Massachusetts’ contentious tactic to fight its opioid crisis: jailing addicts

https://www.theguardian.com/us-news/2019/apr/23/massachusetts-contentious-tactic-to-fight-its-opioid-crisis-jailing-addicts

Eight days into his stay, he said jail was “the best thing that’s probably ever happened to me”.

As Massachusetts struggles against an opioid crisis that kills five times as many people than automobile accidents every year in the state, the placement of civilly committed men in correctional facilities has emerged as one of the most controversial tactics to confront addiction in the state – and one not seen anywhere else in the nation.

To proponents, the section 35 process is seen as lifesaving, putting people in a place where they absolutely cannot get drugs and where they cannot simply walk out. But its detractors say that forced rehabilitation does not work, that putting men in correctional facilities is unconstitutional and that putting patients in prison settings is detrimental to recovery and increases the risk of relapse once patients are released.

Women were once held in correctional facilities in Massachusetts for addiction, but after an ACLU lawsuit, the state ended the practice in 2016.

But the state has ramped up its incarceration of civilly committed men. According to Prisoners’ Legal Services, a not-for-profit that has been a key opponent of the practice, Massachusetts places more than 2,000 men involuntarily committed for substance abuse in correctional facilities per year.

In March, PLS filed a lawsuit against the department of correction and department of public health on behalf of 10 unnamed patients being held at the Massachusetts Alcohol and Substance Abuse Center (Masac), a facility operated by the DoC in the town of Plymouth.

The lawsuit charges that holding the men in correctional facilities is unconstitutional, constitutes unlawful discrimination on the basis of gender and disability and is overall detrimental to recovery. They also describe an abusive environment where patients are “routinely” humiliated by correctional officers (COs) and where patients lack access to opioid substitution medications such as Suboxone.

“These people are being shamed and stigmatised on the basis of a disease that’s acknowledged as a disability,” said Bonnie Tenneriello, PLS staff attorney.

One of the unnamed plaintiffs said officers called patients pussies, bitches, junkies and crackheads while telling him that his “mother is a whore”.

Another plaintiff described how during detox, his roommate urinated and defecated on himself, but that nobody cleaned it up.

Others described being too afraid to call their employers or loved ones as all phone calls coming from the facility inform the person being called that they are receiving a call from a correctional facility.

PLS says patients have been sent to solitary confinement for seemingly minor offences like smoking a cigarette, not answering questions or taking extra milk with their meals.

“All of that is counter-therapeutic, all of that is traumatising, all of that is telling people you are not a full citizen, you are not to be trusted, you are a bad person,” said Tenneriello of placing patients in correctional facilities.

‘It’s a jail mentality’

Joel Kergaravat, 36, was hooked on heroin and crystal meth when his mother petitioned him to be sectioned last summer. They both thought that sectioning him would mean rehab, but instead he was put in restraints and loaded into a hot van for a long drive to Masac.

His experience at Masac appeared to mirror allegations laid out in the lawsuit.

Once he got to Masac, he did not have access to detox medications. “It’s barbaric not to give people that medication, because you’re basically vomiting and shitting yourself for six days,” he said. “That’s what happens. It’s not pretty.”

Inside, he said guards were abusive. He felt the place was unsanitary and unclean and worried about getting sick. Patients would get into fistfights.

“It’s a jail mentality,” he said. “They have you in a prison setting so people act accordingly.”

When he got out, he was traumatized. He got back on drugs and at one point tried to kill himself by overdosing – a result, he says, of his experience at Masac.

“If you’re going to force people into treatment, that’s fine, put them into treatment,” he said. “You can’t just rename a prison or a section of a prison and call it treatment.”

A sheriff champions section 35

The Hampden county sheriff, Nick Cocchi, might be the biggest proponent of section 35 in the state.

