Tagged Mental Health

Purity, Potency Of Illegal Drugs Have Reached New Levels, Worrying Health Officials

Purity, Potency Of Illegal Drugs Have Reached New Levels, Worrying Health Officials

Doctor’s Rx For A Stiff Knee: A Prescription For 90 Percocet Pills

I recently hobbled to the drugstore to pick up painkillers after minor outpatient knee surgery, only to discover that the pharmacist hadn’t yet filled the prescription. My doctor’s order of 90 generic Percocet exceeded the number my insurer would approve, he said. I left a short time later with a bottle containing a smaller number.

When I got home and opened the package to take a pill, I discovered that there were 42 inside.

Talk about using a shotgun to kill a mosquito. I was stiff and sore after the orthopedist fished out a couple of loose pieces of bone and cartilage from my left knee. But on a pain scale of 0 to 10, I was a 4, tops. I probably could have gotten by with a much less potent drug than a painkiller like Percocet, which contains a combination of the opioid oxycodone and the pain reliever acetaminophen, the active ingredient found in over-the-counter Tylenol.

When I went in for my follow-up appointment a week after surgery, I asked my orthopedist about those 90 pills.

“If you had real surgery like a knee replacement you wouldn’t think it was so many,” he said, adding that the electronic prescribing system set the default at 90. So when he types in a prescription for Percocet, that’s the quantity the system orders.

Such standard orders can be overridden, but that’s an extra step for a busy physician and takes time.

As public health officials grapple with how to slow the growing opioid epidemic — which claims 91 lives each day, according to federal statistics — the over-prescription of narcotics after even minor surgery is coming under new scrutiny.

While patients are today often given opioids to manage post-operative pain, a large supply of pills may open the door to opioid misuse, either by the patients themselves or others in the family or community who get access to the leftovers.

Post-surgical prescriptions for 45, 60 or 90 pills are “incredibly common,” said Dr. Chad Brummett, an anesthesiologist and pain physician at the University of Michigan Medical School.

Last year, the Centers for Disease Control and Prevention released a general guideline saying that clinicians who prescribe opioids to treat acute pain should use the lowest effective dose and limit the duration to no longer than seven days.

But more detailed guidance is necessary, clinicians say.

“There really aren’t clear guidelines, especially for surgery and dentistry,” Dr. Brummett said. “It’s often based on what their chief resident taught them along the way, or an event in their career that made them prescribe a certain amount.” Or, as in my case, an automated program that makes prescribing more pills simpler than prescribing fewer.

Brummett is co-director of a Michigan program that has released recommendations for post-surgical opioid prescribing for a growing list of procedures.

To determine the extent to which surgery may lead to longer-term opioid use, Brummett and his colleagues examined the insurance claims of 36,177 adults who had surgery in 2013 or 2014 for which they received an opioid prescription. None of the patients had prescriptions for opioids during the prior year.

The study, published online in JAMA Surgery in June, found that three to six months after surgery, roughly 6 percent of patients were still using opioids, having filled at least one new prescription for the drug. The figures were similar whether they had major or minor surgery. By comparison, the rate of opioid use for a control group that did not have surgery was just 0.4 percent.

Some insurers and state regulators have increasingly stepped in to limit opioid prescriptions. Insurers routinely monitor doctors’ prescribing patterns and limit the quantity of pills or the dosage of opioid prescriptions, said Dania Palanker, an assistant research professor at Georgetown University’s Center on Health Insurance Reforms who co-authored a study on insurers’ response to the opioid crisis.

At least two dozen states have passed laws or rules in just the past few years aimed at regulating the use of opioids.

In my state of New York, Gov. Andrew Cuomo last year signed legislation that reduced the initial opioid prescription limit for acute pain from 30 days to no more than a seven-day supply.

As my experience demonstrated, however, a seven-day limit (those 42 pills in my case) can still result in patients receiving many more pills than they need. (For those who find themselves in a similar situation with excess pills, here is the safe and proper way to dispose of them.)

Still, some caregivers and patients worry that all this focus on overprescribing may scare physicians away from prescribing opioids at all, even when they’re appropriate.

“That’s my concern, that people are so afraid of things and taking it to such an extreme that patient care suffers,” said Dr. Edward Michna, an anesthesiologist and pain management physician at Brigham and Women’s Hospital in Boston who is on the board of the American Pain Society, a research and education group for pain management professionals. Michna has been a paid consultant to numerous pharmaceutical companies, some of which manufacture narcotics.

But other doctors say that one of the reasons doctors call in orders for lots of pills is their convenience.

“When you land on the front lines, you hear, ‘I like to write for 30 or 60 pills because that way they won’t call in the middle of the night’ ” for a refill, said Dr. Martin Makary, a professor of surgery and health policy at Johns Hopkins School of Medicine.

Makary is spearheading a consortium of Hopkins clinicians and patients that provides specific guidelines for post-surgical opioid use. The program, part of a larger effort to identify areas of overtreatment in health care, also identifies outlier prescribers nationwide to encourage them to change their prescribing habits.

