2017 in review … what killed us

Today is 02/24/2018.. who will not be here tomorrow

2016 in review … what killed us

6775 Americans will die EVERY DAY – from various reasons


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




Here is the list from the end of 2016 if interested in comparing
United States of America
from Jan 1, 2017 – Dec 31, 2017 (11:36:39 AM)

Abortion*: 1090465
Heart Disease: 613479
Cancer: 590862
Tobacco: 349505
Obesity: 306566
Medical Errors: 251098
Stroke: 132915
Lower Respiratory Disease: 142741
Accident (unintentional): 135861
Hospital Associated Infection: 98860
Alcohol: 99859
Diabetes: 76380
Alzheimer’s Disease: 93409
Influenza/Pneumonia: 55149
Kidney Failure: 42702
Blood Infection: 33417
Suicide: 42713
Drunk Driving: 33760
Unintentional Poisoning: 31713
All Drug Abuse: 24970
Homicide: 16775
Prescription Drug Overdose: 14979
Murder by gun: 11477
Texting while Driving: 5981
Pedestrian: 4993
Drowning: 3909
Fire Related: 3495
Malnutrition: 2768
Domestic Violence: 1458
Smoking in Bed: 779
Falling out of Bed: 598
Killed by Falling Tree: 149
Lawnmower: 68
Spontaneous Combustion: 0

Totals of all categories are based upon past trends documented below.



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 v 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.”



















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

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


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.


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


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

John Lester shot himself on Jan. 8, 2014.

 Anne Örtegren took her life on Jan. 5  

 Debra Bales, 52 – Civilian – January 10, 2018 – Petaluma, CA – Denied Pain Meds/Suicide

Liberty Mutual WC Carrier : just cut my husbands pain medication from 120 a month to 30

Work Comp carrier’s “utilization management” team just cut my husbands pain medication from 120 a month to 30, they call it a “weaning” process. What a joke – in 10 days next stop hospital. He broke is back in 1977 and has been in Pain Management treatment since then. Do you really think that Liberty Mutual WC Carrier and whiz bang utilization management gives a shit – I can’t even talk to them on the phone – have to go through a process – and they could still deny the appeal. What a screwed up mess this is and I thought that the new drug rules were not to effect people that are in desperate need of pain meds for chronic pain – NO ONE CARES THE CRACK DOWN JUST LOOKS GOOD FOR THEIR BOTTOM LINE.

Opioid Crisis – Dr. Stephen Ziegler interview with George Knapp

To submit a story idea to one of the ABC News shows

To submit a story idea to one of the ABC News shows

listed below, write a single page letter including your name, phone number, and address. Include photocopies of backup information. On the outside of the envelope, write “Story Idea.” If a producer is interested in your story, he/she will contact you. Here are the show addresses:

147 Columbus Avenue
New York, NY 10023

Primetime/What Would You Do?
147 Columbus Avenue
New York, NY 10023

Nightline/This Week
1717 DeSales Street NW
Washington, DC 20036

ABC World News with David Muir
47 West 66th Street, 2nd Floor
New York, NY 10023

Good Morning America
147 Columbus Avenue
New York, NY 10023

If you are submitting a LOCAL news story:

Go to ABC.com
Go to the bottom of the home page and click on “FAQ”
Click on Question #2
Click on “nationwide affiliate map”
Follow the instructions to get the website, address and phone number for your local ABC station.

Note: The Company’s long-established policy does not allow us to accept for review or consideration any ideas, suggestions, or creative materials not solicited by us or our subsidiaries. Therefore, in the event that you have submitted such content, please be advised that the submission has been forwarded to the Company’s legal department for handling.

This email has been sent to you from an outbound email account that will not accept inbound mail. Therefore, please do not respond to this email



USE THIS LINK   https://www.cnn.com/2017/08/31/health/high-dose-opioids-fda-petition/index.html

or this https://www.regulations.gov/document?D=FDA-2017-P-5396-0001

PLEASE SHARE/Copy&Paste encouraged/please ask admins first before posting in other groups/FDA deadline Weds. 2/28/18

Andrew Kolodny and PROP has submitted a petition to the FDA that could threaten to limit your access to high dose opioid medications, regardless of your doctor’s prescriptions or your medical needs. The FDA is considering this petition which would remove ultra high dose (UDHU) opioids from the market. This is a very, very serious issue and 100% participation is needed before Wednesday, February 28th, 2018, to stop this from happening. The FDA already removed Opana ER, lets not let this happen to a medication YOU or your loved ones might need. Please remember, the FDA will toss if comments appear similar, so use this as a guide.

