http://staging.inforum.com/lifestyle/health/4380376-north-dakota-sees-steep-drop-opioid-painkiller-prescriptions

Filed under: General Problems | 4 Comments »

https://kingfish1935.blogspot.com/2017/12/mississippi-doctors-on-opioid-regs.html

More than a few Mississippi doctors objected to proposed opioid prescription regulations.  The Mississippi Board of Medical Licensure proposed new regulations that will overhaul how physicians prescribe and administer narcotics.* JJ obtained copies of the comments through a public records request.  Several are posted below.  More will be published in future posts. Earlier post covering proposed regulations.   Words such as dangerous, idiots, absurd, ridiculous, and burdensome are used.  Keep reading.

Congratulations! You are about to penalize everyone for the actions of a few! To burden everyone to take the time to contact the PMP on every prescription and then maintain documentation forever is absolutely ridiculous! There is already too much time, money and effort spent on overreaching regulations to add this to the mix.  As a surgeon who writes only postoperative prescriptions for 5 day (10 pill) , these regulations will ,for better or worse ,make me stop writing pain meds altogether. As I talk to my colleagues they are incredulous that you have chosen regulations so burdensome. You know who the outliers are, you should address these individual’s prescribing patterns and leave the rest of us alone!! And less I forget to mention it, take action against the criminal acts  of the patients in their drug seeking behavior and stop trying to hang everything on hard working physicians.

Dr. Jeff Cook

A few of these recommendations are overly burdensome and costly. Hopefully the board members wont reflexively incorporate all these recommendations to the detriment of patient care in order to address political objectives.

While initial prescribing of opioids it is reasonable to obtain prescription monitoring and UDS, to require UDS testing at every follow up for stable compliant chronic pain patients is unreasonable and unnecessary, as well as a significant expense to patients.

“Benzodiazepines and opioids may not be prescribed concurrently, with limited exception for an acute injury and for no more than 7 days. “   This is absurd and dangerous to patient care. While physicians should seriously consider the risk of concurrent prescribing, to absolutely prohibit concurrent use will result in severe, possibly life threating withdrawal as well as cause patients in pain to not receive appropriate pain medicines. Frequently, benzo’s are written by other physicians who refer to us to take over opioid pain medicines. While we endeavor to address the concurrent use and encouraging weaning of both classes, this proposal is outright dangerous and ill conceived. It is upsetting to me that studies clearly demonstrate alcohol is involved in 50% of opioid deaths, and benzo’s involved 30% but nothing has been said of concurrent alcohol use, nor do the CDC guidelines even mention concurrent alcohol use….

Ken Staggs
MD Total Pain Care
Meridian

As an orthopedic surgeon, I treat multitrauma patients and shoulder surgery patients that require post surgery opioids for a month or longer. Only allowing pain scripts post op for a seven day supply will place an unfair burden on those patients and our clinical staff. Please consider making some exceptions with regards to sometimes VERY painful surgeries.

Many times opioids are required for successful therapy to be obtained after these surgeries as well.  The proposed rule would require patients to come back weekly which again isn’t fair to patients or our clinical staff.

Thank you for consideration for these patients. Please feel free to contact me for further discussion as required.

D. Ross Ward, MD

I am a board certified emergency medicine physician practicing with the Singing River Hospital System here on the Mississippi coast. I’ve been licensed in Mississippi for 17 years. Although I wholeheartedly agree  there is an opioid abuse issue in the United States and Mississippi is no exception, I must vehemently protest the following clause in the MS State Board of Medical Licensure’s plans on regulating narcotic
prescription writing:

“Every licensee regardless of practice specialty must review the MPMP at each patient encounter in which an opioid is prescribed for acute and/or chronic noncancerous pain”

This rule would be way too burdensome in a busy emergency department. Patients are already waiting hours to get seen by an Emergency Physician and this rule would simply add to our already busy workload. This will inevitably, significantly add to the patient wait times if we have to run a MPMP check on every patient we see who receives a narcotic prescription in the emergency department. Pain, not surprisingly, is by far the most common complaint seen in the emergency department (ED). This would yet again be another uncompensated mandate put upon us by government. You must understand the vast majority of patients receiving a narcotic prescription in the ED are not abusers. All of these innocent patients and doctors are going to pay a heavy price for this massively sweeping rule just to weed out a handful of narcotic abusers. Do we really need to run a background check on a 8 year old who has a fractured forearm before we prescribe codeine? Or even on an adult who has an obvious legitimate reason to receive a narcotic pain medicine, regardless of his prescription history? Am I not going to prescribe a narcotic to an adult who has acute 2nd degree burns even if he has filled several narcotic prescriptions in the past?

