Is the opiate conversion tables putting prescribers at risk of malpractice claims ?

Posted on March 29, 2018 by Pharmaciststeve

Below is the “warnings” from one of the many opiate conversion tables that are available to calculate MME’s… they all have – or should have – the same or similar warning to those who are expected to be using them to stay within the CDC and other daily opiate guidelines and/or state laws.  I am also including 4 statements from the CDC guidelines that provides the prescriber with latitude in providing a pt’s doses above the CDC daily MME limits.  Also a link to a published article by Dr Tennant concerning the importance of the CYP-450 enzyme deficiencies testing and opiate dosing for individual pts.

IMO… these three issues pretty much establish what is – or should be – a standard of care and best practices in treating chronic pain pts.

If a pt is being forced to reduce their opiate dosing and it is important for the pt to inquire as to which formula/table the prescriber is using to calculate these MME equivalents. The one below is just one of many out there, but… they all come up with the same/similar conversion figures and NONE OF THEM… are 100% accurate for each and every pt, may not be accurate for ANY PT ?

I am sure that no prescriber would use a piece of equipment that is known to be less than accurate and base the pt’s therapy on the results from that equipment, but isn’t that exactly what these prescribers are doing by blindly following these opiate conversion tables and ignoring the warning that comes with these conversion tables as to their accuracy and reliability ?

While I am not an attorney, I would think that any prescriber that is blindly using these opiate conversion tables maybe setting themselves up for some legal issues… maybe malpractice, maybe pt abuse, maybe unprofessional conduct, maybe failing to meet best practices and standard of care.  Only time will tell as things progress.

Before using this application, please review these important points:

https://globalrph.com/medcalcs/opioid-pain-management-converter-advanced/
bullet Published equianalgesic ratios are considered crude estimates at best and therefore it is imperative that careful consideration is given to individualizing the dose of the selected opioid. Dosage titration of the new opioid should be completed slowly and with frequent monitoring. 

bullet Factors that must be addressed during the conversion process include: Age of the patient or presence of coexisting conditions. Use additional caution with elderly patients (65 years and older), and in patients with liver, renal, or pulmonary disease. 

bullet Conversion ratios in many equianalgesic dosing tables do not apply to repeated doses of opioids.

bullet The amount of residual drug in the patient’s system must be accounted for. Example: fentanyl will continue to be released from the skin 12 to 36 hours after removal of the patch. Residual effects from discontinued long-acting formulations should also be assessed before converting a patient to a new opioid.

bullet The use of high but ineffective doses of a previous opioid may result in overestimation of the converted opioid. 

bullet Ideally, methadone conversions (especially patients who were previously receiving high doses of an opioid) should only be attempted in cooperation with a pain specialist or a specialist in palliative medicine. 

bullet Meperidine should be used for acute dosing only and not used for chronic pain management (meperidine has a short half-life and a toxic metabolite: normeperidine). Its use should also be avoided in patients with renal insufficiency, CHF, hepatic insufficiency, and the elderly because of the potential for toxicity due to accumulation of the metabolite normeperidine. Seizures, confusion, tremors, or mood alterations may be seen. In patients with normal renal function, total daily doses should not exceed 600mg/24hrs. 

Here is four quotes from the CDC opiates guidelines:

https://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm

“The guideline is intended to ensure that clinicians and patients consider safer and more effective treatment, improve patient outcomes such as reduced pain and improved function.”

“Clinicians should consider the circumstances and unique needs of each patient when providing care.”

“Clinical decision making should be based on a relationship between the clinician and patient, and an understanding of the patient’s clinical situation, functioning, and life context.”

“This guideline provides recommendations for primary care clinicians who are prescribing opioids for chronic pain outside of active cancer treatment, palliative care, and end-of-life care.”

 

https://www.practicalpainmanagement.com/treatments/pharmacological/opioids/cytochrome-p450-testing-high-dose-opioid-patients

Severe, chronic pain patients who seek opioid dosages above normal standards should now be tested for genetic cytochrome P450 deficiencies.

Filed under: General Problems | 1 Comment »

Trying to find objective evidence to justify treating subjective disease ?

Posted on March 29, 2018 by Pharmaciststeve

In my experience of reviewing thousands of patient histories for chronic pain management in greater than 15 states, including extensive physician chart notes, the overwhelming majority of prescribers of opioids in chronic pain management [excluding cancer related pain, palliative care and sickle cell anemia (because there exists bonafide clinical evidence in the safety and effectiveness in these conditions)], the results are this: The vast majority of prescribers are NOT following evidence based medicine as a general guideline, not even close. This includes pain management specialists. But don’t worry, the PBM’s have their market shares/rebates to protect for their bottom line, so chances are, the prior auths will get a approved. And if not, they’re making plenty of money on their market shares/rebates of buprenorphine products. Win-Win for them.

Opioids Don’t Treat Chronic Pain Any Better Than Ibuprofen: Study

The above comment was made by someone who identified themselves as a PharmD.  It was one of several comments on a post that referenced the above Newsweek article.  From what this PharmD stated at the end of the comment he/she does reviewing of pt’s records for a insurance or PBM company.  I had a “flashbulb” moment in reading these words..

