yourvote1-ribbonFirst they came for the mentally ill addicts, and I did not speak out—
Because I was not a mentally ill addict.

Then they came for the empathetic prescribers, and I did not speak out—
Because I was not a empathetic prescriber.

Then they came for the Pharmacists, and I did not speak out—
Because I was not a Pharmacist.

Then they came for me—and there was no one left to speak for me

Imagine this: Federal courts protecting the (illegal ?) actions of the DEA ?

Menominee Indian Tribes Lawsuit agaisnt the DEA Dismissed

MENOMINEE COUNTY, Wis – The Menominee Indian Tribe’s Lawsuit against the Drug Enforcement Administration and Department of Justice was dismissed by a federal court in Green Bay. DEA and DOJ agents raided Menominee Tribal land last October. The government says it took tens of thousands of high-grade marijuana plants. But the Tribe maintains it was industrial hemp protected under the farm bill.

The Menominee Indian Tribe released this statement today in response, “The Tribe is disappointed with this recent setback that challenges our sovereignty as a Tribal Nation and inhibits our ability to pursue research initiatives exploring the viability of this versatile and sustainable crop.  The Tribe is currently reviewing the decision to determine what options it may or may not pursue.”

I’m from the government… and don’t worry about getting screwed

screwed1Why victims of deadly meningitis outbreak haven’t been compensated

Kathy Pugh quit her job when her mother got sick from a tainted medication, and now Pugh spends her days helping the once-vibrant 85-year-old get out of bed, shower and dress. If her mom ever were compensated for what she endured, Pugh said she would like to install laminate flooring — which would make it easier to move around in a wheelchair — and maybe buy a handicap van.

Evelyn Bates-March, Pugh’s mother, is one of hundreds of victims of a 2012 outbreak of fungal meningitis that federal investigators traced to a batch of contaminated steroid injections manufactured by the New England Compounding Center. A civil fund of more than $200 million was created after victims sued the compounding center and companies with which it did business. The federal government also has money available to compensate crime victims.

But the 85-year-old, like all the others affected by the outbreak, has yet to see a dime to help her cope with how her life has changed since she was given a tainted shot.

[Federal prosecutors charge 14 in deadly meningitis outbreak]

Ongoing negotiations with the Centers for Medicare and Medicaid Services over what portion that agency, which paid some of the medical bills, should receive have stalled any payments to victims from the civil fund.
Kathy Pugh, right, sits with her mother, Evelyn Bates-March, who fell ill after receiving a tainted steroid shot in 2012. (Photo courtesy of Kathy Pugh)

Prosecutors — who charged two leaders of the compounding center with racketeering and second-degree murder — separately have advocated making federal victim-assistance money available to the victims, though their request has been waylaid by a dispute in the top levels of the Justice Department, people familiar with the case said.

“It’s been devastating,” Pugh said. “Everybody has dropped the ball.”

The case illustrates how the court system, the Justice Department and other parts of the federal bureaucracy can slow or even stop crime victims from obtaining financial assistance that most would agree they deserve.

Wyn Hornbuckle, a Justice Department spokesman, said in a statement, “We are still exploring funding options for the NECC victims,” but he declined to provide any specific information about what that exploration entailed. A spokeswoman for the U.S. attorney’s office in Boston, which is prosecuting the criminal case, reiterated that “no final determination has been made.”

“We will continue to do all that we can to ensure compensation for the victims in this case,” said the spokeswoman, Christina Sterling.

The 2012 meningitis outbreak had a devastating impact. According to federal prosecutors and the U.S. Centers for Disease Control and Prevention, more than 750 people got a fungal infection after receiving injections from the New England Compounding Center, and at least 64 people died — making it the deadliest meningitis outbreak in U.S. history.

In 2014, federal prosecutors alleged the incident was criminal. They charged 14 people in a 131-count indictment, alleging employees at the New England Compounding Center knew they were producing medication in an unsafe and unsanitary way and shipping it to customers anyway. Owner and head pharmacist Barry J. Cadden and supervisory pharmacist Glenn A. Chin were charged with 25 acts of second-degree murder and are scheduled to go on trial later this year.
Lyn Laperriere in 2006, six years before he was killed by a deadly meningitis outbreak. His wife, Penny Laperriere, is now among hundreds unsuccessfully seeking compensation as crime victims from the Justice Department. (Photo courtesy of Penny Laperriere)

[Compounding pharmacy linked to meningitis outbreak knew of mold, bacteria contamination]

Lawyer Stephen J. Weymouth, who represents Chin, said his client, who has pleaded not guilty, “wants people to be compensated financially from as many different sources as can be possibly financed.” An attorney for Cadden did not immediately return phone and email messages seeking comment.

Penny Laperriere, 59, of Sterling Heights, Mich., said her husband, Lyn, began to struggle within a few weeks of having a shot with the tainted medication in 2012. A bowler whose average topped 200 a game, Lyn suddenly began to struggle with balance and couldn’t finish a practice, she said. Then came the splitting headaches, which caused pain so severe he had to be hospitalized, she said.

Laperriere said doctors traced Lyn’s symptoms to a contaminated shot, but the treatment — anti-fungal medication with nasty side effects — failed. One night, when Lyn’s parents and sister were in town visiting, Laperriere said doctors called to say her husband, a retired General Motors machine repairman who would travel the country racing cars, had “flat-lined.” She said doctors revived him but “I knew he was brain-dead.”