From: Valorie Hawk/Director/C-50/Coalition of 50 State Pain Advocacy Groups -Please join your state advocacy group and work alongside your neighbors at your state and local level. https://www.facebook.com/Coalition-of-State-Pain-Advocacy-…/


1.Check out the petition to the FDA here: http://www.supportprop.org/wp- content/uploads/2014/12/ Citizen-Petition-UHDU-Opioids- 8.30.17-final-signatures-2.pdf

2.Go to https://www.regulations.gov/ comment?D=FDA-2017-P-5396-0065 to comment

3. In the large text box, enter your comments about WHY you oppose this petition and why the FDA should as well. These are some points you could make. Please tailor them to your own situation – if you copy these exactly the FDA will NOT consider them.

A. I am a chronic pain patient with ___________ (diagnosis)

B. I rely upon opioid medications to: manage my incurable pain, allow for increased function, preserve my way of life, and remain productive. Please explain how benefits outweigh risks.

If you are taking high dosage or extended release opioids, please discuss how they control your pain better/longer than other options, please be brief, clear and concise – no caps. Things you may want to include:

* benefits outweigh risks, over 95% of legitimate pain patients
do not abuse
* explain how opioid medications help(ed) you and how for
long, especially if they are/were high dosage.
* discuss function – the things you are able to do (work,
chores, travel, enjoy life, sleep) with pain relief and what it is
like (or would be like) without it. Mention if you have had to
leave your job, lost your house, your family, car, etc. Share
if you have had increased BP/pulse or other adverse health
effects if your medications have been reduced/dropped.
* discuss the non-opioid medications you have tried (and
adverse reactions) –
* explain you do not get high/euphoria
* discuss all of the treatments you have tried – for example –
PT, OT, Aqua T, Chiropractic, Osteopathic, TENs, MENs,
mindfulness, yoga, CBT therapy, biofeedback, acupuncture,
acupressure, CBD, Kratom, etc., and how they failed to
‘heal’ you or lessen your pain.
* explain you have been a model, compliant patient, and if
you have a pain contract (include how often you have UAs,
pill counts, and if you have to use one pharmacy, avoid
alcohol, etc.). Mention that it’s unlikely your condition will
approve, and the effects of time and aging will make things
* Opioids and pain management were a last resort option.

D. I always secure my medications where they cannot be
stolen, never allow others to borrow and do NOT have
excess medication.

E. These proposed regulations are not supported by any
reliable science.

* the 90 MME cutoff that defines what medications are ultra-
high dose is arbitrary
* everyone genetically metabolizes medications differently
* the CDC guidelines were written outside the rules by non-
pain management physicians, some who may have
professionally or personally profited from the outcome
* none of the petitioners are qualified or Board Certified in pain
*cancer patients need these, as well

F. Not everyone can just “swallow more pills” – *some pain
patients have conditions (e.g. nausea, esophageal
spasms) that make swallowing difficult

G. If enacted, these policies could:

* force even more doctors away from treating pain
* force more patients onto Disability, Medicare and Medicaid
* create more demand for emergency room and social
* increase the rate of expensive and possibly dangerous
* increase the rate of suicides
* possibly put many more pills into circulation

3. Fill in the information at the end
4. You may choose to be anonymous or use your name
5. Do not write anything under the category “organization”
6. Choose SUBMIT. If you get a receipt, you have been
successful! It will take a few days to see your comment


Sun says FDA again faults plant that is its key launch site for U.S. drugs

Halol manufacturing facility


After more than three years of effort and a couple of reinspections, India’s Sun Pharma has been unable to satisfy the the FDA’s expectations for its key plant.


