Here’s The Opioid Crisis the News Isn’t Talking About

Posted on June 15, 2018 by Pharmaciststeve

www.lifenews.com/2018/02/23/heres-the-opioid-crisis-the-news-isnt-talking-about/

We are members of Not Dead Yet, a national grassroots disability rights organization, and some of us are living with chronic pain ourselves. Based on our knowledge of the disability community through personal experience and through our work, we have not seen disabled people with chronic pain experiencing opioid use disorder. What we are seeing is many disabled people who are suffering due to the lack of access to opioid medication[2]  previously available as part of comprehensive strategies and approaches to address chronic pain. They are experiencing an increase in chronic pain and other symptoms associated with that pain. Disabled people and others with chronic pain are rarely the ones who are abusing opioids,[3] but they are the ones who are having to deal with chronic pain symptoms without access to medications that made this pain more tolerable.

That is not to say that some disabled people will not have opioid use disorder. However, from our observation, chronic pain is not a causal factor[4] in who has abused opioids. Instead, opioids are a mitigating factor in how independent those with chronic pain are able to be. Having to deal with chronic pain with no relief, when opioid medication prevented such pain, can greatly affect the quality of life[5] disabled people with chronic pain have. It can affect their ability to perform activities of daily living. It can affect their ability to sleep. It can affect their mood. It can affect their productivity. Those with chronic pain that is untreated or mistreated are more likely to be depressed,[6] and depression itself can also be linked[7] to physical pain. Being depressed and in pain can also make disabled people more susceptible to suicidal ideation,[8] especially when there is seemingly no relief to the long-term pain they experience.

For some disabled people, opioids are the only medication or treatment that can help their pain. Now, those who have chronic pain are treated with suspicion,[9] as though they are abusing opioids, especially by medical personnel at doctors’ offices and hospitals when they seek out this medication. Doctors are increasingly afraid and unwilling[10] to prescribe opioids, so instead of continuing effective treatment for those who have seen great benefits from using these medications, too often doctors are essentially abandoning those who truly need access to opioids.

Opioid abuse is a problem, but it is not a problem for the overwhelming majority[11] of the disability community or others with chronic pain. It’s a problem for those who have already been abusing these medications. Those are typically not people who need these medications to handle long-term chronic pain.

Yet, as sometimes misguided approaches to addressing the opioid crisis are hastily undertaken across the country, the very individuals, who benefit greatly in terms of health and productivity from continued opioid use as part of a comprehensive pain management strategy, are the people who face the most scrutiny and harm by not having access to medically necessary and appropriate medication.

HHS/ACL must recognize the harmful effects of a misguided crackdown on the legitimate use of opioids for chronic pain, educate state governments and providers about research on this issue, and discourage federal, state and local programs that do more harm than good in addressing the opioid crisis.

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[1] https://www.acl.gov/sites/default/files/about-acl/2018-01/Final_RFI_Opioid_Use_Disorder_PwD_Jan2018.pdf
[2] Andrew Rosenblum, et al., Opioids and the Treatment of Chronic Pain: Controversies, Current Status, and Future Directions (2008)https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2711509/
[3] Maia Szalavitz, Opioid Addiction Is a Huge Problem, but Pain Prescriptions Are Not the Cause (Scientific American, May 10, 2016)https://blogs.scientificamerican.com/mind-guest-blog/opioid-addiction-is-a-huge-problem-but-pain-prescriptions-are-not-the-cause/
[4] Michael A, Yokell, et al., Presentation of Prescription and Nonprescription Opioid Overdoses to US Emergency Departments (Jama Intern Med, Dec 2014)https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1918924
[5] McCarberg BH, et al., The impact of pain on quality of life and the unmet needs of pain management: results from pain sufferers and physicians participating in an Internet survey (Am J Ther 2008) https://www.ncbi.nlm.nih.gov/pubmed/18645331
[6] Bair MJ, et al., Depression and pain comorbidity: a literature review, (Arch Intern Med, Nov 2003) https://www.ncbi.nlm.nih.gov/pubmed/14609780
[7] Madhukar H. Trivedi, M.D., The Link Between Depression and Physical Symptoms (Prim Care Companion J Clin Psychiatry, 2004)https://www.ncbi.nlm.nih.gov/pmc/articles/PMC486942/
[8] Beverly Kleiber, et al., Depression and Pain (Psychiatry, May 2005) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3000181/
[9] Chronic pain patients say opioid crackdown is hurting them (Chicago Tribune, June 5, 2017) http://www.chicagotribune.com/lifestyles/health/ct-opioid-patients-backlash-met-20170603-story.html
[10] Kelly K. Daneen, et al., Between a Rock and a Hard Place: Can Physicians Prescribe Opioids to Treat Pain Adequately While Avoiding Legal Sanction? (Am J Law Med 2016)https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5494184/

[11] Nobel M, et al., Opioids for long-term treatment of noncancer pain (Cochrane, Jan 2010) http://www.cochrane.org/CD006605/SYMPT_opioids-long-term-treatment-noncancer-pain

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First-Ever Ketamine Guidelines for Acute Pain Management Released

Posted on June 15, 2018 by Pharmaciststeve

Evidence supports the use of intravenous (IV) ketamine for acute pain in a variety of contexts, including as a stand-alone treatment, as an adjunct to opioids, and, to a lesser extent, as an intranasal formulation, according to the first guidelines on the use of ketamine for acute pain management.

