Texas: Rumor on the street

I was told – by someone I trust – that in Texas … the TX Medical Licensing Board is taking a “hard line” on pharmacists changing a pt’s prescription (LOWERING daily dose/quantity) without contacting the prescriber.

One of the basics of the practice of medicine is the starting, changing, stopping a pt’s therapy.

Apparently when complaints are filed with the TX Medical Licensing Board gets a complaint about a pharmacist changing the pt’s prescription – generally involving a controlled substance, particularly a opiate… they are going after these pharmacists for practicing medicine without a license.

All health professional licenses are managed at the state level… and these various state Medical practice act and what they say is the legal practice of medicine do not vary that much.

So if one state is looking into/doing this… the other 49 states could probably find some statue verbiage in their practice act to take action against pharmacist who are changing a pt’s prescription without conferring with the prescriber.

So if one state is doing it… it is probably within the other states practice acts to take similar actions

It is also against the Control Substance Act for a legally licensed prescriber to prescribe a controlled substance to a pt that they have not done a in person physical exam on. 

Pharmacists have neither the training nor legal authority to do a in person exam and few would not even have the space to do a in private in person exam.

So would a pharmacist found guilty of practicing medicine without a license also be in violation of the Controlled Substance Act ?

It has been reported that some of the chain pharmacies have implemented corporate policies mandating that  their employee pharmacists MUST NOT DISPENSE CERTAIN CONTROLLED SUBSTANCES ABOVE A CERTAIN DAYS SUPPLY AND/OR MGS/DAY.

I have also been told my some pts that some pharmacists will call the prescriber and tell the prescriber and demand that the prescriber LOWER the pt’s dose and if the prescriber refuses the pharmacist threatened to call the DEA on the prescriber.

Of course, if neither the pt nor the prescriber file complaints with the state Medical Licensing Board NOTHING WILL CHANGE !

These states have been hit the hardest by the opioid epidemic

These states have been hit the hardest by the opioid epidemic

https://www.ksat.com/health/these-states-have-been-hit-the-hardest-by-the-opioid-epidemic

While there’s early evidence that the explosive rate of opioid deaths has started to slow, opioids killed more than 49,000 people in the United States in 2017, according to preliminary data. A new study reveals which part of the country has been affected the most by the ongoing epidemic.

In a study of opioid deaths from 1999 to 2016, “we found that, in general, opioid mortality is skyrocketing,” said Mathew Kiang, a postdoctoral research fellow at Stanford University’s Center for Population Health Sciences.

Synthetic opioids are manmade drugs such as fentanyl, as opposed to semi-synthetic opioids such as hydrocodone and oxycodone, or natural opioids such as codeine and morphine.

Fentanyl is up to 50 times more powerful than heroin, and just ¼ of a milligram can be deadly. For comparison, a standard low-dose aspirin is 81 mg. If you were to cut that tablet into 324 pieces, one of those pieces would equal ¼ milligram.

“One thing I do want to highlight is that, despite the large differences in deaths across states, there’s no evidence to suggest that there’s differences in use,” Kiang said. “What we think is happening is that the heroin just continues to get more and more potent in the eastern United States, whereas heroin [in] the western United States has traditionally been this brown tar heroin. It’s much harder to lace with fentanyl or other synthetic opioids.”

At the national level, opioids were responsible for shaving 0.36 years off Americans’ life expectancy in 2016, the study says. That’s a greater loss of life than caused by guns or motor vehicle accidents.

New Hampshire and West Virginia saw the biggest drops in life expectancy, of more than a year, due to opioid deaths. Montana and Oregon were the only states to see a decline in opioid deaths from 1999 to 2016.

According to the report, “emerging research … suggests the opioid epidemic has evolved as a series of 3 intertwined but distinct epidemics, or waves, based on the types of opioids associated with mortality”:

  • 1990s-2010: Prescription painkillers
  • 2010-present: Heroin
  • 2013-present: Synthetic opioids

Utilizing data from the US Centers for Disease Control and Prevention’s National Center for Health Statistics and the US census, Kiang and his colleagues identified 351,630 opioid-related deaths from 1999 to 2016. Over that 18-year period, deaths from opioids increased by 455%. Men, on average, died at age 39.8, women at age 43.5.

