Tag Archives: prescription

Costs of widely prescribed drugs jumped up to 5,241 percent in recent years

Jess Franz-Christensen did not realize the seriousness of her son’s Type 1 diabetes diagnosis until staff in the doctor’s office offered to call an ambulance to take him to the hospital.

Her next shock: The cost of Jack’s medicines.

The drugs, administered through an insulin pump, cost $1,200 a month.

“We’re really fortunate. We’re able to pay for stuff,” said Franz-Christensen, whose husband, Scott, is a physicist, while she stays home to care for Jack, 8, and their daughter, Kendall, 11.

“But there are people who are making decisions whether to feed their kid or get test strips — whether to pay rent or get a vial of insulin. It’s heart-breaking.”

Prices for insulin products have nearly doubled in recent years, including Lantus SoloSTAR — one of the drugs that Medicaid and Medicare spent the most on in 2015. Its price increased by 81.5 percent between 2011 and 2014, according to data analyzed by the Wisconsin Center for Investigative Journalism. The data were provided by California-based First Databank, a supplier of U.S. commercial drug pricing information.

The costs of seven widely prescribed antibiotics, cancer drugs, arthritis medications and other prescriptions have escalated between 29 percent and 5,241 percent in recent years, according to a joint investigation by the Wisconsin Center for Investigative Journalism, Wisconsin Health News and Wisconsin Public Radio.

The investigation examined the impacts of and reasons behind the overall rise in prescription costs, including drug price increases since 2011, using proprietary First Databank data.

Overall, the price of insulin nearly tripled between 2002 and 2013, prompting calls this month for a federal investigation by former Democratic presidential candidate Sen. Bernie Sanders from Vermont.

“They (drug companies) are making billions and billions of dollars on people who literally can’t afford it,” said Franz-Christensen, who has joined #MyLifeIsNotForProfit, a national grassroots parent movement.

Recent nationwide news coverage has focused on the rising cost of EpiPens, which counteract potentially fatal allergic reactions to peanuts, bee stings and other triggers. But the $600 cost for a two-pack of that medicine is just one example of lifesaving drugs with skyrocketing prices.

Synthroid, which is used to treat hypothyroidism, is the most commonly prescribed medication in the United States and has been on the market for more than 60 years. In just the past six years, it has nearly doubled in price, according to the Center’s analysis. The generic version of Synthroid, levothyroxine, has gone from 14 cents to 46 cents per pill, an increase of 231 percent between 2011 and 2016, the analysis shows.

A single two-week dose for Humira, a medication that treats conditions including rheumatoid arthritis, has increased 129 percent since 2011, to $2,000, according to First Databank data analyzed by the Center.

The price increases, which continue to mount, place economic and emotional pressure on patients and their families, squeeze the budgets of health care providers and raise costs for taxpayers in Wisconsin and nationwide, the joint investigation found.

Lack of competition raises costs

Spending on medications is rising for a variety of reasons:

  • Some pharmaceutical companies have taken action to extend the patent protections on their products, blocking cheaper generic versions from being developed.
  • As some companies stop making certain low-cost drugs, other companies gain monopolies over the market.
  • Companies are introducing more high-cost “speciality” drugs that treat lifelong conditions.
  • As the nation’s population ages, the demand for prescription drugs increases; more than half of Americans now use them.

In one practice known as “product hopping,” a company makes changes to a drug to extend its patent protections, keeping others from entering the market with cheaper alternatives.

Wisconsin Attorney General Brad Schimel filed an antitrust lawsuit in September alleging that the makers of Suboxone, a drug used to treat opiate addiction, changed the product from a tablet to a film that dissolves in the mouth to block alternatives and “maintain monopoly profits.”

Drug maker Indivior said it takes “these allegations seriously” and “intends to defend this and other related actions.”

“As long as drugs are on patent protection, manufacturers at that point have monopoly pricing ability and they can price their products at levels that the market will bear,” said Chuck Shih, who leads Pew Charitable Trusts’ specialty drugs research initiative.

In addition, as competitors drop out of the market, the remaining companies are “raising prices significantly and earning substantial profits,” said Larry Levitt, senior vice president for special initiatives at the California-based Kaiser Family Foundation.

The price jumps have caught the attention of Congress, which held hearings after Turing Pharmaceuticals increased the price of a drug that treats toxoplasmosis — an illness that can cause brain damage, blindness, miscarriage or birth defects — by 5,000 percent shortly after acquiring it.

The increase in the price of EpiPens has also drawn congressional scrutiny. Between 2010 and 2016, the price has more than quadrupled, according to data from First Databank.

Seventeen senators, including Democratic Wisconsin Sen. Tammy Baldwin, sent a letter to EpiPen maker Mylan in early November asking for more pricing information. The senators said the skyrocketing prices were raising costs for taxpayers and jacking up insurance premiums.

