CDC urges providers to consider risks of opioid treatments

Although opioid prescriptions declined for five years since a peak in 2010, the Centers for Disease Control and Prevention (CDC) found that the highest-prescribing counties dispensed six times more opioids per resident in 2015. The CDC urges providers to consider evidence-based guidance for opioid prescriptions and weigh the risks and benefits of such treatment with patients.

Demographics

According to the CDC’s Vital Signs report, a breakdown of the number of opioids prescribed per person in 2015 by county revealed considerable variation, with clusters of high-rate counties located in various places across the country. The CDC believes that the variation reveals inconsistencies among providers who prescribe opioids. Counties with higher prescribing tended to have small cities or large towns, more white residents, more dentists and primary care providers, a higher rate of uninsurance or unemployment, and more people with a chronic condition like diabetes or arthritis, or a disability.

Issues

The CDC identified three specific issues with high prescribing that pose risks for patients. In 2015, there were enough opioids prescribed to keep every American constantly medicated for three weeks. This level of prescription may indicate that providers need to consider more non-opioid treatment options, such as physical therapy and other medications, and only use opioids when the benefits are most likely to outweigh the risks.

Even for those on low doses, taking an opioid for more than three months increases a patient’s risk of addiction 15 fold. When treating acute pain, opioids should only be prescribed for the expected duration of severe pain. In addition, a dose of 50 morphine milligram equivalents (MMEs) or more per day doubles a patient’s risk of overdose death. The CDC believes that the average daily MME per prescription remains too high.

Resources

The CDC recommends continuously balancing risks and benefits throughout opioid treatment, from the starting prescription through dosage increases. The agency’s Guideline for Prescribing Opioids for Chronic Pain outlines when a provider should initiate or continue opioids for chronic pain, treatment options, and risks and harms of opioid use.

AGs request Medicaid policy change to fight in-home elderly abuse, neglect

The Centers for Disease Control and Prevention’s (CDC) estimate that one in 10 people aged 65 and over who live at home will become the victim of abuse has drawn the attention of the National Association of Attorneys General (NAAG). Millions of people in this age group are enrolled in Medicaid and the NAAG believes that a change in policy allowing federal funds to investigate more abuse and neglect cases—even those that occur in the home—will help.

Medicaid Fraud Control Units (MFCUs) are charged with investigating and prosecuting state Medicaid provider fraud as well as resident abuse and neglect complaints at Medicaid-funded health care facilities, and can choose to look into complaints at board and care facilities. The MFCUs usually operate within the state attorney general’s office. Because there are strict limitation on the use of MFCU funds to investigate fraud and abuse, the NAAG is now asking Secretary of HHS, Tom Price, to replace or eliminate the “outdated” policies. Instead NAAG provided two recommendations to the Secretary: (1) allow MFCU funds to investigate and prosecute abuse and neglect of Medicaid beneficiaries in non-institutionalized settings; or (2) allow use of MFCU funds to freely screen or review any and all complaints or reports of whatever type, in whatever setting.

The May 10, 1017, letter to Price was signed by attorneys general of 37 states and the District of Columbia. Montana Attorney General Tim Fox noted “abuse and neglect in the home takes many forms, including physical abuse, sexual abuse, and drug diversion. Abuse and neglect is perpetrated by family, friends, and caregivers alike. The requested change in policy would allow our MFCU to investigate reports…regardless of where they reside, whether it’s a home or in a healthcare facility.” David Y. Chin, Attorney General of Hawaii, cited “[the Hawaii MFCU] receives thousands of complaints relating to fraud and abuse and neglect every year…We hope that the federal government will hear our concerns and support our efforts to protect Hawaii’s most vulnerable residents.”

Owner of compounding company at the center of the 2012 meningitis outbreak acquitted of murder

A Boston jury convicted Barry Cadden, the owner and head pharmacist of the New England Compounding Center (NECC), of racketeering and mail fraud in connection with the 2012 nationwide fungal meningitis outbreak but acquitted him of 25 second-degree murder charges. His sentencing is scheduled for June 21, 2017; he faces a statutory maximum sentence of up to 20 years’ imprisonment on each of the mail fraud and racketeering counts.

