1-ribboncryingeyevoteFirst 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



Lawsuit: Indifference by medical staff at Forsyth jail led to woman’s death


A lawsuit filed in Forsyth County court alleges that a private healthcare company and medical staff at the local jail displayed deliberate indifference, causing the death of a woman awaiting trial in 2014.


A lawsuit filed in Forsyth County court last week alleges that medical staff at Forsyth County jail acted with deliberate indifference, causing the death of a pregnant woman who was undergoing withdrawal from opiates while awaiting a hearing on charges of prescription drug fraud in 2014.

The lawsuit, filed on Aug. 17 by the estate of Jen McCormack, names Correct Care Solutions — a Tennessee-based healthcare company with extensive contracts in detention facilities across the country — as defendant.

McCormack’s unexpected death at Baptist Hospital after being found unresponsive in the jail in downtown Winston-Salem first came to light in a series of articles [1, 2, 3] published by Triad City Beat in 2015 that included details of her deteriorating health during the 16 days of her detention while calling into question an official narrative suggesting she died as a result of a hunger strike.

McCormack’s death certificate, which is cited in the lawsuit, notes an “uncertain contributory role of reported intent to starve self v. deficient pre-emptive custodial intervention.”

Meanwhile, on Aug. 18, the US Justice Department announced that it will gradually phase out contracts with private prison providers, noting among other factors that “they do not provide the same level of safety and security” as those directly administered by the government. A review of inmate medical records by the Nation that focused on 11 immigrant-only contract prisons, including one in west Texas where Correct Care Solutions was the medical provider, found “prison medical units repeatedly failing to diagnose patients correctly despite obvious and painful symptoms, as well as the use of under-qualified workers pressed to operate at the borders of their legal scope of practice.” The investigative report, published in February, also said the files showed “men dying of treatable diseases — men who very likely would have survived had they been given access to adequate care.”

The lawsuit filed in Forsyth County court last week by McCormack’s estate fills in critical gaps about her access to medication in the jail and about concerns raised by an obstetrics nurse at an off-site clinic as to whether her deteriorating condition warranted her hospitalization.

McCormack had received Subutex — a brand name for the opioid-withdrawal medication buprenorphine — during a stay at Forsyth Medical Center prior to her arrest, according to the lawsuit. She also received Zofran to treat nausea. McCormack had wanted to receive treatment for her addiction to prescription drugs at an inpatient facility, but because no beds were available she planned to go home and begin outpatient rehabilitation, according to the lawsuit. Instead, she was arrested for multiple charges of felony prescription-drug fraud and booked in jail.

McCormack experienced nausea and vomiting for much of her time in jail, complaining of dizziness and chest pain, and exhibited lethargy and disorientation that worsened over time. The lawsuit alleges that although Zofran was ordered to treat her nausea, it was only administered to her once. The complaint alleges, “As a result of her uncontrolled nausea, decedent was unable to take many of the medications that were prescribed for her symptoms of opioid withdrawal, anxiety disorder, depression, and prenatal vitamins for her unborn baby.”

The lawsuit alleges that Registered Nurse Miriam Cornatzer Hauser and Nurse Practitioner Emma Aycoth, who worked in the medical unit at the jail at the time of McCormack’s detention and who are named as individual defendants in the lawsuit, and other members of the nursing staff “failed to properly and adequately assess decedent’s signs, symptoms and her severely deteriorated condition.”

The complaint alleges that Cornatzer and Aycoth violated McCormack’s constitutional rights “by intentionally, willfully, maliciously and with conscious and deliberate indifference, failing to secure adequate and reasonable medical care for decedent when they subjectively knew or should have known that decedent had an objectively serious medical need and faced a substantial risk of harm, by disregarding such risk of harm and by failing to take reasonable measures that were readily available to avoid that risk.”

The complaint goes on to say that the two nurses “had actual knowledge that decedent had failed for several days to take in and retain amounts of food and/or liquid sufficient to sustain life, as a result was exhibiting a seriously declining physical condition, and required immediate medical attention and intervention.

“Decedent’s condition would have been diagnosed by a physician as mandating treatment and/or was so obvious that even a lay person would easily recognize the necessity of medical attention,” the lawsuit continues. “Defendants RN Cornatzer and NP Aycoth failed to notify physician staff or otherwise secure reasonable and necessary medical attention for decedent. Their failure to do so and deliberate indifference ultimately led to her death.”

The lawsuit charges that the company’s cost-cutting policies were “a moving force” in Jen McCormack’s death.

