06.25.08
Posted in Primary at 3:10 pm by pharmacist.steve
A number of states have NASPER type databases http://www.nasper.org/facts.htm that collect and make available to law enforcement and health care professionals the on-line capability to check/verify a patient’s controlled substance prescriptions that they have filled in that particular state.
It has been brought to my attention that in one particular state, two of the largest chain pharmacies will not allow their pharmacists the ability to access the internet to have access to this database. Could it be that these corporate pharmacies do not want to lose the revenue from filling and/all prescriptions presented or they don’t want the staff to waste their time checking the database, which may result in no revenue.
It has also been reported that some rural hospitals in this particular state refuse to allow their ER Physicians from accessing this database because of fear of losing revenue, by turning away “drug seekers” on nights and weekends.
Likewise, this state level agency is being provided a federal grant to fund time/resources to make health care professionals aware of the availability of this database. Few professional organizations will put these speakers on their meeting agenda.
So if you are a legit chronic pain patient and having your prescriptions filled at one of those big national pharmacy chains. The Pharmacist may have not way to confirm or deny that you are only getting your prescriptions filled at one pharmacy and written by one doctor. So if you feel you are being treated/judged unfairly… this might help to explain it.
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11.03.07
Posted in Primary at 7:00 pm by pharmacist.steve
In the small town of Grangeville, ID (pop ~3500) , http://www.grangevilleidaho.com/community/index.htm
which is the county seat of Idaho county (pop ~15,000). http://www.idahocounty.org/idaho/index.htm
Idaho county claims to be the largest county in the country - as large as the state of New Jersey.
http://www.idahocountyfreepress.com/IFPNews6.shtml
http://www.idahocountyfreepress.com/ArcStoryPage.asp?Database=Story&StoryID=13145
If you look at a couple new articles from the local newspaper gives some in-site into the mind set of the people in power in this area of our country.
Their US representative votes AGAINST a bill outlawing dog fighting and a teacher found guilty of sexual abuse of one of his students given PROBATION!
Then it would come to little surprise that the county’s only district judge runs his court like a dictator over a small fiefdom.
This judge presides over both the county’s mental health court and felony drug court.
There are a number of chronic pain people before his court that have mandated that they abstain from all pain meds - including OTC’s. It has been reported that this judge has even went as far as to mandate that a person undergo a root canal procedure without any post procedure pain meds.
One particular gentlemen who has been diagnosed with schizophrenia, PTSD, Bi-polar and chronic pain. Because for many years he chose to self-medicate his chronic pain with MJ.. he has been labeled an ADDICT.
This poor soul is on Medicaid and Medicare disability with a income of ~ $400/month. He has been living with family friends, because the family friends have been advocating for him… getting his story out … the judge has demanded that any more people contacting his office.. because of their advocacy… he will put this poor soul in jail … This judge has now passed a decree that this poor soul must move out of his friend’s house and establish his own residence. $400 a month won’t go far in providing for his needs, and while he is capable of managing his own personal needs it is doubtful that he will be able to have the energy or pain management to do the necessary housekeeping chores.
If one person intentional inflict pain on another person .. it is called TORTURE.. here we have a judge that is INTENTIONALLY causing elevated pain on this poor soul and 2 or 3 others just like him.
As a society, we condemn those who would use “torture” on terrorists .. who would harm us or our society, but those who are “in power” particularly in remote locations… are free to act like a “school yard bully” without consequences.
US representatives approving of dog fighting, teachers who sexually molest their students getting probation, judges torturing residents… can genocide be far behind?
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07.02.07
Posted in Primary at 9:37 am by pharmacist.steve
Tips For Dealing With People In Pain
1.People with chronic pain seem unreliable (we can’t count on ourselves).
When feeling better we promise things (and mean it) when in serious pain; we may not even show up.
2. An action or situation may result in pain several hours later, or even the next day. Delayed pain is confusing to people who have never experienced it.
3. Pain can inhibit listening and other communication skills. It’s like having someone shouting at you, or trying to talk with a fire alarm going off in the room. The effect of pain on the mind can seem like attention deficit. Disorder. So you may have to repeat a request, or write things down for a person with chronic pain. Don’t take it personally, or think that they are stupid.
