First 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
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In a randomized, double-blind, placebo-controlled clinical trial—the gold-standard design—a component of marijuana called cannabidiol (CBD) reduced seizures in children with a rare and devastating form of epilepsy.
The results, published in the New England Journal of Medicine, provide the first solid evidence that marijuana can be used to treat epilepsy, something some patient groups and advocates have argued for years. It also adds to mounting data supporting the medicinal value of the controversial plant. The Drug Enforcement Administration currently lists marijuana as a Schedule I drug, a type of drug with no accepted medical use but a high potential for abuse.
A landmark review of marijuana research, released in January by the National Academies of Science, Engineering, and Medicine, concluded that marijuana can effectively treat chronic pain in some patients. But for other conditions, including epilepsy, the data is still inconclusive. Earlier trials on epilepsy, for instance, were small or suboptimal and provided mixed results.
For the new high-quality trial, neurologist Orrin Devinsky of New York University Langone Medical Center and colleagues enrolled 120 US and European kids, aged 2 to 18 (average age of 9.8). All of the kids had a rare form of epilepsy, called Dravet syndrome, and suffered from drug-resistant seizures. Dravet syndrome is a life-long intractable condition generally caused by a mutation in the SCN1A gene. This gene is critical for proper electrical signaling in the brain because it contributes to voltage-gated sodium ion channels in neurons. Dravet syndrome affects only about one in 16,000 people. Between 10 and 20 percent of those affected don’t survive to adulthood.
The 120 participants in the study were, on average, taking three drugs to try to control their seizures. For the first four weeks of the trial, the researchers tracked each participant’s seizure frequency as a baseline. The kids were then randomly assigned to take either CBD—a non-psychoactive component of marijuana taken as an oil—or a placebo for 14 weeks along with their normal drug regimen. The kids and their caretakers didn’t know if they were taking CBD or a placebo.
In the end, the group of kids taking CBD saw their average number of convulsive seizures drop from 12.4 per month to 5.9. The placebo group’s average only dropped from 14.9 to 14.1 seizures per month. Parsing the data further, the researchers found that 43 percent of those taking CBD saw their seizure rate at least halved, while only 27 percent of the placebo group saw the same. Three of the participants taking CBD became completely free of seizures, but none in the placebo group did. Caregivers were also nearly twice as likely to report that the participant’s overall condition improved while taking CBD compared with placebo.
But these benefits had costs. Ninety-three percent of those taking CBD reported side effects, while only 75 percent of placebo participants made similar reports. The most common side effects reported in the CBD group (and at much higher rates than the placebo group) were sleepiness, diarrhea, and loss of appetite. Other side effects included fatigue, vomiting, raised body temperature, lethargy, upper respiratory tract infections, and elevated liver enzymes. Eight participants taking CBD withdrew from the trial due to the side effects, as did one in the placebo group.
But some of the side effects may have been due to drug combinations, not CBD alone. For instance, kids in the CBD group who were also taking the epilepsy drug valproate were the only ones to experience liver problems as a side effect.
The researchers note that some of the side effects had the potential to “unblind” participants, clueing them in to their treatment group. But when the researchers did extra analysis of the data from the kids that seemed to benefit from CBD, there was no link between improvement and common CBD side-effect reporting. This hints that those participants may not have figured it out.
Still, the authors concluded that they’ll need more data to determine the long-term efficacy and safety. But the trial definitely showed that CBD reduced seizures in kids with Dravet syndrome.
The trial was sponsored by GW Pharmaceuticals, which has branded its CBD oil Epidiolex. The company has already received a “Fast Track” designation from the Food and Drug Administration to hasten its approval process, which will begin later this year. Currently there are no FDA-approved drugs specifically for Dravet syndrome.
“This trial represents the beginning of solid evidence for the use of cannabinoids in epilepsy,” Samuel F. Berkovic, of the Epilepsy Research Centre at the University of Melbourne, wrote in an accompanying editorial. “After an era dominated by anecdote and obfuscated by medicolegal issues and emotionally infused debate, more scientific studies are under way.”
NEJM, 2017. DOI: 10.1056/NEJMoa1611618 (About DOIs).
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http://www.sun-sentinel.com/news/florida/fl-reg-cocaine-surge-fueling-overdoses-20170523-story.html
Cocaine is making a comeback in South Florida.
Colombian cocaine production is at a record high, and traffickers are bringing the drug into the southern half of the Sunshine State more now than in the last decade, Drug Enforcement Administration officials say.
While Americans turned their attention to confront an opioid epidemic, Colombia has been producing more cocaine than at the height of the Miami drug wars in the 1980s, they say.
“There is a mountain of cocaine, much of it is likely headed our way,” said Justin Miller, intelligence chief for the DEA’s Miami field division. “But we are already seeing these drug combinations, and cocaine deaths are already going up significantly.”
Generally, 90 percent of the cocaine seized in the U.S. is traced back to Colombia, which already has tripled production over the past few years, Miller said.
Florida’s Customs and Border Protection says it had slightly fewer seizures but still confiscated 61 percent more cocaine — nearly 9,500 pounds — last year over the prior year.
