TODAY IS….. WHO WILL NOT BE HERE TOMORROW

Today is 12/16/2017

2016 in review … what killed us

2600 Americans will die EVERY DAY – from various reasons

2700 people  WILL ATTEMPT SUICIDE

140 will be SUCCESSFUL – including 20 veterans

270 will die from hospital acquired antibiotic resistant “bug” because staff won’t properly wash hands and/or proper infection control.

350 will die from their use/abuse of the drug ALCOHOL

1200 will die from their use/abuse of the drug NICOTINE

1400 will contract C-DIF from Hospital or Nursing home because staff doesn’t properly wash their hands are adhere to infection control       80 WILL DIE mostly elderly.

850 will die from OBESITY

700 will die from medical errors

150 will die from Flu/Pneumonia

80 will die from Homicide

80 will die in car accidents

70 From ALL DRUG ABUSE


I am being completely weaned off my meds, & suspect I will kill myself with the amount of pain I am in, & will be by the time this is over (the wean that is). Already can’t function.


My husband committed suicide after being abandoned by his pain dr.


Please pray for me as I am on the brink of suicide! I don’t want to die but can’t handle the pain anymore! The doctor that I am currently seeing will not give me enough pills to last all month every month… I have to wait until Oct to get in with a pain management doctor whom I already know by others that I know sees this doctor that he will help me, need prayer to hold on until oct… I keep thinking of my family who needs me hear.


“We just lost another intractable member of our support group two nights ago. She committed suicide because her medications were taken away for interstitial cystitis (a horribly painful bladder condition) and pudendal neuralgia, both of which she had battled for years


D D., journalist and prescribed fentanyl patient for a dozen years joined me on air last weekend with her husband and spoke of her suicide plan should the only relief from constant agony be heavily reduced or taken away.


I was told last Friday that my Dr. will be tapering my meds again . When I told him I didn’t think my body could take another lowering he stated ” it wasn’t my
License on the line”, I stated ” no , but it’s my life on the line”!!!!! I can not continue to live this way . I can not continue to suffer in agony when my medications and dose where working just fine before and I was a productive member of society . I can no longer take this. I have a plan in place to end my life myself When I am forced to reduce my Medications again . I just can’t do it anymore .


On Friday at around 9 p.m. U.S. Navy veteran Kevin Keller parked his red pickup truck in the parking lot at the Wytheville Rite-Aid, walked across the grass and stood in front of the U.S. Veterans Community Based Outpatient Clinic next door.

Sick and tired of being in pain, he pulled out a gun, shot a hole in the office door, aimed the gun barrel at his head and ended his hurt once and for all.


As a longterm pain patient with a current unsupportive pain dr, I just thought I’d share the reality of the position I’m in right now…

I’m in very bad pain all the time for very legit and well documented reasons. My pain dr however never gives me enough meds to help me. He just keeps reducing them, which is causing me to be in even more pain and suffer so much more. My quality of life also continues to go downhill at the same time. I was just given a letter by him recently too about some study indicating an increase in deaths if you take opioids and benzos. It stated he’s no longer going to give pain meds to anyone who is taking a benzo. I take one, because I have to, for a seizure disorder, not because I want to. He told me to pick one or the other though, plus went ahead and reduced my pain meds some more. He doesn’t seem to care the least bit. I’ve looked hard and so far I can’t find another one to get in to see near me at this time, but I’m desperately still trying. Unfortunately, they’re few and far between here, in addition to the wait for an appointment being long. I’ve even called hospice for help. So far, they haven’t been of much help either, because I don’t have a dr who will say I have six months or less to live. I told them either choice my pain dr is giving me is very inhumane, so I’d rather just quit eating and drinking, to the point where I pass away from that, while I get some kind of comfort care from them. I don’t really want to though, although I do have a long list of some very bad health problems, including a high probability that I have cancer and it’s spread. Am I suicidal? No. Will I be if my pain and seizure meds are taken away. Highly likely. I never ever saw this coming either. I don’t have a clue what to do and the clock is ticking, but I’m still fighting for an answer. So far, I can’t find not even one dr to help me though. Not one. I know my life depends on it, but at what point will these drs let my suffering become so inhumane that I just can’t take it anymore. I just don’t know right now. It’s a very scary place to be in for sure. That I do know.


The patient was being denied the medicine that had been alleviating his pain and committed suicide because, “he couldn’t live with the pain anymore. He could not see a future. He had no hope. He had no life.”


I am a chronic pain patient who has been on fairly high doses of opiates for about nine years now. My dose has been forcibly reduced since the cdc guidelines. I moved to Oregon from Alaska and can’t find a doctor to prescribe my medication. I pray I have the strength not to take my own life!


Zach Williams of Minnesota  committed suicide at age 35. He was a veteran of Iraq and had experienced back pain and a brain injury from his time in service. He had treated his pain with narcotics until the VA began reducing prescriptions.


Ryan Trunzo committed suicide at the age of 26. He was an army veteran of Iraq. He had experienced fractures in his back for which he tried to get effective painkillers, but failed due to VA policy. His mother stated “I feel like the VA took my son’s life.”


Kevin Keller, a Navy veteran, committed suicide at age 52. He shot himself after breaking into the house of his friend, Marty Austin, to take his gun. Austin found a letter left by Keller saying “Marty sorry I broke into your house and took your gun to end the pain!” Keller had experienced a stroke 11 years earlier, and he had worsening pain in the last two years of his life because VA doctors would not give him pain medicine. On the subject of pain medication, Austin said that Keller “was not addicted. He needed it.”


Bob Mason, aged 67, of Montana committed suicide after not having access to drugs to treat his chronic pain for just one week. One doctor who had treated Mason was Mark Ibsen, who shut down his office after the Montana Board of Medical Examiners investigated him for excessive prescription of opioids. According to Mason’s daughter, Mason “didn’t like the drugs, but there were no other options.”


Donald Alan Beyer, living in Idaho, had experienced back pain for years. He suffered from  degenerative disc disease, as well as a job-related injury resulting in a broken back. After his doctor retired, Beyer struggled without pain medicine for months. He shot himself on his 47th birthday. His son, Garrett, said “I guess he felt suicide was his only chance for relief.”


Denny Peck of Washington state was 58 when he ended his life. In 1990, he experienced a severe injury to his vertebrae during a fishing accident. His mother, Lorraine Peck, said “[h]e has been in severe pain ever since,” and his daughter, Amanda Peck, “said she didn’t remember a time when her dad didn’t hurt.” During the last few years of his life, Peck had received opiates for his pain from a Seattle Pain Center, until these clinics closed. After suffering and being unable to find doctors who would help with his pain, Peck called 911. Two days later, Peck was found dead in his home with bullet wounds in his head. A note found near Peck read: “Can’t sleep, can’t eat, can’t do anything. And all the whitecoats don’t care at all.”


Doug Hale of Vermont killed himself at the age of 53. He had experienced pain from interstitial cystitis, and decided to end his life six weeks after his doctor suddenly cut off his opiate painkillers. He left a note reading “Can’t take the chronic pain anymore” before he shot himself in the head. His doctor said he “was no longer willing to risk my license by writing you another script for opioids”  (see attachment A for details of the problem as relyed by his wife Tammi who is now 10 months without a husband as a direct result of the CDC guidelines to prevent deaths)Bruce Graham committed suicide after living with severe pain for two years. At age 62, Graham fell from a ladder, suffering several severe injuries. He had surgery and fell into a coma. After surgery, he suffered from painful adhesions which could not be removed. He relied on opioid painkillers to tolerate his pain, but doctors eventually stopped prescribing the medicine he needed. Two years after his fall, Graham shot himself in the heart to end the pain.


Travis Patterson, a young combat veteran, died two days after a suicide attempt at the age of 26. After the attempt to take his own life, Patterson was brought to the VA emergency room. Doctors offered therapy as a solution, but did not offer any relief for his pain. Patterson died two days after his attempted suicide.


