Among Teenagers Marijuana Use on the Rise

More teens are turning to pot and see it as less of a risk at the same time alcohol use among the same age group has dipped to historic lows, according to an annual national survey of drug use released Wednesday. The findings were based on a survey of 47,000 eighth-, 10th- and 12th-graders conducted by the University of Michigan for the National Institute on Drug Abuse ( see http://www.ns.umich.edu/new/multimedia/9-videos/20124-marijuana-use-continues-to-rise-among-us-teens-while-alcohol-use-hits-historic-lows). Among the more important findings from this year's Monitoring the Future survey of U.S. secondary school students are the following: Marijuana use among teens rose in 2011 for the fourth straight year—a sharp contrast to the considerable decline that had occurred in the preceding decade. Daily marijuana use is now at a 30-year peak level among high school seniors. Synthetic marijuana," which until earlier this year was legally sold and goes by such names as "K2" and "spice," was added to the study's coverage in 2011; one in every nine high school seniors (11.4%) reported using that drug in the prior 12 months. Alcohol use—and, importantly, occasions of heavy drinking—continued a long-term gradual decline among teens, reaching historically low levels in 2011. Energy drinks are being consumed by about one third of teens, with use highest among younger teens. SUMMARY: The proportion of young people using any illicit drug has been rising gradually over the past four years, due largely to increased use of marijuana—the most widely used of all the illicit drugs. The proportion of students reporting using any illicit drug other than marijuana has been following a gradual decline for some years, but has remained fairly stable over the most recent three years, with 2011 levels being similar to the 2008 levels. Yours Bernd

Florida Medicaid Pilot

On Thursday the federal officials agreed to extend Florida's five-county Medicaid managed-care experiment to 2014 but required the state to make significant improvements to the program. They include the denial of the medical-loss-ratio waiver requiring the participating private health plans to spend 85 percent of funds on patient care and the denial to cap benefit levels for Medicaid beneficiaries preventing the termination of Medicaid services because recipients had already met their $500,000 maximum for the year. These requirements will protect patients from arbitrary insurance service denials and will force private health insurance plans to manage taxpayers dollars efficiently and responsibly. Meanwhile, we should continue to oppose any expansion of the pilot project UNLESS the State of Florida can provide solid and indisputable data that the pilot project improves access and enhances the quality of care for all  Medicaid enrollees. So far I have not found any evidence to substantiate Governor Scott's claim that "we've seen higher quality in administration of care, produced cost savings and consumers in the pilot have found improved access for Medicaid recipients." Looking forward to your feedback. Yours Bernd For more information see: http://htpolitics.com/2011/12/15/feds-make-key-decisions-on-medicaid-and-health-insurance-for-floridians http://blogs.orlandosentinel.com/news_politics/2011/12/what-is-changing-in-florida-medicaid-maybe.html

