From the prescriber

Sued by widow of patient who committed suicide 12/19,

He has been tapering for months.

Successfully came off fentanyl. 

No one else in the state would prescribe for him. 

After Dr xxxxx was convicted ,

I notified my remaining 8-9 patients on opiates that I could no longer do this for them. 

Gave them notice,

Promised to help for two more months as I retire from practice, due to the hostile regulatory environment. 

pt was initially sanguine,

But a few days before his death got very suicidal, his son wrestled a gun away,

Was placed on a hold,

Then released. 

He cancelled an appointment with me Sunday

Died by Tuesday, self inflicted gsw. 

So awful. 

Now 

Sued for NOT treating a patient

Apparently some family members of pts that are being weaned from their opiates and things go “sideways” for the pt’s outcome have found attorneys that will sue for a prescriber stopping to prescribe opiates for a opiate dependent pt with chronic pain.

maybe it is time for prescribers to start having as much or more fear of the pt’s and/or their survivors when they are taken and/or weaned off their opiates ?

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The above 2 page letter was received by one of those unfortunate intractable chronic pain pt has CVS Health/Caremark as their PBM.  This pt has been on 70 mg of Methadone/day and 20 mg Oxycodone 3xd as needed for some time. According to CVS this pt needs to be at abt 25 mg/day of Methadone to help assure that the pt’s use of opiates is safe.  IMO .. one of the basics of the practice of medicine is the starting, changing, stopping a pt’s therapy … I am pretty sure that a corporation cannot obtain a medical degree nor pass the medical licensing board.. So who within CVS is attempting to practice medicine ?

They have a Chief Medical Director Dr. Troyen Brennan… so one could presume that anything dealing with a pt’s medication would have to be signed off by the CHIEF MEDICAL DIRECTOR recently did a post about CVS and Dr Brennan  CVS Pharmacy Will Limit Prescriptions for Opioids

This post is a “little long” .. .but goes into some detail about how – IMO – pts need to deal with this “practicing medicine with a license”.

Many public corporations seem to function under the premise that “nothing is illegal… until they get caught..”  If you doubt this, just look at all the lawsuits and fines involving large corporations.

Those in the chronic pain can continue to “sit on their hands” … try to keep “their heads low enough to stay off the radar”…but… there are entities out there that are for all intensive purposes are intending to CARPET BOMB the chronic pain community.

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https://www.doximity.com/doc_news/v2/entries/11034750

I spoke with a pharmacist the other day who told me her job was messing up her life.

Her favorite pharmacy tech was being transferred to another location, and she was convinced that her manager didn’t understand the implications for her or the pharmacy.

Pharmacists, especially those in a retail setting, are feeling the pressure. Burnout is happening at higher and higher rates and the result is low productivity and high turnover. Pharmacists in any community setting will confirm they are incredibly busy, extremely distracted, and they often don’t have time to take a break or even use the bathroom. The long-term result is a loss of talent.

In the face of these circumstances, some businesses callously suggest that the pharmacists themselves carry the blame for burnout because they don’t handle pressure well.

To me, that thought is appalling. I would argue that if you put any pharmacist in a community store with a requirement to fill more than 400 prescriptions a day with the help of only one pharmacy tech, over the span of 5, 10, 20, or 30 years, you will create a burned-out pharmacist.

It’s worth mentioning, too, that these pharmacists successfully completed the PharmD degree, which requires 4 years of stressful professional work in addition to the undergraduate requirements. It’s a huge accomplishment, and that level of perseverance suggests that working in a pharmacy should be no problem for pharmacists.

Unfortunately, I would argue that it’s the work environment that has created burnout in more than 50% of practicing pharmacists. There are exceptions to this, of course, but it isn’t a certain niche of pharmacy that is experiencing the burnout. It’s the profession as a whole.

1. Distractions

Beth Lofgren wrote a piece for Pharmacy Times about how many times she was distracted in a single day while working in a hospital setting. She recorded more than 150 distractions in one day, including ringing phones, personal conversations, busy doorways, background music, and out-of-stock medications.

In fact, a University of California study found that it takes workers an average of 25 minutes to return to an original task after distraction.

