#30: How Much Do You Know About the Drug Narcan (Naloxone)?

Should we not all be thankful for the drug naloxone?  After all, as a society we know by now how using this drug has saved lives by reversing the effect of an opioid overdose.  It is even being distributed in communities.  All you have to do if you are in the presence of someone suffering from an opioid overdose is give them the drug Naloxone in time and you will save their life, right?  Okay, how many of you reading this know how to do that?  How many of you know that there are actually three methods taught in community programs in this country as to how to administer the drug Narcan (Naloxone)?  What if you give Narcan to someone who has overdosed on something other than opioids such as Cocaine?  Hmmm, it has gotten very quiet out there.  Here is another question:  How long does Narcan last once administered and why do we care?  I guess that was actually two questions in one. 

First and foremost Narcan has no effect on people who have not taken an opioid.  So if you walk onto a scene where someone is unconscious and there is a suspicion of a drug overdose it is better to be safe than sorry.  If it is available use the Narcan on that person.  The three methods, all used by Naloxone community programs, include a preloaded nasal spray; an intramuscular shot; or an improvised nasal atomizer kit that requires assembly of the three pieces before use.   You should familiarize yourself with all three.  This can be done even by watching some youtube videos on how they are used.  Yes, there are big bold instructions with each, however, there is a saying in boxing which applies here:  “Everyone has a plan until they get punched in the mouth”.  When your loved one is lying unconscious, hardly breathing and people are screaming at the top of their lungs around you, that is a punch in the mouth!  Try reading step by step instructions calmly during that.   Having studied in a calm, quiet atmosphere where you were able to concentrate on instructions on how to deliver Narcan might allow you to respond calmly and quickly in such a scenario.  The AMA has a short two-minute video showing how to use these devices.  Just type AMA-How to use Naloxone in your browser.  Providers have been encouraged to prescribe Naloxone to family and friends of people who may have an opioid use disorder.  Please ask your doctor if you are in that situation.  All of the clinics we deal with should have Naloxone on hand due to the clients they see.  You need to know where it is and how to use it.

Naloxone lasts between 30-90 minutes.  The effects of an opioid overdose last much longer, therefore it is possible after the Naloxone wears off the overdose could recur.  People are not “better” if revived with Naloxone and should always be taken to a medical facility.  If an individual does not respond to an initial dose or responds but then relapses into respiratory depression, additional doses of the Narcan nasal spray may be given every 2 to 3 minutes until emergency help arrives.  Although personal experience led me to write this particular blog, I pray none of you will ever need the information within. 

Have an awesome and safe weekend and as always thank you for your business.

Lance Benedict

President/CEO Industry Lab Diagnostic Partners  02/21/2020

#29: First-ever Criminal Action Against an EHR Company

Some of you may want to sit down before reading this one. In a Department of Justice release on January 27, 2020, the first-ever criminal action against an EHR company was announced.  Practice Fusion, a San Francisco-based health information technology developer, used by many providers, will pay $113.4 million to the federal government, $5.2 million to states and $26 million in criminal fines and forfeiture.  

Practice Fusion has admitted to soliciting and receiving kickbacks from a major opioid company in exchange for utilizing its EHR software to influence physician prescribing of opioid pain medications.  In addition, in exchange for “sponsorship” payments from pharmaceutical companies, Practice Fusion allowed these companies to influence the development and implementation of the CDS (Clinical Decision Support) within its software system in ways aimed at increasing sales of the pharmaceutical company’s products. 

The CDS alerts that Practice Fusion agreed to implement did not always reflect accepted medical standards.  They allowed pharmaceutical companies to participate in designing CDS alerts, including selecting the guidelines used to develop the alerts, setting the criteria that would determine when a healthcare provider received an alert, and in some cases even drafting language used in the alert itself.  This is akin to a fox building a “safe” place for chickens to live!!   As Christina Nolan, the U. S. Attorney for the District of Vermont stated, “Practice Fusion’s conduct is abhorrent.” 

Practice Fusion also knowingly caused eligible healthcare providers who used certain versions of its 2014 Edition EHR software, to falsely attest to compliance with HHS requirements necessary to receive incentive payments from Medicare during the reporting periods for 2014 through 2016 and from Medicaid during the reporting periods for 2014 through 2017. 

Okay, go take a shower to get some of that slime off you.  On another front, on January 21, 2020, CMS announced a national coverage determination that would cover acupuncture for people with chronic low back pain, in an attempt to give patients alternatives to potentially addictive narcotic painkillers.  There are, of course, some guidelines such as the pain must have persisted for at least 12 weeks or longer and have no identifiable cause, such as infections, disease, surgery and pregnancy.  Regardless of your opinion of alternative therapies, CMS is making the effort to take another approach to chronic pain. 

I am sure all of you have by now heard of the deadly virus, Influenza.  Thought I was going to say Coronvirus didn’t you?  So far this winter the flu has sickened 15 million Americans, hospitalized 120,000 and killed 8,200.  People freak when they hear Coronavirus and yawn at the word Flu.  Yes, familiarity breeds indifference. 

I hope y’all had a great first month of the new decade and as always I would like to thank you for your business.

Lance Benedict

President/CEO Industry Lab Diagnostic Partners  2/07/2020