This “expert” is looking for clinical/objective evidence to justify the treatment for a SUBJECTIVE DISEASE.  He/she is reading physician’s notes on a pt’s subjective disease issues…  So those notes is the prescriber’s interpretation of what the pt stated as to their pain, the intensity of their pain, etc, etc… There is no objective means of measuring the pt’s intensity of pain and highly unlikely that the prescriber will adequately translate the pt’s body language into the pt’s medical record.

This is similar to two people exchanging emails, texts, messages and there is a misunderstanding by one side of the “conversation” because the conversation is basically a TWO DIMENSIONAL conversation… whereas, if the conversation had been in real time – face to face – and “body language” was part of the conversation… the misunderstanding may not have happened.

With the increased use of electronic medical records, is it time for prescribers to start recording the office visit of those pts dealing with subjective diseases and perhaps “forcing” those “experts” who are outsiders reviewing pt’s medical records to go past the typical two-dimensional pt chart reviews ?

I was right, I found out where this PharmD works  https://www.welldynerx.com/ 

and from their website:   

WellDyneRx took early steps to combat the opioid epidemic

In 2014, WellDyneRx clinicians decided they needed to take steps to curb opioid abuse. Through a multifaceted approach, members are managed via real-time cumulative morphine equivalent dose (MED) point-of-sale (POS) edits and prior authorizations for targeted high-risk medications.

EXPLAINS A LOT !!

Filed under: General Problems | 1 Comment »

Message to President Trump

Posted on March 28, 2018 by Pharmaciststeve

Millions of Veterans & Americans are suffering needlessly because President Trump has been lied to & provided falisified data. Only he can end the nightmare.

www.youtube.com/watch?time_continue=2&v=MTKY2ldEt8c

Filed under: General Problems | 1 Comment »

Is Government Opioid Data Telling the Wrong Story?

Posted on March 28, 2018 by Pharmaciststeve

www.nationalpainreport.com/is-government-opioid-data-telling-the-wrong-story-8835885.html

Another report has been issued that concludes that the CDC strategy of targeting legal prescriptions to reduce opioid overdose deaths is not working.

In fact, Dr. John Lilly of Springfield, Missouri argues it may increase them by driving more users to illegal sources.

Dr. Lilly’s study–published online by the Association of American Physicians and Surgeons– reviewed existing government data. After looking at the Centers for Disease Control and Prevention (CDC) Wonder data base, Dr. Lilly sorts out the deaths associated with illicit fentanyl.  Until 2013, deaths attributed to synthetic opioids were fairly stable, but a sharp upward trend began then, with an increase of 635% from 2014 to 2016.

Notably, the spike in deaths has occurred while opioid prescribing is being heavily discouraged and placed under increasingly severe constraints. Dr. Lilly concludes that these policies are apparently driving opioid misusers from legally prescribed drugs to illicit drugs, which are far deadlier because of high potency and unreliable dosing.

Dr. Lilly’s study is the latest in a number of analyses that indicate the CDC action has been misdirected.

One of the critics is Dr. Terri Lewis; a public health advocate shared her feelings with the National Pain Report.

“Since the CDC Guidelines were a cloud on the horizon, persons with chronic and intractable pain have questioned the assumptions that CDCs guidelines are predicated upon.  The ultimate error is to base wholesale changes to public policy without accounting for all of the data – including the missing data.

“If fewer than 2% of persons who rely on opiates get into trouble, what’s to be said about the 98% of users for whom opiates have made a profound difference in the quality of their days?  Checking that assumption is something that our government has been profoundly uninterested in, choosing to respond to the loudest voices in the room.

“The obvious conflation of pain care with the needs of other user groups has predictably led to catastrophic care failure for persons with crises of pain and substance abuse even as user groups have been pitted against each in the competition for public funds.

“When we ask the wrong questions we get the wrong answers. The recent analyses by Michael Schatman and Stephen Ziegler, Stefan Kertesz, Josh Bloom, and now John Lilly make it abundantly clear that not only is CDC’s recent mea culpa insufficient, but it is still wrong from a design of data perspective.  It demands that the systemic error installed throughout the entire system must be addressed to right the wrong course of public policy so that we can get back to the business of caring for patients instead of servicing errors.”

One of the definition of SOCIALISM… is for a bureaucracy  to create a problem and then the same bureaucracy attempts to solve the problem that they created.

In 1914, our Congress passed the Harrison Narcotic Act which created the “black drug market”

In 1969, our Congress passed the Controlled Substance Act which created the DEA

Now in 2016, the CDC .. whose primary purpose is to deal with contagious diseases, chose to publish their opiate dosing guidelines… which since the opiate crisis is not contagious disease… where CDC believed that they had the legal authority to do this… I don’t understand…  Maybe this is why – at the time – the head of the CDC CLEARLY STATED that these guidelines did not bear the weight of law.

Could NO FEDERAL AGENCY legally publish any opiate dosing guidelines because they would be targeting a segment of the population that is a protected class under the American with Disability Act.. which would make them illegal/constitutional ?