Kiang said that, if anything, the number of opioid deaths is probably underreported because synthetic opioids require additional testing by a medical examiner. He hopes testing for synthetic opioids will become standard whenever the cause of someone’s death is classified as an overdose.

Dr. Andrew Kolodny, the co-director of the Opioid Policy Research Collaborative at Brandeis University, said, “to talk about solutions, you have to frame the problem the right way.” To him, that means looking at the opioid crisis not as an overdose epidemic but as an addiction epidemic.

“Preventing opioid addiction is necessary for the long term, so that this crisis ultimately comes to an end. And preventing opioid addiction really means much more cautious prescribing.”

Kiang agrees that there are multiple factors at work. “We need to make treatment at least as accessible, available and affordable as heroin,” he said. “It shouldn’t be harder to get help than it is to get heroin.”

Facebook Tells Law Enforcement to Quit Using Phony Accounts

Facebook Tells Law Enforcement to Quit Using Phony Accounts

https://www.criminallegalnews.org/news/2019/feb/14/facebook-tells-law-enforcement-quit-using-phony-accounts/

Facebook recently told law enforcement to stop using fake accounts as a ruse to bust people on its service. The social media giant also shut down several law enforcement accounts that violated its policy against phony accounts.

The fake accounts came to light in a lawsuit filed by the ACLU of Tennessee against the Memphis Police Department. The ACLU uncovered evidence that fake Facebook accounts were created to gather intelligence on activist groups. When Facebook was made aware of the fake accounts, it shut them down and issued a notice to Memphis police to stop creating fake accounts.

In a letter to Memphis Police Director Michael Rallings on September 19, 2018, Facebook requested the department to “cease all activities on Facebook that involve the use of fake accounts or impersonation of others.” Facebook reminded Rallings that its policy forbids users from misrepresenting their identity, misusing Facebook profiles, and impersonating others on its service—and that “Facebook has made clear that law enforcement authorities are subject to these policies.”

Memphis isn’t alone. The Drug Enforcement Administration, as well as police in Georgia, Nebraska, New York, and Ohio, also were found to be using the same tactics. Even prosecutors have endorsed the practice.

At the 2016 Indiana Child Support Conference, a slide presentation told prosecutors that “police and federal law enforcement may create a fake Facebook profile as part of an investigation even though it violates the terms and policies of Facebook” in order to gather evidence in a case.

Facebook has since updated its policy banning fake accounts to be more clear that everyone— including law enforcement—must follow its policies, or their accounts will be deleted.

Whether this will deter law enforcement from creating fake accounts is questionable, considering their blatant disregard for the rules in the past. 

Supreme Court Limits Drug War’s Civil Asset Forfeiture

Supreme Court Limits Drug War’s Civil Asset Forfeiture

www.filtermag.org/2019/02/22/drug-war-civil-asset-forfeiture-supreme-court/

On February 20, the Supreme Court ruled unanimously to limit a key drug war policy that allows state and local law enforcement agencies to seize items or property that they deem connected to crime.

The Court has previously limited the ability of federal law enforcement to do the same.

The justices concluded that the eighth amendment’s prohibition on “excessive fines” also applies to states, under the due process clause of the 14th amendment. In the case at hand, law enforcement had seized a $42,000 Land Rover owned by plaintiff Tyson Timbs. The Supreme Court did not rule on the question of whether the seizure of the vehicle actually amounted to an “excessive” fine, leaving that up to lower courts. But they did say that it was “grossly disproportionate to the gravity of Timbs’s offense,” which included dealing in a controlled substance—heroin—and conspiracy to commit theft.

To be clear, the Court’s ruling does not ban outright civil asset forfeiture, a practice notorious for being abused for the financial benefit of public law enforcement.

“People are still going to lose their property without being convicted of a crime, they’re still going to have their property seized,” Timbs’s lawyer, Wesley P. Hottot of the Institute for Justice, told The New York Times. “The new thing is that they can now say at the end of it all, whether I’m guilty or not, I can argue that it was excessive.”

The Times article references two other cases, one involving a woman who was almost dispossessed from her home because an illicit drug sale occurred on her property, and another where a family in fact lost their house because of a drug purchase made by their teenaged son.

