hi, I take  Oxycodone,( its workers comp), live in xxxx seeing a Dr. for pain, have 2really bad knees,. he’s more of  a family Dr, an is willing to help me. the question is, the manager there, said I have to see the Dr,same day as I get my pills filled. t never had to do that before… that he can only see me no more than   5 days before script is filled..,she said its  a law …I know other people on opioid, they get their scripts a week ahead of time, the one , gets predated scripts, for opioid… my question is this .. is it a workers comp rule  now? I think the girl does not know too much about workers comp, I’m looking for somewhere else, its really hard here to find a pain Dr. they’ve shut alot down. the , one I went to  b 4 was  raided, they had own pharmacy, they were great, got quality pills, my husband takes pain pills,, he asked a pharmacist,,about how many days for filling scripts.he said,,, the script has to be filled in  14 days. I have been on workers comp for 18 years, , one more question, my husband is on 40 mg of Oxycontin , the 12 hr.. do you know did they change it? he notices a difference, my husband said something is wrong with them,not working for him, at first they were working . no problems, after that no relief.., and hasn’t been working since. he had drug test,, metabolites were 6100 ,, after he noticed no relief, he paid for a drug test. and the metabolites were, 1300..that’s a big difference, my metabolites are higher than his. he didn’t do anything different,,.. think the Dr,& insurance company  and Purdue are doing something,to them. Dr. not saying anything.when he talked to him, I think he needs to get off those, and take short acting, he has spinal problems,  appreciate you listening, an any help we would appreciate. thank you 

It is often the case where front office staff make up their own set of rules and the prescriber has no idea of what is going on. He/she is focused on treating pts.  Pts who run into such situations it is best that they discuss their concerns with the prescriber.

Sometimes front office staff self-appoint themselves as the “dictator” of their own “little fiefdom”.

I am sure that these “little dictator’s” world is not made up of perfect circles and perfectly smooth roads… they are never too sick to get out of bed, their cars never breakdown, Mother Nature never puts obstacles in their way.. like the rest of us in the real world.

Anytime someone tells you that they must or can’t do something because “it is the law”.. just ask for a copy of the law and/or statue number – so you can look it up on the web – if they can’t/won’t is because the law doesn’t exist and they have establish this “law” as their office policy… which they can do.

Metabolites from medication is never going to be a constant… more like a bell curve from the time you take it until the next dose is due… The body is in constant flux… a test is just a “moment in time”…  just take your driver’s license out and look at your picture on it… that is a snap shot in time.. does it do a good job of representing you ?

People who are put on pain meds – and gets good results – they tend to increase their activity… and end up being in pain from activity induced pain… there is also aging, deterioration of the condition causing the pain and MAYBE a little bit of tolerance.

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https://www.washingtonpost.com/local/dc-politics/regulators-fault-public-hospital-for-care-of-patient-left-on-floor-before-he-died/2018/02/15/9c63b424-11a9-11e8-9570-29c9830535e5_story.html

Officials at the District’s only public hospital were unable to show that they promptly assessed a patient who repeatedly cried out that he couldn’t breathe, an investigation by the D.C. Department of Health has found.

The investigation also determined that the hospital’s initial report of the incident to regulators was not accurate.

The probe, made public this week, found multiple shortcomings in the care provided at United Medical Center’s nursing home to Warren Webb, who died of a heart attack at the facility in August.

Before his death, Webb called for help, fell out of his bed and was left on the floor for an extended period.

Inspectors concluded there was “no evidence that facility staff assessed [Webb] after he/she complained of not being able to breathe” and said hospital officials omitted key details about Webb’s death from an incident report they filed with the health department.

That report, among other things, left out the fact that Webb died and contained what one hospital employee told investigators was a false account of Webb being told at the incident’s conclusion to “wait for staff before attempting to get out of bed by himself.”

Regulators also found that the UMC nursing home did not have an instrument prepared to measure patients’ blood sugar in emergencies.

[‘I can’t breathe!’ A nursing home patient called for help. His nurse left him on the floor]

The health department began its probe in response to The Washington Post’s reporting on the circumstances surrounding Webb’s death.

Based on an audio recording of the incident and interviews with three eyewitnesses, The Post reported in October that Webb, despite crying out at least 25 times, was left on the floor for approximately 20 minutes by his charge nurse, Christiana Ekwue.

When Webb, 47, was finally lifted back into bed, his nurses were unable to find a pulse. He was transferred on a stretcher from the hospital’s 7th floor to its emergency room and was pronounced dead just after 6 a.m. on Aug. 25.

It is unclear what consequences, if any, hospital employees or managers could face as a result of the health department’s findings.

A UMC spokeswoman did not immediately respond to requests for comment.

Ekwue did not return calls for comment.