Prescription Drug Abuse Update

Attached you find facts and information regarding the prescription abuse epidemic in the US and Florida: In October 2011 the Drug Enforcement Administration on Friday announced the formation of a new squad created to solely investigate the illegal use and distribution of prescription drugs in Central Florida. That squad is investigating rogue doctors and pharmacies, and details of their first probe — involving a Winter Park pharmacy — was one of several cases statewide announced by the nation's top law-enforcers. In this context it is of concern in June 2011, DEA received 263 applications for new pharmacy licenses nationwide. Of those, 139 were from Florida. That means that the drug dealers in white coat referring their "patients" to "friendly" pharmacies to fill their prescriptions for controlled substances. Most of these clinics are probably owned by the same business people who run pain clinics. About 170,000 Medicare patients sought prescriptions for frequently abused drugs from five or more physicians and other health professionals in 2008, a Government Accountability Office analysis of claims data found.The Oct. 4 report accused 1.8% of the Part D beneficiary population of doctor shopping for one or more of 14 abused drugs, such as painkillers hydrocodone and oxycodone. Spending on the drugs cost the program $148 million, representing 5% of the total spent on these drugs in 2008. Some examples quoted in the report include: One Georgia patient obtained prescriptions for a 1,679-day supply of oxycodone pills from 58 prescribers, the GAO said. A physician treating the patient recalled her asking for early refills of the painkiller repeatedly; A patient in California received prescriptions for fentanyl from 21 prescribers in 2008. The patient's physician later received a letter from the state prescription drug-monitoring program informing her that within a four-month period the patient had 33 prescriptions from 10 prescribers. The physician then notified the patient that she would no longer treat the patient. The best way to prevent doctor shopping is through state prescription drug-monitoring programs. Each of us by now should have access to E-FORCSE, Florida's Prescription Drug Monitoring Program, and use it to look up each and every patient who is being prescribed a controlled substance. The House of Representatives voted on 12.08. 2011 to ban synthetic drugs nicknamed "bath salts" and other compounds that mimic marijuana, cocaine and methamphetamines (http://www.miamiherald.com/2011/12/08/2537445/house-votes-to-ban-synthetic-drugs.html#ixzz1gZAWX7YG).Rep. Charlie Dent, R-Pa., said his legislation identifies chemical compounds that affect the brain in ways similar to THC, the active ingredient in marijuana. They would be added to the highly restrictive Schedule I of the Controlled Substances Act. The bill also bans chemical compounds in synthetic drugs marketed as "bath salts" or "plant food" and under brand names such as K2 and Spice that have been used as substitutes for cocaine and other narcotics. They are now sold legally in some states.The vote was 317-98, with some Democrats saying the bill went too far in restricting chemicals that could be valuable to researchers looking for cures to diseases such as Parkinson's disease. When a drug is placed on Schedule I, said California Democrat Zoe Lofgren, "It becomes difficult to obtain not only for illegal purposes but for researchers who wish to study its pharmaceutical and medical potential.A Miami Herald editorial titled "Dangerous prescription" the Miami Herald called for a federal law banning the online sale of narcotics. Such a legislation must be enforced through a strong, combined effort. Authorities along with domain registering websites, social media networks and credit card companies need to be alert to spot online pill mills and report suspicious activity involving illegal, counterfeit and dangerous products. We should strongly support such efforts because questionable online pharmacies skillfully abuse loopholes to provide anyone with controlled substance of their choice provided they can pay. Read more: http://www.miamiherald.com/2011/12/09/2539336/dangerous-prescription.html#ixzz1gZByFnoW

Personhood Amendment

On November 8th Mississippi voters will be asked to decide on a proposed amendment to the state constitution, which would define as a person “every human being from the moment of fertilization, cloning, or the functional equivalent thereof.” For most voters it sounds like a good idea and it will most probably pass. Therefore, several other states, including Florida http://personhoodfl.com/, are preparing similar constitutional amendments. Florida Senate Majority Leader and former US Senate Candidate Mike Haridopolos recently signed the FL Personhood Amendment!! The ambiguous language in the Florida and Mississippi 'personhood' amendment are intentionally not being represented properly by the proponents of this ballot initiative. A recent New York Times article http://www.nytimes.com/2011/10/31/opinion/mississippis-ambiguous-personhood-amendment.html correctly points out the following problems: "First, what does “fertilization” mean? As embryologists recognize, fertilization is a process, a continuum, rather than a fixed point. The term “fertilization” — which is sometimes considered synonymous with “conception” — could mean at least four different things: penetration of the egg by a sperm, assembly of the new embryonic genome, successful activation of that genome, and implantation of the embryo in the uterus. The first occurs immediately; the last occurs approximately two weeks after insemination (or, in the case of embryos created through in vitro fertilization that do not get implanted, never). Thus, on some reasonable readings of the amendment, certain forms of birth control, stem cell derivation and the destruction of embryos created through in vitro fertilization would seem impermissible, while on other equally reasonable readings they are not." Following the "logic" of the "personhood" advocates doctors can be charged with manslaughter or even murder by prescribing morning after pills, because it can irritate the lining of the uterus (endometrium) so as to inhibit implantation of a fertilized egg, i.e. "killing a person." A doctor could also be criminally charged by inserting an IUD because it adversely affects a new embryo as it enters the uterus, thus preventing it from implanting in the uterine lining . Again, according to the "personhood" advocates this constitutes the "killing of a person." Even though, abortions are still being protected by federal law women may still face criminal charges according to state law. Other unintended consequences include the question if the treatment of an ectopic or a molar pregnancy requires first a court order to overrule a "personhood" amendment in the respective state constitution. Needless to mention that any delay of these time-sensitive treatment decisions may harm the mother and even jeopardize the life and well-being of a women. I urge all of you to speak up against any such ballot initiatives, to protect the physician-patient relationship and to guard against further state intrusion into our lives. Yours Bernd

