Half of Americans Take Prescription Drugs That Could Lead to Addiction
Not Easy to Find Drug Take-Back Locations, But They're Out There
Hospital Discharge Is One of the Most Dangerous Times for Patients
California Searches for Prescription to Treat Rising Drug Costs
California's New Health Laws Coming in 2016
National Drug Take-Back Day Is Saturday; 350 California Sites
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Since 2011, she's been writing and editing stories for the site. Before taking up blogging, she toiled for many years (more than we can count) producing health stories for television, including\u003cem> Dateline NBC\u003c/em> and San Francisco's CBS affiliate, KPIX-TV. She also wrote up a \u003ca title=\"http://www.kqed.org/news/health/obamacare/obamacare-guide.jsp\" href=\"http://www.kqed.org/news/health/obamacare/obamacare-guide.jsp\">handy guide to the Affordable Care Act\u003c/a>, especially for Californians. Her work has been honored for many awards. Most recently she was a finalist for \"Best Topical Reporting\" from the Online News Association. You can follow her on Twitter: \u003ca title=\"https://twitter.com/laliferis\" href=\"https://twitter.com/laliferis\">@laliferis\u003c/a>","avatar":"https://secure.gravatar.com/avatar/86c339d5cdcb0dcd2b6cf5d7c3f5886b?s=600&d=blank&r=g","twitter":"laliferis","facebook":null,"instagram":null,"linkedin":null,"sites":[{"site":"news","roles":["subscriber"]},{"site":"futureofyou","roles":["subscriber"]},{"site":"stateofhealth","roles":["subscriber"]},{"site":"science","roles":["subscriber"]},{"site":"food","roles":["contributor"]}],"headData":{"title":"Lisa Aliferis | KQED","description":null,"ogImgSrc":"https://secure.gravatar.com/avatar/86c339d5cdcb0dcd2b6cf5d7c3f5886b?s=600&d=blank&r=g","twImgSrc":"https://secure.gravatar.com/avatar/86c339d5cdcb0dcd2b6cf5d7c3f5886b?s=600&d=blank&r=g"},"isLoading":false,"link":"/author/lisaaliferis"}},"breakingNewsReducer":{},"campaignFinanceReducer":{},"firebase":{"requesting":{},"requested":{},"timestamps":{},"data":{},"ordered":{},"auth":{"isLoaded":false,"isEmpty":true},"authError":null,"profile":{"isLoaded":false,"isEmpty":true},"listeners":{"byId":{},"allIds":[]},"isInitializing":false,"errors":[]},"navBarReducer":{"navBarId":"home","fullView":true,"showPlayer":false},"navMenuReducer":{"menus":[{"key":"menu1","items":[{"name":"News","link":"/","type":"title"},{"name":"Politics","link":"/politics"},{"name":"Science","link":"/science"},{"name":"Education","link":"/educationnews"},{"name":"Housing","link":"/housing"},{"name":"Immigration","link":"/immigration"},{"name":"Criminal Justice","link":"/criminaljustice"},{"name":"Silicon Valley","link":"/siliconvalley"},{"name":"Forum","link":"/forum"},{"name":"The California Report","link":"/californiareport"}]},{"key":"menu2","items":[{"name":"Arts & Culture","link":"/arts","type":"title"},{"name":"Critics’ Picks","link":"/thedolist"},{"name":"Cultural Commentary","link":"/artscommentary"},{"name":"Food & Drink","link":"/food"},{"name":"Bay Area Hip-Hop","link":"/bayareahiphop"},{"name":"Rebel Girls","link":"/rebelgirls"},{"name":"Arts Video","link":"/artsvideos"}]},{"key":"menu3","items":[{"name":"Podcasts","link":"/podcasts","type":"title"},{"name":"Bay Curious","link":"/podcasts/baycurious"},{"name":"Rightnowish","link":"/podcasts/rightnowish"},{"name":"The Bay","link":"/podcasts/thebay"},{"name":"On Our Watch","link":"/podcasts/onourwatch"},{"name":"Mindshift","link":"/podcasts/mindshift"},{"name":"Consider This","link":"/podcasts/considerthis"},{"name":"Political Breakdown","link":"/podcasts/politicalbreakdown"}]},{"key":"menu4","items":[{"name":"Live Radio","link":"/radio","type":"title"},{"name":"TV","link":"/tv","type":"title"},{"name":"Events","link":"/events","type":"title"},{"name":"For Educators","link":"/education","type":"title"},{"name":"Support KQED","link":"/support","type":"title"},{"name":"About","link":"/about","type":"title"},{"name":"Help Center","link":"https://kqed-helpcenter.kqed.org/s","type":"title"}]}]},"pagesReducer":{},"postsReducer":{"stream_live":{"type":"live","id":"stream_live","audioUrl":"https://streams.kqed.org/kqedradio","title":"Live Stream","excerpt":"Live Stream information currently unavailable.","link":"/radio","featImg":"","label":{"name":"KQED Live","link":"/"}},"stream_kqedNewscast":{"type":"posts","id":"stream_kqedNewscast","audioUrl":"https://www.kqed.org/.stream/anon/radio/RDnews/newscast.mp3?_=1","title":"KQED Newscast","featImg":"","label":{"name":"88.5 FM","link":"/"}},"stateofhealth_234838":{"type":"posts","id":"stateofhealth_234838","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"234838","score":null,"sort":[1473378786000]},"guestAuthors":[],"slug":"half-of-americans-take-prescription-drugs-that-could-lead-to-addiction","title":"Half of Americans Take Prescription Drugs That Could Lead to Addiction","publishDate":1473378786,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>Almost half of all Americans take prescription painkillers, tranquilizers, stimulants or sedatives, according to results of a \u003ca href=\"http://www.samhsa.gov/data/sites/default/files/NSDUH-FFR2-2015/NSDUH-FFR2-2015.htm\">federal survey\u003c/a> released Thursday. The prevalent use of these drugs could help explain why millions of Americans end up misusing or abusing them.\u003c/p>\n\u003cp>Last year, for the first time, the government's National Survey on Drug Use decided to ask the people it interviewed about all uses of prescription medicines, not just inappropriate use. The survey found that 119 million Americans over the age of 12 took prescription psychotherapeutic drugs. That's 45 percent of the population.\u003c/p>\n\u003cp>Of those, about 19 million Americans didn't follow a prescription. Most misuse involved people who acquired the drugs from friends or family. More than a third had a prescription but took those drugs excessively. And about 5 percent bought drugs from a dealer or stranger.\u003c/p>\n\u003cp>All told, 16 percent of all prescription drug use was actually misuse, according to the report.\u003c/p>\n\u003cp>There's no question that these drugs help alleviate pain and suffering for millions of Americans. But it's also clear that the system encourages overuse.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"Any of us go to the doctor and feel like we don't get our money's worth if we don't come out with a prescription, right?\" Kim Johnson told Shots. She is director of the Center for Substance Abuse Treatment at the federal \u003ca href=\"http://www.samhsa.gov/\">Substance Abuse and Mental Health Services Administration\u003c/a>.\u003c/p>\n\u003cp>\"Just like any drug, the more it's out there, the more it's available, the more likely it is to be abused,\" she said. And many of these drugs pose an additional risk because of their physical effects, including in some cases their addictive properties.\u003c/p>\n\u003cp>The Centers for Disease Control and Prevention is trying to \u003ca href=\"https://www.cdc.gov/media/modules/dpk/2016/dpk-pod/rr6501e1er-ebook.pdf\">reform prescribing practices\u003c/a>, particularly for opioid drugs, to reduce the overuse of these pain medications. The new survey also documents the dire need for affordable and accessible treatment options.\u003c/p>\n\u003cp>\"One in 12 people aged 12 or over needed treatment for substance use disorder, yet nearly 90 percent of those people didn't get specialty treatment that could have helped them toward recovery,\" said Kana Enomoto, SAMHSA's principal deputy administrator, at a news conference.\u003c/p>\n\u003cp>That need for treatment pertains not just to prescription drug abuse but to street drugs such as heroin.\u003c/p>\n\u003cp>\"We need to expand access to treatment and we need to do it now,\" said Michael Botticelli, director of the White House \u003ca href=\"https://www.whitehouse.gov/ondcp\">Office of National Drug Control Policy\u003c/a>. \"Because, like every other disease, people who want treatment should be able to get it. And it should not be dependent on where they live or how much money they have.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>President Obama's budget for fiscal year 2017 called for more than $1 billion to expand access to drug treatment, but Congress has not acted on it.\u003c/p>\n\n","blocks":[],"excerpt":"There's no question that these drugs help alleviate pain and suffering for millions of Americans. But it's also clear that the system encourages overuse.\r\n","status":"publish","parent":0,"modified":1473378842,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":14,"wordCount":470},"headData":{"title":"Half of Americans Take Prescription Drugs That Could Lead to Addiction | KQED","description":"There's no question that these drugs help alleviate pain and suffering for millions of Americans. But it's also clear that the system encourages overuse.\r\n","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"234838 http://ww2.kqed.org/stateofhealth/?p=234838","disqusUrl":"https://ww2.kqed.org/stateofhealth/2016/09/08/half-of-americans-take-prescription-drugs-that-could-lead-to-addiction/","disqusTitle":"Half of Americans Take Prescription Drugs That Could Lead to Addiction","customPermalink":"2016/09/08/234838/","nprByline":"Richard Harris \u003cbr />\u003ca href=\"http://www.npr.org/sections/health-shots/\">NPR Shots\u003c/a>","path":"/stateofhealth/234838/half-of-americans-take-prescription-drugs-that-could-lead-to-addiction","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Almost half of all Americans take prescription painkillers, tranquilizers, stimulants or sedatives, according to results of a \u003ca href=\"http://www.samhsa.gov/data/sites/default/files/NSDUH-FFR2-2015/NSDUH-FFR2-2015.htm\">federal survey\u003c/a> released Thursday. The prevalent use of these drugs could help explain why millions of Americans end up misusing or abusing them.\u003c/p>\n\u003cp>Last year, for the first time, the government's National Survey on Drug Use decided to ask the people it interviewed about all uses of prescription medicines, not just inappropriate use. The survey found that 119 million Americans over the age of 12 took prescription psychotherapeutic drugs. That's 45 percent of the population.\u003c/p>\n\u003cp>Of those, about 19 million Americans didn't follow a prescription. Most misuse involved people who acquired the drugs from friends or family. More than a third had a prescription but took those drugs excessively. And about 5 percent bought drugs from a dealer or stranger.\u003c/p>\n\u003cp>All told, 16 percent of all prescription drug use was actually misuse, according to the report.\u003c/p>\n\u003cp>There's no question that these drugs help alleviate pain and suffering for millions of Americans. But it's also clear that the system encourages overuse.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"Any of us go to the doctor and feel like we don't get our money's worth if we don't come out with a prescription, right?\" Kim Johnson told Shots. She is director of the Center for Substance Abuse Treatment at the federal \u003ca href=\"http://www.samhsa.gov/\">Substance Abuse and Mental Health Services Administration\u003c/a>.\u003c/p>\n\u003cp>\"Just like any drug, the more it's out there, the more it's available, the more likely it is to be abused,\" she said. And many of these drugs pose an additional risk because of their physical effects, including in some cases their addictive properties.\u003c/p>\n\u003cp>The Centers for Disease Control and Prevention is trying to \u003ca href=\"https://www.cdc.gov/media/modules/dpk/2016/dpk-pod/rr6501e1er-ebook.pdf\">reform prescribing practices\u003c/a>, particularly for opioid drugs, to reduce the overuse of these pain medications. The new survey also documents the dire need for affordable and accessible treatment options.\u003c/p>\n\u003cp>\"One in 12 people aged 12 or over needed treatment for substance use disorder, yet nearly 90 percent of those people didn't get specialty treatment that could have helped them toward recovery,\" said Kana Enomoto, SAMHSA's principal deputy administrator, at a news conference.\u003c/p>\n\u003cp>That need for treatment pertains not just to prescription drug abuse but to street drugs such as heroin.\u003c/p>\n\u003cp>\"We need to expand access to treatment and we need to do it now,\" said Michael Botticelli, director of the White House \u003ca href=\"https://www.whitehouse.gov/ondcp\">Office of National Drug Control Policy\u003c/a>. \"Because, like every other disease, people who want treatment should be able to get it. And it should not be dependent on where they live or how much money they have.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>President Obama's budget for fiscal year 2017 called for more than $1 billion to expand access to drug treatment, but Congress has not acted on it.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/234838/half-of-americans-take-prescription-drugs-that-could-lead-to-addiction","authors":["byline_stateofhealth_234838"],"categories":["stateofhealth_2746"],"tags":["stateofhealth_643","stateofhealth_2808","stateofhealth_2519","stateofhealth_2888","stateofhealth_2525","stateofhealth_2891","stateofhealth_2890","stateofhealth_2889"],"featImg":"stateofhealth_234857","label":"stateofhealth"},"stateofhealth_189809":{"type":"posts","id":"stateofhealth_189809","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"189809","score":null,"sort":[1464967845000]},"guestAuthors":[],"slug":"not-easy-to-find-drug-take-back-locations-but-theyre-out-there","title":"Not Easy to Find Drug Take-Back Locations, But They're Out There","publishDate":1464967845,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>Opioids like Vicodin and Percocet are commonly prescribed to dull pain after medical procedures and to treat chronic pain. They also commonly languish in medicine cabinets, sometimes for years, making easy pickings for someone with an addiction.\u003c/p>\n\u003cp>The consequences can be deadly: More than 165,000 people died in the U.S. from overdoses related to prescription opioids between 1999 and 2014, says the \u003ca href=\"http://www.cdc.gov/drugoverdose/data/overdose.html\" target=\"_blank\">Centers for Disease Control and Prevention.\u003c/a>\u003c/p>\n\u003cp>I’m guilty of keeping them too long myself. I had a bottle of opioids left over from a dental procedure three years ago and kept it in a freezer bag full of unwanted and expired medications. In April, I turned them all in on the twice-a-year \u003ca href=\"http://www.dea.gov/divisions/hq/2016/hq050616.shtml\" target=\"_blank\">National Prescription Drug Take-Back Day\u003c/a>.