Email steve@steveariens.com 502-938-2414
Pay Attention
This is a pt with MS and has contracted SHINGLES… who said that we have the BEST HEALTHCARE SYSTEM IN THE WORLD ?
My DOG gets better care from her VET.. than it would seem to be provided this pt.. Don’t know where this pt is and/or what “hospital” she is in… Doesn’t sound like one I would want to be in “sick” and be expecting to receive appropriate treatment.
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NEW YORK (Reuters) – CVS Health Corp agreed to pay a $1.5 million civil fine to resolve U.S. charges that some of its pharmacies in Nassau and Suffolk counties in New York failed to report in a timely manner the loss or theft of prescription drugs, including the opioid hydrocodone.
Richard Donoghue, the U.S. Attorney for the Eastern District of New York, on Thursday said delays contribute to opioid abuse, and that CVS’ failures impeded the ability of Drug Enforcement Administration agents to investigate, violating federal law.
CVS, based in Woonsocket, Rhode Island, did not immediately respond to a request for comment.
“This settlement is significant because it shows that big chain pharmacies, like CVS, are taking responsibility for violating federal law, which is a step in the right direction for curbing the opioid epidemic,” DEA Special Agent-in-Charge James Hunt said in a statement.
Opioids, including prescription painkillers and heroin, played a role in a record 42,249 U.S. deaths in 2016, according to the U.S. Centers for Disease Control and Prevention.
CVS has more than 130 pharmacies in Nassau and Suffolk, according to its website.
The company reached a $5 million settlement with the U.S. government last July over similar claims involving pharmacies in California.
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https://flmedical.org/Florida/Florida_Public/Docs/FMA-Opioid-HB21.pdf
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https://ramblingsoapbox.com/2018/06/26/an-open-letter-to-dr-andrew-kolodny/amp/
Update 6/27/18: I am overwhelmed by the positive responses I have received for this letter. I would ask that readers also take a look at all the articles and references cited in this piece, and share those as well. Those references go into much, much more detail and research than I have had space or time for here. Thank you all so much for reading and sharing, I believe we will make a difference and win this fight for our lives! #wearehere
See also: A Rock and a Hard Place, The Truth About the Opioid Crisis, and Strangulation on Medicine
Dear Dr. Kolodny,
I am one of millions of chronic pain patients in the United States who has been continually and increasingly oppressed over the past few years by progressively invasive and prohibitive laws at the state and federal levels concerning the delicate relationship between doctors and patients, particularly when it comes to a certain class of drugs, i.e. opiates.
Ever since my very real, physical condition began about 4 years ago, my family and I have been disoriented again and again by a lack of what might be termed, “help,” from doctors. We have discovered a very confused medical community, corruption, and a growing collection of laws being passed so fast and furiously hardly anyone seems to know just what is going on.
This has resulted in doctors leaving my city, doctors outright refusing to accept chronic pain patients (or, if they do accept these patients, refusing to treat them with medications that suit the patient best) or new patients, and unprecedented referrals to pain management clinics and psychiatrists. I have a detailed post planned addressing the pain management clinics, but the psychiatrist referrals were more baffling to me. My local psychiatrists even refused me as a patient about a year ago because, “we don’t see chronic pain patients.” That made sense to me as I don’t suffer from mental illness, still my providers insisted I must be mistaken.
I began researching you and your career last night out of curiosity. I wanted to answer the question, “Who is this Dr. A. Kolodny, that everyone from journalists to policy makers and bloggers keep quoting as an “expert on opiates”?” And I found out. You, sir, are a psychiatrist and board-certified addiction specialist-turned policy maker (1) and buprenorphine (Suboxone) “evangelist” (2).
