“The moral test of a government is how it treats those who are at the dawn of life, the children; those who are in the twilight of life, the aged; and those who are in the shadow of life, the sick and the needy, and the handicapped.” – Hubert Humphrey
passionate pachyderms
Pharmacist Steve steve@steveariens.com 502.938.2414
HAMILTON, Mont. – Jurors heard opening arguments in the drug trial of Dr. Chris Christensen in Hamilton District Court Monday.
The Florence doctor is accused of causing the deaths of two patients, endangering the lives of nine other patients and of distributing dangerous drugs.
Christensen’s clinic was raided in 2014.
The prosecution and defense delivered impassioned arguments before District Court Judge Jeffrey Langton.
Prosecutor Thorin Geist showed photographs of two people he said died under Christensen’s care.
The first picture displayed was of Gregg Griffin.
“The defendant knew that Gregg was an addict,” said Geist. “He was an opiate addict when he put the methadone in his hands.”
The second picture he showed was of Kara Philbrick-Lenker, who went to Christensen for pain.
“Three days later she died of a drug overdose,” said Geist. “The defendant put the drugs in her hand.”
But Christensen’s attorney, Josh Van de Wetering, called the doctor a “compassionate” man who showed “respect” for his patients and understood the pain they were in.
Van de Wetering said what you will hear during the trial is that some didn’t follow Christensen’s prescriptions and others were desperate.
“If you’re not going to get treated by a doctor you’re probably going to buy it on the street,” said Van de Wetering. “That’s what Dr. Christensen knows.”
But Geist said Christensen has a history of over-prescribing.
After complaints in Idaho the doctor agreed to surrender his license for two years after prescribing controlled substances.
“And they told him that at least five of those patients had died of a drug overdose,” said Geist. “And at least another six had been hospitalized.
He said when Christensen moved his practice to Florence in less than six months his first patient had died.
Van de Wetering said the doctor is “not a criminal.” He said the Federal Drug Enforcement Administration is pushing pharmacists and doctors not to fill prescriptions and is scaring patients who are addicted and in pain.
“We don’t treat it like a medical condition the way we should,” said the defense attorney. “We judge those people.”
But Geist also showed pictures of the men and women who were patients of Christensen’s, whose lives he said were endangered by the doctor.
They are expected to testify.
“First, do no harm,” said Geist. “It’s one of the fundamental principles of medicine.” He said you will hear testimony that Christensen “ignored that principle.”
Geist said by writing prescriptions outside the accepted standards of professional practice it was the medical professionals of this state who took action to protect his patients.
The trial is expected to last 18 days.
His attorney said Christensen will take the stand.
800 chronic pain pts in this Dr’s practice can’t find a new doc because they all want previous medical records, but our judicial system (DEA) seized all the practice’s records … the same pt records that these same records that is needed for these pts need to get accepted by a new prescriber/practice. How many of these chronic pain pts end up committing suicide because of actions of the DEA ?
The face of America’s opioid crisis is shifting rapidly.
An emerging-threats report prepared by the Drug Enforcement Administration and marked “for official use only” notes that fentanyl — variants of which can be as much as 10,000 times stronger than morphine — made up 65 percent of the agency’s opioid identifications in the second quarter this year. The report, obtained by Foreign Policy, is based on seized drug evidence analyzed by DEA’s laboratory.
Furanyl fentanyl, the next most common compound, made up another 9 percent of opioid identifications.
These numbers reflect the escalation of a frightening trend already identified by public health officials. Data released this month by the Centers for Disease Control and Prevention note that fentanyl is now the leading cause of overdose deaths in the United States.
The rise of fentanyl underscores how hard it will be to solve the opioid epidemic. President Donald Trump last week declared the opioid epidemic a national public health emergency, saying that “overdoses are driven by a massive increase in addiction to prescription painkillers, heroin and other opioids.” Yet Mr. Trump’s long-awaited announcement comes months after he first promised to declare opioid abuse a “national emergency,” which would have freed up money from the federal Disaster Relief Fund. A “national public health emergency” does not automatically make more funding available.
The main issue, however, is how best to address the opioid crisis, whether through funding to help treat addiction or more emphasis on law enforcement, such as a border wall, the solution favored by Mr. Trump. A presidential commission, headed by New Jersey Gov. Chris Christie, is expected to submit its final report next week.