It’s no surprise that so many forfeitures are associated with cases involving drug charges. That’s because the war on drugs invented civil asset forfeiture as we know it today. In an amicus brief filed in the Timbs case, a coalition of organizations including the Drug Policy Alliance, the NAACP, and the Law Enforcement Action Partnership (LEAP)* noted that Congress developed the “federal asset-forfeiture regime” with the Comprehensive Drug Abuse Prevention and Control Act of 1970 in an effort to “cripple drug trafficking organizations and their kingpins.”

The Drug Enforcement Administration (DEA) claims it operates its current civil asset forfeiture program “to disrupt the financial dealings and dismantle the financial infrastructure of illegal drug traffickers.” Seized items often include firearms, computers, and vehicles. But it is unclear how some items seized are implicated in the “financial infrastructure of illegal drug traffickers.”

For example, the DEA and collaborating agencies seized huge sums of high-priced jewelry, totaling over $560,000 in the fourth quarter of 2018. Other items included “assorted televisions” and designer shoes.

But luxury items aren’t the typical seizure. Rather, the usual assets are mostly those of lower-value. That’s because low-income people and those indirectly involved in drug trafficking—rather than “kingpins”—are the ones swept into the DEA’s asset forfeiture program. And in around 80 percent of cases, the owner is not even charged with a crime.

“These days,” explains the amicus brief, “states do not seize the assets of drug kingpins (if they ever did), but of ordinary Americans, often with little or no connection to criminal activity. And, because the proceeds of a forfeiture proceeding often go to the enforcement agency itself, state agencies employ these proceedings as a mechanism for funding their operations—with assets seized predominantly from the poor and people of color.”

Additionally, DEA’s civil asset forfeiture program exploits the particular circumstances of the drug trade to maximize the value of assets seized. According to a Drug Policy Alliance report, California police were incentivized to carry out “cash grabs,” or in other words, to wait for the completion of a drug transaction to intervene. That way, the agency accrues cash, instead of drugs—which they’re required to destroy.

While some of the media reports on the Supreme Court’s decision may have over-hyped its significance, it is nevertheless an important step for the Court to recognize, as Justice Ginsberg wrote in the Court’s opinion, that “[p]rotection against excessive punitive economic sanctions […] is, to repeat, both ‘fundamental to our scheme of ordered liberty’ and ‘deeply rooted in this Nation’s history and tradition.’”

 

El Chapo going to prison for life: The Sinaloa cartel remains a strong drug-smuggling and violence threat on both sides of the Southwest Border

After El Chapo: Sinaloa, other Mexican drug cartels still strong, and now diversifying

https://www.usatoday.com/story/news/nation/2019/02/22/joaquin-el-chapo-guzman-loera-sinaloa-jalisco-nueva-generacion-cartel/2885199002/

NEW YORK – So long, El Chapo. El Mayo is still around. And El Mencho is on the rise.

El Chapo – the internationally notorious drug trafficker born Joaquín Archivaldo Guzmán Loera – faces life in prison for running a continuing criminal enterprise.

Federal prosecutors say the Sinaloa drug cartel leader smuggled tons of cocaine and other drugs into the United States, generating billions of dollars in illegal profits over more than two decades.

The jury in Guzmán’s federal trial agreed last week, voting to convict on each of 10 criminal counts. He still faces charges in other U.S. courts.

Officials declared victory, touting the deterrent effect and symbolic value of taking down the world’s most famous drug trafficker.

But analysts and researchers on Mexican crime organizations that the actual impact on the transnational drug trade might be minimal.

The Sinaloa cartel remains a strong drug-smuggling and violence threat on both sides of the Southwest Border, they say, and a newer, rival crime group, the Cártel de Jalisco Nueva Generación, poses similar danger.

“The conviction is a great moral victory for the United States, Mexico and other countries that have been severely damaged by the flow of illegal drugs coming from the flow of Chapo Guzmán and the Sinaloa cartel,” said Mike Vigil, a former chief of international operations for the U.S. Drug Enforcement Administration.

“The unfortunate aspect is that the Sinaloa cartel continues to function and is just as powerful,” Vigil said.

He likened the organization to “a very strong NFL team that has a great backup quarterback,” along with a “diversified income stream.”

