Medications

Physicians writing on KevinMD about the drugs they prescribe and the ones they cannot get: prior authorization and step therapy, opioid prescribing and the tapers that followed the CDC guideline, the GLP-1 drugs from Ozempic to oral Wegovy and what happens when patients stop them, shortages, compounded versions, and what a prescription costs the patient. Three maintained records draw on this archive: Opioids: what physicians and pain patients say, in their own words, Prior authorization: what physicians say, in their own words, and GLP-1 drugs: what physicians say about Ozempic and its successors, in their own words.

The insanity of American health care prices played out in this one, real oncology appointment

Peter Ubel, MD

Medications

December 3, 2018

The oncologist had prescribed Xgeva hoping it would strengthen her bones while also delaying the progression of Angela Kahn’s breast cancer. But Kahn (a pseudonym) couldn’t get over the price of the drug. Before the oncologist had a chance to ask how she was feeling, she blurted out that the medication cost “$15,000 a shot.” “That’s crazy,” the oncologist replied, continuing by saying the price “fits right in with the …

The recent fish oil and vitamin D studies: Go beyond the headlines

Mary Chris Jaklevic

Medications

December 1, 2018

Results of a much-anticipated trial on fish oil and vitamin D generated conflicting headlines recently.

Some stories declared good news about the popular supplements.

Reuters wrote that fish oil “can dramatically reduce the odds of a heart attack while vitamin D’s benefits seem to come from lowering the risk of death from cancer.”

The Washingto n Post reported fish-oil medications were found “effective” in protecting …

Beware the hazards of over-the-counter (OTC) pain medications

Abeer Arain, MD, MPH

Medications

November 29, 2018

A 30-year old male patient was recently admitted to my service via the emergency department. He came in complaining of abdominal pain and dark tarry stools. He mentioned a recent fall resulting in knee pain for which he had been taking 400 mg ibuprofen four times daily. He underwent upper GI endoscopy and was diagnosed with a bleeding gastric ulcer from his self-prescribed misuse/overuse of ibuprofen.

Fortunately, he recovered, but this …

3 ways pharmacists can change your prescribing habits

Alex Barker, PharmD

Medications

November 28, 2018

As the health care landscape evolves, health care provider roles continue to shift.

Industries recognize the power of collaboration and the strength of communication between different providers; among those, the pharmacist and the physician.

Unfortunately, doctors and pharmacists have historically had strained relationships. In many cases, communication suffers, which can lead to adverse drug events (ADEs), or harm caused to a patient as a result of medication exposure.

It’s worth noting, though, that …

Don’t miss this adverse drug reaction when tapering benzodiazepines

Christy Huff, MD

Medications

November 27, 2018

“Alice Woods” is dying of metastatic breast cancer, but she cares little for awareness efforts like pink ribbons and catchy hashtags like #stage4needsmore. You see, Alice has akathisia due to an adverse effect from discontinuing Klonopin — a condition that has caused her far more suffering than her terminal cancer. It has also prevented her from receiving adequate cancer treatment and is, therefore, ending her …

Suboxone for pain makes sense. Why don’t more doctors prescribe it?

Hans Duvefelt, MD

Medications

November 19, 2018

Many patients who end up in Suboxone treatment have chronic pain. They were originally prescribed other opiates and ended up addicted to them.

Skeptics argue that is just substituting one opiate for another. But that isn’t quite accurate. More on that in a bit.

In my seven years of prescribing Suboxone for opiate addiction, I have often observed how potent a pain reliever this medication is, even in fairly low doses. More …

The thorny side of medical marijuana

Barbara Ficarra, RN, MPA

Medications

November 15, 2018

Patients legally using medical marijuana (cannabis) at home may be stunned if they are admitted to a hospital because many hospitals may prohibit them from using it.

In the United States, medical marijuana is legal in 31 states, and research shows that medical marijuana can effectively treat pain — but patients beware. The issue of medical marijuana is a complicated one, and patients may be precluded from …

Read more…

The thorny side of medical marijuana

Students shouldn’t take Adderall as a study aid

Roy Benaroch, MD

Medications

November 13, 2018

College students work hard, and many are looking for ways to improve their studying and learn more effectively. Getting more sleep and more exercise would probably help, but up to a third are trying ADHD medications to see if pills can give them that extra boost. A small, recent study shows that they’re not getting the effect they’re looking for.

We’re not talking, here, about teens who have ADHD. There’s …

3 ways physician-pharma partnerships are improving quality of care

Jack Pinney, MD

Medications

November 4, 2018

We’ve all heard about the importance of greater stakeholder collaboration in health care. It’s the premise of current movements aimed at improving the outlook on some of the most costly, chronic conditions.