\u003c/p>\n\u003cp>What are consumers to do the rest of the year if they want a safe alternative to flushing unwanted drugs down the toilet or tossing them into the garbage? Drugs that are flushed can taint our rivers, lakes and water supplies. Drugs in the trash \u003ca href=\"http://www.epa.illinois.gov/topics/waste-management/waste-disposal/medication-disposal/faqs/index\" target=\"_blank\">also may harm the environment\u003c/a>, and can be found by children, pets — and even adults looking for a high.\u003c/p>\n\u003cp>There are a growing number of year-round disposal sites in California, but your options depend largely on where you live and what kind of drugs you’re trying to unload.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>For instance, it might be difficult to find a place that will accept \u003ca href=\"http://www.dea.gov/druginfo/ds.shtml\" target=\"_blank\">“controlled” drugs\u003c/a>, which include legal drugs that are closely regulated by the government, such as addictive opiates.\u003c/p>\n\u003cp>In reality, it might be hard for you to find a convenient place at all.\u003c/p>\n\u003cp>“It’s very time-consuming and you may get the runaround,” warns Heidi Sanborn, executive director of the \u003ca href=\"http://calpsc.org/\" target=\"_blank\">California Product Stewardship Council\u003c/a>, a nonprofit that created the website \u003ca href=\"http://dontrushtoflush.org/\" target=\"_blank\">DontRushToFlush.org\u003c/a>. (The group also calls on pharmaceutical companies to share in the cost of drug disposal.)\u003c/p>\n\u003cp>The safest and most environmentally responsible option is to take unwanted medications to a drug take-back site.\u003c/p>\n\u003cp>But there’s no consistent, statewide collection system because there’s no consistent source of funding, Sanborn says. “It’s whoever can afford to offer it and whoever wants to do it,” she says.\u003c/p>\n\u003cp>Some communities, mostly in Northern California, have adopted ordinances to operate drug collection programs funded by drug makers. They include \u003ca href=\"http://www.acgov.org/aceh/safedisposal/\" target=\"_blank\">Alameda\u003c/a>, \u003ca href=\"http://www.marincounty.org/depts/cd/divisions/environmental-health-services/safe-drug-disposal-ordinance\" target=\"_blank\">Marin\u003c/a> and \u003ca href=\"http://www.codepublishing.com/CA/SantaCruzCounty/html/SantaCruzCounty07/SantaCruzCounty0795.html\" target=\"_blank\">Santa Cruz\u003c/a> Counties. One is also pending before the Los Angeles County Board of Supervisors.\u003c/p>\n\u003cp>But most of these programs are not yet up and running, Sanborn says.\u003c/p>\n\u003cp>So, to find sites near you, start with \u003ca href=\"http://dontrushtoflush.org/dontrush2flush/map/\" target=\"_blank\">Don’t Rush To Flush\u003c/a>, where you can search by California zip code.\u003c/p>\n\u003cp>Pay attention to the search results, which explain whether controlled drugs are accepted. (Some other medications — such as chemotherapy drugs — also come with specific disposal instructions and locations. Same with sharps, such as hypodermic needles.)\u003c/p>\n\u003cp>For more options, try the state’s CalRecycle website at \u003ca href=\"http://www.calrecycle.ca.gov/\" target=\"_blank\">www.calrecycle.ca.gov\u003c/a>. Click on the “Consumers” tab and then on the “Medication Waste” link, where you’ll be directed to \u003ca href=\"http://www.calrecycle.ca.gov/FacIT/Facility/Search.aspx?Activity=Medication\" target=\"_blank\">a not-very-user-friendly search page\u003c/a>.\u003c/p>\n\u003cp>When I asked CalRecycle for more information, I was advised to contact the state Department of Public Health, which I was told supplies the data for the search function. I did on May 17 and several times thereafter, but as of May 26, the department had not answered my questions, opting only to \u003ca href=\"http://www.cdph.ca.gov/certlic/medicalwaste/Documents/MedicalWaste/2013/HomeGenShConsolPtjune09.pdf\" target=\"_blank\">send me a link to a spreadsheet on its website\u003c/a>, which is even less user-friendly than the CalRecycle search function.\u003c/p>\n\u003cp>To find take-back sites that definitely accept controlled drugs, check the federal Drug Enforcement Administration’s website at \u003ca href=\"http://www.deadiversion.usdoj.gov/drug_disposal/\" target=\"_blank\">www.deadiversion.usdoj.gov/drug_disposal/\u003c/a> or call 800-882-9539.\u003c/p>\n\u003cp>It turns out the most convenient option may be a new one. The drugstore chain Walgreens \u003ca href=\"http://news.walgreens.com/press-releases/general-news/walgreens-leads-fight-against-prescription-drug-abuse-in-california-with-new-program-to-help-curb-misuse-of-medications-and-the-rise-in-overdose-deaths.htm\" target=\"_blank\">announced plans\u003c/a> to install medication disposal bins at 500 stores nationwide.\u003c/p>\n\u003cp>The effort began last month in California with 50 stores, says Walgreens spokesman Phil Caruso.\u003c/p>\n\u003cp>The bins are available during pharmacy hours — usually 24-hours — and accept prescription medications, including controlled drugs, and over-the-counter medications. They don’t accept sharps.\u003c/p>\n\u003cp>“Our goal is to get at the misuse of medications as well as to help curb the rise in overdose deaths,” Caruso says.\u003c/p>\n\u003cp>Don’t Rush To Flush has integrated participating Walgreens stores into its search results, or find a list of stores here: \u003ca href=\"http://bit.ly/246LNQ4\" target=\"_blank\">http://bit.ly/246LNQ4\u003c/a>.\u003c/p>\n\u003cp>If your search is still coming up short, try checking with your garbage hauler, local household hazardous waste program, pharmacy or hospital, or local law-enforcement agency.\u003c/p>\n\u003cp>Finally, if you can’t find a convenient disposal site, most government agencies — including the \u003ca href=\"http://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/EnsuringSafeUseofMedicine/SafeDisposalofMedicines/ucm186187.htm\" target=\"_blank\">U.S. Food and Drug Administration\u003c/a> and the U.S. Environmental Protection Agency — suggest you throw unwanted drugs into the trash following these rules:\u003c/p>\n\u003cul>\n\u003cli>Remove the drugs from their containers and mix them with dirt, kitty litter or used coffee grounds to make them unappealing to kids and pets, and to dissuade anyone who might be hunting for drugs.\u003c/li>\n\u003cli>Before tossing in the trash, place the mixture in a sealable plastic bag or other container to prevent it from leaking.\u003c/li>\n\u003cli>Scratch out any personal information on prescription labels to protect your privacy before disposing of medicine containers.\u003c/li>\n\u003c/ul>\n\u003cp>And though Sanborn and some others disagree, the FDA says some drugs should be flushed if you can’t find a take-back site because they “may be especially harmful and, in some cases, fatal with just one dose,” says spokesman Christopher Kelly. The list of drugs, which you can find at \u003ca href=\"http://1.usa.gov/1YWB4q7\" target=\"_blank\">http://1.usa.gov/1YWB4q7\u003c/a>, includes Fentanyl, Oxycodone and other opioids.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“We believe that this risk far outweighs any potential risk to human health or the environment that may come from disposal by flushing,” \u003ca href=\"http://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafel\" target=\"_blank\">the FDA says\u003c/a>.\u003c/p>\n\n","blocks":[],"excerpt":"You need to dispose of unwanted or expired prescription drugs properly. But finding a convenient take-back site requires time and patience.","status":"publish","parent":0,"modified":1464722113,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":28,"wordCount":1019},"headData":{"title":"Not Easy to Find Drug Take-Back Locations, But They're Out There | KQED","description":"You need to dispose of unwanted or expired prescription drugs properly. But finding a convenient take-back site requires time and patience.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"189809 http://ww2.kqed.org/stateofhealth/?p=189809","disqusUrl":"https://ww2.kqed.org/stateofhealth/2016/06/03/not-easy-to-find-drug-take-back-locations-but-theyre-out-there/","disqusTitle":"Not Easy to Find Drug Take-Back Locations, But They're Out There","nprByline":"Emily Bazar\u003cbr />\u003ca href=\"http://californiahealthline.org/\">California Healthline\u003c/a>","path":"/stateofhealth/189809/not-easy-to-find-drug-take-back-locations-but-theyre-out-there","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Opioids like Vicodin and Percocet are commonly prescribed to dull pain after medical procedures and to treat chronic pain. They also commonly languish in medicine cabinets, sometimes for years, making easy pickings for someone with an addiction.\u003c/p>\n\u003cp>The consequences can be deadly: More than 165,000 people died in the U.S. from overdoses related to prescription opioids between 1999 and 2014, says the \u003ca href=\"http://www.cdc.gov/drugoverdose/data/overdose.html\" target=\"_blank\">Centers for Disease Control and Prevention.\u003c/a>\u003c/p>\n\u003cp>I’m guilty of keeping them too long myself. I had a bottle of opioids left over from a dental procedure three years ago and kept it in a freezer bag full of unwanted and expired medications. In April, I turned them all in on the twice-a-year \u003ca href=\"http://www.dea.gov/divisions/hq/2016/hq050616.shtml\" target=\"_blank\">National Prescription Drug Take-Back Day\u003c/a>.\u003c/p>\n\u003cp>What are consumers to do the rest of the year if they want a safe alternative to flushing unwanted drugs down the toilet or tossing them into the garbage? Drugs that are flushed can taint our rivers, lakes and water supplies. Drugs in the trash \u003ca href=\"http://www.epa.illinois.gov/topics/waste-management/waste-disposal/medication-disposal/faqs/index\" target=\"_blank\">also may harm the environment\u003c/a>, and can be found by children, pets — and even adults looking for a high.\u003c/p>\n\u003cp>There are a growing number of year-round disposal sites in California, but your options depend largely on where you live and what kind of drugs you’re trying to unload.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>For instance, it might be difficult to find a place that will accept \u003ca href=\"http://www.dea.gov/druginfo/ds.shtml\" target=\"_blank\">“controlled” drugs\u003c/a>, which include legal drugs that are closely regulated by the government, such as addictive opiates.\u003c/p>\n\u003cp>In reality, it might be hard for you to find a convenient place at all.\u003c/p>\n\u003cp>“It’s very time-consuming and you may get the runaround,” warns Heidi Sanborn, executive director of the \u003ca href=\"http://calpsc.org/\" target=\"_blank\">California Product Stewardship Council\u003c/a>, a nonprofit that created the website \u003ca href=\"http://dontrushtoflush.org/\" target=\"_blank\">DontRushToFlush.org\u003c/a>. (The group also calls on pharmaceutical companies to share in the cost of drug disposal.)\u003c/p>\n\u003cp>The safest and most environmentally responsible option is to take unwanted medications to a drug take-back site.\u003c/p>\n\u003cp>But there’s no consistent, statewide collection system because there’s no consistent source of funding, Sanborn says. “It’s whoever can afford to offer it and whoever wants to do it,” she says.\u003c/p>\n\u003cp>Some communities, mostly in Northern California, have adopted ordinances to operate drug collection programs funded by drug makers. They include \u003ca href=\"http://www.acgov.org/aceh/safedisposal/\" target=\"_blank\">Alameda\u003c/a>, \u003ca href=\"http://www.marincounty.org/depts/cd/divisions/environmental-health-services/safe-drug-disposal-ordinance\" target=\"_blank\">Marin\u003c/a> and \u003ca href=\"http://www.codepublishing.com/CA/SantaCruzCounty/html/SantaCruzCounty07/SantaCruzCounty0795.html\" target=\"_blank\">Santa Cruz\u003c/a> Counties. One is also pending before the Los Angeles County Board of Supervisors.\u003c/p>\n\u003cp>But most of these programs are not yet up and running, Sanborn says.\u003c/p>\n\u003cp>So, to find sites near you, start with \u003ca href=\"http://dontrushtoflush.org/dontrush2flush/map/\" target=\"_blank\">Don’t Rush To Flush\u003c/a>, where you can search by California zip code.\u003c/p>\n\u003cp>Pay attention to the search results, which explain whether controlled drugs are accepted. (Some other medications — such as chemotherapy drugs — also come with specific disposal instructions and locations. Same with sharps, such as hypodermic needles.)\u003c/p>\n\u003cp>For more options, try the state’s CalRecycle website at \u003ca href=\"http://www.calrecycle.ca.gov/\" target=\"_blank\">www.calrecycle.ca.gov\u003c/a>. Click on the “Consumers” tab and then on the “Medication Waste” link, where you’ll be directed to \u003ca href=\"http://www.calrecycle.ca.gov/FacIT/Facility/Search.aspx?Activity=Medication\" target=\"_blank\">a not-very-user-friendly search page\u003c/a>.\u003c/p>\n\u003cp>When I asked CalRecycle for more information, I was advised to contact the state Department of Public Health, which I was told supplies the data for the search function. I did on May 17 and several times thereafter, but as of May 26, the department had not answered my questions, opting only to \u003ca href=\"http://www.cdph.ca.gov/certlic/medicalwaste/Documents/MedicalWaste/2013/HomeGenShConsolPtjune09.pdf\" target=\"_blank\">send me a link to a spreadsheet on its website\u003c/a>, which is even less user-friendly than the CalRecycle search function.\u003c/p>\n\u003cp>To find take-back sites that definitely accept controlled drugs, check the federal Drug Enforcement Administration’s website at \u003ca href=\"http://www.deadiversion.usdoj.gov/drug_disposal/\" target=\"_blank\">www.deadiversion.usdoj.gov/drug_disposal/\u003c/a> or call 800-882-9539.\u003c/p>\n\u003cp>It turns out the most convenient option may be a new one. The drugstore chain Walgreens \u003ca href=\"http://news.walgreens.com/press-releases/general-news/walgreens-leads-fight-against-prescription-drug-abuse-in-california-with-new-program-to-help-curb-misuse-of-medications-and-the-rise-in-overdose-deaths.htm\" target=\"_blank\">announced plans\u003c/a> to install medication disposal bins at 500 stores nationwide.\u003c/p>\n\u003cp>The effort began last month in California with 50 stores, says Walgreens spokesman Phil Caruso.\u003c/p>\n\u003cp>The bins are available during pharmacy hours — usually 24-hours — and accept prescription medications, including controlled drugs, and over-the-counter medications. They don’t accept sharps.\u003c/p>\n\u003cp>“Our goal is to get at the misuse of medications as well as to help curb the rise in overdose deaths,” Caruso says.\u003c/p>\n\u003cp>Don’t Rush To Flush has integrated participating Walgreens stores into its search results, or find a list of stores here: \u003ca href=\"http://bit.ly/246LNQ4\" target=\"_blank\">http://bit.ly/246LNQ4\u003c/a>.