The Hopkins group doesn’t have an opioid recommendation for my surgery. The closest procedure on their website is arthroscopic surgery to partially remove a torn piece of cartilage in the knee called the meniscus.  The post-surgical opioid recommendation following that surgery: 12 tablets.

Please visit khn.org/columnists to send comments or ideas for future topics for the Insuring Your Health column.

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Viewpoints: Dangerous Roads; Cracking Down On Stem Cell Clinics, Half-Hearted Fight Against Hep A

State Highlights: NYC Submitted False Lead-Paint Inspections Claims; Fla. Scrubs Its Website Of Information On Troubled Nursing Homes

A Snapshot Of Those In The Trenches Of America’s Addiction Crisis

Canceled Appointments And Lengthy Wait Times Still Occurring At VA Medical Centers

Putting A Dollar Value On An Epidemic: Opioid Crisis Has Cost Economy $95B In 2016 Alone

Putting A Dollar Value On An Epidemic: Opioid Crisis Has Cost Economy $95B In 2016 Alone

State Highlights: Hospitals Still Reeling From Devastation In Puerto Rico; Conn. Senate Votes To Fix Hospital Tax Flaw

The Power Of #MeToo: Why Hashtag Sparks ‘Groundswell’ Of Sharing — And Healing

As a Ph.D. candidate in the social sciences more than 20 years ago, Duana Welch, 49, had done enough research to know the consequences she’d face by reporting sexual harassment in the workplace.

“When women came forward with allegations of sexual abuse and sexual harassment, the woman was the person blamed and the woman was not believed,” she said. “I was very angry that I would pay the price for coming forward. I knew what would happen.”

Like most who’ve had similar experiences, Welch, a relationship expert in Eugene, Ore., kept quiet. She wanted to bury the inappropriate encounters initiated by men who outranked her in the workplace. Welch worried that her fledgling career would be doomed.

That was until #MeToo.

“I jumped in immediately,” she said. “I knew that this was our moment. It was the first time I became very public about abuses and inappropriate sexual conduct that I’ve experienced.”

But figuring out why Welch and the millions who have posted on social media using #MeToo isn’t as simple as chalking it up to the power of the hashtag. Rather, a complex set of psychological and sociological factors is at work. Sparked by revelations about Hollywood titan Harvey Weinstein, the mushrooming list of accused harassers and those unwilling to stay silent any longer illustrate that what’s happening with this avalanche of disclosures is more than just a show of strength in numbers.

“Admissions of being a victim are stigmatizing,” said John Pryor, a professor of psychology emeritus at Illinois State University who has studied sexual harassment for more than 30 years and is participating in a National Academy of Sciences study of sexual harassment in STEM fields — science, technology, engineering and mathematics.

“Research has shown that people with stigmatizing conditions that can be hidden often engage in what is called ‘label avoidance.’ With regard to sexual harassment, the more people who come forward and say ‘me, too,’ the less stigmatizing the label,” he said.

Gayle Pitman, a professor of psychology and women’s studies at Sacramento City College in California, said the sense she’s gotten from the #MeToo posts are “almost like a catharsis.”

“‘Finally, I can release this.’ There’s also some fear. ‘What happens now that I outed myself? What are people going to think of me and how am I going to feel now?’” she said. “There is definitely a possibility of reliving a traumatic experience or dredging up past wounds. A lot of people who have been victims of sexual violence probably have untreated PTSD [post-traumatic stress disorder] and can lie dormant for a long time until something triggers it — even a deliberate disclosure.”

The risk of triggering a traumatic experience is lessened as more women step up and validate the experience. “You think less that it’s my fault and I did something wrong and you’re blaming yourself,” said Lucia Gilbert of San Jose, Calif., a professor emerita of psychology at Santa Clara University. “It validates that you have been validated. Now there’s a validation in the culture, and that’s huge.”

Social media is at the heart of this change, experts agree.

“It connects one person’s story to a much broader story and simultaneously creates heft to your story. It’s not just me. My voice is a part of this giant groundswell,” said Amanda Lenhart, of the nonpartisan think tank New America, who has studied the internet and American life at the research institute Data & Society as well as at the Pew Research Center.

Although viewed as a critic of social media, psychology professor Jean Twenge of San Diego State University — whose book “iGen: Why Today’s Super-Connected Kids Are Growing Up Less Rebellious, More Tolerant, Less Happy — and Completely Unprepared for Adulthood — and What That Means for the Rest of Us” explores the detrimental effects of smartphones on youth — said the #MeToo trend illustrates the positives of social media.

“It allows people to band together and share their stories at lightning speed,” she said. “The workplace certainly ups the stakes for the person experiencing the sexual harassment, and it also ups the level of anger because you’re talking about someone’s livelihood. You’re talking about a career or feeding their kids. Part of the conversation is not just the Hollywood starlet but the cashier at the grocery store.”

Women may believe now is a safer time to disclose what they wouldn’t have before, said Gilbert.

“Women are speaking up, and the political environment feels different,” she said. The worldwide women’s march on Jan. 21 “was huge. Women may better understand the importance of fighting for their rights.”

She suggests that change is possible when power shifts to more women at the top in certain traditionally male-dominated industries, such as the entertainment and media arenas, politics, the sciences and tech.

