“The moral test of a government is how it treats those who are at the dawn of life, the children; those who are in the twilight of life, the aged; and those who are in the shadow of life, the sick and the needy, and the handicapped.” – Hubert Humphrey
passionate pachyderms
Pharmacist Steve steve@steveariens.com 502.938.2414
JOHNSON CITY, TN (WJHL) – In the months since Mountain Home VA started weaning veterans off opioids, many of those patients filed formal complaints, according to federal records. A breakdown of complaints, obtained through a Freedom of Information Act request, identified nearly 300 complaints since October linked to opioids.
“They have every right to be upset in the sense that they have their own personal feelings, at the end of the day though we’re here to help take care of them in a safe way,” Mountain Home VA Chief of Staff Dr. David Hecht said. “We will look closer to make sure we’re not making any mistakes, but at the end of the day, if there is a disagreement we have to do what’s safe.”
Despite the number of complaints and intensity of some of them, Dr. Hecht said there are some veterans who have come around to the change.
“I think there’s a lot of buy in, I think a lot of new understanding of why we’re trying to do this. For the safety of our veterans is really the main reason,” he said. “Some veterans have been very happy, have said that they’ve never felt better and didn’t realize how much the medications were affecting their daily function.”
The roughly 60 complaints a month came after VA administration sent a letter to patients in September clarifying the reasons for the change, which include research and federal guidelines that warn opioids on their own and mixed with anti-anxiety medications are not only dangerous, they’re also not as effective as once thought.
Dr. Hecht says the VA’s priority is providing veterans with pain management alternatives that are not only safer, but work better. For those with non-cancer pain, the VA is recommending acupuncture, yoga, therapy and mental health support as alternatives to opioids.
Army veteran Tony Hughes, Sr. is among those who are unhappy. Hughes says he relies on an opioid to treat a lower back injury.
“They’ve started cutting me back,” he said. “It bothers me, because as many years as I’ve put in, they need to take care of me.”
In the months since the Opiate Safety Initiative, Dr. Hecht says he’s met personally with veterans and in group sessions to address their concerns. He says patient advocates are also there to help veterans through the appeals process.
“We try to take this on an individual basis,” Dr. Hecht said. “We’re always open for better ways of doing things, suggestions and improvements.”
In a statement, Congressman Phil Roe (R), TN-District 1, told us while he supports the VA’s recent decision, “there’s no question more needs to be done.”
I found your info while trying to figure out WHY/HOW,I was denied by the Pharmacy, inside Gelson’s market in Calabasas, CA! I have multiple health issues that are excruciating! I had been with Dr. Brown in Woodland Hills, well….. after over 8 years, she decided (with no notice), to stop treating folks!!! I was on the same maintenance meds for all those years! Even asking her to lower some of the amounts, because I really do my very best to get by on as little meds as possible!!! Ok… that whole nightmare is a whole different issue, but is intertwined. After I tried to ‘manage’ without any Western medicine help, for a few months, and was unable to leave my house/bed, I finally went to another specialist! Mind ya, I have been through every ‘ologist’ there is and have been diagnosed with multiple issues! I would not wish all of this on ANYONE!!! Ok, once my new doctor sent me off with my scripts, I called the pharmacist mentioned above, and was told that they would no longer take my business! I have great Ins., and had been going to them for the same maintenance meds (and prior at a bit higher # even), but was treated so harshly!! The pharmacy manager said, “Tell her to go to re-hab”! She then follows up with, “I know Dr. Brown, but not your new doctor”. I was thinking why should that matter? It is the same meds….(?) And this is a soul that knows I have serious issues!!! This is no game!!! I am trying to LIVE my life not escape it!!! I felt belittled and treated like a criminal or worse!!! Well, then trying to find a different pharmacy has been a nightmare! And again, I am being treated like a criminal!
I have CF/ME, a raised Ana (a not yet found immune issue), FMS as well as a jumble of other fun stuff, being an retired stunt person, gymnast and all around active/athlete, in my youth! And, now paying for all that fun, on top of my other medical issues!
I was just put through a battery of tests by my new doc. She said beyond my ‘issues’, all my organs and such look great! If there were only a cure for all the other stuff…..
Sorry to go on, I am just very confused, frustrated, hurt AND hurting!!! Any advice would be appreciated!
