A HIPAA violation, a $1.8 million verdict, and three takeaways

http://www.pharmaciststeve.com/?p=10780

Second, a HIPAA violation may amount to malpractice. A violation can be as dangerous and as costly as a misfilled prescription. Under federal law, patients cannot directly sue under HIPAA. There is no “right of private action” by the law. HIPAA can, however, be evidence of the pharmacist’s standard of practice. A violation of HIPAA is negligence and may be used to establish duty. Violation of duty along, with an injury caused by that violation, may amount to malpractice…

Legally and ethically, a patient’s records may be used only for the benefit of the patient…

If this was really true, then the use of PDMP databases — freely accessed by law enforcement, other government agencies, and state medical boards — would be both illegal and unethical. Not that those two concerns make any difference to the DEA or state medical boards.

Congress to VA: More Oversight Needed for Vets in Pain

http://www.medpagetoday.com/Washington-Watch/Washington-Watch/52086?xid=nl_mpt_DHE_2015-06-12&eun=g875301d0r

A subcommittee to the House Committee on Veteran Affairs questioned the Department of Veteran’s Affairs about the unrelenting tide of soldier suicides and mismanagement of opioid prescriptions at a hearing on Wednesday. Some representatives suggested the two crises might be intertwined.

“I’m concerned that a potentially deadly mix of opioid use, mental health disorders, and lack of oversight is contributing to our high rate of veteran suicide,” said ranking member Ann McLane Kuster (D-N.H.).

In her opening statement, she cited the Centers for Disease Control and Prevention’s description of opioid abuse as “the worst drug addiction epidemic in the country’s history.” Yet, half a million veterans are taking the potent medications to manage serious pain problems, she said.

You can use statistics like this, that half a million veterans are taking opioids, but that doesn’t even begin to identify the problem.  In fact, when you break down these statistics, it may very well show that chronic pain is being under-treated and mistreated, with weak medications and drugs like mood stabilizers. Everyone can keep blaming opiates for addiction and suicides, but as long as the blame is being misplaced, nothing will get better.  And how come nobody addresses the high rates of alcohol abuse in this patient population?

Have there been cases where opioids were the only cause of an overdose or suicide?  If so, I haven’t read about it.  But I have read about veterans who have committed suicide because their pain medications were reduced or taken away — to be replaced with nothing.

A recent report from the Government Accountability Office questioned the VA’s efforts both to address veterans’ mental health problems and to properly oversee prescriptions. The report noted that the VA doesn’t have an accurate count of the number of veterans with depression because of “inappropriate coding.”

-VA data may “understate prevalence of major depressive disorder” in veterans treated at VA centers
-VA centers neglected to use standard assessment tools within 4 to 6 weeks of beginning antidepressants, VA’s own clinical practice guidelines (CPGs)
-VA reports of clinical and demographic data related to veterans’ suicides were flawed

With regard to opioid abuse, the Department of Veterans Affairs said it is helping to combat overuse of prescription drugs. Since the implementation of an opioid abuse prevention program 2 years ago, 100,000 fewer patients have been receiving opioids and another 34,000 fewer patients were given opioids and benzodiazepines together — because of known drug interactions. Another 75,000 patients were asked to take urine tests to ensure that veterans are using the drugs and not “diverting” or selling them.

You take away the drugs that work, and you don’t expect the suicide rates to increase?  Why? And how many drug test results were inaccurate?  How many veterans were abandoned because of this?

In trying to rein in one problem the VA may have created another. Rep. Beto O’Rourke (D-Texas) said that because of new policies aimed at reducing prescription abuse, some veterans’ prescriptions were cut off without notice and without the kind of tapering that patients taking such powerfully addictive drugs require.

You can correctly taper patients off these drugs, but then what kind of treatments can successfully replace them?  Surgery or acupuncture?  They’re not addressing the complete picture of treating chronic pain and are only concerned about addiction.

Other veterans, who must visit their doctors monthly in order to refill their prescriptions — another safety provision — aren’t able to get appointments, he said…  “So they go without or they go with something that they shouldn’t have that perhaps they buy on the street,” O’Rourke said. “At minimum they’re suffering, and in some cases I would connect that suffering to the suicides that we see in El Paso,” he added.

