Chronic, Noncancer Pain Boosts Suicide Risk

https://www.medscape.com/viewarticle/804832

Certain types of noncancer pain conditions are associated with an increased risk for suicide, a new study suggests.

A study conducted by investigators at the University of Michigan in Ann Arbor showed that psychogenic pain, back pain, and migraine, but not arthritis or neuropathy, were associated with an increased risk for suicide.

Although some of this risk appears to be due to co-occurring mental health problems, there may be something about the experience of pain that also contributes directly to suicide risk, lead author Mark A. Ilgen, PhD, told Medscape Medical News.

“Treatment providers, particularly those who work in pain treatment settings, should be aware of these risks and consider mental health and suicide risk assessments in their patients,” Dr. Ilgen said.

 

Previous research suggests that individuals with pain may be at increased risk for suicidal thoughts and behaviors, but it is likely that “not all pain is created equal” in terms of its association with suicide, and that the association between pain and suicide could vary, depending on the type of pain patients experience, Dr. Ilgen said.

The study was published online May 22 in JAMA Psychiatry.

Arthritis Most Common Dx

In the current study, the investigators sought to understand the degree to which specific pain conditions related to suicide risk. The investigators also wanted to understand whether pain remained an important predictor of suicide, even after controlling for other mental health conditions that are associated with both pain and suicide risk.

The team looked at treatment records of all patients (n = 4,863,036) who were seen in the Veterans Health Administration system in fiscal year 2005 and who were alive at the start of fiscal year 2006.

They then examined the association between baseline clinical diagnoses of the following pain-related conditions: arthritis, back pain, migraine, neuropathy, headache or tension headache, fibromyalgia, and psychogenic pain, as well as the extent to which each of these conditions predicted risk for suicide in fiscal years 2006 to 2008.

Arthritis was the most common diagnosis, occurring in 2,076,514 patients (42.7%), followed by back pain, in 1,111,187 (22.8%). Psychogenic pain was the least frequent diagnosis, occurring 18,145 patients (0.4%). Suicide occurred in 4823 (0.01%) in the subsequent fiscal years.

After controlling for demographic and other factors, including age, sex, and Charlson score, the researchers found that except for arthritis and neuropathy, each pain condition was associated with an elevated risk for suicide.

 

Psychogenic pain was associated with the greatest risk for suicide death (hazard ratio [HR], 2.61; 95% confidence interval [CI], 1.82 – 3.74).

 

Back pain was associated with a 33% increased risk for suicide death (HR, 1.33; 95% CI, 1.22 – 1.45), migraine with a 68% increased risk (HR, 1.68; 95% CI, 1.28 – 2.20), headache or tension headache with a 38% increased risk (HR, 1.38; 95% CI, 1.17 – 1.64), and fibromyalgia with a 45% increased risk (HR, 1.45; 95% CI, 1.16 – 1.81).

When these analyses were further controlled for concomitant psychiatric conditions, these associations between pain conditions and suicide death were reduced.

 

However, significant associations remained for back pain (HR, 1.13; 95% CI, 1.03 – 1.24), migraine (HR, 1.34; 95% CI 1.02 – 1.77), and psychogenic pain (HR, 1.58; 95% CI, 1.11 – 2.26).

 

Controversial Diagnosis

 

“Psychogenic pain is listed within the ICD-9 [International Classification of Diseases, Ninth Revision] coding system and characterizes pain that is caused by psychological instead of purely physical factors,” Dr. Ilgen explained.

Dr. Mark Ilgen

“This is a diagnosis that is used relatively infrequently within the VA, and there is considerable disagreement among pain and mental health professionals about the validity and utility of this diagnosis,” he said.

 

Because of the type of data that were analyzed in this study, it is impossible to tell what treatment providers were thinking when they used the diagnosis of psychogenic pain, Dr. Ilgen added.

 

“Still, this diagnosis had the strongest association with suicide of any of the pain disorders that we examined. It is my guess that a diagnosis of psychogenic pain is given to patients with pain that is poorly understood and that may be particularly difficult to treat. Also, there is the possibility that patients with this diagnosis are particularly frustrated with their care and hopeless about the resolution of their pain condition. I do not interpret our findings to indicate that ‘psychogenic pain,’ as it is defined in the ICD-9, is directly causing suicide, rather, that there is something about being diagnosed with this condition that is associated with a particularly poor prognosis.”

