Scrutiny Of Painkiller Distributors Harms Patients

Scrutiny Of Painkiller Distributors Harms Patients Sally Satel,  Contributor – Dec 2019

Anyone following the opioid problem knows about the delinquent practices of some drug distributors, the companies that deliver painkillers from manufacturers to pharmacies. 

By transporting “suspicious orders” – regulatory code for unrealistically large shipments — to rogue pharmacies, they helped fuel the crisis of addiction and overdose.

This is like a history lesson from 10 years ago when this was happening. By now the overdoses are no longer from pills because they’re too difficult to get and too expensive. Instead, they use some powdered street drug (heroin, meth, cocaine) that’s been laced with undetermined quantities of fentanyl, frequently enough to kill them. 

A crackdown was long overdue. But there’s an important untold story: distributors are now so spooked by class action lawsuits against them and the possibility of federal fines and even criminal action, that they are reducing the supply of pills available to patients in pain.

James DeMicco, pharmacist-in-charge at J and J State Street Pharmacy in Hackensack, New Jersey. On November 1, he learned that his distributor, AmerisourceBergen, would no longer supply his store with opioids.

DeMicco pored over thirty patient cases that the company had flagged as suspicious. Irregularities included his dispensing more than one controlled drug to a given patient and the numbers of out-of-state patients who patronized J and J, signals that perhaps the pharmacy was supplying pills to patients who were abusing them.

As DeMicco explained to the reviewer, many of his patients suffered “high impact pain syndromes” and required complex dosing regimens.

But these days, a doctor isn’t allowed to make decisions about a patient’s pain care because the government has already decided that we don’t need what our doctors want to prescribe.

Thus, some patients were prescribed two or more classes of controlled (addictive) substances, such as an opioid with a benzodiazepine (e.g. Valium) for muscle relaxation and/or a stimulant (e.g. Desoxyn) for chronic fatigue. And some of his patients traveled considerable distances to see the pain specialist in the adjoining office building – one of the increasingly few pain specialists who still prescribed opioids long term and in high doses for patients whose pain did not respond to other interventions.

the compliance officer at AmerisourceBergen, who had the final say in whether the company would remain DeMicco’s supplier, told him that shipments would stop.

The problem is widespread.

Distributors are fearful of being held liable for patients becoming addicted or overdosing,” according to attorney Steven Cava, so they set limits on how much a pharmacy can order.

They are still going after pills, even though all the overdoses involve various combinations of other substances or other opioids.

It’s just easier to go after pills because they can be quantified, unlike the illegal drugs that are unmeasured and often deadly exactly for that reason.

The measured doses in opioid medications are NOT causing overdoses. It’s all about street drugs of unknown origin and unknown contents.

Oddly, those limits are confidential so pharmacies only discover they have breached them after the fact.

This bizarre type of “confidentiality” reeks of corruption and venality. There is no above-board reason to explain such secrecy – they are obviously hiding something.

a pharmacy in eastern North Carolina that recently began serving a facility caring for ailing elderly people. The added demand pushed the pharmacy’s orders over the undisclosed threshold so its distributor terminated the supply of morphine for the last twelve days of October.

Granted, distributor monitoring was egregiously lax in many cases between 2005 and 2016.

This is “closing the barn door after the horse is gone” because drug addiction and overdose have shifted away from pills to far cheaper street heroin/fentanyl.

distributors have admitted delivering huge quantities of opioids to pharmacies that colluded with shady physicians and that shipped directly to pill mills (bogus pain clinics prescribing opioids to virtually anyone who paid) and internet pharmacies.

In October, federal prosecutors initiated a criminal investigation into whether distributors and others allowed opioid painkillers to flood communities, potentially charging violation of he Controlled Substances Act, a laws normally used to go after drug traffickers, according to the Wall Street Journal.

And here again, we see how the drug-war has spread to the legitimate medical care of patients.

Walmart and Sam’s Clubs’ pharmacies, for example, have imposed daily limits per patient of 50 morphine milligram equivalents,

And if you’re a poor metabolizer of opioids, and need three or four times as much to get an effect… tough luck. They are treating numbers and statistics, not patients.

As for doctors, the story of their retreat from treating chronic pain patients has been well documented.

Physicians worry about losing their licenses lest they prescribe opioids and attract the attention of the DEA or their state medical boards.

Why can’t the under-treatment of pain “attract the attention” of state medical boards as well?