Aycoth declined to comment and Cornatzer could not be reached for this story.

The lawsuit accuses Correct Care Solutions of maintaining “policies, practices and/or customs” that constituted deliberate indifference to McCormack’s serious medical needs and that “were a direct and proximate cause” of the nursing staff’s conduct.

The lawsuit charges that the company’s cost-cutting policies were “a moving force” in McCormack’s death, while alleging that “CCS has stated that it is committed to measures that minimize the need to transport inmates offsite.”

Jim Cheney, a spokesman, said Correct Care Solutions would not be able to comment because the case is under litigation.

The lawsuit alleges that “misconduct of nursing staff” at Forsyth County jail and other detention facilities served by Correct Care Solutions was “widespread,” adding that at least seven inmates, including McCormack, have died at the local jail “due to inadequate or improper medical care.”

Correct Care Solutions, along with the Forsyth County Sheriff’s Office, is currently defending itself against a lawsuit filed by the family of Dino Vann Nixon, a man who died in the jail in 2013. The lawsuit alleges that medical staff refused to provide Nixon with Xanax, an anti-anxiety medication also known as benzodiazepine. A report by a local medical examiner found that his death “was related to withdrawal from benzodiazepine.”

Despite the finding by the medical examiner, the defendants deny that Nixon’s death was related to withdrawal from the medication, while maintaining that he received appropriate care.

Correct Care Solutions also provides medical services in the Guilford County detention center. A woman named Ellin Schott who had been arrested for panhandling died at Cone Hospital after her health rapidly deteriorated during a brief stay in one of the jails in downtown Greensboro. A local medical examiners report chronicled medical staff’s apparent unwillingness to provide Schott with her prescribed anti-seizure medication and concluded that the immediate cause of death was “complications of prolonged seizure activity.”

According to the lawsuit filed in Forsyth County court last week, McCormack reported to the nursing staff on the fifth day of her detention that she was weak and dizzy, that she had been vomiting, and that the anti-nausea medication she had been receiving “is not sufficient.”

The lawsuit alleges that Dr. Alan Rhoades assessed that McCormack was apparently fainting, further concluding that she was exhibiting “drug seeking behaviors.” The complaint continues, “Decedent had been placed on Vicodin because CCS did not have access to Subutex. Dr. Rhoades ordered that Vicodin dose be decreased and ordered, ‘no change in management otherwise,” with the doctor emphasizing the first two words in all capitals.

Rhoades’ LinkedIn page identifies him as the medical director for the Forsyth County jail, along with the three Guilford County detention centers. Rhoades could not be reached for comment for this story.

The next day, according to the lawsuit, McCormack visited an OB/GYN at a clinic off site from the jail. “The obstetrical nurse contacted NP Aycoth expressing concern about decedent seeming drugged and drowsy and because decedent had vomited ginger ale she had been given,” the lawsuit alleges. “The obstetrical nurse questioned whether decedent should be hospitalized, and NP Aycoth instructed the obstetrical nurse to have decedent returned to the jail.”

Later that day, the lawsuit alleges that despite discovering that McCormack had vomited in her wash basin back in her cell and was struggling to eat, Aycoth failed to report those developments to physician staff.

“After September 9, 2014, nursing staff made no assessment of blood pressure or vital signs until September 13, 2014,” the lawsuit alleges. “Meanwhile, decedent was becoming more and more dehydrated due to continued nausea and vomiting. Nursing staff made no measurement of decedent’s food and water intake or output except for one notation of water intake that was made on September 13, 2014. Decedent was becoming at high risk for a serious and significant dehydration setting the stage for injury to her brain, kidneys and heart that did, in fact, cause a severe downward spiral in decedent’s condition, including changes in cognition, damage to her kidneys placing her at high risk for kidney failure, and culminating in a cardiac arrest that led to hypoxic brain injury and death.”

paybacks are hell ?

EpiPen price skyrockets 400%

spiderwebWhat I find interesting… Mylan’s President is the daughter of Sen Manchin (D-VA)… The Senator has proposed a OPIATE TAX and one of Mylan’s major products is Hydrocodone/Acetaminophen… which is taking a volume/profit hit because the DEA changed this product to a C-II a couple of years ago… So now that the only competitor to Mylan’s Epi-pen has had a voluntary recall.. they are “the only game in town”… Are they trying to regain the profits they believe that they have lost…. because of the actions or proposed actions of the FEDS.