Are all those entities – CMS, Insurance companies, PBM, various healthcare corporations – who are adopting these CDC guidelines … will be guilty of discriminating under the American Disability Act against this protect class of chronic pain pts ?

Filed under: General Problems | 1 Comment »

Medicare Is Cracking Down on Opioids. Doctors Fear Pain Patients Will Suffer.

Posted on March 28, 2018 by Pharmaciststeve

Medicare Is Cracking Down on Opioids.
Doctors Fear Pain Patients Will Suffer.

Officials are close to limiting doses of the painkillers, but doctors say doing so
could put older patients into withdrawal or lead them to buy deadly street drugs.

By JAN HOFFMAN

Medicare officials thought they had finally figured out how to do their part to fix the troubling problem of opioids being overprescribed to the old and disabled: In 2016, a staggering one in three of 43.6 million beneficiaries of the federal health insurance program had been prescribed the painkillers.

Medicare, they decided, would now refuse to pay for long-term, high-dose prescriptions; a rule to that effect is expected to be approved on April 2. Some medical experts have praised the regulation as a check on addiction.

But the proposal has also drawn a broad and clamorous blowback from many people who would be directly affected by it, including patients with chronic pain, primary care doctors and experts in pain management and addiction medicine.

Critics say the rule would inject the government into the doctor-patient relationship and could throw patients who lost access to the drugs into withdrawal or even provoke them to buy dangerous street drugs. Although the number of opioid prescriptions has been declining since 2011, they noted, the rate of overdoses attributed to the painkillers and, increasingly, illegal fentanyl and heroin, has escalated.

“The decision to taper opioids should be based on whether the benefits for pain and function outweigh the harm for that patient,” said Dr. Joanna L. Starrels, an opioid researcher and associate professor at Albert Einstein College of Medicine. “That takes a lot of clinical judgment. It’s individualized and nuanced. We can’t codify it with an arbitrary threshold.”

 
Mr. Zobrosky’s medication regimen is strictly monitored at home. He submits to random urine tests and brings his pills to his doctor to be counted. Eamon Queeney for The New York Times

Underlying the debate is a fundamental dilemma: how to curb access to the addictive drugs while ensuring that patients who need them can continue treatment.

The rule means Medicare would deny coverage for more than seven days of prescriptions equivalent to 90 milligrams or more of morphine daily, except for patients with cancer or in hospice. (Morphine equivalent is a standard way of measuring opioid potency.)

According to Demetrios Kouzoukas, the principal deputy administrator for Medicare, it aims to further reduce the risk of participants “becoming addicted to or overdosing on opioids while still maintaining their access to important treatment options.”

The Centers for Medicare and Medicaid Services estimates that about 1.6 million patients currently have prescriptions at or above those levels. The rule, if approved as expected at the end of a required comment and review period, would take effect on Jan. 1, 2019.

Dr. Stefan G. Kertesz, who teaches addiction medicine at the University of Alabama at Birmingham, submitted a letter in opposition, signed by 220 professors in academic medicine, experts in addiction treatment and pain management, and patient advocacy groups.

His patients include formerly homeless veterans, many of whom have a constellation of physical and mental health challenges, and struggle with opioid dependence. For them, he said, tapering opioids does not equate with health improvement; on the contrary, he said, some patients contemplate suicide at the prospect of suddenly being plunged into withdrawal.

“A lot of the opioid dose escalation between 2006 and 2011 was terribly ill advised,” Dr. Kertesz said. “But every week I’m trying to mitigate the trauma that results when patients are taken off opioids by clinicians who feel scared. There are superb doctors who taper as part of a consensual process that involves setting up a true care plan. But this isn’t it.”

Some two dozen states and a host of private insurers have already put limits on opioids, and Medicare has been under pressure to do something, too. Last July, a report by the inspector general at the Department of Health and Human Services raised concerns about “extreme use and questionable prescribing” of opioids to Medicare recipients. In November, a report from the Government Accountability Office took Medicare to task, urging greater oversight of opioid prescriptions.

If the rule takes effect, Mark Zobrosky’s experience could be a harbinger for many patients. Mr. Zobrosky, 63, who lives in the North Carolina Piedmont, takes opioids for back pain, which persists despite five surgeries and innumerable alternative treatments. He has an implanted spinal cord stimulator that sandpapers the edge off agony, and has broken four molars from grinding because of pain, he said. He receives Medicare as a result of his disability, including a private plan that pays for his drugs.

He submits to random urine tests and brings his opioids to his doctor to be counted every month. To prepare for mandatory reductions, his doctor has tapered him down to a daily dose equivalent of about 200 milligrams of morphine. (Mr. Zobrosky has a large frame; doctors say that opioid tolerance depends on many factors — one person’s 30 milligrams is another person’s 90.)

In February, Mr. Zobrosky’s pharmacist told him that his insurance would no longer cover oxymorphone. His out-of-pocket cost for a month’s supply jumped to $1,000 from $225, medical records show. “I can’t afford this for very long and I’m nervous,” he said.