Blessings,
Apparently Gelson’s is a 8 store grocery store chain in S California. Who knows why this pt was “tossed”… was there a new district manager that has decided that this company was going to fill less/fewer/no opiates. After all, most likely the pharmacy dept in these grocery stores – like most grocery store chains – is a very very small part of the store’s revenue and profits. While the DEA keeps tell the general public that they want those who have a valid medical need for opiates to get them. One has to wonder what the DEA agents in the field are telling prescribers and pharmacies/pharmacists to make these healthcare providers to act and make decisions that they are doing.
What could have been said to cause the pharmacy manager to tell this long term pt to “go to rehab”
I haven’t posted this in a while but it is the Pharmacist’s Oath and pay attention to the first bullet point …
The revised Oath was adopted by the AACP House of Delegates in July 2007 and has been approved by the American Pharmacists Association. AACP member institutions should plan to use the revised Oath of a Pharmacist during the 2008-09 academic year and with spring 2009 graduates.
“I promise to devote myself to a lifetime of service to others through the profession of pharmacy. In fulfilling this vow:
I will consider the welfare of humanity and relief of suffering my primary concerns.
I will apply my knowledge, experience, and skills to the best of my ability to assure optimal outcomes for my patients.
I will respect and protect all personal and health information entrusted to me.
I will accept the lifelong obligation to improve my professional knowledge and competence.
I will hold myself and my colleagues to the highest principles of our profession’s moral, ethical and legal conduct.
I will embrace and advocate changes that improve patient care.
I will utilize my knowledge, skills, experiences, and values to prepare the next generation of pharmacists.
I take these vows voluntarily with the full realization of the responsibility with which I am entrusted by the public.”
Has anyone ever noticed that every state has a Medical Licensing Board and Pharmacy Board… whose primary charge is to protect the public’s health and safety and yet it is the judicial/legal system that goes after those prescribers and pharmacies for failing to protect the public’s health and safety… Is it appropriate that law enforcement and NOT MEDICAL PROFESSIONAL that are determining who is “bad docs”, “bad pharmacies/Pharmacists” ?
Right now we have numerous of cities, counties, states lining up to sue drug wholesalers… The drug wholesalers just fill orders (Form 222 or electronic CSOS) that are sent in from licensed pharmacies. These wholesalers have no idea who the prescriber that has written a prescriptions for these C-II’s, have no idea who the pt is that is getting a prescription filled. But the boards of pharmacy have had access to the state’s PMP databases that some “data mining” could have isolated prescribers & pharmacies that are writing and dispensing a ton of C-II’s… but apparently they have not bothered to look at those reports ?
The DEA has had access to all the wholesaler reports as to which pharmacies have been buying tons of C-II’s … but apparently they have not bothered to look at these reports ?
So why are the wholesalers being sued ? Unless it is because there are three major wholesalers that control some 80%-90% of the market and have some very deep pockets. Maybe the AG’s and attorneys are “striking now” as there is more and more evidence that legal opiate Rxs are lower than they were 10 yrs ago and more information coming out that all those OD”s are from ILLEGAL OPIATES from Mexico and China… as it gets reported in the media more and more may blunt all those lawsuits of being successful.
We now have all these state legislatures passing bills that are limiting opiates to pts… both acute and chronic… are they totally ignorant of the failure of their state pharmacy boards, or just turning a BLIND EYE to what is going on…and/or figures that once it all hits the fan that it will give them the opportunity to pass another bill/law that will give them more controls and/or tax revenues. After all some states are looking at a prescription opiate tax… tax one group of people suffering from a chronic disease to help pay for treating another group dealing with a chronic health issues (addiction).
Then we have the insurance/PBM industry that is imposing daily MME limits – using the prior authorization process to impose these limits. Could the insurance industry have a couple of different motives… Doing this now may blunt any attempts of various cities, counties and states suing the insurance industry for paying for all those opiate prescriptions and helping cause the opiate crisis and all those OD’s and they could also being using this period as a means to increase their profits… After all most insurance companies are publicly held FOR PROFIT businesses and they can claim that they are just following the CDC opiate guidelines.