4. The senses can overload while in pain. For example, noises that wouldn’t normally bother you, seem to much.
5.Patience may seem short. We can’t wait in a long line; can’t wait for a long drawn out conversation.
6. Don’t always ask, “How are you” unless you are genuinely prepared to listen it just points attention inward.
7. Pain can sometimes trigger psychological disabilities (usually very temporary). When in pain, a small task, like hanging out the laundry, can seem like a huge wall, to high to climb over. An hour later the same job may be quite OK. It is sane to depressed occasionally when you hurt.
8. Pain can come on very quickly and unexpectedly. Chronic pain people appear to arrive and fade unpredictably to others.
9. Knowing where a refuge is, such as a couch, a bed, or comfortable chair, is as important as knowing where a bathroom is. A visit is much more enjoyable if the chronic pain person knows there is a refuge if needed. A chronic pain person may not want to go anywhere that has no refuge (e.g. no place to sit or to lie down).
10. Small acts of kindness can seem like huge acts of mercy to a person in pain. Your offer a pillow or a cup of tea can be a really big thing to a person who is feeling temporarily helpless in the face of encroaching pain.
11. Not all pain is to locate or describe. Sometimes there is a body wide feeling of discomfort, with hard to describe pains in the entire back, or in both legs, but not in one particular spot you can point to. Our vocabulary for pain is very limited, compared to the body’s ability to feel varieties of discomfort.
12. We may not have a good “reason” for the pain. Medical science is still limited in it’s understanding of pain. Many people have pain that is not yet classified by doctors as an officially recognized “disease”. That does not reduce the pain, - it only reduces the ability to give it a label, and have you believe us.
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06.24.07
Posted in Primary at 11:31 am by pharmacist.steve
The insurance industry spends untold $$$ trying to figure out new ways to deny paying for certain medications .. specially expensive brand name drugs…
The new trend is to deny because the drug is not FDA approved for a particular disease state… normally referred to as “off-label use”.. which is perfectly legal for a doc to do.
Here seems to be the logic… virtually all policies will pay for FDA approved drugs… however… most won’t pay for experimental drugs… thus if a medication is being prescribed for non-FDA approved disease state .. it must be experimental!… and NOT COVERED… Here is where it becomes interesting .. virtually all insurance companies will pay for a generic regardless if being prescribed for on-label or off-label use…
Why doesn’t a Drug Manufacturer get a drug approved for a disease state that it appears to be useful in treating?? It boiling down to economics … a new drug must go thru three levels of clinical trials costing 500 Million +… recently a few drugs have crapped out in the third level of clinical trials… mostly because they caused more harm in unrelated areas than they were causing good in treating a specific disease… so hundreds of millions of dollars were literally - thrown down the drain .. now if these companies were trying to prove this same drug for a multiple of disease states .. those wasted millions could easily be turned into BILLIONS. Likewise .. the target population for additional disease state to be treated must be large enough to warrant the expense of doing additional trials .. after the drug has been introduced… Even if the Manufacturer goes forward with additional clinical trials .. it may well take a few years to get the data collected to get a FDA approval.
If you are denied drug coverage under these circumstances… all insurance companies have prior authorization processes and/or appeal processes.. and most times the patient wins… It also helps if the therapeutic alternatives have not produced a adequate or positive therapeutic outcome… To help win your appeal.. see if your doc can get you enough samples for a long enough period to measure how effective the drug is going to be in treating your condition. Showing a positive therapeutic outcome should help you win your appeal..
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Posted in Primary at 11:13 am by pharmacist.steve
Generally, DAW on a prescription is a MD request to provide a brand name drug when a generic is available… but .. there is another side to DAW that can work in the patient’s favor. Some patient - for various reasons - find one particular generic may work - or perceived to work better - than another generic.
Having the doc write the Rx for a manufacturer’s specific generic and marking the Rx as DAW… will force the Pharmacist to do one of several things.
1. Decline to fill the Rx because the specific generic is unattainable . either because wholesaler doesn’t stock or corporate policy prohibits stocking other than a specific generic.
2. Special order the specific generic for the patient
3. Call the doc and ask to use another generic
4. Ignore the DAW (which is illegal) and fill with the generic in inventory.
If the Pharmacist elects to ignore the DAW .. then the patient has the right to decline accepting the filled Rx and requesting the Rx back. Few, if any, insurance companies specify a specific generic brand.. so that should not be an issue and the patient should be charged their generic co-pay.