\u003c/p>\n\u003cp>If your search is still coming up short, try checking with your garbage hauler, local household hazardous waste program, pharmacy or hospital, or local law-enforcement agency.\u003c/p>\n\u003cp>Finally, if you can’t find a convenient disposal site, most government agencies — including the \u003ca href=\"http://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/EnsuringSafeUseofMedicine/SafeDisposalofMedicines/ucm186187.htm\" target=\"_blank\">U.S. Food and Drug Administration\u003c/a> and the U.S. Environmental Protection Agency — suggest you throw unwanted drugs into the trash following these rules:\u003c/p>\n\u003cul>\n\u003cli>Remove the drugs from their containers and mix them with dirt, kitty litter or used coffee grounds to make them unappealing to kids and pets, and to dissuade anyone who might be hunting for drugs.\u003c/li>\n\u003cli>Before tossing in the trash, place the mixture in a sealable plastic bag or other container to prevent it from leaking.\u003c/li>\n\u003cli>Scratch out any personal information on prescription labels to protect your privacy before disposing of medicine containers.\u003c/li>\n\u003c/ul>\n\u003cp>And though Sanborn and some others disagree, the FDA says some drugs should be flushed if you can’t find a take-back site because they “may be especially harmful and, in some cases, fatal with just one dose,” says spokesman Christopher Kelly. The list of drugs, which you can find at \u003ca href=\"http://1.usa.gov/1YWB4q7\" target=\"_blank\">http://1.usa.gov/1YWB4q7\u003c/a>, includes Fentanyl, Oxycodone and other opioids.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“We believe that this risk far outweighs any potential risk to human health or the environment that may come from disposal by flushing,” \u003ca href=\"http://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafel\" target=\"_blank\">the FDA says\u003c/a>.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/189809/not-easy-to-find-drug-take-back-locations-but-theyre-out-there","authors":["byline_stateofhealth_189809"],"categories":["stateofhealth_2407","stateofhealth_2746"],"tags":["stateofhealth_2519","stateofhealth_2525"],"featImg":"stateofhealth_189980","label":"stateofhealth"},"stateofhealth_179751":{"type":"posts","id":"stateofhealth_179751","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"179751","score":null,"sort":[1462299741000]},"guestAuthors":[],"slug":"hospital-discharge-is-one-of-the-most-dangerous-times-for-patients","title":"Hospital Discharge Is One of the Most Dangerous Times for Patients","publishDate":1462299741,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>Within two weeks of Joyce Oyler’s discharge from the hospital, sores developed in her mouth and throat, and blood began seeping from her nose and bowels.\u003c/p>\n\u003cp>Her daughter traced the source to the medicine bottles in Oyler’s home in St. Joseph, Missouri. One drug that keeps heart patients like Oyler from retaining fluids was missing. In its place was a toxic drug with a similar name but different purpose, primarily to treat cancer and severe arthritis. The label said to take it daily.\u003c/p>\n\u003cp>“I gathered all her medicine, and as soon as I saw that bottle, I knew she couldn’t come back from this,” said the daughter, Kristin Sigg, an oncology nurse. “There were many layers and mistakes made after she left the hospital. It should have been caught about five different ways.”\u003c/p>\n\u003cp>Oyler’s death occurred at one of the most dangerous junctures in medical care: when patients leave the hospital. Bad coordination often plagues patients’ transitions to the care of home health agencies, as well as to nursing homes and other professionals charged with helping them recuperate, studies show.\u003c/p>\n\u003cp>“Poor transitional care is a huge, huge issue for everybody, but especially for older people with complex needs,” said Alicia Arbaje, an assistant professor at the Johns Hopkins School of Medicine in Baltimore. “The most risky transition is from hospital to home with the additional need for home care services, and that’s the one we know the least about.”\u003c/p>\n\u003cfigure id=\"attachment_179754\" class=\"wp-caption aligncenter\" style=\"max-width: 1600px\">\u003cimg class=\"size-full wp-image-179754\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/05/042216-Health-Meds-3.jpg\" alt='Joyce Oyler, left, died because of medication mistakes by a Missouri pharmacy and home health agency. Her daughter, holding the photo of her mother and aunt, says the error \"should have been caught about five different ways.\" ' width=\"1600\" height=\"1068\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/05/042216-Health-Meds-3.jpg 1600w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/042216-Health-Meds-3-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/042216-Health-Meds-3-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/042216-Health-Meds-3-768x513.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/042216-Health-Meds-3-1440x961.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/042216-Health-Meds-3-1180x788.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/042216-Health-Meds-3-960x641.jpg 960w\" sizes=\"(max-width: 1600px) 100vw, 1600px\">\u003cfigcaption class=\"wp-caption-text\">Joyce Oyler, left, died because of medication mistakes by a Missouri pharmacy and home health agency. Her daughter, holding the photo of her mother and aunt, says the error \"should have been caught about five different ways.\" \u003ccite>(Travis Young/Austin Walsh Studio/2016 for KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Medication mistakes like the one in Oyler’s case — which, according to court records, slipped past both her pharmacist and home health nurses — are in fact one of the \u003ca href=\"https://psnet.ahrq.gov/primers/primer/11\" target=\"_blank\">most common complications\u003c/a> for discharged patients. The \u003ca href=\"http://health.gov/hcq/ade-action-plan.asp\" target=\"_blank\">federal government views\u003c/a> them as “a major patient safety and public health issue,” and a Kaiser Health News analysis of inspection records shows such errors are frequently missed by home health agencies.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Between January 2010 and July 2015, the analysis found, inspectors identified 3,016 home health agencies — nearly a quarter of all those examined by Medicare — that had inadequately reviewed or tracked medications for new patients. In some cases, nurses failed to realize that patients were taking potentially dangerous combinations of drugs, risking abnormal heart rhythms, bleeding, kidney damage and seizures.\u003c/p>\n\u003cp>The variety of providers that patients may use after a hospitalization — including pharmacies, urgent care clinics and a range of specialists — creates fertile ground for error, said Don Goldmann, chief medical and scientific officer at the nonprofit Institute for Healthcare Improvement. “This episodic care at different places at different times is not designed to keep the overall safety of the patient in mind,” Goldmann said.\u003c/p>\n\u003cp>One factor is the lack of organization and communication among these other parts of the medical system. Of the $30 billion that Congress appropriated to help shift the system to electronic medical records — to ensure better coordination of care and reduce errors across the board — none went to nursing homes, rehabilitation facilities or providers working with individuals in their homes.\u003c/p>\n\u003cfigure id=\"attachment_179755\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003cimg class=\"size-thumbnail wp-image-179755\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/05/042216-Health-Meds-4-400x599.jpg\" alt=\"Sigg says many people don’t know that lapses in communication sharing among doctors can lead to danger for patients.\" width=\"400\" height=\"599\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/05/042216-Health-Meds-4-400x599.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/042216-Health-Meds-4-800x1199.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/042216-Health-Meds-4-768x1151.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/042216-Health-Meds-4-960x1438.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/042216-Health-Meds-4.jpg 1068w\" sizes=\"(max-width: 400px) 100vw, 400px\">\u003cfigcaption class=\"wp-caption-text\">Sigg says many people don’t know that lapses in communication sharing among doctors can lead to danger for patients. \u003ccite>(Travis Young/Austin Walsh Studio/2016 for KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\"In retrospect, that might have been a mistake,” said Robert Wachter, a professor at the University of California, San Francisco who studies patient safety. “The systems are not adequately connected.”\u003c/p>\n\u003cp>At any point, problems can occur:\u003c/p>\n\u003cp>— At hospitals, where federal data show that fewer than half of patients say they confidently understood the instructions of how to care for themselves after discharge.\u003c/p>\n\u003cp>— In nursing homes, where case management frequently comes up short. A \u003ca href=\"http://oig.hhs.gov/oei/reports/oei-02-09-00201.pdf\" target=\"_blank\">2013 government report\u003c/a> found more than a third of facilities did not properly assess patients’ needs, devise a plan for their care and then follow it through.\u003c/p>\n\u003cp>— At pharmacies, where counseling and reviewing drugs with patients is often pro forma, and better exertions do not always help. A \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/22751755\" target=\"_blank\">2012 study\u003c/a> in the journal Annals of Internal Medicine found that half of patients had a clinically significant medication error within a month of discharge from two highly regarded academic medical centers. The study found that these errors persisted even when pharmacists took a more active role in counseling the patient and reviewing the prescription.\u003c/p>\n\u003cp>— And at home health agencies, where failures to create and execute a care plan are the most common issues government inspectors identify, followed by deficient medication review, according to KHN’s analysis. Over the first half of this decade, 1,591 agencies — one in eight — had a defect inspectors considered so substantial that it warranted the agencies’ removal from the Medicare program unless the lapses were remedied.\u003c/p>\n\u003cp>\u003cstrong>‘Devastating’ Cancer Drug\u003c/strong>\u003c/p>\n\u003cp>Oyler’s death in October 2013 shows how a fatal mistake can slip by multiple checkpoints. The 66-year-old retired safety manager left Heartland Regional Medical Center in St. Joseph after being treated for \u003ca href=\"https://www.nlm.nih.gov/medlineplus/heartfailure.html\" target=\"_blank\">congestive heart failure\u003c/a>, in which the heart fails to pump effectively, causing fluid build-up in the lungs, shortness of breath and swelling in the feet. She returned home as a hospital nurse telephoned the local Hy-Vee Pharmacy with eight new prescriptions. One was for the diuretic metolazone.\u003c/p>\n\u003cp>But the medications a pharmacy technician wrote down did not include metolazone. Instead it listed \u003ca href=\"https://www.nlm.nih.gov/medlineplus/druginfo/meds/a682019.html\" target=\"_blank\">methotrexate\u003c/a>, which can damage blood cell counts, organs and the lining of the mouth, stomach and intestines. The drug is so potent that the Institute for Safe Medication Practices includes it among\u003ca href=\"https://www.ismp.org/communityRx/tools/ambulatoryhighalert.asp\" target=\"_blank\"> eight “high-alert” medications\u003c/a> with consequences so “devastating” that they warrant \u003ca href=\"https://www.ismp.org/hazardalerts/ha.pdf\" target=\"_blank\">special safeguards\u003c/a> against incorrect dispensing.\u003c/p>\n\u003cp>Oyler’s prescription included daily dosage instructions for the diuretic. Methotrexate is never supposed to be taken more than once or twice a week for patients not being treated for cancer, and almost always at a much lower dose.\u003c/p>\n\u003cfigure id=\"attachment_179781\" class=\"wp-caption alignleft\" style=\"max-width: 357px\">\u003cimg class=\"size-full wp-image-179781\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/05/Screen-Shot-2016-05-03-at-11.17.23-AM.png\" alt=\"Joyce Oyler’s prescription was written for a toxic drug instead of a common diuretic.\" width=\"357\" height=\"255\">\u003cfigcaption class=\"wp-caption-text\">Joyce Oyler’s prescription was written for a toxic drug instead of a common diuretic.\u003c/figcaption>\u003c/figure>\n\u003cp>“Here’s a drug that every patient, even if it’s on the refill, should get counseled on, why they’re taking methotrexate and how they’re taking it because of the mistakes of errors we’ve seen with the daily dosing rather than the weekly dosing,” said Allen Vaida, a pharmacist and executive vice president at the Institute for Safe Medication Practices.\u003c/p>\n\u003cp>In a court deposition taken as part of the lawsuit the family brought, Hy-Vee’s pharmacist blamed himself for not catching the error. “For whatever reason, on that certain day, that didn’t trigger with me,” he said. Hy-Vee argued that its safeguards were as strong as at other pharmacies, although the pharmacy manager admitted in a deposition that “quite honestly, there was a breakdown in the system.”\u003c/p>\n\u003cp>The family’s attorney, Leland Dempsey, said court evidence suggested the drug mix-up was made by the pharmacy technician who transcribed the prescription orders. “The pharmacy tech made numerous spelling errors on the drugs,” he said. “She had a dosage off on another drug.”\u003c/p>\n\u003cp>In February, a jury awarded Oyler’s family $2 million in damages from the pharmacy. The judge lowered the award to $125,000 because of Missouri’s cap for non-economic damages in medical malpractice cases. Hy-Vee declined to comment.\u003c/p>\n\u003cp>\u003cstrong>Nurses Overlook Prescription Mistake\u003c/strong>\u003c/p>\n\u003cp>Yet the error could have been caught right away as Oyler began getting care from Heartland’s home health care agency. Medicare requires home health agencies to examine details of a patient’s medications to ensure all the drugs match the prescriptions ordered, are being taken in the right dose and frequency, and don’t have negative interactions.\u003c/p>\n\u003cp>Less than a year before, Missouri state \u003ca href=\"http://health.mo.gov/cgi-bin/hcrs2.pl?facid=MO267064\" target=\"_blank\">inspectors had cited the agency\u003c/a> for inadequately reviewing medications for three patients, and the agency had pledged to make improvements, records show. Still, neither of two agency nurses who visited Oyler at home stopped her from taking the wrong drug.