Lack of access to mental health care exacerbates this problem, said O’Rourke, who noted a 24% vacancy rate in mental health providers at veteran centers in El Paso, where mental health services for veterans are ranked 157 out of 158.

Tim Walz ( D-Minn.) reminded the VA that some of the questions plaguing the agency were answered by the Military Pain Care Act of 2008, which he helped author. Walz asked Carolyn Clancy, MD, interim undersecretary for Health at the Department of Veterans Affairs, why a bill designed 7 years ago to target the same issues in pain managment was never fully implemented. The bill expired 8 months ago. Three months ago, Walz sent a letter and still hasn’t received a response. “This might not have been the fix, but why didn’t we do it?… Why hasn’t it been done?”

Congress doesn’t follow up on implementation or the letters they write, and then allows a bill to expire — so where does the blame fall?

My Pain or Me?

My pain could not exist
without me
It wants to take over
It wants all
that’s left of me
It wants to be
what I live and breathe

Now, who is stronger?
My pain or me?
Unfortunately
we are one in the same
and that is quite
the tragedy

But right now
we both think
it’s time
for a brownie

https://painkills2.wordpress.com/?s=Me+And+My+Pain%2C+Watching+The+Sunrise

The Great Alien Escape Of 2015

“Those who dream by day are cognizant of many things that escape those who dream only at night.”  Edgar Allan Poe

“Every man has the right to risk his own life in order to preserve it. Has it ever been said that a man who throws himself out the window to escape from a fire is guilty of suicide?”  Jean-Jacques Rousseau

(Photo taken 6/10/2015.)

(2014) Musculoskeletal Pain Relief With Stem Cell Injections

http://www.medscape.com/viewarticle/832501

The evidence on the therapy’s efficacy is inconclusive, and the patient-reported levels of improvement typically fall short of a slam-dunk, but their reports of pain relief of at least 50% are relatively consistent — and in the challenging realm of chronic pain treatment, that’s getting somewhere, said Harry Adelson, ND, medical director of Docere Clinics in Park City, Utah.

“To put this into perspective, arthroscopic surgery has been shown to be no better than placebo or conservative medical treatment for arthritis of the knee,” he told Medscape Medical News, “while autologous MSC therapy shows significant benefit 3 years out from treatment.” …

The therapy is based on the potential healing capabilities of MSCs, which contain growth factors and signalling proteins that can instigate the regeneration of damaged tissue, Dr. Adelson explained.

“We’re taking stem cells from where they live and injecting them to where the problem is and then stepping back and letting nature take its course, allowing the body’s natural healing cascade to occur.”

The stem cells can be harvested and concentrated or isolated from bone marrow or fat, respectively, to be reinjected directly into damaged or degenerated tissues.

The therapy is most commonly used to treat such conditions as degenerative disc disease, desiccated discs, spinal stenosis (both central and foraminal), facet arthrosis, sacroiliac joint syndrome, osteoarthritis of any joint, and sports/overuse injuries, Dr. Adelson said.

While Dr. Adelson said he has seen “not a single serious adverse outcome” among the approximately 2000 patients he’s treated, he advised warning patients who undergo bone marrow aspiration from the posterior superior iliac spine not to lie on a hard floor or to do sit ups on a hard floor for at least 2 weeks to avoid formation of a painful spur.

Tricky statistics used against chronic pain patients

http://www.pharmaciststeve.com/?p=10774

Pharmacist Steve says:

Isn’t it amazing how LARGE NUMBERS makes things sound BAD…  but when you break down the numbers, the picture is much different:

259 million Rxs…  Let’s presume that 25% are for acute or intermittent pain. Leaving 195 million Rxs for chronic pain patients. Proper protocol for treating chronic pain is one long acting and one short acting for breakthru. Then most people will get a 30 days supply at a time. That means that about 8 million chronic pain pts could get proper pain management using these numbers. There is a estimated 106 million chronic pain patients…  So this GROSS NUMBER OF 259 million would suggest that <10% of chronic pain patients get proper pain management therapy with oral opiates. So the epidemic… would seem to be a PANDEMIC of DENIAL OF CARE for chronic pain patients.