A Medicare official who would speak only on background said that the limit for monthly high doses was intended not only to catch doctors who overprescribe, but also to monitor patients who, wittingly or not, accumulate opioid prescriptions from several doctors. When the dose is flagged, the pharmacist or patient alerts the doctor.

But it falls to pharmacists to be the bad-news messengers. James DeMicco, a pharmacist in Hackensack, N.J. who specializes in pain medications, said that negotiating opioid insurance rejections for patients was already “beyond frustrating.” He spends hours shuttling between doctors and insurers. “My heart goes out to patients because they feel stigmatized,” he said.

Dr. Anna Lembke, an addiction medicine expert at Stanford, sees merit in the intent of the proposed rule, if not its design.

“The C.D.C. declared a drug epidemic in 2011, which they unequivocally and rightly attributed to overprescribing,” she said. “Without external limits, I do not believe that prescribers will be able to limit their prescribing to the extent necessary to address this public health crisis.”

But, she added, Medicare also needed to establish a reasonable grace period to allow patients on high doses to taper down safely.

According to a draft of the rule, when a high-dose prescription is rejected, a doctor can appeal, asserting medical necessity — although there is no guarantee that the secondary insurer covering the drugs under Medicare would relent. A pharmacist may fill a one-time, emergency seven-day supply.

Opponents of the new limit say that doctors are already overwhelmed with time-consuming paperwork and that many will simply throw up their hands and stop prescribing the drugs altogether.

A delay or denial would put chronic pain patients — or those with inflammatory joint diseases, complex shrapnel injuries or sickle cell disease — at risk of precipitous withdrawal and resurgence of pain, doctors said.

The Medicare proposal relies on guidelines from the Centers for Disease Control and Prevention that say doctors should not increase an opioid to a dose that is the equivalent of 90 milligrams of morphine.

But experts say that Medicare misread the recommendations — that the C.D.C.’s 90-milligram red flag is for patients in acute pain who are just starting opioid therapy, not patients with chronic pain who have been taking opioids long-term. The acute pain patient, the guidelines say, should first be offered treatments like acetaminophen or ibuprofen. A short course of a low-dose opioid should be a last resort.

“We didn’t take a specific position on people who were already on high doses,” said Dr. Lewis S. Nelson, the chairman of emergency medicine at Rutgers New Jersey Medical School and University Hospital, who worked on the guidelines.

“We did say that established, high-dose patients might consider dosage reduction to be anxiety-provoking, but that these patients should be offered counseling to re-evaluate,” he added. “There is a difference between a C.D.C. guideline for doctors and a C.M.S. hard stop for insurers and pharmacists.”

Dr. Erin E. Krebs recently released a comprehensive study showing that patients with severe knee pain and back pain who took opioid alternatives did just as well, if not better than, those who took opioids. Nonetheless, she and seven others who worked on the C.D.C. guidelines signed the letter opposing the Medicare rule.

“My concern is that our results could be used to justify aggressive tapering or immediate discontinuation in patients, and that could harm people — even if opioids have no benefit for their pain,” said Dr. Krebs, an associate professor of medicine at the University of Minnesota.

“Even if we walk away from using opioids for back and knee pain, we can’t walk away from patients who have been treated with opioids for years or even decades now,” she added. “We have created a double tragedy for these people.”

 

Filed under: General Problems | 2 Comments »

Veteran kills self in John Cochran VA Medical Center waiting room

Posted on March 28, 2018 by Pharmaciststeve

Veterans Administration

http://www.stltoday.com/news/local/crime-and-courts/veteran-kills-self-in-john-cochran-va-medical-center-waiting/article_98b297b8-1ed2-52f9-8301-dc49c23fe2ea.html

A veteran committed suicide inside the John Cochran VA Medical Center at 915 North Grand Boulevard early Monday

Authorities have not identified the victim. The hospital said he was a veteran.

“We are grieved to confirm that a Veteran was found deceased in our medical center early this morning,” spokeswoman Marcena C. Gunter said in an email. “Our deepest sympathies are with the Veteran’s family and loved ones, our medical center staff and the members of the community affected by this tragic incident.”

St. Louis Police Officer Michelle Woodling said the 62-year-old man committed suicide inside the hospital waiting room at 4:19 a.m. Monday.

John Bauer Known him for many years as a neighbor, he was always complaining to the VA for help. Tried to be a friend/neighbor for support, needless to say he didn’t want my support. I always thank him for his service as a Vietnam veteran. Rest in peace neighbor.

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Sherry Harvel Thank you he was my brother 😭😭😭

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Ang PCock #1 Please stop saying “committed suicide.” Suicide is not a crime.

#2 we need to stop waiting for the VA to heal us and turn toward each other. Learn how to sit and listen to a veteran. There are community organizations that can help. …See More

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Amanda Nicole Well said

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Amanda Nicole I’m going to copy this and share it along with this story. I absolutely agree with you!

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Andrea Geringer “Completed suicide” is the correct term to use.

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Matthew Pendegraft Completed suicide sounds horrible, in my opinion I just always say, my dad checked out.

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Marcus Bennett Call it what you want…It’s still a failure by the VA to support the veteran with Health Care.