Because of the time lag between drug production and distribution, the full impact has just begun to hit the U.S., say DEA officials.
Overdose deaths related to the white powder are at their highest since 2007 in Florida, according to the state Medical Examiner Commission. Cocaine overdose deaths climbed year over year from 2012 to 2015, the latest figures available, rising from 1,318 to 1,834 deaths.
And South Florida saw 614 overdose fatalities in Broward, Miami-Dade and Palm Beach counties in 2015 — a 29 percent increase over the prior year.
Cocaine was second only to fentanyl — a cheap, synthetic painkiller — in contributing to Florida overdose deaths in the first half of the last year, medical examiner records show.
Authorities predict the boom in the production and availability of cocaine will lead to even more overdose deaths, especially when the drug is combined with other narcotics like heroin.
Cocaine production has surged since October 2015 when the Colombian government stopped aerial spraying of herbicides over coca fields used to make cocaine, Miller said. The Colombian government ended the decadeslong program over health concerns.
“The aerial spraying worked quite well,” said Richard Mangan, a former DEA agent and Florida Atlantic University criminal justice professor. “But there was a lot of pushback after a while to the damage it was doing to legitimate crops, the damage it was doing to people.”
But even before the program ended, DEA reports indicated the Revolutionary Armed Forces of Colombia, more commonly known as FARC, encouraged farmers to plant more coca ahead of the government’s peace agreement with the rebel group, signed last November, according to a report this year from the U.S. Department of State.
At the same time, the Colombian government cut back operations to uproot coca fields in FARC-controlled territory while farmers used blockades and improvised explosive devices to limit access to fields, according to the report.
The DEA estimates Colombia produced 710 tons of pure cocaine last year, or enough to fill about 18 semitrucks.
“We’ve never seen cocaine production at these numbers, which tells you there is more cocaine being produced now than at the height of the Medellin and Cali cartels,” Miller said. “That’s significant.”
Not all of that cocaine heads to the U.S., but the bulk of it does, he added.
The increase is already driving down prices in Miami, and more generally, in South Florida, Miller said.
One kilo — about 2.2 pounds — of pure cocaine was worth between $28,000 and $35,000 two to three years ago, he said. Today, the same amount is worth $26,000 to $28,000.
On the streets of Miami, a gram sells for between $50 and $80 these days, Miller said.
South Florida long ago drew national attention over cocaine problems.
On July 11, 1979, two men stepped out of a white Ford van in broad daylight and gunned down a pair of men at the Dadeland Mall in Miami-Dade. The bloody execution was tied to Colombian drug lord Pablo Escobar, his Medellin cartel and the drug trade in South Florida.
The incident marked the beginning of the era of the “cocaine cowboys.”
Over the next decade, South Florida became the main artery for cocaine shipments heading for U.S. markets. Cocaine and cash flooded the streets. Drug dealers walked into banks with bags full of cash, and Colombian drug violence spilled over into American cities as criminal organizations fought for control.
But unlike the days of Escobar, today’s cocaine producers are more decentralized, in large part due to government efforts to take down large-scale criminal organizations.
“Now you have these smaller cartels, they don’t want to run for Congress like Escobar or run TV stations like the Cali cartel, they want to remain low profile,” Mangan said.
Colombian criminal organizations still have ties to South Florida to help launder cash, but remain smaller and less violent than during the heyday of the Miami drug wars.
Often Colombian producers sell their product wholesale to drug traffickers in the Caribbean, who skip from island to island by air and sea, evading patrols in the Gulf of Mexico and offloading their products in South Florida and other destinations, Miller said.
Miami and Orlando remain a point of arrival for cocaine shipped from Colombia, though more cocaine is trafficked over the U.S. border with Mexico than anywhere else, according to DEA reports.
Traffickers today are sneaking cocaine into South Florida on cheap speedboats, shipping containers and commercial flights, DEA reports show.
In the last decade, traffickers also have begun using semi-submersible ships designed to be barely visible on the ocean’s surface. Underneath the water hide hollow containers filled with drugs and manned by crews of three to four people, Mangan said.
“Unless you are right on top of it, it is almost impossible to detect,” he said.
Cocaine overdose deaths peaked in the state in 2007, declined with the Great Recession and are again on the rise, said Jim Hall, epidemiologist for Nova Southeastern University.
“I think all the attention we have given to opioids might give the impression that cocaine is a safer drug,” Hall said.
Last August a 28-year-old Lake Worth resident died from a fatal combination of cocaine and fentanyl, according to a medical examiner report.
Sterling Redwine was a heroin addict in recovery, but died with a crack pipe in his hand. His mother, Wendy Fields, thinks he used cocaine to avoid relapsing on heroin, she said.
“He did not want to turn back to heroin, however for whatever reason, he felt he had to have something that day. Unfortunately, what he had was also cut with fentanyl,” Fields said.
Across the state, more and more users are “speed balling” cocaine and opioids like fentanyl, metastasizing the number of deaths amid the opioid epidemic.
Of the 1,144 cocaine-related overdose deaths statewide in the first half of last year, 88 percent involved at least one other drug, Hall said.