One patient called him in tears because five other pharmacies could not fill his prescription for buprenorphine, an anti-addiction medication that DeMicco would normay have in stock.

So it’s just as bad for people with addiction; they can’t get their medication either because it’s an opioid.

They need their medication just as badly as we pain patients need ours, to preserve some quality of life these days. Lack of medication can cause people to lose jobs, lose their homes, and end up on the street.

That’s the real drug crisis: people cannot get legal access to the opioid medication they need to treat an ongoing medical issue, whether pain or addiction.

All agree that judicious oversight and accountability are imperative.

“Judicious” is exactly what’s missing when blanket restrictions are placed on every patient, every doctor, every pharmacy, and every distributor.

But under intense scrutiny, distributors are practicing defensive medicine and unintended casualties –patents in pain — will surely mount.

I wonder how much worse this insanity will get before something changes. Perhaps more well-known people, those so often displayed in the media, need to suffer from a lack of pain treatment, someone like Oprah or famous musicians… who had to get theirs from the black market and were given unmeasured unofficial and poisonous doses of fentanyl they didn’t expect.

 

6 thoughts on “Scrutiny Of Painkiller Distributors Harms Patients

  1. Kathy C

    They refuse to look at how the system was undermined in the first place. Long after they made bad decisions, by going after patients and physicians rather than the distributors a the request of big pharma, they are still demonizing patients. It is very clear that whatever they are doing is not working, and leading to more deaths, so they are doubling down, to make it appear they did something.
    Maybe some day they will investigate all of this. How deregulation, corruption, and corrupt politicians conspired to kill Americans. The media ran stories sensationalizing addiction, and misreported the amount of treatment available. The lied about he number of people with serious pain disorders, they would not want people working grinding stressful jobs to know what they were in for. They had to downplay the effects of endless wars too, Veterans who managed to survive, IEDs and trauma, had to be re-framed, for American audiences. Their massive injuries, that were unsurvivable in the past, had to be glossed over. They had to cast doubt about the pain, to discredit them.
    They rolled out the ACA, but the corporations had decided they did not want to cover treatment, so they went back to the drawing board and 2 years later they released some funding. There were no enforceable regulations about treatment either. It was a profitable free for all. of course none of the experts, pointed this out, they were making good money endorsing them. They even had reality shows, where they pretended to cure people, even though a number of the addicts/reality stars died anyway. They experimented on people with abstinence, cold turkey, meditation, and they died anyway. Parents spent hundreds of thousands, mortgaged their homes to save their children, and they still died. Treatment centers were not required to use fact based or evidence based programs, it was more profitable not providing medication assisted treatment, and resorting to prayer or shaming.
    From the very first day some craven pharmaceutical executive decided to increase sales, after they did way with regulations about health marketing, this has been about profit. In The For Profit Market Based healthcare system, creating a bigger market for opioids was profitable. The Makers of Oxycontin, had to expand their market for their brand name drug. It was important to blame the sick people, and the ones who were addicted, to maintain sales. There were no regulations anymore. The authorities decided to go after physicians and patients instead of the corporations, even the DEA had their hands tied.
    Facts and data tell us that most of the deaths are illegal street drugs, and fentanyl, but they can undermine healthcare, and target sick people instead of looking at the societal problems. There is so much denial over the Epidemic of Despair. They managed to demonize patients, and injured workers with one propaganda campaign. They have been using the so called opioid epidemic to frighten the populace, and for marketing purposes. The only physicians they will allow to speak in the media, are the ones who misreport the facts. Most of them are seeking careers as influencers, and demonizing people in pain, the sick people who have been silenced and marginalized is good business. Creating a scapegoat for the decline of America, and the refusal to address the level of hopelessness and despair, that drove people to seek out drugs for comfort, is a good marketing and propaganda technique.

    They new about this problem two decades ago, yet they allowed the big pharmaceutical companies to market direct to the consumer. Industry insider at the regulatory agencies protected these corporations. When anyone spoke up they were fired, the healthcare industry refused to take action, they saw a profit in all of this confusion. When they could label sick people as addicts, they did not have to treat them. There is a lot of money to be made in alternative treatments, of course there was no one counting the suicides and deaths of despair. They could turn away injured people at the ER, ensuring life long chronic pain.