In October 2012, the family took him off life support. He was six days shy of his 62nd birthday.

Laperriere said she had to sell her home because it required too much maintenance, and she had to put her and her husband’s dogs up for adoption because their vet and other bills were too high. She said she does not think she will see any money in compensation after lawyers and others take their cut.

“Which is really sad,” Laperriere said. “My husband died, and his pain and suffering is worth nothing?”

There are two pools of money from which victims might be paid: federal funds and funds from the civil lawsuits. Kimberly Dougherty, a Boston lawyer representing 100 victims, said each victim has been sent a letter stating how much he or she is eligible to receive from the civil fund, but payouts have been stalled while lawyers negotiate with the Centers for Medicare and Medicaid Services, which covered some of the victims’ medical care and has liens on the payouts. Dougherty said the victims share “a sense of frustration, particularly when they know there’s money sitting in a bank account that they can’t access.”

A spokesman for the Centers for Medicare and Medicaid Services said in a statement that Medicare “paid for medical care associated with” the outbreak and was “required by law to recover those payments from settlements like the NECC settlement.”

“We understand that many NECC settlement recipients who are Medicare beneficiaries are concerned about the distribution of the settlement money,” the spokesman said. “Medicare routinely works to make sure that, in similar situations, beneficiaries are able to keep a portion of their settlement.”

Separately, federal prosecutors in Boston and the Justice Department’s Office for Victims of Crime have advocated that victims be compensated using funds from the Antiterrorism and Emergency Assistance Program, which sets aside $50 million from the federal government’s $9 billion Crime Victims Fund for victims of terrorism or mass violence. But the Office of Justice Programs’ Office of General Counsel determined that the injuries sustained by the victims were not the result of an “intentional violent criminal act,” as the program requires and, thus, were not eligible for funds from it, according to officials familiar with the matter.

Though Justice Department officials say other funding mechanisms are being discussed, victims say they think they are being treated unfairly.

Willard Mazure Jr., 55, of Jackson, Mich., said before he received the tainted shot, he was a heavy-equipment operator who would hunt and fish regularly. Now he lives off disability and his wife’s income, unable to work because his short-term memory is virtually gone and even modest physical activity can leave his legs feeling as if they’re being prodded with pins and needles.

The compensation for each victim from Justice Department funds, which are administered through the state, might be minimal. Massachusetts law likely limits the payouts for most to $25,000, though those with “catastrophic” injuries could receive as much as $50,000. The victims say even that would help, and they have waged an aggressive campaign to persuade government officials to free up the money. Officials estimate that as much as $25 million might be needed for all those affected.

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The day’s most important stories.

Eighteen members of Congress from both political parties recently wrote to Shaun Donovan, the director of the Office of Management and Budget, asking that the decision to keep money from the victims be reversed. A spokeswoman for that agency said in a statement that the issue was “still being considered by the Department of Justice and has not yet been referred to the Office of Management and Budget.”

“If and when it is, we will move swiftly to make a determination,” the spokeswoman said.

Mazure said although financial compensation would be welcome, it would not undo the damage the shots inflicted on him.

“Every cent will help,” Mazure said, “but nothing will make me whole.”

Adam Goldman contributed to this report.

Telemedicine…trade off of convenience over proper diagnosis ?

telemedicineStudy Finds Misdiagnosis, Prescription Errors In Teledermatology

Research reveals virtual visits may be less than effective in treating patients.

By Christine Kern, contributing writer

A study of 16 online telemedicine companies published by JAMA Dermatology revealed some online physicians misdiagnosed skin cancer, herpes, and syphilis and also prescribed medication without taking a patient’s medical history.

The article, Choice, Transparency, Coordination, and Quality Among Direct-to-Consumer Telemedicine Websites and Apps Treating Skin Disease, asserts that, while evidence supports the use of teleconsultation to increase patient access to dermatological services, “Little is known about the quality of rapidly expanding direct-to-consumer (DTC) telemedicine websites and smartphone apps diagnosing and treating skin disease.”

The study sought to assess the performance of these DTC teledermatology services and found while telemedicine has the potential to expand access to high-value healthcare, there are serious concerns regarding the quality of skin disease diagnosis and treatment provided by many DTC websites. The authors concluded, “Ongoing expansion of health plan coverage of these services may be premature. Until improvements are made, patients risk using healthcare services that lack transparency, choice, thoroughness, diagnostic and therapeutic quality, and care coordination.”

As part of the study, researchers created several fake skin condition scenarios and downloaded stock photos of them with prepared medical histories of “patients” if the physicians asked for them. Diagnoses were provided in 48 of 62 completed online visits and 31 prescribed medications, but only 10 patients were advised about potential risks or side effects. Less than 30 percent of the sites allowed users to select their own clinician.

“The services failed to ask simple, relevant questions of patients about their symptoms, leading them to repeatedly miss important diagnoses,” said Jack Resneck, a dermatologist with the University of California, San Francisco, and lead author of the study.

The Wall Street Journal reported DTC telemedicine services have seen a recent growth in popularity, and the American Telemedicine Association anticipates there will be more than one million virtual medical visits this year alone. But while telemedicine is being touted as convenient and inexpensive, and as a way to expand coverage to those in underserved areas, there is also growing concern among some physician groups the services are undermining doctor-patient relationships deteriorating the quality of care and undermining the healthcare system as a whole.

