To cut costs, Medicare adopts CDC’s regulations

I think you’d be surprised at how many federal and state government agencies are a part of the opioid war. As predicted, the CDC’s opioid guidelines are being treated more like regulations than simple guidelines. With the backing of the CDC’s false theories, these agencies are deciding which treatments for pain will be available to patients — and which will label you a criminal. If you’re a pain patient with Medicare, this information will affect you.

A new strategy being developed by Medicare to combat the abuse of opioid pain medication will encourage pharmacists to report physicians who may be prescribing opioids inappropriately. Patients that a pharmacist believes are abusing opioids could also be referred for investigation.

The strategy, which has yet to be finalized, was outlined by the Centers for Medicare & Medicaid Services (CMS) last week in a 30-page report on the agency’s “Opioid Misuse Strategy.” It has not been widely publicized by CMS or reported in the news media…

I read a story the other day about a pain patient who was reported to his doctor by the pharmacist for buying alcohol with his prescription drugs. But I don’t think it’s news that doctors and pharmacists have also become an extension of the DEA in the opioid war, just like other government agencies.

Here are some excerpts from CMS’s “Opioid Misuse Strategy” report:

Increase the use of evidence-based practices for acute and chronic pain management. Evidence-based practice is an integral part of all of CMS’s priority areas, but expanding the evidence base of effective and alternative treatments for acute and chronic pain is especially vital. CMS stated this priority area specifically to emphasize the need to address the limitations of research that is currently available.

By January 1, 2019, CMS will enforce requirements that the vast majority of prescribers who write prescriptions for Medicare Part D beneficiaries must be enrolled in Medicare or be validly opted out in order for the beneficiaries’ drugs to be covered. This enrollment requirement will allow Medicare to have better oversight of prescriber behaviors and revoke enrollment of providers proven to demonstrate inappropriate behaviors.

The Medicare Part D Opioid Prescriber Summary File, which will build on this Medicare prescriber enrollment requirement, presents information on the individual opioid prescribing rates (for new prescriptions as well as refills) of prescribers of Part D drugs. This public data set will provide information on the number and percentage of prescription claims for opioid drugs, as well as each provider’s name, specialty, state, and zip code. The file can be used to explore the impact of prescribing practices of controlled substances on vulnerable populations.

Finally, through CMS’s Overutilization Monitoring System (OMS), Part D sponsors are provided quarterly reports on high risk beneficiaries and provide CMS with the outcome of their review of each case. Since 2011, the OMS helped sponsors reduce the number of potential opioid overutilizers by 47 percent among Medicare Part D beneficiaries.

Additionally, CMS is addressing the issue of drug diversion by identifying consistent thresholds across programs to flag providers as “high prescribers” and patients as “high utilizers” who may require additional scrutiny.

CMS is in the exploratory phase of identifying metrics to quantify and track progress in each priority area. For priority area 1, metrics are currently under consideration in the following areas:

For prescribers enrolled in Medicare who prescribe Part D drugs:

Percentage of opioid prescriptions:
o Exceeding CDC guideline of 90 morphine milligram equivalents (MME) per day
o Exceeding 7 days of treatment
o Written for extended release/long-acting opioids

Percentage with beneficiaries receiving an opioid prescription without other supportive therapies/treatments

Research would also increase the focus on identifying methods for migrating the significant number of chronic pain patients with long standing opioid use to other medications along with alternative modalities. Without initiating other medications at the same time as alternative therapies, these patients may vigorously resist reducing or giving up the opioids that for many years have allowed them to manage their pain at tolerable levels and lead functional lives. The benefit of tolerable pain levels and functional lives may outweigh the risk of opioid use for these patients.

Recognizing its critical role in promoting and reinforcing appropriate treatment approaches, Medicare, Medicaid, and Marketplace plans would cover therapies that are consistent with CMS’s evidentiary standards.

CMS has a number of initiatives underway to increase the use of recommended evidence-based practices for pain management. CMS provides outreach regarding best practices and technical assistance through the Transforming Clinical Practice Initiative’s Practice Transformation Networks. CMS has distributed publications on evidence-based prescribing practices to providers, often in coordination with other HHS agencies, including the Office of the Surgeon General.

CMS is also playing a part in expanding the evidence base to identify and support effective nonpharmacologic therapies and additional non-opioid pharmaceuticals. The agency’s key role is to identify services that need more evidence to support coverage by Medicare and other health plans. CMS then collaborates with research-focused HHS agencies, such as NIH, who can concentrate research on these need areas.

The focus of CMS’s immediate efforts under this priority area is twofold. First, identify non-covered treatments that already have sufficient evidence in order to quickly expand coverage of those therapies; for example, for certain common pain conditions, such as chronic lower back pain, CMS is exploring ways to streamline coverage of evidence-supported alternative therapies.

Secondly, educate providers and beneficiaries in order to improve provider utilization of evidence-based treatments and adjust patient expectations appropriately.

CMS’s long term priorities focus on broadening coverage and increasing utilization of therapies that are [might be] proven to be effective. This approach will accelerate identification and implementation of effective alternative treatments for pain.

What happens when access to the only adequate treatments for pain are reduced and removed before other “effective” therapies are found? Like, what happens when Republicans repeal Obamacare before having something comparable to replace it with? I think the term “chaos” fits.

“The opioid epidemic is one of the most pressing public health issues in the United States today.” – Health and Human Services (HHS) Secretary Sylvia Mathews Burwell

Really? If more people suffer from untreated chronic pain than suffer from addiction, which is the epidemic? If more people die from suicide than from drug overdoses, which is the epidemic?

Many Medicare and Medicaid beneficiaries and their families have been affected by the consequences of opioid misuse and opioid use disorder, commonly referred to as addiction. Given the growing body of evidence on the risks of misuse, highlighted by the Centers for Disease Control’s (CDC) new guidelines for prescribing opioids that was released earlier this year, and the Administration’s commitment to combatting the opioid epidemic, CMS is outlining our agency’s strategy and the array of actions underway to address the national opioid misuse epidemic. The actions outlined here do not include CMS’s vision for the treatment of cancer and hospice patients.

