drusso

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http://khn.org/news/pain-patients-s...ine-after-crackdown-on-illegal-rx-drug-trade/

Riley, of the DEA, says it would be wrong to draw a line between these actions and problems like those Chaikin is experiencing. “If there is a chilling effect, it’s clearly not at our direction,” Riley said. “We’re simply enforcing the law, taking bad people off the street and really trying to interrupt the supply of illegal prescriptions.”

In a statement, CVS/caremark said that the dosage of pain medication prescribed to Chaikin “exceeded the recommended manufacturer dosing.” It also said that she “continued to receive her controlled substance prescriptions from CVS/caremark without interruption.” CVS/caremark said it has a legal obligation to make sure controlled substance prescriptions are for legitimate ailments and “that patients are receiving safe medication therapy, including appropriate dosing.”

Ora Chaikin’s wife, Roseanne Leipzig, who is a geriatrician and palliative care physician, says when it comes to narcotics, there is nothing in medical literature that says a dose is too high.
“There is no maximum dose for narcotics,” she says. “It’s the dose you need to take care of the pain.”
 

lobelsteve

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http://khn.org/news/pain-patients-s...ine-after-crackdown-on-illegal-rx-drug-trade/

Riley, of the DEA, says it would be wrong to draw a line between these actions and problems like those Chaikin is experiencing. “If there is a chilling effect, it’s clearly not at our direction,” Riley said. “We’re simply enforcing the law, taking bad people off the street and really trying to interrupt the supply of illegal prescriptions.”

In a statement, CVS/caremark said that the dosage of pain medication prescribed to Chaikin “exceeded the recommended manufacturer dosing.” It also said that she “continued to receive her controlled substance prescriptions from CVS/caremark without interruption.” CVS/caremark said it has a legal obligation to make sure controlled substance prescriptions are for legitimate ailments and “that patients are receiving safe medication therapy, including appropriate dosing.”

Ora Chaikin’s wife, Roseanne Leipzig, who is a geriatrician and palliative care physician, says when it comes to narcotics, there is nothing in medical literature that says a dose is too high.
“There is no maximum dose for narcotics,” she says. “It’s the dose you need to take care of the pain.”
2005 called. You are needed back there.
Bet we are talking more meds than most of us have ever prescribed.
 

101N

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Why would Rachel Gotbaum select a palliative care physician- CA/end of life care - to interview about patients with CNP who are clearly outside of his area of medical expertise. And perhaps more importantly, why would
an academic palliative care physician be so bold as to speak about the treatment of CNP? Not very good editorial work by KHN.

It will come as no surprise that R. Sean Morrison trained at Mt. Sinai under Portenoy.
 
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drusso

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Why would Rachel Gotbaum select a palliative care physician- CA/end of life care - to interview about patients with CNP who are clearly outside of his area of medical expertise. And perhaps more importantly, why would
an academic palliative care physician be so bold as to speak about the treatment of CNP? Not very good editorial work by KHN.

It will come as no surprise that R. Sean Morrison trained at Mt. Sinai under Portenoy.
Because if content expertise on a topic doesn't matter, then everyone's an expert.

Let them eat Moo-shu Pork.
 

emd123

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[sarcasm:font] Because we see how well the "Opiates Have No Limit" theory has worked over the past 20 years [end-sarcasm:font]

Unbelievable.
 

Aether2000

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We are fighting the "no limit" opioid mantra in my state with some drugs-for-injections quid pro quo pain doctors complaining about any potential state medical association resolutions that would set a "soft" ceiling of 120mg MED. I had a spirited debate in a public forum with one physician and there will be more in September during our state medical association meeting. However, I do think we are evolving as a country to a no-limit opioids policy for active cancer pain, a high dosage opioids acceptance for recently active but currently inactive cancer s/p radiation treatment with radiation damage, and a finite dosage limit for most chronic intractable non-malignant pain patients.
 

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So this story ran on Kaiser and NPR. Sounds to me like propoganda to account for the changes in healthcare payment which will encourage opioids > procedures under "value" based payment/ACO models. Pain docs are expensive, pain procedures are expensive. An NP/PA writing opioids looks much better to the beancounters, at least in the short term.
 

101N

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Opioids are low hanging fruit to improve member patient satisfaction. Hope the aren't going there.
 

emd123

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Opioids are low hanging fruit to improve member patient satisfaction. Hope the aren't going there.
They will and in fact already do. This is pushed hardcore by administrators in EDs across the country as standard fare and has been for many years.

In fact, patient satisfaction and resultant twisted conflicts of interest like this will increasing be codified into law and tied to physician pay by the government through CMS' HCAHPS

http://www.forbes.com/sites/brucejapsen/2013/07/02/patient-satisfaction-hits-physician-pay/

HCAHPS and physician pay:

http://scribeamerica.com/blog/hcahps-true-impact-patient-satisfaction/

It's a bomb waiting to re-explode the opiate prescription drug abuse epidemic. In other words, they will pay higher reimbursement to physicians with higher patient satisfaction scores, ie, those that enable drug abuse and diversion with a smile and a quick prescription and no argument, and decrease reimbursement to those refusing to enable drug abuse by refusing to "satisfy" addicts seeking a quick prescription fix. In this case, the ED is the canary in the coal mine, but this disaster has already been codified in law through ACA and coming CMS/HCAHPS plans. It is coming to a Pain department near you.
 
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drusso

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They will and in fact already do. This is pushed hardcore by administrators in EDs across the country as standard fare and has been for many years.

In fact, patient satisfaction and resultant twisted conflicts of interest like this will increasing be codified into law and tied to physician pay by the government through CMS' HCAHPS

http://www.forbes.com/sites/brucejapsen/2013/07/02/patient-satisfaction-hits-physician-pay/

HCAHPS and physician pay:

http://scribeamerica.com/blog/hcahps-true-impact-patient-satisfaction/

It's a bomb waiting to re-explode the opiate prescription drug abuse epidemic. In other words, they will pay higher reimbursement to physicians with higher patient satisfaction scores, ie, those that enable drug abuse and diversion with a smile and a quick prescription and no argument, and decrease reimbursement to those refusing to enable drug abuse by refusing to "satisfy" addicts seeking a quick prescription fix. In this case, the ED is the canary in the coal mine, but this disaster has already been codified in law through ACA and coming CMS/HCAHPS plans. It is coming to a Pain department near you.
This is a prime example of what happens when non-experts are permitted to make health policy. Most of this policy is informed by GIGO science that the Federal Government itself paid for...the circle is completed.
 

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that thought process is quite paranoid.

i highly doubt it will happen, because of 2 factors - the government and CDC have been forceful about reducing misuse of opioids and the dangers of overprescribing, and the fact that insurance companies know that killing off their patients cost a lot more money than any benefit they may get with slightly higher patient satisfaction scores.

do you think insurance companies have not done cost analysis of smoking cessation teaching and appropriate alcohol intake education?
 
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