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  • "We're getting some traction. We see it in the news coverage and now on judicial decisions!" ~Ron Chapman

    "We are taking on this fight for you. I've heard your voice and I've put it into the briefs we submitted." ~Atty Ron Chapman

    We posted an article last week about the Supreme Court case coming up on March 1, 2022. On Jan 4, Claudia interviewed Ron Chapman, who submitted an Amicus Brief in support of the doctors in this case.  Ron broke it down for us explaining what this means for CPP's and doctors. Listen to the interview to find out what Ron thinks the best and worst case scenarios are depending on the outcome of this hearing.

    Summary of the issue

    • Under the Controlled Substance Act (CSA), the criminal standard for prescribing says a physician can't prescribe outside the course of professional practice other than for a legitimate medical purpose, When a doctor elects to prescribe a medication, he needs to make sure he establishes a physician patient relationship and that the prescription is for a legitimate medical need. That should be the extent of the discussion. Courts should not debate about whether it's the right or effective treatment. All the court should ask is if the doctor was acting like a doctor and if he was, then it should be done, acquitted. No conviction.
    • Over the last ten years the federal government has decided to crack down on opioids. They took out pill mills because there were bad doctors. So they hired a bunch of prosecutors and DEA agents, and they started going after these doctors. Once the government ran out of nails (doctors) to hammer and already had all these hammers (DEA agents/prosecutors), it needed more nails to go after. So, they started asking judges and juries to decide closer and closer calls in the practice of medicine, so more doctors would be caught up in its net. This started around 2011.They hired experts to get on the stand and say "here is what the standard is, and if you don't do what I think you should do then you're committing a crime." They got on the witness stand and started spouting their theories of what doctors should and shouldn't do.
    • In 2016 the federal government decided to take these theories of expert witnesses and they codified them in the CDC Guidelines. Now federal courts are using the Guidelines to convict physicians. The problem is there is no consensus on how a physician should prescribe, it's patient specific and can't be reduced to these ideas. The idea that it can is nonsense.
  • AMA Report Shows Decrease In Opioid Prescribing and Increase in Overdoses

    American Medical Association Endorses Ban on Energy Drink Marketing to Minors - BevNET.com

    AMA (American Medical Association) has been vocal about their view of the 2016 CDC Opioid Prescribing Guidelines and the changes they feel are necessary. On September 21, 2021, AMA released a report showing that while there has been a 44.4% decrease in opioid prescribing, the drug overdose epidemic has never been worse. The press release for the new report can be found here. The report also discusses how as PDMP use has greatly increased, overdoses and deaths skyrocketed.  Does that mean the PDMP actually increases deaths?  It's possible. This issue is discussed further in this Reason article by policy analyst, Jacob James Rich. The DOJ has put hundreds of millions of dollars into funding the PDMP. Will they stop funding the PDMP since the results are definitely less than impressive? Doubtful, but we'll see. Contrary to what anti-opioid zealots like Andrew Kolodny from PROP and Gary Mendell from Shatterproof want people to believe, AMA President Gerald E. Harmon, M.D. said “The nation’s drug overdose and death epidemic has never just been about prescription opioids.” 

  • DEA Warns of Counterfeit Pill "Surge" Following its Crackdown on Prescriptions

    Truth Out published an article on October, 1, 2021 regarding the DEA's recent public safety alert about the abundance of counterfeit prescription pills. Mike Ludwig's article is part of the series "The Policing of Pain: Inside the Deadly War on Opioids." This increase demand for prescription pills is largely due to a crackdown on prescribing of controlled substances. Mike explains that the link between "overprescribing" and the overdose crisisis greatly exaggerated, citing the fact that opioid prescribing has plummeted to the lowest it has been in a decade as overdoses have skyrocketed. Claudia Merandi, Founder and President of The Doctor Patient Forum, was interviewed for this article.

  • FAQs

    How can I sign up to receive The Doctor Patient Forum's free newsletters?

    How do I advocate for a loved one who is in the hospital?

    What is NarxCare?

    What do all of the abbreviations and acronyms mean?

    What is the PDMP?

    Is there a list of up-to-date statistics, research, and studies that I can use to show to media, my legislator, or my doctor?

    Did the CDC know their Guidelines could potentially harm patients? Were they warned?