Following the “money trail” is like tracing a spider web…

On Fox Business today they had the Mother of a son who died 3 yrs ago because of a food allergy.  Which has created a FOUNDATION to help make sure that no one goes without access to this necessary medication.. and no one loses someone to allergic reactions.

Perhaps the chronic pain community needs to take notice of what is going on around us… ONLY DEAD BODIES GET ATTENTION OF THE MEDIA !

The chronic pain community have DEAD BODIES… from pts being thrown into cold turkey withdrawal and dying because of that in combination with their co-morbidity issues… those who have committed suicide because their quality of life was flushed down the crapper because of reduced or eliminated pain medication.

As I have heard before with the media ” IF IT BLEEDS IT LEADS “… Your disease, your suffering is INVISIBLE … is our society making those who die from various reason associated with the inadequate/non-treatment of your pain … also INVISIBLE  ?

If you have a friend/relative that dies because of lack of adequate medical care committed suicide… please don’t stand around the casket saying ” at s/he is no suffering any more”… “s/he is now at peace”…  and other platitudes…  Where is the OUT RAGE that making sure than no one else has to go down that path ?


Target stores has lost “foot traffic” because CVS now operates their pharmacies ?

Customers: CVS Takeover Erased Everything Good About Target Pharmacies

Customers: CVS Takeover Erased Everything Good About Target Pharmacies

One of the reasons that Target gave for its poor performance during a recent earnings call was that stores may have lost some foot traffic because of “some disruptions” when the discount store sold its pharmacy business to CVS. We wondered what that meant, and asked if readers had experienced those “disruptions.” They had, but the bigger problem is something that Target’s executives may not have realized: people filled prescriptions there because they liked things that Target did differently.

The Bottles

Image courtesy of Eric Spiegel

The ClearRX system, which Target introduced in 2005, solved most of the annoying problems with the standard amber prescription bottle, even making it easy to tell which medication is which with bottles standing up in a drawer or box. For nearly all customers who contacted us, these bottles were the main reason why they chose the pharmacy.

targetbottle“Target had the best prescription packaging I’ve seen,” reader R. wrote. “Labels were easy to read and the color-coded bands made telling whose bottle was whose without glasses simple.”

The safety-minded packaging for prescriptions at Target drew many customers to the chain’s pharmacy counter over other options that might have even been in the same strip mall. A Target representative told Consumerist that the ClearRX patents were part of the sale of Target’s pharmacy business to CVS, and the drugstore giant now owns them, but is not using them.

It would be nice if CVS implemented them across the entire chain, but readers report that the red bottles have been discontinued since the changeover, and their meds are in classic CVS amber containers.

The People

Image courtesy of Mike Mozart

“My local pharmacy team was always very friendly, and even knew my name,” reader S. wrote. “Now, they are staffed with new people who are extremely rude.”

This was a common complaint of readers about CVS: whether it was because previous staff members left or because CVS brought its own people in, the familiar faces behind the pharmacy counter disappeared.

“Target Pharmacies were great,” G. wrote. “They were like your old-time neighborhood pharmacists.” He notes that he used to drive past about a dozen other pharmacies just to patronize Target, but will no longer be doing that.

The Cost

Image courtesy of Brittany Loubier

Reader G. shared her experience trying to use her discount card through GoodRX, a site that lets you compare prices at different pharmacies in your area. She used the company’s discount card on the mobile app just as she always had at Target…or she tried to.

“I used to use it at Target with no problems,” she wrote to Consumerist. “Since CVS took over, even though they are still listed in the GoodRX app, when I went to pick up two of my prescriptions I was told they do not honor it.”

Other customers mourned the end of the discounts they received from pharmacy rewards. In states where such programs are legal, customers would receive a 5% off certificate good or a whole Target shopping trip after filling five prescriptions at the store.

The Actual Drugs

Image courtesy of Edward Kammerer

M. takes a medication with a very specific extended-release mechanism, and she has found the generic version from one manufacturer to be the most reliable. Target used that one, but the new CVS inside Target stocks a version from a different manufacturer that she doesn’t trust. “So many recalls,” she notes.

The pharmacy was able to get the drug for her after a month of taking the less trustworthy version, but didn’t stock it consistently, leading to wasted trips. She gave up and switched her prescriptions to Walmart.

“I like shopping at Target, and now I have no built-in reason to go there every month,” she wrote to Consumerist. “Sad for them too, because I never, ever walked out of there with just a prescription bag. I probably spent anywhere from $25 to $75 every time I went in to get my refill.”