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Linda Melonson Glasper What should we all say ? Took their life ? Completed suicide ? What ? That doesn’t even sound like medical terminology. It’s like saying they done it over, and over, and over until they finished. Well, if they say attempted suicide numerous times maybe…See More

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Ang PCock Stop blaming the VA. We all have a part to play. If anyone would like to volunteer with a veteran charity, please let me know and I will send opportunities. Maybe we each can prevent things like this by getting involved.

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Gina White Kuelker Andrea Geringer no, the correct term is “died by suicide”

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Kevin Lotz Most grief/death/loss experts and thanatologists i.e. experts in the science of death/grief/loss recommend instead of saying “committed suicide,” one refers to suicide as follows…”Jane Doe suicided.” Yes, at first it sounds “awkward,” however as a li…See More

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Karl Wilder Kevin Lotz And sometimes language can mislead.

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Brian Conley Ang PCock, I would like to help. 10th Mountain Veteran 03-10

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Ang PCock Brian Conley join our group here Post 9/11 Veterans Greater St. Louis!

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Deborah Weber-Finley The VA provided my father good care free of charge. He worked at the VA in Poplar Bluff for years. They could probably use reform but PLEASE do not call for the VA to be closed. Do not even begin to think that v private would be better!

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Kay Bradford Unfortunately maybe this is what it will take to wake people up to the unnecessary suffering of our Veterans. This poor man took his own life IN A HOSPITAL! I mean if anyone could help him they should have been able to.

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Jennifer Pallone This isn’t exclusive to the VA. Not long ago a man jumped off a railing at BJC into the lobby below. I can’t recall a time this has happened at the St. Louis VA

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Kay Bradford I have a friend who has to get treatment at the VA, this one in particular, there are a lot of needs and not so many things that are taken care of in a timely manner.

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Cathy English Amen they didn’t help him he pleaded with them for years and they didn’t help him with his pain I hope his family sues va. And also the person working there what happen to hippo law? Shaking my head. Dan I’m so sorry for the loss of your grandpa please set up a go fund me account love You dan and Brittany

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April Bishop-Sennholtz We don’t need a go fund me page! We already hv it payed for! Please do not contribute to any of this. My family has it takin care of. We don’t want no money!

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Rivka Gottschall How many scandals have to happen at this hospital before they shut it down? The VA is a failure. I’m a veteran. I’ve experienced their poor care system.

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Belinda Denson Sorry, I disagree. I am sorry you had a bad experience, but they saved my husband’s life in September and have given him great care.

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Rivka Gottschall I’m glad things worked out for you.

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Belinda Denson Thanks, and I hope it will be better for you in the future.

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Rivka Gottschall Thank you. I hired a private person.

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Ang PCock Don’t let people tell you your bad story doesn’t matter. Your voice matters just as much as those they help.

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Katie Hansen Rivka Gottschall my dad received care here i hate this place with a passion.

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Dan Varga He was my grandpa and they shunned him like he was nothing for years and told him nothing was wrong. He was sick and anyone that knew him could tell he was suffering for the better part of the past 15 years. The last ten he’s been begging them to find …See More

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Rivka Gottschall I’m so sorry for your loss. The St. Louis VA has been troubled for years. They have been sued in the past. They infected people with HIV and Hep B. They’ve botched surgeries. I say enough is enough. Something needs to happen to change that place. You could file a law suit. Write to your congressman too. You and your family are in my thoughts and prayers. Our veterans deserve the best.

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April Harris So sad!!😕 the poor man needed help but it didn’t come fast enough!! Sometimes when you mix certain meds they can have a negative effect on ones mind!!😕 My condolences to his family and friend. May he now rest in peace.

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Sherry Harvel Thank you

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Maureen Whalen King This is real…. and sometimes over 20 years of aggressive therapy and medication does not help….

I am very sorry to the family of this Veteran…. May Peace be with you …See More

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Sherry Harvel Thank you

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Sara Thomas It is very sad and tragic yes…..but we don’t know what he told them what his complaint was when he checked in…….I’m sure he didn’t come out and say “I’m suicidal” or they would have triaged him immediately

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Richard Plotzker Over the years I’ve had two attempted suicides by hospital inpatients on medical floors, one a wrist slashing at a different VA, the other a man climbing out the seventh floor window. Both were rescued by heroic efforts of the nurses on site. Suicide…See More

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Richard L Jones I’m 100% disabled through Agent Orange. I don’t use the VA nearest us except for dental care. Just recently, I was notified that my next dental appointment is on June 24. I also have a dermatology appointment with a civilian doc on April 19. Both a…See More

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Missie DeMay My dad was there back in Sept…he has/had early onset dementia and a known drug hx he was in a sitter room…no one notified us he was “missing” for 8hrs. The only reason we found out was bc my sister went to check on him and they said they didnt know where he was.He left the hospital with an IV in none the less. This is our VA system at its best. So sorry for this families loss.

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Penny Johnson Hopefully Trump will change that. It seems he is trying. Prayers for you and your family. To think the wars we fought were about money or oil. Something to make the rich richer. I pray for a better world.

