1-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 an 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

Chronic fatigue syndrome linked with differences in gut bacteria

A study found that people with chronic fatigue syndrome had higher levels of certain gut bacteria and lower levels of others compared to healthy people who didn't have the condition.Chronic fatigue syndrome linked with differences in gut bacteria


People with chronic fatigue syndrome may have imbalances in their gut bacteria, a new study suggests.

The study found that people with chronic fatigue syndrome had higher levels of certain gut bacteria and lower levels of others compared to healthy people who didn’t have the condition.

The researchers then checked to see if these imbalances also characterized the subset of patients in the study who had irritable bowel syndrome (IBS), an intestinal disorder that is common in people with chronic fatigue syndrome. Results showed that patients did indeed have different patterns of gut bacteria disturbances depending on whether they had only chronic fatigue syndrome or both chronic fatigue syndrome and IBS.

The findings suggest that researchers may be able to divide chronic fatigue syndrome patients into different groups depending on their gut bacteria imbalances, which could aid in the diagnosis and treatment of the disease, the researchers said. 

Chronic fatigue syndrome is a disorder in which people have extreme fatigue that is not improved by rest and is not the result of another medical condition. An estimated 35 percent to 90 percent of patients with chronic fatigue syndrome also report abdominal discomfort consistent with symptoms of IBS, the researchers said.

The reason for the link between chronic fatigue syndrome and IBS is not clear; chronic fatigue syndrome may predispose patents to developing IBS, or the two conditions might share underlying causes, the researchers said.

Previous studies have already found district differences in gut bacteria in chronic fatigue syndrome patients compared to healthy people. But the new study is one of the first to look for differences between gut bacteria in chronic fatigue syndrome patients who have IBS and bacteria in those who do not have IBS.

The researchers analyzed fecal samples from 50 patients with chronic fatigue syndrome and 50 healthy people who did not have the condition. Nearly half of the chronic fatigue syndrome patients, 21 out of 50, also had IBS.

The researchers found that differences in the levels of six types of gut bacteria — Faecalibacterium, Roseburia, Dorea, Coprococcus, Clostridium, Ruminococcus and Coprobacillu — were strongly linked with chronic fatigue syndrome. In fact, the relative abundance of these species in participants’ guts could be used to predict whether the patients had chronic fatigue syndrome, the researchers said.

In addition, researchers found that people with chronic fatigue syndrome and IBS had higher levels of a type of bacteria called Alistipes and lower levels of a type of bacteria called Faecalibacterium. Meanwhile the patients who had chronic fatigue syndrome but not IBShad higher levels of a genus of bacteria called Bacteroides but lower amounts of a specific species in this genus called Bacteroides vulgatus.

Some researchers have hypothesized that altered gut bacteria may play a role in the causing chronic fatigue syndrome, because some research shows that a person’s gut bacteria may affect their central nervous system and immune system. However, it’s also possible that changes in gut bacteria are a consequence of having chronic fatigue syndrome.

Future studies should look further into gastrointestinal symptoms and their relation to gut bacteria disturbances in people with chronic fatigue syndrome, the researchers said.

It’s possible that one day researchers could use information about a patient’s gut bacteria, the metabolic pathways that those bacteria are involved in and the immune molecules present in the blood to more accurately diagnosis people with chronic fatigue syndrome and develop more specific treatments for the condition, the researchers said.

The study was published online April 26 in the journal Microbiome.


Could “safe consumption sites” help the heroin epidemic in the US?

Could “safe consumption sites” help the heroin epidemic in the US?


As heroin use continues to take an increasing toll on American lives, public health leaders are looking for novel ideas to address the epidemic. “Safe consumption sites” are medically-supervised venues where heroin users can inject heroin in clean, safe, and medically-supervised facilities, and where overdose prevention medication (naloxone) is ready for use if needed.

While not new in international settings (Vancouver utilizes this approach), to date there are no safe consumption sites in the United States. Seattle is currently considering such a program, and it has prompted much discussion and some opposition.

Those opposed to safe consumption sites typically voice concerns about these facilities increasing heroin use, with the assumption that safe places to use heroin will bring more users. Some feel that this approach validates heroin use, sending the message to users that it’s fine to keep using heroin. Other common concerns are that this approach will result in increased drug use in the vicinity of the sites, and that making heroin use easier will decrease the number of heroin users interested in seeking the care of opioid treatment programs.

