The Real Cost of Tennessee’s New Pain Management Laws

http://www.dailykos.com/story/2015/01/19/1357066/-The-Real-Cost-of-Tennessee-s-New-Pain-Management-Laws

My first shock was when I discovered that it was illegal for a pharmacy in Tennessee to fill a prescription for pain medication which had been written in another state. I mailed them back to my pharmacy in Colorado who filled it for me without question, and then mailed them to me. This gave me thirty days to find a doctor here.

Both of the first two pain management clinics, that I got appointments with, closed after raids by the DEA. The third clinic I tried, refused to write me the medications that I had been on. They wanted to switch me to the extended release form, which runs about 10 times what the instant release tablets cost. I explained that I was on Medicare, which allows me about 2900$ to spend on drugs yearly. What they wanted me to take would have used my benifit in less than three months. I explained, and was told that my financial problems wern’t their problem. They told me to go check into drug rehab. How, exactly, is that going to treat my pain? For that, Medicare paid for a new patient intake, and I paid a 45$ copay. What a total waste of time and money…

I finally found a clinic which writes the medications that I need. They do not accept any type of insurance. I pay them 250$ cash each month. I have been going there for three years now. I am drug tested every month, and I have to pay 50$ a month for it. That is my food budget for two weeks which is just gone. I would love to find a clinic that takes my Medicare. If I go to another pain clinic, even if all I do is check them out, I can be dismissed from my current clinic. I can’t risk that.

If I were to lose my clinic for any reason, they would blackball me in TN, making it almost impossible to find treatment elsewhere…

I used to be allowed to fill three months of all my scripts. That saved me a significant amount of money. The pain clinics in Chattanooga require that you see the doctor once a month. For a long term pain management client like me, that is not needed. I have been on my same regime for over 5 years now. It is the law in Tenneessee. It is designed to bilk me of my money, and give it to someone who already has plenty of cash…

My clinic has cameras and listening devices everywhere. I am certain that the DEA can listen and watch us by taping into that feed. They routinely stand by the entrance and take photos of people going in. They claim that they are searching for fugitives. I don’t believe their lame story. My picture has been taken a few times. I always ask politely if they would like to have my address, so they can send me a copy.

My Medicare Advantage plan took medications that were once Teir 1 and raised them to Teir 3 and 4. My cost went from 8$ per script to 45$ per scrip. That increase alone would feed us for a week…

I have had to muddle through being stopped, and searched, without my consent, by a policeman at a routine traffic stop. I was the passenger. When he asked me for ID, I told him that he has no probable cause to ask me anything. That pissed him off. He searched the car, then he searched us. Then he searched my handbag and found my prescriptions. He accused me of being a drug dealer. I was taken in, for questioning. The first words out of my mouth were, “I wish to assert my legal right to have my lawyer, please.” I used my one phone call to call our lawyer. He had me released within 10 minutes.

I am fed up with being treated like a junkie because I need pain medication to function. Do you know that untreated pain kills? It kills the inner organs. They fail in a sort of cascade. Once the process begins, it can’t be stopped. An ER doctor told me that bit of information…

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Texas: Med Board lets DEA sneak peeks at patient records

http://www.pharmaciststeve.com/?p=11625

The Drug Enforcement Administration has been sifting through hundreds of supposedly private medical files, looking for Texas doctors and patients to prosecute without the use of warrants.
Instead, the agents are tricking doctors and nurses into thinking they’re with the Texas Medical Board. When that doesn’t work, they’re sending doctors subpoenas demanding medical records without court approval. The DEA can’t even count how many times it has resorted to the practice nationwide. A spokesman estimated it was in the thousands…

In Texas, the DEA’s criminal investigators do an end run around the Constitution’s warrant requirements by getting the Texas Medical Board to order doctors to open their records…

The problem is this: The medical board has authority to issue “administrative subpoenas,” as they’re called, because it’s in the business of administering the medical industry. The DEA isn’t. It’s in the business of criminal investigations, which can be hindered by the Fourth Amendment.