Cocchi views his mission as a rehabilitative one. His COs don’t carry weapons of any kind and those on the section 35 wing don uniforms consisting of polo shirts – an attempt to look less guard-like. He keeps a folded, ageing piece of paper in his pocket that lists the names of those that have died at the jail in the 26 years he has been working there. When western Massachusetts residents call him and send him Facebook messages pleading for advice about loved ones who have been trapped by addiction, he invites them to his office, even if it is a weekend. Men who have previously been sectioned call him up when they are relapsing.

Cocchi says that when done right, forced rehab works.

His enthusiasm about section 35 was born out of a desire to provide treatment closer to home for residents of western Massachusetts.

“You serve no purpose taking somebody two and a half hours from home, detoxing them and then saying ‘here’s a bus ticket to get back to where you’re going.’ Where’s the support?” he said. “There’s no support. And when there’s no support, there’s relapse.”

He said the kind of abusive treatment outlined against Masac in the lawsuit brought by PLS doesn’t happen at his jail. He said that there need to be reforms to the section 35 process, but that his facility is “second to none” in the state.

Recently the gregarious sheriff brought the Guardian into the section 35 wing, walking in with a five-month-old bull mastiff puppy named Brooklyn.

“What’s up guys?” he beamed at the patients – or “clients” as they are referred to in the jail administration’s parlance. “I don’t want anyone to panic – this is not a drug sniffing dog!”

The wing appeared clean and orderly. The patients wore a uniform of brown pants and yellow or blue T-shirts with inspiring mottos like “recovery works” and “one day at a time” on them. They appeared friendly with the sheriff and the COs, stopping them to share their thoughts and concerns about their time on the unit.

Several patients eagerly lined up to speak to the Guardian about their experience at the jail, all saying positive things. Many were optimistic that being closer to home, having counseling about their discharge plan and having access to advice after they were out would mean it would be easier to stay off drugs or alcohol once released.

Some had spent time at Masac in Plymouth and said their current surroundings were much better.

Jim, the 29-year-old student who was sectioned after an overdose, said: “The COs don’t treat you like inmates, they treat you like a patient essentially.”

The wing has only been receiving section 35 patients since May, but Cocchi says he is confident that statistics will eventually show that his program has a higher success rate than any other treatment facilities.

“There’s also a group out there that says forced treatment doesn’t work – when you force someone to go into treatment, it doesn’t work,” he said. “That is absolutely false.”

If people trying to put an end to correctional facilities holding civilly committed men are successful, Cocchi says “they will devastate the commonwealth of Massachusetts, specifically western Massachusetts right now … And I will not lay down on that.”

‘Setting them up to die’

But opponents of jailing section 35 patients say that even if the abuses laid out against Masac are not present at a correctional facility, keeping civilly committed men there is wrong and dangerous.

“No matter how well run any prison might be, we’re saying that it’s a disease,” said Tenneriello, the PLS attorney. “Putting people in prison because they have a disease is fundamentally wrong”

Leo Beletsky, an associate professor of law and health sciences at Boston’s Northeastern University is an expert on the opioid epidemic and sits on the state’s section 35 commission.

He points to studies, like one by the Massachusetts department of public health, that show that persons recently released from incarceration are 120 times more likely to die of an opioid overdose than members of the general public.

“By putting people in correctional settings, we’re essentially setting them up to die,” he said.

Physician Sarah Wakeman, an addiction medicine specialist and medical director of the Substance Use Disorders Initiative at Boston’s Massachusetts general hospital, said those leaving forced rehab are at particular risk for overdosing given they did not want to be there in the first place and have lowered their tolerance.

To Wakeman, more focus needs to be placed on making sure that voluntary treatment for substance abuse is more readily accessible.

“The reality is that tough love is not a useful intervention to help a person suffering from addiction,” she said.

Beletsky said the section 35 system remains popular as it is much easier to access than voluntary treatment programs.

“Section 35 in many ways is the path of least resistance for getting into treatment,” he said. “It’s immediate, it’s free, it requires no navigation.”