Ketamine has captured headlines recently for its potential role in treating severe depression and posttraumatic stress syndrome. Ketamine is also increasingly being used in inpatient and outpatient settings to manage acute pain.

One driving force behind this is the growing effort to reduce the risk for long-term opioid use after acute exposure and its subsequent complications, including addiction. Yet, to date, few recommendations have been available to guide this emerging acute pain therapy.

“The goal of this document is to provide a framework for doctors, for institutions and for payers on use of ketamine for acute pain, who should get it and who should not get it,” guideline author Steven Cohen, MD, from Johns Hopkins School of Medicine in Baltimore, Maryland, told Medscape Medical News.

Reduced Need for Opioids

Development of the guidelines on use of ketamine for acute pain was a joint effort spearheaded by the American Society of Regional Anesthesia and Pain Medicine and the American Academy of Pain Medicine, which approved the document, as did the American Society of Anesthesiologists’ Committees on Pain Medicine and Standards and Practice Parameters.

The guidelines state that subanesthetic ketamine infusions should be considered for patients undergoing painful surgery and may be considered for opioid-dependent or opioid-tolerant patients undergoing surgery.

Ketamine may be considered for opioid-dependent or opioid-tolerant patients with acute or chronic sickle cell pain. For patients with sleep apnea, ketamine may be considered as an adjunct to limit opioids, the guidelines note.

The use of ketamine in subanesthetic doses has “exploded and there definitely seems to be a strong signal that ketamine is effective for acute pain, and a lot of patients don’t have other options,” Cohen commented.

On dosing, the guidelines recommend that ketamine bolus doses do not exceed 0.35 mg/kg and that infusions for acute pain generally do not exceed 1 mg/kg per hour in settings without intensive monitoring. The authors acknowledge that individual pharmacokinetic and pharmacodynamic differences, as well as other factors, such as prior ketamine exposure, may warrant dosing outside this range.

The guidelines also state that moderate evidence supports use of subanesthetic intravenous ketamine bolus doses (up to 0.35 mg/kg) and infusions (up to 1 mg/kg per hour) as adjuncts to opioids for perioperative analgesia.

Ketamine should be avoided in people with poorly controlled cardiovascular disease, those with active psychosis, and pregnant women.

For hepatic dysfunction, evidence supports that ketamine infusions should be avoided in individuals with severe disease and used with caution, with monitoring of liver function test results before infusion and during infusions in surveillance of elevations in individuals with moderate disease. Ketamine should be avoided in individuals with elevated intracranial pressure and elevated intraocular pressure.

“Powerful, Inexpensive” Tool

The guidelines state that intranasal ketamine is beneficial for acute pain management; it provides not only effective analgesia but also amnesia and procedural sedation.

Scenarios in which this should be considered include individuals for whom IV access is difficult and children undergoing procedures.

For oral ketamine, the evidence is “less robust, but small studies and anecdotal reports suggest it may provide short-term benefit in some individuals with acute pain,” the authors say.

They found only “limited” evidence to support patient-controlled IV ketamine analgesia as the sole analgesic for acute or periprocedural pain. However, there is moderate evidence of benefit of the addition of ketamine to opioid-based IV patient-controlled analgesia for acute and perioperative pain management, the authors note. When a person receives an IV drip therapy, they’re receiving a liquid mixture of vitamins and minerals through a small tube inserted into a vein. This allows the nutrients to be absorbed quickly and directly into the bloodstream, a method that produces higher levels of the vitamins and minerals in your body than if you got them from food or supplements. This is because several factors affect our body’s ability to absorb nutrients in the stomach. Factors include age, metabolism, health status, genetics, interactions with other products we consume, and the physical and chemical makeup of the nutritional supplement or food. Higher levels of the vitamins and minerals in your bloodstream lead to greater uptake into cells, which theoretically will use the nutrients to maintain health and fight illness.

They conclude that “despite its drawbacks, ketamine remains a powerful and inexpensive tool for practitioners who manage acute pain. We believe its use will continue to expand as more institutions treat increasingly challenging patients in the perioperative period as well as those with painful disease exacerbations while trying to combat the opioid epidemic.”

They say more research is needed to “refine selection criteria for the treatment of acute pain and possible prevention of chronic pain, to determine the ideal dosing and treatment regimen to include coadministration of ketamine with opioids and adjuvants, and to better understand the long-term risks of ketamine in patients who receive serial treatments for frequent acute pain exacerbations.”

This research had no commercial funding. The authors have disclosed no relevant financial relationships.

Reg Anesth Pain Med. Published online June 7, 2018. Abstract

 

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Doctor has DEA license suspended because he didn’t have access to computer

Posted on June 15, 2018 by Pharmaciststeve

Doctor at opiate treatment center in Limestone loses license

http://www.bradfordera.com/news/doctor-at-opiate-treatment-center-in-limestone-loses-license/article_031e44d6-7046-11e8-bcb0-af8b955a5884.html

A doctor who had been operating an opiate treatment center for several months in the Town of Carrollton Municipal Complex in Limestone, N.Y., has voluntarily surrendered his license to prescribe narcotics to patients at the facility.