54-year-old Bryan Spece of Montana  killed himself about two weeks after he experienced a major reduction in his pain medication. The CDC recommends a slow reduction in pain medicine, such as a 10% decrease per week. Based on information from Spece’s relative, Spece’s dose could have been reduced by around 70% in the weeks before he died.


In Oregon, Sonja Mae Jonsson ended her life when her doctor stopped giving her pain medicine as a result of the CDC guidelines.


United States veterans have been committing suicide after being unable to receive medicine for pain. These veterans include Peter Kaisen,Daniel Somers, Kevin Keller, Ryan Trunzo, Zach Williams, and Travis Patterson


A 40-year-old woman with fibromyalgia, lupus, and back issues appeared to have committed suicide after not being prescribed enough pain medicine. She had talked about her suicidal thoughts with her friends several times before, saying “there is no quality of life in pain.” She had no husband or children to care for, so she ended her life.


Sherri Little was 53 when she committed suicide. She suffered pain from occipital neuralgia, IBS, and fibromyalgia. A friend described Little as having a “shining soul of activism” as she spent time advocating for other chronic pain sufferers. However, Little had other struggles in her life, such as her feeling that her pain kept her from forming meaningful relationships. In her final days, Little was unable to keep down solid food, and she tried to get medical help from a hospital. When she was unable to receive relief, Little ended her life.


Former NASCAR driver Dick Trickle of North Carolina shot himself at age 71. He suffered from long-term pain under his left breast. Although he went through several medical tests to determine the cause of his pain, the results could not provide relief. After Trickle’s suicide, his brother stated that Dick “must have just decided the pain was too high, because he would have never done it for any other reason.”


39-year-old Julia Kelly committed suicide after suffering ongoing pain resulting from two car accidents. Kelly’s pain caused her to quit her job and move in with her parents, unable to start a family of her own. Her family is certain that the physical and emotional effects of her pain are what drove her to end her life. Kelly had founded a charity to help other chronic pain sufferers, an organization now run by her father in order to help others avoid Julia’s fate.


Sarah Kershaw ended her life at age 49. She was a New York Times Reporter who suffered from occipital neuralgia.


Lynn Gates Jackson, speaking for her friend E.C. who committed suicide after her long term opiates were suddenly reduced by 50% against her will, for no reason.  Lynn reports she felt like the doctors were not treating her like a human being (Ed:  a common complaint) and she made the conscious decision to end her life.


E.C. committed suicide quietly one day in Visalia California.  She was 40.  Her friend reported her death.  “She did not leave a note but I know what she did”.  The doctor would only write a prescription for 10 vicodin and she was in so much pain she could not get to the clinic every few days.   We had talked many times about quitting life. Then she left.  She just left.


Jessica, a patient with RSD/CRPS committed suicide when the pain from her disease became too much for her to bear. A friend asserted that Jessica’s death was not the result of an overdose, and that “living with RSD isn’t living.”


https://mobile.nytimes.com/2016/02/27/business/media/sarah-kershaw-former-times-reporter-dies-at-49.html?referer=https://t.co/qcSF8qOBp6?amp=1


http://www.news-press.com/story/news/crime/2014/09/08/death-investigation-at-groves-rv-park-in-fort-myers/15280035/


http://www.kpaddock.org/


https://m.facebook.com/FibroPrince/posts/948610075216801


http://www.pharmaciststeve.com/?p=14073


http://www.pharmaciststeve.com/?p=14574


http://www.pharmaciststeve.com/?p=15023


http://linkis.com/painnewsnetwork.org/7IoUl


http://linkis.com/whotv.com/2016/11/10/ibRof


https://articles.al.com/news/index.ssf/2016/12/alabama_pain_centers_troubles.amp


https://www.painnewsnetwork.org/stories/2016/12/22/chronic-pain-patient-abandoned-by-doctor-dies#.WFwJ5-Lk6Xg.twitter


http://linkis.com/painnewsnetwork.org/oKRZ5


http://linkis.com/www.seattletimes.com/tgyL7


https://edsinfo.wordpress.com/2017/04/20/%ef%bb%bfpain-and-suicide-the-other-side-of-the-opioid-story/amp/


http://www.bendbulletin.com/topics/5342867-151/opioid-crisis-pain-patients-pushed-to-the-brink


https://www.painnewsnetwork.org/stories/2017/5/26/patient-suicide-blamed-on-montana-pain-clinic


https://www.painnewsnetwork.org/stories/2016/5/27/are-cdcs-opioid-guidelines-causing-more-suicides?rq=suicide


http://www.pressofatlanticcity.com/news/breaking/man-who-set-himself-on-fire-at-northfield-veterans-clinic/article_b7a4a712-f04e-11e5-a39b-3f42b9138511.amp.html


Aliff, Charles


Beyer, Donald Alan


Brunner, Robert “Bruin”


Graham, Bruce


Hale, Doug


Hartsgrove, Daniel P


Ingram III, Charles Richard


Kaisen, Peter


Keller, Kevin


Kershaw, Sarah


Kimberly, Allison


Little, Sherri


Mason, Bob


Miles, Richard


Murphy, Thomas


Paddock, Karon


Patterson, Travis “Patt”


Peck, Denny


Peterson, Michael Jay


Reid, Marsha


Somers, Daniel


Son, Randall Lee


Spece, Brian


Tombs, John


Trickle, Richard “Dick”


Trunzo, Ryan


Williams, Zack


Karen Shettler Paddock  committed suicide on August 7, 2013  http://www.kpaddock.org/


https://www.facebook.com/photo.php?fbid=1616190951785852&set=a.395920107146282.94047.100001848876646&type=3&theater 

Jessica Simpson took her life July 2017


Mercedes McGuire took her life on Friday, August 4th. She leaves behind her 4 yr old son. She could no longer endure the physical & emotional pain from Trigeminal Neuralgia.


www.disabledveterans.org/2017/08/16/veteran-commits-suicide-front-amarillo-va-emergency-department/

Another Veteran Suicide In Front Of VA Emergency Department


 Depression and Pain makes me want to kill self. Too much physical and emotional pain to continue on. I seek the bliss fullness of Death. Peace. Live together die alone.


 Dr. Mansureh Irvani  suspected overdose victim  http://www.foxnews.com/health/2017/08/18/suspended-oral-surgeon-dies-suspected-overdose.html


Katherine Goddard’s Suicide note: Due to the pain we are both in and can’t get help, this is the only way we can see getting out of it. Goodbye to everybody,”   https://www.cbsnews.com/news/florida-man-arrested-after-girlfriend-dies-during-alleged-suicide-pact/  


Steven Lichtenberg: the 32-year-old Dublin man shot himself   http://www.dispatch.com/news/20160904/chronic-pains-emotional-toll-can-lead-to-suicide  


Fred Sinclair  he was hurting very much and was, in effect, saying goodbye to the family.  http://www.pharmaciststeve.com/?p=21743


Robert Markel, 56 – June 2016 – Denied Pain Meds/Heroin OD  http://www.pennlive.com/opioid-crisis/2017/08/heroin_overdose_deaths.html


 Lisa June 2016  https://youtu.be/rBlrSyi_-rQ


Jay Lawrence  March 2017  https://www.painnewsnetwork.org/stories/2017/9/4/how-chronic-pain-killed-my-husband


Celisa Henning: killed herself and her twin daughters...http://www.nbcchicago.com/news/local/Mom-in-Apparent-Joliet-Murder-Suicide-said-Body-Felt-Like-It-was-On-Fire-Grandma-Says-442353713.html?fb_action_ids=10213560297382698&fb_action_types=og.comments