It “illustrates how broken our systems of care are,” he said. “In many ways it’s easier to put somebody away than have them access normal healthcare.”

In 1917 the DOJ declared that opiate addiction was a CRIME and not a DISEASE and any prescriber treating/maintaining a opiate addiction would be jailed.

So it would appear that that declaration did not bear the weight of law.. or these people would have been jailed and charged with a CRIME.

This program seems to parallel what is – and has been done – with the Civil Asset Forfeiture Act where 85% of the people who have had their assets confiscated and no charges were ever filed and most people are lucky to get MAYBE half of the dollars confiscated and if other assets that were confiscated and liquidated (sold at auction) may get little or nothing of what the assets were actually worth.

There are several states that have involuntary mental health admission – in CALF it is referred to as a 5150 and in FL it is referred to as the Baker Act, but the involuntary mental hold is 72 hrs.

Generally “abstinence rehab” has a 5% success rate because pts who have been provided opiates for a long period of a couple of months and are cut off of their medication – of course – does into withdrawal because their prescriber did not properly wean the pt off their opiates and the fact that they are suffering withdrawal symptoms they are told that they are addicted., and when they are properly weaned off their opiates… they turn out that they were never  actually “addicted”.

I find it interesting that ACLU sued the state over the same treatment for woman and the state loss and the state discontinued this treatment ONLY FOR WOMEN. What happened to EVERYONE IS EQUAL ? and is supposed to be treated equally ?

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Alvogen Inc. Issues Voluntary Nationwide Recall of Fentanyl Transdermal System Due to Product Mislabeling

https://www.fda.gov/Safety/Recalls/ucm636384.htm

Alvogen, Inc. is voluntarily recalling two lots of Fentanyl Transdermal System 12 mcg/h transdermal patches to the consumer level. A small number of cartons labeled 12 mcg/h Fentanyl Transdermal System patches contained 50 mcg/h patches. The 50 mcg/h patches that were included in cartons labeled 12 mcg/h are individually labeled as 50 mcg/h. This transdermal system is manufactured by 3M Drug Delivery Systems, St. Paul, MN.

Application of a 50 mcg/h patch instead of a prescribed 12 mcg/h patch could result in serious, life threatening, or fatal respiratory depression. Groups at potential increased risk could include first time recipients of such patches, children, and the elderly. To date, Alvogen Inc. has not received any reports of adverse events related to this issue.

The product is indicated for the management of pain in opioid tolerant patients and is packaged in primary cartons of five individually wrapped and labeled pouches. The affected Fentanyl Transdermal System lots include:

Lot 180060 of Fentanyl Transdermal System, 12 mcg/h, expiration date 05/2020.

Lot 180073 of Fentanyl Transdermal System, 12 mcg/h, expiration date 06/2020.

The mislabeled product is packaged in a 12 mcg/h primary carton. These lots of Fentanyl Transdermal System were distributed Nationwide to the pharmacy level.

See images example for lot 180073.

Alvogen Inc. is notifying its distributors and direct customers by certified letter and is arranging for return and replacement of all recalled products. Pharmacies are requested not to dispense any product subject to this recall. Patients that have product subject to this recall should immediately remove any patch currently in use and contact their health care provider. Patients with unused product should return it to point of purchase for replacement.

Questions regarding this recall should be directed to Alvogen Customer Complaints by calling 866-770-3024 or sending an e-mail to pharmacovigilance@alvogen.com from Monday to Friday from 9:00 am to 5:00 pm EST. Consumers should contact their physician or health care provider if they have experienced any problems that may be related to taking or using this drug product.

Adverse reactions or quality problems experienced with the use of this product may be reported to the FDA’s MedWatch Adverse Event Reporting program either online, by regular mail or by fax.

