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Selfie medicine: Phone apps push people to take their pills

SEATTLE — Take two tablets and a selfie? Your doctor’s orders may one day include a smartphone video to make sure you took your medicine.

Smartphone apps that monitor pill-taking are now available, and researchers are testing how well they work when medication matters. Experts praise the efficiency, but some say the technology raises privacy and data security concerns.  Selfie medicine works like this: Open an app on your phone, show your pills, put them in your mouth and swallow. Don’t forget to show your empty mouth to the camera to prove today’s dose is on its way. Then upload the video proof to the clinic.  Fans say the technology addresses a big problem: About half of drugs for chronic conditions aren’t taken as prescribed because of cost, side effects or patient forgetfulness.

With treatment for opioid addiction, a skipped dose can mean a dangerous relapse. The National Institute on Drug Abuse is funding research to tailor a smartphone app for those patients and see if they’ll use it.  “If we can keep patients engaged, we can keep them in treatment longer,” said lead researcher Dr. Judith Tsui of the University of Washington School of Medicine in Seattle.  The next phase of her research will compare a group of patients who use the monitoring app called emocha with those who don’t to see if there’s a difference. At one Tennessee treatment center, some patients with opioid addiction are already using the app to upload selfies of their daily dose and answer questions about how they’re doing.  “Every time they sign on, it allows us to capture data. Are they having cravings? Suicidal tendencies?” said Scott Olson, CEO of Dallas-based Pathway Healthcare, which is trying the app at its Jackson, Tennessee, site. “Maybe a phone call from a counselor might make the difference between staying clean and a relapse.”

Olson thinks insurers will pay for the service with more evidence. For monitoring tuberculosis patients, health departments pay roughly $35 to $50 per patient each month for systems that include encrypted data storage. A small health department might pay as little as $500 a month.  The idea of watching someone take their medicine — called directly observed therapy or DOT — has roots in tuberculosis where one person’s forgetfulness can be serious for everyone. If patients don’t take all their antibiotics, their infectious TB germs can get stronger, developing drug resistance and endangering the broader community.  But taking a handful of pills daily for up to a year is difficult, so public health departments traditionally sent workers to people’s homes and workplaces to watch them take their doses. Today, many TB patients prefer remote monitoring. Nurses like it too.

Nurse Peggy Cooley has used Skype for years to chat live with patients taking TB medicine.  “We can accomplish in a two-minute phone call something that might have taken an hour to do and most of that hour was in the car,” said Cooley, who works for the Tacoma-Pierce County Health Department in Washington state.  The new uploaded selfies don’t need an appointment. They are a daily routine for many tuberculosis patients in Seattle, San Francisco, Los Angeles and Houston, where savings on mileage and worker time amounted to $100,000 in a recent year.  In Boston, Albuquerque and five other cities, researchers are studying whether the technology works for hepatitis C, a blood-borne virus that’s surging among a new generation of injection drug users. New drugs for hepatitis C can cure, but they’re expensive — $75,000 for a 12-week course of treatment — so insurers want to make sure patients take them.

“I think it holds a lot of promise,” said researcher Dr. Alain Litwin of University of South Carolina School of Medicine, who’s testing whether patients do better when someone watches them take their pills.  What’s next? An insurer in Maryland plans to use the technology in diabetes and high blood pressure to make sure Medicare and Medicaid patients take their medicine. Startups selling the apps say they could be used by faraway adult children monitoring an elderly parent’s daily pill-taking.  Experts worry about privacy, data security and penalties for poor pill-taking.  “That’s the biggest ick factor,” said Carolyn Neuhaus, a medical ethicist at the Hastings Center in New York. “You can imagine a program where benefits are tied to compliance and the insurer says, ‘We won’t pay for medication anymore unless you’re taking it correctly.'”