Sun Pharma, India’s largest generic drugmaker, said that at today’s conclusion of it the FDA’s latest reinspection of its Halol plant in Gujarat, India, it was presented with a Form 483 with three observations.

“The company is committed to addressing these observations promptly,” Sun said in the announcement (PDF), adding that it continues to work closely with the agency “to enhance its GMP compliance on an ongoing basis.”

While it only received three observations this time, Sun has been been at this remediation and reconciliation effort since September 2014 when the the FDA first noted issues at the Halol facility.

While Sun has 40 manufacturing sites worldwide, Halol is the plant from which Sun launches most of its new products for the U.S., its largest market.

But new launches were cut off when the FDA in 2015 vilified the plant in a warning letter.

A reinspection in late 2016 was unable to lift the stigma. That visit resulted in 10 observations, some of which the FDA noted were repeats.

RELATED: Sun’s key plant in Halol again cited by FDA

The plant’s problems have also stymied Sun’s efforts to expand beyond the deteriorating U.S. generics market into novel drug products. Last year, Sun received a second complete response letter for novel epilepsy drug Elepsia XR (levetiracetam) that it licensed from its drug development arm SPARC. It said the application was denied after an inspection of the Halol facility.


On top of the deteriorating pricing situation for U.S. generics, this has roiled India’s top generics producer. In its latest earnings report this month, Sun reported that its U.S. finished dosage sales were down 35% to $328 million from the same quarter a year ago.

Total revenue from operations fell 16% to about $1 billion, while net profit fell to to about $57 million from about $227 million a year earlier.

House kicks off opioid legislative agenda, but appropriators will steer the money


The U.S. House of Representatives is launching an intense legislative push to try to stem the opioid epidemic as the last big healthcare initiative before the election cycle, but the priorities for the new $6 billion allocated to address the crisis will fall to Congress’ appropriators.

The House Energy and Commerce Committee is kicking off the first of three hearings to consider a bundle of bills that focus on enforcing current law, none of which would set up additional funding streams, which means the $6 billion allocated in the 2017 budget deal is it for now. That money will be distributed over two fiscal years—$3 billion annually.

The specifics of where this money will go falls to appropriators. It could cover law enforcement and Justice Department efforts as well as treatment and prevention, and those decisions are all being worked out by leaders of both chambers and both parties as they approach the March 23 deadline for the spending omnibus.

President Donald Trump renewed his designation of the epidemic as a public health emergency last month. However, he has never called on Congress for new funding.

So far, Sens. Shelley Moore Capito (R-W.Va.), Joe Manchin (D-W.Va.), Jeanne Shaheen (D-N.H.) and Maggie Hassan (D-N.H.) have been the most vocal lawmakers requesting more money to combat the epidemic. They want to change the funding formula set in the 21st Century Cures Act, which set up $1 billion in grants to be administered by the Substance Abuse and Mental Health Services Administration. Their states have been hit with alarmingly high death rates, and they want the allocation to take into consideration mortality and scarcity of treatment centers and providers.

The Cures grants will run out next year and lawmakers are looking into where the money is going and whether the grants are effective.

Providers on the front lines have told Modern Healthcare the most important guarantee is knowing that money will continue. Missouri, for example, has started a pilot medication-assisted treatment and peer support program for 600 opioid-addicted patients in St. Louis. Missouri hospitals tout success so far—75% of these 600 people have stuck to treatment—but it doesn’t start to address the scale of the program.

Jennifer Sherman, a spokesperson for the House Energy and Commerce Committee, said the panel’s policymakers are working the appropriators “to ensure the $6 billion dedicated for new resources to combat the epidemic under the Bipartisan Budget Act of 2018 goes where it is needed most.”

Sherman also named the opioid crisis as House Energy and Commerce Chair Greg Walden’s “top priority.” In the hearings that are slated to start next week, legislative proposals will include mandating training for providers on best practices for prescribing opioids and detecting addiction; adding fentanyl to the controlled substance list; and expanding the use of telehealth in treating addicts.

We are already spending some 81 billion/yr in fighting the war on drugs… and adding another 3 billion/yr will make a dramatic impact ?

