This is a new law that went into effect Aug 1, 2022 in Minnesota. It is designed to protect prescribers who are treating chronic pain pts.  In reading this, it only prohibits the state’s commissioner of health from taking action against any prescriber in the state.  This law also references the MME system – which is know to be highly inaccurate and has no science nor double blind clinical studies supporting its data.

There is also no mention of the DEA in this regulation.  What is to hinder or prevent the DEA from coming in the state of Minnesota and charging a prescriber with violation of the Controlled Substance Act.

Here is a article about DEA recent legal actions against a prescriber  https://doctorsofcourage.org/stanley-charles-evans-do/  after the SCOTUS (9-0 vote) in the Ruan/Kahn case  https://www.pharmaciststeve.com/donald-hyungjoon-kim-md-victory-united-states-motion-dismissed-indictment-9-0-supreme-court-ruling-in-ruan-khan/

It would seem like the DEA is going down the same path that the EPA is taking after the SCOTUS ruled that the they could not create new interpretation of the Environmental Protection Act… that was the function of a legislative body… and the EPS basically told the SCOTUS to stick it up their ass.

Minn. Stat. § 152.125
Section 152.125 – [Effective 8/1/2022] INTRACTABLE PAIN
Subdivision 1. Definitions.
(a) For purposes of this section, the terms in this subdivision have the meanings given.
(b) “Drug diversion” means the unlawful transfer of prescription drugs from their licit
medical purpose to the illicit marketplace.
(c) “Intractable pain” means a pain state in which the cause of the pain cannot be removed
or otherwise treated with the consent of the patient and in which, in the generally accepted
course of medical practice, no relief or cure of the cause of the pain is possible, or none
has been found after reasonable efforts. Conditions associated with intractable pain may
include cancer and the recovery period, sickle cell disease, noncancer pain, rare diseases,
orphan diseases, severe injuries, and health conditions requiring the provision of palliative
care or hospice care. Reasonable efforts for relieving or curing the cause of the pain may
be determined on the basis of, but are not limited to, the following:
(1) when treating a nonterminally ill patient for intractable pain, an evaluation
conducted by the attending physician, advanced practice registered nurse, or physician
assistant and one or more physicians, advanced practice registered nurses, or physician
assistants specializing in pain medicine or the treatment of the area, system, or organ of
the body confirmed or perceived as the source of the intractable pain; or
(2) when treating a terminally ill patient, an evaluation conducted by the attending
physician, advanced practice registered nurse, or physician assistant who does so in
accordance with the standard of care and the level of care, skill, and treatment that
would be recognized by a reasonably prudent physician, advanced practice registered
nurse, or physician assistant under similar conditions and circumstances.
(d) “Palliative care” has the meaning given in section 144A.75, subdivision 12.
(e) “Rare disease” means a disease, disorder, or condition that affects fewer than 200,000
individuals in the United States and is chronic, serious, life altering, or life threatening.
Subd. 1a. Criteria for the evaluation and treatment of intractable pain.
(1) a diagnosis of intractable pain by the treating physician, advanced practice registered
nurse, or physician assistant and either by a physician, advanced practice registered nurse,
or physician assistant specializing in pain medicine or a physician, advanced practice
registered nurse, or physician assistant treating the area, system, or organ of the body that
is the source of the pain is sufficient to meet the definition of intractable pain; and
(2) the cause of the diagnosis of intractable pain must not interfere with medically
necessary treatment, including but not limited to prescribing or administering a controlled
The evaluation and treatment of intractable pain when treating a nonterminally ill patient is
governed by the following criteria:
1
substance in Schedules II to V of section 152.02.
Subd. 2.Prescription and administration of controlled substances for intractable pain.
(a) Notwithstanding any other provision of this chapter, a physician, advanced practice
registered nurse, or physician assistant may prescribe or administer a controlled substance
in Schedules II to V of section 152.02 to a patient in the course of the physician’s,
advanced practice registered nurse’s, or physician assistant’s treatment of the patient for a
diagnosed condition causing intractable pain. No physician, advanced practice registered
nurse, or physician assistant shall be subject to disciplinary action by the Board of
Medical Practice or Board of Nursing for appropriately prescribing or administering a
controlled substance in Schedules II to V of section 152.02 in the course of treatment of a
patient for intractable pain, provided the physician, advanced practice registered nurse, or
physician assistant:
(1) keeps accurate records of the purpose, use, prescription, and disposal of controlled
substances, writes accurate prescriptions, and prescribes medications in conformance
with chapter 147 or 148 or in accordance with the current standard of care; and
(2) enters into a patient-provider agreement that meets the criteria in subdivision 5.
(b) No physician, advanced practice registered nurse, or physician assistant, acting in
good faith and based on the needs of the patient, shall be subject to disenrollment or