Tujuana Bigelow, right, in front of an image of her son, Warren Webb, who may have died as a result of medical errors at the United Medical Center Nursing home. (Michael Robinson Chavez/The Washington Post)

In a corrective plan submitted in response to the investigation,

UMC officials said two employees were “disciplined” as a result of the hospital’s internal investigation of the incident, but provided no further details.

The plan also said the nursing home’s staff were being retrained on “respiratory assessments, treatments and documentation” and that unit managers are now required to conduct hourly rounds to monitor the condition of nursing home residents.

[‘Simply unacceptable’: D.C. lawmakers press hospital operator on patient’s death]

The plan states that medical staff would be trained on “accurate completion of incident reports” and requirements for notifying the health department of events within the hospital. All incident reports being sent to regulators are also now being reviewed by the nursing home administrator, hospital officials said.

Webb’s death came at a critical moment for UMC, as the hospital was under scrutiny for dangerous medical errors that led regulators to shut down its obstetrics ward in early August. Concerns about patient safety and mismanagement ultimately led the D.C. Council to vote in November against renewing a lucrative contract for Veritas of Washington, the consulting firm hired by the city to run the hospital.

This week, the hospital’s former chief medical officer filed a whistleblower lawsuit asserting that he was fired for testifying before the council about problems at UMC.

The health department’s investigation sheds light on at least one key question about Webb’s death: whether his nurses immediately assessed him when he first called out for help. Medical experts place a heavy emphasis on prompt assessments — including measurements of heart rate, respiration rate, blood pressure and blood-oxygen saturation — for patients who complain of shortness of breath.

Investigators found no documentation or other evidence that such an assessment took place for Webb until he was lifted back into bed after 20 minutes on the floor.

The report also raises questions about the hospital’s initial, inaccurate statements to the health department concerning Webb.

[Hospital report on patient death omitted key details]

In testimony before the D.C. Council’s health committee in October, top hospital officials said that they had performed “an exhaustive review” of Webb’s case and reported it to the appropriate regulatory authorities.

However, the health department’s inspection found that the report on Webb was incomplete and that the hospital did not file another report — required whenever a nursing home resident is taken to the emergency room — until 11 days after Webb’s death. D.C. law requires that such reports be filed within 48 hours.

An unnamed hospital worker identified as “the person who reviews all incident reports for completeness and correctness” acknowledged errors in the incident report to health department investigators, saying it “should have contained the facts that the resident became unresponsive, CPR was started and that the resident was sent to the ER.”

The employee also said the statement about Webb being encouraged to ask for help when trying to get out of bed “is not right” and “should have been amended.”

When asked by investigators why the false statement about Webb was included, the hospital employee who originally typed up the report said, “I don’t know why I did that.”

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www.courthousenews.com/cvs-hit-with-class-action-lawsuits-from-hiv-patients/

(CN) – A group of HIV-positive plaintiffs filed a class action lawsuit against pharmacy giant CVS and its subsidiaries in federal court Friday, claiming that the company’s pharmacy insurance plan violated their privacy by forcing them to purchase HIV/AIDS medication at CVS retail stores or have them mailed to their homes.

The lawsuit, filed by four John Doe plaintiffs in the Northern District of California, claims that CVS Caremark stopped covering their prescription costs at out-of network pharmacies, along with other restrictions. As a result, the plaintiffs have had to compromise their privacy, according to the lawsuit. A similar lawsuit was filed in the Central District of California the same day.

According to one of the plaintiffs, he was forced to accept the program because he was running low on his month’s supply of medications, which would have cost him more than $2,000 out-of-pocket if he purchased it at his local pharmacy.

“I received no written notice to prepare for this impending policy change,” John Doe One said in the lawsuit. “I had to scramble into action since I only had a seven-day supply remaining.”

He purchased a three-month supply to be delivered to his home, only to discover that the delivery came during the day while he was at work, “baking in the afternoon sun.” Storage at high temperatures can degrade the medications, the lawsuit states. Additionally, the medications were left out for his neighbors to see, risking both his privacy and possible theft.

After that, John Doe One decided to pick up his medications at a CVS store instead. Whereas his local pharmacy had accurate records of the medications he takes, the lawsuit said the CVS pharmacist had no such information. Additionally, the medications are filled at a remote location and not at the pharmacy. Plaintiffs are asked to go to the CVS pharmacy to pick up the shipment.

“CVS Caremark does not have a full and accurate record of all of the medications JOHN DOE ONE is taking and cannot anticipate or warn against potential adverse drug interactions, which are common with HIV/AIDS Medications,” the lawsuit states.

According to the lawsuit, the company incentivizes employers to enroll their employees in the program, and names Amtrak as a defendant. Additionally, the lawsuit states that the plaintiffs have concern over their privacy when picking up medications at the stores.