Speaking of those CDC guidelines… does anyone really believe that the CDC had the legal authority to publish those guidelines after all they are THE CENTER FOR DISEASE CONTROL and according to our current and previous Surgeon General … ADDICTION – all addictions – are a mental health issue (addictive personality) and not a moral failing and isn’t their primary charge to deal with DISEASES.. contagious disease.. and addiction(s) are not contagious diseases… So where did they get – or did they never have – the authority to even convene the committee to put these opiate guidelines together ?
My little blog just started its 7th year … and the chronic pain community appears to be getting “more hostile”… so hostile that some within some of the Face Book pages are attacking each other and some are “walking away”… there has always been a lot of whining, bitching and moaning… Everyone wants change, but don’t ask most to “sign on the dotted line”, put their name, picture or fingerprints anywhere on the processes that might cause things to change. It would seem that all too many are waiting for “george” to come and fix things or a knight on a white horse coming over the horizon to save their ass. The TRUTH IS… neither is going to happen.
PETITIONS
How many dozens or HUNDREDS of petitions have put out there by someone in the chronic pain community… has any of them reached the number of signatures where the White House or others promised to “look at” what the petition was for ? and exactly does the promise to “look at” really mean ?
LEGISLATORS
How many have made phone calls, sent letter, faxes, emails concerning the denial of getting chronic pain medicine? and has anyone got back anything but a form letter talking about the legislator’s concerns about the opiate EPIDEMIC… they are so clueless that they don’t know the difference between a EPIDEMIC – which is normally about a contagious disease – and what MAY BE a crisis. There are a lot of other societal issues that are causing more tombstones than opiates – especially legally prescribed opiates – but none of them have been labeled as a crisis, epidemic or some other descriptive word.
Has anyone asked or seen a legislator to introduce a bill and/or sponsor a bill that will make can changes in the status quo ? If a legislator has stated that they “feel your pain” but has done nothing to submit a bill that would address his concerns about your pain… then the legislator is just full of BULL SHIT.
THE ACHILLES HEAL
We are seeing a lot of employers of prescribers that are establishing opiate prescribing guidelines … these are generally hospitals that own numerous hospitals, urgent care centers , physicians practices and the like… I have been told of one such healthcare corporation in the mid west that has some 560 such outlets and I have been told that they have issued edicts/letters to their employed prescribers that if they prescribe ANY OPIATES .. they will be fired. With that many outlets there are thousands or tens of thousands pts whose quality of life is being compromised. These corporations are rescinding the professional discretion that these prescribers have been granted by the state practice act. These corporations don’t have a medical degree nor a license to practice medicine and typically these corporations have “deep pockets” and could be a great target by some class action law firms. Right off hand I can come up with a handful of laws that are being violated.
The above could also apply to insurance companies and PBM ( Prescription benefit managers) who are imposing dosing limits on pts. One of the basics of the practice of medicine is the starting, changing, stopping a pt’s therapy. Again these corporations do not have a medical degree nor a license to practice medicine. Pts are telling me that these companies are refusing to tell the pt who made the decision to reduce their dosage. One huge “brick wall ” the pts are running up against. Again thousands, tens of thousands or millions of pt can have their quality of life harmed. The law firms that may be interested is class action, civil rights, or personal injury.. if a pt runs into another brick wall… it might work by sending the legal dept and the medical director a certified letter stating that you are giving them one opportunity to correct (cease and decease) the discrimination of you – a person covered by the Americans with Disability Act and Civil Rights Act. They might just figure that stopping discriminating against a single pt that bother to complain, might be the least expense route to take. May be the situation that the “Squeakie wheel” get their opiate prescriptions paid for ?
If the chronic pain pt becomes house, chair, bed confined by the actions of a number of these corporations – or any reason that their opiates are reduced and their quality of life deteriorates – and they have a spouse.. there is such a thing as loss of companionship and consortium and states have 300,000 – 400,000 limits on the damages… The last thing that these various entities would be expecting is a lawsuit from spouse and kids.
CHICAGO (CN) – Considering whether to uphold a $1 million jury award, the Seventh Circuit heard Friday from an Indianapolis attorney who claims CVS pharmacists acted with actual malice when they told his patients he was under investigation for running a pill mill.
Dr. Anthony Mimms convinced a jury this year that CVS pharmacists defamed him by refusing to fill his patients’ prescriptions on repeated occasions at multiple pharmacies.
As a reason for their refusal, pharmacists and pharmacy techs told Mimms’ patients that he had been arrested, that he was under investigation by the Drug Enforcement Agency, or that his license had been revoked.
