#11: Polypharmacy and Adverse Drug-Drug Interactions

Visiting my 90 year old mother in law the other day, I couldn’t help but shake my head as I counted the 22 different prescription medications she was on.  This did not count the additional OTC meds she had on her bed stand.  Polypharmacy, defined as use of five or more medicines, has a high risk of adverse drug-drug interaction.  One does not have to imagine what illegal drug “cocktails” might do.  We read about it daily.  Many, if not all, of us have been touched by an overdose tragedy.  Face it; we are a country that likes to take drugs.  Patients get mad at their provider if they go to them with a problem and the provider doesn’t give them something.  You can’t sit through one hour of television without seeing an advertisement selling a drug.  (Then listen to the speed talker describe the possible side effects and give you the legal disclaimer)  The providers have to fight against this crap.  There are now drugs being developed to treat side effects caused by other drugs.  Legal polypharmacy is an unfortunate consequence of medical advancement.  We are living longer and more drugs are being discovered and created to treat more conditions.  It makes one wonder if it is such a stretch to fall into the world of addiction when drugs are handed out like candy by some providers.  I can hear the nay sayers screaming at me already.  My point is we are a society that takes large amounts of medication without a thought of the consequences.

For the most part, we (you and I) deal in the world of pain and addiction medicine where misuse of multiple drugs is common.  Patients take stimulants to wake up and then depressants to come down.   Opiates and Opioids are abused for the purpose of obtaining the euphoric effect.  Benzodiazepines are misused because it is easier to treat anxiety with a pill than to put the effort into cognitive behavioral therapy.  Alcohol is abused because the world is temporarily easier to live in when one is slightly tipsy.  I realize it is popular to join in the cacophony of voices screaming about the opioid epidemic, but we cannot turn a blind eye to other drugs being used in conjunction with, or in place of opioids.  From 2015 to 2016 drug overdose deaths involving Cocaine, psychostimulants with abuse potential, or both substances combined, increased by 42.4%!!  If this statistic is not strong enough to convince clinics to appropriately order drug testing, I am not sure what is.  Governing authorities have scared many physicians into either not testing enough or not testing enough drugs.  We do not want anyone to over test; however you cannot know if a patient is using cocaine, or any drug, without testing for that particular drug.  Test correctly, document correctly and tell the governing authorities to ………… Whoops, I do tend to get my ire up when discussing how health care is being governed out of the physician’s hands. 

 

Hopefully all of you had a great Memorial Day weekend and spent at least one moment remembering those that died while in service of the US Military.  So thankful for their sacrifice.  Thank you for your business.    

Lance Benedict

President/CEO Industry Lab Diagnostic Partners
05/31/2019

#10: Sending Insurance Checks Directly to Patients

 “ARE YOU KIDDING ME?” is the reaction the director of medical ethics for New York University’s School of Medicine, Arthur Caplan, had upon hearing of Anthem’s BCBS policy of sending insurance money to patients. My reaction would likely contain more colorful language so I will stick with his. One woman received nearly $375,000 over a period of several months for treatment she received at a California rehabilitation facility. A father received more than $130,000 after he sent his fiancée’s daughter for substance abuse treatment. In one current lawsuit, which has been ongoing for several years, Anthem BCBS is accused of sending more than $1.3 million in payments to patients. Money, owed to facilities such as our lab! Sadly the patients end up right in the middle.

It is bad enough the insurance companies practice such disgusting tactics in an attempt to force providers to join their networks where they can pay them low contracted fees, however when they send money to the most vulnerable, those with SUD or those in SUD treatment, it is reprehensible, if not criminal. In 2017, a 29 year old North Carolina man received a check for $33,000, including $2,405.28 of interest which was generated by services at an emergency department. The following four days after receiving and depositing this check, which was not his money, he made three cash withdrawals totaling $13,000 dollars. The young man who had been in treatment for SUD was found dead, from cocaine and heroin toxicity, at a local hotel on the fourth day after using the cash to go on the biggest drug and alcohol binge of his life. Somehow, Anthem BCBS claims this was not their problem.

