Chronic Pain Update – Canada Easing Opioid Restrictions – COVID-19

Chronic Pain Update – Canada Easing Opioid Restrictions – COVID-19

We are sharing three updates of developments that we want to make sure you are aware.

Medicare Comment Period Ends Monday

You have until this Monday (April 6th) at 5 pm Eastern time to comment on some proposed technical changes in Medicare and Medicaid Programs. They call for technical changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicaid Program, Medicare Cost Plan Program, and Programs of All-Inclusive Care for the Elderly

This proposed rule would revise regulations for the Medicare Advantage (Part C) program, Medicare Prescription Drug Benefit (Part D) program, Medicaid program, Medicare Cost Plan program, and Programs of All-Inclusive Care for the Elderly to implement certain sections of the Bipartisan Budget Act of 2018, the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act, and the 21st Century Cures Act. This proposed rule would also enhance the Part C and D programs, codify several existing CMS policies, and implement other technical changes.

You can comment here

Canada Eases Opioid Restrictions

Chronic Pain Advocate Richard “Red” Lawhern PhD sent this note around from Health Canada which has eased opioid prescribing restriction. His suggestion—a sound one—is to let your State Medical Board know what they have done.

Health Canada’s concessions for opiate medications during the Covid-19 pandemic are a start – but only a start.

In an edict issued March 19th, Health Canada is allowing pharmacists to:

  • extend opiate prescriptions to pain patients.
  • transfer prescriptions to other pharmacies.
  • accept verbal subscriptions over the phone from physicians.
  • deliver opiates directly to the patient.

How Has COVID-19 Impacted Your Care?

We should have asked before now, but we’re interested in how the COVID-19 public health emergency impacted your medical care?

Is your doctor more or less available to you because of the COVID-19 public health emergency?

Are you having more or less problems getting your prescriptions filled?

Are you working with your doctor/nurse practitioner/practice through telemedicine? If so, is it working well or badly?

We will publish some of the responses.

Thanks and Be Safe!

Subscribe to our blog via email

Enter your email address to subscribe to this blog and receive notifications of new posts by email.

Authored by: Ed Coghlan

18
Leave a Reply

2000
18 Comment threads
0 Thread replies
0 Followers
 
Most reacted comment
Hottest comment thread
15 Comment authors
  Subscribe  
newest oldest
Notify of
Anthony Harding

Most doctors in the United States are worthless, not all of them just about 90% of them. They don’t care about a patients wellbeing. I suffer from depression and PTSD from losing my wife and daughter in an auto accident. But my pain doctor says if I’m being treated for pain I’m not allowed to take medication from depression or anxiety because of the laws. People who need help are being punished because some people want to be junkies, it’s not fair. I go through extreme anxiety and depression every day and on top of that the chronic pain from being crushed in a car accident. My doctor says” well just get over it” it disgusts me he says this. When did the doctors and government become so heartless?? Oh yeah I know it was when junkies were dieing, so they said we can just screw over the disabled and chronic pain suffers and that will fix everything.

Elizabeth Rogers

WAY too involved and detailed for such a short review period–even for those knowledgeable about the ridiculously arcane terminology. All these “rules” are a waste of time and effort, IMO. A good starting point (once the C-19 pandemic wanes): why not correctly classify compliant use of prescribed medication vs. illicit use of street drugs and allow licensed physicians to treat their legitimate patients without the DEA threatening their livelihoods? What a concept!

Thomas Wayne Kidd

My pain doctor is insisting that I keep my appointment in person. He is still being an uncaring practitioner. I will have drive 85 miles one way and see him as always. Our governor has said not to do this. The evil opioid medications policy and the Covid19 virus are direct effects one of the other. But blind people cannot see.

Cindy too

Ed – I have skimmed the below comments. It seems that most people are not aware of the DEA emergency order relaxing opioid rules for the duration of the national public health crisis declared by the national surgeon general.
so perhaps you could remind people of this fact, periodically.

Stephen

I love telemedicine, I actually get to talk to my doc on the phone! In the process of my moving 1/2 way cross country, my doctor has committed to support me through my transition to new city, finding new doctors, etc. Because of the national emergency he can send electronic scripts to my new city and state.
In California, my former residence, there are some drugs dosages not available but by working with my doc, we found suitable substitutes. Maybe this emergency will bring back some compassion especially when we get a new administration in November,

Jeanette French

I dont know yet how this is working and having to say by Monday is too soon, considering this crisis just started we need more time to see how all these new rules work out.

Badger

Nobody gave a damn today, nobody will give a damn tomorrow.

I feel lucky to have my pain doctor. So far this awful virus has not affected my care. But the opioid crisis has. My doctor is afraid to give me stronger pain meds of the one that works. The telemedicine just became available, but I’m not sure if my insurance will pay. I will be calling my doctor on Monday. I am still working and will as long as I can.

Thanks for this chance to voice myself.
Billie J Vazquez (NC)

I live in a rural area where it’s mostly small farm towns & our medical clinic is all we have without driving more than hour to see a Dr or hospital. They are not doing the telemed for chronic pain pts which I am happy about. Any Dr doing the telemed for cpp needing opiods is opening themselves up to being a target from DEA when the virus is over. If they took out these Dr’s it would be a very big knock out to our community.

Wendy R Burnett

Wendy R Burnett
I tried to get a 3 month supply of my pain medication fearing there could very well be a problem with getting needed supplies from China and manufacturing here. My drug plan finally agreed to authorize . However, my pharmacy refused to fill the prescription fearing the DEA would close them down for dispensing such a large quantity of opiods. I have intractable pain from Adhesive Arachnoiditis.

