What are your thoughts?

[CAdamsPAC]

https://www.tennessean.com/story/news/2018/10/11/opioid-epidemic-tennessee-pill-mills-christina-collins/1488026002/

[Reality Check 2]

Pretty unbelievable.

ZERO remorse from the NP and ZERO medical legitimacy, logic, evidence based treatment or common sense.

Her license should be revoked permanently. She showed no concern for her actions.

Working for the VA, I am thankful everyday for the national limits and complete inability at my location to mix benzo with narcotics and soma doesn’t exist.

Bad provider - period.

[rev ronin]

I wasn't a PA until 2012, but c'mon, people, I knew as a new graduate not to do stupid stuff like that.

[CAdamsPAC]

I don't understand why her license wasn't revoked or why she was not prosecuted by state or federal agencies.

[Joelseff]

I don't understand why her license wasn't revoked or why she was not prosecuted by state or federal agencies.

Me neither. A friend of mine sits in our disciplinary committee for our state board and he says if ever there was a strong case against someone for malpractice the board comes down hard on them.

 

I wonder why Tennessee's BON gave her a break. I mean those RX's with evidence and her admitting she has RX'd opiates despite knowing her pts weren't taking it is just negligence on the BON's part. They should be prosecuted as well.

 

Having said that though, I have seen some cases of Providers getting called up to disciplinary action for doing what a lot of providers do. Some of my colleagues don't check a CURES PAR all the time. Our state has a 4 month mandatory check. I check with EVERY fill. I have been called out for being too cautious for this but I tell them that it's MY license and MY family's well being on the line and will continue to do so. I am also known to cut off pts when they breach Pain Contracts while some of my colleagues will consider extending them and giving another chance. Thing is I used to work Pain and I've been close to getting burned on that so I will stick to being strict.

 

I refer out to Pain mgmt whenever I get a new pt with an opiate and I start planning reduction of doses if they are on BZDs (esp with opiates and BZD). I've gotten some push back again but since the state (CA) and pretty much every other state has started shining light on the subject and actually prosecuting folk, my colleagues are now becoming as strict. Our new policy is no more than 10 days worth for acute pain but NSAIDs preferred given studies showing superior analgesia to Norco 5-10mg. I fthey need more or stronger we send to specialty and Pain mgmt. CURES reports q 4 mos for anyone still on roster for opiate mgmt outside of PM and my CP and I started reducing pt's monthly supply by 5 every month until they are down to PRN use and then no more than 30 pills per fill. If they want or "need" more, they go to PM.

 

If pts are on long term BZD (which I know happens from time to time [emoji6]) I try them on long term anxiolytics like Buspar or SSRI with counseling (CBT etc) if they require more than that they go to psychiatry.

 

With the dearth of Psychiatrists and Pain Mgmt clinics around this often falls on our laps as PCPs but it's part of the job. I think in the past we as PCPs have been lazy and just gave the RX to the pt. Now though there is incentive (not just CYA) to stop the scheduled meds.

 

My Pain Mgmt guy I refer to has stopped opiates for any new pts and he has started reducing opiates especially for the multiple opiate pts. He has reported to our group a 40% decrease in opiate RXs with a REDUCTION of average pain reports from pts from 7-10/10 to now 2-4/10! That's freaking incredible.

 

It just shows if we take the time we can get pts off the pain meds. Most chronic pain pts, I would wager, do not require opiates.

 

Anecdote: I just recently have been recovering from a torn rhomboid, teres major and minor and infraspinatus tears. 3rd worst pain in my life (kidney stone is #1 and Biliary Colic is #2) and I have a blown knee and ankle, CLBP and radic. I was out on Norco. It only made me dizzy. I took Aleve instead and it actually reduced the pain so much better than the Norco.

 

Anyhoo. Long rant I know but the original topic and this article should serve to move towards smarter more responsible prescribing practices...

 

Ok good night! [emoji3577][emoji42][emoji42][emoji99][emoji99]

 

 

Sent from my SAMSUNG-SM-G891A using Tapatalk

 

 

 

[rev ronin]

Heh. I got a call from a pharmacist Friday because I gave a chronic pain patient 30 Norco 5./325s and 10 Temazepam at the same visit.  Mind you, I last Rx'ed him the same amount of Norco 3 months ago, Temazepam 6 months ago, and both Rx'es said "use sparingly" on them, but hey, it triggered the Opioid+Benzo flag.  I thanked the pharmacist very much for his attention to the matter (NEVER reprimand anyone for double checking your safety; treat healthcare like CRM...) and confirmed I'd meant to Rx in that way.  I don't mind working this way.  New Opioid rules in Washington are going to make me do a database check with every fill, but that's a small price to pay (I already did one q6m for all patients, and don't prescribe for "high risk" patients at all).

I'm working at getting my Alaska license right now, and I am having to provide proof of at least 2 hours of opioid CME.  I have more like 10, mostly from Medscape, over the last three years.

At any rate, all of this is a far cry from what this NP did, which I still consider unconscionable.  Diverted meds end up in middle schools.

[ventana]

should be stripped of her license and put in jail....

[Kaepora]

These providers should absolutely lose their licenses - and worse.  Earlier this month a physician in my local area was just arrested for exchanging opiates for sexual favors.  And a PA in Harrisburg was arrested for diverting almost 10,000 narcotics pills.  How any prescriber could think they would get away with this stuff when the PDMP is watching every prescription written is beyond me.