A review of the literature shows little evidence supporting these concerns, and offers evidence that in Canada and Australia, safe consumption sites have not had the negative impacts cited. There also appears to be no reduction in admission to opioid treatment programs.

While in Seattle there appears to be wide-spread consensus among political and policy leaders about moving forward with these facilities, it remains to be seen whether such a consensus can trump the strongly held beliefs of citizens opposing this harm-reduction-based approach to the opioid use epidemic.

People in central Indiana have one less choice of where to get their Rxs filled

Marsh to close all pharmacies after selling their pharmacy business to CVS



INDIANAPOLIS — Marsh Supermarkets announced Friday that they will be closing all of their pharmacies after they were sold to CVS.

The sale will affect 37 Marsh pharmacies.

Marsh pharmacies will close over a three-day period beginning May 3. All prescription information and inventory will be transferred to CVS during that time, according to a spokesperson for the company. 

The news comes amid a flurry of store closures across the state because of ‘weak performances.’

MAP | Marsh store closures in Indiana in 2017

The company announced last week that they would be closing seven locations by the middle of May.

A Marsh spokesperson said current Marsh pharmacy customers will be notified by CVS when their prescriptions are transferred and by signs in the Marsh stores about where their nearest location will be.

A spokesperson for CVS released the following statement:

“CVS and Marsh will work together to ensure that pharmacy patients experience a seamless transition with no interruption of service. Each Marsh location will have signage with the location of the nearest CVS Pharmacy. However, any CVS Pharmacy location will be able to fill prescriptions for Marsh’s pharmacy patients.”  

RELATED | Marsh to close seven more locations by mid-MayMarsh to close longtime Indianapolis store at the end of January | Marsh is closing another Indianapolis store at the end of February | Marsh to close two more Indy stores by mid-April; that makes four in 2017 | Greenfield, Indy Marsh stores closing in May

Going to jail… could be a “DEATH SENTENCE” ?

Lawsuit filed in Schenectady County inmate's death

Lawsuit filed in Schenectady County inmate’s death


Schenectady County Jail medical staff failed to provide proper medication to a man with a variety of ailments, leading to his death last year, a new lawsuit contends.


Jimmy Richardson, 53, of Emmett Street, died at the jail Jan. 17, 2016, of a heart issue. The lawsuit contends he managed his health concerns outside the jail, but that the jail medical staff contributed to his death by withholding some medication and changing pain medication.

“While [Richardson] was obviously not the healthiest person, he had been successfully managing his medical conditions for several years. It was not until the defendants denied him his medication for several weeks … that [Richardson] died,” the suit reads, adding that the defendants’ actions caused his death.

Richardson’s widow, Bernita Richardson, filed the suit last week in federal court in Albany seeking unspecified damages. Attorney E. Robert Keach is representing the estate.

Named as defendants are the jail’s medical provider Correctional Medical Care, Schenectady County and individuals connected to the jail and medical provider.

 Schenectady County Attorney Christopher Gardner on Thursday said the county is reviewing the case, but reserved comments on the allegations.

Correctional Medical Care President Emre Umar issued a statement Friday saying that, while the company is “always saddened to learn about any loss of life or negative medical outcome,” it “stands by the quality of services provided.”

Umar noted that jails house “a population with the highest levels of chronic disease, mental health and substance-abuse problems,” and the company employs thousands of qualified and caring professionals.

“It has become a cottage industry for some plaintiffs’ attorneys to abuse public perception and distort and exaggerate facts under the pretense that they care about this patient population, doing so for their own personal financial gain,” Umar’s statement reads. “This complaint, like any other, will go through the litigation process to separate facts from unfounded allegations.”

According to the lawsuit, Richardson “died a preventable death.”

Richardson suffered from a series of ailments, including a cardiac disease called Brugada’s Syndrome that can cause sudden death. He took various medications to address his conditions. He also took strong opiate pain medication that can cause withdrawal symptoms if stopped, the suit reads.

 Richardson was jailed twice in the weeks leading up to his death, first for five days in December 2015, then again starting Jan. 4, 2016. 

The suit alleges he wasn’t provided with any of his medication in his first stint at the jail and that records showing he received medication from the start of his second stint are fabricated.

The suit notes that attorneys are still waiting for Richardson’s pharmacy records, but based the fabrication allegations on a medical provider’s note in conflict with his jail medical records and numerous handwritten “sick call” slips written by Richardson. He wrote in one dated Jan. 11, 2016, included in the suit “I am Hurting so Bad I need Help!!!”