“It’s much harder to change the pattern of behavior and the sense of entitlement when you don’t change the power differential,” Gilbert said.

In his 1995 study of more than 2,600 employees at a government agency with more than 8,000 employees in 37 offices nationwide, Pryor found that office norms and the workplace culture are underlying factors — which hasn’t really changed in the decades since.

“If you look at women in those offices, office by office, women were more likely to say they were sexually harassed in the offices where the men said it was tolerated,” Pryor said.

Family law attorney Cindi Graham, 53, of Amarillo, Texas, knows all about how such behavior can be tolerated.

“There’s a lawyer who says inappropriate statements, and everybody just laughs and says that’s who he is,” she said. “It’s offensive. He’ll blatantly stare at women’s breasts. He won’t go so far as grope, but he’ll leer.”

Welch said the inappropriate behavior and harassment she experienced ranged from having a supervisor expose himself to her in his office (which caused her to quickly transfer and take a pay cut) to being harassed over a two-year period by a man whose office was located in her path.

“He had a lot of power, including power over my career,” she said. “I found another way to get into the building and he came to my office and said, ‘It’s starting to feel like you’re avoiding me.’”

“In my early 20s, my story would have been an isolated event brushed away and me blamed for it,” Welch said. “I wanted to add to what I see is a really important cause. Now most people are believing us.”

KHN’s coverage of women’s health care issues is supported in part by The David and Lucile Packard Foundation.

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State Highlights: In Ill., Feds Investigate Cook Co. Health System Security Lapse; Survey Grades Patient Safety At San Francisco Hospitals

State Highlights: In Ill., Feds Investigate Cook Co. Health System Security Lapse; Survey Grades Patient Safety At San Francisco Hospitals

Media outlets report on news from Illinois, California, Massachusetts, Arkansas, Texas and Ohio.

San Francisco Chronicle: How Safe Is Your Hospital? Survey Grades SF-Area Medical Centers
About 1,000 patients die in the United States each day because of preventable hospital errors, according to the Leapfrog Group, a national nonprofit organization that compiles an annual survey on hospital performance. The Leapfrog Hospital Safety Grade assigns letter grades to hospitals based on their record of patient safety. … We wanted to see how local hospitals compare on safety issues, so we chose those in a 25-mile radius of downtown San Francisco. Of 26 hospitals, seven received A’s, seven earned B’s, another seven got C’s and five were marked D’s. (Moffitt, 11/14)

Boston Globe: Beth Israel Deaconess To Build 10-Story Patient Building
Beth Israel Deaconess Medical Center plans to construct a new 10-story patient care building, its largest such project in more than 20 years. The building in Boston’s Longwood Medical Area would house private patient rooms, operating rooms, and imaging facilities, and it would include a rooftop landing pad for medical helicopters, according to a letter hospital officials filed with the Boston Planning & Development Agency. The building would have 345,000 square feet of space and would be located on the western end of the hospital campus. (Dayal McCluskey, 11/14)

The Associated Press: Appeals Court Won’t Reconsider Planned Parenthood Defunding
A federal appeals court said Monday it won’t reconsider a ruling that Arkansas can block Medicaid funding to Planned Parenthood, setting up a potential showdown over defunding efforts by conservative states over videos secretly recorded by an anti-abortion group. The 8th U.S. Circuit Court of Appeals denied a request by three Planned Parenthood Great Plains patients to reconsider a three-judge panel’s decision upholding the state’s defunding decision. (11/13)

Boston Globe: Catholics Split Over Petition Drives At Churches
A controversy is brewing at local churches between Catholics whose faith guides their politics and those who favor a wall between church and state, after the archbishop of Boston said late last month that political signature drives are permissible on church property. Mary Collins, who has attended Marlborough’s Immaculate Conception Parish for 15 years, said she was “startled” when it was announced last Sunday that some parishioners would gather signatures in the church lobby after Mass for a measure that would prohibit funding abortions with state dollars. (Fox, Capelouto and Guerra, 11/13)

Texas Tribune: Health Clinic Provides Free Abortions To 85 Women Affected By Hurricane Harvey
Whole Woman’s Health provided free abortions to 85 women affected by Hurricane Harvey, the clinic said Monday. The procedures, which took place at the clinic’s Austin and San Antonio locations, were offered for free to Harvey victims during September. A dozen other women received free consultations through the clinic but did not have abortions performed. (Platoff, 11/13)

NPR: AARP Foundation Sues Nursing Home To Stop Illegal Evictions
A California judge could decide Tuesday if Gloria Single will be reunited with her husband, Bill. She’s 83 years old. He’s 93. The two have been married for 30 years. They lived in the same nursing home until last March, when Gloria Single was evicted without warning. Her situation isn’t unique. Nationwide, eviction is the leading complaint about nursing homes. In California last year, more than 1,500 nursing home residents complained that they were discharged involuntarily. That’s an increase of 73 percent since 2011. (Jaffe, 11/13)

The Associated Press: CA Doctor’s License Suspended After 2 Patient Deaths
The board’s ruling says one of the patients experienced respiratory arrest after waking up from breast augmentation surgery in 2013 and died after being taken to a hospital. It says another patient’s 2013 death was “likely due to ‘trauma’ caused by the surgical procedure.” Yoho’s attorney, Albert Garcia, said that the women died from fat embolisms but he decided to settle with the medical board. (11/13)