Dr. Reed Haag confirmed that he had his license recently suspended by the New York Division of the Drug Enforcement Administration (DEA). Haag said he lost his license due to a technical issue.  

Haag, who also has an office in Wellsville, had decided to open the office in Limestone last year to better serve patients from communities that include Limestone, Olean and Salamanca, as well as Bradford, Smethport and Warren in Pennsylvania.

Edward Orgon, resident agent in charge with the DEA in Buffalo, said agents conducted “enforcement action” May 31 at Haag’s office in Wellsville, resulting in the license suspension.

He said Haag can reapply for his license, but the decision of reinstatement would likely be up to the Medical Board of New York State.

“He can reapply, but he’ll have to go through a procedure,” Orgon said of Haag. “It will probably be a lengthy process — he could get it back, but he could never get it back.”

Special agent Erin Mulvey, who serves as the public information officer for the DEA, also confirmed that Haag had voluntarily surrendered his license following the agents’ visit.

In commenting on the issue, Haag said that while working at the Limestone center one day a week, he didn’t have access to a computer in that office.

“What I would do is call the nursing manager (at the Wellsville office) and she would electronically (process) the prescription,” Haag said, claiming the nurse kept well-documented records for the prescriptions. “The DEA found out I was in one place, but the prescriptions were coming from another and they said that was a no-no. They did pull my ability to prescribe narcotics.”

Haag said when he explained the situation to the DEA, he was told he had made a “stupid mistake” and let him reapply for his license a couple of weeks ago.

“How long it’s going to take (for a new license) I’m not sure,” Haag said. “But what I’m also doing is trying to find another provider to work with me.”

He said if another professional did come on board, he would hope to work in collaboration with the individual, who could electronically process prescriptions after he reviewed the patient’s history, physical information and urine/blood screens.

“I’ve been calling the patients and (conveyed) that things are still up in the air and that I’m not 100 percent sure” of the outcome, he added. “I don’t know what’s going on with regard to my reapplying for my ability to prescribe.”

Haag said if all goes well, he is hopeful to receive a new license within two to three weeks.

“There are so many physicians who have lost their licenses for stupid reasons, like diverting drugs to other people or taking drugs themselves,” he continued. “The only thing I did was I didn’t have access to a computer, so I called my nurse (in Wellsville) to take care of the prescriptions.”

Haag noted he didn’t lose his physician’s license, therefore he could see patients for other maladies, such as high blood pressure or other medical issues.

“The only thing I can’t do is prescribe controlled substances like oxycontin, valium or things like that,”  he explained.

Haag said he didn’t visit the Limestone center this week and instead called his patients and cancelled the appointments.

“There is a website and a phone number I’m giving (the patients) where they can find providers near them,” Haag added, noting the website is www.insupport.com. When the individuals provide a zip code they will learn of providers near them. Haag said there are several area physicians who have indicated they can accept his Pennsylvania and New York state patients.

On a final note, Haag said that until he receives a new license, he’s just sitting and waiting “and being very frustrated.

“I went up to that area (in Limestone) because it was a small town and a physician-depleted area,” Haag lamented. “I was trying to be a nice guy, but because I didn’t have a computer they’re slapping me on the wrist.”

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With More People Killing Themselves – What to Do?

Posted on June 15, 2018 by Pharmaciststeve

www.nationalpainreport.com/with-more-people-killing-themselves-what-to-do-8836496.html

By Geralyn Datz, Ph.D.

(Editor’s Note—The recent CDC report on suicide was alarming. Suicide rates have increased in nearly every state over the past two decades, and half of the states have seen suicide rates go up more than 30 percent. While the CDC didn’t release any data about what’s happening in the chronic pain community, most observers believe that the increased suicide rate is at least partially due to an increase in more chronic pain patients taking their own lives. We asked Dr. Geralyn Datz, a psychologist and former head of the Southern Pain Society to share a few thoughts.)

The topic of suicide itself has a huge taboo around it. The challenge in discussing suicide is always to acknowledge the vulnerability of the individuals that suffer from this type of thinking, as well as to address mischaracterizations of these individuals as weak, selfish, or simply “crazy”. In the life of a mental health professional, suicide is an occupational hazard that is haunting and challenging. While all suicides cannot be prevented, the number of them can be reduced through education.

Geralyn Datz, PhD

For people who suffer with pain, suicide may be viewed as an escape from the unsolvable problem that is chronic pain. Depression and anxiety also often co-occur with chronic pain, further adding to the mental obstacles in the life of pain patient, and making escape from reality, and suffering, all the more tempting. Finally, access to adequate pain treatments, including opioids, is very challenging, adding to the pressure and anguish that exists for pain patients today.

When applied to the problem of chronic pain, for a large subset of people with pain and suicidal thinking the issue is not that they want to die, it’s that they don’t want to feel pain and suffer any more. And suicide can unfortunately seem like a reasonable option.