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Michael L Bates The new budget that was passed by our government had items helping Veterans removed before approval….The promised healthcare of the people they send to war is not a major concern to our politicians…..

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Mary St Clair They had cut off his pain meds 3 years ago per the family post. Do you realize that there are honest strong legitimate chronic pain patients who are suffering terribly because of the opioid crisis and doctor’s fear of prescribing? Until there is a repl…See More

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Sherry Harvel He was not on pain meds

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Cynthia McCullison Probst I am so sorry for this family and all the other veterans and their family’s that have no (financial) choice but to go to this criminal institution. My father was a WWII vet that was in Cochran a little over 8 years ago. He was a fall risk and his room …See More

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Sherry Harvel I’m sorry for your loss that was my brother who shot himself

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Jennifer Brown You know maybe if you could get appointments not a month or two out could be a start. Also telling them they are fat,drink too much coffee,and smoke is not really a diagnosis. Maybe do your job and this wouldn’t happen. You should be ashamed of yourselves! These veterans deserve better than what you provide!

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Maria Bonetti Mary Mistretta
You know this is not funny, but my first thought was hearing your stories about the long waits to be seen down there!

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Heather Dawn Kartal I truly believe if u want to kill yourself, no one can stop u
The pain inside is greater than any force outside
I have battled depression most of my life and it is a painful road and many do not have the strength to make it one more minute or day…See More

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Roy Boyer I have used the same hospital for 12 years without a problem, apparently we don’t know the whole story.

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Barbara Johnson Omg this is so tragic and senseless. Prayers for veteran who didn’t get the help he needed . May you Rest In Peace. We must do a hell of a lot better for our veterans!!! God Bless each and everyone of you for your service and sacrifice for our country!

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Paris Rosenberg How did he kill himself? Was it intentional overdose or was he actually with a gun in the ER? Did I miss some of this article?

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Maria Bonetti This is the exact same thing my friend talks about when she brings her Veteran father down there! Apparently, it’s a nightmare and a joke, all rolled into one! My condolences to your family.

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Sherry Harvel That was my brother and I miss him already please don’t say negative things about him he was very sick 😭😭😭😭😭

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Whitchurch Gary Debbie I m a vietnam vet have been using the VA for several years now , they have treated me good, some how we are not seeing the complete story here. As for as getting into the hospital with a gun, you can walk right into most hospitals unchecked

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Nancy Pingel And Congress doesn’t think there should be more funds for the military. Pitiful.

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Linda Jamerson This isn’t a surprise and I can’t believe it hasn’t happened more. The VA is its own worst enemy in some ways and we, the Veterans are sometimes the unfortunate victim.

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Alex Stevenson I feel like the veteran community is very often it’s own worst enemy as well. Guys get so worked up about this stuff, and yet, I’d bet a good percent of these incidents would occur no matter what the VA does.

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Liz Stasieczko Wait until trumps war starts and we have more damaged people.

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Christopher Slater Liz Stasieczko This is President Trump’s fault? 16+ years of war, under two Presidents – and it was probably broken before that.

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Linda Jamerson I would agree with you to a certain point Mr. Stevenson and yes, these incidents could very well happen anywhere and to anyone. I’m a Veteran and work for the federal government, in a system that is broken and has been for some time. There are so many …See More

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Ang PCock Congress just gave $60 billion to the DOD to spend before the end of fiscal year.

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Marcus Bennett “I will create a private White House hotline – that is answered by a real person 24 hours a day – to make sure that no valid complaint about the VA ever falls through the cracks. I will instruct my staff that if a valid complaint is not acted upon, the…See More

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Top Comments is selected, so some replies may have been filtered out.
Belinda Denson It is so sad when any person loses hope to the point of suicide. My prayers are with this family.

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Dan Carthen Gotta build that wall! No money to improve the VA.

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Karen Shaw So sorry for the individual’s family

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Laura Bridegan Curran Tragic… praying for all who knew and love him… praying for all veterans…

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Emily Ann What was he doing at 4:15 a.m. in the waiting room? How long had he been there waiting?

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Kathryn Elizabeth Well since waiting rooms are open 24/7 he could have come in at any time…

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Diane Landfried How did he do it???? Was it obvious????? How long was he there??????

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Sherry Klingeman Wilkerson How awful! Prayers to the family for comfort and strength. 🙏🏼

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Lynn Whitbeck Hepner Tragic and indicates lack of supervision

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Linda Melonson Glasper He was ” found deceased ” ???? I read several articles that said he shot himself. So, how do they ” find him dead ” and no one heard the shots ? He was right there in a hospital and obviously no one saw any signs. It probably wasn’t his first time going there either. Very sad….

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Lori Ann Believe the other news.. the wording on this story isn’t correct

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Joan Jensen It was also 4 am so maybe no one was in that area.

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Sherry Harvel He shot himself he was my brother 😭😭😭😭😭

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Linda Melonson Glasper Condolences to you and your family. 😢

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Katie Hansen I absolutely hate this place with a passion.

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Ali Kat They don’t care about vets, this is soooooo upsetting 😭

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Annie Daugherty Why is this VA such a hellhole? The VA in Mt Vernon, Missouri is wonderful.

