This article is from Aug 2017, and according to this .. their timetable for and contributing factors to opiate epidemic. Once again Congress gets a pass on their passing of the Decade of Pain Law that became law in 1999-2000. That was a significant cause of the creation of “the fifth vital sign” and the joint commission adopted that as a major standard that hospital had to address pt’s pain and most had discharge surveys that included a question if their pain was well treated. When the law expired the political party in control of Congress had flipped and it was not renewed.  The “fifth vital sign” DISAPPEARED and no longer  any concern of the Joint Commission.  Opiate Rxs peaked in 2011-2012 and have dropped every year since and now about 60% down from their peak, but the number opioid poisoning – most all from illegal “street fentanyl” has increased SEVEN TIMES in the last 10 yrs. It seems, that most all bureaucrats still believes that the “jury is still out on the matter of prescribing opiates to treat pain doesn’t cause addicts ” Since “we” don’t track suicides from untreated pain and/or premature deaths from under/untreated pain very well… “we” really don’t seem to care how many people are dying while bureaucrats are trying to satisfy their opiophobia.

BCBS takes steps to respond to opioid abuse

https://mibiz.com/sections/health-care/bcbs-takes-steps-to-respond-to-opioid-abuse

Jody Gembarski, pharmacy manager at Blue Cross Blue Shield of Michigan

Nearly one in five Blue Cross Blue Shield of Michigan members had a prescription for an opioid filled in 2015. The dispensing rate nationally was higher, at 21.4 percent. Between 2010 and 2016, the 36 Blue Cross Blue Shield plans across the U.S. recorded a 493-percent spike in enrollees diagnosed with a disorder associated with opioid use. Those statistics from the Chicago-based Blue Cross Blue Shield Association reflect the opioid epidemic in America that in 2016 resulted in more than 33,000 overdose deaths. MiBiz spoke with Jody Gembarski, a pharmacy manager at Blue Cross Blue Shield of Michigan who oversees its controlled substance work group, to discuss the association’s analysis and the role the state’s largest health insurer has in responding to the epidemic.

What do you make of the Blue Cross Blue Shield Association data on opioid use?

There clearly is a problem with opioids for our members and across the nation. Michigan definitely has a problem. You can see the statistics. We have a high dispensing rate of opioids and high opioid use disorder. It’s definitely a problem and we are very invested in attacking that and seeing what we can do to improve the situation for everyone involved.

What can Blue Cross Blue Shield of Michigan do?

We try to look at it on multiple different avenues. There’s no one solution that fixes this. We look at it from the providers, our physicians and health care providers that are involved with this. We have educational webinars (and) an opioid toolkit for them to use. We encourage them to check the Michigan Automated Prescribing System that will let them see if the member and their patient has gone to a physician a week before or a month before (for an opioid prescription).

What about from the member perspective?

We have a new pilot program that focuses on overdoses and trying to get those members connected to treatment or help. My controlled substance work group, what we do is we monitor claims and if somebody has a concerning behavior, we try to connect them with appropriate resources, whether behavioral health, case management, a pain management referral, or even treatment of a substance abuse disorder that they have.Do you have a way of identifying doctors who perhaps are outside of the norm and have a higher prescribing rate for opioids?

We have a corporate and financial investigations unit. They do look at prescribers who are outliers and compare them to their peers and they investigate those prescribers. There is a whole process to evaluate physicians prescribing opioids, and we have a process to remove them from our network. A lot of times we are ahead of the state and federal government because we have our own data. We actually receive reports from the Centers for Medicare and Medicaid Services — it’s a prescriber outlier report — and we take action on that as well.

Is Blue Cross getting more aggressive in identifying outliers prescribing opioids?

We’ve definitely increased our focus there as we’re seeing how much the opioid epidemic is impacting everything. We are looking much more closely at those that are outliers and identifying what’s going on (and) why. It’s definitely a high priority for us.

Why should this be an issue for employers?

The impact of the opioid epidemic is significant. It’s raising health care costs overall with the prescribing of opioids, and then once somebody is addicted, it is very costly for the health care system. The cost for the health care system is definitely going to impact employers and everyone else involved.

What should an employer do?

Ask what type of programs are in place from the health care provider that they have. We have a list of initiatives and programs and things that we do to help identify fraud, waste and abuse. We have initiatives in providing treatment of our members. As an employer, it is worth investigating and asking the question of what’s being done from the health provider perspective? What are you doing to help improve the situation or decrease prescribing?

Is there any consensus out there on what led to the epidemic?