\u003c/p>\n\u003cp>“Why they didn’t catch it was beyond me,” her husband, Carl, said recently. “They had a printout from the hospital,” with every medication correctly listed. “It was all there,” he said.\u003c/p>\n\u003cfigure id=\"attachment_179753\" class=\"wp-caption aligncenter\" style=\"max-width: 1600px\">\u003cimg class=\"size-full wp-image-179753\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/05/042216-Health-Meds-2.jpg\" alt=\"Kristin Sigg looks at wedding photos that include her mother. \" width=\"1600\" height=\"1068\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/05/042216-Health-Meds-2.jpg 1600w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/042216-Health-Meds-2-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/042216-Health-Meds-2-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/042216-Health-Meds-2-768x513.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/042216-Health-Meds-2-1440x961.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/042216-Health-Meds-2-1180x788.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/042216-Health-Meds-2-960x641.jpg 960w\" sizes=\"(max-width: 1600px) 100vw, 1600px\">\u003cfigcaption class=\"wp-caption-text\">Kristin Sigg looks at wedding photos that include her mother. \u003ccite>(Travis Young/Austin Walsh Studio/2016 for KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>After 18 days, her family took her to North Kansas City Hospital, where doctors determined that the methotrexate had irreparably damaged her bone marrow’s ability to create blood cells. She died three days later of multiple organ failure.\u003c/p>\n\u003cp>“By the time we got her into the emergency room, essentially she had no blood cell count,” her husband recounted. “It was irreversible. It was a gruesome, slow, painful way to die.”\u003c/p>\n\u003cp>Heartland Regional Medical Center paid Oyler’s family $225,000 in a settlement, court records show. Mosaic Life Care, the name by which Heartland now operates, said in a statement that it is “consistently improving processes and adopting new technologies to further reduce risks of errors and to improve communication.”\u003c/p>\n\u003cp>Nonetheless, last November inspectors again cited Heartland for failing to properly review medications for two patients.\u003c/p>\n\u003cp>“Most people don’t know this is a problem,” Sigg said. “They assume doctors are talking to each other, until they experience it, and it’s not the case.”\u003c/p>\n\u003cp>\u003cem>If you’d like to share your reaction to this article and your experience with a home health agency, you can contact Kaiser Health News. Send an email to patients@kff.org.\u003c/em>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This story was produced by \u003ca href=\"http://khn.org/\" target=\"_blank\">Kaiser Health News\u003c/a>, an editorially independent program of the \u003ca href=\"http://kff.org/\" target=\"\">Kaiser Family Foundation\u003c/a>.\u003c/em>\u003c/p>\n\n","blocks":[],"excerpt":"Poor communication and coordination put patients at risk at a vulnerable time -- when they're discharged from the hospital.","status":"publish","parent":0,"modified":1462299741,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":36,"wordCount":1726},"headData":{"title":"Hospital Discharge Is One of the Most Dangerous Times for Patients | KQED","description":"Poor communication and coordination put patients at risk at a vulnerable time -- when they're discharged from the hospital.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"179751 http://ww2.kqed.org/stateofhealth/?p=179751","disqusUrl":"https://ww2.kqed.org/stateofhealth/2016/05/03/hospital-discharge-is-one-of-the-most-dangerous-times-for-patients/","disqusTitle":"Hospital Discharge Is One of the Most Dangerous Times for Patients","nprByline":"Jordan Rau\u003cbr />\u003ca href=\"http://khn.org/\">Kaiser Health News\u003c/a>","path":"/stateofhealth/179751/hospital-discharge-is-one-of-the-most-dangerous-times-for-patients","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Within two weeks of Joyce Oyler’s discharge from the hospital, sores developed in her mouth and throat, and blood began seeping from her nose and bowels.\u003c/p>\n\u003cp>Her daughter traced the source to the medicine bottles in Oyler’s home in St. Joseph, Missouri. One drug that keeps heart patients like Oyler from retaining fluids was missing. In its place was a toxic drug with a similar name but different purpose, primarily to treat cancer and severe arthritis. The label said to take it daily.\u003c/p>\n\u003cp>“I gathered all her medicine, and as soon as I saw that bottle, I knew she couldn’t come back from this,” said the daughter, Kristin Sigg, an oncology nurse. “There were many layers and mistakes made after she left the hospital. It should have been caught about five different ways.”\u003c/p>\n\u003cp>Oyler’s death occurred at one of the most dangerous junctures in medical care: when patients leave the hospital. Bad coordination often plagues patients’ transitions to the care of home health agencies, as well as to nursing homes and other professionals charged with helping them recuperate, studies show.\u003c/p>\n\u003cp>“Poor transitional care is a huge, huge issue for everybody, but especially for older people with complex needs,” said Alicia Arbaje, an assistant professor at the Johns Hopkins School of Medicine in Baltimore. “The most risky transition is from hospital to home with the additional need for home care services, and that’s the one we know the least about.”\u003c/p>\n\u003cfigure id=\"attachment_179754\" class=\"wp-caption aligncenter\" style=\"max-width: 1600px\">\u003cimg class=\"size-full wp-image-179754\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/05/042216-Health-Meds-3.jpg\" alt='Joyce Oyler, left, died because of medication mistakes by a Missouri pharmacy and home health agency. Her daughter, holding the photo of her mother and aunt, says the error \"should have been caught about five different ways.\" ' width=\"1600\" height=\"1068\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/05/042216-Health-Meds-3.jpg 1600w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/042216-Health-Meds-3-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/042216-Health-Meds-3-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/042216-Health-Meds-3-768x513.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/042216-Health-Meds-3-1440x961.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/042216-Health-Meds-3-1180x788.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/042216-Health-Meds-3-960x641.jpg 960w\" sizes=\"(max-width: 1600px) 100vw, 1600px\">\u003cfigcaption class=\"wp-caption-text\">Joyce Oyler, left, died because of medication mistakes by a Missouri pharmacy and home health agency. Her daughter, holding the photo of her mother and aunt, says the error \"should have been caught about five different ways.\" \u003ccite>(Travis Young/Austin Walsh Studio/2016 for KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Medication mistakes like the one in Oyler’s case — which, according to court records, slipped past both her pharmacist and home health nurses — are in fact one of the \u003ca href=\"https://psnet.ahrq.gov/primers/primer/11\" target=\"_blank\">most common complications\u003c/a> for discharged patients. The \u003ca href=\"http://health.gov/hcq/ade-action-plan.asp\" target=\"_blank\">federal government views\u003c/a> them as “a major patient safety and public health issue,” and a Kaiser Health News analysis of inspection records shows such errors are frequently missed by home health agencies.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Between January 2010 and July 2015, the analysis found, inspectors identified 3,016 home health agencies — nearly a quarter of all those examined by Medicare — that had inadequately reviewed or tracked medications for new patients. In some cases, nurses failed to realize that patients were taking potentially dangerous combinations of drugs, risking abnormal heart rhythms, bleeding, kidney damage and seizures.\u003c/p>\n\u003cp>The variety of providers that patients may use after a hospitalization — including pharmacies, urgent care clinics and a range of specialists — creates fertile ground for error, said Don Goldmann, chief medical and scientific officer at the nonprofit Institute for Healthcare Improvement. “This episodic care at different places at different times is not designed to keep the overall safety of the patient in mind,” Goldmann said.\u003c/p>\n\u003cp>One factor is the lack of organization and communication among these other parts of the medical system. Of the $30 billion that Congress appropriated to help shift the system to electronic medical records — to ensure better coordination of care and reduce errors across the board — none went to nursing homes, rehabilitation facilities or providers working with individuals in their homes.\u003c/p>\n\u003cfigure id=\"attachment_179755\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003cimg class=\"size-thumbnail wp-image-179755\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/05/042216-Health-Meds-4-400x599.jpg\" alt=\"Sigg says many people don’t know that lapses in communication sharing among doctors can lead to danger for patients.\" width=\"400\" height=\"599\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/05/042216-Health-Meds-4-400x599.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/042216-Health-Meds-4-800x1199.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/042216-Health-Meds-4-768x1151.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/042216-Health-Meds-4-960x1438.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/042216-Health-Meds-4.jpg 1068w\" sizes=\"(max-width: 400px) 100vw, 400px\">\u003cfigcaption class=\"wp-caption-text\">Sigg says many people don’t know that lapses in communication sharing among doctors can lead to danger for patients. \u003ccite>(Travis Young/Austin Walsh Studio/2016 for KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\"In retrospect, that might have been a mistake,” said Robert Wachter, a professor at the University of California, San Francisco who studies patient safety. “The systems are not adequately connected.”\u003c/p>\n\u003cp>At any point, problems can occur:\u003c/p>\n\u003cp>— At hospitals, where federal data show that fewer than half of patients say they confidently understood the instructions of how to care for themselves after discharge.\u003c/p>\n\u003cp>— In nursing homes, where case management frequently comes up short. A \u003ca href=\"http://oig.hhs.gov/oei/reports/oei-02-09-00201.pdf\" target=\"_blank\">2013 government report\u003c/a> found more than a third of facilities did not properly assess patients’ needs, devise a plan for their care and then follow it through.\u003c/p>\n\u003cp>— At pharmacies, where counseling and reviewing drugs with patients is often pro forma, and better exertions do not always help. A \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/22751755\" target=\"_blank\">2012 study\u003c/a> in the journal Annals of Internal Medicine found that half of patients had a clinically significant medication error within a month of discharge from two highly regarded academic medical centers. The study found that these errors persisted even when pharmacists took a more active role in counseling the patient and reviewing the prescription.\u003c/p>\n\u003cp>— And at home health agencies, where failures to create and execute a care plan are the most common issues government inspectors identify, followed by deficient medication review, according to KHN’s analysis. Over the first half of this decade, 1,591 agencies — one in eight — had a defect inspectors considered so substantial that it warranted the agencies’ removal from the Medicare program unless the lapses were remedied.\u003c/p>\n\u003cp>\u003cstrong>‘Devastating’ Cancer Drug\u003c/strong>\u003c/p>\n\u003cp>Oyler’s death in October 2013 shows how a fatal mistake can slip by multiple checkpoints. The 66-year-old retired safety manager left Heartland Regional Medical Center in St. Joseph after being treated for \u003ca href=\"https://www.nlm.nih.gov/medlineplus/heartfailure.html\" target=\"_blank\">congestive heart failure\u003c/a>, in which the heart fails to pump effectively, causing fluid build-up in the lungs, shortness of breath and swelling in the feet. She returned home as a hospital nurse telephoned the local Hy-Vee Pharmacy with eight new prescriptions. One was for the diuretic metolazone.\u003c/p>\n\u003cp>But the medications a pharmacy technician wrote down did not include metolazone. Instead it listed \u003ca href=\"https://www.nlm.nih.gov/medlineplus/druginfo/meds/a682019.html\" target=\"_blank\">methotrexate\u003c/a>, which can damage blood cell counts, organs and the lining of the mouth, stomach and intestines. The drug is so potent that the Institute for Safe Medication Practices includes it among\u003ca href=\"https://www.ismp.org/communityRx/tools/ambulatoryhighalert.asp\" target=\"_blank\"> eight “high-alert” medications\u003c/a> with consequences so “devastating” that they warrant \u003ca href=\"https://www.ismp.org/hazardalerts/ha.pdf\" target=\"_blank\">special safeguards\u003c/a> against incorrect dispensing.\u003c/p>\n\u003cp>Oyler’s prescription included daily dosage instructions for the diuretic. Methotrexate is never supposed to be taken more than once or twice a week for patients not being treated for cancer, and almost always at a much lower dose.\u003c/p>\n\u003cfigure id=\"attachment_179781\" class=\"wp-caption alignleft\" style=\"max-width: 357px\">\u003cimg class=\"size-full wp-image-179781\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/05/Screen-Shot-2016-05-03-at-11.17.23-AM.png\" alt=\"Joyce Oyler’s prescription was written for a toxic drug instead of a common diuretic.\" width=\"357\" height=\"255\">\u003cfigcaption class=\"wp-caption-text\">Joyce Oyler’s prescription was written for a toxic drug instead of a common diuretic.\u003c/figcaption>\u003c/figure>\n\u003cp>“Here’s a drug that every patient, even if it’s on the refill, should get counseled on, why they’re taking methotrexate and how they’re taking it because of the mistakes of errors we’ve seen with the daily dosing rather than the weekly dosing,” said Allen Vaida, a pharmacist and executive vice president at the Institute for Safe Medication Practices.\u003c/p>\n\u003cp>In a court deposition taken as part of the lawsuit the family brought, Hy-Vee’s pharmacist blamed himself for not catching the error. “For whatever reason, on that certain day, that didn’t trigger with me,” he said. Hy-Vee argued that its safeguards were as strong as at other pharmacies, although the pharmacy manager admitted in a deposition that “quite honestly, there was a breakdown in the system.”