 

Need for Screening and Treatment

 

Commenting on this study for Medscape Medical News, Colonel (retired) Elspeth Cameron Ritchie, MD, chief medical officer for Washington, DC, Department of Mental Health and an expert on suicide in the military and veterans population, called it important, although not a surprise.

 

“It’s not a revelation because anecdotally, we have known that pain is a risk factor for depression and for suicide. But it is looking at a very large population, and this adds to its importance,” she said.

 

Dr. Ritchie, who retired from the army 2 years ago, said she saw this firsthand.

 

“Pain was a major risk factor. Many service members, after 12 or 20 years of service, have a lot of aches and pains. So in the military, pain is a risk factor.”

 

She added that for her, the “take-home message” is that clinicians should be evaluating suicide risk in all patients with pain.

 

“The standard questions for evaluating risk for suicide are, ‘Have you given away your possessions?’ and ‘Have you made a will?,’ but it’s not a standardized question in the psychiatric setting to ask about pain, and it absolutely should be.”

 

Also, asking about pain is not enough. Clinicians should make sure that patients with pain are getting appropriate treatment, she added.

 

The study was sponsored by the Veterans Health Administration. Dr. Ilgen and Dr. Ritchie report no relevant financial relationships.

 

JAMA Psychiatry. Published online May 22, 2013. Abstract

Filed under: General Problems | 1 Comment »

Filed under: General Problems | 4 Comments »

www.nationalpainreport.com/opinion-medicare-considering-opioid-restrictions-comment-on-docket-by-monday-3-5-8835679.html

Most of us knew this had been coming; however, it doesn’t make it any easier to swallow.  This is probably one of the most important tasks you will be asked to do as a chronic pain patient or for pain patients.  We know there have been literally hundreds of ‘Calls to Action’ over the years, but this is it.  Medicare is considering limiting coverage for opioid dosages over 90 MME and putting a 3, 5, or 7-day cap on new prescriptions for acute pain.  There is a proposed 7-day supply to be provided while you seek an exemption to an over 90 MME prescription.  Medicare is also proposing adding extra flags for Gabapentin, Lyrica and Benzos in combination with opioids.  Final approval is given to your insurance carrier, not your doctor.  We must ask for a legacy exemption for those already stabilized above 90 MME.

We have until Monday to badger as many people as we can to comment on the federal docket.  Pain patients are now joining their State Pain Advocacy Groups, created several months ago for direct action and advocacy.  These groups are a little different than your typical advocacy groups, as they discourage personal stories, memes, medical talk and surgical photos.  We are focusing on the collective and not individual experiences, though they are the most important part of this.  We will comment on federal dockets, attend legislative hearings, talk with reporters/policy makers and even protest at the nationwide ‘Don’t Punish Pain’ rallies on April 7, 2018.

We must bombard Capitol Hill with calls, faxes, Tweets and emails and meet with them if we can.  Not only do we need to let them know how medically fragile and chronically ill we are, and that we depend on these medications for our very existence, but we have to PROVE to them we are not functioning addicts.  They must see us speaking as one, with clear speech and clear eyes.  We must be rational, calm, cool and collected – not an easy thing to be when you are fighting for your life along with daily fatigue, illness and disability.

Please comment on the federal docket that closes on Monday, March 5th, 2018.  Use these steps as a guide, but please do not copy them verbatim, as Medicare will disregard duplicate comments.  Join your state pain advocacy group – it’s your state name and ‘Pain Advocacy Group’ on Facebook – the website is under construction.  We will never ask for money from chronically ill pain patients, as most don’t have any to spare.  Ask how you can help in your state group, as there’s so much to be done.  We are just at the beginning of what we fear will be a very long battle.  It’s way past time for us to be advocating together – if we wait until our pain relief has been completely taken away, it could be nearly impossible to fight.  Please know that we are all just one appointment away from losing access to pain medication – whether it’s your doctor unwilling or unable to prescribe, your insurance denying coverage or your pharmacist being out of supply or refusing to fill.  It’s happening and it’s real.  Come join us – we need you now!