That new Sinaloa boss isn’t actually new at all. He’s Ismael “El Mayo” Zambada, who was indicted with Guzmán, but never captured. The longtime cartel leader is believed to be living in Mexico, government testimony during the trial showed.

Zambada’s son and brother testified against Guzmán during the trial. But Zambada himself remains a force in Mexico, Vigil and other say.

As Guzmán’s trial opened in November, the Sinaloa cartel remained prominent in the Drug Enforcement Administration’s 2018 assessment of Mexican transnational criminal organizations.

“It maintains the most expansive international footprint compared to other Mexican transnational criminal organizations,” the DEA reported.

The Sinaloa cartel still smuggles wholesale quantities of methamphetamine, marijuana, cocaine, heroin and the synthetic opioid fentanyl into the United States through border crossings in California, Arizona, New Mexico and Texas, the DEA said. Distribution is handled through hubs in Phoenix, Los Angeles, Denver, and Chicago, and other cities.

Major drug seizures in recent years demonstrate the cartel’s reach.

DEA investigators in New York City seized more than 145 pounds of fentanyl in August 2017. The synthetic opioid is 50 times more potent than heroin and 100 times more potent than morphine, according to the Centers for Disease Control and Prevention.

Linked to the Sinaloa cartel, it was the largest fentanyl haul in the United States up to that time, the DEA said.

The Ventura County, California, Sheriff’s Office arrested 13 suspects with alleged Sinaloa ties in October 2018. Detectives seized 161 pounds of methamphetamine, 121 pounds of cocaine, 13.2 pounds of heroin and 6.6 pounds of fentanyl – a haul with a combined street value of more than $10.8 million.

U.S. Customs and Border Protection officers reported a record load of hidden fentanyl last month at the border crossing in Nogales, Arizona. They say they discovered nearly 254 pounds of the opioid hidden in a special floor compartment of a tractor-trailer truck carrying a load of cucumbers from Mexico. The compartment also held almost 395 pounds of methamphetamine, they say, bringing the combined street value to an estimated $4.6 million.

Driver Juan Antonio Torres Barraza, a Mexican national, was arrested on drug charges. He said he had no knowledge of the illegal cargo. The case against Torres is still at an early stage, and federal investigators have not yet publicly linked the incident to a specific Mexican drug cartel.

David Shirk, director of the Justice in Mexico project at the University of San Diego, says the Sinaloa cartel and its rivals plunged into the growing fentanyl market after Guzmán’s reign peaked.

“Fentanyl is shaping the drug trade in Mexico today,” said Shirk. “It’s cheaper, and so much more potent. With a small amount of fentanyl, you can make the same profit” as with cocaine or other drugs.

 

 

 

By many accounts, the Cártel de Jalisco Nueva Generación is vying with the Sinaloa organization for market share.

Described by the DEA as “one of the most powerful and fastest growing cartels in Mexico and the United States,” the organization maintains drug distribution hubs in Los Angeles, New York, Chicago, and Atlanta. It smuggles drugs through several border cities, including Tijuana, Juarez, and Nuevo Laredo, the agency said.

Nathan Jones researches drug policy and Mexican security issues at Sam Houston State University in Texas.

He says the Cártel de Jalisco Nueva Generación began a rapid rise in 2010 – aided in part by the U.S.-Mexican strategy of targeting drug kingpins that captured Guzmán.

The group enlisted “orphan” criminal cells left by the fragmentation in Mexico’s organized crime groups, Jones wrote in a study last year.

Notorious mexican drug lord Joaquin “El Chapo” Guzman has been convicted of drug-trafficking charges at a trial in New York. (Feb. 12) AP

The rise of the new cartel shows how organized crime groups adapt after leadership structures have been disrupted, Shirk and co-author Lucy La Rosa concluded in a separate study, also released last year.

The organization now rivals the Sinaloa cartel as the primary suspects in smuggling fentanyl across the Southwest Border, the DEA said.

The Cártel de Jalisco Nueva Generación is also suspected of smuggling “high heat” cocaine, a high-end product reported as more than 97 percent pure.

Investigative reporting from San Diego “identified a wholesaler operating between Tijuana, Mexico and San Diego who was seeking to import ‘High Heat’ cocaine into the U.S. supplied by CJNG for prospective clients,” the DEA reported.