The Associated Press: Man: Psychiatric Hospital Staff Tormented, Kicked Brother
A man who says his brother was abused repeatedly by staff at Connecticut’s only maximum-security psychiatric hospital urged lawmakers on Monday to look more deeply into the case and make changes at the state-run facility. Al Shehadi said he came forward to give a name to the victim at the center of internal and criminal investigations, to tell his brother’s story and to “encourage this committee to continue to investigate what happened.” (11/13)

Fresno Bee: They Went To A Plastic Surgeon To Improve Their Looks, But Wound Up Dead
The state medical board has ordered a 30-day suspension for a Visalia plastic surgeon accused of gross negligence and incompetence in the treatment of four patients, including two women who died in 2013. Dr. Robert Alan Yoho, who has had offices in Pasadena and Visalia, cannot practice medicine from Nov. 19 through Dec. 16 under the disciplinary order by the Medical Board of California. The suspension was part of a five-year probation the board imposed. (Anderson, 11/13)

Cincinnati Enquirer: Cincinnati-Based Chemed Pays $75M To Settle Medicare Lawsuit
Chemed has paid the U.S. government a record $75 million to settle lawsuits claiming the hospice care provider submitted false claims to Medicare. The settlement resolves allegations that between 2002 and 2013 Chemed subsidiary Vitas knowingly submitted or caused to be submitted false claims to Medicare for services to hospice patients who were not terminally ill. (Coolidge, 11/13)

KQED: A Food Community Unites To Pay Local Farmers And Feed Fire Evacuees Nourishing, Home-Cooked Meals
On the first Friday after the North Bay fires swept through Sonoma County, displacing an estimated 100,000 people, Tim Page drove from San Francisco to the Salvation Army in Sonoma County with 2,000 fresh, chef-made breakfasts, courtesy of SF Fights Fire, stacked in the back of his company van. The trip was the first of many made over the next two weeks by Page and his employees at F.E.E.D. Sonoma, a micro-regional produce aggregation and distribution food hub in Sebastopol that functions as a conduit between dozens of small, organic farms and chefs and restaurants across the Bay Area. (Clark, 11/13)

KQED: Benicia Still Looking for Answers from Valero Six Months After Refinery Outage
When a massive refinery outage sent flames, black smoke and toxic gas shooting into the sky from Valero’s Benicia plant last spring, the city’s mayor said the local government had little information about what was going on. Days later Mayor Elizabeth Patterson called for the city to develop regulations that would give Benicia more oversight over the oil giant it hosts. She proposed regulations similar to those in Contra Costa County, home to several refineries, that require oil refining facilities to undergo safety audits and share their risk management plans. … But six months after one the Bay Area’s worst refinery malfunctions in the last five years, the refinery oversight measure has not moved through the City Council. (Goldberg, 11/14)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

In Fighting Opioid Crisis, States Are Often Isolated In Their Efforts. A Nationwide App Could Change That.

The app lets law enforcement officials track overdoses in real time, a rarity in the data-starved landscape of the opioid epidemic. Media outlets report on the crisis out of New York and Massachusetts as well.

Stateline: New App Maps Overdose Epidemic In Real Time
In an opioid overdose epidemic that killed more than 53,000 Americans last year and shows no signs of relenting, nearly every community in the nation is fortifying its public health, emergency medical and law enforcement response. But with limited resources, it’s essential to target efforts where they are needed most, said Washington/Baltimore HIDTA deputy director Jeff Beeson. (Vestal, 11/14)

The New York Times: At The New York Division Of Fentanyl Inc., A Banner Year
The middle-aged couple in the station wagon went shopping at a New Jersey Walmart on a warm night in August. They stopped for dinner at an IHOP on the way home. And when they arrived at their apartment building in a quiet residential section of Queens, the narcotics agents following them got a warrant to go inside. They found several suitcases loaded with brick-shaped bundles of what appeared to be heroin. But lab tests determined that most of it — 141 pounds — was pure fentanyl, a synthetic and supremely dangerous opioid 50 times more powerful than heroin. (Miroff, 11/13)

WBUR: Mass. Opioid Overdose Deaths Are Down 10 Percent So Far This Year
There’s some relief in the latest snapshot of opioid overdose deaths in Massachusetts, as an estimated 167 fewer residents died in the first nine months of 2017, as compared with the same period last year. The estimated 10 percent drop in deaths is included in a third quarter report from the Baker administration, which is tracking and presenting near-real-time data on the state’s opioid epidemic. (Bebinger, 11/13)

WBUR: Amid Opioid Crisis, Boston Elementary School Parents Worry About Discarded Needles
Caroline Toth Bernstein has a pretty convenient commute to her 6-year-old son Oscar’s school every morning. They walk a couple of blocks to Orchard Gardens K-8 Pilot School on Albany Street in Boston. But in that short journey, she has been spotting something that disturbs her: an orange cap lying in the grass. “I’ve trained myself to look for the orange caps for the [hypodermic] needles, because if there’s a cap, there’s probably a needle nearby,” Toth Bernstein explained. … Orchard Gardens near Boston Medical Center is in the heart of what some call “Ground Zero” for the opioid epidemic in the city. (Becker and Amer, 11/14)

