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.

The problem of polypharmacy in psychiatry

Allen Frances, MD

Medications

July 14, 2016

Polypharmacy was once the exception in psychiatry; now it seems to have become the rule. Patients frequently are taking 3, 4, even 5 psych meds at one time. And often it’s primary care doctors, not psychiatrists, who are doing the prescribing — usually without adequate training in psychiatry.

Some polypharmacy is rational — e.g., a patient with bipolar disorder who receives the combination of antidepressant and mood stabilizer.

But most polypharmacy is …

Prescription drug savings: You have to know where to look

Miranda Yaver, PhD

Medications

July 11, 2016

I don’t want to need it.

That is a thought that has been all too familiar to me when I venture on the patient side of health care, an industry that I study as a scholar as well with the distance of one investigating a foreign land in which they do not intend to become entrenched.

It is a thought that has been all too familiar as I see added to my …

Did Prince die because he had bad doctors?

Peter Ubel, MD

Medications

June 30, 2016

Prince died of an opioid overdose. A tragic and avoidable fate but, even more tragically, one that is becoming increasingly common in the United States. Some people who overdose live on the edge of society–homeless and with no access to good medical care. Prince, by contrast, had several mansions and a number of physicians actively involved in his care, physicians aware of his problem with opiates. …

The widespread use of fentanyl escalates the risk of overdose

Karen S. Sibert, MD

Physician

June 30, 2016

A fentanyl overdose led to the recent death of musician and singer Prince, according to the medical examiner’s report released June 2. The drug seems likely to become as notorious as propofol did after the death of Michael Jackson in 2009.

For all of us in anesthesiology who’ve been using fentanyl as a perfectly respectable anesthetic medication and pain reliever for as long as we can remember, it’s startling …

People are going broke because they can’t afford care. It needs to end.

Michael P. Jones, MD

Health Policy

June 29, 2016

“I need help with my colitis.”

“Really? I thought we had things pretty well controlled.”

I hadn’t seen her in the better part of a year. I remembered how hard it had been to get her ulcerative colitis into remission. How sick she had been, how miserable her life was. There was a bit of trial and error in the office, followed by a hospitalization for intravenous steroids, then a tapering dose …

How Tylenol may relieve both physical and emotional pain

Manoj Jain, MD, MPH

Medications

June 26, 2016

Last week, when I stubbed my toe on our family room coffee table, a throbbing pain ensued. Over the next two to three days, as the bruise turned pink and then purple, the pain persisted.

During the same time, I had a case of the blues. I am overstressed at work with several staff on vacation, my college-age children had come home and then left to start their internships, and my …

Addressing racial bias in the treatment of pain

Leigh-Ann J. Webb, MD

Physician

June 21, 2016

The opioid (painkiller) epidemic, with its seemingly indiscriminate reach, has embraced an alarming number of Americans. In the most recent statistics available, two million Americans either abuse or are dependent on prescription opioids. Even the death of internationally acclaimed artist, Prince Rogers Nelson, has now been attributed to fentanyl overdose, a strong prescription opioid whose illicit version has become …

How pain scores escalated the opioid crisis

Mark Vierra, MD

Physician

June 10, 2016

“It’s an 8,” I heard him say from behind the curtain as I walked into the room.

The nurse’s aide dutifully recorded the number while the automated blood pressure cuff searched for his pulse, and the plastic clip on the tip of his index finger measured his oxygen saturation.

“What does an 8 mean?” I asked.

“Oxycodone!” he chirped cheerfully, without a moment’s hesitation. “An 8 means oxycodone. Five milligrams!”

“Ah, but you’re wrong,” …

A family physician duped by a patient on chronic opioids

Hans Duvefelt, MD

Physician

May 12, 2016

A woman in her mid-thirties with a terrible limp and a past surgical history in the dozens became my patient two years ago. Her prosthetic left leg served her well, but her right leg was moving awkwardly because of advanced hip arthritis and a formerly shattered ankle.

She was on long-acting morphine and short acting oxycodone. Her Social Security disability insurance didn’t cover the long-acting form of oxycodone.

She told me several …

Don’t forget the power of over the counter remedies

Edwin Leap, MD

Medications

May 3, 2016

I recently had an enormous kidney stone. Well OK, it seemed enormous to me. But in terms of kidney stones, it was reasonably large; 9 mm, in fact. Large enough that I had to have lithotripsy (the use of sound waves to break up the stone) performed by my friend and most excellent urologist, Dr. Robert McAlpine in Seneca, SC.

