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Disability Rights Resources by State

Find Disability Rights Organizations in your State:

Alabama ▪ Alaska ▪ Arizona ▪ Arkansas ▪ California ▪ Colorado ▪ Connecticut▪ Delaware ▪ Florida ▪Georgia ▪ Hawaii ▪ Idaho ▪Illinois▪ Indiana ▪ Iowa ▪ Kansas ▪ Kentucky ▪ Louisiana ▪Maine ▪ Maryland ▪Massachusetts ▪ Michigan ▪ Minnesota ▪ Mississippi ▪ Missouri ▪ Montana ▪Nebraska ▪ Nevada▪ New Hampshire▪ New Jersey ▪ New Mexico ▪New York ▪North Carolina▪ North Dakota ▪Ohio▪ Oklahoma ▪ Oregon ▪ Pennsylvania ▪ Rhode Island ▪South Carolina ▪South Dakota ▪ Tennessee ▪ Texas ▪ Utah. ▪ Vermont.▪ Virginia. ▪ Washington. ▪ West Virginia ▪ Wisconsin • Wyoming ▪ *District of Columbia

Americans with Disabilities Act (ADA)

ADA law is enforced by agencies like the Department of Justice and the Equal Employment Opportunity Commission. Many disability advocacy groups like the American Association of People with Disabilities or the National Organization on Disability advocate for implementation of the law.

The ADA is a civil rights law that prohibits discrimination against individuals with disabilities in all areas of public life, including jobs, schools, transportation, and all public and private places that are open to the general public.

The ADA law does prohibit discrimination against individuals with disabilities who have chronic pain, as well as people in recovery from opioid and substance use disorders. People with disabilities who use medically prescribed opioids for pain cannot be discriminated against in access to employment and government programs, for example. However, the ADA law does not address the prescribing decisions of doctors.

The National Council on Independent Living (NCIL) Chronic Pain/ Opioids Task Force has written a letter about chronic pain to U.S. senators and representatives that has been signed by many organizations:

https://www.ncil.org/wp-content/uploads/2019/06/6-25-19-Chronic-Pain-Sign-On-Letter.pdf(link is external)

In this letter, the organizations push back against one size fits all policy making approach to prescribing, unintended consequences that risk patient safety, and the need for comprehensive care. This letter does an excellent job describing the policy issues related to pain and opioid use and is recommended reading.

If you have a disability and are experiencing abuse, neglect or discrimination, are experiencing a legal problem or are having difficulty obtaining disability services, call your state’s P&A.

FIND YOUR P&A

ABOUT SELF-ADVOCACY

A description of Self-Advocacy and the materials and links on this page.

THE AMERICANS WITH DISABILITIES ACT

A description of the Americans with Disabilities Act, its history, and each part of the Act.

SELF-ADVOCACY MATERIALS

Information and materials you and other self-advocates can use to explain and understand Olmstead, Medicaid Waivers, and other concepts.

PODCASTS

Five Minutes of Olmstead Podcasts.

DISABILITY RESOURCES IN YOUR STATE

Find Olmstead, Advocacy, Medicaid and other resources in your state.

OLMSTEAD LINKS

The best websites on Olmstead and related information

More Information

Resources

Additional Rx Resources

State Specific Resources: HERE

NCSL's Prescription Drug Policy Resource Center - a new online feature provides streamlined accesss to numerous research and resources custom designed for state legislative use.

Injury Prevention Legislation Database a companion project, offering searches for prescription drug abuse, pain clinics, rescue drugs, monitoring program and others.

The Health Innovations Database" covers what state legislatures are enacting that changes Medicaid, private and commercial health insurance, access, health exchanges and other state action on health reforms.

NCSL Prescription Drug Reports and Meetings (Library and Archives) - a table-of-contents of meeting sessions, articles, archive report, all in one page.

Prescription Drug News, Research and Opinions.- outside experts resources and points of view, again including some archive materials.

On July 24, 2019, the OIG released a report titled: “Oversight of Opioid Prescribing and Monitoring of Opioid Use: States Have Taken Action To Address the Opioid Epidemic.” The report reviewed the actions taken by eight states to monitor opioid prescribing and use. The OIG detailed how states are using data analytics and implementing outreach programs for both patients and providers. The report also compares the states’ opioid prescribing limits with CDC guidelines.

FSMB | Opioids and Pain Management - Federation of State Medical Boards
Highlighted State Initiatives.

FSMB Releases Updated Guidelines for Chronic Use of Opioid Analgesics - Federation of State Medical Boards
May 17, 2017 · “As our nation's opioid epidemic worsens, it is critical that state medical and osteopathic boards - and the physicians and physician assistants they license and regulate - have updated guidance on the responsible management of chronic pain,” said FSMB President and CEO, Humayun Chaudhry, DO, MACP.