Medical records did record that Richardson did not receive any pain medication beyond Tylenol until Jan. 13, 2016, the suit reads, due to an apparent problem with a prescription written by a jail doctor.

However, the prescription also changed his pain medication to morphine without consulting his personal doctor. He then received overdoses, the suit alleges.

The night before he died, the suit alleges that Richardson again sought help and was in “obvious need of medical assistance,” but a corrections officer threatened him with disciplinary action and denied him care.


“The case is obviously in the early stages and we need more information,” Keach said Thursday, “but Mr. Richardson’s death is certainly indicative of a disturbing pattern of deaths at correctional facilities where health care is overseen by Correctional Medical Care.”

Keach has brought lawsuits for other deaths at the Schenectady County Jail and elsewhere related to Correctional Medical Care’s work.

He filed a lawsuit in January over the death of 57-year-old Michael Revels, alleging Schenectady County Jail medical officials continually interrupted his medication, leading to his November 2015 death. That case remains pending.

Keach earlier won a $425,000 settlement in a 2013 Schenectady County Jail death and an undisclosed settlement in the 2014 suicide of an inmate at the jail after his suit contended he sought help for depression.

Any settlements involve no county money as part of the county’s agreement with the company, Gardner has said.

Correctional Medical Care’s contract with the county ran out in December and has been extended through June, Gardner said. The county is preparing a request for proposals to determine whether Correctional Medical Care or another company gets the next contract, Gardner said.

UTAH: Bureaucrats concerned about 9000 prescribers writing <1 opiate Rx/day

Pharmacists launch campaign educating people about the dangers of opioids

Pharmacists launch campaign educating people about the dangers of opioids


SALT LAKE CITY – Utah health leaders unveiled a new plan to help fight opioid overdoses.

Drop in at any pharmacy across the state during the month of May, and you’ll notice stickers on the bottle caps of prescription opioids.

“Every time a patient opens that bottle, they’ll see that sticker and be reminded, ‘Hey, this is kind of a dangerous medication,” said Greg Jones, Director of the Pharmacy at Harmons, and the Chair of the Utah Board of Pharmacy.

It’s part of a new campaign called, “Talk to Your Pharmacist Month.” The label serves as a cue to talk to your pharmacist about the dangers of taking opioid prescriptions.

“Our bodies can build tolerance to opioids, meaning we need to take more to get the same effect. This drug tolerance can lead to physical dependence, addiction, abuse, and even overdose,” said Dr. Angela Dunn, Deputy State Epidemiologist for the Utah Department of Health.

Twenty-four Utahns lose their lives every month to prescription opioid overdoses. The Utah Department of Health and Utah Pharmacy Association are working to prevent deaths in our state. Often times, people don’t recognize what they are.

“If you’re not sure, ask your prescriber, ask your pharmacist when you pick the prescription up, and they can help you better understand,” Jones said.

Health leaders point to their data that shows a troubling trend.

In January of 2016, there were more than 21,000 opioid prescriptions written by 9,000 prescribers. That’s a monthly average of 23 opioid prescriptions per prescriber.

“We also know that females receive more opioid prescriptions than males. Males are prescribed more high dosages,” Dunn said.

People underestimate the dangers of opioids.

“They think my doctor gave me this prescription. My pharmacist filled it. I’m gonna be just fine,” Jones said. “And they don’t understand how dangerous the medications can be by themselves, and especially taken with other medications.”

You can also pick up Naloxone over the counter. It’s a life-saving drug that can reverse the effects of an opioid overdose. Here’s information on where and how to get a naloxone kit.

“If you’re prescribed an opioid you can pick that Naloxone kit up for yourself, or if you’re concerned about one of your children or you’re a caregiver for a parent, you can pick up that prescription as well,” Jones said.

Saturday, April 29 from 10 a.m. to 2 p.m. is National Drug Take Back Day. It’s a good opportunity for you to clean out your medicine cabinets and dispose of the old prescription medications you have lying around.


“You can’t just refuse to fill a legitimate prescription issued for a legitimate purpose.”

“You can’t just refuse to fill a legitimate prescription issued for a legitimate purpose.