Here are some tips on how to comment on the federal regulations:

1. https://www.regulations.gov/document?D=CMS-2017-0163-0007
2. Click Blue Box ‘COMMENT NOW’
3. You may want to write your comment in a document and then copy/paste in case the site glitches or it’s too long and you need to attach it as a doc – ‘Choose files’ – if you need to upload it.
4. Name/City/Sate/Zip/Country/email or submitting on behalf of 3rd party – we can submit your comment anon for you/CONTINUE.
5. I am a Medicare/Medicaid patient or future patient – or have a private insurer which often follows Medicare policies.
6. I am a pain patient diagnosed with (diagnosis) for (how many?) years. I tried( ______ ) – list all the non-opioids (n-saids, Tricyclic anti-depressants, SSRIs, SNRIs, Steroids, anti-epileptics, etc.) you tried BEFORE opioids and include all the different therapies/treatment/surgeries (i.e., PT, OT, Aqua T, Chiro, Osteo, injections, devices, procedures, CBT/mindfulness, acupuncture, acupressure, massage, biofeedback, Medical Cannabis, creams, TENs, MENS, natural remedies, etc.) but they all failed to heal/help or adequately control my pain, so I require opioid pain medications. Opioids help me by managing my pain and (_____) – talk about improved function that opioids help with – working, chores, childcare, travel, entertainment, etc.
7. If Medicare/Medicaid/private insurer refuses to pay and if I do not have access to my medication over 90 MME/any dosage I will (____) – explain how your life will change – lose your job, income, home, car, entertainment, not be able to care for family/house, etc.
8. Explain you have been a model, compliant patient, and if you have a pain contract – include how often you have UAs, pill counts, secure you medications and if you use one pharmacy, avoid alcohol, cannabis, etc. Mention it is unlikely your condition will improve and the effects of time and aging will make things worse. Opioids and pain management were a last resort option.
9. Proposed policies are not supported by proven studies, everyone genetically metabolizes medications differently, the CDC guidelines were written outside the rules by non-pain management physicians, some who may have professionally or personally profited from the outcome.
10. These policies could: create more chronic pain by not treating acute pain, scare more doctors out of pain treatment, create more demand for urgent care, increase the rate of expensive and possibly dangerous procedures, more disability claims/unemployment, and need for social services.
11. Force involuntary tapers, withdrawals, risk of suicide, high blood pressure, stroke risk, and cardiac issues.
12. I am disabled, NOT over 65 and pain medication helps me PREVENT falls by stabilizing my pain.
13. My medical care and decision making should be left to my doctor, who understands my complicated and complex case, not CMS/Medicare.
14. A 7-day supply while seeking an exemption to 90MME would cause extreme stress, paperwork burden for my doctor, extra copays at pharmacy/doctor, plus another trip to doctor/pharmacy when you are in pain.
15. A 7-day limit on prescriptions for new patients would be a physical and financial hardship – doesn’t take into account injury, size, metabolizing, genetics or other factors.
16. I take _____ (Benzos, Gabapentin, Lyrica) safely – I do not mix them with alcohol, other substances and use as directed.  Explain what might happen if these were to be discontinued.
17. Prescribing has been going down for over 5 years while ODs to illicit heroin/Fentanyl coming in from Mexico/China is skyrocketing – deaths will continue to rise, as this crisis is NOT an over prescribing issue.

Valorie Hawk lives in Washington and has experience working with Congress. She can be reached by Email: C-50painadvocacygroups@outlook.com and you can follow her on Twitter   @C50painadvocacy

Filed under: General Problems | 4 Comments »

http://www.wpxi.com/news/national/president-trump-says-drug-dealers-may-deserve-ultimate-penalty/709651660

WASHINGTON (AP) – President Donald Trump said Thursday the “ultimate penalty” may be in order for drug dealers because the nation’s drug problem will never be solved without a show of strength and toughness.

The comments were Trump’s most explicit on the matter to date. He previously has alluded to death for drug dealers by noting that some countries are “very harsh” with drug dealers. Trump also has said he knows the answer to the drug crisis, but he isn’t sure the country is “ready for it yet.”