termination by the commissioner of health solely for prescribing a dosage that equates to
an upward deviation from morphine milligram equivalent dosage recommendations or
thresholds specified in state or federal opioid prescribing guidelines or policies, including
but not limited to the Guideline for Prescribing Opioids for Chronic Pain issued by the
Centers for Disease Control and Prevention and Minnesota opioid prescribing guidelines.
(c) A physician, advanced practice registered nurse, or physician assistant treating
intractable pain by prescribing, dispensing, or administering a controlled substance in
Schedules II to V of section 152.02 that includes but is not limited to opioid analgesics
must not taper a patient’s medication dosage solely to meet a predetermined morphine
milligram equivalent dosage recommendation or threshold if the patient is stable and
compliant with the treatment plan, is experiencing no serious harm from the level of
medication currently being prescribed or previously prescribed, and is in compliance with
the patient-provider agreement as described in subdivision 5.
(d) A physician’s, advanced practice registered nurse’s, or physician assistant’s decision to
taper a patient’s medication dosage must be based on factors other than a morphine
milligram equivalent recommendation or threshold.
(e) No pharmacist, health plan company, or pharmacy benefit manager shall refuse to fill a
prescription for an opiate issued by a licensed practitioner with the authority to prescribe
opiates solely based on the prescription exceeding a predetermined morphine milligram
equivalent dosage recommendation or threshold. Health plan companies that participate in
Minnesota health care programs under chapters 256B and 256L, and pharmacy benefit
managers under contract with these health plan companies, must comply with section
2
Section 152.125 – [Effective 8/1/2022] INTRACTABLE PAIN Minn. Stat. § 152.125
1004 of the federal SUPPORT Act, Public Law 115-271, when providing services to
medical assistance and MinnesotaCare enrollees.
Subd. 3.Limits on applicability.
(1) a physician’s, advanced practice registered nurse’s, or physician assistant’s treatment of
a patient for chemical dependency resulting from the use of controlled substances in
Schedules II to V of section 152.02;
(2) the prescription or administration of controlled substances in Schedules II to V of
section 152.02 to a patient whom the physician, advanced practice registered nurse, or
physician assistant knows to be using the controlled substances for nontherapeutic or drug
diversion purposes;
(3) the prescription or administration of controlled substances in Schedules II to V of
section 152.02 for the purpose of terminating the life of a patient having intractable pain;
or
(4) the prescription or administration of a controlled substance in Schedules II to V of
section 152.02 that is not a controlled substance approved by the United States Food and
Drug Administration for pain relief.
Subd. 4.Notice of risks.
Subd. 5. Patient-provider agreement.
(a) Before treating a patient for intractable pain, a physician, advanced practice registered
nurse, or physician assistant and the patient or the patient’s legal guardian, if applicable,
must mutually agree to the treatment and enter into a provider-patient agreement. The
agreement must include a description of the prescriber’s and the patient’s expectations,
responsibilities, and rights according to best practices and current standards of care.
(b) The agreement must be signed by the patient or the patient’s legal guardian, if
applicable, and the physician, advanced practice registered nurse, or physician assistant
and included in the patient’s medical records. A copy of the signed agreement must be
provided to the patient.
(c) The agreement must be reviewed by the patient and the physician, advanced practice
registered nurse, or physician assistant annually. If there is a change in the patient’s
treatment plan, the agreement must be updated and a revised agreement must be signed by
This section does not apply to:
Prior to treating a patient for intractable pain in accordance with subdivision 2, a physician,
advanced practice registered nurse, or physician assistant shall discuss with the patient or
the patient’s legal guardian, if applicable, the risks associated with the controlled substances
in Schedules II to V of section 152.02 to be prescribed or administered in the course of the
physician’s, advanced practice registered nurse’s, or physician assistant’s treatment of a
patient, and document the discussion in the patient’s record as required in the patient-
provider agreement described in subdivision 5.
3
Section 152.125 – [Effective 8/1/2022] INTRACTABLE PAIN Minn. Stat. § 152.125
the patient or the patient’s legal guardian. A copy of the revised agreement must be
included in the patient’s medical record and a copy must be provided to the patient.
(d) Absent clear evidence of drug diversion, nonadherence with the agreement must not
be used as the sole reason to stop a patient’s treatment with scheduled drugs. If a patient
experiences difficulty adhering to the agreement, the prescriber must evaluate the patient
for other conditions, including but not limited to substance use disorder, and must ensure
that the patient’s course of treatment is appropriately adjusted to reflect any change in
diagnosis.
(e) A patient-provider agreement is not required in an emergency or inpatient hospital
setting.
Minn. Stat. § 152.125
1997 c 124 s 1
Amended by 2022 Minn. Laws, ch. 98,s 2-2, eff. 8/1/2022.
This section is set out more than once due to postponed, multiple, or conflicting
amendments.
4
Section 152.125 – [Effective 8/1/2022] INTRACTABLE PAIN Minn. Stat. § 152.125