Even with red flags.   How many Rx’s we fill would be argued as legit if we say no ? The bop visiting if you say no! To their law of corresponding responsibility: This from Tony Park. (See 733 in BOP law book)  More good news from professor Park : our white lie? You know : gee sorry we’re out of norco ?  The bop is responding to complaint and citing and fining if pharmacies say we’re out n pt complains to bop.  Bop visits and does a back count.  “

Pharmacists are damned if they do and if they don;t, they have their licenses taken, all because management and corporations will not provide manpower and workplace issues, all due to OBRA 90 laws.

This showed up in my inbox today…it would appear that the California Board of Pharmacy is taking complaints from pts seriously when they are told that the pharmacy “does not have inventory” or lies to pts in some other manner to deny a pt from getting a legit/on time/medically necessary prescription filled.

By Federal law, all pharmacies are required to keep a perpetual physical inventory on all C-II’s. So if a audit is done on a medication to see if a pharmacy did in fact have inventory on hand when the Pharmacist claims that the pharmacy is “out of stock” and declines/refused to fill a valid/on time/medically necessary prescription… it would take only a few minutes to confirm/deny having inventory on hand at the time the pt presented a prescription.


733. Dispensing Prescription Drugs and Devices
(a) A licentiate shall not obstruct a patient in obtaining a prescription drug or
device that has been legally prescribed or ordered for that patient. A violation
of this section constitutes unprofessional conduct by the licentiate and shall subject the licentiate to disciplinary or administrative action by his or her licensing agency.
(b) Notwithstanding any other law, a licentiate shall dispense drugs and
devices, as described in subdivision (a) of Section 4024, pursuant to a lawful order or prescription unless one of the following circumstances exists:
(1) Based solely on the licentiate’s professional training and judgment,
dispensing pursuant to the order or the prescription is contrary to law, or the
licentiate determines that the prescribed drug or device would cause a harmful
drug interaction or would otherwise adversely affect the patient’s medical condition.
(2)  The prescription drug or device is not in stock. If an order, other than an
order described in Section 4019, or prescription cannot be dispensed because
the drug or device is not in stock, the licentiate shall take one of the following
(A) Immediately notify the patient and arrange for the drug or device to be
delivered to the site or directly to the patient in a timely manner.
(B) Promptly transfer the prescription to another pharmacy known to stock the
prescription drug or device that is near enough to the site from which the
prescription or order is transferred, to ensure the patient has
timely access to the drug or device.
(C) Return the prescription to the patient and refer the patient. The licentiate
shall make a reasonable effort to refer the patient to a pharmacy that stocks the
prescription drug or device that is near enough to the referring site to ensure
that the patient has timely access to the drug or device.
(3) The licentiate refuses on ethical, moral, or religious grounds to dispense a
drug or device pursuant to an order or prescription. A licentiate may decline to
dispense a prescription drug or device on this basis only if the licentiate has
previously notified his or her employer, in writing, of the drug or class of drugs
to which he or she objects, and the licentiate’s employer can, without creating
undue hardship, provide a reasonable accommodation of the licentiate’s
objection. The licentiate’s employer shall establish protocols that ensure that
the patient has timely access to the prescribed drug or device despite the licentiate’s refusal to dispense the prescription or order. For purposes of this section, “reasonable accommodation” and “undue hardship” shall have the same meaning as applied to those terms pursuant to subdivision (l) of Section 12940 of the Government Code.
(c) For the purposes of this section, “prescription drug or device” has the same  meaning as the definition in Section 4022.
(d) This section applies to emergency contraception drug therapy and self- administered hormonal contraceptives described in Section 4052.3.191
(e) This section imposes no duty on a licentiate to dispense a drug or device pursuant to a prescription or order without payment for the drug or device, including payment directly by the patient or through a third-party payer accepted by the licentiate or payment of any required copayment by the patient.
(f) The notice to consumers required by Section 4122 shall include a statement
that describes patients’ rights relative to the requirements of this section.


Why does our system allow Pharmacist to refuse to fill medically necessary Rxs without justification


These questions relate to Safeway:

1). Can a pharmacy refuse to refill a 30 day prescription (60 pills) if the refill date is on day 29? 