Depending on how many customers are like M., this is exactly the kind of news that Target CEO Brian Cornell won’t want to hear.

While they aren’t exactly drugs, reader D. noticed a really common medical supply missing from his local pharmacy in Florida after the transition to CVS. “Basic diabetic supplies, such as test trips and lancets – no longer carried, with or without insurance,” he observed. Let’s hope that isn’t a permanent change.

The Data Migration

Image courtesy of jsbn123

Patients had less information on this, but recounted that their prescriptions were assigned new numbers under CVS. That makes sense. However, this broke the auto-refill system, causing problems for customers.

N. reports that the transition didn’t go well in Target’s home state of Minnesota. “Once the new CVS systems launched there were a lot of issues with employees struggling to input prescriptions and complete pickups with the new computer system,” he writes, saying that lines were exceedingly long for the first two weeks after CVS took over.

C. had her prescription for a controlled drug disrupted: her doctor needs to authorize it for three months at a time, and the pharmacy had to contact her doctor to confirm it even though he had just done so the month before CVS took over.

“It was a one-time inconvenience,” she wrote to Consumerist, “but enough of an aggravation that I elected to move my prescriptions elsewhere, since Target no longer had the bottles that made me interested in filling prescriptions there in the first place.”

Take heed, CVS: people really, really, really like those bottles.

Target Sales Are Down Because Customers Are Fixing Up Their Homes Instead

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The truth and all the truth that “the spin” will allow ?

daffydizzy (1)Report: Pills in Prince’s home mislabeled, contained fentanyl


It is amazing how some reporters have to spin the TRUTH to make a point.  It has been reported that the tablets found in Prince’s position was a “Watson 385”.  This tablet was a commercial product containing 7.5 mg of Hydrocodone and 500 mg of Acetaminophen.  But about 3 yrs ago, all production of opiates with more than 325 mg of Acetaminophen could no longer be legally produced in the USA.  This product was replaced with a 7.5 mg Hydrocodone and 325 mg of Acetaminophen.

To the best of  my knowledge there is NEVER BEEN a legally produced, commercially available Fentanyl in a tablet form in the USA.  So to suggest that the manufacturer “mislabeled” the product is so small a possibility it is virtually NON-EXISTENT. 

There have been reports of ILLEGAL produced tablets that resemble both NORCO and Xanax that contained Fentanyl.. One thing that they did not clarify is that the Fentanyl that is legally available in the USA is Fentanyl Citrate.. the illegal products contain Acetyl Fentanyl and a new variation coming in from China furanyl fentanyl. Both of which are less potent than the Fentanyl citrate.  That single determination would have clarified if the tablets that Prince took were legally manufactured in the USA.

The question has to be asked … was Prince one of those 1%-2% of chronic pain pts that became addicted. Could he not find a doctor to treat his chronic pain (hip ?) adequately and resorted to getting his hands on something to allow him to continue doing is job of preforming ?

IMO.. because this was a OD death of a high profile person.. most of the details of his death will be kept confidential. So the truthful facts may never be known… just the spin that the media can put on this story…

Image result for watson 385

(CNN)Pills seized inside Prince’s Paisley Park compound by investigators were labeled as hydrocodone but actually contained fentanyl — the drug that killed the singer — according to a source with knowledge of the investigation who revealed the information to the Minneapolis Star Tribune.

The revelation gives more insight into what may have caused Prince’s overdose. There are two likely possibilities: Either a pharmaceutical manufacturer mislabeled the pills, or the pills were illegally manufactured and obtained illegally.
However, according to the Star Tribune, investigators are working under the theory that the pop star did not know the pills contained fentanyl. Prince died on April 21 from an accidental overdose of fentanyl, according to the medical examiner.
Is Prince overdose a wake-up call for doctors?

If the manufacturer mislabeled the pills, there would have likely been a recall, as fentanyl is an extremely potent opioid medication and a controlled substance. It would be a serious health hazard if a batch was mislabeled and given to the public.
Fentanyl is 50 times more potent than heroin and up to 100 times more potent than morphine.
Unintended consequences: Why painkiller addicts turn to heroin

Investigators have not said whether Prince ingested those pills or whether he knew the pills contained fentanyl.
Star Tribune sources said Prince’s toxicology report, which has not been released, also revealed the presence of lidocaine, alprazolam and Percocet in his system.
CNN’s Dr. Drew Pinsky said the combination of fentanyl, (which is an opioid based drug), and alprazolam (which is a benzodiazepine) could be the key to why Prince died.
“It is all too common for people to overdose if they are taking a combination of a benzodiazepine and an opioid,” Pinsky said. “This is what I’ve been warning was a likely possibility.”

