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Comment Archives: Stories: News + Opinion: Health Care

Re: “Nurse Shortage Puts Vermont Parents on the Hook for Kids' Care

Really great article! A good follow up would be to interview the nurses themselves. Find out why they aren't flocking to Home Health Care! Based on nurses I've spoken with, it's the pay and benefits. In fact, research this: Are VNA agencies not employing additional staff at "Full-Time status" because of the added costs related to Health Insurance requirements? We've all read about how small businesses are cutting down on full time staff in favor of part time staff as then they don't need to provide health insurance benefits. Are the costs of insurance and forcing employers to provide them causing our own residents to suffer?

1 like, 0 dislikes
Posted by Scott Grant on 08/16/2017 at 5:24 PM

Re: “Nurse Shortage Puts Vermont Parents on the Hook for Kids' Care

Bravo for finally running an article on this topic. As a parent with a medically fragile child, the situation in VT is grim; our experiences with high tech in-home nursing with VNA has been less than stellar. In large part, as you mention, the pay stinks and their is few supports for in-home nursing.

6 likes, 0 dislikes
Posted by Kirsten Isgro on 08/16/2017 at 3:34 PM

Re: “Vermont Fights Opiates With More Opiates. Is There a Better Way?

This article COMPLETELY IGNORES 5 decades of evidence...

MAT, in and of itself, is NOT TREATMENT.... It is harm reduction... MAT with methadone and buprenorphine cuts death rates by 50% or more-- look at the data, Mark...

For example:

https://www.ncbi.nlm.nih.gov/pubmed/28446428

https://www.ncbi.nlm.nih.gov/pubmed/26452239

https://www.ncbi.nlm.nih.gov/pubmed/19608355

https://www.ncbi.nlm.nih.gov/pubmed/18190664

https://www.ncbi.nlm.nih.gov/pubmed/25644938

https://www.ncbi.nlm.nih.gov/pubmed/24349294

https://www.ncbi.nlm.nih.gov/pubmed/2787586

How do you explain these results?

A rise in death rates is despite -- not by virtue of-- methadone and suboxone "treatment" (which really is not treatment but just a way to cut death rates... by the way, the Chittenden Clinic here in Vermont offers evidence-based treatment such as CBT and Motivational Interviewing) is due to fentanyl and senseless drug laws.

Posted by Zach Rhoads on 07/13/2017 at 7:44 PM

Re: “Vermont Leaders Make a Case for Opiate Prescription Data Transparency

Stella - Three things: 1.) Even though they acknowledge the older age of the Medicaid population, they are still trying to make the case for the general population. 2.) An example of "How to Lie with statistics" is particularly apparent in the "Changes in Claims per Opioid Patient" where the axis goes from <3 to 4 in 0.2 increments making any differences look substantial even though we are not told whether the differences between states is statistically significant. 3.) VPMS was devised as a clinical tool and should remain as such without any law enforcement input.

2 likes, 2 dislikes
Posted by John Searles on 06/29/2017 at 8:15 AM

Re: “Vermont Leaders Make a Case for Opiate Prescription Data Transparency

The problem is not in the Medicare age people - chronic pain cripples many older residents. I don't think we're proving here that every doctor needs surveillance - it's much more important to follow up on the Doctors who over-prescribe for patients they hardly know.. Do all these states have the same general age-percentages as Vermont? "Per-opioid patient" seems an odd term for that chart that shows VT way way on the top. There are some facts in the article, and some spin which is independent of the facts.

6 likes, 0 dislikes
Posted by stickinthemud on 06/28/2017 at 11:54 PM

Re: “Vermont Leaders Make a Case for Opiate Prescription Data Transparency

John, a few things. First, the fact that Medicare Part D recipients are mostly older folks is acknowledged in the story - you comment as though it is not. Second, you seem to assume that none of the opioid prescriptions going to recipients aged 65 and older are contributing to the opioid epidemic. That doesn't seem like a very sound assumption. Third, should we not care about physicians' prescribing habits as to their older patients? Aren't they likely indicative of their prescribing habits overall, and doesn't that matter? Fourth, presumably Part D demographics are uniform across states, and yet Vermont prescriptions are still consistently higher than other states year over year. Even if we ONLY care as to the 15%, shouldn't we care? Finally, the vertical axes are clearly labeled and you'd need to be pretty dumb to misinterpret them.