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04.22.07
Posted in Primary at 8:06 pm by pharmacist.steve
Just how much is your health/quality of life really worth? More and more things in our lives are treated as a commodity. When someone goes looking for a airline ticket .. what is the first thing they look for … PRICE?
When you go to the grocery store to buy soda… do you buy the one on sale
( Coke-Pepsi-RC-house brand) or do you only buy your favorite soda when it is on sale and you “stock up”… or you buy your favorite soda .. regardless of price?
This is not the first time that our beloved government has put healthcare in the commodity arena.
During the early 70’s when Congress was debating the MAC ( Maximum Allowable Costs) in mandating generic substitution for Medicaid prescriptions. The then FDA commissioner testified before Congress that the FDA - in establishing the MAC’s - would never put quality at risk to get a lower price.
After the law as passed.. the quote became .. We can accept a variance in quality to maintain a PRICE!
In the 80’s… Congress dangled money in front of the HMO industry… with the promise of the HMO industry that they were going to help/educate Medicare folks in preventative healthcare. The HMO industry provided Medicare folks with drug coverage and other benefits to maintain or improve their health and quality of life.
All was going well, until Congress refused to increase the monies paid to the HMO’s to cover the increase in the cost of providing medical care for this Medicare population. In response, the HMO industry starting raising premiums and reducing benefits. In many markets the HMO’s pulled out completely. Leaving these people back in the standard Medicare program, no drug coverage, higher out of pocket costs and higher supplemental premiums.
Well Congress is at it again. This time it is called Medicare Advantage.. but it is a replay of the 80’s… giving the private insurers generous government subsidies to keep premiums down and availability and scope of services broad. Rep Pete Stark (D-Cal), chairman of the House Ways and Means Health Subcommittee, considers these subsidies OVERPAYMENT!
Since the cost of health is increasing at a minimum of 6%-7%… how long before we see the $$$ being given to the Medicare Advantage segment being frozen and how long before we see the premiums increase, benefits decrease and the number of markets the Medicare Advantage program offered in .. dwindle?
Who will be affected the most?… those that have the biggest expenses - most likely.. those that lack the mental/physical energy to fight with the system to get the medical care they need and deserve?
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02.18.07
Posted in Primary at 7:19 pm by pharmacist.steve
http://www.boguspatients.com/boguspatients/lpdnarcs.pdf
This link is a copy of a newsletter distributed by the Louisville, KY “Prescription Drug Squad”
You will notice that the first paragraph is trying to “intimidate” the local docs about pre-printing any controlled substances prescriptions. The fact of the matter is, if bogus patients get their hands on a prescription blank, if they don’t know how to write the prescription. They will find someone who will !! Any doc that is not keeping his Rx blanks in his/her pocket or under lock and key is at risk of having them stolen.
This Narc Squad is offering the local Pharmacists “AWARDS” for turning in bogus patients.. yes it is a “token gift”. Shouldn’t the “give-a-ways” be left to the local radio stations?
Also according to this newsletter.. it would appear that not many healthcare professionals are using the KASPER (Kentucky All Schedule Prescription Electronic Reporting) to isolate the bogus patients from the legit ones.
Point of interest … listed on this newsletter is the name of the supervisor of this Drug Squad … Bill Stivers… this person is also associated with http://www.naddi.org/ ( National Association of Drug Diversion Investigators, Inc.) on their website he is listed as Training and Education Director Oddly enough, last April (2006), I faxed Sgt Stivers a letter offering my assistance in developing policies and procedures to help docs isolate the bogus patients from the legit ones. TO DATE … His response has been amazingly UNDERWHELMING never bothered to respond.
Of course, if you look at the name of the national organization DRUG DIVERSION INVESTIGATORS - on their website it pretty much says it all
NADDI’s objective is simple: to improve the members’ ability to investigate, and prosecute, pharmaceutical drug diversion.
There would appear to be little interest in PREVENTING DIVERSION
Of course, we are AT WAR ON DRUGS and since typically at war you either kill or capture the enemy. Killing unarmed citizens on our streets by police is usually frowned upon.. the only thing left is to capture them. If the docs were successful in isolating bogus patients.. the cops would have to go out on the street & alleys to fight drug diversion.