Powerful painkiller

At the beginning of the investigation into Prince’s death, sources told CNN that painkillers were found inside his Paisley Park compound and they could not find a valid prescription for the medication. The Star Tribune now reports that their source said no prescription for fentanyl has been found in the months since Prince’s death. So, a burning question remains. How did Prince acquire the drug?
What you need to know about fentanyl
Fentanyl, the most powerful painkiller on the market, is normally prescribed to cancer patients in extreme pain. It’s also used to ease the pain of someone who is dying or as part of anesthesia during surgery.
But illegally manufactured fentanyl pills are readily available across America.
Why do so many pop stars die young?

Just last month, the Drug Enforcement Administration published a report saying counterfeit pills are fueling the fentanyl and heroin/opioid crisis in the United States, which has become an epidemic. The DEA issued a national health alert over the rise in fentanyl overdoses in 2015.
That year, the DEA said its National Forensic Laboratory Information System showed “there were approximately eight times as many fentanyl exhibits (confiscated drugs that tested positive for fentanyl) in 2015 as there were during the 2006 fentanyl crisis, clearly demonstrating the unprecedented threat and expansion of the fentanyl market.”
Feds seeking answers on how Prince got fentanyl, the opioid that killed him

Prince’s death at 57 years old shocked the world. For months fans mourned the musical genius by showing up by the hundreds to pay their respects. Many left purple mementos on the fence that surrounds the Paisley Park Compound where Prince died.
He was discovered dead inside of an elevator in the complex.

Dosage would have killed anyone

Officials never revealed the amount of fentanyl that was in Prince’s system. But the Star Tribune reported that a source said the amount of fentanyl in his system was so high it would have killed anyone, no matter their size.
Opioids and overdoses: 4 things to know

It has been four months since Prince died and the investigation into his death is still ongoing. The DEA began working the case alongside the Carver County Sheriff’s Office from the very early stages. But no one knows exactly why Prince was taking strong painkillers or how he obtained them.

Palliative care – revisited

Some of my readers seem to have the same mental concept as some of the legislators that pass many of the laws that are impaling many in the chronic pain community.

PALLIATIVE CARE is a process not a structure.

Yes palliative care is normally associated with cancer care and end of life Hospice, but it is not a process restricted to Hospice or caring for terminal or end of life pts.

Hospice is a structure that is regulated by – who else – the government.  Normally, when a person enters Hospice.. their doc will confirm (guess) that the pt has less than 6 months to live.  In the case of a pt on Medicare/Medicaid, they relinquish their Medicare/Medicaid and the Hospice organization gets paid – normally a per diem amount – to provide all the services that the pt needs for the balance of their life.

Their goal is to “comfort” both the pt and their family and make the pt comfortable and do nothing that will extend their life.. Again it is about saving money for the system… paying for heroic procedures that may add hours or days to the pt’s life.

If you read the WHO’s definition of palliative care in this post  what would happen if ?

It is about helping a pt and the family deal with the pt’s life threatening disease… be that diabetes, hypertension, heart failure… whatever disease that if not properly addressed could impact both the pt’s quality of life and life expectancy.

How many pts’ quality of life have been compromised by the reduction or elimination of their pain medication therapy ?  How many chronic pain pts have committed suicide because their medication was reduced or eliminated.

Is providing a pt with physical therapy, a cane, walker or wheelchair to improve the pt’s quality of life, part of  palliative care ?

what would happen if ?

I hear from pts .. nearly daily.. about their medications being pulled back, dropped altogether and/or discharged from a practice.  I read in a lot of state laws and CDC guidelines the word “PALLIATIVE” which is often aligned with the clause that exempts terminal/cancer pts from any limitations on their opiate/pain management therapy.

If you look to WHO (World Health Organization) as to their definition of Palliative care you get the following

WHO Definition of Palliative Care

Palliative care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual. Palliative care:


  • provides relief from pain and other distressing symptoms;
  • affirms life and regards dying as a normal process;
  • intends neither to hasten or postpone death;
  • integrates the psychological and spiritual aspects of patient care;
  • offers a support system to help patients live as actively as possible until death;
  • offers a support system to help the family cope during the patients illness and in their own bereavement;
  • uses a team approach to address the needs of patients and their families, including bereavement counselling, if indicated;
  • will enhance quality of life, and may also positively influence the course of illness;
  • is applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life, such as chemotherapy or radiation therapy, and includes those investigations needed to better understand and manage distressing clinical complications.