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NCPA Laments Decision Allowing UnitedHealthcare Merger

https://ncpa.org/newsroom/news-releases/2022/09/19/ncpa-laments-decision-allowing-unitedhealthcare-merger

Ruling is a setback for patients and independent pharmacies, says National Community Pharmacists Association

The National Community Pharmacists Association today released the following statement on behalf of CEO B. Douglas Hoey, pharmacist, MBA in response to a federal court ruling clearing the way for insurance giant UnitedHealthcare to acquire medical data firm Change Healthcare:

“We would like to thank the Department of Justice for meeting with us, listening to our concerns, and fighting to block two dominant companies from becoming even more dominant. We are deeply disappointed in Judge Carl Nichols’ decision, which we believe will ultimately lead to less competition and consumer harm in the form of patient steering, less access, and higher costs.

“With its insurance business, its pharmacy benefit manager business, and its mail-order pharmacy business, UnitedHealthcare is already a three-headed dragon and one of the worst actors in the market. The acquisition of the Change Healthcare will give it a massive advantage over its competitors, and it will create an irresistible incentive for the insurance company to use patient data to steer business to its own pharmacy, and away from local, small-business pharmacies.”

NCPA has been fighting the merger since last year. Visit the NCPA Legal Center to learn more about its efforts.

Founded in 1898, the National Community Pharmacists Association is the voice for the community pharmacist, representing nearly 19,400 pharmacies that employ approximately 215,000 individuals nationwide. Community pharmacies are rooted in the communities where they are located and are among America’s most accessible health care providers. To learn more, visit www.ncpa.org.

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The Devil You Know – Neurontin’s Massive Flop as an Opioid Alternative

https://www.acsh.org/news/2022/09/16/devil-you-know-neurontins-massive-flop-opioid-alternative-16551

Wanna hear something sickening? Neurontin, a drug developed for epilepsy and used off-label for neuropathic pain, had its sales grow 350% between 2004 and 2019. Why? We don’t have 350% more epileptics. No, it’s because the drug is being forced down the throats of people who can no longer get sufficient pain relief. The result? Abuse and also more overdose deaths. Just another chapter in our psychotic war against legitimate opioid drugs and the people who need them.

Ask any chronic pain patient about gabapentin (Neurontin) as a replacement for opioids and you’ll probably get one of two reactions: Laughter or tears. Yet, the drug, originally intended to treat seizures, and subsequently found to be useful for controlling nerve pain and restless leg syndrome has been pushed (along with miscellaneous other useless drugs and techniques) as a safe and effective alternative to legitimate opioid analgesics drugs. It is neither. A new JAMA article makes this painfully obvious.

Using a useless drug?

