Cigna temporarily banned from new Medicare plans

Cigna: Medicare Advantage Programs …widespread and systemic failures

In an enforcement letter, CMS accused Cigna of “widespread and systemic failures,” including the denial of health care coverage and prescription drugs to patients who should have received them…

My Death Plans

I died once, so I’ve probably thought about death more than the average person. Well, obviously I didn’t die, but I was told my heart stopped and I was clinically dead. So, yeah, I’ve been dead before.

The subject of death plans recently came up here:

An important question

https://seachysuffers.wordpress.com/2016/01/12/death-it-will-get-me-and-you-so-why-is-it-taboo/

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Most of us will not get to choose how we die (even though most of us have chosen the way we’ve lived, which doesn’t seem fair). But, unless you’re at death’s door, there’s no way to tell when it’s our time. So, it only makes sense to be prepared for the inevitable.

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I guess a lot of people will visit an attorney to have legal documents prepared, like a will. But that’s really for people with money or property, not really for poor people, like me. Now you can find a lot of legal documents online, which you can prepare yourself, only needing to pay for a notary. In fact, hospitals have some legal documents (like DNRs) for patients to access, hopefully with an attorney available to answer questions at no charge. Now that Medicare is covering end-of-life counseling, legal assistance should become more readily available to the public.

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So, really, all I need to worry about is what I want to happen after I’m gone. That’s easy, because I don’t want to be confined in a coffin and buried under the ground — leaving cremation as the only other option. (Not that I’d want another option, like being covered in chocolate and sent into space in a cryochamber.)

But, I don’t want my ashes confined in an urn, either. And I don’t like the idea of having my ashes scattered somewhere — I don’t see any point in that, and honestly, it seems kinda gross. No, I’d just like my remains to be taken out with the trash, disposed of in an environmentally-clean way…

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Now, if I could save enough money to pay for a cremation before I need this service, that would be great. (But I don’t see that happening.)

As for funerals, I don’t like them. At one time, I thought it would be nice to request a party to celebrate my life after I die, but I no longer like that idea. Celebrate my life while I’m living — don’t wait until after I’m gone.

So, my death plans are cremation and no funeral. I do so hereby swear (to my blog), on this, the 12th day of January, 2016.

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Where chronic pain patients will end up

http://www.npr.org/sections/health-shots/2016/01/06/459226490/medicaid-may-soon-pay-for-some-inpatient-addiction-treatment

For decades, if people on Medicaid wanted to get treatment for drug or alcohol addiction, they almost always had to rely solely on money from state and local sources.

Now, in a dramatic shift, the federal government is likely to chip in, too. The agency that governs Medicaid is proposing to cover 15 days of inpatient rehab per month for anyone enrolled in a Medicaid managed care plan.

But in Pennsylvania, those who work in the addiction field aren’t happy with that news. While it’s a good start, they say, only 15 days of residential care isn’t nearly enough time for many people addicted to heroin, opioids, alcohol or other drugs to get clean and stay that way…

Hey, CDC, can you hear us now?

At this point, there are 486 comments on the CDC’s new opioid guidelines. And while I didn’t read every single one, I think it’s extremely important for the voices of pain patients to be heard — which is why I copied and pasted some of the comments (mostly excerpts) here on my blog. Now these comments can be found by a simple Google search, instead of being buried on the CDC website (for however long).

I think it’s also important for patients to know which doctors agree with the CDC (you know, so you can avoid them). (See comments under “Doctor” heading.)

Just like I want my story to be read, other pain patients want the same thing, so please take a little time to read a few of these comments. You can find my story here:

https://painkills2.wordpress.com/2014/11/15/medical-cannabis/

In my overall review of the comments, I’d say that 95% of them are from patients and are against the CDC.  I also noticed that there were a significant number of comments from patients with CPRS, EDS, Arachnoiditis, Interstitial Cystitis, and Fibromyalgia.

I’d also like to mention the defensiveness and fear within all the comments from patients. Many comments include lengthy descriptions of medical conditions, along with adamant protestations of innocence for abusing medications, such as:

“I take my medication exactly as my dr has prescribed it.”

“BUT, I DO NOT ABUSE MY PAIN MEDICATION AND I’M NOT A ADDICT”!!!

I hate to break it to pain patients, but I don’t think that matters to the CDC. See, in this agency’s view, almost EVERY non-cancer pain patient on opioids is taking too high of a dosage. In fact, the CDC believes chronic pain patients shouldn’t be taking opioids at all, so it doesn’t matter if you’re taking your medications as prescribed.

I also noticed that too many commenters posted under “Anonymous,” obviously afraid to use their real names.

Lastly, I noticed that many pain patients are rooting for doctors, saying these decisions are between doctors and patients. Until your doctor abandons you, I suppose you might still have faith in him or her… Yeah, good luck with that.

Because if you believe that the medical industry is on the side of pain patients, I’m afraid you’re in for a rude awakening. If you believe your current doctor will never abandon you, I don’t see how you’ll be prepared for the eventuality. And as a pain patient, if you have to find another doctor for any reason, you’ll be up shit creek (right next to suicide alley).