Continuing Medical Education by State - Federation of State Medical Boards

OPIOIDS AND PAIN MANAGEMENT

Overview

FEDERAL GOVERNMENT RESOURCES

Federation of State Medical Boards Opioid Policy Survey, 2019

Learn More

PRESCRIPTION DRUG MONITORING PROGRAMS

State-by-State Overview

Learn More

Board-by-Board Overview of Laws, Regulations, and Guidelines

Learn More

Pain Management by State

Board-by-Board Overview

Continuing Medical Education by State

Board-by-Board Overview

Continuing Medical Education Legislative Summary

The Latest Legislative Tracking on Telemedicine

Pain Management Legislative Summary

The Latest Legislative Tracking on Pain Management

Medical Marijuana - Continuing Medical Education by State

Continuing Medical Education requirements for medical marijuana

Medical Marijuana by State

State-by-State Overview

More Information

What is Appriss and Narxcare?

New Appriss Health Resource Page to Help Inform Patients and Their Families

BACK TO BLOG

Millions of Americans suffer from chronic pain and part of their treatment plan often includes prescription opioids to treat and manage their conditions. However, when considering opioid therapy for chronic pain, it is important to consider the risks along with the benefits. With an emphasis on patient safety and better outcomes, Appriss Health provides healthcare providers with solutions to inform and support clinical decision-making.

While we are committed to helping providers, and others involved in patient care, work together to achieve better patient outcomes through earlier interventions, we also feel the responsibility and obligation to always communicate with patients and put them at the forefront of our solutions. That’s why we have dedicated a new section of our website specifically designed to help patients and their families better understand how Appriss Health’s solutions support them and enable better patient care.

This resource page includes:

An FAQ about our prescription drug monitoring and risk assessment solutions.

Our 12-part blog series “A Balanced Approach to Opioid and Chronic Pain,”which highlights our approach to benefit/risk assessment, data presentation, clinical support, and more.

And a Contact Us form so that if someone would like to reach out and talk with us they can.

Every day we approach our work with the goal to provide a usable and balanced clinical tool that protects access to care while also ensuring that clinicians and patients are well informed of potential risks. We will continually update this page, and we hope this will serve as a valuable resource to patients and their families.

Narxcare = Big Brother on Steroids

In the name of battling our misnamed "opioid epidemic," (1) which has only resulted in making things worse (2) there is a casualty that is far worse than anything that could be caused by a drug - the loss of our right to make healthcare decisions with our own providers and the right to privacy. A whistleblower document from Walmart which I obtained discusses "scoring" patients based on their medical and prescription history. It should terrify you. And it will. Following are some passages from the seven-page document, which, despite its benign-sounding title, is anything but.

What you will read is not guidance. It is all but certain it will become a mandate, just like the CDC 2016 Opioid Prescribing Guidelines are now law or becoming law in most states. And it goes far beyond its alleged goal of helping to control opioid overprescription. Very far beyond. Here are some "highlights" that Walmart does not want you to know about.

Page 1: Pharmacist "guidance" for prescription drug users with different scores as determined by NarxCare (2), an algorithm designed to sniff out potential problems with the legal use of certain prescribed medicines.

Two things jump off the page here. First, the group that encompasses people with scores of 10-200 represents most of the people with a prescription. In the red circle on the right, it becomes obvious how badly Walmart is overstepping. Let's get this straight. If I have a legitimate prescription for Vicodin from my doctor I do not want to "consider the risks/benefits of new prescriptions."

Here's how healthcare works:

The doctor writes the prescription
The pharmacist fills the prescription.
There is no #3

You may wonder what it takes to get into the 10-200 scoring group. Not much. From page 2:

Out of the blue, we are no longer talking about painkillers. Walmart is now interested in other potential drugs of abuse. If you happen to be taking Vicodin for chronic pain, Valium as a muscle relaxant, and an ADHD drug - a legitimate combination for some patients, you are going to get a worse score, which will likely mark you as a higher risk.

This is really awful. First, if you use an MME calculator it becomes quickly obvious that Walmart is not talking about addicts who are taking huge doses of opioids. But that doesn't stop the company from treating people that way. And it doesn't have to be much.

Walmart calls 40 MME an "unsafe condition," and is recommending tapering or discontinuing other drugs, such as Valium, which could potentiate the action of the opioid. How much is 40 MME? It's equivalent to 26.6 mg of oxycodone - 2.7 10 mg Percocet pills - not even half the maximum recommended daily dose of 60 mg.

The maximal daily dose of Percocet. Source: RxList

It is perfectly clear that patients are going to get some kind of a grade from The Walmart Enforcement Agency and you'd better believe that there will be consequences if that grade isn't good. Good luck getting a legal prescription filled there if you don't make the grade.

