Could put thousands of otherwise innocent Americans into locked treatment units

Posted on January 18, 2018 by Pharmaciststeve

New Laws Force Drug Users Into Rehab Against Their Will

https://www.thedailybeast.com/new-laws-force-drug-users-into-rehab-against-their-will

Involuntary commitment laws are being opened up to allow some people to be detained for overdosing or even having visible track marks—in some cases up to 90 days.

Debra Hicks went to work on Sept. 19, 2011, to teach California high school students about the Constitution. But that night she got a crash course on how easily her own civil rights could be violated, when she overdosed on her pain pills and a psychiatrist she’d never met involuntary committed her to Glendale Adventist Medical Center, near Los Angeles.

By the time she was released six days later, Hicks claims she had been placed in five-point restraints and “forcibly and unwillingly subjected to the use of strong antipsychotic medications”—according to an ongoing lawsuit against the facility.

Her only “crime,” she says, was having a bad reaction to her doctor-prescribed opioid medication.

Now lawmakers in at least eight states are considering bills that would make it even easier for drug users like Hicks to be forced into treatment against their will.

Proponents insist the bills are an unfortunate but necessary response to a troubling rise in the number of Americans dying from drugs like Oxycontin and heroin. But patients rights advocates say involuntary commitment is an overly extreme measure that will only make addicts’ lives worse.

Meanwhile, the private prison industry is waiting quietly in the wings, sensing an opportunity to get new business in the wake of declining prison populations.

 “The idea of using the criminal justice system or civil commitment to compel drug users to accept treatment is ridiculous,” said Dr. Mark Willenbring, an internationally recognized addiction psychiatrist and founder of the Alltyr clinic in Minnesota. “Why aren’t we incarcerating people with heart disease who continue to smoke or people with diabetes who don’t manage their diet?”

According to the National Alliance for Model State Drug Laws, 37 states already have statutes that allow substance abusers who have not committed a crime to be briefly detained against their will. In most cases the legal bar is high—often requiring a finding that the person being committed has threatened to harm themselves or another person.

Over the past several years, however, states have been quietly revising their laws to allow for longer periods of commitment with fewer legal hurdles.

Kentucky and Ohio led the push. And in 2015 Mike Pence signed a law permitting involuntary commitment for drug users in Indiana.

Last year, Florida followed suit, passing a new measure that allows individuals with substance abuse problems to be held up to 90 days against their will. A petition can be filed by “any adult with direct personal observed knowledge of the respondent’s impairment,” and must only show probable cause that the individual has “lost the power of self-control with respect to substance abuse” and are “incapable of making a rational decision regarding his or her need for care.”

Lawmakers in New Jersey have been trying for the past two years to get a similar measure on the books there. The latest iteration of the bill, introduced by Democratic Assemblyman Joseph Lagana (Paramus), would allow a police officer with no addiction training to detain a person if they have “reasonable cause” to believe that the person is in need of involuntary treatment.

 A bill proposed this session in the Washington Senate would expand civil commitment to include individuals who have had three or more arrests “related to activities connected to substance abuse,” who have ever been in rehab or detox, or who have three or more visible track marks (PDF).

Three such bills are currently being considered in Pennsylvania, including one that would permit forced treatment for any individual who “has ingested an amount of drugs as to render himself unconscious or in need of medical treatment to prevent imminent death or serious bodily harm.”

Like many of the new measures, the bill would authorize up to 90 days of involuntary inpatient drug treatment.

Since most addicts are not “severely mentally impaired,” legal experts say that once they are detoxed it will become increasingly difficult to justify involuntary detention. That means that, in practice, the period of commitment is likely to be much shorter.

Addiction experts say that could actually lead to an increased risk of overdose, as drug users return to the community without the physical tolerance they had only days or weeks earlier.

“Often what will happen is that people will remain sober through treatment but then rapidly return to use as soon as they are out,” said Kirk Bowden, a certified addiction clinician and the former president of the Association for Addiction Professionals.

Lawmakers in New Hampshire, Alabama, Maryland, Michigan, and Mississippi are also considering broad civil commitment measures this session.

David Freed, district attorney for Cumberland County, Pennsylvania—where overdose fatalities doubled in 2016—supports the measure, and says states have a “moral obligation” to help drug addicts who he says won’t help themselves.