Your first private clinic was a Suboxone clinic in New York City, established sometime around 2003-2005, and it appears you (and/or other health officials) felt stymied by the federal limit at the time of just 30 patients for such clinics (put in place to stem corruption), because said health officials have been in the background, quietly working away at this very limit which was amended in 2006 (called DATA), to allow 100* patients after 1 year, and is now up in the House for being overturned altogether, along with expanding legal prescribers to nurses and other non-doctor medical staff. And look what has happened as a result:
Health officials, concerned about restricted access, lobbied alongside Reckitt Benckiser for the patient cap to be raised. “Why should we bind a healer’s hands from helping as many as he or she could?” Senator Hatch said, getting an amendment passed in 2006 that allowed doctors, on request, to go from 30 to 100 patients after a year.
The stage was set for more patients, prescriptions and problems. “It’s when the limit was raised from 30 that doctors started to get commercial about it,” said Dr. Art Van Zee, whose buprenorphine program at a federally funded community health center in rural Virginia is surrounded by for-profit clinics where doctors charge $100 for weekly visits, pulling in, he estimated, about $500,000 a year.
“They are not savvy about addiction medicine, don’t follow patients very closely, don’t do urine testing and overprescribe,” he said. “That’s how buprenorphine became a street drug in our area.” https://www.nytimes.com/2013/11/17/health/in-demand-in-clinics-and-on-the-street-bupe-can-be-savior-or-menace.html (4)
“In the early days of Suboxone, with Reckitt Benckiser barely marketing its own drug, Dr. Kolodny, then a New York City health official, crisscrossed the city with colleagues to spread the word about the new medication, entice public hospitals to try it with $10,000 rewards and urge doctors to get certified.”
Since at least 2005, you have been marketing buprenorphine as if you had a personal stake in the drug, to government institutions and agencies including prisons, public hospitals, and rehabilitation facilities (2). In the fall of 2013, you were appointed Chief Medical Officer (5), of the largest chain of non-profit detox/rehab facilities in the USA (cited for questionable practices and abuse from at least 2012-2015) (6) called Phoenix House, which received $131 million in June 2013 (7), championing the use of MAT, or “Medication Assisted Treatment”. I wonder which drug Phoenix House used?
Since you often cite the United States vs. Purdue Pharma (2007) settlement in your interviews and writings, perhaps you saw an opportunity to expand the use of buprenorphine by targeting and demeaning chronic pain patients as mere “addicts”.
It was odd to me in researching that incident, in the official “Purdue Guilty Plea” document (8), the very words they were condemned for, claiming OxyContin to be “less addictive” and “less subject to abuse and diversion” (8), appear to be the exact words you use time and again when describing the benefits of buprenorphine (2).
Kolodny reminds his colleagues of the drug’s advantages. He stresses that bupe in the form of Suboxone is safe and almost impossible to abuse, a huge selling point at many of the clinics they will visit. Suboxone has a second active ingredient in the mix, he explains, an anti-overdose drug called naloxone.
It does nothing if you take bupe as directed. But if you sniff bupe or inject it or otherwise try to pack enough into your bloodstream to get high, the naloxone acts like a chemical booby trap, erasing the effects of any opiate, bupe included, and bringing on sweaty, nauseating withdrawal. “That’s the last time you’ll do it,” Kolodny says dryly. https://www.wired.com/2005/04/bupe/
In 2016, your organization, PROP (Physicians for Responsible Opiot Prescribing), got the ear of the CDC and helped to write the now-infamous, misinformed, and rushed guidelines for prescribing opiates. While these guidelines were fairly general in nature, they have been used as a springboard for countless pieces of state legislation and DEA investigations, which has, in turn, led to the above-mentioned abuse and abandonment of chronic pain patients and doctors, as well as opiate shortages in hospitals and ERs (The DEA, in an attempt to prevent diversion of opiates to the black market, has cut production by an incredible 45% in the past 2 years). I imagine that suits you just fine, since you have publicly stated you believe opiates should be discontinued for all but the dying and post-major surgery “for a few days” (https://www.ket.org/opioids/inside-opioid-addiction-10-questions-with-dr-andrew-kolodny/), and that “more treatment” is needed (https://www.vox.com/science-and-health/2017/8/3/16079772/opioid-epidemic-drug-overdoses), i.e. MAT/Suboxone clinics like Phoenix House.
