Opioid Crisis! Alarm! Panic!

 

The opioid crisis has struck America. I know, because my health insurance has notified me of such. It’s Cigna’s “goal to offer access to coverage for safe, effective and affordable medications.” They want me to know that starting July 1st, they will restrict my coverage to amounts that they consider to be safe.

I was shocked, just shocked, to see that “accidental opioid overdoses reportedly kill more people than car accidents.”

Thank God Cigna is there to save me from myself!

I mean, with my Butalbital-ASA-Caffeine that I take rarely for migraines, it’s so important that they prevent me from taking it frequently. Also, without this letter, I never would have known that it was a narcotic or opiate. Butalbital is usually classed as a barbituate, but who am I to judge? This letter explains to me just how dangerous all of this is!

Thank God that they are here to save me from myself and my appropriate medical knowledge.


Coming to a mailbox near you: coverage limits on drugs that will be reclassed as “opiates” simply because the insurance does not want to cover larger amounts and does not want to be responsible for potential overdoses. I wouldn’t be so outraged if the Pharm D. who signed this inane form letter had a specific provision stating that not all medications in this were opiates, but were going to be subject to increased oversight. It particularly irks me that their Chief Pharmacy Officer is spouting information from Cleveland Clinic and is being completely indiscriminate. Less educated people would just accept that they had somehow been on opiates all this time and simply did not know. I consider this letter to be an example of bad faith and inappropriate education, bordering on fraudulent misinformation. It increases panic and increases the stigma for people who happen to use and need opiates for pain control.

Just be aware. Misinformation is not just on the news anymore.

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  1. TheRightNurse Member
    TheRightNurse
    @TheRightNurse

    Post Script: “goal to offer access to coverage for safe, effective and affordable medications”

    This is one of the lamest goals ever.  Their goal is to offer access to coverage.  What exactly does that mean, really?  Just signing up more people?  GOAL MET!  Pizza party for everyone!  They have access to coverage…they just might not ever actually get it.

     

    • #1
  2. MarciN Member
    MarciN
    @MarciN

    Yup.

    It makes me so angry.

    • #2
  3. Nanda Panjandrum Member
    Nanda Panjandrum
    @nandapanjandrum

    Eeekkkk! Glad it’s a couple of OTCs and “naturaceuticals” here, at present.  Dealing with endemic idiocy is way above my paygrade: Props, TRN!  (Prayers, too.)

    • #3
  4. Gary McVey Contributor
    Gary McVey
    @GaryMcVey

    On some level it always surprises me, a mere civilian, that when nurses go to the doctor, you have to deal with the same systems the rest of us do.

    • #4
  5. TheRightNurse Member
    TheRightNurse
    @TheRightNurse

    Nanda Panjandrum (View Comment):
    Eeekkkk! Glad it’s a couple of OTCs and “naturaceuticals” here, at present. Dealing with endemic idiocy is way above my paygrade: Props, TRN! (Prayers, too.)

    The idiocy never ends.  I’m starting to take my Public Health Nurse certification more seriously these days.  I’ve done the work, I paid for those letters, I work with chronic pain patients and I have done public education seminars and worked at geriatric outreach days.  More and more I’ve started to see that the PHN isn’t just about local politics and local awareness or educational programs, but it is becoming more important to a national political process to ensure that the consumers/patients are well aware of their care.

     

    • #5
  6. TheRightNurse Member
    TheRightNurse
    @TheRightNurse

    Gary McVey (View Comment):
    On some level it always surprises me, a mere civilian, that when nurses go to the doctor, you have to deal with the same systems the rest of us do.

    Sometimes worse, Gary.  I’ve had wonderful doctors that level with you.  I’ve also had doctors that limit you to “just a nurse”.  I am beginning to worry that my current doctor is going to be even worse: the doctor that believes that nurses overuse the medical system and are all hypochondriacs.

