Technology to Keep Your Heroin Safe?

 

We’re all concerned about the opioid crisis. Americans are dying in increasing numbers from drug addiction. Solutions to this crisis are in great demand.

One such solution growing in acceptance is giving drug addicts the tools to determine if their illegal drugs are safe. Fentanyl, a potent opioid often mixed with heroin and other drugs like Xanax, is a deadly killer. Inexpensive to manufacture, it is combined with other illicit drugs to increase potency and addictive potential. But it is often fatal due to its strong inhibition of respiration.

To combat this problem, a new test strip, originally designed by the medical profession to test urine, is being used to test heroin for the presence of fentanyl.

Arian Campo-Flores, writing in The Wall Street Journal, says overdose-prevention organizations in the U.S. first started buying and handing out fentanyl test strips about two years ago. Now, states like California and Rhode Island and cities such as Baltimore, Philadelphia and Columbus, Ohio are distributing them, or plan to soon.

How will these test strips solve the opioid crisis?

This is an effective way to have people thinking about risks,” said Louise Vincent, executive director of the Greensboro, N.C. chapter of the advocacy group Urban Survivors Union, which has been distributing strips since 2017. “It’s so important to give people as many tools as we can.”

Those who advocate the use of these test strips say the strips provide an additional means of saving lives. Other means include distributing the overdose-reversal drug naloxone and clean needles.

There has been opposition to this new approach. Elinore McCance-Katz, head of the federal government’s Substance Abuse and Mental Health Services Administration, said the approach relied on the flawed premise that drug users would make rational choices. She also said the strips aren’t guaranteed 100% accurate. “We can’t afford to create a false sense of security” for users, Dr. McCance-Katz wrote on the agency’s blog in October. “Let’s not rationalize putting tools in place to help them continue their lifestyle more ‘safely.’”

Do the test strips actually alter drug addict behavior?

Several studies published in 2018 suggest test strips couldalter drug users’ behavior. In one study, among users who tested such drugs as cocaine, heroin and prescription painkillers with the strips, half got at least one positive result, according to researchers at Brown University. Among that half, 45% responded by using smaller amounts of the drug, 42% ingested it more slowly, and 36% did a test hit before taking a full dose.

While test strips may help addicts identify the presence of fentanyl in their heroin or cocaine, this is certainly not evidence that the test strips reduce drug addiction – or even that they save lives. Using less of a drug that can kill you seems a bit like playing Russian roulette with a smaller gun. Sooner or later you’re going to lose.

It seems analogous to teaching your daughter to abstain from sex and then giving her a condom to put in her purse, “just in case.” The mixed message is sure to lead to the undesirable behavior, albeit with perhaps less risk.

 

A Wake-Up Call For Bernie and Friends

 

Venezuela is imploding. Anyone paying attention to the economic disaster taking place in this socialist country could see this coming. As Americans, our concern should be for the increasing clamor of socialist Democrats who want to bring the same disaster to our country.

Mary Anastasia O’Grady, writing in The Wall Street Journal, says the democratically elected National Assembly President Juan Guaido took an oath to become Venezuela’s interim president last week, as prescribed by the country’s constitution. Within hours he was recognized by the U.S. and 20 other democracies, 11 in Latin America. Even the European Union has declared it will recognize Guaido as the rightful interim president if dictator Nicolas Maduro doesn’t agree to a new election by this weekend.

Maduro took over the presidency after the death of his socialist predecessor, dictator Hugo Chavez. Chavez introduced socialism into Venezuela in 1999, then stole, dominated, polarized and jailed anyone who disagreed. Despite the world’s largest oil reserves, the country has suffered economic collapse on an unprecedented scale.

I previously discussed this situation in an earlier post, A Tragic Lesson About Socialism. In that post six months ago the annualized rate of inflation was estimated by economist Steve Hanke at 112% in 2015, and 2,800% in 2017. For the first six months of 2018 it was rising at an annual rate of 65,000%! But the latest estimates by the International Monetary Fund now place that inflation rate at one million percent. That’s not an error – one million percent! 

The response of the citizens of Venezuela has been predictable. O’Grady says, “Not since the fall of the Soviet empire has a nation risen with such fury and determination to throw off the yoke of socialism. And not since then has Marxist misery been so clear for all the world to see. Venezuelans are experiencing what millions of Russians, Chinese, Cubans and countless others have suffered. Destitute and angry, they want it to end.”

Which brings us back to our own country. This very same week California Senator Kamala Harris announced her candidacy for the president of the U.S. and declared her support for the socialist agenda that includes Medicare For All (socialized medicine) and free education for all including college. She also continues to oppose border security and limitations on immigration.