“The process should be seamless. It should be standard, and frankly, it should not be optional,” he testified last year.

But morality and medicine are frequently at odds, as Hicks’ case shows.

Like millions of other Americans, Hicks suffers from chronic pain issues, including fibromyalgia—a painful nerve condition—three herniated disks and two pinched nerves.

Her treatment includes seeing a pain management specialist, and taking prescribed medications that include opioid painkillers.

According to a lawsuit she filed in Los Angeles Superior Court, on the day her ordeal began Hicks had forgotten to take her morning dose of painkillers. As the hours wore on she found herself in increasing physical distress. By the time she got home that evening she says she was experiencing severe pain, and erroneously believed she needed to take more than her prescribed dose to make up for the missed one.

Hicks’ roommate found her passed out on the floor of the apartment they shared and called 911.

Though she managed to walk to the ambulance that would take her to the emergency room, doctors there told Hicks that, as a matter of protocol, patients who have suffered a drug overdose must speak to a psychiatrist before being released.  

According to her lawsuit, Hicks waited nine hours after she was discharged from the emergency room before a nurse informed her she was being detained under a 1967 law that  gives psychiatrists in California limited powers to hold a person who is dangerous to themselves or others due to mental illness against their will for up to 14 days.

Hospital records attached to Hicks’ lawsuit say her only formal diagnosis was “depression.” When Hicks attempted to leave the hospital—a full 24 hours after being released from the ER—she was chased down and brought back by local police and hospital security guards, she asserts in her complaint.

“The Hicks case is a dramatic example of how a person can be captured into a system by people who pretend to be trained to help but actually completely misunderstand the process,” said Hicks’ attorney, Gary S. Brown, in an email to The Daily Beast.

In court filings, the hospital does not dispute the facts of the case, but argues that it is immune from civil action under California’s civil commitment law—which requires only a finding of probable cause that an individual is a danger to themselves.

Brown, who has spent the better part of three decades defending clients who’ve been involuntarily committed, says that while patients can challenge that finding in court after a few days of confinement, the odds are often stacked against them.

While forcing substance abusers into treatment may provide temporary relief for family members who are dealing with an addicted loved one, experts say it offers little help for the person actually suffering from addiction.

A recent study published by the medical journal the Lancet found that heroin users forced into treatment “had significantly more rapid relapse to opioid use post-release” compared with those who voluntarily sought help.

Involuntary commitment also violates the ethics codes of some treatment organizations, such as the Association for Addiction Professionals (PDF).Meanwhile, detaining a person who has committed no crime based on what they might do in the future has potentially severe long-term repercussions.

“Involuntary commitment gives someone a lifelong marker that interferes with their ability to get health care coverage or own a firearm, and it could prevent them from getting certain jobs, like federal employment,” said Mary Catherine Roper, of the the American Civil Liberties Union of Pennsylvania.

Once a civil commitment is on a person’s record, Roper says, it’s nearly impossible to get it expunged.

But there’s another, more pressing problem with involuntary commitment for substance abuse: Most states don’t have enough treatment beds even for the people who want them.

Massachusetts—which has permitted courts to force drug users into treatment for more than two decades—has so little bed space for drug addicts seeking help that those compelled into treatment are often sent to one of two state correctional facilities instead. Last year, the state actually had to pass a law to ensure that women who are involuntarily detained for drug abuse go to an actual treatment facility instead of jail.

Doctors say giving precedence to drug addicts who don’t want treatment will almost certainly make it harder for those who do want treatment to access it.

“There are waiting lists for treatment right now,” said Dr. Raymond Bobb, an addiction doctor in Philadelphia who treats patients with methadone and Suboxone. “Plenty of people are seeking treatment and waiting for spots to open up, do these people supersede them?”

That has caught the attention of the private prison industry—which has been refocusing its efforts on treatment and reentry services as states have moved to reduce the number of inmates in their correctional systems.ennsylvania lacks any secure drug treatment facilities—with the exception of those currently contracted by the Department of Corrections. In February, Gov. Tom Wolf announced the state would cut $40 million from its community corrections budget and plans to eliminate 1,500 halfway house beds.  