Karen Boje-58  CPP-Deming, NM


Katherine Goddard, 52 –  June 30, 2017 – Palm Coast, FL -Suicide/Denied Opioids  http://www.news-journalonline.com/news/20170816/palm-coast-man-charged-with-assisting-self-murder


https://medium.com/@ThomasKlineMD/suicides-associated-with-non-consented-opioid-pain-medication-reductions-356b4ef7e02aPartial List of Suicides, as of 9–10-17


Suicides: Associated with non-consented Opioid Pain Medication Reductions


Lacy Stewart 59, http://healthylivings247.com/daughter-says-untreated-pain-led-to-mothers-suicide/#


Ryan Trunzo of Massachusetts committed suicide at the age of 26  http://www.startribune.com/obituaries/detail/18881/?fullname=trunzo,-ryan-j  


Mercedes McGuire of Indiana ended her life August 4th, 2017 after struggling with agony originally suppressed with opioid pain medicine but reappearing after her pain medicine was cut back in a fashion after the CDC regulations. She was in such discomfort she went to the ER because she could not stand the intractable pain by “learning to live with it” as suggested by CDC consultants. The ER gave her a small prescription. She went to the pharmacy where they refused to fill it “because she had a pain contract”. She went home and killed herself. She was a young mother with a 4 year old son, Bentley. Bentley, will never get over the loss of his mom.


Suicides: Associated with non-consented Opioid Pain Medication Reductions


“Goodbye” Scott Smith: Vet w/PTSD committed murder/suicide. Killed his wife then himself today 11/27/2017


http://www.sfchronicle.com/news/crime/article/Ex-California-lawmaker-charged-with-aiding-wife-12405065.php

Pamela Clute had been suffering from agonizing back problems and medical treatment had failed to relieve pain that shot down her legs While California’s assisted suicide law went into effect a couple months before Clute’s death, the law only applies to terminally ill patients who are prescribed life-ending drugs by a physician. Clute wasn’t terminally ill


Kellie Bernsen 12/10/2017 Colorado suicide


Scott Smith: Vet w/PTSD committed murder/suicide. Killed his wife then himself today 11/27/2017


  Michelle Bloem committed suicide due to uncontrolled pain


The DEA hasn’t updated their Guidance on Controlled Substances since 2006. Important information for everyone to know

The DEA hasn’t updated their Guidance on Controlled Substances since 2006. Important information for everyone to know

www.familiesforiprelief.com/advocacy/issues-and-opportunities/

DEA GUIDANCE AND DEMANDS FOR PHYSICIANS WHO PRESCRIBE CONTROLLED SUBSTANCES

THE PRACTITIONER’S MANUAL OF 2006*

CORE INSTRUCTION

Stated in 2 sentences on page 19: “A prescription for a controlled substance must be issued for a legitimate medical purpose by a practitioner acting in the usual course of professional practice.  The practitioner is responsible for the proper prescribing and dispensing of controlled substances.

“ACCEPTABLE MEDICAL PRACTICE”

Stated on page 30:  “The legal standard that a controlled substance may only be prescribed, administered, or dispensed for a legitimate medical purpose by a physician acting in the usual course of professional practice has been construed to mean that the prescription must be “in accordance with a standard of medical practice generally recognized and accepted in the United States”.

Federal courts have long recognized that it is not possible to expand on the phrase “legitimate medical purpose in the usual course of professional practice” in a way that will provide definitive guidelines to address all the varied situations physicians may encounter.

While there are no criteria to address every conceivable instance of prescribing, there are recurring patterns that may be indicative of inappropriate prescribing:

An inordinately large quantity of controlled substances prescribed or large numbers of prescriptions issued compared to other physicians in an area; No physical examination was given;  Warnings to the patient to fill prescriptions at different drug stores;  Issuing prescriptions knowing that the patient was delivering the drugs to others;  Issuing prescriptions n exchange for sexual favors or for money;  Prescribing of controlled drugs at intervals inconsistent with legitimate medical treatment; The use of street slang rather than medical terminology for the drugs prescribed; or,  No logical relationship between the drugs prescribed and treatment of the condition allegedly existing.

Each case must be evaluated based on its own merits in view of the totality of circumstances particular to the physician and patient.

For example, what constitutes “an inordinately large quantity of a powerful Schedule II opioid might be blatantly excessive for the treatment of a particular patient’s mild temporary pain, yet insufficient to treat the severe unremitting pain of a cancer patient.

*This is the only written guidance from DEA published in the last 11 years.

Is prescribing medication for pain, at non-standard levels, or off label, a violation or not?


California Pain Patients Bill of Rights:   PART 4.5. PAIN PATIENT’S BILL OF RIGHTS [124960 – 124961]

( Part 4.5 added by Stats. 1997, Ch. 839, Sec. 1. ) 124960.

The Legislature finds and declares all of the following:

(a) The state has a right and duty to control the illegal use of opiate drugs.

(b) Inadequate treatment of acute and chronic pain originating from cancer or noncancerous conditions is a significant health problem.

(c) For some patients, pain management is the single most important treatment a physician can provide.

(d) A patient suffering from severe chronic intractable pain should have access to proper treatment of his or her pain.

(e) Due to the complexity of their problems, many patients suffering from severe chronic intractable pain may require referral to a physician with expertise in the treatment of severe chronic intractable pain. In some cases, severe chronic intractable pain is best treated by a team of clinicians in order to address the associated physical, psychological, social, and vocational issues.

(f) In the hands of knowledgeable, ethical, and experienced pain management practitioners, opiates administered for severe acute pain and severe chronic intractable pain can be safe.

(g) Opiates can be an accepted treatment for patients in severe chronic intractable pain who have not obtained relief from any other means of treatment.

(h) A patient suffering from severe chronic intractable pain has the option to request or reject the use of any or all modalities to relieve his or her pain.

(i) A physician treating a patient who suffers from severe chronic intractable pain may prescribe a dosage deemed medically necessary to relieve pain as long as the prescribing is in conformance with Section 2241.5 of the Business and Professions Code.

(j) A patient who suffers from severe chronic intractable pain has the option to choose opiate medication for the treatment of the severe chronic intractable pain as long as the prescribing is in conformance with Section 2241.5 of the Business and Professions Code.

(k) The patient’s physician may refuse to prescribe opiate medication for a patient who requests the treatment for severe chronic intractable pain. However, that physician shall inform the patient that there are physicians who treat severe chronic intractable pain with methods that include the use of opiates.

(Amended by Stats. 2011, Ch. 396, Sec. 2. (AB 507) Effective January 1, 2012.) 124961.

Nothing in this section shall be construed to alter any of the provisions set forth in Section 2241.5 of the Business and Professions Code. This section shall be known as the Pain Patient’s Bill of Rights.

(a) A patient who suffers from severe chronic intractable pain has the option to request or reject the use of any or all modalities in order to relieve his or her pain.

(b) A patient who suffers from severe chronic intractable pain has the option to choose opiate medications to relieve that pain without first having to submit to an invasive medical procedure, which is defined as surgery, destruction of a nerve or other body tissue by manipulation, or the implantation of a drug delivery system or device, as long as the prescribing physician acts in conformance with the California Intractable Pain Treatment Act, Section 2241.5 of the Business and Professions Code.

(c) The patient’s physician may refuse to prescribe opiate medication for the patient who requests a treatment for severe chronic intractable pain. However, that physician shall inform the patient that there are physicians who treat pain and whose methods include the use of opiates.

(d) A physician who uses opiate therapy to relieve severe chronic intractable pain may prescribe a dosage deemed medically necessary to relieve the patient’s pain, as long as that prescribing is in conformance with Section 2241.5 of the Business and Professions Code.

(e) A patient may voluntarily request that his or her physician provide an identifying notice of the prescription for purposes of emergency treatment or law enforcement identification.