Unfortunately, pharmacists are barraged with distractions. Within the health care industry, they may have the most distracting job of all. The danger, of course, is that distraction can cause fatigue, and fatigue can reduce efficiency, resulting in a failure to complete all the day’s requirements.

2. Constant Multitasking

Think of multitasking as a single drop of water falling on a rock. One drop of water will leave no visible marks on the stone, but hundreds of drops a week will eventually wear a hole in the rock. In the same way, multiple distractions in a day lead to decision fatigue: a deteriorating quality of decisions that results from long sessions of decision-making. In the wake of such fatigue, simple decisions such as what to eat for dinner become overwhelming.

David Meyer, in a University of Michigan study, found that switching tasks midstream increases the time required to finish both tasks by 25%.

Furthermore, a study in England revealed that task-switching in pharmacies can lead to dispensing errors, which affects both pharmacist and patient.

The multitasking problem is a system issue rather than a personal issue, and it leads to pharmacist burnout.

3. High Demands and Insufficient Time

Pharmacists constantly tell me they are being asked to do more work with fewer resources. Stated another way, they don’t know how to meet their managers’ demands because they haven’t been given the means to do so.

Pharmacists have extremely high demands on their time and their decisions. The priorities in one day often exceed the time needed to complete them, so sometimes high-priority tasks are neglected for lower-priority tasks. The result could mean compromised patient care.

4. Lack of Training

Pharmacists on the front lines are often told what to do by management without being given a viable plan of action. One pharmacist told me she had more cases than she could humanly handle within one day. With no plan of action, it was impossible to do all that was required of her.

As a result, she was constantly behind in her work and fearful of losing her job.

5. Lack of Connection to Company

I’ve never met a single pharmacist who absolutely loved his company: a pharmacist who was able to state the company’s vision statement and core values. I know they exist, but there aren’t many of them.

Pharmacists who don’t feel connected to their company often feel alienated from the company’s larger purpose. They aren’t able to identify with the company’s larger, altruistic mission and they aren’t able to see how they fit within that purpose. Without that purpose for their job, they feel distant, which ultimately leads to a negative company culture.

What Burnout Feels Like

Can you blame pharmacists for being negative at work? There are numerous demands on their time and countless ways for them to feel as though they are failing. They feel naturally pessimistic. They are frequently yelled at by patients, doctors, nurses, and managers. They never win and they never feel as though they can get ahead. Pharmacists are victim to an endless raid on their attention and ultimately, they feel trapped.

Independent pharmacists .. the pt is their BOSS… they don’t have a whole ladder of supervisors and management… they also do have all the expensive of supporting all of that infrastructure.  Most will instead invest in ancillary staffing and the best ancillary automation… all  of that means is that they are able to provide better customer service both in regards to prompt and personal service.

Here is a website that can help you locate a independent by zip code http://www.ncpanet.org/home/find-your-local-pharmacy

most accept most insurances and your out of pocket copays are generally the same, and on top of that… these locally owned stores all the money stays in YOUR COMMUNITY.

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https://www.blacklistednews.com/article/63664/scientists-blast-fda-warn-that-a-ban-on-kratom-would-cause-more-opioid.html

The United States Food and Drug Administration ramped up its “War on Kratom” this week by labeling the natural herb as an opioid, and a group of scientists is stepping up to vouch for kratom’s safety, and to argue that banning it would only lead to more opioid-related deaths.

In a statement, FDA Commissioner Scott Gottlieb warned that there is “even stronger evidence of kratom compounds’ opioid properties.” He claimed that there is evidence of 36 deaths related to kratom, but that “many of the cases received could not be fully assessed because of limited information provided.”

In response, a group of scientists came together to send a letter to the acting administrator of the Drug Enforcement Administration, Robert Patterson; and the counselor to the president who is overseeing the administration’s response to the opioid crisis, Kellyanne Conway.

The letter strongly criticized the FDA’s recommendation to label kratom as a Schedule I drug, which would mean that the government will claim that it has no medicinal value.