You have hailed local municipalities and states in their further pursuit of legal action against American Big Pharma, the companies who make such things as Vicodin and Percocet, but not Suboxone/buprenorphine (which is also an opiate), which is made by an overseas company, Reckitt Benckiser, or Naloxone (Narcan), which is produced in a nasal spray exclusively by Amphastar Pharmaceuticals (10), a relatively new company founded in California in 1996 (11), whose stock (and Narcan prices) has been rising quite a bit, lately (12, 13). Are you truly against the use of opioids, or just the ones that help pain?
Although your policies, based on inaccurate data (14-15) https://www.acsh.org/news/2017/10/12/opioid-epidemic-6-charts-designed-deceive-you-11935 (15), and http://www.mdmag.com/journals/pain-management/2012/october-november-2012/just-how-responsible-is-prop, have been wildly ineffective at stopping heroin/fentanyl overdoses; although you are not a pharmacologist, opiate researcher, pain doctor, pain patient, surgeon, or even general practitioner; although you ran a private clinic for a short time in 2005 (as far as I’ve been able to learn) that dispensed buprenorphine/Suboxone, you have, for the majority of your career as far as I can tell, been a policy-maker and not directly involved with addiction patients or chronic pain patients whom you recently claimed were simply addicts who needed compassion and “treatment” (and, presumably, Suboxone).
“Many Americans are truly convinced that opioids are helping them. They can’t get out of the bed without them.”
“Policy makers were told by industry-funded pain organizations not to penalize pain patients because of drug abusers. We realized that this wasn’t true. We don’t have these two distinct groups, one for pain patients and the other for drug abusers.” https://www.kolmac.com/2015/12/qa-dr-andrew-kolodny-chief-medical-officer-phoenix-house/ (15a)
You are cited and quoted in an impressive number of articles and interviews as a compassionate person who wants to see people and their families heal from the devastation of addiction, which is why it surprised me to find quotes from you that didn’t seem, well, “nice.”
It is the FDA’s role to vigilantly regulate the approval, labeling, and promotion of pharmaceutical products, not that of counties or municipalities. County and municipal lawyers are inadequately qualified to make or enforce federal drug policy, and these lawsuits serve as a vehicle for local governments to seek revenue through ill-informed measures under the guise of drug abuse prevention. In a May 30,2014, interview with FDA Week, a CLAAD spokesman voiced these positions and expressed concern that these lawsuits are part of “a trend that will distract us from the real meaningful approaches to reducing prescription drug abuse.”
After reading the interview, Dr. Andrew Kolodny, president of Physicians for Responsible Opioid Prescribing (PROP)and Chief Medical Officer of Phoenix House, contacted CLAAD via telephone to condemn its comments. During this conversation, Kolodny threatened that the Internal Revenue Service would revoke CLAAD’s tax-exempt status when alerted to the comments, which he believes conflict with CLAAD’s charitable mission. CLAAD takes these false allegations and threats very seriously, and responded in a letter which is publicly available for view on our website.
Critics who categorically dispute the motives of organizations like CLAAD and its diverse coalition members are, at best, narrowly focused. Their zealotry reveals their otherwise undisclosed health insurance industry bias. At worst, they endanger the lives of people who live with pain and other conditions that can require controlled substances by stifling access to quality care. http://paindr.com/claad-and-phoenix-house-square-off/ (16)
Anyone who questions your authority, expertise, policies, or the efficacy of your pet drug, buprenorphine, is loudly dismissed by you as uneducated (17), addicted (15a), or corrupt (15a, 18), regardless of how closely they actually work with addicts and pain patients (17).
