Written by: Whit Carmon, Esq.  As of January 6, 2017, SB 319 took effect in Ohio. Signed into law by Governor John Kasich, on January 4, 2017, the bill contains two key provisions relating to outpatient prescriptions for opioid analgesics. First, the law prohibits pharmacists, pharmacy interns, or terminal distributors from dispensing opioid analgesics if more than fourteen (14) days have elapsed since the prescription was issued and the prescription is for drugs to be used on an outpatient basis. Second, the bill restricts such providers from dispensing more than a 90-day supply of these drugs, regardless of whether the prescription was issued for a greater amount. Importantly, however, the bill does not apply to individuals who are inpatient at institutional facilities. Section 3727.01 of the Revised Code defines an “institutional facility,” which includes Convalescent homes, Developmental facilities, Long term care facilities, Nursing homes, Psychiatric facilities, Rehabilitation facilities, Developmental disability…       Read More

I. INTRODUCTION “Opioids are a class of drugs that includes the illegal drug heroin; synthetic opioids such as fentanyl; and pain relievers available legally by prescription, such as oxycodone (OxyContin®), hydrocodone (Vicodin®), codeine, morphine, and many others. Opioid pain relievers are generally safe when taken for a short time and as prescribed by a doctor, but because they produce euphoria in addition to pain relief, they can be misused (e.g., taken in a different way or in a larger quantity than prescribed, or without a doctor’s prescription). Regular use—even as prescribed by a doctor—can lead to dependence and, when misused, opioid pain relievers can lead to overdose and/or death.” •https://www.drugabuse.gov/drugs-abuse/opioids • July 6, 2017 Oxycodone is a Schedule II narcotic. Schedules are based on risk of abuse. Any drugs that are Schedule I (drugs with high risk and no counterbalancing benefit) are banned from medical practice. •https://medshadow.org/resource/drug-classifications-schedule-ii-iii-iv-v/ • March 14,…       Read More

Written by: Alex Battey, Esq. Anesthesia professionals often find themselves on the front lines of the ongoing fight against opioid addiction. Whether in the subspecialty of pain management or through their treatment of post-surgical patients, physicians and nurse anesthetists are often faced with the difficult taks of balancing the need for effective pain control measures with the patient’s risk for, or history of, opioid abuse. Some providers are exploring the use of regional anesthesia, in which nerve blocks are implemented to delivery non-opioid, long-acting numbing medication directly to nerves affected by certain surgical procedures in the days immediately following surgery. Anesthesiologists implementing these techniques in orthopedic surgeries have reported shorter hospital stays as the patients are able to move around sooner following surgery. Providers have also had success limiting the need for post-surgical opioids by utilizing doses of IV acetaminophen or ibuprofen on the day of surgery. The American Association…       Read More

Written by Beth W. Kanik, Esq. In 1999, Dr. Abraham Verghese wrote of his relationship with a physician who succumbed to his drug addiction in spite of all efforts to help in “The Tennis Partner”. Then, it was thought that a physician addicted to drugs was an anomaly. Nearly 20 years later, published studies have shown that each year, more than 160,000 health care providers will misuse the drugs that they have access to. Easy access to controlled substances not only puts the individual provider at risk, but also brings risk to their patients. Just as this nation’s leaders were slow to recognize the opioid crisis enveloping the nation, courts and medical societies have been slow in protecting the patients from their own medical providers. One way medical societies and boards tried to address physician mis-use was through voluntary diversion programs. Based on widely accepted estimates of substance abuse among…       Read More

Written by: Duke Regan, Esq. President Trump’s recent declaration of a national state of emergency regarding the opioid crisis serves as yet another reminder of the scope and seriousness of the opioid threat. Some states, such as Florida, have already declared state emergencies and established state databases to assist healthcare providers in assessing and fighting the opioid crisis. While organized efforts are certainly a significant step in the fight against the opioid crisis, health care facilities and health care providers need to consider factors extending beyond their own patient encounters. These include a patient’s drug seeking tendencies, opioid tolerance, and also outside pressures from the pharmaceutical industry. Since 2009 pharmaceutical companies have been allowed to disseminate information suggesting certain products may have uses beyond their specific FDA approvals. The companies cannot directly market these uses but can suggest some medications, including opioids, have broader applications. There is no question so…       Read More