(f) Nothing in this section shall do either of the following:

(1) Limit any reporting or disciplinary provisions applicable to licensed physicians and surgeons who violate prescribing practices or other provisions set forth in the Medical Practice Act, Chapter 5 (commencing with Section 2000) of Division 2 of the Business and Professions Code, or the regulations adopted thereunder.

(2) Limit the applicability of any federal statute or federal regulation or any of the other statutes or regulations of this state that regulate dangerous drugs or controlled substances.

(Amended by Stats. 2011, Ch. 396, Sec. 3. (AB 507) Effective January 1, 2012.)


 Update on the Opioid Crisis:

During the past year, deaths have continued to rise from illicit drug use, even as prescriptions for opioid medications have declined.
There are two very separate problems going on that involve the same substances
The use of medically prescribed opioids to treat painful conditions
The misuse and abuse of illegally obtained opioids often resulting in death
In March 2017, Debra Houry, MD, Director of the CDC’s National Center for Injury Prevention and Control, stated that heroin and illicit fentanyl were primarily to blame for the soaring rate of drug overdoses. “Although prescription opioids were driving the increase in overdose deaths for many years, more recently, the large increase in overdose deaths has been due mainly to increases in heroin and synthetic opioid overdose deaths, not prescription opioids. Importantly, the available data indicate these increases are largely due to illicitly manufactured fentanyl,” Houry said in her prepared testimony before the House Energy and Commerce Committee’s Oversight and Investigations Subcommittee. The CDC blamed over 33,000 deaths on opioids in 2015, less than half of which were linked to pain medication.
Latest information is that the majority of deaths are now due to heroin and illicit fentanyl being shipped into the U.S. from Mexico and China, often purchased via the “dark web” on the internet
The conflating of the two very separate issues – the use of prescribed opioids to treat painful conditions and the abuse of illicit drugs – is causing unintended consequences on chronic pain patients. Both chronic pain and addiction are very serious medical problems that deserve compassionate care.
Concerns:
Media and political attention to the opioid abuse and overdose problem have failed to acknowledge the existence of severe intractable pain patients
 The CDC Guideline for Prescribing Opioids for Chronic Pain issued in March 2016 were intended to be voluntary guidelines applicable to primary care physicians
Misinterpreted as imposing mandatory dose ceilings
Incorporated by Congress into Veterans Affairs spending bill in Dec 2015 before finalized by CDC
Some state legislatures and medical boards have followed with laws and regulations imposing mandatory limits on doses and quantities
CMS planned to impose “hard edits” at 200 MED doses to stop fill of prescriptions at pharmacies in April 2017; backed off based on comments
In May 2017 FDA announced public meeting to discuss plans for prescriber training to be modeled on CDC guidelines; no acknowledgement of severe chronic pain patients or requirement to train prescribers to meet their needs
President’s Commission on Combating Drug Addiction and Opioid Crisis working now:
Stacked with anti-opioid activists and addiction experts
No voice for hands-on pain care clinicians who treat patients
No voice for chronic pain patients or advocates
No assessment of unintended consequences of CDC Guideline or other legislative and regulatory actions
Myths and misinformation about prescription opioids abound
Unintended consequences of actions to combat drug addiction and overdose are having a tremendous impact on chronic pain patients:
 Sudden extreme reductions in dose with no warning
Patients abandoned by doctors as healthcare systems impose restrictions
Doctors leaving pain care practice due to fear of prosecution
Pharmacies refusing to fill scripts
Insurance companies denying payment
Suicides of chronic pain patients increasing
Under-treated pain causes serious physiological impacts including death
Increased cardiac work, increased metabolic rate, reduced oxygen levels, impaired wound healing, impaired immune function, severe insomnia, hypertension, hormone abnormalities
Can bring about death due to cardiac arrest, stroke, or adrenal failure
In the June 2002 issue of Hospital Physician, B. Eliot Cole spoke to the significance of untreated pain. “The axiom ‘No one ever died from pain’ is clearly incorrect…”
Well-funded anti-opioid lobby continues to carry out a tremendous, multi-faceted campaign to limit the availability of opioid medications:
Influencing Federal agencies, state agencies, Congress, state legislatures
Some have expressed the desire and intent to see opioid medications abolished in the United States
Our issue today: Find a compromise solution that provides for acknowledgement of severe intractable pain patients and access to the care they require
 Proposed Solution:
Families for Intractable Pain Relief (FIPR) will ramp up our educational campaign to combat the myths and misinformation about properly prescribed opioid medications.
We recommend establishment through legislation of a Federal program similar to the buprenorphine addiction treatment program that would allow interested qualified physicians to take special training and be certified to prescribe high doses of opioids for severe intractable pain patients for whom all other treatments have failed, or special exemptions be made for their unique and complex medical care that often involves non-standard medication regimens
Consider special identification for these patients
We must have a say in all policies going forward that affect pain care, and treatment of pain patients at the federal, state and local level. A patient or patient advocate needs to provide expert information about the needs of Intractable Pain patients. A special certification program, or special exemptions could serve their complex medical needs to the satisfaction of all concerned regulators, medical boards and federal state and local jurisdictions.
Take our concerns and proposals forward to the Senate HELP Committee and other relevant legislative Committees to introduce legislation to address the pain care needs of citizens whose lives are at risk due to unforeseen consequences of the war on opioid drugs.
We must have a say in all policies going forward that affect pain care, and treatment of pain patients at the federal, state and local level. No more about us without us. A patient or patient advocate needs to provide expert information about the needs of Intractable Pain patients at every policy meeting going forward.  A special certification program,  “exemptions” or “carve outs” could serve Intractable Pain patients and their doctors going forward. This would address their complex medical needs to the satisfaction of the patients and all concerned regulators, medical boards and federal state and local jurisdictions.
Families for Intractable Pain Relief 2017

We advocate for: Access to health care that includes: Non-standard and opioid medications, when indicated, to treat patients with rare diseases and injuries causing Intractable Pain. We need qualified doctors who are willing to treat these complex patients, who suffer with Intractable Pain- in every state.

 

 

The other side of the opioid debate: What to do about the pain?

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Minnesota effort to reduce overdose deaths is putting doctors, patients in a bind.

http://www.startribune.com/the-other-side-of-the-opioid-debate/463071143/#

Jerry Larson waits for his granddaughter Mia, 9, to come home from school as he rests on the couch with a chihuahua he calls Taco. He wished he could go out to a nearby playground, but the back pain makes it too difficult with the reduced opioid

Jerry Larson loved being an active babysitter for his 9-year-old granddaughter — chasing her outdoors after school and exploring the Science Museum on weekends.

All that changed after doctors reduced his monthly dosage of prescription opioids.

“Now all I do is sit on the chair,” said Larson, 67, who suffers from severe back pain.

Amid a national movement to reduce opioid usage, the Burnsville man just wants his painkillers back.

Larson and others with severe, chronic pain are counterpoints to a state and nationwide effort to reduce opioid prescribing. First they followed doctors’ orders and became dependent on the drugs. Now they fear losing them.

The campaign to limit prescriptions has emerged in response to an epidemic of opioid addictions and overdoses. Opioid-related deaths in Minnesota rose from 54 in 2000 to 402 last year, according to a Star Tribune review of state death records, even though the rate of opioid prescribing in the state has been relatively low.

 

This month, the Minnesota Department of Human Services rolled out stringent opioid prescribing guidelines, including a plan to track doctors and warn or sanction those who are too liberal with prescriptions. The U.S. ­Centers for Disease Control and Prevention and the Bloomington-based Institute for Clinical Systems Improvement (ICSI) have also issued guidelines that limit initial prescriptions for acute injury pain and urge alternatives to opioids for the treatment of chronic pain.

While none of the guidelines outlaw opioids for chronic pain, they might have spooked some doctors into cutting prescriptions and persuaded health insurers to impose limits that can create havoc for patients already on high doses of the drugs.