• Complete and submit the report Online: www.fda.gov/medwatch/report.htm
• Regular Mail or Fax: Download form or call 1-800-332-1088 to request a reporting form, then complete and return to the address on the pre-addressed form, or submit by fax to 1-800-FDA-0178

This recall is being conducted with the knowledge of the U.S. Food and Drug Administration.

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https://abcnews.go.com/US/drug-executive-laurence-doud-iii-arrested-opioids/story?id=62575543

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lynnwebstermd.com
When Will Forced Tapering of Opioids End?
Lynn Webster, M.D.
6-8 minutes
When Will Forced Tapering of Opioids End?

20th April, 2019

By Lynn Webster, M.D.

This article, in a slightly edited form, first appeared on Pain News Network on April 17, 2019.

“Larry” recently wrote to me asking for advice. He describes himself as “virtually crippled totally” after having his opioid medication cutback.

“I am being forced tapered and the PA I now have will not budge one inch on the weaning, as he calls it. I hate him. I have never had a more callous doctor in my life,” Larry wrote.

“What does one do in my situation? Blow my brains out? A[n] intentional overdose? I have two beautiful dogs that depend on me and a son who needs me. I have to stay here on planet Earth although I want out of here so bad I beg God to kill me every morning noon and night. It is my daily prayer.”

Unfortunately, Larry is only one of many patients who are struggling to be heard by their providers. Physicians are under government pressure to adhere to the CDC’s 2016 opioid prescribing guideline.

Although the CDC designed its guideline as voluntary, government agencies interpreted it as a mandate instead. The Drug Enforcement Administration has pursued doctors who prescribe a level of opioids that exceeds the guideline’s recommended daily limit of 90 MME (morphine milligram equivalent), even when no patients have been harmed.

According to Maia Szalavitz, writing for Tonic, Dr. Forest Tennant was one of the few physicians who still were willing to prescribe high-dose opioids for the sickest pain patients. The DEA raided his California office and home, allegedly because the agency had reason to believe some of his patients were selling their medication.

There simply was no evidence of that. But as a result of the raid, Dr. Tennant retired from clinical practice.

Szalavitz wrote that the raid “terrifies pain patients and their physicians, who fear that it could lead to de facto prohibition of opioid prescribing for chronic pain and even hamper end-of-life care.”

Dr. Mark Ibsen in Montana had his license suspended by the state medical board for allegedly overprescribing opioids. According to Dr. Ibsen, the DEA warned him “he was risking his livelihood and could end up in jail if he kept prescribing.” A judge later overturned the board’s decision.

As Dr. James Patrick Murphy, a Kentucky-based pain and addiction specialist, told the Courier-Journal, “many well-intended doctors are unfairly arrested ‘all the time’ in the hunt for those who recklessly contribute to patients’ addictions and fatal overdoses.”

As of this writing, The American University Law Journal plans to publish an alarming article by Michael Barnes, JD, about the raids on America’s top physicians.

Although few physicians are incarcerated for prescribing high dosages of opioids, many of them are threatened with losing their licenses to practice medicine. Doctors and pharmacists told a POLITICO survey that they felt enormous pressure to limit their prescriptions for painkillers. Their fear of the consequences of noncompliance with the CDC guideline exceeded their responsibility to treat patients with severe pain.
Second Thoughts About CDC Guideline

On April 1, the attorneys general of 39 states and territories wrote a letter on behalf of the National Association of Attorneys General to Dr. Vanila Singh of the U.S. Department of Health and Human Services. The letter expressed concern with the draft report of the Pain Management Best Practices Inter-Agency Task Force, which recommends changes in the CDC guideline to end the forced tapering of patients.

The attorneys general said “it is incomprehensible that officials would consider moving away from key components of the CDC guideline.” Additionally, they expressed their hope that the report would be revised “to clearly state that there is no completely safe opioid dose.”

Yet on April 9, the Food and Drug Administration issued a medical alert warning doctors not to abruptly discontinue or rapidly taper patients on opioid medication, because it was causing “serious harm” to patients, including uncontrolled pain, psychological distress and suicides.