As uncomfortable as the whole experience was (and it wasn’t my …

God is in the statins

Dr. Saurabh Jha

Medications

April 18, 2016

Of life’s two certainties, death, and cataracts, it seems statins defer one and prompt the other, although not necessarily in the same person. If you blindly love life, you may be blinded by your love for life.

In the HOPE-3 trial, ethnically diverse people without cardiovascular disease were randomized to 10 mg of rosuvastatin daily and placebo. The treatment group had fewer primary events: death from myocardial infarction (MI), non-fatal …

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God is in the statins

How the medical profession can solve the opioid crisis

Robert Pearl, MD

Medications

April 14, 2016

Opioids, also known as opiates, serve as important prescription medications in medical practice. But within the last decade or so, because of their overuse, misuse and abuse, they’ve also emerged as a leading cause of addiction and death.

Sadly and surprisingly, those most instrumental in creating this epidemic — however unwittingly — are physicians and the pharmaceutical industry.

The question is, how could this crisis have happened? What responsibility should physicians take, …

MKSAP: 32-year-old woman is evaluated for anticoagulation management

mksap

Conditions and Diseases

April 2, 2016

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 32-year-old woman is evaluated for anticoagulation management after an uncomplicated vaginal delivery of a healthy newborn. She was diagnosed with a bilateral pulmonary embolism at 25 weeks’ gestation and was treated with therapeutic low-molecular-weight heparin (LMWH). The LMWH was discontinued at the onset of labor and was restarted 6 hours after delivery. Medical history …

Talk to your doctor about health costs. It can save you money.

Peter Ubel, MD

Health Policy

March 30, 2016

Health care is often really costly. And with increasing frequency, a significant chunk of those costs is being passed on to patients in the form of high deductibles, copays, or other out-of-pocket expenses. As a result, millions of Americans struggle to pay medical bills each year.

What’s a poor patient to do?

For starters: They can talk to their doctors about these costs. According to a study my colleagues and …

A doctor confronts his addiction

Peter Grinspoon, MD

Physician

March 21, 2016

An excerpt from Free Refills: A Doctor Confronts His Addiction.

It was a frigid winter day in February 2005, when two officers — one from the state police, one from the Drug Enforcement Agency — arrived at my office and sat waiting amid the spellbinding view of the neighboring arboretum and …

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A doctor confronts his addiction

Ignore Martin Shkreli. Focus on drug prices instead.

Naomi Freundlich

Medications

February 28, 2016

Activism over prescription drug pricing has reached a fever pitch. The recent House subcommittee hearings featuring testimony (or non-testimony in the case of bad-boy Martin Shkreli) from Turing Pharmaceuticals and Valeant executives provided an outlet for public outrage over those companies’ price gouging on life-saving drugs. Meanwhile, presidential candidates Hillary Clinton and Bernie Sanders have both talked up plans to rein in spending on prescription drugs, and even Donald Trump …

Insider tips for drug reps to get more face time with clinicians

Paul B. Kubin, PA-C

Medications

February 22, 2016

Dear drug reps,

I write you today as a primary care provider who — at the risk of giving you “the keys to the kingdom” — has advice for you.

First, I am not anti-pharma. I recognize the need that my patients and I have for new medications, and I believe that innovation in medicine can grow from free enterprise. But it’s rare that I walk away from an interaction with you …

We want access to safe and effective Avastin. Here’s a solution.

Robert Wong, MD

Conditions and Diseases

February 15, 2016

Recently, two states in India halted all use of Avastin for the treatment of eye disease following the report of 15 patients who underwent emergency surgery for potentially blinding infections at the C.H. Nagri Municipal Eye Hospital in Ahmedabad. Though further investigations are ongoing, there is worry that the cluster of infections centered around a tainted lot of compounded Avastin. This most recent event serves as a reminder of …

The games drug companies play can dramatically raise costs for patients

Rob Lamberts, MD

Physician

February 14, 2016

I had a patient last week who was a real pain in the ass. Wait. No. He was actually a really nice guy. He wasn’t a pain in the ass; he had a real pain in the ass. Literally.

I was initially concerned about a pilonidal cyst, given the unfortunate fact that he was previously afflicted with this condition (which I consider to be incontrovertible proof of Satan). But, fortunately to …

Strategies for coping with the side effects of medications

Toni Bernhard, JD

Patient

February 11, 2016

Many of us who suffer from chronic pain and illness are on medications that carry side effects that, in some cases, can be as difficult to cope with as our initial health problems. I’ve recently started a medication that I’m scheduled to be on for five years. I’m taking it because it significantly reduces the risk of a recurrence of my recent bout with breast cancer.

And so, yes, I’m taking …