McKnight’s had another great article on medical marijuana; this time, in Virginia.  As a bill that expands access to medical cannabis becomes law, associations representing assisted living operators in Virginia are looking for guidance on whether it applies to assisted living residents and their caregivers, as the Virginia chapter of the National Organization for the Reform of Marijuana Laws maintains.  The legislation was passed unanimously in both the state House of Delegates and the state Senate.

SB 1719 allows for “registered agents” to pick up or receive delivery of medical cannabis — specifically, cannabidiol (CBD) oil and THC-A oil — for people who physically are unable to do so for themselves. The bill language does not reference assisted living, but Virginia NORML said the bill applies to assisted living communities and hospices as well as home healthcare providers.

Virginia Assisted Living Association Executive Director Judy M. Hackler told McKnight’s Senior Living that the organization has contacted state regulators to see how the bill, if signed, will be implemented in long-term care settings.  “We have been telling our providers that we know that it’s coming, that all the laws are changing for all the states,” she said. “And so we’re asking them all to be proactive in developing company policies as far as what they want to have allowed and, of course, full disclosure to residents and staff. You’ve got to think about who is going to be administering it for the residents and whether there are going to be any side effects to the employees. …There need to be some safety measures in place.”

The Virginia Health Care Association / Virginia Center for Assisted Living also is taking a closer look at the legislation to see how assisted living communities could be affected, said Amy Hewett, CAE, the group’s vice president of strategy and communications.

“We have plans to meet with representatives of the Virginia Board of Pharmacy to learn more,” she said. Agents must register with the pharmacy board.

LeadingAge Virginia President and CEO Melissa Andrews said the bill is “a step toward our mission of ensuring positive aging for every Virginian.”

The organization, she added, “supports legislation that enables older adults to have access to all necessary prescribed medication, regardless of their physical ability or location. We are pleased that our legislature is taking this positive step and are confident that regulations will be promulgated to ensure the health, welfare and safety of residents within these communities.”

Federal prosecutors are filing charges against six Iowa women accused of stealing drugs from residents at the nursing homes where they worked.

Prosecutors say they used their employment at nursing homes to steal painkillers including Oxycodon and Fentanyl from residents.  Charges of “acquiring a controlled substance by misrepresentation, fraud, deception, and subterfuge” were filed against:

  • Arminda Cruickshank, 36, Calvin Community and Valley View Village nursing homes in Des Moines
  • Katie Howard, 31, University Park Nursing and Rehabilitation Center in Des Moines
  • Samantha Mills, 29,  Des Moines
  • Alicia Swenson, 32, Carlisle Center for Wellness and Rehabilitation
  • Barbara Tindall, 47, Keosauqua Health Care Center and Savannah Heights in Mount Pleasant
  • Christine Weilbrenner, 30, The Bridges of Ankeny

Howard pleaded guilty to two counts in February.  She will be sentenced in July.  The five other suspects have all pleaded not guilty.

Popular Science had a great article on the #1 public health crisis–the opioid epidemic sweeping the United States.  The article shows several factors caused the crisis including the greed of the pharmaceutical companies and doctors, opioid overprescription, slow government response, and the availability of street drugs like heroin.

The largest and easiest to control is overprescription of this dangerous and addictive painkillers by doctors themselves. The medical community now recognizes the dangers opioids pose and the FDA introduced a special protocol for handling them. However, a new study, published last month in JAMA, from researchers at Johns Hopkins University shows that protocol was ignored by most doctors.

The most potent class of prescription opioids is known as transmucosal immediate-release fentanyls (TIRFs). These painkillers, which are fast-acting and powerful, are intended to help breakthrough pain in cancer patients, whose normal opioid pain relievers aren’t managing all the pain. “This is not a usual drug,” says Caleb Alexander, a Johns Hopkins professor of medicine and the corresponding author of the new study. It’s a last-resort drug. For that reason, he says, in 2011, the FDA instituted a program, known as the Risk Evaluation and Mitigation Strategy for TIRFs, or TIRF REMS.

The strategy didn’t work. Through careful analysis of the reports, which cover the years 2011 to 2017, Alexander and his colleagues found that between 34.6 and 55.4 percent of TIRF prescriptions had been given inappropriately. That’s especially troubling because TIRFs can cause a person who isn’t already “opioid tolerant”—that is, taking a specifically defined number of opioid painkillers—to overdose, because their bodies aren’t used to them.

