To watch Health Quality Committee Hearing 02/22/17 regarding HB 557 click on the Support Link above advance to about 54 mins on video . Representative Pigman and Representative Duran agreed to amend HB 557 to add limitations on opiate prescriptions during the acute phase of needed treatment. Language is being written in preparation for the next committee hearing, Health & Human Services Committee ( no date yet) Chair is Representative Travis Cummings; Vice Chair Representative David Santiago; Democratic Ranking Member Bobby DuBose.
Rep Cummings: 850 717-5018
Rep Santiago 850 717-5027
Rep DuBose 850 717-5094
Rep Duran 850 717-5112 (Sponsor HB 557)
Please call all of them to support HB 557 with amendment for fewer pills. Fewer pills = Fewer deaths
U. S. Senate S 3075 114th Congress
Call and write your Senators office today to co-sponsor
There are currently 3 questions relating to pain on hospital surveys that affects hospital reimbursement. Hospital administrators are focused on their bottom line and this creates an environment of overprescribing. Many addictions start here.
Senate Bill 2758 and HR 4499 removes these questions giving patient care back in the hands of the doctors not the government
The bill has been referred to the Finance Committee:
Members, 114th Congress
Orrin Hatch, Utah, Chairman
Chuck Grassley, Iowa
Mike Crapo, Idaho
Pat Roberts, Kansas
Mike Enzi, Wyoming
John Cornyn, Texas
John Thune, South Dakota
Richard Burr, North Carolina
Johnny Isakson, Georgia
Rob Portman, Ohio
Pat Toomey, Pennsylvania
Dan Coats, Indiana
Dean Heller, Nevada
Tim Scott, South Carolina
Ron Wyden, Oregon, Ranking Member
Chuck Schumer, New York
Debbie Stabenow, Michigan
Maria Cantwell, Washington
Bill Nelson, Florida
Bob Menendez, New Jersey
Tom Carper, Delaware
Ben Cardin, Maryland
Sherrod Brown, Ohio
Michael Bennet, Colorado
Bob Casey, Pennsylvania
Mark Warner, Virginia
The House Bill is HR 4499
Proposal for Florida Leislators
Reconsideration of Pharmacy Crawl Bill. There is not a shortage of pills so perhaps better distribution is in order.
Top 98% of dispensing doctors were in Florida. Dispensing no longer legal however, those same doctors are still here. They are writing prescriptions. We must screen for non-cancer high prescribing doctors?
Tie to DEA number.
Task force to monitor.
ME to report deaths with toxicology report positive for narcotics.
ER’s to report drug overdoses.
Limit number prescribed for acute pain to a 72 hour supply. (Similar to Gov. Charlie Baker. Mass)
Improve PDMP while strengthening.
Data base located within patients medical record
In order to maintain the patient advisory report in the electronic medical record, 893.0551, F.S., would need to be changed.
Mandate that prescribers use prior to writing schedule II,III, and IV narcotics.
STATUS OF SENATE INVESTIGATION ?
The Honorable Orrin G. Hatch
Committee on Finance
United States Senate
Washington, DC 20510
The Honorable Ron Wyden
Committee on Finance
United States Senate
Washington, DC 20510
Dear Chairman Hatch and Ranking Member Wyden:
On behalf of dozens of organizations on the front line of our nation’s prescription opioid and heroin crisis and on behalf of hundreds of thousands of American families devastated by opioid addiction, we are writing to you about a Senate Finance Committee investigation launched in 2012. We respectfully request that you make public the findings from this investigation.
On May 8, 2012, Senators Grassley and Baucus sent letters to three opioid manufacturers and seven non-profit organizations that have promoted aggressive opioid use. In their letters to these groups, they wrote:
“There is growing evidence that pharmaceutical companies that manufacture and market opioids may be responsible, at least in part, for this epidemic by promoting misleading information about the drugs’ safety and effectiveness.”
The Senate Finance Committee investigation sought information on efforts by opioid makers and nonprofit groups to encourage aggressive opioid prescribing for common conditions like low back pain, where risks of use outweigh benefits. These efforts led to a sharp increase in opioid prescriptions and consequently to soaring rates of addiction, overdose deaths, infants born opioid-dependent, and other health and social problems. According to the CDC, overexposure of our population to opioid painkillers has also led to a new heroin problem.