Another study published by JAMA Internal Medicine questioned the effectiveness of telemedicine, especially in the synchronous variety of telemedicine found in video and phone consults. Variation in Quality of Urgent Health Care Provided During Virtual Visits found these methods of providing virtual care to patients often fail to adhere to clinical best practices.

FDA takes significant steps to protect Americans from dangers of tobacco through new regulation

FDA takes significant steps to protect Americans from dangers of tobacco through new regulation

Today, the U.S. Food and Drug Administration finalized a rule extending its authority to all tobacco products, including e-cigarettes, cigars, hookah tobacco and pipe tobacco, among others. This historic rule helps implement the bipartisan Family Smoking Prevention and Tobacco Control Act of 2009 and allows the FDA to improve public health and protect future generations from the dangers of tobacco use through a variety of steps, including restricting the sale of these tobacco products to minors nationwide.

“We have more to do to help protect Americans from the dangers of tobacco and nicotine, especially our youth. As cigarette smoking among those under 18 has fallen, the use of other nicotine products, including e-cigarettes, has taken a drastic leap. All of this is creating a new generation of Americans who are at risk of addiction,” said HHS Secretary Sylvia Burwell. “Today’s announcement is an important step in the fight for a tobacco-free generation – it will help us catch up with changes in the marketplace, put into place rules that protect our kids and give adults information they need to make informed decisions.”

Tobacco use is a significant public health threat. In fact, smoking is the leading cause of preventable disease and death in the United States and responsible for 480,000 deaths per year. While there has been a significant decline in the use of traditional cigarettes among youth over the past decade, their use of other tobacco products continues to climb. A recent survey supported by the FDA and the Centers for Disease Control and Prevention shows current e-cigarette use among high school students has skyrocketed from 1.5 percent in 2011 to 16 percent in 2015 (an over 900 percent increase) and hookah use has risen significantly. In 2015, 3 million middle and high school students were current e-cigarette users, and data showed high school boys smoked cigars at about the same rate as cigarettes. Additionally, a joint study by the FDA and the National Institutes of Health shows that in 2013-2014, nearly 80 percent of current youth tobacco users reported using a flavored tobacco product in the past 30 days – with the availability of appealing flavors consistently cited as a reason for use.

Before today, there was no federal law prohibiting retailers from selling e-cigarettes, hookah tobacco or cigars to people under age 18. Today’s rule changes that with provisions aimed at restricting youth access, which go into effect in 90 days, including:

  • Not allowing products to be sold to persons under the age of 18 years (both in person and online);
  • Requiring age verification by photo ID;
  • Not allowing the selling of covered tobacco products in vending machines (unless in an adult-only facility); and
  • Not allowing the distribution of free samples.

The actions being taken today will help the FDA prevent misleading claims by tobacco product manufacturers, evaluate the ingredients of tobacco products and how they are made, as well as communicate their potential risks.

Today’s rule also requires manufacturers of all newly-regulated products, to show that the products meet the applicable public health standard set forth in the law and receive marketing authorization from the FDA, unless the product was on the market as of Feb. 15, 2007. The tobacco product review process gives the agency the ability to evaluate important factors such as ingredients, product design and health risks, as well as their appeal to youth and non-users.

Under staggered timelines, the FDA expects that manufacturers will continue selling their products for up to two years while they submit – and an additional year while the FDA reviews – a new tobacco product application. The FDA will issue an order granting marketing authorization where appropriate; otherwise, the product will face FDA enforcement.

For decades, the federal government and the public health community have fought to protect people from the dangers of tobacco use. Since the first Surgeon General’s report on Smoking and Health in 1964, which warned Americans about the risks associated with smoking, significant progress has been made to reduce smoking rates among Americans. In fact, tobacco prevention and control efforts have saved at least 8 million lives in the last 50 years, according to the 2014 Surgeon General’s Report on the Health Consequences of Smoking. In 2009, Congress took a historic step in the fight for public health by passing the bipartisan Family Smoking Prevention and Tobacco Control Act (TCA) giving the FDA authority to regulate the manufacturing, distribution and marketing of tobacco products to protect the public health.

Today’s action marks a new chapter in the FDA’s efforts to end preventable tobacco-related disease and death and is a milestone in consumer protection.

“As a physician, I’ve seen first-hand the devastating health effects of tobacco use,” said FDA Commissioner Robert M. Califf, M.D. “At the FDA, we must do our job under the Tobacco Control Act to reduce the harms caused by tobacco. That includes ensuring consumers have the information they need to make informed decisions about tobacco use and making sure that new tobacco products for purchase come under comprehensive FDA review.”

Today’s actions will subject all manufacturers, importers and/or retailers of newly- regulated tobacco products to any applicable provisions, bringing them in line with other tobacco products the FDA has regulated under the TCA since 2009.

These requirements include:

  • Registering manufacturing establishments and providing product listings to the FDA;
  • Reporting ingredients, and harmful and potentially harmful constituents;
  • Requiring premarket review and authorization of new tobacco products by the FDA;
  • Placing health warnings on product packages and advertisements; and
  • Not selling modified risk tobacco products (including those described as “light,” “low,” or “mild”) unless authorized by the FDA.