Often drug users don’t know what they are taking. Heroin can be cut with drugs such as fentanyl, xanax and cocaine. The DEA has also analyzed samples of cocaine-fentanyl combinations in the last few years, according to a report.
And Florida likely will see more overdose deaths as potency and availability increases, Hall said.
“Substance abuse in this stage of the 21st century is more hazardous, more dangerous, more addictive and more deadly than at any other point in our lifetimes,” Hall said.
I bet the SOUTH FLORIDA is glad that AG Pam Bondi “ran all the oxy docs” out of Florida a couple of years back. I wonder what she is going to do about all the illegal Cocaine traffickers coming to South Florida… I doubt if they will set up store fronts like the “oxy docs” and doubtful they will create a “paper trail” like a medical office.. and one other important factor… odds are they will be ARMED TO THE TEETH and not concerned about shooting those in law enforcement that are interfering with their business plan and profits..
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By Pat Anson, Editor
A Washington-based legal firm is calling for more openness and transparency by the Centers for Medicare and Medicaid Services (CMS) as it establishes new rules that are likely to limit access to opioid pain medication for millions of Medicare patients.
“While opioid abuse undoubtedly presents a serious public health issue, CMS should take steps to foster transparency and avoid harming patients and providers alike by offering them a meaningful opportunity to participate in the development of policies that could limit pain management,” wrote Michelle Stilwell, a staff attorney for the Washington Legal Foundation (WLF), a non-profit law firm that generally supports business groups and companies in litigation against government agencies.
At issue are mandatory rules being developed by CMS for 2018 that would bring Medicare opioid policies into alignment with the “voluntary” prescribing guidelines released last year by the Centers for Disease Control and Prevention.
CMS wants to set a daily ceiling on opioid pain medication at 90mg morphine equivalent dose (MED). If a dose exceeds that level, Medicare insurers would be expected to impose a “soft edit” that would automatically block the prescription from being filled until the edit is overridden by a pharmacist. Pharmacies would have to check with the prescribing physician to make sure the higher dose is warranted.
Stilwell wrote on the WLF’s blog that patients and providers were given little opportunity to see and comment on a Call Letter announcing the rule changes, while the insurance industry was.
“CMS’s changes will inevitably lead to even tighter restrictions on opioid prescriptions—which directly affects the patient community. Many patients, doctors, and healthcare providers already complain that rules designed to prevent the improper prescribing of opioids are complicating patients’ legitimate access to appropriate medication,” said Stilwell.
“But instead of directing this Call Letter at the affected patient community and granting that community an adequate opportunity to comment on the new opioid overutilization criteria, CMS directed it only to insurance companies. In reality, opioid consumers and providers are given little to no notice or opportunity to comment.”
As PNN has reported, the insurance industry appears to have played a major role in drafting the CMS rules, which contains some of the same strategies suggested in a “white paper” prepared by the Healthcare Fraud Prevention Partnership (HFPP), a coalition of insurers, law enforcement agencies and government regulators formed to combat insurance fraud. The HFFP met to discuss the white paper in a “special session” last October that was not open to the public.
Stilwell said the HFFP “operates largely in the dark” and may be in violation of the Federal Advisory Committee Act (FACA), which requires open meetings for all federal advisory panels. This week the WLF filed a Freedom of Information Act Request seeking more information about HFPP membership and meetings.
Major insurers such as Aetna, Anthem, Blue Cross Blue Shield, Cigna, Highmark, Humana, Kaiser Permanente and the Centene Corporation participate in the HFPP.
“It is time for CMS to bring HFPP into compliance with FACA requirements. Doing so will reduce the risk that a court may invalidate any CMS policies found to have been adopted at least in part in reliance on HFPP recommendations. It would also enable any patients affected by changes in opioid reimbursement policies to play a role in the development of HFPP’s opioid-related recommendations,” Stilwell wrote.
CMS contracts with dozens of insurance companies to provide health coverage to about 54 million Americans through Medicare and nearly 70 million in Medicaid. CMS policies often have a sweeping impact throughout the U.S. healthcare system because so many insurers and patients are involved.
In addition to limits on opioid prescribing, CMS plans to implement an opioid Overutilization Monitoring System (OMS) to identify physicians who regularly prescribe high doses of opioids. Patients who receive opioids from more than 3 prescribers and more than 3 pharmacies during a 6 month period would also be red-flagged. Insurers would be required to identify pharmacies, doctors and patients who do not follow CMS policies, and could potentially drop them from Medicare coverage and their insurance networks.
FDA to ‘Take Whatever Steps We Can’ to Stop Opioid Abuse
Meanwhile, the new commissioner of the Food and Drug Administration is calling on the agency to “take whatever steps we can” to ensure that opioids are only prescribed under “appropriate clinical circumstances.”
In a blog post on the FDA website, Scott Gottlieb, MD, announced the formation of an Opioid Policy Steering Committee to develop additional tools and strategies the FDA can use to prevent opioid abuse.
“Patients must be prescribed opioids only for durations of treatment that closely match their clinical circumstances and that don’t expose them unnecessarily to prolonged use, which increases the risk of opioid addiction,” he wrote.
