UPDATE: Hagerstown police sergeant who faced drug charges dies by suicide

https://www.heraldmailmedia.com/news/local/update-hagerstown-police-sergeant-who-faced-drug-charges-dies-by/article_6f199e52-9c0f-11e8-87f2-a740ab07e8ed.html

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Suit: Woman killed herself after Olathe doctor got her hooked on opioids, cut her off

https://www.kansascity.com/news/business/health-care/article216457440.html

Some time around Jan. 19, Jacquelyn Spicer sent one last email to her Olathe doctor, the man who had treated her back pain with opioids for a decade before he suddenly stopped, according to court documents.

Then she killed herself.

In a lawsuit filed Thursday in Johnson County court, Spicer’s family accuses Douglas Brooks of getting her hooked on pain medicine and then leaving her with no way to get off it safely after the Kansas medical board ordered him to stop treating chronic pain patients because of his dangerous prescribing patterns.

Brooks didn’t respond to a phone message left Friday at his Olathe clinic, Brooks Family Care. An attorney who represented him before the Kansas medical board didn’t either.

The order issued by the Kansas Board of Healing Arts in October stated that Brooks, a primary care doctor, was supposed to refer all of his chronic pain patients to specialists “without abandoning the patient in need of care.”

But according to the lawsuit, Brooks didn’t do that for Spicer.

Instead, he allegedly cut her off cold turkey, and ignored her requests for a referral to a methadone clinic or other provider who could help with withdrawal symptoms. The lawsuit says Spicer warned him that she was very concerned about withdrawal and contemplating suicide.

“I have had several patients get off high doses very quickly without issues so don’t predetermine your outcome,” Brooks responded on Jan. 13, according to the suit. “It won’t be as bad as you can imagine.”

About six days later, after sending Brooks a final email, Spicer committed suicide.

According to his website, Brooks was the chairman of the department of obstetrics and pediatrics at Olathe Medical Center from 2004 to 2006, before starting a primary care practice.

The suit brought by Spicer’s family says she started seeing Brooks in 2007. From then until the end of 2017 he prescribed her between 240 and 450 tablets of 60-milligram morphine sulfate every month.

The family’s lawyers wrote that Spicer showed signs of opioid addiction and, at one point in 2016, told Brooks she wanted to get off the painkillers. But he didn’t refer her to an addiction specialist and kept prescribing the morphine.

According to the suit, the staff at Brooks’ clinic called him “The Candy Man” because of his “history of freely prescribing addictive controlled medications.”

Last year the Kansas medical board said that an investigation revealed Brooks was negligent or grossly negligent in his treatment of five chronic pain patients.

“He improperly and inappropriately prescribed and refilled excessive doses of opioid/controlled medications, failed to properly monitor the patients’ adherence to treatment, failed to address the red flags for opioid/controlled medications abuse, failed to properly treat/modify his treatment plan, failed to refer to appropriate specialists, failed to address a patient’s presenting illness and failed to properly document within the patients’ medical record(s),” the board’s attorney wrote.

The board ordered Brooks to hand off his chronic pain patients to specialists, submit monthly reports of his narcotic prescribing for a year, complete continuing education courses on proper prescribing and medical record-keeping and pay some of the costs the board incurred in hearing his case.

Brooks’ current clinic advertises itself as a direct primary care practice, a model in which the medical provider doesn’t take insurance but instead charges patients directly.

Unlike some other direct primary care practices, though, Brooks’ website says that his patients are bound to 12-month contracts, rather than being able to opt out of membership on a monthly basis.

According to the lawsuit, Brooks’ patients were charged by the minute. That’s also different from most direct primary care practices, which charge a flat monthly rate for unlimited office visits.

The suit also names Price Chopper Pharmacy as a defendant, alleging that staff at the Price Chopper at 2101 E. Santa Fe St. in Olathe was negligent in continuing to fill and refill Spicer’s prescriptions without warning her of the risks of addiction or notifying authorities about the “excessive opioid/controlled medications” Brooks was prescribing her.

Staff at that Price Chopper pharmacy declined to comment, citing medical privacy laws.