One common myth that surrounding suicide is the thought that the person wants to die and can’t be helped.  One study that explored the desire to escape suffering vs the will to live is a famous study of individuals who jumped off the golden gate bridge in attempt to commit suicide. More than 3,000 people have leapt to their death from San Francisco’s Golden Gate Bridge, but out of the 26 people who survived the jump, all 26 reported that the moment they leapt from the bridge, they regretted their action and wanted to live.

Another myth is that asking about, or talking about suicidal thinking with the person experiencing it, increases the likelihood suicide will happen. The vast majority of suicide-related research—including a very well done study in 2014—suggests that open conversations about suicide are unlikely to increase suicidal ideation and may actually decrease it.

Sometimes suicidal thinking is the result of interactions of factors. Genetic factors, like a personal or family history of psychological diagnosis, or of attempted suicide or completed suicide, can influence a person who has come to the point of contemplating suicide. Childhood trauma, of any sort, physical, emotional, sexual, and parental neglect, can also affect the development of suicidal thinking.

However suicidal thinking has developed, and the circumstances that surround it, it must be confronted. The following are some recommendations for dealing proactively with suicidal thinking:

  1. Don’t isolate, reach out. Be it talking to a friend, family member, faith community member, medical provider or calling a therapist, break the silence and shame feelings that are often present with severe depression and anxiety.
  2. Call or text a crisis hotline. Suicide Prevention Lifeline (1-800-273-8255) or Crisis Text Line (text HOME to 741741).
  3. If you feel you are in immediate danger, call 911, go the ER or local 24-hour psychiatric facility for admission.
  4. Safety first. If you are feeling like a threat to yourself, remove any harmful means from your home, and ask someone to help you monitor or co-administer your prescription medications to reduce the likelihood of overdose.
  5. Develop a safety plan. Write out your plan for action in a crisis. Also, the My3 app is a safety planning and crisis intervention app that can help develop these supports and is stored conveniently on your smartphone for quick access. It is difficult to plan and think clearly when in crisis, and having a plan can give you support.
  6. Get help. Suicidal thinking is a sign of severe depression and also anxiety. Schedule a consult with a mental health provider, psychologist, psychiatrist, counselor or primary care doctor. If you are without insurance, find your community mental health center that offers low cost assessments. Consider psychotherapy to develop coping skills for navigating this difficult period in your life. Medications can also be helpful for addressing mood disturbances, sleep difficulty, and panic attacks that often accompany suicidal thinking.

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DEA: nearly 50 yrs of FAILED programs and Congress keeps giving them more money

Posted on June 15, 2018 by Pharmaciststeve

When DEA Cracked Down on Opioids, Abusers Moved to Black Market

https://consumer.healthday.com/bone-and-joint-information-4/opioids-990/when-dea-cracked-down-on-opioids-abusers-moved-to-black-market-study-734885.html

FRIDAY, June 15, 2018 (HealthDay News) — Illegal opioid sales on the internet have surged in the wake of U.S. government crackdowns on prescriptions for the highly addictive painkillers, a new study shows.

In 2014, the U.S. Drug Enforcement Administration reclassified the opioid hydrocodone (Vicodin). The change made the drug harder to prescribe and banned automatic refills.

Not surprisingly, the number of such prescriptions plunged by 26 percent between mid-2013 and mid-2015.

Yet a team of international investigators also found that since the new regulation took effect, more people have turned to purchasing opioids online without a prescription, using software-encrypted online portals that permit illegal sales and elude regulators.

Exhibit A: Since 2014, dark web opioid sales have increased their share of all online drug sales by an estimated 4 percent per year.

“This [DEA] action did have the hoped-for effect of reducing the number of prescriptions issued for these products,” said study author Judith Aldridge, a professor of criminology at the University of Manchester in England.

“[But] our team found that sales on the so-called ‘dark net’ of opioid prescription medications increased following the DEA’s initiative,” Aldridge added. “And this increase was not just observed for medications containing hydrocodone. We also saw increased dark-net sales for products containing much stronger opioids, like oxycodone [OxyContin] and fentanyl.

“Our study cannot definitively rule out that something else caused these rises in illicit sales of prescription opioid medications,” Aldridge acknowledged. “However, the fact that the rises happened only after the DEA scheduling change — and happened only for dark-net sales in the U.S.A. and no other countries — is strongly suggestive.”

To get a handle on the dark web drug market, the study investigators used “web crawler” software to peek behind the curtain of 31 so-called “cryptomarkets” that were in operation both before and after implementation of the DEA regulation

The team found little, if any, change in the sales records of sedatives, steroids, stimulants or illegal opioids (meaning opioids never prescribed by doctors).

In contrast, sales of prescription opioids on the dark web had spiked as a percentage of overall drug sales by 2016, accounting for nearly 14 percent of all such sales.

In another twist, the investigators found that although prescription opioid sales were up as a whole, fewer dark web purchases were for oxycodone, and more were for the far stronger prescription opioid fentanyl.

In fact, while fentanyl had been the least most popular prescription opioid in terms of dark web sales back in 2014, by 2016 it had become the No. 2 seller.