In fact, many doctors are taking advantage of the opioid war by taking advantage of pain patients — overcharging and other abuses (including sexual abuse) against patients are not reported, but believe me, the medical industry is rife with abuse against patients. Ya’ll be careful out there…

PAIN PATIENTS:

Comment from Anonymous

It is very frustrating to have my orthopedic Dr. be with a group that has passed a policy to not give out pain meds after a certain number of months post surgery, then sends me to a pain clinic who won’t prescribe narcotics either…

Comment from Emily Valtreaux

Why are your “professional panels” made up of people that will greatly benefit by throwing us all in detox I wonder? Why do you cry “hyperalgesia” (apparently the new fear mongerer word favorite) even when an individual is still in pain, just to the point that is tolerable? …

Comment from S S

Announcing this with no notice and over the holiday season keeps the PATIENTS (the citizens who need these medicines) from having any input on the topic…

Comment from Jaymie Reed

One of the biggest problems we face is that the very people who are suffering are the ones that need to speak out but won’t because of fear of reprisal from the DEA. They won’t sign petitions or comment on public forums such as this, because they are afraid that they won’t even be able to fight to get the pain medication they need that it will simply be taken from them completely… The number of heroin deaths are increasing and it isn’t because the chronic pain patient who is being treated for their pain. It is because of the chronic pain patient that is no longer receiving treatment for their pain. They turn to the streets and buy a drug they have no idea how to use and end up overdosing…

Comment from Rebecca

In Colorado they had me try medical marijuana and that also helped but I had to move back to West Virginia and the medical marijuana is not legal here so I haven’t had any real relief in over a year. I need help…

Comment from John Bocchicchio

A colleague of mine who had a similar condition and had been battling out the pain management paradox, I.e. You are treated like a drug seaker until further proven. He dealt with the suspicions, urine tests, and intense scrutiny as he was fighting for his life with the pain that sought to kill him. Unfortunately, the pain won. Faced with disability battles, and struggles obtaining relief from chronic pain that is constantly screaming at you to give up, he took his own life in 2009 rather face another day of pain and frustration. I don’t want to end up being like my colleague…

Comment from Shelley Anderson

Do you know what it’s like to feel split open from the waist down, have red ants dumped on you, and be eaten alive from the inside out…. YEAH… THAT’S HOW I FEEL EVERY SINGLE DAY… and yet – the answer I get from our local clinic is…just go to the ER to get some pain relief. REALLY? For Gods sake – I DESERVE TO LIVE A SOMEWHAT NORMAL LIFE…I feel like a begging junkie every single month when I have to pick up my “piece of paper”….how gross to live like this. It’s just so damn frustrating. Today…I’d be better off dead. What a sad and pathetic way to try and get my point across. So so so sad. No one should have to live like this. No one.

Comment from Kevin Howerton

I have a degree in neuroscience… Likewise “they aren’t terminal” seems like a very poor argument for denying someone treatment that has the potential to drastically improve their quality of life. I’d rather a short and painful life to a long and painful one.

Some of the more “serious” arguments seem to revolve around the idea that opiate use increases exponentially. “Opiates require an infinite increase to quench an ever increasing tolerance”. You’d be surprised but this idea is preposterous. You have a finite number of receptor sites in your brain; your head occupies a finite amount of space … how could you expect an infinite amount of tolerance. Tolerance does increase with chronic opiate use though it is far from infinite. Having to titrate up a patient to a useful therapeutic dose as their treatment and disease progresses is not something physicians have to uniquely do with opiates … rather this is the nature of all drugs…

Comment from Dana Spencer

I will never get better. I will only get worse.

Comment from Anonymous

SHAME ON YOU

Comment from Anonymous

I just notice the comment I submitted 12/20 was not listed. In fact, comments between 12/19-20 were missing. [This was not the only mention of disappearing comments.]

Comment from Lori Mahloch

I am appalled that the CDC thinks that the only people who deserve to be treated humanely are people with Cancer. I have Reflex Sympathetic Dystrophy, This rates the HIGHEST on the McGill pain scale for pain. Yet I am unable to get treatment by physicians because of CDC guidelines. Walking into a doctors office for a first visit and the first words out of a doctors mouth should NOT be we don’t give pills here. Because of the audacity of the CDC many doctors will not see, nor treat anyone who has a chronic pain disease. I have not been able to see a doctor for a year because of these guidelines. I have lost friends to suicide , due to not being able to get pain meds for their pain…

Comment from Rebecca Scarbrough

Do you think regulations that label sick people as drug addicts or dealers helps with the personal anxiety and depression that almost always accompanies chronic pain? Why add to this? I wonder how many lives were lost when a pharmacist stare and judgement was the final straw. Have you ever thought of that? …

Comment from George Gregorich

I no longer respect or trust doctors…

Comment from Rhonda Barth

You all should be ashamed! My husband is 100% service connected disabled Veterans who is being made to suffer in agony now because you have made it to where the VA is taking away his pain medication. He is now bedridden and has no quality of life, he does not want to be here anymore…