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Margie Summers It actually isn’t a hellhole. This hospital treated my husband for years. The staff is overworked, but does a great job in spite of working with too many patients and too few resources. There are long wait times for appointments, but I get medical care…See More

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Michel Cohen I’m sorry I can’t see how lack of staff equates to lack of compassion.

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George Sellers Sr. That’s so so so very sad I’LL PRAY for the FAMILY WAY CAN’T WE HELP

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John Visaggio No one noticed until hours later,

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Catherine Weitekemper So very sad…what’s wrong with this country???

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Peggy Price Feld How sad. We need to spend more time helping our veterans.

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Ginny Ocello Something really needs to be done about that place

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Melissa Hard Elliott Davis should look into this!

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Cathy Clay So sad. Hiring freeze is not helping the wait time!! 😡🤬

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Jennifer Lopez Who has a hiring freeze? I know nurses that started there this month

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Cathy Clay Jennifer Lopez I bet they were beyond short. I bet they were short 10 and got 2. Go ask. I work at a VA hospital, so I know. Short 8 techs for a year, just hired one.

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Kelly Dee Only hiring to fill previous positions, no new positions. (As far as I know)

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Lori Ann Yes, we are currently in California for my spouse’s job and she had to wait several months to see a doctor or nurse practitioner at the V.A. here. The staff apologized and explained that it was due to the hiring freeze. Also, with the recent budget cuts, they are short on supplies. The V.A. pharmacy here was even closed temporarily.

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Carmen Oyston Prayers 💖

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Pat Powell Prayers for his family

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Barb Collico Campanella How sad.

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Kathy Martin Brandsma Very sad

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Mike Jones End illegal wars now!

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Brenda Love Collins May he rest in peace.

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Terry Berry Lindemann So sorry RIP

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Pam Pc Cordova

🙏🙏🙏

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Hollie Rena Eric Pollack did you see this??

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Rita Walker Awe! So sad.

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Angela Houston Tragic. My God I’m so sorry. Rest in peace.

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Dawn Glover This is a tragedy!

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Beverly Stout God Bless you

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Carolyn Bond

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Ryan Conklin Get me in there.

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Nathan Ernst socialized medicine

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Bob Lechleitner Prayers. RIP>

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Janet Martin Prayers for you all !

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Terry Cox

❤️🙏🏻🇺🇸

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MikeandMarcia Ziska This is so sad. R I P Sir.

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Sabrina TaiDoll Simpson Wow

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Ruth Tinker BBB

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Filed under: General Problems | 1 Comment »

When medical bureaucrats are “all-knowing and all-powerful”… yet blatantly ignorant ?

Posted on March 27, 2018 by Pharmaciststeve

As this reads, it would appear that the state’s medical board has instructed  all prescribers in the state to reduce the number of opiates prescriptions. So the medical board is denying/discriminating against all pts who are covered by the Americans with Disability Act and Civil Rights Act appropriate care. So bureaucrats at the STATE LEVEL can dictate the violation of a FEDERAL LAW by all the licensed physicians in this particular state.

Last I looked.. it is against the Control Substance Act to prescribe (de-prescribe) controlled medications for a person that the prescriber has not done a in person physical exam. According to this posted letter, these same bureaucrats have not even bothered to review the medical records of any patient that they have decided to deny care.

Filed under: General Problems | 3 Comments »

After 50 yrs and > 1 TRILLION.. DEA needs more staffing.. to keep digging a “deeper hole” ?

Posted on March 27, 2018 by Pharmaciststeve

DEA adds 250 more task force officers to fight opioid crisis

http://thehill.com/policy/healthcare/380543-dea-adds-250-more-task-force-officers-to-fight-opioid-crisis

The Drug Enforcement Administration (DEA) is deploying 250 additional task force officers and dozens more analysts across the U.S. in an effort to crackdown on the opioid epidemic.

The additional manpower will be in areas the epidemic has hit the hardest, the DEA announced this week.

A press release touts DEA task force officers as having “been some of the most essential and effective partners in building cases against drug trafficking organizations across the globe.”

“Positioning more robust resources such as task force officers in areas hardest hit by this epidemic will provide the strength and support needed to tackle this crisis in regions that need it most,” DEA acting Administrator Robert W. Patterson said in a press release.

A DEA spokesperson wrote in an email that where the officers and analysts will be positioned is still under consideration. The additional personnel resulted from a reallocation of resources and did not stem from new funding.

Last week, President Trump unveiled a three-pronged approach to combating the opioid epidemic: reducing the demand and over-prescription of opioids, cutting off the supply of illegal drugs and boosting access to treatment.

Filed under: General Problems | 3 Comments »

Apparently CVS believes that they have the authority to practice medicine ?

Posted on March 27, 2018 by Pharmaciststeve

Hi, I apologize for not reading thru your web site. But I am in pain since CVS has made my doctor decrease my pain medicines in half to the dose that gave me relief. Right now I am in pain.