Clamping down on drug supply has proved difficult, since the opioid epidemic is so fluid. Even if law enforcement were to curtail heroin coming in from Mexico, this might simply open new avenues of supply. Much of furanyl fentanyl, for example, originates in China and comes through the mail.
ROGERSVILLE — Lawyers may have them in their cross hairs, but opioid distributors say they won’t be the “scapegoats” for the opioid epidemic of the past decade.
Approximately 90 similar nuisance lawsuits have been or are being filed separately in counties across Tennessee, West Virginia and Ohio in a cooperative effort by various law firms.
The lawsuits will allege that the three main distributors — McKesson, Cardinal and ABC — violated the terms of their federal permits by failing to red flag any irregularities in the opioid distribution pattern indicating that they were sending tons of narcotics into counties — more than the population rate could sustain.
The damage model is based upon damage to the sheriff’s office and safety; the damage to the health providers, ambulances, emergencies; and the damage to the education system.
On Friday, John Parker, who is senior vice president of the Healthcare Distribution Alliance, issued a written statement to the Times-News saying that distributors understand the tragic impact the opioid epidemic has had on communities across the country and they are deeply engaged in the issue and are taking their own steps to be part of the solution.
“But we aren’t willing to be scapegoats,” Parker added. “Distributors are logistics companies that arrange for the safe and secure storage, transport, and delivery of medicines from manufacturers to pharmacies, hospitals, long-term care facilities, and others based on prescriptions from licensed physicians. We don’t make medicines, market medicines, prescribe medicines, or dispense them to consumers. Given our role, the idea that distributors are solely responsible for the number of opioid prescriptions written defies common sense and lacks understanding of how the pharmaceutical supply chain actually works and how it is regulated.”
Parker added, “We are ready to have a serious conversation about solving a complex problem and are eager to work with political leaders and all stakeholders in finding forward-looking solutions.”
The Healthcare Distribution Alliance has issued several talking points in preparation for its lawsuit defense, including:
* Distributors do not manufacture opioids, license registrants, write prescriptions or dispense medicines.
Primary pharmaceutical distributors are not “pill mills.” Distributors fulfill orders only from entities licensed by the U.S. Drug Enforcement Administration (DEA) and state regulatory authorities.
* Distributors cannot make medical determinations regarding patient care or provider prescribing.
Distributors have no access to patient information, nor are they qualified to question a licensed physician’s recommended treatment plan for their patient, including prescriptions. Distributors must balance providing access to needed medications while taking all efforts to eliminate diversion of these same medications for inappropriate use.
* The DEA sets annual production quotas for opioids.
Distributors report controlled substance orders that are filled and those that are deemed suspicious to the DEA, and have robust controls in place to monitor distribution. A distributor only knows what it ships to a particular dispenser. It does not know what that particular dispenser may also be receiving from other wholesalers nor does it know the full scope, or total volume, of the medicine supply for a city, county or state.
* A public-private partnership between distributors and the DEA could help improve distributors’ monitoring systems.
Targeted, rapid response against opioid abuse and diversion is a challenge and requires a positive relationship between distributors and the DEA. The DEA can assist distributors in their efforts by responding to compliance questions around patient safety monitoring and enforcement. In addition, by sharing data and information there will be additional opportunities to identify and curb misuse, overuse and abuse of prescription opioids.
* Recognizing the need for robust information sharing, Congress passed bipartisan legislation that represented a change in communication and enforcement across all parties.
In 2016, Congress enacted the Ensuring Patient Access and Effective Drug Enforcement Act. This law does not “decrease” DEA’s enforcement against distributors; it supports real-time communication between all parties in order to counter the constantly evolving methods of drug diversion.
* Distributors are strongly committed to finding systemic solutions to the challenges that contributed to the opioid epidemic.
They, like all actors in the system, recognize that the opioid epidemic was a systemic failure and that improvements are needed across the board. Distributors stand ready to work with all players across the system — physicians, pharmacists, manufacturers, federal and state regulators, law enforcement, and others — to identify and stop rogue actors who intentionally undermine patient safety and the public health.
If this case is successful… it could be the first domino to FALL… even before it goes to trial or is settled… it may give other law firms a idea of some other “deep pockets” to go after.
