimed.

Rather, “Social Security disability beneficiaries are among the most severely impaired in the country,” the agency’s site says. “In fact, Social Security disability beneficiaries are more than three times as likely to die in a year as other people the same age.”

But perhaps more troubling, experts say, is the way Mulvaney talks about disabled people.

“I feel like there’s a lot of language being used that reflects attitudes that somehow people with disabilities are faking it or are slackers or just don’t have the right attitude,” Kate Lang, a senior staff attorney from Justice in Aging, a non-profit legal advocacy organization, told CBS News.

“Unfortunately there is a certain lack of sympathy or understanding of what life is like for people with disabilities, it seems,” Lang added.

The Organization for Economic Development ranks the eligibility standard for federal disability benefits in the United States as being “one of the most stringent eligibility criteria, including the most rigid reference to all jobs available in the labor market” among member countries. Only Korea has a more stringent standard.

Mulvaney also did not mention is that “the best available evidence shows that the level of actual disability fraud is below one percent,” due to pre-existing fraud programs already in place, according to a 2014 testimony from Carolyn Colvin, the Acting Commissioner of the Social Security Administration at the time. Other research from the Social Security Administration shows that only four in ten people who apply to SSDI are approved, and the process can take months and even years.

“All evidence is that the agency is making every effort to make accurate decisions and to make sure people get the right benefits at the right time,” said TJ Sutcliffe, the director of income and housing policy at The Arc, a non-profit advocacy group for people with disabilities.

Based off of numbers from the Congressional Budget Office, The Arc estimates that about 946,000 SSDI beneficiaries could be kicked off of the program or be prevented from eligibility. They estimate that roughly 2.1 million people could lose access to SSI.

“Cutting people’s basic living standards and ability to get by after experiencing the onset of a disability is not a way to help to get people to work,” Sutcliffe added.

Also lost in the shuffle of President Donald Trump’s trip overseas and the drama of a White House in disarray was another misleading claim: that “not a single thing in here touches Social Security retirement or Medicare,” Mulvaney said of the budget proposal.

Mulvaney argued that SSDI was not technically a part of “mainline” Social Security, and therefore Mr. Trump was not breaking a campaign promise.

“If you ask 999 people out of a thousand, they’d tell you Social Security disability is not part of Social Security,” Mulvaney stated.

Paul Van de Water, a senior fellow at the left-leaning Center on Budget and Policy Priorities, said Mulvaney’s claims are politically expedient.

“I’ve worked on the issues for a long time, and we’ve always said that Social Security is a program that protects people against various risks of losing their earning capacity,” Van de Water said. “Not least in cases where people lose their earning capacity because of a disability.”

“The programs are completely integrated,” he added.

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CVS-Brand Nasal Spray Recalled for Potential Bacterial Contamination

Posted on August 8, 2018 by Pharmaciststeve

https://www.livescience.com/63286-cvs-nasal-spray-recall.html

A CVS-brand nasal spray is being voluntarily recalled due to potential bacterial contamination, the U.S. Food and Drug Administration (FDA) announced today (Aug. 8).

The recall applies to Lot# 173089J of CVS Health 12 Hour Sinus Relief Nasal Mist, a nasal decongestant, according to the FDA statement.

The nasal spray is manufactured by a Florida company called Product Quest Manufacturing, which initiated the voluntary recall after discovering that the product was contaminated with a bacterium called Pseudomonas aeruginosa. [6 Superbugs to Watch Out For]

The symptoms of Pseudomonas infections depend on what part of the body becomes infected with the bacteria. For example, if the bacteria get into the lungs, a person can develop pneumonia, according to the Centers for Disease Control and Prevention (CDC). Pseudomonas bacteria can also cause ear, skin, eye and blood infections.

People who are hospitalized or those with a weakened immune system are most at risk for a Pseudomonas infection, the CDC says. In these groups of people, the infection can lead to severe illness and death.

Infections are treated with antibiotics, though they are becoming more difficult to treat as the bacteria develop resistance to the drugs, according to the CDC.

Repeated use of the recalled nasal spray could potentially lead to a buildup of the bacteria in a person’s body, which could make them sick, the FDA said. In addition to people with weakened immune systems, people with cystic fibrosis are also at risk for life-threatening complications from this infection, the FDA said. (Cystic fibrosis is a disease that causes damage to the lungs, digestive system and other organs, according to the Mayo Clinic.)

To the best of Product Quest’s knowledge, the company hasn’t received any reports of adverse events related to the product that’s being recalled, the FDA statement said.

People who have purchased the recalled product should stop using it immediately and return it to the place of purchase or throw it away. Anyone with questions regarding the product can contact Product Quest Manufacturing at 386-239-8787.