Please tell me where to turn. I am a 56 yr old with multiple spinal injuries. I have been on opioids for pain management for 13 years. I live in New Jersey, Mickleton. I have thought about changing my residency to Florida to reside with my daughter. Another option is to return to my Philadelphia home. Which state offers the best protections from these rules set up by the pharmaceutical companies to minimalize my medications.

I am on disability for my illnesses. My insurance is with my employer out of Philadelphia PA. Primary coverage is with Blue Cross but Prescriptions are with CareMark, CVS.  How do I file a case against this discrimination. My life is dreadful as I am in pain every hour of the day.

 

Here is a post I made back with CVS publicly stated that they were going to start imposing daily opiate limits CVS Pharmacy Will Limit Prescriptions for Opioids

It would seem that all too many in corporate America seems to work under the premise that “nothing is illegal until you get caught”.. and as long as no one “pushes back”  they will continue to do as they please…. regardless of the harm caused to their employees or customers.

 

Filed under: General Problems | Leave a Comment »

two opioid epidemics: One is the opioid addiction and overdose epidemic. The other is people with chronic pain being forgotten. They’re being ignored

Posted on March 27, 2018 by Pharmaciststeve

‘Gun-shy’ doctors and the second opioid crisis: patients in chronic pain

The addiction epidemic has led to a clampdown on legit prescriptions.

www.billypenn.com/2018/03/27/gun-shy-doctors-and-the-second-opioid-crisis-patients-in-chronic-pain/

Growing up, Amie was always double-jointed. Compared to her peers, she could extend her joints far past what was normal. For some kids, double-jointedness is like a party trick. But as Amie grew older, it became painful. She started dislocating her joints. Eventually, Amie was diagnosed with Ehlers-Danlos syndrome, characterized by hyper-mobility and chronic pain.

For a while, Amie mostly resigned to staying home. The pain got so bad some days that she couldn’t get out of bed. She couldn’t concentrate on work, and she had to quit her job as a Center City health care attorney in 2012.

In the years since her initial diagnosis, one technique has worked better than the rest to manage her pain: opioids.

Amie is among more than 460,000 Philadelphians who have taken a prescription opioid in the last year. Many of them, like Amie, take them for legitimate reasons.

But now, due to strict CDC guidelines inspired by the nation’s worsening opioid abuse epidemic, people suffering from chronic pain are having trouble getting their meds.

“The public perception is…people were prescribed opioids to treat pain, and they accidentally became addicted and moved onto heroin,” said Brooke Feldman, a person in longterm recovery who has written about the topic. “But there are people who benefit from these medications.”

Indeed, the grand majority of people who take prescription opioids do not fall into the addiction trap.

Per stats from the National Institute on Drug Abuse, between 8 and 12 percent of people develop substance use disorder after being prescribed opioids, and an estimated 4 to 6 percent of people who misuse prescription opioids transition to heroin.

‘Gun-shy’ doctors

Dr. Ira Cantor of Phoenixville, Pa., said he treats many patients with chronic pain — often by prescribing opioids.

It does require “considerable attention to detail,” he said. “When you’re dealing with patients with chronic pain, the decision to prescribe an opioid or change a dose requires you to look at a lot of other factors,” like a patient’s past prescription history, their co-occurring medical conditions and any side effects.

But in many cases, he finds opioids are still the best solution, something he thinks many doctors are now fearful of doing.

Physicians have become “gun-shy,” Cantor said, because doctors and pharmaceutical companies are often demonized for over-prescribing.

There are precautions doctors can take, per Cantor. The CDC recently released prescription drug monitoring programs, which give access to a patient’s full prescription history. Using the PDMPs, a doctor can tell if patients are getting drugs from several doctors at once.

“If they have, that’s a red flag,” Cantor said.

Cantor also performs toxicology tests — like the traditional urine drug test — and he asks patients to complete a questionnaire that includes tip-offs to potential addiction or misuse.

Every day, Cantor said he sees “loads of patients” because their previous doctor refused to continue prescribing their opioids.

“It’s been very common that…their doctors started tapering their medications, and they became much less functional,” Cantor said. “Many patients end up being bed-bound.”

Meeting in the middle

There are actually two opioid epidemics occurring at once in the United States, Cantor insists.

One is the opioid addiction and overdose epidemic. The other is people with chronic pain.

“The other epidemic, in many ways, is even larger,” Cantor said. “There are millions of people who have chronic pain, and they’re being forgotten. They’re being ignored.”

Amie counts herself as one of the lucky ones, despite her double-jointed condition — her physician hasn’t attempted to taper her off her medication.

With a low dose, she can finally get out of bed in the morning, and she even started volunteering for the Coalition of 50 State Pain Advocacy Groups. But from her advocacy work, she now knows knows countless chronic pain patients who have lost access to their medication because their doctors are wary to prescribe. Through Facebook, she’s even heard of people committing suicide because they lost access to their opioids.

Feldman, the recovery advocate writer, has also heard of pain sufferers ending their own lives because they were kicked off their prescriptions.

“When you’re living with pain and it’s not being treated properly,” Feldman said, “the thought of suicide becomes very real.”

Filed under: General Problems | 1 Comment »

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