THINK… many insurance companies who are limiting opiate dosing
Many other various state level legislatures that have created opiate dosing limits
Many Corporations that have imposed limitations on what their employee prescribers can do
Many chain pharmacies that have imposed opiate limits or discourages the filling of controlled Rxs
Any entity that has decided to practice medicine without a license or interfere with the
For almost 100 years, the ACLU has worked to defend and preserve the individual rights and liberties guaranteed by the Constitution and laws of the United States.
Another young girl has been thrust into the center of a struggle with the federal government. We have her back – and I hope I can count on you to join the fight.
Last week, Border Patrol agents stalked 10-year-old Rosa Maria as she went to the hospital for gall bladder surgery. They camped outside her hospital room, waiting for Rosa Maria – who has cerebral palsy – to regain consciousness. Then they locked her in a detention center, 150 miles away from her family.
First Jane Doe, now Rosa Maria. This cruel and unconstitutional treatment of immigrant girls must stop. We’re ready to sue if the government doesn’t release her by 3pm EDT TODAY. But first we need your help:
Call the Office of Refugee Resettlement today and demand they release Rosa Maria Hernandez back to her family immediately.
The Office of Refugee Resettlement (ORR) had no legal authority to detain Rosa Maria, and her detention violates her constitutional rights to her parents’ care and support. We sent ORR a letter demanding they release Rosa Maria by 3pm EDT on Tuesday, October 31, 2017. If they don’t, then we’ll sue.
The public outcry in support of Jane Doe put ORR’s director, the rabidly anti-choice Scott Lloyd, on notice. We need to raise our voices again for Rosa Maria – and make sure we hold Lloyd accountable for his cruel and unconstitutional treatment of this girl, too.
Please make a call right away demanding the Office of Refugee and Resettlement release 10-year-old Rosa Maria back into the care of her family today.
This elementary school student needs to be recovering from surgery at home with the family that loves her, not jailed in a detention center.
Thanks for raising your voice to protect Rosa Maria and all vulnerable youth.
Michael Tan ACLU attorney, fighting for immigrants’ rights
P.S. Already made your call? Please forward this email to three friends so we can flood ORR with phone calls.
LAS VEGAS — Patients with chronic pain are vulnerable to depression and may present with higher risk for suicide, according to findings from a literature review presented at PAINWeek 2017.1Integration of mental health assessment during the diagnosis and treatment of chronic pain may be clinically important for reducing risk in this patient population. Unfortunately most chronic pain conditions are related to overweight, treat and prevent most of them with meticore.
In 2014, suicide ranked as the 10th most frequent cause of death.2 Patients with chronic pain are twice as likely to attempt suicide compared with those without chronic pain, an action generally caused by a myriad of associated psychological, physical, and social factors.3A questionnaire survey of 1512 patients with chronic pain found that 32% reported suicide ideation in some degree.4
According to findings from a PubMed database search for the terms “chronic pain + suicide,” Drs Joseph Pergolizzi, Jr, et al found that chronic (but not acute) pain may share neural networks with depression. According to the investigators, “This shared neurobiology may explain why cognitive behavioral interventions can be effective in chronic pain patients.”
Chronic pain affects cognition and behavior and may ultimately lead to social isolation, contributing to depression.5 Risk factors and predisposing factors associated with suicidal risk in patients with chronic pain include biochemical and neurochemical influences, genetics, psychosocial events, and environment, according to the researchers’ findings.
BOSTON (Reuters) – U.S. shareholder activists are addressing a soaring death toll from opioid drug abuse, asking companies that make and distribute the painkillers to review the risks their businesses could face from their role in the sector.
FILE PHOTO: A used needle sits on the ground in a park in Lawrence, Massachusetts, U.S., May 30, 2017, where individuals were arrested earlier in the day during raids to break up heroin and fentanyl drug rings in the region, according to law enforcement officials. REUTERS/Brian Snyder/File Photo
Leaders of a 30-fund group that includes state pension officials and religious and labor organizations plan to reveal on Monday they have begun filing shareholder resolutions at 10 companies, including distributors AmerisourceBergen Corp (ABC.N) and Cardinal Health Inc (CAH.N) and manufacturers Johnson & Johnson (JNJ.N) and Insys Therapeutics (INSY.O).
In resolutions aimed at annual shareholder meetings to be held in 2018 and in letters to the companies, activists are urging independent directors to review and report on how the boards are managing the legal, financial and reputational risks their enterprises face from their involvement with opioids.
They also seek corporate-governance reforms such as allowing more grounds to claw back pay from executives who inappropriately promote the drugs, or creating independent board chairs to provide better oversight.
