“The moral test of a government is how it treats those who are at the dawn of life, the children; those who are in the twilight of life, the aged; and those who are in the shadow of life, the sick and the needy, and the handicapped.” – Hubert Humphrey
passionate pachyderms
Pharmacist Steve steve@steveariens.com 502.938.2414
HealthDay News &,dash; Concomitant exposure to pregabalin and opioids is associated with increased odds of opioid-related death, according to a research letter published online Aug. 21 in the Annals of Internal Medicine.
Tara Gomes, Ph.D., from the University of Toronto, and colleagues conducted a population-based nested case-control study and identified a cohort of persons aged 15 to 105 years who received publicly funded opioid prescriptions between Aug. 1, 1997, and Dec. 31, 2016. Case patients (1,417), defined as those who died of an opioid-related cause, were matched with up to four controls based on age, sex, index year, history of chronic kidney disease, and Charlson comorbidity index (5,097 participants).
The researchers found that, compared with opioid exposure alone, concomitant exposure to pregabalin in the preceding 120 days correlated with significantly elevated odds of opioid-related deaths (adjusted odds ratio, 1.68). Results were consistent in sensitivity analyses assessing pregabalin use overlapping the index date and after matching on prior use of central nervous system depressants (odds ratios, 1.81 and 2.00, respectively). A high dose of pregabalin correlated with increased odds of opioid-related death compared to no pregabalin exposure in the dose-response analysis (adjusted odds ratio, 2.51), while the odds of opioid-related death were lower but still significantly elevated with a low or moderate dose of pregabalin (adjusted odds ratio, 1.52).
The pharmacy industry continues to provide superior levels of customer satisfaction in the brick-and-mortar and mail-order segments, according to the J.D. Power 2018 U.S. Pharmacy Study, released Tuesday. Health-and-wellness services available in brick-and-mortar pharmacies and the timeliness of delivery for mail order pharmacies are among the key factors driving customer satisfaction.
Good Neighbor Pharmacy ranked highest overall among brick-and-mortar chain drug stores, with a score of 903. Health Mart (890) ranked second and Rite Aid Pharmacy ranked third (846). Sam’s Club ranked highest overall among brick-and-mortar mass merchandiser pharmacies, with a score of 892. Costco (860) ranks second and CVS/pharmacy inside Target (859) ranks third. Among brick-and-mortar supermarket pharmacies, Wegmans ranked highest overall, with a score of 906. H-E-B (897) ranked second and Publix (891) ranked third.
Humana Pharmacy ranked highest overall in mail order with a score of 885. Kaiser Permanente Pharmacy (866) ranks second and Express Scripts (862) ranks third.
The 2018 study is based on responses from 10,749 pharmacy customers who filled a prescription during the three months prior to the survey period of May-June 2018.
“The retail pharmacy business has been in the spotlight ever since Amazon announced in June 2018 that it’s getting into the space,” J.D. Power senior director and healthcare practice leader Greg Truex, said, in a press statement. “Amazon, or any other organization looking to disrupt the $100 billion U.S. mail order pharmacy market, will have their work cut out for them. Legacy pharmacy players have invested heavily in delivering superior service, while brick-and-mortar pharmacies are starting to reap significant customer satisfaction gains from retail-style clinics offering health and wellness services.”
The study also found the following:
The average customer satisfaction score for brick-and-mortar pharmacies was 847 on a 1,000-point scale; mail order was 859, which is favorable when compared to h other high-scoring industries evaluated by J.D. Power, such as direct banks (863), property and casualty insurance companies (860) and full-service investment advisors (839). Among the different pharmacy segments, supermarkets have the highest levels of overall satisfaction (863).
Among brick-and-mortar pharmacies, the key driver of overall customer satisfaction is the availability of health and wellness services. Availability of these services is associated with a 66-point improvement in overall satisfaction. Such services are currently present in 86% of chain drug stores, 83% of supermarket pharmacies and 75% of mass merchandiser pharmacies.
Among mail-order pharmacies, the key driver of overall customer satisfaction is having a prescription ready/delivered when promised. Delivering prescriptions on time is associated with a 78-point increase in overall customer satisfaction. Customers also evaluate the speed of delivery, adding 42 points to overall satisfaction scores when prescriptions are received within five days of completing an order.
•Some of the most significant drivers of customer satisfaction in all pharmacy segments include friendly, engaging service. Among brick-and-mortar pharmacies, the second-most effective driver of overall satisfaction is “non-pharmacist staff greeted you in a friendly manner,” which is associated with a 64-point increase in customer satisfaction. Even in the mail-order segment, a “thank you” from non-pharmacist staff is associated with a 17-point increase in satisfaction.
