Hurricane Harvey Emergency Dispensing of Prescription Medications

Governor Greg Abbott has declared a state of disaster in the following counties: Aransas, Austin, Bee, Calhoun, Chambers, Colorado, Brazoria, DeWitt, Fayette, Fort Bend, Galveston, Goliad, Gonzales, Harris, Jackson, Jefferson, Jim Wells, Karnes, Kleberg, Lavaca, Liberty, Live Oak, Matagorda, Nueces, Refugio, San Patricio, Victoria, Waller, Wharton and Wilson.

The laws and rules governing the practice of pharmacy in Texas, allow pharmacists to provide emergency refills when the prescriber cannot be reached. Specifically, in an emergency, a pharmacist may use his/her professional judgment in refilling a prescription drug order for a drug (other than a Schedule II controlled substance) provided failure to refill the prescription might result in an interruption of a therapeutic regimen or create patient suffering.

In most cases, pharmacists may not dispense more than a 72-hour supply of medication. However, in the event of a natural or manmade disaster, the Texas Pharmacy Act (Sec. 562.054) and board rule 291.34 allow a pharmacist to dispense up to a 30-day supply of a prescription drug, other than a Schedule II controlled substance, without the authorization of the prescribing practitioner if:

 failure to refill the prescription might result in an interruption of a therapeutic regimen or create patient suffering;  the natural or manmade disaster prohibits the pharmacist from being able to contact the practitioner; the governor has declared a state of disaster under Chapter 418, Government Code; and the board, through the executive director, has notified pharmacies in this state that pharmacists may dispense up to a 30-day supply of a prescription drug.

Accordingly, Gay Dodson, R.Ph., Executive Director/Secretary, has authorized ALL pharmacists in Texas to dispense up to a 30-day supply of medication (other than a II controlled substance) for patients affected by Hurricane Harvey. Board rule 291.34(b)(8)(E) outlines the procedures for dispensing medication in emergency situations as follows:

§291.34 Records

(b) Prescriptions. (8) Refills. (E) Natural or manmade disasters. If a natural or manmade disaster has occurred that prohibits the pharmacist from being able to contact the practitioner, a pharmacist may exercise his professional judgment in refilling a prescription drug order for a drug, other than a controlled substance listed in Schedule II, without the authorization of the prescribing practitioner, provided: (i) failure to refill the prescription might result in an interruption of a therapeutic regimen or create patient suffering; (ii) the quantity of prescription drug dispensed does not exceed a 30-day supply; (iii) the governor has declared a state of disaster; (iv) the board, through the executive director, has notified pharmacies that pharmacists may dispense up to a 30-day supply of prescription drugs; (v) the pharmacist informs the patient or the patient’s agent at the time of dispensing that the refill is being provided without such authorization and that authorization of the practitioner is required for future refills; (vi) the pharmacist informs the practitioner of the emergency refill at the earliest reasonable time; (vii) the pharmacist maintains a record of the emergency refill containing the information required to be maintained on a prescription as specified in this subsection; (viii) the pharmacist affixes a label to the dispensing container as specified in §291.33(c)(7) of this title; and (ix) if the prescription was initially filled at another pharmacy, the pharmacist may exercise his professional judgment in refilling the prescription provided: (I) the patient has the prescription container, label, receipt or other documentation from the other pharmacy that contains the essential information; (II) after a reasonable effort, the pharmacist is unable to contact the other pharmacy to transfer the remaining prescription refills or there are no refills remaining on the prescription; (III) the pharmacist, in his professional judgment, determines that such a request for an emergency refill is appropriate and meets the requirements of clause (i) of this subparagraph; and (IV) the pharmacist complies with the requirements of clauses (ii) – (viii) of this subparagraph.

Notice that the TX BOP is concerned about ...interruption of a therapeutic regimen or create patient suffering... but this does not apply to pt that have a medical necessity of C-II’s.. So those pts with ADD/ADHD and/or chronic pain… will just have to deal with the flooding, loss of home, finding food/water… while the chronic pain pts may also have to deal with cold turkey withdrawal and all the physical symptoms of withdrawal..

“..In most cases, pharmacists may not dispense more than a 72-hour supply of medication. However, in the event of a natural or manmade disaster, the Texas Pharmacy Act (Sec. 562.054) and board rule 291.34 allow a pharmacist to dispense up to a 30-day supply of a prescription drug, other than a Schedule II controlled substance, without the authorization of the prescribing practitioner if:

 failure to refill the prescription might result in an interruption of a therapeutic regimen or create patient suffering..”