But Dr. Kolodny, I have nothing left to lose — your policies and attitudes have directly impacted my health, my freedom, my ability to be a parent, my work, my hobbies, my family, my finances, my friends, and my personhood. I have no problem announcing to the public, as loudly as I can, “The Emperor is not wearing any clothes!”
Citations
(1) http://www.cecentral.com/search/faculty/136145
(2) https://www.wired.com/2005/04/bupe/
(6) https://www.reuters.com/investigates/special-report/usa-rehab-phoenixhouse/
(7) http://www.phoenixhouse.org/wp-content/uploads/2014/06/2013-Financial-Report.pdf
(8) https://assets.documentcloud.org/documents/4378824/Purdue-Guilty-Plea-Copy.pdf
(9)
(11) http://www.amphastar.com/about-us.html
https://www.ket.org/opioids/inside-opioid-addiction-10-questions-with-dr-andrew-kolodny/
(15) https://www.acsh.org/news/2017/10/12/opioid-epidemic-6-charts-designed-deceive-you-11935
(15a) https://www.kolmac.com/2015/12/qa-dr-andrew-kolodny-chief-medical-officer-phoenix-house/
(16) http://paindr.com/claad-and-phoenix-house-square-off/
(17) https://www.nytimes.com/2016/05/29/opinion/sunday/addicted-to-a-treatment-for-addiction.html
(18) https://www.kolmac.com/2015/12/qa-dr-andrew-kolodny-chief-medical-officer-phoenix-house/
https://www.vox.com/science-and-health/2017/8/3/16079772/opioid-epidemic-drug-overdoses
https://www.cdc.gov/drugoverdose/prescribing/guideline.html
Further Resources
https://www.cdc.gov/drugoverdose/prescribing/guideline.html
https://www.bendbulletin.com/topics/5342867-151/opioid-crisis-pain-patients-pushed-to-the-brink
http://nationalpainreport.com/cdc-does-not-comply-with-federal-law-8828305.html
https://www.chronicle.com/article/To-Counter-Opioid-Crisis-NIH/240219
https://www.painnewsnetwork.org/stories/2016/8/11/prop-ends-affiliation-with-phoenix-house
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“We have been told directly per company policy and multiple emails that in cases where we refuse to fill controls we are to cite “professional judgment” and are absolutely not supposed to give any more details than that. We wouldn’t want to get sued for being ‘defamatory’ toward a prescriber, of course. This is mainly in situations where we feel the doctor is basically running a pill mill or has other unethical practices though. In general we try to explain dosing issues and the need to call an office when things seem legitimate”
“Was told by ohio board investigator that we cannot be specific with the patient as to why we are refusing. We can only tell them we are not comfortable filling the prescription, and that their doctor can call and discuss with us. He said that when we start explaining why we are refusing to fill it is deemed as “practicing medicine.”
“Our corporate guidelines prohibit us from being specific such as not to cause a customer service issue. Our state has made it a felony to discuss controlled database findings with patients but made it mandatory for both MD and RPh to utilize it…yet here we are. A script that shouldn’t be filled, but I can’t be truthful with the patient as to why…talk about an enthical conundrum…”
“one of the big chains has a refusal policy in place, but you’re not allowed to tell the patient specifically why you’re refusing it, as that would be “disclosing proprietary company information.” This definitely has patients leaving without an understanding of why it’s not being filled. I can’t tell you how much I would love to be able to say “Because your prescriber is a lying sleezeball and I don’t want my name on anything associated with him.”
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A man who said he was an Air Force veteran upset with the Department of Veterans Affairs set himself on fire outside the state Capitol in Atlanta on Tuesday morning.
Capt. Mark Perry of the Georgia State Patrol said that the man parked a passenger vehicle around 10:45 a.m. and began walking toward the Capitol.
“He was strapped with some homemade incendiary devices, some firecrackers and doused himself with some kind of flammable liquid and attempted to set himself on fire,” Captain Perry told reporters.