According to Mimms, CVS corporate employees knew that he was not under DEA investigation, and that he had only been named by a person questioned by the DEA who was later found to lack credibility.
Further, he said, CVS has a policy that explicitly told its pharmacists under no circumstances to make disparaging comments about a prescriber, such as that the prescriber is under DEA investigation, operating a pill mill, or about to lose their license – exactly the statements the pharmacists made about Mimms.
A jury found in Mimms’ favor and awarded him $1 million for damage to his reputation.
On appeal, CVS attorney Alice Morical with Hoover Hull Turner told the Seventh Circuit on Friday morning that “Mimms needed to show actual malice” on the part of the pharmacists who said the defamatory statements, but he failed to do so.
Instead, Morical said he “imputed knowledge of a corporate representative to four speakers in Indiana.”
She argued that the imputation of knowledge of Mimms’ innocence, known at CVS corporate offices, to lower level pharmacists was an error.
The verdict would expand Indiana law to criminalize an instance where “someone makes a statement and someone else in the company knows it is not true,” Morical argued.
But Mimms’ attorney, Bryan Babb with Bose McKinney & Evans, urged the Chicago-based appeals court to recognize that “there is no direct evidence, this is a difficult case.”
Babb said Mimms’ situation has important ramifications for whether a public figure – such as a federal judge – could pursue a defamation claim against a person who later denied making the statements at all, as happened with several pharmacists Mimms accused.
“Do we really want a public policy where the person can just deny making the statements and that’s the end of it?” Babb asked.
He said the pharmacists undoubtedly held ill will against Mimms, as many of his patients repeatedly came in too early to refill their prescriptions, and this ill will motivated the pharmacists to willfully and maliciously violate CVS’s non-disparagement policy.
“These folks were trained on the policy,” Babb said. “They knew when they said these things that they were false.”
He argued that the CVS policy expressly prohibiting its employees from accusing prescribers of being under investigation or running a pill mill is valid circumstantial evidence that the speaker must have spoken with malice if they intentionally violated that policy.
Without allowing this kind of circumstantial evidence, “if someone denies making a statement, how can you possibly get to their subjective state of mind?” Babb asked.
U.S. Circuit Judges Michael Kanne and Illana Rovner sat on the panel, joined by U.S. District Judge Thomas Durkin, sitting by designation from the Northern District of Illinois.
The court is expected to rule on the matter within three months.
The investigation by Missouri’s Sen. Claire McCaskill shed light Monday on the opioid industry’s ability to shape public opinion and raises questions about its role in an overdose epidemic that has claimed hundreds of thousands of American lives. Representatives of some of the drugmakers named in the report said they did not set conditions on how the money was to be spent or force the groups to advocate for their painkillers.
The report from McCaskill, ranking Democrat on the Senate’s homeland security committee, examines advocacy funding by the makers of the top five opioid painkillers by worldwide sales in 2015. Financial information the companies provided to Senate staff shows they spent more than $10 million between 2012 and 2017 to support 14 advocacy groups and affiliated doctors.
The report did not include some of the largest and most politically active manufacturers of the drugs.
The findings follow a similar investigation launched in 2012 by a bipartisan pair of senators. That effort eventually was shelved and no findings were ever released.
Bottles of Purdue Pharma L.P. OxyContin medication sit on a pharmacy shelf in Provo, Utah, on Aug. 31, 2016. George Frey / Bloomberg via Getty Images
While the new report provides only a snapshot of company activities, experts said it gives insight into how industry-funded groups fueled demand for drugs such as OxyContin and Vicodin, addictive medications that generated billions in sales despite research showing they are largely ineffective for chronic pain.
“It looks pretty damning when these groups were pushing the message about how wonderful opioids are and they were being heavily funded, in the millions of dollars, by the manufacturers of those drugs,” said Lewis Nelson, a Rutgers University doctor and opioid expert.
The findings could bolster hundreds of lawsuits that are aimed at holding opioid drugmakers responsible for helping fuel an epidemic blamed for the deaths of more than 340,000 Americans since 2000.
McCaskill’s staff asked drugmakers to turn over records of payments they made to groups and affiliated physicians, part of a broader investigation by the senator into the opioid crisis. The request was sent last year to five companies: Purdue Pharma; Insys Therapeutics; Janssen Pharmaceuticals, owned by Johnson & Johnson; Mylan; and Depomed.