Comment from Theresa Schramm

After 32 years of dealing with temporomandibular joint pain and dysfunction, I had both of my jaw joints replaced and all of my remaining natural teeth pulled earlier this year. The TMJ dysfunction has improved, and is still improving as I slowly get used to dentures, but the headaches and myofascial pain have not. The surgeon was very clear in warning me up front that the pain might not improve with this surgery, and he was right. It seems that the 32 years I spent trying to find ways to treat this has left me with incurable scar tissue all around my jaw joints on both sides. This scar tissue affects every move I make with my face, from simple carrying on a conversation all the way up to eating. My mouth will never open as wide as it should, nor will it move from side to side. I experience pain on a daily basis, sometimes in my jaw joint areas and more often all over my head. It hurts to talk on the phone for more than 15 minutes. Singing causes such pain I have almost completely given it up…

Comment from George Gregorich

I can’t wait for the day when I watch the news and see you people being arrested for crimes against humanity. You are just as bad as chronic pain , you don’t know when to quit…

Comment from Richard Osband

Opiates (of one form or another) have been the sovereign analgesics for centuries. The CDC’s efforts to essentially criminalize them when no other really effective alternative to their use exists is simply sadistic. While there are many ways to treat addiction there are no other ways to treat intractable pain. The proposed guidelines seem to make pain management a matter of morality rather than of proper clinical practice…

Comment from Anonymous

I have lived with Severe pain since I was 14 years old. There is no doubt what the cause is behind the pain. I have had 13 brain surgeries since then and 4 spine surgeries. If I did not have access to my daily dose of Morphine, and Hydrocodone I would not be able to get out of bed because of Hydrocephalus, and a spine disorder called Arachnoiditis. Please stop the madness surrounding to restrict access to much needed life-improving medications. Doctors have all said to me, I may not have cancer but its clear from my vital signs, my labwork and scan results I am living in constant severe pain, and need to be treated adequately before it kills me. It’s proven that chronic pain can put a strain on your heart and other vital signs if not treated appropriately patients can die prematurely.I am fearful that the government wants to do is kill off all chronic pain patients rather than helping us have a better quality of life. The pain we are in isn’t psychological.

Comment from Paul Clay

I work in emergency medicine and critical care. Here’s what happened to opiod abusers. They couldn’t get prescription pills easily enough so the abuser went to heroin,which resulted in more overdose deaths in a few months more than i had seen in my 20 yrs. . If your goal was to kill off the abuser and make it more difficult for true needs patients then congratulations you have succeeded…

Comment from barbara williams

I was nave in thinking that when people are in pain that going to a pain clinic would fix everything. Going to the pain clinic did nothing. Tramadol took a bit of the edge off, but ganglion blocks, injections, trial l with spinal chord stimulator did nothing. We then tried alternative methods of chiropractor care acupuncture, calmare scrambler, ozone injections, dry needling and biofeedback to the tune of $10,000…

Comment from Arianne Grand-Gassaway

Relief from pain should not be a crime…

Comment from Angela Farthing

I am a victim of the 2012 Fungal Meningitis outbreak. I was injected with a contaminated vial of methylprednisone acetate to treat sciatic pain. Shortly thereafter I was diagnosed with fungal meningitis, suffered a stroke, a brain aneurysm, an intradural abscess, and ultimately adhesive arachnoidits. The arachnoiditis left me in horrific pain, pain that literally made me wish I never survived the meningitis (which I almost didn’t). When I initially told my doctors about the pain that left me crying on the floor, my plea for pain relief began…  I now take Low Dose Naltrexone and am completely opioid and synthetic opioid free…

https://edsinfo.wordpress.com/2015/12/22/one-pitfall-of-chronic-oral-low-dose-naltrexone/

DOCTORS:

Comment from Stephen Pew, Ph.D.

My own Mother ended her own life by starving herself because her chronic pain was mismanaged and the doctor would not allow her IV morphine to be administered even in the hospital because “she might get addicted”… I myself ended up in the emergency room with a kidney stone. I was shuffled around for over two hours in terrible pain because the ER was hesitant to administer care for pain. After an hour I was finally given an IV for pain and it was explained to me by the doctor that new regulations limited their ability to treat efficiently. No follow up opioid medication for pain was allowed…

Comment from Elayne Baumgart, Ph.D.

It would be one thing to remove opiates if you had something with which to replace them. Something that would effectively manage pain. But, you don’t…

Comment from Kathryn Rosenberg

I am a Family Physician with 33 years experience in the field. I began to see a pain specialist for back pain about 3 years ago mainly to prevent any questions about my use of opiates. Since then I have started Lyrica and ymbalta for pain control. I have found Tylenol to be of little use… I simply do not see how I could go on living if opiates were not available to me.

Comment from Paul McCurry

As an anesthesiologist, pain physician and addictionologist [made-up term], I applaud the CDC’s efforts to assist in curbing the current opioid addiction epidemic our country is experiencing… All of these adverse consequences are due to continued prescribing of drugs that have NO LONG TERM PROVEN EFFICACY…

Comment from Nathan Hitzeman

These recommendations look reasonable… As a primary care doc losing the war on chronic pain, I applaud the CDC for coming up with these guidelines!