Now it seems the CDC may be moving in the same direction.

Dr. Daniel Alford, a Professor of Medicine at Boston University, wrote a letter to the CDC asking it to address the misapplication of its guideline with a “public clarification.” He was writing on behalf of Health Professionals for Patients in Pain, and 300 healthcare professionals signed his letter.

The CDC’s response, published on April 10, echoed the FDA’s statement. CDC Director Dr. Robert Redfield observed that the CDC guideline “offered no support for mandatory opioid dose reductions in patients with long-term pain.” He reinforced the fact that the guideline was voluntary and that doctors should use their knowledge of their patients to determine which dosages were appropriate for them.

Dr. Redfield wrote that “CDC is working diligently to evaluate the impact of the Guideline and clarify its recommendations to help reduce unintended harms.” And he agreed that “patients suffering from chronic pain deserve safe and effective pain management.”

STAT News points out that the overzealous enforcement of the CDC guideline was indeed causing patients harm. “Denying opioids to patients who have relied on them — sometimes for years — may cause some to turn to street drugs, thereby increasing their risk of overdose,” STAT warned.

According to The Washington Post, “Many patients have claimed that long-term use of the drugs is all that stands between them and unrelenting pain, and that they can take the medication without becoming dependent or addicted.”

The CDC and the FDA now admit the guideline has been misapplied and mainstream media outlets are beginning to pick up the story. The question is: Will the DEA stop pursuing doctors who treat pain patients with levels of opioids that exceed the guideline’s recommendations?

For Larry and other pain patients who have been forcibly tapered, the answer may be a matter of life and death.

http://www.lynnwebstermd.com/forced-tapering/

Here is four quotes from the CDC opiates guidelines:

https://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm

“The guideline is intended to ensure that clinicians and patients consider safer and more effective treatment, improve patient outcomes such as reduced pain and improved function.”

“Clinicians should consider the circumstances and unique needs of each patient when providing care.”

“Clinical decision making should be based on a relationship between the clinician and patient, and an understanding of the patient’s clinical situation, functioning, and life context.”

“This guideline provides recommendations for primary care clinicians who are prescribing opioids for chronic pain outside of active cancer treatment, palliative care, and end-of-life care.”

The entire CDC guidelines are some 90 odd pages.   What “key components” of the CDC guidelines are they focused on 90 MME ? – out of 90+ pages.  I particularly like this quote from these 39 “medical experts”  to clearly state that there is no completely safe opioid dose… there is no really “safe dose” of ANY MEDICATION… they are trying to force our body to do something that it naturally wants to do.

The CDC guidelines completely ignores the fact that we have a test .. CYP-450 opiate metabolism test – a simple cheek swab – that will determine if a pt is slow, normal, fast, ultra fast metabolizer and the pt’s dose may have to be increased and/or frequency of the dose increased and/or BOTH !

These same guidelines IGNORE that all of the opiate conversion programs have a footnote stating – the same or similar – that the results of using these conversion programs – ARE CRUDE ESTIMATES AT BEST and should not be used as black/white pt dosing .. only as a starting point.

Some of us believe that the CDC did not have the statutory authority to even generate and publish these guidelines.  Maybe that is why the then head of the CDC Tom Frieden shortly after they were released made a public statement that these guidelines were just RECOMMENDATION and DID NOT HAVE THE AUTHORITY/WEIGHT OF LAW.  Could that have been a “back door” admission that the CDC did not have the legal authority to publish these guidelines ?  After all the CDC’s primary charge is dealing with contagious diseases.

But then when you assembly a committee to develop these guidelines that each has a personal interest in treating substance abusers, what would one expect but a final product that primarily deals with .  It also seems suspicious that this committee met behind closed doors and the CDC tried to keep the committee members anonymous .