Lawmakers on the state and federal level are calling for new regulations to rein in drug prices. A dozen states have enacted laws requiring greater transparency in drug pricing and other measures, but no state has enacted price controls.

California voters rejected a proposal earlier this month to implement their own price control system, which would require state agencies to pay the same rates negotiated by the U.S. Department of Veterans Affairs. The two sides poured more than $100 million into the effort, most of it from pharmaceutical companies opposed to the measure.

Holly Campbell, spokeswoman for the Pharmaceutical Research and Manufacturers of America, attributed the increase in EpiPen prices to a U.S. Food and Drug Administration backlog in approving new generics and a “lack of competition” in the market.

Working poor hit hard

For those without insurance or who cannot afford their share, the rising cost of medications has left them facing hard choices.

Kathryn Drexler, a registered nurse and certified diabetic educator at the free Living Healthy Community Clinic in Oshkosh, said some of her patients ration their insulin. So many are asking the clinic for medication help “that it’s draining our budget,” she said.

“I think it’s hitting the working poor the hardest,” Drexler said. “They can’t afford their co-pays, and they can’t afford insulin out of pocket.”

Free clinics provide care and drugs to the roughly 323,000 people, or 5.7 percent of state residents who lack insurance, as well as some people who are underinsured. And while drug companies offer free prescriptions to certain low-income people with no insurance, generic medications — which comprise eight out of every 10 prescriptions — do not qualify.

University of Wisconsin pediatric endocrinologist Dr. Ellen Connor said the price increases have thrown some of her patients into despair.

“Families — this is what they agonize over,” Connor said. “They lose sleep over it. I have parents sobbing in the office over this. They feel like failures because they had lost jobs and couldn’t afford $500 of medications a month. It breaks your heart.”

For the insured, drug price hikes have contributed to higher deductibles and co-pays, said Dr. Tim Bartholow, chief medical officer for the not-for-profit insurer WEA Trust in Madison.

The price increases are hitting hospitals too, costing University of Wisconsin Hospitals and Clinics an additional $14 million in the past year, according to Steve Rough, pharmacy director.

Rough noted large increases among generic drugs with no competitors.

“I call it generic price-jacking, where companies purchase the rights to a low-cost generic drug that is routinely used in the care of many patients, just for the sole purpose of raising the price to make money, because they can,” he said.

Taxpayers left with hefty tab

Prescription drugs are a growing portion of health care spending nationwide, accounting for 16.7 percent or $457 billion of total U.S. health care spending in 2015 — about double the percentage from the 1990s, according to a report released in March.

The U.S. Department of Health and Human Services report found the number of prescriptions is rising, but most of the spending growth is due to rising prices and a shift toward more expensive medications.

The state’s Medicaid program — which receives both federal and state funding — spent $329.4 million in the fiscal year between July 2011 and June 2012 on prescription drugs, according to the Legislative Fiscal Bureau. By July 1 of this year, annual spending had grown to $427.7 million — a 30 percent increase. The amount can vary year to year because of rebates the program receives from drug manufacturers.

Elizabeth Goodsitt, Wisconsin Department of Health Services spokeswoman, said the program has taken numerous steps to address growing costs, such as requiring patients to get prior approval before receiving more expensive medications.

Meanwhile, a September poll from the Kaiser Family Foundation found that 55 percent of Americans nationwide reported taking prescription drugs. About 26 percent of them — or 14 percent of the U.S. population — found it somewhat or very difficult to pay the cost of their prescription medication.

Even generics now too expensive

Paul Hoffmann, manager of the Bread of Healing Clinic in Milwaukee, said his free clinic can no longer afford to provide some generic medications.

“I’ve been a pharmacist for 35 years, and this is a phenomenon that we never saw,” Hoffmann said. “All these long-standing generics that have been generic for some 20, 30 years are going up in astronomical prices.”

He cited doxycycline, used to treat infections. First Databank figures show the price skyrocketed by 12,024 percent from 2011 to early 2013 because of drug shortages. The price has dropped, but the antibiotic is still 5,240 percent higher than in 2011 — or more than 50 times more expensive.

Lawmakers eye transparency initiatives

Some state lawmakers are looking for ways to curb drug prices. Rep. Debra Kolste, D-Janesville, plans to introduce legislation next year requiring the Office of the Commissioner of Insurance to collect information about the cost of drugs to public health care programs and develop a strategy to reduce prices.

Meanwhile, Baldwin has co-authored a bill at the federal level requiring pharmaceutical companies to submit a report to the federal government a month before increasing a product’s price by 10 percent or more.

PhRMA spokeswoman Campbell called the proposal “a thinly veiled attempt to build a case for government price setting.”

But observers say the conversation around drug pricing has changed.