“This final rule is a foundational step that enables the FDA to regulate products young people were using at alarming rates, like e-cigarettes, cigars and hookah tobacco, that had gone largely unregulated,” said Mitch Zeller, J.D., director of the FDA’s Center for Tobacco Products. “The agency considered a number of factors in developing the rule and believes our approach is reasonable and balanced. Ultimately our job is to assess what’s happening at the population level before figuring out how to use all of the regulatory tools Congress gave the FDA.”

To assist the newly-regulated tobacco industry in complying with the requirements being announced today, the FDA is also publishing several other regulatory documents that provide additional clarity, instructions and/or the FDA’s current thinking on issues specific to the newly-regulated products.

The FDA, an agency within the U.S. Department of Health and Human Services, protects the public health by assuring the safety, effectiveness, and security of human and veterinary drugs, vaccines and other biological products for human use, and medical devices. The agency also is responsible for the safety and security of our nation’s food supply, cosmetics, dietary supplements, products that give off electronic radiation, and for regulating tobacco products.

The Pain of Social Isolation

The Pain of Social Isolation

Almost all of my patients suffering from chronic pain are socially isolated.  When you are trapped in pain you have a difficult time reaching out. Others do not necessarily want to interact with angry people. The problem becomes greatly magnified in that it has been shown that social rejection shares the same neurological circuits in the brain as chronic physical pain. Not a great situation.


10 years in a wheelchair

Jane, a woman in her early 60s, was exactly such a patient. She’d lived with severe scoliosis all her life. Then, in 2001, she was rear-ended while driving, and the following year, she had a bad fall while grocery shopping. By the time she came to see me, she had severe pain everywhere. She’d been using an electric wheelchair for nearly a decade. She was taking over 200 mg of morphine per day and high doses of anti-anxiety drugs.

When I examined her, she was tilted forward and to the left, barely able to stand. Her spinal curve was severe enough that I recommended surgery but I warned her that the treatment had a high rate of complication.   Because of this, it was unsafe to do the operation until her medications were stabilized, her pain significantly diminished, and she was more mobile.

I gave her my book, Back in Control and referred her to a colleague to coordinate her care. She was not that interested and they mutually agreed to not continue care. Eight months passed and I saw her on my schedule. I was curious because I knew the size of her curve and the severity of her pain. High-dose narcotics makes it all the more difficult because they sensitize the nervous system. I did not have high expectations…

Out of the wheelchair

I was shocked when I walked into the room and there was no wheelchair, walker, or cane. She was standing up to greet me. She was off all of her medications, had no pain, and was working out in the gym three times per week. She was animated, smiling, and engaging. I ended up an hour behind in schedule, as I wanted to find out what had turned her life around.

Jane admitted that she had spent the last 10 years sitting alone in her house stewing over all the wrongs that had been done to her. She only went out when necessary. After understanding the linkage between anger and the pain pathways, she decided to forgive. She forgave her ex-husband, the person driving the car that had hit her, the people involved in her legal battle, and the medical system that had not helped her. This process took several months to work through – but within weeks of doing so, her pain began to abate.  She still had scoliosis but as her pain diminished, she stopped stooping over protectively to guard her back. She now could stand up straight and tall.

Reconnecting through forgiveness

Forgiveness researchers, such as Dr. Fred Luskin, have shown how rumination and anger influence central and autonomic nervous system function and impair functioning of the hypothalamic-pituitary adrenal cortical axis (stress system). While forgiveness is seen as a coping mechanism that helps to relieve the stress of anger, it also has direct and indirect effects on health and nervous and endocrine function. Out of The Abyss with forgiveness

It has been my position that anxiety-induced anger is the driver of chronic pain. The manifestations of unrelenting anger are profound and one of them is becoming socially isolated. Now you have all the time in the world to think about your pain and all the ways you have been treated badly. You body is full of adrenaline, which decreases the blood supply to your brain. Indeed, it is well-documented that patients’ brains shrink in the presence of chronic pain. Between the adrenaline and using just part of your brain that would make sense. Fortunately, your brain will re-expand with resolution of the pain. Anxiety, anger and adrenaline


Social isolation

Besides moving too fast, our modern societal structure does not encourage us to interact with each other in a meaningful way. I read a US New and World report several years ago that the average number of close friends that person in the US had was 2.2. That means that many people have essentially no close friends.

I am a pretty social person but when I was in the midst of my own burnout I became isolated. It wasn’t that there weren’t people around. I had so many intensely negative thoughts about myself whirling around in my head that I couldn’t believe that anyone would want to hang out with me. The loneliness was crushing. When I arrived back in Seattle in 2003, a close friend invited me over for a barbeque and I was shocked. I have not forgotten that day and it was the beginning of my re-entering life.

People being with people

At our five-day Omega workshop my first priority was to create a safe environment where people could be with other people and share experiences. One of the most effective ways to re-connect is play and as people began to relax and laugh their pain would disappear. Of course it returned when they returned to the real world and their triggers. But most of the participants learned the skills to consistently remain out of pain. The more satisfying aspect of the process though was that as the pain abated many re-engaged with their lives in a much more powerful way. Play

As Dr. Fred Luskin, my wife and I presented our material throughout the week, I realized that we did not have to do much. It was the participants being with other people that created healing. It was remarkable. Dr. Louis Cozolino wrote an exhaustive review on The Neuroscience of Human Relationships. He points out that humans evolved by interacting with other humans. Therefore, the consequences of becoming isolated are consistent and often severe. Studies out of Australia have shown that there are damaging mental health effects when workers become disabled and out of the workflow of the day. Sitting around the house without a sense of purpose is not a great way to thrive.