Like most physicians today, I maintain a tight work schedule to keep bottom-line margins in the black. On a daily basis, I see between 25 and 30 patients while also serving as the medical director of employee health for …

When Western medicine fails patients and clinicians

Kimberly Rogers, MD

Medications

November 3, 2018

It’s a common scenario: a patient shows up to my office lugging a bagful of over-the-counter supplements, defiantly informing me that they “don’t believe in prescription drugs.” In the very next breath, they present a lab slip with a list of bloodwork that their alternative medicine doctor wants me to order to help diagnose their myriad symptoms.

I’ll admit, my initial natural reaction in this situation was a feeling of annoyance …

Market-based approaches solving the opioid epidemic

Julie Craig, MD

Medications

October 17, 2018

Mary first took oxycodone after a minor surgery and found she liked it. Returning to her surgeon a month later with vague ongoing pain, she received another prescription. Her primary care provider took over from there — until one day that physician checked a urine drug screen and a prescription monitoring program (PMP) report, only to find that she was obtaining various opioids from several providers. The physician cut her …

A physician’s breakthrough against prior authorization

Niran S. Al-Agba, MD

Medications

October 15, 2018

A few weeks ago, I saw a young patient who was suffering from an ear infection. It was his fourth visit in eight weeks, as the infection had proven resistant to an escalating series of antibiotics prescribed so far. It was time to bring out a heavier hitter. I prescribed ciprofloxacin, an antibiotic rarely used in pediatrics, yet effective for some drug-resistant pediatric infections.

The patient was on the state Medicaid …

Take a close look at the number of opioid pills you’re prescribing

Tia Powell, MD

Medications

October 15, 2018

Recently, a generally healthy friend of mine had two small, unrelated surgeries over the course of a few months. For the first, a small operation on his hand, he received a prescription for 30 oxycodone pills. He used one the night after surgery, to make sure pain wouldn’t wake him. Over the next few days he used a few over the counter acetaminophen tablets for his modest discomfort, and then …

Telemedicine should be easy. Here’s why it’s not.

Dennis Wichern

Medications

October 12, 2018

Who was Ryan Haight?

Ryan Haight was an 18-year-old honor student from La Mesa, California who died on February 12, 2001, from an overdose of hydrocodone ordered from an online doctor he never saw — and shipped to his home from a rogue online pharmacy during the beginning of the opioid epidemic.

The pharmacist, Clayton Fuchs, filled the online prescription …

Stop stigmatizing medication-assisted treatment

Brandon Jacobi

Medications

October 12, 2018

Imagine yourself as a patient burdened with a chronic disease that necessitated daily medication adherence to function. Now imagine that medication has become so stigmatized by society that you feel judged and ashamed every time that you use it. That’s the world that individuals with opioid use disorder are forced to live in when they’re prescribed methadone or buprenorphine to get through the day. Without these medications, Read more…

Stop stigmatizing medication-assisted treatment

At the top of patients’ wish lists: price transparency

Miranda Gill, MSN, RN

Medications

October 11, 2018

One of the most important factors on patients’ minds is affordability of care. According to a recent McKinsey study, 72 percent of consumers are concerned about at least one kind of health care expense, be it related to health insurance, routine medical procedures, end-of-life care or otherwise.

As it pertains to prescriptions, patients carry these affordability concerns from their providers’ offices to the pharmacy. More often than not, …

Doctors as the gatekeepers of marijuana is a race to the bottom

John Schumann, MD

Medications

October 10, 2018

This year Oklahoma voters made a clear choice to legalize medical marijuana, joining thirty other states that permit cannabis for medicinal use.

Unsurprisingly, immediately in the vote’s aftermath, patients began asking me to “prescribe” medical marijuana licenses, as the new law stipulates users must have as a precondition for legal purchase. The new law does not, however, specify qualifying diagnoses for which medical marijuana might be clinically …

How to avoid negative press and fines during the opioid crisis

Dennis Wichern

Medications

October 5, 2018

No news is good news.

Especially for hospitals in the middle of the opioid epidemic.

Recently, the University of Michigan Health System (UMHS) agreed to a civil penalty in the amount of $4.3 million for failing to prevent opioid drug diversion and federal recordkeeping violations as a result of a DEA investigation. The headline from the U.S. Attorney’s Office, Eastern District of Michigan read: “Eastern District of Michigan …

The way U.S. drug makers price their products is legal, but it’s not moral

Robert Pearl, MD

Medications

October 3, 2018

While walking through the duty-free at Dulles International Airport in Washington, DC, I happened upon the price tag of an imported French purse. Looking around, I wondered how many travelers could afford a $2,000 handbag.At the gate, I found a seat and logged on to the internet, where I happened upon a story about the CEO of Nostrum Laboratories, Nirmal Mulye. In an interview, Mr. Mulye explained why he raised the …