Comment from Blaise Vitale

I am a family physician who regularly sees that chronic narcotics are simply ineffective for chronic pain. I know there are a lot of people who are addicted who think their lives will be ruined by stopping narcotics, but they simply can’t see how the narcotics are harming them. These guidelines may not go far enough to discourage opioids for chronic non-cancer pain. In particular, any patient who has any history of addiction to substances like tobacco or alcohol should never be prescribed these medications chronically. [This is what discrimination looks like.]

Comment from Adrian Bartoli

As a physician specializing in chronic pain management for the past 20 years, double board certified in Anesthesiology and Pain Management, involved in clinical research and the pharmaceutical industry, I strongly and unequivocally SUPPORT the CDC recommended guidelines for restrictions on opioid prescriptions…

Comment from Dr. Edwin Cabassa, DNP, FNP, BC

Unfortunately, there is a significant abuse for opiods in all socio-economic communities. Doctors and Nurse practioners are a major source for those seeking illegal use of such asnd ssimilar substances. My experience is such I will not prescribe opioids unless there is a definitive diagnosis indicating its use. From my panel of patients, I’ve been able to isolate my patients to just 3 who require opiods…

Comment from Maryn Sloane

As an MD board certified in addiction medicine with a sub specialty in the hopefully growing field of effectively treating opiate dependent chronic pain pts… [Someone is seeing lots of dollar signs…]

2. ANYONE on an opiate >30 days will develop opioid induced hyperalgesia… [Liar, liar, pants on fire.]

Opiates ARE NOT INDICATED EVER for neuropathic pain. They WORSEN IT. [Maybe in some patients, but not all.]

Man up docs! – JUST SAY NO!

it takes the simple writing of a prescription to create a substance dependent patient… [Speak for yourself, not everyone else.]

Chronic opiate users should be registered

detoxes should be offered for any pt on opiates for >1y

SUBOXONE MUST BE STANDARD OF CARE

Comment from Richard Webb, MD, Addiction Psychiatry

The use of opiates should be used with extreme caution in anyone with a personal or family history of addiction. [How many Americans don’t have a personal or family history of addiction?]

Comment from Maxwell Stepanuk

I am an orthopedic surgeon and the abuse of opioids is appalling… The problem, as I see it, is with the GPs. [Doctors turning against each other?]

Comment from Barry Saver

As a family physician who has spent my career working in the health care… I would say I have seen some patients genuinely helped by chronic opioid therapy for pain – but far more harm, including addiction, overdose, and diversion… Based on conversations with colleagues, at least 99% would happily accept a time limitation for how long they could prescribe opioids to an individual patient (with exceptions for oncology and palliative care)…

Too bad there aren’t many doctors who commented that still believe in medical science. (Still think doctors are on your side?)

Maybe you’re wondering if I made a comment? No, and I’m not sure I will. However, considering I am currently without bud and in a really bad mood, I might just change my mind. And since I don’t see a rule about how many comments one person can make, I’m sure I could wrangle some fun out of the experience. 🙂

Note:  Comments are due by January 13, 2016.

When will the drug war come for you?

https://www.consumeraffairs.com/news/indiana-employers-grapple-with-prescription-drug-abuse-120915.html

“We’ve seen how the public health crisis of prescription drug abuse is taking a toll on families and communities in Indiana and this survey shows that it has infiltrated our workplaces, just as it has with so many other facets of our society,” said Indiana Attorney General Greg Zoeller. “Beyond the loss of productivity, prescription abuse can cause impairment, injury and may lead employees to bad choices such as theft or embezzlement from the employer.” …

My comment:

Telling employers that pain patients are potential criminals is probably not as bad as telling doctors that we’re potential drug addicts. Should we also tell employers that it’s their white employees who are the most likely to abuse prescription drugs? Maybe minorities will get a boost in employment opportunties, all thanks to the opioid war, which would be the height of irony.

One of these days, the media will connect the dots between the opioid war and the increased suicide rate. You could start by looking up the suicide statistics for every state that reports a problem with opioid abuse and including that information in your article. What you will find is that at least twice as many people die from suicide in these states than from a drug overdose. You will also find pain patients struggling to find health care after the DEA shut down doctors, clinics, and pharmacies. You will find thousands of patients abandoned by their doctors (and everyone else).

First, the drug war came for minorities and drug addicts. Then, it came for pain patients and their doctors. Now, it’s looking at seniors, children, and those on worker’s comp and Medicaid/Medicare. First, the drug war targeted illegal drugs, then opioids, and now benzodiazapines and stimulants. When will the drug war come for you?

Dr. Shame

If you’re not a chronic pain patient, this post won’t interest you…

And it’s really (really) long, because the linked article is full of lies, hypocrisy, and voices of “experts” who aren’t really experts. In other words, there’s a bad word (or two) in this post, as I really (really) dislike liars. Don’t say I didn’t warn you…

You’re still reading? Seriously, since this is my blog, I get to rant, but you don’t have to read it. 🙂

http://www.mailtribune.com/article/20151108/NEWS/151109770

Patient reactions are ranging from dismay to newfound hope as doctors cut back on narcotic painkiller prescriptions for chronic pain in an effort to combat addiction.

Newfound hope?  Ummm, okay, this should be interesting…

And just so we get this straight:  Doctors are reducing or stopping medications to combat addiction, not treat pain. So, really, what doctors are doing is treating about 90% of pain patients for addiction — a condition they don’t have — while also refusing to adequately treat their pain.