7 likes, 9 dislikes
Posted by stellaquarta on 06/28/2017 at 6:26 PM

Re: “Vermont Leaders Make a Case for Opiate Prescription Data Transparency

This is a remarkably inept analysis. About 85% of Medicare recipients are age 65 or older. Older individuals have much different drug use profiles than others. Most opioid overdose deaths in Vermont are among the 30-49 year old age group. Finally,the vertical axes on all the graphs are compressed in a "How to Lie with Statistics" manner. Presenting Medicare Part D data is extremely misleading.

11 likes, 4 dislikes
Posted by John Searles on 06/28/2017 at 5:35 PM

Re: “Vermont Fights Opiates With More Opiates. Is There a Better Way?

I was on 90mg of mscontin daily for pain management. In a sleep study I found I was experiencing central sleep apnea. I was having pauses in my breathing for up to 2 minutes. This was caused by the morphine. Dr told my wife that this would kill me. My wife asked about alternatives and medical marijuana came up. I skeptically tried and like turning a switch my morphine usage was reduced by 66% and within 6 months was opioid free. I went through withdrawals but believe that cannabis even made those more bearable. That was 3 years ago and I still use cannabis exclusively to manage my pain and opioids are now a medicine of last resort as it should be
.

4 likes, 1 dislike
Posted by Jeff Marshall on 05/15/2017 at 11:08 PM

Re: “Vermont Fights Opiates With More Opiates. Is There a Better Way?

For our patients, loved ones, and for our state, for each other... we can do better. Hub & Spoke has its place and has maximized its usefulness at this point. OD rates have increased not decreased despite our "All-In" heroic efforts with MAT. The "not dead" argument only holds when OD rates decrease with MAT. Some argue vociferously that Methadone and Bupe and Naltrexone and Naloxone (Narcan) saves lives. Might these drugs also be contributing to death rates? Controversial statement for sure. Might anti-depressants and anti-anxiety and anti-psychotic meds contribute to depression, anxiety, and overall disease burden as much as they may relieve symptoms for many? Should any one form of treatment be promoted over all others? Population health approach fails to account for individual variability. Medicine - pharmacotherapy - is the quintessential example of this principle. Let's invest in diversity not uniformity.

https://vtdigger.org/2016/04/26/rick-barnett-maintenance-medication-madness/

Not Dead should not be end goal:
https://vtdigger.org/2017/04/03/not-dead-shouldnt-end-goal/

https://vtdigger.org/2017/03/05/rick-barnett-better-health-care-psychology/

1 like, 2 dislikes
Posted by Rick Barnett on 05/14/2017 at 2:00 PM

Re: “Vermont Fights Opiates With More Opiates. Is There a Better Way?

MAT is marketed as though there is no other option for opiate addicts. There is - it is called abstinence-based recovery. I failed miserably on the methadone program; I used every day and found the withdrawal symptoms as bad, if not worse, than heroin. There are many folks like me, men and women who have achieved long-term recovery wo the use of medications. However, we are never invited to the table to discuss solutions. Why? Because we have no giant lobby behind us. MAT is not therapy. It is drug replacement. Time we give clients real choices in treatment. ANd not what is only endorsed by Big Pharma and their psychiatric minions. Show me a shrink who ever got an addict better....

9 likes, 2 dislikes
Posted by Piers Kaniuka on 05/11/2017 at 1:39 PM

Re: “Vermont Fights Opiates With More Opiates. Is There a Better Way?

I owe my life to methadone. It let me become a productive member of society while I dealt with the issues that contributed to my heroin addiction. When I was strong enough to manage it, I left methadone behind. That was 46 years ago. I've led a good life, without opiates, and with purpose since then. Medically assisted treatment _can_ be a useful tool; I am proof of that.

9 likes, 1 dislike
Posted by Michael Poster on 05/11/2017 at 1:35 PM

Re: “Vermont Fights Opiates With More Opiates. Is There a Better Way?

Abstinence and long-term supports lead to true change and growth, not just harm reduction. The money behind medications to manage opiate addiction is astounding. I have 30 years of abstinence. If these medications were used when I got clean, I don't think I would have survived. I gave up my drug and alcohol counselor license because of the direction that treatment took.

15 likes, 3 dislikes
Posted by Lauren Bisson on 05/10/2017 at 6:51 PM

Re: “The Doctor Is Out: Lawmakers Seek 'Lifeline' for Independent Physicians

The subsidization for the academic medical center argument by Brumsted fails to recognize that independent physicians with hospital privileges are expected to teach medical students and residents as well, with no compensation.

