Literature Review

Pain management in the wake of the opioid crisis Forbes; by Web Golinkin; 7/15/24 Pain is the single most frequent reason for patient visits in the United States. An estimated 20 percent of adults experience chronic pain, and nearly seven percent experience a level of chronic pain that limits their daily activities. However, most doctors and other healthcare professionals have very little education in pain management, according to Scott Fishman, MD, an internationally recognized expert in pain management, ... This lack of education was one of the main causes of the Opioid Crisis, Fishman says ... of the part of the crisis that was caused by the over-prescribing of opioids, many clinicians have become so wary of the medical-legal issues surrounding pain management that they have gone from an overly liberal approach to a restrictive one in which some prescribers are effectively abandoning patients who need to have their symptoms treated. Both extremes are frequently fueled by lack of knowledge and training, according to Fishman. ... The solution is to close the education gap ...

DOJ slaps $20M opioid prescription penalty on OptumRx Fierce Healthcare; by Noah Tong; 7/2/24 OptumRx will pay $20 million to resolve claims the company violated the Controlled Substances Act by improperly filling certain opioid prescriptions, the Department of Justice recently announced. The agency claims OptumRx did not fill prescriptions correctly for "trinity prescriptions" like benzodiazepines and other muscle relaxants from April 2013 to April 2015. These prescriptions, which are addictive, may not have been “intended for legitimate medical use” and carry “significant risk of harm,” according to a news release. “Pharmacies providing opioids and other controlled substances have a duty under the Controlled Substances Act to ensure that they fill prescriptions only for legitimate medical purposes,” said Principal Deputy Attorney General Brian Boynton, head of the Justice Department’s Civil Division, in a statement. “The department will continue to work with its law enforcement partners to ensure that pharmacies do not contribute to the opioid addiction crisis.”

Optum to pay $20M to settle improper prescription allegations Becker's Hospital Review; by Rylee Wilson; 6/28/24 OptumRx will pay $20 million to settle allegations it improperly dispensed some opioid medications, the Justice Department said June 27. The settlement resolves an investigation into if OptumRx improperly filled certain opioid prescriptions between 2013 and 2015. The Justice Department alleged the pharmaceutical benefit manager improperly dispensed opioids in combination with other drugs, including benzodiazepines and muscle relaxants, from its mail-order pharmacy operations in Carlsbad, Calif. Opioids prescribed alongside benzodiazepines and muscle relaxants are commonly referred to as "trinity" prescriptions. These prescriptions raise red flags that the drugs may not be for legitimate medical use, and could lead to the diversion of controlled substances, the Justice Department said. In its investigation, the department alleged OptumRx dispensed trinity prescriptions without resolving red flags. OptumRx does not admit liability as part of the settlement.

Interdisciplinary Pain Board for managing patients with palliative care needs and substance use disorder: A pilot study Journal of Palliative Medicine; Sarah Hauke Given, Patricia Reid Ponte, Kate Lally, Isaac S Chua; 6/20/24 online ahead of print Context: Patients with cancer-related pain and concurrent substance use disorder (SUD) present a unique set of challenges for palliative care clinicians. A structured forum for interdisciplinary collaboration is needed to effectively manage this complex population. Objectives: Describe the feasibility and acceptability of a palliative care Complex Pain Board (CPB), an interdisciplinary team meeting to provide concrete care recommendations for patients with cancer-related pain and concurrent SUD and/or psychosocial complexity. 

Managing palliative care challenges for patients with complex symptoms Pharmacy Times; 6/7/24In an interview with the Pharmacy Times, Justin Kullgren, PharmD, FAAHPM, Palliative Medicine Clinical Pharmacist Specialist and PGY2 Pain Management & Palliative Care Residency Program Director at The Ohio State University Wexner Medical Center, James Cancer Hospital, shares insights into palliative care and common challenges faced by pharmacists treating patients with complicated symptoms. ... Pharmacy Times: What do you wish pharmacists understood about hospice and palliative care in terms of patient care for patients with complicated symptoms? Kullgren: So, I think, number 1, pharmacists across all healthcare systems, in the hospital, at community pharmacies, long-term care, you are all going to be involved in these patients— it’s just to what degree. ... We want to do those therapies that ... are going to have the least amount of risk for our patients, or at least side effects for our patients. ...

Rural pharmacy owners say it's getting harder to stay open Times West Virginian; by Devi Shastri; 6/5/24 Rural pharmacies can be a touchstone for their communities. The staff knows everyone’s names and drugs, answers questions about residents’ mail-order prescriptions or can spot the signs of serious illness. But their business models face unrelenting pressures to the point that sometimes they have to close. An AP analysis of data from 49 states and the National Council for Prescription Drug Programs shows that several largely rural states have some of the lowest number of pharmacies per ZIP code. Editor's Note: This trend for closures in rural areas is rampant for hospitals, emergency departments, physicians, and more. Click here for a letter from NHPCO and numerous hospice providers to Congress, Jan. 5, 2024: Protect rural and frontier American's access to hospice and palliative care.