Linda Stotts, who lives in the town of Rogue River, said she has tried almost every available painkiller since rupturing disks in her back while trying to lift a desk in 1987. She has taken methadone for four years to ease her pain, but has been told she must taper off the drug until she is methadone-free in two months.

As she reduces her dose and her pain worsens, Stotts said she is contemplating suicide… Stotts, 69, said she fears she no longer will be able to care for herself and will have to move to a nursing home. She said she has been classified as a drug addict because of her painkiller use…

Dr. Jim Shames, medical director for Jackson County Health and Human Services, has been spearheading the local effort to curb use of addictive opioid painkillers…

And so enters the black knight in tarnished armor…

“These drugs are powerful, addictive and dangerous,” Shames said. “But at the same time, people are in pain and we’re bringing their doses down. They’re in a tough place and I recognize that. The trick is how to compassionately put them in a safer place and give them better tools to manage pain. Nationwide, there are millions of legacy patients on high doses. No one is trying to be cruel.” …

“Legacy” patients — what an interesting term. I looked up the definition of that word, but I’m still not sure what this Dr. Shame (I mean, Dr. Shames) is referring to. One of the ways Google defines legacy is:

“denoting software or hardware that has been superseded but is difficult to replace because of its wide use”

If you’re a pain patient currently on opioid treatment, what do you think your chances are of being one of these legacy patients, allowed to continue on opioid therapy?

I read about another anti-drug doctor who suggested that doctors wait for legacy patients to die out, but not create any new ones. I think he said this would take a couple of decades. Isn’t it comforting to know that the medical industry is waiting for current pain patients to die out? Doctors don’t have to feel guilty about not treating us because we’re terminal.

Wait a minute…  If we’re terminal, are we now “legitimate” pain patients?

Shames said the pharmaceutical industry oversold the benefits of opioid painkillers. New research shows they are only about 30 percent effective in treating chronic, long-term pain.

Did Big Pharma oversell the benefits of opioids or did doctors just hear what they wanted to hear? And why would doctors trust their local pharma rep over their own experiences? Did you know that oxycodone has been in clinical use since 1916? (Per Wikipedia.)

Funny how easy it is for doctors to scoff at medication that’s 30% effective, although there’s no reference or link to the research, so I’m not exactly sure what Dr. Shame is talking about. Is he saying that opioids give a patient 30% relief from the pain? Or that 30% of pain patients show increased function with opioids?

Exercise, physical therapy, adequate sleep and cognitive behavioral therapy can yield better results, he said.

If doctors won’t tell you the truth, then I will:  Do you know what treatment yields the best results?  By itself, that would be opioids. But if you have enough money and time to include all these other treatments along with opioids, then the combination of treatments would provide the best results.

Some researchers have reported long-term use of opioids can leave patients hyper-sensitive to pain. Shower spray can feel like needles driving into the skin, for example.

Gosh, I really hate to nitpick (obviously not), but I haven’t read about too many patients who actually suffer from hyperalgesia. But I’m wondering, if you stop taking opioids and your pain doesn’t magically decrease or disappear, would Dr. Shame then allow you to access opioids again? Somehow I doubt it, which makes this doctor a freaking hypocrite.

Because of opioids’ addictive nature, patients become physically dependent on them. Without the medications, patients can suffer withdrawal symptoms such as nausea, vomiting, diarrhea, muscle pain, sweating, chills, insomnia, anxiety, irritability and low energy.

So, how about we don’t take these medications away from patients? Instead, increase efforts at educating (not scaring) patients about the drugs they’re taking. There, problem solved.

Touchstone Interventional Pain Center in Medford is among local medical groups working to transition patients to safer doses or off opioids altogether. A few months ago, the center sent a letter to 1,500 patients saying changes in the field of pain management likely will cause adjustments to pain medication prescriptions. The high risk of overdose death, coupled with studies showing many patients with chronic pain failed to show substantial improvements in pain, have caused a shift in policy about prescriptions, the letter said. Patients on high doses were told they would need to taper down to safer levels within three to six months…

I can’t imagine receiving one of these letters…  I’m sure the thoughts of many of these patients turned to suicide. Lucky for them, they live in Oregon, which is one of a very few states that have a right-to-die law.

“For the majority of patients, this transition can be done slowly and in a way that is tolerable,” the letter said. “Many patients may even notice an improvement in their pain as several studies suggest that pain medication over time may actually worsen pain.”

Let me translate:  I’m the doctor. I know what’s best. I paid hundreds of thousands of dollars for those fancy degrees on my wall. And I’ve decided that you should suffer. But hey, don’t worry about it, you could be part of a very small percentage of patients who actually feel BETTER after they stop taking medication to treat their pain. Anyway, there’s nothing you can do about it, so you can either agree, or… fuck off.

Dr. Shawn Sills, a pain expert with Touchstone, said most patients have been understanding about the changes. 

Most? Ah, Mr. Sills, just another liar and hypocrite…

He battled opioid addiction himself several years ago and was the subject of an Oregon Medical Board investigation. After undergoing treatment, Sills opened Touchstone in 2012 with firsthand knowledge of the addictive power of opioids. He is also the medical director for Addiction Recovery Center and Rogue Valley Fresh Start Detox in Medford.

