In recent weeks, I have been struggling to put pen to paper or, should I say, fingers to keys. I have found, there is so much information that I would like to be able to share, at times the information becomes unwieldy as I attempt to cover all the distinctions within the medical information that may be useful to you as an attorney.

A perfect example, is information I planned to share regarding the opioid crisis. Nearly every day, that I found time to write, there would be release of a brand-new piece of information regarding the topic. Read on for a sampling of that information.

When I first identified that I wanted to blog about “the crisis”, the blaming game had already begun, and physician were finding themselves squarely in the political cross-hairs (Frellick, 2017). In a short time-span, guidelines for opioid use following general surgery were released (Janeczko, 2017) and the DEA employed what is described as a permanent solution, expanding access to drugs used to treat opioid addiction by increasing the number of nurse practitioners and physician assistants with prescriptive authority (Ault, 2018).

In January, the Washington Post printed an expose that detailed the decade-long shipment of opioids to a small town in West Virginia of fewer than 3,200 people. It is of interest to note that West Virginia leads the states in both number of opioid overdoses and in resultant deaths, the latter, 52 per 100,000 residents in 2016. A congressional committee looking into the matter learned that between 2006 and 2016, two West Virginia pharmacies near the Kentucky state line received 10.2 million and 10.5 million pills respectively. There is documentation that distributors provided as many as 39,000 pills in a two-day period to those two pharmacies during 2007. A distance of 2/10 of a mile separates the pharmacies (Bever, 2018).

While laws in 48 states and the District of Columbia allow the supplying of the anti-overdose drug naloxone without a prescription to either the patient or their friends or relatives, in Calistoga, California, for example, there has been little demand for the drug. An interviewed pharmacist surmised this was because those addicted to opioids are not in a place where they can see a need to treat the illness (Gorman, 2018).

In February of this year, following restructuring and commercial operation reduction, Purdue Pharma, an active distributor of opioids, notified physicians that drug reps would no longer visit doctor’s offices to discuss opioid products carried by the company. This action came on the heels of investigations by the L.A.Times and the New Yorker that outlined how Purdue pursued doctors to increase sales (Pagliarulo, 2018).

The Drug Enforcement Administration has called for a 25% reduction in the manufacture of opioids in 2018 and an additional 20% reduction the following year attempting to control misuse of the drugs. This has lead to shortages of pain killers in the acute healthcare setting. A coalition including representatives from the American Hospital Association, the American Society of Clinical Oncology and the American Society of Health-System Pharmacists has taken the position that the shortage of the drugs increases the potential for patients to be in pain, suffer treatment delays or be impacted by medical error (Kaiser Health News, 2018).

Over time, because of the breadth of this issue, the crisis may influence the cases you develop for clients. You may see the impact related to individuals abusing opioids or the effect may be related to a delay in treatment for patients in the acute care setting because of opioid shortages.

Because we live in an ever-changing world, I’ve decided to manage this blog differently. Beginning this week, I will write short postings on current topics. As always, I will be writing to give you food for thought related to your legal practice. I encourage you to call me, so I can interpret nuance and assist you in using the information as you work toward a good result for your client.

Terri Chabaud, RN, CLNC

References

Ault, A. (2018). DEA expands access to opioid addiction treatment via NPs and Pas. Medscape (January 29.2018). Retrieved from Medscape.com.

Bever, L. (2018). A town of 32,000 was flooded with nearly 21 million pain pills as addiction crisis worsened, lawmakers say. The Washington Post (January 31, 2018). Retrieved from https://www.washingtonpost.com/news/to-your-health/wp/2018/01/31/a-town-of-3200-was-flooded-with-21-million-pain-pills-as-addiction-crisis-worsened-lawmakers-say/?utm_term=.7f1a106ba22d

Frellick, M. (2017). Physicians get too much blame for opioid crisis, some say. Medscape (December 21, 2017). Retrieved from medscape.com/viewarticle/885760

Gorman, A. (2018). Pharmacists slow to dispense lifesaving overdose drug. Medscape (January 3, 2018). Retrieved from https://www.medscape.com/viewarticle/890852?nlid=119921_4622&src=WNL_mdplsnews_180105_mscpedit_nurs&uac=172420MZ&spon=24&impID=1527133&faf=1

Janeczko, L.L. (2017). Patient specific guidance for opioid use after inpatient general surgery. Medscape (January 29, 2018). Retrieved from medscape.com/viewarticle/890338

Kaiser Health News. (2018). The other opioid crisis: Hospital shortages lead to patient pain, medical errors. Kaiser Health News (March 16, 2018). Retrieved from https://www.news-medical.net/news/20180316/The-other-opioid-crisis-Hospital-shortages-lead-to-patient-pain-medical-errors.aspx

Pagliarulo, N. (2018). Maker of oxycontin to halt opioid promotion to doctors. Biopharma Dive (February 12, 2018). Retrieved from https://www.biopharmadive.com/news/maker-of-oxycontin-to-halt-opioid-promotion-to-doctors/516863/