    • #6
  7. 9thDistrictNeighbor Member
    9thDistrictNeighbor
    @9thDistrictNeighbor

    TheRightNurse: I mean, with my Butalbital-ASA-Caffeine that I take rarely for migraines, it’s so important that they prevent me from taking it frequently.

    My mom took that for her migraines…it was the only thing that worked.

    • #7
  8. MarciN Member
    MarciN
    @MarciN

    Can doctors override these regulations somehow for their patients?

    “This patient really needs this and I’m prescribing it and you’re paying for it.”

    Is that possible? Or are doctors too living in terror of some tyrannical computer in Washington yanking their license for writing a prescription not allowed for in the computer codes?

    We will all need our own drug dealers soon.

    These laws will be really good for the drug cartels.

    • #8
  9. Nanda Panjandrum Member
    Nanda Panjandrum
    @nandapanjandrum

    TheRightNurse (View Comment):

    Gary McVey (View Comment):
    On some level it always surprises me, a mere civilian, that when nurses go to the doctor, you have to deal with the same systems the rest of us do.

    Sometimes worse, Gary. I’ve had wonderful doctors that level with you. I’ve also had doctors that limit you to “just a nurse”. I am beginning to worry that my current doctor is going to be even worse: the doctor that believes that nurses overuse the medical system and are all hypochondriacs.

    My mom was an RN [OR/Med-Surg.] (trained/credentialed, not degreed, 1953) who *underutilized* the system (for herself and us).  If it was broken/burned/bleeding profusely – off you went; if not, routine office visit and/or monitoring. Who’s your doc hanging with, TRN, that he sees nurses ‘overusing’?  Sheesh!

    • #9
  10. TheRightNurse Member
    TheRightNurse
    @TheRightNurse

    MarciN (View Comment):
    “This patient really needs this and I’m prescribing it and you’re paying for it.”

    This occurs with crappy paperwork justifying it.  Given how little doctors care for paperwork, it is only a matter of time before that prevents prescribing in general.

    • #10
  11. Kozak Member
    Kozak
    @Kozak

    TheRightNurse (View Comment):
    Post Script: “goal to offer access to coverage for safe, effective and affordable medications”

    This is one of the lamest goals ever. Their goal is to offer access to coverage. What exactly does that mean, really? Just signing up more people? GOAL MET! Pizza party for everyone! They have access to coverage…they just might not ever actually get it.

    I love it. For about 2 decades I’ve been hammered to prescribe narcotics to patients.  “Fifth vital sign”, “must document improvement in pain before discharge”, and of course “patient satisfaction scores”.    Nearly everyone states their pain is a 10 out of 10. Even when they are smiling, texting and have completely normal vitals. No matter.  I’ve had parents scream at me to give their 12 year old Percocet for a minor ankle sprain.   Sage researchers assured us their was no problem prescribing potent narcotics for anyone who had pain.  We warned them this would be a problem.  And it is.   Those same researchers now admit they might have been a wee bit optimistic.  And now the pendulum is swinging hard back and I will no doubt to hammered to not write narcs even for terminal patients with intractable pain.

    • #11
  12. I Walton Member
    I Walton
    @IWalton

    I suppose there is no way to manage these things from the top down, whether from government or insurance companies.  Clearly they are being widely abused, resold after medicare pays for them, over prescribed and too easily renewed and fraudulently prescribed.  Probably the only solution is to insist people pay for their own medical care and drugs.    Imagine that, being accountable one’s  own decisions.

    • #12
  13. TheRightNurse Member
    TheRightNurse
    @TheRightNurse

    Kozak (View Comment):
    And now the pendulum is swinging hard back and I will no doubt to hammered to not write narcs even for terminal patients with intractable pain.

    Yep.  The stupidest (smartest?) thing the government did was link satisfaction scores to repayment.  It has meant that people who are protected by their doctors not prescribing opiates or antibiotics are also disgruntled by this, refuse to give a good score, and deny repayment.  This is great for MediCare and other government programs.  It saves huge amounts of money.  It was a calculated play by the government.

    This is all madness.