See, those who suffer from cancer, or are under hospice care, deserve to have their pain treated, while everyone else can just suffer. Thanks, CDC.

Comments are closed.

Of course comments are closed. They don’t want anyone to invade their bubble. But Medicare is on Facebook, along with the agency that oversees it, HHS:

My comment posted today on Medicare’s Facebook page:

The CDC’s opioid regulations, and Medicare’s adoption of them, are forcing tens of millions of Americans to find alternative treatments for pain, like marijuana and kratom. How much savings does that amount to for Medicare?

What happens when you reduce and remove access to the only successfully proven treatment for pain before equally successful alternative treatments are available? How smart is it to repeal before you replace?

Many pain patients are unable to find safe and adequate replacements for opioids. Some will be forced into the underground drug market. Some will choose suicide. Most will survive, but their lives won’t be worth living. Many will just hunker down, suffer quietly, and wait to die — shamed by the opioid war into believing they deserve to suffer.

Has Medicare/CMS identified metrics to quantify and track the destruction being caused by it and the CDC? Like the increase in addiction rates, poisonings, and suicides. The increase in the use of alcohol, cigarettes, acetaminophen and NSAIDs, sugar, and other legal, over-the-counter drugs and supplements. The increase in domestic violence, family break-ups, obesity, kidney and liver disease, disability claims, and homelessness. The increase in anxiety, depression, and PTSD.

Once the government cures addiction (with money and good intentions), what is it going to do about the epidemic of intractable pain? The epidemic of suicides and gun violence? The epidemic of Americans being unable to trust even one government agency in this country?

For most of us, it’s about survival

Among the 200 top-paid U.S. executives at public companies, those in health care and pharmaceutical businesses were awarded average pay packages of $37 million in their most recent fiscal year, the most of any sector, according to the Bloomberg Pay Index, which ranks executives based on awarded compensation. Information-technology managers were No. 2 at $35.3 million…

Without federal guidelines, states will push poor people out of programs, eliminate important benefits, and cut already-low payment rates to providers to save money. I remember a time in Arizona when poor men and women qualified for state assistance for health and food. Now, you must have children to qualify for many of our assistance programs…

My comment:

I was totally unprepared for the asteroid that hit me when my pain doctor dumped me. That was about 5 years ago. One of the things I’m most thankful for is that I’m no longer addicted to doctors. They no longer have any control over me. I no longer have to depend on a doctor for my pain management, and in that, there is quite a bit of freedom. Being chained to pain for so long, it’s nice to feel just a little bit of freedom.

Of course, there may be consequences for someone who is disabled by pain to remove themselves from medical treatment. It appears that one must be paying a doctor to manage a chronic illness or one isn’t considered disabled. I’ve written to Social Security Disability explaining my situation almost 2 years ago, but I’ve received no response. One day, an overworked employee will get to my file, and I don’t know what the result of that scrutiny will be. If I lose my benefits, like these poor people, I will be homeless.

I don’t consider myself stronger than anyone else, so I know that others can recover from their addiction to doctors. I chose cannabis, while other pain patients are choosing kratom. But even with those treatments, there are still an enormous amount of obstacles. Tragically, some pain patients will give up and choose suicide. I don’t blame them.

I suppose it all comes down to how much risk we are willing to take. Money is the primary concern, because a person’s financial condition determines which treatment options are available. For me, the next most important concern is my pain. It’s my pain that determines how much risk I’m willing to take. It’s even my pain that decides how much money I’m willing to spend for treatment. My checkbook is the boss; however, my pain can overrule the boss, but only to a certain point — zero money.

So, here I am, wondering when my disability checks will be cut off. Wondering how Trump is going to affect my disability benefits and access to cannabis. Wondering when I’ll have to start living in my car. I don’t suppose I’ll be prepared for that asteroid, either. But at least I don’t have to wonder if my doctor will support me through all this mess.

In the meantime, all I can do is survive the best way I know how. Because, when you come right down to it, this is about survival. Good luck to us all.

Goodbye, Vicodin

“…crucial efforts to steer physicians away from prescription opioids — addictive pain medications involved in the deaths of more than 165,000 Americans since 2000.”

How much more effort will it take? How much more fear can be instilled in doctors and patients?

Pain medications are not addictive for the majority of people who take them, so to describe them as such is just pure ignorance. Let’s see the number for the amount of Americans who have taken pain medications since 2000 without becoming addicted. Because believe it or not, opioids provide benefits to tens of millions of Americans. And while it’s easy to throw around huge numbers like 165,000 (within a 16-year period), the truth is that the percentage of Americans who suffer from an opioid addiction is very low (0.6% of the population).

“An estimated 78 Americans die from heroin and prescription opioid overdoses every day.”

For comparison, according to the CDC, in 2013 there were 113 suicides every day.

The CDC also says that “firearms are the most commonly used method of suicide among males (56.9%).” When will the government force gun manufacturers to make an abuse-deterrent gun? When will they force gun owners to buy a more expensive, abuse-deterrent model?

“The FDA already has begun moving in the direction suggested by companies, mapping out a process for removing older opioids from the market when newer versions are shown to be more effective at thwarting abuse.”

How many other drugs are considered effective only because they’ve been shown to thwart abuse? Is that the purpose of these medications, or is their purpose to treat pain? Has the FDA determined that it’s not important to show how effective the abuse-deterrent opioids are at treating pain? Because as a 30-year intractable pain survivor who’s taken almost every prescription opioid, I find it hard to believe that these new formulations work better, or even as well as, ubiquitous painkillers such as Vicodin and Percocet.

Some drugmakers aim to replace ubiquitous painkillers such as Vicodin and Percocet with harder-to-abuse formulations that are patent-protected and command higher prices — a plan that could cost government-funded health programs hundreds of millions of dollars in higher medication expenses…

#DearCDC: A basic principle of medical ethics says that when you have an intervention that works, you don’t introduce alternatives unless there are significant advantages. Please share with the public which alternative treatments for chronic pain show significant advantages over opioids for a majority of patients. In other words, prove that the CDC’s guidelines are in compliance with the basic principles of medical ethics.