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5 Questions for Florida Attorney General Candidate Ashley Moody

https://www.law.com/dailybusinessreview/2018/07/06/5-questions-for-florida-attorney-general-candidate-ashley-moody/

Attorney General Bondi has made opioids and human trafficking key issues of her office. From a legal stance, what is the biggest issue right now facing the state? I wish I could say that we’re at a point where the attorney general coming in will no longer have to focus on the opioid epidemic or will no longer have to focus on human trafficking. The sad reality is, despite the amazing accomplishments of Attorney General Pam Bondi, we’re still dealing with 15 deaths a day. My biggest fear is that we as a state get tired of talking about opioids — because it’s been such an issue for so long — and we lose energy and focus to attack it. And so, what I’d like to do when I come in is immediately put together a state force, a statewide task force, or use maybe our grand jury system to bring in experts to figure out where we need to go and direct our resources. A mistake we can make if we’re not careful is we pump a bunch of money towards a specific issue and we don’t do it in an effective way. So, I want to make sure we’re good stewards of the taxpayer money and we do invest resources, and I don’t just mean money, I also mean human resources, sheriffs’ investigations, prosecutors, that we’re doing it in a way that we’re going to reduce the numbers. I’m a numbers person. I was trained in accounting. At the end of four years, being attorney general, I want to make sure I have the numbers to show I’ve been working to address this.

https://www.mypanhandle.com/news/florida-attorney-general-candidate-ashley-moody-stops-in-bay-county/1287678156

The Plant City native is familiar with Bay County, her mother born and raised in Panama City. Moody is a former federal prosecutor and judge married to a DEA agent. She plans to fight opioid epidemic by continuing the conversation and focusing on synthetic drugs like fentanyl.

5 Questions for GOP Attorney General Candidate Frank White

https://www.law.com/dailybusinessreview/2018/07/16/5-questions-for-gop-attorney-general-candidate-frank-white/

What reforms or improvements do you see as needed within the Attorney General’s Office?

I think Attorney General Bondi has done a fantastic job. She has done a wonderful job. She’s saved lives, particularly in the opioid crisis. I think there are some areas where we disagree. One I’d point [to] would be the identity of Jane Doe in the NRA’s lawsuit against the state. It’s just a difference of opinion where I think Jane Doe’s identity should remain anonymous. I think it’s really a difference in terms of emphasis. One important part of it [the job] will be government accountability, making sure politicians are held accountable. That’s just one area where I particularly want to focus on immediately.

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FDA seeks to tailor length of opioid prescriptions to patient conditions

https://www.bendbulletin.com/health/6432868-151/fda-seeks-to-tailor-length-of-opioid-prescriptions

The Food and Drug Administration is developing new opioid prescribing guidelines that would tailor the duration of the prescriptions to specific patient conditions.

Speaking at a provider roundtable with Rep. Greg Walden, R-Hood River, on Tuesday in Bend, FDA Commissioner Dr. Scott Gottlieb said the agency was working with provider groups and the National Academy of Medicine to determine what amount of prescription pain medication would be appropriate after various surgeries and procedures, instead of relying on the current one-size-fits-all approach.

Prescribing guidelines from the Centers for Disease Control and Prevention, for example, say that three days or less of opioids are often sufficient and that more than seven days will rarely be needed, but do not differentiate based on condition.

“From my perspective, one of the concerns about the five-day, seven-day sort of limit is the 14 days becomes seven days, but the two days becomes seven days,” Gottlieb said. “So you’re going to be bringing some prescriptions down to a more appropriate duration, but you’re also going to be bringing prescriptions that are shorter to a longer duration.”

The commissioner said the guidelines will focus initially on acute care conditions where over prescribing has been rampant. Agency data suggests that patients often need opioids for only one or two days after laparoscopic gallbladder or hernia surgeries, but may need pain killers for a week or more after a heart bypass or orthopedic procedures.

Gottlieb is also leading a joint effort with cancer groups to develop better guidelines for opioid use to treat cancer pain, but the agency will not be looking at new guidelines for chronic pain conditions at this time.

Gottlieb spoke just two days before an Oregon committee plans to begin reviewing a proposal that would limit Medicaid coverage for five broad chronic pain conditions to 90 days of opioid pain relievers and would force patients who have been taking opioids for longer to be tapered off those medications within a year. Oregon implemented a similar strategy for low back pain two years ago.