    • #13
  14. RushBabe49 Thatcher
    RushBabe49
    @RushBabe49

    There is a very simple solution to this problem.  Don’t use insurance for cheap generic drugs!!  Buy all your own medication, and bypass those evil insurance companies.  I have been doing this for years; my doctor and I determine what I need, and I pay for it.  Get your prescriptions filled at your local Costco for the lowest prices.

    There, isn’t that better?

    • #14
  15. TheRightNurse Member
    TheRightNurse
    @TheRightNurse

    I Walton (View Comment):
    Clearly they are being widely abused, resold after medicare pays for them, over prescribed and too easily renewed and fraudulently prescribed.

    So what is the answer?  We have places like the UK where codeine is OTC and they do not seem to have the same abuse problems.  So what is it?  It can’t simply be physical use and need.  It has to be a combination of how the drugs are used, who they are used by, society’s expectations and the ability to access the drugs.

    • #15
  16. TheRightNurse Member
    TheRightNurse
    @TheRightNurse

    RushBabe49 (View Comment):
    There, isn’t that better?

    Heh!  Except for the fact that they’re misinforming people… yep.  I have no problem paying more for my drugs in some cases.

    • #16
  17. Kozak Member
    Kozak
    @Kozak

    RushBabe49 (View Comment):
    There is a very simple solution to this problem. Don’t use insurance for cheap generic drugs!! Buy all your own medication, and bypass those evil insurance companies. I have been doing this for years; my doctor and I determine what I need, and I pay for it. Get your prescriptions filled at your local Costco for the lowest prices.

    There, isn’t that better?

    Well, that works for now. But with the Feds and States tightening the screws and firing up  the Retrospectoscope, expect doctors to be a lot less willing to write those Rx’s.

    • #17
  18. TheRightNurse Member
    TheRightNurse
    @TheRightNurse

    Kozak (View Comment):

    RushBabe49 (View Comment):
    There is a very simple solution to this problem. Don’t use insurance for cheap generic drugs!! Buy all your own medication, and bypass those evil insurance companies. I have been doing this for years; my doctor and I determine what I need, and I pay for it. Get your prescriptions filled at your local Costco for the lowest prices.

    There, isn’t that better?

    Well, that works for now. But with the Feds and States tightening the screws and firing up the Retrospectoscope, expect doctors to be a lot less willing to write those Rx’s.

    They already are.  God help you if you need it for anything.  How about people take responsibility for taking their medications as ordered?  How about if you take a dose higher than what is prescribed and you happen to die, your doctor is not responsible: you are.  How about that?  How about limiting lawsuits when that occurs?  It’s unfortunate and it’s horrible, but people need to be responsible for their own.

    I’m not talking about doctors that prescribe multiple types of opiates and benzos.  I’m not talking about egregious errors.

    We have people who overdose on Tylenol and Motrin.  They should be responsible for not using it as directed.

    • #18
  19. Kozak Member
    Kozak
    @Kozak

    TheRightNurse (View Comment):

    Kozak (View Comment):

    RushBabe49 (View Comment):
    There is a very simple solution to this problem. Don’t use insurance for cheap generic drugs!! Buy all your own medication, and bypass those evil insurance companies. I have been doing this for years; my doctor and I determine what I need, and I pay for it. Get your prescriptions filled at your local Costco for the lowest prices.

    There, isn’t that better?

    Well, that works for now. But with the Feds and States tightening the screws and firing up the Retrospectoscope, expect doctors to be a lot less willing to write those Rx’s.

    They already are. God help you if you need it for anything. How about people take responsibility for taking their medications as ordered? How about if you take a dose higher than what is prescribed and you happen to die, your doctor is not responsible: you are. How about that? How about limiting lawsuits when that occurs? It’s unfortunate and it’s horrible, but people need to be responsible for their own.

    I’m not talking about doctors that prescribe multiple types of opiates and benzos. I’m not talking about egregious errors.

    We have people who overdose on Tylenol and Motrin. They should be responsible for not using it as directed.