One of the first Omega participants sent me this video link. She experienced profound healing after being in pain for over 35 years and has been a true inspiration. TED talk: Our lonely society makes it hard to come home from war

This Fox segment was filmed with another one of our Omega participants. She has a great story amongst many others. We never anticipated the power of people healing people.  Video: Write your way out of pain

Jane was in a wheelchair for over 10 years and on high dose narcotics with a severe spinal deformity. It was by her working past her anger, getting out of the house and re-connecting with her friends did she heal. No medical treatment can replicate the power of the body to heal itself. Anger disconnects – play connects.

Dr. Kostenko files defamation lawsuit against CBS Evening News

The passionof Dr. Kostenko

Dr. Kostenko files defamation lawsuit against CBS Evening News


Dr. Michael Kostenko has filed a lawsuit against CBS Evening News claiming defamation in two news segments aired in January and April this year.

The suit alleges CBS “aired a series of intentional misrepresentations about Dr. Kostenko’s medical practice, including describing his medical facility as a pain clinic and used him as an example of a ‘drug trafficker.'”

His attorney, Christina Kostenko, who is also his daughter, alleges Michael suffered damage to his reputation, emotional distress and harassment from the federal government. They are seeking $1 million in damages.

Kostenko, owner and operator of Coal Country Clinic in Daniels, utilizes a self-management program to treat patients with progressive chronic degenerative disease that have components of pain, according to the suit filed May 20 in Raleigh County Circuit Court.

The suit claims CBS did not contact Kostenko before airing the Jan. 6 segment titled “West Virginia allows painkiller addicts to sue prescribing doctors.”

The news piece reported Kostenko has written more than 40,000 pain pill prescriptions in the past two years; however, the suit said that information was taken out of context, as Kostenko writes weekly prescriptions, four per month, for a total of 52 each year.

Kostenko agreed to an interview April 1 with Jim Axelrod, a senior national correspondent for CBS, to discuss corruption and drug abuse in West Virginia.

Kostenko’s medical license was suspended March 3 after the West Virginia Osteopathic Board of Medicine found probable cause of unprofessional and unethical conduct that may have contributed to the death of three patients.

“He did not agree to talk about the three patients that died in 2014,” the suit said, but Axelrod asked Kostenko in the interview if he felt responsible for the death of one of the patients.

In the news segment, he responded, “Yes, I do,” but according to the suit, Kostenko’s full response was, “Yes, I do. I take responsibility for every man, woman and child’s health in West Virginia. I’m a doctor. That is my job.”

“Dr. Kostenko was under the impression that Defendants wanted to interview him about his upcoming whistle-blower lawsuit against state agencies for waste and wrongdoing that had led to the drug abuse problem in West Virginia.”

The suit claims the two-hour interview and video shot at his office were “maliciously edited” to connote Dr. Kostenko being a ‘drug trafficker’ and to make it look like an employee was handing out signed prescriptions to anyone that would walk into his clinic.

“The Defendant’s actions were so extreme and outrageous in character that it goes beyond all bounds of decency and is atrocious and utterly intolerable in a civilized community and it truly offended community notions of acceptable conduct,” the suit said. “Dr. Kostenko not only felt that the Defendant’s behavior was extreme and outrageous, but the community, through communications, thought so as well.”

CBS Evening News, CBS Inc., CBS Broadcasting Inc., CBS Corporation, Jim Axelrod and Ashley Velie are listed as defendants in the suit.

The case has been assigned to Raleigh County Circuit Court Judge John A. Hutchison.

It is time to cut fish or cut bait…

keepcalmThis election season is going to be maybe a once in a lifetime event for change. On the one hand we have two candidates… one which is winning the majority of the primaries but trails in delegates because the INSIDERS have rigged the process so that their “preferred candidate” will get the nomination of their party.

The other party is just as bad.. some of the INSIDERS are contemplating how the apparent choice of the voters is not acceptable to the INSIDERS and how they can get “their choice” as the nominee of their party.

Of course, all the dust won’t be settled until both conventions are over by the end of July.

Those in Congress are very concerned about how this apparent attempt to “fix” the Presidential election will sit with the voters and could cause a revolt against the incumbents.

I was a video clip this week that Clinton believed that she could keep guns out of the hands of criminals.. all you have to do is look at Chicago and Washington DC, which has some of the toughest gun laws in the country and yet has some of the highest homicide rates.  Would she be similarly out of touch about the war on drugs and the medical needs of those in the chronic pain community ?

We are seeing what the anti-opiates groups have accomplished.. getting dozens of bills out of Congress to help addicts get treatment.. at some of the very same facilities that some of the anti-opiate groups operate. They have convinced Congress that addicts deserves COMPASSION… while convincing them that the mere act of prescribing opiates will just create more addicts.  Those that are suffering from chronic pain … deserves NO COMPASSION.