“You have these very high profile seemingly outrageous price hikes that have focused the attention of policymakers in a way that I haven’t seen before,” said Levitt, of the Kaiser Family Foundation. “There’s a window where we could see some policy changes.”

Franz-Christensen hopes Congress will fix the problem.

“The people that can’t afford it, they’re so overwhelmed,” she said. “They can’t fight. … If it’s hard for us, people who have everything, imagine the people who don’t.”

Cara Lombardo and Andrew Hahn of the Wisconsin Center for Investigative Journalism contributed to this report.

Sean Kirkby reports for Wisconsin Health News, an independent, nonpartisan, online news organization serving Wisconsin health care professionals and decision makers. Dee J. Hall is managing editor of the Wisconsin Center for Investigative Journalism. Bridgit Bowden is a reporter for Wisconsin Public Radio. The nonprofit Center (www.WisconsinWatch.org) collaborates with WPR, Wisconsin Public Television, other news media and the University of Wisconsin-Madison journalism school. All works created, published, posted or disseminated by the Center do not necessarily reflect the views or opinions of UW-Madison or any of its affiliates.

What’s Fentanyl? The facts about the synthetic opioid

Prince died of an overdose of the powerful opioid fentanyl, according to autopsy results released in June.

Among the questions investigators were reviewing was whether Prince had a prescription for painkillers before his death.

A person close to the investigation of Prince’s death told The Associated Press that pills found in Prince’s home marked as acetaminophen-hydrocodone actually contained fentanyl, suggesting they were counterfeit pills obtained illegally.

Prescription opioid overdoses reached nearly 19,000 in 2014, the highest number on record.

Total opioid overdoses surpassed 29,000 that year when combined with heroin, which some abusers switch to after becoming hooked on painkillers.

Some information on fentanyl:

 

WHAT IS FENTANYL?

Fentanyl is a synthetic opioid, 50 times more potent than heroin, that’s responsible for a recent surge in overdose deaths in some parts of the country. It also has legitimate medical uses.

Doctors prescribe fentanyl for cancer patients with tolerance to other narcotics. It comes in skin patches, lozenges, nasal spray and tablets.

Because of the risk of abuse, overdose and addiction, the Food and Drug Administration imposes tight restrictions on fentanyl; it is classified as a Schedule II controlled substance.

Some pharmaceutical fentanyl is illegally diverted to the black market. But most fentanyl used illicitly is manufactured in clandestine labs.

The U.S. Drug Enforcement Administration has tied fentanyl seizures to Mexican drug-trafficking groups.

On the street, fentanyl is sold alone as powder, added to heroin or made into counterfeit OxyContin pills. Users don’t always know when they’re taking fentanyl, increasing the risk of fatal overdose.

The DEA issued a nationwide alert about fentanyl overdose in March 2015. More than 700 fentanyl-related overdose deaths were reported to the DEA in late 2013 and 2014.

Since many coroners and state crime labs don’t routinely test for fentanyl, the actual number of overdoses is probably much higher.

WHAT IS A LETHAL DOSE?

It’s tricky with opioids like fentanyl.

Anyone who takes prescription opioid painkillers for a long time builds up a tolerance to the drugs. A dose that could kill one person might provide medicinal pain relief to another.

Experts in medical toxicology say it’s important to know how much opioid medication a person has been using before a death to know how to interpret post-mortem blood levels. Pill bottles and medical history may become crucial evidence.

DOES PAIN TREATMENT LEAD TO ADDICTION?

Prince had a reputation for clean living, and some friends said they never saw any sign of drug use. But longtime friend and collaborator Sheila E. has told the AP that Prince had physical issues from performing, citing hip and knee problems that she said came from years of jumping off risers and stage speakers in heels.

Becoming tolerant to opioid painkillers may lead some patients to seek stronger drugs from their doctors.

Some users — whether they start as recreational users or legitimate pain patients — become addicted, experiencing an inability to control how much they take, so they use much more than is prescribed or seek out drugs on the black market.

With good management, however, opioids can offer relief to people with only a small risk of addiction, according to a 2010 review of the available studies.

By sharing painkillers, friends and family can fuel opioid epidemic

As lawmakers grapple with how best to combat the nation’s prescription drug abuse crisis, a recent survey is shedding light on how patients who get these painkillers  — drugs such as OxyContin, methadone or Vicodin — sometimes share or mishandle them.

According to findings detailed in a research letter published Monday in JAMA Internal Medicine, about one in five people who were prescribed the highly addictive drugs reported having shared their meds with a friend, often to help the other person manage pain. Most people with a prescription either had or expected to have extra pills left after finishing treatment. And almost 50 percent didn’t know how to safely get rid of the drugs left over after their treatment was complete, or how to store them while going through treatment.

The study’s authors suggested that the results point to changes doctors could make in prescribing practices and counseling to help alleviate the problems.