A Georgia State Patrol trooper rushed toward the man with a fire extinguisher “and was able to douse him pretty quickly,” he said. In a phone interview, Captain Perry said that trooper was not on duty at the time — he was driving by, and jumped out of his patrol car when he saw the flames.
The Georgia Bureau of Investigation identified the man as John Michael Watts, 58, and said he had no current address. He was taken in critical condition to Grady Memorial Hospital with burns on 85 to 90 percent of his body.
Captain Perry said he was able to speak after the fire was extinguished.
“He did indicate that he is disgruntled with the V.A. system and was seeking attention for that,” he said.
The authorities shut down the area around the Capitol and called the bomb squad to assure the man’s vehicle did not contain explosives. Nearby buildings were evacuated. No other injuries were reported.
The incident unfolded during a news conference about a new state law on hands-free driving. A series of loud bangs and then sirens could be heard in video of the event.
Natalie Dale, a spokeswoman for the state Department of Transportation who was speaking at the time, said she assumed at first that the sounds were fireworks. But as they continued, the Georgia State Patrol officers behind her started to peel off.
“They were really calm, so I stayed really calm,” she said. “I was with trained professionals.”
The Department of Veterans Affairs is a sprawling agency that includes more than 1,700 clinics and hospitals and has been plagued by scandal.
In March 2016, a 51-year-old veteran died after setting himself on fire outside of a Veterans Affairs clinic in northern New Jersey. An investigation found that the staff at the clinic repeatedly failed to ensure that he had received adequate mental health care.
Critics of the agency have long voiced frustrations. Michael Owens, a Marine Corps veteran from Mableton, Ga., and state leader with the Truman National Security Project, said many veterans say it is not responsive to their needs.
“Being a disgruntled veteran is something that I hear a lot throughout our veteran community here in Atlanta,” he said.
Mr. Owens added that the agency needed to do a better job of flagging indicators that a veteran might be in trouble. “We’ve got to do better,” he said.
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The Department of Veterans Affairs has reportedly backed off its own suicide report after reporters noted its own data revealed no change in suicide numbers and that suicides among troops were higher than expected.
Military Times noted VA was displeased that reporters and readers noted statistical outcomes it did not want. This year, the agency included breakdowns between various groupings of suicides. One of those groups is of active duty troops showing higher suicides than previously reported.
For 2015, the new numbers were 1,400 deaths, which is 900 higher than previously reported. Over the four-year span reported, the number of unreported deaths is over 3,400.
RELATED: Veterans Twice As Likely To Commit Suicide
Now, VA is backing off the report saying the numbers led to a “misperception” about the suicide numbers leading to “confusion” about military suicides.
According to the Military Times article:
“In our report, VA did not differentiate deaths between active duty, current never federally activated Guard and Reserve, and discharged never federally activated Guard and Reserve,” said Dr. Keita Franklin, VA’s national director of suicide prevention.
“This difference in the report may have caused some confusion and led to the misperception that approximately 1,000 more current service members died by suicide than DoD reported in 2015.”
Franklin said including the breakdown in the report was designed to provide more information about the demographics of individuals who took their own lives. The updated report also contains new information on veterans’ era of service, ethnicity and comparison age groups in an effort to provide “more data points for us to look at.”
VA officials blamed the confusion on the troops’ suicide information on inconsistent definitions used in various agencies. Individuals who served in the guard or reserves and are considered “veterans” in census reports may not have been counted in the Defense Department statistics because of different mobilization authorities and state rules.
But the VA researchers are now emphasizing they have not found fault with official military suicide statistics, which have counted between 550 and 450 active-duty, guard and reserve suicides in each of the last five calendar years.
The report still shows veteran suicides are holding steady at 20 per day despite record spending on vendor programs supporting the agency’s goal to reduce suicides.