If you want change.. you need to be part of change… find the Face Book Page and Twitter of your members of Congress, same for local investigative reporters from the media… you don’t have to tell your story… re-post such stories as this one in Florida

Another “opiate related death” ?

86 y/o that shot/killed his  78 y/o wife because she was in pain and they could not afford her medication. While this is in Florida.. it is happening most everywhere else in the country… what we don’t know is how many suicides are just swept under the rug as a “opiate related death”.

There is TSUNAMI of paranoia running thru Congress… The media is paying attention to that TSUNAMI.. Between now and Nov 8th (election day) may be the BIGGEST OPPORTUNITY to “move the needle”.

A lot of the early Republican Presidential candidates learned a painful lesson that dollars can buy advertising … but.. they can’t buy VOTES..

GET OFF YOUR ASS… while you can.. because the anti-opiate groups are gaining success in reducing and/or taking your opiates away. Just imagine how – OR IF  – you are going to function without any pain medications ?  THE CLOCK IS TICKING !!!


The Opioid Crisis Is Really a Crisis of Compassion – More SAVE THE ADDICT !

2016-05-20-1463766413-8822460-Ozsignage.jpgThe Opioid Crisis Is Really a Crisis of Compassion


Yesterday I found myself in an odd discussion – I was trying to imagine under what circumstances I would tell a patient that I simply couldn’t treat them because I had reached my quota of 100 heart surgeries and they were number patient 101. It was in discussion with a fellow physician, Senator Rand Paul (R-KY), who posed the hypothetical scenario as part of our town hall panel for the Coalition To Stop Opioid Overdose.

2016-05-20-1463770132-8271042-ozwrandpaul.jpgI was in the U.S. Capitol to advocate on behalf of the millions of families who are struggling with the disease of addiction, the loved ones of those we have lost and the millions more in recovery who deserve support. I sat at lunch with a mother and father whose child died from an overdose and their story was heartbreaking and preventable. I happily joined stakeholders as we met with lawmakers to persuade final passage of the Comprehensive Addiction and Recovery Act (CARA). The House recently overwhelmingly passed its version of the Senate bill and soon the two chambers confer to comprise on a final version to send to the White House to be signed into law. CARA will allow the government to grant money for addiction prevention, treatment and recovery support services, and increase countermeasures for overdose – our leading cause of accidental death.

Senator Ed Markey (D-MA) gave me an even deeper understanding of Dr. Rand’s hypothetical rationing challenge. His bill would raise the cap on buprenorphine to 500 patients. The bill that passed the House earlier this month only includes a “sense of congress,” which wouldn’t actually change the law, to raise the cap to 250 patients. Of all the points that must be part of comprehensive addiction reform, this is both the easiest and most urgent. But apparently, according to the Congressional Budget Office, raising the cap would cost money that was unaccounted for, a no-no in modern law making. By raising the cap, more patients could get care, which would cost money. The reality that money would also be saved by avoiding addictive behaviors including overdoses that cause expensive hospitalizations is amazingly not part of the cost analysis. Figuring out how to pay for care is routine for Congress. Deciding how many people are entitled to care even if they can pay should not be the burden of non-medical elected officials.

What is the big deal with buprenorphine? Unlike methadone, buprenorphine was easily administered by a primary care physician and could be a discreet office based solution. But the DATA 2000 law required physicians to take an eight-hour course in order to earn permission to treat up to 100 patients with buprenorphine. The 101st patient would be turned away. This made no sense – would it be conceivable to tell the 101st cancer patient that they could not be treated because you had reached your official quota? No other prescription or medical treatment has such a limit. As a physician, the thought of turning away any person who needs treatment and is at risk of dying is counterintuitive to everything we are taught. Yet DATA 2000 did exactly that. What was behind this thinking?

Like methadone, buprenorphine can be abused. Lawmakers were concerned about patients taking too much or re-selling the drug, a process called diversion. But since 2000, technology has improved making diversion more difficult. Implantable pumps similar to insulin pumps can prevent abuse and a soon to be approved implant will slowly release enough drug to stop cravings. With the tripling of drug overdoses since 2000, we should re-visit this flawed rationing.

A quota on medical treatment of any other kind for any other disease would never be tolerated by the public. But addiction is different. Addiction is a disease that hurts others as well as the patient. Addiction frequently involves crimes or violence. It’s the only medical condition for which there are mandatory prison sentences. Addiction has been synonymous with the marginalized and disenfranchised fringe of society, viewed as the moral failure of a lost ungrateful soul. The patient cap is allowed to flourish in plain sight because we didn’t want “those people” at doctor’s offices in our neighborhoods getting an undeserved second chance.

But we have evolved in our understanding of addiction’s pathology, and so too must our acceptance of those who suffer as equals in need of treatment, deserving of care and possessing the hope and potential to get better. The vast majority of people addicted to opioids do not want to be.. Seeing someone struggling through a craving and getting “dope sick” is utterly heart wrenching. It is unthinkable to not help them. Yet imposing a limit on how many patients can be treated raises their risk of failure while guaranteeing they feel like one. Often it ends in their death.