Gottlieb wants the committee to focus on three areas:
scott gottlieb, MD
Gottlieb cited some questionable statistics to dramatize the extent of the opioid prescription problem.
“In 2015, opioids were involved in the deaths of 33,091 people in the United States. Most of these deaths – more than 22,000 (about 62 people per day) – involved prescription opioids,” he wrote.
The new FDA commissioner may want to check his facts. As PNN has reported, a news release last December from the White House Office of National Drug Control Policy stated that 17,536 Americans died in 2015 from overdoses involving prescription opioids.
A CDC news release a few days later provided an an even lower estimate; that over 12,700 Americans died from pain medications in 2015.
When asked to explain the discrepancy, PNN was given a third estimate by the CDC, which put the number of deaths involving prescription opioids at 15,281 in 2015.
Gootlieb’s post links to a CDC website that provides a fourth estimate, which is based on a “standard analysis approach” that combines all overdoses caused by natural, semi-synthetic, and synthetic opioids. Such an approach is misleading, because it counts overdoses caused by illicit fentanyl as prescription drug deaths.
“Unfortunately, information reported about overdose deaths does not distinguish pharmaceutical fentanyl from illegally-made fentanyl,” the CDC said, which Gottlieb neglected to mention in his blog post.
One needs to read the warnings in some of these conversion programs… that by and large.. they are AT BEST… FUZZY MATH… unless you are talking about Methadone conversions… then they are FUZZIER MATH. Any healthcare professional that believes that opiate conversions are BLACK & WHITE… is – IMO – a healthcare professional that should not be trusted in dosing opiates.
And these tables don’t even consider the CYP450 enzyme system .. which can cause a person to metabolize opiates fast/slower that “normal”.. it is estimated that 20%-30% of pts are fast/ultra fast opiate metabolizers.. They also ignore pts with GI issues that will affect absorption.. like IBS with/without diarrhea, short gut, crohn’s disease and others issues.
IMO, this is just another example of our healthcare system moving toward treating pts/disease(s) by a simple check lists and/or “cookie cutter methodology”.. which means that those pts that are at 10%-20% at each end of the “bell curve” will end up getting medically “screwed” by the system. Remember, nearly all health insurance companies are publicly held FOR PROFIT companies… their primary interest is to the stock market and their stock holders. Policy holders are just a means to generate revenue and if they can place obstacles – prior authorization, declaring treatment is experimental, first fail step therapy and other tactics to “deny care that should be covered”. Pts need to be made aware that everything denied by a insurance companies can be APPEALED and the majority of pts that go thru their entire appeal process will get their treatment approved. They don’t have to tell you about their appeal process, unless you ask, then they have to provide their appeal process is some form of printed format – could be a website.
Single-dose studies: Early studies determining equianalgesia were based on single doses, not chronic administation.8 Due to drug accumulation, half-life, tolerance, and active metabolites, subsequent chronic administration studies often vary greatly from the original single-dose data.
Bidirectional conversions: When converting between certain opioids, the direction of conversion (eg, morphine to hydromorphone versus hydromorphone to morphine) will produce a different conversion ratio. These bidirectional differences are not captured in a traditional equianalgesic table.5,7
Dose-dependent conversions: The conversion ratio of certain opioids can be dependent on the dose of the original opioid. In the case of converting morphine to methadone, methadone has a relative potency of 4:1 at lower morphine doses, but becomes much more potent (12:1) in patients converting from very high morphine doses.5,7
Cross-tolerance: Many references recommend a cross-tolerance reduction between 25-50% when converting between unlike opioids.9 In patients with very high opioid requirements, the difference between 25% and 50% can be a very significant discrepancy.
Equianalgesic Discrepancies: There are significant discrepancies in equianalgesic dosing tables, with even FDA-approved drug labels not demonstrating agreement.10 These discrepancies are a factor of both references using old data (single-dose studies) and an overall paucity of data in chronic dosing studies.
Patient-specific factors: No equianalgesic table is able to take into account patient-specific factors — primarily hepatic function, renal function, and age. Opioid metabolism and excretion do differ among the opioids; therefore, alterations in drug disposition will alter the relative potencies of different opioids.
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Order Dismissing Charge – Ibsen
Dismissal With Prejudice: When a lawsuit is dismissed with prejudice, the court is saying that it has made a final determination on the merits of the case, and that the plaintiff is therefore forbidden from filing another lawsuit based on the same grounds.
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May 25 (1 day ago)
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Hello
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Microsoft Dot NET Web Dev */* Certified Web App Developer Microsoft
I received the email while I was out running errands on May 25, 2017 and as soon as I got home I DELETED the post on my blog, Face Book, Twitter that I could find and/or remembered. The blog I posted appeared to be sent by Mark Ibsen and I posted the link to the order dismissing charge *.pdf.
Apparently to some of Dr Ibsen’s close supporters … deleting the posts was not sufficient… I should make a RETRACTION… UN-RING THE BELL… I just reposted what was sent to me… The only thing that I added was the definition of what “Dismissal With Prejudice” meant… I believed this email was from Dr Ibsen… and I did not make any comments or statements about this was – OR WAS NOT – concerning Dr Ibsen’s case with the Medical Licensing Board in MT. Apparently others believed that I should have KNOWN that the case addressed in this email was from a different law firm and a different judge… than the one dealing with the Medical Licensing Board issues.