StateServ Rebrands to Dragonfly HealthPR Newswire; 6/3/24StateServ, a leading provider of benefit management solutions for durable medical equipment ("DME") and pharmaceuticals for the post-acute care market, announced today it has rebranded to Dragonfly Health. The new identity marks an inflection point for the Company, as it combines DME and pharmacy offerings, enabling a scalable, holistic care-at-home service platform driven by advanced technology and robust analytics. Through its comprehensive offering of equipment and medication solutions, Dragonfly Health seeks to improve quality of life and transform the care-at-home experience for caregivers, patients, and their families.

BetterRX and Hospice Dynamix announce strategic partnership to reduce pharmacy costs for hospice agencies NBC News Channel 8, Salt Lake City, UT; by EIN Presswire; 5/31/24 BetterRX, a leading hospice pharmacy services and technology provider, and Hospice Dynamix, a revolutionary time-on-service predictive analytics platform, today announced a strategic integration partnership. This collaboration will leverage Hospice Dynamix's proprietary Predicted Length of Stay (PLOS) technology to enhance BetterRX's proprietary medication ordering and management platform, enabling hospice providers to make ordering decisions based on the individual patient, creating immediate savings for the hospice.

Laws in motion to bring ‘Right to Try’ psychedelics at end-of-life Hospice News; by Holly Vossel; 5/21/24Hospice providers are navigating an evolving landscape of laws opening up pathways of access around psychedelic utilization at the end of life. Despite mounting evidence that psychedelics can improve experiences and reduce symptom burden in some terminally ill patients, these drugs remain difficult to access for those wishing to utilize them. Some states and the federal government have considered legislation that would establish a “right to try” psychedelics and other experimental interventions for certain seriously ill patients. 

Optum Rx puts emphasis on predictability with new pricing model Fierce Healthcare; by Paige Minemyer; 5/20/24 Optum Rx is rolling out a new pharmacy model that seeks to make drug costs more predictable and transparent for clients. The Optum Rx Clear Trend Guarantee aligns guarantees into single per member cost, encompassing retail, home delivery, specialty drug and rebate components in one guarantee. It provides an alternative to Optum's Cost Made Clear offering, which includes pass-through models and cost-plus pricing. ... Clear Trend Guarantee will be available on Jan. 1 alongside the existing Cost Made Clear program, Optum said.

A narrative review of risk mitigation strategies in the management of opioids for chronic pain and palliative care in older adults: interprofessional collaboration with the pharmacist Annals of Palliative Medicine; by Insaf Mohammad, Candice L Garwood, Lisa Binns-Emerick Key content and findings: A variety of risk mitigation strategies to improve safety for older adults using opioids exist. They include risk assessment, tapering opioids, reducing high-risk concomitant medications, utilizing non-opioid therapies, screening for and treatment of opioid use disorder (OUD), toxicology testing, co-prescribing naloxone, utilizing controlled substance agreements, reviewing prescription drug monitoring program data, prescriber and patient education, and collaboration with pharmacists and palliative care specialists.

Association between opioid use disorder and palliative care: a cohort study using linked health administrative data in Ontario, CanadaCMAJ; by Jenny Lau, Mary M. Scott, Karl Everett, Tara Gomes, Peter Tanuseputro, Sheila Jennings, Rebecca Bagnarol, Camilla Zimmermann and Sarina R. Isenbergl; 4/29/24Background: People with opioid use disorder (OUD) are at risk of premature death and can benefit from palliative care. We sought to compare palliative care provision for decedents with and without OUD.Conclusion: We identified important differences in palliative care provided at the end of life between people with and without OUD. People with OUD were less likely to receive palliative care despite accessing palliative care earlier, which may reflect their end-of-life illness trajectories and underlying structural vulnerability that may prompt them to receive palliative care primarily in acute care. Health care providers should receive training in palliative care and addiction medicine to support people with OUD. 

Deciphera Pharmaceuticals to be acquired by Ono Pharmaceutical for $2.4 billion LevinPro HC; 4/30/24Deciphera Pharmaceuticals announced on April 29 that it has entered into a definitive merger agreement with Ono Pharmaceutical Co., Ltd. to be acquired for a total equity value of $2.4 billion. Upon completion, Deciphera will operate as a standalone business of Ono, from its headquarters in Waltham, Massachusetts.