The entire apparatus of administrative law is something of a shadow government grafted onto a constitutional system back in the New Deal era, and this shadow government has few safeguards. Rather than checks and balances, the regulatory state is characterized by agencies that handle all the investigation, prosecution, adjudication and appeals in-house, with little interference from other bodies…

UNM Project ECHO bites the dust

http://www.pharmaciststeve.com/?p=11648

Just six weeks after New Mexico announced that the overdose death rate had unexpectedly climbed, the state received a federal grant to target opioid overdoses with big data, better monitoring and more education. The New Mexico Department of Health said it received an $850,000-a-year grant for the next four years to enhance prescription drug overdose prevention. If renewed each year, the grant would provide $3.4 million for five more staffers working on overdose prevention initiatives.

“This funding allows the New Mexico Department of Health to develop new partnerships with the Board of Pharmacy and the Workers Compensation Administration. It will increase our capacity to reach communities with a high overdose burden,” Health Secretary Retta Ward said in a statement.

After two years of decline, the number of people in New Mexico who died from a drug overdose in 2014 hit 536, a jump of 20 percent over 2013. Officials say 265 of those deaths were the result of prescription opioids. The statewide rate of 26.4 overdose deaths per 100,000 population stands at one of the worst in the United States, along with West Virginia and Kentucky.

A major focus of the grant will be to better coordinate a Board of Pharmacy registry that is to be used by medical professionals who prescribe pain medication — an online tool called the Prescription Monitoring Program. The information is meant to help monitor patients who misuse pain prescriptions by shopping for several different providers around the state to write scripts.

But because there are seven medical occupations that can prescribe — from medical doctors to dentists — there are inconsistencies in how the database is used, as each reports to a different regulatory board where enforcement varies.

“Sometimes people get introduced to opioids in different ways. They’ll get injured and go see a medical provider and they’ll prescribe opioids. In cases, that person can then get addicted and overdose can result,” said Dr. Michael Landen, an epidemiologist with the state Health Department. “This whole pathway starts with that initial prescription and ensuring that prescription is appropriate is important.”

The grant will not only allow the state to capture more data from prescription writers, but also to deploy caseworkers into areas where they see “prescription hot spots” for drugs such as oxycodone, fentanyl, methadone, hydrocodone and buprenorphine.

“We’ll be able to use the data to work with individual doctor’s offices to improve prescribing in those offices,” Landen said.

Between 2001 and 2011, for instance, oxycodone sales in the state tripled, according to the Health Department.

Another emphasis for how the money is used will be to coordinate education efforts with the state Workers Compensation Administration, which has data on prescriptions for workers who were injured on the job — such as those with back ailments from heavy machine work or long-distance driving.

Landen said Washington state had success reducing overdoses in this population, which might come from a background where they haven’t seen addiction and don’t recognize it.

“We’d be able to analyze the data and make decisions on how to improve prescribing through their program,” he said.

Which means they will be seeking out any doctors prescribing over the maximum morphine-equivalent level and “educating” them about reducing dosages (and abandoning patients).

Some states, for instance, have looked at a “lock in” requirement, in which workers filling pain prescriptions have to use one medical provider and one pharmacy to better monitor usage.

Now only used in Medicaid, but soon coming to Medicare.

New Mexico is one of 16 states that successfully competed for the four-year grant from the U.S. Centers for Disease Control and Prevention. The grant is from a new program called Prescription Drug Overdose: Prevention for States that helps states address the ongoing prescription drug overdose epidemic.

How did the state successfully complete the grant if the programs didn’t work?

The Health Department also will collaborate with the Human Services Department to increase public awareness of potential harm from prescription opioid medications.

Landen said the grant also will pay for an evaluator who can assess the state’s effort on overdose prevention and determine what approach is working.