2). I was told by their Regional Office just now that it will depend on the pharmacist whether future refills are given?  They have spoken to my doctor twice…  I was told today it is each of their rights to accept or deny my prescription – they do not need a reason.  They asked my doctor to change my refill date… he said no.  I’m on disability. Thank you-

I get emails like this several times a week from all over the country…

FEMA and the American Red Cross recommend that people maintain a TWO WEEK SUPPLY of FOOD & WATER in the case of an emergency


“Even though it is unlikely that an emergency would cut off your
food supply for two weeks, consider maintaining a supply that will
last that long.”
I have been told by pts that some Pharmacists refuse to fill/refill controlled medications until after the pt as taken their last dose. I guess that these Pharmacists live in a “perfect world”… Cars always start, pts always feel well enough to make a trip to the pharmacy in a very small (a few hours) window. Pharmacies are NEVER OUT OF STOCK of a particular medication. The area that they live in NEVER EXPERIENCE a tornado, hurricane, ice storms, wild fires, floods or “zombie apocalypse”, and that a opiate dependent pt being thrown into cold turkey withdrawal is just a “minor inconvenience”
I have been told by Pharmacists that work for the large chains that the chains have:
The allotted technician hours for a Rx dept is mostly determined by the number of prescriptions filled, but many of the large chains have removed the number of controlled Rxs filled from this calculation… so the if a Rx dept fills 20% controls… that volume doesn’t provide tech hours for the Rx dept.. So.. if the Rx dept fills ZERO CONTROLS… technically the Rx dept has better tech staffing.  Also historically Pharmacists in the chains get annual bonuses that are based on growth of Rx volume… I have been told that the chains have taken the controlled Rxs filled out of the bonus calculation.  So, it would appear that both directly and indirectly, some/many of the chains are actually discouraging the filling of controlled Rxs.
The DEA uses a phrase in the Controlled Substance Act 1970 – corresponding responsibility- that the Pharmacist is suppose to basically give a “second opinion” on the prescriber’s diagnosis … without doing a in person physical exam of the pt and not having access to the pt’s medical records.  IMO, the pharmacy practice act does not grant Pharmacists the legal right to be involved in giving a “second opinion”.. and I have yet to see/hear about a Board of Pharmacy (BOP) formally objecting to the DEA mandating that Pharmacist do this.
Basically, corresponding responsibility – from the DEA’s perspective – means that a Pharmacist can be held liable for getting a controlled medication into the “wrong hand”.. but the DEA has no authority to make sure that medication gets into the “right hand”.  “Corresponding Responsibility” should be a TWO WAY STREET… this is where the 51 Boards of Pharmacy should come into the picture, but I have yet to see a BOP to state anything other than “we don’t have the authority to require that a Pharmacist fill a prescription”
Could that be because the majority of BOP’s are “stacked” with non-practicing corporate/chain pharmacists… employed by the same corporate entities who are discouraging their pharmacists in filling controlled medications.
So if a Pharmacist gets a controlled substance in the “wrong hand”… if they get their employer fined by the DEA… they will be probably be fired…  we have a very serious & growing Pharmacist surplus..  so getting fired.. could mean long term unemployment.  Likewise, if the Walgreen/Rite Aid merger goes thru… two chains (CVS & Walgreens) will be controlling about 35% of all community pharmacy prescription depts.
The BOP could “come down” on the Pharmacist and fine, suspend, revoke their license.
So, it would appear that no one is going to “come down” on a pharmacist for refusing to fill a controlled medication prescription…  so there seems to be potentially more adverse consequences to a pharmacist for filling a controlled substance than just electing to “JUST SAY NO “.

Pain Patients Advocacy Week April 23-30, 2017

Could your healthcare just come down to “numbers” ?

Cherokee Nation Sues CVS, Walgreens, and Others Over Opioids

Did major chain pharmacies and distributors contribute to the opioid epidemic in Oklahoma?


The Cherokee Nation has filed a lawsuit against six major pharmacy chains and PBMs for failing to prevent the spread of illegally prescribed opioids in the Cherokee Nation.

The lawsuit was filed against McKesson Corporation, Cardinal Health, Inc., AmerisourceBergen, CVS Health, Walgreens Boots Alliance, Inc., and Walmart Stores, Inc. The lawsuit is reportedly the first of its kind, according to a Cherokee Nation press release, because it is “holding retailers responsible or perpetuating the opioid crisis in the 14 counties in northeast Oklahoma that comprise the Cherokee Nation.”

The move is not entirely unprecedented, however. In March, Cabell County in West Virginia filed a lawsuit against drug wholesalers and several chain pharmacies. However, one of the attorneys working on the case, William Ohlemeyer, told Drug Topics that this lawsuit is unique because the Cherokee Nation is such a large political entity. He said that the lawsuit should be thought of in the same way as if a state were suing the companies, and added that it was the first state-wide claim against pharmacies and distributors.