There are a number of factors and we all ask, ‘What’s the root cause?’ Some of the national meetings that I sit on, there is discussions about how in the ’90s there was this push about the ‘fifth vital sign’ and pain management. That was kind of the focus and people shouldn’t be in pain if they’re having pain. Maybe that fueled a little. Everyone you talk to might have a different idea about that, but that is something that is on the table. There was this focus on pain management. It wasn’t being assessed appropriately and it wasn’t given enough attention. That could be the reason that partly led to this, but that’s not the reason. I don’t think there’s one reason. There are multiple things that led to this and it’s kind of hard to point to something.

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Is Sen. Tammy Baldwin (D-Wisc.) suggesting that opiates should not be prescribed to treat pain and/or all opiate prescribing creates addicts ?

Senators Press HHS Chief on Alzheimer’s Drugs, Opioids at Budget Hearing

https://www.medpagetoday.com/publichealthpolicy/healthpolicy/103674

WASHINGTON — Alzheimer’s disease treatments, the opioid epidemic, and funding for rural healthcare were all in the spotlight during a Senate hearingopens in a new tab or window on the Biden administration’s proposed budget for the Department of Health and Human Services (HHS) in fiscal year 2024.

“It is with great disappointment that [I understand] CMS [the Centers for Medicare & Medicaid Services] is blocking and acting as a roadblock for patient access to drugs that could be very helpful to these patients,” Sen. Susan Collins (R-Maine) told HHS Secretary Xavier Becerra, the lone witness at Wednesday’s hearing held by the Senate Appropriations Subcommittee on Labor, HHS, Education, and Related Agencies. “I just do not understand CMS’s misguided and outright unprecedented decision to not cover a whole class of Alzheimer’s drugs. It is not CMS’s job to second-guess the drug approvals of the FDA. That’s not what CMS is supposed to do.”

Collins was referring to the agency’s decision in Januaryopens in a new tab or window not to cover the Alzheimer’s disease treatment lecanemab (Leqembi) for Medicare beneficiaries unless the beneficiary is enrolled in a clinical trial of the drug. The FDA approved lecanemabopens in a new tab or window under an accelerated approval pathway, as it had done with aducanumab (Aduhelm) in 2021opens in a new tab or window. Medicare also has the same coverage requirement for aducanumabopens in a new tab or window.

“It’s not enough to say you can get it if you’re in a clinical trial,” Collins continued. “That’s so little help to states like ours where there may not be a clinical trial going on, or it may be far away from most people in the state. I’m just asking you to tell CMS to let this drug be used, and let people get access to it when the patient and the clinician agree it’s the appropriate treatment.”

But Becerra pushed back. “There’s no doubt we want to get to the type of lifesaving treatment Americans can benefit from,” he said. “The difficulty here is that we have to remember that the process that the FDA uses is different from the process that legally CMS must use to make their determinations. And while it may not make a lot of sense to folks, there is a legal distinction. And CMS has to remain consistent in the way it treats any drugs.”

Subcommittee chair Sen. Tammy Baldwin (D-Wisc.) asked Becerra to discuss the administration’s plans for tackling the mental health and substance use disorder crises, which have worsened during the pandemic. “In my state of Wisconsin, there were over 1,427 opioid-related deaths in 2021, a 16% increase over 2020 and a 70% increase over the number of deaths in 2018,” she said. “I know my colleagues are seeing similar grim statistics in their states. Of particular interest, I will want to know what the administration is doing to curb the tragic increase in overdoses and poisonings due to fentanyl. This drug is wreaking havoc across the country, and we must partner to take an ‘all of government’ approach to prevent it from coming into our communities.”

“This budget invests some $11 billion, including some $10 billion in discretionary funding for programs that try to target opioids and overdose-related activities,” Becerra said. “It is a significant increase over previous years, and it complements the work that we’ve done to establish a new strategy when it comes to drug overdose and treatment, where we don’t only try to prevent people from taking up a drug, but also … we worry about harm reduction, to make sure that we’re preventing people from harming themselves before they finally can get the treatment they need.” HHS also is investing in post-treatment services so people become productive members of society after they finish treatment, he added.

Sen. Cindy Hyde-Smith (R-Miss.) asked what HHS was doing to help keep smaller, rural hospitals open. Although hospitals are paid a set amount for each patient’s illness using the diagnosis-related group (DRG) system, “patients are staying longer and they’re exceeding those DRG payments, and hospitals are losing money hand over fist,” she said. “They’re held longer in their smaller hospitals while waiting for bed placements in a larger hospital … But how do we overcome a financial challenge that was made worse by COVID and inflation? Have you or the agency considered establishing a temporary per diem payment to the hospitals to help address this?”