So in the end we have 39 state AG’s who wish to continue honoring “guidelines” as LAW that were created by a Fed agency that may not have had the statutory authority to generate them in the first place and they may well be unconstitutional. 

Also it seems to be a quote from these AG’s “it is incomprehensible that officials would consider moving away from key components of the CDC guideline”.. so it would appear that these AG’s prefer to only chose a favorite sentence, paragraph or page out of the 90+ page document to be the “key components” that they wish to have adhered to.

It would not be the first time that a legislative body will have passed a bill that gets signed into law and remains on the books and is enforced until someone challenges the constitutionality of the law in the courts.  In our legislative system, there is no process to validate the constitutionality of a bill before it gets signed into law.

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Pain Patients Get Relief from War on Opioids

https://www.scientificamerican.com/article/pain-patients-get-relief-from-war-on-opioids/

U.S. agencies warn doctors not to abruptly cut off the medications for long-time users

Ever since U.S. health authorities began cracking down on opioid prescriptions about five years ago, one vulnerable group has suffered serious collateral damage: the approximately 18 million Americans who have been taking opioids to manage their chronic pain. Pain specialists report that desperate patients are showing up in their offices, after being told by their regular physician, pharmacy or insurer that they can no longer receive the drugs or must shift to lower doses, no matter how severe their condition.

Abrupt changes in dosage can destabilize patients who have relied for many years on opioids, and the consequences can be dire, says Stefan Kertesz, an expert on opioids and addiction at the University of Alabama at Birmingham School of Medicine. “I’ve seen deaths from suicide and medical deterioration after opioids are cut.”

Last week, after roughly three years of intensive lobbying and alarming reports from the chronic pain community, the Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC) took separate actions to tell clinicians that it is dangerous to abruptly curtail opioids for patients who have taken them longterm for pain. The FDA did so by requiring changes to opioid labels specifically warning about the risks of sudden and involuntary dose tapering. The agency cited reports of “serious withdrawal symptoms, uncontrolled pain, psychological distress, and suicide” among patients who have been inappropriately cut off from the painkillers.

One day later, CDC director Robert Redfield issued a clarification of the center’s 2016 “Guideline for Prescribing Opioids for Chronic Pain,” which includes cautions about prescribing doses above specific thresholds. Redfield’s letter emphasized that these thresholds were not intended for patients already taking high doses for chronic pain but were meant to guide first-time opioid prescriptions. The letter follows another recent clarification sent by the CDC to oncology and hematology groups, emphasizing that cancer patients and sickle cell patients were largely exempt from the guideline.

Taken together, these actions represent a significant victory for the chronic pain community. “The combination of the FDA and CDC speaking out reconfigures the conversation going forward in a very, very helpful way,”  says Kertesz, who was one of five doctors associated with the advocacy group Health Professionals for Patients in Pain (HP3) who received Redfield’s letter.

Tougher rules on opioid prescriptions from federal and state authorities, health insurance companies and pharmacies, were an understandable response to the nation’s “opioid crisis,” an epidemic of abuse and overdose that led to a 345 percent spike in U.S. deaths related to legal and illicit opioids between 2001 and 2016. Since 2016, most fatal overdoses have involved illegally produced fentanyl sold on the street, according to CDC data, but past research has shown that many victims got started with a prescription opioid such as oxycodone.

The CDC’s 2016 guideline was aimed at reining in irresponsible prescribing practices. (The agency’s own analysis showed that prescriptions for opioids had quadrupled between 1999 and 2010.) The guideline stressed that the first-line treatments for chronic pain are non-opioid medications and non-drug approaches such as physical therapy. When resorting to opioids, the guideline urged doctors to prescribe “the lowest effective dosage,” to carefully size up risks versus benefits when raising doses above 50 morphine milligram equivalents (MME) a day, and to “carefully justify a decision” to go to 90 MME or above.