In remarks Thursday at a White House summit on the opioid epidemic, Trump said drug dealers and pushers kill hundreds of people but that that most don’t go to jail.

“You know, if you shoot one person, they give you life, they give you the death penalty. These people can kill 2,000, 3,000 people and nothing happens to them,” he said, referring to drug dealers.

“Some countries have a very, very tough penalty – the ultimate penalty. And, by the way, they have much less of a drug problem than we do,” Trump continued. “So we’re going to have to be very strong on penalties.”

Trump also held out the possibility of initiating federal lawsuits against opioid makers and distributors. He also said his administration will be “rolling out a policy” on opioids in the coming weeks that will be “very, very strong.” Neither he nor his aides provided any details.

Trump said he had spoken with Attorney General Jeff Sessions about suing opioid makers. Sessions announced this week that the Justice Department will support local officials in hundreds of lawsuits against opioid makers and distributors.

Addressing potential federal litigation, Trump said: “I think it’s very important because a lot of states are doing it, but I keep saying, if states are doing it, ‘Why isn’t the federal government doing it?’ So that will happen. So that will happen.”

Trump’s wife, Melania, opened the summit. She said many people are grieving loved ones lost to the opioid crisis and “we need to change that.”

She read from a letter from Betty Henderson, a Florida woman who lost her 29-year-old son, Billy, to drugs last September. Henderson appealed to Mrs. Trump for help “in claiming these lost souls before drugs take them from this earth.”

Opioids, including prescription opioids, heroin and fentanyl, killed more than 42,000 people in this country in 2016, more than any year on record, according to the Centers for Disease Control and Prevention. Trump has declared that fighting the opioid epidemic is a priority for the administration but critics say the effort has fallen short.

Trump in the past has addressed the issue of tough penalties for drug dealers and pushers.

In January, Trump said: “We’ve never had a problem with drugs like we do, whether it’s opioid or drugs in the traditional sense. It’s never been like it is.

“And we are going to do everything we can. It’s a very difficult situation, difficult for many countries,” Trump said. “Not so difficult for some, believe it or not. They take it very seriously and they’re very harsh. And those are the ones that have much less difficulty. “

Trump raised the issue later that month as he signed legislation giving Customs and Border Protection agents new resources to stop the illicit drug flow. He suggested that he’d like to take a more aggressive approach to the drug crisis – but said the country isn’t ready for what he has in mind.

“So we’re going to sign this. And it’s a step. And it feels like a very giant step, but unfortunately it’s not going to be a giant step, because no matter what you do, this is something that keeps pouring in,” he said.

“And we’re going to find the answer. There is an answer. I think I actually know the answer, but I’m not sure the country’s ready for it yet,” he added. “Does anybody know what I mean? I think so.”

Pres Trump, when it comes to the opiate crisis and the war on drugs.. is so out of his league and he is depending on the advice of that numb-nuts AG Sessions who is still in the 70’s or 80’s in trying to fight the war on drugs… nothing like trying to deal with 21st century crooks with 20th century policies and processes.

Everyone who has three brain cells holding hands that when you take out a drug dealer… there are two or three waiting in the wings to step up and take over selling the product to meet the demands for the product in the general population of our society.

We already have the highest percent of our population in jails/prisons of any civilized society on the globe… most for non-violent drug offenses…  Perhaps Trump and Sessions need to be given an abbreviate education in Economics 101 and the law of supply and demand.

Is it time for a valid THIRD POLITICAL PARTY ?

Filed under: General Problems | 2 Comments »

http://www.whsv.com/content/news/West-Virginia-AG-says-new-opioid-directive-came-from-his-DEA-lawsuit-475689823.html

According to Attorney General Patrick Morrisey, his December 2017 lawsuit was the cause behind Attorney General Jeff Sessions’ new directive for the DEA to change its regulation establishing how many opioid pills can be manufactured each year.

The announcement came just hours before a key deadline in Morrisey’s lawsuit, which sought greater transparency and broader input in the process the DEA uses to establish those limits.