What about me?


And now, Trump has persuaded Carrier to keep at least half of the 2,000 jobs it planned to outsource in Indiana, a remarkable instance of federal arm-twisting aimed at a single corporation…

Everyone’s talking about how Trump saved 1,000 jobs, yet no one wants to mention the other 1,000 jobs that are going to be outsourced. So, if your friend gets to keep her job and you don’t, how are you going to feel, and vice versa? Wow, thanks for saving my friend’s job, but what about me?


Go have a beer, friend. Looks like 2017 is going to suck for you, too.


Things cost more, but my Social Security Disability check has either stayed the same, or like this year, is going to actually be less.

Fall Is Cranky

First, we got some rain. (Thanks, Mother Nature.)


Then came the snow clouds…


…but no snow, not yet.





Thanksgiving Day sunset.



Does this look like snow?


Because it ain’t. It’s bugs.


Bugs and more bugs. (Cover your nose!)


I’m just hanging around, waiting for payday, so I can buy some weed. One day, Medicare will cover weed. Seriously. But I can’t wait for that day.



Superman and Superwoman! 🙂

What happened to middle-class America?

President Obama promised jobs and he delivered. But these were 21st-century jobs, like in a call center or an Amazon warehouse. Trump has promised jobs by negotiating better trade deals and building a wall to keep out job-stealing foreigners, but these are only pieces of the puzzle. It’s not the whole picture.

Obama saved part of the auto industry, but this year, I’ve seen lay-offs in just about every industry. Americans want good-paying jobs with adequate benefits, but they don’t really exist anymore. Corporations don’t have to pay good wages or supply benefits when they can go overseas for cheap labor, no benefits, and no environmental regulations. Even China is talking about raising prices so that wages can be increased. (China!) Many Americans haven’t yet realized that they’re competing for jobs with people from all over the world. This is the digital age, where concrete walls and borders don’t exist.

Republicans convinced Americans all over the country that unions were anti-business, so Americans destroyed the only power that could save middle-class jobs. Who else was gonna do it? American workers have had to fight for themselves, which obviously doesn’t work. Especially after Republicans destroyed the different ways Americans have used to fight back, like capping legal damages. Maybe some people think it’s a good thing that the legal industry has shrunk so much, but who’s left to fight?

If Trump is even able to bring back good-paying jobs, who will fight to keep them? (Many years ago, New Mexico paid Intel to open up a location in this state, but the relationship didn’t last. After many rounds of lay-offs, the city where most of the workers lived is now a ghost town.)

What kind of jobs will Trump help to create in this country? Could a President make Intel stay in New Mexico or is all of this going to be business that’s left up to the states? In other words, nothing will change.

This from Rudy Giuliani on CNN today:

“You’re forgetting his campaign promise of increasing dramatically the size of the military and doing away with the sequester. We’re going to go up to 550,000 troops… we were going down to 420,000… and we’re going to increase the size of the Marines… So he’s going to be facing Putin with a country that’s not diminishing it’s military, but a country that’s dramatically increasing it to Reagan-like levels, so that he can negotiate… he’s going to negotiate for peace, but with strength…”

I suppose dramatically increasing our military will put more Americans to work. (There are probably not very many foreigners or immigrants in our military taking jobs away from Americans, but since Bush’s wars, the military hasn’t had that high of a bar for admittance.) Are these the jobs that Trump supporters want, to work for the government, specifically the military?

As far as I know, it’s mostly corporations that outsource contractors from other countries, not the military. Thing is, the military relies on contractors from the private sector quite a bit. I guess it will be poor Americans who fight on the ground, while the “elite” work at their desks from around the world — the type of job that pays well and has good benefits. (The recession caused a lot of job loss in state and local governments — but not so much in Washington.)

I recently saw a billboard advertising for the Marines. It talked about honor. There may be honor in serving this country, but I can find no honor in war. (And just because I’m anti-war, that doesn’t mean I’m anti-military.)

Every day is veteran’s day because America can’t stop fighting wars. Trump wants to increase our military when we haven’t even financially recovered from Bush’s wars. How many women and men will he send into danger? How many will come back broken beyond repair?

There are men and women who will suffer for the rest of their lives with medical conditions caused by their military service. It would be one thing if the healthcare system took care of our veterans, but that’s not always the case.

This country has been cutting back on spending for services we depend on just so we could pay for Bush’s wars, like infrastructure and education. Americans have been cutting back to pay for 9/11 for the last 15 years.

Here in New Mexico (as reported on 11/4/16 by the right-leaning and financially-in-trouble Albuquerque Journal):

“With New Mexico in the middle of a budget crisis, cities and counties around the state are going to have to look for new ways to boost behavioral health services and fight the effects of opioid abuse. Bernalillo County Commissioner Maggie Hart Stebbins made the comments while visiting Washington, D.C., for a meeting hosted by the White House Office of National Drug Control Policy. Hart Stebbins and other officials on Thursday talked about the potential of pay-for-success programs in which local governments make payments to contractors and other service providers only if they meet certain milestones and outcomes…”

It appears that government has embraced the idea of corporations proving success before they get paid. But is this a good idea in the healthcare industry? What kind of successes are they expecting in addiction programs? What will clinics do — how far will they go — to make their patients “succeed”?

The drug war costs billions of dollars. States can’t afford to provide adequate healthcare. We’re in a gigantic financial hole from Bush’s wars — wars that Obama has continued, albeit at a much smaller pace. Military spending was out of control for so long. Americans have given their military a blank check, with very little accountability. Obama reigned in the spending, but just in how fast it was growing. Military spending has always included an annual increase. Can’t say the same for Social Security. In fact, presidents have stolen money from Social Security to fund the military.

And now Trump wants to make our military even bigger. We already have the biggest military on planet Earth. Maybe even in the whole galaxy. Our military is everywhere. Why do we need to make it bigger? As a show of force? Does Trump need a gigantic military at his back so he can negotiate with other countries? Well, guess what? He already has one.

