Medications and Prescribing

Physicians writing on KevinMD about prescribing: the prior authorization that stands between a prescription and a pharmacy, opioids and the tapers that followed the CDC guideline, GLP-1 drugs and what happens when patients stop them, compounded and direct-to-consumer drugs, shortages, and what a prescription costs the patient. Three maintained records draw on this archive: Prior authorization: what physicians say, in their own words, Opioids: what physicians and pain patients say, in their own words, and GLP-1 drugs: what physicians say about Ozempic and its successors, in their own words.

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 …

Tips to help you afford medications

Roy Benaroch, MD

Medications

September 24, 2018

A doctor writes prescription, pharmacist fills prescription, insurance covers prescription. Simple, right? But that’s not the way it works anymore.

Some changes are good. Gone are the cryptic abbreviations and illegible handwriting — replaced by computer printed scripts, or better yet scripts magically transmitted via the ether. But along with fewer errors there’s even less transparency on pricing and coverage. Patients, who haven’t been to pharmacy school and couldn’t possibly decode the pages of …

Read more…

Tips to help you afford medications

Opioid cheating is a billion-dollar industry

Giri Venkatraman, MD, MBA

Conditions and Diseases

September 20, 2018

If you search for “how to pass a urine drug test” on the internet, you will get several million results. As physicians, we see and manage the national opioid crisis every day. We see the impacts of this in our practices and our lives. The crisis frankly shows no signs of abating or becoming a less critical issue. Unfortunately, one major reason for our inability to control this issue might …

Pain care must be patient-centered, integrated, and individualized

Jianguo Cheng, MD, PhD

Conditions and Diseases

September 5, 2018

Purdue Pharma recently ran a full-page advertisement in the Wall Street Journal and the Washington Post asserting that the company, which manufactures prescription opioids, wants to limit the use of prescription opioids. While this ad may have left some readers confused, one point rang true: “we believe the country needs a new approach to prescribing opioids.”

In its approach to addressing the opioid crisis, Purdue Pharma is encouraging limiting patient access …

The erosion of informed consent in medical research

Ruth Macklin, PhD

Conditions and Diseases

August 21, 2018

The bedrock requirement to obtain informed consent before patients may be enrolled in research has been eroding. I’ve documented the different ways and different reasons for this several times over the years (“Informed Consent for Babies: When Experts Disagree,” “Informed Consent in Infant Research: Ethical Problems Remain,” “Informed Consent in Comparative Effectiveness Research,” and “The Erosion of Informed Consent in Medical Research”). The latest example is a clinical trial of …

Kratom: harmless herbal supplement or dangerous drug?

Dennis Wichern

Medications

August 17, 2018

What is it?

Kratom is a powdered herbal supplement derived from the leaves of a tropical evergreen tree that is native to Southeast Asia and is usually taken orally but can also be brewed into teas.

It is commonly used by consumers as an alternative medicine to self-treat opioid addiction and chronic pain. The leaves contain two compounds, mitragynine and 7-a-hydroxymitragyine, which interact with various receptors in the brain.

At low doses the …

Changing the treatment plan when covering for another doctor

Hans Duvefelt, MD

Physician

August 8, 2018

I was a little taken aback when Dr. C. changed my patient from warfarin to one of the novel anticoagulants. And one I seldom use, at that.

I have only worked with her for about three years, and we seem to come from the same mold: seasoned family docs with a penchant for teaching and patient empowerment. I had not imagined she would step in and completely change my treatment plan …

We should all care when patients get too many Z-paks

Linda Girgis, MD

Medications

August 2, 2018

Many people seem to believe that the Z-pak possesses magical qualities. Patients come in requesting it for the common cold, because it worked for them in the past. Not only do many believe it cures the common cold, but they think it can treat any infection. Have a urinary tract infection? Just ask your doctor to prescribe a Z-pak! Sniffles got you under the weather? Do the same!

Anyone who believes …

The misguided expectation of eliminating pain

Michael Kirsch, MD

Physician

July 31, 2018

I am against all forms of bodily pain, both foreign and domestic. I wish the world were pain-free. When I am suffering from even a routine headache, I want immediate relief just like everyone else. The medical approach to pain control has changed dramatically even during my own career. When I started practicing a few decades ago, the strategy was pain reduction. We gave narcotics for very few indications such …

Are abuse-deterrent opioids the solution to the opioid crisis?