    Do studies show that prescription opioids don't work for long-term chronic non cancer pain?

    What is the SPACE Trial and does it prove that prescription opioids don't work for chronic long-term non cancer pain?

    What is MME? Are the concepts of MME (Morphine Milligram Equivalent) and MME limits such as 90 MME, based on solid scientific evidence?


    How can I sign up to receive The Doctor Patient Forum's free newsletters?

    Click here to sign up!

    Catch up on all of our past newsletters 


    How do I advocate for a loved one who is in the hospital?

    Some basic facts:

    • If the patient is currently a chronic pain patient and takes daily prescription opioids, the patient is less likely to receive opioids while in the hospital.
    • Chances are the hospitalist is already biased against the patient.

    Step by step instructions: 

    1. Have the patient ask for the charge nurse.
    2. If you’re on the phone, ask the patient to put you on speaker so you can start a conversation with the charge nurse.
    3. Introduce yourself saying:
      1. “Hello, my name is (insert your name here). I am a patient advocate based out of (insert your location). First, thank you for your hard work during the pandemic.  I know you’re terribly busy but I imagine we both have the same goal of controlling this patient’s pain.”
      2. “Can you please tell me whose care this patient is under? Is the hospitalist a resident? A fellow? Would you kindly provide me with their name, please?”
      3. Would you please contact the hospitalist, tell them the patient’s pain is unmanaged and he needs adequate pain relief?”
      4. “If the doctor is unwilling to put in an order for adequate pain medication, would you please tell me why?”
    4. If the doctor still doesn’t put an order in, the next step is the have risk management, the charge nurse, the hospitalist and the surgeon all come to the patient’s room at the same time so you all can have a conversation together.
    5. This is a time-consuming but necessary process.
    6. Once discharged, if the patient’s health was made worse by the treatment received at the hospital, then the next step would be to contact a medical malpractice attorney.

    Some more tips:

    • Documentation is key. Write down the names of every person you speak with and exactly what they say to you. This will be very important if you choose to file a complaint with the medical board.
    • Hospitals have protection from the feds, so there is no reason pain shouldn’t be treated while inpatient.
    • Remember, hospitals do have patient advocates, but they work for the hospital, not for the patient.
    • If the patient is under a pain management contract, the patient should not accept an opioid prescription upon discharge unless already agreed upon by the pain management doctor. Even accepting a prescription for 5 pills can cause a patient to be discharged from pain management if it hasn’t been discussed in advance.
    • If the patient’s pain management doctor has agreed to allow the patient to accept a prescription from the hospitalist or surgeon, it’s always best to take it to the patient’s pharmacy instead of filling it at the hospital’s pharmacy.

    PDF version of these instructions


    What is NarxCare?

    NarxCare, a product of a company called Appriss, is a proprietary data analytics program. It uses up to 70 data points (that only Appriss knows) and mixes them with your PDMP (prescription history) to assign a 3 digit score letting your doctor or pharmacy know if you have a high risk of abuse or overdose. According to Appriss, "NarxCare aids care teams in clinical decision making, provides support to help prevent or manage substance use disorder, and empowers states with the comprehensive platform they need to take the next step in the battle against prescription drug addiction." Essentially, NarxCare pulls data from multiple state registries looking for red flags of drug seeking behavior. 

    The three categories of prescription medication it looks at are narcotics (opioids), stimulants (ADHD meds) and sedatives (benzos, sleeping meds, etc.). "The NarxCare report identifies risk factors with interactive visualizations, as well as an Rx Graph, and a set of scores that numerically correspond to the patient’s PDMP data." Although Appriss states on their website that their product shouldn't be used by itself to make medical decisions, that's not what's actually happening. As shown in this NarxCare article, patients are being denied medication or even being dismissed from a medical practice based on a NarxCare score alone.

    Some of the risk factors used in the proprietary algorithm are:

    1. The number of prescribers a patient has had in a two-year period.
    2. The number of pharmacies a patient used in a two-year period. 
    3. The dosage (MME-Milligram Morphine Equivalent).
    4. Amount of other medications that may increase potency of other medications.
    5. Number of times prescriptions overlap with prescriptions from other providers

    Nobody knows (except Appriss) exactly what goes into the ORS (Overdose Risk Score).  Some of the factors we've found listed are criminal history, diagnoses in your EHR (Electronic Health Record) including mental health diagnosis (such as depression or PTSD), distance patient drives to the doctor, and diagnosis of sleep apnea.  