Oh. My. God. Another ex-addict turns his personal experiences into a profit-making machine…

“If opioids worked, we would be happy to continue prescribing them,” he said. “But the majority of patients develop tolerance. Doses go up, they get tolerant, the dose escalates, and then they’re at risk of dying — even when they’re not abusing and they’re taking their medication as prescribed.”

If doctors admitted that opioids actually do work, your business would suffer, right Mr. Sills? And I have to wonder if your clinic prescribes bupe or methadone. (You hypocrite.) Or do you just over-prescribe antidepressants and anti-psychotics? (Still a hypocrite.)

The truth is that the majority of pain patients are not abusing their medications; they work just fine. And if patients are taking their meds as prescribed (including being careful of interactions), they’re not at risk for dying. Wow, they’ll let anyone be an “expert” these days, won’t they?

“As they cut down on medications, they experience withdrawal. It’s really hard for our patients, and not all of them understand why they’re being cut down,” he said. “They say, ‘I’ve been taking these for years and I haven’t died.’

Yeah, but tomorrow, you could become a drug addict.

We try to discuss research with them that opioids can make pain worse. If we slow down the taper and educate them, most understand. About 10 to 15 percent are really struggling and may need to be kept on those higher doses.”

Well, there you go. About 10 to 15 percent of current pain patients will be allowed to become “legacy” patients. Talk about death panels…

Continued opioid use may be appropriate for patients who experience pain relief and improvements in their ability to function.

What a thin line patients walk when trying to prove they deserve pain medications:  If you don’t show enough improvement, the meds are taken away. But if you show too much improvement, doctors will say you’re cured… and then the meds are taken away.

Some older patients also may be kept on their medication because they are less likely to escalate their dosages compared to younger patients, Sills said.

Another wow, because this doctor is basically (and publicly) discriminating against young people.  Especially when the age group allegedly abusing their meds is the older one. I wonder how he feels about women and black people?

Many insurance companies are now covering other pain treatment methods, including physical therapy and counseling. There are also procedures that can target pain generators, such as radiofrequency ablation, in which a current targets nerve tissue, Sills said.

I’m sure these treatments help some pain patients, but tell me Mr. Sills, if you burn nerve tissue and it makes the pain worse, how are doctors going to treat the resulting (and new) pain?

I think it’s important for patients to realize that if a treatment is unsuccessful, treating the new (and old) pain with opioids will not be an option (at least for very long). I assume that goes for surgery, too. If your pain levels haven’t been reduced within a couple of weeks or months after surgery, you won’t have access to pain meds.

I know a pain patient in the U.K. who was told at her last doctor appointment that from now on, opioids will only be prescribed for cancer patients. And even though she’s a cancer survivor, she’s technically in remission, so no opioids for her.

Sills is also using the new Senza spinal cord stimulation system, which was approved in May by the federal Food and Drug Administration as a method to combat pain…

Before you have an implant, be sure to check for recent FDA and international recalls.

While attending pain resiliency group sessions, Eshoo said she learned opioids can be appropriate to treat short-term acute pain from injuries such as a broken bone, but they can do more harm than good for chronic pain…

Brainwashing or placebo effect?

She learned relaxation, moving, breathing and stretching techniques, and how to manage the negative emotions and thoughts that come with chronic pain. Her quality of life has improved and she lost 70 pounds…

Okay, I’m gonna guess that this patient is an exception, not the rule.

Statewide, prescription opioid overdose deaths skyrocketed from 48 in 2000 to 239 in 2006, when deaths peaked. Deaths have been trending downward to 150 in 2013…

https://olis.leg.state.or.us/liz/2015R1/Downloads/CommitteeMeetingDocument/58819

Total number of suicides in Oregon (2013):  698

I think the use of the word “skyrocketed” says a lot. Funny, no one talks that way about the increased suicide rate. 😦

Yeah, that’s me.  Fighting hypocrisy.  (With my keyboard.)  Every. Single. Day. 🙂

A Prescription for Sticker Shock Caused by Drug Costs

http://well.blogs.nytimes.com/2015/11/23/a-prescription-for-sticker-shock-caused-by-drug-costs/

During the current enrollment period, from Oct. 15 to Dec. 7, I decided to switch to another insurer. Since everyone with a computer is supposed to be able to do this, I gave it a try.

I am most happy to report that, despite the problems many consumers initially had signing up for insurance under the Affordable Care Act, the government did a great job with the website for Medicare Part D. Expecting the task to take hours, I enrolled with a new company in about 15 minutes. Here is the link:https://www.medicare.gov/find-a-plan/questions/home.aspx.

You start by entering your ZIP code and answering two questions about your Medicare coverage. (Be sure to have your subscriber number handy.) Type in the name of each prescription drug you take, up to 25, as well as the dosage, quantity and frequency, and whether you get it from a pharmacy or by mail order.

If you choose a pharmacy, you are given a list of those near your home (the distances vary depending on your ZIP code). You are then asked to select the desired type of Medicare and drug plan. For example, I selected “drug plan with original Medicare.”