“At my retail specialty pharmacy, they have a little alcove for privacy,” John Doe Two said in the lawsuit. “I can take my medications out and match it with a list I have of all my drugs. I can meet with my pharmacist and explain any changes I have felt and ask any questions I have. At CVS, I am within hearing distance of everyone waiting in line, including many people who do not have HIV/AIDS. I can hear other patients’ questions and the pharmacists’ answer. I am concerned with other people finding out about my HIV positive status.”

The plaintiffs say they’ve been forced to stick with the program because they can’t afford the out-of-pocket expenses for the medications. When asked if they could opt-out of the CVS Caremark program, they were either denied or ignored, according to the lawsuit.

One of the plaintiffs called CVS Caremark “more than 20 times” to try to opt-out, but was denied.

The lawsuit said that by forcing HIV/AIDS patients to purchase their medications through CVS pharmacies, the company “effectively reduces the quality of prescription drug care provided to Class Members, and thus a reduction or elimination of benefits, by forcing enrollees to only obtain such medications through their sister co-conspirator and wholly-owned subsidiary.”

According to the lawsuit, CVS Caremark’s business practices specifically target HIV/AIDS patients.

“The Program denies HIV/AIDS patients full and equal access to utilize the in-network pharmacies and method of delivery of their choice specifically because of the medications attributable to their illness, while at the same time permitting other enrollees to enjoy full access to the pharmacies of their choice,” the lawsuit states.

The plaintiffs are represented by Alan Mansfield of Whatley Kallas LLP. Calls made to Mansfield and CVS Caremark were not immediately returned.

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Recreational Drug Users needed in Toronto !

http://www.studies4u.com/

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We are in the THIRD DAY of wall-to-wall 24/7 coverage of the school shooting in Florida that happened 02/14/2018 where 17 died.  I don’t want to seem insensitive, but nearly 7,000 people die every day in our country

Every day – on average

…  some 135 commit suicide – including 20 vets

… some 120 die in vehicle accidents – including 12  because of drowsy drivers and 9 from distracted drivers

…  22 KIDS died from the flu in the last week

…  some 325 died from medical errors

…  some 350 died from their use/abuse of alcohol

…. some 1200 died from their use/abuse of Nicotine.

It is obvious that it is unfortunate that a mentally unstable person did this shooting, but our society is not perfect… never has been perfect … and never will be perfect.

And now the FBI is admitting that they were warned about the shooter SIX WEEKS AGO and DID NOTHING ABOUT IT.

Does all of this wall to wall coverage just giving others some ideas to be a copy-cat mass shooter ?

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This BS about the “BNE staff assured that the goal of the letter was no intimidation, but education for these physicians regarding the CDC’s chronic pain guidelines”

Right off the bat, you get the impression that they are treating the “guidelines” as “law”…

I have seen this sort of thing in pharmacy.. normally around wanting to document fill errors… not for punitive action but to analyze how misfills happen and what can be done to prevent them in the future.

What normally happens is that it is discovered that there are parts of “the system” that is causing the errors, and to solve these errors changes has to be made to the system. It takes money that the employer doesn’t have or wants to put the money out to fix things… and all of a sudden this “collecting data” exercise turns into punitive actions against those who make errors.  They come to the conclusion that their system cannot be the cause of these misfills, it has to be a problem with the staff.

Who believes that the BNE is going to change their opinion of what/how the CDC guidelines are to be followed/observed ?  Just watch at some point in the future that those physicians that initially got these “educational letters” and they don’t bring all their pts in line with the CDC guidelines.. the next letter will either be a threat to have all pts conform to the CDC guidelines or else or they will just skip that step and go right to sanctions ? Because the first letter should have “educated them enough” for them to start reducing their pt’s doses to CDC guideline levels.

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http://www.philly.com/philly/health/the-other-opioid-epidemic-chronic-pain-patients-in-need-of-care-20180212.html

We have two epidemics related to misuse of opioids in America.  First: people with addiction and premature death from abuse of opioids.  Second: also devastating but getting far less attention, people suffering for years from chronic unrelenting pain losing access to needed medicine. They are in more pain and experiencing terrible deterioration of their quality of life – unnecessarily.

With his medicine decreased, his pain increased. He was mostly homebound and needed a cane.  Then it got worse.  He told me, “I was shocked, and scared when my doctor said I had to find a new doctor; he wouldn’t prescribe pain medicines anymore.”

I hear this type of story multiple times every day in my practice.  Fearful, teary-eyed patients, wondering what I, their new doctor, will be like.  Harsh, judgmental, rushed, uncaring? Or perhaps, understanding?