    What are some of the problems with NarxCare?  What isn't it a good thing?

    1. There is no room for context.  What does this mean?  As mentioned above, if someone has more than one prescriber within a two-year period, that will increase the ORS.  But, there isn't a way to include an explanation such as if a patient moves, if a patient has multiple surgeries within that time period, or if a patient's doctor retires causing the need for a new physician.
    2. A patient's pet's prescription history is included.  This means if a patient has surgery and if her pet has surgery, it appears as though the patient is getting prescriptions from more than one doctor.  
    3. The NarxCare algorithm has never been externally validated.  What does this mean? Essentially, it means the results of the study the algorithm is based on haven't been proven to apply to people outside of the study.  Yet, that's exactly what they are doing.  They are calling it evidence-based even though it is not.  
    4. If someone is prescribed 90 MME (Morphine Milligram Equivalent) or more, the NarxCare score is automatically at the to 1% of all Overdose Risk Scores.  Why is this bad?  Well, the whole concept of MME and arbitrary thresholds such as 90 MME are flawed and not based in science.
    5. The NarxCare algorithm has inherent gender and racial bias.  How?  Since they use criminal history, it is racially biased.  Since more it women tend to have mental health diagnoses such as PTSD due to trauma, it automatically is biased against women.  We have heard stories of women who have been denied prescription opioids due to having been a survivor of sexual abuse.

    As summarized in this Wired article, the entire concept of NarxCare is flawed and is flagging patients who shouldn't be flagged.  "According to one study, 20 percent of the patients who are most likely to be flagged as doctor-shoppers actually have cancer, which often requires seeing multiple specialists. And many of the official red flags that increase a person's risk scores are simply attributes of the most vulnerable and medically complex patients, sometimes causing those groups to be denied opioid pain treatment."

    Many people are fighting against the use of NarxCare.  Almost every state uses Aprriss' PDMP platform and roughly 25 states in USA use NarxCare. Contact your local Department of Health to find out if your state uses it. For more information about Narxcare, we've included links to a few articles.

    PDMP and NarxCare

    Dosing discrimination 

    What Every Patient Should Know About NarxCare

    PDMP and NarxCare

    The flawed study NarxCare is based on


    What do all of the abbreviations and acronyms mean?

    • CDC - Center for Disease Control and Prevention
    • CDC GL - CDC Guidelines (usually referring to the 2016 guidelines for opioid prescribing).
    • CNCP - Chronic non-cancer pain
    • CPP - Chronic Pain Patient
    • DPP - Don't Punish Pain
    • EHR - Electronic Health Record
    • HHS - Health and Human Services
    • LTOT - Long-term opioid therapy
    • MME - Morphine Milligram Equivalent
    • OIH/OIHA - Opioid-induced hyperalgesia
    • ORT - Opioid Risk Tool
    • PDMP/PMP - Prescription Drug Monitoring Program
    • PROP - Health Professionals for Responsible Opioid Prescribing

    What is the PDMP?

    PDMP (Prescription Drug Monitoring Program) is a data base that records all controlled substance prescriptions including opioids, sleeping pills, ADHD medication, muscle relaxers, among some others. The first PDMP was developed in New York in 1918. It is now in all 50 states (as of 2021).  These data bases have been funded by the Department of Justice (to the tune of hundreds of millions of dollars).

    We've seen several goals listed for the PDMP, but the most common is to give healthcare professionals real-time access to your prescription history so they can make sure you're not "doctor shopping," or otherwise abusing your medication.  Each state runs its own PDMP, usually by the HHS (Dept. of Health and Human Services). Thanks to a company called Appriss, PDMP's are now interconnected between states.

    Some common questions answered:

    1. Who enters your information into the PDMP?  The pharmacist/pharmacy technician.
    2. Do you have real-time access to your PDMP report?  No.  Each state has different rules. Contact your HHS and ask how you can see your PDMP history and how to fix any errors.
    3. Who has access to your PDMP? Pharmacies, doctors, hospitals, and in some states veterinarians and law enforcement.
    4. What's a risk score in the PDMP?  This brings us to Narxcare.  PDMP pulls from many different data bases (criminal history, financial history, school grades, Electronic Health Records, etc.) and mixes it all with your prescription history to spit out a risk score as to whether your doctor should prescribe to you or not.  See the FAQ "What is Narxcare?" for a more detailed explanation. 