He says evidence of diversion has been ignored for years in setting those limits, and he moved to suspend his lawsuit Thursday after getting the federal directive.

“The era of unlimited supply must end,” Attorney General Morrisey said. “We are losing too many neighbors, too many friends, too many sons and too many daughters to senseless death.

“The DEA’s quota system is fundamentally broken,” Morrisey said. “For far too long, it served the industry’s wants, instead of the patients’ needs, inexcusably neglecting evidence of diversion to rely on a formula that continues to kill hundreds each day. This must stop.”

Morrisey says the new process should require the DEA to formally seek input from the Department of Health and Human Services, Food and Drug Administration, Centers for Disease Control and Prevention, as well as every state.

He says that would be “a reversal from years of reckless oversight and abject failure.”

“I heartily applaud Attorney General Sessions for the major step he is taking and for his continued collaboration with our office to protect West Virginians from this deadly scourge of opioid excess,” Attorney General Morrisey said. “I am also appreciative of President Trump’s dedication to addressing the opioid problem, as it represents such a stark departure from the past.”

You can read Morrisey’s lawsuit here, Sessions’ directive here, and Morrisey’s motion to suspend the suit here.

legal opiate prescriptions in 2016 was less than 2006 and DEA cut opiate prescription manufacturing quotas in 2016.. again in 2017 and again in 2018… many opiates production quotas are abt 50% of what they were in 2015. .. and this numb-nuts attorney wants a larger cut… because the citizens of his state because of genetics, or socioeconomic reasons they have decided to abuse and/or be diverters of controlled substances.

Filed under: General Problems | 3 Comments »

www.rxinjuryhelp.com/news/2018/03/02/unnecessary-use-of-fluoroquinolone-antibiotics-prompts-new-cdc-warning/

The U.S. Centers for Disease Control (CDC) is now warning doctors to prescribe fluoroquinolone antibiotics – a class of drugs that includes Levaquin, Avelox and Cipro – only when “absolutely necessary” because of their potential to cause serious adverse events.

Fluoroquinolones Often Prescribed for Uncomplicated UTIs, Viral Respiratory Conditions

The CDC warning follows the release of data suggesting that the drugs are often used to treat conditions that do not require antibiotic treatment or those with a different recommended first-line therapy,

According to a report published in Clinical Infectious Diseases, 1.5 million fluoroquinolones were prescribed to adults during ambulatory care visits in 2014. Genitourinary conditions (24.5%) and respiratory conditions (21.6%) accounted for the majority of these prescriptions.

Nearly 20% of fluoroquinolone prescriptions were written for patients with uncomplicated urinary tract infections or viral respiratory infections and bronchitis that don’t require antibiotic treatment. What’s more, fluoroquinolones were the MOST COMMONLY prescribed antibiotic for uncomplicated UTIs (40.3%) and the third most commonly prescribed antibiotic for respiratory conditions.

“Fluoroquinolones’ side effects can involve tendons, muscles, joints, nerves and the central nervous system, or could lead to life-threatening Clostridium difficile infection, which causes diarrhea that can lead to severe colon damage and death,” the CDC said in a statement responding to the report. “Because of these serious side effects, in 2016, the [U.S. Food & Drug Administration (FDA)] issued a warning advising health care providers to not use fluoroquinolones for conditions for which alternative and effective treatment is available and when the potential risks outweigh the benefits.”

Fluoroquinolone Side Effects

The FDA warning followed an agency review that suggested fluoroquinolone antibiotics could cause potentially permanent side effects involving the tendons, muscles, joints, nerves and central nervous system. At the time, the FDA required fluoroquinolone manufacturers to add this information to the Black Box Warning included with the drugs’ prescribing information. A Black Box Warning is the most urgent type of safety notice.

That warning was only the most recent FDA alert to focus on fluoroquinolone antibiotics. In August 2013, the agency ordered the drugs’ manufacturers to modify label information regarding their potential to cause a serious nerve disorder called peripheral neuropathy. While mention of the condition had been added to the prescribing information in 2004, the FDA determined that the labels did not reflect the possible rapid onset of the condition, or the potential for permanence.

In 2008, information regarding the potential for tendon damage – including ruptures and tears of the Achilles tendon – was added to the drugs’ Black Box Label.