“We’ve all been saying leftover medications are an issue,” said Wilson Compton, deputy director of the federal National Institute on Drug Abuse, who wasn’t involved with the study. “Now I have a number that is concerning.”

The survey was sent to a random sample of almost 5,000 people in 2015. Of the recipients, about 1,000 had used prescription painkillers in the past year. Almost all of the people in this group responded to the survey.

Public concerns about painkiller abuse are growing louder. About 2 million people were addicted to prescription opioids in 2014, the most recent year for which data is available, according to the Centers for Disease Control and Prevention. Overdoses kill 44 people per day, the U.S. Department of Health and Human Services estimates. Researchers say deaths in 2014 were almost four times as common as they were in 2000.

“There’s a growing awareness among medical advisers, policymakers and even members of the general public that these are medications that can do serious harm,” said Colleen Barry, one of the study’s authors. She is a professor of health policy at Johns Hopkins University and co-director of the university’s Center for Mental Health and Addiction Policy Research.

And it is not news that most people who use prescription painkillers for nonmedical reasons often get them through social channels rather than a physician. In 2013 — the most recent year for which this data is available — the National Survey on Drug Use and Health estimated that number to be more than 80 percent.

But this paper’s findings illustrate some of the forces behind drug-sharing, Barry said, and in turn indicate how to stop it. For instance, the authors recommend that doctors prescribe smaller amounts of drugs, to minimize leftovers that could be shared or stolen. That tracks with new opioid prescribing guidelines issued by the Centers for Disease Control and Prevention.

“We probably prescribe a little bit more than we need to, and it’s not like people throw these away afterward. The leftovers are something we’re not thinking about,” said Jonathan Chen, an instructor at Stanford University School of Medicine, who has researched opioid abuse. Chen, who was not involved in the study, is also a practicing physician.

Meanwhile, it’s still tough for people to get rid of the drugs when they finish with them, and few say they know about safe storage practices. That’s another avenue for prevention.

Most respondents, for instance, didn’t lock up the pills when storing them. That makes it easier for someone else to take them.

And the prevalence of sharing medications suggests consumers need to be better educated about how addictive prescription opioids are, Barry said.

Doctors, added NIDA’s Compton, also need to understand the risk that, when they prescribe pills, they could end up used by someone else.

“One out of five people that I write a prescription to for opioids may share those with someone else. That’s a lot of people,” he said.

Physicians, meanwhile, haven’t historically been trained to counsel patients on safe drug disposal, meaning patients are often left unaware. Just under a quarter of respondents reported they remembered learning from the doctor or nurse about how to get rid of their meds safely. Chen said he couldn’t recall ever going over disposal practices with a patient. Even if he did, he said, it’s hard to know if patients would remember that information.

And when they are informed, it’s still difficult for consumers to easily get rid of pills they no longer need. The federal Drug Enforcement Administration sponsors “drug take-back days” twice a year. Some local law enforcement agencies hold similar events. But such events are often sporadic enough that it’s hard to make them a real habit, Barry noted.

Making those practices easier is essential, Barry said. And changing the culture around those drugs is key, so people understand the risk.

“Just the realization on the part of the public as well as physicians that these medications are not like Tylenol — these are highly addictive meds,” she said. “That message is starting to get out there.”

Published under a Creative Commons License courtesy of Kaiser Health News, a national health policy news service that is part of the nonpartisan Henry J. Kaiser Family Foundation.

Confronting the ‘heroin tsunami’ in Kootenai County, Idaho

Crushing news came shortly after Cindy Schaffner heard sirens just a few blocks from her Post Falls home.

The sirens, Schaffner learned, were for her 19-year-old daughter, Cathryn Mason.

Cathryn, who loved the outdoors and was majoring in recreation management at North Idaho College, was in critical condition. She’d overdosed on heroin and alcohol.

Cathryn died two days later after she was taken off of life support. That was in May 2014.

“She was a very driven and focused person,” Schaffner said, fighting back tears. “She loved to go on hikes and was full of life. She was celebrating getting good grades for the semester.”

Schaffner said it was the first time she was aware of that her daughter had used drugs.

“She had a strong sense of morals and values and she had faith, but, for whatever reason, she decided to compromise those values,” Schaffner said. “It was a surprise to all of us because she wasn’t a user.”

Cathryn was caught on the edge of what officials refer to as the “heroin tsunami,” a nationwide opioid abuse epidemic that Kootenai County has not been immune to in recent years.

“We have seen a significant increase in the usage of heroin in our community,” Post Falls Police Chief Scot Haug said.

Haug said the rise of heroin usage is due to two reasons. It is not only used as a recreational drug for the intense euphoria it induces, but it is an opioid painkiller that people turn to when they are taken off prescription medications or those medications aren’t offering as much relief as desired.

