This story is a collaboration between STAT and ProPublica.

In May 1997, the year after Purdue Pharma launched OxyContin, its head of sales and marketing sought input on a key decision from Dr. Richard Sackler, a member of the billionaire family that founded and controls the company. Michael Friedman told Sackler that he didn’t want to correct the false impression among doctors that OxyContin was weaker than morphine, because the myth was boosting prescriptions — and sales.

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  • ALL Nursing Homes recently got this letter below. All Nursing Home nurses will ever read is the first page or two; which means all they’ll get out of this letter is NO MORE Opioids for elderly patients (no matter how close to death) & use Naloxone??? THE CDC HAS GONE INSANE! If anyone is addicted to opioids at Nursing Homes IT’S THE NURSES! Yet they are not mentioned in this letter??? ———————————————-

    QUANTUM REHABILITATION AND NURSING
    63 OAKCREST AVE
    MIDDLE ISLAND NY 11953-1415
    JKA02152019

    Dear Health Care Provider:
    IT
    Thank you for your participation in Medicare and the services you and your colleagues provide to more than 55 million people with Medicare. You are integral to our work at the Centers for Medicare & Medicaid Services (CMS) to combat the opioid epidemic.
    We recently published an opioids roadmap at https://www.cms.gov/About-CMS/Agency Information/Emergency/Downloads/Opioid-epidemic-roadmap.pdf outlining our efforts to address this issue of national concern. In this roadmap, we detail our three-pronged approach, focusing in on preventing new cases of opioid use disorder, treating patients who have opioid use disorders, and using data from across the country to target prevention and treatment activities.
    CMS is working with the U.S. Department of Health and Human Services (HHS) to encourage health care providers to co-prescribe naloxone to certain at-risk patients who use opioids. We are also strengthening Medicare drug plan policies to promote care coordination and safe use of prescription opioids, and encouraging health care providers to promote a range of safe and effective pain treatments, including courses of action other than opioids.
    Co-prescribing Naloxone
    HHS issued guidance at https://www.hhs.gov/opioids/sites/default/files/2018-12/naloxone coprescribing-guidance.pdf and recommended a set of indications for naloxone prescriptions. As a provider, you can have important conversations with your patients about pain management, and opioid safety. You can help expand naloxone access and awareness by co-prescribing naloxone for certain patients who get opioids for pain management and who may be at-risk for an opioid overdose. In concert with standing pharmacy orders, pharmacist prescriptive authority, and other naloxone laws, regulations and policies, your action can help ensure your high-risk patients have naloxone more readily available to them, and, when needed, to their families and caregivers.
    .
    New Medicare Part D Opioid Policies
    :
    CMS recently finalized new policies for Medicare drug plans, effective January 1, 2019. The policies broaden our partnership with providers to address the opioid crisis while maintaining access to needed medications. It’s very important you understand the new policies to minimize additional burden on you and your patients. It is also critical in avoiding adverse and unintended impacts on your patients’ access to prescribed opioids.
    Our approach centers on increasing communication tools to improve safety, especially as we process opioid prescriptions. The new policies include improved safety alerts (pharmacy claim edits) when a patient fills an opioid prescription at a pharmacy, and drug management programs to help coordinate care for patients with high-risk opioid use, such as those receiving high levels of opioids from multiple prescribers and/or pharmacies.

    Detailed training materials about these new policies are available:
    A Prescriber’s Guide to the New Medicare Part D Opioid Overutilization Policies for 2019: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network MLN/MLNMatters Articles/downloads/SE18016.pdf.

    Information for Prescribers, such as slide deck and tip sheet: https://www.cms.gov/Medicare/Prescription-Drug Coverage/Prescription Drug CovContra/RxUtilization.html

