HFPP SECRET ALGORITHM UNIQUELY TARGETED “OLDER WHITE PHYSICIANS,” BASED ON ASSETS, AGE, AND SPECIALTY IN MASSIVE GOVERNMENTAL OVERREACH: PT-2

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“LET THEM DIE-OFF” UNITED STATES GOVERNMENT EXPERT ANDREW KOLODNY, MD., THE MOST DANGEROUS PSYCHIATRIST IN AMERICA AND EXPOSING “THE OPIOIDGATE MEDICAL SCANDAL”

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1306.04(a) “CORRESPONDING RESPONSIBILITY,” DANGERS WHEN PHARMACISTS WITHHOLDS YOUR PAIN CARE: “I DON’T FEEL COMFORTABLE,” THE STORY OF KATHERINE ROSENBURG-DOUGLAS A CHICAGO TRIBUNE REPORTER ‘WHO HAD BROKE-NED HER BACK’

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I normally don’t share emails from pts having problems getting their meds. This pt is having a problem he has been patronizing a particular Meijer store for 20 yrs. For those of you not familiar with Meijer, they are a “big box” store with 259 stores mostly in the mid-west. I find this statement very humorous the team of Pharmacist at this location. Most chain pharmacies function with one Pharmacist per shift and most Meijer stores are open 7 days a week with 12 hrs open Mon-Fri and shorter hours on Sat & Sun. So in most Meijer’s pharmacies the “team of Pharmacist” would probably be a COLLECTIVE OF TWO. While 60 mg is the FDA recommended max daily dose of Adderall, but that dosing was determined before there was DNA pharmacogenomics (PGx) tests and I have not heard that even these days that the Pharmas use  PGx testing in their clinical trials. Then there is the issue of the pt having a record at this pharmacy of him taking 85 mg of Adderall daily for some time, which may suggest that he is a ultra fast metabolizer of Adderall. So this team of Pharmacists is IGNORING the pt’s clinical medication records – right under their nose. One of the core functions of the practice of medicine is the starting, changing, stopping a pt’s therapy. Commonly referred to as prescriptive authority, and pharmacists – even Doctors of Pharmacy – do not have prescriptive authority. I have never heard of a pharmacy having a pt “take a pledge”, the only thing close is some independent pharmacists – that work with chronic pain pts – asking them to sign a pain contract with the pharmacy.  Apparently, this team of Pharmacists has dramatically expanded our scope of practice ?

Good Morning Steve,

I am writing you today for help with the filling of my Adderall prescription at Meijer’s Pharmacy  I have been a customer with Meijer’s Pharmacy for roughly 20 years and never had a problem filling my scripts. Now with the Adderall shortage this particular Meijer’s will not fill over 60mg per day stating the shortage and that 60mg is the recommended daily allowance, even though they have transferred my prescription to other Meijer’s Pharmacies to fill my 85mg script which they have done, they say the Pharmacists at this store have agreed not to dispense more than 60mg dosage per day. I take two 30mg tablets a day along with an extended 25mg capsule.

When they first told me about this I had the tablets that added up to 60mg per day dosage filled at their store and found another Pharmacy to fill my 25mg daily capsules. When I went back this month they told me they couldn’t fill it due to the fact that I filled my capsules else ware and they will not fill my 60mg tablets due to the fact it would put me over their 60mg a day pledge. Yes I said pledge, I was told by a pharmacist at the location that the team of Pharmacist at this location have agreed not to dispense more then the recommended amount of 60mg per day. This is a maintenance drug for me and I need this medication to maintain my day to day activities. I am wondering if you can help me out with this or direct me to someone that can help me with this situation. Thanks 

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ended her life through intervention assisted euthanasia – suicide.

This poor intractable chronic pain pt, from a work place injury, after having lost all her pain meds,  to be able to put a end to her physical pain.  Now, the family left behind is suffering. Our politicians and bureaucrats talk about HARM REDUCTION, apparently that only applies to those dealing with mental health issues and dealing with some SUBSTANCE USE DISORDER.

This Administration, Congress, and numerous bureaucrats at city/county/state levels are all about DEI (Diversity, Equity, Inclusion). Regardless if the number is 10’s or 100’s of millions of people dealing with chronic pain. The chronic pain community is the largest minority in our country.