Pharmacies around the country are already arbitrarily deciding who does or does not get their scripts filled. Although is not explicitly stated it a pretty safe bet that patients could be refused prescriptions because of their score doesn't meet Walmart's "standards."

What can make scores bad? All sorts of things. For example, if you:

See your doctor too often within a certain time period.
See more than five different doctors in one year. It doesn't matter if they are dermatologists or cardiologists.
Use more than four pharmacies in a three-month period.
Take an average of more 40 morphine equivalents (less than three 10 mg Percocet) in one day
Take a total of 100 morphine equivalents (total) in a day. There are plenty of pain patients who need more than this just to get by.

Questions that need to be asked

Walmart sells lawnmowers to people who could run over their own own foot, yet it doesn't claim the authority or ability to monitor and control how they are used. So, how can the company claim it is better equipped than doctors to determine what painkillers, stimulants, and antianxiety drugs you are permitted to buy?

Walmart sells ovens, but can't teach you how to cook. How does this give it the right or ability to determine who should have their medicines tapered and at what rate?

What is Appris Health, the company that created the algorithm Narx Care, which does the scoring?
How did it get so much information on and influence over our private, personal matters? Why and how did the State of Ohio decide to implement this program in 2017 despite the fact that it already has a Prescription Monitoring Program?

Why should Appris (and of course, Walmart) have access to our individual health histories? In what other ways will this information be used? What safeguards are in place to safeguard our privacy?

Why is Walmart lying? The CDC's number, which itself is ridiculous, it 90.

"Within the next 60 days, Walmart and Sam’s Club will restrict initial acute opioid prescriptions to no more than a seven-day supply, with up to a 50 morphine milligram equivalent maximum per day. This policy is in alignment with the Centers for Disease Control and Prevention’s (CDC) guidelines for opioid use."
Walmart press release.

Take a good look in your rearview mirror. Most likely you'll see your right to determine your own medical care growing steadily smaller.

NOTES:

(1) We are having a fentanyl epidemic, NOT an opioid epidemic. It should be called by its correct name.

(2) Numbers of prescription for opioid painkillers have declined by almost 30 percent since 2011. Total opioid deaths shot up during that same time. Big surprise.

Continue Reading FULL ACSH Article

What Every Patient Should Know About NarxCare

NarxCare, is a prescription tracking tool that analyzes real-time data about opioids and other controlled substances from Prescription Drug Monitoring Programs (PDMP’s).

Recent studies question the value of PDMP’s, but 49 states have implemented them so that physicians, pharmacists and insurers can see a patient's medication history. Granted, there is a need for monitoring the select few who doctor shop and/or abuse their medications, albeit that number is only in the 2 percent range.

What is NarxCare? Appriss Health developed NarxCare as a “robust analytics tool” to help “care teams” (doctors, pharmacists, etc.) identify patients with substance use disorders. Each patient is evaluated and given a “risk score” based on their prescription drug history. According to Appriss, a patient is much more willing to discuss their substance abuse issues once they are red flagged as a possible abuser.

“NarxCare automatically analyzes PDMP data and a patient’s health history and provides patient risk scores and an interactive visualization of usage patterns to help identify potential risk factors,” the company says on its website.

“NarxCare aids care teams in clinical decision making, provides support to help prevent or manage substance use disorder, and empowers states with the comprehensive platform they need to take to the next step in the battle against prescription drug addiction."

Sounds great doesn't it? Except prescription drugs are not the problem and never really have been. Illicit drug use has, is, and will continue to be the main cause of the addiction and overdose crisis.

Even the name NarxCare has a negative connotation. “Narx” stands for narcotics. And in today's environment, narcotics is a very negative word. NarxCare makes me feel like a narcotics police officer is just around the corner.

Each patient evaluated by NarxCare gets a “Narx Report” that includes their NarxScores, Overdose Risk Score, Rx Graph, PDMP Data and my favorite, the Red Flags. The scores are based on the past two years of a patient’s prescription history, as well as their medical claims, electronic health records and even their criminal history.

Ohio, Michigan, Indiana, Iowa, and several other states are using NarxCare to supplement their own PDMPs. And Walmart isn’t the only big retail company to adopt it. Kroger, Ralphs, Kmart, CVS, Rite Aid and Walgreens are already using NarxCare. There’s a good chance your prescriptions are already being tracked by NarxCare and you don’t even know it.

Rochelle Odell lives in California. She’s lived for nearly 25 years with Complex Regional Pain Syndrome (CRPS/RSD).

Continue Reading FULL PNN Article

Calling ALL Pain Warriors, It's NOW or NEVER!

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Disability Rights Resources by State

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OPIOIDS AND PAIN MANAGEMENT

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What is Health IT EHR Technology?

What is Appriss and Narxcare?

New Appriss Health Resource Page to Help Inform Patients and Their Families

Narxcare = Big Brother on Steroids

What Every Patient Should Know About NarxCare

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