That advice on dosage was widely misinterpreted as a hard limit for all patients. Kertesz has collected multiple examples of letters from pharmacies, medical practices and insurers that incorrectly cite the guideline as a reason to cut off long-term opioid patients.

Frank Gawin, a retired psychiatrist in Hawaii, is one of many chronic pain sufferers ensnared by that kind of mistake. For 20 years he took high-dose opioids (about 400 MME daily) to manage extreme pain from complications of Lyme Disease. Gawin, an expert on addiction himself, was well aware of the risks but notes that he stayed on the same dose throughout those 20 years. “It helped me profoundly and probably extended my career by 10 to 15 years,” he says. About five months ago, his doctor, a pain specialist he prefers not to name, informed Gawin and other patients that she would be tapering everyone below 80 MMEs because she was concerned about running afoul of medical authorities. Gawin has not yet reached that goal, but his symptoms have already returned with a vengeance. “As I am talking to you, I am in pain,” he said in a phone interview. “I’m having trouble concentrating. I’m depleted. I’m not myself.”

Last week’s federal actions could go a long way in informing physicians not to cut off patients like Gawin. Of particular value, say patient advocates and experts, is the emphasis on working together with patients on any plan to taper the drugs. “It’s finally about patient consent,” says Andrea Anderson, former executive director of the Alliance for the Treatment of Intractable Pain, an advocacy group. She notes that the FDA urged doctors to create an individualized plan for patients who do wish to taper and that the agency stated that “No standard opioid tapering schedule exists that is suitable for all patients.”

The CDC is relying on pain advocacy groups to get the word out about its clarification. Any formal update to the guideline will await the results of a systematic review of chronic pain research currently underway, said Debbie Dowell, chief medical officer of the CDC’s Injury Center, in an email; Dowell is the lead author of the 2016 guideline.

Gawin hopes the federal actions will persuade his doctor that forced tapering is wrong for him. “The only way I can see getting back to normal,” he says, “is to get back to the medication that worked for me.”

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Washington state lawmaker riles nurses by saying that some spend ‘considerable’ time playing cards

https://www.foxnews.com/politics/washington-state-lawmaker-riles-nurses-by-saying-that-some-spend-considerable-time-playing-cards

A Washington state lawmaker has provoked the ire of nursing professionals after saying that some nurses “play cards” for a “considerable” portion of their shifts.

State Sen. Maureen Walsh, R-Walla Walla, was debating a bill on Tuesday that would require uninterrupted meal and rest breaks for nurses and would also provide mandatory overtime protections for them.

Walsh pushed for an amendment that would exclude hospitals with fewer than 25 beds from the provision, arguing that such small facilities struggle to provide 24-hour care as it is.

“I would submit to you that those (small hospital) nurses probably do get breaks,” Walsh said, according to The Olympian. “They probably play cards for a considerable amount of the day.”

Walsh’s remarks were posted to a blog by the Washington State Nurses Association, receiving so many hits that the site crashed.

The ill-received comments also inspired plenty of social media mockery; the hashtags #maureenwalsh and #nursesplaycards went viral.

Walsh’s comments even drew backlash from comedian Kathy Griffin who said her mother worked in a hospital for decades.

The bill specifically requires that nurses and some other staff, such as surgical and diagnostic radiologic technologists, be given uninterrupted meal and rest periods, except when there is an unforeseeable circumstance.

If a rest break is interrupted before 10 complete minutes, an additional 10-minute break is required. The measure would also prohibit health care facilities from using what the nurses’ association considers a legal loophole to require overtime.

Ultimately the bill was passed with Walsh’s amendment. It previously passed the House without it but both bills will have to be reconciled before it can be signed into law.

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Commentary: Suicide Signals a Broken Health Care System

www.nationalpainreport.com/commentary-suicide-signals-a-broken-health-care-system-8839600.html

I read this article recently about a veteran killing himself in a VA waiting room and it brought me back to a recent conversation that we’ve been having on the National Pain Report about suicide.