Palliative care seems to have a very broad definition and while normally associated with treating pts with cancer…there seems to be the potential to apply to pts with a large array of chronic disease states.

The CDC guidelines and/or any guidelines – while don’t carry the weight of law – they do bear the weight of creating a “standard of care”  and/or “best practices”.  To establish a MINIMUM OF CARE for pts but not to exclude care provided to the pt above and beyond the MINIMUM care.

It is common knowledge that chronic pain pts typically suffers from depression and anxiety and is at twice the risk of committing suicide.

A pt’s medical records is clinical proof of what has been tried and what has been successful.  When a prescriber start changing/reducing the pt’s medication therapy.. could that be considered a form of pt abandonment or a form of malpractice because they are deviating from what has been proven clinically successful for a particular pt.

Currently Barb’s pain management is – IMO – at a optimum level, but like everyone else… she/we are at risk of various changes that could impact that situation… PCP retiring, dying… the teaching hospital where her pain clinic is located could have a change in policies and procedures.

If her pain management is reduced.. it is obvious that her quality of life goes in the same direction… and to the same degree it has an impact on my quality of life..

There is a part of the law:


What is Loss of Companionship and Consortium?

Loss of companionship and consortium also called the loss of society, loss of conjugal fellowship, and loss of marital compatibility are all different names for the same thing. Essentially, these terms refer to the emotional sadness one goes through when an immediate family member (spouse or child) has been injured or killed. It can include the grief from the loss of sexual relations or the loss of the ability to have children. 

Under these circumstances… deviating away from therapy that has proven to optimize her quality of life… we could have a pt that is being placed at a higher risk of suicide and loss of companionship on my part..

Personally, I would have my attorney send the physician a certified letter that the palliative care provision of the law applies to Barb… that there is clinical evidence of what amount of medication that she needs to optimize her pain management and quality of life… so do anything less would constitute a failure to meet ‘best practices” and “standard of care”… a form of malpractice and pt abandonment … and if the prescriber’s actions/in-actions contributes to her committing suicide that I will file charges that he contributed to/assisted in causing her to take that action.

This could paint the prescriber into a corner … “CHECK MATE”… if he discharges her… then there is the issue of retaliation, pt abandonment and I am sure that a good attorney can think up a few other charges.

One has to ask, if a prescriber can be charged with the death of a pt that OD’s for prescribing opiates to them… why can’t they be charged equally if a pt – who the prescriber knew or should have known was at risk of  a deepening depression – if their medication was reduced or eliminated.

What I think would be quite interesting is the spouse suing the prescriber for lost of companionship because of their actions/in-actions.  This would probably only work if the pt’s pain management had been stable and went downhill because of reduction of pain management meds.


Professional moral responsibility to treat pain ?

I have started this presentation in the middle and you need to listen to about 7 minutes of it. The entire presentation is abt ONE HOUR and can be viewed in its entirety on www.youtube.com


LIFE Before Death Opium: Sinner or Saint

LIFE Before Death Opium: Sinner or Saint


Our healthcare system has evolved to a point where now they label many things as “PRE”… pre-hypertensive, pre-diabetic, pre-cancerous  each of us has a finite number of days, weeks, months years to be on this earth..  let’s admit it.. everything after BIRTH is PRE-DEATH !

When I was born.. my life expectancy was 65.. since I have passed that “bar”… my life expectancy is now in the late 70’s – early 80’s .. Every birthday that I manage to make.. my life expectancy extends somewhat.

Over those decades, I have become “dependent” on many things… food, drink, sleep, air.. and now certain medications that keep what medical science considers “normal ranges”  trying to extend my life expectancy and hopefully my quality of life.

We are seeing more and more of those suffering from subjective diseases …specially chronic pain … as their medications are being pulled back and or they are dropped all together.. if their “quantity of life”/life expectancy is worth much without a optimized quality of life that their medications use to provide them.

I have been told by friends, relatives and doctors of people who are suffering so from their untreated pain.. have exercised their final and only option to finally stop their torturous level of pain.  