Please seriously reconsider the wording of this clause and consider the impact on all the patients who are waiting to receive care in our busy emergency departments. Please don’t hesitate to contact me for any concerns or questions.

Thanks
Matthew L. Emerick. MD, FACEP

1. The requirement for all licensees to run a PMP report is too burdensome. The BOML should have the ability to login to the PMP and see if it has been checked remotely. It takes an average of 90 sec. to login and search for each patient-(try it and you will see). This will add over an extra hour, not included scanning to each provider, and unecessary burden. If implemented by BOML, an extra cost may have to passed to the patient for this.

2. Agree completely with opioid and benzodiazepines not to be prescribed concurrently.

3. Disagree with only a 7 day supply of opioids for acute pain. Rationale: As an orthopedist treating acute complex fractures, these patients have acute post surgical pain for fracture treatment. I service a rural community. It is not realistic to have them travel long distances each week to retrieve a opioid prescription.

Regards,
W.Todd Smith, MD
Starkville Orthopedi   Clinic

Once again a bunch of bureaucratic idiots making a bunch of rules without reasonable judgement. No
balance at all.

Dr. Lance Line
Southern Bone & Joint Specialists (Hattiesburg)

I have a pain mgt. patient who is well controlled on methadone for 8 years.   May he continue his high functioning on methadone or must I no longer prescribe him methadone?

Dr. Ed Aldridge
OnCall Medical Clinic

This is patently ridiculous, a public bandaid for a problem CREATED by government policy. Yet another hurdle to taking care of my oncology and postoperative patients.

Dr. Phillip Ley

I am a Physician Assistant working in Mental Health. The only change that I don’t entirely agree with is not prescribing Benzodiazepines with Opioids. I have several military veterans that have suffered injuries that have severe PTSD that really need both medications to have a semblance of a normal life. I also work with PTSD patients that have chronic pain and were physically abused for 20 years. I understand the black box warnings and I understand this is an attempt to combat the epidemic in this country, but to take away the provider’s discretion is taking away the treatment some people need. Thank you for taking my comments into consideration.

Sincerely,
Heather Huguley, PA-C

I maintain my license in Mississippi, though I am not currently practicing there. I am a full time emergency
physician in Dallas, Texas.

The proposed legislation is so restrictive, it is another reason for physicians to MOVE OUT OF MISSISSIPPI and not return to practice.

Increasing the labor and documentation burden for physicians will not have a significant impact on the drug problem in Mississippi. It will have an impact on your physician work force. Best of luck.

Dr. Walter Green

I am very much in favor if this ruling. However, there need to be stiffer penalties for prescribers who do not
adhere. Great work!

Dr. Gerry Morrison

This proposed policy will be an efficiency problem for all surgeons if we have to stop after every
operation/procedure to check website before writing prescription for post‐op pain relief.

Dr. John Bailey

I am very much in favor of making it harder for drug seeking patients to get opioid prescriptions. I am also in favor of making it harder for physicians who are enabling patients with their opioid dependence. However, of the
proposed changes that the Medical Licensure Board is recommending, I must disagree with the proposal to require all licensees to run a Prescription Monitoring Program (PMP) report at each encounter when prescribing opioids, especially for acute pain. I use the PMP regularly for patients who have any drug seeking behavior, but because patients who are having major surgery usually need a narcotic post operatively, it will not make a difference what the PMP report says when treating a patient with post operative pain. The PMP site is not the most user friendly site and can be very time consuming. To run a PMP on every surgery patient will be difficult for busy practitioners.

Dr. Ronald Young
OB/GYN

As a medical doctor who daily sees the harm caused by the over-prescribing of opioids and benzos, it is clear that certain physicians and NPs in our state are irresponsible or careless in prescribing these medications.

At our hospital, we have removed the automatic sleeping pill off all standing orders. We have developed a step-wise approach to pain management for which opioids are a second or third line choice and not a first line choice. We have developed rules that limit the number of days an opioid can be prescribed for acute pain management.

I fully support developing these proposed guidelines for responsible use of opioids and benzodiazepines as they primarily address patient protection and safety, and secondly address the epidemic of diversion that affects us all. Thank you for taking a bold step to be a strong advocate of responsible health care within our state.