    Still interested in reading more about PDMP? Here are a couple of articles we recommend:

    This study finds that Prescription Drug Monitoring Programs fail to reduce opioid overdoses and increase the use of black market opioids

    Dosing Discrimination: Regulating PDMP Risk Scores


    Is there a list of up-to-date statistics, research, and studies that I can use to show to media, my legislator, or my doctor?

    Yes!  We have a printable document (both Word and PDF) listed here under Advocacy Tools


    Did the CDC know their Guidelines could potentially harm patients? Were they warned?

    Yes to both! They were warned by many organizations. They knew these Guidelines were dangerous. We gave all the details in our Debunking Lies section. It includes links to all the warnings and an explanation of what happened and how the CDC responded. Read our answer here.


    Do studies show that prescription opioids don't work for long-term chronic non cancer pain?

    No, they don't! But, that doesn't stop anti-opioid zealots from making this claim. Read all about it and how to counteract this false narrative here, in our Debunking Lies section.


    What is the SPACE Trial and does it prove that prescription opioids don't work for long-term chronic non cancer pain?

    It is a study funded by the VA and done by Dr. Erin Krebs. No, it doesn't prove that prescription opioids don't work for long-term chronic non cancer pain. Yet, it is cited as a reason to not prescribe opioids and to force taper. We broke down this study for you with all the links and information you need to counteract this false statement.


    What is MME? Are the concepts of MME (Morphine Milligram Equivalent) and MME limits such as 90 MME, based on solid scientific evidence?

    We answered this question in detail in our Debunking Lies section. Read all about it here.

  • George Knapp Interviews Dr. Dain Laird "Pain Med Prescriptions Did Not Cause the Opioid Epidemic"

    Listen to pain doctor and mal-practice attorney, Dr. Dan Laird discuss the false narrative and what the "opioid crisis" actually is. You won't want to miss him talking about the litigation narrative and how chronic pain patient advocates are helping to set the record straight. Click the following link:

    Pain Med Prescriptions Did Not Cause the Opioid Epidemic 

    • "Chronic pain patients are in a fight for their lives" ~Dr. Dan Laird

    • "Prescribed opioids are approaching a 10-year low and opioid deaths are higher than they've ever been in the history of the world." ~Dr. Dan Laird

  • Judge Ruled Against the Plaintiffs in Opioid Litigation in California

    An article in Reason came out yesterday about the ruling for the Defendants (four drug companies-Teva, Johnson & Johnson, AbbVie, and Endo) in opioid litigation. This is huge for our community. The Judge said the  Plaintiffs failed to prove the charges of public nuisance and false advertising. Superior Court Judge, Peter J. Wilson wrote a 42 page ruling. This was the first of thousands of cases filed across the country regarding the "opioid crisis," filed in 2014. The Plaintiffs' claims were:

    1. The companies used false advertising
    2. They engaged in unlawful business practices
    3. They created a public nuisance

    Judge Wilson ruled the Plaintiffs failed to prove any of these claims. Some direct quotes from Judge Wilson's ruling:

  • NPR show 1A with Bev Schechtman and Maia Szalavitz discussing NarxCare and how it affects pain treatment

    NPR's show, 1A, had our VP, Bev Schechtman on a panel on November 11, 2021. The name of the segment is "Against The Pain: The Opioid Crisis and Medication Access." NPR became interested in the show after reading Maia Szalavitz's article about NarxCare in Wired.  Listen to the recording of the show.  You don't want to miss this!  

    "We have these people who have been on these meds for 20-30 years and doctors are under extraordinary pressure to get their numbers down" ~Maia

    "In a criminalized environment where doctors are not only afraid of losing their license, but of going to prison, and where patients are being squeezed because they're being told 'you can only have x amount because otherwise my numbers are too high,' you end up with a lot of untreated pain." ~Maia

    "I'd like to see context added (to these algorithms), if someone moves 3 times in 2 years, it needs to not look like they're 'doctor shopping,' I'd like to see a return to individualized care and stop these arbitrary guidelines where people are having a hard stop on what they can and can't have and they're not looking at what's actually going on with the patient." ~Bev

    "I was treated like a criminal; I was mocked, laughed at, scolded, I was embarrassed...I felt revictimized." ~Bev

    "There are tremendous gender and racial bias in these algorithms and in this false narrative." ~Bev

    "No one should ever be denied care, that's just cruel and unusual punishment." ~Dr. Dombrowski

    "Electronic Health Records are just a billing system, not to make patient care better...if you hit something by accident like malingering, next thing you know it's in the chart permanently. It's dangerous." ~Dr. Dombrowski

    Dr. Mark Ibsen, who is a fierce advocate for the CPP community, recorded the show with running commentary.  