If any of you have forwarded/shared the original post, please do the same with this post. I do not appreciate being accused of postings/sharing FALSE STATEMENTS…
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http://www.wfmj.com/story/35506202/heroin-epidemic-can-it-be-stopped-at-the-source
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https://www.msn.com/en-us/news/us/dea-misled-congress-about-honduras-shootings/ar-BBBuIi2
Among the most serious findings in the 329-page report released Wednesday was that the DEA long clung to unsubstantiated assertions that occupants of a passenger boat initially fired on a U.S.-Honduran anti-drug unit, prompting officers to return fire in the chaotic May encounter that left four dead, including a 14-year-old boy.
“Not only was there no credible evidence evidence that the individuals in the passenger boat fired first, but the available evidence places into serious question whether there was any gunfire from individuals in the passenger boat at any time,” the report stated.
Justice investigators found no evidence to contradict prior DEA claims that none of the U.S. agents discharged their weapons. However, investigators determined that a DEA agent “directed” a Honduran helicopter gunner to open fire on the river boat.
“The (helicopter) door gunner then fired multiple rounds at the passenger boat,” the report stated. “Honduran authorities later determined that four individuals in the passenger boat had been killed and four more injured. No evidence of narcotics was ever found on the passenger boat.”
And even as information emerged that conflicted with the DEA’s account of the incident – that the water taxi had no connection to illegal drug operations – DEA officials “remained steadfast with little credible corroborating evidence that any individuals shot by the Hondurans were drug traffickers” attempting to retrieve a shipment of seized cocaine that was being held on a nearby vessel occupied by U.S. and Honduran drug agents.
Much of the conflicting evidence was contained on a detailed video recording of the incident, which investigators concluded had been either disregarded or ignored by DEA officials.
The DEA did not launch a formal review of the encounter until weeks later when public reports of the civilian deaths surfaced, “resulting in mounting pressure from (Justice) leadership and congressional inquiries.”
Instead, U.S. officials largely relied on a Honduran government account that almost entirely absolved both Honduran and American law enforcement of any misconduct during the in the raid in the country’s Mosquitia region. Honduran investigators, however, did not question DEA agents or examine their weapons at the time.
“The resulting (U.S.) investigation was little more than a paper exercise,” the inspector general concluded, adding that the DEA review included no interviews and omitted key facts, including the U.S. agent’s order for the Honduran machine-gunner to open fire on the boat. While such DEA reviews require weapons inspections, none were conducted.
Nevertheless, the DEA provided assurances to then-Attorney General Eric Holder, while preparing for a 2014 Senate Judiciary Committee hearing, that the weapons had been examined.
The information, according to the inspector general’s report, was emailed by then-DEA chief Michele Leonhart, though the message “does not reflect (Leonhart’s) source for this belief.”
Leonhart resigned in 2015 in the wake of a furor over agents’ misconduct including their participation in sex parties with prostitutes supplied by drug cartels in Colombia.
None of the conduct by DEA agents or executives was referred for prosecution, because the inspector general found insufficient evidence to prove that the officials knowingly provided false statements to government investigators or actively obstructed inquiries.
“The loss of life and injuries which occurred….were tragic,” DEA chief compliance officer Mary Schaefer said in the agency’s written response to the inspector general. “DEA acknowledges that its pre-mission preparation was not as thorough as it should have been and that the subsequent investigation lacked the depth and scope necessary to fully asses what transpired that (May) night.”
Since 2012, when DEA agents were involved in two other fatal shootings in Honduras, much of the agency’s top leadership has been restructured. In 2015, then-Attorney General Loretta Lynch appointed former federal prosecutor and FBI senior counselor Chuck Rosenberg to run the agency.
“In the nearly five years that have elapsed since the events referenced in the report, much has changed internally… to include agency leadership and significant changes” to the agency’s teams deployed abroad,” Shaefer said.
![Former Drug Enforcement Administration (DEA) Administrator Michelle Leonhart listens while testifying on Capitol Hill in Washington, Friday, April 12, 2013, before the House Commerce, Justice Science and Related Agencies subcommittee hearing on the DEA's fiscal 2014 budget request.]({"default":{"load":"default","w":"73","h":"49","src":"//img-s-msn-com.akamaized.net/tenant/amp/entityid/BBBuBid.img?h=491&w=728&m=6&q=60&o=f&l=f&x=1209&y=827"},"size3column":{"load":"default","w":"62","h":"42","src":"//img-s-msn-com.akamaized.net/tenant/amp/entityid/BBBuBid.img?h=421&w=624&m=6&q=60&o=f&l=f&x=1209&y=827"},"size2column":{"load":"default","w":"62","h":"42","src":"//img-s-msn-com.akamaized.net/tenant/amp/entityid/BBBuBid.img?h=421&w=624&m=6&q=60&o=f&l=f&x=1209&y=827"}})
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http://www.washingtonexaminer.com/dea-chief-marijuana-is-not-medicine/article/2624211
“If it turns out that there is something in smoked marijuana that helps people, that’s awesome,” he said, speaking at the Cleveland Clinic in Ohio. “I will be the last person to stand in the way of that. … But let’s run it through the Food and Drug Administration process, and let’s stick to the science on it.”
