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Response to NYT bogus editorial regarding pain medications and Medicare

2011 October 5

cheap viagra overnight t size-full wp-image-35939″ />By Sandy L. Sullivan,WWH – Living in chronic pain is frustrating enough without having bogus articles written by the NYT claiming patients are committing fraud and prescription drug abuse all funded with Medicare. Anyone that is a CPP patient knows how hard it is to get treated with respect by a doctor.

It can be hard enough to even get treatment but whether you have Medicare Part D or private insurance one thing we all know – regardless of the type of medication, you can never get a prescription filled early, let alone 5 different doctors in the same month writing the max dosage for the same medication and your insurance company filling it. In fact, you would get arrested at the pharmacy by doctor #2! That was before Florida had it’s new database – which helps weed out “doctor shoppers” – who pay CASH to commit fraud to obtain multiple prescriptions pain medications in a single month. Unlike the editorial which claimed it was all paid for by Medicare part D!

Link to article: http://www.nytimes.com/2011/10/04/health/policy/04medicare.html?_r=2&partner=EXCITE&ei=5043

There wasn’t a way to comment on the article it’s self but I took the time to write the writer at the above link, below is my letter – edited only slightly.

Hi! Your report on “Medicare Prescription Drug Abuse” just doesn’t
make sense. It simply would not be possible to use Medicare or any
insurance in that way to obtain scheduled medication.

The only way one could do what you claim in your article is with
“cash only” transactions – not through any insurance and especially
not Medicare. If one is prescribed by a doctor a 28 day supply of
oxycodone and attempted to fill more – regardless of pharmacy it
would come back as “refill too soon” on the computer. Then, you
would get arrested!!

Even before the Fl “database” went into effect on Sept 1st 2011; if
I had attempted to see 2 docs in the same month with insurance AND
tried to get narcotics filled I would have been flagged.

The primary problem that had been going on was in South Florida’s
clinics. Owned by 2 ne’er do well brothers of a wealthy real-estate
father, they opened 10-15 clinics (FYI I’m in NE FL but this has
been in the news all year). They owned the clinics, without having
so much as a degree, hired doctors and paid them quite well to over
prescribe. Often getting legit patients hooked so they would return
by prescribing the MAX dosage.

Those clinics and any like them ran on “cash only” the local
pharmacies turned them away but eventually they would find
somewhere to fill it. It would simply be impossible to do on
insurance. Call your local pharmacy and ask!

The database here in Florida now sorts that issue out as even if
using cash – your name, DOB, picture ID etc is entered in and
connects with other databases through out the state and the many
other states that use such programs. Any attempt at getting another
scheduled drug filled would flag the system and you would be
arrested.

Those South Florida clinics are now closed.

The bad news is real pain patients, who go by the book – using
their insurance, good doctors etc are getting shafted.

Once sided articles are terribly damaging to those of us that suffer
under chronic pain. The problem of chronic pain in the US is huge;
misunderstood, often under treated due to fear and ignorance of the
situation.

Many do no know what chronic pain means and the names behind the
faces that suffer in silence – lest they be judged.

We pay the price physically and emotionally for lack of proper media
focus on our plight. Would love to see a write up that addressed
“our” side.

Be sure to check out: http://www.painfoundation.org/

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3 Responses leave one →
  1. Ken McIntyre MD permalink
    February 11, 2012

    I am sincerely sorry to hear that you are suffering from chronic pain. And I wish you well.

    We physicians have no “pain-o-meter”. If a Medicare patient relays that that are unable to perform activities of daily living such as walking the dog, carrying groceries, doing laundry etc, due to rampant arthritis, and they have a medical reason NSAIDS or other meds can’t be prescribed, then opioids move closer to the top of list of drugs to prescribe.

    It may be the only thing that limits their living hell. Of course tolerance and dangers are associated with opioids, and therefore great care and excellent communication needs to occur between the doctor and the patient, and strict medication contract rules need to be explicitly adhered to avoid termination. It can be a very burdensome and time consuming endeavor that most of us would rather avoid entirely. Periodic pill counts , Urine drug screens etc etc.

    There are legitimate patients that do divert their meds because they can’t afford to heat their home, or just to make extra money some are elderly, or disabled medicare patients who have gone on to be arrested.

    Is there abuse of medicare dollars and other insurance dollars in this way of course. It is not all or nothing. And slamming the doctors is not the answer.

    I agree that there is a problem with legitimate patients getting what they need when they need it, and a lot of suffering is going on, in my opinion due to the high anxiety in physicians created by the public lynchings of innocent doctors by Medical Boards, FBI, DEA, State and Local Police and the occasional trigger happy, politically motivated DA’s. Do they get some bad guys of the street, sure they do, but there has been a lot of collateral damage. Who wants to spend$100,000.00 to fend of an attack it’s safer to just not prescribe!

    It is a sad state of affairs, and I see no end in sight. My sense is that more honest competent doctors are going to just say no to prescribing controlled meds.

    After 27 years I think I get it right most of the time on those occasions where the decision to prescribe an opioid or other controlled medication arises, however, I have probably denied them to a legitimate patients now and then due to a gut feeling or detail in their “story”. As I said we have no Pain-O-Meter, or for that matter a Lie-Detector plugged in next to the EKG or x-ray machine. It would be nice to have a combined unit to screen people. I may start working on that today!

    I believe, until the physicians are protected by harsher penalties for patients who fraudulently misrepresent their pain level and functional capacity during their history and physical, there will be the tendency for doctors to adopt a no opioid policy due to their uncertainty about the legitimacy of the patient’s complaints.

    A comprehensive approach to the problem with help legitimate patients get what the need and limit the misuse and diversion of controlled medication by fraudulent patients

  2. Maria Spring permalink
    October 6, 2011

    Hi Sandy if you sign in at Site, or register there then log on again, with your e- mail you can do a letter of response or get into comment thread. There is a awesome discussion there This would be useful to help educate those thinking GOV is paying people to abuse medications. This letter is very good as a article of response. You are correct, major Pharmacies should have people in the computers &synced. Most do. I’m guessing their citing the little Pharmacies on outskirts being used.

    Medicare part D covered medications especially narcotics are classed as to how abusive and misused they are with Medicare D and all Pharmacy Insurances , only allowed to be filled so often, 28 to 30 days standard. I am agreeing if a person had several Rx’s they must be paying cash or going to several Dr’s and facilities but their not using Medicare to get those extra meds.

    Also regarding Medicare D plan, in order to get medications they deem are abused more, one now had to prove a condition warranting that drug and no other drug comparable. So the drug is reviewed under a Prior Authorization , even though your Dr says,(pt has this condition) Independent hired Drs and tests are implemented or Dr has to defend with prior documentation proper test done &Specialists referrals-in that their documentation is now required a visit to a pain Specialist or Clinic. Of course this puts more money in the Govs pocket and more pain and suffering for the pt.

    The only thing I can think of is Dr’s can use CODE A and or CODE D written on controlled substances, to up quantities one says basically pt will die or be in danger of death without the large quantity available to them, the other says pt is going out of Town so a 3 month prescription can be written and some Drs actually will write the highest amount they can prescribe so the pt has the medication longer. Drs usually do this when they know for certain the patient is NOT abusing the drug.
    Thanks for this article
    Peace N love

  3. October 5, 2011

    Thanks for writing that letter! I don’t handle pain meds very well, but sometimes I have to give in and say I need something to break the grip of this unmanageable pain… I know personally, that everything you wrote is true. I wish you could have busted her publicly as a pseudo-journalist who distorts facts to fit the news THEY want the public to read!

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