For a state with a medical cannabis program that’s about 8 years old, it’s surprising that overdoses keep rising. Other states’ programs have reduced overdose deaths by about 25%, yet not here in New Mexico. Perhaps it’s not surprising after all, considering the sad condition of New Mexico’s medical cannabis program.  Without a program that provides adequate access for all, there are few public benefits to be had.

And New Mexico is one of the poorest states in the country, so poverty plays a big role in overdose deaths and suicides.

Targeting opioids doesn’t seem like a very thorough plan. It leaves out so many drugs that contribute to overdoses, like alcohol, anti-anxiety drugs, muscle relaxers, and anti-depressants. And it leaves out one of the most important issues of all:  suicide.  (Way to honor National Suicide Day, Department of Health.) And what’s the deal with the Department of Health working with the Worker’s Compensation Administration? Easy to pick on the disabled, right?

Ironically, in January of this year, the University of New Mexico was announcing it might have found the “holy grail” of stopping opiate abuse (mostly centered around education):

https://painkills2.wordpress.com/2015/01/26/has-university-of-nm-found-the-holy-grail-of-stopping-opiate-abuse/

New Mexico’s Project ECHO is all about reducing opioid usage in chronic pain patients, and last I heard, is working with the Veteran’s Administration. UNM calls it a program for pain patients — I call it a program to treat addiction. The fact that the program doesn’t work just confirms my opinion that addiction in the chronic pain population is not the huge problem it’s made out to be. If you can’t find and don’t treat enough chronic pain patients that suffer from drug addiction, the program won’t work.

Ironic that the federal government is spending so much more money on programs that aren’t working, but I would say that most of the funding is really for the PDMPs, the blacklist for pain patients. And PDMPs are popular with the DEA, insurance industry, government agencies, and now the medical industry.

It’s also ironic that in October, 2013, Dr. Katzman authored a study about the epidemic of chronic pain. From someone who’s recognized the problem, all the way to today with Project ECHO, this doctor has taken a mighty long fall in a really short time. Here are my posts about the director of the program, Dr. Katzman:

https://painkills2.wordpress.com/?s=katzman

“This is a witch hunt of epic proportions.”

http://ravallirepublic.com/missoula/news/local/article_cdbc86b1-205f-5c1c-b547-25cc5eaa5913.html

HAMILTON – A Florence physician was arrested at his home Thursday morning and charged with more than 400 felonies, including two counts of negligent homicide.

Dr. Chris Christensen, 67, has been under investigation since his Florence clinic, Big Creek Family Medicine, and his home were raided by a joint local, state and federal drug task force in April 2014…

Christensen’s business operated almost exclusively in cash, the affidavit stated. Financial records indicated the business earned about $2,500 a day and grossed more than $500,000 annually…

The DEA believes that any pain doctor that doesn’t take insurance is running a pill mill, and of course that’s very far from the truth. And it seems like the DEA can only charge pain doctors if any of their patients die of a drug overdose.  In Dr. Christensen’s case — a doctor that has been practicing for a very long time — all they found were two deaths. Considering the kinds of patients that pain doctors treat, I’d say two patient deaths out of thousands is not bad at all.

At a news conference Thursday, the special agent in charge of the U.S. Drug Enforcement Administration’s Denver Field Division, Barbara Roach, said Christensen’s patients traveled to his clinic from 10 different states, from as far away as Oregon, Nevada and even Ohio. In Montana, Christensen’s patients came from 62 different cities and towns.

Instead of realizing that the reason for this is that pain patients are unable to find access to health care in their own states, the DEA looks at this as criminal activity. Because… drug war.

Roach said investigators compared the number of prescriptions for controlled substances written by Christensen against seven other physicians from similarly sized communities. Christensen wrote more prescriptions for those type of medications than all of the seven doctors combined, she said.