If you want to get a clue of the typical cop’s mindset watch this 12 minute video
http://www.leap.cc/Multimedia/LEAPpromo.php
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02.17.07
Posted in Primary at 8:51 pm by pharmacist.steve
The American Pain Foundation just released a survey funded by Endo Pharmaceuticals on
Devastating Impact of Chronic Pain on Patients’ Lives
The medical community in treating chronic pain got a RESOUNDING F!!!
The Voices of Chronic Pain, a new patient survey released by the American Pain Foundation, reveals the devastating impact of chronic pain on the lives of patients, and the strong desire of patients for more options to help manage their pain. This survey is the first of its kind to evaluate patient attitudes and the impact that chronic pain has on patients who have sought care from their physician and are currently using an opioid to treat their pain.
Who suffers from chronic pain?
Control Over Chronic Pain
• More than half of patients (51%) felt they had little or no control over their pain
• Six out of ten patients (60%) said they experience breakthrough pain one or more times daily, severely impacting their quality of life and overall well-being.
Impact on Quality of Life
• Almost two thirds (59%) reported an impact on their overall enjoyment of life
• More than three quarters of patients (77%) reported feeling depressed
• 70% said they have trouble concentrating
• 74% said their energy level is impacted by their pain
• 86% reported an inability to sleep well
Impact on Day-to-Day Life
• More than half (52%) said their chronic pain has put a strain on relationships with family and friends
• Nearly 70% said their pain has a great deal of impact on their work
• 50% have lost a job due to their chronic pain
• More than a quarter (27%) said chronic pain impacts their ability to drive a car
Desire For New Options
• More than three quarters of patients (77%) strongly agreed that new options are needed to treat their pain
• Only 14% reported that they were satisfied with their current medications
• Less than half (48%) felt they were currently getting enough information on the most effective ways to manage chronic pain
We are suppose to have the world’s best medical system… maybe we just have the most expensive medical system that is failing to adequately treat chronic pain patients.
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01.22.07
Posted in Primary at 12:21 pm by pharmacist.steve
Like any subset of our population, you cannot stereotype or fit every Pharmacist into the same mold., but there can be a lot of similarities.
When it comes to opiates, controlled substances or meds that tend to be abused, they can be influenced by what is seen in the media .. just like anyone else..
Lets start with how the typical Pharmacist’s mind is molded… Without a doubt, the Pharmacists you deal with at the Pharmacy are very bright. Today after finishing the first two years of pre-Pharmacy.. if you don’t have at least a GPA of 3.0 on a 4.0 scale .. don’t even bother to appy to Pharmacy school. If you do pass that bar you will be competing with 6 or 7 others for the available slot. Being granted a slot in a Pharmacy school is no guarantee that you will graduate .. the “wash out rate” is substantial. In my class <20% of those who were declared freshman Pharmacy majors made graduation.
These freshly minted Pharmacists have little hands-on experience and most encounter a rude awakening when they enter the real world of working “behind the counter”. They “know” what they read in the books … they “know” what their professors - who most likely hadn’t been behing a pharmacy counter in years - what is expected of them and what they would be doing .. once they got that diploma and license.
Instead of interacting with patients and helping them improve their quality of life.. they are faced with dealing with 3-4 phone lines and a similar number of technicians. They are expected to be overseeing a average fill rate of every 60-90 SECONDS and during peak periods, could be a couple of hours behind.
It was recently announced that one of the largest Pharmacy chains has installed a red/green light on the pharmacy computer terminals… if the pharmacist is not moving fast enough .. the RED LIGHT comes on and a note is automatically added to the computer time management file for this pharmacy staff and/or Pharmacist. Just like the drive-thru window at a fast food place.
So, human nature being what it is.. those people that cause the most problems, show up the most, keep calling asking about “.. if the doctor called back yet on your refill…” is routinely requesting refills early … tend to stick in the pharmacy’s staff memory..
If you are a chronic painer … you can’t do much about all the meds you have to take, but you can do something about all the days you show up in a month to get a Rx filled.
Remember, the Pharmacist most likely doesn’t knows your ICD9’s, other than your drug profile… may not have a clue as to your array of medical problems.