IASP Statement on Opioids


Opioids are indispensable for the treatment of severe short-lived pain during acute painful events and at the end of life (e.g., pain associated with cancer). Currently, no other oral medication offers immediate and effective relief of severe pain. Although opioids can be highly addictive, opioid addiction rarely emerges when opioids are used for short-term treatment of pain, except among a few highly susceptible individuals. For these reasons, IASP supports the use and availability of opioids at all ages for the relief of severe pain during short-lived painful events and at the end of life. IASP’s 2010 Declaration of Montreal states that access to pain management is a fundamental human right. In some cases, there is no substitute for opioids in achieving satisfactory pain relief.

Despite this stated value of opioids, the role of opioids in the treatment of chronic pain has come into question. Recent open-ended and indiscriminate long-term prescribing of opioids in the United States and Canada has led to high rates of prescription opioid abuse, unacceptable death rates, and an enormous burden to the affected societies. This burden has been a consequence largely of opioid prescribing for the treatment of chronic pain, where long-term effectiveness is uncertain and where harms, especially for high doses, are clear and strongly supported by cautionary data from the affected countries. Such harms include, but are not limited to, addiction and death. Increased prescribing for chronic pain is occurring in some other developed nations, while the developing world continues to struggle with lack of opioid availability for appropriate indications.

IASP strongly advocates for access to opioids for the humane treatment of severe short-lived pain, using reasonable precautions to avoid misuse, diversion, and other adverse outcomes. At the same time, IASP recommends caution when prescribing opioids for chronic pain. There may be a role for medium-term, low-dose opioid therapy in carefully selected patients with chronic pain who can be managed in a monitored setting. However, with continuous longer-term use, tolerance, dependence, and other neuroadaptations compromise both efficacy and safety. Chronic pain treatment strategies that focus on improving the quality of life, especially those integrating behavioral and physical treatments, are preferred. IASP also strongly advocates for continued research to identify ways to minimize opioid risk and find effective alternatives to opioids for the treatment of various pain problems.


  1. This statement is based on best available evidence and expert opinion. See References below.
  2. IASP recommends adherence to and promotion of local opioid prescribing guidelines, with special attention to assessing the supportive evidence with appropriate scientific rigor.
  3. IASP recognizes the importance of comprehensive educational efforts to teach safe and appropriate opioid use.