You can then refine your search according to such options as “limit to the monthly premium” (up to $290), “limit to annual deductible” (up to $360) and the company’s rating (I chose one with four stars out of five, the highest among the companies that fit my criteria).

The next screen estimated my annual drug and health care costs. Nineteen Part D plans were found in my ZIP code, listed from least to most expensive. For each company, the website showed my estimated annual drug costs if purchased retail or by mail order (cheaper by mail); the monthly premium, which in my case is deducted from my Social Security benefit; the annual deductible, if any; the drug co-pay amount; whether all my drugs are in the company’s formulary; and the company’s star rating.

By the way, if you can get your prescriptions written for a 90-day supply, the cost is less than for a 30-day supply refilled twice.

I did a general search on the Medicare website and found 23 other Part D plans that are cheaper than the one I currently have. But my plan has a zero deductible and only one of my new options has that. The others have at least a $360 annual deductible. Now, I have to look at all of them and choose one… my head hurts…

Health insurance companies and ideology

Keep in mind that when you choose an insurance company, you’re also choosing to abide by its ideologies (other than the most important one — to make a profit). This is especially important for a chronic pain patient.

Along with the DEA, insurance companies are the ones that decide how medical conditions are treated. And if an insurance company advocates for the opioid war, then it’s likely it will offer few benefits for pain patients. (It’s very easy for a private insurance company to discriminate, but it’s generally a little more difficult for government programs like Medicare and Medicaid.)

As an example, let’s look at the new health insurance policies offered only to religious people, like Catholics. With a policy like that, if you’re raped and need an abortion, you’ll be paying for that yourself. (Of course, you’ll also be paying for your contraception, which most say 95% of Catholics have used.) If you’re a terminal patient seeking assisted suicide services, you’ll be paying for that yourself. And if you’re a patient who wants to manage their pain with medical cannabis or opioids, I’m sure the Catholic religion has an opinion about that, too.

Almost all the large insurance companies now have new restrictions and hoops that pain patients have to jump through. So, before you choose an insurance company, it’s probably a good idea to do a little research first.

The ACA and buyer remorse

I know many people are unhappy with the Affordable Care Act.

http://www.nytimes.com/2015/11/15/us/politics/many-say-high-deductibles-make-their-health-law-insurance-all-but-useless.html

http://www.bloombergview.com/articles/2015-11-17/deductibles-are-the-price-you-pay-for-obamacare

Even though I have Medicare, some of the same problems apply. I don’t know my exact annual deductible, but I know it’s over $100. While that may not seem like much to you, it’s an awful lot to me. Which means that if I wanted to go to the doctor, my first visit of the year comes out of my pocket. And if I’m sick enough to go to the doctor, then the expense would include tests and medications… all this is out of my budget.

Of course, my budget includes bud, medicine not covered by any insurance. I’m still waiting to hear from Medicare about whether it will cover the annual doctor visit for a certification in the state’s medical cannabis program (it’s been 8 months):

https://painkills2.wordpress.com/2015/05/29/my-response-from-medicarecms/

But here’s the thing…  Even though the ACA didn’t apply to me, that didn’t stop me from learning about it. And all the things people are now complaining about were predicted before the ACA even went into effect. I know people are too busy (and political) to do their own research, but yeah, if they had, then they would have been better prepared for the insurance industry’s new cash cow.

https://sheridegrom.wordpress.com/2015/11/16/healthcare-no-longer-insurable-bipolar-at-68/

painkills2 says:
November 17, 2015 at 1:59 am
I think it’s a little shortsighted to blame the ACA for the problems in our health care system. After all, it’s not the government that benefits from the ACA — it’s the insurance industry. And when you make deals with the devil, a lot of people are likely to get burned.

Veterans Drop Empty Pill Bottles In Front Of White House To Rally For Medical Marijuana Access

http://www.techtimes.com/articles/105785/20151112/veterans-drop-empty-pill-bottles-in-front-of-white-house-to-rally-for-medical-marijuana-access.htm

In line with the news, the senate passed the Military Construction and Veterans Affairs (MilCon-VA) Appropriations Bill for 2016 on Tuesday, Nov. 10. The said bill entails VA doctors to prescribe medical marijuana in states where it is legal…

Too bad the government can’t help veterans who live in states that don’t have a medical cannabis program, or veterans trying to cope with a crappy program. And too bad the government can’t help with the cost of a drug that isn’t covered by insurance. If the VA (and Medicare) can cover opioids, why can’t they cover cannabis?

VA is cheaper than Medicare

http://www.modernhealthcare.com/article/20151107/NEWS/311079937

McDonald described a VA that is doing much to address problems that investigators say caused chronic delays for veterans seeking care. McDonald said the VA completed 3.1 million more appointments in the latest fiscal year than the previous one. It also hired thousands of new doctors and nurses.

Still, the organization is struggling to keep up. McDonald said the number of appointments not completed in 30 days has grown from 300,000 to nearly 500,000.