\u003c/p>\n\u003cp>The family’s attorney, Leland Dempsey, said court evidence suggested the drug mix-up was made by the pharmacy technician who transcribed the prescription orders. “The pharmacy tech made numerous spelling errors on the drugs,” he said. “She had a dosage off on another drug.”\u003c/p>\n\u003cp>In February, a jury awarded Oyler’s family $2 million in damages from the pharmacy. The judge lowered the award to $125,000 because of Missouri’s cap for non-economic damages in medical malpractice cases. Hy-Vee declined to comment.\u003c/p>\n\u003cp>\u003cstrong>Nurses Overlook Prescription Mistake\u003c/strong>\u003c/p>\n\u003cp>Yet the error could have been caught right away as Oyler began getting care from Heartland’s home health care agency. Medicare requires home health agencies to examine details of a patient’s medications to ensure all the drugs match the prescriptions ordered, are being taken in the right dose and frequency, and don’t have negative interactions.\u003c/p>\n\u003cp>Less than a year before, Missouri state \u003ca href=\"http://health.mo.gov/cgi-bin/hcrs2.pl?facid=MO267064\" target=\"_blank\">inspectors had cited the agency\u003c/a> for inadequately reviewing medications for three patients, and the agency had pledged to make improvements, records show. Still, neither of two agency nurses who visited Oyler at home stopped her from taking the wrong drug.\u003c/p>\n\u003cp>“Why they didn’t catch it was beyond me,” her husband, Carl, said recently. “They had a printout from the hospital,” with every medication correctly listed. “It was all there,” he said.\u003c/p>\n\u003cfigure id=\"attachment_179753\" class=\"wp-caption aligncenter\" style=\"max-width: 1600px\">\u003cimg class=\"size-full wp-image-179753\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/05/042216-Health-Meds-2.jpg\" alt=\"Kristin Sigg looks at wedding photos that include her mother. \" width=\"1600\" height=\"1068\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/05/042216-Health-Meds-2.jpg 1600w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/042216-Health-Meds-2-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/042216-Health-Meds-2-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/042216-Health-Meds-2-768x513.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/042216-Health-Meds-2-1440x961.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/042216-Health-Meds-2-1180x788.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/05/042216-Health-Meds-2-960x641.jpg 960w\" sizes=\"(max-width: 1600px) 100vw, 1600px\">\u003cfigcaption class=\"wp-caption-text\">Kristin Sigg looks at wedding photos that include her mother. \u003ccite>(Travis Young/Austin Walsh Studio/2016 for KHN)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>After 18 days, her family took her to North Kansas City Hospital, where doctors determined that the methotrexate had irreparably damaged her bone marrow’s ability to create blood cells. She died three days later of multiple organ failure.\u003c/p>\n\u003cp>“By the time we got her into the emergency room, essentially she had no blood cell count,” her husband recounted. “It was irreversible. It was a gruesome, slow, painful way to die.”\u003c/p>\n\u003cp>Heartland Regional Medical Center paid Oyler’s family $225,000 in a settlement, court records show. Mosaic Life Care, the name by which Heartland now operates, said in a statement that it is “consistently improving processes and adopting new technologies to further reduce risks of errors and to improve communication.”\u003c/p>\n\u003cp>Nonetheless, last November inspectors again cited Heartland for failing to properly review medications for two patients.\u003c/p>\n\u003cp>“Most people don’t know this is a problem,” Sigg said. “They assume doctors are talking to each other, until they experience it, and it’s not the case.”\u003c/p>\n\u003cp>\u003cem>If you’d like to share your reaction to this article and your experience with a home health agency, you can contact Kaiser Health News. Send an email to patients@kff.org.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>This story was produced by \u003ca href=\"http://khn.org/\" target=\"_blank\">Kaiser Health News\u003c/a>, an editorially independent program of the \u003ca href=\"http://kff.org/\" target=\"\">Kaiser Family Foundation\u003c/a>.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/179751/hospital-discharge-is-one-of-the-most-dangerous-times-for-patients","authors":["byline_stateofhealth_179751"],"categories":["stateofhealth_13"],"tags":["stateofhealth_53","stateofhealth_2525"],"featImg":"stateofhealth_179752","label":"stateofhealth"},"stateofhealth_170760":{"type":"posts","id":"stateofhealth_170760","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"170760","score":null,"sort":[1460271697000]},"guestAuthors":[],"slug":"california-searches-for-prescription-to-treat-rising-drug-costs","title":"California Searches for Prescription to Treat Rising Drug Costs","publishDate":1460271697,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>In a small room at a neighborhood clinic in Sacramento, a handful of hepatitis C patients wait to see their physician, hoping they’ll be found sick enough to be approved for a cure.\u003c/p>\n\u003caside class=\"pullquote alignright\">“There are very few tools in our toolbox” to control pharmaceutical spending\u003ccite>Diana Dooley, secretary of California’s Health and Human Services\u003c/cite>\u003c/aside>\n\u003cp>The low-income patients hope to be prescribed new breakthrough drugs, such as Sovaldi or Harvoni, which offer cures with almost no side effects. But treating the virus comes with a high price tag: at least $84,000 for a course of treatment. Getting Medi-Cal to pay for such drugs can involve a long, arduous process of tests and paperwork to prove infection has progressed to liver damage.\u003c/p>\n\u003cp>“If you’re practically dead … they’ll approve you,” said Laura Castillo, 54, who has been navigating the Medi-Cal system for four months to get Sovaldi. The former legal clerk said she contracted the virus from a blood transfusion in the early 1980s. Patients can live for years symptom free with hepatitis C, but left untreated, it can eventually lead to liver disease and death. Castillo has waited for treatment with substantial liver damage, which burdens her with overwhelming fatigue, depression and what she describes as a “brain fog.”\u003c/p>\n\u003cp>“It’s very, very frustrating, knowing that you have an illness and there is a cure, and you can’t do anything about it,” Castillo said.\u003c/p>\n\u003cp>Castillo’s physician, Dr. Catherine Moizeau, says she treats hundreds of Medi-Cal patients who wait months to get approval for the hepatitis C drugs. Moizeau says health plans, under state guidelines, are rationing the drugs because of the high cost. But Medi-Cal officials say patients receive the treatments based on medical necessity, not on cost.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Hepatitis C drugs are not the only part of California’s troubling drug spending picture. Despite recent cost-cutting measures, such as putting tighter controls on which patients get coverage for which drugs and when, California’s spending on pharmaceuticals has gone up, and so has the number of pricey drugs it is covering. It’s not clear state agencies have the means to balance drug cost pressures in a way that serves the best interests of patients, taxpayers and public health.\u003c/p>\n\u003cp>“There are very few tools in our toolbox” to control pharmaceutical spending, said Diana Dooley, secretary of California’s Health and Human Services. She says high prescription drug costs are a problem across California’s public and private health insurance, and should be addressed on a national level.\u003c/p>\n\u003cp>Drug price concerns will also be a matter of public policy debate this year. California voters are expected to decide in November on a measure to put a ceiling on what the state pays for drugs, and lawmakers have proposed drug price transparency requirements on pharmaceutical manufacturers and health insurers.\u003c/p>\n\u003cp>“We all have to do everything we can to try to control these drug costs,” Dooley said.\u003c/p>\n\u003cp>[contextly_sidebar id=\"kO3lkbe6TLc7SIMiuJ3FinItNEnjyfYz\"]A CALmatters analysis found that state prisons, a California public pension system, and one subset of the Medi-Cal program spent $600 million more on pharmaceuticals in 2014 than in 2012. That does not include the Medi-Cal population in a health plan, nor does it account for discounts the state may have received from drugmakers.\u003c/p>\n\u003cp>Over the past decade, Medi-Cal has seen a 57 percent increase in the drugs it covers that cost $600 or more per prescription. And when it comes to hepatitis C drugs alone, Medi-Cal estimates it will spend almost $482 million over this fiscal year and last. As of September 2015, only 4,200 Medi-Cal patients had received the drugs in that time period, out of 237,000 who are estimated to have the disease.\u003c/p>\n\u003cp>These cost trends exist despite new protocols various state agencies have introduced to tamp down on pharmaceutical spending, which include stricter controls on which patients get which prescription drugs and how.\u003c/p>\n\u003cp>“The people that pay for health care, be it the government or employers, are asking for more prior authorization because we’re having to scrutinize every penny we spend now,” said Steve Miller, chief medical officer at Express Scripts, which manages pharmacy benefits for health plans nationally, including 7.5 million Californians.\u003c/p>\n\u003cp>Miller said involvement from the payer is meant to get “the right patient, the right drug, at the right dose.” But the process, can be “clunky” and cause delays and frustrations for patients like Castillo.\u003c/p>\n\u003cp>Drugmakers say the value of the new hepatitis C drugs, the first of which hit the market at the end of 2013, is worth the cost, and in the long term, may eventually even bring savings to the health system.\u003c/p>\n\u003cp>The new hepatitis C drugs involve only a few months of treatment, and produce a cure in about 90 percent of patients. The older generation of treatments are cheaper, but are also about half as effective, and have side-effects that resemble the flu.\u003c/p>\n\u003cp>“These patients are now healthier. They’re more productive. They’re functioning,” said Priscilla VanderVeer, deputy vice president of communications at the Pharmaceutical Research and Manufacturers of America (PhRMA).\u003c/p>\n\u003cp>“You’re going to have less people who need long-term medication therapy for their hep C, they’re not going to need liver transplants, they’re not going to need significant hospitalizations,” VanderVeer said.\u003c/p>\n\u003cp>Health consumer advocates and economists argue that paying a lot for some drugs that only treat a limited population may not serve larger public health interests, or be the best use of taxpayer dollars.\u003c/p>\n\u003cp>For example, if the cost of the new hepatitis C drugs were cheaper, the hundreds of millions of dollars spent on treating just a few thousand patients could have been spent to help eradicate the disease, says Anthony Wright, executive director of Health Access, an advocacy group.\u003c/p>\n\u003cp>“You could imagine a strategy to provide this cure in a much more broad population strategy,” Wright said.\u003c/p>\n\u003cp>\u003cimg class=\"alignright wp-image-170763 size-thumbnail\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/04/DrugsOver600-400x828.png\" alt=\"DrugsOver600\" width=\"400\" height=\"828\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/04/DrugsOver600-400x828.png 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/04/DrugsOver600.png 550w\" sizes=\"(max-width: 400px) 100vw, 400px\">Specialty drugs, which the federal government defines as costing $600 or more a month, are raising concern among health insurers and state agencies. In CalPERS, for instance, specialty drugs are taking up a larger share of total drug expenditures, despite the fact that they account for a small percentage of prescriptions.\u003c/p>\n\u003cp>Drugmakers are investing more in these types of drugs, said Joel Hay, a pharmaceutical economist at the University of Southern California, because “the profits are very high.”\u003c/p>\n\u003cp>But paying a high price for drugs that treat a small number of patients raises an equity question, Hay said. It may not be fair to the larger patient population for a health system to pay a high price for cancer drugs that extend a patient’s life by three weeks.\u003c/p>\n\u003cp>“You can get a lot more lives saved if you take that budget and put it into colon cancer screening or any number of other more efficient, more effective interventions,” Hay said.\u003c/p>\n\u003cp>The cost pressure from specialty drugs may not go away soon. Pharmaceutical benefits manager Express Scripts estimates that this class of drugs will continue to grow in Medicaid programs by 13.6 percent over the next three years.\u003c/p>\n\u003cp>“Are we going to have a sustainable (pharmaceutical) industry where we are making sure the drug companies make enough money where they can bring great new products to the marketplace, yet we control cost well enough that people –- all people, even the most vulnerable -- have access to the drugs they need?” asked Miller.\u003c/p>\n\u003cp>State Medi-Cal administrators say it’s too soon to assess the sustainability of current prescription drug spending trends. Meantime, their guidelines about which patients can get covered by new hepatitis C drugs has recently loosened up. As of July 2015, patients with a less advanced stage of liver disease can get covered for the drugs, as well as IV drug users and women who want to get pregnant.\u003c/p>\n\u003cp>Castillo got her medication in March, after an attorney helped her challenge denied coverage for Sovaldi through a health insurance regulator. Castillo says she’s glad she’s in treatment now, but she doesn’t know why her Medi-Cal health plan made it so hard for her to get the medicine.\u003c/p>\n\u003cp>“They need to get it together,” she said. “It’s our health and our life that they’re messing with.