HHS Secretary: 259 Million Opioid Prescriptions in U.S. in 2012 Outnumbered American Adults

Burwell offered three solutions to the problem of opioid overdose. The first solution, she said, is prescribing. Burwell proposed providing new prescribing guidelines for pain and pain medication and the use of “prescription drug monitoring plans,” which exist in almost all 50 states…

http://consumer.healthday.com/encyclopedia/aging-1/misc-aging-news-10/pain-control-at-the-end-of-life-643650.html

More than half of patients with terminal cancer, for example, suffer from poorly managed pain, according to a report in the American Journal of Hospice and Palliative Care…

For people suffering from severe cancer pain, for example, hospice providers often advise caregivers to give them pain medication at safe, regular intervals to prevent “breakthrough” pain — sudden bouts of relentless, uncontrolled pain. If you wait until the patient asks for pain medication, he or she may already be suffering, and the pain will be harder to get under control…

But when pain gets tough, doctors need to move to the third step on the ladder and prescribe the most effective drugs in their arsenal. That means opioid drugs such as morphine. “Opioids are really essential,” Dahl says, especially for patients with cancer pain. Opioids can also be effective for treating the pain from damaged nerves — doctors call it “neuropathic” pain — that’s often associated with diabetes or other diseases that attack the nervous system, she says…

You need to have cancer or be knocking on death’s door to deserve adequate pain treatment.

What DEA agents do when they retire

http://www.pharmaciststeve.com/?p=10765

In one of the schemes, Whittington posed as a lawyer, and Herrera, who was a real former special agent with the U.S. Drug Enforcement Administration, posed as an FBI agent, prosecutors said. Whittington and Herrera promised the victim they could help him recover losses in fraudulent schemes related to two companies, Pacific Property Assets and Medical Capital Corporation. They claimed they could seize assets from the fraudulent firms if the victim first posted bonds that were purportedly required prior to seizing the assets, prosecutors said.
Whittington told the victim he had obtained a $4 million judgment, and was paid $290,000, some of which he split with Herrera and some of which he used to fund other fraud schemes, according to prosecutors.

In a separate scheme, Whittington allegedly posed as a former federal prosecutor and Herrera as an FBI investigator and offered to help with a victim’s wife’s immigration case. The men were allegedly paid $8,500 for help they never provided.

Whittington was indicted last year for allegedly posing as an attorney and fleecing two victims out of about $165,000 for investments in a phony real estate deal and tech company…

Discarded

Photo taken yesterday while I was taking out the trash.  Methinks there are quite a few in the Q walking around without underwear.

https://painkills2.wordpress.com/?s=%22someone+had+fun+last+night%22

(2013) The risks of epidural and transforaminal steroid injections in the Spine

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3642757/

Multiple type of spinal injections, whether epidural/translaminar or transforaminal, facet injections, are offered to patients with/without surgical spinal lesions by pain management specialists (radiologists, physiatrists, and anesthesiologists). Although not approved by the Food and Drug Administration (FDA), injections are being performed with an increased frequency (160%), are typically short-acting and ineffective over the longer-term, while exposing patients to major risks/complications…

Results:  Multiple recent reports cite contaminated epidural steroid injections resulting in meningitis, stroke, paralysis, and death. The Center for Disease Control (CDC) specifically identified 25 deaths (many due to Aspergillosis), 337 patients sickened, and 14,000 exposed to contaminated steroids. Nevertheless, many other patients develop other complications that go unreported/underreported: Other life-threatening infections, spinal fluid leaks (0.4-6%), positional headaches (28%), adhesive arachnoiditis (6-16%), hydrocephalus, air embolism, urinary retention, allergic reactions, intravascular injections (7.9-11.6%), stroke, blindness, neurological deficits/paralysis, hematomas, seizures, and death.

Conclusions:  Although the benefits for epidural steroid injections may include transient pain relief for those with/without surgical disease, the multitude of risks attributed to these injections outweighs the benefits.

http://abcnews.go.com/Health/epidural-steroid-injection-risk-incurable-arachnoiditis/story?id=17552260

Helen Bertelli, a mother of two young girls from Raleigh, N.C., has been crippled with weird symptoms — electric shocks, muscle cramps and the sensation that water is running down her legs — all since she received an epidural steroid injection for back pain in 2011.

Three months after a medical “fellow” administered the shot at a pain clinic, she had trouble urinating, then both her feet went numb.