Fluoroquinolone Antibiotic Lawsuits

Hundreds of people are currently pursuing peripheral neuropathy lawsuits against the manufacturers of Cipro, Levaquin and Avelox. Among other things, plaintiffs accuse the drug companies of downplaying this risk and failing to provide doctors and patients with adequate safety warnings.

Claims have also been filed on behalf of patients who suffered aortic injuries – including  aortic aneurysm and aortic dissection – allegedly associated with the use of Cipro, Avelox and Levaquin.

Filed under: General Problems | 8 Comments »

It is amazing how the media can start down one story path and end up with prescribers and legal opiates being the problem..  Here is a kid that is suppose to be the 16th best hockey player in the USA.  Apparently a over achiever, nothing wrong with that… but apparently accepted a offer from someone before a game to “take the edge off” and it was a opiate (Heroin) … and he never played another competitive game without his “little helper”… I believe, in athletics that is considered “doping/cheating”…  But those illegal acts by this kid – using a illegal substance and taking an illegal substance to help him win in a competitive team sport not part of this media’s message.

Mrs Kruczek and Ainsley headed directly to about prescribers … OVER PRESCRIBING… as the cause of all of these deaths. In this particular case it would appear that this kid’s “gateway drug” … was directly from the street and no prescriber was ever involved in giving him a prescription opiate.

https://www.nytimes.com/2017/06/14/business/media/fox-news-fair-and-balanced.html

Apparently this article explains a lot 

Fox News Drops ‘Fair and Balanced’ Motto

www.nytimes.com/2017/06/14/business/media/fox-news-fair-and-balanced.html

Mr. Ailes, who died in May, created the slogan with both purposes in mind. He coined the phrase when he and Rupert Murdoch founded Fox News in 1996, and it stuck.

Executives at Fox News acknowledge that it is rebuilding.

This year, Fox News has continued its yearslong streak as the top-rated cable news station over all, beating its rivals MSNBC and CNN in total viewership.

But the loss of the anchors Megyn Kelly and Bill O’Reilly has taken a toll in prime time. In May, MSNBC was the highest-rated network in a key industry category, weeknight viewers 25 through 54, for the first time in nearly 17 years.

On Wednesday, executives at Fox News played down the shedding of “Fair and Balanced,” saying that the move was strictly a marketing decision and that the network’s approach to news coverage had not changed.

One senior network official emphasized that the slogan was officially dropped last August and virtually no one had noticed.

Filed under: General Problems | Leave a Comment »

Filed under: General Problems | 6 Comments »

Kentucky House votes to tax opioids to close budget gap

http://abcnews.go.com/US/wireStory/kentucky-house-votes-tax-opioids-close-budget-gap-53447557

For six years, a pharmaceutical distributor sent more than 50 million doses of prescription opioids to five eastern Kentucky counties, enough for every person there to have 417 pills each.

Kentucky’s attorney general has sued that company and others like it. Thursday, state lawmakers voted to tax them.

In a state with the fifth highest drug overdose death rate in the country, Kentucky’s Republican-controlled House of Representatives approved a tax on prescription opioids Thursday. If approved by the state Senate, Kentucky could become the first state in the country to tax the addictive prescription painkillers that have spurred a wave of addiction across the country.

Lawmakers say the goal is to reduce the number of opioids available in Kentucky. But they won’t use the money from the tax specifically for drug treatment, instead using it to fund public education and other services.

“These pills are profiting the big pharmaceutical drug companies billions and billions and billions of dollars a year. You know how much our state budget gets? Zero,” Democratic Rep. James Kay said.

As the opioid epidemic rages across the country, state and local governments have filed hundreds of lawsuits against pharmaceutical companies and distributors to recoup some of the costs to their health care systems.

Kentucky’s proposal is a step in the other direction, using taxes to fill sparse state coffers while discouraging aggressive prescription of the drugs.

“I think it could help reduce aggressive prescribing,” said Dr. Andrew Kolodny, director of opioid policy research at Brandeis University and an expert advising the court in lawsuits against pharmaceutical companies. “Right now it is too cheap and easy to give a patient a narcotic when they have a pain problem.“

Kentucky is one of at least 13 states with pending legislation to tax opioids, according to the National Conference of State Legislatures. None of those proposals have been enacted.