    Starting January 1, 2019, Medicare drug plans will employ the following safety alerts at the pharmacy:
    ..
    7 day supply limit for opioid naïve patients: This is a policy to limit an initial opioid prescription supply to 7 days or less until the pharmacy gets an override from the plan for Medicare patients who have not recently filled an opioid prescription (e.g., within 60 days). The pharmacist can fill part of the initial prescription (e.g., a 7 day supply) per state and federal regulations. If a prescriber writes another prescription for the remainder of the days-supply, or any subsequent prescriptions, those prescriptions are not subject to the 7 day supply limit because the patient is no longer considered opioid naïve. However, if a prescriber believes that an opioid naïve patient will initially need more than a 7-day supply initially, the prescriber can contact the plan to request a coverage determination on behalf of the patient attesting to the medical need for a supply greater than 7 days. The prescriber can also request an expedited or standard coverage determination in advance of prescribing an opioid.
    Opioid care coordination alert: This is an alert for pharmacists to review when the patient’s cumulative morphine milligram equivalents (MME) reaches 90 mg or greater per day across all. opioid prescriptions. Some plans use this alert only when the patient uses multiple opioid prescribers and/or opioid dispensing pharmacies.
    This 90 MME threshold identifies potentially high risk patients who may benefit from closer monitoring and care coordination. It is cited in the Centers for Disease Control and Prevention (CDC) Guideline (https://www.cdc.gov/drugoverdose/prescribing guideline.html) as the level above which primary care prescribers should generally avoid. This is not a prescribing limit. In reviewing the alert, the pharmacist may contact the prescriber to confirm medical need for the higher MME. The pharmacist may talk with the prescriber about other opioid prescribers or increasing level (MME) of opioids. After that discussion to confirm intént, the pharmacist can fill the prescription.
    The prescriber who writes the prescription will trigger the alert and a pharmacist will contact the prescriber even if that prescription itself is below the 90 MME threshold. Once a pharmacist consults with a prescriber on a patient’s prescription for a plan year, the prescriber will not be contacted on every opioid prescription written for the same patient after that unless the plan implements further restrictions.
    The new CMS policies also include drug management programs to encourage care coordination and safe use of opioids as required by the Comprehensive Addiction and Recovery Act of 2016. Starting in 2019, for patients who could potentially abuse or misuse prescription drugs – including opioids and benzodiazepines – a Medicare drug plan will contact prescribers through case management to review patients’ total utilization pattern of frequently abused drugs and discuss the following.coverage:

    Requiring the patient to get these medications from a specified prescriber and/or pharmacy, or Implementing an individualized point of sale edit that limits the amount the drug plan covers for these medications.

    Medicare drug plans identify potential at-risk patients by their opioid use which involve multiple doctors
    and pharmacies. After the plan conducts case management with prescribers and before implementing any coverage limitation tools, the Medicare plan will notify your patients in writing. Plans must make reasonable efforts to send the prescriber a copy of the letter.

    Prescribers and patients can respond to the notice within 30 days. After this 30 day time period, if the plan determines based on its review that the patient is at-risk and implements a limitation, the plan must send the patient a second written notice confirming the specific limitation and its duration.
    If the plan decides to limit coverage under a drug management program, the patient and their prescriber have the right to appeal the plan’s decision. The patient or prescriber should contact the plan for additional information on how to appeal.
    Promoting a range of safe and effective pain treatments

    .
    Opioids are one tool to help your patients with chronic pain. You may also want to consider other treatments when you discuss options with your patients. Medicare covers a variety of services to treat pain. Medicare covers some services across the country, including physical therapy, individual and group therapy, behavioral health integration services, psychiatric collaborative care services and electrical nerve stimulation. Local coverage of additional services may vary somewhat by jurisdiction; you can find detailed information, related coding information, and any restrictions on our website at https://www.cms.gov/medicare-coverage-database/indexes/national-and-local-indexes.aspx along with a searchable database https://www.cms.gov/medicare-coverage-database/overview-and-quick search.aspx
    ..

    Medicare also covers care management services to give patients medical care and care coordination services that can help manage their medical condition(s). Information about Chronic Care Management, Behavioral Health Integration, and Transitional. Care Management at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service Payment/PhysicianFeeSched/Care-Management.html. Medicare’s Initial Preventive Physical Exam and subsequent Annual Wellness Visits give you other opportunities to discuss your patients’ general health issues including pain, and review and promote options for pain treatment. See more information about coverage of these services at https://www.cms.gov/Outreach-and-Education/Medicare-Learning Network-MLN/MLNMattersArticies/downloads/SE18004.pdf. There are community programs to help your Medicare patients manage their pain and other chronic conditions. Find out how to access these programs through Area Agencies on Aging and other community-based organizations at: https://eldercare.acl.gov/Public/Index.aspx. CMS has dedicated quality improvement contractors to work with you and community organizations to improve health care safety and reduce opioid related adverse events in every state with the Quality Innovation Network Quality improvement Organizations (QIN-QIOS https://gioprogram.org/locate-your-gio), and the Hospital Improvement and innovation Network (HIIN)

    https://partnershipforpatients.cms.gov/wherepartnershipsareinaction/wherepartnershipsarein action.html#HIIN).
    CMS is committed to exploring and offering viable options to address the opioid crisis, sharing information on the data we collect with other agencies and organizations, and protecting our beneficiaries and communities affected by the crisis. Together, we can make progress in addressing. many aspects of the opioid epidemic. For questions on CMS opioid policies, please see our available resources at: https://www.cms.gov/about-cms/story-page/opioid-misuse-resources.html#provider.