These socialist ideas were once considered ignorant and naïve when espoused by a little-known Vermont Senator Bernie Sanders. But Sanders became a household name when he ran for president in 2016 and nearly beat Democratic front-runner Hillary Clinton. Today Sanders could be easily described as the “Father of American Socialism.”

Sanders’ influence has rubbed off not only on Harris but other Democratic presidential hopefuls such as Senators Elizabeth Warren, Corey Booker, and Kirsten Gillibrand. Perhaps no freshman Congresswoman has ever received more media attention than N.Y. Representative Alexandria Ocasio-Cortez (AOC) who is a Sanders’ acolyte. Are these people blind to what is happening in Venezuela?

Those who do not learn history are doomed to repeat it.”These are the words of Harvard professor George Santayana in 1905. Winston Churchill modified his words in a speech to the House of Commons in 1948 when he said, “Those who cannot remember the past are condemned to repeat it.” The tragic irony of our current situation is that these politicians don’t need to remember anything – they only need to be aware of what is happening in Venezuela as they speak!

Hospitals Pressure Doctors At Your Expense – Part II

 

In Part I of this series, I discussed how doctors in hospital-acquired practices are being pressured to refer their patients to the hospital for medical tests and procedures. The impact of this practice is higher medical costs for insurance and higher out-of-pocket costs for the patient. In Part II we’ll look at how widespread is this practice and how dramatically it impacts referral patterns.

Hospitals routinely rationalize the pressure to refer patients to them as necessary to provide the best care. SwedishAmerican Hospital said, “Patients have the final say in where they choose to receive care. We also believe that there is benefit to patients receiving ancillary services within our health system as it provides opportunities for enhance continuity of care.”

Trinity Health system justified their tracking of physician referrals by saying, “Referral tracking within our network helps us confirm that our providers are creating and optimizing opportunities for coordinated care.”

Phoebe Putney Health system responded by saying, “We do not use our referral tracking data to put pressure on our physicians to refer to their partners within our system. However, if an employed physician routinely refers patients outside of our group without good reasons to do so, then that physician is not demonstrating commitment to the best interest of the patients and may not fit well within our team of outstanding healthcare professionals.”

Doctors, unlike lawyers, do not get paid for making referrals. They have no incentive to refer someone except to be sure they receive the best care possible at the lowest reasonable cost. Only when hospitals put pressure on doctors to refer must the doctor consider issues unrelated to the best interests of the patient – despite the claims of these hospital systems.

How dramatic is the impact of hospital pressure on referrals?

The graphic below is quite impressive. It makes it very clear that referral patterns change when the physician is employed by the hospital.

 

Anna Wilde Mathews and Melanie Evans, writing in The Wall Street Journal, exposed these alterations of referral patterns by hospitals. They say federal rules generally block hospitals from directly tying physicians’ pay to referrals, because of worries that factors other than patient needs could impact physicians; decisions. Doctors and hospital officials said that hospitals make the goals clear in ways both subtle and overt.

Some hospitals have employment contracts that mandate doctors refer within their system, with a few exceptions required by law. They may also try to influence referrals by training sessions for the doctors’ staffs, since doctors often leave the final decision up to them.

Some hospitals have taken extreme measures to enforce doctor compliance. Southern Illinois Healthcare (SIH) has used employment contracts to restrict referrals. One contract viewed by these reporters said the doctor, “shall be required to refer all patients to an SIH facility.”

Documents from an antitrust case filed against SIH by a local surgery center showed the system going further. In a 2014 letter to doctors and managers of the SIH Medical Group, a SIH executive said the group “will no longer refer patients” to two surgeons because  “they regularly take patients” to a rival hospital to do procedures after being referred by SIH physicians.

Dr. Kevin Koth, one of the surgeons referred to in the letter, said, “I don’t conform to what the hospital wants, I do what’s best for the patient.” He said he typically did operations at whichever hospital could schedule the surgery soonest because that was better for the patients.

This issue hits remarkably close to home for me. My own hospital, Orlando Health, is mentioned in the same article. Orlando Health has more than doubled its physician employees since 2010 to more than 550 doctors and acquired local outpatient imaging centers in late 2014. (I am not one of those 550 doctors.)

When the primary care group affiliated with the hospital wasn’t utilizing the acquired imaging centers, they were approached by the hospital to find out why. Poor quality service and higher fees was the explanation. In response, the hospital imaging centers improved service and lowered fees – but only for that group’s referrals. For other physicians the fees remain higher.

The next time your doctor refers you for lab tests, imaging, or medical procedures, ask why he believes that’s the best place to go. You may not like the answer.