  1. Contextual evidence review for the CDC guideline for prescribing opioids for chronic pain – United States, 2016. CDC Stacks, Public Health Publications, March 18, 2016.
  2. Injury Prevention and Control: Opioid Overdose. Prescription opioid overdose data. Centers for Disease Control, Atlanta, GA, 2016.
  3. Attal N, Cruccu G, Baron R, Haanpaa M, Hansson P, Jensen TS, Nurmikko T. EFNS guidelines on the pharmacological treatment of neuropathic pain: 2010 revision. Eur J Neurol 2010;17(9):113-e88.
  4. Baron MJ, McDonald PW. Significant pain reduction in chronic pain patients after detoxification from high-dose opioids. J Opioid Manag 2006;2(5):277-82.
  5. Bohnert AS, Valenstein M, Bair MJ, Ganoczy D, McCarthy JF, Ilgen MA, Blow FC. Association between opioid prescribing patterns and opioid overdose-related deaths. JAMA 2011;305(13):1315-21.
  6. Boscarino JA, Rukstalis MR, Hoffman SN, Han JJ, Erlich PM, Ross S, Gerhard GS, Stewart WF. Prevalence of prescription opioid-use disorder among chronic pain patients: comparison of the DSM-5 vs. DSM-4 diagnostic criteria. J Addict Dis 2011;30(3):185-94.
  7. Campbell G, Nielsen S, Bruno R, Lintzeris N, Cohen M, Hall W, Larance B, Mattick RP, Degenhardt L. The Pain and Opioids IN Treatment study: characteristics of a cohort using opioids to manage chronic non-cancer pain. Pain 2015; 156(2):231-42.
  8. Case A,Deaton A. Rising morbidity and mortality in midlife among white non-Hispanic Americans in the 21st century. Proc Natl Acad Sci USA 2015; 112(49):15078-83.
  9. Cherkin DC, Anderson ML, Sherman KJ, Balderson BH, Cook AJ, Hansen KE, Turner JA. Two-Year Follow-up of a Randomized Clinical Trial of Mindfulness-Based Stress Reduction vs Cognitive Behavioral Therapy or Usual Care for Chronic Low Back Pain. JAMA 2017;317(6): 642-4.
  10. Cherkin DC, Sherman KJ, Balderson BH, Cook AJ, Anderson ML, Hawkes RJ, Hansen KE, Turner JA. Effect of Mindfulness-Based Stress Reduction vs Cognitive Behavioral Therapy or Usual Care on Back Pain and Functional Limitations in Adults With Chronic Low Back Pain: A Randomized Clinical Trial. JAMA 2016;315(12):1240-9.
  11. Chou R, Deyo R, Devine B, Hansen RL, Sullivan S, Jarvik JG, Blazina I, Dana T, Bougatsos C, Turner J. The effectiveness and risks of long-term opioid treatment of chronic pain. Rockville (MD): Agency for Healthcare Research and Quality (US); 2014 Sep. (Evidence Reports/Technology Assessments, No. 218). Report No.: 14-E005-EF.
  12. Chou R, Deyo R, Friedly J, Skelly A, Hashimoto R, Weimer M, Fu R, Dana T, Kraegel P, Griffin J, Grusing S, Brodt E. Noninvasive Treatments for Low Back Pain 2016, Comparative Effectiveness Reviews, No. 169. Rockville (MD): Agency for Healthcare Research and Quality (US): 2016 Feb. Report No.: 16-EHC004-EF
  13. Cunningham JL, Evans MM, King SM, Gehin JM, Loukianova LL. Opioid Tapering in Fibromyalgia Patients: Experience from an Interdisciplinary Pain Rehabilitation Program. Pain Med 2016;17(9):1676-85.
  14. Dillie KS, Fleming MF, Mundt MP, French MT. Quality of life associated with daily opioid therapy in a primary care chronic pain sample. J Am Board Fam Med 2008;21(2):108-17.
  15. Dunn KM, Saunders KW, Rutter CM, Banta-Green CJ, Merrill JO, Sullivan MD, Weisner CM, Silverberg MJ, Campbell CI, Psaty BM, Von Korff M. Opioid prescriptions for chronic pain and overdose: a cohort study. Ann Intern Med 2010;152(2): 85-92.
  16. Eriksen J, Sjogren P, Bruera E, Ekholm O, Rasmussen NK. Critical issues on opioids in chronic non-cancer pain. An epidemiological study. Pain 2006;125:172-9.
  17. Finlayson RE, Maruta T, Morse RM, Martin MA. Substance dependence and chronic pain: experience with treatment and follow-up results. Pain 1986;26(2):175-80.
  18. Frank JW, Lovejoy TI, Becker WC, Morasco BJ, Koenig CJ, Hoffecker L, Dischinger HR, Dobscha SK, Krebs EE. Patient Outcomes in Dose Reduction or Discontinuation of Long-Term Opioid Therapy: A Systematic Review. Ann Intern Med 2017;167(3):181-91.
  19. Goldenberg DL, Clauw DJ, Palmer RE, Clair AG. Opioid Use in Fibromyalgia: A Cautionary Tale. Mayo Clin Proc 2016;91(5):640-8.
  20. Gomes T, Mamdani MM, Dhalla IA, Paterson JM, Juurlink DN. Opioid dose and drug- related mortality in patients with nonmalignant pain. Arch Intern Med 2011;171(7):686-91.
  21. Han B, Compton WM, Blanco C, Crane E, Lee J, Jones CM. Prescription Opioid Use, Misuse, and Use Disorders in U.S. Adults: 2015 National Survey on Drug Use and Health. Ann Intern Med 2017;167(5):293-201.
  22. Hooten WM, Townsend CO, Sletten CD, Bruce BK, Rome JD. Treatment outcomes after multidisciplinary pain rehabilitation with analgesic medication withdrawal for patients with fibromyalgia. Pain Med 2007;8(1): 8-16.
  23. Kamper SJ, Apeldoorn AT, Chiarotto A, Smeets RJ, Ostelo RW, Guzman J, van Tulder MW. Multidisciplinary biopsychosocial rehabilitation for chronic low back pain. Cochrane Database Syst Rev 2014(9):
  24. Noble M, Treadwell JR, Tregear SJ, Coates VH, Wiffen PJ, Akafomo C, Schoelles KM. Long-term opioid management for chronic noncancer pain. Cochrane Database Syst Rev 2010(1):
  25. Palmer RE, Carrell DS, Cronkite D, Saunders K, Gross DE, Masters E, Donevan S, Hylan TR, Von Kroff M. The prevalence of problem opioid use in patients receiving chronic opioid therapy: computer-assisted review of electronic health record clinical notes. Pain 2015;156(7):1208-14.
  26. Paulozzi LJ. CDC Grand Rounds: Prescription Drug Overdose, a U.S. Epidemic Morbidity and Mortality Weekly Report (MMWR), 2012; 61(01);10-13.
  27. Richmond H, Hall AM, Copsey B, Hansen Z, Williamson E, Hoxey-Thomas N, Cooper Z, Lamb SE. The Effectiveness of Cognitive Behavioural Treatment for Non-Specific Low Back Pain: A Systematic Review and Meta-Analysis. PLoS One 2015;10(8):e0134192.
  28. Schaafsma F, Schonstein E, Whelan KM, Ulvestad E, Kenny DT, Verbeek JH. Physical conditioning programs for improving work outcomes in workers with back pain. Cochrane Database Syst Rev 2010(1):Cd001822.
  29. Sjogren P. Epidemiology of chronic pain and critical issues on opioid use. Pain 2011;152(6): 1219-20.
  30. Toblin RL, Mack KA, Perveen G, Paulozzi LJ. A population-based survey of chronic pain and its treatment with prescription drugs. Pain 2011;152(6):249-55.
  31. Vowles KE, McEntee ML, Julnes PS, Frohe T, Ney JP, van der Goes DN. Rates of opioid misuse, abuse, and addiction in chronic pain: a systematic review and data synthesis. Pain 2015;156(4): 569-76.