  • For ALL:
    http://nationalpainreport.com/what-is-largest-chronic-pain-patient-survey-showing-8838943.html
    Which states. Sackler ios just the tip of the iceberg who is ruining our lives

    What is Largest Chronic Pain Patient Survey Showing?
    by Terri A Lewis, PhD.

    For the last several months, The National Pain Report has been promoting the efforts of Terri Lewis’ to calculate the impact of changes in chronic pain treatment on the patient population. Nearly 4,000 people have filled out the survey. If you haven’t you can do by clicking here.:https://www.surveymonkey.com or put in browser addy line. PLEASE FILL OUT THIS SURVEY !!!/r/Y8YXRJ9

    Here’s more on what the survey is showing:

    Seventy percent (70%) report that their health care has either worsened or they have lost support entirely. Twenty-five (25%) of individuals have lost access to a primary care provider. Forty percent (40%) lack access to specialty care for disease management. Of those who have lost access to care management, 63% report that the burden of self-managing their illness has increased, reliance on over the counter medications has increased with little effect, feelings of hopelessness have increased, and family relations are excessively strained. Many express concern about the long term use of over the counter analgesics and the apparent disregard of potential risks by their physicians.

    Forty percent (40%) are unhappy with their insurance carrier for reasons that are unique, complex, and reflect the various differences in plan implementation across the states. This, together with comments about integration with financial resources and public benefits programs requires close scrutiny – I am still working to understand the influence of external factors on this area of responses. It appears that the loss of economic basis imposed by the onset of chronic disease imposes significant limitations on resources to manage care. Roughly 70% of respondents are living at or near poverty levels. This limitations on choices and increases dependence on systems of care that are not operating consistently or optimally across the states.

    Suicidal ideation and action are ever present in the pain community. Two hundred sixty-seven (267) persons thoughtfully reflect upon their suicide stories; 89 persons shared the story of a friend or family member who ended their life, while the balance of respondents describe the conditions under which they will take action to end their life. I have not yet teased out the factors that correlate to respondent characteristics. Many comments reflect loss of care support, concern for burden on care partners, and running out of energy and personal resources for this difficult race.

    Thirty-five (35%) of respondents have changed pharmacies one or more times in the last two years – either because of pharmacy plan changes to formularies, out of stock issues, errors, or because the pharmacy stopped stocked necessary medications. Limitations of mobility, transportation, and impact of disability require reliance on friends or family to handle filling of scripts. The pharmacy crawl causes extra stressors as many report feeling like they are treated like criminals upon presentation of a legitimate prescription.

    Follow on Twitter:

    @NatPainReport

  • They are still lying to the public. Read any mass media article, or statement by a politician. Every single one of them conflates Oxycontin with oxycodone, an opiate that has been prescribed for more than 60 years. This was part of the deception started by Perdue. Illegal Fentanyl is being used in pills, and sold as any random brand name they think will sell, people are dying. Kolodny was a safe choice for Perdue, since he was peddling a lot of misinformation, which took atttention awsy from the marketing tactics of Perdue. Their tactic of going after physicians and pain patients was also part of the distraction. They knew that as the population of older retired overworked Americans, would need future pain management. They targeted Veterans, older Americans, the disabled, and sick people, and portrayed them all as addicts. They deliberaely confalted addiction and dependance for a reason, they had to malign sick people, and the ones the healthcare system could not cure. There was also a significant number of people who had undergone surgery, and were left with intractable chronic pain. Portraying all of these groups as mindless drug addicts, was designeod to protect our broken healthcare system.
    The Fact that industry rgualtions and profit generating proceedures, such as filling a prescription for 30 days, becuse often patients were unable to see their physicans for months was not adressed. With insurance paying for the medications, and protecting the profit generating healthcare system, it was simpler to fill for a 30 day supply. This left unused medications in people’s homes. When Kolodny or the other propagandists made claims about prescription drugs, they meant drugs stolen from patients. There was a significant amount of theft from the supply chain too, millions of doses, that went tot he balck market. The industry chose to avoid that topic, it was bad for PR, and they interfered with DEA investigations. All of this was not covered by mass media, as the deaths increased. These big corporations are above the Law.
    Oxycontin was profitable, and when the pharma industry did away with the Laws, that controlled pharmaceutical and health advertising, none of this was illegal anymore. The so called opaite epidemic has been profiable for people like Kolodny, who could profit from treatment providors, while appearing to be stemmming the epidemic he created.
    The US is the only only developed nation that is seeing this kind of epidemic. Of course none of the underlying social and economic problems that led to this, are being examined. When they turned addiction into a reality show, and people died, no one paid attention. Publicizing the so called opaite epidemic is have the reverse effect creating more users. They lined childen up, with corporate publicists, to teach them about opiates. Children that would never be exposed to opaites, were now educated about getting high. Kids who did not know that the stuff in grandmas medicine chest was woth money or could get them high, were bringing them to school, and sharing with their friends. The propganda told them that opiates could kill, but they rarely saw proof, and kids are lied to all of the time.
    Koldny and the Perdue family and every one else that profited, turned a health crisis inot a marketing and misinformation extravaganza. They even justified peddling quackery as a benefit to public health. Previously discredited unscintific cures, were suddenly legiamate, because the were better thant the horrers of opiate addiction.
    Even the psychologists got in on the action, equating their profession with medical doctors. They rewrote the DSMV to broaden the definitions of addiction, and to descibe people with inadequate medical care, as mentally ill. They left out chronic pain for a reason, it was just more profitble. They even made up words, like “Catastrophization” and “Opiod Unduced Hyperalgia” to further stigmatize people left with chronic pain.
    The mass media presented spuedo scince as if it were factual. They ran articles to misinform, confuse and frighten the public. The Internet was full of deceptive advertising, Content Marketing, Patient Testimonials, and lies.