While Gottlieb said the agency wasn’t focused on what states were doing with respect to opioid limits, he spoke about the need to balance efforts to address over prescribing and give doctors the flexibility to prescribe opioids for those who need them.

“There are certain patients for whom chronic use is appropriate,” Gottlieb said. “We need to recognize that and allow for that.”

Rick Treleaven, director of Redmond-based BestCare Treatment Services, expressed concerns that after years of promoting opioid use, the pendulum was swinging too far the other way at both the federal and the state level.

“We’re getting so tight again with the pain medication, that it’s inhumane,” he said at the round table. “We’ve got to find that middle ground.”

The wide-ranging discussion with local Central Oregon health officials, held at the Oregon State University, Cascades campus, touched on a number of opioid-related topics.

• Walden touted the 57 separate opioid measures passed by the House Energy and Commerce committee he chairs and rolled into H.R. 6, passed by the House in June. Senate leaders are now working on their own version of the opioid bill, which will then have to be reconciled with the House version.

“Hopefully, in September, we hope to get it on the president’s desk,” Walden said. “I don’t anticipate major changes.”

• Included in the House bill was a measure to allow providers treating patients with addiction to coordinate care with those patients’ other medical providers. Doctors have complained that a privacy measure last updated in 1987 was preventing better integration of their care.

• Gottlieb reiterated the agency’s commitment to developing new abuse-deterrent formulations of pain medications. Some attempts by drug makers to produce abuse-deterrent drugs have run into hurdles, causing the manufacturers to withdraw from the approval process. But Gottlieb said there were new technologies and novel approaches that had merit.

“I think they can be potentially very effective,” he said.

• The FDA issued new rules on Monday that would allow drug makers to get approval for addiction treatments without having to prove they could get patients with addictions completely off of opioids.

“That was a high threshold to hit,” Gottlieb said. “If you could have a treatment, for example, that cuts down the risk of overdose or cuts down on craving, that might be an important adjunct to an overall approach to care.”

• Gottlieb said that while the U.S. has made progress in reducing over prescribing of opioids, the progress has been more than offset by the increase in illicit opioids, such as fentanyl, flowing into the country.

“The amount of illicit drugs is dramatically more than the reduction that we’ve seen,” he said. “It’s being backfilled with fentanyl.”

• The agency has received new authority and funding to ramp up efforts to intercept illicit substances and unapproved drugs coming into the U.S. by mail. Gottlieb said more than 800 million packages were mailed to the U.S. last year, and this year, the number could exceed 1 trillion. That provides a gap through which illicit substances such as fentanyl can be shipped into the U.S. “What we’re trying to do,” he said, “is plug those gaps.”

• Crook County Health Director Muriel Delavergne-Brown raised concerns about the rising cost of and difficulty of obtaining Narcan, the drug used to reverse opioid overdoses. The county health department supplies the Prineville Police Department and the Crook County sheriff’s deputies with the medication but is facing challenges in acquiring sufficient supply.

• Several providers at the round table raised concerns over the continued prescribing of opiods and benzodiazepines, a combination that has been shown to dramatically increase the risk of overdose.

“It’s kind of the shadow epidemic to the opioid epidemic,” said Kim Swanson, chair of the Central Oregon Pain Standards task force. “And it’s not been hit as hard with education or guidelines.”

—Reporter: 541-633-2162, mhawryluk@bendbulletin.com

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‘Middlemen’ Account for One Third of US Drug Costs

https://www.medscape.com/viewarticle/900505

About one third of drug spending in the United States goes to pharmacies, pharmacy benefit managers (PBMs), and hospitals or clinics that dispense drugs, according to an analysis published by Health Affairs.

US healthcare spending is a critical economic and political issue, with skyrocketing drug costs reaching crisis levels. Now, Nancy Yu, BA, MBA, a biopharma industry analyst from the Center for Health Policy and Outcomes at Memorial Sloan Kettering Cancer Center in New York City, and colleagues estimate that the United States spent $480 billion on drugs in 2016, including the profits of pharmacies and other intermediaries.

That is nearly 50% higher than the Centers for Medicare & Medicare Services’ 2016 estimate of $328 billion in US drug spending, which did not include drugs dispensed in hospitals or clinics.