“We believe strongly that the current body of credible research on the actual effects of kratom demonstrates that it is not dangerously addictive, nor is it similar to ‘narcotics like opioids’ with respect to ‘addiction’ and ‘death’ as stated by the FDA in its November 14th Kratom Advisory. Equally important, four surveys indicate that kratom is presently serving as a lifeline away from strong, often dangerous opioids for many of the several million Americans who use kratom. A ban on kratom that would be imposed by CSA Scheduling would put them at risk of relapse to opioid use with the potential consequence of overdose death. Similar unintended consequences are to be expected in some who would be forced to use opioids to manage acute or chronic pain.”

The scientists noted that when kratom is consumed in raw plant form, “it does not appear to produce the highly addictive euphoria or lethal respiratory depressing effects of classical opioids.” In fact, they argued that labeling kratom as a Schedule I drug would actually increase the number of opioid-related deaths in the United States.

“It is our collective judgment that placing kratom into Schedule I will potentially increase the number of deaths of Americans caused by opioids because many people who have found kratom to be their lifeline away from strong opioids will be vulnerable to resumption of that opioid use, whether their prior opioid use was for relief of pain or due to opioid addiction,” the scientists wrote.

The letter cited several national surveys and a wealth of studies from both the U.S. and Asia, which found that “kratom has been used as a safer alternative to opioids for more than a century,” and if the government truly cared about the safety of the consumer, they would refrain from making kratom a Schedule I drug.

Although the FDA is claiming that kratom is responsible for at least 44 deaths, that is nothing when compared to the number of deaths that have occurred from opioid overdoses in recent years. As President Trump noted at his first State of the Union address, “In 2016, we lost 64,000 Americans to drug overdoses: 174 deaths per day. Seven per hour.”

However, the scientists questioned whether the FDA could actually prove that the deaths it cited were related to kratom overdoses. They noted that while opioid overdose deaths result from respiratory depression and death at high doses, the deaths the FDA claims are from kratom overdoses include “a wide variety of apparent causes in people suffering from various diseases and/or taking other substances that also likely contributed to their deaths.”

Why is the FDA pushing to ban kratom when research has shown that not only is it a safer alternative to opioids, but that it actually helps to prevent opioid-overdose deaths?

As The Free Thought Project has reported, by pushing for a ban on kratom, the FDA is ensuring that Big Pharma will have a lifetime of profit, and the commissioner of the FDA is directly responsible:

Before taking over the FDA and using his position to enrich his fellow legal drug dealers, Gottlieb was a member of GlaxoSmithKline’s product investment board. And, as TFTP has previously reported GlaxoSmithKline owns a patent on a kratom alkaloid designed for the very purpose of treating pain, thereby alleviating dependency on opioids. One of Kratom’s alkaloids—Speciofoline—was researched decades ago by Gottlieb’s former employer and its effects have been widely studied and reported on.

It just so happens that a patent was filed for Speciofoline on August 10, 1964. The patent claims the “alkaloid has useful pharmacodynamic activity, particularly analgetic and antitussive activity.” But that’s not all. Other studies—which the FDA says do not exist—have been conducted for the specific task of treating opioid dependency.

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http://www.foxnews.com/health/2018/02/08/many-people-take-dangerously-high-amounts-ibuprofen.html

Many adults who use ibuprofen and other so-called nonsteroidal anti-inflammatory (NSAID) drugs take too much, increasing their risk of serious side effects like internal bleeding and heart attacks, a U.S. study suggests.

About 15 percent of adults taking ibuprofen (Motrin, Advil) or other NSAIDs like aspirin, naproxen (Aleve), celecoxib (Celebrex), meloxicam (Mobic) and diclofenac (Voltaren) exceeded the maximum recommended daily dose for these drugs, the study found.

“NSAIDs are among the most commonly used medicines in the U.S. and worldwide,” said lead study author Dr. David Kaufman of Boston University.

“These drugs can have serious side effects, including gastrointestinal bleeding and heart attacks, and are often taken without medical oversight because many products are available over-the-counter,” Kaufman said by email. “The attitude that users can choose their own dose regardless of label directions, along with poor knowledge of dosing limits, is associated with exceeding the daily limit.”