Outbreak. In September 2012, the Centers for Disease Control and Prevention (CDC) began investigating a multistate outbreak of fungal meningitis and other infections among patients who received contaminated preservative-free methylprednisolone acetate (MPA) steroid injections from NECC. The CDC reported that 753 patients in 20 states were diagnosed with a fungal infection after receiving injections of NECC’s MPA. Of those 753 patients, the CDC reported that 64 patients in nine states died.

Indictment. In December 2014, the U.S. Attorney’s Office in Massachusetts announced a 131-count federal criminal indictment in connection with the outbreak. Cadden and NECC’s supervisory pharmacist, Glenn A. Chin, were charged with 25 acts of second-degree murder in Florida, Indiana, Maryland, Michigan, North Carolina, Tennessee and Virginia. Twelve other individuals associated with NECC, including six other pharmacists, the director of operations, the national sales director, an unlicensed pharmacy technician, two of NECC’s owners, and one other individual were charged with additional crimes.

Prosecutors alleged that Cadden directed and authorized the shipping of contaminated MPA nationwide. In addition, he authorized the shipping of drugs before test results confirmed their sterility, failed to notify customers of nonsterile results, and compounded drugs with expired ingredients. NECC also used fictional and celebrity names on fake prescriptions to dispense drugs.

 

Highlight on Indiana: Lead and arsenic contamination causes health problems for children in East Chicago

Approximately 1,200 residents of the West Calumet public housing complex in East Chicago, Indiana, are looking for new homes after dangerously high levels of lead and arsenic in the area’s soil were detected. The Indiana State Department of Health (ISDH) is partnering with the East Chicago Health Department to offer free blood lead testing clinics for city residents, particularly those living in the West Calumet Housing Complex. However, a lawyer for some of the complex’s residents says it may already be too late; he reports that 85 children have tested for high lead levels.

East Chicago

East Chicago, Indiana, has about 30,000 residents. According to the Environmental Protection Agency, multiple manufacturing facilities in the area could have caused the contamination. The U.S. Smelter and Lead Refinery Inc. operated as a primary and secondary lead smelter in East Chicago from 1920 to 1985. Smelting operations generated waste materials including blast-furnace slag and lead-containing dust, and volatilized metals, including arsenic. Some of the waste materials were stockpiled south of the plant building and spread over an adjoining 21-acre wetland, and some lead-containing dust was deposited on area soils by the wind. Other potential sources of lead and arsenic contamination in the residential area include the former Anaconda Copper Company site, which manufactured white lead and zinc oxide, and the E.I. DuPont de Nemours Company facility, which manufactured the pesticide lead arsenate.

Soil contamination

In parts of the West Calumet Housing Complex, soil tested high for levels of lead and arsenic. Residents have been notified about these results, and warned not to allow children to play in dirt. The Agency for Toxic Substances and Disease Registry, advises parents to prevent children from playing in dirt or mulch, to wash toys regularly, and to wash children’s hands after they play outside. All residents should remove shoes before walking into their homes. Residents have also been advised to not disturb the mulch or dig or garden in their yards.

The Environmental Protection Agency initially planned to clean up the area by removing and replacing two feet of soil; however, after delays and accusations of not going far enough to protect residents, East Chicago Mayor Anthony Copeland ordered the removal of all complex residents.

Lead poisoning in children

According to the Mayo Clinic, lead poisoning can affect anyone of any age, but children under six are the most at risk. The signs and symptoms of lead poisoning in children may include:

  • Developmental delay
  • Learning difficulties
  • Irritability
  • Loss of appetite
  • Weight loss
  • Sluggishness and fatigue
  • Abdominal pain
  • Vomiting
  • Constipation
  • Hearing loss