Tonight on #CAWNATION With guest DR. MARK ISBEN Topic: MMJ, Ketamine Infusions & Legal Updates Please call in with questions at (415) 915-2291. Tune in either at www.cawnation.com or YouTube Channel, Conspiracies Against Wellness Live Stream. #CAW360NETWORK #TDC #WeR1
“THE DOCTOR’S CORNER” w/ DR. KLINE & Jonelle Elgaway
Topic: The ABC’s of Addiction (3 types) Website: www.cawnation.com YT: Conspiracies Against Wellness Call in w/ questions: (415) 915-2291 #TDC#CAW360NETWORK#WeR1
Sign this #MEAction petition and stop the CDC from making ME treatment guidelines without our input! View this email in your browser
Take urgent action to stop the CDC from repeating a terrible mistake.
Dear GivePain,
We need your help.
The US Centers for Disease Control (CDC) is updating its ME treatment guidelines. As part of this work, it is attempting to quietly hire the same independent contractor that previously recommended graded exercise therapy (GET) and cognitive behavioral therapy (CBT) for the treatment of ME. We cannot let history repeat itself: Sign the #MEAction petition to stop the CDC from repeating a terrible mistake. Then SHARE on social media and with friends and loved ones. We must act quickly and respond by Friday, Aug. 31st. That’s this Friday!
We encourage allies around the world to fight this contract by signing the petition, no matter where you live.
The CDC is attempting to quietly hire the Pacific Northwest Evidence-based Practice Center (EPC) for a sole-source contract to help them develop new federal guidelines for ME/CFS treatment. That may not sound that bad, but there is plenty of reason to be alarmed. This same contractor was hired four years ago to do a similar literature review of the evidence base for ME/CFS treatments by a CDC sister-agency, the Agency for Healthcare Research and Quality (AHRQ). It did not go well. The EPC’s 2014 report included recommendations for graded exercise therapy (GET) and cognitive behavioral therapy (CBT), and concluded that PACE was a good trial with little bias! Only through the dogged work of many ME advocates and an #MEAction petition did EPC finally issue a reanalysis TWO YEARS LATER. However, they still refused to publish this 2016 addendum in a peer-reviewed journal, making their conclusions effectively invisible to any future developers of treatment guidelines for ME. This is not a contractor whose expertise or quality of work the CDC should trust.
We cannot let history repeat itself. We have to stop this right now. The CDC is trying to rush the EPC contract through with minimum time for us to respond. We only have until August 31 – THIS Friday – to respond.
Sign the petition to demand that the CDC not issue this contract, put the project on hold, and meet with #MEAction immediately to discuss implementing a transparent and collaborative process for creating future guidelines that engages advocates and community representatives, and includes experienced ME researchers and expert practitioners. We need you to take this urgent action today. EVERYONE can SIGN and SHARE this petition to the CDC, including those living outside the US.
Sign the Petition Now!
Let’s make NOISE the CDC can’t ignore.
In Solidarity, Ben HsuBorger Community and Campaigns Director
UPDATE: You have changed things. I just got a call from a lady at VA. Someone sent the video to a senator and that senator (she would not give me the senators name) contacted the VA and told them to find a way for me to receive after treatment where ever I want. This is a big deal. However, while this does help me obtain the treatment I need it still doesn’t change the fact that had they done things the way they should have I would not be dying.
My desire and wish is to force changes in the va to allow ALL veterans to get the care they need. If they can now allow me to get treatment where ever I want then they can allow ALL veterans to get treatment where ever they want. Please don’t stop now. This is a fight you can win.
For patients taking chronic opioids with or without an overlapping benzodiazepine prescription, the rate of emergency department (ED) visits and hospitalizations decreased in the United States from 2009 to 2015, according to a study published in The Clinical Journal of Pain.
Researchers conducted a retrospective cohort analysis using the MarketScan database to identify patients aged ≥18 years who were prescribed opioids for at least 90 days between 2009 and 2015 (N= 2,533,878). Patients were excluded if they had cancer or were receiving palliative or hospice care. The number of patients with chronic opioid use, opioid-related ED visits, and opioid-related hospitalizations was calculated for both year and region.