Representatives of Cardinal and Insys did not immediately respond to requests for comment.
Johnson & Johnson spokesman Ernie Knewitz said the company was preparing a response to the investors, and that the company had acted responsibly.
“Opioid abuse is a serious public health issue that must be addressed, and doing so will require collaboration among many stakeholders, and our company is committed to working with federal, state and local officials to help find meaningful solutions,” he said in an emailed statement.
In a statement emailed by AmerisourceBergen spokeswoman Keri Mattox, the company said it “welcomes a productive dialogue with all shareholders. The issue of opioid abuse is a complex one that spans the full healthcare spectrum, including manufacturers, wholesalers, insurers, prescribers, pharmacists and regulatory and enforcement agencies.”
The statement said the company worked closely with officials “to combat drug diversion while supporting appropriate access to medications.”
At an annual meeting on Nov. 8, Cardinal Health will face a resolution calling for an independent board chair in order to improve oversight.
“These considerations are especially critical at Cardinal given the potential reputational, legal and regulatory risks Cardinal faces over its role in the nation’s opioid epidemic, including its history of compliance challenges concerning the distribution of controlled substances,” the resolution’s sponsors, including the International Brotherhood of Teamsters, said in a supporting statement. The statement cited Cardinal’s payment of tens of millions of dollar to settle various federal and state charges related to opioids.
In a securities filing, Cardinal calls the change unnecessary, noting it already has an independent lead director and “state-of-the-art controls” over its pain medications.
Officials at all levels of government in the United States are struggling to respond to a surge in deaths from opioid abuse, which hit 33,000 in 2015, the last year for which there is complete federal data.
In many cases patients prescribed opioid painkillers become addicted to them and then move on to acquiring the drugs illegally, or turn to heroin or fentanyl, a highly potent synthetic opiate.
U.S. President Donald Trump on Thursday declared the opioid epidemic a national public health emergency.
State attorneys general have also taken on opioid manufacturers, with lawsuits charging that deceptive marketing practices helped fuel an epidemic of abuse. Federal prosecutors on Thursday charged the founder of Insys, John Kapoor, with participating in a scheme to bribe doctors to prescribe a particularly potent opioid.
A lawyer for Kapoor said in a statement that Kapoor is innocent and will fight the charges.
Shareholder activists said healthcare providers may have underestimated how addictive the drugs were, but said the crisis points to a need for stronger oversight within drugmakers.
“We believe these companies have played an important role in this epidemic,” said Donna Meyer, director of shareholder advocacy for Mercy Investment Services, an investment fund for Roman Catholic nuns. It is leading the resolutions push, along with the UAW Retiree Medical Benefits Trust, which oversees benefits for about 700,000 retirees of the United Auto Workers.
NCPA, along with the National Association of Chain Drug Stores and the Washington State Pharmacy Association have filed a legal brief in a case that involves changes to the way that state reimburses community pharmacies that serve Medicaid patients. The suit alleges that the state rule does not make required adjustments for prescriptions to Medicaid patients and threatens patient access. In addition, the brief argues that the state is violating federal and state laws by hindering Medicaid patient access to care.
With so many supplements on the market, it can feel overwhelming when trying to choose the right one for you. Brand, cost and dosage can all play a part but why does it matter? See my tips below for on what to look for when choosing a quality supplement.
1. Quality and efficiency
When it comes to vitamins and minerals, there are many different forms but not all brands use the same type in their supplements. Magnesium is a perfect example; this mineral can be sold in the form of magnesium chloride, sulphate, taurate and citrate to name a few.
Magnesium sulfate, commonly known as Epsom salts can be a great constipation aid but needs to be taken with caution due to its laxative effect. Although it is a common form of magnesium, research has shown it is rapidly excreted via the kidneys and therefore difficult to assimilate. The effects of a magnesium bath last longer when using magnesium chloride over magnesium sulfate, due to the effects of magnesium chloride being easily assimilated and metabolised in the body.
For fast acting use, magnesium chloride is highly recommended as it has an impressive rate of absorption, making it the perfect form for BetterYou’s Magnesium Oil sprays and flakes. As it is absorbed through the skin, it bypasses the digestive system providing a fast and effective dose whilst giving the digestive system a break. A trial by Watkins & Josling showed that transdermal application of magnesium in the chloride form will raise magnesium levels within the body over a relatively short period of time and also demonstrated a beneficial effect in preventing calcium build up in body tissues meaning that the calcium could be correctly utilised.