1 like, 1 dislike
Posted by DerekP on 05/03/2017 at 12:36 PM

Re: “The Doctor Is Out: Lawmakers Seek 'Lifeline' for Independent Physicians

So they like independent practices because they represent competition, but don't want them to have to compete for reimbursement.

5 likes, 0 dislikes
Posted by Nate Awrich on 05/03/2017 at 10:34 AM

Re: “Do No Harm: New Rules Discourage Overprescribing Opiates

"In 2015, enough painkillers were handed out in Vermont to give every man, woman and child a bottle of 100 pills," former governor Peter Shumlin said in his signing statement."

How many were given to post-surgical patients? How many were for hospice patients?

The vast majority of opiate users are not addicts. Opiates are becoming as stigmatized as psych meds.

5 likes, 1 dislike
Posted by Liz Leyden on 04/27/2017 at 5:43 PM

Re: “Do No Harm: New Rules Discourage Overprescribing Opiates

i understand your concerns @David Skillman, however I think the same limitations in people that move them towards addiction also prevent them from being able to "take responsibility for their actions and bad choices". most people i've met who've made really bad life decisions didn't know at the time how bad those choices were. those who were able to take responsibility in terms of remorse or reparations had to have some kind of intervention, whether medical, psychological or reaching some kind of desperate situation where circumstances force them into a learning curve. but not everyone suffers. i've met 'functional' alcoholics and opiate users who don't bottom-out, don't commit robberies, earn a decent wage and live a productive life - as addicts, but not criminals in the sense of having to take responsibility for anything at all. addiction isn't by definition about depravity and desperation although it often is.

1 like, 0 dislikes
Posted by parallax on 04/27/2017 at 2:48 PM

Re: “Do No Harm: New Rules Discourage Overprescribing Opiates

I have two comments. People always want to blame others for people's shortcomings. At some point, an addict, or someone moving towards addiction needs to take some responsibility for their actions and bad choices. It's not all the Doctor's fault. Also, nothing in these laws is going to keep an addict from getting what they want. It will only make it harder for responsible people to get medicine they need.

8 likes, 1 dislike
Posted by David Skillman on 04/27/2017 at 12:14 PM

Re: “Do No Harm: New Rules Discourage Overprescribing Opiates

The worst part seems to be the idea that we have to trade painfree medical treatment for stringent controls. This isn't a zero-sum game and it's possible to obtain both as long as you're willing to accept the consequences. Pain perception is impossible to understand objectively so pain meds can't be presumed necessary or excessive. If the patient says they're in pain then presume they're in pain and experience should guide the proper prescribing, not the state. The idea that you can "go into a doctor's office and come out with a bagful." isn't about pain, it's about criminal activity on the part of the doctor, not the patient. The consumption or illegal resale of the pills is about very difficult socio-economic problems, not about surgical procedure aftermath or chronic pain and it's the price we pay for addictive pain meds. We made this tradeoff easily enough when adopted the automobile as a lifestyle improvement device and we quietly accept half a million deaths each year. We accept this easily with readily available nicotine and pay the price of cancer deaths and medical support for the adult addicts. It's so easy with cigarettes and cars and alcohol and a whole host of things. Painfree medical treatment is an incredibly awesome achievement and we're worried about a few deaths each year? We're complaining about decreased productivity and costs to society by supporting the medically needy addicts? Big deal. That's pennies compared to what we're already paying for due to cars, nicotine and alcohol. How about considering the question of *over* prescription and consumption outside of the context of the doctor-patient relationship and focus on standards of care instead of treating pain intolerance or even opium addiction as some kind of moral failing that doesn't deserve relief.

4 likes, 0 dislikes
Posted by parallax on 04/27/2017 at 11:38 AM

Re: “Do No Harm: New Rules Discourage Overprescribing Opiates

Jimm the doctors and dentists that you are defending are the same people that helped create all the lovely addicts that we have in the state today. It's about time they were held accountable for the mess they created in order to line their own pockets when they prescribed opiates to people that did not need such strong drugs in the first place.

5 likes, 6 dislikes
Posted by citizen on 04/26/2017 at 3:36 PM

Re: “Do No Harm: New Rules Discourage Overprescribing Opiates

Aren't we lucky that Vermont politicians and bureaucrats are so knowledgeable in their craft that they are in a better position than the Physicians and Dentists with medical degrees to dictate to them how to practice Medicine and care for their patients.

10 likes, 4 dislikes
Posted by JimM on 04/26/2017 at 12:30 PM

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