Written by: R. Spencer Smith III, Esq. When opioids are more readily available, deaths from overdose follow, as clearly seen in the following two maps. But simply limiting access to prescriptions from doctors and clinics may not be enough to reverse the trend of opioid addiction, and may lead to unintended consequences.     Opioids have hit Ohio about as hard as anywhere. Governor John Kasich and the Ohio legislature have enacted multiple measures to combat its opioid problem. Guidelines were enacted in 2011 and 2012 for emergency departments and acute care clinics limiting the use of prescription opioids, and in 2013 similar guidelines were established for management of chronic pain. Further, Ohio enacted an automated reporting system in 2015 called OARRS to combat physician shopping by integrating electronic medical records, thus enabling physicians to search for a patient’s history of opioid prescriptions. The effects of these forms seem to…       Read More

Written by: Adam Peoples, Esq. More than 400 healthcare providers were recently charged with taking part in a health care fraud and opioid scam totaling $1.3 billion. According to Attorney General Jeff Sessions, this was the “largest health care fraud takedown operation in American history.” Sessions also commented that the nurses, doctors, and pharmacists involved chose to “violate their oaths and put greed ahead of their patients.” Kelly Norris was among those charged. Norris was a sales representative for Northside Pharmacy, which did business as Global Compounding Pharmacy. As charged, Global conspired to generate and bill for fraudulent and high-reimbursement prescriptions by, among other things, hiring sales representatives who were married or related to doctors and other prescribers. According to the filings, Norris was closely related to an Alabama physician who wrote a significant number of the prescriptions benefitting Norris and Global. Global also encouraged its sales representatives to push…       Read More

Written by: Jeffery Saxby, Esq. On an average day in this nation, more than 650,000 opioid prescriptions are dispensed,1)IMS Health National Prescription Audit  3,900 people initiate non-medical use of prescription opioids,2)SAMHSA National Survey on Drug Use and Health.  580 people initiate heroin use,3)Id.  and 78 people die from an opioid-related overdose.4)CDC National Vital Statistics System.   Included in the opioid-related overdoses are those arising from the use of prescription opioids and illegal opioids such as heroin. On an annual basis, the opioid epidemic costs the nation $55,000,000,000 in health and social costs5)Pain Med. 2011;12(4):657-67.  and $20,000,000,000 in emergency department and inpatient costs.6)Pain Med. 2013;14(10):1534-47. In order to quell this epidemic, governmental agencies began publishing guidelines to assist medical facilities and physicians by identifying appropriate steps to take in conjunction with prescribing opiates for pain management.  While diagnosis and treatment of the pain associated with acute and chronic disease must be…       Read More

Written by: Charles A. Dorminy, Esq. A report released by the federal Centers for Disease Control and Prevention July 6, 2017, shows that the opioid epidemic is still raging. https://www.cdc.gov/vitalsigns/opioids/index.html The report showed that providers in the highest prescribing counties prescribed six times more opioids per person than the lowest prescribing counties in 2015. Half of US counties had a decrease in the amount of opioids (MME*) prescribed per person from 2010 to 2015. The MME prescribed per person in 2015 was about three times as high as in 1999. Counties covering the majority of Eastern Tennessee and Northern Alabama appear to be tops on the list. According to the report, the amount of opioids prescribed per capital in those counties were in the highest range, from 959 to 5,543 MME, morphine milligram equivalents. This calculation is a way to calculate the total amount of opioids, accounting for differences in…       Read More

Written by: Jeffery R. Saxby, Esq. A St. Louis (MO) jury recently spotlighted the considerable danger associated with opioid injury or death litigation – a jury’s potential imposition of exorbitant punitive damage awards as an effort to cure a perceived social ill.  Healthcare providers and medical facilities must institute and follow specific practices and procedures in an effort to protect and insulate themselves from the threat of runaway juries assessing ridiculously high compensatory and punitive damage awards. Fertile Ground for Liability Let’s face facts, the opioid epidemic has caught physicians and medical facilities unprepared.  Due to a lack of preparedness and training, physicians who have prescribed opioids for pain management are facing liability both for prescribing too much as well as too little.  The new wave of opioid related litigation not only arises from physical injuries or death associated with the use of opioids, but is increasingly arising from reported…       Read More