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>CALmatters data reporter Matt Levin contributed to this article. \u003c/em>\u003ca href=\"https://calmatters.org/\" target=\"_blank\">\u003cem>CALmatters\u003c/em>\u003c/a>\u003cem> is a nonprofit journalism venture dedicated to explaining state policies and politics. Pauline Bartolone wrote this article while participating in the \u003c/em>\u003ca href=\"http://www.centerforhealthjournalism.org/event/2015-california-health-data-journalism-fellowship\">\u003cem>California Data\u003c/em>\u003c/a> \u003ca href=\"http://www.centerforhealthjournalism.org/event/2015-california-health-data-journalism-fellowship\" target=\"_blank\">\u003cem>Fellowship,\u003c/em>\u003c/a>\u003cem> a program of the \u003c/em>\u003ca href=\"http://www.centerforhealthjournalism.org/\" target=\"_blank\">\u003cem>Center for Health Journalism\u003c/em>\u003c/a>\u003cem> at USC’s Annenberg School of Journalism.\u003c/em>\u003c/p>\n\n","blocks":[],"excerpt":"California voters are expected to decide in November on a measure to put a ceiling on what the state pays for drugs.","status":"publish","parent":0,"modified":1460264496,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":33,"wordCount":1503},"headData":{"title":"California Searches for Prescription to Treat Rising Drug Costs | KQED","description":"California voters are expected to decide in November on a measure to put a ceiling on what the state pays for drugs.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"170760 http://ww2.kqed.org/stateofhealth/?p=170760","disqusUrl":"https://ww2.kqed.org/stateofhealth/2016/04/10/california-searches-for-prescription-to-treat-rising-drug-costs/","disqusTitle":"California Searches for Prescription to Treat Rising Drug Costs","nprByline":"Pauline Bartolone\u003cbr />\u003ca href=\"https://calmatters.org/\">CALmatters\u003c/a>","path":"/stateofhealth/170760/california-searches-for-prescription-to-treat-rising-drug-costs","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>In a small room at a neighborhood clinic in Sacramento, a handful of hepatitis C patients wait to see their physician, hoping they’ll be found sick enough to be approved for a cure.\u003c/p>\n\u003caside class=\"pullquote alignright\">“There are very few tools in our toolbox” to control pharmaceutical spending\u003ccite>Diana Dooley, secretary of California’s Health and Human Services\u003c/cite>\u003c/aside>\n\u003cp>The low-income patients hope to be prescribed new breakthrough drugs, such as Sovaldi or Harvoni, which offer cures with almost no side effects. But treating the virus comes with a high price tag: at least $84,000 for a course of treatment. Getting Medi-Cal to pay for such drugs can involve a long, arduous process of tests and paperwork to prove infection has progressed to liver damage.\u003c/p>\n\u003cp>“If you’re practically dead … they’ll approve you,” said Laura Castillo, 54, who has been navigating the Medi-Cal system for four months to get Sovaldi. The former legal clerk said she contracted the virus from a blood transfusion in the early 1980s. Patients can live for years symptom free with hepatitis C, but left untreated, it can eventually lead to liver disease and death. Castillo has waited for treatment with substantial liver damage, which burdens her with overwhelming fatigue, depression and what she describes as a “brain fog.”\u003c/p>\n\u003cp>“It’s very, very frustrating, knowing that you have an illness and there is a cure, and you can’t do anything about it,” Castillo said.\u003c/p>\n\u003cp>Castillo’s physician, Dr. Catherine Moizeau, says she treats hundreds of Medi-Cal patients who wait months to get approval for the hepatitis C drugs. Moizeau says health plans, under state guidelines, are rationing the drugs because of the high cost. But Medi-Cal officials say patients receive the treatments based on medical necessity, not on cost.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Hepatitis C drugs are not the only part of California’s troubling drug spending picture. Despite recent cost-cutting measures, such as putting tighter controls on which patients get coverage for which drugs and when, California’s spending on pharmaceuticals has gone up, and so has the number of pricey drugs it is covering. It’s not clear state agencies have the means to balance drug cost pressures in a way that serves the best interests of patients, taxpayers and public health.\u003c/p>\n\u003cp>“There are very few tools in our toolbox” to control pharmaceutical spending, said Diana Dooley, secretary of California’s Health and Human Services. She says high prescription drug costs are a problem across California’s public and private health insurance, and should be addressed on a national level.\u003c/p>\n\u003cp>Drug price concerns will also be a matter of public policy debate this year. California voters are expected to decide in November on a measure to put a ceiling on what the state pays for drugs, and lawmakers have proposed drug price transparency requirements on pharmaceutical manufacturers and health insurers.\u003c/p>\n\u003cp>“We all have to do everything we can to try to control these drug costs,” Dooley said.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>A CALmatters analysis found that state prisons, a California public pension system, and one subset of the Medi-Cal program spent $600 million more on pharmaceuticals in 2014 than in 2012. That does not include the Medi-Cal population in a health plan, nor does it account for discounts the state may have received from drugmakers.\u003c/p>\n\u003cp>Over the past decade, Medi-Cal has seen a 57 percent increase in the drugs it covers that cost $600 or more per prescription. And when it comes to hepatitis C drugs alone, Medi-Cal estimates it will spend almost $482 million over this fiscal year and last. As of September 2015, only 4,200 Medi-Cal patients had received the drugs in that time period, out of 237,000 who are estimated to have the disease.\u003c/p>\n\u003cp>These cost trends exist despite new protocols various state agencies have introduced to tamp down on pharmaceutical spending, which include stricter controls on which patients get which prescription drugs and how.\u003c/p>\n\u003cp>“The people that pay for health care, be it the government or employers, are asking for more prior authorization because we’re having to scrutinize every penny we spend now,” said Steve Miller, chief medical officer at Express Scripts, which manages pharmacy benefits for health plans nationally, including 7.5 million Californians.\u003c/p>\n\u003cp>Miller said involvement from the payer is meant to get “the right patient, the right drug, at the right dose.” But the process, can be “clunky” and cause delays and frustrations for patients like Castillo.\u003c/p>\n\u003cp>Drugmakers say the value of the new hepatitis C drugs, the first of which hit the market at the end of 2013, is worth the cost, and in the long term, may eventually even bring savings to the health system.\u003c/p>\n\u003cp>The new hepatitis C drugs involve only a few months of treatment, and produce a cure in about 90 percent of patients. The older generation of treatments are cheaper, but are also about half as effective, and have side-effects that resemble the flu.\u003c/p>\n\u003cp>“These patients are now healthier. They’re more productive. They’re functioning,” said Priscilla VanderVeer, deputy vice president of communications at the Pharmaceutical Research and Manufacturers of America (PhRMA).\u003c/p>\n\u003cp>“You’re going to have less people who need long-term medication therapy for their hep C, they’re not going to need liver transplants, they’re not going to need significant hospitalizations,” VanderVeer said.\u003c/p>\n\u003cp>Health consumer advocates and economists argue that paying a lot for some drugs that only treat a limited population may not serve larger public health interests, or be the best use of taxpayer dollars.\u003c/p>\n\u003cp>For example, if the cost of the new hepatitis C drugs were cheaper, the hundreds of millions of dollars spent on treating just a few thousand patients could have been spent to help eradicate the disease, says Anthony Wright, executive director of Health Access, an advocacy group.\u003c/p>\n\u003cp>“You could imagine a strategy to provide this cure in a much more broad population strategy,” Wright said.\u003c/p>\n\u003cp>\u003cimg class=\"alignright wp-image-170763 size-thumbnail\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/04/DrugsOver600-400x828.png\" alt=\"DrugsOver600\" width=\"400\" height=\"828\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/04/DrugsOver600-400x828.png 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/04/DrugsOver600.png 550w\" sizes=\"(max-width: 400px) 100vw, 400px\">Specialty drugs, which the federal government defines as costing $600 or more a month, are raising concern among health insurers and state agencies. In CalPERS, for instance, specialty drugs are taking up a larger share of total drug expenditures, despite the fact that they account for a small percentage of prescriptions.\u003c/p>\n\u003cp>Drugmakers are investing more in these types of drugs, said Joel Hay, a pharmaceutical economist at the University of Southern California, because “the profits are very high.”\u003c/p>\n\u003cp>But paying a high price for drugs that treat a small number of patients raises an equity question, Hay said. It may not be fair to the larger patient population for a health system to pay a high price for cancer drugs that extend a patient’s life by three weeks.\u003c/p>\n\u003cp>“You can get a lot more lives saved if you take that budget and put it into colon cancer screening or any number of other more efficient, more effective interventions,” Hay said.\u003c/p>\n\u003cp>The cost pressure from specialty drugs may not go away soon. Pharmaceutical benefits manager Express Scripts estimates that this class of drugs will continue to grow in Medicaid programs by 13.6 percent over the next three years.\u003c/p>\n\u003cp>“Are we going to have a sustainable (pharmaceutical) industry where we are making sure the drug companies make enough money where they can bring great new products to the marketplace, yet we control cost well enough that people –- all people, even the most vulnerable -- have access to the drugs they need?” asked Miller.\u003c/p>\n\u003cp>State Medi-Cal administrators say it’s too soon to assess the sustainability of current prescription drug spending trends. Meantime, their guidelines about which patients can get covered by new hepatitis C drugs has recently loosened up. As of July 2015, patients with a less advanced stage of liver disease can get covered for the drugs, as well as IV drug users and women who want to get pregnant.\u003c/p>\n\u003cp>Castillo got her medication in March, after an attorney helped her challenge denied coverage for Sovaldi through a health insurance regulator. Castillo says she’s glad she’s in treatment now, but she doesn’t know why her Medi-Cal health plan made it so hard for her to get the medicine.\u003c/p>\n\u003cp>“They need to get it together,” she said. “It’s our health and our life that they’re messing with.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>CALmatters data reporter Matt Levin contributed to this article. \u003c/em>\u003ca href=\"https://calmatters.org/\" target=\"_blank\">\u003cem>CALmatters\u003c/em>\u003c/a>\u003cem> is a nonprofit journalism venture dedicated to explaining state policies and politics. Pauline Bartolone wrote this article while participating in the \u003c/em>\u003ca href=\"http://www.centerforhealthjournalism.org/event/2015-california-health-data-journalism-fellowship\">\u003cem>California Data\u003c/em>\u003c/a> \u003ca href=\"http://www.centerforhealthjournalism.org/event/2015-california-health-data-journalism-fellowship\" target=\"_blank\">\u003cem>Fellowship,\u003c/em>\u003c/a>\u003cem> a program of the \u003c/em>\u003ca href=\"http://www.centerforhealthjournalism.org/\" target=\"_blank\">\u003cem>Center for Health Journalism\u003c/em>\u003c/a>\u003cem> at USC’s Annenberg School of Journalism.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/170760/california-searches-for-prescription-to-treat-rising-drug-costs","authors":["byline_stateofhealth_170760"],"categories":["stateofhealth_14","stateofhealth_13"],"tags":["stateofhealth_2650","stateofhealth_2519","stateofhealth_2525"],"featImg":"stateofhealth_170766","label":"stateofhealth"},"stateofhealth_132165":{"type":"posts","id":"stateofhealth_132165","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"132165","score":null,"sort":[1451505314000]},"guestAuthors":[],"slug":"californias-new-health-laws-coming-in-2016","title":"California's New Health Laws Coming in 2016","publishDate":1451505314,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>The new year arrives Friday, and with it a host of new state laws.\u003c/p>\n\u003cp>Here's our roundup of new ones coming in health. Most take effect on Friday, except where noted:\u003c/p>\n\u003cp>\u003cstrong>Vaccines: \u003c/strong>\u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160SB277\" target=\"_blank\">SB 277\u003c/a> was perhaps the most vehemently debated bill in Sacramento in a long time. Sen. Richard Pan (D-Sacramento) introduced the bill just weeks after a measles outbreak tied to Disneyland. The law requires that all children be fully vaccinated to attend school -- both public and private -- unless they have a medical exemption. The law takes effect July 1, in advance of the 2016-2017 school year.\u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160SB792\" target=\"_blank\"> A second law\u003c/a> related to vaccines requires all child-care workers to be vaccinated against measles, pertussis and influenza.\u003c/p>\n\u003cp>\u003cstrong>Physician-Assisted Suicide\u003c/strong>: Gov. Jerry Brown signed the \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520162AB15\" target=\"_blank\">End of Life Option Act \u003c/a>into law with\u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/10/05/governor-brown-signs-physician-assisted-suicide-bill-into-law-california-right-to-die/\" target=\"_blank\"> an unusually personal comment.\u003c/a> The law permits physicians to prescribe lethal medication to terminally ill patients who request it. There is no firm date for the law to go into effect because it was passed as part of an ongoing special legislative session that was called by the governor to address health care financing. It won't take effect until 90 days after the session ends. California became the fifth state to allow the practice, along with Oregon, Washington, Montana and Vermont.\u003c/p>\n\u003cp>\u003cstrong>Medi-Cal for Undocumented Children\u003c/strong>: California became\u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/06/17/california-budget-includes-health-coverage-of-undocumented-children-a-first-nationally/\" target=\"_blank\"> the first state in the country\u003c/a> to extend state-subsidized health coverage to children who are living in the United States illegally. An estimated 170,000 children under age 19 will become eligible for Medi-Cal, the state's health insurance problem for people who are low income, when \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160SB4\" target=\"_blank\">the law\u003c/a> goes into effect on May 1. (Legislators are expected to consider \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160SB10\" target=\"_blank\">SB10,\u003c/a> which would extend Medi-Cal to adults, in 2016 as well.)