Fourteen nonprofit groups, mostly representing pain patients and specialists, received nearly $9 million from the drugmakers, according to investigators. Doctors affiliated with those groups received another $1.6 million.
Most of the groups included in the probe took industry-friendly positions. That included issuing medical guidelines promoting opioids for chronic pain, lobbying to defeat or include exceptions to state limits on opioid prescribing, and criticizing landmark prescribing guidelines from the U.S. Centers for Disease Control and Prevention.
“Doctors and the public have no way of knowing the true source of this information and that’s why we have to take steps to provide transparency,” said McCaskill in an interview with The Associated Press. The senator plans to introduce legislation requiring increased disclosure about the financial relationships between drugmakers and certain advocacy groups.
Bottles of OxyContin medication sit on a pharmacy shelf. Bloomberg via Getty Images
A 2016 investigation by the AP and the Center for Public Integrity revealed how painkiller manufacturers used hundreds of lobbyists and millions in campaign contributions to fight state and federal measures aimed at stemming the tide of prescription opioids, often enlisting help from advocacy organizations.
Bob Twillman, executive director of the Academy of Integrative Pain Management, said most of the $1.3 million his group received from the five companies went to a state policy advocacy operation. But Twillman said the organization has called for non-opioid pain treatments while also asking state lawmakers for exceptions to restrictions on the length of opioid prescriptions for certain patients.
“We really don’t take direction from them about what we advocate for,” Twillman said of the industry.
The tactics highlighted in Monday’s report are at the heart of lawsuits filed by hundreds of state and local governments against the opioid industry.
The suits allege that drugmakers misled doctors and patients about the risks of opioids by enlisting “front groups” and “key opinion leaders” who oversold the drugs’ benefits and encouraged overprescribing. In the legal claims, the governments seek money and changes to how the industry operates, including an end to the use of outside groups to push their drugs.
U.S. deaths linked to opioids have quadrupled since 2000 to roughly 42,000 in 2016. Although initially driven by prescription drugs, most opioid deaths now involve illicit drugs, including heroin and fentanyl.
Purdue Pharma, the maker of OxyContin, contributed the most to the groups, funneling $4.7 million to organizations and physicians from 2012 through last year.
In a statement, the company did not address whether it was trying to influence the positions of the groups it supported, but said it does help organizations “that are interested in helping patients receive appropriate care.” On Friday, Purdue announced it would no longer market OxyContin to doctors.
Insys Therapeutics, a company recently targeted by federal prosecutors, provided more than $3.5 million to interest groups and physicians, according to McCaskill’s report. Last year, the company’s founder was indicted for allegedly offering bribes to doctors to write prescriptions for the company’s spray-based fentanyl medication.
A company spokesman declined to comment.
Insys contributed $2.5 million last year to a U.S. Pain Foundation program to pay for pain drugs for cancer patients.
“The question was: Do we make these people suffer, or do we work with this company that has a terrible name?” said U.S. Pain founder Paul Gileno, explaining why his organization sought the money.
Depomed, Janssen and Mylan contributed $1.4 million, $650,000 and $26,000 in payments, respectively. Janssen told the AP the company acted responsibly; Mylan objected to being included because of its “minuscule role” in opioid sales and marketing; while calls and emails to Depomed were not returned.
Senator McCaskill doesn’t have to run for reelection until 2022… her position on this … the voters will have forgotten about this by Nov 2022. One study suggested that 90% of the families with a chronic pain pt is struggling financially either because one spouse can’t work and/or the cost of therapy. Less than ONE MILLION DOLLARS to a dozen different pain advocacy groups… McCaskill is part of Congress with 535 members who the lobbyist industry spend 9+ million EACH DAY to INFLUENCE those 535 members. HYPOCRITE seems so inadequate for the mindset of Senator McCaskill and other like her
For many people, the face of the opioid crisis in this country is the scene of a drugged-out mother and father passed out on a couch with a little child forlornly looking at them. It is a heartbreaking image of a family being destroyed by addiction, and of young lives being shattered.
But the opioid crisis has another face, too, as we were reminded this week on the front page of this newspaper. That is the face of a woman who could be your friend, your neighbor or a family member, sitting calmly on a couch and talking about being cut off from the pain medications that make her life tolerable. Another heartbreaking image.