“I had this feeling I was connected to the end of a guitar string and someone was plucking it,” said Bertelli, 36, and a former runner and hiker. “My legs just exploded like there were fireworks in them. My muscles twitched like they were boiling.”

For months doctors told her the knife-like pains were in her head, but six months later, Bertelli was diagnosed with arachnoiditis, an incurable condition that can be associated with epidural steroid injections…

http://nationalpainreport.com/fda-warns-about-epidurals-8823722.html

“I am relieved and hopeful that things are on the right track, but there is still much more that needs to be done to stop these ineffective, harmful pain treatments from maiming and crippling people and ruining their lives,” said Dawn Gonzalez, whose spine was permanently damaged by an epidural during child birth. She now suffers from arachnoiditis and is an advocate for Arachnoiditis Society for Awareness and Prevention (ASAP).

“They need to do something to warn specifically about arachnoiditis, and do something to help those of us that have already been damaged by these procedures. They will find that these instances are not in fact rare like they say, but are in epidemic proportions relative to the number of these injections that have been given over the last 10 or so years.” …

http://www.burtonreport.com/infspine/epiduralsteroidshistory.htm

How then historically, given this checkered background, did epidural steroid injections (ESI) become such a widespread non-specific treatment for low back pain? There can be no question but that this “shotgun” therapy is commonly used in the United States, as well as other countries. It’s popularity seems to relate, to a large degree, to be a “knee-jerk” means of providing short-term back pain relief. The only rationale for ESI use is the generalized anti-inflammatory action of steroids and also the observation that many patients with back pain can recover spontaneously if their initial pain is moderated. Statistics demonstrate however that the same result can be achieved with most forms of other non-invasive therapies…

In a 1999 review of 13 studies published on the use of epidural steroids 8 of the reports showed no measurable benefits (Rozenberg S et al: Efficacy of epidural steroids in low back pain and sciatica, Rev. Rhum. Engl. Ed., 66:79-85, 1999 (Feb)). In a review editorial published in the British Medical Journal the authors pointed out that randomized controlled studies and the systematic reviews of randomized trials have not shown convincing evidence that ES injections provide predictable relief for sciatica and/or back pain (Samanta A, SamanthaJ: Is epidural injection of steroids effective for low back pain? BMJ, 328:1509-10, 2004)…

http://www.health.harvard.edu/blog/new-recommendations-aim-to-improve-safety-of-pain-relieving-spinal-steroid-injections-201505077991

Following the recommendations is entirely voluntary, and there are no studies to prove they actually prevent injuries…

https://en.wikipedia.org/wiki/New_England_Compounding_Center_meningitis_outbreak

Doses from these three lots had been distributed to 75 medical facilities in 23 states, and doses had been administered to about 14,000 patients after May 21 and before September 24, 2012. Patients began reporting symptoms in late August, but, because of the unusual nature of the infection, clinicians did not begin to realize the cases had a common cause until late September. Infections other than meningitis were also associated with this outbreak, which spanned 19 states. As of March 10, 2013, 48 people had died and 720 were being treated for persistent fungal infections…

http://www.pharmacist.com/track-and-trace-law-2015-deadlines-new-requirements

January 1 and July 1 are key deadlines in 2015 for new requirements for pharmacists under the Drug Supply Chain Security Act—the track-and-trace part of the compounding and track-and-trace legislation known as the Drug Quality and Security Act and signed into law in 2013…

By January 1, 2015, dispensers (primarily pharmacies) must establish systems for verification and handling of suspect or illegitimate product, according to the FDA website. The agency published a related draft guidance in June 2014…

Chronic back pain and injections

http://www.ninds.nih.gov/disorders/backpain/detail_backpain.htm

National Institute of Neurological Disorders and Strokes

Low Back Pain Fact Sheet

Nerve block therapies aim to relieve chronic pain by blocking nerve conduction from specific areas of the body. Nerve block approaches range from injections of local anesthetics, botulinum toxin, or steroids into affected soft tissues or joints to more complex nerve root blocks and spinal cord stimulation. When extreme pain is involved, low doses of drugs may be administered by catheter directly into the spinal cord. The success of a nerve block approach depends on the ability of a practitioner to locate and inject precisely the correct nerve. Chronic use of steroid injections may lead to increased functional impairment.