\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cstrong>Reproductive Services Notification\u003c/strong>: \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160AB775\" target=\"_blank\">The new law\u003c/a> covers required notifications at two types of facilities. Unlicensed facilities now will be required to notify clients that they are not licensed as medical facilities by the state. Meanwhile, licensed medical facilities are required to notify clients that California has public programs that provide free or low-cost access to contraceptives, prenatal care and abortion services. The law was\u003ca href=\"http://ww2.kqed.org/news/2015/11/04/california-law-adds-new-twist-to-abortion-religious-freedom-debate\" target=\"_blank\"> challenged by centers \u003c/a>that do not provide abortions. Just before Christmas, \u003ca href=\"http://www.sacbee.com/news/politics-government/capitol-alert/article51197235.html\" target=\"_blank\">a federal judge upheld the law\u003c/a>.\u003c/p>\n\u003cp>\u003cstrong>Translation of Prescription Drug Information\u003c/strong>: Pharmacists are now required, upon request, \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/09/10/calif-legislature-approves-bill-requiring-prescription-labels-in-5-foreign-languages/\" target=\"_blank\">to provide labels or medication information \u003c/a>in the five most common languages in California, after English: Spanish, Tagalog, Chinese, Vietnamese or Korean.\u003c/p>\n\u003cp>\u003cstrong>Hospitals and Caregivers\u003c/strong>: \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160SB675\" target=\"_blank\">AB675\u003c/a> requires hospitals to include family caregivers in the hospitalization and discharge process. \u003ca href=\"http://newamericamedia.org/2015/12/california-latest-state-requiring-hospitals-to-keep-caregivers-in-the-loop.php\" target=\"_blank\">The goal \u003c/a>is to improve a patient's care and reduce the chance of readmission. California is one of 18 states to pass this type of law in the last two years.\u003c/p>\n\u003cp>\u003cstrong>CONSUMER PROTECTIONS:\u003c/strong>\u003c/p>\n\u003cul>\n\u003cli>\u003cstrong>Caps on Drug Copays\u003c/strong>: \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160AB339\" target=\"_blank\">This law\u003c/a> limits patient's cost-sharing on specialty drugs to $250 a month and prohibits placing most or all drugs used to treat a certain condition on the highest cost tier in drug formularies.\u003c/li>\n\u003cli>\u003cstrong>Accurate Provider Directories\u003c/strong>: Insurers now must maintain an accurate database of providers on a website -- and they must update that directory every week, under \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160SB137\" target=\"_blank\">this new law. \u003c/a>The directories will include languages spoken by providers other than English.\u003c/li>\n\u003cli>\u003cstrong>Cost-sharing Limits in Family Plans\u003c/strong>: \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160AB1305\" target=\"_blank\">This law\u003c/a> brings California into line with federal regulations, that an individual patient faces the out-of-pocket maximum set by the Affordable Care Act (now $6,600) for an individual, even if they are in a family plan (which has a max of $13,200 at present).\u003c/li>\n\u003cli>\u003cstrong>Insurance offered by Large Employers\u003c/strong>: Large employers \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160AB248\" target=\"_blank\">must now follow consumer protections \u003c/a>that ensure they do not offer so-called junk insurance that does not offer minimum value, as defined.\u003c/li>\n\u003c/ul>\n\u003cp>\u003cstrong>LGBT HEALTH CARE:\u003c/strong>\u003c/p>\n\u003cul>\n\u003cli>\u003cstrong>Sperm Donation:\u003c/strong> \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160AB960\" target=\"_blank\">AB960 \u003c/a>was inspired by lesbian couples who want to have children. Many receive sperm donations from friends or relatives. This law says that the donor will not be viewed as the \"natural parent\" unless otherwise agreed to in writing prior to conception of the child.\u003c/li>\n\u003cli>\u003cstrong>Demographic Data Collection\u003c/strong>: \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160AB959\" target=\"_blank\">This law requires\u003c/a> state departments overseeing health programs to collect voluntary information about sexual orientation and gender identity just as they collect race and ethnicity data.\u003c/li>\n\u003c/ul>\n\u003cp>\u003c/p>\n\u003cp>\u003cstrong>FOSTER CHILDREN\u003c/strong>:\u003c/p>\n\u003cul>\n\u003cli>\u003cstrong>Placements for Trans Children\u003c/strong>: Foster children \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160SB731\" target=\"_blank\">now have the right \u003c/a>to placements consistent with their gender identity.\u003c/li>\n\u003cli>\u003cstrong>Psychotropic Medications\u003c/strong>: Child welfare social workers \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160SB238\" target=\"_blank\">will be better able \u003c/a>to oversee mental health treatments, including use of psychotropic medications, by foster children.\u003c/li>\n\u003cli>\u003cstrong>Foster Children Who Are Parents\u003c/strong>: This law \u003ca href=\"http://www.calyouthconn.org/assets/files/AB%20260%20Fact%20Sheet%20(4.1.15).pdf\" target=\"_blank\">provides support and protections\u003c/a> for foster children who are parents themselves.\u003c/li>\n\u003c/ul>\n\n","blocks":[],"excerpt":"New laws include required vaccines for schoolchildren, physician aid-in-dying, consumer protections in health insurance and more.","status":"publish","parent":0,"modified":1452014180,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":13,"wordCount":779},"headData":{"title":"California's New Health Laws Coming in 2016 | KQED","description":"New laws include required vaccines for schoolchildren, physician aid-in-dying, consumer protections in health insurance and more.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"132165 http://ww2.kqed.org/stateofhealth/?p=132165","disqusUrl":"https://ww2.kqed.org/stateofhealth/2015/12/30/californias-new-health-laws-coming-in-2016/","disqusTitle":"California's New Health Laws Coming in 2016","path":"/stateofhealth/132165/californias-new-health-laws-coming-in-2016","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>The new year arrives Friday, and with it a host of new state laws.\u003c/p>\n\u003cp>Here's our roundup of new ones coming in health. Most take effect on Friday, except where noted:\u003c/p>\n\u003cp>\u003cstrong>Vaccines: \u003c/strong>\u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160SB277\" target=\"_blank\">SB 277\u003c/a> was perhaps the most vehemently debated bill in Sacramento in a long time. Sen. Richard Pan (D-Sacramento) introduced the bill just weeks after a measles outbreak tied to Disneyland. The law requires that all children be fully vaccinated to attend school -- both public and private -- unless they have a medical exemption. The law takes effect July 1, in advance of the 2016-2017 school year.\u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160SB792\" target=\"_blank\"> A second law\u003c/a> related to vaccines requires all child-care workers to be vaccinated against measles, pertussis and influenza.\u003c/p>\n\u003cp>\u003cstrong>Physician-Assisted Suicide\u003c/strong>: Gov. Jerry Brown signed the \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520162AB15\" target=\"_blank\">End of Life Option Act \u003c/a>into law with\u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/10/05/governor-brown-signs-physician-assisted-suicide-bill-into-law-california-right-to-die/\" target=\"_blank\"> an unusually personal comment.\u003c/a> The law permits physicians to prescribe lethal medication to terminally ill patients who request it. There is no firm date for the law to go into effect because it was passed as part of an ongoing special legislative session that was called by the governor to address health care financing. It won't take effect until 90 days after the session ends. California became the fifth state to allow the practice, along with Oregon, Washington, Montana and Vermont.\u003c/p>\n\u003cp>\u003cstrong>Medi-Cal for Undocumented Children\u003c/strong>: California became\u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/06/17/california-budget-includes-health-coverage-of-undocumented-children-a-first-nationally/\" target=\"_blank\"> the first state in the country\u003c/a> to extend state-subsidized health coverage to children who are living in the United States illegally. An estimated 170,000 children under age 19 will become eligible for Medi-Cal, the state's health insurance problem for people who are low income, when \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160SB4\" target=\"_blank\">the law\u003c/a> goes into effect on May 1. (Legislators are expected to consider \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160SB10\" target=\"_blank\">SB10,\u003c/a> which would extend Medi-Cal to adults, in 2016 as well.)\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cstrong>Reproductive Services Notification\u003c/strong>: \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160AB775\" target=\"_blank\">The new law\u003c/a> covers required notifications at two types of facilities. Unlicensed facilities now will be required to notify clients that they are not licensed as medical facilities by the state. Meanwhile, licensed medical facilities are required to notify clients that California has public programs that provide free or low-cost access to contraceptives, prenatal care and abortion services. The law was\u003ca href=\"http://ww2.kqed.org/news/2015/11/04/california-law-adds-new-twist-to-abortion-religious-freedom-debate\" target=\"_blank\"> challenged by centers \u003c/a>that do not provide abortions. Just before Christmas, \u003ca href=\"http://www.sacbee.com/news/politics-government/capitol-alert/article51197235.html\" target=\"_blank\">a federal judge upheld the law\u003c/a>.\u003c/p>\n\u003cp>\u003cstrong>Translation of Prescription Drug Information\u003c/strong>: Pharmacists are now required, upon request, \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/09/10/calif-legislature-approves-bill-requiring-prescription-labels-in-5-foreign-languages/\" target=\"_blank\">to provide labels or medication information \u003c/a>in the five most common languages in California, after English: Spanish, Tagalog, Chinese, Vietnamese or Korean.\u003c/p>\n\u003cp>\u003cstrong>Hospitals and Caregivers\u003c/strong>: \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160SB675\" target=\"_blank\">AB675\u003c/a> requires hospitals to include family caregivers in the hospitalization and discharge process. \u003ca href=\"http://newamericamedia.org/2015/12/california-latest-state-requiring-hospitals-to-keep-caregivers-in-the-loop.php\" target=\"_blank\">The goal \u003c/a>is to improve a patient's care and reduce the chance of readmission. California is one of 18 states to pass this type of law in the last two years.\u003c/p>\n\u003cp>\u003cstrong>CONSUMER PROTECTIONS:\u003c/strong>\u003c/p>\n\u003cul>\n\u003cli>\u003cstrong>Caps on Drug Copays\u003c/strong>: \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160AB339\" target=\"_blank\">This law\u003c/a> limits patient's cost-sharing on specialty drugs to $250 a month and prohibits placing most or all drugs used to treat a certain condition on the highest cost tier in drug formularies.\u003c/li>\n\u003cli>\u003cstrong>Accurate Provider Directories\u003c/strong>: Insurers now must maintain an accurate database of providers on a website -- and they must update that directory every week, under \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160SB137\" target=\"_blank\">this new law. \u003c/a>The directories will include languages spoken by providers other than English.\u003c/li>\n\u003cli>\u003cstrong>Cost-sharing Limits in Family Plans\u003c/strong>: \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160AB1305\" target=\"_blank\">This law\u003c/a> brings California into line with federal regulations, that an individual patient faces the out-of-pocket maximum set by the Affordable Care Act (now $6,600) for an individual, even if they are in a family plan (which has a max of $13,200 at present).\u003c/li>\n\u003cli>\u003cstrong>Insurance offered by Large Employers\u003c/strong>: Large employers \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160AB248\" target=\"_blank\">must now follow consumer protections \u003c/a>that ensure they do not offer so-called junk insurance that does not offer minimum value, as defined.\u003c/li>\n\u003c/ul>\n\u003cp>\u003cstrong>LGBT HEALTH CARE:\u003c/strong>\u003c/p>\n\u003cul>\n\u003cli>\u003cstrong>Sperm Donation:\u003c/strong> \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160AB960\" target=\"_blank\">AB960 \u003c/a>was inspired by lesbian couples who want to have children. Many receive sperm donations from friends or relatives. This law says that the donor will not be viewed as the \"natural parent\" unless otherwise agreed to in writing prior to conception of the child.\u003c/li>\n\u003cli>\u003cstrong>Demographic Data Collection\u003c/strong>: \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160AB959\" target=\"_blank\">This law requires\u003c/a> state departments overseeing health programs to collect voluntary information about sexual orientation and gender identity just as they collect race and ethnicity data.\u003c/li>\n\u003c/ul>\n\u003cp>\u003c/p>\n\u003cp>\u003cstrong>FOSTER CHILDREN\u003c/strong>:\u003c/p>\n\u003cul>\n\u003cli>\u003cstrong>Placements for Trans Children\u003c/strong>: Foster children \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160SB731\" target=\"_blank\">now have the right \u003c/a>to placements consistent with their gender identity.\u003c/li>\n\u003cli>\u003cstrong>Psychotropic Medications\u003c/strong>: Child welfare social workers \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160SB238\" target=\"_blank\">will be better able \u003c/a>to oversee mental health treatments, including use of psychotropic medications, by foster children.\u003c/li>\n\u003cli>\u003cstrong>Foster Children Who Are Parents\u003c/strong>: This law \u003ca href=\"http://www.calyouthconn.org/assets/files/AB%20260%20Fact%20Sheet%20(4.1.15).pdf\" target=\"_blank\">provides support and protections\u003c/a> for foster children who are parents themselves.