Here’s what I usually tell my patients (after a comprehensive history and exam, toxicology studies, reviewing questionnaires and databases which alert me to misuse): “There was no good medical reason to taper your medications. They were helpful and weren’t abused. There aren’t new regulations, rather, recommendations about not using higher levels of opioid medications unless there is a compelling reason. Chronic severe pain, and deterioration of quality of life, are significant compelling reasons, if the medicines help decrease your pain, and if no other treatments can accomplish this.”

Patients frequently breathe a sigh of relief after this.  As I begin to treat them carefully and act as their ally, most note decreasing pain and quality-of-life improvement.  There are few greater physician rewards.

Opioids are prescribed in different clinical situations.  In acute scenarios — tooth abscess, a bone fracture — a prescription should be limited. Overprescribing has frequently occurred in such cases. Patients with malignancies can develop severe pain, but for them, opioids are often underprescribed.

Then there are chronic-pain patients. Many have exhausted such options as physical therapy or had surgery without benefit.  Physicians are backing away from opioid medications in all these situations. Why?  Two reasons. First, with the harsh public spotlight, they are uncomfortable that they’ll come under professional and legal scrutiny.

The second reason is it’s complex and time-consuming to care for chronic pain patients.  Opioids must be prescribed with proper knowledge and attention, or they can cause severe side effects, including death.  When prescribed carefully to appropriate patients, they are commonly very helpful. If the goal is to adequately reduce pain and suffering, there are often no replacements.

The negative side of prescribing opioids, devastating and important, has been widely publicized.  A survey last year showed that two-thirds of primary-care physicians had cut back on prescribing, though one-third believed that this was causing harm.  Finding a new physician is becoming very difficult for chronic-pain patients.  Many pain physicians don’t participate in insurance plans.  Many pain patients are disabled and poor.

Opioids are double-edged swords, with potential for great harm and great benefit.  But will denying opioids to chronic-pain patients who have no other options solve the addiction epidemic?  Unlikely. The solution doesn’t lie here, and is only causing more suffering. These patients don’t typically become addicts or overdose on opioids.  The overwhelming majority of patients with chronic pain who are prescribed opioids by a trained, careful physician, do not abuse or sell their medications.

Do some physicians debate the efficacy of these medicines? Of course.  This is usually when opioids are prescribed inappropriately to the wrong type of patient.  For the observant physician treating pain, and for countless chronic-pain patients, there is absolutely no question that they can be beneficial.

There is great suffering brought about by the first epidemic of addiction and overdose.  We are compounding this by inappropriate undertreatment of bona fide chronic pain patients.  Physicians, and patients suffering from chronic pain, are caught in the crossfire.  Still, physicians owe it to their patients – and to fulfilling medical vows – to help those who suffer.

Ira Cantor, M.D., is an internal medicine physician specializing in pain management at Steiner Medical & Therapeutic Center in Phoenixville.

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Minnesota renews push for tax on prescription opioids

https://www.reuters.com/article/us-minnesota-opioid-tax/minnesota-renews-push-for-tax-on-prescription-opioids-idUSKCN1FY2VR

(Reuters) – Citing rising opioid fatalities, Minnesota Governor Mark Dayton on Wednesday announced a renewed legislative proposal to tax prescription opioid pills to help fund treatment.

Dayton’s proposal would levy a one-cent tax on drugmakers for each milligram of active ingredient in a prescription pain pill, generating an estimated $20 million a year for prevention, policing, emergency response and treatment.

Dayton last fall blamed “special corporate interests” for blocking a similar proposal in 2017.

“We must take decisive action in this legislative session to reduce abuses and to ensure that all Minnesotans suffering from these addictions receive the treatment and support they need,” Dayton, a Democrat, said in a statement.

The efforts come as a growing number of states and counties are suing opioid manufacturers to recoup costs of a worsening epidemic. In December, the U.S. Centers for Disease Control and Prevention reported that the U.S. rate of drug overdose deaths in 2016 grew 21 percent from the prior year.

The Pharmaceutical Research and Manufacturers of America, a national trade association, said the proposal could divert money for developing new non-opioid painkillers and medication-assisted addiction treatments.

“It’s clear that this proposed tax ignores all the factors that led to this public health crisis, including the substantial influx of heroin, counterfeit fentanyl and other illegal drugs, and fails to recognize existing funding available for treatment, prevention and other important programs to help communities,” association spokesman Nick McGee said in a statement.

Dayton’s proposed measure, part of a larger effort to boost treatment, access to overdose medications and enforcement, will be debated in the legislative session starting Feb. 20.

Andrew Kolodny, an opioid policy researcher at Brandeis University, said the tax is a good way to increase treatment

“I don’t think we’re going to see overdose deaths start to come down until we do a better job of expanding access to effective outpatient treatment,” he said.

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