Opioids are a scourge. They have ensnared millions of people into addiction, and 64,000 Americans lost their lives to overdoses in 2016 alone. Greedy drugmakers and clueless doctors flooded our nation with poison.
Opioids are a salvation as well. For millions more, the drugs offer relief from chronic, incapacitating pain, and have given many people a chance at a better life.
This country has such a tangled, twisted relationship with drugs and drug abuse. We seem to lurch from one overreaction to another as we grapple with our drug problems.
Drugs go from miraculous to the epitome of evil, one after another. Marijuana, cocaine, morphine, heroin: all hailed, all condemned, most outlawed as dangerous. The opioids were just a continuation of this process.
In 1996, a drug manufacturer called Purdue Pharma introduced OxyContin. Mother Jones magazine said it debuted with the most aggressive marketing campaign in pharmaceutical history, downplaying its potential addictiveness.
At the same time, doctors were being pushed by pain management specialists to assess the pain of every patient they saw, and to treat pain more readily.
The American Journal of Public Health, in a 2016 article tracing the origins of the opioid epidemic, reported:
“The dimensions of the problem were and are immense. An estimated 25 million adult Americans, according to the most recent data, suffer daily from pain, and 23 million others suffer from severe recurrent pain, resulting in disability, loss of work productivity, loss of quality of life, and reduced overall health status.”
Researchers were telling doctors that pain management was an important aspect of patient care. Drug companies were promoting new opioids as a safe method of pain management. It is no wonder that the number of opioid prescriptions exploded.
But everything started to go wrong in short order. Again, from the Journal of Public Health:
“Purdue advertised Oxycontin as nonaddictive because the drug was released within the body over 12 hours; recreational users quickly learned to get high by crushing or dissolving the pills, or simply taking very high doses. Overstressed and well-intentioned general practitioners, and a number of unscrupulous ‘pill mill’ operators, wrote liberal prescriptions for the new analgesic. The ready supply of Oxycontin made diversion and sale, particularly by low-income patients on Medicaid or Medicare, attractive and easy; but when pill addicts found their drug too expensive, they sought an alternative.”
That alternative was heroin. As one addict said, Oxycontin cost $40 a pill, but he could get the same effect for $10 from heroin.
Drug overdose deaths increased 137 percent from 200 to 2014, and non-fatal overdose went up 200 percent. States in the West, Midwest and Appalachia were hit especially hard.
As the extent and depth of the problem began to sink in, the opioid backlash was underway.
In 2016, the federal Centers for Disease Control and Prevention issued new guidelines for prescribing opioids “as part of the urgent response to the epidemic of overdose deaths.” The guidelines urged primary care providers not to consider opioids as a “first-line or routine therapy” for chronic pain.
Terrified by the ways in which opioids had come to be abused and by the resulting wave of death, doctors, pharmacies and insurance companies quickly began changing their accepted practices.
A seven-day supply for new prescriptions, limits on daily dosage and other restrictions are now the industry standard for many pharmacies and health insurance companies. Patients are required to renew prescriptions within weeks instead of months.
But where does that leave the patients with chronic pain?
According to local patients interviewed by News-Post reporter Kate Masters, it is leaving them in limbo, and worried about what the future might hold.
They are finding it increasingly difficult to get the medicine they need and are encountering more hassles and roadblocks.
Terri Boettcher, of Middletown, said she and many others feel stigmatized. Restrictions by insurance companies and pharmacies are hurting patients’ ability to receive customized care.
After being injured in 2000, she tried several medications, surgery, steroid injections, physical therapy, acupuncture and more, all trying to manage the pain from a herniated disc.
Eventually, she and her doctor settled on a daily dose of oxycodone. However, under the new rules, her prescription has been reduced from a 60-day supply to a 20-day supply.
“I’ve had less pain relief because I’m trying to take less medication to make it last longer,” she told our reporter.
Her fear is that even more restrictions might result in her being denied continuous use of opioids completely.
Pain management specialists and their patients are groping for a way forward that does not endanger their health while helping to battle the huge societal problems caused by abuse of the drugs.
Dr. Paul Christo, a pain specialist and associate professor at the Johns Hopkins University School of Medicine, told our reporter that long-term pain management patients are not among those who are likely to abuse narcotic painkillers. Most have extremely high levels of discomfort and are too worried about being cut off from their medication to abuse or divert it, he said.