Approximately 60% of the study population were women; median age remained consistent throughout the study period (54 in 2009 and 55 in 2015). The North Central region had the largest percentage of individuals taking opioids chronically (2.7%, n=129,915) in 2015, with the Northeast at the lowest percentage (1.5%, n=66,443). For the duration of the study, the rate of opioid-related ED visits decreased from 85 per 100,000 people in 2009 to 73 per 100,000 in 2015. The South was the region with the highest rate of opioid-related ED visits in 2015 (23 per 100,000), while the Northeast again had the lowest (15 per 100,000). No significant difference was found for overall ED visit rates by year.
Opioid-related hospitalizations decreased from 168 per 100,000 in 2009 to 103 per 100,000 in 2015. The South had the highest rate of hospitalizations for all years, with 39 per 100,000 reported in 2015. The West had the lowest rate in 2015 at 19 per 100,000.
Approximately 66% of patients with an opioid-related ED visit and 73% of patients with an opioid-related hospitalization had an overlapping benzodiazepine prescription. The rate of opioid-related ED visits for patients also receiving a benzodiazepine decreased from 2009 to 2015 (160 per 100,000 people to 137 per 100,000). The West had the highest rate for all years at 42 per 100,000 in 2015, and the Northeast had the lowest with 27 per 100,000. The hospitalization rate decreased from 327 per 100,000 in 2009 to 203 per 100,000 in 2015. The Northeast once again had the lowest rate for all years, with 33 per 100,000 in 2015, while the South had the highest with 67 per 100,000.
Although the rates for opioid-related ED visits and hospitalizations decreased, the authors caution that “more research is needed to examine regional variation in chronic pain management and if or how concurrent opioid and benzodiazepine use can be less dangerous.”
Attorney General Jeff Sessions made the announcement in a speech in Ohio on Wednesday. He said the action was the first of its kind and a sign of how serious the administration is about fighting the opioid epidemic.
The DOJ said the doctors had been served this week with temporary restraining orders preventing them from prescribing.
“These injunctions – a temporary restraining order – will stop immediately these doctors from prescribing—without waiting for a criminal prosecution,” Sessions said.
So much for innocent until proven guilty ?
It would seem that every time that the DOJ “steps over the line” and pushes what can legally be done and they get “away with it” .. the next time… it seems like they try to find how much farther they can go pass the line and get away with it.. This action by AG Session in Ohio – IMO – demonstrates how bold the DOJ is getting toward opiate prescribers.
The DEA has ran “help wanted ads” forForfeiture Financial Specialist Supporting the DEA does this suggest that the DEA is more interested in the assets of a prescriber than the “dead bodies” as the reason they claim that they are going after a prescriber
And why should they worry about crossing the line ?… there is no resistance nor consequences for their actions !
All they have to do is look at what is going on in and around the chronic pain community.. There was a fund raiser to help Dr Tennant with his legal expenses started EIGHT MONTHS AGO and to date there has been 119 contributors
And there was a fund raiser started a few days ago forPain Warriors ~ the Movie and to date there has been 32 donors and they have reached ELEVEN PERCENT of their goal…
Then there are the prescribers… logic would suggest that – before the vultures start circling – they could put all their assets into a irrevocable trust and basically make themselves personally a pauper and leave nothing for the the DEA’ s forfeiture Financial Specialist to find and the DEA nothing to confiscate and maybe have fewer reasons to go after the prescriber ?
One would think that ALL PRESCRIBERS would have by now jointly created a legal defense fund to help get cover legal expenses of their professional colleagues. SOP for the DEA is to raid a practice/clinic, confiscate all of the assets of the prescriber and toss them in jail… so they have no money to pay bail, no money to hire a first class attorney and left with very few options which you can click here for more info other than accept a public defender or plead guilty to a couple of charges and get a dozen or two years in prison.
When is the last time that you read where the DEA has caught anyone other than some “end of the food chain” drug mule transporting illegal drugs ?
Wouldn’t take much to see that prescribers are not trying to protect themselves … the entire prescriber community is not financially coming together to create a legal defense fund
The chronic pain community is failing to come together to create a legal defense fund. In fact some within the chronic pain community believes that agree with the DEA that addicts are causing their problem of being unable to get their necessary pain medication. They refuse to acknowledge, and agree with our Surgeon General, that all addictions are a mental health disease and not a moral failing.
Over the last 6-7 years I have seen chronic pain pts and other who are interested in advocating for the chronic pain community come and go. I suspect that some have come to the realization that they are nothing more than a ” Don Quixote ” and they cease to advocate… It may not be long before more will come to that conclusion and more will cease to advocate and few will step up to take their place. What will be left, will be “easy prey” for the DEA to have their way with.