That alone is concerning, the investigators said, given that fentanyl is now the No. 1 cause of opioid overdoses in the United States.

But the bigger concern, they noted, is that the more people turn to the dark web for illicit prescription opioids, the more difficult it becomes to monitor and treat opioid addiction.

The findings were published June 13 in the BMJ.

“Solutions here are not simple,” Aldridge said. “However, we know very well that our results were entirely predictable. Solutions must combine cutting supply and tackling demand at the same time. This requires making prevention and treatment grounded in good science available for all.”

That thought was seconded by Dr. Scott Hadland, an addiction expert with the Grayken Center for Addiction at Boston Medical Center, and author of an accompanying journal editorial.

“That dark web opioid sales rose afterwards is not surprising, given that amidst this policy change the demand for opioids was unchanged,” he said. “So, people began looking for opioids elsewhere, including online.

“The way to durably reduce demand for opioids is to ensure strong prevention, treatment and harm reduction throughout the country,” Hadland said. “Tightening access to prescription opioids like hydrocodone [common brands: Vicodin, Lorcet, Norco] will simply drive people who use opioids to look elsewhere for them if demand is not also reduced at the same time.”

More information

There’s more on the U.S. opioid overdose crisis at the U.S. National Institute on Drug Abuse.

SOURCES: Judith Aldridge, professor, criminology, School of Law, University of Manchester, England; Scott Hadland, M.D., M.P.H., pediatrician and addiction expert, Grayken Center for Addiction, Boston Medical Center; June 14, 2018, BMJ

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Empathy at the ER ? or “healthcare” at a comedy club ?

Posted on June 14, 2018 by Pharmaciststeve

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Healthcare … is all about the money ?

Posted on June 14, 2018 by Pharmaciststeve

Hospital facing loss of federal money asked nurses to falsify records, inspectors say

https://www.kansascity.com/news/business/health-care/article213180824.html

Blue Valley Hospital offered employee discounts on weight-loss surgery and asked workers to falsify records to try to pump up its inpatient numbers enough to continue getting Medicare money, according to inspectors.

So far, it hasn’t worked.

U.S. District Judge Julie Robinson this week dismissed Blue Valley Hospital’s lawsuit against the agency that runs Medicare. Robinson wrote in her dismissal ruling that the court system can’t intervene every time a hospital is dinged financially for not following Medicare rules and, given what inspectors found during an initial inspection in November and a followup in April, this is not a case that warrants intervention.

“BVH was tagged with numerous deficiencies in both surveys, including compromise of patient care,” Robinson wrote. “As such, the government interest in protecting patients through an expeditious provider-termination procedure is quite strong.”

Blue Valley Hospital, a four-bed facility at 12850 Metcalf Ave. in Overland Park, is now set to lose its Medicare reimbursements starting Friday.

The hospital, which mostly does bariatric procedures, has said that could cripple it financially. Its lawyers filed a last-ditch appeal this week and asked that the reimbursements keep flowing until the appeal is heard.

“There has been no effect on existing patients and the hospital is still accepting new patients,” Blue Valley Hospital attorney Curtis Tideman said via email. “Blue Valley Hospital is still very hopeful that this entire issue will be resolved quickly and appropriately.”

Blue Valley Hospital filed suit after the Centers for Medicare and Medicaid Services pulled its certification. The agency cited an inspection that found the facility didn’t treat enough patients and wasn’t performing enough surgeries that require long stays to qualify for the higher Medicare reimbursements it had been receiving as an inpatient hospital.

Hospital officials have said that the loss of Medicare certification is due only to a technical change in the way federal rules are interpreted. They say the quality of care that patients receive is not an issue.

But Robinson wrote that inspectors found several patient care red flags when they made a followup survey after the lawsuit was filed.

“The re-survey found that BVH ‘failed to use safe practices for medication administration,’ ” Robinson wrote, “and cited examples of failing to document or properly monitor medication administration, including medications that BVH routinely allowed patients to bring from home, leading to ‘the potential for medication errors, drug overdose, adverse drug reactions, and ineffective medication management.’ ”

Robinson also wrote that Blue Valley Hospital’s leaders knew the facility wasn’t following federal rules and took extraordinary measures to try to pump up its patient load and average length of stay to get in compliance.

During the followup survey in April, two nurses told inspectors they rebelled after they were asked to falsify records to include complications that would justify keeping patients longer.

The chairman of the hospital’s board also told the inspectors the facility offered to absorb all out-of-pocket costs for employees and family members who medically qualified for a “gastric sleeve” surgery. According to inspection records, the chairman told inspectors it was something the staff had requested for years.

“Unfortunately, I have a lot of obese employees and they wanted this surgery,” the records quoted the chairman as saying. “So it was something that could help us both. We have done about 50-60 employee/family surgeries to date with about 70 more that want it.”

Robinson wrote that Blue Valley Hospital’s lawyers called the followup inspection “a sham” but didn’t provide any details to back that up.

Tideman didn’t immediately respond to a request for comment on the followup inspection Thursday.

Blue Valley Hospital officials have said that the loss of Medicare money could force it to close.