    Check out the “Dr Feelgood” documentary, which  is on Netflix

    • #19
  20. Randy Webster Member
    Randy Webster
    @RandyWebster

    RushBabe49 (View Comment):
    There is a very simple solution to this problem. Don’t use insurance for cheap generic drugs!! Buy all your own medication, and bypass those evil insurance companies. I have been doing this for years; my doctor and I determine what I need, and I pay for it. Get your prescriptions filled at your local Costco for the lowest prices.

    There, isn’t that better?

    I take two blood pressure medicines.  Before I turned 65, I had BC/BS health insurance, and the drugs (generic) cost roughly $5 each for 3 months.  I was lackadaisical about setting up my medicare part D insurance.  My BC/BS insurance ended on Oct 1, and my Part D insurance didn’t start until Nov 1.  Unfortunately, my prescriptions ran out in the month of Oct.  When I filled them, it cost $213 for both for three months.  After my new insurance kicked in, the payments went back to $10 for 3 months.  I asked the pharmacist how the insurance company could buy me drugs costing $213 for three months while only charging me $84.  He didn’t really have an answer.

    • #20
  21. TheRightNurse Member
    TheRightNurse
    @TheRightNurse

    Randy Webster (View Comment):
    After my new insurance kicked in, the payments went back to $10 for 3 months. I asked the pharmacist how the insurance company could buy me drugs costing $213 for three months while only charging me $84. He didn’t really have an answer.

    Because they have an agreement with certain drug companies and different types of drugs.  They can fill certain prescriptions with certain brand names or generics.  It basically becomes a matter of bulk.  They aren’t buying it in bulk themselves, but they’re more or less guaranteeing that their subscribers will only purchase certain drugs on the formulary.  They get cut a deal and there we have it.  Everyone else can just suck it up.

    • #21
  22. Midget Faded Rattlesnake Contributor
    Midget Faded Rattlesnake
    @Midge

    RushBabe49 (View Comment):
    There is a very simple solution to this problem. Don’t use insurance for cheap generic drugs!! Buy all your own medication, and bypass those evil insurance companies. I have been doing this for years; my doctor and I determine what I need, and I pay for it. Get your prescriptions filled at your local Costco for the lowest prices.

    There, isn’t that better?

    I grant that, say, prednisone, is much cheaper than, say, inhaled steroids. But there’s a reason it’s not smart to take prednisone, cheap as it is, for problems mostly treated by, say inhaled steroids. Are you talking about purchasing drugs overseas and smuggling them in, then?

    • #22
  23. Midget Faded Rattlesnake Contributor
    Midget Faded Rattlesnake
    @Midge

    I mean, if it weren’t a really bad idea to take prednisone every day for the rest of my life, I’d do it – it’s better than opiates at making all problems disappear (since it suppresses any kind of inflammation, rather than drugging you up). But in several ways, it’s a more dangerous drug than your typical mild opiates.

    • #23
  24. TheRightNurse Member
    TheRightNurse
    @TheRightNurse

    Midget Faded Rattlesnake (View Comment):

    RushBabe49 (View Comment):
    There is a very simple solution to this problem. Don’t use insurance for cheap generic drugs!! Buy all your own medication, and bypass those evil insurance companies. I have been doing this for years; my doctor and I determine what I need, and I pay for it. Get your prescriptions filled at your local Costco for the lowest prices.

    There, isn’t that better?

    I grant that, say, prednisone, is much cheaper than, say, inhaled steroids. But there’s a reason it’s not smart to take prednisone, cheap as it is, for problems mostly treated by, say inhaled steroids. Are you talking about purchasing drugs overseas and smuggling them in, then?

    I think her idea was basically to pay for all your drugs out of pocket.

    • #24
  25. Nanda Panjandrum Member
    Nanda Panjandrum
    @nandapanjandrum

    TheRightNurse (View Comment):
    I think her idea was basically to pay for all your drugs out of pocket.