You can’t compare one physician’s prescribing habits against others, unless you are comparing apples to apples. Were these seven physicians practicing pain management? Were they treating cancer pain? Were they treating pain patients from out-of-state?

The case against Christensen focuses on 11 patients selected by the Ravalli County Attorney’s Office and the drug task force. In nearly all of those cases, Christensen neither contacted the patients’ former physicians nor reviewed medical records before prescribing drugs including methadone, oxycodone and Dilaudid, the affidavit stated…

See, they only found 11 patient records out of thousands. And is there a law that says a doctor is required to contact former physicians for every patient they see? Please, someone show me where this law is located.

After the DEA attempted to contact Marchand, he said he alerted Christensen. The doctor allegedly replied “the DEA can’t do anything to me,” the affidavit stated.

Christensen was indicted in U.S. District Court in Idaho in 2005 on 18 counts of distribution of controlled substances outside the course of a professional practice and without legitimate medical purpose. He was acquitted on those charges in 2010…

Looks like the DEA is after revenge.

The maximum penalty Christensen could face is 388 life sentences, plus 135 years in prison and fines of $20 million.

The DEA overloads the charges like this to put fear in the hearts of their victims. And it works. Fear and the inability of victims to pay for an adequate defense gives the DEA an incredible amount of power that is rarely defeated.

“This has been a long process,” Fulbright said. “More than a year of investigation work was completed before search warrants were issued for Dr. Christensen’s office and home. Those searches … resulted in the task force seizing 4,718 medical patient files, and 1,500 additional files for medical marijuana patients…

Does the DEA realize that these pain patients cannot find another doctor without their freaking medical records? (As if they’re going to be able to find another doctor anyway.) Where are these records now? Is the DEA following HIPAA rules while working with them? Will each of these patient’s records now come with warnings:  Treated by a doctor arrested by the DEA. Drug addict.

Where will over 6,000 patients find another doctor willing to treat them? The State of Montana should be prepared for a rise in heroin use and overdoses, new cases of patients suffering from addiction, and suicides.

Citizens of Montana, don’t blame drugs for the additional medical problems and deaths you will be seeing in your family members — blame the DEA.

Thinking of you, Jamycheal Mitchell

http://www.theguardian.com/us-news/2015/aug/28/jamycheal-mitchell-virginia-jail-found-dead

Young black man jailed since April for alleged $5 theft found dead in cell

Mitchell’s family said they believed he starved to death after refusing meals and medication at the jail, where he was being held on misdemeanour charges of petty larceny and trespassing. A clerk at Portsmouth district court said Mitchell was accused of stealing a bottle of Mountain Dew, a Snickers bar and a Zebra Cake worth a total of $5 from a 7-Eleven.

“His body failed,” said Roxanne Adams, Mitchell’s aunt. “It is extraordinary. The person I saw deceased was not even the same person.” Adams, who is a registered nurse, said Mitchell had practically no muscle mass left by the time of his death…

A few hours after Mitchell was arrested on 22 April by Portsmouth police officer L Schaefer for the alleged theft, William Chapman was shot dead by officer Stephen Rankin outside a Walmart superstore about 2.5 miles away in the same city. State prosecutor Stephanie Morales said on Thursday she would pursue criminal charges over Chapman’s death.

Except for a brief item stating that an inmate had been found dead, the story of Mitchell’s death has not been covered by local media in Virginia, and is reported for the first time here.

Adams said in an interview that her nephew had bipolar disorder and schizophrenia for about five years. Nicknamed Weezy, he lived with his mother Sonia and had been unable to hold down work. “He just chain-smoked and made people laugh,” said Adams. “He never did anything serious, never harmed anybody.” …

Adams said prison officials said her nephew had also been declining to eat. She said she saw Mitchell in court in recent weeks and estimated that he had lost 65 pounds since being detained. “He was extremely emaciated,” said Adams…

The public shaming of chronic pain patients

http://www.fortsmithpd.org/NarcoticUnit/PrescDrugCase.asp

The link is to a page full of people who have been arrested for prescription drugs in Arkansas. And I just can’t believe that it includes their photos. When you move your arrow over the photos, they even get bigger. Fancy technology.