Weeks later private prison firm The GEO Group completed its $360 million acquisition of Community Education Centers, which operates five residential reentry facilities in Pennsylvania. The GEO Group spent more than $112,000 lobbying lawmakers in Harrisburg over the past 12 months.

Correct Care Recovery Solutions (CCRS), a subsidiary spun off by GEO Group in 2013, also operates residential psychiatric treatment hospitals, as well as the only privatized civil commitment facility in the country (in Florida). In addition to Pennsylvania, the company manages facilities in several states where civil commitment measures are being considered.

New laws that would put thousands of otherwise innocent Americans into locked treatment units could potentially be a windfall for the company and others like it. But like so many other failed policies in the War on Drugs, it will be the most desperate and marginalized Americans who will pay the price.

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Ravenna eyes fees for marijuana businesses

Posted on January 17, 2018 by Pharmaciststeve

http://www.record-courier.com/news/20180117/ravenna-eyes-fees-for-marijuana-businesses

Ravenna City Council is considering imposing a $25,000 licensing fee for any medical marijuana-related businesses that might operate in the city after learning that all taxes from such a business would go to the state.

Council’s Community and Economic Development committee recently discussed the potential fee. Councilman Andrew Kluge said Lakewood implemented an identical fee for such businesses. Akron, he said, implemented a fee of $60,000 for businesses related to the new medical marijuana program in the city limits.

Under the state program, the Ohio Board of Pharmacy is issuing licenses to cultivators, processing plants and dispensaries throughout the state.

Geauga County businessman Tom Hobson recently got the green light from the state to open a cultivation business at 4000 Lake Rockwell Road in Ravenna Township. FN Group Holdings, LLC, which is doing business as Wellspring Fields, will be owned by Hobson’s daughter, Claire, and his son, Spencer. The group holds the only cultivation license issued in Portage County, and reportedly applied for a processing license, an application that is pending.

Groups have approached Ravenna City Engineer Bob Finney about operating dispensaries in city limits. Council members implemented legislation to pave the way for such businesses, and some council members expressed hope that the city would benefit from the taxes generated by the new enterprises.

However, officials later learned that the taxes would go back to the state, and the city would have little to gain from such a business locating in the city.

That’s why some cities are implementing licensing fees, reasoning that most medical marijuana businesses have already paid much higher fees at the state level to obtain their licenses. Under Ravenna’s plan, the fee would be charged annually for five years, and could possibly drop in the years after that.

Kluge said the money would go into the city’s general fund. From there, the money can be used toward other purposes, such as drug education.

Councilman Rob Kairis said he doesn’t object to the fee, but thinks talk about drug education misses the point.

 “This is something that is meant for medical purposes for specific conditions,” he said. He suggested directing the fees toward the city’s safety forces instead.

He pointed out that Kent is looking at ending its moratorium, and Streetsboro seems to be reversing its proposed ban on the program.

“There is competition out there,” he said.

Councilman Scott Rainone said he read about a similar enterprise out of state that paid a $25,000 fee, but sued when that city raised its fee by $100,000.

“If it’s low enough, they see that fee as the cost of doing business,” he said.

Council President Joseph Bica pointed out that a fee of $50,000 is roughly equivalent to the entry-level salary of a police officer.

Councilwoman Amy Michael said the city should think carefully before deciding how much the fee should be.

“Whatever we go in at, we’re going to be there for a very long time,” she said.

All these bureaucrats can see is a “cash cow”… they are too myopic to see that taxing the crap out of a legit MMJ business will just allow those selling MJ on the street to be able to UNDER CUT the price of the product from the legal distributor… because they have no legal taxes and the cost of permits to the state and any other middleman bureaucracy  to pay…  Remember there is no education required or previous experience to be an elected or appointed bureaucrat and these bureaucrats in Ohio seem to be clearly demonstrating why there should be.

 

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Survey: 42% of Physicians Report Burnout, Some Cite Depression

Posted on January 17, 2018 by Pharmaciststeve

https://www.medscape.com/viewarticle/891411

Forty-two percent of physicians said they feel burned out, while 15% reported feeling depressed, according to a new Medscape survey.

Half of those who reported burnout experienced those feelings on a regular basis. Of the smaller number of physicians who reported depression, 70% called it “colloquial,” while 19% said they had clinical depression.