Benzodiazepine Harms Overlooked, Especially in Older Adults


As attention remains focused on opioid abuse, another drug epidemic rages outside the spotlight: inappropriate prescription of benzodiazepines.

In an editorial published in the February 22 issue of the New England Journal of Medicine, Anna Lembke, MD, Jennifer Papac, MD, and Keith Humphreys, PhD, from Stanford University School of Medicine in California, point out that from 1996 to 2013, the number of adults who filled a benzodiazepine prescription rose from 8.1 million to 13.5 million, an increase of 67%. During roughly the same time (1999-2015), deaths from benzodiazepine overdose increased from 1135 to 8791.

“Despite this trend, the adverse effects of benzodiazepine overuse, misuse, and addiction continue to go largely unnoticed,” they write.

Concurrent opioid use figured in three quarters of the overdoses, “which may explain why, in the context of a widely recognized opioid problem, the harms associated with benzodiazepines have been overlooked,” the editorialists state. They cite data showing that coprescription rates nearly doubled between 2001 and 2013, going from 9% to 17%.


Of particular concern is benzodiazepine use among the elderly, who are especially vulnerable to adverse effects, including an increased risk for falls, fractures, motor vehicle accidents, impaired cognition, and dementia. Professional societies in several countries, including the American Geriatrics Society, have issued guidelines recommending against prescribing benzodiazepines to these patients, as has the Choosing Wisely International campaign, which aims to reduce inappropriate and low-value care.

Nevertheless, “[p]rescribing to older adults continues despite decades of evidence documenting safety concerns, effective alternative treatments, and effective methods for tapering even chronic users,” Donovan T. Maust, MD, MS, and coauthors wrote in the Journal of the American Geriatric Society in 2016. Other researchers have found that clinicians often are unaware of the dangers these drugs pose to seniors, or believe they have no other therapeutic options.

Now a new observational study of older adults in the United States, Canada, and Australia confirms that, despite a modest decline in benzodiazepine prescriptions in this population, “use remains inappropriately high — particularly in those aged 85 and older — which warrants further attention from clinicians and policy-makers,” the authors write.