Becerra agreed this was a problem. “Everyone is trying to figure out: How do we get resources and commitments into these communities?” he said. “One of the things we’re trying is [with] graduate medical education slots … Maybe we could try to get some of these into communities that haven’t always had these teaching slots available, because the evidence shows that if you locate a student in the residency program, by the time they finish that residency program in that community, they often stay there and develop their practice there.”

Hyde-Smith seemed dissatisfied with that answer. “So are you saying that a temporary per diem is not being considered?”

“I have to get back to you — I’m not sure if that is one of the considerations,” said Becerra. “I would suspect that one of the issues with a temporary per diem would be the cost. Where would the money come from to do that?”

Sen. Jeanne Shaheen (D-N.H.) wanted to know how well the $35-per-month cap on insulin copayments for Medicare beneficiaries — passed as part of the Inflation Reduction Act — was working. “Do we have any data that shows what the impact of that has been?”

“We’re beginning to collect the data,” Becerra said. “And the anecdotal stories I’m hearing from actual insulin users is perhaps the best evidence.” He cited a North Carolina woman he had spoken to who was shocked when she was only charged $35 for her monthly supply of insulin after previously paying $117. “She went back to the insurer and said, ‘I think I owe some money.’ She had to be told, ‘No, that’s the cost now.'”

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A conversation with Kristen Ogden, patient advocate for Dr. David Bockoff

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The FBI took her life savings. Now she’s fighting to help others get theirs back

https://www.foxnews.com/us/fbi-took-life-savings-now-fighting-help-others-get-back

Linda Martin feels ‘misled’ and ‘angry’ after the FBI seized her life savings

Linda Martin thought she was being responsible by putting her nest egg in a safe deposit box where she wouldn’t be tempted to touch it. 

She never imagined the FBI would seize her life savings.

“They didn’t tell us why they took our money. They haven’t told us anything as far as what we did wrong,” Martin, 58, told Fox News. “We haven’t done anything wrong. We work and we saved our money because we were trying to save and buy a house.”

Two years later, Martin still doesn’t know why her money was taken or if she’ll ever get it back. 

THE FBI TOOK HER LIFE SAVINGS, BUT SHE HASN’T BEEN CHARGED. HEAR HER STORY BELOW:

“The FBI, they feel like they can get away with anything,” she said. “I just feel like it’s unfair.”

On March 22, 2021, the FBI seized Martin’s and 1,400 other customers’ safe deposit boxes from U.S. Private Vaults, a Beverly Hills–based company. The FBI took the $40,200 Linda was saving for a down payment on a home in addition to another $86 million in cash and tens of millions more in gold, silver, jewelry and other valuables from other safe deposit box renters. 

Martin found out about the raid while watching the local news with her husband. 

“I just couldn’t believe it,” Martin said. “I really didn’t believe it. I sat down to start watching the news with him, and the FBI was raiding our private vault place.”

Several months later, she received a notice stating that the FBI wanted to keep her money through a process known as civil forfeiture. Confused by the legal jargon, Martin chose to file a petition with the bureau, the first option listed on their notice, without realizing doing so conceded that her property could be forfeited and, consequently, allowing the FBI to determine if she could get her money back.

Martin told Fox News she hasn’t received a determination.

She also said that to her knowledge, no one who had their assets taken have been charged with or even suspect of any crime. Rather, the FBI had been investigating U.S. Private Vaults, which shut down following the raid and pleaded guilty to conspiracy to launder drug money. 

Linda Martin is filing a class-action lawsuit to recover her life-savings which were seized from her safe deposit box by the FBI in a 2021 raid. 

“Unfortunately, this is legal,” Institute for Justice attorney Bob Belden told Fox News. “Civil forfeiture is a process in the United States where law enforcement can take property from people who have never been charged with a crime.” 

Last week, Martin and Institute for Justice filed a putative nationwide class action lawsuit seeking to help anyone who has had property taken by a government agency in the last six years and received a deficient forfeiture notice. 

FORMER FBI AGENT CONVICTED OF ACCEPTING $150K IN BRIBES TO PROVIDE CONFIDENTIAL INFORMATION

According to the FBI notice Martin received, her life savings were taken under administrative forfeiture, an action under the Tariff Act of 1930 that allows federal agencies to seize property without judicial involvement.  

“It’s really a system where the agency is the not only the prosecutor, judge and jury,” Belden said, “but also, a governor or a president thinking about giving a pardon.” 