WBUR: An ‘Underground World’: This Urban Tent Community Is Dangerous For Heroin Users
Kristin, an active drug user, is homeless. That makes her up to 30 times more likely to die after an heroin of fentanyl overdose, according to data analyzed by the Massachusetts Department of Public Health. Kristin has beaten the odds so far, but a tour of the small urban tent community in Greater Boston where she stores things and often stays illustrates the risks. … “Isn’t it baffling that there is this grimy, filthy, intriguing underground world amongst such a beautiful place,” Kristin says. “It really blows my mind.” (Bebinger, 11/14)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

In Fighting Opioid Crisis, States Are Often Isolated In Their Efforts. A Nationwide App Could Change That.

The app lets law enforcement officials track overdoses in real time, a rarity in the data-starved landscape of the opioid epidemic. Media outlets report on the crisis out of New York and Massachusetts as well.

Stateline: New App Maps Overdose Epidemic In Real Time
In an opioid overdose epidemic that killed more than 53,000 Americans last year and shows no signs of relenting, nearly every community in the nation is fortifying its public health, emergency medical and law enforcement response. But with limited resources, it’s essential to target efforts where they are needed most, said Washington/Baltimore HIDTA deputy director Jeff Beeson. (Vestal, 11/14)

The New York Times: At The New York Division Of Fentanyl Inc., A Banner Year
The middle-aged couple in the station wagon went shopping at a New Jersey Walmart on a warm night in August. They stopped for dinner at an IHOP on the way home. And when they arrived at their apartment building in a quiet residential section of Queens, the narcotics agents following them got a warrant to go inside. They found several suitcases loaded with brick-shaped bundles of what appeared to be heroin. But lab tests determined that most of it — 141 pounds — was pure fentanyl, a synthetic and supremely dangerous opioid 50 times more powerful than heroin. (Miroff, 11/13)

WBUR: Mass. Opioid Overdose Deaths Are Down 10 Percent So Far This Year
There’s some relief in the latest snapshot of opioid overdose deaths in Massachusetts, as an estimated 167 fewer residents died in the first nine months of 2017, as compared with the same period last year. The estimated 10 percent drop in deaths is included in a third quarter report from the Baker administration, which is tracking and presenting near-real-time data on the state’s opioid epidemic. (Bebinger, 11/13)

WBUR: Amid Opioid Crisis, Boston Elementary School Parents Worry About Discarded Needles
Caroline Toth Bernstein has a pretty convenient commute to her 6-year-old son Oscar’s school every morning. They walk a couple of blocks to Orchard Gardens K-8 Pilot School on Albany Street in Boston. But in that short journey, she has been spotting something that disturbs her: an orange cap lying in the grass. “I’ve trained myself to look for the orange caps for the [hypodermic] needles, because if there’s a cap, there’s probably a needle nearby,” Toth Bernstein explained. … Orchard Gardens near Boston Medical Center is in the heart of what some call “Ground Zero” for the opioid epidemic in the city. (Becker and Amer, 11/14)

WBUR: An ‘Underground World’: This Urban Tent Community Is Dangerous For Heroin Users
Kristin, an active drug user, is homeless. That makes her up to 30 times more likely to die after an heroin of fentanyl overdose, according to data analyzed by the Massachusetts Department of Public Health. Kristin has beaten the odds so far, but a tour of the small urban tent community in Greater Boston where she stores things and often stays illustrates the risks. … “Isn’t it baffling that there is this grimy, filthy, intriguing underground world amongst such a beautiful place,” Kristin says. “It really blows my mind.” (Bebinger, 11/14)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Taking A Page From Pharma’s Playbook To Fight The Opioid Crisis

https://californiahealthline.files.wordpress.com/2017/11/unsellingopioidsbartolone.mp3

Dr. Mary Meengs remembers the days, a couple of decades ago, when pharmaceutical salespeople would drop into her family practice in Chicago, eager to catch a moment between patients so they could pitch her a new drug.

Now living in Humboldt County, Calif., Meengs is taking a page from the pharmaceutical industry’s playbook with an opposite goal in mind: to reduce the use of prescription painkillers.

Meengs, medical director at the Humboldt Independent Practice Association, is one of 10 California doctors and pharmacists funded by Obama-era federal grants to persuade medical colleagues in Northern California to help curb opioid addiction by altering their prescribing habits.

She committed this past summer to a two-year project consisting of occasional visits to medical providers in California’s most rural areas, where opioid deaths and prescribing rates are high.

“I view it as peer education,” Meengs said. “They don’t have to attend a lecture half an hour away. I’m doing it at [their] convenience.”

This one-on-one, personalized medical education is called “academic detailing” — lifted from the term “pharmaceutical detailing” used by industry salespeople.

Detailing is “like fighting fire with fire,” said Dr. Jerry Avorn, a Harvard Medical School professor who helped develop the concept 38 years ago. “There is some poetic justice in the fact that these programs are using the same kind of marketing approach to disseminate helpful evidence-based information as some [drug] companies were using … to disseminate less helpful and occasionally distorted information.”