Jonathan Brett, MBBS, from the Medicines Policy Research Unit at the University of New South Wales in Sydney, Australia, and colleagues published their findings online February 12 in the Journal of the American Geriatric Society.

The authors used prescription claims data from the US Department of Veterans Affairs (VA), the Ontario (Canada) Drug Benefit Program, and the Australian Pharmaceutical Benefits Scheme to analyze annual incident and prevalent benzodiazepine use among people 65 years of age or older between January 2010 and December 2016. The entire cohort included 8,270,000 people.

They observed a significant and linear decline in prevalent benzodiazepine use, defined as people with at least one prescription claim for a benzodiazepine during a given calendar year, in all three countries during the period studied. In the United States, it declined from 9.2% to 7.3%; in Ontario, Canada, it declined from 18.2% to 13.4%; and in Australia, it declined from 20.2% to 16.8%.

Incident use, defined as a new prescription in a given year for someone with no previous history of benzodiazepine use, also declined in the United States, going from 2.6% to 1.7%, and in Ontario, going from 6.0% to 4.4%. In Australia, incident use changed only slightly and nonsignificantly, going from 7.0% to 6.7%.

In all three countries, rates of incident and prevalent use were highest among women, Brett and colleagues write. In Australia and Ontario, prevalent use was highest among patients 85 years of age or older, but “decreased with advancing age in the U.S. VA population.”

 The observed decreases in prescriptions “are likely to be in response to safety concerns and lack of evidence of effectiveness,” the authors write.
 Still, despite these “modest changes,” and “in spite of consistent messaging about the hazards of using benzodiazepines in this population, the rates of benzodiazepine use in older adults remain high,” perhaps related to a tendency by clinicians and patients alike to minimize the risk these drugs pose.
 The finding of high use among the oldest patients in Canada and Australia was “particularly troubling,” the authors add, because of the greater potential for harm in this age group.
 They also express concern that clinicians may be prescribing “Z-drugs,” agents such as zopiclone and zolpidem, instead of benzodiazepines, in a mistaken belief that those products are safer.
 One way to begin reducing benzodiazepine prevalence might be to limit the conversion of new to chronic use by “explicitly limiting the duration of new prescriptions and not routinely providing repeat prescriptions,” the authors suggest. “For people who have been using benzodiazepines for a long time, a discussion about the risks and benefits of continued therapy and attempts to reduce the dose gradually might be the best strategy.”
 Lembke and colleagues also emphasize the need for discussions about tapering, and note numerous parallels between patterns of benzodiazepine and opioid use: “Despite the many parallels to the opioid epidemic, there has been little discussion in the media or among clinicians, policymakers, and educators about the problem of overprescribing and overuse of benzodiazepines and z-drugs, or about the harm attributable to these drugs and their illicit analogues,” they write.
 If measures designed to discourage people from using opioids divert them to benzodiazepines instead, “[i]t would be a tragedy,” Lembke and colleagues conclude in their editorial. “We believe that the growing infrastructure to address the opioid epidemic should be harnessed to respond to dangerous trends in benzodiazepine overuse, misuse, and addiction as well.”
 The authors have disclosed no relevant financial relationships.
 J Am Geriatr Soc. Published online February 12, 2018. Abstract
 N Engl J Med. 2018;378:693-695. Full text
Interesting the time frames they looked at  among people 65 years of age or older between January 2010 and December 2016 . In Jan 2011 the first baby boomer turned 65 and 10,000/day turn 65 since then and
use remains inappropriately high — particularly in those aged 85 and older this is the FASTEST growing segment of our population.. even if percentages remain the same… the raw numbers are going to increase..

Despite this trend, the adverse effects of benzodiazepine overuse, misuse, and addiction continue to go largely unnoticed,” they write. Concurrent opioid use figured in three quarters of the overdoses, “which may explain why, in the context of a widely recognized opioid problem

So there is little/few OD’s from benzo alone… so they have to put into the equation that opiates were involved… again … no suggestion that these OD could have been intentional as in SUICIDES ?  Is this another study that culled the data and the time frames to prove a preconceived conclusion ?