Wendy R Burnett

I tried to get a 3 month supply of my pain medication fearing there could very well be a problem with getting needed supplies from China and manufacturing here. My drug plan finally agreed to authorize . However, my pharmacy refused to fill the prescription fearing the DEA would close them down for dispensing such a large quantity of opiods. I have intractable pain from Adhesive Arachnoiditis.

Cindy too

Part 2

The DEA Order says it’s subject to state laws, and it allows for phone rx’s for opioids. The FL order is silent about phone rx’s.

No one could tell me the answer — given what the 2 orders say, are phone rxs allowed in FL?

For me, in the end it didnt’ matter b/c my PM finally used electronic rx’s instead of paper. But it may matter for others.

Also worthy of note –
my state senator sent me a prompt reply to my email, but with wrong info. Her email sent me the regular FL State of Emergency law, which relaxes normal rx laws during declared states of emergency. BUT, that law expressly excludes Schedule II drugs from that relaxation — meaning that even in declared States of Emergency — which happen here kind of often due to hurricanes — the normally super strict opioid laws remain in effect.
When I emailed her back about this issue, and that it’s cruel and immoral to keep regular opioid laws in place during states of emergency, I got no further reply. Meteorologists are predicting a very bad hurricane season here and so this is another reason for stress on top of the virus.

Anyway, I think it’s important to note that our legislators do not necessarily know what the laws are and so informing them is super important. With the virus crisis, this may not be the best time to get anyone’s attention about non-virus issues, but when the crisis passes, I hope everyone will contact their legislators, governor, state boards, etc.

Cindy too

I had my monthly PM appt this week by laptop. Florida now has an emergency order (google it at FL DOH 20-002 and see the first full paragraph on page 3) that is similar to the DEA Order which is at deadiversion.usdoj.gov/coronavirus.html. But the federal order is a bit broader and lasts longer.

To begin the appt, my PM’s office sent me an email and I linked to it and we were on a tele-appt. It was that easy.
No need for Zoom like another doctor used for me this week, and now there’s a scandal that so many Zoom calls are available for anyone to see.

My PM has always insisted on paper Rx’s even though electronic rx’s are legal in FL, but this week he finally used electronic system. I’m so happy b/c going to Walgreens each month and standing in line and hoping they have what I need in stock and then waiting the hour average is so awful. Now I can just pick it up in the drive thru.

fyi, The DEA Order allows phone rx’s for opioids. The FL Order is silent.

Walgreens is delivering most rx’s for free, but not opioids. I’m not surprised.

And, I asked my PM for a larger Rx due to fear of shortages. He said no and also said he doesn’t believe there will be shortages. Nothing I could do, but, he is so wrong about shortages. The AMA has warned of them; and Wapo today has a News Alert about them; and the Canadian company I use for one very expensive Rx sends frequent emails about shortages and supply chain issues; that even if the drugs are available, there are no planes etc for transport.

Before I knew of the FL Order, I emailed my governor, Dept of Health, state legislators, fed legislators, and state Bd of Medicine, Bd of Health, Bd of Pharmacy.

I got few replies; most were worthless but one informed me of the FL emergency Order. But no one could answer my questions about differences between the DEA Order and FL Order.

See part 2

CarolynRombardo

I brought my scripts to the pharmacy….through the drive up …n..they were ready in one hrs time…..not the usual 4 to 5 hrs wait….it was a stark reminder of how much things have changed since quidelines were put into place…how hard its become at every point…the stress level …Its the only good thing thats come out of this nightmare Covid-19….back to the days…when being crippled and 24-7 pain…..was a good enough reason to expect some relief..E

Margie

Glad government saving lives during covid 19 but confusing on no/yes none medical ware mask. Saying people can be carriers but asymptomatic but their breath carries covid 19 droplets that others inhale. So if there can be asymptomatic carriers than why cant there be pain people who are not addicts? Just a thought.
Yes, virus is new to U.S but the medical use of opiates are not.

Barbara Danley

My niece and myself have been fighting for 2 years for the medicine my sister was on for 10 years. We are waiting for a doctor who is tirf rems to check her medical records, over8,000 pages, to treat her. It was apparently it was medically necessary and appropriate for 10 years, for her. She was always compliant and took it as ordered, with no side effects. She has a autoimmune disease that has caused her to have a partially necrotic left kidney, has a complete artificial aorta, blood thickening disease, intractable pain, and has now been bedridden for 2 years. She was a palliative care patient through her pain management doctor. Nothing has changed for her, she has 51 documented allergies and servers autoimmune reactions. I hope things wii change here in NJ for the patients who actually NEED this type of pain medication. There is a big difference between addiction and dependence on a medication that is actually needed for physical pain, not mental pain. Pain management doctors should be able to tell the difference. Patients who actually need it have proper documentation, proper lab test, and should not be punished for those who never needed it in he first place. If anyone knows a tirf rems doctor in south jersey I would love to have a name. I know she will be approved for her medication, just need a doctor. She is getting weaker each day that passes.

Deb

Hi,
Just wanted to say I got my comment in on the Medicare and Medicaid thing this morning. I hope more comments. Stay safe everyone.
Deb

Bram Judy Cast

I have not had a problem filling my prescriptions. Hopefully this will continue.
I do have a telemed appointment the end of April. We’ll see how that goes. But so far I have to physically pick up my prescriptions from the office. I wish they could be called in.
So far my doctor has been available for me. I just email her on their medical app.
Stay safe Everyone!

Bram