Federal attorneys essentially said that’s not the government’s problem, writing in a court filing that it “is the risk BVH has assumed in basing its entire business model on government reimbursement.”

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Will Walgreen Pharmacists become more “uncomfortable” about filling controlled med Rxs ?

Posted on June 14, 2018 by Pharmaciststeve

Kentucky sues Walgreens over opioid epidemic

http://thehill.com/policy/healthcare/392309-kentucky-sues-walgreens-over-opioid-epidemic

Kentucky’s attorney general sued Walgreens Thursday, alleging that the company contributed to the state’s opioid epidemic.

Attorney General Andy Beshear, a Democrat, sued Walgreens for its role as both a distributor and a pharmacy. The lawsuit alleges that the company failed to report suspicious shipments of opioids to authorities and that it dispensed large quantities of the painkiller.

“As Attorney General, my job is to hold accountable anyone who harms our families,” Beshear said in a press release. “While Walgreens’ slogan was ‘at the corner of happy and healthy,’ they have significantly harmed the health of our families in fueling the opioid epidemic.”

Walgreens declined to comment because the subject is a matter of pending litigation.  

The company has over 70 locations in Kentucky, according to Beshear’s press release.

This is the sixth lawsuit Beshear has filed against companies in relation to the opioid epidemic, which is contributing to an estimated 115 American deaths per day. Other states have also been suing opioid distributors and manufacturers. Another new legal challenge was just filed on Wednesday, when Massachusetts sued Purdue Pharma and 16 current and former directors and executives.

On another legal track, hundreds of lawsuits from cities, counties and tribes have been consolidated in Cleveland, Ohio, where federal District Court Judge Dan Polster is aiming to “do something to dramatically reduce the number of opioids that are being disseminated, manufactured and distributed” and also “get some amount of money to the government agencies for treatment.”

Some opioid manufacturers and distributors have pushed back on the notion that they’re to blame for the opioid epidemic, and said they are working to be part of the solution.

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What Pharmacists Want Physicians to Know

Posted on June 13, 2018 by Pharmaciststeve

https://opmed.doximity.com/what-pharmacists-want-physicians-to-know-b52de53c09dd

Having worked as a retail pharmacist for 17 years, I have learned many tips that can help ease communication between doctor’s offices and pharmacies. Pharmacists are overworked and almost never have enough help, so when we call you, it’s not because we want to annoy you or waste your time. Here are some tips that will help you become every pharmacist’s favorite doctor.

Think Before You Prescribe That Opioid

With the opioid epidemic at crisis level, all healthcare professionals need to be more vigilant. Is the patient suffering with cancer pain, or is the patient coming back month after month for a prescription of a too-high dose of oxycodone that was originally given for a surgery one year ago? If that opioid is being prescribed in conjunction with a benzodiazepine, it’s time to start tapering. According to the FDA, combining these drugs comes with risks of “extreme sleepiness, respiratory depression, coma and death”

Insurance companies are starting to realize this and beginning to reject prescriptions, not only for the combination of benzodiazepine plus opioid, but often for high dose or quantity. Pharmacists and physicians need to work together to help these patients. Not only are patient’s lives at risk, our licenses are as well. Before you mindlessly send off another prescription, think — is this really needed? Can we start tapering? Does this patient exhibit signs of substance use disorder, and if so, what are the next steps? Have those difficult conversations with your patients.

It is also important to pay attention to the date on the prescription. Pharmacies are enforcing strict policies on filling/refilling of controlled/narcotic prescriptions. For example, if a patient fills a 30-day supply of oxycodone on June 1, the next due date would be July 1. Most pharmacies have policies to only fill these prescriptions a maximum of one or two days early. Filling a prescription 3 days early every month would supply the patient with an entire extra month of medication after just ten months. It is helpful when the doctor writes on the prescription (or in the comments of the electronic prescription) “Please fill on or after June 29,” as well as communicates this to the patient.

Also, please include a diagnosis code, especially with the larger quantities/dosages. ALWAYS write out the quantity. Once, I had a patient change #10 to #60. I asked, “Did you change the number?” and he admitted it. It is best when you write the number in parenthesis too, i.e., #60 (SIXTY). And never forget to sign and date the prescription, and be sure your DEA and NPI are on the prescription.

Always Check Allergies

I can’t even tell you the number of times a patient comes in with a prescription for an antibiotic they are allergic too. In fact, I have even had the same patient with a penicillin allergy come in with a prescription for amoxicillin three different times in one year, and each time I had to call and have it changed. Not only does it tie up the pharmacist and inconvenience the doctor, but the patient who is feeling sick is the one who has to wait. A quick question (and updating the electronic record), before prescribing an antibiotic will save everyone a lot of time!

Be Dedicated to the Pharmacy

My favorite doctor’s office has an extremely efficient nurse, Julie. She knows that the doctor will not reply to electronic refill requests in a timely manner, so she asks pharmacies to change the preferred contact method to fax, where she is able to quickly return our faxes. You can check here get better faxing solutions.