The Fed agency in charge of enforcing the Americans with Disability Act is part of the DOJ as is the DEA. Might be the reason that they never have the resources to handle a civil rights violation/discrimination of the chronic pain community.

How many others – like Jessica – is living/existing in a torturous level of pain – NO HARM REDUCTION HERE – NO INCLUSION HERE – NO EQUITY HERE.  How many Jessica’s are no long among us, took a similar path of Jessica and just “faded” from being part of the community.

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Buprenorphine Initiation Rates Stall Despite Policy Efforts to Boost Uptake

https://www.medpagetoday.com/psychiatry/addictions/104181

Furthermore, just one in five patients remained on therapy for at least 180 days

Monthly initiation rates for buprenorphine increased and then flattened from 2016 to 2022, suggesting that recent efforts to increase use of the treatment for opioid use disorder have been insufficient, an analysis of prescription data showed.

Using data from the IQVIA Longitudinal Prescription Database, an all-payer database that includes 92% of prescriptions dispensed in U.S. retail pharmacies, the monthly buprenorphine initiation rate increased from 12.5 to 15.9 per 100,000 from January 2016 through September 2018 (monthly percentage change 0.62%, 95% CI 0.40-0.84, P<0.001), reported Kao-Ping Chua, MD, PhD, of the University of Michigan Medical School in Ann Arbor, and co-authors.

The initiation rate then became flat from October 2018 through October 2022 (monthly percentage change -0.03%, 95% CI -0.16% to 0.09%, P=0.62), they noted in a JAMA research letteropens in a new tab or window.

Of note, the median monthly retention rate was 22.2% from January 2016 to April 2022, and increased only slightly during that period (monthly percentage change 0.08%, 95% CI 0.005-0.15, P=0.04).

“Opioid overdose deaths are at a record high in the U.S.,” Chua told MedPage Today in an email. “Despite this, our study shows that buprenorphine initiation rates have been flat since the end of 2018.”

“This is disappointing, especially because there were a lot of policy and clinical efforts to maintain and expand access to buprenorphine during the COVID-19 pandemic, such as allowing buprenorphine to be prescribed via telehealth without an in-person visit and eliminating training requirements for the waiver that previously was required to prescribe buprenorphine,” Chua added. “The fact that buprenorphine initiation rates did not rise after these efforts were implemented suggests that they were insufficient to meet the rising need for this medication.”

The researchers noted that the pandemic was not responsible for the flattening of initiation rates, since the trend emerged earlier. However, the median monthly buprenorphine initiation rate during the early months of the pandemic did dip lower than the months before and after:

• January 2019 to February 2020: 15.5 per 100,000
• March 2020 to December 2020: 14.4 per 100,000
• January 2021 to October 2022: 15.0 per 100,000

Chua said that this study adds to the growing body of research that suggests clinicians have not maximized opportunities to initiate buprenorphine treatment for patients with opioid use disorder. He highlighted another study he was involved with that showed that just one in 12 patients were prescribed buprenorphineopens in a new tab or window within 30 days of an emergency department visit for opioid overdose.

Throughout the current study period, just one in five patients who initiated buprenorphine remained on the therapy for at least 180 days, which the researchers said was similar to a prior study that examined data through 2020opens in a new tab or window.

“A comprehensive approach is needed to eliminate barriers to buprenorphine initiation and retention, such as stigma and uneven access to prescribers,” Chua and colleagues concluded.

Chua said that his hope is that this “study will further underscore to clinicians how much the healthcare system is under-using a critical tool to prevent opioid overdose deaths.”

For this analysis, the researchers included 93,713,163 prescriptions. During the study period, 3,006,629 patients initiated buprenorphine, 42.9% of whom were female.

Chua and team defined initiation as a new prescription for a patient without buprenorphine dispensing in the previous 180 days. They defined retention as at least 180 days of continuous buprenorphine treatment following the initial prescription, without gaps exceeding 7 days.

Limitations to the study included a lack of data on race and ethnicity, in-clinic buprenorphine administration, and buprenorphine dispensing in methadone outpatient treatment programs. In addition, some patients may have initiated buprenorphine to treat pain instead of opioid use disorder.

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