Oklahoma, and Native Americans in particular, has been deeply impacted by the opioid epidemic. In the state of Oklahoma, 10.14% of the population aged 18 to 25 admitted to abusing prescription pain killers in the last year. The rate of opioid abuse among Native Americans is almost twice that of the general U.S. population. When former U.S. Surgeon General Vivek H. Murthy, M.D. visited tribal representatives in 2016, he said that the “prescription opioid epidemic that is sweeping across the U.S. has hit Indian country particularly hard.”

The petition filed by the Cherokee Nation claims that “the brunt of the epidemic could have been, and should have been, prevented by the defendant companies acting within the U.S. drug distribution industry, which are some of the largest corporations in America. These drug wholesalers and retailers have profited greatly by allowing the Cherokee Nation to become flooded with prescription opioids.”


The lawsuit alleges multiple wrongdoings on the part of the defendants. These include allegations that the defendants “regularly filled prescriptions in circumstances where red flags were present,” “have not adequately trained or supervised their employees,” that “monetary compensation programs” for filling a certain number of prescriptions created incentive to ignore “red flags,” and “consciously oversuppl[ied] the market in and around Cherokee Nation with highly-addictive prescription opioids.”

Ohlemeyer argues that “it’s a very simple, straightforward claim,” and that he expects to prove that the defendants “recklessly or knowingly oversupplied opioids.” When asked about other states such as West Virginia, where the source of many illicitly obtained opioids came not from major chains but from community pharmacies, he argued that these drugs had to have come from the distributors. He said that looking at the data based on prescription drug monitoring programs can pinpoint where drugs are being over-distributed, and that “there is no question that pharmacies get their drugs from these distributors.”

The petition states that Walgreens, CVS, and Walmart each have “one or more pharmacies ranked in the top 10 of Oklahoma pharmacies that fill prescriptions for opioids, some of which are operating within or in close proximity to the Cherokee Nation.” Pharmacies, Ohlemeyer argued, “are supposed to figure it out. They are supposed to figure out that they [opioids] are being distributed [incorrectly] before they get out.”

Ohlemeyer summed it up this way: pharmacies and distributors failed in their “duty to make sure suspicious claims aren’t filled,” and there is “no other explanation for why there is so much of this drug on the street. It’s not because legitimate prescriptions are being written.”

Though this lawsuit is the first of its kind in terms of scope, Ohlemeyer believes that similar lawsuits will follow.

Walgreens declined to comment on the litigation. CVS Health Senior Director of Corporate Communications did not mention the lawsuit specifically in a statement to Drug Topics, but did say that CVS Health has “stringent policies, procedures and tools to ensure that our pharmacists properly exercise their corresponding responsibility to determine whether a controlled substance prescription was issued for a legitimate medical purpose before filling it.”


Typically chain stores will tell customers that they do have the authority to tell a Pharmacist to fill a prescription, because the Pharmacist is granted professional discretion by the Pharmacy practice act and the chain store only has a permit to operate a prescription dept… provided that there is a licensed Pharmacists that is designated as “Pharmacist in charge” (PIC) and is legally responsible to the board of pharmacy ( BOP) for the legal operation of the Rx dept.  Technically/legally the chain/permit holder has no authority in the Rx dept.. they only have the right to hire and fire the personnel working in the Rx dept.

Where is the BOP’s “friend of the court” statement regarding the limited legal rights of the permit holder in the operation of the Rx dept.

Strangely missing is lawsuits against the PIC and/or other Pharmacists working in the Rx dept… the lawsuits against the prescribers… someone had to write all of those opiate prescriptions that were filled in those chain drug stores.

Wholesalers are being sued for selling opiates to legally licensed pharmacies… which in turn had filled prescriptions written by legally licensed prescribers… the wholesalers have no access to the pt, to the pt’s records nor any direct information about the prescriber.

If some/any of these lawsuits against those who are part of the prescription distribution system prevail… against those that have no direct involvement in pt care… could we see more “cookie cutter medical care” based on some determination as to what is “average ” from some spread sheet(s).

Unfortunately, pts are generally spread out over your typical “bell curve” and their medical treatment should also be as individualized likewise.