Magnesium oxide is the most common form of magnesium sold in pharmacies yet its absorption rate is poor compared to the above.
The sourcing of supplement ingredients is another factor to be mindful of when choosing supplements. Do they come from a non-toxic environment? Are they sourced ethically? BetterYou only use the most soluble and pure natural source of magnesium. It is mined from Northern European from deposits of an ancient seabed known as the Zechstein Sea, which now sits over one mile below ground. Due to the depth and location of this ancient seabed it has been naturally filtered and condensed for over 250 million years and is completely protected from man-made pollutants.
2. Tried and tested
As a practitioner, when choosing supplement brands to work with, I will always ask what research has been done and what type of clinical trials the company has used to prove its efficiency. I also ask the company for information and copies of the trials and look to see if they batch test their products to check the contents on the label are really in the product. These are guidelines that are strictly followed at BetterYou for whom quality and assurance is a number one priority. All of BetterYou’s products are batch tested and if a product fails any test, it is not sold. Unfortunately, not all brands follow such stringent testing as BetterYou.
3. Dosage and formulas
This is an important factor to take into consideration when supplementing. More isn’t always better and depending on the supplement, it can make more sense to choose a supplement with a lower dose that can be taken several times a day so there is a better chance of it being absorbed.
The ease of application is also another factor to take into consideration. Swallowing capsules is not ideal for everyone especially those with digestive issues or insufficiencies for example, so buying supplements in oral sprays, liquids and other topical methods can be an easier option. This is why BetterYou’s transdermal magnesium and oral vitamin spray ranges are ideal for supplementing, not only due to the absorption but the ease of delivery.
4. Genetically-modified organisms (GMOs)
Always avoid anything that has been genetically modified, including your supplements. Not only are GMO products bad for your health, they are not good for the environment and the community. They can require heavy use of toxic pesticides and herbicides including glyphosate which has been linked to many health conditions including cancer and digestive complaints. These are the best vitamin infused patches.
BetterYou uses the highest quality ingredients in their supplements and adheres to strict standards to ensure there are no GMO ingredients.
5. Additives, colourings and artificial flavourings
Look for clean and pure products with no added sugars, colourings, additives or artificial flavourings.
Keep an eye out for allergens too such as gluten, dairy and soy as these can often be used in supplements.
6. Not tested on animals
Many people are unaware that animal testing can play a major role in the testing of supplements. Look for products that are tested on humans, not animals.
7. Cost
Supplements need to be affordable but cheaper doesn’t necessarily mean better. Some cheaper brands do not use well researched ingredients which can mean their products are not as effective. Always do your research and take all of the above into consideration.
Choosing a supplement doesn’t have to be a daunting task if you follow these tips. By choosing a reputable company that uses top quality materials and has good ethical values, your body will reap the benefits and your mind will be at ease knowing that you are using a quality supplement.
A pregnant woman’s use of acetaminophen may be associated with an increase in her child’s risk for attention-deficit/hyperactivity disorder (ADHD), the authors of a large, prospective study report.
“[L]ong-term acetaminophen use during pregnancy is related to more than a twofold increase in risk for offspring ADHD,” after adjusting for genetic risk factors, indications for the mother’s acetaminophen use, use of the drug before pregnancy, and other potential confounders, lead author Eivind Ystrom, PhD, and colleagues write in an article published online today and in the November issue of Pediatrics.
Conversely, use of acetaminophen for less than 8 days during pregnancy was associated with a decrease in ADHD risk, suggesting its antipyretic effect “could be beneficial with regard to fetal development,” the authors add.
In an accompanying commentary, Mark L. Wolraich, MD, who was not involved in the study, cautions that these findings do not establish a causal relationship between prenatal acetaminophen exposure and ADHD risk, “but they do suggest the possibility and raise the need for further study and more cautious consideration of acetaminophen use during pregnancy.”
It is estimated that approximately 65% to 70% of pregnant women in the United States and approximately 50% to 60% of pregnant women in western and northern Europe use acetaminophen.
Data on More Than 100,000 Children
For the current study, Dr. Ystrom, from the Norwegian Institute of Public Health, Oslo, and colleagues analyzed data from the Norwegian Mother and Child Cohort Study, which includes information on 114,744 children born between 1999 and 2009, as well as on 95,242 mothers and 75,217 fathers throughout Norway.