\u003c/li>\n\u003c/ul>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/132165/californias-new-health-laws-coming-in-2016","authors":["240"],"categories":["stateofhealth_14"],"tags":["stateofhealth_160","stateofhealth_2519","stateofhealth_754","stateofhealth_2525","stateofhealth_461","stateofhealth_725"],"featImg":"stateofhealth_132229","label":"stateofhealth"},"stateofhealth_83815":{"type":"posts","id":"stateofhealth_83815","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"83815","score":null,"sort":[1443208558000]},"guestAuthors":[],"slug":"national-drug-take-back-day-is-saturday-350-california-sites","title":"National Drug Take-Back Day Is Saturday; 350 California Sites","publishDate":1443208558,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{},"content":"\u003cp>Roughly 350 drop-off sites in California will take consumers' unwanted or unused medications on Saturday and properly dispose of them.\u003c/p>\n\u003cp>It's part of an annual nationwide event Saturday called the 10th annual \u003ca href=\"http://www.deadiversion.usdoj.gov/drug_disposal/takeback/\" target=\"_blank\">National Prescription Drug Take-Back Day\u003c/a>, organized by the federal Drug Enforcement Administration and involving hundreds of police stations across California as well as a large number of Kaiser Permanente medical offices. (\u003ca href=\"https://www.deadiversion.usdoj.gov/NTBI/NTBI-PUB.pub?_flowExecutionKey=_c7A27A4CE-B30B-D21F-E593-91FD10C1A30E_kEF810816-0A7D-6A83-7B91-2A6CA227C291\" target=\"_blank\">Look up a collection site near you.\u003c/a>)\u003c/p>\n\u003cp>It's one of several efforts statewide to control misuse and abuse of prescription medication.\u003c/p>\n\u003cp>\"When left laying around, too often unused medications get into the hands of seniors, children and others, and usually those medications are expired or no longer being taken,\" said Steve Gray, a Kaiser Permanente pharmacist and KP's pharmacy professional affairs leader for California.\u003c/p>\n\u003cp>\"The most important part of this [effort] is public safety,\" Gray said, \"so people don't hurt themselves or hurt others.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Seniors sometimes self-prescribe with leftover medications, he said, or they give them to other seniors. Children can take them by accident, or drug abusers can steal them.\u003c/p>\n\u003cp>As part of his job, Gray travels around the state to counties that are considering ordinances to require drug manufacturers to take back unused and unwanted prescription medications.\u003c/p>\n\u003cp>So far, at least four counties have adopted these rules and another seven to 10 counties are considering legislation, Gray said. He said he's meeting with Los Angeles County officials on Monday to help shape their take-back policy.\u003c/p>\n\u003cp>\"There is nothing at the state or federal level to deal with this so the counties are trying to do what they can through their ordinances. It gets difficult if each of the 58 counties have a different program. So I try to help identify best practices so [the ordinances] are the same,\" Gray said.\u003c/p>\n\u003cp>There are a couple of other ways to keep prescription medications from piling up, he said:\u003c/p>\n\u003cul>\n\u003cli>\u003cstrong>Small initial quantity.\u003c/strong> Instead of prescribing a drug for the first time for a full course of a month or even three months, Gray said there's an effort underway to start with a smaller amount. \"The provider doesn't know what will be tolerated by you, and doesn’t know whether it's going to work,\" Gray said, \"so let's start out with a small quantity that would be a good test of whether it might work or not first.\"\u003c/li>\n\u003cli>\u003cstrong>Mail-back envelopes.\u003c/strong> Many retail drug stores now sell pre-paid unused-medication envelopes, to more easily dispose of unwanted prescription drugs. \"The envelopes are approved by the federal government,\" Gray said. \"That is probably the most convenient at this point.\"\u003c/li>\n\u003c/ul>\n\u003cp>Opioids are the most-misused and dangerous medication, he said, but they're not the only ones that can be deadly.\u003c/p>\n\u003cp>\"That's just one category,\" he said. \"You can really hurt yourself with opioids, but many times people think, 'I have diabetes, too,' and they can kill themselves by taking someone else's diabetes medication.\"\u003c/p>\n\u003cp>Gray said his own parents lived through the Great Depression, \"and they don't like to see anything thrown away,\" he said. \"They think, 'Maybe someday I'll need that.' This is a real problem with seniors.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>David Gorn is a senior reporter with \u003c/em>\u003ca href=\"http://www.californiahealthline.org/\" target=\"_blank\">\u003cem>California Healthline. \u003c/em>\u003c/a>\u003c/p>\n\n","blocks":[],"excerpt":"350 drop-off sites in California will take your unwanted or unused medications on Saturday and properly dispose of them.","status":"publish","parent":0,"modified":1443208558,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":16,"wordCount":549},"headData":{"title":"National Drug Take-Back Day Is Saturday; 350 California Sites | KQED","description":"350 drop-off sites in California will take your unwanted or unused medications on Saturday and properly dispose of them.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"83815 http://ww2.kqed.org/stateofhealth/?p=83815","disqusUrl":"https://ww2.kqed.org/stateofhealth/2015/09/25/national-drug-take-back-day-is-saturday-350-california-sites/","disqusTitle":"National Drug Take-Back Day Is Saturday; 350 California Sites","source":"California Healthline","sourceUrl":"http://www.californiahealthline.org","nprByline":"David Gorn","path":"/stateofhealth/83815/national-drug-take-back-day-is-saturday-350-california-sites","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Roughly 350 drop-off sites in California will take consumers' unwanted or unused medications on Saturday and properly dispose of them.\u003c/p>\n\u003cp>It's part of an annual nationwide event Saturday called the 10th annual \u003ca href=\"http://www.deadiversion.usdoj.gov/drug_disposal/takeback/\" target=\"_blank\">National Prescription Drug Take-Back Day\u003c/a>, organized by the federal Drug Enforcement Administration and involving hundreds of police stations across California as well as a large number of Kaiser Permanente medical offices. (\u003ca href=\"https://www.deadiversion.usdoj.gov/NTBI/NTBI-PUB.pub?_flowExecutionKey=_c7A27A4CE-B30B-D21F-E593-91FD10C1A30E_kEF810816-0A7D-6A83-7B91-2A6CA227C291\" target=\"_blank\">Look up a collection site near you.\u003c/a>)\u003c/p>\n\u003cp>It's one of several efforts statewide to control misuse and abuse of prescription medication.\u003c/p>\n\u003cp>\"When left laying around, too often unused medications get into the hands of seniors, children and others, and usually those medications are expired or no longer being taken,\" said Steve Gray, a Kaiser Permanente pharmacist and KP's pharmacy professional affairs leader for California.\u003c/p>\n\u003cp>\"The most important part of this [effort] is public safety,\" Gray said, \"so people don't hurt themselves or hurt others.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Seniors sometimes self-prescribe with leftover medications, he said, or they give them to other seniors. Children can take them by accident, or drug abusers can steal them.\u003c/p>\n\u003cp>As part of his job, Gray travels around the state to counties that are considering ordinances to require drug manufacturers to take back unused and unwanted prescription medications.\u003c/p>\n\u003cp>So far, at least four counties have adopted these rules and another seven to 10 counties are considering legislation, Gray said. He said he's meeting with Los Angeles County officials on Monday to help shape their take-back policy.\u003c/p>\n\u003cp>\"There is nothing at the state or federal level to deal with this so the counties are trying to do what they can through their ordinances. It gets difficult if each of the 58 counties have a different program. So I try to help identify best practices so [the ordinances] are the same,\" Gray said.\u003c/p>\n\u003cp>There are a couple of other ways to keep prescription medications from piling up, he said:\u003c/p>\n\u003cul>\n\u003cli>\u003cstrong>Small initial quantity.\u003c/strong> Instead of prescribing a drug for the first time for a full course of a month or even three months, Gray said there's an effort underway to start with a smaller amount. \"The provider doesn't know what will be tolerated by you, and doesn’t know whether it's going to work,\" Gray said, \"so let's start out with a small quantity that would be a good test of whether it might work or not first.\"\u003c/li>\n\u003cli>\u003cstrong>Mail-back envelopes.\u003c/strong> Many retail drug stores now sell pre-paid unused-medication envelopes, to more easily dispose of unwanted prescription drugs. \"The envelopes are approved by the federal government,\" Gray said. \"That is probably the most convenient at this point.\"\u003c/li>\n\u003c/ul>\n\u003cp>Opioids are the most-misused and dangerous medication, he said, but they're not the only ones that can be deadly.\u003c/p>\n\u003cp>\"That's just one category,\" he said. \"You can really hurt yourself with opioids, but many times people think, 'I have diabetes, too,' and they can kill themselves by taking someone else's diabetes medication.\"\u003c/p>\n\u003cp>Gray said his own parents lived through the Great Depression, \"and they don't like to see anything thrown away,\" he said. \"They think, 'Maybe someday I'll need that.' This is a real problem with seniors.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>David Gorn is a senior reporter with \u003c/em>\u003ca href=\"http://www.californiahealthline.org/\" target=\"_blank\">\u003cem>California Healthline. \u003c/em>\u003c/a>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/83815/national-drug-take-back-day-is-saturday-350-california-sites","authors":["byline_stateofhealth_83815"],"categories":["stateofhealth_1"],"tags":["stateofhealth_2519","stateofhealth_2525"],"featImg":"stateofhealth_83820","label":"source_stateofhealth_83815"}},"programsReducer":{"possible":{"id":"possible","title":"Possible","info":"Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. Together in Possible, Hoffman and Finger lead enlightening discussions about building a brighter collective future. The show features interviews with visionary guests like Trevor Noah, Sam Altman and Janette Sadik-Khan. Possible paints an optimistic portrait of the world we can create through science, policy, business, art and our shared humanity. It asks: What if everything goes right for once? How can we get there? Each episode also includes a short fiction story generated by advanced AI GPT-4, serving as a thought-provoking springboard to speculate how humanity could leverage technology for good.","airtime":"SUN 2pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Possible-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.possible.fm/","meta":{"site":"news","source":"Possible"},"link":"/radio/program/possible","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/possible/id1677184070","spotify":"https://open.spotify.com/show/730YpdUSNlMyPQwNnyjp4k"}},"1a":{"id":"1a","title":"1A","info":"1A is home to the national conversation. 1A brings on great guests and frames the best debate in ways that make you think, share and engage.","airtime":"MON-THU 11pm-12am","imageSrc":"https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/1a.jpg","officialWebsiteLink":"https://the1a.org/","meta":{"site":"news","source":"npr"},"link":"/radio/program/1a","subscribe":{"npr":"https://rpb3r.app.goo.gl/RBrW","apple":"https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=1188724250&at=11l79Y&ct=nprdirectory","tuneIn":"https://tunein.com/radio/1A-p947376/","rss":"https://feeds.npr.org/510316/podcast.xml"}},"all-things-considered":{"id":"all-things-considered","title":"All Things Considered","info":"Every weekday, \u003cem>All Things Considered\u003c/em> hosts Robert Siegel, Audie Cornish, Ari Shapiro, and Kelly McEvers present the program's trademark mix of news, interviews, commentaries, reviews, and offbeat features. 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You ask the questions. You decide what Bay Curious investigates. 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You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Mindshift-Podcast-Tile-703x703-1.jpg","imageAlt":"KQED MindShift: How We Will Learn","officialWebsiteLink":"/mindshift/","meta":{"site":"news","source":"kqed","order":"2"},"link":"/podcasts/mindshift","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/mindshift-podcast/id1078765985","google":"https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM1NzY0NjAwNDI5","npr":"https://www.npr.org/podcasts/464615685/mind-shift-podcast","stitcher":"https://www.stitcher.com/podcast/kqed/stories-teachers-share","spotify":"https://open.spotify.com/show/0MxSpNYZKNprFLCl7eEtyx"}},"morning-edition":{"id":"morning-edition","title":"Morning Edition","info":"\u003cem>Morning Edition\u003c/em> takes listeners around the country and the world with multi-faceted stories and commentaries every weekday. 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On Our Watch brings listeners into the rooms where officers are questioned and witnesses are interrogated to find out who this system is really protecting. Is it the officers, or the public they've sworn to serve?","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/On-Our-Watch-Podcast-Tile-703x703-1.jpg","imageAlt":"On Our Watch from NPR and KQED","officialWebsiteLink":"/podcasts/onourwatch","meta":{"site":"news","source":"kqed","order":"1"},"link":"/podcasts/onourwatch","subscribe":{"apple":"https://podcasts.apple.com/podcast/id1567098962","google":"https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5ucHIub3JnLzUxMDM2MC9wb2RjYXN0LnhtbD9zYz1nb29nbGVwb2RjYXN0cw","npr":"https://rpb3r.app.goo.gl/onourwatch","spotify":"https://open.spotify.com/show/0OLWoyizopu6tY1XiuX70x","tuneIn":"https://tunein.com/radio/On-Our-Watch-p1436229/","stitcher":"https://www.stitcher.com/show/on-our-watch","rss":"https://feeds.npr.org/510360/podcast.xml"}},"on-the-media":{"id":"on-the-media","title":"On The Media","info":"Our weekly podcast explores how the media 'sausage' is made, casts an incisive eye on fluctuations in the marketplace of ideas, and examines threats to the freedom of information and expression in America and abroad. 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