Let’s hear from Trump’s new national security “guru”:

Luckily, there are some answers to Flynn’s views in a book he published in July, “Field of Fight: How We Can Win the War Against Radical Islam”. Flynn claims that the United States is in a “world war” with radical Islam, a war that “we’re losing” that could last ‘several generations.” He also asserts that “political correctness forbids us to denounce radical Islamists.”

American Islamists, Flynn claims, are trying to create “an Islamic state right here at home” by pushing to “gain legal standing for Sharia.” Flynn cited no evidence for this claim.

In particular, Flynn portrays Iran as the source of many of America’s national security problems…

Flynn advocates going after the “violent Islamists wherever they are,” which doesn’t sound much different than what the Obama administration is already doing, given that it is conducting various forms of warfare in seven Muslim countries…

Looks like Trump and his cronies are gonna pick a fight with Iran. Will we never stop fighting over oil? Hey, Trump supporters, if we had more solar and wind power, we wouldn’t have to depend on other countries to supply our oil addiction. Or do all you gun-lovers enjoy wars that last forever? As Trump’s new cabinet member says, we’ll be fighting radical Islam for “several generations.”

Trump, the New Face of War. How appropriate. I guess the best we can hope for is that he doesn’t push the button.

I blame religion

Democrats have been sliding right for decades. Instead of joining Democrats in the middle, Republicans ran to the far right. And now we have President Donald Drumpf.

Pundits will place blame for Hillary’s loss on things like fear, anger, and apathy. I’m sure there are a myriad of reasons that America voted for a racist, homophobic misogynist.

Some say that women voters were the reason that Obama became president. Some say it was black people who put him in office. Now it appears that men, as a voting block, are the reason that Trump is now president. But, there’s more to the story than that…

A large majority of Republican women voted for Trump. Does that mean these women are ignorant? (Like, do any of them even know who Angela Merkel is? Do any of them believe that a woman can be president?) Does it mean that party affiliation is stronger than common sense? Why would any woman vote for someone like Trump?

Chelsea Handler: The only person with more respect for women than Donald Trump is Bill Cosby.
7:57 PM – 19 Oct 2016

I’ll tell you why: religion. If you think about the divisions between Democrats and Republicans, all of them can be traced back to religious beliefs. The only groups that Americans dislike more than atheists are Muslims and Mexicans.

Funny thing is, I think Trump is an atheist, not that he’d ever admit it. He will always worship money and power over anything else. And perhaps that says more about the Republican party than anything else. It’s all about the worship of money. Not that the Democrats are any different.

Yes, the Republican party is full of racists and bigots, but it’s also full of people who don’t believe in science. People who believe more in their own religion than in the facts. Hypocrites who say they believe in individual rights, but not the right to smoke pot or the right to die. These people are now in power with no one to stop them…

Dude, that’s some scary shit.

The only thing I’m wondering right now is which group Trump will pick to shit on first. Is he coming for Mexicans or Medicare? Women’s or gay rights? Republicans voted him in, but will they have any control over him? (My stomach hurts.)

Donald Trump was declared the winner around 1am. He said in his victory speech that it’s time for us to become “united.” How long has he spent trying to divide us? That’s what you call hypocrisy at it’s finest.

I live in a state that voted for Hillary, but if I lived in a Trump state, I’d be looking suspiciously at my neighbors. Which one of them voted this asshole into the highest office in the land?

To everyone who doesn’t live in America, from this very sad American:  I’m so sorry.

I can understand how news like this might trigger someone who is depressed into thinking about suicide. If you’re thinking about suicide, please click on the candle widget on the right side of your screen.

Thanks for listening, everyone. 🙂

Et tu, John Oliver?

Maybe you will recall an article in the New York Times this year about the ER at St. Joseph’s Regional Medical Center in Paterson, New Jersey, deciding to use opioids only as a “last resort” to treat pain:

Here’s a recent article praising the virtues of these new programs to treat pain from the American Hospital Association:

When leaders set out to create a more uniform approach to emergency pain treatment, the original goal was to run an “opioid-free ED.” However, Rosenberg says they soon realized that this was unrealistic and, instead, have fostered a culture in which physicians have a broader range of resources. Opioids are now the last line of defense.The medical center’s Alternatives to Opioids program was launched in January for patients who present with one of five acute pain diagnoses — headache, long bone fractures, kidney stones, back pain and other musculoskeletal pain…

Since January, St. Joe’s already has cut the number of opioids prescribed in its ED by 38 percent…

The opioid war loves to tell us how much the supply of opioids has been decreasing. How wonderful. But this one statistic doesn’t tell us much. Why don’t we visit Paterson, NJ, and see how it’s doing?

Seven people overdosed on drugs in a 24-hour period Thursday in Paterson – four of them in a one-hour period in a park on Ward Street, authorities said Friday…  All seven victims survived after receiving medical treatment, police said…

“Fentanyl and carafentinal are increasingly apparent and becoming a national problem,” Speziale said Friday. “Many toxicology reports come back with what is categorized as polypharm, which means there’s a combination of heroin, fentanyl and other opiods.” …

In fact, law enforcement intelligence points to Paterson and Newark, N.J., as the sources for much of the heroin that’s plaguing the lower Hudson Valley, northern New Jersey and the Tri-State area where Port Jervis sits.

“For western Orange County, Paterson is the connection,” said Orange County District Attorney David Hoovler. Why Paterson? Heroin there is cheap and accessible…

The treatment courts are full. The narcotics unit is running full bore. Meanwhile, overdoses are worsening…

Back to the article by the American Hospital Association:

The massive Veterans Health Administration — with more than 1,700 care sites treating nearly 9 million patients annually — recently rolled out a systemwide effort to better address the complex pain from which returning vets often suffer. Dubbed the Opioid Safety Initiative, it targets individuals on high-dose prescriptions, and helps them to treat their pain through education, a mobile app called Pain Coach, and such alternative treatments as acupuncture. At the initial implementation sites, the VA reduced high-dose opioid use by more than 50 percent, with no rise in pain scores…

With no rise in pain scores? (I’m sorry, but if you believe that, I want to sell you some bitcoins.) Even with those patients who didn’t see a rise in their pain scores after being forced off of opioids, that just means their pain scores didn’t change and are still high.