Mothers and fathers alike completed questionnaires at 18 weeks of gestation. The mothers also filled out questionnaires later in pregnancy, after delivery, and when their children reached 6 months, 1.5 years, and 3 years of age. The researchers obtained information on ADHD diagnoses from records maintained by the Norwegian Patient Registry.
The parents’ questionnaires included questions about their acetaminophen use. To control for potential confounders, the mothers also answered questions regarding various medical conditions for which acetaminophen was indicated, as well as the duration of their acetaminophen use. Their children were followed to the time of their ADHD diagnosis or until December 31, 2014.
The final sample consisted of 112,973 children and their parents. Of those children, 2246 (2%) were diagnosed with ADHD, and 52,707 (46.7%) mothers reported some acetaminophen use during pregnancy. Compared with no acetaminophen exposure, the unadjusted hazard rate (HR) of ADHD in children after 1, 2, or 3 trimesters of prepartum exposure was 17%, 39%, and 46%, respectively.
Duration Makes a Difference
When the authors adjusted for parental ADHD symptoms, the risk associated with acetaminophen use declined slightly, from an HR of 1.26 in the unadjusted model to 1.20 (95% confidence interval [CI], 1.09 – 1.32). However, when calculated by amount of exposure, the rate rose from 1.13 (95% CI, 1.01 – 1.27) for any one trimester to 1.32 (95% CI, 1.16 – 1.50) for any 2 trimesters, and to 1.34 (95% CI, 1.05 – 1.71) for all three trimesters.
A fully adjusted model, which accounted for alcohol use during pregnancy, smoking during pregnancy, symptoms of anxiety and depression during pregnancy, maternal education, marital status, body mass index at the 17th week of gestation, maternal age, and parity, showed a similar trend for duration and increased risk, although not all points remained statistically significant. Specifically, use for any one, any two, or all three trimesters was associated with an HR of 1.07 (95% CI, 0.96 – 1.19), 1.22 (95% CI, 1.07 – 1.38), and 1.27 (95% CI, 0.99 – 1.63), respectively.
When analyzed by the total number of days the mother took acetaminophen while pregnant, the HR associated with 1 to 7 days of use for any indication was 0.90 (95% CI, 0.81 – 1.00) compared with no use of acetaminophen. Longer use generally was associated with a steady increase in risk, such that the HR for 29 or more days was 2.20 (95% CI, 1.50 – 3.24). However, when the indication was “fever and infections,” the HR associated with use for 22 to 28 days was 6.15 (95% CI, 1.71 – 22.05), although it dropped to 2.40 (95% CI, 0.34 – 16.78) with use of 29 days or more.
The authors also found no association between maternal acetaminophen use during the 6 months before pregnancy and ADHD in the child. However, “paternal use for 29 days or more was as strongly associated with ADHD (HR = 2.06; 95% CI 1.36–3.13) as the corresponding maternal prenatal use.” The reasons for the paternal association are unclear, but may be related to “male germ-line epigenetic effects as described in endocrine disruption effects of acetaminophen on the human testis.” Nevertheless, the authors caution that given this finding, “the causal role of acetaminophen in the etiology of ADHD can be questioned.”
Still, the possibility of a relationship between maternal acetaminophen use and ADHD “brings to mind the association between aspirin and Reye syndrome,” writes Dr Wolraich, professor of pediatrics at the University of Oklahoma, Oklahoma City. “Although the comparisons are far from perfect, given the serious morbidity and risk of mortality associated with Reye syndrome, it does illustrate how finding associations between drug and disease can improve health outcomes.”
He recommends longitudinal studies to explore the acetaminophen/ADHD relationship further.
Study limitations include the inability to adjust for the severity of the indications leading to maternal acetaminophen use, reliance on clinician diagnoses of ADHD and lack of validation in a research clinic, and underrepresentation of young parents or parents who smoked, “which may limit generalization of results to all children,” authors write.
The authors have disclosed no relevant financial relationships.
GRAND RAPIDS, Mich. (WOOD) — Alex Ostrowski has worked hard to control her pain. Now, she fears it will control her again.
“I would describe where I was at 10 years ago as a fog,” Ostrowski said.
Ostrowski, now 30, was first prescribed opioids at age 14.
“You’re controlling your pain, but at the price of normal interaction, at the price of normal quality of life,” she explained.