Figure out the best way to address prescription refills. Have a staff member assigned to taking care of refills by phone, fax, voicemail. We like to take care of our patients and keep them happy and taking days to reply to a request for a maintenance medication is frustrating for the patient and pharmacy.

Also, train your staff to always check with you on pharmacy questions. Sometimes electronic prescriptions come over with crazy directions such as “Take 25 tablets daily.” The most annoying thing is when we call to clarify, and the person answering the phone says, “Well, that’s what the doctor said, so it’s correct.” No, it’s not.

Also, on the topic of electronic prescriptions, never tell a patient, “I sent it over, it will be ready when you get there.” Sometimes, especially during busy hours, prescriptions can take up to an hour to arrive. Pharmacies are processing many other prescriptions at the same time, and someone who doesn’t work at the pharmacy is not equipped to tell the patient when their prescription will be ready (although we will be glad to tell the patients that they don’t have to wait when they come to your office, ha-ha!)

Also, please do not tell the patient how much a prescription will cost. You don’t know, we don’t even know until we process the prescription with the insurance card.

Speaking of insurance, pharmacists also do not like prior authorizations. We don’t send them to annoy you, as some doctors think we do. So, when you get a prior authorization request, have that dedicated staff person (better yet, if you have a busy office and the budget to do so, hire a part time pharmacist to handle your prior authorizations!) either take care of it in a timely manner, or consult with you about changing the medication to something that is covered. Whatever you do, we just want the patient to get the medication that they need, in a reasonable amount of time.

Use the Comment Section

On electronic prescriptions, we love when doctors use the comment section to clarify something that may raise a question. For example, say your patient went from atorvastatin 10 mg to atorvastatin 80 mg. Since it wasn’t a small increase to the next dose, most pharmacists would probably call the doctor’s office to see if it was an intentional increase or an error. If you make a dosage adjustment it always helps to make a short note in the comments: “note- dosage increase from 10 to 80”

Or, say you’re aware of a drug interaction but you have already discussed it with the patient — if you put a note in the comments such as “patient will hold warfarin while on fluconazole” this will save us all a lot of time.

Be Friendly!

Being friendly doesn’t cost anything. We are all swamped in our respective professions and dealing with different challenges. And feel free to ask our recommendations on anything pharmacy related, that’s what we are here for.

Karen Berger, PharmD, graduated from the University of Pittsburgh School of Pharmacy in 2001. After working many years in chain pharmacies, she currently enjoys working as a pharmacist at an independent pharmacy.

The paragraphs gives a good insight into the minds of some pharmacists working in community pharmacy…  pt taking a opiate a year after surgery… should be tapered.. I guess that this pharmacist has never hear of failed back surgery – where the pt’s pain is worse after the surgery  than before… never heard of a pt having a nerve severed during surgery and the pt becomes a chronic pain pt.

START TAPERING if the pt has been taking a opiate and benzo together… apparently some pharmacists believe that when the FDA states that the combination of the two MAY COME WITH SOME RISKS… does not mean that every pt is going to experience ..extreme sleepiness, respiratory depression, coma and death… the word MAY… SHOULD NOT BE INTERPRETED as WILL… Should you taper pts that have been taking these two in combination for some time without any serious side effects when only a few pts could experiences these side effects..  OF COURSE NOT…  a “good pharmacist” will have a conversation with the pt about the side effects – they may experience if a new pt – or talk to the pt that has been on them for a while to see if they noticed any side effects and you make notes in their medical records in the pharmacy computer system..  the pharmacist license is seldom at risk if they do proper counseling and documenting in the pt’s notes.

Here is the simple math question you could have gotten in grade school.. if a pt gets 3 extra days every month …how many  months does it take for them to have a extra month’s supply ? Of course, you must assume that the prescriber knows exactly the intensity of the pt’s pain every day of every month and prescribe an amount to take care of that potentially highly variable intensity that all chronic pain pts experience.

Those ICD10 codes can be troublesome… I consider myself a fairly healthy 71 y/o and I recently got paperwork after seeing my prescriber and included on the paperwork was all the ICD10 codes that apply to me – ALL THIRTY OF THEM…  How many pts are comfortable with a pharmacists knowing all the ICD10 on their medical records ?… what if the prescriber picks 1-2 ICD10 codes and puts them on the Rx and the pharmacist is not “satisfied” with the ICD10 codes and the medication prescribed ?

Pharmacist need to start talking to pts.. have a “conversation”… quit practicing pharmacy “by the numbers” … and quit interpreting all “MAY HAPPEN” to “WILL HAPPEN” and making absolute decisions about appropriate therapy.

Pts who encounter those type of pharmacists …need to find themselves a new pharmacy and pharmacist… of course, my normal recommendation is a INDEPENDENT PHARMACY …

Filed under: General Problems | 3 Comments »

Kolodny: has advised members of both political parties on opioid policy

Posted on June 13, 2018 by Pharmaciststeve

What Do These Political Ads Have in Common? The Opioid Crisis.

www.nytimes.com/2018/06/07/us/opioid-ads-democrats-republicans.html

The scenes in the political ads play out in almost the same order: A heartbreaking story about someone who can’t seem to stop taking drugs. A grim statistic about opioids. And then a somber pitch from a candidate promising solutions.