Filed under: General Problems | 4 Comments »

More DENIAL OF CARE by a Pharmacist “floater” on a existing chronic pain pt

IMG_8234     CLICK ON Link to play video 

Filed under: General Problems | Leave a Comment »

I-Team: The Opioid Conundrum

http://www.lasvegasnow.com/news/i-team-the-opioid-conundrum/803064908

VIDEO ON ABOVE LINK

LAS VEGAS – Nightly newscasts across the country are filled with stories about the opioid epidemic — the opioid crisis. Tens of thousands of Americans who die each year are found with opioids in their systems, and so government at every level has stepped in to put limits on otherwise legal medications, including here in Nevada.

For millions of chronic pain patients, the crackdown has been a nightmare. They are the forgotten victims in the opioid debate.

Approximately 50,000 people a year die with opioids of one kind or another in their systems. The number you don’t hear is this one — there are as many as 25 million Americans who suffer with chronic pain. For many of them, opioid medication means the difference between leading somewhat normal lives, or surviving in constant agony.

These are not the people who O.D. on heroin or mix drugs with booze. For the most part, they suffer and die in silence.

“It was like, for the first time in my life, I wasn’t in pain anymore. I felt great for a couple of years and then they started this total crackdown,” said Gary, a chronic pain patient, who asked that his real name not be used.

Gary’s life changed when his spine was shattered in a rollover accident. After several operations, his doctors prescribed opioids and he was able to lead a somewhat normal life, even as the discs in his back crumbled further. But then the opioid crisis blew up. His prescriptions were cut in half and it became tougher to find a pharmacy that would fill them.

“I’d have to drive to 10 to 12 pharmacies just to get four prescriptions filled. Just to fill them,” he said.

Reporter George Knapp: “And they look at you like…”
Gary: “Yeah, like you’re a criminal.”

“The only ones who understand chronic pain are the ones who have chronic pain. When you have chronic pain, it’s on your mind all the time,” said Jeremy, a chronic pain patient, who asked that his real name not be used.

Jeremy is a self-employed business professional whose work requires him to both drive and walk daily. A skiing accident and later a hip replacement led to sharp, constant pain over half his body. He tried various surgeries, therapies, and medications but nothing worked until a time-released pain med called oxycontin was developed.

“You can go to work and function and chronic pain patients don’t get high off of oxycontin. It just alleviates their pain and allows them to function,” he said.

The opioid crisis has meant significant reductions in the amounts that can legally be prescribed for Jeremy, Gary, and pretty much every other chronic pain patient. Contrary to what their doctors recommend, their medications have been reduced by half, sometimes more. And they’ve been told, more reductions are likely.

For millions of people, the consequences have been immediate and drastic. They can’t sleep, can’t work, lose their jobs. Some decide to put an end to the constant pain by taking their own lives.

“People are dying. People are committing suicide right now because their doctor tapered them down involuntarily off opioid medications,” said Rick Martin.

He has seen it from both sides. He spent decades working as a pharmacist, and even though he has chronic pain from a deteriorating spine and hip, with medication, he continued to work and could also pursue his passion — landscape photography.

“I used to be able to do stuff by myself, but I can’t do that anymore.”

Chronic pain patients like Rick follow their doctor’s instructions, undergo monthly drug screenings and urinalysis and have become collateral damage in the opioid crisis. Most of the publicity has focused on overdose deaths among people who obtain opioids illegally, mix them with booze or other drugs including heroin. 

The CDC, DEA, and various opioid task forces have responded to deaths caused by illicit drugs by cutting back on legally prescribed medications, the same drugs that make life bearable for millions with chronic pain.

Insurance companies have slashed coverage, and pharmacies now operate under strict quotas, to the point they won’t fill prescriptions for new patients, even those fresh out of surgery. Opioid prescriptions have actually declined significantly in each of the last three years, yet opioid deaths keep rising.

“The unintended victims are the senior citizens. If they can’t get their medications, they aren’t going to go buy heroin and shoot it and die of a heroin overdose. they’re going to suffer,” Jeremy said.

So, how do we explain that while legal prescriptions keep dropping, opioid deaths keep rising? It isn’t a simple issue, though politicians have seized on it as a winner. Cracking down on drugs is a tried and true political strategy, even though enforcement has never worked as a solution to drug abuse.

In the coming months, 8 News NOW will be looking beyond the obvious rhetoric about various opioid issues. As part of this project, we’d like your input. We’ve created a page where opioid patients, pain doctors, pharmacists, families of O.D. victims can share stories, either publicly or privately.