McDonald said more veterans are coming to the VA despite often having access to Medicare, Medicaid or private insurance. He said the VA is more convenient, effective and cheaper. A veteran would have to pay a $5,000 co-pay to get a knee replacement through Medicare, but not at the VA. For veterans with hearing loss, going to the VA can save them about $4,000 compared to other coverage…

DNA test designed to predict drug response

http://www.reuters.com/article/2015/11/06/us-usa-genetics-consumers-idUSKCN0SV2A020151106

Just as 23andMe has made peace with the U.S. Food and Drug Administration, another direct-to-consumer genetics company is testing the regulatory waters with the launch of a $249 DNA test designed to predict drug response…

Currently, pharmacogenetics tests are ordered directly by a treating physician and are not available to consumers. One, GeneSight, made by Assurex Health, is covered by Medicare and some insurers. GeneSight’s sticker price is more than $3,000, but the company says the average patient pays no more than $330…

For Zimmer, the push is personal, born out of the experiences of his 16-year-old daughter, who suffered with severe depression while her doctor tried to find the right medication and dose to treat her. Zimmer believes consumers should have access to their own data through an affordable test…

And the disabled get screwed again…

http://www.huffingtonpost.com/entry/social-security-advocates-shrug-budget-deal_562fee63e4b0c66bae59fd2c

The bill comes with a host of provisions that tweak disability insurance, and it eliminates a program that allowed 20 states to award disability benefits to some applicants without an independent medical evaluation…

The Social Security provisions, which take up more than a third of the bill’s text, save about $4 billion over 10 years, according to the Congressional Budget Office. (For some perspective, disability benefits are expected to cost the federal government roughly $144 billion this year.) Congressional aides said the estimated savings come from the medical evaluation requirement that slightly delays new benefits for some people…

http://oig.ssa.gov/audits-and-investigations/audit-reports/A-01-12-11218

SSA’s Single Decisionmaker (SDM) model authorizes disability examiners to make certain initial determinations without requiring a medical or psychological consultant’s signature…

An ADA lawyer’s advice for chronic pain patients

http://www.pharmaciststeve.com/?p=12249

Essentially, the doctors you speak of appear to be denying services based on your disability which necessitates that you be prescribed pain medication in accordance to medical evaluation and as consistent with any treatment deemed necessary by a given doctor or specialist. Whatever the reasons for these refusals to treat, doctors are liable under Title III of the ADA for failing to provide their services to patients based on any stigma or stereotype associated with anyone who has a condition that imposes chronic pain. Moreover, a doctor is likely violating ethical codes by refusing to treat a given patient when the doctor is licensed appropriately to treat as a general practitioner and/or specialist in a given area. Hence, they may decline to treat patients that require medical services from a different practice area. But they may not decline to treat patients inside their scope of practice and/or they may not decline to provide a helpful referral even if the condition is outside their area of practice.

I would recommend that you forward them this response and seek to obtain treatment so as to avoid filing complaints against these doctors under the ADA and other applicable laws…

I am available for questions.

Regards,
Diego Demaya, J.D.
Southwest ADA Center
TIRR Memorial Hermann
1333 Moursund St.
Research Center 2nd Flr. Suite 212
Houston, Texas 77030
Toll Free: (800) 949-4232
Office: (713) 797-7114
Fax (713) 520-5785
E-Mail: diego.demaya@memorialhermann.org
Web: http://www.SouthwestADA.org

Under comments:

Bob Schubring, on October 21, 2015 at 2:20 am said:

The Montana doctors who are being persecuted by the assistant AG, are powerless against him…but their patients have the right, under ADA, to sue his boss (the AG), and demand the right to be treated for pain. Moreover, they also have the right to demand payment from Montana, of their legal fees and costs, of asserting that right…

Yes, it’s true. The US Justice Department has an ADA office with the power, theoretically, to act. The difficulty anyone in that office will have, in bringing a case, is that the DEA constitutes a large percentage of the Justice Department’s payroll and budget. It’s going to be quite a trick, for the ADA lawyers to keep their jobs at the Justice Department, if they go up against the entrenched forces of the DEA and the Drug War lobby. This is a clear conflict of interest. Accordingly, anybody at the ADA office willing to help pain patients, needs all the help we patients can provide…

Seems to me that this advice would also work for medical cannabis patients. But what it will come down to is the question of which treatments have been proven effective — and approved by the FDA (and now the CDC). Of course, we all know about the flaws in allegedly evidence-based research, so I don’t know how either side will “prove” their beliefs. Considering the questionable ethics of the scientific and medical industries, perhaps we should start relying more on anecdotal evidence.

Another question will be who is considered a “legitimate” pain patient. Which painful medical conditions deserve treatment? Only cancer or terminal conditions?

Doctors will argue that evidence for treating long-term chronic pain with opioids (or cannabis) doesn’t exist, and will try to prove there’s more harm than benefit with these treatments (especially to the public). Doctors and parents will continue to tell stories of lives ruined by drug abuse and addiction, and shout, “It’s a crisis! It’s an epidemic! And it all started with (name any drug)!”

But there’s no evidence that other treatments for pain are successful, so as always, the question becomes:  What are the alternatives? There’s an abundance of evidence for the harms associated with all other treatment options besides opioids, so who’s going to dictate which treatments patients are allowed access to? It doesn’t make sense (and it won’t work) for government agencies, law enforcement, and the medical industry to make decisions for patients — we’re the ones suffering, not them.