The Kentucky proposal would tax each dose of opioids 25 cents.

State officials say it would generate about $70 million per year. In Minnesota, Gov. Mark Dayton has proposed a “penny a pill” tax on narcotic medications to raise about $20 million to pay for drug treatment programs.

Kentucky’s opioid tax revenue would not be set aside for drug treatment, instead going to fill a budget gap caused by the state’s struggling pension system.

“I think that’s a mistake,” Kolodny said. “States (need) to be investing and building out a treatment system that doesn’t really exist yet. This is a very sensible place to get that money.”

Some Kentucky lawmakers complained that the opioid tax, coupled with an accompanying 50-cent tax hike on cigarettes, disproportionately affects poor people.

But the proposal gives Kentucky’s attorney general authority to prosecute drug companies that pass the tax along to their customers.

That might not be legal, according to Nick McGee, spokesman for the Pharmaceutical Research and Manufacturers of America. He said that idea, plus the tax itself, have “some serious legal and policy questions.”

“Taxing prescribed medicines that people legitimately rely on to raise revenue for a budget shortfall is a pretty problematic precedent,” McGee said.

It’s unclear how the proposal will fair in the state Senate, a smaller legislative body that is dominated by Republicans. Senate President Robert Stivers said it would be “difficult” to pass any tax increase without a comprehensive reform of the tax code.

Republican Gov. Matt Bevin told WSON radio he would “reserve my thoughts” on the opioid tax. But later in the interview, he indicated he would not favor raising taxes just to balance the state budget.

“They are trying to put certain monies back in certain areas based on certain political pressure, when I think we need to have a collective effort in Kentucky,” Bevin said.

Filed under: General Problems | 4 Comments »

https://www.medpagetoday.com/publichealthpolicy/opioids/71434

WASHINGTON — Interoperability, predictive analytics, e-prescribing: these were some of the terms buzzing around the dais at a hearing of the Senate Health, Education, Labor and Pensions Committee on Tuesday.

The focus of the hearing was to solicit expert input on the role of technology and data in addressing the opioid crisis. The committee is currently drafting legislation related to the epidemic, which it plans to mark-up as soon as late March.

Specifically, Chairman Lamar Alexander (R-Tenn.) asked the experts how the federal government can use the data it collects to identify and stop the overprescribing of opioids.

Sen. Patty Murray (D-Wash.), the committee’s top Democrat, also spoke of the challenge of interoperability with prescription drug monitoring programs, noting that “the prescription a patient receives in one state may not show up in the system of another state. Two doctors in different states may not see they are writing prescriptions for the same patient.”

The concern is that providers may miss meaningful data that could alert providers to signs of a substance use disorder, she added.

Snezana Mahon, PharmD, vice president of clinical product development for pharmacy benefit manager Express Scripts in St. Louis, offered several recommendations to the committee.

First, pass the “Every Prescription Conveyed Securely Act,” which would mandate e-prescribing for opioids for all Medicare enrollees, she said.

“Encouraging e-prescribing of controlled substances would restrict pharmacy shopping [and] enable better prescription tracking, as well as reducing fraud waste and abuse,” Mahon explained.

Second, limit prescription for a first-time opioid user to 7 days (with exceptions for cancer, hospice, and palliative care) in keeping with the “Opioid Addiction Prevention Act,” she said.

Mahon also urged Congress not to mandate coverage for abuse-deterrent opioids saying that it was a “flawed approach” because some providers and patients mistakenly believe such products are less addictive.

Sherry Green, CEO of Sherry L. Green & Associates and co-founder of the National Alliance for Model State Drug Laws in Santa Fe, New Mexico, urged the committee to establish a federally funded hub that would break down the data silos and have consistent standards.

Green told MedPage Today after the hearing that there needs to be standards in each state for three key elements: what data is recorded, who can access it, and for what purpose.

In addition, she recommended that all states should integrate Prescription Drug Monitoring Programs (PDMP) into electronic health record (EHR) systems.