Dr. Barry Bertolet

20 Emergency Physicians that treats over 100,000 patients in the two ED’s of Singing River Health Systems feels the same. The Board of Directors of the Mississippi Chapter of the American College of Emergency Physicians is also opposed to these rules.

Our setting in Emergency Medicine is unique in that we treat patients with acute conditions on a daily basis at a fast pace that is episodic, chaotic and time demanding. These requirements are onerous in our setting.

When we do write for opiates or benzodiazepines in this acute setting, they are for smaller doses and fewer numbers of pills than our colleagues utilize in private practices and clinics. It has been shown that our setting is not responsible for the large numbers of these types of medicines being prescribed.

However, we definitely do selectively use the Prescription Monitoring Program website on a frequent, as needed, and case by case basis. This is appropriate, as some of our patients clearly do not have an acute condition and some are clearly in our departments inappropriately seeking prescription medications. Please consider exempting Emergency Departments from these proposed rules.

Dr. Lawrence Leak
Past President MSACEP

*Here is the nutshell version of the proposed regs that have drawn so much controversy:

1. Narcotic prescriptions must be limited to seven days for non-cancerous acute pain.  The patient must see the physician again to obtain a prescription for another seven days.  This includes patients recovering from major surgeries.

2. All physicians must run a PMP (Prescription Monitoring Report) on each new patient and every three months afterwards if the patient is prescribed controlled substances.  This includes patients suffering from non-cancerous pain or psychiatric conditions.

3. Rule 1.7 (K)  Point of service drug testing must be done each time a Schedule II medication is written for the treatment of non-cancer pain…..

There are other changes that are covered in the December 7 post but these are the ones addressed by the letters published in this post.

 

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http://www.lasvegasnow.com/news/our-pain-changes-in-state-law-focus-on-opioids/891931403

LAS VEGAS – Tens of thousands of Nevadans who suffer with chronic pain issues will face new challenges after Jan. 1, 2018.

Changes in state law will make it more difficult for doctors to prescribe opioid pain medicine, and will allow pharmacists more power to refuse to fill the prescriptions.

What’s likely to happen as a result? Here are two things we can predict with confidence. More people will suffer and more people will die.

It’s been proven all across the country when you take away prescription medicine from chronic pain patients, overdose deaths go up, not down. Nevada has already proven this point. State officials have pushed for more restrictions on opioid medications, even though the overwhelming majority of drug overdoses occur in people who are not in pain management programs.

Every year since 2011, prescription opioids have dropped in Nevada. Not coincidentally, during that same period, deaths from heroin have gone up.

People in chronic pain have few choices when their medication is taken away. Most end up suffering in silence and misery. Some end the pain by committing suicide. A few turn to street drugs such as heroin or fentanyl, which are deadly and unpredictable. Experts have seen this pattern everywhere it’s been tried.

“They seem to be okay when they are receiving opioids and as their doctors involuntarily take away their medicine that they’ve been stable on, the patients destabilize and often fall apart, and that can result in suicides or overdoses. They try to compensate by taking multiple other substances either prescribed or not prescribed,” said Dr. Stefan Kertesz, Univ. of Alabama, Birmingham School of Medicine.

As many as 90 percent of overdoses involve illegal drugs, or combinations of many substances. Patients in pain management programs are more stable. But doctors  have been forced to cut prescriptions and get rid of pain patients. The results have been tragic. Nationally, overdoses and suicides have gone up as legal prescriptions have been cut.

The opioid crackdown has been pushed by the CDC which never before published even a single paper about chronic pain. It is supported by insurance companies, who save money by not paying for pain management. 

On Saturday, Dec. 30, at 6:30 p.m., you can watch the I-Team special, The Other Side of Opioids. on Channel 8.

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When my phone rings, you never know what is going to “come to light”. Got a phone call from a pt that is being seen by a prescriber within the Franciscan Health System     The pt’s PCP has been reducing the pt’s opiates that the pt had been using for years in treating chronic pain caused by a incurable genetic disease.

The prescriber told the pt – NO MORE OPIATES – and showed the pt a letter the prescriber had received from the corporation’s HQ… that plainly stated that any employed prescriber found to be prescribing opiates to pts… WOULD BE FIRED…

Apparently this LARGE CORPORATE HEALTHCARE PROVIDER has decided that within their 569 different centers… chronic pain pts are PERSONA NON GRATA.

Whoever from this corporation’s HQ who come up with this decision of denial of care – and put it in writing.. apparently has never had a concern about pt abuse, denial of care, medical battery, discrimination under the Americans with Disability Act and Civil Rights Act and pt abandonment.