Below is a link to a article from the National Institute on drug abuse that claims that Native Americans are 2-3 times more likely to be alcoholics than the rest of the USA population.  Since our Surgeon General recently stated that addiction is a mental health issue and not a moral failing… one would expect that the potential for abuse/addiction to other substances would be expected ?


We can’t torture those trying to kill us… but “torture” using denial of care – IS OK ?

Sen. John McCain (R-Ariz.) speaks to reporters after a Senate policy luncheon on Capitol Hill in Washington, June 16, 2015. The Senate on Tuesday voted to outlaw the practice of torture in an amendment to the 2016 National Defense Authorization Act. (Zach Gibson/The New York Times)Torture Is Already Illegal, So Why “Ban” It?


Sen. John McCain (R-Arizona) speaks to reporters after a Senate policy luncheon on Capitol Hill in Washington, June 16, 2015. The Senate on Tuesday voted to outlaw the practice of torture in an amendment to the 2016 National Defense Authorization Act. (Photo: Zach Gibson/The New York Times)

The US Senate voted by a high margin to ban the use of torture on June 16. The bill is an amendment to the 2016 National Defense Authorization Act, an annual defense policy measure. It passed 78-21 but the entire bill currently remains in the Senate. Leading the effort was Senate Armed Services Committee Chairman John McCain (R-Arizona) who coauthored the bill with Senate Intelligence Committee Vice Chair Dianne Feinstein (D-California). The bill is a departure from the CIA’s torture program during the Bush administration. However, it is also a redundant measure: Torture is already illegal under US and international law.

Under the CIA torture program, the US government snatched over 100 people it suspected were terrorists from various countries like Afghanistan, Pakistan and Mauritania, and detained them in numerous secret prisons around the world. They were subjected to numerous acts of torture, such as waterboarding, sexual abuse, anal rape, stress positions, sleep deprivation, beatings and wall slamming. While the program was ineffective in gathering useful intelligence, it was useful (indeed, its key purpose was) for exploitation: namely, to elicit false confessions that were used to justify the Iraq war and turn some detainees into informants.

US domestic law already prohibits torture, the punishment for which is either a maximum of 20 years in prison or a fine, or both. If someone dies as a result of torture, the perpetrator gets the death penalty or a life sentence. US courts’ jurisdiction in this matter applies to any US national or if “the alleged offender is present in the United States.”

Torture also violates international law. The UN Convention Against Torture explicitly prohibits torture. It even states, “No exceptional circumstances whatsoever, whether a state of war or a threat of war, internal political instability or any other public emergency, may be invoked as a justification of torture,” and adds, “An order from a superior officer or a public authority may not be invoked as a justification of torture.” The United States signed that treaty in 1988 and ratified it in 1994, so it is bound by it.

“They’re passing a bill that affirms exactly what has always been the case. Torture was illegal then and it’s illegal now.”

Moreover, torture violates customary international law, which, according to the International Court of Justice Statute, is “a general practice accepted as law.” The prohibition against torture is established under customary international law as jus cogens (Latin for “compelling law”), also called a “peremptory norm,” which is a principle under international law that forbids any deviation. As Human Rights Watch explains, jus cogens “has the highest standing in customary law and is so fundamental as to supersede all other treaties and customary laws (except laws that are also jus cogens). Criminal acts that are jus cogens are subject to universal jurisdiction, meaning that any state can exercise its jurisdiction, regardless of where the crime took place, the nationality of the perpetrator or the nationality of the victim.”

Walter Ruiz, defense lawyer for Mustafa al-Hawsawi, a defendant in the 9/11 case and Guantánamo detainee who was held and tortured in CIA black sites, clarified the reach of the Convention Against Torture in a conversation with Truthout. He explained that the convention is “a far-reaching international document that brings everyone and all nations together to affirm that torture is, in fact, illegal. So now they’re passing a bill that affirms exactly what has always been the case? As if to say, before, it wasn’t illegal? It’s nonsense. Of course it was illegal then and it’s illegal now.”

There’s nothing wrong with the passage of the Senate bill, according to Ruiz; he calls it a “nice, positive public affirmation of the principle.” However, he says, we must remember that it does not do anything new, and that the law prohibited torture during the thick of the “war on terror,” as well.

“[The bill] doesn’t change what has always been the case,” Ruiz said. “And it has always been the case in 2000 and 2001, 2002, 2003, when these things were happened by US-sponsored actors and by US government agents, as well.”

Ruiz’s team has argued in the Guantánamo military commission hearings that torture violates international law.