Recent lawsuits have alleged that drug companies pushed painkillers too aggressively, laying the groundwork for widespread opioid addiction.

Avorn noted that detailing has also been used to persuade doctors to cut back on unnecessary antibiotics and to discourage the use of expensive Alzheimer’s disease medications that have side effects.

Kaiser Permanente, a large medical system that operates in California, as well as seven other states and Washington, D.C., has used the approach to change the opioid-prescribing methods of its doctors since at least 2013. (Kaiser Health News is not affiliated with Kaiser Permanente.)

In California, detailing is just one of the ways in which state health officials are attempting to curtail opioid addiction. The state is also expanding access to medication-assisted addiction treatment under a different, $90 million grant through the federal 21st Century Cures Act.

The total budget for the detailing project in California is less than $2 million. The state’s Department of Public Health oversees it, but the money comes from the federal Centers for Disease Control and Prevention through a program called “Prevention for States,” which provides funding for 29 states to help combat prescription drug overdoses.

The California doctors and pharmacists who conduct the detailing conversations are focusing on their peers in the three counties hardest hit by opioid addiction: Lake, Shasta and Humboldt.

They arrive armed with binders full of facts and figures from the CDC to help inform their fellow providers about easing patients off prescription painkillers, treating addiction with medication and writing more prescriptions for naloxone, a drug that reverses the toxic effects of an overdose.

“Academic detailing is a sales pitch, an evidence-based … sales pitch,” said Dr. Phillip Coffin, director of substance-use research at San Francisco’s Department of Public Health — the agency hired by the state to train the detailers.

In an earlier effort, Coffin said, his department conducted detailing sessions with 40 San Francisco doctors, who have since increased their prescriptions of naloxone elevenfold.

“One-on-one time with the providers, even if it was just three or four minutes, was hugely beneficial,” Coffin said. He noted that the discussions usually focused on specific patients, which is “way more helpful” than talking generally about prescription practices.

Meengs and her fellow detailers hope to make a dent in the magnitude of addiction in sparsely populated Humboldt County, where the opioid death rate was the second-highest in California last year — almost five times the statewide average. Thirty-three people died of opioid overdoses in Humboldt last year.

One recent afternoon, Meengs paid a visit during the lunch hour to Fortuna Family Medical Group in Fortuna, a town of about 12,000 people in Humboldt County.

“Anybody here ever known somebody, a patient, who passed away from an overdose?” Meengs asked the group — a physician, two nurses and a physician assistant — who gathered around her in the waiting room, which they had temporarily closed to patients.

“I think we all do,” replied the physician, Dr. Ruben Brinckhaus.

Brinckhaus said about half the patients at the practice have a prescription for an opioid, anti-anxiety drug or other controlled substance. Some of them had been introduced to the drugs years ago by other prescribers.

Dr. Ruben Brinckhaus says his small family practice in Fortuna, Calif., has been trying to wean patients off opiates. (Pauline Bartolone/California Healthline)

Meengs’ main goal was to discuss ways in which the Fortuna group could wean its patients off opioids. But she was not there to scold or lecture them. She asked the providers what their challenges were, so she could help them overcome them.

Meengs will keep making office calls until August 2019 in the hope that changes in the prescribing behavior of doctors will eventually help tame the addiction crisis.

“It’s a big ship to turn around,” said Meengs. “It takes time.”

This story was produced by Kaiser Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

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Profit-Mining The Opioid Crisis: Treatment Facilities Target Union Workers For Their Generous Benefits

A Stat and Boston Globe investigation found that these workers are bused into these facilities and can be cut off from their family and friends. “I felt like a prisoner,” said Michael Barone, a special education aide in a New Jersey public school. In other news: scientists try to find ways to combat chronic pain without opioids; experts are trying to figure out how people with chronic pain can be treated with opioids but avoid addiction; and more.

Stat: Targeted By An Addiction Treatment Center, Union Workers Feel Trapped As Their Benefits Are Drained
STAT and The Boston Globe interviewed 10 people treated at the institute over the last five years — teachers, mostly from New Jersey, as well as school custodians and social workers or their relatives. Most said they were allowed only limited contact with family. They complained about inadequate and cookie-cutter treatment, consisting mostly of group counseling and 12-step meetings, massages at a local chiropractor’s office, and plenty of free time. Several said the staff warned that their jobs would be at risk when they tried to leave before the treatment center deemed it appropriate. Although the patients were there voluntarily, many needed letters indicating they were fit to return to work. (Armstrong and Allen, 11/10)

NPR: Brain Scientists Look Beyond Opioids To Conquer Pain
The goal is simple: a drug that can relieve chronic pain without causing addiction. But achieving that goal has proved difficult, says Edward Bilsky, a pharmacologist who serves as the provost and chief academic officer at Pacific Northwest University of Health Sciences in Yakima, Wash. “We know a lot more about pain and addiction than we used to,” says Bilsky, “But it’s been hard to get a practical drug.” (Hamilton, 11/13)