“Pendulums swing both directions,” said Dr. David Thorson, president of the Minnesota Medical Association and a leader in the development of the ICSI guidelines. “Sometimes when they are swinging, they go too far.”

Thorson admits that, like many doctors, he got swept up two decades ago by the movement to consider pain as a fifth vital sign. Marketing campaigns sought to convince the nation’s doctors that opioids were the best choice for treating it. He has since apologized to his patients who became dependent on opioids.

“I have actually said to patients, ‘You know, I was treating you the best way I knew. Now, we know better,’ ” Thorson said.

 

Fentanyl patch

Because of his disability, Larson is a stay-at-home grandfather who looks after his granddaughter before and after school and maintains the family condominium for his daughter, who works in retail.

He believes he’s a victim of an overreaction against opioids. He started taking them years ago due to back problems that caused compression in his spine and nerve pain.

He had a Fentanyl patch that emitted 50 micrograms per hour of pain relief, but that left him foggy, so he switched to 25 micrograms. Then his doctor cut that to 12.5. His monthly supply of Percocet also has been cut, from 120 pills to 90 — or three per day.

Larson said he needs two pills to get to sleep. If he wakes in the middle of the night, he often needs a third — leaving him with none to take for the next day if he wants his supply to last the month.

 

“Everything was fine and dandy,” he said. “Now I’m in constant pain.”

Joan Skeie, a retired schoolteacher in Coon Rapids, said she’s fighting to keep her opioid prescriptions for severe arthritis and spinal deformities. Once allowed 240 pills per month, Skeie said a new insurance restriction left her with 60 to get through the first half of November. Only after her doctor appealed did the 83-year-old get her usual supply for the second half of the month.

“I barely get along on this,” said Skeie, who takes a pill in the late afternoon just so she can tolerate standing to make dinner. “I need this.”

Research has never proved that opioids effectively treat chronic pain, said Dr. Chris Johnson, an Allina physician who led the work group that created the state guidelines. Drugs have been misused for this purpose, he said, and now patients are caught in a spiral because they grow tolerant to opioids and need higher and more dangerous doses to achieve the same level of relief.

Even so, he said, “You can’t just take opioids away from these patients. If it’s been that long, they are now dependent.”

 

Anxious doctors

Doctors could find themselves in a bind, between cutting unnecessary prescriptions and serving dependent patients. Many are choosing instead to simply stop seeing chronic pain patients because they don’t want to risk getting accused of overusing opioids, said Dr. Alfred Anderson, a Brooklyn Park pain specialist.

Anderson wants to retire, but keeps getting referrals from doctors who no longer want to treat opioid-dependent patients, he said.

“I am so scared at this time for these people that I have virtually obligated myself to help them,” he said.

Anderson said he understands the need for caution on opioid prescribing, because addicts have tried to dupe him into writing prescriptions. As a former member of the state board of medical practice, he also has seen doctors overprescribing pain pills or suffering addictions of their own.

 

But he estimated that one in 10 chronic pain patients won’t find relief in alternatives such as physical therapy or even medical marijuana.

“They have failed with everything else and they have done very well” on opioids, Anderson said. “I’ve got a patient [on opioids] who built a deck and dug out two footings after having back surgery.”

It’s unclear whether opioid-dependent patients could wean themselves now that the risks are known, but Thorson said doctors should at least try because many of the patients are miserable.

“Even though they say they’re OK, they’re not really great,” he said. “And they’re all having some side effects, whether it’s constipation or fatigue or sleeping or worrying about driving.

“There are people for whom opioids are the best choice,” he added, “but that’s not as many as we currently have.”

 

Still, Larson said he believes the new restrictions are misplaced. Anyone abusing opioids is not getting them from his medicine cabinet, he said. He believes the answer is to crack down on illicit opioids instead. “They aren’t looking at the real problem,” Larson said.

Johnson said the new guidelines are critical — not just to prevent abuse, but to keep pain patients from becoming dependent on high-dose opioids that they didn’t need in the first place.

“You can’t continue creating these patients,” he said.

Former Narcotics Detective Russell Jones : “The War on Drugs”… is a WAR ON PEOPLE !

More videos check out www.leap.cc  LAW ENFORCEMENT AGAINST PROHIBITION !

NOTICE TO PATIENTS OF ANY PAIN CLINIC

NOTICE TO PATIENTS OF ANY PAIN CLINIC, ANYWHERE. We are being advised that in some instances where DEA has stepped up their activities regarding targeting of pain clinics and physicians, that patients are also being approached in their homes. BE AWARE, that unless you are presented with a WARRANT signed by a Judge with YOUR NAME on it, you are under no obligation to allow anyone into your home under any circumstances no matter how much they attempt to convince you that they have a right to enter your home. They have NO RIGHT or AUTHORITY to enter your home, inspect your medications, search your home or COUNT YOUR MEDICATIONS. Do not get into an argument. Be firm, polite, and send them on their way. You are patients, not criminals.

 

 

 

Hidden fees at the pharmacy: Why it may be cheaper not to use your insurance

Hidden fees at the pharmacy: Why it may be cheaper not to use your insurance

RICHMOND, Va. (WRIC) — A woman uses her insurance to purchase the drug Sprintec. Her copay was $50.

However, if she didn’t use her insurance and paid cash for the drug, it would only have cost her $11.65. That’s a difference of $38.35.

This is called a copay clawback. It’s a little-known secret driving up the price of your prescriptions.

Douglas Hoey, CEO of the National Community of Pharmacists Association explains to 8News how it works.

“The insurance company tells the pharmacy what to charge. The insurance company overcharges the consumer and then the insurance company takes the extra money back from the pharmacy that the pharmacy was forced to collect,” Hoey said.

It’s carried out through a middleman known know as a pharmacy benefit manager or PBM.

PBM’s negotiate drug prices with drug companies on behalf of your insurer.

 

Some PBM’s then charge a co-pay that exceeds the cash price.

Your pharmacist is expected to charge whatever price insurers set, and that middleman pockets or clawbacks the profit.

“The insurer sends back a message that says this is how much to charge the patient. That is the first time the pharmacy knows how much a patient is going to pay,” Hoey explained.

Many pharmacists can’t tell you that if you just paid with cash it would be cheaper. They’re sworn into secrecy with a sort of contract gag clause.

“The pharmacist is restricted or actually threatened by the PBM to tell the patient that they can maybe get the drug cheaper if they use cash,” Hoey said.

 

There is a language in the contract that implies if the pharmacist shares information with the consumer … the insurance plan can terminate the pharmacist contract,” Hoey said.

Federal lawsuits filed against United Healthcare, OptumRx and CVS Health allege these clawbacks impact a wide range of drugs and tend to target mostly those on high deductible health plans.

In one suit filed in Minnesota, the plaintiff, Megan Schultz alleges she got ripped off. She says she paid $165.68 for a generic drug with her insurance. Yet, if she paid cash, it would have only cost $92.00.

“We definitely do not want to be in that position as being the bad guy. Our goal is to get the safest medicine, the best medicine for the patient at the lowest cost,” Hoey said.

So what can you do? Medliminal, a medical billing advocacy group says just ask.

If you ask, “What’s cheaper, paying with my insurance or cash?” then the pharmacists can tell you.

Medliminal also tipped us off to the website GoodRX.com. It lets you type in your zip code to find the lowest price near you. Then you’ll know what you should be paying for that prescription before you get to the pharmacy. It also offers coupons for certain drugs.

Some states like Texas are trying to outlaw these clawbacks.

We reached out to United Healthcare, OptumRx and CVS health. CVS responded saying:

“Our PBM, CVS Caremark’s long-standing practice is not to engage in copay clawbacks, and we have no plans to implement clawbacks. If a PBM plan member’s copay for a drug is greater than the dispensing pharmacy’s contracted rate, it is not CVS Caremark’s practice to collect that difference from the pharmacy. If the pharmacy’s cash price is lower than the co-pay, the patient would be charged the lower price.”