Rollin Gallagher, M.D., the deputy national program director for pain management at the VA, believes these results can be duplicated easily at any hospital…

Groups like the American Hospital Association urged the Centers for Medicare & Medicaid Services to remove pain-related questions from patient satisfaction surveys and, in July, CMS agreed to do so…

From a graphic in the article:

The U.S. has experienced a 300 percent surge in prescription opioids dispensing since 1999, with no corresponding drop in the amount of pain reported by Americans.

I don’t know where they got this information, and I’m not sure what it’s supposed to be telling us. Opioids help manage pain, they don’t get rid of it, so why would there be a drop in the amount of pain reported? Using this questionable information, we could also say that there hasn’t been an increase in the amount of pain reported by Americans. And that would be a good thing, but we’re not allowed to give any credit to opioids.

The CDC said it will “take time” before overdoses start to decline.

“Reducing the level of opioid prescribing is a long term strategy to limit exposure to these drugs. Mortality outcomes would not be expected to change for several years after implementation, and impact would be complicated by the increasing supply of illicit opioids,” Courtney Lenard, a CDC spokesperson, said in an email to Pain News Network…

The actions of the DEA, CDC, and VA have actually increased the size of the underground drug market. They have created this demand. They are the reason that people are overdosing on unsafe, illegal drugs. But you see, these government agencies have decided that they’re okay with that. This is a “long term strategy,” and they know that some people will be lost. They think they’re saving lives in the future, which for some reason, is more important than saving lives in the present.

The thing is, everything may be getting even worse for pain patients. Because, allegedly, corporate power has been hampering the DEA’s efforts to get at suppliers and distributors, at least according to recent articles in the Washington Post. Even if Big Pharma just keeps getting a slap on the wrist, that doesn’t mean they’re still operating in the same way. They don’t want to pay more fines and they’re spending millions to develop new and “safe” painkillers (which will be expensive, probably less effective, and out of reach for many patients). And there are millions of corporate dollars funding the opioid war, matched by our tax dollars.

Before Reeves’s arrival, Geldhof said, investigators had to demonstrate that they had amassed “a preponderance of evidence” before moving forward with enforcement cases, which are administrative, not criminal. Under Reeves, Geldhof said, investigators had to establish that their evidence was “beyond a reasonable doubt,” a much higher standard used in criminal ­cases…

You can label a case as “administrative,” but it still involves drugs and crime, so why shouldn’t the agency be required to prove the higher standard? It appears that the DEA has been stripped of some of its abusive power — and they want it back. So, they’re blaming corporate power for the slowdown in cases. Will Congress give this power back to the DEA? Perhaps I should say, when Congress gives this power back to the DEA, things will get worse for pain patients.

To top it all off, the latest episode of John Oliver is about the opioid “crisis.” I don’t think he added any new information about the opioid war, but he appeared to be on the side of the CDC. He mentioned that opioids were only previously prescribed for acute pain. He included a video from PFROP. He made one slight mention of patients who need these medications, but he mostly blamed the whole thing on Big Pharma, singling out Purdue. He mentions how insurance needs to cover alternative treatments, without including the fact that alternative treatments only work for a small percentage of patients.

For me — who finds humor in just about anything (even Trump) — I didn’t find anything funny in John Oliver’s take on the opioid “crisis.” For the first time, I’m disappointed in Mr. Oliver. I’m sad that so many intelligent people cannot see the whole picture of the opioid war. Cannot see the millions of chronic pain patients who are suffering. And why doesn’t the media ever mention the epidemic of suicide in this country? It’s as if those deaths have nothing to do with pain and the opioid war.

Today I’m very sad that there is not one person with any power who is willing to stand up for pain patients. As if we are unimportant and mean absolutely nothing. As if science means absolutely nothing.

Thanks for reading. Sorry if I bummed you out. Blame John Oliver and Trump. 🙂

“I hate the person pain has made me become.”

Under comments:

Morgan Thorne

At the beginning of my ‘chronic pain journey’, I tried to stay positive and would never wish this on anyone else.

After 10 years of intense suffering, being told I’m faking or an addict, doctors who don’t care or openly mock me – I hope that every single one of them gets to live with the joys of CRPS. I’ve lost my career, family, friends, pretty much everything. Oh and when they beg for relief, I want to laugh in their face, the way so many have done to me. I want them to know that there is something that could ease their suffering, help them have a life, get a job (escape horrific poverty), but they aren’t worthy of it.

I hate the person pain has made me become.

I can so relate to this comment — losing everything and ending up isolated and encased in a bubble of unrelieved pain. Seems only fair that all of the opioid-war advocates should also have to suffer at some point.

Revenge would be sweet, when so much of life is not. Do I believe in revenge? Isn’t that how wars are started?

Lately, it seems like every time I interact with the public, I lose my temper. Yesterday, I actually got out of my car in the Walgreens parking lot to angrily address a couple of women who were rude to me. It appears my fear of guns was not strong enough to overcome my anger. Because you never know who’s carrying a gun in this country, especially a woman who would throw the f-word at a stranger (me).

I caused a scene in the Walgreens parking lot. I’ve never done that before. At first, I was just angry. Then, embarrassed. Now, I can’t help but laugh at myself. (Thank you, Bud Fairy.)

The scene of this crime occurred after I had waited in line for a long time at the pharmacy, just so I could have the privilege of buying my allergy medicine (which I have to do every 10 days, regardless of the weather or my pain levels).

However, the woman behind the Walgreens pharmacy counter was very nice, apologizing for keeping me waiting. I’m like, sorry, if my foot didn’t hurt so much, I wouldn’t be acting so irritated. I told her they needed more pharmacy staff and she said that wasn’t happening. She told me that the latest from corporate was how they wanted the pharmacy staff to open the locked restroom door for customers. She’s like, we’re too busy to handle additional responsibilities.

Seems like the answer would be to keep the restroom doors unlocked. But what do I know.