Heroin is synthesized from morphine, a naturally occurring substance extracted from the seed pod of the Asian opium poppy plant. It appears as a “China white” or brown powder or as a sticky black substance as “black tar” heroin.

Heroin can be injected, inhaled by snorting or sniffing, or smoked. All three methods deliver the drug to the brain rapidly, contributing to its health risks and high risk for addiction.

“Some experts believe that heroin is more addictive than meth and more difficult to detox off of,” Haug said.

The street value of heroin is about $300 per gram, according to police. It is usually sold by the “point” — or tenth of a gram — for $30.

While Cathryn, who graduated from Post Falls High in 2012, was not on painkillers, her sudden and unexpected death shows how lethal heroin can be, Schaffner said.

“Some do it for years and years, while others may try it once and it kills them,” she said. “It’s like playing Russian roulette.”

Rising numbers

News earlier this month that multiple law enforcement agencies had busted an alleged heroin ring that included a Coeur d’Alene physician put a local point on the severity of the problem nationally.

At least 28,648 people in the U.S. died of causes linked to opioid drugs in 2014, according to the U.S. Centers for Disease Control, almost as many as are killed annually in car crashes. The class of drugs includes heroin and prescription painkillers such as oxycodone.

A CDC report released last year revealed the number of U.S. heroin users has grown by nearly 300,000 over a decade.

Haug said heroin has surpassed methamphetamine as the most common drug behind marijuana in the community.

PFPD processed no heroin into its evidence storage in 2010, but it obtained 20 heroin items in 2013, 19 in 2014 and 21 in 2015 (the numbers do not reflect heroin-related medical calls).

Haug said he’s aware of several heroin-related deaths across Kootenai County around the time that Cathryn died. Investigations into some of those cases, including Cathryn’s death, continue.

Haug said his department receives heart-wrenching calls on almost a weekly basis from families of those using heroin who are desperate for help.

“But many times the users don’t want help,” he said. “The challenge for us is that we can’t knock down doors and force people to get help, but we point them and their families in the right direction when there’s opportunities.”

Kootenai County Sheriff Ben Wolfinger said the rise in heroin has a ripple effect in the community, from law enforcement to substance abuse councils to the mental health sector.

“It’s not just a law enforcement problem; it’s a community problem,” he said.

Dr. Joseph Abate, medical director at the nonprofit Heritage Health, said he believes one reason heroin has regained momentum is because it’s cheaper than some prescription painkillers.

“That’s an attraction to people who are using opioids without a doctor’s recommendation,” Abate said. “But people who have been on opioids with a doctor’s recommendation turn to heroin too because they have a problem with tolerance to pain, especially younger people. They may start on low doses of pain medication, then they take more and more to get the same amount of relief. It may not make sense to you or I, but to patients who are trying to get relief . 

“Part of the rise of heroin is that people start on painkillers for legitimate reasons and then it just gets out of control. In the past people received the message that pain could be controlled with the right dosage, but now we’ve learned the hard way that it does nothing more than make a person worse over the long term rather than better.”

Spirit Lake Police Chief Keith Hutcheson said as prescription drugs have become more regulated in response to the rise in addictions, people revert to illegal drugs such as heroin. It’s a vicious cycle, he said.

“Instead of buying pills on the street, they’re now buying heroin because it’s cheaper and they can get a higher high for a longer time,” Hutcheson said.

Combating the epidemic

One of the ways Heritage Health is trying to right the ship when no opioid is enough is to educate on “mindfulness-based solutions.”

“It’s thinking of pain differently, just something you learn to deal with,” Abate said. “It’s not us saying that pain is all in your head. What we’re saying is how you perceive your pain makes a difference in what you search for as the solution.”

Part of the program is sharing with others how pain affects your daily life and how you label it.

“A lot of people don’t have a chance to tell about how it affects your life,” Abate said.

Abate said if the only weapon in one’s toolbox to fight pain is opioids, it’s not likely you’ll find relief in a fashion that will allow you to live a reasonable life. Mindfulness solutions, exercise, physical therapy and acupuncture are other tools people can use to treat pain.

“There are better ways to treat pain rather than assuming the only thing that will make it go away is pain medicine,” he said. “If people are willing to look at why the pain is not very well-controlled, we can offer them other options so they are safely and reasonably treated without fear of an unintentional overdose.”

Abate said while there are good substance abuse treatment programs available, there aren’t a lot of affordable ones. He said providers also need to be educated on who the highest-risk populations are before prescribing medication.

Abate said there has been a push in recent years for providers to monitor patients more closely and lower the maximum doses of painkillers. He said emergency doctors will now often times refer frequent patients back to their primary care providers for pain medication.