It’s easy to do the right thing here. While I support removing the cap on buprenorphine prescribing entirely, understanding the political realities, in the short term: when Congress sends a comprehensive bill addressing the opioid epidemic to the President by the 4th of July, it must raise the cap as high as possible by including the Senate’s bill, the TREAT Act. We need to start saving lives with tools we know work instead of making it harder for those fighting addiction to succeed and survive. Most importantly we need to see the life of a person struggling with addiction as more worth saving than the cost of the medicine. Comprehensive reform means acknowledging “new normals.” CARA’s new normal is that people struggling with addicition can get better and deserve to get better. “Those people” are no longer our lowest common denominator to be punished and discarded; rather they are part of us and sit at our family dinner tables. CARA might not end our opioid crisis, but it would definitely help end our crisis of compassion. Let’s lose the cap.


Do we now have a new autonomous federal entity ?

DEA agents raid Four Corners dispensary

Even after being instructed by Pres Obama and AG Holder, Congress passed a law and a Federal Court declared that the DEA was NOT TO BOTHER MJ dispensaries in states where it has been declared legal… the DEA apparently has decided to continue with BUSINESS AS USUAL. Congress provides the funding for DEA’s operation…  Is all of these mandates by the Administration, Congress and Federal courts being done with a “wink and a nod” ?


A marijuana dispensary was part of a sting operation this Wednesday morning.

One of the operations took place at Montana Buds, on Zoot Way in Four Corners. DEA agents raided the business but would not allow us to photograph agents or the actual bust. Authorities would not release any information on why the raid was conducted because it’s an ongoing federal matter. Agents were on scene interviewing employees at the dispensary while we were there. This type of activity by the DEA is not something that has been normal in Montana for several years.

“This is absolutely not common in the last five to six years. There was a time period back in 2010 that there were a lot of raids,” said Eugenio Garcia, publisher of Cannabis Now Magazine. 

DEA ignoring Congress and Federal courts on MJ enforcement ?

Opiate Rxs DOWN.. Heroin deaths UP.. connection ?

Changes to Ohio laws endanger patients’ access to opioids

Opioid pain medications can lead to addiction, but they’re also the most effective drugs for some patients. State and federal guidelines have been crafted to guide doctors.

Bob remembers the exact date he hurt his back: June 11, 2005. He picked up a scrap item at work and gave it a toss.


Bob ruptured a disk and herniated two others. A decade and three surgeries later, he takes five different medications daily to manage his pain, including two opioids, methadone and oxycodone.

Bob has tried other medications and therapies, including an implant that is supposed to block pain signals from reaching his brain, but opioids work best, he said.

They dull his back pain enough for him to run errands and take care of his family. But he can’t work, and he can’t play softball, basketball or golf, sports he enjoyed before his injury. His back aches most on cold and rainy days.

Bob plans his life around monthly trips to his pain specialist in Summit County and takes random drug tests.

“I do not like putting poison in my body every day,” Bob said. “And that’s what this is. It’s not good for anything but the pain. But without it, I don’t know what I would do.“

Bob is in his 60s and lives in Perry Township. He is one of the estimated 25.3 million adults in the United States who suffer chronic pain.

Bob agreed to speak to The Repository on the condition his last name wouldn’t be used. He fears becoming a target of pill thieves, he said.

He also fears that growing concern over the addictive effects of opioids and their link to heroin use could someday mean he can’t get his medicine. Under current restrictions, if he loses his pills, he can’t get more until the following month.

“It’s a horrible way to live,” he said of his daily pill regimen, “but it’s either live like that or lay in there and writhe around in the bed in pain all day.”

Cutting back

No one is planning an outright ban on prescription opioids, a class of drugs that includes familiar pain relievers like Vicodin, OxyContin and Percocet. Doctors, government regulators and addiction specialists agree that opioids can provide legitimate and effective pain treatment for some patients.

But after years of doctors freely prescribing opioids, Ohio has steadily made them harder to get as part of the state’s strategy to combat opioid and heroin addiction.

The state requires doctors to check a state database before prescribing opioids, and since 2012 has written guidelines to encourage doctors to use alternative pain treatments and to better monitor patients who take opioids.

The reforms have taken about one opioid dose in 10 out of circulation since 2012.

Some doctors stopped prescribing opioids altogether because of the stricter regulation, which leaves their patients to look elsewhere for treatment. And overlapping state and federal guidelines have created a contradictory patchwork of standards for doctors and patients alike.

Prescription opioids carry a significant risk of addiction and death. Consider:

• Almost 19,000 people in the U.S. died from overdoses of opioid pain relievers in 2014, more than five times the number in 2001, according to the National Institute on Drug Abuse.

• 4.3 million people ages 12 or older reported non-medical use of prescription pain relievers in the 2014 National Survey on Drug Use and Health.

• 4 out of 5 heroin users started by abusing opioid medications, according to “JAMA Psychiatry.”

• All opioids, including prescription drugs and heroin, killed 2,000 people in Ohio in 2014, according to the Ohio Department of Health.

Tighter regulation

Gov. John Kasich shut down so-called “pill mills” — doctors who inappropriately prescribed opioids — in 2011 by signing a law requiring licenses for pain-management clinics.

The following year, the Governor’s Cabinet Opiate Action Team rolled out prescribing guidelines for emergency rooms, such as limiting opioids to three-day prescriptions. Guidelines for treating chronic pain, including dosage thresholds, followed a year later.