Filed under: General Problems | 3 Comments »

Filed under: General Problems | 1 Comment »

Nurse Arrested After Protecting Patient From Blood Draw

http://www.medscape.com/viewarticle/885157

Video images released Thursday show a Utah nurse screaming while being arrested for refusing to allow an officer to draw blood from an unconscious patient.

According to the Salt Lake Tribune in Salt Lake City, the images came from officers’ body cameras and University Hospital burn unit footage and were released in a news conference.

The video shows that after the nurse, Alex Wubbels, explained to Salt Lake Police Detective Jeff Payne that, according to the hospital’s policy, the police needed a warrant or consent from the patient or had to put the patient under arrest before she could allow a blood draw, she was handcuffed and shoved into a patrol car while she screamed, “Help! Help! Somebody help me! Stop! Stop! I did nothing wrong!” She was not charged, but several news reports indicated she was in the patrol car about 20 minutes.

In the video, Payne acknowledges that none of those three conditions had been met but says he still has the authority to take the blood.

According to the Tribune, Payne wrote in a report that he was carrying out a request from Logan police to draw the sample to check whether it showed the patient had illicit substances in his blood at the time of the crash.

In a videotaped statement after the incident, Wubbels said, “The only job I have as a nurse is to keep my patients safe. A blood draw just gets thrown around like it’s some simple thing. But blood is your blood, that’s your property.”

The Washington Post reports, “Wubbels was right. The U.S. Supreme Court has explicitly ruled that blood can only be drawn from drivers for probable cause, with a warrant.”

Today the American Nurses Association (ANA) released a statement expressing outrage and is “calling for the Salt Lake City Police Department to conduct a full investigation, make amends to the nurse, and take action to prevent future abuses.”

“It is outrageous and unacceptable that a nurse should be treated in this way for following her professional duty to advocate on behalf of the patient as well as following the policies of her employer and the law,” said ANA President Pam Cipriano, PhD, RN.  

The encounter is now the subject of an internal investigation by the police department, the Tribune reported.

According to the Washington Post, Salt Lake police spokesman Sgt. Brandon Shearer told local media that Payne was suspended from the department’s blood draw unit but is still on active duty.

Filed under: General Problems | Leave a Comment »

CVS Accused Of Revealing HIV Status Of 4,000

Ohio Customershttps://consumerist.com/2017/08/31/cvs-accused-of-revealing-hiv-status-of-4000-ohio-customers/

Filed under: General Problems | Leave a Comment »

Report of the Special Rapporteur on torture and other cruel, inhuman or degrading treatment or punishment
Juan E. Méndez

Summary The present report focuses on certain forms of abuses in health-care settings that may cross a threshold of mistreatment that is tantamount to torture or cruel, inhuman or degrading treatment or punishment. It identifies the policies that promote these practices and existing protection gaps. By illustrating some of these abusive practices in health-care settings, the report sheds light on often undetected forms of abusive practices that occur under the auspices of health-care policies, and emphasizes how certain treatments run afoul of the prohibition on torture and ill-treatment. It identifies the scope of State‟s obligations to regulate, control and supervise health-care practices with a view to preventing mistreatment under any pretext. The Special Rapporteur examines a number of the abusive practices commonly reported in health-care settings and describes how the torture and ill-treatment framework applies in this context. The examples of torture and ill-treatment in health settings discussed likely represent a small fraction of this global problem.

Full report -23 pages

Filed under: General Problems | 1 Comment »

Fentanyl, carfentanil and cocaine overdose deaths surge in 2016

https://www.10tv.com/article/fentanyl-carfentanil-and-cocaine-overdose-deaths-surge-2016

Filed under: General Problems | Leave a Comment »

Kasich hopes pain-pill limits will reduce opioid addiction

http://www.timesreporter.com/news/20170830/kasich-hopes-pain-pill-limits-will-reduce-opioid-addiction

Ohioans and their medical-care providers face stricter limits on pain-pill prescriptions beginning Thursday as the state seeks to choke off abuse leading to opioid addiction.

Likening opioid pain prescriptions to a “loaded gun,” Gov. John Kasich said the restrictions hold the promise of preventing abuse and keeping excess pain pills off Ohio’s streets.

The new requirements prohibit doctors, dentists and others from prescribing more than seven days of opioids — five days for minors — for treatment of pain.

Refills can be prescribed only if physicians and others document the need for extending pain-relief medication.

Medical-licensing and pharmacy boards are monitoring the prescribing of opioids with an eye toward cracking down on medical professionals who prescribe opioids without medical justification.

“You violate these guidelines and the medical board will come after you,” Kasich said of physicians who could face the loss of their licenses.

The limits do not apply to opioids prescribed for cancer, palliative care, end-of-life care and medication-assisted treatment for addiction.