Bridget M. Kuehn, MSJ, writing in JAMA Medical News & Perspectives primarily focuses on how gabapentin is increasingly contributing to the soaring (1) drug overdose death toll but does not ignore the fact that off-label use of the drug to treat non-neuropathic pain is lacking in evidence, perhaps on an unprecedented scale.

In her article, Ms. Kuehn quotes a number of experts. Don’t be surprised if you are surprised. [My emphasis]

“Gabapentin, by some estimates, is more widely prescribed off-label than what it is indicated for…We really don’t have data on what efficacy and dosages look like for this off-label use.”

Matthew Ellis, Ph.D., MPE, Washington University School of Medicine

If this isn’t a red flag I don’t know what is.

“Physicians have been afraid to prescribe opioids for fear that they will be contributing toward opioid misuse and abuse or that the Drug Enforcement Administration will prosecute them for prescribing opioids…There’s been a significant movement to nonopioids and gabapentin because it is believed by most physicians that it is not abused and that it is less harmful.”

 Lynn Webster, MD, Center for US Policy

Isn’t that wonderful? Physicians living under a cloud of fear and terror. From their own government. Let’s give CDC, DOJ, DEA, and PROP our heartfelt thanks for destroying liberties and lives. Nice job, idiots.

“People are trying to use things other than opioids, and there aren’t a lot of options when it comes to medication for pain”

And

“The elephant in the room is the role of the pharmaceutical industry in the growth of gabapentinoid prescribing…We are living in the world created by that push for off-label use.”

Christopher Goodman, MD,  University of South Carolina School of Medicine Columbia (2)  

Additionally, Dr. Goodman co-authored an article, “A Clinical Overview of Off-label Use of Gabapentinoid Drugs” in a 2019 JAMA Special Communication in which the authors concluded:

The evidence to support off-label gabapentinoid (3) use for most painful clinical conditions is limited. For some conditions, no well performed controlled trials exist. For others, one or several placebo controlled studies have been published, but results have generally shown the drugs to be either ineffective or only modestly and inconsistently effective.

 

And I wrote a mini-review on the utility (lack thereof, really) of Neurontin in managing pain in 2019. (See Neurontin: The Darling Of The Anti-Opioid Crowd. But Does It Work?)

So, it is safe to say that, aside from certain neuropathic conditions gabapentin fails miserably when used off-label for pain, something any pain patient who has been denied opioid therapy will tell you.

Someone who did just this is Crystal Lindell, a pain patient who wrote of her experiences with the drug (and the doctors who shoved it at her, in a 2021 column on the Pain News Network site:

When gabapentin didn’t help with the pain, I went back to my doctor and told him as much. He increased the dose, while assuring me that that was all that was needed. 

Wash, rinse, repeat, until I was on the highest allowable dose. Still with no relief. 

Crystal Lindell, PNN 12/10/21

That’s some mighty bad medicine, according to Chuck Dinnerstein, our Director of Medicine:

As a result, gabapentin does not follow the more is stronger or better rule of thumb that physicians apply to other drugs. As a result, the dosage of gabapentin is increased and continually oversaturates receptors rather than producing a stronger response.

C. Dinerstein, M.D., Private communication 9/12/22

To digress for a moment, Isn’t it funny that PROP fails to acknowledge the lack of viable options during any of its anti-opioid screeds? The group (falsely) maintains that opioids don’t work for chronic pain, yet offer no useful alternative. Is the following the best they can do?

[Tylenol] is a very weak painkiller. I completely agree with you that it’s, it’s very weak painkiller. It actually has, um, can be extremely effective when it’s combined with a nonsteroidal anti-inflammatory drug. It can actually increase the effect of the NSAIDs. So it’s kind of a magic combination combining Ibuprofen or another NSAID, um, with Tylenol, even though the Tylenol on its own is really quite weak.

PROP member Adriane Fugh-Berman, Transcript from a Debate with Jeffrey Singer, June 7th, 2022

Fugh-Berman’s cutting-edge medical advice involves combining a 67-year-old virtually useless drug (Tylenol) with a 53-year-old drug (Advil) that many people can’t even take. How innovative!