 

United Healthcare issued this statement:

“Pharmacies should always charge our members the lowest amount available under their benefit plans. The ‘clawbacks’ referenced in the class action suit had no impact on what members agreed to pay for prescription drugs per their benefit plans. We continue to believe this case has no merit and should be dismissed by the court.”

 

 

 

 

 

 

OptumRX did not respond to our inquiries.

 

 

 

 

 

 

 

 

 

 

I recently got a call from a person on Medicare and has Silver Scripts Part D .. which is part of CVS HEALTH.  This person had a certain medication that requires a prior authorization to be covered and even though the pt has been on this particular medication for several years… it was a “fight” every year with Silver Scripts over the prior authorization.. they wanted to have the pt’s prescriber to fill out a new PA form EVERY YEAR…

Recently filling this prescription … before the end of the year and the PA ran out… the COPAY … with using the Part D insurance was $500 and change for a 90 day supply

The pharmacist called the pt and stated that the pharmacy had a “discount card” and in running it thru the discount card program.. the TOTAL PRICE was just UNDER $200.00.. and NO MORE PRIOR AUTHORIZATIONS to screw with…

Here is the website of the pharmacy discount card  https://www.communitycaresrx.com/clients/communitycares/Home.aspx

You can check the price of your prescriptions on their website and find participating pharmacies.  I am sure that not every pt will experience this great of a discount in out of pocket costs, but isn’t it worth at least checking it out ?

PA Bureau of Narcotics: opiate EPIDEMIC …on the brink of a SUPER PANDEMIC

Officials call opioid abuse a ‘pandemic

http://www.neshobademocrat.com/Content/NEWS/News/Article/Officials-call-opioid-abuse-a-pandemic-/2/297/42265

The growing impact of opioids in Philadelphia and other communities was discussed at a town hall meeting last week where an officer with the state Bureau of Narcotics told about 75 people in attendance that the nation was “on the brink of a super pandemic.”

Lt. Jon Harless of MBN was among officials speaking at the meeting in the Philadelphia High School auditorium.

Harless said a super pandemic may sound like overkill to some people, but noted that Mad Cow disease and Asian Flu were at one time described as a pandemic.

It costs $78.5 billion to treat and provide healthcare and/or incarcerate people nationwide who are addicted to opioids, he said.

MBN Director John Dowdy and Harless cited several statistics during the presentation which ended with a question and answer session with those in attendance.

In 2016 alone, 45,087 opioid prescriptions were written in Neshoba County, Dowdy said, noting that the county’s total population is 29,403.

“That tells you how drastic the problem is,” he said.

In many cases, those opioid prescriptions are the doorway to addiction, Harless said.

While some people may think the face of an opioid drug addict is a homeless man sleeping in a ditch, Harless said that was not the case.

“Look to your left, look to your right and look in the mirror,” he said. “The addict looks just like us. It does not discriminate on who becomes addicted.”

In 2015, there were 52,404 death from overdoses in the United States, 33,091 of those were from opioids.

For comparison, 37,757 individuals were killed in vehicle accidents and 36,252 were killed by firearms.

“The average Boeing 747 passenger jet carries 416 people,” Harless said. “Opioid overdoses kill the equivalent of one 747 crash ever 4.5 days.”

Accidental drug overdose is now the leading cause of death for persons under the age of 50 in the United States, he said.

While the United States accounts for about 5 percent of the world’s population, Harless said, “we consume about 80 percent of the opioids manufactured in the world.”

In 2016, Mississippi was ranked Number 5 in the nation per capita for annual opioid prescriptions.

“That is 1.07 prescriptions per citizen,” Harless said.

He also addressed the rise in heroin use, noting that MBN heroin cases increased by over 300 percent from 2012 to 2016.

“The path to heroin addiction begins with prescription opioid addiction,” he said. “Over 80 percent of heroin addicts begin with prescription drugs.”

From 2013 until 2016, deaths from heroin related overdoses rose 2,000 percent in Mississippi, he said.

He also noted statistics that opioid addiction has brought about an increase in crime across the state.

From Jan. 1, 2014, until Dec. 4, 2017, Mississippi has experienced 133 successful burglaries at pharmacies, 53 attempted burglaries and nine armed robberies.

“In 2016, 146,389 dosage units of opioids were stolen from pharmacies in Mississippi,” Harless said.

Dowdy told those in attendance that officials were seeing success with the drug Naloxone, sold under the brand name Narcan, which is used to block the effects of opioids, especially in overdoses.

He said there was an ongoing effort to distribute Narcan to EMTs, law enforcement and other first responders across the state.

Dowdy said Narcan was used on a 19-year-old college freshman recently who had overdosed on heroin.

When first responders arrived, Dowdy said the student was blue and had a faint heart beat.

“They saved his life,” he said. “Every life matters.”

Dowdy said that young man “15 years down the road may find a cure for cancer.  As long as I am director that will be the case. Every life matters.”

Dowdy also talked about regulations that are placed on doctors and pharmacists in an effort to identify people who “doctor shop” to obtain opioid prescriptions.

The Mississippi’s Prescription Monitoring Program is an electronic tracking program managed by the Mississippi Board of Pharmacy to aid practitioners and dispensers in providing proper pharmaceutical care relating to controlled substances.

It also serves as a tool for regulatory agencies and authorized law enforcement to identify potential inappropriate use of controlled substance prescription medication.

During the question and answer session, one Philadelphia physician said the regulations were causing him anxiety and required more and more his time.

He said many people come into his office in need of opioids to treat various conditions.

“So many are doing it just right with no abuse,” he said.

Dowdy said many doctors share the same concerns and the legislature was looking to address some issues.

“There is a lot of misinformation in the medical field,” he said, noting that the legislature hasn’t finalized all the regulations.

“There are likely to be some tweaks,” he said.

Dowdy called the Prescription Monitoring Program a tool for doctors and pharmacists to identify doctor shoppers.

He said nurses or office managers could be trained to input data into the program.

“It’s not an unnecessary burden on doctors as others on staff can do it,” he said.

A former federal prosecutor, Dowdy described the program as a benefit to doctors.

“If my daughter died because a doctor kept writing prescriptions to her for opioids, I’m going to sue you if you did not check the PMP,” he said. “ I hope you did because if not you’re going to need a whole lot of money. It is there to protect you as well as the patient.”

He urged doctors and pharmacists to be patient until all the regulations are in place.

While he is 26 agents short because of funding, Dowdy said his agency continues to work all over the state.

When asked if they investigate pain clinics as well, Dowdy said, “we have our eye on some of those folks. I’m not afraid to arrest a doctor. It’s on our radar. Trust me.”

Chief of Police Grant Myers, who attended the town hall meeting, said his officers were certified to administer Narcan.

“I’ve seen those numbers and statistics about opioids before but this really put it into perspective when it is described as a 747 jet crashing every four-and-a-half days,” Myers said. “Anytime an airplane crashes it makes national news and is all over social media but you rarely hear about an opioid overdose.”

Myers said Philadelphia was fortunate, for now, that heroin “hasn’t made it here up to this point but we feel like it is coming. We have heard talk about it being here at times. We will continue to work with MBN and other state and federal agencies to combat this epidemic.”

Myers said if anyone has a relative or friend who is addicted, it is important to get them help before they end up in jail or deceased.

“If you don’t know where to turn you are welcome to come to the police department and I will try to point you in the right direction.

“ I will help get you in touch with someone who can assist them.”

The town hall meeting was hosted in partnership with several Mississippi agencies, including the Department of Mental Health, the Department of Public Safety, the Bureau of Narcotics, the Board of Pharmacy and the Mississippi offices of the FBI.