Rosenberg noted that the DEA takes recommendations about how to classify the drug from the FDA. He pointed out that marijuana studies have been ongoing and acknowledged some studies show it may have medical benefits for children with epilepsy.
Former Surgeon General Vivek Murthy, who was speaking alongside Rosenberg at the event, said that the country should be researching medical marijuana.
“Should we be reducing the administrative and other barriers to researching that in the government? 100 percent,” he said. “But what we should not do is make policies based on guesswork. When we do that, what we do is put people at risk.”
He also appeared to show some concern around state laws regarding recreational marijuana, saying that it is addictive, which can be harmful to a developing brain that is vulnerable to developing substance abuse and addiction.
State legislators, he said, have gotten “caught up in momentum” and passed policies on recreational marijuana that aren’t always supported by science.
“When you develop a substance use disorder at a young age, it actually increases the likelihood of you developing an addiction to other substances,” he said. “So in that sense addiction to marijuana or any substance, including nicotine, during adolescence and young adulthood when the brain is developing is very concerning.”
“I worry that we have gotten away from allowing science to drive our policy when it comes to marijuana,” he added.
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The ACLU is concerned that the repeal of Obamacare will cause millions to go without healthcare, but try to get the ACLU to express any concern about the untold millions that are being denied pain management and mental health care because of the CDC guidelines, the DEA regulations, many of the state legislatures have decided to “practice medicine without a license” and without any medical knowledge/background and many healthcare corporations and insurance companies that have instituted some sort of opiate dosing limitations… without regard of the real medical need of the pt.
Healthcare is quickly become a “by the numbers” process.. “cookie cutter medicine”… and those who hold the pocket book strings… tend to believe that they can dictate the type or limit of healthcare that a person can receive.
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http://www.alternet.org/story/85637/why_some_hospitals_are_allowing_unnecessary_suffering
“His heart filled virtually his whole chest,” recalls Dr. Diane Meier describing her very first patient, an 89-year-old suffering from end-stage congestive heart failure.
It was the first day of Meier’s internship at a hospital in Portland Oregon, and after being assigned 23 patients, she was suddenly told that one of her patients, who had been in the Intensive Care Unit for months, was “coding.” She raced to the ICU where the resident told her to put in a “central line.”
“I didn’t know how,” Meier admits. “I felt overwhelmed and inadequate. Then, the patient died …
“Everyone just walked out of the room,” she remembers. I stood there. I still sometimes flash back on that scene: the patient, naked, lying on the table, strips of paper everywhere, the room empty. This was my patient. I felt I was supposed to do something — but I didn’t know what.”
Meier left the room and, in the hallway, saw the patient’s wife. “I walked right past her,” she recalls, nearly shuddering at her own cowardice. I didn’t know what to say. I didn’t even say ‘I’m sorry.’ As a physician, I didn’t think that I was supposed to do that. “
I heard Dr. Diane Meier tell this story at a conference for medical students at Manhattan’s Mt. Sinai School of Medicine last week. When she finished, she asked her audience, “What is the hidden curriculum here? What does this story tell you?’
“Once the patient dies, he no longer matters,” said one student.
“If we can’t save the patient, the patient doesn’t matter,” added another.
Meier drew a third lesson: “Before he died, this patient had spent two months in the ICU. We had done everything possible to prolong the dying process.” As a doctor, you have to step back and say, ‘What is this experience telling me, and is this right?'”
As a palliative care specialist, Meier spends much of her time with dying patients. For many, “palliative care” offers a middle road between pulling out all the stops and simply giving up hope. Like traditional “hospice” care, palliative care focuses on “comfort” rather than “cure,” emphasizing pain management and easing the emotional trauma of facing death, both for the patient and for the family. But palliative care also includes procedures aimed at treating the symptoms of the disease.
In the past, Meier explains, physicians have seen caring for a terminally ill patient as an “either/or” situation: “Either we are doing everything possible to try to prolong your life — or when there is ‘nothing more that we can do,’ only then do we make the switch to providing comfort measures. This dichotomous notion — that you can do one thing alone and then the other thing alone later — has nothing to do with the reality of what patients and their families go through.”
In her talk last week, Meier explained that her first patient was one of three who marked turning points on her life as a physician. Originally, she trained to become a geriatrician, a doctor who cares for people over 65. “I think because I was very close to my grandfather,” she explained, “and because I’m a ‘lumper’ not a ‘splitter’,” she added, referring to the distinction between doctors who prefer to treat the whole patient, head to toe, and those who prefer to specialize in a body part: the foot, for example, or the eye.’
Her interest in treating the elderly brought her to Mt. Sinai, which, at the time, had the only Department of Geriatrics in the country. But as her career unfolded, she found herself “become more and more alienated from medicine. Here, in the hospital, everyone was running around, ostensibly trying to help the patient, but actually often hurting the patient. I thought about quitting. I had a fantasy of opening a bakery/book shop where I could read and eat brownies …” she told the med students.