Improper use and abuse: Unintended (but not unforeseen) consequences

if you predicted in 1993, when gabapentin was approved, that it would be used three decades later as a primary pain medication you could have possibly become the founding member of QAnon. Yes, it’s that crazy, But because of the CDC- and DEA-sponsored mad rush away from opioids many doctors adopted an “it probably won’t help but at least it won’t hurt” mindset if only to get pain patients out of the office with something. This is reinforced by prescribing data. Between 2004 and 2019 the number of prescriptions for gabapentin rose from 18 million to 45 million – an increase of 350% – much of which was certainly a result of opioid phobia. This has created its own set of problems: lack of efficacy and abuse. 

It is more than a little ironic that in the thoroughly misguided attempt to get a handle on drug overdose deaths by imposing severe restrictions on opioid prescribing use (down by 60% and counting) gabapentin, the designated substitute, is being thrown at patients. And why not? After all, it is a Schedule V drug, along with other monsters like Lomotil and Robitussin AC. Gabapentin can be refilled up to five times, so it is not surprising that there is plenty of it around. 

Which should be no surprise to anyone who was paying attention six years ago.

Neurontin (gabapentin) came out of nowhere and joined the list of the top 15 drugs involved in overdose deaths in 2016. How did a Parkinson’s drug get there?? Source: National Vital Statistics Reports

Of course, once gabapentin abuse began it was virtually guaranteed to proliferate. It did. Even the CDC figured this out:

Although gabapentin is generally considered safe and is infrequently associated with overdose on its own, when used with other central nervous system depressants such as opioids, there is risk for respiratory depression, potentially resulting in death.

[D]ata indicate gabapentin exposures associated with intentional abuse, misuse, or unknown exposures reported to U.S. poison centers increased by 104% from 2013 to 2017…[A]mong 58,362 deaths with documented toxicology results, a total of 5,687 (9.7%) had gabapentin detected on postmortem toxicology. Gabapentin-involved deaths occurred in 2,975 of 5,687 decedents (52.3%) with a positive gabapentin test result.

CDC, Notes from the Field: Trends in Gabapentin Detection and Involvement in Drug Overdose Deaths — 23 States and the District of Columbia, 2019–2020

Isn’t it obvious that the more we continue to bungle the unwinnable “war on drugs” the result will be more and different abused drugs, more deaths, and more suffering for pain patients, who play no significant part in overdose deaths? (3)

My colleague Dr. Jeffrey Singer emphasizes what he calls “opioid prohibition,” and how (as was the case with alcohol prohibition) when one drug is prohibited people will find something else that is less safe, in this case, fentanyl, heroin, cocaine, methamphetamine, and now gabapentin, which may be abused but also used in separation:

I suspect gabapentin OD deaths are not from recreational use, but from pain patients who are in such agony that they take bigger and bigger doses to try to get relief. I suspect that doctors are increasing the dose when the initial dose is ineffective, that sends some patients the message to patients that it’s safe and OK to increase the dose until you achieve the desired result.

Jeffrey Singer, M.D. Private Communication, 9/14/22

As has been the case since fentanyl hit the US in 2013 there are still lessons to be learned about what really happens when legal and necessary medications are demonized and prohibited. How many more “drugs of abuse” will be futilely added to the DEA’s hit list? How many more pain patients will continue to face a choice between living in agony and trying to quell it with whatever pharmaceutical crumbs are tossed their way?

Such unspeakable cruelty. 

NOTES:

(1) Of course, it is illicit fentanyl that continues to be responsible for the vast majority of OD deaths and will probably maintain first place until something worse comes along.

(2) Isn’t it ironic that the pharmaceutical industry, which has been blamed for causing the opioid crisis, is now blamed for pushing hard for a replacement drug? Just asking. 

(3) The term “gabapentenoid” is used because there are several structurally similar drugs that form a class.. People generally hate all of them.