Other Forms of Torture

The Guardian recently reported that the “McCain-Feinstein amendment codifies an existing ban on torture introduced by Obama shortly after he was installed in the White House in 2009.” That order “restricts all government employees, including CIA agents, to only use the techniques specified in the Army Field Manual.” Yet former Air Force intelligence officer and SERE (Survival, Evasion, Resistance and Escape) instructor Michael Kearns told Truthout, “That manual allows torturous acts like sleep deprivation.”

The permissions that Kearns refers to are included in the Army Field Manual‘s Appendix M. While there are protections against certain acts of torture, Appendix M explicitly allows others, such as separation and sleep deprivation for so-called “unlawful enemy combatants.” The manual states that physical separation “involves removing the detainee from other detainees and their environment,” while a “field expedient method” of separation using “goggles or blindfolds and earmuffs” can be used to “generate a perception of separation” if physical separation is not feasible. According to the manual, “separation” is intended to prevent detainees from communicating with each other, suppress resistance to interrogation, “prolong the shock of capture” and “foster a feeling of futility.” This is all done while ostensibly still complying with prohibitions against torture and ill treatment.

The manual makes several linguistic contortions to say that their form of separation is humane and not a form of isolation. However, both the Committee Against Torture and Just Security, a US national security law forum based at New York University School of Law, argued that the manual’s separation technique is no different than isolation or solitary confinement, which is widely regarded as a form of torture and ill treatment by human rights groups and the international community. Isolation can lead to several harmful psychological effects, such as anxiety, depression, anger, paranoia, memory loss, disorientation, hallucinations, self-mutilation and suicide.

Appendix M also states that isolation “must not preclude the detainee from getting four hours of continuous sleep every 24 hours.” However, the Committee Against Torture notes that four hours of sleep is not enough, especially over the course of long periods of time. It says, “Such provision applicable over an initial period of 30 days, which is renewable, amounts to authorizing sleep deprivation – a form of ill-treatment.”

Indefinite detention – detaining people for a prolonged period of time without charge or trial – is a form of torture.

Solitary confinement also occurs in US domestic prisons. Of the over 2.4 million people in prison throughout the United States, around 80,000 are held in solitary confinement. They are confined in solitary cells for 22 to 24 hours a day. Many people held in solitary confinement are mentally ill and the isolation makes their illness worse. In March 2014, Michael Anthony Kerr, a 54-year-old Black man and mentally ill prisoner who was held in solitary confinement at a North Carolina prison for 35 days, died in a prison van. Kerr had schizoaffective disorder, a mental illness that has symptoms of schizophrenia and bipolar disorder, and was not treated in prison. A September 2014 autopsy revealed that Kerr died of thirst, but did not determine how he became dehydrated. Other forms of abuse and torture by guards occur regularly in US prisons, including sexual abuse and rape, coercion, beatings, choking, wall slamming and stunning with electronic devices.

Ruiz also pointed out that indefinite detention – detaining people for a prolonged period of time without charge or trial – is a form of torture. In an interview with HuffPost Live, Kristine Huskey, a Guantánamo defense lawyer who worked on the Omar Khadr case, noted that a report by Physicians for Human Rights “looked at the consequences of indefinite detention on individuals. And there’s an actual physical harm, and in many cases its severe: hypertension, chronic and acute stress … problems to the nervous system … PTSD.” She added that there are instances where “indefinite detention can rise to the level of torture.” Moreover, indefinite detention also violates human rights and international law. Article 9(1) of the International Covenant on Civil and Political Rights – which the US is also a party to – states: “Everyone has the right to liberty and security of person. No one shall be subjected to arbitrary arrest or detention. No one shall be deprived of his liberty except on such grounds and in accordance with such procedure as are established by law.”

However, in May 2009, just months after entering office, President Obama acknowledged that some Guantánamo prisoners would continue to be detained indefinitely without charge or trial. That policy has not changed. Currently, there are 116 prisoners remaining in Guantánamo. Of those, 51 are cleared for release and over three dozen are recommended for indefinite detention by the Obama administration.

Despite the Senate’s passage of the torture ban, it is important to remember that torture is already illegal under US and international law. It is also crucial to scrutinize what is defined as torture, considering that certain forms of torture remain in active practice, including solitary confinement, sleep deprivation and indefinite detention.

As Ruiz pointed out, the Senate’s torture ban “doesn’t change anything … It’s stating the obvious.”


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