Not to mention the fact that this pt is probably going to be bed/chair/house confined and the pt’s spouse could experience the “loss of companionship”

Of course, is the corporation going to have any responsibility if any of these chronic pain pts commits suicide as a result of their chronic pain treatments being withdrawn ?  No telling how many pts are being impacted since this healthcare provider – according to their website – has 569 different locations… so there could be TENS OF THOUSANDS OF CHRONIC PAIN PTS that are being affected.

This is not the first corporation that I have heard about … telling their employed prescribers to stop prescribing opiates to chronic pain pts.  One pt I heard from recently, from a different hospital system, was discharged from a specialist with a “10 days supply of opiates”.. after being on around 300+ MME for several years…

 

While it highly unlikely that the DEA will intervene in these issues because they have no legal authority concerning pts not getting proper therapy… even though many of their policies and procedures are the genesis behind what is happening to chronic pain pts.

Time will tell if any law firm will step up to the plate to seek justice for those chronic pain pts that are being harmed or for the families left behind because chronic pain pts have committed suicide because of lack of pain management and can no longer stand their unrelenting pain and chose the only option that they have left to them to “silence their pain permanently”.

After all, these large healthcare corporations should have some “very deep pockets” and that is the normal target of law firms when corporations have harmed people with the products/services that they provide.

Should chronic pain pts start filing complaints with the states’ Medical Licensing Boards for prescribers failing to meet best practices and standard of care and allowing employers to dictate how they will “practice medicine”… could this be considered UNPROFESSIONAL CONDUCT.

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www.libertylawsite.org/liberty-forum/legalizing-opioids-would-dramatically-reduce-overdoses/#comments

In his Liberty Forum essay, Robert VerBruggen argues that the dramatic increase in opioid deaths in the United States over the past two decades has resulted mainly from over-selling by pharmaceutical companies and over-prescribing by physicians and other healthcare providers. As such, he concludes that policy should further restrict access to prescription opioids, while expanding access to Medication Assisted Therapies (MATs) such as methadone and buprenorphine.

I argue here that opioid overdoses occur mainly when policies are in place that restrict or outlaw opioids. The right policy is therefore legalization or at least substantially greater legal access; expanding MATs is only a small step in that direction. Legalization might increase opioid use, and legalization will not eliminate all adverse consequences from opioids. But legalization would dramatically reduce overdoses, facilitate safe use of opioids by pain patients and others, and reduce or eliminate other prohibition-induced ills such as violence, corruption, racial profiling, and civil liberties infringements.

This conclusion follows from historical and recent evidence on past restrictions and prohibitions on opioids, alcohol, and other drugs. These substances have been dangerous when illegal or highly restricted and far less dangerous—indeed, often beneficial—when legal or mildly restricted.

Prohibition makes opioids more dangerous because it forces the market underground, which inhibits normal quality control. In legal markets consumers know the potency of the drugs they purchase; they do not buy beer and receive grain alcohol or aspirin and get morphine. Similarly, if opioids were legal, consumers would not buy heroin and receive fentanyl or heroin laced with fentanyl. Legal markets provide good quality control, via several mechanisms, and therefore rarely produce accidental overdoses.

Under prohibition, however, buyers cannot sue or complain to consumer-protection agencies when a dealer sells them adulterated or mislabeled goods. Likewise, sellers cannot advertise their products against others whose drugs may be more dangerous. Canadian physician Evan Wood indicates that “simply cutting [patients] off of opioids can lead to all sorts of problems with people turning to the street and transitioning to intravenous use and, of course, with fentanyl out there in the drug supply it can be very, very, very dangerous.” Wood highlights that many users substitute harder street drugs when access to less potent opioids is cut off, yielding an increase in overdose deaths. As one recovering New Jersey addict told a reporter for nj.com, “They’re selling bags of fentanyl and calling it heroin. People are dropping like flies. People are used to using a bag or two of heroin and they’re getting straight fentanyl and it’s killing them.”

Note that even before the major crackdown on access to prescription opioids that occurred around 2010 in the United States, the increased prescribing occurred under a regime in which  access to prescription opioids was strictly limited. Thus many who began use for medical conditions were not allowed to continue use indefinitely, thereby creating a group of patients forced into the gray or black market, and into the uncertainties just described.