The authors note that President Trump and the pharmaceutical industry “have stressed that supply chain intermediaries, or ‘middlemen,’ are capturing much of the money that is often categorized as drug spending.” Yu and colleagues crunched the numbers and found these intermediaries account for about one third of the spending.

“A clearer understanding of the total market size, as well as the revenues retained from the purchase, distribution, and payment of prescription drugs throughout the US supply chain, may be useful for policy makers as they seek reforms while working to preserve incentives for innovation and efficiency,” Yu and colleagues write in a Health Affairs blog post published July 31.

In May, President Trump announced a raft of possible initiatives to reign in drug prices, including creating tools for Medicare to negotiate some drug prices, speeding approval for over-the-counter drugs, and promoting competition between drug makers. He also said he’d like to eliminate “middlemen,” who have “become very, very rich.”

The estimates by Yu and colleagues suggest that two thirds of US drug spending ($323 billion) goes to drug manufacturers’ net revenues. Of the remaining $157 billion retained as gross profit by intermediaries in the supply chain, about half ($73 billion) goes to retail or specialty pharmacies and 20% ($35 billion) goes to hospitals or physicians’ offices. PBMs bring in $23 billion and drug wholesalers another $18 billion, together accounting for slightly more than 25%.

“Our intent is not to infer or draw conclusions on where there are outsize profits or how difficult it would be to reduce spending within the supply chain, nor do we opine on the consequences of reducing that spending,” the authors write. “But a recent policy focus on the supply chain suggests that understanding those consequences will be important.”

Allan Coukell, senior director of health programs at The Pew Charitable Trusts, called the analysis useful in detailing where in the drug chain money is being spent. He said the findings largely align with a similar analysis by Pew that has yet to be published. However, he noted that PBMs pass a portion of the profits they make back to the health plans they work for, which isn’t accounted for in Yu’s analysis.

Much of the policy debate in Washington about the potential role of “middlemen” in driving up costs has focused on the role of PBMs in drug costs, Coukell explained. But he noted that they also provide several services including paying claims, designing drug formularies, and negotiating rebates with drug manufacturers.

“In terms of turning the tide of overall drug spending, that’s not the thing driving drug spending,” Coukell said. “The evidence shows PBMs are playing an important role in keeping drug costs down.”

Instead, Coukell said most of the growth in drug spending is driven by high prices on new drugs and year-to-year increases on the prices of drugs still under patent with no competition. To reign in these costs, he suggested optimizing drug discounts for government programs, introducing competition in Medicare B, or boosting use of generics or biosimilars.

One study coauthor reports receiving personal fees from the American Society for Hospital Pharmacy, Gilead Pharmaceuticals, WebMD, Goldman Sachs, Defined Health, Vizient, Foundation Medicine, Anthem, Excellus Health Plan, Hematology Oncology Pharmacy Association, Novartis Pharmaceuticals, Janssen Pharmaceuticals, Third Rock Ventures, and JMP Securities unrelated to the study. The other authors and Coukell have disclosed no relevant financial relationships.

My first summer working in a pharmacy (1967) I got assigned a task to calculate the average Rx price for the chain store that I was working for…  Back then.. there were virtually no generics… almost everything was BRAND NAME MEDS… there was no PBM/drug cards, Medicaid was in its infancy. All prescriptions were CASH and the average price was in the $4 -$5 range.

Here we are 50 yrs later and the average price is pushing $60 and there is a 85%-90% generic utilization and PBM’s collectively pay for some 80%-90% of all prescriptions…

If one applied the CPI to the average Rx price back in 1967… one would expect that today the average Rx price would be in the $35 – $45 range.. that is ignoring that we now are dispensing all of those generics..  which is suppose to save everyone money.

The two major changes in 50 yrs is the massive change from totally brand name meds to generics and PBM’s – a middleman – controlling the prices that the pharmacy get paid and what the insurance company pays for the prescriptions and the PBM’s are in the position to be able to DEMAND rebates/kickbacks/discount from the pharmas to make sure that they meds are on the PBM’s formula..

According to my calculations … there is some $15 – $25 per Rx that shouldn’t be there in the average price of prescriptions..  Guess where that extra cost is going ?

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Big Brother Walmart Is Watching Your Meds Very Carefully. And Not Just Painkillers

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

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Chicago limits opioid prescriptions for city employees

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

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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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