The most recent edition of The Associated Press Stylebook – the premier guide for copy editors – has a number of updates that are important for health journalists to be aware of. Many of them are around the subject of drug and alcohol use and misuse, which many of my colleagues find themselves writing about quite a bit these days.
Reporting on how drug shortages are impacting paramedics, The Associated Press’ Jonathan Cooper discovered things had deteriorated to the point that, he writes, “Paramedics reported asking some of those facing medical emergencies: ‘Is it OK if we use this expired drug?’”
Based in Oregon, Cooper found that, in fact, paramedics around the northwest have been forced to dig up supplies of expired drugs to meet critical needs. He writes that, while manufacturers don’t seem to be willing to discuss drug effectiveness beyond declared lifespans, “Medications are only guaranteed to work as intended until their expiration date. When stored properly, most expired drugs won’t be harmful to patients but will become less effective with time, according to medical professionals.”
State public health officials, who license ambulances and in some cases dictate the medications they must carry, are loosening their rules to help emergency responders deal with the various shortages. Oregon health officials last week began allowing ambulances to carry expired drugs, and southern Nevada has extended the expiration dates for drugs in short supply. Arizona has stopped penalizing ambulance crews for running out of mandated medications.
Some agencies have reported keeping their drug kits fully stocked by substituting alternative medications, some of which have additional side effects or higher costs, or by diluting higher dosages to get the less-concentrated dose needed.
Past shortages have included key painkillers and sedatives. Current critical needs include epinephrine and morphine – and you don’t have to be a pharmacist to imagine why a shortage of those might be problematic for front-line medics.
Manufacturing quality lapses, production shutdowns for contamination and other serious problems are behind many of the shortages, according to manufacturers and the FDA. Other reasons include increased demand for some drugs, companies ending production of some drugs with small profit margins, consolidation in the generic drug industry and limited supplies of some ingredients.
The Associated Press’ Chris Hawley has worked through the latest numbers on the prescription painkiller boom, helping to illustrate the ongoing toll the opiod abuse epidemic is taking on traditional hotspots like Appalachia and emerging ones like the American Southwest and parts of New York City. Nationally, numbers continue to hit new heights.
Nationwide, pharmacies received and ultimately dispensed the equivalent of 69 tons of pure oxycodone and 42 tons of pure hydrocodone in 2010, the last year for which statistics are available. That’s enough to give 40 5-mg Percocets and 24 5-mg Vicodins to every person in the United States.
Hawley writes the numbers can be distorted by things like clinics for returning servicemembers, whose ranks have greatly increased in the past decade, as well as by mail-order clinics, but they still paint a detailed picture of where the opiods are going. Absent federal regulation, there is currently only a patchwork of state prescription drug tracking systems, many of which are not fully interoperable, but Hawley’s federal numbers help fill in the gaps.
The AP analysis used drug data collected quarterly by the DEA’s Automation of Reports and Consolidated Orders System. The DEA tracks shipments sent from distributors to pharmacies, hospitals, practitioners and teaching institutions and then compiles the data using three-digit ZIP codes. Every ZIP code starting with 100-, for example, is lumped together into one figure.
Using data obtained through a public records request, Associated Press reporter Kelli Kennedy (@kkennedyap) reviewed federal Medicare fraud reports from between 2006 and 2009 and found that “Regulators fighting an estimated $60 billion to $90 billion a year in Medicare fraud frequently suspend Medicare providers, then quickly reinstate them after appeals hearings that government employees don’t even attend.”
Officials revoked the licenses of 3,702 medical equipment companies in the fraud hot spots of South Florida, Los Angeles, Baton Rouge, La., Houston, Brooklyn, N.Y., and Detroit between 2006 and 2009, according to data provided to the AP under a public records request. Those areas represent the highest concentrations of Medicare fraud in the country, according to federal authorities who have set up task forces there.
Of the providers who lost their licenses in those cities, about 37 percent, or 1,371, were eventually back in business, sometimes within days and often within months.
Furthermore, she writes, officials have not taken advantage of security bonds put in place two years ago to provide redress should a fraudulent provider vanish from the map. “Officials blame the delay on personnel changes,” she writes.
The gaps in the system grow out of poor communication between one set of contractors paid to inspect Medicare providers and alert officials to suspicious activity; a separate set of contractors that handles payments; and the agency that runs Medicare.
Kennedy’s report dives deep into the Medicare fraud reinstatement program, and reporters looking to better understand the system would be well served to read the full investigation.
AHCJ member and Associated Press reporter Margie Mason won the science reporting category of the National Association of Science Writers’ Science in Society awards for “When Drugs Stop Working,” a five-part series on drug resistance she wrote with Martha Mendoza. Charles Duhigg’s “Toxic Waters” series in The New York Times tied for the honor.
When Drugs Stop Working