NPR: Is There A Way To Keep Using Opiod Painkillers And Reduce Risk?
Jon McHann, 56, got started on prescription opioids the way a lot of adults in the U.S. did: he was in pain following an accident. In his case, it was a fall. “I hit my tailbone just right, and created a severe bulging disc” that required surgery, McHann says. McHann, who lives in Smithville, Tenn., expected to make a full recovery and go back to work as a heavy haul truck driver. But 10 years after his accident, he’s still at home. (Aubrey, 11/13)

The Associated Press: NY State Lawmakers To Discuss Heroin, Opioid Epidemic
The New York state Senate is planning another meeting to hear from local law enforcement, mental health experts and the loved ones of those lost to heroin and opioids. Tuesday’s meeting in Newburgh in the Hudson Valley will be hosted by Republican Sens. George Amedore, Fred Akshar and William Larkin. 11/11)

CQ Magazine: Almost By Default, FDA Takes The Lead Role In Opioid Crisis
During his confirmation hearings to lead the Food and Drug Administration, Scott Gottlieb promised to make the opioid crisis his top priority, calling it “a public health emergency on the order of Ebola and Zika.” His comparison of the opioid crisis to those attention-grabbing international outbreaks was a reflection of its growing magnitude. Abuse of prescription painkillers, heroin and other opioids in the United States caused 33,000 deaths in 2015, a number likely to exceed 53,000 when 2016 data is finalized. It was also a course correction for Gottlieb. When he was an FDA official in 2005, he warned against FDA actions that could limit patients from getting pain pills, calling chronic pain an “undertreated medical problem.” (Siddons, 11/13)

Miami Herald: Rushing An Overdosing Woman To The Hospital, This Paramedic Overdosed, Too, Police Say
Across the country, rates of opioid addiction and abuse have been skyrocketing in recent years — killing more than 30,000 Americans each year, according to Centers for Disease Control and Prevention data analyzed by Blue Cross Blue Shield, one of the largest health insurers in the country. Blue Cross Blue Shield reports that, among those it insures, diagnoses of opioid use disorder have spiked nearly 500 percent in just the last seven years. (Gilmour, 11/10)

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State Highlights: Mass. Senate OKs Bill To Curb Health Care Costs; San Diego Hospitals Move Into Medical Tourism Market

Media outlets report on news from Massachusetts, California, Oregon, Illinois, Ohio, Connecticut, Georgia, Tennessee, Pennsylvania, Texas and Louisiana.

Boston Globe: Mass. Senate Approves Sweeping Health Care Bill
Massachusetts senators approved a sweeping bill at midnight Thursday that seeks to control the rising costs of medical care and prescription drugs, including a controversial plan that would fine hospitals if spending rises too fast. The legislation also would require pharmaceutical companies to submit to more scrutiny from state officials. (Dayal McCluskey, 11/9)

Los Angeles Times: San Diego’s Big Hospitals Plan A Push Into Medical Tourism
Planning a visit to San Diego? Hit the beaches. Check. Spend a day at the zoo or a theme park. Check. Sample craft beer. Check. Book a stay at a local hospital for cutting-edge cardiac or cancer treatment? For decades, San Diego has traded on its reputation for year-round sun, a captivating coastline and family-friendly attractions to woo tourists. But enticing visitors with the promise of lifesaving treatments by acclaimed physicians and hospitals has never been offered up as a selling point. Until now. (Weisberg, 11/9)

Stat: Explore: How Many Young Doctors Does Your State Retain After Residency?
Desperate to persuade young doctors to settle in rural areas — or just keep them from leaving the state — medical schools, hospitals, and state legislators are getting creative. They’re forgiving tens of thousands of dollars in loans, setting up mentorships, and recruiting med school grads with local ties in an effort to hold on to providers. …But on this crucial metric, some states are faring far worse than others. California, with an abundance of space and jobs for doctors, retains 70 percent of residents and fellows trained in-state — compared to just 28 percent in tiny New Hampshire, where full-time physician jobs are few and leaving the state may only mean moving a short distance. (Robbins and Bronshtein, 11/9)

Oregonian: Website Helps Patients Battling With Health Plans
A website launched this week in Oregon to help consumers in disputes with health plans. The site, MyPatientRights.org, is directed at consumers who are denied coverage, experience delays or are unhappy with decisions by their health insurer. It lists patient rights, such as to see their personal health records and to keep those private. It lists some of the issues patients might face, such as co-insurance costs, high deductibles and adverse tiering, which involves a company putting all medications for a specific condition into the highest cost bracket. (Terry, 11/9)

San Francisco Chronicle: California Seeks Injunction To Halt Trump Rollback Of Birth Control Mandate
California Attorney General Xavier Becerra on Thursday filed a legal motion asking a judge to halt the implementation of federal rule changes, announced by the Trump administration last month, that give employers more leeway to opt out of the Affordable Care Act’s contraceptive mandate. Becerra, along with the attorneys general of Delaware, Maryland, New York and Virginia, filed a request for a preliminary injunction in U.S. District Court for the Northern District of California in San Francisco. (Ho, 11/9)