    In the meantime they are marketing everything, acupuncture, defective deadly pain pumps, dangerous surgeries, as long as the “customers’ don’t know the outcomes, desperate people in pain will try anything. There are still a few remnant laws about physician marketing, but they are not being enforced. Psychologists and psychiatrists got in on the action too, peddling two different versions of reality, one for the industries, to discredit injured workers for the insurers and big corporations, and another for prospective clients. The healthcare industry did not want any accountability, just like the other industries. The so called opioid epidemic is a really good marketing tool.

    We are now down the rabbit hole, in an alternative reality. The facts are not relevant anymore. Watching this situation evolve over 30 years, gives a certain perceptive. The for profit model, does not work. Casting blame on patients, has not made a dent in the death rate, the only indicator we have. In my community there are homeless and addicted people everywhere, but they are only advertising actual services. There is no housing, even for people with jobs, they advertise several “treatment centers” but they have a long wait. The corporate media tell us that charity, and stigma are the only answer. The real damage now is generational, yet they are willfully ignorant even now.
    I live in a state with the highest rates of suicide and drug addiction, yet they are only doing half measures. They took a big chunk of the money they got for the opioid epidemic and plowed it into the PDMP. this was on of the first states to enact a PDMP, yet it has had no effect on the number of deaths from street drugs. They only found a couple of cases of two prescribing doctors (doctor shopping) in all of these years, and these were likely a misunderstanding. A patient undergoing surgery and getting a second prescription would be an infraction. Zero evidence that the PDMP has done anything, except for an increase in Heroin and fentanyl deaths, since it was implemented. The corporation selling “Data Driven Solutions” apparently had no solutions. The money should have gone to treatment, maybe they could have saved a few lives.

    Thirty years out after families and communities were devastated, they are still looking for a solution. https://apnews.com/6fb1dc028dd74c0eca211706b3706927 This is from 2015, they leave out the Fact that people are still dying, and overdosing and abusing street drugs.
    http://hscnews.unm.edu/news/education-program-successful-in-reducing-opioid-abuse010715
    it is four years later, and nothing, more dead people, more homeless and more of the same. i guess the Opioid Board had to make it appear they did something. Many doctors opted out of the “education’ not wanting to treat their patient anymore. Of course no “research” was done on that. There is zero evidence anywhere that they “reduced opioid abuse.” What they did do was leave people with multiple surgeries, and long term intractable pain, without physicians. One would think it would be immoral or not ethical to make a statement like this, as people died. They gave the public the false impression that doctors and patients were at fault. They turned a serious public health issue,into a marketing and fundraising scheme that led to more deaths.

    At one time in America, there was a law against this kind of marketing. When the lies and misreported facts, lead to bad healthcare decisions, financial ramifications and death, it is clearly immoral, and it used to be against the law. These alternate facts led to more deaths. This is the same doctor who sits on the Opioid Board, and claimed that exercise tape could prevent heroin addiction.
    This is from 2017
    https://www.santafenewmexican.com/news/local_news/overdose-deaths-hold-steady-in-new-mexico/article_ab2a80a0-88ca-5d74-b2e7-b57151439d25.html

    Now they are giving out medication at a few more locations, There is a severe doctor shortage and a physician must give out the medications. There has been no improvement in any of the factors that led to this problem, no jobs, no hope of economic improvement, no housing. I have friends who are grandparents that are taking care of the children of addicted parents. The damage has been horrific for some of these families. Over the years as they incarcerated the parents without treatment, they tossed kids into foster homes. Now those kids have been drugged, to make them more compliant, traumatized, and some of them are now having kids.

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  2. Kathy C

    Once again media misinforms and demonizes people in pain. Of course they selected a healthy white male with health insurance, a good jobs, and an ACL injury, for their patient testimonial. the surgery requires a tiny opening, and minimal tissue damage.

    “How Hospitals Are Helping Patients Manage Pain With Fewer Opioids”

    “Dr. Charla Fischer, a spine surgery expert and colleague of Campbell’s at NYU Langone’s orthopedics department (and no relation to Dane Fischer), said that most of the time when a person becomes addicted to opioids, it’s not a result of their own medical treatments.” What the surgery expert is saying is that this has nothing to do with patients, or their pain levels, it is about keeping the drugs out of the community. The communities are full of fentanyl and other dangerous drugs, so limiting pain treatment to patients makes so much sense.

    There are plenty of dead people who started with heroin or street drugs. Many of the deaths attributed to prescription drugs were not patients, the drugs were stolen or diverted. Teens stole them from grandmas medicine chest. 10 years ago they were diverted from the supply chain and sold on the street.