Have those deaths been intentionally mis-classifed as “opiate related death” and not the real cause… basically hidden from view and/or swept under the rug. There seems to be little indignation by the relatives that their loved one was forced down that path.  Unlike those who have lost a loved one who OD’d because they suffered from addictive personality disorder and for whatever reason… their death spiral could not be stopped.

Only the chronic pain community and their relatives can stop this INSANITY that is centered in Washington DC and many state capitals. The solution is not as tragic as what some in untreated pain are having to do…  but is would be a sort of  SHARING YOUR PAIN


When GRIEF blinds the TRUTH ?

This is a “platform” of a anti-opiate group that consist mostly of family members who have lost a loved one to the mental health disease of addictive personality disorder and/or those groups who operate FOR-PROFIT substance abuse facilities. I am going to comment on this platform to show how – IMO – narrow minded, self serving and myopic their collective view point is.
call on our federal government to take the following actions:
1.Take all measures necessary to ensure that opioids and other controlled drugs are prescribed more cautiously.
The steps that the Fed/State have already taken has cause the prescribing of opiates peaked in 2012 while use/abuse of opiates and OD’s continue to climb.  The Feds (CDC) and a number of states have implemented “cookie cutter” guidelines… to foster treatment of pts with subjective diseases where there is no “medical yardstick test’ that can measure the intensity of how the disease is impacting the pt’s quality of life… only the pt can determine that.
2.FDA should take the following actions:
Prohibit marketing of opioids for conditions where risks outweigh benefits
Since all medications have some RISKS.. and some medications and all term benefits are not measurable .. think treating diabetes, hypertension, cholesterol and other diseases where quality of life and life expectancy itself cannot be determined in the short term.
Consult its advisory committee before approving  any new opioids.
To the best of my knowledge there are advisory committees involved with the approval of all new medications… although the FDA does not have to accept the recommendation of the committee to approve a new medication
Add an upper dose and a suggested duration of use on opioid labels.
Does this suggest that they don’t want chronic pain treated or if they are only interested in acute pain limitations.. why don’t they say so ?
Designate naloxone an over-the-counter drug.
Is making Naloxone an OTC medication… encouraging/condoning the abuse of opiates ? I predict that we will still have deaths because only a single dose of Naloxone will be on hand when there is a over dose .. when multiple doses will be needed to successfully revive a person who has OD’d
Ensure that abuse-deterrent opioid formulations are NOT marketed as less addictive.
What doctor would believe that abuse-deterrent opiate is less addictive… they are suppose to be able to be harder to abuse the medication via shooting up, snorting or other non-recommended administration routes.  BUT.. there is rumors out there that some have been able to circumvent the abuse deterrent in one or more opiates that include an abuse deterrent. Every time you try to make something idiot proof .. they build better idiots
3.DEA should mandate prescriber education, free of industry bias, for all registrants who intend to prescribe more than a 3-day supply of opioids.
Now they are suggesting that the DEA – a law enforcement agency – is to determine the content of prescriber education
4.HHS should immediately reduce barriers to buprenorphine treatment
They are endorsing replacing the ADDICTION to a C-II medications to the DEPENDENCY on a C-III medication. while there is an effective non-controlled medication – VIVITROL… that does not depend on the pt taking their medication daily but a shot every 28 days. If they don’t show up for their 28 day shot.. you know that they are probably going “off the reservation” as opposed to knowing/not knowing if a pt has taken their daily dose of buprenorphine and may be back on track to seriously abusing their favorite or most available substance.
5. Increase funding for evidence-based addiction treatment, especially in communities hit hardest by the epidemic.
Are they admitting that addiction is a TREATABLE DISEASE ? So are they trying to segregate pts with certain diseases that deserve treatment and others should not to be afforded treatment
6. CDC and SAMHSA should improve public health surveillance of opioid addiction and overdose deaths.
What stats can be believe from the CDC… there has been evidence that they count each drug in the toxicology of a OD as a “cause of death” … so one OD can cause stats of multiple death counts.  The CDC can’t even keep track of how many people die of the flu.. all they can give you is a probability RANGE of several tens of thousands deaths between the bottom and top of the range.
7. Incentivize states to mandate prescriber use of Prescription Drug Monitoring Programs
The PMP program is a concept developed in the late 20th century and we are using this antiquated concept/process trying to isolate 21st century criminals.  Congress passed the NASPER act http://nasper.org/  that would create a NATIONAL PMP program and was signed into law in 2005 … but .. Congress has never passed any funding for this program.  Our driver’s license system has been seriously compromised, so a determined substance abuser .. having multiple driver’s licenses… could doctor/pharmacy shop and never show up in the PMP. Right now, we have state level programs in 49 states ( Missouri has not passed a law) and maybe 45 states whose program is up and running. Some states have attempted to interconnect their PMP with other states’ PMP’s.
these anti-opiate groups fault the pharma’s for have a FOR PROFIT MOTIVE… yet this group and other groups are interwoven .. and financially supported by entities that are PROFIT DRIVEN…   Maybe this is way the use of Vivtrol is not being mentioned or endorsed .. because it may not help those entities generate as much revenue or profits.  Since a 28 day Vivitrol program could be handled by community healthcare providers.  Perhaps, when your goals are driven by grief of a loved one… you can be mislead by those who express empathy, but whose real motives are profit driven.  Sort of like “the pot calling the kettle black ” ?