At the national level, President Barack Obama will ask Congress for $1.1 billion in his next budget to combat the opioid abuse epidemic, which has emerged as a 2016 campaign issue. The amount Obama wants to spend over two years is slightly more than the $1 billion he’s requested to expedite cancer treatments.

“Prescription drug abuse and heroin use have taken a heartbreaking toll on too many Americans and their families while straining resources of law enforcement and treatment programs,” the White House said in a statement.

Abate said the number of people who seek urgent medical care after using heroin is limited.

“We usually don’t see them,” he said. “They don’t wander into the clinic looking for care. They’re more likely to be found by law enforcement.”

Lisa Aitken, Kootenai Health spokeswoman, said there also hasn’t been an increase in people coming to the hospital’s emergency room with heroin-related issues.

“That’s definitely not to say that the use of heroin is not on the rise; they are just not making it to the hospital at this point,” she said. “It’s sad to think that there are people not coming to the hospital if they are in need of medical care related to heroin use.”

Schaffner said that since her daughter died, young women who have struggled or have been tempted have gravitated toward her for support.

“You need to have open communication with your kids and you’ve got to know where they are at,” she said. “If they think you are overbearing, too bad. It’s for their own good.”

Schaffner said she still struggles with what caused Cathryn to make a “foolish choice.” She said her faith and two other daughters have helped her from “rolling into a ditch” after the tragedy.

“You’ve got to stay focused on the things you do have,” Schaffner said. “You can’t stop living when other people love you and need you. I have good memories of Cathryn, and I think about her every day. There’s a purpose and reason for things and some day I’ll understand.”

Published via the AP member exchange. 


Want to avoid HIV? Take a pill

When Milwaukeean Josh Beck, 34, posts a profile on gay dating sites, he gets a lot of questions about his HIV status: “negative plus PrEP.”

PrEP is an acronym for “pre-exposure prophylaxis,” which means taking anti-retroviral medication to protect against acquiring HIV infection. PrEP is a growing strategy in combating HIV. It puts protection in place when at-risk people don’t use condoms or don’t know the true HIV status of their partners.

A number of online meeting sites for gay and bisexual men have begun adding the “negative plus PrEP” option to their apps, but the vast majority of primary care physicians in Wisconsin seem to know nothing about it.

Although most HIV-positive people are honest about their status, a large number of them don’t know theirs. As many as 60 percent of infected young gay and bisexual men are unaware of their status, according to a 2012 study.

Gay men cruising online and elsewhere might believe they’re negative based on their latest HIV test results. But they could have become infected since their last test without knowing it. Or they might have contracted the virus so soon before their last test that their bodies didn’t have enough time to develop the HIV antibodies that produce a positive test result.

Given these unknowns, a “negative plus PrEP” status is reassuring to prospective sex partners. “People seem much more comfortable because I’m on it,” Beck says. 

Beck learned about PrEP from an ad he saw in The Advocate and asked his doctor about it. Although his doctor had never heard of it, he looked into the treatment on Beck’s behalf and provided a referral.

Now Beck takes one Truvada pill per day, which research shows can provide him up to 97 percent protection from contracting HIV — if he takes the pill with food at the same time every day without fail. Failure to comply with the dosing guidelines lowers PrEP’s effectiveness significantly.

Truvada is a combination of two anti-retroviral drugs that are also used together to treat active HIV infections. Beck’s insurance covers the cost, which is much less than treating an HIV infection.

PrEP has been around for many years, and the U.S. Centers for Disease Control and Infection recommends it for some sexually active gay and bisexual men who are negative, as well as for some negative men whose partners are sexually active. But very few of the people who need it are aware of PrEP, according to a September 2104 survey by The Kaiser Family Foundation. The survey found that only 26 percent of gay and bisexual men knew there’s a treatment that can prevent HIV infection.

Dr. Andrew Petroll is trying to build awareness of PrEP among his peers in Wisconsin. Petroll is an infectious disease specialist with the Froedtert and Medical College of Wisconsin health network and an associate professor of psychiatry/behavioral medicine at the college’s Center for AIDS Intervention Research.

Even as he’s working to increase awareness of PrEP in Wisconsin, Petroll is conducting a survey to determine the level of PrEP awareness among physicians in the cities with the 10 highest populations of people living with HIV.

The lack of awareness concerning PrEP in Wisconsin is troublesome, because the strategy has had great impact elsewhere. In San Francisco, where both HIV-testing and PrEP are promoted aggressively, the HIV-infection rate has been coming down for the past three years, Petroll says.

He currently has about 40 Wisconsin patients on PrEP, including Beck.

“We’re seeing signs of an increase in demand for this (in Wisconsin),” Petroll says. “But people who are really interested in finding it are having a hard time getting it.”

Lack of awareness among physicians isn’t the only barrier to receiving PrEP. Some patients face discrimination from doctors when they ask about it, Petroll says. And doctors who are unfamiliar with PrEP are inclined to dismiss it due to dubious concerns.