Some of the people do, indeed, look like criminals. Some look like drug addicts. Some are old and just look pitiful. Men, women, old, young, all races, but mostly white people. I’m sure there are a few that look like your neighbors. Of course, chronic pain patients are represented in these photos, especially considering the drugs involved in their convictions.

I suppose this police department is showing off, counting the number of people’s lives they ruin by publishing it on the internet. For all eternity. It’s not enough for the criminal injustice system to ruin these people’s lives. No, it’s also important to add all this shame. Because… drug war.

If there’s any police officer out there who wonders why so many people dislike them, well, here you go.

Perhaps chronic pain patients should own this discrimination. Start tattooing bar-code numbers on our forearms so everyone can keep track of us. Perhaps a teardrop for every year we’ve suffered from chronic pain. I suppose we could shave our heads and get “Pain Patient” tattooed on our foreheads — that would be instantly recognizable, just like skin color or sex.

How Identity Theft Sticks You with Hospital Bills

http://www.pharmaciststeve.com/?p=11379

Fueling medical identity theft is the surge in electronic medical records and data breaches at insurers and health-care providers. Medical identity theft-in which someone fraudulently uses data to bill for medical services-affected 2.3 million adult patients in 2014 versus 1.4 million in 2009, according to a survey published in February by the Ponemon Institute LLC, a research concern.

Such identity theft has led about 40 companies, including Blue Cross Blue Shield Association and Aetna Inc., to form the Medical Identity Fraud Alliance. Some hospitals have turned to biometric screening to confirm patient identities…

“Data breaches are increasing and becoming more common,” says Dr. Shantanu Agrawal, director of the Center for Program Integrity at the Centers for Medicare and Medicaid Services. “You can end up with diagnoses being placed in your file without your knowledge.” …

Unlike in financial identity theft, health identity-theft victims can remain on the hook for payment because there is no health-care equivalent of the Fair Credit Reporting Act, which limits consumers’ monetary losses if someone uses their credit information…

Thieves use many ways to acquire numbers for Social Security, private insurance, Medicare and Medicaid. Some are stolen in data breaches and sold on the black market. Such data are especially valuable, sometimes selling for about $50 compared with $6 or $7 for a credit-card number, law-enforcement officials estimate. A big reason is that medical-identification information can’t be quickly canceled like credit cards…

Hospitals are setting up special investigative units to catch medical identity fraud. BayCare Health System, which has hospitals in Florida, is one of hundreds of hospitals that give patients the option to register by scanning veins in the palm. The image is converted into a number that correlates with the patient’s medical record, according to its website…

Some victims say the problems from medical identity theft haunted them for years.

Anndorie Cromar, now a 36-year-old medical-lab supervisor in Salt Lake City, says Utah’s child-protective services called her in 2006 to say her newborn had tested positive for methamphetamine at Alta View Hospital in Sandy, Utah.

Ms. Cromar hadn’t given birth then. Someone had stolen her identification, gone into labor, delivered a baby girl and left the infant at the hospital. The case grabbed headlines at the time, but few knew the ordeal took years to straighten out.

She says she was never able to fully settle the hospital bill the thief had racked up and eventually charged it off when she filed for bankruptcy for unrelated reasons. For months, she continued to get appointment reminders for the baby. She wasn’t able to view her own full medical records because they now contained the thief’s health information. She says she also had to go to court to get her name taken off the baby’s birth certificate.

An Alta View spokesman declines to comment, saying the hospital didn’t have an updated privacy form signed by Ms. Cromar. The Utah Division of Child and Family Services declines to comment.

“To this day, I don’t know if my name is in the baby’s medical record,” Ms. Cromar says. “It’s insidious.”