After Walgreens, I had to go to a specific grocery store for items I can’t get anywhere else. And guess what? The store didn’t have 2 out of the 4 items I needed. I get up to the register (after waiting in another long line) and it turns out I can’t buy the Dr. Pepper on sale unless I spend $25. (I should’ve known the special was too good to be true.) I’m like, if ya’ll weren’t out of these other items, I would’ve spent that much. Then I said, thanks anyway, left my cart blocking the customer behind me, and walked out of the store. (Can you feel my foot throbbing?)

Is this me being rude or my pain? And aren’t they one and the same?

So, I went to the same grocery store chain at a different location. And guess what? They actually had everything I needed. And the cashier was nice. We talked about how we both dislike coffee.

The purpose of this rant is to agree with Morgan’s comment: Sometimes I hate the person pain has made me become. Even though I knew that my irritation, anger, and impatience were due to pain, I couldn’t get past it. It felt like I wanted everyone else to feel the pain I was feeling. Because it’s so unfair that I no longer have access to adequate, affordable, and consistent pain relief, even for a broken foot.

As I was driving away from Walgreens, all I could think about was what I wished I had said to those rude women. I called one of the women “unfriendly” for dropping the f-bomb, when I really wanted to call both of them “white trash.” I’m not sure if that’s me talking or the pain.

Funny thing is, I was going to apologize for getting in their way (when the opposite was true), but their reactions were so freaking rude, I’m like, okay, now it’s on, dude…




The End. 🙂

When will I become homeless?

A year and a half ago, I wrote to Social Security and CMS:

About three months later, I received a postcard saying my letter was being referred to another office (in New Mexico):

Yesterday in the mail, I received a letter from the Social Security Administration in Kansas City, Missouri:

“We sent you a letter telling you that we were going to review your disability case. However, we do not need to review your case at this time. Therefore, we will not contact your doctor now. We will keep any information that you have given us. We will contact you later if we need to review your case…”

Uh, no, you didn’t send me a letter saying you were going to review my case. I sent you a letter and I never received a response to any of the issues discussed therein. Nothing. Nada.

I always feel anxious when I receive anything from Social Security, just like when I received letters from Unum, my ex-long term disability insurance provider. Since Unum terminated my benefits, I keep waiting for Social Security to do the same. See, disability providers believe that if you’re not taking medications (and seeing a doctor regularly), you’re not disabled:

The DEA and CDC have taken away the most successful treatment for chronic pain. Doctors will no longer treat many pain patients. Medical cannabis programs, where they exist, are too expensive for many of the disabled. So, who has the money and access to see a doctor regularly? Is that a requirement to be disabled? And if you aren’t seeing a doctor, you get kicked to the curb?

No wonder so many people believe in conspiracy theories. Use the drug war to kick people off of disability. Genius.

Checking my mail is a stressful activity. When will I get that letter cutting off my disability benefits? When will I become homeless?

Dr. Steve Miller, You Suck

I had no idea that so many pain medications also came in topical form, including Gabapentin and Tramadol. And I can’t believe how much they’re charging for them:

“$18,000 for one-month supply, three creams, that’s about right,” said Wurtz…

Western Medical pitched the creams as a “free benefit” paid by insurance. If a patient said “yes” Western Medical told their doctor: “One of your patients has expressed interest in a non-invasive topical cream to help alleviate pain.” It also sent over pre-written prescriptions for the doctor to sign…

Sources linked to Western Medical tell CBS News the company collected up to 200 prescriptions a day, billing them to Medicare and private insurance for more than $1 million a week…

“This is really abuse in the marketplace,” said Dr. Steve Miller.

Dr. Miller is the chief medical officer at Express Scripts, the nation’s largest pharmacy benefit manager. They paid for John Picard’s creams, but recently stopped covering many of them because, Dr. Miller said, there’s no research proving they work.

“If you talk to almost any pain expert, they’ll tell you these things are working strictly through a placebo response and not through a physiological response through the pain receptors,” said Dr. Miller…

How many pain “experts” would declare that topicals don’t work? That topicals only provide a placebo response? (Is your pain doctor a paid consultant for Express Scripts? A paid consultant for pain medications that aren’t topicals?)

I’m not a big fan of topicals, but I’ve read plenty of comments from pain patients who say that they help. I’ve used Lidocaine patches and I’ve tried a compounded topical with Soma. I have to agree with Dr. Miller about the placebo effect, but I don’t think every patient who gets relief from topicals is experiencing a placebo effect. And for a doctor to discount the relief that can be obtained from a placebo effect is very short-sighted.

For Dr. Miller, this is about money. And I guess Express Scripts is not willing to pay for drugs which can provide the benefits of a placebo effect. Even though the percentage of patients who benefit from a placebo effect are fairly small, they’re not inconsequential. Express Scripts is saving a lot of money by denying the benefits of placebos, as well as denying that topical pain medications can and do work.

Dr. Miller, you suck. How can you call yourself a doctor?

Under comments:

THIS NAME USED? February 26, 2015 7:7AM
This report only scratches the surface of the fraud and laws being broken around the compounding pharmacy industry. I happen to work for a compounding pharmacy and understand the business. There are good, ethical compounding pharmacies out there that follow all the rules. Then there are those that solicit physician “investment” and compensate those physicians handsomely for using their pharmacy exclusively. Medimix and RXpress are prime examples…

Can your DNA be used against you?

4. Riding in a car with my cousin, some cops pull us over and wants to search the car. We were young and just assumed they could do that…

Valutsky told them there had been a string of car break-ins recently in the area. Then, after questioning them some more, he made an unexpected demand: He asked which one of them wanted to give him a DNA sample.

After a long pause, Adam, a slight 15-year-old with curly hair and braces, said, “Okay, I guess I’ll do it.” Valutsky showed Adam how to rub a long cotton swab around the inside of his cheek, then gave him a consent form to sign and took his thumbprint. He sealed Adam’s swab in an envelope. Then he let the boys go.