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Provider Alert: Your Urine Drug Testing Program May Not Be Compliant, Here’s Why…

https://ccghealthcare.com/2022/09/13/elementor-2836/

Urine drug testing is commonly used in healthcare practices to ensure patients are compliant with their medication and not diverting or abusing medication and illicit substances. Many states have implemented drug testing requirements that providers must follow. Additionally, there has been increasing pressure by the Drug Enforcement Administration and Health and Human Services to frequently drug test patients. Failure to do so could result in investigations for unlawful drug diversion, state licensing action or even criminal charges under the Controlled Substance Act. As a result of this pressure, most providers who wish to be compliant have added a urine drug testing protocol or program to their practice to ensure patients are properly tested and to ensure compliance.

Seeing the increased expense of urine drug testing on the federal budget, the Department of Justice has initiated a rash of false claims cases against physicians under the false claims act for failing to properly risk stratify and bill urine drug testing. This is in part because providers have increased utilization of in-house labs to order drug testing for their patients which is a highly scrutinized activity by Health and Human Services (HHS). Failure to properly order urine drug tests and to document medical necessity could result in millions in civil monetary penalties, significant recoupment in audits, and perhaps be a business ending event for a healthcare practice.

In this article, we will walk you through typical mistakes and how you can correct them.

The False Claims Act

In order to receive Medicare reimbursement a service must be reasonable and necessary. 42 U.S.C. 1395y(a)(1)(A). Failure to ensure that a service is reasonable and necessary is a violation of the False Claims Act. The false claims act states that “any person who knowingly presents, or causes to be presented a false or fraudulent claim for payment or approval is liable to the United States for three times the amount of damages which the Government sustains, plus a civil penalty per violation”. 31 U.S.C. 3729(b).

Thus, in order to order urine drug testing for a patient the physician who orders the service must maintain documentation of the medical necessity in the patient’s medical record. 42 C.F.R. 410.32(d)(2).

Common Compliance Issues in Urine Drug Testing Programs

Medicare has specific requirements for what is considered eligible for payment. The most common areas of non-compliance seen by our healthcare compliance specialists are”

• Not ensuring documentation of medical necessity of the specific urine drug test,
• Not properly risk stratifying patients before ordering frequent urine drug tests,
• Not specifically issuing a physicians order for a urine drug test,
• Implementing standing orders for urine drug tests,
• Testing for substances for which there is no reasonable probability of use,
• Running duplicative presumptive and confirmatory tests,
• Using unnecessarily large urine drug profiles.

Many practices in order to be compliant have implemented standing orders for drug testing. Patients may be tested two to four times per year based on a standing order. The problem with standing orders are that they are not specific to the patient. If a provider is audited and the only proof of medical necessity is the standing order, they may risk large fines and civil monetary penalties for failure to properly document the medical necessity of the urine drug test. To make matters worse, many practices have utilized medical assistants or laboratory technicians to determine the frequency of testing based on this standing order. Again, the issue is that medical necessity is not determined specifically by the physician after consultation with the patient.

Misuse of Reflexive Testing Protocols

In addition to standing orders, we are seeing the Department of Justice increasingly investigate the use of presumptive and qualitative testing. HHS has encouraged the use of presumptive testing as an initial screen to determine if more expensive confirmation is necessary. Here, a provider will utilize a point of care cup or chemistry analyzer to screen a patient’s sample to determine the presence of medication or drugs not prescribed and the absence of prescribed medication. When a potential aberrant screen is noted the provider will send the screen for confirmation utilizing an LCMS or GCMS to determine the presence or absence of metabolites.

Here at CCG we commonly see providers reflexively testing samples, meaning they are immediately confirming the result before analyzing the results of the point of care cup to determine issues.

In theory, this shouldn’t be considered a bad practice. Many providers believe the results of a point of care cup are essentially useless in determining the need for future testing because of the high error rate of presumptive tests. Unfortunately, insurers have insisted that patients be screened prior to a confirmation to lower costs.

The fix here is easy, prior to confirmation, a sample must be reviewed by a provider and a short entry into the patients medical record showing the need for confirmation is essential for good documentation. The point of care cup can be analyzed during the patient appointment and a conversation between the patient and the provider can occur. Once this happens, the sample can be sent for confirmation or tested in an in-house lab to determine the accuracy of the initial screen and a further discussion with the patient can occur at the next visit.

Providers are often concerned at how time consuming this may be. But remember, if the visit is more complex, a provider can bill a higher evaluation and management code for the visit.