Those reporting to be the happiest at work were ophthalmologists, orthopedists, plastic surgeons, and pathologists. Those who were the least happy included clinicians in diabetes and endocrinology; family medicine; critical care; internal medicine; and, at the bottom, cardiology. Some 15,000 physicians from 29 specialties participated in the Medscape survey.

Burnout was reported at the highest rates by critical care physicians (48%), neurologists (48%), and family medicine doctors (47%). In a large number of specialties, 40% or more of the respondents said they felt burned out. Among oncologists, 39% reported burnout. Lower numbers — but still somewhat large — of orthopedic physicians (34%), ophthalmologists (33%), pathologists (32%), and dermatologists (32%) said they were burned out.

 The smallest number of clinicians who said they were burned out were plastic surgeons, with just 23% reporting that feeling.

Medscape also asked whether physicians felt both burnout and depression. Ob/gyns were the leaders, with 20% saying they felt both. Specialists in public health and preventive medicine, urology, neurology, and family medicine followed. At the bottom, just 8% of psychiatrists said they were both burned out and depressed.

Women tended to report feeling burned out more than men. Mid-career physicians also seemed to be hit the hardest, with half of those aged 45 to 54 reporting burnout.

For those who said they felt depressed, the job was the biggest contributing factor, approaching a 6 on a 7-point scale used by Medscape. Finances followed, at around 4, with health considered the least important factor in depression.

Too much bureaucracy and paperwork was the main factor contributing to burnout, listed by 56% of respondents. Spending too much time at work, and lack of respect — from colleagues, administrators, or staff — took the second and third spots.

Government regulations, decreasing reimbursement, emphasis on profit over patients, and maintenance of certification requirements were all also listed as burnout factors, but were less important, with only about 15% to 16% of respondents citing those.

Disconnect on Perceived Impact on Care

Medscape asked physicians who reported feeling depressed whether their depression had any impact on patient care. Some 40% said it did not affect their interaction with patients.

However, about a third said they were less engaging, more exasperated, and less friendly with patients because of their depression. Fourteen percent of respondents said they make errors that might not otherwise occur.

A larger number seemed to recognize that their distress was affecting interactions with staff and colleagues. Forty-two percent admitted to being less engaged with or actively listening to staff and peers. An equal number acknowledged being more easily exasperated, and a slightly smaller percentage said they were less friendly and that they expressed frustration in front of colleagues and staff.

 Coping With Burnout

Survey respondents were also asked about what might reduce their burnout, what kinds of coping strategies they employ, including whether they might seek professional help, and whether their workplace offered any sort of assistance in dealing with burnout.

 The most popular coping mechanisms were exercise — cited by 50% overall, with slightly more men than women favoring that — and talking with family and friends. More women than men said they turned to friends or family. Sleeping and isolating themselves from others were also much employed, as was listening to music. A third said they would eat junk food, and a fifth turned to alcohol. Few clinicians — less than 3% — said they used prescription drugs or marijuana to cope.
 Similarly, a small number of survey respondents said they currently were receiving professional help or planned to do so. Sixty-six percent of men and 58% of women said they were not receiving counseling and had not done so in the past. Not surprisingly, the specialists most likely to seek help were psychiatrists, followed by plastic surgeons. At the bottom, 17% of cardiologists said they would be likely to do so.
 Nonhospital academic practices, healthcare organizations, and hospitals were most likely to offer a workplace program to help. Office-based single specialty and solo practices were least likely. Only 10% of respondents from single practices said that a program was place. Interestingly, the highest number of clinicians who said they had used such a program were in office-based solo practices.
 Some of the respondents had advice for colleagues on how to avoid burnout, including finding a way to make themselves happy on the job. Another suggested leaving the laptop at the office. “Stay at work until 6:00 pm if need be to finish your work, but when you go home, BE at home,” the respondent said.
 Said another respondent, “Count your blessings.”
 Respondents, who were recruited for the survey from July to October 2017, were required to be practicing medicine in the United States. The margin for error was ±0.79%, with a 95% confidence level using a point estimate of 50%.