Tens of millions each year in spending on vendor projects to make suicide prevention programs look sexy has led to a zero decrease in suicide numbers. Imagine if VA spent that money on hiring psychologists to treat veterans?
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.- An Arizona pharmacist is under investigation after refusing to fill a medical abortion prescription, citing ethical objections.
The case involves a 35-year-old woman named Nicole Arteaga, who was told by her doctor at nine weeks pregnant that she had an unviable pregnancy and would ultimately miscarry. She was prescribed a drug called misoprostol, which would induce a medical abortion.
When Arteaga went to fill the prescription at the local Walgreens, the pharmacist told her that he was ethically opposed to filling the drug and asked if he could transfer her prescription. Arteaga wrote about her experience on Facebook, in a post which was shared more than 36,000 times.
According to the National Women’s Law Center,
Walgreens also upholds a policy saying its pharmacists are allowed to refrain from filling drugs to which they have moral objections.
“To meet the health care needs of our patients while respecting the sincerely held beliefs of our pharmacists, our policy allows pharmacists to step away from filling a prescription for which they have a moral objection,” read a June 25 statement released by Walgreens.
“It’s important to note in that situation, the pharmacist also is required to refer the prescription to another pharmacist or manager on duty to meet the patient’s needs in a timely manner,” the statement continued, adding “we are looking into this incident.”
The Associated Press reported that the pharmacist in question was the only one on duty at the time, so he transferred her prescription over to another pharmacy.
Arteaga was able to get the abortive drug elsewhere, but the Arizona State Board Pharmacy said it would be investigating the situation. Once the investigation is presented to the board, they will either dismiss the case or seek further action, according to the Associated Press.
The Arizona case is not the first time pharmacists’ conscientious objection rights have been in the headlines. In 2007, a Christian family-run pharmacy filed a lawsuit against the state of Washington, which was requiring pharmacies to distribute abortion-inducing drugs, saying the enforcement violated their religious freedom rights.
“We believe that life is precious and sacred – and that it begins at conception. We want to promote life and true health, not death or anything that goes against our religious beliefs,” said Greg Stormans, one of the Christian pharmacists who fought against the Washington law.
“We never thought that we would have to choose between living our faith and our family business – or that we would be embroiled in a legal battle. It is unfortunate, but the commission left us no choice,” Stormans had told EWTN News in a previous interview.
A federal appeals court ultimately ruled against the pharmacists in 2015, in a decision that Luke Goodrich, deputy general counsel of the Becket Fund for Religious Liberty, called “unfortunate.”
What if a pharmacist has a moral/ethical objection to any/all opiates and/or ADD/ADHD medications ? The list of medications that a pharmacist could have a moral/ethical objection to, could be quite extensive.
A large/majority of chain pharmacies only have one pharmacist on duty so this requirement “the pharmacist also is required to refer the prescription to another pharmacist or manager on duty to meet the patient’s needs in a timely manner” could be pretty much MEANINGLESS
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‘For years, we got the scraps. And now we’re the big time,’ says an anti-addiction consultant.
https://www.politico.com/story/2018/06/22/house-opioid-bills-lobbying-637695
The House is touting passage of dozens of bills that could help combat the national opioid crisis — but a small handful of companies that have spent millions lobbying Congress could reap a windfall if any of the bills become law.
In a two-week legislative blitz, the House cleared several narrowly tailored measures that would spur sales for companies that have ramped up their influence game in Washington, according to a review of the more than five dozen bills up for votes.
Those poised to benefit include:
• Alkermes, which spent $1 million lobbying in part to support a bill to fund full-service centers where people can detox, receive medical care and start treatment — a setup that could boost the fortunes of its best-selling product, anti-addiction treatment Vivitrol, which has been held back by the need for patients to fully detox before taking the drug.
• Indivior, an Alkermes rival that spent $180,000 largely in support of a bill that eases restrictions on certain controlled substances used in injectable anti-opioid treatments — a change that would make it easier for doctors to buy Indivior’s once-a-month injectable Sublocade.