Opioid overdoses, once rare in the United States, have caused more than 220, 000 deaths (175,000 from painkillers and 45,000 from heroin) since 1999. That is more than double the number of American lives lost in Vietnam, Iraq and Afghanistan combined. In other words, the efforts by opioid manufacturers to increase opioid prescribing have led to a public health catastrophe that may take decades for our country to recover from.
Senate Finance Committee staff spent several months collecting and sorting through the records they requested. Regrettably, the findings from this investigation have never been shared with the public. This is why we are writing to you.
The results of the investigation are not simply a matter of historical importance. Some of these same companies and non-profit groups have continued to promote aggressive opioid use and continue to block federal and state interventions that could reduce overprescribing. In addition, some of the specific individuals mentioned in the Committee’s letters to drug companies continue to work as advisors to federal agencies, including the Food and Drug Administration and the National Institutes of Health
To bring our nation’s epidemic of opioid addiction to an end, we must reduce overprescribing of opioids. This goal will be difficult to achieve if opioid makers, and the groups they fund, continue to promote aggressive and inappropriate prescribing. We urge you to release the findings from the Committee’s investigation of their activities. By doing so, their ability to continue putting profits ahead of the public’s health will be greatly diminished.
John H. Stewart
President and Chief Executive Officer Purdue Pharma L.P.
One Stamford Forum
201 Tresser Boulevard
Stamford, Connecticut 06901-3431
Dear Mr. Stewart:
May 8, 2012
As Chairman and a senior member of the Senate Finance Committee, we have a responsibility to the more than 100 million Americans who receive health care under Medicare, Medicaid, and CHIP. As part of that responsibility, this Committee has investigated the marketing practices of pharmaceutical and medical device companies as well as their relationships with physicians and non-profit medical organizations.
It is clear that the United States is suffering from an epidemic of accidental deaths and addiction resulting from the increased sale and use of powerful narcotic painkillers. According to CDC data, “more than 40% (14,800)” of the “36,500 drug poisoning deaths in 2008” were related to opioid-based prescription painkillers.1 Deaths from these drugs rose more rapidly, “from about 4,000 to 14,800” between 1999 and 2008, than any other class of drugs,2 killing more people than heroin and cocaine combined.3 More people in the United States now die from drugs than car accidents as a result of this new epidemic.4 Additionally, the CDC reports that improper “use of prescription painkillers costs health insurers up to $72.5 billion annually in direct health care costs.”5
In Montana, prescription drug abuse is characterized by the state’s Department of Justice as an “invisible epidemic” killing at least 300 people per year and contributing to increases in
1 Center for Disease Control, “Drug Poisoning Deaths in the United States, 1980-2008, NCHS Data Brief, No. 81, December 2011 at http://www.cdc.gov/nchs/data/databriefs/db81.pdf.
3 CDC Press Release, “Prescription painkiller overdoses at epidemic levels,” November 1, 2011 at http://www.cdc.gov/media/releases/2011/p1101_flu_pain_killer_overdose.html.
4 LA Times, “Drug deaths now outnumber traffic fatalities in U.S., data show,” September 17. 2011 at http://articles.latimes.com/2011/sep/17/local/la-me-drugs-epidemic-20110918.
5 International Business Times, “Prescription Painkiller Overdoses Cost Insurers $72.5 Billion Yearly: CDC,” November 3, 2011 at http://www.ibtimes.com/articles/242437/20111103/prescription-painkiller-overdoses-cost- insurers-72-5.htm.