Misuse of Drug Testing Panels

Many labs have a common “drugs of abuse” panel that tests for specific illicit and prescribed drugs. Providers who have contracted with labs are often informed by the lab that a custom panel is appropriate. The issue here is that in many cases the panel is too large and tests for too many substances thereby making it too expensive according to Medicare. Many providers correctly believe that utilizing a common drugs of abuse panel is appropriate because a provider cannot know specifically what medications a patient might be abusing before the test. This puts providers between a rock and a hard place. Test for too many and Medicare seeks recoupment. Test for too few and the patient may be at risk.

The solution here is to properly document the medical necessity of the panel chosen and specifically indicate on the requisition form and the patient documentation the panel chosen and the medical necessity of the panel. It’s ok to test a large group of patients for the same substances as long as there is complete and clear documentation of the rationale for testing.

How to Correct Compliance Issues in Your Drug Testing Program

Providers must properly assess compliance risks in their drug testing program and frequently review federal and state guidance to ensure compliance. This starts with a practice urine drug testing policy that informs staff and patients about the need for urine drug testing and specifically describes the risk stratification method used by the practice to test patients. This policy should also indicate that a provider must always document the medical necessity for the specific panel utilized and document the results of the test along with a conversation with the patient.

Once a clear policy is in place it must be trained and enforced to ensure providers are following the policy. Frequent checkups and reviews of provider documentation by a third party can ensure that your practice is in compliance and not engaging in unnecessary risks.

At CCG we provide comprehensive compliance reviews of drug testing programs and all other areas of your practice to ensure that you are compliant. Our experience compliance professionals can do a front door to back door assessment of your practice to ensure that your urine drug testing program is compliant with federal and state guidelines. This gives you the peace of mind to continue treating your patients without fear of government intervention. We utilize the most up-to-date federal guidance and train your staff on how to run a compliant practice.

Once you have implemented a urine drug testing policy and properly trained your staff, we can do periodic checkups to monitor the effectiveness of your program and to re-train staff where necessary. Contact us for a free compliance review today to determine if you require a compliance plan and an update to your policies and procedures.

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For those chronic pain pts who have had their pain meds reduced or eliminated all together… and have become bed, chair, house confined…  those pts may end up suffering from one more potential health issues that could contribute to a premature failure.  At the bottom of this post, I have included a chart of all the possible complication of a pt’s comorbidity issues by under/untreated pain and premature deaths

Chronic ‘Exercise Deficiency’ Linked to HFpEF

https://www.medscape.com/viewarticle/980642

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It was the CALF Medical Board that starting going after what prescribers wrote for up to TEN YEARS AGO…  Even going after some prescribers that had been retired for a few years.

Remember the Biden’s Admin attempt to create a dis-information czar in the Dept of Homeland Security ?  That job lasted about 2 weeks – at most.

Just imagine, if this bill is signed into law, that the Medical licensing board could state that opiates have no proven efficacy in treating pain long term and any prescriber who prescribes opiates to especially intractable chronic pain pts… could be threatened with license revocation.  What would be the outcome if the licensing board decided that any prescriber that prescribes any medication that was not backed by FDA clinical trials (OFF LABEL)… is misinformation.  The permutations of this law may not be calculated up front…

Former Planned Parenthood president warns against California’s medical misinformation bill

https://www.foxnews.com/media/former-planned-parenthood-president-warns-against-californias-medical-misinformation-bill

Leana Wen warned that the California legislation could have a ‘chilling effect on medical practice, with widespread repercussions’

Former Planned Parenthood president Leana Wen gave a dire warning in a Monday op-ed that California’s bill, regardless of its intention, can actually hurt the medical system rather than reform it.

“One of the many lessons from the COVID-19 pandemic is that misinformation can be deadly,” Wen recalled. She stated that mentality is in California’s AB 2098, a bill she describes as one, “that passed the California legislature and is waiting to be signed into law by Gov. Gavin Newsom.” 

She further noted that, “The measure would make California the first state that could take legal action against health-care professionals for conveying false information about COVID-19 and its treatments.”

While she did not ascribe bad faith to the people pushing the bill, she warned that it would have disastrous results.