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STUDY: Patients Who Receive Prescription Opioids Are More Satisfied with Their Care

Posted on January 17, 2018 by Pharmaciststeve

www.nationalpainreport.com/study-patients-who-receive-prescription-opioids-are-more-satisfied-with-their-care-8835295.html

Patients with musculoskeletal conditions who receive prescription opioids are more satisfied with their care than comparable patients who do not receive opioids.

“In the current payment paradigm, reimbursement is partially based on patient satisfaction scores. We sought to understand the relationship between prescription opioid use and satisfaction with care among adults who have musculoskeletal conditions,” lead author, Brian D. Sites, MD, MS, Geisel School of Medicine at Dartmouth, Dartmouth-Hitchcock Medical Center, wrote.

In a study of nationally representative data, 13 percent (2,564) of more than 19,000 patients with musculoskeletal conditions used prescription opioids. Among those who used opioids over time, moderate and heavy use was associated with greater likelihood (55 percent and 43 percent, respectively) of being most satisfied, compared to single or no use of opioids.

Although opioids may be expected to offer patients with musculoskeletal conditions improved pain control, patients taking opioids in this study had more pain and worse health and disability than those taking limited or no opioids, suggesting a more complex picture.

As clinician compensation is increasingly linked to patient satisfaction, and as the United States struggles with an epidemic in opioid use, the authors suggest it is imperative to determine whether improved satisfaction with care is associated with demonstrable health benefits.

Dr. Sites’ study, Prescription Opioid Use and Satisfaction With Care Among Adults With Musculoskeletal Conditions, is published in the American Academy of Family Physicians’ journal, Annals of Family Medicine.

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Intractable Pain Treatment Report No.1 Dr Tennant

Posted on January 17, 2018 by Pharmaciststeve

Filed under: General Problems | 4 Comments »

Illinois Judge Orders State to Add Intractable Pain as Qualifying Medical Cannabis Condition

Posted on January 17, 2018 by Pharmaciststeve

www.thejointblog.com/illinois-judge-orders-state-add-intractable-pain-qualifying-medical-cannabis-condition/

In a decision that will significantly expand the pool of people eligible to use medical cannabis in Illinois, a judge has ruled that the state must add intractable pain as a qualifying medical cannabis condition.

In 2016 the Illinois Department of Public Health rejected a petition to add intractable pain to the state’s medical cannabis program. Now, two years later, Cook County Judge Raymond Mitchell has ordered the agency to add the condition. Intractable pain is defined as pain that’s resistant to standard treatment options.

The ruling comes from a lawsuit brought forth by Ann Mednick, who often experiences extreme pain associated with osteoarthritis; Mednick uses prescription opioids, but says they fail to control the pain and result in numerous side effects.

“Illinois is years behind the times,” says Mednick. “The state needs to get [it] together.” Mednick previously petitioned the now-disbanded Medical Cannabis Advisory Board to recommend the state add intractable pain as a medical cannabis condition; if you want to learn more about marijuana click here for weed online. The board voted unanimously to approve the petition, 10 to 0. However, this didn’t stop Department of Public Health Director Dr. Nirav Shah from rejecting the recommendation in January of 2016.

In his ruling Judge Mitchell stated that Dr. Shah’s decision was  “clearly erroneous”. He pointed to the fact that Dr. Mednick said intractable pain is not a condition listed in the International Statistical Classification of Diseases and Related Health Problems as a recognized unique medical condition, despite that not being true. The judge also said that; “The record shows that individuals with intractable pain would benefit from the medical use of cannabis”.

Unsurprisingly, the Department of Public Health says it plans to appeal the judge’s ruling.

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Computer crashed and burned

Posted on January 16, 2018 by Pharmaciststeve

See the source image

Yesterday… about mid afternoon… my computer just decided to self destruct… This is only the second time in all my decades of using computers that I had to seek “professional help” to put my computer back together… Off to Best Buy today and Geek Squad to the rescue… According to them .. .they have seen a “rash” of “C drives” just self destructing – at least the OS on the drive…they suspect that a update from Windows or Dell… has been sent out.. and they are not saying anything about how their little “bug” has trashed computer’s OS.