Trading an addiction to an opiate.. for a dependency on a controlled medication ?

Is the use of medications like methadone and buprenorphine simply replacing one addiction with another?


In treating substance abuse… are we trying to replace an ADDICTION to a C-II opiate by creating a DEPENDENCY on a C-III medication ? Is this an admission that substance abuse is NOT CURABLE… just TREATABLE… but still involves a controlled medication.. with – according to the DEA – still  has an abuse potential.. since it is a controlled (scheduled) medication.

No. Buprenorphine and methadone are prescribed or administered under monitored, controlled conditions and are safe and effective for treating opioid addiction when used as directed. They are administered orally or sublingually (i.e., under the tongue) in specified doses, and their effects differ from those of heroin and other abused opioids.

Heroin, for example, is often injected, snorted, or smoked, causing an almost immediate “rush,” or brief period of intense euphoria, that wears off quickly and ends in a “crash.” The individual then experiences an intense craving to use the drug again to stop the crash and reinstate the euphoria.

The cycle of euphoria, crash, and craving—sometimes repeated several times a day—is a hallmark of addiction and results in severe behavioral disruption. These characteristics result from heroin’s rapid onset and short duration of action in the brain.

As used in maintenance treatment, methadone and buprenorphine are not heroin/opioid substitutes.

In contrast, methadone and buprenorphine have gradual onsets of action and produce stable levels of the drug in the brain. As a result, patients maintained on these medications do not experience a rush, while they also markedly reduce their desire to use opioids.

If an individual treated with these medications tries to take an opioid such as heroin, the euphoric effects are usually dampened or suppressed. Patients undergoing maintenance treatment do not experience the physiological or behavioral abnormalities from rapid fluctuations in drug levels associated with heroin use. Maintenance treatments save lives—they help to stabilize individuals, allowing treatment of their medical, psychological, and other problems so they can contribute effectively as members of families and of society.

How effective is drug addiction treatment?


In addition to stopping drug abuse, the goal of treatment is to return people to productive functioning in the family, workplace, and community. According to research that tracks individuals in treatment over extended periods, most people who get into and remain in treatment stop using drugs, decrease their criminal activity, and improve their occupational, social, and psychological functioning. For example, methadone treatment has been shown to increase participation in behavioral therapy and decrease both drug use and criminal behavior. However, individual treatment outcomes depend on the extent and nature of the patient’s problems, the appropriateness of treatment and related services used to address those problems, and the quality of interaction between the patient and his or her treatment providers.

Relapse rates for addiction resemble those of other chronic diseases such as diabetes, hypertension, and asthma.

Like other chronic diseases, addiction can be managed successfully. Treatment enables people to counteract addiction’s powerful disruptive effects on the brain and behavior and to regain control of their lives. The chronic nature of the disease means that relapsing to drug abuse is not only possible but also likely, with symptom recurrence rates similar to those for other well-characterized chronic medical illnesses—such as diabetes, hypertension, and asthma (see figure, “Comparison of Relapse Rates Between Drug Addiction and Other Chronic Illnesses”)—that also have both physiological and behavioral components.

Unfortunately, when relapse occurs many deem treatment a failure. This is not the case: Successful treatment for addiction typically requires continual evaluation and modification as appropriate, similar to the approach taken for other chronic diseases. For example, when a patient is receiving active treatment for hypertension and symptoms decrease, treatment is deemed successful, even though symptoms may recur when treatment is discontinued. For the addicted individual, lapses to drug abuse do not indicate failure—rather, they signify that treatment needs to be reinstated or adjusted, or that alternate treatment is needed (see figure, “Why is Addiction Treatment Evaluated Differently?”).


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