For the study, 1,326 people who reported taking ibuprofen in the previous month completed online medication diaries every day for one week.

All of the participants took ibuprofen during the diary week, and 87 percent of them only used over-the-counter, or nonprescription, versions, researchers report in Pharmacoepidemiology & Drug Safety.

Overall, 55 percent of participants took ibuprofen at least three days during the week, and 16 percent took it every day.

In addition to ibuprofen, 37 percent of the participants reported taking at least one other NSAID during the week, most often aspirin or naproxen. Less than half of them recognized that all of the products they were taking were NSAIDs.

One limitation of the study is that researchers only focused on recent and current ibuprofen users, which may not reflect what doses might be typical for sporadic or new users, the authors note.

Even so, the findings highlight a potential downside of making NSAIDs widely available without a prescription, said Dr. Gunnar Gislason, director of research for the Danish Heart Foundation in Cophenhagen.

“I believe that the message sent to the consumer when these drugs are widely available in convenience stores and gas stations is that these drugs are safe and you can use them safely for pain relief – thus no need for reading the label,” Gislason, who wasn’t involved in the study, said by email.

Even when people do read the label, they may still ignore it.

“If the recommended dosage does not give sufficient pain relief, it is easier to take more pills than seeking professional advice from a healthcare person or doctor,” Gislason added.

While doctors may prescribe NSAIDs for some muscle and joint disorders and certain other health problems, these drugs aren’t appropriate for many of the reasons that patients may buy them at the drugstore, said Dr. Liffert Vogt of the Academic Medical Center at the University of Amsterdam in the Netherlands.

“In my opinion NSAIDs should not be available as an over-the-counter drug, because of all their deleterious effects,” Vogt, who wasn’t involved in the study, said by email.

“For occasional use, acetaminophen (again in the right dose) is a much safer option and very efficacious as a pain killer,” Vogt added. “But we know that many people use NSAIDs for indications other than pain, such as flu, allergies, fever – and there is no medical base that indicates that NSAIDs or acetaminophen are of any use under these circumstances.”

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Lawsuit: Clinics wrote thousands of fraudulent addiction drug prescriptions

The lawsuit alleges that The Recovery Center and four of its owners defrauded Medicaid by claiming it offered patients medical advice

https://www.ems1.com/addiction/articles/375129048-Lawsuit-Clinics-wrote-thousands-of-fraudulent-addiction-drug-prescriptions/

BREATHITT COUNTY, Ky. — A clinic with locations in Central and Eastern Kentucky improperly prescribed thousands of doses of a drug designed to help treat people addicted to opioids such as heroin and pain pills, Attorney General Andy Beshear’s office charged in a lawsuit filed Friday.

The lawsuit alleges that The Recovery Center, which is based in Breathitt County, and four of its owners defrauded the Medicaid program by falsely claiming it offered patients required medical advice and individual treatment along with prescriptions for Suboxone.

The lawsuit seeks to recover money from The Recovery Center received under the Medicaid program, as well as fines and other financial damages.

Beshear said his office recently raided four clinics operated by the business and that a criminal investigation is underway.

Clinics can qualify for Medicaid payments for providing medication-assisted addiction treatment. Suboxone, which combats cravings for opioid drugs, is widely used in such treatment.

However, clinics are supposed to provide individual treatment that includes steps to reduce a patients’ use of Suboxone over time, Beshear said in a news release.

The Recovery Center was billing Medicaid for spending 15 minutes with each patient, but that was “mathematically impossible” given the number of doctors in its clinics, Beshear said.

For example, the lawsuit alleges that on one day in 2017 at the Recovery Center clinic in Jackson, the owners wrote 136 Suboxone prescriptions, all for the same dosage amount.

The Recovery Center has clinics in Jackson, Hazard, London, Paintsville, Frankfort, Richmond and Mount Sterling, Beshear said.

Beshear called the clinics “pill mills.”

“The owners are strictly operating for profits and couldn’t care less about the health and safety of our families and neighbors who are struggling with addiction,” Beshear said in a news release.