  • Oklahoma's hearing on November 1, 2021 about harm done to pain patients due to forced tapers

    On November 1, 2021 the Oklahoma, Alcohol, Tobacco, and Controlled Substances Committee held a hearing. The  purpose was to discuss an interim study that was done about rapid de-prescribing and the horrific effects it has had on patients.  This was requested and organized by Tamera Stewart-P3Alliance Policy Director, Julia Heath-P3Alliance Director of Medical Initiatives, along with their leadership team.

    Some of the speakers were Beth Darnall ,PhD from Stanford University, Dr. Vanila Singh, other doctors, a pharmacist, and chronic pain patients.

    Beth Darnall, Phd:
  • Roger Chou’s Undisclosed Conflicts of Interest: How the CDC’s 2016 Guideline for Prescribing Opioids for Chronic Pain Lost Its Clinical and Professional Integrity

    An extremely important article was just posted last week on September 17, 2021.  We at The Doctor Patient Forum/Don't Punish Pain have been researching the CDC Guidelines and how they were written.  We specifically have focused on one of the main authors, Dr. Roger Chou.  We had the privilege of collaborating with a palliative care doctor who is also on the AMA Opioid Task Force, Dr. Chad Kollas. Dr. Kollas along with a few other chronic pain patients and advocates worked together to put out this phenomenal article showing in detail the unacceptable conflicts of interests Roger Chou has, and explains in why we need a congressional investigation into how the guidelines were written.  How can you help?  Familiarize yourself with the content of this article, and forward it to your local legislators. your local representatives, your senators, etc.  The following goals are listed at the end of the article:

  • State Legislation Prescribing Laws and Tips For Starting The Process of Getting Legislation In Your State

    Many states have prescribing laws.  Read An Examination of State and Federal Opioid Analgesics and Continuing Education policies which was printed in 2020. We've also included the pdf version of the article. The purpose of the article is "To evaluate the impact of its Opioid Analgesic Risk Evaluation and Mitigation Strategy (REMS) program, the US Food and Drug Administration (FDA) requested the opioid manufacturers responsible for implementing that program provide information regarding opioid policy changes from 2016 to 2018. FDA also requested a survey of state requirements for pain and opioid prescribing continuing education (CE), the number of prescribers affected by those requirements, the extent to which a REMS-compliant CE program would meet each state’s requirements, and the number of relevant CE programs available."  

    We've included two charts that list prescribing laws state by state

    1. This includes state laws and Continuing Education laws
    2. Laws limiting the prescribing and dispensing of opioids done by the Network For Public Health Law

    See our Advocacy Tools to see tips on how to start the process of getting legislation in your state.

  • The Pain Was Unbearable. So Why Did Doctors Turn Her Away? NarxCare is the reason.

    When our VP, Bev Schechtman, was denied adequate pain medication when hospitalized for kidney stones due to having been a victim of sexual abuse, she became obsessed with researching how this could happen. She learned about NarxCare and the Opioid Risk Tool. We, at The Doctor Patient Forum/Don't Punish Pain, have been researching these topics for the past four years. We've reached out to countless investigative journalists only to be shot down. Thankfully, Maia Szalavitz, an author and leader in harm reduction, was interested in telling the story of NarxCare and other risk tools. This was our first piece of national media, and we are so excited to share it with you. We suggest holding on to this article and sharing it with your local legislators.  About half of the states use NarxCare, and this article can help you fight against it. Read about how our country has tried to help the "opioid crisis" by using a risk score algorithm, yet it seems they're only making matters worse.

     

The Doctor Patient Forum

Claudia A. Merandi 5 Chedell Avenue / East Providence, RI 02914 / USA 1.401.523.0426

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