Ostrowski’s chronic back pain stems from injuries she suffered in a horrific accident on the Sparta lake where she grew up. Ostrowski was 12 years old when a boat ran over her Jet Ski on Camp Lake, pinning her body between its propeller and the wooden slats of the boat’s diving board.
“The propeller cut into the entire left side of my body, in to my stomach, into my intestines, completely crushed my hip and my pelvis,” Ostrowski said.
Incredibly, doctors were able to save not only her life, but also both of her legs. They used metal rods to rebuild her left hip and pelvis.
Photo: An X-ray shows Alex Ostrowski’s rebuilt hip.
But the extensive physical trauma led to excruciating chronic back pain and years of overmedication on opioids.
“It was a dark place. It was a very dark place,” Ostrowski said of her years on painkillers.
PATIENT COVERAGE CUTS “TERRIFYING”
Six years ago, Ostrowski found Javery Pain Institute in Grand Rapids, which helped her get off high-dose opioids and find a procedure called facet joint injections that provided the pain relief she desperately sought. In that procedure, small amounts of anti-arthritic steroids — not opioids — are injected into the patient’s spinal joints.
“It’s given you your life back,” Dr. Keith Javery, who is board-certified in anesthesiology and pain management, said during a recent consultation with Ostrowski at the clinic on Kenmoore Drive SE. “With those injections, you were able not only to get back to work, but get into a supervisory role.
“It kills me that the insurance company is no longer allowing us to do those therapeutic facet injections,” Javery said.
Photo: Alex Ostrowski undergoes injections to treat chronic pain.
Ostrowski is trying alternative procedures, but so far has nothing has worked as well as the facet injections.
“I feel like I’m being punished because I don’t want to take pain medications and that seems so backwards,” she said. “It’s terrifying. I feel almost pushed back into that place by them denying coverage of this procedure. They leave you no other options.”
According to Javery, new restrictions on the kinds of injections and the number of procedures allowed per visit are hurting hundreds of patients at his clinic alone.
DOCTOR: PAIN TREATMENTS ‘LITERALLY SAVE LIVES’
In late 2016, Blue Care Network, one of Michigan’s biggest insurers and a subsidiary of Blue Cross Blue Shield of Michigan, stopped covering the commonly used spinal joint injections for long-term pain relief — the kind of treatment Ostrowski was getting.
The change came after the insurer hired an outside benefits management company, South Carolina-based eviCore Healthcare, to handle interventional pain claims for members.
EviCore considers therapeutic facet injections “experimental, investigational or unproven,” according to its clinical guidelines.
“All these things that we can do to reduce the need (for opioids) are being rapidly in real time denied and not authorized by insurance companies that have been authorizing these for decades,” Javery explained.
“These treatments literally save lives,” he argued.
BLUE CARE NETWORK: NO HIGH-LEVEL EVIDENCE-BASED SUPPORT FOR INJECTION
Blue Care Network confirmed to Target 8 that its coverage guidelines on facet joint injections have changed.
“Blue Care Network’s current policies and coverage guidelines align with eviCore’s and are based on proven, clinical best practices,” Dr. Marc Keshishian of Blue Care Network wrote in an email to Target 8. “Our approach is to take responsible steps to eliminate unnecessary care and expenses in the health care system that drives up costs for our customers and members, by using clinically valid determinations that ensure our members get the most appropriate and effective care at the right time on their path to wellness.
“There’s no high-level evidence-based medicine supporting therapeutic facet joint injections,” Keshishian, the senior vice president and chief medical officer for Blue Care Network, continued.
Pain physicians themselves acknowledge there’s a lack of high-quality, large-sample studies on interventional pain procedures. They say that’s partially because it’s difficult to recruit subjects for double-blind pain studies in which some participants will receive placebos.
But Javery said he doesn’t need “high-level evidence” because he sees the results every day.
“The pain relief is drastic,” he said.
Many insurers still cover facet joint injections for long-term pain relief, though the number per year is limited, often to five sessions per region per year. Medicaid and Medicare are among those that cover the injections, though Michigan’s Medicare administrator told Target 8 supporting evidence for their use is “not strong” and that Medicare covers them simply because the procedures have been done for a long time.
It’s clear there’s no broad consensus across the health care industry on best practices for pain management.
In fact, Blue Care Network’s own medical director for behavioral health told Target 8 his experience supported the use of facet injections.