Let’s look at the numbers… there is 29,403 people in the county… we can presume that abt 2/3 are adults. I will take the low end figure that about 15% of the adult population suffers from chronic pain severe enough to require 24/7 opiate medication. What is now “best practices and standard of care” in treating pain 24/7 would entail both a long acting and short acting opiate… the first for “basal pain management” and the other for break thru pain.  Presuming that each pt is given a 30 days supply of each ..requiring 24 prescriptions for each pt every year.   Leaving abt 4,400 chronic pain pts in that county… and needing 105,600 opiate prescriptions for a full year.. NOT COUNTING opiates needed for pts suffering with acute pain… broken bones, surgery and the like.

45,087 opiate prescriptions were written during 2016. Suggesting that not all pts with mod-severe chronic pain got proper pain management nor did all pts dealing with acute pain.

Isn’t it amazing how they USE NUMBERS to prove their point and when you get “down into the weeds” they confirm what a lot of us already know.. chronic pain pts – and some acute pain pts – are not receiving adequate treatment… which some would consider a form of pt/senior abuse or torture.

Definition of a PANDEMIC:

A pandemic (from Greek πᾶν pan “all” and δῆμος demos “people”) is an epidemic of infectious disease that has spread through human populations across a large region; for instance multiple continents, or even worldwide.  https://en.wikipedia.org/wiki/Pandemic

Since our current and previous Surgeon Generals have clearly stated that ADDICTION is a MENTAL HEALTH issue and not a MORAL ISSUE… once again .. it would seem that non-medical trained professionals – mainly those in law enforcement – are calling mental health issues a CONTAGIOUS INFECTIOUS DISEASE…  Does this demonstrate their lack of understanding of what is going on, just pain stupidity on their part, or just their only known way to help create job security for them and others in law enforcement. ?

 

the Senate Judiciary Committee held a hearing to review the Ensuring Patient Access and Effective Drug Enforcement Act

In Judiciary Hearing, Bipartisan Senators Set Record Straight on DEA/Opioid Legislation

Washington, DC—This morning, the Senate Judiciary Committee held a hearing to review the Ensuring Patient Access and Effective Drug Enforcement Act—a bill that was passed in the previous Congress to clarify the Drug Enforcement Administration’s enforcement authority with regard to the medicine supply chain.

The legislation, sponsored by Senator Orrin Hatch (R-UT) and Sheldon Whitehouse (D-RI), addressed a flaw in the system that gave the Drug Enforcement Administration’s (DEA’s) Office of Diversion Control undefined authority cut off prescription supply chains without warning, thereby threatening access to lifesaving treatment.

 The benefits of this proposal were almost entirely overlooked in a one-sided Washington Post report that misrepresented the law’s intent and the process by which it was passed. The same report additionally downplayed the overwhelming bipartisan support for the bill, which passed Congress with unanimous support and was signed by President Obama on the advice of his own DEA.

In setting the record straight, Hatch noted that the very phrase that the news report claims “gutted DEA’s enforcement authority” actually came from agency lawyers. At today’s hearing, Hatch and other members of the panel had the opportunity to ask Demetra Ashley—the Acting Assistant Administrator for Diversion Control at DEA—about the bill’s impact and to rebut claims that the bill has impeded DEA’s ability to do its job. Senator Hatch also took the opportunity to explain the pressing need for the legislation, a key point that has been lost in the one-sided reporting on the bill.

Senators Hatch and Whitehouse Set the Record Straight on their Legislation Clarifying DEA Rules

In subsequent questions with Senators Hatch and Whitehouse, Acting Assistant Administrator Ashley made clear that Senator Hatch and Senator Whitehouse’s legislation had not caused a decline in DEA enforcement efforts. [VIDEO] Click here for copies of the two charts Senator Hatch referenced in his questions. [LINK]

  • Senator Hatch has previously addressed flaws in the reports about this legislation on the Senate floor. [VIDEO]
  • Numerous media outlets have likewise pointed out a number of omissions in the reporting on the bill. [LINK]
  • Patient groups have also written in to express support for the legislation. [LINK] [LINK]
  • In addition, a VCU medical professor has described some of the problems at DEA in the years leading up to the bill. [LINK]
  • Hatch wrote an op-ed in the Washington Post correcting a number of errors in reports about the bill and its impact on DEA’s enforcement capabilities. [LINK]
  • Representative Marino, the House sponsor of the bill, submitted a statement at the hearing explaining the need for the bill. [LINK]

Senator Hatch’s full remarks, as prepared for delivery, are below:

Thank you, Mr. Chairman, for holding this hearing and for allowing me to make a statement.

Too often in this town, narrative gets ahead of facts. A newspaper prints an explosive headline, and it’s off to the races. It doesn’t matter what the actual facts are. The bandwagon starts rolling, and everyone wants on, or off, as the case may be.

Indeed, Mr. Chairman, I was both surprised and disappointed by how quickly everyone seemed to start running from this bill the moment some negative news reports came out. From Senator McCaskill to Senator Manchin to Attorney General Sessions, it seems like everyone’s trying to wash their hands of it. But no one ever told me they were dubious about this bill when it was going through. No one entered a statement of opposition into the record or offered an amendment to change the bill. To the contrary, the bill passed this committee by voice vote and passed the full Senate by unanimous consent.

So these last two months have been deeply frustrating to me, Mr. Chairman. I wish some of my colleagues would stop trying to rewrite history or pretend this was some sort of shell game.

That’s why I’m glad we’re holding this hearing today. I want to talk about the facts. The facts of this law. The facts of my involvement and of this committee’s involvement. And the facts of the law’s impact.

Let’s start with the impetus for this law. This law came about, not because I or anyone else got some giant check, but because of very real concerns that the way DEA was operating was threatening patient access.

Representative Marino has said that he became involved after meeting with a community pharmacist in his district who was “having so much trouble obtaining prescription opioids that he had to turn away legitimate patients.” I heard similar concerns from constituents, one of whom will be testifying today.

And it wasn’t just Utah and Pennsylvania. Across the nation, pharmacies were facing supply chain problems. A January 2014 survey by the National Community Pharmacists Association found that 75 percent of respondents had experienced three or more problems with stopped shipments in the previous 18 months and that a majority had had to turn patients away as a result. News reports from Indiana to Florida detailed stories of legitimate patients who were having significant difficulty obtaining needed medication.

No doubt these supply chain problems had multiple causes, but DEA’s activities were a contributing factor. According to a 2015 GAO report, the lack of clear guidance from DEA to distributors on what constitutes a suspicious order and what can trigger an enforcement action was leading many distributors to place quotas on drug shipments to pharmacies, a practice that the report found can “negatively impact . . . patients’ access.” The report detailed how fear of enforcement actions, coupled with lack of agency guidance, was leading distributors to decline to fill orders even in cases where a distributor had no evidence that a pharmacy or doctor was engaging in diversion.

And it wasn’t just lack of guidance. I’ve had a number of individuals tell me that DEA’s attitude toward registrants during this period was downright antagonistic. I have a letter here from a VCU Professor that describes some really troubling conduct by diversion control agents and that explains how difficult he found it to try to work with the agency in good faith.

And it wasn’t just the private sector that was having difficulty dealing with DEA, either. In a separate 2015 report about drug shortages, GAO described the great difficulty it had getting information from DEA’s Office of Diversion Control. According to the report, completion of GAO’s work “was delayed significantly because of DEA’s refusal to comply with [GAO’s] requests for information . . . for over a year.” Only after the intervention of “senior DOJ management officials” was GAO able to obtain the data it was seeking.

The Ensuring Patient Access and Effective Drug Enforcement Act was an effort to respond to these problems, to provide clearer guidance for supply chain members, and to encourage greater cooperation between DEA and the regulated community. That’s why it defined the agency’s immediate suspension order authority. That’s why it provided for corrective action plans. This wasn’t some effort to help drug companies kill people. Give me a break. This was an effort to ensure that DEA’s praiseworthy efforts to stem abuse don’t end up hurting legitimate patients.