These specialists need the support of the insurance companies and national pharmacies to continue treating patients with chronic pain in the ways that are most effective. They need to be heard at the CDC as the rules on pain management evolve.
The broad-brush rules deployed to fight the opioid crisis in 2016 might have to be revised and narrowed so that doctors specializing in the treatment of pain have more freedom than primary care doctors do.
This is the only fair way to help those patients devastated by chronic pain.
The current attempts by a number of parties to castigate and humiliate pain patients and their medical practitioners is not just pathetic and mostly false, it is dangerous to the fate and life of many intractable pain (IP) patients. If it wasn’t so serious, some of the claims, biases and beliefs would make good comedy.
First and foremost there has been no discussion about the difference between intractable pain and chronic pain. There really is no bigger issue.
The proper identification and treatment of the IP patient is not only essential for the health and well-being of the IP patient, it is a major key to the prevention of overdoses and diversion of abusable drugs. IP patients must have special care and monitoring.
The basic definition of IP is a “moderate to severe, constant pain that has no known cure and requires daily medical treatment.”
Chronic pain, on the other hand is a “mild to moderate, intermittent, recurring pain that does not require daily medical treatment.” While there are millions of persons with chronic pain, only about 10% are intractable.
The cause of “intractability” is two-fold:
The initial injury or disease which initiated IP was severe enough to cause a pathologic transformation of the microglial cells in the spinal cord and/or brain. It is this transformation that produces neuroinflammation and the constancy of the pain. This process is known as “centralization” or “central sensitivity.”
To have enough injury to cause “centralization” one must have a most serious disease or condition of which the most common are: adhesive arachnoiditis, traumatic brain injury, reflex sympathetic dystrophy, post-viral encephalopathy, or a genetic disease such as Ehlers-Danlos Syndrome, porphyria, or sickle cell disease.
Medical practitioners must have minimally-restricted prescribing authority and autonomy to adequately treat IP. For example, the proper treatment of IP not only requires analgesics, opioids and non-opioid, but specific anti-inflammatory, hormonal, and corticosteroid agents that will cross the blood brain barrier and control inflamed and pathologic microglial cells. Treatment of IP has to be individually tailored and may require non-standard, off-label, or an unusual treatment regimen.
Make no mistake about it. The new treatment approach to IP is quite effective in reducing pain, controlling neuroinflammation, and allowing patients to biologically function well enough to have a good quality of life. Also be advised that the new IP approach is not just reducing pain but treating the underlying cause of pain. Consequently, a lot of expensive procedures, therapies, and opioids are no longer needed.
As long as I am practicing I will continue to push forward this new approach.
Dr. Tennant specializes in the research and treatment of intractable pain at the Veract Intractable Pain Clinic in West Covina, California, which remains in operation after recently being raided by DEA agents. Many of Dr. Tennant’s patients travel from out-of-state because they are unable to find effective treatment elsewhere.
The information in this column should not be considered as professional medical advice, diagnosis or treatment. It is for informational purposes only and represents the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.
As part of its FY19 budget request, the agency is looking into how to leverage PDMPs to track prescribing histories, as well as reporting suspected abuse to the DEA.
President Trump’s proposed FY19 budget for the U.S. Department of Health and Human Services stresses the need for the agency to make the opioid crisis a top priority.
While HHS’ budget would be slashed by 21 percent, Trump would give the agency $10 billion in new discretionary funding for both the opioid epidemic and mental illness. To accomplish this, HHS wants to track high prescribers and utilizers of prescription drugs within Medicaid.
HHS Secretary Alex Azar told the House Energy and Commerce Subcommittee on Health that the agency would “require states to monitor high-risk billing activity to
identify and remediate abnormal prescribing and utilization patterns that may indicate abuse in the Medicaid system.”
HHS could leverage data from the Centers for Medicare and Medicaid Services to help “identify a practitioner who is writing an inordinate number of prescriptions,” Rep. Michael Burgess, MD, R-Texas, told Azar.
And those trends could be easy to spot within those databases.
In addition to leveraging Medicaid data, HHS could potentially look to state PDMP data to identify bad actors, Azar testified. The agency could also use its “authority to make sure that whenever we exclude a provider, it will automatically lead to transmission of that information [to the Drug Enforcement Administration].”