“I think our findings raise serious concern regarding the role of manufacturers and the FDA,” Alexander says. They also suggest that far more documents currently unavailable for public and academic scrutiny might contain even more key information about the state of the opioid crisis—that’s if we can get them.

“These documents provide just a tiny peek through one window that reveals just one piece of the epidemic,” says Alexander. “There’s an enormous amount about the inner workings of the FDA and pharmaceutical manufacturers that the public hasn’t been able to see.”

The CDC estimates that 130 Americans die each day from opioid overdose, while the Substance Abuse and Mental Health Services Administration reports that millions of Americans misused prescription opioids in 2017.

In September 2018, the FDA approved a widespread REMS program covering opioid painkillers more generally, but it remains to be seen if that program will be more effective than the TIRF REMS. “The FDA’s opioid REMS activities extend far beyond the TERF products,” Alexander says, “and our findings raise questions as to the adequacy of the broader response of the FDA and manufacturers to the epidemic.”

An Oregon woman claims that a nursing home’s neglect caused her mother additional health problems and deprived the woman of prescription medication.  The Oregonian/OregonLive reports the lawsuit filed by Laurie Jeandin seeks damages from Linda Vista Nursing and Rehab Center nursing home.

The suit claims 85-year-old Betty White was denied methadone for about two weeks and developed pressure ulcers and toenail fungus before her wrongful death in May 2017.

The suit also names the parent company, Vancouver, Washington-based Prestige Care as defendant. One employee has been indicted on seven felony charges of stealing medication.

 

Purdue Pharma is one of the biggest drug dealers in the world.  Victims of the opioid crisis have filed lawsuits against Purdue because of the aggressive and deceptive marketing of the dangerous and powerful addictive painkiller OxyContin. Numerous internal documents prove that the disregarded safety and addiction as it pursued massive profits from patients who became dependent on its products.

After the government cracked down on illicit prescribers and tried to address the flow of pills to the black market, those addicted to the painkillers turned to heroin.  Landau claims that Purdue and its OxyContin pills were not responsible for sparking the opioid crisis. The company paid $600 million in fines in 2007 as part of a federal case. Company executives also pleaded guilty to criminal charges after claiming the product was not as addictive as other opioids.

Craig Landau, Purdue Pharma’s chief executive, threatened to declare bankruptcy instead of compensating Americans they injured and killed with their unsafe products.  Landau, said in an interview with The Washington Post that the company has not yet decided whether to file bankruptcy, but he said it is something the company is weighing as it considers the impact of potential legal settlements or jury verdicts that could cost tens of billions of dollars.

Declaring bankruptcy could halt litigation against the company, bankruptcy lawyers said, and it can be more difficult for plaintiffs to secure judgments in bankruptcy court than in civil court.

Interestingly, now Purdue is attempting to make money off the opioid crisis by developing a drug to reverse opioid overdoses.

The company’s initiatives include providing millions of dollars to support the creation of an over-the-counter naloxone spray and training law enforcement to administer the drug; supporting education on the proper storage and disposal of prescription opioids; and conducting research into non-opioid painkillers.

McKnight’s had an article about Congressional leaders concerned over the off label and unsafe use of anti-psychotic medications in nursing homes. Rep. Richard Neal (D-MA) sent a letter to the Centers for Medicare & Medicaid last month, asking for explanation on how SNFs and Medicare plans are acting to address such prescriptions. He wants the agency to specify how many Medicare dollars go toward adverse events stemming from inappropriate prescribing, and any links they might have to nursing home staffing levels.

The latest CMS data shows that nursing homes are making minimal progress in decreasing anti-psychotic prescribing. At the end of 2011, almost 24% of residents received an anti-psychotic medication. Since then, there has been a decrease to a national prevalence of 14.6% in the second quarter of 2018, the agency reported.

“Unfortunately, CMS’ data are still extremely disappointing, showing that progress reducing inappropriate use of anti-psychotics in nursing homes has slowed,” he wrote. “Moreover, I am concerned that the ‘improvement’ is not the result of changed prescribing behavior but, instead, stems from some nursing homes falsifying psychosis diagnoses, making incidence of this contra-indicated prescribing appear improved when it is, in fact, not.”