“Then I met a patient I will call Mr. Santanaya.”
Meier first encountered Santanaya when she was walking down a hospital hallway and heard a man screaming and moaning in pain. She looked into his room and there he was, pinioned to his bed, hand and foot, in “four-point restraint.”
“I went to the nurse and asked, ‘Why is this man in a four-point restraint?” The nurse called for the intern.
“I’ll never forget this kid’s face,” Meier recalled “To me, he looked about twelve years old. And terrified.
Meier asked the question again, and the intern explained: “He has lung cancer that spread to his brain and he’s delirious. We put a feeding tube up into his nose and down to his stomach, and he pulled it out. So we tied his hands. Then he pulled it out with his knees and feet — so we tied his knees and feet.”
“The feeding tube is very uncomfortable,” Meier told the students. “It makes the nose and esophagus raw. I asked the intern, ‘Why do we have to do this?'”
“He looked at me with tremendous distress in his eyes: ‘Because if we don’t, he’ll die.”
“I realized he didn’t know any better,” said Meier. “Neither did the resident or the attending physician. I realized that this was an educational problem.
“They cared about the patient. This wasn’t callousness or indifference or venality. They just didn’t know when too much is too little.” So Mr. Santayana spent 33 days tied hand and foot to his bed before he died. He spoke no English, but during that time, he kept screaming “Ayudeme! Ayudeme!” (Help Me! Help Me!)
Why didn’t Mr. Santayana’s physician intervene to do something to help him? “He didn’t have a primary care physician because he was on Medicaid,” Meier explained. So it was left to the hospital staff, and not knowing what else to do, they simply followed procedure.
“This was the early 1990s, and that is when I decided to shift my career to try to make up for what happened to Mr. Santayana,” said Meier. Then she got lucky.
Dr. Robert Butler, founder of gerontology at Mount Sinai, and a friend of George Soros, urged her to apply for funding from Soros’s newly formed Project on Death in America. Meier and three colleagues won the funding and in 1995, with help from Soros and the United Hospital Fund, launched the Hertzberg Palliative Care Institute at Mount Sinai School of Medicine. The Robert Wood Johnson Foundation also invested in developing content. In 1999 Meier and Dr. Christine Cassel founded the Center to Advance Palliative Care (CAPC) . As a result of CAPC’s program, by 2005, the number of hospital-based palliative care programs in the U.S. had roughly doubled to 1,240, and some 3,100 health care professionals had been taught CAPC’s methods and ethics.
The third patient who Meier told the students about last week is a 24-year-old who she called “Kate.” Kate had just graduated from college and had worked and saved enough money to go to Australia. There she developed the worst headache of her life. “She called her mother from Sydney and her mother came to get her,” Meier told her audience. “In retrospect, she might have been better off if she had stayed in Australia.”
The problem was that Kate had no health insurance. She was only 24 and she thought she didn’t need insurance.
Her mother brought her directly from the airport to Mt. Sinai, “where she was admitted directly to the oncology service, not to a doctor,” Meier explains. Like Mr. Santayana, she would be on Medicaid and so wouldn’t have her own doctor. Kate was diagnosed with leukemia.
“I met Kate on day 7 when a consult called me to say that they had a manipulative drug-seeking patient with acute myeloid leukemia,” Meier recalled. “By then, Kate had earned the contempt and hostility of the house staff because she was constantly screaming for pain-killers.
“It turned out that no one knew the half-life of the opiate they were giving her — not the attending physician, not the resident, not the intern.”
Meier then turned to her audience, made up largely of second-year medical students. “Does anyone here know the half-life,” she asked, naming the pain-killer.
No one did. (The half-life of a pain-killer tells you how long it will be before it wears off.)
“What they were giving her provided relief for only 90 minutes,” said Meier, “and they were giving it to her every six hours.” After 90 minutes , Kate would begin ringing for nurse. Then, after a half hour, when no one came, she would begin ringing more and more frantically, and finally begin screaming. “Between four and six hours, she would just be screaming,” said Meier.
This had been going on for seven days. “The pain specialists wouldn’t see her because she had no insurance.”
“I doubled the dose and ordered that it be given to Kate every three hours, around the clock,” said Meyer. “And before long, she was transformed into the sweet, charming intelligent person she always had been.”
“Kate had become the victim of iatrogenic pseudo-addiction,” Meier added. She wasn’t an addict, but she was behaving like an addict and seemed like an addict — a pseudo-addiction created by her doctors, which makes it an “iatrogenic disease,” an illness caused, inadvertently, by medical care.
Why hadn’t her mother tried to persuade the doctors to give her more pain-killers? “Kate was the middle child in an Irish family of seven kids and one of her brothers had become addicted to drugs. As a result, the mother was terrified of opiates,” said Meier. “The palliative care team had to spend time with the parent, explaining that pain kills.
The only possible hope for Kate was a bone marrow transplant. Because she was on Medicaid, this would be very hard to get. “It took six weeks of begging to get someone to take her,” Meier recalled. “And then the transplant failed.