Globally, the rapid spread of smartphones creates an opportunity to eradicate TB, say the app developers.  But eliminating TB may take simpler, cheaper technologies that can be scaled for millions of cases, said Dr. Daniel Chin, who leads TB efforts for the Bill and Melinda Gates Foundation.  The group supports research in China and India on two homegrown technologies. China’s tool, about the size of a child’s shoebox, reminds patients to take their pills and saves data for review. In India, the government favors a blister pill pack printed with phone numbers; a patient punches out a daily pill, then calls the revealed number.  Worldwide, TB kills more than 1.6 million people annually, even though most deaths are preventable with treatment.  “If we are going to eliminate the disease, we need technology,” said Dr. Richard Garfein of the University of California, San Diego School of Medicine, who helped develop one of the smartphone apps, SureAdhere.

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Northern California Tribe Sues Drug Companies for Opioid Epidemic

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KLAMATH, Calif. — The Yurok Tribe of the Klamath River basin in California has filed suit in federal court against 20 major pharmaceutical companies. The case alleges corrupt practices by drug companies which contributed to widespread misuse of opioid painkillers in communities—such as the tribe itself.  According to the lawsuit, the 20 defendants violated a 1970 law known as the Racketeer Influenced and Corrupt Organizations Act (RICO). The tribe claims that drug companies systematically concealed the dangers of opioid drugs—engaging in false advertising, public nuisance, and unlawful, unfair, and fraudulent business practices.  “It is clear that we as a nation have been sold a bill of goods as it relates to opiate painkillers. These drugs have caused so much unnecessary heartache as well as the untimely deaths of many Native American and non-Indian people. The companies that produce, marker and distribute them need to be held accountable,” said Amy Cordalis, the Yurok Tribe’s General Counsel. Cordalis is a member of the tribe herself.  The defendants of the lawsuit include Purdue Pharma and Johnson & Johnson, among other notable drug manufacturers and distributors.  Humboldt and Del Norte counties in California were hit early and hard by opioid addiction, according to a statement from the tribe. The tribe has seen overdose rates and inquiries for addiction treatment skyrocket over the last decade.  “There is not a single Yurok family that has not either directly or indirectly experienced the horrors of opiate addiction,” said Cordalis.  The Yurok Tribe is not alone in suing drug companies for the explosion in opiate addiction. Cities, counties, and municipalities across the country have filed individual lawsuits against drug companies—including New York City, the New York Times reports.

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Cost Of U.S. Opioid Epidemic Since 2001 Is $1 Trillion And Climbing

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The opioid epidemic has cost the U.S. more than a trillion dollars since 2001, according to a new study, and may exceed another $500 billion over the next three years.  The report by Altarum, a nonprofit group that studies the health economy, examined CDC mortality data through June of last year. The greatest financial cost of the opioid epidemic, according to the report, is in lost earnings and productivity losses to employers. Early deaths and substance abuse disorders also take a toll on local, state and federal government through lost tax revenue.  These costs are rising. One reason for the increase, says Corey Rhyan, a senior research analyst with Altarum’s Center for Value and Health Care, is that more young people are being affected as the epidemic moves from prescription opioids to illicit drugs like heroin and fentanyl.  “The average age at which opioid deaths are occurring — you’re looking at something in the late 30s or early 40s,” Rhyan says. “As a result, you’re looking at people that are in the prime of the productive years of their lives.”  Health care expenses linked to the crisis — more than $215 billion since 2001 — have been significant, too, the report suggests. Those expenses stem largely from emergency room visits, ambulance costs and the use of naloxone, a drug used to stop and reverse the effects of an opioid overdose.

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To solve opioid epidemic, governors say there need to be federal dollars behind pledges

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The governors of Maryland and Oregon are making an urgent call for greater federal help to deal with the opioid epidemic in their hard-hit states. Gov. Larry Hogan, R-Md., and Gov. Kate Brown, D-Ore., sit down with William Brangham to discuss the problems in their states, what works and what they need to end the suffering.