Beshear’s office filed the lawsuit in Breathitt County against the business and the owners — Dr. George Burnette, Jerry Campbell, Justin Neace and Robert Jack Duncan.

No one returned a telephone message left at a number listed for the clinic in Jackson.

The lawsuit charges that The Recovery Center billed Medicaid for services that were not provided or were not needed. It required unnecessary weekly appointments and drug screens, and unneeded prescriptions led to the state “being flooded with thousands of dangerous and addictive doses of Suboxone that were subject to abuse and diversion.”

Beshear said his office has been reviewing a trend in the abuse of Buprenorphine medications — Suboxone is one — by clinics that prescribe them without the necessary counseling and treatment. There is a black market for the drug.

“Now we are seeing a treatment for addiction being the cause of addiction due to the reckless behavior of clinic owners like those who run The Recovery Center,” Beshear said in the release.

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Hi Steve! My name is xxxx.xxxxx and my attorney recommended that I reach out to you. I have had a horrific traumatizing experience recently with a Walgreens pharmacist. This went beyond refusal to fill a prescription and the pharmacist actually edited my Walgreens profile as well as flag my prescription. I have been using a different Walgreens consistently for 2+ years and seeing the same doctor who writes these prescriptions for me. However my local Walgreens was out of two of the three medications I desperately needed and recommended I take my prescriptions to a different Walgreens, one that had what I needed in stock. Needless to say this turned into a nightmare, total humiliation and shame and I literally feel like I was criminalized by this pharmacist. Again my situation goes way past refusal to fill a much needed prescription. This particular pharmacist became vindictive and I believe crossed a line most certainly of ethical duty but possibly a legal one. I know this because after spending several hours going back and forth and going to a third Walgreens pharmacy after her refusal , I was treated horribly. I then returned to my pharmacy in tears and pain and my pharmacist was dumbfounded at how I was treated. When she went into the computer to see why my prescription was flagged, she was irate at what she saw. She was not surprised when I told her the other pharmacists name that treated me so badly but she was very surprised to see what she had done to my Walgreens profile. I am angry at myself for not getting the specifics in that moment but as I said earlier it was a long day and I was in so much pain. I do know for a fact that my two pharmacists could not apologize enough about what transpired and could not wrap their heads about this others pharmacists negative actions against me. I believe they said not only did she flag the script as a possible non valid prescription, she proceeded to alter my profile or erase it including the icd-9 or 10 codes that were established. Off the record my pharmacist insisted I speak to corporate and the district manager and file a complaint with the California board of pharmacist. Needless to say that I still have not received all my medications as my Walgreens has been unable to obtain one of the meds and on top of my many pre-existing issues I was involved in a pretty severe riding accident 3 days prior to this experience where I was thrown off a quad going about 30 miles per hour and thrown 3-4feet in the air before landing very hard on hard sand on my left side.needless to say I really damaged my left shoulder and arm and still have little to zero mobility of my left side. I would so appreciate talking with you if possible because i wanted to not send a novel with some of the important details regarding this but wanted to at least send you a summary and hope to get your attention with this so we can then speak further .I am determined if nothing else, to see some serious consequences for this pharmacist and if In fact her actions against me are illegal then I plan on pursuing legal action. Also just another fact in this, I actually work in the field of mental health and substance abuse and have done so for the last 8 years. I was an integral part of developing and launching the first two free standing detoxes in San Diego. I have my own small company and have been self employed for approximately 3 years. I am very well known and respected in this field and because of that this is a very sensitive issue for me. Although all my colleagues know that I am not a person in recovery or have struggled with addiction issues, I try to keep this very private for several reasons .

Our country has a serious – and growing – Pharmacist surplus.. so if any chain is not happy with the attitude or the way one of their employed pharmacist treats pts.. they could replace them in a heart beat… but .. apparently chose not to.  They all claim how much they care about pts… maybe many of their employees have not read that memo..

Here is a link where pts can find local independent pharmacies where you will be dealing with the owner/pharmacist… who use “good customer service” as the reason people keep returning to patronize their pharmacy. http://www.ncpanet.org/home/find-your-local-pharmacy

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https://www.bellinghamherald.com/news/article199479559.html

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