Drug Treatment Instead of Prison

Attached a link http://www.sun-sentinel.com/news/opinion/editorials/fl-prison-bill-editorial-dl-20111030,0,3676874.story to an interesting editorial published in today's Sun Sentinel titled " State prisons need drug treatment alternative." The Sun Sentinel Editorial Board supports legislation — CS/HB 177 and SB 448 — which intends to establish a re-entry program for nonviolent offenders that offers intensive substance abuse treatment, adult education courses and vocational training as alternatives to long prison sentences. The idea is to reduce recidivism, which is essential if state officials want to get a handle on the costs of incarceration. The bills are sponsored by State Sen. Ellyn Bogdanoff, R-Fort Lauderdale, and State Rep. Ari Porth, D-Coral Springs. The two lawmakers are trying to pass needed, positive legislation to help the state of Florida reduce the costs of operating its prisons. In my opinion we should support this legislation and begin lobbying members of the Florida House and Senate. E-mail, twitter, mail or call your representative because " Unlike prison privatization and the more controversial ideas to cut state prison costs, the re-entry program is a simple solution that promises both savings and a much-needed reduction in the state's ongoing recidivism problem." Yours Bernd

Substance Abuse Counseling and Preventive Health Care

Attached a link http://www.ama-assn.org/amednews/2011/10/17/bica1017.htm to an interesting article titled "Counseling on alcohol helps patients and is billable" published in AMA News and posted on October 17th, 2011. Several highlights:

* Since early 2011, many commercially insured patients have been able to receive alcohol counseling paid at 100% with no co-pay or deductible, and the same is expected to be true for Medicare beneficiaries as of Jan. 1, 2012.
* Just asking about alcohol abuse will not necessarily lead to reimbursable payment, but treating those who screen positive most probably will. In addition to the usual fee-for-service, other incentives on the table should further make dealing with the issue more financially feasible for practices and make it more likely that patients will enter treatment.
* Tracking the percentage of adolescents and adults with new episodes of alcohol or other drug dependence who initiate treatment is on the list of eligible professional measure specifications from the Centers for Medicare & Medicaid Services.
* Information should be noted in the patient's chart, along with the time spent on this task. Counseling sessions longer than 15 minutes are billable, but shorter ones are not.
* On July 19, CMS issued a proposed decision memo stating that, as of Jan. 1, 2012, Medicare will cover annual alcohol misuse screening. (A final decision has not yet been made.) Under the proposal, Medicare would pay for four brief, face-to-face behavioral counseling interventions a year. The American Medical Association and other medical societies support his move.
* In addition, alcohol misuse screening and counseling is on the list of preventive services that non-grandfathered health plans must cover at 100% with no deductible or co-pay, according to the Patient Protection and Affordable Care Act. Grandfathered health insurance plans are those that have not changed since the health system reform law was enacted. Non-grandfathered ones are new policies issued after Sept. 23, 2010, and must cover a recommended list of preventive services with no cost-sharing with patients.
* When billing private insurers, the CPT codes are 99408 for an intervention lasting 15 to 30 minutes. An intervention longer than 30 minutes should be coded 99409. H0049 is the code for alcohol and drug screening of Medicaid beneficiaries. H0050 can be used for every 15 minutes of intervention. The services can be provided by a nurse practitioner or physician assistant as well as a physician.

Yours
Bernd

Drug Testing Halted

Attached a link http://www.miamiherald.com/2011/10/24/2470519/florida-welfare-drug-testing-halted.html to another article titled "Florida's welfare drug testing halted by federal judge" reporting that A federal judge in Orlando on Monday temporarily blocked Florida’s controversial law requiring welfare applicants be drug tested in order to receive benefits. Judge Mary Scriven issued a temporary injunction against the state, writing in a 37-page order that the law could violate the Constitution’s Fourth Amendment ban on illegal search and seizure.Gov. Rick Scott, who signed the measure into law on May 31, touted it as a way to ensure taxpayer money isn’t “wasted” on those who use drugs. “Hopefully more people will focus on not using illegal drugs,” he said then.
But, in her order, Scriven issued a scathing assessment of the state’s argument in favor of the drug tests, saying the state failed to prove “special needs” as to why it should conduct such searches without probable cause or reasonable suspicion, as the law requires. “If invoking an interest in preventing public funds from potentially being used to fund drug use were the only requirement to establish a special need,” Scriven wrote, “the state could impose drug testing as an eligibility requirement for every beneficiary of every government program. Such blanket intrusions cannot be countenanced under the Fourth Amendment.”
Fortunately, our legal system still provides protection against the growing government intrusion in our lives spearheaded by a conservative majority in our legislature. We need to continue to push back the growing number of bills threatening not only the practice of medicine but also the freedoms each and every citizen is entitled to.
Yours
Bernd