Prohibition also makes opioids more dangerous by encouraging drug mixing. In 2013, 77 percent of deaths involving prescription opioids involved mixing with either alcohol or another drug. If opioids are easily accessible, people tend to use the substance they desire; when access is limited, however, some consumers obtain an insufficient quantity and therefore improvise with alcohol, benzodiazepines, and other drugs. Taking these drugs together increases the risk of overdose, especially when dealing with depressants like opioids, which, according to a government document from the state of South Australia, “can cause a person’s breathing and heart rate to decrease dangerously.”

Prohibition further increases overdoses by disrupting tolerance, which makes use less dangerous as the body develops resistance to opioids’ respiratory-depressing effects. Medically, opioids neither cause organ damage nor have a dosage ceiling, in which “additional dose increases produce no change in efficacy and only cause more side effects or toxicities.”[1] If higher dosages can treat pain without damaging organs, limitations make little sense.

Worse, under prohibition users who have developed tolerance get cut off, whether by legal or  medical restrictions or by being forced into non-MAT treatment. Tolerance then declines, according to medical experts in drug rehabilitation, so users who resume use are more prone to suffer an overdose.

One study proposes that environmental factors also influence tolerance, and that “a failure of tolerance should occur if the drug is administered in an environment that has not, in the past, been associated with that drug.”[2] Therefore, prohibition may increase the chance of overdose by driving users out of their routine into unfamiliar settings in which their tolerance against the respiratory effect of opioids is diminished.

Prior to 1914 in the United States, opioids (and all other drugs) were legal, easily accessible, and commonly prescribed. Yet no opioid “crisis” or “epidemic” gripped the nation.[3] Similarly, alcohol consumption declined modestly during Prohibition in the 1920s and early 1930s[4], but deaths due to alcohol increased as adulterated, low-quality, and even poisonous versions of alcohol proliferated.[5] Thus in both cases, restrictions made use more dangerous, even if it reduced use.

More recently, Portugal decriminalized all drugs—including opioids—in 2001 and then witnessed a dramatic decline in drug-related deaths. In fact, “In 2012, they had just 16 drug-related deaths in a country of 10.5 million,” according to Justin McElroy of CBC News. Decriminalization also allowed individuals to purchase and use in safer settings and gain better access to harm-reduction resources such as needle exchanges, thus decreasing HIV and other transferable diseases.

Experience in other countries tells the same story. Between 2000 and 2005, the number of patients receiving buprenorphine, a partial opioid agonist, in France increased from 65,000 to 90,000. In this period, “the rapid spread of buprenorphine treatment in France has been associated with individual, social, and economic benefits” including “a dramatic reduction in deaths resulting from drug overdose [and] a reduction in HIV infection prevalence among [injection drug users].”[6] While the subdued euphoric effects of buprenorphine distinguish it from other opioids, this case still demonstrates how the de-stigmatization can facilitate access to medically efficacious treatments.

Compare this to the United States. Most opioids are listed by the DEA as prohibited Schedule I or Schedule II drugs. Buprenorphine and other medically efficacious alternatives are highly regulated and restricted. Yet overdoses continue to increase year after year even in the face of  heavy-handed interdiction. With fewer restrictions on methadone, buprenorphine, and other medically efficacious opioid addiction treatments, the detox process would be more accessible. VerBruggen acknowledges this point, suggesting that, “addiction medications have proven to be highly effective, if far from 100 percent so.” It is perplexing that he recognizes the benefits of allowing legal access to methadone and other MATs, but ignores this logic for other opioids. Methadone, a “very potent opiate medication,” is accepted as “safer” because it can be legally administered in a controlled setting with the contents known to the user. The same could be true for any opioid under legalization.

Prohibition proponents nevertheless argue that limiting opioid prescribing will decrease overdose deaths. VerBruggen commands that doctors “must prescribe” opioids “less often without denying relief to people who really do suffer from extreme pain.” This idealist policy prescription is a pipe dream. Take, for instance, the 2010 federal crackdown on pill mills (networks of doctors and pain clinics that prescribe high quantities of opioids and other painkillers). To limit prescribing, state legislatures passed laws limiting a doctor’s ability to dispense opioids. Concurrently, the federal Drug Enforcement Administration enhanced its efforts to raid pill mills.

Though perhaps well-meaning, these actions harm those who desire opioids for pain management. As one patient recently told a Boston radio station, providers “just do not have the medications because they have run out [of] their allocation within the first week . . . It’s just that bad where I know I am gonna end up in the ER because I don’t have my medications.” Limits on prescribing withhold medical treatment from those who need it because of the inability of sweeping regulation to discern need.