• Pennsylvania drugmaker Braeburn Pharmaceuticals, which spent $100,000 lobbying and backed the same bill because it is developing a competing injectable.
• A group of drugmakers that produce non-opioid pain relief medications, including California-based Heron Therapeutics, which spent hundreds of thousands to lobby for legislative changes to create an additional Medicare payment for non-opioid pain drugs.
The measures come as part of a House package that anti-addiction advocates and even some lawmakers say will make only incremental progress toward fighting a public health crisis that’s killing an estimated 115 Americans per day.
“This is a very energetic effort to pretend we’re doing something significant,” said Rep. Peter Welch (D-Vt.), who supported the package but stressed the need to devote greater resources to the opioid fight. “By and large it’s better to do than not, but it falls way short of what is required.”
Yet as the epidemic morphs into a major campaign issue — and Congress runs out of time to pass other legislative packages — interest in the opioid effort has ballooned. Congress used February’s budget deal to authorize spending $6 billion over two years to address the crisis, prompting more than 300 companies and interest groups to flood Capitol Hill to lobby on opioids during the first three months of 2018, according to disclosure forms.
“When you hear they’re investing $3 billion in this in 2018 and $3 billion in 2019, everyone’s ears are going to perk up,” said Andrew Kessler, the founder of behavioral health consulting firm Slingshot Solutions. “For years, we got the scraps. And now we’re the big time.”
Alkermes, a big potential winner, has already attracted attention for its aggressive marketing tactics and Washington lobbying presence. Former HHS Secretary Tom Price toured the company’s Wilmington, Ohio, plant last year to tout Vivitrol — stirring controversy by belittling rival medication-assisted treatments that are more widely-used.
Alkermes spent $1 million lobbying Congress from January through March, focusing on a bipartisan bill from Reps. Brett Guthrie and Gene Green that directs millions of dollars to create full-service centers where people can detox, receive medical care and start treatment under the same roof. The proposal, passed last week in the first wave of House opioid votes, attempts to address the difficulty many patients face finding comprehensive treatment, the lawmakers said.
It also neatly addresses a chief problem holding back Alkermes’ best-selling product: While Vivitrol is one of just three FDA-approved drugs treating opioid addiction, it’s the only one that requires patients to fully detox before taking it.
That’s a major roadblock for doctors who are often unsure whether a patient has been in withdrawal for at least a week, and for patients desperate for immediate treatment, crimping Vivitrol’s market potential just as providers increasingly embrace medication-assisted treatment.
“The issue with Vivitrol is the fact that 25 percent of patients fail the detox component and therefore relapse, and is also one of the reasons why patients prefer Suboxone or Sublocade,” said Biren Amin, a pharmaceutical analyst for Jefferies LLC, referring to competing treatments. “Vivitrol growth [is] clearly impacted.”
By contrast, doctors in the recovery centers proposed by Guthrie and Green could closely monitor and manage patients’ progress, and then start treatment as soon as they’re fully detoxed.
The bill was one of only two opioid bills that Alkermes targeted in its lobbying, according to disclosure documents. Of the four main lobbyists for the company on the issue, one previously served as Guthrie’s deputy chief of staff. Another was Green’s former legislative director.
Both Guthrie and Green rejected any suggestion the bill was written to benefit Alkermes, pointing to its support from anti-addiction groups. The bill doesn’t mandate the recovery centers use one medication over another.
“We met with all the stakeholders,” Guthrie said. “We just think most people need access to all the [treatment] options.”
In a statement, Alkermes highlighted the legislation’s broad support, adding that it “is not about a particular form of treatment, but rather focuses on … comprehensive care.” The company said it has always supported using all FDA-approved medications for opioid dependence.