Epidural steroid injections are a commonly used short-term option for treating low back pain and sciatica associated with inflammation. Pain relief associated with the injections, however, tends to be temporary and the injections are not advised for long-term use. An NIH-funded randomized controlled trial assessing the benefit of epidural steroid injections for the treatment of chronic low back pain associated with spinal stenosis showed that long-term outcomes were worse among those people who received the injections compared with those who did not.

Click to access lbpinject-topicref.pdf

Pain Management Injection Therapies for Low back Pain (9/19/2014)

Between 1994 and 2001, use of epidural injections increased by 271 percent and facet joint
injections by 231 percent among Medicare beneficiaries.19 Total inflation-adjusted reimbursed
costs (based on professional fees only) increased from $24 million to over $175 million over this
time period. More recent data indicate continued rapid growth in use of spinal injection therapies among Medicare beneficiaries, with an increase of 187 percent in use between 2000 and 2008…

Given the continued growth in use of injection therapies for low back pain and continued
uncertainty regarding their role and optimal use, a systematic review to summarize the current
state of evidence, identify and evaluate inconsistencies in the evidence, and identify important
research gaps is warranted to help inform clinical practice and policy…

Despite these dramatic increases, use of injection therapies for low back pain remains
controversial. Systematic reviews of injection therapies have come to conflicting conclusions
regarding the benefits of injection therapies and clinical practice guidelines provide
discordant recommendations regarding their use…

http://www.bmj.com/content/350/bmj.h1748

Epidural steroid injections compared with gabapentin for lumbosacral radicular pain: multicenter randomized double blind comparative efficacy study (April 16, 2015)

Conclusions:  Although epidural steroid injection might provide greater benefit than gabapentin for some outcome measures, the differences are modest and are transient for most people.

Pain Consultants of East Tennessee

http://www.wbir.com/story/news/2015/03/16/prescription-drug-task-force-combats-pill-problem/24883265/

Joe Browder, head of multidisciplinary pain management at Pain Consultants of East Tennessee, said there is a large problem with prescription drug abuse in this area, but his clinic uses a screening process with a psychologist first to asses addiction risk before moving onto other forms of treatment for pain.

“I want to work with law enforcement to get rid of the poor practices where bad decision making is being made and these blatantly criminal activities are going on,” Browder said…

Pershing said she believes the Prescription Drug Task Force is seeing results. She said providers in Knox County are writing fewer prescriptions overall…

http://www.topix.com/forum/knoxville/TQP52K3HFLMH031E9

Review: Pain Consultants Of East Tennessee

Jul 11, 2013
this place is a joke I made 3 trips . first a nurse . went back and passed urine sample I take my medication as prescribed from my family doctor which is a very good doctor . dr choo told me to wear a back brace and stay with my family doctor . he more or less told me the dea is cracking down I think he will not get any of my money any time soon . I filled my gas tank 3 times for 3 trips for him to tell me to wear a back brace? trust me I do take my meds like I am supposed to from my family doctor. they WILL NOT GET A PAYMENT FROM ME the $200 they charged my ins. will be contested trust me on that

Jul 11, 2013
PCET is, without a doubt, the safest, most stringent, strict, by the book clinic , in the area, hands down! Joe Browder is one of the best in the state, period! Whomever said he “will pump you on morphine”, total BS! I have a relative that has used this clinic since 99 and stayed with them at Baptist, and went with them to FSW and still with them at their new location!, if you’re looking for a bunch of drugs or a pill mill, save your time. They don’t work that way, thank God! You will have a urine check every visit, pill count and you will accept any surgery, therapy, etc …they recommend, or you’re out, no exceptions! Handles the problems before they get a chance to magnify and worsen!

Dec 18, 2013
This service is simply a legal pill mill – run like an assembly line. An assembly line that makes major mistakes the patient has to pay for the rest of their life. For me a drug screen that was put in my file with someone elses name and address. It was dirty and I had no recourse to this company removing me from their practice. Going there: fill out form, wait, see nurse aide, get rx (printed before you even get there) and leave. No exam, no doctor just go there, tow the line and leave with an rx. No other tx offered, specifically state they don’t want to hear about any other health, emotional health or social issues which can have major impact on pain and tx.
Simply legal drug dealer with a hefty dose of paternalistic humiliation thrown in for good measure.