Tiffany Lu, MD

Medications

July 17, 2018

As a primary care doctor who cares for many patients with opioid-use disorder, I am invested in timely and effective strategies to curb our nation’s opioid epidemic. Because so many instances of opioid addiction and overdoses begin with or involve commonly prescribed opioids, we need multiple strategies that address the significant harms associated with prescription opioids.

I am skeptical of one strategy, however: The President’s Commission and the Food and Drug Administration are …

Why do so few doctors treat people with opioid addictions?

Patrick Skerrett

Conditions and Diseases

July 15, 2018

Dear Doctor,

Please help me understand why so few of you have chosen to treat people with opioid addictions.

I’ve been following the topic of opioid addiction for years. It is one of the most common themes for First Opinion submissions. Authors routinely point to the importance of medication-assisted therapy, the standard of …

10 ways to stay out of the DEA’s crosshairs

Dennis Wichern

Physician

July 12, 2018

No news attracts attention like a physician who’s in trouble with DEA or their state medical board. So, how does it happen, what are the common issues and what can a physician do to safeguard themselves?

First, let’s look at what the numbers and the research tell us.

The Federation of State Medical Boards (FSMB) tells us that 4,091 physicians were disciplined during …

Want to dispose of drugs properly? Here’s how.

Dennis Wichern

Medications

June 7, 2018

According to Bloomberg, Americans spend more on prescription drugs per year than any other country in the world at around $1,100 per person.

Additionally, the CDC reports that four out of five new heroin users started their addiction by using prescription opioid painkillers like hydrocodone or oxycodone.

And we know from the Partnership for a Drug-free America that students and young adults oftentimes …

To Paxil, with love

Jennifer L. Barkin, PhD

Medications

May 12, 2018

In 1994, Penguin Books published what would become a national bestseller titled, Listening to Prozac written by Dr. Peter Kramer, a Clinical Professor of Psychiatry at Brown University at the time. Throughout the book, he debates the ethics of “cosmetic pharmacology” a term associated with the transformation of personality traits through medication. Kramer describes several patients as becoming “better than well” on Prozac — more socially adept, less inhibited, and …

Read more…

To Paxil, with love

Internet support forums for benzodiazepine withdrawal: the good, the bad, and the ugly

Christy Huff, MD

Physician

May 5, 2018

Since the advent of the internet and rise of social media, patients can connect and compare their experiences with prescribed drug withdrawal. A problem that was once considered rare is a worldwide epidemic that is finally getting noticed. A recent New York Times article discussed the problems many have discontinuing antidepressants, and more than 8,800 readers responded about their difficulty stopping …

It’s time to start thinking about cannabinoids

Virginia Thornley, MD

Conditions and Diseases

April 4, 2018

A patient comes to you asking, “Doc, my seizures are getting worse, I really hate the side effects of my medications, I want to go a different route. What do you think about medical marijuana?” You start sweating profusely, fidgeting in your seat, thinking of every single reason why not to recommend it and come up with the standard response, “Uh, well, I’m not qualified to recommend it, and it’s …

Take a pill and stop aging. Really?

Stephen C. Schimpff, MD

Medications

January 6, 2018

Part of a series.

A pill to end aging.

Is there or could there be such a pill? Some researchers think so.

Many believe that rather than attack the causes and treatment of chronic illnesses one by one, it would be better to understand the biology of aging and from that learn how to slow the process and hence prevent or delay the onset of various …

Read more…

Take a pill and stop aging. Really?

Here’s why direct-to-consumer drug ads need FDA oversight

Zachariah Tman

Medications

December 25, 2017

Many physicians in different fields have voiced criticisms against direct-to-consumer (DTC) prescription drug ads. First, a 2013 survey found that 74 percent of physicians believe DTC drug ads overemphasize the benefits of the drugs and misinform patients. Steven Nissen, a Cleveland Clinic cardiologist, interviewed by Rebecca Ruiz on DTC prescription drug ads states, “It’s almost impossible for the public to actually parse the ads and come …

A psychiatrist’s perspective on the digital pill

Maria Yang, MD

Health Technology

December 2, 2017

One of my readers, Natalie, wondered about my thoughts about the digital pill.

My initial reactions were similar to several of those who were interviewed for the article. The digital pill, which provides electronic information to confirm whether someone has ingested the medication, has great potential to become a tool of coercion. Aripiprazole (Abilify) is classified as an antipsychotic medication, which is often prescribed to people who have beliefs that machines …

Medications and Prescribing

Medications and Prescribing

Most Popular

Past Week

Past 6 Months

Recent Posts

Subscribe to KevinMD and never miss a story!

Most Popular

Past Week

Past 6 Months

Recent Posts