addiction and crime.6 The University of Montana Bureau of Business and Economic Research estimated that prescription drug abuse is costing the state $20 million annually in additional law enforcement, social services, and lost productivity.7
In Iowa, “the use of opioid painkillers such as hydrocodone and oxycodone has increased dramatically in the last decade,” according to the Governor’s Office of Drug Control Policy. Annual overdose deaths from opioids “increased more than 1,233% from 3 deaths in 2000 to 40 deaths in 2009.”8 Data from Iowa’s prescription drug monitoring program demonstrates that in 2010, 89,500,000 doses of hydrocodone and oxycodone were prescribed totaling nearly 40% of all controlled substance prescriptions.9
Concurrent with the growing epidemic, the New York Times reports that, based on federal data, “over the last decade, the number of prescriptions for the strongest opioids has increased nearly fourfold, with only limited evidence of their long-term effectiveness or risks” while “[d]ata suggest that hundreds of thousands of patients nationwide may be on potentially dangerous doses.”10
There is growing evidence pharmaceutical companies that manufacture and market opioids may be responsible, at least in part, for this epidemic by promoting misleading information about the drugs’ safety and effectiveness. In 2007, top executives from Purdue Pharma, the original manufacturer of OxyContin, one of the most notorious and heavily abused painkillers, “pleaded guilty…in federal court to criminal charges that they misled regulators, doctors and patients about the drug’s risk of addiction and its potential to be abused.”11
In addition to illegal off-label marketing, which has been prevalent in the pharmaceutical and medical device industries, drug and device companies have been found to engage in marketing, regulatory, and public relations activities through supposedly independent medical organizations financed by industry.12 Recent investigative reporting from the Milwaukee Journal Sentinel/MedPage Today and ProPublica revealed extensive ties between companies that manufacture and market opioids and non-profit organizations such as the American Pain Foundation, the American Pain Society, the American Academy of Pain Medicine, the Federation of State Medical Boards, and the University of Wisconsin Pain and Policy Study Group.
6 See the Montana Department of Justice website at http://doj.mt.gov/prescriptionabuse/.
7 Bureau of Business and Economic Research, “The Economic Cost of Prescription Drug Abuse in Montana”, June 2011 at http://mbcc.mt.gov/PlanProj/Projects/PDMP/Prescription%20Drug%20Abuse%2020110629.pdf.
8 Iowa Governor’s Office of Drug Control Policy, “Iowa Drug Control Strategy: 2012,” November 1, 2011 at http://www.iowa.gov/odcp/drug_control_strategy/Strategy2012.Final.pdf
10 NY Times, “Tightening the Lid on Pain Prescriptions,” April 8, 2012 at http://www.nytimes.com/2012/04/09/health/opioid-painkiller-prescriptions-pose-danger-without-oversight.html. 11 NY Times, “In Guilty Plea, OxyContin Maker to Pay $600 Million,” May 11, 2007 at http://www.nytimes.com/2007/05/11/business/11drug-web.html.
12 See Senate Finance Committee, “Staff Report on Sanofi’s Strategic Use Of Third Parties to Influence the FDA,” at http://finance.senate.gov/newsroom/chairman/download/?id=69451e85-4d4c-403b-93e0-2d5e7b4010be; ProPublica, “Financial Ties Bind Medical Societies to Drug and Device Makers,” May 5, 2011 at http://www.propublica.org/article/medical-societies-and-financial-ties-to-drug-and-device-makers-industry; and NYTimes OpEd, “Cleaning Up Medical Advice,” April 30, 2010 at http://www.nytimes.com/2010/05/01/opinion/01sat3.html.
According to the Milwaukee Journal Sentinel/MedPage Today, a “network of national organizations and researchers with financial connections to the makers of narcotic painkillers…helped create a body of dubious information” favoring opioids “that can be found in prescribing guidelines, patient literature, position statements, books and doctor education courses.”13 For example, the Sentinel reported that the Federation of State Medical Boards, with financial support from opioid manufacturers, distributed more than 160,000 copies of a model policy book that drew criticism from doctors because “it failed to point out the lack of science supporting the use of opioids for chronic, non cancer pain.”14
In a ProPublica story published in the Washington Post, the watchdog organization examined the American Pain Foundation, a “health advocacy” organization that received “nearly 90 percent of its $5 million funding from the drug and medical device industry.” 15 ProPublica wrote that its review of the American Pain Foundation’s “guides for patients, journalists, and policymakers play down the risks associated with opioids and exaggerate their benefits. Some of the foundation’s materials on the drugs include statements that are misleading or based on scant or disputed research.”16
In 2003, a GAO report pointed to Purdue’s partnership with the Joint Commission on Accreditation of Healthcare Organization (JCAHO) as possible means for Purdue to have “facilitated its access to hospitals to promote OxyContin.”17 The report revealed that Purdue “funded over 20,000 pain-related educational programs through direct sponsorship or financial grants” in addition to funding the Joint Commission on Accreditation of Healthcare Organization’s (JCAHO) pain management programs.18
Although it is critical that patients continue to have access to opioids to treat serious pain, pharmaceutical companies and health care organizations must distribute accurate information about these drugs in order to prevent improper use and diversion to drug abusers.
As part of our effort to understand the relationship between opioid manufacturers and non-profit health care organizations, please provide the following information:
1) Provide a detailed account of all payments from 1997 to the present between Purdue and the following organizations in table format:
- The American Pain Foundation
- The American Academy of Pain Medicine
- The American Pain Society
- The American Geriatric Society
13 Milwaukee Journal Sentinel/MedPage Today, “Follow the Money: Pain, Policy, and Profit,” February 19, 2012 at http://www.medpagetoday.com/Neurology/PainManagement/31256.
15 ProPublica, “The Champion of Painkillers,” December 23, 2011 at http://www.propublica.org/article/the- champion-of-painkillers.
17 GAO, “OxyContin Abuse and Diversion and Efforts to Address the Problem,” December 2003 at http://www.gao.gov/new.items/d04110.pdf.
- The Wisconsin Pain and Policy Study Group
- The Alliance of State Pain Initiatives
- The Center for Practical Bioethics
- Beth Israel Medical Center, Department of Pain Medicine andPalliative Care
- The Joint Commission (and all related entities)
- The Federation of State Medical Boards
- Russell K. Portenoy, M.D. – Chairman, Department of Pain Medicine And Palliative Care at Beth Israel Medical Center
- Scott M. Fishman, M.D. – Chief, Department of Pain Medicine, University of California, Davis
- Perry G. Fine, M.D. – Professor of Anesthesiology, Pain Research Center, University of Utah School of Medicine
- Lynn R. Webster, M.D., F.A.C.P.M., F.A.S.A.M. – Medical Director and Founder, Lifetree Clinical Research & Pain Clinic
- Rollin M. Gallagher, M.D., M.P.H. – Director of Pain Management, Philadelphia Veteran Affairs Medical Center
- Bill McCarber, M.D. – Founder of the Chronic Pain Management Program for Kaiser Permanente in San Diego, CA
- Martin Grabois, M.D. – President, American Academy of Pain Medicine
- Myra Christopher – Kathleen M. Foley Chair for Pain and Palliative Care, Center for Practical Bioethics
c. For each organization or individual identified in 1(a) and 1(b), provide:
- Date of payment.
- Payment description (CME, royalty, honorarium, research support, etc.).
- Amount of payment.
- Year-end or year-to-date payment total and cumulative total paymentsfor each organization or individual.
2) All documents and communications from 2004 to the present pertaining to the book, “Responsible Opioid Prescribing: A Physician’s Guide,” distributed by the Federation of State Medical Boards.
- Provide the names, titles, and job descriptions of all employees who collaborated with the Federation of State Medical Boards, Dr. Scott Fishman, or third-party contractors on the development of this book.
- For each employee identified in 2(a), provide a summary of the work performed pertaining to the book.
- 3) All documents and communications from 2007 to the present pertaining to the development or changes to JCAHO’s19 pain management standards, including but not limited to communications with the American Pain Society and other organizations involved in developing JCAHO pain management standards.
- 4) All documents and communications from 2007 to the present pertaining to the development or changes to The American Pain Society’s pain guidelines.
- 5) All documents and communications from 2004 to the present pertaining to the American Pain Foundation’s Military/Veterans Pain Initiative.
- 6) All documents and communications from 2007 to the present pertaining to any policies, guidelines, press releases and/or position papers distributed by the American Pain Foundation.
- 7) All presentations, reports, and communications to Purdue’s management team or board of directors from 2007 to the present pertaining to the funding of and/or collaborations with of any of the organizations or individuals specified in request 1(a) or 1(b).
In cooperating with the Committee’s review, no documents, records, data, or other information related to these matters, either directly or indirectly, shall be destroyed, modified, removed, or otherwise made inaccessible to the Committee.
We look forward to hearing from you by no later than June 8, 2012. All documents responsive to this request should be sent electronically, on a disc, in searchable PDF format to my staff. If you have any questions, please do not hesitate to contact Christopher Law with Senator Baucus at (202) 224-4515 or Erika Smith with Senator Grassley at (202) 224-5225.
Charles E. Grassley Senator
Max Baucus Chairman
19 All requests pertaining to JCAHO include related organizations such as the “Joint Commission Resources.”