    The Patient Groups, were funded by pharma interests and the effect of the lies and content marketing could be measured in real time. Vulnerable patients were Gas Lighted, and sold Mindfullness, useless creams, dangerous steroid injections, and unproven implants. Quack Doctors, psychologists, and psychiatrists launched Television marketing careers and made millions. Of course the deaths could be counted in real time, but those were only reported in fear based marketing. The costs and adverse outcomes from all of this profit generating marketing, lies and misinformation is incalculable.

    The US is experincing the effect of 20years of lies and advertising, and even as the death toll rises, they are told to demonize pain patients, while the only “treatment” for people with addiction is a faith based church program. The media has been complicit, they advertised the few available treatments as if they were adequate. They lied about how the sytem responded, it failed. 20 years out, and they are looking at Perdues marketing. All of this was made possible by corrupt politicians, in bed with the industries that profited.

    This is just one element of “Market Based” healthcare, no one is looking at how they undermined the laws that were supposed to protect us. The criminal actions of the Sakler family are just the tip of the iceberg. Funny we should have a Reality Show response to all of this as the lies and deception continue!

    • Mavis,
      That’s why I never watch the mass media anymore, the “FAKE/DUMB NEWS” won’t get my limited use eyes.
      Legal Fentanyl hidden with different names are still VERY EXPENSIVE, which is why the CDC/DEA won’t pull that from the market, but kids are making their own Heroin/Fentanyl mixes to get a better high; causing many of the overdoses (not to mention all the kids smoking or snorting it)! But that’s ignored for now by the US Government because of all the money they are making off of Fentanyl.

      Today at my pain manage t doctor’s office there was a guy there (first time patient) who had been REFUSED to be seen a (14) other pain clinics/doctors before he tried mine. So I vetted him myself; he had a torn stomach/abdominal muscle that no doctor will operate on, plus he have severe knee problems and a herniated disc that was operated on 5-years ago, helped for 2-years then the pain came back twice as bad. He volunteered that all he wants is around (150) oxycodone 5mg pills so that he can make it through each day in the month. Otherwise he’s bedridden in excruciating pain. He also volunteered that he doesn’t care if my doctor lowers what he was on to (120) pills a month (until his hospital refused to see him anymore for pain). THESE ARE NOT THINGS ADDICTS SAY! Yet my doctor made him wait 2-full hours just to tell him “I can’t treat you!” and sent him home after the guy tried to explain his medical problems and my doctor just shut him down. THIS IS INSANE WHAT’S GOING ON!
      I told him to go to a big Manhattan Hospital and collapse on the street in from of the ER entrance. At least this way they have to see him in the ER, have to find our his medical history, and have to give him a referral to see Pain Management at least ONCE (the specific hospital is how I got to see the doctor I’m dealing with now, so I know it worked in early 2012).

      I’m on board with the things you say. But I have to start working on CHANGING THIS as soon as I’m physically able.
      I’ve made huge changes to things everyone told me “You’ll never get done”, or “Don’t waste your time.”. Once I put my mind to something it gets fixed.. and there is no OR or BUT! I copied your post to read slower when I can see better.

      Thanks for knowing the real truth…

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