“While well-intentioned, this legislation will have a chilling effect on medical practice, with widespread repercussions that could paradoxically worsen patient care,” she suggested.

She illustrated how the bill could end up punishing doctors who are acting with the best of intentions.

“AB 2098, taken to the extreme, could put many practitioners at risk. But is it really right for physicians to be threatened with suspension or revocation of their license for offering nuanced guidance on a complex issue that is hardly settled by existing science?” she asked.

Wen also recounted one of the most contentious aspects of the COVID-19 pandemic, the week-to-week overhauls of COVID-19 guidance policies from experts and government officials. 

“Indeed, another lesson from COVID is that science is constantly evolving. In a public health emergency, official guidance often lags cutting-edge research,” Wen recalled. “Consider how long it took the CDC to acknowledge that the coronavirus is airborne. Should doctors have been censured for recommending N95 masks before they were accepted as an effective method for reducing virus transmission?”

Wen followed by claiming that the bill, if anything, was similar to a Trump-era policy.

“In a way, though the California bill was introduced by Democratic legislators, it is not unlike the Trump administration’s Title X ‘gag rule,’ which barred health-care providers who worked in clinics that received federal funding from referring patients for abortion care,” she recounted. “I strongly opposed the Title X gag rule for the same reason I oppose AB 2098: Both censor what doctors can say to our patients. Both represent political interference with the practice of medicine.”

She concluded her piece by warning that “California’s bill is a recipe for medical practice to be subject to the whims of partisan politics.”

Wen has dissented with many liberals on handling COVID-19 before, declaring in a previous op-ed for The Post that she will be sending her kids back to school this fall, a major turnaround from her earlier rhetoric on the lockdown.

“I began trying to think of the coronavirus as I do other everyday risks, such as falls, car accidents or drowning,” she noted. “Of course I want to shield my children from injuries, and I take precautions, such as using car seats and teaching them how to swim. By the same logic, I vaccinated them against the coronavirus. But I won’t put their childhood on hold in an effort to eliminate all risk.”

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Some believe our country is on the verge of a Civil War, they may be right, but it won’t be a bilateral war like our last Civil War..  Our society has voluntarily divided itself in – for lack of a better description – TRIBES.

The chronic pain community is not all that different from our country of as a whole.

Recently a fellow chronic pain pt who had been advocating for end stage pediatric pts in a large hospital system that has a “no opiate” policy.  All of a sudden the advocated was told that he was no longer permitted to advocate for these end of life pediatric cancer pts.  I suppose that this major hospital system will return to treating these pediatric pts with NSAIDS and Acetaminophen and let them live the rest of their lives in a torturous level of pain.

There are rumors as to who said what and to whom… I am not going to elaborate. However, they know who they are and what was said to cause this to happen.  One can only imagine the deprived mental status of those who have been involved in this.

Some have told me that this tribe of malcontents have monetized chronic pain pts’- personal information  and several other covert processes. I started my blog in 2012 and have tried to motivate and educate chronic pain pts in some ways that they can navigate their way to getting their pain management back.  Some chronic painers have told me that I should charge for my advice.  My Pharmacy degree, license and career has provided for Barb and myself a comfortable retirement.

After this issue with these end of life pediatric pts,  Going forward… I am going to ASK of people that want my advice to make a contribution to one of the four national charities listed below, these are all about THE KIDS… and charities we support.  Maybe in some small way, my advice can help more than just one person/family. 

https://www.stjude.org/ St. Jude Children’s Research Hospital – deals with kids dealing with cancer and/or life threatening health issues

https://lovetotherescue.org/ Shriners Hospital – deals with kids, born with “broken bodies” and birth defects

https://rmhc-kentuckiana.org/ Ronald Mc Donald House – this is near us and just a few blocks from a very large regional pediatric hospital ,3 other major hospitals within blocks, one being a teaching hospital and having the only LEVEL ONE TRAUMA CENTERS for 100 miles and part of a medical university and  helps provide housing for families with kids in the hospital

https://t2t.org/ Tunnel to Towers Foundation – helps get handicapable housing for veterans, first responders with “broken bodies” , families with spouse/parent killed in the line of duty and Gold Star Families

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