The good and bad of it for me… my computer has a solid state C DRIVE and all my data was on a old reliable typical hard drive labeled as “D”… but all the programs had to be downloaded and reinstalled and change their default configurations to my liking… – the ones that I could remember was on the system… I will probably be finding “missing” programs for weeks going forward.. when I need to do something.

If my blog seems rather “silent” over the next few days or I don’t get to your email for a few days… I am not intentionally ignoring anyone…

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possible for an individual to go to prison as a result of evidence the U.S. government has deliberately kept hidden and that it may have gathered illegally

Posted on January 15, 2018 by Pharmaciststeve

www.thecipherbrief.com/us-agents-can-change-story-court-legally

The United States owes its existence as an independent nation partly to objections over excessive searches by British colonial authorities. Yet today, it is possible for an individual to go to prison as a result of evidence the U.S. government has deliberately kept hidden and that it may have gathered illegally.

Human Rights Watch just published an investigative report documenting parallel construction, a practice in which government agents create an alternative explanation for how evidence in a criminal investigation was found. It does this to avoid disclosing the original sources or methods in open court.

The result is that defense attorneys are unable to discover how evidence was collected and challenge it, and judges are unable to evaluate investigative methods that may have violated fundamental rights. Evidence described in the report suggests that agents may be using this concealment technique regularly and nationwide.

Of immediate relevance, parallel construction could be preventing Congress and the public from understanding the ways Section 702 of the Foreign Intelligence Surveillance Act (FISA), a controversial surveillance law that is currently the subject of a pitched battle over its renewal, affects people in the United States.

The “fruit of the poisonous tree” doctrine generally requires judges to bar prosecutors from introducing evidence that was obtained illegally. However, the government apparently justifies parallel construction based on exceptions to this doctrine.

For example, the U.S. Supreme Court has found that prosecutors may still introduce such evidence if they had a “genuinely independent” source for it. Human Rights Watch found that the government may be secretly deciding for itself what constitutes an “independent” source—cutting judges, whose role it is to ensure the fairness of trials, out of the picture.

One method the federal government may use to conceal sources entails asking local police to find their own reasons to pull over and search a vehicle for evidence of a criminal offense. We cited numerous avowed instances of such traffic stops, which are known in law enforcement circles as “wall” or “whisper” stops. The report provides links to leaked “be on the lookout” orders that explicitly instruct officers to “develop [their] own probable cause” for stopping and searching vehicles.

We also pointed to the possibility that the government is using orders issued under FISA, or closed proceedings under the Classified Information Procedures Act, to prevent the disclosure of activities or programs. Defense attorneys have had little success in finding out whether these or other techniques were used to conceal investigative methods in their clients’ cases.

While we were able to offer the most thorough portrayal of parallel construction to date, the report should inspire further questions. For example, we provided details about the Drug Enforcement Administration’s (DEA’s) Special Operations Division, which facilitates the sharing of intelligence with law enforcement agents and at least part of which has been nicknamed “the Dark Side.”

But a pair of e-mails from the surveillance software vendor Hacking Team that were leaked to WikiLeaks in 2015 point to the possibility that the Federal Bureau of Investigation (FBI) also contains an entity known as the “Dark Side.” (In the e-mails to which links are provided here, “Phoebe” is Hacking Team’s code name for the FBI, and “Charlie” is apparently a reference to an individual with an FBI e-mail address.)

The report also identifies “wall stops” requested by agencies including the FBI, Immigration and Customs Enforcement, and the Bureau of Alcohol, Tobacco, Firearms and Explosives.

Congress should demand—and the executive branch should provide—complete information about which agencies are engaging in parallel construction, and how. The public needs to know what is being done in its name, and everyone needs to be able to have confidence that the U.S. criminal justice system is respecting rights.

Numerous questions also remain about the DEA Special Operations Division’s “Dark Side.” A former federal prosecutor told us, “The Dark Side does stuff that doesn’t come to the public’s attention.” Another former federal prosecutor who has worked in the division said that members “do everything legally,” but suggested that they are operating under laws that confer vast powers. Such statements suggest a need for much greater transparency about the division’s activities and how they affect rights.

One of the most troubling aspects of parallel construction is that government agents could use it to conceal virtually any behavior, from a potentially unconstitutional National Security Agency surveillance program to untested new biometric technologies, or even run-of-the-mill illegal searches of luggage.