He said that in these types of forfeitures, law enforcement only needs probable cause that property is somehow connected to a crime in order to seize it. 

“Linda’s case is a very good example of how that standard in real life is somewhat meaningless,” he said. 

The FBI applied for a seizure warrant against U.S. Private Vaults in March 2021, but both the FBI and the United States Attorney’s Office said in the application that agents would merely “inventory” box renters’ property and that the warrant would “authorize the seizure of the nests of the boxes themselves, not their contents,” according to Institute for Justice’s review of the court documents. 

Using federal forfeiture records, the Institute for Justice calculated that from 2017 to 2021, Department of Justice agencies took in over $8 billion through forfeitures, with the FBI receiving $1.19 billion of that. (Irfan Khan / Los Angeles Times via Getty Images)

The FBI and the United States Attorney’s Office didn’t tell the judge that months prior, they had already planned to use civil forfeiture to seize all assets in customers’ boxes worth over $5,000, the FBI’s minimum monetary threshold for forfeitures, according to findings from Institute for Justice. 

“They had developed probable cause in their own mind before they knew anything about a single box owner,” Belden told Fox News. 

An FBI spokeswoman previously said that the bureau broadly seized safe deposit boxes at U.S. Private Vault “based on allegations of widespread criminal wrongdoing” and that the seizure fell within the bounds of their warrant. But Martin said she never received an explanation.

Additionally, government agencies stand to gain from these types of raids, according to Belden. After an agency submits seized property to the Department of Justice’s Assets Forfeiture Fund, the money is then returned to the agency to pay for “costs associated with accomplishing the legal forfeiture of the property,” according to the DOJ. 

Belden said that just means more money in the agency’s pocket. 

“It is a big incentive,” he told Fox News. “It’s a big incentive to forfeit property.”

Using federal forfeiture records, the Institute for Justice calculated that from 2017 to 2021, Department of Justice agencies took in over $8 billion through forfeitures, with the FBI receiving $1.19 billion of that.

In a previous class-action lawsuit the Institute for Justice filed, a judge ruled in favor of a group of safe deposit box holders and found that the notices of administrative forfeiture sent by the FBI did not provide enough information to the plaintiffs about why and how their property was seized. The judge ordered the FBI to return the property to those named in the lawsuit or send a more detailed notice about the administrative forfeitures. The FBI returned the property. 

DOJ SUED FOR REFUSING TO EXPLAIN WHY IT IGNORED PROTESTS AT SUPREME COURT JUSTICES’ HOMES

“We’ve taken to calling this, ‘Take-now, explain-never forfeiture,’” Belden said. 

The FBI seized an estimated $86 million in cash from hundreds of safe deposit boxes at U.S. Private Vaults in a March 2021 raid.  (Al Seib / Los Angeles Times via Getty Images)

“Linda has no idea what they think she did wrong,” Belden said. “It just illustrates what we think is happening to hundreds or thousands of people in other states throughout the country.”

Martin chose to file a class action lawsuit in hope of retrieving not only her property, but the property of anyone who has fallen victim to administrative forfeiture. 

“I felt misled. I felt angry,” Martin told Fox News. “I’m advocating for just not myself, but for everyone, because there’s a lot of people that don’t know what to do.”

“We’re just trying to get justice,” she added.

Neither the FBI nor the U.S. Attorney for the Central District of California returned Fox News’ request for comment. 

To watch the full interview with Martin and Belden, click here. 

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This unit appears to be just a “re-invented” T.E.N.S. unit or SCS.  We stocked T.E.N.S. units when we had our pharmacy and Home Medical Equipment (HME) business… and a T.E.N.S. unit that uses topical electrodes and some sort of gel on the electrodes to transfer the electrical impulses thru the skin in an attempt to interrupt the nerves impulses to the brain and hopefully the brain will not get a “pain signal” from some area in the body.  The pts that we provided T.E.N.S. units to did not have all that good a long term experience.  We have also read many a horror story about pts and their experiences with implanted SCS. On top of all this, this device/treatment is recommended to be used for 60 days.

UAB among first in Alabama to offer new treatment for chronic pain

https://www.uab.edu/news/health/item/13475-uab-among-first-in-alabama-to-offer-new-treatment-for-chronic-pain#.ZBRkDiE1o7w.facebook

The temporary PNS device can be used to treat chronic nerve pain, as well as joint pain and back pain, for patients for whom oral medications are not effective, or who wish to minimize the use of medications or more invasive procedures.Pain can be debilitating with frustrations that reach well beyond the physical pain. According to the National Institutes of Health, pain affects more Americans than diabetes, heart disease and cancer combined.