Telling the story later, Adam would say of the officer’s request, “I thought it meant we had to.” …

Private DNA databases have multiplied as testing technology has become more sophisticated and sensitive, enabling labs to generate profiles from so-called “touch” or “trace” DNA consisting of as little as a few skin cells. Automated “Rapid DNA” machines allow police to analyze DNA right at the station in a mere 90 minutes. Some states allow “familial searching” of databases, which can identify people with samples from family members. New software can even create composite mugshots of suspects using DNA to guess at skin and eye color.

Strict rules govern which DNA samples are added to the FBI’s national database, but they don’t apply to the police departments’ private databases, which are subject to no state or federal regulation or oversight…

In 2012, New York became the first state to require DNA collection from those convicted of any crime, not just violent ones, and at least 29 states now authorize collection from anyone arrested for certain crimes…

Blackledge said building a private database also allowed the city to collect more DNA from juveniles…

Since 2007, the District Attorney’s office in Orange County, California, has offered certain non-violent offenders the chance to have their charges dismissed in exchange for contributing cheek swabs to a special separate DNA database — a “spit and acquit” program, as the local media nicknamed it. As of mid-August, according to the DA’s office, over 145,000 people had voluntarily donated their DNA to this database…

Police in Branford, Connecticut, draw a different line in collecting DNA. They’re instructed to request DNA from people they merely observe acting inexplicably or strangely…

West Melbourne police say they’ve collected “abandoned DNA” from chewing gum or cigarette butts left by people who refused to sign consent forms…

Under comments:

bdaly • 3 days ago
Has anyone considered how much medical info your DNA has? Imagine the damage that could be done to you if that info were to fall into the hands of insurance companies or potential employers. It’s not like these databases are unhackable.

Genetic discrimination occurs if people are treated unfairly because of differences in their DNA that increase their chances of getting a certain disease. For example, a health insurer might refuse to give coverage to a woman who has a DNA difference that raises her odds of getting breast cancer. Employers also could use DNA information to decide whether to hire or fire workers.

The Genetic Information Nondiscrimination Act of 2008, also referred to as GINA, is a new federal law that protects Americans from being treated unfairly because of differences in their DNA that may affect their health. The new law prevents discrimination from health insurers and employers. The President signed the act into federal law on May 21, 2008. The parts of the law relating to health insurers will take effect by May 2009, and those relating to employers will take effect by November 2009.

The law protects people from discrimination by health insurers and employers on the basis of DNA information. The law does not cover life insurance, disability insurance and long-term care insurance.

American police have for the first time used a marijuana breathalyzer to evaluate impaired drivers, the company behind the pioneering device declared Tuesday, saying it separately confirmed its breath test can detect recent consumption of marijuana-infused food. The two apparent firsts allow Hound Labs to move forward with plans to widely distribute its technology to law enforcement in the first half of next year, says CEO Mike Lynn…

Though breathalyzers are familiar roadside tools, there are other options for officers looking to rapidly test a person for marijuana or other drugs, including increasingly accepted roadside oral fluid tests or — potentially early next year — a futuristic fingerprint-sweat test.

Dr. Paul Yates, a forensic scientist and business development director at U.K.-based Intelligent Fingerprinting, says the sweat-test devices — which can be calibrated to specific thresholds for marijuana and other types of drugs including cocaine and opiates — can indicate drug use in near-term windows…

Duffy Nabors, vice president for sales and marketing at Smartox, says the company has received inquiries from law enforcement departments in California, Colorado and Texas interested in roadside use of the metabolite test, and he expects law enforcement will be among the first American buyers…

The DrugTest 5000 — one of a handful of similar products — indicates if marijuana or other types of drugs are present in a suspect’s saliva. The company counts the New York Police Department, the Nevada Highway Patrol and Oklahoma tribal police among its customers.

Shaffer says the test detects THC in a user’s saliva for roughly 2-6 hours after they consumed the drug, though a heavy user once tested positive 24 hours later. The test only indicates the presence of THC and does not quantify the amount, though like the Intelligent Fingerprinting technology can be calibrated to a specific threshold…

Now, if you’ve read all of the above information, how do you feel about this:

WASHINGTON (Reuters) – The U.S. Justice Department will enlist federal prosecutors to help fight the nation’s opioid crisis by sharing information on overprescribing doctors and coordinating with public health officials to address addiction, USA Today reported on Friday…

Lynch said sharing information about physicians tied to prescription drug abuse could help authorities better identify drug traffickers and the routes they use, the report said, adding that working with local health officials will help give equal attention to prevention and treatment efforts…

She said the department would issue the new plan next week in a memo to its 94 U.S. attorney offices…

Tell me, how are federal attorneys going to “work” with local health officials in regards to prevention and treatment efforts? What do attorneys and the justice system have to do with addiction and health care? Are the attorneys going to give patients free legal advice?

To me, this little tidbit of information from Attorney General Loretta Lynch has to do with the PDMPs. There’s been a push to connect all state databases into a federal database that’s accessible across state lines. Like the FBI has a national database for DNA. “Coordinating with public health officials” might mean that U.S. attorneys are going to require states (doctors, government employees, pharmacists) to input the information into the PDMPs, making their use mandatory.

What does this mean for chronic and intractable pain patients? Looks like the federal government has taken the criminalization of opioids to the next level. Perhaps the U.S. Attorney’s Office is getting tired of waiting for the DEA to make a difference.

If you have a DNA test, make sure you read the release forms. Don’t sign a form that says the lab can share or sell your DNA information, and make sure you see HIPAA language. I’m not saying these things will protect you, but that’s all we’ve got.

Someday in the not-so-distant future, before your health care provider decides which medication to prescribe for your fibromyalgia symptoms, they might first swab your cheek for a few cells and send them off for genetic tests. The genetic data hidden in those cells might reveal which medications you are likely to get benefit from, and which to avoid due to higher chance of side effects.