Beck has heard many of those concerns, both from his primary care physician and from people online. “My doctor was concerned that, like with a lot of antibiotics, my system could build up a resistance to it,” Beck said.

That fear isn’t real, and it’s probably based on the way that HIV mutates into drug resistant strains, forcing infected patients to switch medications from time to time. But without HIV present in the body to mutate, the development of resistance is not a concern for HIV-negative people taking PrEP.

The major concern is side effects. The awful side effects associated with highly active anti-retroviral therapy are legendary. Truvada, however, was chosen for prevention not only because it works and is simple to take, but also because it has the fewest side effects in the anti-HIV drug arsenal, Petroll says.

There’s a 1-2 percent chance of kidney dysfunction for which Petroll monitors patients on a regular basis.

Beck says that he’s experienced virtually no side effects and there have been no indications of side effects in his routine blood work. He said people are more surprised by that than any other aspect of the treatment.

Like nearly everything else to do with HIV/AIDS, there’s also a political dimension to PrEP. Some activists believe it’s a cop-out, a shirking of personal responsibility.

Gay actor Zachary Quinto set off a firestorm on the subject when he criticized PrEP during an interview with Out magazine.

“We need to be really vigilant and open about the fact that these drugs are not to be taken to increase our ability to have recreational sex,” he said. “There’s an incredible underlying irresponsibility to that way of thinking … and we don’t yet know enough about this vein of medication to see where it’ll take us down the line.”

Petroll and Beck say the benefits far outweigh such concerns.

“It puts you in control if you’re not sure that your partner is always taking his meds or telling the truth about his status,” Petroll says.

When people are looking to have uncommitted relationships or one-night stands, it offers peace of mind if their condom slips or they’re too inebriated to use a condom, he adds.

Beck says he plans to remain on PrEP until he enters a committed relationship, and he’ll continue to educate people about it when he has the chance.

“I’m glad people ask me about it,” he says. “Every doctor I’ve talked to sees my medication list and whenever they’ve asked about (Truvada), they’ve thought it’s really cool that I’m being proactive. I’ve gotten nothing but support from people. I think the message is really starting to get out there.”

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Medical marijuana bill goes to Illinois Senate

Illinois physicians could prescribe marijuana to patients with specific terminal illnesses or debilitating medical conditions under legislation approved earlier this month by the state House.

The proposed legislation creates a four-year pilot program that requires patients and caregivers to undergo background checks, limits the amount of marijuana patients can have at a time, and establishes cultivation centers and selling points.

Lawmakers voted 61-57 to send the measure to the state Senate, where a version of the bill was approved in 2009. Senate President John Cullerton’s spokeswoman said he supports the legislation.

Gov. Pat Quinn hasn’t said whether he would sign the measure should it reach his desk.

Supporters said marijuana can relieve continual pain without triggering the harmful effects of other prescription drugs. They touted the legislation as a compassionate measure that would save patients from the agony caused by illnesses such as cancer, multiple sclerosis and HIV.

“I know every single one of you have compassion in your heart, this is the day to show it,” said Rep. Lou Lang, the sponsor of the bill. “… Let people feel better, let them have a better quality of life.”

The bill lists more than 30 medical conditions for which patients can be prescribed marijuana.

The legislative proposal prohibits patients from growing their own marijuana. Instead, the state must approve 22 cultivation centers, as well as 60 dispensaries where patients could buy the drug after getting a prescription from a doctor with whom they have an existing relationship. The legislation sets a 2.5 ounce limit per patient per purchase.

Patients who choose to take marijuana automatically consent to submit themselves to a sobriety field test should a police officer suspect they were driving under the influence of the drug.

Lang, a Democrat from Skokie, said the bill is the strictest in the nation. Still, opponents say the program would encourage the use of marijuana for recreational purposes.

“It’s going to cause confusion in our communities,” said Republican Rep. Mike Bost of Murphysboro. “… I will guarantee you that we will be back adjusting this legislation … because of the problems that can occur or we will be back in this floor for the legalization of marijuana.”

Lang and other supporters have been trying to legalize medical marijuana for several years. A measure that had cleared the Senate failed in the House in 2011, when six Republicans and 50 Democrats voted yes.

Quinn has said the bill’s sponsor hasn’t reached out to him to build support on the measure.

The Democratic governor said he was recently visited by a veteran suffering from war founds who was helped by the medical use of marijuana. Quinn said he was “impressed by his heartfelt feeling” on the issue.

“I’m certainly open-minded to it,” he said.

Eighteen states and the District of Columbia allow the use of marijuana for medical purposes.

A report issued earlier this month by the Pew Research Center poll showed that 77 percent of Americans say marijuana has legitimate medical uses.