Now, I’d like to say a word about how this law came together. I want to be clear right at the outset that this was not a pharma bill. Don’t tell me I did this bill because pharma donated however much money to me.

Prior to introduction, Senator Whitehouse and I negotiated with DEA, distributors, and patient advocacy groups. We may have talked to a pharma company at one point or another, but they were not key players.

And you know what? The bill Senator Whitehouse and I introduced? DOJ was okay with it. They said so in writing to this committee.

Of course, legislating is a process, and after introduction I found it was necessary to make changes in order to move the bill forward. I would have preferred not to, but we all know that legislation requires compromise. And so I had to accommodate some requests from industry stakeholders at the request of other members of this committee.

I negotiated these changes with DEA and DOJ. In fact, DOJ gave me the substantial likelihood language that critics now seem so fixated on.

And once DEA and I came to a point where we agreed on a path forward, I asked the Chairman to put the bill on a markup. And I kept my end of the bargain. I told other members what DEA had asked me to tell them, and I made the floor and record statements I’d promised DEA I would make. I did all of this in good faith.

I later came to find out that notwithstanding our agreement, DEA and DOJ were telling other offices they still had some concerns with the bill. For reasons I don’t understand, they never shared these concerns directly with me. But evidently the concerns weren’t that significant, as DEA didn’t try to stop the bill. As all of us on this committee know, any bill can be stopped by agency opposition. All it takes is one hold.

So that’s how we got here. This bill addressed a very real problem, and it did so in a carefully crafted, carefully negotiated way. If DEA has concerns with the bill, I’m happy to hear them. But I’d also ask DEA to explain why those concerns didn’t cause it to stop the bill 18 months ago, before it became law.

Thank you, Mr. Chairman.

Kentucky’s top agriculture official: DEA wrong to call hemp products illegal

Kentucky’s top agriculture official: DEA wrong to call hemp products illegal

https://www.courier-journal.com/story/news/crime/2017/12/14/hemp-oil-hemp-seeds-legal-kentucky-dea/951836001/

Ryan Quarles, Kentucky’s Agriculture Commissioner, fired a letter to the head of the U.S. Drug Enforcement Administration this week asking to meet to discuss “federal overreach” with industrial hemp.

“I was dumbfounded when I read a Louisville Courier-Journal article that was titled, ‘Are you breaking the law when you buy hemp products?'” Quarles said, according to a copy of the letter.

He referenced statements from DEA spokesman Melvin Patterson calling all hemp products — even chocolate hemp bark — illegal if the product can be consumed. Even though federal law limits the THC amount to a non-intoxicating level.

Hemp vs marijuana: Can you get high off hemp? We’ll help clear the fog about marijuana’s ‘kissing cousin’

“Consumable hemp products are legal to buy,” Quarles said.

Duane Sinning, who oversees the industrial hemp program in Colorado, also views hemp products as legal.

“Agriculture laws are not really that hard, unless you get the DEA involved and they want to make it hard,” he said.

 

Hemp products in Louisville: From beer to bedding, hemp products are easily found at some stores that may surprise you

Hemp for headaches, arthritis, pain?: Hemp is ‘the next big thing’ in pain management as growth and research expand in Kentucky

The 2014 Farm Bill allowed states to pass laws to grow and market industrial hemp, but the law is brief and interpreted in conflicting ways.

Quarles requested a meeting with DEA Acting Administrator Robert Patterson during Quarles’ trip to Washington, D.C., at the end of January to meet with agriculture officials from other states. 

“We enforce the Controlled Substances Act,” Melvin Patterson said Thursday in response to Quarles’ letter. “He’s knocking on the wrong door.

“Unless Congress changes it, we’re going to continue to do our jobs.”

Quarles said he believes Congress should — and eventually will — remove hemp from the federal Controlled Substances Act list.

Reporter Beth Warren: bwarren@courier-journal.com; 502-582-7164; Twitter @BethWarrenCJ. Support strong local journalism by subscribing today: www.courier-journal.com/bethw.

DEA Leads Massive Drug Confiscation In War On Opioids

The “fishing” operation went on to target a total of 4,500 to 5,000 drugstores present in the area. The DEA officers accumulated all the drug tracking that they had gathered, and combined it with the data that was received from insurance and billing, provided by the Department of Health and Human Services, the state-level prescription drug monitoring programs, and the tax information provided by these pharmacists to the IRS.

www.libertynewsnow.com/dea-leads-massive-drug-confiscation-war-opioids/article8362

Results for the Operation Faux Pharmacy were declared on Wednesday by the Drug Enforcement Agency (DEA). The operation targeted 26 pharmacies that were suspected for illegal distribution of prescription drugs and medications. This resulted in the confiscation of a total of 494,000 pills, valued at $2.8 million.

Led by the DEA’s Los Angeles Field Division, the operation included different busts taking place simultaneously in southern California and the state of Nevada, and another set of raids in Hawaii. These raids also included the efforts of 60 people, who were out of the state.

These raids resulted in four of these pharmacists to willingly surrender their licenses; whereas the others would now face civil and criminal proceedings in the months to come.

The basic mission of the operation was to crack down on all of the illicit distribution of prescribed drugs. According to the search warrants that were issued before the operation against pharmacies, these seized drugs include all kinds of opioids, along with other non-specific forms of prescribed medications, like Xanax. As per an estimate, four out of every five heroin addicts on the west coast start their addictions with such prescription pills.

“DEA is fighting the opioid crisis on multiple levels, using every resource available to identify reckless doctors and rogue businesses that fuel addiction in our neighborhoods and communities,” said the Acting DEA Administrator – Robert W. Patterson. “We will continue to identify and hold accountable the most significant drug threats, using every tool at our disposal—administrative, civil, and criminal—to fight the diversion of controlled substances.”

 Deputy special agent and the officer in charge with L.A. Field Division – William Bodner, told the reporters that Faux Pharmacy was a project that took more than a year in strategizing and devising. The project’s very initial goals, he went on to explain, were to go past these small busts of doctors to target the original source of illegal prescription drugs.

“We decided to look at the root of the prescription drug problem,” Bodner had said in a statement. “Where are the prescription drugs coming from?”

The operation went on to target a total of 4,500 to 5,000 drugstores present in the area. The DEA officers accumulated all the drug tracking that they had gathered, and combined it with the data that was received from insurance and billing, provided by the Department of Health and Human Services, the state-level prescription drug monitoring programs, and the tax information provided by these pharmacists to the IRS.

Agents looked for more common identifiers of an illegal drug sale, including pharmacies that had filled remarkably high numbers of oxycodone prescriptions, high or rapid opioid sales, multiple customers with identical addresses, or customers who have to travel long distances to specific pharmacies despite having access to more convenient options. Using these patterns, DEA officers went on to narrow down nearly 5,000 pharmacies, first to 90, and then down to only 26 with unusual patterns of behavior.

The year’s worth of work has led to seizing of more than 600,000 pills, the majority of which were picked up on Wednesday.

Bodner further said that this data-driven approach would be served as the basic framework for similar stings in other states in the upcoming future raids.

“Part of the mindset here is they can take this model back and do it in other states, do a similar type of operation. It starts at the front end, a lot of statistical analysis, and then after that point, it gets into our standard investigative techniques,” Bodner had said.

Bodner also expects that these operations would allow to strongly clamp down the pharmacists who are planning on getting into the business of illegal drugs distribution.

“I think it’ll have a significant impact, because the pharmacists are now on notice because the federal government is looking at them to make sure that they are ethical and they are following the rules of dispensing,” he had said. “If they are, we applaud them, and we have no issue. It’s those that are not that we’re taking a close look at and will be coming after.”

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