The DEA would have the authority to yank a provider’s ability to prescribe controlled substances, Azar said.
Further, PDMPs are already helping states track opioid prescriptions, as they flag patients with suspicious prescribing history, said Azar. But as part of the HHS budget proposal, the agency asks Congress to “require states have effective programs for this type of risk identification.”
At the moment, all states except Missouri currently have PDMPs in place, with varying degrees of use. After Trump declared the opioid crisis a public health emergency, many states have sought changes to laws to increase PDMP efforts and data sharing among states.
While Azar supports the continued interoperability efforts between state PDMPs, “there is a resource and burden question about forcing that interoperability to be nationwide.” Azar told the committee data sharing between bordering states might be more realistic.
The committee also noted that past PDMP efforts by federal agencies to integrate data within EHRs had slowed five years ago. The effort, Burgess told Azar, is “one of the opportunities to reduce the burden on practicing physicians is a way to seamlessly integrate” EHR and PDMP databases.
However, there are states currently sharing data between PDMPs. Just last week, North Carolina became the 46th state to sign onto the PDMP data sharing collective, which is designed to give providers the full prescribing history of patients across state lines.
There is an estimated 20 -30 million pts dealing with moderate-severe intractable chronic pain. There is no known records how many of these same pts are or would test (CYP-450) as high/ultra opiate metabolizers and would require higher than “normal doses”. If HHS/DEA is utilizing databases to come to a “maybe probably cause” and take action on this “maybe”… based on some arbitrary MME dose that anything above is considered abnormal… have they just thrown DUE PROCESS – out the window ?
Wouldn’t we expect many/most of these 20-30 million will be caught in that dragnet along with their prescribers ?
Are we quickly sinking to the point where healthcare and how much a pt is entitled to is being dictated by and driven by DATA that has nothing to do with the evaluation of the needs of individual pts ?
LITTLE ROCK, Ark. (KTHV) — The opioid epidemic is putting a major strain on aspects of the criminal justice system you may not expect.
Last week we told you that a high number of cases is causing a backlog at the Arkansas State Crime Lab.
State coroners, also feeling the heat, are working to ensure each coroner is equipped with what they need to help combat the crisis.
Last year nearly 300 people in Arkansas died of an opioid overdose. While that number may be jarring, it is likely not even close to the reality.
Coroners often determine the cause of death, which is reported to state officials.
Many coroners in our state are so inundated by the epidemic, or uneducated about it, they likely aren’t properly recording the numbers.
“We are busier than I think we have ever been,” Kevin Cleghorn, President of the Arkansas Coroner’s Association said Thursday, Feb. 15. Explaining the opioid epidemic has put a major strain on Arkansas’ coroners. “It’s taxing. So, therefore, a lot of these cases go unnoticed.”
The issue with cases going unnoticed, or unreported, is that death certificates, signed by the coroner, are collected by the Arkansas Department of Health and are then used to portray the epidemic our state is facing.
If coroners aren’t properly documenting the deaths, that affects funding the state needs to combat the epidemic.
The National Medical Examiner’s Association and the State Coroner’s Association both recommend that all bodies of people believed to have died of a drug overdose be brought to the State Crime Lab for an autopsy. But if you live in Little River County, or even as close as Hot Spring County, it can be very difficult to do so.
“A lot of our counties do not have ways to transport, they do not have means to store a body,” Cleghorn said.
“They do not have means to do full investigations simply because the funding is not there.”
Coroners in Arkansas are elected officials. They are not required to have a medical or investigative background.
And are not required to send bodies to the crime lab if the family or others ask them not to. Which could also explain why some deaths go unreported.
“I don’t necessarily like the good ole’ boy system, but I don’t know if it will ever go away,” Cleghorn said but assured us the Coroner’s Association is working hard to educate coroners on the opioid epidemic and their impact. One way of doing so is by offering classes across the State, to make things easier on participants. “I don’t know why someone if we are offering free classes, why they will not come and be a part of that. When it does nothing but make them better.”
Cleghorn says the public can help simply by checking in with County Coroners to see if they are attending training and submitting bodies to the crime lab.
Remember, these are elected officials.
Are coroners being ENCOURAGED in order to GET MORE FUNDING by declaring more deaths OPIATE RELATED DEATHS ?