May 18, 2014

I know of Browder and think he is an OK doctor. I saw him once . I was there in the mid’90’s and was dismissed for loosing 9 tablets. My fault…but I’ve been on these drugs for 25 years-HOW could you NEVER lose some, drop a few into the dishwasher or WHATEVER. I ACTUALLY went camping once and animals, I think skunks, dug my patches out and chewed two to bits! Shit happens.

When it does you are history. No exceptions, no excuses, no second chances. You are guilty and proof of innocence is irrelevant. At the same time they have a LOT of pressure from DEA and state agencies, especially in pill-ridden Tennessee, one of the hardest-hit states…

As it is you have thousands of people just in K-ville living in hell because they cannot get pain treatment for one reason or another. They may be sick but to be a candidate for pain treatment you must be “perfect”. How long can anyone pull that off. A year? Five? Eight? Sooner or later SOMETHING happens…or one of those two bitches mentioned above in Dr. B’s office will do the dirty work, dumping you because you have a “bad attitude”.

A pain clinic can rape, rob, humiliate, extort and molest a patient in any manner because that person is physically dependent on narcotics. You are theirs and they don’t care much about you…none, really. If you twitch they get scared. THIS is the situation, now and it is criminal. It isn’t any one parries fault but we must fix things or those in serious pain will snap…they have little to lose.

Nov 24, 2014

This place is a Nightmare. STAY away from it. NO help, after 8 months of asking for help. You’re a blank face, not even a number. I work in healthcare and this place is a JOKE!!!! STAY away!!!!

https://www.ratemds.com/doctor-ratings/895462/Dr-Joe%2BH.-Browder-KNOXVILLE-TN.html

Jan 3 2015

was with Dr. Lucas then Dr. Browder for long time. Excellant for injections, however you will follow their contract to the letter which I understand. After 14 years was off count by 5 pills on two occasions having had an severe increase in my pain level. The only complaint I have is that I was basically scolded like a bad child from a nurse who saw me before the NP. She informed me that I would be p[laced under a disciplinary review for using up my drugs to soon… one month later I was discharged due to my so called breaking the contract. This is a good clinic but the staff all remain at a distance and at times can be distant and rather cold . If you are in anyway sensitive or looking for a show of human contact with understanding this is not the place you should go.

Feb 10 2014

I have had problems with my back for years. I have been on the same medicine for years. I haven’t had any pain meds because I am new to the area, took 2 months to get an appointment, to my amazement, I supplied empty med bottles, to prove what drug I was on, provided a drug test and listened to the PA. I was told I had to come back for a psychiatric visit, then after that, and only that, I would get another appointment to describe options. I have tried several options. Chiropractic, tens unit, spirals, and the hydrocortisone injections with no luck…

https://www.ratemds.com/doctor-ratings/3224400/Dr-JAMES%2BJ.-CHOO-Knoxville-TN.html

Rate Dr. James J. Choo

Aug 29 2012

Does not manage pain, He is only there to give pain injections. Was at least 1 hour late twice and never thought to apologize, staff was wonderful. Dr Choo never discussed pain management once or physical rehab. I would not recommend him to anyone in need of relief from extreme pain, not very helpful at all.

To control spring break, Florida city bans beach drinking

http://www.reuters.com/article/2015/06/12/us-usa-spring-break-florida-idUSKBN0OS2AT20150612

In the middle of spring break this year, both the city and county adopted temporary emergency drinking bans on the beach and in parking lots after an apparently drugged young woman was gang raped in daylight in front of a crowd of spectators, an incident captured on videotape.

Two weeks later, seven young people were shot at a house party.

One Nation, Under Sedation

https://www.propublica.org/article/medicare-paid-for-nearly-40-million-tranquilizer-prescriptions-in-2013

More than a decade ago, when lawmakers created Medicare’s drug program, called Part D, they decided not to pay for anti-anxiety medications. Some of these drugs, known as benzodiazepines, had been linked to abuse and an increased risk of falls and fractures among the elderly, who make up most of the Medicare population.

But doctors didn’t stop prescribing the drugs to Medicare enrollees. Patients just found other ways to pay for them. When Congress later reversed the payment policy under pressure from patient groups and medical societies, it swiftly became clear that a huge swath of Medicare’s patients were already using the drugs despite the lack of coverage.