“While she was dying, Kate told us that the worst part of the experience had been those first six days when she was labeled a ‘manipulative drug addict.’ She was marginalized because her doctors did not know how to administer the opiates.
“Untreated pain is a medical emergency,” Meier told the students. “The reason no one here knew the half-life of that opiate is because learning about pain-killers is not a priority in medical curriculums.” In fairness, this is the sort of thing that doctors on the ward often look up. But in this case, no one even tried to look it up.
“The relief of suffering is a fundamental part of medicine,” Meier concluded. “In this country there is a tremendous amount of stigma associated with opiates. When you are caring for patients, and you leave an order for the nurse to administer the pain-killers, remember, there’s a real chance that she’ll think, ‘This is dangerous. I don’t want something bad to happen on my shift. Okay, I’ll give it to you — but I won’t give you enough.’
“This is why pain is so poorly managed in this country.”
In Italy, by contrast, a patient dying of cancer is often sent home, with morphine, to die in his own bed. His wife administers the morphine and she is given enough to keep him as much as he wants — when he wants it. In the U.K., where hospice care was invented in the 1960s, there are many more palliative care specialists than in the U.S.
Here, medicine is all about “cure,” not about “care.” “Defeating death at any cost: that is the priority,” Meier told me. “It comes ahead of reducing suffering or considering the quality of the patient’s life. If you look at NIH funding,” she pointed out, “you see that this is where the money goes — to cure cancer, to prevent all heart disease and stroke.”
This is not to say that Meier favors cutting back on end-of-life care because it is so expensive and so much money is “squandered” during the final year of a patient’s life. “The problem is, of course, that we don’t know who is in their last year — or their final three months,” Meier observed. “The fact that we spend so much on these patients in their final months of life is not necessarily a bad thing,” she added. “These are the sickest people in the hospital, who need the most care. We shouldn’t say: ‘We’re wasting money on the dying.’ But,” she added , “we should be asking, ‘Is this the best care? Is it appropriate care?”
Clearly, we need more palliative care specialists like Meier. But this is another case where we don’t pay enough for “thinking medicine” — which involves talking to and listening to the patient — rather than cutting him or radiating him.
“When a three-person palliative care team made up of a doctor, a nurse and a psychologist spends 90 minutes in a meeting with a family, Medicare would probably pay $130 to $140 — for all three people,” Meier told me. “And Medicare is one of the better payers. This explains why Meier earns $100 for every several thousand dollars that her husband, an invasive cardiologist, takes home. “Though,” Meier said mildly, “it would be hard to say that one of us is practicing more sophisticated medicine.”
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U.S. Attorney: There Have Been Fewer Pharmacy Robberies in Indianahttp://www.wibc.com/news/local-news/us-attorney-there-have-been-fewer-pharmacy-robberies-indiana
INDIANAPOLIS–Pharmacy robberies have gone down drastically in the past three years. That may be thanks to a decision to prosecute people who rob pharmacies in the state in federal court and to send them to federal prison.
“Every defendant that commits a crime of pharmacy robbery in the Southern District of Indiana, will be charged in federal court and will face the hammer of federal sentencing,” said Josh Minkler, U.S. attorney, describing a decision that was made three years ago, with help from the Indianapolis Metro Police Dept. and Marion County authorities.
“Indiana led the nation in pharmacy robberies, most of those robberies occurring here in Marion County.”
But, not any more. Minkler described the stats, beginning in 2015.
“In 2015, there were 168 pharmacy robberies in Indiana, 129 of those occurring in Marion County. In 2016, there were 78 pharmacy robberies in the State of Indiana, 42 of those occurring in Marion County. Thus far in 2017, there have been only 10 pharmacy robberies in the State of Indiana, only five of those occurring in Marion County.”
Minkler talked about the stats during a news conference this week where he announced the indictment of a gang called “The Mob” that his office said robbed pharmacies, sold the prescription pills and used young people to do the dirty work.
They also used social media to intimidate neighbors.
Minkler said his office has been working with law enforcement throughout Indiana to round up the robbers.
“The name of this operation was ‘Operation: Pharm Aid’.” He said over the past two years they have arrested and prosecuted 36 people for 62 pharmacy robberies.
Robbing a pharmacy when controlled substances are involved has been a FEDERAL CRIME – the same as robbing a bank… since the mid-early 70’s and it took INDIANA abt FORTY YEARS to figure out that maybe they should use this federal laws..
No mention of the increased illegal Fentanyl analogs & Heroin on the street and opiate OD’s in Indiana and the 200+ people that were diagnosed with HIV+,Hep B&C in the small Scott county a couple of years ago because Indiana has been reluctant to create a “clean needle program”…
While the Legislature passed laws that it is damn near impossible to purchase Sudafed .. which they claim has reduced the number of Meth labs in the state… but.. don’t mention the amount of Meth that is sold on the street.. since 80% of the Meth sold in the USA 
is produced in Mexico.
The “picture” that these bureaucrats are putting forth is like a puzzle with a lot of pieces of the puzzle missing… so that no one can see the entire picture CLEARLY !!!
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