“We’ve got to get this information integrated seamlessly into these [health information exchanges] and [EHR] to get this information to professionals during their clinical work flow, so that they have it when they’re trying to make a decision,” she said.

In his testimony, Sanket Shah, a clinical assistant professor of health informatics at the University of Illinois at Chicago, focused on the impact of predictive analytics to leverage data, and identify warning signs of potential opioid dependency.

He cited a recent study that found “each refill and week of opioid prescription is associated with a large increase in opioid misuse among opioid naive patients. The data from this study suggest that duration of the prescription rather than dosage is more strongly associated with ultimate misuse in the early postsurgical period.”

Shah also stressed that “To truly have predictive analytics we need more data sources.”

He explained in a follow-up email to MedPage Today that self-reported data from people on opioids, after they’re discharged, such as the Current Opioid Misuse Measure, is one type of data that he’d like to see leveraged as it might be more accurate than information patients share in a doctor’s presence. Such data could be used to improve risk assessment tools, and better predict factors leading to relapse for those in recovery, he said.

Shah specifically recommended passage of the Prescription Drug Monitoring Act of 2017, which mandates that any state that receives funding from the federal government for a PDMP must share their data with other states. The bill also includes language around helping fund a data-sharing hub.

He noted in his testimony that the federal government has both “the means and the infrastructure” to develop an “integrated data environment” that could use factors such as social determinants of health, family and medical history and access to complete episodes of care to help health informaticists improve their predictive capabilities.

Alexander balked at the idea of the federal government overseeing a federal hub, and being responsible for data-sharing on a large scale. He pointed to Healthcare.gov and Meaningful Use as examples of government-failed experiments in this same realm.

“Why not instead establish the standards that states can use and why not leave room for Amazon, Google, Delta … Why not let the private sectors come in and offer a way to fill in whatever gap remains after we gradually improve the state PDMP?”

Alexander also asked whether e-prescribing should be tested more gradually, rather than mandated because “the technology is still evolving.”

“Because we have an epidemic, I don’t think we have time to wait. What we can do is carefully figure out what are some of those areas that we could leave some exceptions and give them extended dates of when they should be ready” for e-prescribing, “but certainly the rest of the physician practices that do have the ability to do e-prescribing. We should move on them now,” Mahon said.

As for the idea of a federal hub, Green stressed that the federal government would not need to run the hub.

After the hearing, she suggested to MedPage Today that one program in particular, the National All Schedules Prescription Electronic Reporting program within the Department of Health and Human Services (which has been authorized but not funded), could potentially put out a grant for running such a hub.

Maintaining the right standards would be critical as the data is valuable itself and could become a commercial commodity, if the government isn’t careful.

But “this an area where there truly needs to be a public-private partnership,” she said.

What this group of people are doing.. intentionally, unintentionally or out of ignorance… first of all … faked/forged sets of ID’s are readily available and without giving the healthcare professional the means of validating those ID’s that are presented. A dedicated/organized addict/diverter could cycle thru 1-2-3 office visits a day – 5 days a week… meaning that they could potentially get a 30 days supply of controlled meds 22-66 times a month and NEVER SHOW UP ON ANY PMP DATABASE PRINTOUT… and may never get caught.

They are also ignoring that most/all pts dealing the subjective diseases – including the mental health disease of addiction – are part of a protected class of the Americans with Disability Act and/or Civil Rights Act.

What they are attempting to do is prevent anyone with a undiagnosed disease of addictive personality from encountering “their trigger”, but their trigger may be Caffeine, Nicotine, Alcohol or some substance they got from a friend or off the street… and once they encounter a trigger could cascade into a whole range of experimenting with other substances legal and illegal… They may get to this point without ever having a legal opiate prescription filled for them. Yet, all those millions of chronic pain pts are going to be expected to live in a torturous level of pain to attempt to protect those with mental health issues from falling in that “hole of addiction” that the odds are that they will eventually fall into sooner or later.

To the best of knowledge there has never been any clinical study that documents/proves that abstinence, jail, prison has every been the most appropriate treatment for mental health issues nor a means of controlling/curing mental health issues

Filed under: General Problems | 1 Comment »