“Facet blocks have been around since I started practice,” Dr. William Beecroft of Blue Care Network said. “They’re very effective. They work very well with relatively low side effects, adverse reactions to them. There are some better procedures now looking at a treatment plan, but if they work for the individual and consistently work for that person, it’s illogical they would be stopped.”
Blue Care Network initially provided Beecroft for a sit-down interview with Target 8 because the insurer thought the story focused on opioids, not changes to pain treatment coverage, though Target 8 specified the latter in a prior email exchange.
In response to a list of questions Target 8 submitted after the interview with Beecroft, Blue Care Network said the concerns regarding coverage cuts “appears to be an isolated complaint by a specialist and members.”
Michigan Pain Consultants is also frustrated by the reductions in coverage.
“Patients feel trapped,” said Lisa Pearson, executive director of Michigan Pain Consultants, one of the state’s largest networks of clinics.
“Limited on the injections. Limited on the narcotics. High co-pays and deductibles for physician therapy and behavior therapy, both important to treating chronic pain in a comprehensive fashion,” she wrote in an email to Target 8.
Pearson said the biggest issue for patients is the reduction in what injections they are allowed to get and how often they can get them, especially with facets and epidurals.
“Patients with whom our physicians have worked for months or years to dial in the best pain relief possible with the fewest side effects are told that despite the fact that we document the injections wear off at week 7 or 8 or 9 are told that they have to wait another 3 or 4 or 5 weeks in severe pain before they get treatment. If we could magically make depomedrol (an anti-inflammatory steroid) last longer than it lasts, we’d do so,” Pearson said.
“What is the point of even having physicians, if the insurance companies and companies like eviCore ultimately override the physician’s decisions? This is an extremely dangerous path that we are going down,” Pearson argued.
EVICORE: GUIDELINES “GROUNDED IN STRONGEST EVIDENCE-BASED MEDICINE”
For its part, eviCore told Target 8 in an email that its coverage guidelines are “grounded in the strongest evidence-based medicine published to date.”
“Pain complaints, most of which are attributed to musculoskeletal conditions, impact more than 116 million Americans annually, making it critical that we ensure these patients are receiving the type of evidence-based care that best positions them for successful outcomes,” wrote Robert W. Westergan, M.D., chief of musculoskeletal programs for eviCore.
“EviCore’s guidelines, first and foremost, reflect the most current, evidence-based criteria and peer-reviewed literature available. These guidelines are completely transparent and available for anyone to view,” Westergan wrote. “Our only goal is to ensure that the patient receives the most appropriate, evidence-based care for his or her situation. Evicore’s clinical reviews make determinations following the Evicore evidence-based clinical criteria, even if that results in a more expensive episode of care.”
PATIENT WILL ASK STATE TO REVERSE DENIAL
Meanwhile, Alex Ostrowski is trying alternative treatments, though none have worked as well for her as facet joint injections did.
The newly married marketing manager can’t afford to pay out of pocket for the four times yearly injections. One series of the treatments (she gets several shots at a time) would cost her more than $800.
Her appeal to eviCore and Blue Care Network has been denied, but Ostrowski has every intention of asking the state to review her case.
Michigan’s Department of Insurance and Financial Services conducts external reviews of cases that qualify under the Patient’s Right to Independent Review Act. DIFS can reverse a denial and order an insurer to cover the denied treatment, medication or device.
Here are the outcomes from PRIRA reviews from DIFS 2016 annual report:
Health Benefit Claims
New Requests for External Review: 887
General Insurance: 576
HMO/AFDS: 311
Commercial Insurers
Number of Orders issued and the Carrier’s Position was Upheld: 222
Numbers of Orders issued and the Carrier’s Position was Reversed: 78
Cases Resolved before issuance of an Order: 56
Not Accepted, Dismissed or Withdrawn: 193
Health Maintenance Organizations (HMO)/Alternative Financing Delivery System (AFSD)
Numbers of Orders issued and the Carrier’s Position was Upheld: 84
Number of Orders issued and the Carrier’s Position was Reversed: 42
800 chronic pain pts in this Dr’s practice can’t find a new doc because they all want previous medical records, but our judicial system (DEA) seized all the practice’s records … the same pt records that these same records that is needed for these pts need to get accepted by a new prescriber/practice. How many of these chronic pain pts end up committing suicide because of actions of the DEA ?