Though Alkermes ranked among the biggest-spending companies on opioid issues, it’s far from the only firm spending large sums to capture Congress’ attention.
“Whoever’s stuff is slick gets put to the top of the pile,” one longtime behavioral health lobbyist said of the corporate muscle that’s descended on Capitol Hill.
Indivior backed a bill from Rep. Ryan Costello that would ease restrictions on certain controlled substances used in injectable anti-opioid treatments — an arcane but important change that would effectively make it easier for doctors to buy Indivior’s once-a-month injectable Sublocade. Some view injectable treatments as preferable because they’re less likely to be diverted or misused.
The legislative tweak — which has already passed the Senate — is the only specific House opioid bill that Indivior listed in disclosures showing $180,000 spent on lobbying in the year’s first three months.
Braeburn Pharmaceuticals, which is developing a competing injectable anti-opioid treatment, spent $100,000 over that same period and also listed the Costello bill as the only provision in the House package it focused on.
Indivior did not respond to specific questions about its lobbying effort, saying in a statement that “government policies impacting these treatments must adapt toensure patients have access to all evidence-based treatment options.”
Braeburn said the bill simply codifies prior understandings, and that it supports policies that open up access to all treatments for opioid use disorder.
A spokeperson for Costello said he supports medical innovation and expanding access to a variety of anti-opioid treatments, and noted the bill passed unanimously out of the Energy and Commerce Committee. The legislation wasn’t initially rolled into the House’s main opioid package, but could still be added or passed separately.
Other bills proposed in the House are more direct in the way they would help specific companies.
A small group of post-surgery pain drug makers, including Heron Therapeutics, stand to benefit from Rep. Scott Peters’ legislation creating an additional Medicare payment for certain non-opioid pain drugs.
Heron, which is developing a treatment that would qualify for the payment, spent $40,000 lobbying on rate-setting issues for post-surgical non-opioid drugs from January to March.
The company is headquartered in Peters’ district, and said in an email that it has discussed opioid and addiction policies with the California lawmaker. But it emphasized that none of its currently approved drugs would benefit from the proposal, and that drugs made by other companies could also qualify.
A spokesperson for Peters said he met with Heron employees and toured the company’s headquarters as part of his interest in promoting post-surgery opioid alternatives, but he also met with other groups and developed the bill’s language in coordination with federal health officials and other lawmakers.
A bipartisan effort led by Reps. John Shimkus (R-Ill.) and Raja Krishnamoorthi (D-Ill.), meanwhile, reverses deep cuts to reimbursements for select interventional pain management techniques.
That qualifies as a victory for the main trade group representing doctors who use non-opioid methods — including epidurals and other injections — to manage pain. In a celebratory blog post, the American Society of Interventional Pain Physicians said it turned to Congress to restore its pay levels after unsuccessfully lobbying federal health officials.
“The agency said heck no, we can’t touch it — it needs a legislative fix to be more specific in the intent of Congress,” Shimkus said about when he stepped in. He added that the higher pay rate is needed because those more invasive pain management techniques are often more expensive than prescribing opioids.
A spokesperson for Krishnamoorthi said the lawmaker’s interest stemmed from his support for non-opioid alternatives, and that he never personally met with ASIPP about the legislation. ASIPP’s PAC has donated the maximum $10,000 allowed for this election cycle to both support for the bill.
Behavioral health and anti-addiction advocates have largely shrugged off those narrow provisions, saying they’re a byproduct of a fast-moving, piecemeal effort to address a public health crisis.
Yet they also acknowledge it means crucial funds will be limited to select groups instead of the broader population.
That only heightens the importance of Congress continuing to pursue new proposals for curbing drug abuse, Slingshot Solutions‘ Kessler said.
“There’s a lot of good stuff in there,” he added. “However, there’s a lot to be very, very cautious of as well. And the reason is because as much attention as Congress is paying and as much money as they’re dedicating to it, we’re still not anywhere close to where we need to be.”
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