North Carolina appears to be leading the nation in the effort to reduce drug over-prescription abuse in nursing homes. A report released by the Federal Center for Medicare and Medicaid services shows that the rate of antipsychotic drug use in North Carolina has fallen twenty-three percent. Many nursing homes in America prescribe these drugs in order to control and calm their patients. As a side effect, these patients are more likely to fall and can become too drugged to participate in activities they previously enjoyed.

A North Carolina expert says that to offer better treatment and reduce the dependence on these drugs, a well trained staff is essential. They should pay close attention and build strong relationships with the patients. Some alternative treatments include music therapy and massage for agitated patients. Hopefully other states will take notice of North Carolina’s strides towards improving elder care and follow suit with more efforts to reduce the use of unnecessary prescriptions to control patients.  See full article at WUNC.

Alarming new numbers released by the U.S. Centers for Disease Control document a huge rise in opioid pain reliever prescription use over a ten year span. Opioids are a class of drug commonly prescribed for pain-relief that include Dilaudid, Percocet, Hydrocodone, OxyContin, Oxycodone, Vicodin and Morphine. They are classified as highly addictive and can easily become lethal if too much is given. Deaths due to overdoses of prescription opioid drugs rose 415% among women and 265% among men from 1999 to 2010. A Mayo Clinic report shows opioid pain-killers are now ranking among the three most common types of prescriptions given to Americans. It also showed that women and the elderly are more likely to receive more prescriptions than the average person.

The CDC Director cites aggressive and misleading marketing of these drugs aimed at doctors as one reason for the spike in overdose deaths. The CDC urges doctors to take a second look at pain-management strategies for their patients, and consider alternative therapies such as physical therapy and exercise. Leading the way is Washington state, which has successfully worked with prescribers and insurers on better guidelines for opioid prescriptions and has since seen a 23% decrease in opioid-related deaths.
See article from Healthline here.

The San Francisco Chronicle reported Jodi Alexander, an Oklahoma nursing home worker, has been charged in connection with a prescription drug ring.  Alexander is accused of stealing prescription medications from patients at the Crescent Care Center where she worked, changing medical records so they wouldn’t reflect a discrepancy. Alexander and Dale Steven Markus, her boyfriend, were charged with distribution of a controlled dangerous substance. She was also charged with larceny.

In an article from the Shelbyville Times-Gazette, it was reported that Shelbyville nurse Brooke Sissom was accused of stealing pain medications from patients at the Manchester Health Care Center where she worked.  Brooke Sissom allegedly used the names and prescriptions of patients to order some potent pain medications which she proceeded to take herself, although it is possible that she may have sold some.

On October 12, she was arrested and charged with “nine counts of obtaining controlled substance by fraud,” while she was ordering new prescriptions. The nursing home staff became suspicious of her activities and notified the police, even going so far as to locate and save documents recording the sales which Sissom attempted to destroy.

She is responsible for endangering the lives of patients who were unable to receive their medications. Records from the Tennessee Board of Nursing have recently been brought to light, testifying that Sissom’s nursing license was place in probation back in 2009 due to “‘unauthorized removal of controlled substances without authorization’ and ‘incorrect entries in patient records.’” However, she has just been set free on a $10,000 bond.

USA Today reported on DHHS’s statement that since the beginning of 2011, Medicare beneficiaries have saved $4.5 billion on prescription because of provisions of the 2010 health care law.   “We’re seeing consistent, steady savings for seniors thanks to the health care law,” said Jon Blum, director of the Center for Medicare. “In just 21/2 half years, seniors have seen billions in savings, and those savings will continue to grow as the doughnut hole is fully closed.”

Drugmakers participating in Medicare agreed to give the government a 50% discount on premium drugs and 14% on generic drugs as part of the law, and the government passed those savings on to seniors. In 2012, the coverage gap – or “doughnut hole” – is $2,930. The law eliminates that gap by 2020.

The increased number of patients on medications could also be the result of seniors using the provision of the law that eliminates out-of-pocket expenses for annual and preventive exams.