Public, transparent, fair trials are essential to human rights and democracy, and the rights of criminal defendants lie at the heart of the U.S. Constitution. Our findings should inspire further investigations at both the national and local levels—and a ban on the practice of deliberately hiding the true sources of evidence from people facing the loss of their liberty.

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Opioid lawsuit: Discovery more the point than dollars

Posted on January 14, 2018 by Pharmaciststeve

http://chronicle.augusta.com/opinion/editorials/2018-01-14/opioid-lawsuit-discovery-more-point-dollars

It’s unlikely the city of Augusta will realize much of a windfall, if any, from joining a pack of lawsuits against opioid manufacturers and distributors to recover costs of the epidemic.

 

For one thing, there’s no assurance any monetary awards will be forthcoming.

For another thing, the lead law firm in the case, Dallas, Texas-based Baron and Budd, is representing some 185 cities and counties around the nation. After the law firm’s take of up to 50 percent of damages, and divvying up what’s left, there isn’t likely to be that much per locality.

We also recoil at the notion of predatory lawsuits, with law firms trolling for victims with which to punish U.S. industries. Not that this is one of them, but such practices have become problematic.

Rather, the chief benefit of the opioid lawsuits, which could take up to five years or more to resolve, might be what lawyers call “discovery.”

In a case such as this, that means the plaintiffs can demand relevant documents, correspondence and testimony from the drug companies about what they knew about the epidemic and when, and what they did or didn’t do about it commensurate with their legal duties.

In short, we may find out whether drug companies have acted responsibly or not in the midst of one of America’s worst modern-day epidemics.

Preliminary information indicates Augusta and environs has seen higher-than average prescribing of opioids, which include such drugs as morphine, hydrocodone, fentanyl and methadone.

“Centers for Disease Control and Prevention statistics (show) opioid prescribing rates in Augusta are above the national average of 66.5 per 100 people,” writes The Chronicle’s Susan McCord. “In 2016, the rate was 86.8 prescriptions per 100 people in Augusta while in neighboring Columbia County, the 2016 rate was 81 prescriptions per 100 people.”

If such lawsuits get to the truth, then they will have been well worth it.

But we should probably be more expectant of answers than money.

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Health care deals could make you healthier but may not save you money

Posted on January 14, 2018 by Pharmaciststeve

https://www.usatoday.com/story/money/2018/01/14/health-care-deals-could-make-you-healthier-but-may-not-save-you-money/930635001/

The health care industry’s fever for consolidation has shot up with two major deals closing out 2017, but the big question is whether consumers should be feeling any better this year. 

DaVita Medical Group, which has nearly 300 medical clinics​ along with about 40 surgery centers and urgent care clinics, will become part of UnitedHealth’s prescription drug benefits division.

CVS Health’s own pharmacy benefit management (PBM) business and in-store clinics would be merged with Aetna. PBMs negotiate deals with drug makers that include rebates and other compensation to encourage certain drugs and come up with lists of drugs their insurance plans will cover.

The deals will move the industry closer to a model in which  doctors and insurers are part of the same company, in a “Kaiser Permanente-esque way,” says Craig Garthwaite, who leads the health enterprise management program at Northwestern University’s Kellogg School of Management.

Under that scenario, there would be no incentive for health care providers to perform more tests and procedures than necessary on people. Instead they would be pushed to make sure patients get the right care from the start and to keep them healthy.

 

Since it became law under President Obama, the Affordable Care Act’s concept of health care reform focused on “paying for better health rather than the utilization of health care services,” Garthwaite says.

Susan Hayes, founder of Pharmacy Outcomes Specialists, which audits PBM contracts for employers and unions, says the recent deals are just the first of many, and she’s worried about the effects. 

“More mergers of insurance companies, chain pharmacies and (health care) providers means less transparency and higher costs — bottom line,” she says.

PBMs are billed as a way to lower drug costs for employers and consumers, but they’ve increasingly come under fire in recent years as drug prices have soared.

PBMs’ slice of the costs and role as a middleman is little understood. 