Arkansas to be first in South to vote on medical marijuana

The Arkansas Supreme Court decision to keep medical marijuana’s legalization on the ballot introduces some unpredictability to the November election and shifts attention to an issue that might not be easily defined by party labels.

That’s no small feat for an Arkansas election dominated by predictability when it comes to national politics and partisan bickering when it comes to the state level. With Republicans aiming to win control of the state Legislature for the first time since Reconstruction, this may be one of the few issues where Arkansas voters won’t hew to traditional party lines.

That’s a situation supporters and opponents of the proposed initiated act are counting on after justices last week rejected a lawsuit challenging the ballot measure. The unanimous decision means Arkansas will be the first southern state to ask its voters whether to legalize the drug for medical purposes.

Both sides of the issue say they’re counting on help from both parties to win the debate.

“The support is not as divisive as you would think,” said Chris Kell, campaign strategist for Arkansans for Compassionate Care, the group pushing for the act’s passage. “I’m getting as much or more help from Republicans as from Democrats.”

Seventeen states and the District of Columbia have legalized medical marijuana in some fashion, and three states are expected to vote this year on the drug’s full-scale legalization. But the debate hasn’t been waged in the South, where putting measures on the ballot is more difficult and with conservative legislators throughout the region unlikely to take up the matter on their own.

“I think it’s a sign that marijuana policy reform is an idea that is coming of age now across the nation, rather than just in the states where we’ve seen it so far,” said Morgan Fox, communications manager for the Washington-based Marijuana Policy Project, which has contributed most of the money for the Arkansas effort. “It’s really an important moment.”

Opponents of the measure already have an active network of church leaders and other conservatives in place from past ballot fights, including the successful 2004 campaign to ban gay marriage in the state. But after losing a bid to strike the measure from the November ballot, opponents say they’ve got to build a coalition that goes beyond the conservative activists they’ve relied on for those campaigns.

“I think the success of our campaign against this measure is going to hinge more than most campaigns on our ability or someone’s ability to mobilize coalitions that don’t normally work together to oppose this measure,” said Jerry Cox, head of the Arkansas Family Council and a member of the Coalition to Preserve Arkansas Values.

Cox said that includes reaching out to law enforcement and medical officials that he says could speak out against the act.

The big unknown is just how big of a role either party will play in the debate, especially with so much attention focused on dozens of state House and Senate races in November. The state Democratic Party doesn’t traditionally take a stand on ballot measures, and a spokeswoman said the party didn’t plan to change that when it comes to the medical marijuana proposal.

State Republicans opposed medical marijuana in the party’s platform adopted earlier this year and a spokeswoman said the party opposed this measure.

Two of the state’s top Democrats – Gov. Mike Beebe and Attorney General Dustin McDaniel – have said they’re voting against the measure. But opposition from either party’s leaders doesn’t necessarily mean you’ll see elected officials going out of their way to talk about it on the campaign trail, especially in legislative races focused primarily on issues such as tax cuts and budget issues.

That reluctance shows just how much of a newcomer Arkansas is to the medical marijuana debate, and that’s a position that makes it more difficult to judge it by traditional party lines.

“It just doesn’t work on the same continuum that partisan politics operates,” said Jay Barth, political science professor at Hendrix College.

Or, as University of Arkansas political science professor Janine Parry said: “Voters are of two minds or 16 minds in a good many places almost every election year.”

It’s that kind of unpredictability that Arkansas voters are known for. This is the same state that in 1968 simultaneously elected Republican Winthrop Rockefeller governor, Democrat J. William Fulbright senator and gave its electoral votes to American Independent nominee George Wallace. More recently, it overwhelmingly re-elected Beebe two years ago when voters rejected Democratic Sen. Blanche Lincoln’s bid for a third term.

With that kind of history, would a state that hands Republicans control of the Legislature while legalizing medical marijuana be that much of a surprised primarily on issues such as tax cuts and budget issues.

That reluctance shows just how much of a newcomer Arkansas is to the medical marijuana debate, and that’s a position that makes it more difficult to judge it by traditional party lines.

“It just doesn’t work on the same continuum that partisan politics operates,” said Jay Barth, political science professor at Hendrix College.

Or, as University of Arkansas political science professor Janine Parry said: “Voters are of two minds or 16 minds in a good many places almost every election year.”

It’s that kind of unpredictability that Arkansas voters are known for. This is the same state that in 1968 simultaneously elected Republican Winthrop Rockefeller governor, Democrat J. William Fulbright senator and gave its electoral votes to American Independent nominee George Wallace. More recently, it overwhelmingly re-elected Beebe two years ago when voters rejected Democratic Sen. Blanche Lincoln’s bid for a third term.

With that kind of history, would a state that hands Republicans control of the Legislature while legalizing medical marijuana be that much of a surprise?