What about labs such as ours that request to be in network with some Anthem BCBS contractors and in some cases are denied? They force us to bill out of network and then still send payments to the patients. They send sums of money to patients that at times are more than a patient sees in a year and then “wink” and tell the patient they need to send that to the provider of the services. How ludicrous to place such a burden of temptation upon patients that have difficulty with self control or self discipline. The woman in the above example received 50 checks from Anthem BCBS between August 2014 and May 2015. The treatment facility that provided the services, for which payment was made, has not seen a dime.

Many of you assist us by informing the patients who have Anthem BCBS they may receive a check from BCBS for the drug testing the provider ordered. Your reminding them it is not their money and they should endorse those checks over to the lab is greatly appreciated. Regardless of the repugnant Anthem BCBS policy, we maintain our policy of not chasing patients, even if they receive our money.

Oh well, keep on living and loving! Do the right thing, even if others don’t! Thank ya’ll for your business.

Lance Benedict

President/CEO Industry Lab Diagnostic Partners
05/17/2019

#9: Patients are Extremely Inaccurate Self-reporters

 Rumblin, Stumblin and Bumbling today! Much on my mind. If you don’t already realize this, patients are extremely inaccurate self reporters. They forget what they take, they don’t know what they take, and heavens forbid they sometimes lie about what they take. In a recent case I was privy to, a physician failed to check the PDMP and scripted Buprenorphine to a patient who didn’t report to the physician they were also taking Xanax. The physician scripted prior to getting a drug test report. The patient died from respiratory distress from taking too much of both drugs and a malpractice lawsuit ensued. Once the plaintiff’s attorney got the physician to admit he failed to check the prescription website and scripted prior to getting the drug test results, the trial was over in favor of the plaintiff.

Suboxone, generic suboxone, Zubsolv and Bunavail film all have the same chemical compounds. Regardless of which of these drugs the patient was prescribed, we test for and report Buprenorphine, Norbuprenorphine and Naloxone. It does not matter if Suboxone has 8mg of Bup and 2mg Naloxone or Zubsolv has 5.7mg of Bup and 1.4mg Naloxone or Bunavail has 4.2mg of Bup and 0.7 mg Naloxone. If you are concerned with not being accurate because the pharmacy changes Suboxone to one of the other three, put Buprenorphine and Naloxone down as prescribed drugs and the results will be appropriate for the drugs taken.

Fentanyl has now been found mixed in THC, Heroin, Methamphetamine, Cocaine, Xanax and MDMA. Lots of money to be made by producing a greater high and that is what Fentanyl does with severe consequences.

How many know that Buprenorphine is the number one contraband substance seized in prison systems? It is also the fourth most diverted controlled substance. Some studies show physicians feel as though diversion of Buprenorphine is not a problem due to the fact patients are “self-treating” because they can’t get access to treatment. Wrong!!! If a patient purchases/steals/burrows Buprenorphine on the streets they are “self-medicating” not self-treating, a huge difference! Have you ever considered, the availability of Buprenorphine on the streets actually keeps patients out of treatment?

Opiates are natural substances that come from Opium which is extracted from the opium poppy seed. Morphine and Codeine are Opiates. Opioids are semi-synthetic (made using some natural substances) or synthetic (produced artificially in a lab). Examples of semi-synthetic opioids are Oxycodone and Hydrocodone while Fentanyl and Methadone are two examples of synthetic opioids. Most people use the term Opioid for any substance (natural, semi-synthetic or synthetic) that acts upon one of the three main opioid receptor systems (mu, kappa, or delta) in the brain.

Your test will be mailed to you! Only kidding. Take a breath! “Your calm mind is the ultimate weapon against your challenges. So relax.” Have an awesome weekend. Thank you for your business.

Lance Benedict

President/CEO Industry Lab Diagnostic Partners
05/03/2019