    That’s what I got from it, too…

    • #25
  26. Midget Faded Rattlesnake Contributor
    Midget Faded Rattlesnake
    @Midge

    Ah, I got from ” Don’t use insurance for cheap generic drugs!!” that we should favor paying for cheap generics out of pocket, possibly to the extent of seeking them out from overseas (from India, for example), since getting a generic approved in the good ol’ US of A can take… a while.

    • #26
  27. Midget Faded Rattlesnake Contributor
    Midget Faded Rattlesnake
    @Midge

    The following, for example, seems typical for inhaled steroids and inhaled steroid-LABA combos:

    Adding to the uncertainty about when generics might appear on the shelves, it has been reported that Teva, one of the world’s largest makers of generic drugs, recently decided to shift its focus from developing a generic version of fluticasone and salmetero (Advair) to developing a branded competitor that could potentially compete with the product instead.12 Teva believes it will be able to submit this product for FDA review in 2014 and explained that it is pursuing this path because they believe overcoming regulatory hurdles to gain FDA approval of a generic IC are so great that it is not possible to develop an interchangeable product. Sandoz, the generic unit of Novartis, has also decided to terminate development of a generic Advair.12 Furthermore, Medco released a document that lists anticipated generics over the next several years and has recently begun leaving out all IC-containing products with a note that FDA has not yet finalized the standard for demonstrating bioequivalence of these products. The report also states that currently there is no estimated date for generic approval of these agents.

    Apparently the only generic inhaler on the US market right now is a rescue inhaler. (Really? Hmm…) I periodically search for news on when generic steroid-LABA combos might hit the market, and maybe I’ve missed something, but so far, I’ve been repeatedly disappointed.

    @duaneoyen might have a somewhat more hopeful inside scoop on this business. Given what I know, though, I remain pessimistic.

    • #27
  28. Wiley Member
    Wiley
    @Wiley

    I am 100% behind the sentiment that government and insurance companies shouldn’t try to protect us from ourselves. Still, the opiate crisis is probably real. I have an elderly relative who has become an addict to opiate pain killers. It has triggered paranoia, dis-inhibition, and bouts of rage. Her addiction is now a crisis in the larger family. I think this becoming a problem in the elder population in general.

    • #28
  29. jef1944 Member
    jef1944
    @

    I take opiates for a chronic condition, I would love take something else, but there is nothing that works better, and keeps me sane at the same time. I can only get a 30 day supply at a time, I have to drive to the doctors office every month for a new prescription, then take it to the pharmacy to get filled. I hate this, the doctor hates this, but we’re stuck, I’m paying the price for the 5% of opiate abusers. If it gets any more restrictive I will have to run over the border to Mexico to get my hydrocodone. (Many of my neighbors already go down to Mexico for medical treatment.) I wish the government would stop trying to save every idiot out there.

    • #29
  30. Miffed White Male Member
    Miffed White Male
    @MiffedWhiteMale

    jef1944 (View Comment):
    I take opiates for a chronic condition, I would love take something else, but there is nothing that works better, and keeps me sane at the same time. I can only get a 30 day supply at a time, I have to drive to the doctors office every month for a new prescription, then take it to the pharmacy to get filled. I hate this, the doctor hates this, but we’re stuck, I’m paying the price for the 5% of opiate abusers. If it gets any more restrictive I will have to run over the border to Mexico to get my hydrocodone. (Many of my neighbors already go down to Mexico for medical treatment.) I wish the government would stop trying to save every idiot out there.

    I don’t really get the addiction thing.  I had severe back problems for several months in  2011 (couldn’t sleep in a  bed from August to October because I couldn’t lay flat for more than about 30 seconds – slept face down in a recliner instead).  Was on Percocet for about 2-3 weeks, then my doctor switched me to Vicodin because she was worried about  dependency.  I was taking Vicodin like candy for several weeks then cut down to 1 or 2 a day for a few months, before quitting.

    They killed the pain nicely, but I didn’t notice any “recreational” effect from either one, and didn’t have any withdrawal problems after I quit.

    • #30

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