Canton Rep reported on Ohio’s attempt to reduce the theft of prescription drugs in nursing homes and assisted living facilities. The attempt is one of several state initiatives aimed at reducing the abuse of prescription painkillers, which has led to record numbers of accidental overdose deaths in Ohio.  Another proposal targets emergency room doctors and their role in the large numbers of prescription painkillers disbursed in the state.

 

Kaiser Health News reported a study from the National Institute of Medicine that shows that the U.S. health care system is not prepared for future mental health needs based on demographics and lack of specialists. Aging patients will not receive treatment for depression, dementia and other conditions. “In addition, some experts are concerned that the baby boomer population, which is a growing component of the nation’s older demographic, have an unaddressed problem with substances – namely misuse of prescription medications.”

The Institute of Medicine report says all health workers who see older patients — including primary care physicians, nurses, physicians’ assistants and social workers — need some training to recognize the signs of geriatric mental health problems and provide at least basic care. To get there, it called for changes in how Medicare and Medicaid pay for mental health services, stricter licensing requirements for health workers, and for the government to fund appropriate training programs.

The government is pushing to improve mental health staffing for military veterans, an especially vulnerable subset of the elderly population. In April, the Department of Veterans Affairs announced that it would add around 1,900 psychologists and other staff.

The Washington Post also had an article on the study.  The article states at least 5.6 million to 8 million Americans age 65 and older have a mental health condition or substance abuse disorder

A nursing home in Oklahoma is at the center of a drug ring involving residents’ prescription medications.  Director of Nursing Jackie Allen Alexander and Melanie A. Kirby, the assistant director of nursing were arrested on charges for multiple counts of obtaining controlled substances by fraud or forgery, conspiracy to obtain and conspiracy to distribute.  Prosecutors have filed drug-related charges against six employees at Callaway Nursing Home. The Oklahoma Bureau of Narcotics says the employees are accused of calling in fraudulent prescriptions to pharmacies to obtain painkillers, including hydrocodone.  The drugs were later sold on the street.

An audit showed more than 9,000 dosage units of controlled substances had been diverted by employees, said Mark Woodward, Oklahoma Bureau of Narcotics spokesman. More than 8,400 of the dosage units involved the pain medication hydrocodone.

 

USA Today reported that "almost 4 million seniors saved about $2.16 billion through discounts for their prescription medications in 2011", according to the Department of Health and Human Services.  "The 2010 health care law required a 50% discount on prescription drugs in the so-called doughnut hole, or the gap between traditional and catastrophic coverage in the Medicare drug benefit, also known as Part D. In 2012, the coverage gap is $2,930. The Affordable Care Act eliminates the doughnut hole by 2020." 

In 2010, Medicare sent $250 rebate checks — totaling $846 million — to nearly 3.8 million seniors to try to counterbalance the gap. In the first two months of 2012, about 100,000 people have received $92.7 million in discounts — about $904 per person

Government costs for prescription medications through Medicare should decrease after seniors saved more than $2 billion in 2011 through discounts offered by the program. When Medicare recipients are able to take their medications, they are hospitalized less often for heart attacks, low blood sugar and asthma attacks thus reducing long term health care costs.

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USA Today recently had a disturbing article about the Medicare fraud involving the nation’s largest drugmakers.    The multinational companies have paid at least $8 billion in fines for repeatedly defrauding Medicare and Medicaid over the past decade.  They only remain in business because they hold a monopoly on life saving medications.  Government investigators can exclude these companies from providing medications to Medicaid and Medicare beneficiaries as punishment for prior fraud, but that would leave beneficiaries without drugs patented through a particular company.

Pfizer alone has paid almost $3 billion in fines since 2002 and entered into three corporate integrity agreements with the Department of Health and Human Services aimed at preventing future fraud. Pfizer’s 2009 settlement was for improperly promoting the use of drugs for purposes other than those for which they were approved by the government.

Merck paid $1.6 billion in fines since 2008, Medicare and Justice Department records show, to resolve claims it was not paying proper rebates to the government.  Merck’s 2008 settlement involved claims the company paid illegal kickbacks to health care providers in exchange for prescribing its drugs.

Pharmaceutical companies altogether spent more than $200 million lobbying Congress in 2011, including $12 million spent by Pfizer. At least 12 pharmaceutical and medical device companies are lobbying specifically against a House bill, HR 675, that complements Grassley’s.