 

The Dayton Daily reported about the ongoing problem of giving residents anti-psychotics medications for off-label use.  At most Ohio nursing homes, about 15 percent of long-term residents are on anti-psychotic drugs, which puts patients at risk for dangerous side effects and even death, according to the Federal Drug Administration. For dementia patients, anti-psychotic drugs intended for serious mental illnesses can significantly affect quality of life and result in dangerous and fatal side effects.

Many short-staffed nursing homes have relied too heavily on medications as the quickest and most direct way to address behavior when there is not enough staff to meet the needs of the resident.  Families of residents on these drugs complain that their family members are not acting like themselves, are sleeping all the time or have lost interest in activities they once enjoyed.

To curb the use of these medications for dementia patients, up to 100 Ohio nursing homes could get training at a substantial discount that teaches how to take other approaches to addressing difficult behaviors besides medication. The grant money comes from fines nursing homes have paid over citations.  The value of the training is that it helps nursing home workers have the knowledge base to take other approaches with residents besides medication, said Peter Van Runkle, executive director of Ohio Health Care Association, which represents nursing homes and other long-term care facilities.

The set of training programs are with nonprofit Eden Alternative and the training teaches nursing home staff how to provide individual care that looks to understand the reason behind challenging behavior and find an individual non-medication approach.

The state also has the ability from an enforcement to issue citations and penalties to nursing homes for having residents with drug regimens with unnecessary prescriptions, and the FDA has not approved anti-psychotics to treat dementia symptoms.

How to search anti-psychotic prescribing at your nursing home 

You can look up the percent of residents who are prescribed anti-psychotic medications at every Medicare or Medicaid certified nursing home in the U.S.

  • Go to Medicare.gov/nursinghomecompare/search.html
  • Under “Find a nursing home” type the location and then the name of a nursing home in the two search bars.
  • Click on the “Quality of resident care” tab.
  • Scroll down and click on “long-stay” or “short-stay” to see the percentage of residents of those two groups who got an anti-psychotic prescription. Lower percentages are better.

 

Human Rights Watch received The National Consumer Voice for Quality Long-Term Care’s annual Public Service Award on October 22, 2018.  The National Consumer Voice for Quality Long-Term Care presents the award to an individual or organization whose work has expanded coverage and public understanding of long-term care for older people. The award was presented in recognition of Human Rights Watch’s 2018 report “‘They Want Docile’: How Nursing Homes in the United States Overmedicate People with Dementia.”

The report estimates that every week in US nursing facilities, more than 179,000 people, most of them older and living with dementia, are given antipsychotic drugs without a diagnosis for which their use is approved. In many cases, nursing facilities use these drugs without obtaining or even seeking informed consent.  Human Rights Watch found that nursing homes routinely give antipsychotic drugs to residents with dementia to control their behavior. Regulations prohibit this misuse of drugs as “chemical restraints.” This abusive practice remains widespread even though the use of antipsychotics on older people with dementia is associated with a nearly doubled risk of death.

Using antipsychotic medications as a “chemical restraint” – for the convenience of staff or to discipline residents – violates US federal regulations and may amount to cruel, inhuman, or degrading treatment under international human rights law. Using the drugs without adequate indication for use or appropriate monitoring is also barred under federal standards.

“We are honored to receive Consumer Voice’s recognition for this work,” said Bethany Brown, researcher on older people’s rights at Human Rights Watch. “We are proud of our partnership with them and with other dedicated advocates around the country to promote equality and dignity for older people living in nursing facilities.”

Human Rights Watch recommended that national government and state agencies should strengthen their enforcement of federal regulations regarding antipsychotic drugs. Residents and their families should be told they have the right to be informed of their treatment alternatives and their right to refuse. The government should ensure that nursing homes employ enough staff to provide adequate care.

“Human Rights Watch research and reporting sparked a greater understanding of some of the risks to older people in nursing homes in the United States,” said Lori Smetanka, executive director of the Consumer Voice. “With this award, we recognize this important contribution to public awareness and encourage government and state agencies to ensure all older people have the right to choose and refuse treatment for themselves.”

Nursing homes across the United States routinely give antipsychotic drugs to residents with dementia to control their behavior, despite regulatory prohibitions on this misuse of drugs as “chemical restraints.” This abusive practice remains widespread even though the use of antipsychotics is associated with a nearly doubled risk of death in older people with dementia.