More and more, politicians in competitive races are using emotional pleas about opioid abuse to woo voters. In states like Wisconsin, where hundreds of people are dying of opioid overdoses every year, candidates are talking about drugs in stump speeches, on Facebook and in ads.

The opioid fight has become a shared talking point for Democrats and Republicans, who discuss the crisis using startlingly similar language and often vote together to pass bills.

On Thursday, President Trump’s administration announced a series of public service announcements that aim to warn young adults about the dangers of opioid abuse. In one ad, a young woman says she intentionally crashed her car to get more opioids; in another, a man recounts breaking his arm to get another prescription. The videos all include the line, “Opioid dependence can happen after just five days.”

Know the truth | Chris’ Story | OpioidsCreditVideo by truthorange

Historically, Republicans have taken a law enforcement-first approach to drug crises, while Democrats have focused on treatment and prevention. Some sharp partisan divisions still exist over the best approach to the opioid crisis, including on Mr. Trump’s call for the death penalty for drug dealers and a wall along the border with Mexico to keep drugs out of the country. And some Democrats have moved to spend more on treatment, including a bill in Congress that calls for spending $100 million on opioid resources each year.

But with overdoses ravaging Republican and Democratic strongholds alike, members of both parties have found broad areas of agreement, a rarity in today’s politics.

“This is really a unique issue where there’s tremendous amounts of overlap,” said Dr. Andrew Kolodny, a Brandeis University researcher who has advised members of both parties on opioid policy, and is himself a physician who treats opioid addiction.

Here’s a look at how some candidates are talking about opioids:

Illinois

Brendan Kelly | JenniferCreditVideo by Brendan Kelly

The candidate: Brendan Kelly, Democratic nominee for Congress. Mr. Kelly, a county prosecutor, is seeking to unseat Representative Mike Bost, a two-term Republican, in a Southern Illinois race that could help determine control of the House.

The ad: In an ad that runs for nearly two minutes, a mother recounts her daughter’s addiction to Vicodin and her death in 2012. “Giving her them pills when she first was prescribed all that was the loaded gun,” the mother says.

Opioids in the region: Between January and August of 2017, 36 people died of overdoses in St. Clair County, where Mr. Kelly is prosecutor.

The candidate’s record on opioids: Mr. Kelly is one of many city and county officials to sue drug companies that make opioids.

Wisconsin

To Save LivesCreditVideo by Scott Walker

The candidate: Gov. Scott Walker, Republican. Mr. Walker, a two-term governor running for re-election, has cautioned Republicans not to underestimate Democrats in November. At one point, he said on Twitter that the state was “at risk of a #BlueWave.”

The ad: “Tyler was only 80 pounds,” the mother of a recovering addict says. “I had his funeral planned.”

Opioids in the region: Wisconsin had 865 fatal opioid overdoses in 2016, and had a death rate higher than the national average.

The candidate’s record on opioids: Last year, Mr. Walker called a special legislative session on opioids and signed bills providing more funding for treatment and law enforcement. Democrats have criticized Mr. Walker for accepting donations from people with ties to pharmaceutical companies.

Wisconsin

KnockCreditVideo by Tammy Baldwin

The candidate: Senator Tammy Baldwin, Democrat. Ms. Baldwin’s seat is one of 10 that Democrats are defending this year in states that Mr. Trump carried in 2016. Republicans are spending heavily to try to defeat her.

The ad: Ms. Baldwin describes coming home from school as a child to find her mother passed out. “My mother had a drug abuse problem,” Ms. Baldwin says in the ad. “I had to grow up fast. Very fast.”

Opioids in the region: Emergency room visits for opioid overdoses increased 109 percent between mid-2016 and mid-2017 in Wisconsin. “I felt strongly that I needed to add my story to help fight the stigma and to help let fellow Wisconsinites know that I’ve been there,” Ms. Baldwin said in an interview.

The candidate’s record on opioids: Ms. Baldwin helped bring federal funds to Wisconsin to fight opioids, but has also faced criticism for her response to a scandal at a Veterans Affairs hospital in her state, in which some patients were overprescribed opioids.

West Virginia

Who Does Patrick Morrisey Really Represent?CreditVideo by Don Blankenship for U.S. Senate

The candidate: Don Blankenship, candidate for Senate. Mr. Blankenship, a businessman and convicted criminal, lost the Republican primary to Patrick Morrisey, West Virginia’s attorney general, but later said he would run as a third-party candidate. Both men are seeking to unseat Senator Joe Manchin III, a Democrat, in November.

The ad: Mr. Blankenship uses clips from a CBS News report on Mr. Morrisey’s financial and business ties to the pharmaceutical industry. A narrator notes that Mr. Morrisey “is in charge of prosecuting these drug companies.”

Opioids in the region: In 2016, West Virginia had the highest drug overdose death rate in the country. A Fox News poll conducted in April found that Republican primary voters there rated the opioid crisis as the most important issue facing the country.

The candidate’s record on opioids: Mr. Morrisey has negotiated settlements with opioid distributors, including $20 million from Cardinal Health.

Filed under: General Problems | 2 Comments »

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