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Some of those hit hardest by the opioid epidemic are not rural, white Americans

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There’s one prominent story that may be helping Americans get beyond the myth that the opioid epidemic is limited to working-class Americans in rural communities.  In a recorded video shown at the White House Opioid Summit, former Fox News host Eric Bolling shared how he discovered that his 19-year-old son had overdosed on opioids hours after the TV personality lost his job over sexual harassment allegations.  “We never saw it coming. We never thought we would get that call,” he said. “There’s one underlying issue that I think parents need to understand. And it’s very, very important. I’ve seen it over the last few months since Eric passed —  ‘not my kid’ syndrome.”  “ ‘Not my kid’ syndrome is terrible. ‘Not my kid’ syndrome is a killer, because you just don’t know. It could very well be your kid,” Bolling added.  Bolling, a wealthy, college-educated media professional based in New York City, isn’t part of the demographic group that often comes to mind when people think of opioid overdoses. But Bolling said the epidemic doesn’t discriminate.

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Here’s what Trump should say about opioids in his State of the Union address

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When President Trump delivers his State of the Union address Tuesday night, he’d be wise to ask Congress to join him in endorsing recent bipartisan recommendations from the National Governors Association (NGA) to respond to America’s opioid crisis.
The NGA calls on the Trump administration and Congress to:
·  Give states more funding and other assistance to deal with the crisis, along with flexibility in deciding how to use the assistance for prevention, treatment and law enforcement programs. This includes giving states a greater ability to use Medicaid funding as they see fit to pay for drug treatment and mental health services.·         Provide federal training and set education requirements for health care providers who prescribe opioids. Also, give these providers more flexibility to prescribe drugs to treat opioid dependence.
·  Provide more training and assistance to help public health and law enforcement agencies work together to share information about the opioid crisis.
·  Improve coordination among federal agencies so they can more effectively respond to the crisis.Embracing the NGA recommendation would be a positive step forward. Today and every day roughly 91 Americans will die from opioid overdoses.  Opioids are becoming increasingly deadly to Americans. In 2016, two-thirds of drug-related deaths involved opioids. In fact, since 1999 opioid-related deaths in the United States have increased nearly fourfold.  Drug abuse is a burden shared by every state. Nearly 63,600 Americans lost their lives to drug overdoses in 2016 – a 21 percent increase over the previous year. From 2000 to 2016 the U.S. Centers for Disease Control and Prevention estimates that more than 600,000 people died from drug overdoses in the United States.  Opioids – which typically refer to oxycodone, hydrocodone, and fentanyl – are highly addictive painkillers. Nearly 3 in 10 Americans prescribed opioids for chronic pain will abuse them.  Some parts of the country are particularly at risk. The Mid-Atlantic and Northeastern states, for example, have an extra-high concentration of opioid abuse. The state of Massachusetts had some of the highest opioid-related death rates in the country, at 1,990 deaths in 2016 alone. Maryland wasn’t far behind with 1,821 deaths in 2016.

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Fighting the opioid epidemic will require more court battles

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New York City’s decision to file a lawsuit this week against eight big pharmaceutical corporations and distributors that ignited the nation’s raging opioid epidemic cannot bring back the hundreds of thousands of loved ones who have perished during this crisis.  But for families like my own that have suffered, it raises some hope that Big Pharma companies may yet be held responsible for their actions.  Unfortunately, accountability has been quite elusive since pill makers began flooding the market with prescription painkillers more than two decades ago.  As far back as 2001, Connecticut’s then-Attorney General (and now U.S. Senator) Richard Blumenthal sounded the warning cry about Oxycontin abuse, publicly urging manufacturer Purdue Pharma to take action to warn about the potential for addiction connected to the drug, which it aggressively marketed as “non-addictive.”  Three years later West Virginia became the first state to sue Purdue in a case that never went to trial and resulted in a $10 million settlement.  In 2007, Purdue finally pleaded guilty to misleading doctors and the public about Oxycontin’s potential for addiction and abuse, paying $600 million in fines and payments to settle the Justice Department case against the company.  By this time addictive pain pills, often snagged from unused bottles in family medicine cabinets, were as readily available as candy in the halls of the high school where my 16-year-old son Tommy, like many teens, was wrestling with his identity.  By 2010, pharmacies in Florida, where we were living, were selling more than 650 million oxycodone pills per year, with 93 of the top opioid-dispensing doctors in the U.S. operating in the state.

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