In 2013, the year Medicare started covering benzodiazepines, it paid for nearly 40 million prescriptions, a ProPublica analysis of recently released federal data shows. Generic versions of the drugs — alprazolam (which goes by the trade name of Xanax), lorazepam (Ativan) and clonazepam (Klonopin) — were among the top 32 most-prescribed medications in Medicare Part D that year…

Some geriatric psychiatrists worry that doctors may have turned to the drugs in place of antipsychotic medications to sedate patients with conditions such as dementia. In the past several years, Medicare has pushed to reduce the use of antipsychotics, particularly in nursing homes, because of strong warnings about their risks…

Fall River, Mass., psychiatrist Claude Curran wrote more than 11,700 prescriptions for benzodiazepines (including refills) in 2013, ranking him behind only four other doctors, all from Puerto Rico. He said the drugs worked well for his patients, many of whom are trying to kick addictions to narcotics but struggle with anxiety and depression.

“First of all, they’re reliable,” he said. “Second of all, they’re cheap because they’re all generic … They tickle the brain in the same way alcohol does.”  Without benzodiazepines, he added, patients in recovery often need higher doses of methadone, which carries significant risks of its own…

The vast majority of Curran’s Medicare patients were younger than 65 and qualified for coverage based on a disability. Disabled patients made up about a quarter of Part D’s 35 million enrollees in 2013, but used benzodiazepines disproportionately, accounting for about half of all prescriptions…

Rodriguez readily acknowledged the risks of the drugs for elderly users — recently, researchers found that the longer a person took benzodiazepines, the higher his or her risk of being diagnosed with Alzheimer’s Disease. The drugs’ labels say they are generally for short-term use but many patients take them for years…

Many paid out of pocket for the relatively inexpensive drugs, which can cost less than $10 for a 30-day supply…

A worrisome aspect of the newly released data is that some doctors appear to be prescribing benzodiazepines and narcotic painkillers to the same patients, increasing the risk of misuse and overdose. The drugs, paired together, can depress breathing.

ProPublica found that this pattern was most common in southeastern states, which struggle with opioid abuse and overdoses. In 2013, 158 doctors in Florida wrote at least 1,000 prescriptions each for opioids and for benzodiazepines, tops in the nation. Alabama, Kentucky and Tennessee also had unusually high numbers of doctors who often prescribed both narcotics and benzodiazepines. The data does not indicate if the prescriptions were given to the same patients, although that prospect worries experts…

Dr. Leonard J. Paulozzi, a medical epidemiologist at the Centers for Disease Control and Prevention, co-authored an analysis showing that benzodiazepines were involved in about 30 percent of the fatal narcotic overdoses that occurred nationwide in 2010.

“It increases the possibility of overdoses,” he said.

Click to access select-benzodiazepines-10-16-14.pdf

Select Benzodiazepines to Have Daily Quantity Limits (Vermont)

The National Institute of Drug Abuse (NIDA) and the DEA has identified benzodiazepines as one of the classes of prescription drugs with a high potential for diversion and abuse…

http://www.justice.gov/usao-edtn/criminal-division/drug-diversion-task-force

The Drug Diversion Task Force was created to help combat the growing abuse and trafficking of prescription drugs. Unscrupulous doctors, physician assistants, and pharmacists may be involved in the illegal distribution of controlled substances, including oxycodone, oxycontin, morphine, methadone, fentanyl, hydrocodone, and xanex…

Left in the Brain: Potentially Toxic Residue from MRI Drugs

https://www.propublica.org/article/left-in-the-brain-potentially-toxic-residue-from-mri-drugs

The Food and Drug Administration put a “black box” warning on the drugs the following year, saying patients with kidney impairment may be at risk of NSF because they were unable to excrete the gadolinium…  Doctors now routinely screen MRI patients for kidney problems before injecting them with contrast agents…

GE and Bayer have confidentially settled hundreds of lawsuits – many involving deaths – while denying liability for their contrast agents.  In 2013, one case went to trial in Cleveland and resulted in a $5 million verdict against GE. A federal appeals court upheld the verdict last year. By then the plaintiff, who had NSF, had died…