Critics of PBMs say the companies sometimes agree to favor high-cost drugs on the lists of medicines your insurer agrees to pay for and that they agree they won’t place quantity limits — or prior authorization programs — on the drugs. That’s despite the fact doing so could help health plans save money and make medical sense, 

How these deals could affect you: 

• You might get healthier. The companies will have a strong incentive to make and keep you well. Right now, CVS’ Minute Clinics don’t have that incentive, as the more you show up there, the more money they make. Currently, Aetna, and the employers whose plans they administer, already have a strong profit motive to keep patients healthy. But without employing the doctors or owning the hospitals, they can’t truly control how many tests, prescriptions or visits you get. When the insurer and the health care provider are one and the same, you’re more likely to find things that encourage health to be covered. 

 

Linda Fish, who is the caregiver for her husband and brother near Albuquerque, is excited by the prospects of a CVS-Aetna deal. She has gotten good service at CVS and likes that she can get a flu shot and affordable vitamins there. She was also impressed the company took a stand against Mylan’s huge price boost on EpiPens about a year ago when it began offering a low-cost generic version of an EpiPen competitor. 

“I’m a strong supporter of wellness first,” she says.

 

Fish’s husband, Richard, is a retired professional chef and they “eat the right foods prepared the right way,” she says, as “you don’t have to cook things in lard and grease.” The couple also have free membership to gyms in Albuquerque, thanks to their Humana Medicare Managed Care plan, so they work out as much as possible.

Still, Fish hopes she and her family can switch to Aetna’s Medicare plan if the deal goes through. 

Dave deBronkart, a cancer survivor and patient safety advocate who blogs as e-Patient Dave, says he is “in favor of any evolution that makes it easier for people with health problems to get the care they need.” But whether that will happen, he acknowledges, is “hard to assess” at the time of a merger. 

More:

CVS buying Aetna in deal valued at $69 billion

UnitedHealth pays $4.9B for DaVita Medical Group clinics, health care services

Coordinated care with doctors and hospitals can improve health and save money

•Your care could come under one roof. Davita — best known for its dialysis centers — could help launch UnitedHealth into the movement away from high-priced hospital care. Emergency room (ER) visits are the costliest form of health care for insurers, in large part because of the higher costs involved in running a hospital and the fact that, under law, ERs have to at least stabilize all the patients who show up. With more of these clinics, and expanded versions of CVS’ clinics, these insurers will have a place to send patients where they can control most types of care. Within a few years, clinics in or outside of stores, including CVS, could consolidate vision and dental care, as well as primary and specialty care.

 

• You might save money — or not. If insurers save money on healthier patients, it’s far from clear whether they will pass it along as lower premiums, Garthwaite says. Even if they do, more competition will be needed among big companies such as CVS-Aetna for premiums to truly come down. If there is a worry there, he says it’s that this kind of consolidation means it will be that much harder for new entrants to enter, so prices may not come down. 

• Your insurer may still be able to game the system. Insurers have to spend a certain percentage of their premium dollars on claims and other expenses that improve the quality of the health care you receive. But Garthwaite says they still find ways to get around that, and it will be even easier if they own the health providers who treat you. If UnitedHealth is setting the price at the Davita clinics, they will have far less of incentive to make them lower than they would if they were truly negotiating. 

• You may not have as much choice. Teresa Stickler, an Arizona pharmacy owner, founded Pharmacists Unity for Truth and Transparency because of what she calls “abusive practices”  by PBMs, such as steering consumers to drugs with higher list prices. Now these insurance companies will be able to steer you to the doctors and drug stores they want you to go to, or at least make it even costlier to go elsewhere, Stickler says. 

•You may not know who’s profiting. Drugmakers have gotten the brunt of the criticism over soaring drug prices, but the pharmaceutical industry has successfully turned some of that negative attention onto PBMs due to their lack of transparency. These companies make their money on rebates and what’s known as “spread pricing,” or fees charged in addition to maintenance fees that boost drug prices. And they’re doing quite well at it if they’re buying insurance companies, as in the case of CVS’ Caremark.

“I think it is apparent that PBMs are generating so much money through rebates and spread pricing that they are now looking for ways to control the entire vertical,” Hayes says.

Hayes predicts that in the “very near future,” we will see a health care company that includes a drug manufacturer, wholesaler, retail drug chain, insurers, doctors and clinics.

“Then there will be no negotiation possible at arm’s length,” she says

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