Evidence suggests that these policies have been counterproductive if the end goal is to decrease overdose deaths. A study of Proscription Drug Monitoring Programs in New York state finds that “prescription opioid morbidity leveled off following the implementation of a mandated PDMP although morbidity attributable to heroin overdose continued to rise.”[7] These results are consistent with the view that restrictions on prescribing induce substitution to more easily accessible—yet more dangerous—street drugs.

The fact that overdoses increased along with prescribing during the period before 2010 does not mean the prescribing caused the overdoses. Set aside the possibility that misreporting generated at least some of the measured trend in overdoses.[8] According to the Centers for Disease Control and Prevention, even if the increase in overdoses is entirely real, it occurred under strict restrictions on access to prescription opioids, and outright prohibition of other opioids such as heroin and fentanyl.

Since 2010, moreover, opioid prescribing has leveled off yet the opioid death rate has continued to increase, if anything at a faster rate than previously. A growing fraction of the recent deaths reflect heroin and fentanyl rather than prescription opioids. This illustrates perfectly the claim that more restrictions generate more dangerous use.[9]

Thus prescription opioids may have played a role in the deaths over this period, by increasing the number of people who would be tempted by the black market. Had the increase in prescribing occurred in a legal market, however, the vast majority of the deaths would not have occurred.

Opioid overdoses have increased substantially in the United States—this fact is undeniable. But the increased prescribing did not by itself cause the increase in overdoses; instead, restrictions on access cause overdoses by diverting consumers to the black market. If consumers could easily obtain opioids, no black market would arise, thus decreasing the violence, uncertainty of dosage, and ultimately opioid overdose deaths.

In addition to increasing overdoses, prohibition harms users and society by increasing violence and corruption, exacerbating racial discrimination, infringing civil liberties, limiting medical research and uses, and eroding respect for the law.[10] Prohibition and other restrictions also raise the costs of using opioids for those who benefit from such use, whether for medical or any other purposes.[11] VerBruggen puts forth an impassioned yet ultimately unpersuasive essay echoing the standard narrative of the opioid crisis—that prescriptions should be limited because an increase in prescriptions has caused the spike in deaths. This account fails to recognize that prohibition and associated restrictions—not prescribing per se—bear the primary responsibility for this human tragedy.

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DEA: Methamphetamine bigger threat in San Antonio than opioids

https://www.ksat.com/news/dea-methamphetamine-bigger-threat-in-san-antonio-than-opioids

SAN ANTONIO – The U.S. Drug Enforcement Administration reports methamphetamine, which is manufactured by the ton in Mexico, is pouring across the border.

“In Texas, the biggest drug threat we have right now is methamphetamine,” said Will Glaspy, DEA special agent in charge of the Houston division.

Glaspy said were it not for the opioids that plague other parts of the country, “We’d be reading about the methamphetamine crisis.” He said the product is “high purity and relatively cheap to purchase.”

Princess Frago, a 32-year-old recovering meth addict, said the drug is so cheap, some dealers even offer free samples to get people hooked or “chase the dragon,” as it’s called.

But because it’s man-made, Frago said not all meth is the same.

“It’s crazy what I’m saying, but it does bring in different demonic spirits,” Frago said.

She said she was 28 the first time her now ex-boyfriend shot her up with meth.

“I found myself doing crazy stuff,” she said.

Frago said she after walking into a major retail store, “I started putting on stuff. I felt no one was watching me. I started taking stuff.”

Rosa Medrano, a 25-year-old recovering meth addict, said she was part of the DARE Just Say No to Drugs campaign at her school. She said students were warned about meth.

She told herself, “’I would never, ever.’ Like, that’s the scariest thing.”

That changed when Medrano was 21 after seeing people still being able to function after using meth to stay awake. Medrano said the people had houses, cars and jobs, so she inhaled it for the first time.

“It wasn’t that bad at first, until I started losing control of my life and myself,” Medrano said.

Both Frago and Medrano said they used meth to cope with personal trauma in their lives, but it came at high cost.

“I lost my friends. I lost my family. I lost my kids,” Medrano said.

“I lost everybody I loved, everyone I cared about,” Frago said.

They both lived to tell their stories, unlike many who did not.

In its 2015-2016 annual report, the Bexar County Medical Examiner’s Office recorded a 92 percent increase in meth-related deaths, yet a 24 percent decrease in deaths involving heroin. That came as a surprise to Medrano.