“What we’ve learned is it’s effective,” said Andrea Boxill, deputy director of the Opiate Action Team. “We’ve certainly seen a decrease in the number of pills that have been prescribed, at least according to the Board of Pharmacy data.”

From 2012 to 2015, the amount of opioids dispensed to Ohio patients dropped 11.6 percent, to 701 million doses, according to Board of Pharmacy.

In Stark County, the number of doses dispensed dropped from a peak of 27.7 million in 2013 to 25.4 million in 2015.

Earlier this year, the federal Centers for Disease Control and Prevention and the state’s Opiate Action Team each released additional prescription guidelines. The CDC guidelines address chronic pain. The state guidelines address the treatment of acute pain.

Both guidelines urge doctors to use non-opioid treatments when possible, to use the lowest dosage possible when prescribing opioids, to develop a strategy to end opioid treatment, to monitor patients and to check their prescription histories before giving them opioids.

How did we get here?

“This is my opinion, we’ve created this mess because we’ve so liberally given away narcotics for things we traditionally wouldn’t have,” said Dr. Paul D. Hrics.

Hrics is chairman of Canton Aultman Emergency Physicians. Multiple times a week, he and other doctors treat overdose patients in Aultman Hospital’s emergency department.

At one time, narcotic painkillers were generally reserved for cancer patients or patients who were in end-of-life care, Hrics said. If you sprained your ankle or had dental pain, a doctor or dentist prescribed Tylenol or ibuprofen.

But during the 1990s and early 2000s, there was a national push for doctors to better treat pain. Pain became the “fifth vital sign.”

“It had to be documented just like your heart rate, your blood pressure, your temperature,” Hrics said.

Satisfaction surveys put pressure on doctors to meet their patients’ wishes, including demands for opioid pain medication.

At the same time, new extended-release opioids, such as OxyContin, came on the market. Some of the marketing materials suggested patients would be able to use less of the new medication and that it would be less addictive, “which ended up not being true,” said Dr. Amol Soin, vice president of the State Medical Board of Ohio.

Managing pain

After years of over-prescribing opioids, doctors are cutting back, looking for alternative treatments and having tough conversations with their patients.

Dr. Stacey Hollaway said one of her partners at Stark County Medical Group in Jackson Township no longer prescribes opioids, but she still does. Hollaway is certified in internal medicine and pediatrics and sees 4,000 patients on a regular basis. About 60 percent of them are adults.

There are a lot of non-opioid medicines that can be used to treat pain; and neuromuscular therapy, massotherapy, chiropractic therapy, and acupuncture are other options, she said.

But sometimes opioids are the best treatment for a patient, such as a person who has already had back surgery or who is allergic to non-opioid pain relievers.

“Do people get addicted to it? Absolutely,” Hollaway said. “Are there people who can take it every single day and never get addicted to it? Absolutely.”

Hollaway said before she prescribes long-term opioid treatment, her patient has to sign a contract.

The patient promises to use a single pharmacy, to not get a prescription from another doctor and to submit to random drug tests to make sure they’re using the medication as prescribed and not mixing it with other drugs.

Hollaway started using the contracts after Ohio set its first prescription guidelines in 2012. She estimated she has had about 50 patients on contracts for opioid pain medicines. She’s had to revoke three of those agreements.

Pain-management contracts or agreements have become standard and are recommended by the state medical board, Soin said.

Soin graduated from Northeastern Ohio Universities College of Medicine (now Northeast Ohio Medical University) in 2002 and later trained at The Cleveland Clinic.

He sees about 140 patients a week at his Dayton-area pain-management clinic. Some of them do well on opioids, but addiction can happen to anybody.

“I think the important thing is to educate the patient so they’re aware of how dangerous these drugs really are and how there are members of society who would love to get their hands on these pills, so they have to be very careful with the medications that they have,” Soin said.

When opioids aren’t right for a patient, having government guidelines makes it easier for doctors to explain why they can’t prescribe them, the doctors said.

On the horizon

While the federal and state guidelines are similar in their intent, they differ on particulars, and that can cause confusion for doctors, Soin said.

“At some point it would be really nice to marry all of these into one document or one formal guideline we could all follow nationally,” Soin said.

Doctors, pharmacists, and patients can expect more prescription drug regulation in the future.

Kasich’s administration wants to cap the supply of opioid pills a patient can get at 90 days, and prescriptions that haven’t been used in 30 days would be invalid.

To cut down on drug theft, the Board of Pharmacy wants to register the 42,000 pharmacy technicians in the state. It also wants to license doctors, dentists, and veterinarians who store and dispense controlled substances.

The media and politicians are paying more attention to opioid addiction, but good intentions can lead to burdensome regulations, Soin said. Time will tell how effective these reforms will be.

“That’s going to be part of the learning process over the next three to four years,” Soin said. “We’ll probably overcorrect and then hopefully fix what needs to be fixed.”

Hrics said he expects to be busier in the ER as the supply of prescription opioids tightens even further.

“Near term, I think we’re going to see a lot more people overdosing because they’re going to turn to heroin,” he said.

Meanwhile, Bob and other pain patients will fight their daily battles. Right now, his pill regimen is working. But if there was something he could do to get off opioids for good, he would, even if it meant losing a limb, he said.

“You find your new normal and you learn how to live with it,” Bob said. “… I am going to be in pain management, probably for the rest of my life.”

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