The Wall Street Journal: Outcome Health’s Investors Receive Subpoenas From Justice Department
Investors in Outcome Health on Thursday said in a court filing that they were receiving subpoenas from the Justice Department as part of a fraud investigation into the prominent Chicago advertising startup. The filing, submitted to the New York State Supreme Court in New York County, said Goldman Sachs Group Inc. and other investors, which are suing Outcome for allegedly defrauding them, were receiving the subpoenas on Thursday. The investors also said “additional inquiries” were expected from the Securities and Exchange Commission, without elaborating. (Winkler, 11/9)

Chicago Tribune: Outcome Health Investors Receive DOJ Subpoenas As Chicago-Area Hospitals Back Away
The Justice Department is subpoenaing investors in Chicago-based Outcome Health in the wake of a lawsuit accusing the prominent health information and advertising startup of committing fraud to secure nearly $500 million in funding. The orders from federal investigators, revealed in court documents filed by investors Thursday, come as hospitals and health care advertisers back away from the fast-growing company, which places interactive screens and tablets in doctors’ offices. The court filing indicates investors also anticipate inquiries from the Securities and Exchange Commission. (Schencker and Marotti, 11/9)

The Associated Press: Feds Backing Out Of Lawsuit Against Nursing Chain
The federal government is moving to dismiss a lawsuit it brought two years ago against a national nursing-care provider after a judge tossed out the government’s key witness over issues of credibility. The Justice Department joined in on a whistleblower lawsuit against Toledo, Ohio-based HCR ManorCare, which operates more than 250 skilled nursing facilities nationwide. Authorities say the chain fraudulently overbilled Medicare for millions of dollars. (Barakat, 11/9)

Modern Healthcare: HCA Partners With Meharry Medical College To Train Students
HCA will train Meharry Medical College students at HCA’s TriStar Southern Hills Medical Center, the organizations announced Thursday. HCA, the nation’s largest hospital system with 177 hospitals, signed a memorandum of agreement that expands upon the relationship between the two Nashville institutions. It will give HCA access to medical students and allow it to leverage Meharry’s global reputation for educating future primary-care doctors. (Kacik, 11/9)

The Tennessean: Meharry To Train Students At HCA Hospital Under ‘Historic’ Agreement
A “historic” agreement between Meharry Medical College and HCA Healthcare will transform how the college trains its students and push its reach further into Davidson County. Under the agreement, Meharry students in their their third and fourth years will train at TriStar Southern Hills Medical Center, a hospital in HCA’s TriStar Health subsidiary. (Fletcher, 11/9)

The Tennessean: Nashville General To End Inpatient Care, Mayor Megan Barry Announces
Mayor Megan Barry on Thursday announced plans to end inpatient care at Nashville General Hospital, the city’s only safety net hospital. Barry said her administration would submit to the Metro Council a “substantial request” for funds to stabilize the facility until the end of the fiscal year. Thereafter, Barry said, she would focus her efforts on transforming the facility into an ambulatory surgical care center, which would provide only outpatient services. (Wadhwani, 11/9)

The Philadelphia Inquirer: Government Bails On Fraud Case Against ManorCare
The U.S. Department of Justice has scored hundreds of millions in settlements from nursing homes for allegations of fraudulent billing for therapy, but those efforts faltered Thursday in a whistle-blower case against HCR ManorCare Inc., one of the largest companies in the industry. Government lawyers, after being ordered this week to pay ManorCare’s attorneys the cost of a single filing in a dustup over a government witness, notified U.S. District Court for the Eastern District of Virginia that they were in agreement with ManorCare to dismiss the case. (Brubaker, 11/9)

The Philadelphia Inquirer: Genesis HealthCare CEO Calls Restructuring ‘A Huge Step’
Genesis HealthCare chief executive George V. Hager Jr. told investors Thursday that the nursing home company’s latest financial restructuring “a huge, huge step for us bridging to the recovery and moving to the next cycle of this industry.” Under the deal announced Wednesday, Genesis’s largest landlords Welltower Inc. and Sabra Health Care REIT Inc., will sell certain properties leased to Genesis. Genesis is then expected lease them from the new owners at lower rents. That rent reduction is expected to be $54 million annually starting in January. (Brubaker, 11/9)

Houston Chronicle: Harvey-Damaged East Houston Regional Medical Center Will Close
East Houston Regional Medical Center, swamped by 6 feet of water during Hurricane Harvey in August, is closing for good in what is being called the biggest medical casualty of the storm. The 131-bed hospital, an institution in the region after 40-plus years in operation, was recently determined to not be salvageable after the storm roared ashore and devastated the area with historic flooding. (Deam and Ackerman, 11/10)

New Orleans Times-Picayune: New Orleans Woman Found Guilty In $3.2 Million Medicare Kickback Scheme
A New Orleans woman was found guilty Thursday (Nov. 9) of participating in a roughly $3.2 million Medicare fraud and kickback scheme that involved fraudulent billing for power wheelchairs and other medical equipment, according to federal officials. A federal jury convicted Sandra Parkman, who is in her 60s, of one count of conspiracy to commit healthcare fraud, one count of conspiracy to pay and receive kickbacks, two counts of healthcare fraud and five counts of accepting kickbacks. (McKnight, 11/9)

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