    A small study of pre selected patients with routine minimally invasive surgeries, and no complications, used to misrepresent pain and demonize people with long term intractable pain conditions.

    At least they are loosening up a little admitting that sometimes a patient does need opiates.
    “Sometimes you do need opioids,” Fischer said, “but we’re looking at alternative methods” such as breathing exercises or acupuncture. “In my opinion, I think that’s a better, more holistic way of treating pain than just giving someone opioids.”
    Acupuncture is proven to be a theatrical scam, yet they are still peddling it for long term pain conditions.

    These articles are a combination of content marketing, advertising for the corporation they are promoting. There is no data available about the number of surgical mistakes and post op secondary infection. Open heart surgery might require a little more pain relief, but if it works for a laparoscopic surgery on a healthy white males’ ACL, why not apply it to every condition.

    Patients who were scared out of their wits over “pain pills” or who were afraid to say they were in pain, suffered through C-Sections without medication.
    “Opioid use after C-sections at Fairview plummeted by 70% within the first month, and the number of patients who never needed any opioids at all shot up from 12% to 51%. By mid-2019, C-section patients who did use opioids were discharged with around 12 pills, and by the end of the year that number was down to three to five pills. If a patient hasn’t received opioids in the hospital, she’s sent home with no opioid prescription at all.” After all of the media hype and fear over addiction, patients were too scared to say they were in pain. We can almost seethe disparaging look on the nurses pinched faces, if a patient reported pain. In order to keep the pill numbers down they would have slow walked any medications, or pretended not to understand. They probably educated the patient that they could get addicted, by a little post op pain relief.

    “Sometimes patients can drive the change, said NYU Langone’s Charla Fischer. “The media’s coverage of opioid use has changed a lot for me as a provider,” she said. “Now patients are saying, ‘I don’t want opioids. How do I avoid opioids?’ They want to manage the pain but don’t want to just pop a pill.”
    Patients are terrified, so of course they are going to say they do not want any opioids, or any pill. They are traumatizing the patients who do need pain relief. It is easy to misreport findings and it is easy to see the bias here.

    Even before the opioid hysteria, lot of patients chose to take minimal opioids, especially fitness types in good health, with no complications. People who have less support at home, who waited longer for their surgeries, or had complications will have to follow the same protocol, or be shamed and accused of being a drug addict. This is how they shut people up, who have adverse events, and post operative surgical infections.

    These ridiculous pieces of carefully written marketing and public relations, they pretend are news or informational, have not improved healthcare or public health. These are done for advertising and promotion. The industry pays well for this kind of stuff. They give the public the false idea of safety, and attract a better clientele, the ones with higher reimbursing insurance. Advertising has replaced fact based information. There is no way to find out their surgical infection rates, or how many adverse event occurred with the procedures they cover here. The hospital industry found ways to avoid reporting those. There is no guarantee that anyone with a painful condition, with get appropriate treatment, or even a diagnosis, after all they believe acupuncture is just fine.

    Alternate facts! A miscegenation of marketing and journalism. They have been using the so called opioid epidemic for marketing for years, and people are still dying.

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    1. Zyp Czyk Post author

      If a person refuses opioids because they’re afraid of getting addicted, I think their pain must not be that bad. My years of pain make me fear it unrelieved more than addiction or even dying. Without the pain relief I get from opioids I would not want to live.

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  3. Kathy C

    I know from experience, I refused them for years. I thought they were for the “weak’ I had no idea of what I was in for. I was one of these pople who did not bother to fill a prescription after a painful procedure. One physician years ago before all of this. told me that I had a “dangerous level of pain tolerance.” Of course every time I sought medical care, I was gaslighted. I was led to believe the lies about mindfulness and CBT. Week after week I went to the appointments, as the pain got worse, and my life went into a downward spiral. I spent thousands of my savings on PT, Chiropractors, and the other symptoms that went along with the ongoing nerve damage. My foot got infected, because I was dragging it as the nerves to my leg were compressed.

    A few years later I looked at the therapy notes. One particular time, I had driven 30 miles from a job-site, to an appointment, I was in agony. The damage to my spine made it excruciating painful to sit. This was consistent with the damage to my spine. The therapist though I was “angry” and wrote it in her notes,and made no mention of the pain I described. At that time I did not want opiates, I just wanted the pain to stop. Every time I went to the doctor, it was like the first time as if I was reporting pain for the first time. They sat there and gas-lighted me.