All of us, come to conclusions based on perception… Pharmacist are no different. I wonder how many chronic painers could lessen the problems they encounter at the pharmacy counter if they had a sit-down talk with their Pharmacist. I am sure, that in most cases, a 5-10 minute talk explaining that you would rather not take all the meds you are on to re-gain some quality of life and having to deal with all the side effects, not to mention all the money spent and days spent in doc’s offices… would do wonders in how they are treated. If it doesn’t change the way you are treated .. you need to find another pharmacy/pharmacist!
Talk to one of the pharmacist, use the excuse that you hate to have to come in every few days for one of your Rxs and if there is someway that you could get all of them arranged to have them filled at the same time. If you are only at the pharmacy counter once a month.. you are less likely to stand out - with all the meds you take - as opposed to showing up every few days to get one of them. This will save you time, save the pharmacy staff time and if the doc has to be called on refills… their staff time… and YOU have a lower profile
If the pharmacy has a on-line refills system or a IVR (Interactive Voice Recognition system) that allows you to input the refills yourself .. use it … these systems will automatically fill the Rx if it has authorized refills and/or fax a refill request to the doc’s office ..without the pharmacy staff having to touch it.. One less point of recognition for the pharmacy staff.
If neither one of these are available, fax in a request for refills.. It will just fall into the system with all the fax-back from the doc’s offices and more likely to be handled matter of factly …anything that you can do to not interrupt the work flow - like calling in refills, when all these other options are available …will be appreciated by the staff.
Talk to your doc, see if he/she will let you get/keep a 5-7 day buffer of your meds.. you never know when mother nature is going to disrupt our lives. Use this buffer to give the pharmacy a “heads-up” on needing a refill. Order your refills when you have a 5-7 days supply remaining - tell the pharmacystaff that you have it .. and will pick them up in a few days. If it is a C-II.. drop it off and tell them you will pick it up in a few days.
Justified or not .. those that are always pushing to get their refills NOW and “calling back every 30 minutes wanting to know if the doc OKed their Rx” .. are perceived to have a “drug problem”
If you take some time and talk to the Pharmacist - best if you make an appt or ask when is the best time - ask how- as a patient - you can make their life easier.. fit into the work flow… you might be surprised… you may become one the pharmacy’s “preferred patients” .. rather than one of their “problem patients”
If you allow the Pharmacist and/or pharmacy staff develop their opinion of you .. based on their perceptions.. their opinion may have nothing to do with reality.
Pharmacist Steve
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01.18.07
Posted in Primary at 11:15 am by pharmacist.steve
As a whole.. our society is extremely paranoid about anyone becoming addicted to opiates.. even when there is a legimate medical need.
If you are reading this and the area you live in is not subject to one of the following natural disasters… you need not bother to read any further
Natural disasters : Snow storms, ice storms, flooding, hurricaines, tornadoes, earth quakes
While some healthcare professionals considered it prudent medical practices to keep those taking opiates on a very tight leash
recent natural disasters bring to the forefront the absolute necessity to allow patients to have a 5-7 days buffer of medication.
The Rockies and mid-west just hit with a massive ice storm… knocking out power for days.. of course the doc’s offices are going to shut down.. no lights.. no heat .. no computers .. they have basically been thrown back into the “stone age”. The same goes for pharmacies in the area.
So here is your typical chronic painer.. due to pick up their paper Rxs the day after Mother nature has pitched her “fit”.. the doc’s office is unavailable and so is their pharmacy. Even if they could make it to an emergency room and convince the ER doc that they are just not “drug seekers” taking avantage of the situation and gets a Rx .. where are they going to get it filled .. remember NO ELECTRICITY… no pharmacies are open… Okay .. maybe one enterprising pharmacy has a back up generator and is “open”.. they will most likely going to run out of inventory real quick trying to meet the needs of those in the community. So unless you are one of the first in the door .. you may still be out of luck.
So the average chronic painer, caught in such a situation, is going to trying to keep warm in a house without heat & electricity, with their severe pain quickly returning and going into withdrawal..
this all happens BECAUSE … healthcare providers are affraid that a 5-7 day buffer supply of opiates will temp the chronic painer to become addicted or abuse the opiates.
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