Lawmakers, Pharmacists Meet with CVS over Regulation of Pharmacy Benefit Managers


LITTLE ROCK, Ark. – Hundreds of pharmacists and patients from every corner of the state spilled out of the Old Supreme Court Room at the capitol Wednesday to fight for change. 

The nearly 750 pharmacies in Arkansas noticed cuts to their drug reimbursement rates at the beginning of the year. They have been working with lawmakers ever since to regulate who they say is to blame: pharmacy benefit managers (PBMs).

“This room is packed because this is an Arkansas issue,” Lt. Gov. Tim Griffin told the crowd. “This is every household in Arkansas. We don’t have a healthy market. We don’t have healthy competition. What we have is dysfunction because of oversized players who are basically helping themselves at your expense.”

The Arkansas Pharmacists Association obtained records of more than 270 popular drugs in the state and found CVS pays itself at least $60 per prescription more than it pays pharmacies.  

“This is an example of blatant self-dealing,” CEO Scott Pace told the crowd. 

Pace pointed to two cases in particular. While Arkansas pharmacies received about $28 for 30 tablets of Aripiprazole, a medication to treat depression, CVS received $512. The other showed the state’s pharmacists received about $909 for 20 tablets of Temozolomide, a cancer treatment. CVS received nearly $4,000. 

“When the fox guards the hen house, all sorts of games can be played and in Arkansas with the PBMs, they have been,” Pace said. “They operate behind a curtain of secrecy.”

The CEO has been working with lawmakers on the legislation to regulate these PBMs, giving the state insurance department oversight of them. 

Pace said they have trimmed the resolution from 14 to seven pages, which CVS saw for the first time Wednesday morning right before the press conference. He had another meeting scheduled with CVS representatives at 4 p.m. at the capitol. 

The Pharmaceutical Care Management Association, who represents PBMs across the country, released the following statement on the proposed Arkansas legislation: 

“This resolution would raise prescription drug costs for Arkansas’s patients, employers, state government, and taxpayers and do nothing to improve the quality of pharmacy benefits. The state should be encouraging market-based solutions to reduce drug costs, not giving special protections to the drugstore lobby.”

Arkansas pharmacists argue PBMs have forced them to cut hours and jobs, even consider closures in the near future. 

“They say it’s proprietary, but it’s affecting my business every day that I love,” said Mike Smith, the owner of Rose Drugstore in Russellville. “We are the boots on the ground. We are the ones with all the customers. We have been serving families for generation after generation that we need to take care of. We would like to have a reasonable, fair reimbursement on a level playing field.”

Gov. Asa Hutchinson plans to call a special session on this issue once lawmakers wrap up the fiscal session.

St. Rep. Michelle Gray, R- Melbourne, who is sponsoring the PBM legislation on the House side, is adamant about her colleagues addressing the issue immediately during the fiscal session. However, Gray said a meeting with Hutchinson Wednesday morning convinced her to back off.

“He assures me that this bill, which we are still working to finalize to make sure that there are no unintended consequences, will be on the special call,” Gray told the crowd. “He looked me in the eyes, and I have to trust that. If I can’t trust my governor to do what he says he’ll do, I might as well just pack up and go home.”

Rep. Gray and the legislation’s sponsor on the Senate side, St. Sen. Ron Caldwell, R-Wynne, said they would not have been able to act this fast without the help of their colleagues, pharmacists, patients and other community members across the state. 

 After CVS cuts reimbursement to independent pharmacies via their PBM ( Caremark )… then they send out solicitation letters to these same independents inquiring if they want to sell their stores to CVS Health.
For those of you who remember your history about Standard Oil.. where they would go into a area and sell gasoline below cost until all the competition had gone out of business and then Standard Oil would raise the price of the gasoline they sold above what it was before they entered the market.  That anti-competitive actions caused the Sherman Antitrust Act to be passed.
The PBM came into existence in 1969-1970 and they have never been transparent in how they operate financially. CVS Health/Caremark is just one of the many “bad actors”… here is a recent law suit where Anthem claims that Express Scripts – maybe the largest of the PBM’s… failed to share rebates on medications from the Pharmas  http://www.modernhealthcare.com/article/20160321/NEWS/160329992
No automatic alt text available.
%d bloggers like this: