August 2008

News from Attorneys General Offices

  1. Kansas Attorney General Steve Six announced charges against pharmacy owners and a pharmacist in Lyons, Kansas, for running a rogue Internet pharmacy. The complaint alleges that the owners and the pharmacist violated Kansas law by shipping prescription drugs without a valid prescription.
  2. Massachusetts Attorney General Martha Coakley announced the arraignment of a former Certified Nurse Assistant in connection with the alleged assault of a 92-year old resident at a nursing facility.
  3. Mississippi Attorney General Jim Hood announced the indictment of three women for crimes against a nursing home resident. The women are accused of using the social security number of the victim to obtain cellular phones and obtain various credit cards.
  4. Oklahoma Attorney General Drew Edmondson announced that a former administrator at a nursing home had pled guilty to stealing more than $3,000 from residents in her care.
  5. Oregon Attorney General Hardy Myers published the latest annual drug threat assessment for Oregon’s high intensity drug trafficking area (HDTA) on his website this month. The report notes that, after methamphetamine and marijuana, the next tier of drugs of concern are heroin, cocaine, and prescription drugs. Treatment admissions for pharmaceutical abuse have increased 332 percent in the last 10 years in Oregon.
  6. Washington Attorney General Rob McKenna spoke about the abuse of prescription narcotics this month. General McKenna is organizing a youth conference on prescription drug abuse in October for teen-agers. He has also advocated a take-back program for disposing of drugs both to stem prescription drug diversion and to avoid environmental pollution.

Judicial Developments

  1. The U.S. Court of Appeals for the Seventh Circuit issued its decision in United States v. David Chube & Charles Chube, Nos. 06-3674 & -3675 (Aug. 15, 2008). These physician brothers were convicted in 2005 on several counts of unlawful distribution of controlled substances. While the court upheld their conviction, rejecting the doctors’ arguments regarding their objection to the expert testimony, the court did remand for re-sentencing. The court found that the government had not carried its burden of showing that additional prescriptions were dispensed with no legitimate purpose and, thus, the trial court’s application of relevant conduct to enhance the doctors’ offense for sentencing purposes.
  2. In Cardoza v. USC University Hospital et al., No. B195092 a California appellate court held that the plaintiff, who had alleged that the hospital and its doctors had concealed the fact that her mother had an advance health care directive (AHCD), should be allowed to amend her pleading under the California Health Care Decisions Law. That law states that a person who intentionally conceals a patient’s AHCD is subject to liability up to $10,000 or actual damages and attorney’s fees.

Legislative Developments

  1. Senator Ken Salazar (D-CO) has introduced the Consumer Health Education and Transparency Act of 2008, S. 3402. It calls for a report concerning end-of-life care education and spending.
  2. Governor Arnold Schwarzenegger signed California AB 3000 that enables a patient with a serious illness and life expectancy of a year or less to utilize a Physicians Order for Life Sustaining Treatment (POLST) to express his/her wishes regarding end-of-life care.

Pain Management

  1. In August, the website Pain-Topics featured an article discussing opioid-induced hyperalgesia (OIH). Although the majority of patients taking opioids will not suffer from OIH ─ a condition whereby ongoing opioid therapy for chronic pain actually worsens, instead of alleviating, the pain ─ the author notes that it is essential that healthcare providers carefully monitor patients’ responses to opioid therapy and monitor the signs of OIH.
  2. The Lexington, Kentucky, Herald-Leader ran a lengthy article noting that physicians are divided on how they approach pain management. Dr. Russell Portenoy, a New York pain specialist, is quoted as saying that “the drugs [narcotics] are highly stigmatized.” According to the article, the debate is not concerning use of narcotic drugs to treat post-surgical pain or pain from illnesses such as cancer, but the continued use by chronic pain patients of high dosages over a long period of time.
  3. MedScape Neurology and Neurosurgery published an update on opioid policy. Titled, “Understanding and Navigating the Laws and Regulations Governing Pain Relief with Opioids,” the article notes that many practitioners are unaware of the opioid prescribing requirements and recommendations established in state policies.

Prescription Drug Diversion

  1. An article in USA Today reported the result of a survey from the National Center on Addiction and Substance Abuse (CASA). Headlined “Prescription Drugs More Accessible to Teens than Beer,” the article notes that the main source of prescription drugs for teen-agers is mom and dad’s medicine cabinet. The survey also found that the later teen-agers hang out with their friends on school nights the more likely they are to be involved with drugs and alcohol. Of those surveyed, 46% of teen-agers admitted to socializing with friends on school nights while only 14% of parents said that their children engage in such behavior. CASA president Joseph Califano stated: “Parents who are not aware of such conduct by their teens, or are not candid about it, are problem parents whose failure to monitor their children’s school night activities increases the risk of drug or alcohol use.”

Other News of Interest

  1. The Competitive Enterprise Institute has launched its “Politics of Pain” campaign, developed in conjunction with the Pain Relief Network, to support change in DEA rules and procedures. The campaign has collected stories from physicians and patients who express their views on the difficulty of treating and receiving treatment for chronic pain conditions.
  2. An article in the August 31 issue of the journal Pain reports results of a study examining the use of opioids for non-cancer pain conditions (NCPC) among two population groups: one national and commercially insured population (HealthCore plan data) and one state-based and publicly-insured (Arkansas Medicaid) population over a six year period (2000–2005). The proportion of enrollees receiving NCPC diagnoses increased and cumulative yearly opioid dose. Use of Schedule II opioids increased most rapidly, both in proportion of NCPC patients treated and in cumulative yearly dose. According to the authors, the trends have occurred without any significant change in the underlying population prevalence of NCPC or new evidence of the efficacy of long-term opioid therapy and thus likely represent a broad-based shift in opioid treatment philosophy.
  3. A detailed description of a transplant procedure involving removing the hearts of severely brain-damaged newborns less than two minutes after the babies are disconnected from life support is detailed in the New England Journal of Medicine. The journal published four commentaries in connection with the report that demonstrates that debate among medical personnel and ethicists regarding the propriety of removing hearts from patients who do not meet the long-accepted definitions of death.
  4. An article in the August issue of Archives of Surgery remarks on the differences between healthcare providers and the public regarding certain end-of-life issues.
  5. An article in the New York Times states that the Food and Drug Administration is considering making a recommendation that doctors have specialized education in order to prescribe certain scheduled medications. The agency is also considering new rules requiring drugmakers to monitor how their narcotics are being prescribed.
  6. An article in the Providence Journal noted that just two percent of elder abuse and neglect cases reported each year to state protective service agencies are reported by physicians. Although doctors in every state are required by law to report suspected elder abuse in their patients, it seems that doctors do not report because they are not aware of the signs of abuse, are asked by their patients not to report the abuse for fear they will be moved out of their homes, or are simply reluctant to bring up the subject of abuse with their elderly patients. Other doctors do not report because they have no faith that social workers will handle the situation appropriately. Only one in fourteen incidents of elder physical abuse in domestic settings is ever reported.
  7. A doctor who writes the Rural Doctoring blog had some interesting thoughts regarding prescription drug abuse.

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