Canadian nursing homes will participate in research to study the effectiveness of medical cannabis in treating pain and improving cognitive function in seniors. The 6-month pilot program will be one of the largest of its kind, enrolling up to 500 nursing home residents.  The pilot study will focus on evaluating the impact of medical cannabis on residents’ health and quality of life, as well as caregiver stress and the economic benefits of cannabis use in nursing homes.

“Medical cannabis is currently prescribed for residents as appropriate, but it’s still an emerging area,” says Candace Chartier, CEO of OLTCA, which represents over half of Ontario’s 630 long-term care homes.

“Through this partnership and pilot study, we hope to provide more clarity to long-term care clinicians and frontline staff about the use of medical cannabis for residents.”

Can cannabis improve cognitive function? The popular image of clueless stoners breezing through life like Jeff Bridges as the Dude in “The Big Lebowski” may not be entirely accurate.

A small 2016 study by researchers at Harvard Medical School and Tufts University found that cognitive function improved in 24 adults who smoked marijuana for three months. Participants also reported better sleep, less depression and a significant decrease in their use of medications such as opioids — all qualities that would be welcomed in nursing homes.

“There is clearly an interest in the long-term care space to explore medical cannabis as an alternative to traditional medications for pain and degenerative cognitive function,” said Mark Zekulin, President & Co-CEO of Canopy Growth. “The pilot study we’ve announced… is the first step in developing an evidence-based, best practice approach to medical cannabis that will result in consistent care for thousands of seniors and ultimately improve quality of life and outcomes in long-term care homes.”

A recent survey in Israel of over 2,700 elderly patients found that medical cannabis significantly reduced their chronic pain.  About a third of the patients used CBD oil, about 24 percent smoked marijuana, and about six percent used a vaporizer.

Over half of the seniors who originally reported “bad” or “very bad” quality of life said their lives improved to “good” or “very good.”

“We found medical cannabis treatment significantly relieves pain and improves quality of life for seniors with minimal side effects reported,” said Victor Novack, MD, a professor of medicine at Ben-Gurion University and head of the Soroka Cannabis Clinical Research Institute.

A recent survey by the American Association of Retired Persons (AARP) found that most older Americans think marijuana is effective for pain relief, anxiety and nausea.

Some 150 million people worldwide are expected to be affected by dementia by 2050. And while there are many ways people can change their behavior to lower their risk of heart disease and cancer–such as eating a healthy diet, exercising and avoiding or stopping smoking–there are few similar steps that have been scientifically proved to reduce the risk of degenerative brain disorders like Alzheimer’s. Genes play a prominent role in determining who will develop the disease, and age is also a major factor–neither of which are under human control.  That’s why Alzheimer’s experts have focused their attention on developing drug treatments for the disease.

Wake Forest Baptist Medical Center sought people with hypertension to volunteer for a study called SPRINT MIND which was designed to test whether aggressively lowering blood pressure would have an effect on people’s risk of cognitive decline, including symptoms of dementia related to Alzheimer’s disease.  So far the trial’s results are the first solid confirmation that lowering blood pressure reduces the risk of both mild cognitive impairment (MCI), a degree of brain decline that’s considered the gateway to dementia.   The study provides the strongest evidence yet that there may be something in people’s control that lowers their risk of cognitive decline. The results of the trial, which was funded by various agencies in the National Institutes of Health, were presented at the annual meeting of the Alzheimer’s Association in Chicago in July and immediately buoyed the hopes of Alzheimer’s experts.

The SPRINT MIND study involved more than 9,300 elderly people who had had heart problems or were at higher risk of developing heart disease–some because they had high blood pressure. They were randomly told to lower their blood pressure to either less than 120 mm Hg or 140 mm Hg systolic. (Current guidelines, revised in 2017 after the study began, now recommend that most people keep the upper number, or systolic pressure, under 130 mm Hg.) They were tested over an average of three years on various cognitive skills, including memory and processing of new information.

After an average of three years, people who lowered their blood pressure to less than 120 mm Hg lowered their risk of developing MCI or probable dementia as measured by the tests by 15%, compared with people who lowered their blood pressure to 140 mm Hg.

There are finally some promising drugs for Alzheimer’s that are now being tested.  These could be the first to actually slow or even reverse the damage to brain nerves that cause memory loss, disorientation and other problems related to thinking skills. The latest studies on two drugs, BAN2401 and aducanumab, show they may shrink the amount of disease-causing protein plaques in the brain and could even slow the progression of cognitive decline.