And so, I spent some looking at the comments sections on the stories and was struck—again—by the increasing feelings of hopelessness and isolation that are permeating many people who have chronic pain.

The system is failing them.

When I was talking with Terri Lewis, Ph.D. recently about the topic, she said something that has stuck with me.

“Every person has a plan for exiting the planet when they’ve had enough. Remarkably, communities and health systems don’t have a plan.”

Hard to argue.

Reader Dave Brooks wrote about the importance of loved ones.

“The thought (of taking his life) has crossed my mind more than once. I keep going knowing my children always tell me they love me when I have a chance to talk to them… Always!!!

Elizabeth R. spoke about the fear that many are feeling in a place where they shouldn’t be fearful—their doctors’ offices.

“If We patients tell our doctors the truth about our pain and how it really affects us despite our efforts to manage it, we will be punished.”

A reader named Lindsey is at her wit’s end.

I have my suicide plan and materials ready. It gives me peace of mind. I have cancer also and am six months overdue on my surgery. I have so much pain that I KNOW I would never survive recovery on 2 or 3 days off extra pain relief

David Hickle expressed the fear that the government not only hasn’t been listening, it won’t.

“Our government isn’t going to listen all they are doing is buying their time covering their ass until they betray the American citizens, I don’t trust anyone anymore in the USA or humanity because whatever anyone says is a load of crap.”

When you consider that 22 veterans—at least some of them with chronic pain– are taking their lives EACH DAY and that many people who have chronic pain are telling us they are considering suicide, it tells you—or at least tells me—that this health care system is failing people.

It’s long past time to do something.

Don’t you agree?

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US Attorney expects more opioid take downs of medical providers in the future

US Attorney expects more opioid take downs of medical providers in the future

MADISON COUNTY, Ala. – We’re learning more about the largest opioid takedown of medical providers in the nation. It resulted in charges against 60 individuals from seven states including Alabama. Three of the four arrests in Alabama are doctors from Madison County. US attorney for the Northern District, Jay Town, says investigations into doctors can take years. The task force completed theirs in just a few months.

To help combat the opioid crisis, the U.S. Department of Justice formed a strike force for the Appalachian region designed to investigate illegal opioid prescriptions and distribution.

“We ended up doing investigations that would normally take two years, took about 4 months,” Town said.

Town credits that to the use of resources. “We have hyper-accurate data at the DEA and other agencies in the federal government where we are able to that data and we can sort of pinpoint where these pills are being over-prescribed just by the population center in which they’re being prescribed.”

The takedown itself was coordinated in 18 hours. Town says 60 people were arrested, 31 were doctors who allegedly prescribed 32 million pills.

“That’s more pills than people in these states in which these cases are being prosecuted,” he said.

That sounds like a lot, but Town says it only scratches the surface of this issue.

“There are more doctors out there, there are more people working in clinics, and physicians offices, or pharmacies, or in compounding pharmacies, that we still have ongoing investigations or beginning investigations,” Town said.

And he is confident there will be more takedowns like this in the future.

“If you’re a doctor and you want to act like a drug dealer, we’re going to treat you like one. And sometimes the only difference between a doctor and a drug dealer is a white coat,” he said.

Often times, takedowns can leave patients without a doctor. This task force took measures to help patients. Town says they were able to get access to their file and agents directed them to clinics that are operating legally in the community.

Isn’t that NICE…these members of LAW ENFORCEMENT was able to get to the pt’s medical records and apparently made the “medical decision” which pts were LEGIT PTS and they DIRECTED them to clinics that are operating legally in the community.  However, did they know if these clinics had the capacity to accept these pts into the practice  and/or if the clinics would accept those pts in the first place.  Typically, when a prescriber’s practice is raided… the pts of those practices are treated like leopards by the other local clinics and few if any will be accepted by those practices as a pt.

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