For patients with chronic pain who wish to minimize the use of medications or more invasive procedures, physicians at the University of Alabama at Birmingham Pain Treatment Clinic at UAB Hospital-Highlands are offering a new alternative — peripheral nerve stimulation, or PNS, that serves as a minimally invasive treatment option for patients with chronic pain.

“We are proud to be among the first sites in Alabama to utilize this technology,” said Prentiss Lawson Jr., M.D., assistant professor at the UAB Marnix E. Heersink School of Medicine Department of Anesthesiology and Perioperative Medicine. “It offers patients the ability to treat their pain without over-reliance on medications that can have side effects and is an alternative treatment option when other conservative treatments have failed.”

The temporary PNS device can be used to treat chronic nerve pain, as well as joint pain and back pain. With the PNS treatment, physicians use imaging guidance to insert a very fine wire, or lead, not much larger than the size of a hair, into the skin close enough to stimulate a target nerve and interrupt the pain signal. The stimulating lead connects to an external battery power supply.

The small PNS device sends gentle pulses, which feel like a small vibration, through the lead to stimulate the nerve. Patients will work with a team to determine the best stimulation level for their condition and use a simple hand-held remote to control stimulation level and turn the device on and off. After 60 days, the lead is removed, and treatment is complete.

“I am excited to offer patients this new treatment option,” Lawson said. “Because it is a minimally invasive option, it can be introduced early in the treatment continuum, and often, earlier intervention leads to better outcomes.”

Studies suggest that some patients experience prolonged relief even after the removal of the temporary device. If results are not prolonged, some people may be candidates for placement of this device periodically.

“Our goal at the UAB Pain Treatment Clinic is to help our patients with chronic pain have the highest quality of life,” Lawson said. “This can help patients who have had repeat surgeries or patients who do not have the option of injections feel better without relying on medications.”

Physicians administering this treatment at UAB include Lawson; Peter Nagi, M.D.; Chris Paul, M.D.; Alethia Sellers, M.D.; and Roland Short, M.D. Patients interested in learning more can schedule an appointment today at the UAB Pain Treatment Clinic at uabmedicine.org.

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FDA warns pharmacy benefit company for distributing unapproved foreign drugs

https://www.raps.org/news-and-articles/news-articles/2023/3/fda-warns-pharmacy-benefit-company-for-distributin

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US sues Rite Aid for allegedly missing ‘red flags’ in unlawful prescriptions

Here is a quote from this article:  Associate attorney general Vanita Gupta said that the pharmacy chain’s prescribing practices had “opened the floodgates for millions of opioid pills and other controlled substances to flow illegally out of Rite Aid’s stores”.  Maybe this is why this attorney is working for the Feds, because apparently believes that Rite Aid PRESCRIBES PRESCRIPTIONS.  Neither Rite Aid nor Pharmacist have prescriptive authority. That is the statutory  function of  physicians and mid-levels practitioners.

The whistleblower lawsuit said that federal and state laws require pharmacies to review prescriptions to ensure they are being prescribed legally and for the right reasons. The complaint comes after three former employees of Rite Aid – Andrew White, Mark Rosenberg and Ann Wegelin – brought a lawsuit against the chain.

Under whistler blower lawsuits https://kkc.com/frequently-asked-questions/whistleblower-rewards-programs-payouts-guide/  Each program requires the government to pay a minimum reward to the whistleblower of between 10 and 15 percent. Under some laws, the reward can be as much as 30 percent of the money recovered.

I just wonder if the DOJ sought out these three pharmacists to file a law suit or they pursued a lawsuit in opens of $$$ they could get from such a lawsuit ?  Since all three of these Pharmacists FORMER EMPLOYERS…it would not be hard for the DOJ to search some databases to find Pharmacists that were employed by Rite Aid during 2014 -2019 time frame, but no longer employed by Rite Aid.

Here is another example of who ever wrote this article has no idea of the proper context of what they wrote Over-prescription of opioids is estimated to have been responsible for 500,000 deaths since 2000.  I have never heard the term “Over-prescription”

US sues Rite Aid for allegedly missing ‘red flags’ in unlawful prescriptions

https://www.theguardian.com/us-news/2023/mar/14/rite-aid-lawsuit-opioids-fentanyl-prescriptions

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Opioid Settlement Hinders Patients’ Access to a Wide Array of Drugs

An agreement between attorneys general and major drug distributors increased scrutiny on medications for A.D.H.D., addiction, anxiety and pain.

https://www.nytimes.com/2023/03/13/us/drug-limits-adhd-depression.html

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