The heads of the medical, nursing and pharmacy boards all joined Kasich in saying the new limits will help Ohio rein in an out-of-control opioid crisis that kills thousands each year.

“There is some light shining through right now,” Kasich said. Voluntary prescribing guidelines have cut the number of overdose deaths from opioid prescriptions from 667 in 2015 to 564 in 2016, he said.

State officials say 74 percent of those who died from drug overdoses in 2015 previously had received legally prescribed opioids.

Kasich said the number of deaths from heroin also are leveling off, but cautioned, “We’re not out of the woods.” Fentanyl, a powerful man-made opioid, increasingly is killing more Ohioans as it is laced into cocaine and other drugs, the governor said.

A federal grant will help pay for a campaign called “Take Charge Ohio” that will begin in October and seek to educate medical professionals and patients about alternatives to pills to treating pain.

More than 4,100 Ohioans died from accidental drug overdoses, largely from opioids, last year, according to a Dispatch survey of county coroners. That number represented a 36-percent increase in OD deaths from 2015, when Ohio led the nation with 3,050 deaths.

The Kasich administration says Ohio spends $1 billion a year to fight opioids, with about two-thirds of that coming from Medicaid coverage of drug-addiction treatment for poor Ohioans. The legislature added nearly $180 million of additional funding in the new two-year budget.

Kasich continues to defend his expansion of Medicaid to more than 700,000 additional Ohioans to help combat drug addiction.

“Think about where Ohio would be … if we hadn’t expanded Medicaid. To kind of keep debating this and wringing our hands because we got some right wingers somewhere who want to kill this program … if we cut this money off, if you take this money away, you will not have the resources needed.”

A 20% drop in prescribed opiates resulting in 103 fewer OD deaths … but .. OD’s from illegal opiates up 1050..  Anyone wonder how many people committed suicide in 2015 and 2016.. No one wants to talk about that ?

Filed under: General Problems | 3 Comments »

How Ibuprofen May Affect Your Heart

https://www.attn.com/stories/15721/how-ibuprofen-may-affect-your-heart?utm_source=facebooklife&utm_medium=fbpost&utm_campaign=internal

Ibuprofen and other non-steroidal anti-inflammatory (NSAID) drugs might be more dangerous than most people think, according to a new study that links these over-the-counter painkillers to heart problems.

Though drugs containing ibuprofen such as Advil are widely sold without a prescription in gas stations and grocery stores around the world — giving consumers the impression that they’re relatively safe — researchers at Copenhagen University Hospital determined that these drugs raise the risk of cardiac arrest by about 31 percent on average.

The researchers are calling for stricter regulation of NSAIDs, such as requiring a prescription to obtain these products, in order to ensure that patients are better informed about the health risks. The risk is greatest for individuals suffering from heart conditions like cardiovascular disease, they found.

Stocksy/Margaret Vincent – stocksy.com

“Allowing these drugs to be purchased without a prescription, and without any advice or restrictions, sends a message to the public that they must be safe,” Gunnar Gislason, a professor of cardiology who co-authored the study, said in a press release. “The findings are a stark reminder that NSAIDs are not harmless.”

Though past studies have arrived at similar conclusions about the cardiac risks of ibuprofen, this new research only looked at NSAID use among patients who were prescribed the drug. The ingredients are the same, but as one UK trade group representing over-the-counter drug makers told The Guardian, “[p]rescribed NSAIDs would normally contain a higher dosage than those medicines available over-the-counter and would typically be used for longer durations.”

For the study, which was published in the European Heart Journal on Wednesday, researchers looked at about 29,000 patients in Denmark who experienced heart attacks from 2001 and 2010. About 3,300 of those patients had taken an NSAID in the 30 days before the cardiac event, and the study compared that finding to each patient’s medical records from the preceding 30 days to evaluate the risk. Here’s what they found, according to the press release:

“Use of any NSAID was associated with a 31 percent increased risk of cardiac arrest. Diclofenac and ibuprofen were associated with a 50 percent and 31 percent increased risk, respectively. Naproxen, celecoxib and rofecoxib were not associated with the occurrence of cardiac arrest, probably due to a low number of events.”

Wikimedia – wikimedia.org

NSAIDs appear to raise the risk of cardiac arrest by causing platelets to build up, which can lead to blood clots. The study also indicated that these drugs make arteries constrict and increase blood pressure.

To avoid adverse cardiac effects of NSAID use, the researchers recommend taking no more than 1,200 milligrams of ibuprofen per day, and to limit use in general.

Filed under: General Problems | 1 Comment »