It sounds futuristic, but in fact this technology is available now, though it has not been widely adopted by medical providers. Testing for a person’s gene-drug interactions is called “pharmacogenetics,” and is a rapidly expanding field with multiple companies now offering panels of tests targeted to different illnesses…

Patient satisfaction surveys and the blame game

The problem is that what matters to patients and doctors does not always align. Someone may push for unnecessary testing because they read it on Google or Dr. Oz recommended it on his show. Someone may push for medications that are not medically indicated, i.e. antibiotics for viral infections. Someone may push for narcotics but refuse other pain control options offered by their providers. People are not always receptive to “no,” and some will threaten doctors with a low score…

I agree with Dr. Lee that patient satisfaction surveys have their place. I agree they can deliver valuable information that can impact positive change. However, as they stand now, they also promote false expectations. They hand the definition of “quality care” to the patients and undervalue the medical judgment of clinicians. There have been negative consequences as a result. To imply that patient satisfaction surveys have not contributed in some way to the opioid epidemic is to shamelessly pass the buck…

No one wants to take responsibility for the opioid crisis. The truth? Multiple factors led to the current state of affairs. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) emphasized pain scales with the implication that patients ought to be pain-free, an unrealistic expectation. Patient satisfaction surveys inadvertently decreased the importance of clinical judgment in the eyes of the public. The federal government also played a part by financially incentivizing hospitals based on patient satisfaction scores. Some doctors began to overprescribe medications due to these external pressures…

I’m a doctor. I have a medical degree. Therefore, I know what’s best. Really? Is that why about 400,000 patients die every year from doctors’ mistakes? Doctors admit they don’t have time to get to know their patients, yet we’re supposed to trust that they know what’s best for us?

Everybody involved in the drug war, including doctors, play their own versions of the blame game for the opioid “epidemic.” Sure, blame pain scales, although I’ve never looked at a pain scale and thought, oh boy, this says I can be pain-free! Doctor, I want to be a zero on the pain scale! Make it happen!

Sure, blame patient satisfaction surveys, although during my 25 years of being treated by the medical industry, I don’t recall filling out too many surveys. The last time I was in the hospital, I vaguely recall a postcard-sized survey, which I filled out to say nice things about one of my nurses. But for all the doctors I’ve seen? No, I don’t recall filling out any patient satisfaction surveys. And I can’t recall Medicare sending me any surveys, either.

Under comments:

Maggie1212 • 5 days ago
Amen. My hospital for about 2 years actually linked our entire bonus to patient satisfaction scores, instead of any measurable factors such as time to cath lab, appropriate ACLS meds given during Code 99s, time to antibiotics for pneumonia, etc which we suggested. During that time we had incredible pressure from hospital administrators to prescribe narcotics. You would get calls, asking, “why didn’t you just give him enough to get him through the weekend?” Absolutely unreal stuff.

DZ-015, M.D. Maggie1212 • 5 days ago
It’s very simple. Once the patient is on benzos or opioids for more than three weeks (with the exception of chronic progressive disease) the patient satisfaction score doesn’t count because their judgment on the issue is now impaired.

What should a bonus be tied to? Because I find it hard to believe that a hospital would base an entire bonus on patient satisfaction scores, instead of including things like how long the employee has worked there. And I also find it hard to believe that hospital administrators pressured employees to prescribe narcotics, although prescribing enough for the weekend doesn’t sound unreasonable. This hospital employee’s attitude pretty much says it all — it’s unreal to be asked to prescribe a couple days worth of painkillers. And low patient satisfaction scores just mean patients didn’t get the drugs they wanted — they have nothing to do with the employee’s performance at all.

Obviously, Medicare is collecting this data, although how many patients are actually participating is questionable. And the information is only on hospitals, not specific doctors.

Patient Experience encompasses 8 important aspects of hospital quality:

Communication with nurses
Communication with doctors
Responsiveness of hospital staff
Pain management
Cleanliness and quietness of hospital environment
Communication about medicines
Discharge information
Overall rating of hospital

Performance period: January 1, 2014 – December 31, 2014

UNM Hospital
Pain management: 0 out of 10
Overall rating: 2 out of 10

Lovelace Medical Center
Pain management: 1 out of 10
Overall rating: 2 out of 10

Lovelace Westside Hospital
Pain management: 4 out of 10
Overall rating: 6 out of 10

UNM Sandoval Regional Medical Center
Rio Rancho
Pain management: 0 out of 10
Overall rating: 4 out of 10

Christus Vincent Regional Medical Center
Santa Fe
Pain management: 3 out of 10
Overall rating: 1 out of 10

(7/12/16) State restrictions not associated with reduced opioid misuse among disabled adults

Controlled substance laws are not associated with reductions in hazardous opioid use or overdose among disabled Medicare beneficiaries, according to research published in the New England Journal of Medicine…

Data were collected for disabled Medicare beneficiaries between the ages of 21 and 64 who were alive between 2006 and 2012 (8.7 million person-years)…

Between 2006 and 2012, states added 81 controlled substance laws. In 2012, 47% of Medicare beneficiaries filled opioid prescriptions, 8% had 4 or more opioid prescribers, 5% had a daily MED greater than 120 mg, and 0.3% were treated for nonfatal prescription opioid overdose

Medicare owes me a refund check

A new study from the journal Health Affairs found that the availability of medical marijuana significantly correlates with lower rates of prescribing other drugs. The authors of the study, Ashley C. Bradford and W. David Bradford, looked at data on all prescriptions filled by patients with Medicare Part D from 2010 to 2013…

The researchers looked at prescribing patterns for medical conditions that states allow to be treated with medical marijuana, like anxiety, seizures and glaucoma.

In states where medical marijuana was legal, Medicare saved $165.2 million in 2013…

So in some ways, the cost has not been “saved” but rather shifted to patients, who must pay for marijuana out of pocket (and sometimes experience many other difficulties obtaining it). But one of the study’s authors explained that if medical marijuana became a regular part of patient care nationally, money would still be saved overall, because marijuana is cheaper than other drugs…

Bud is cheaper than other drugs? Even with insurance, I kinda doubt that. That is, unless you live in a state that has legalized, because prices are a lot lower in those states.

The highest reduction in prescribing other medications was seen for pain—highly relevant for those concerned about opioid prescribing levels. (The dramatic fall in pain medication prescribing should be taken in the context of the national decline since 2013)…