    It is kind of terrifying, since then i have tracked friends and acquaintances who have been through similar situations, and even worse. This is all about profits and protecting the bottom line. Physicians are told that people that report pain are either drug seeking or looking for a “jackpot” so they are afraid to even diagnose the problem. I have been to appointments with people, where I was shocked at the level of gaslighting, misdiagnosis, and keeping track of the minimal time allotted. I went along with friends to the VA, to see for myslef how they were “treating” these conditions. Instead of diagnosis or treating the pain, they were giving these guys anti psychotics. This explained why a lot of these Vets, distrusted the system, and refused to get healthcare.

    I started tracking what was being presented as “healthcare.” This is the hospital where I was initially misdiagnosed and years later had a C- Spine implant. I gave permission to the sale rep, to be in the ER, it was presented as harmless. This was back in 2008, and I have met people who had rods implanted in their spines at this hospital. The rods were later “recalled” and the patients who were lucky enough to survive the agony, had to have them surgically removed. Of course none of this was public knowledge, and most needed opioids for the ongoing pain. This hospital opened a pain clinic, which they advertised heavily as a “cure” for pain. They did an assembly line of steroid injections, which patients were forced into, or they would get no pain treatment. The shot clinic was highly profitable, but few people with serious pain conditions were actually helped. The continued long after the FDA warnings, because it was a profitable alternative to opioids.

    This was on our Sunday local news front page. https://www.santafenewmexican.com/news/local_news/opioid-treatment-evolves-at-christus-st-vincent/article_8fd7b350-4847-11ea-8ef9-43c1fd857e8b.html The “treatment” evolved after they had a name brand drug. Previously and for the last 30 years, they turned these sick people out on the street. Because they were a religious non profit, it was perfectly OK to shame patients, even post surgical patients. Nearly every street corner in our town has a poor soul panhandling, and it is getting worse. We walked our dog yesterday, and found another syringe. This hospital had a monopoly until recently, and did nothing about this until last year. This area has generational heroin usage, and this too little to late approach is only better than nothing. Of course there is no way to track the impact in our community, there is only the (reported) overdoses and death rates

    It is followed by an expensive slick half page advertisement for the “Orthopedic Specialty Clinic.” Further into the paper is another ad for their Medicare Advantage Program, for those that can afford it. They advertise “integrated healthcare” and “free fitness” at a city gymnasium, along with “free socks and blankets” Lot of free advertising, like the opioid article, written by a public relations/ journalist.

    Our legislature is in session, and there is talk of “Medicare For All.” They have to paint these advertisers in a positive light. There is talk of taxing the non profits and tax breaks, in the air. http://nmindepth.com/2019/12/12/are-new-mexicos-hospitals-shortchanging-community-health/ Reading all of this and seeing the non stop advertising, lobbying and public relations, one could be led to believe our healthcare system is functioning, when it is not. This “non profit” has donated money to almost every local politician. They are also one of the largest employers in the area, making them “job creators.”

    It is all about the money, and they will use any means to protect profits, and mislead the general public,when it comes to healthcare. There is no advertising that is off limits anymore, or even considered immoral for being deceptive. The same lawyers, propagandists, and insiders that work to protect corporate profits, function for these non profits too. I have been comparing the so called opioid epidemic, to other epidemics, like the Corona Virus, and they are both being used for marketing. This is already having a serious effect on public health, but that does not seem to matter.
    https://www.santafenewmexican.com/news/local_news/new-mexico-department-of-health-keeps-eye-on-coronavirus/article_6532a7dc-4e81-11ea-a2b6-5b123e5b7405.html All of the media outlets, including NPR discussed the corporation selling the face masks, their stock prices went up as speculators sought to cash in, on the potential shortage. Now our state epidemiologist admonishes the public about the effectiveness of face masks. Nothing about the marketing and misinformation, and how that could endanger public health. More people have died form the flue due to anti vaxxers in our state, but there are a lot of “small businesses” that cashed in. Just like they all cashed in on the so called opioid epidemic.

    I like DR Gunter she cuts through a lot of the BS. https://twitter.com/DrJenGunter

    This article creeps me out, Suaron’s Stare is exactly it! https://www.wired.com/story/facebook-mark-zuckerberg-lost-notebook/#intcid=recommendations_wired-homepage-right-rail-popular_38ab6b04-7e5b-40c0-b69e-d247b94b34e9_popular4-1

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