“Actually got told you can’t die from meth, so this is news to me,” she said.

Frago said she has almost died 17 times.

“Yes, 17 times God saved me from dying, from waking up in hospitals, in bathtubs, overdoses. God was there for me,” Frago said.

They both credit Bexar County Drug Court and Judge Ernie Glenn for helping turn their lives around.

Glenn said he’s also seeing more meth cases in his courtroom.

Medrano and Frago said the court’s resources and counseling have taught them the first step toward recovery is admitting your addiction.

Frago said for many like her, it takes hitting rock bottom. Medrano said she wanted to avoid falling to that level.

Medrano hopes to open a boutique someday, and Frago wants to use her experience to become a drug counselor. 

Medical Examiner’s Office 2015 Annual Report (See page 15 for information on overdose deaths)

Medical Examiner’s Office 2016 Annual Report  (See page 17 for information on overdose deaths)

There is a legal pharmaceutical product of Methamphetamine, the original brand name was Desoxyn and it was used back in the pre 80’s period as a “diet pill”, but it still has a indication for ADD/ADHD and very few – if any – prescribers use it to treat those disease issues.

So the question has to be asked… what is the “gateway drug” that leads to abuse/addiction to this drug ? Bureaucrats and law enforcement likes to blame the legal prescribing of opiates is the direct link to our “opiate crisis”.. which there is a growing evidence that this is a fallacy.

Basic Econ 101 states that a good business results when you find a need/demand and find a way to meet it… apparently the Mexican cartels have found a UNMET NEED/WANT/DEMAND and they are producing a product that meets that.

Who is the bureaucrats going to sue to recoup their expenditures for treating these abusers/addicts ?  The CARTELS…  the STREET DEALERS ?

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Let’s let Mr. Barron DOJ- The Attorney on Dr.Tennant’s case come back from Holiday Vacation with this filling his inbox……please share in all social media..everyone please take a few minutes and send this or something better:

 

Ben.Barron@usdoj.gov

 

Dear Mr. Barron,

What exactly is your point in going after Dr.Tennant’s legitimate medical practice? He has had zero deaths, zero over-doses and zero diversion at his clinic. He has a very small practice and only takes those patients who have failed standard treatments. The patients he treats have gone through many, many different treatments and he is their doctor of last resort. Most have received treatments at the Mayo Clinic, Cleveland Clinic, Stanford, etc., and the treatments for their rare diseases and injuries failed. Some were left in worse condition after surgeries, invasive interventions including implants, spinal stimualtors, spinal epidural injections,and spinal blocks. They have tried so many treatments before coming to Dr.Tennant. Many have been severely injured trying procedures to treat their pain that failed and have been left in worse pain!

What exactly is it you are looking for?

 

 

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Indiana adopts plan to combat addiction

http://www.agrinews-pubs.com/news/overdosed-indiana-adopts-plan-to-combat-addiction/article_39f2fa40-80e1-5583-9685-67a5759dfe4c.html

INDIANAPOLIS — Opioid abuse is something that could happen to anyone.

It could be as simple as a patient becoming addicted to a painkiller that was legally prescribed to them. It could be complicated — someone seeking an escape from life’s pains, even if it means breaking the law.

Indiana’s leaders have recognized that opioid abuse prevention begins with awareness and action.

“Indiana’s opioid epidemic impacts all Hoosiers across our state in every age and socioeconomic group,” said Lt. Gov. Suzanne Crouch. “As a part of the governor’s Next Level Agenda,

we are committed to coming alongside those suffering from addiction and helping them on the path to recovery.

“We are taking this fight directly to this evil substance and those who push it, and along with our partners in the General Assembly, we are attacking the drug epidemic that is devastating our rural communities.”

Taking Action

Gov. Eric Holcomb made attacking the drug epidemic one of the five pillars of his agenda upon taking office in January.

“When it comes to taking down Indiana’s opioid crisis, we must apply every asset,” he said. “I am committed to using a comprehensive, data-driven strategy so that we can address gaps in the system and stop the current trajectory in Indiana.”

His main goals were:

• Create the position of executive director for substance abuse prevention, treatment and enforcement.

• Limit the amount of controlled substances prescriptions and refills.

• Expand local authority to establish syringe exchange programs.
• Enhance penalties for those who commit pharmacy robberies.

Holcomb appointed Jim McClelland as Indiana’s first executive director of drug prevention, treatment and enforcement.

“Hoosier communities are in jeopardy,” McClelland said. “The addiction epidemic is a very real threat to the well-being of our families, businesses, and our state’s social services and health care systems.

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https://www.forbes.com/sites/brucejapsen/2017/12/28/if-gop-cuts-entitlements-in-2018-medicare-advantage-enrollment-soars/#4a917b7b719f

Talk in Washington of entitlement reform that would include reductions in Medicare spending is almost certain to give private health insurance companies a greater role in administering the nation’s health insurance program for the elderly.

Medicare Advantage plans contract with the federal government to provide extra benefits and services to seniors, such as disease management and nurse help hotlines, with some even providing vision and dental care and wellness programs.

It’s long a tradition for Republicans when they are in control of Congress to want to hand off more business to the private sector. That happened with the Balanced Budget Act of 1997 when private insurers saw big increases in enrollment thereafter. But Medicare Advantage also had bipartisan support under the Obama administration and the Affordable Care Act of 2010 when major Medicare spending reforms were implemented. That, too, triggered more enrollment in Medicare Advantage plans.

Seniors are already moving in large numbers to Medicare Advantage plans because out-of-pocket costs tend to be larger in traditional fee-for-service Medicare. Seniors in traditional Medicare “find their 20% coinsurance responsibility more burdensome as healthcare expenses continue to increase,” L.E.K consulting said in a November report.

“Medicare cuts almost certainly mean more cost-sharing and higher deductibles for beneficiaries,” John Gorman , executive chairman of the Gorman Health Group says. “Medicare Advantage offers more benefits for lower cost, and offers an annual limit on out of pocket costs that will be even more attractive after cuts.”

Already, health insurance companies are making moves to prepare for increased enrollment in Medicare Advantage. Anthem last week closed on its acquisition of Florida’s HealthSun, which is a Medicare Advantage plan with 40,000 members. That deal came after Humana agreed to take a stake in Kindred Healthcare’s home division, which provides home health services to seniors and has significant overlap with the insurer’s Medicare Advantage membership.

And once CVS Health completes its acquisition of Aetna, the pharmacy chain and health insurer plan to roll out more programs to coordinate care for seniors in Medicare Advantage plans as a way to step up their marketing to potential customers.

Increasingly, seniors are choosing Medicare Advantage. Currently, just under 35% of Medicare beneficiaries, or about 20 million Americans, are enrolled in MA plans . But Medicare Advantage enrollment is projected to rise to 38 million, or 50% market penetration, by the end of 2025 , L.E.K. Consulting projects.

Insurers are banking on that figure. Four months before the L.E.K report, UnitedHealth Group executives predicted 50% Medicare Advantage penetration but didn’t say how soon that would happen.

“We do think there’s an opportunity to further advance the penetration of Medicare Advantage,” UnitedHealthcare CEO Steven Nelson said on the company’s second-quarter earnings call in July. “Where it can go, hard to tell, but I don’t think it’s unreasonable to think about something north of…40% approaching 50%. It doesn’t seem like an unreasonable idea to us.”

MEDICARE ADVANTAGE is the third attempt of the Feds to reduce costs for Medicare.  Their first attempt several decades ago was called Medicare HMO… it failed after about 10 yrs +/-… “extra” services started to be dropped, copays, deductibles, and premiums started to increase…  healthcare providers started dropping out of the program.. and Medicare HMO was abandoned

A decade or so later … the Feds brought out Medicare-C… with the same promises of extra services, lower copays and premiums and over a decade or so.. it followed the same path as Medicare HMO.

The latest reincarnation is Medicare Advantage… regular Medicare only uses insurance companies to process the claims for services provided Medicare beneficiaries.. the insurance companies only charge a administrative fee and are not a financial risk.

IMO, if you look at the current enrollment of Medicare Advantage I believe that you will find a very large percent of those that are on Medicare disability and those seniors who are “not too well off”..  Generally few – if any – Medicare supplements will write a policy for those on disability and some seniors cannot afford the cost of a Medicare supplement and Part D premiums.. upwards of $200 +/month for each patient..

So our bureaucrats are going to talking about turning over more – or all – of the Medicare population to FOR PROFIT insurance companies… that are going to promise more products/services for less out of pocket money for those on Medicare.

Isn’t it about time that someone DO THE MATH… you turn over healthcare to a number of FOR PROFIT health insurance companies and they are going to promise more product/services for less out of pocket costs for the Medicare beneficiaries they cover and the Feds gets to pay a flat $/person/month.

WHAT COULD GO WRONG ?

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