Federal authorities in North Carolina charged six suspects last week with conspiracy to possess and distribute methamphetamine and cocaine. A confidential informant linked the alleged trafficking to the CJNG, authorities said in a court filing.

The Treasury Department targeted alleged Jalisco Nueva Generación leader Nemesio “El Mencho” Oseguera-Cervantes under the Foreign Narcotics Kingpin Designation Act in 2015.

Oseguera and 10 other alleged members of the cartel were charged in new or superseding drug-trafficking indictments in October.

But U.S. efforts to break or disrupt the alleged criminal organization could prove difficult. In recent years, the cartel has diversified its operations, reportedly making drug trafficking just part of its income stream.

“Kidnaping and extortion have become part of the business model,” along with tapping into fuel lines in Mexico and “forcing businesses to sign contracts with vendors favored by the cartel,” Jones said.

Follow USA TODAY reporter Kevin McCoy on Twitter: @kmccoynyc

 

 

 

Four weeks into the drastic Xanax taper I had a stroke.

I am a chronic pain patient. I have been harmed by the current governmental push restricting opioids. Diagnosed with Chronic Fatigue Syndrome and Fibromyalgia after becoming ill in 2001, my pain had been effectively and safely treated since 2003. I have had pain since my teen years, long before I knew what opiates were.

In January of 2018 the Xanax I had been safely taking since 2001 for severe sleep issues was suddenly, unexpectedly, forcefully, rapidly tapered. Four weeks into the drastic taper I had a stroke. My son took me to the doctor with confusion and altered consciousness. Instead of looking for a cause the doctor assumed I had mis-taken medications, wrote a refill for the pain medication I was on, and a small amount of Xanax, and told my son to take me home. Later that same day my son took me to the hospital. I was there four days. A gross mistake was made on my intake history, a medication I had been prescribed for sleep, Seroquel, was recorded as being taken “100 MILLIGRAMS FOUR TIMES A DAY” instead of the correct “one 100 milligram tablet at bedtime”. With this wrong assumption in place it was, again, assumed I was having a medication problem and assumed, again, wrongly, that I had a psychiatric disorder such as bipolar.

When I awoke in the hospital my right hand was curled in a fist and I could not straighten my right leg. In the hospital records it is recorded that I had “drooping on the right side of my face.” In the political push to demonize opiates proper diagnosis of the stroke I experienced was not done. Once I could eat, drink, and walk, with stable vital signs, I was discharged. It was suggested I stop two medications. I did, not understanding all the mistakes made in my “care”. After the hospital stay I had to find a new primary care doctor, my old physician had dismissed me because he suspected, wrongly, that I mis-took my medications. The new physician did not know me. I was struggling to understand what had happened. About 8 weeks after the hospital stay an MRI was done. The new primary care physician told me I had two small strokes. I asked for physical therapy to help me walk better and to help the pain. I also asked for a neurologist appointment and pain management. The doctor said, “We don’t know when the strokes occurred, physical therapy won’t be covered, do you want to see a chiropractor?” What? Really? I know when it happened…

Did the rapid, forced taper of Xanax contribute to, or cause, the strokes?

That was just over a year ago. I have had zero stroke care, no PT, no neurologist appointment, and no pain management. This current governmental push to limit opioids has many victims. I am one. My 23 year old daughter moved back here from another state to help me, her life also altered by these events. After going to a few doctor’s appointments with me she believes, as do I, that what was written in my medical records has drastically altered my ability to get rational medical care.

I have been slandered by a doctor, mistreated by a hospital, denied care by the system and, with no pain medications I am now housebound. I cannot drive, I cannot go shopping by myself, it is very painful to just get around in the house. With the pain medications I can walk, shop, even ride my bike on a good day, as well as look for part-time work. If doctors had not been pushed to drop chronic pain patients I don’t think this would happening to me. These policies are a nightmare for many people. This ILLEGAL DRUG CRISIS should have never been allowed to interfere in the doctor patient relationship. People are dying and I am trying to not be a casualty of this war.

Crazed Republican Candidate Says We Should Kill The Poor And Disabled

In a Facebook post that has since been deleted, a Republican candidate for Oklahoma governor suggested euthanizing the poor and the disabled in order to cut down on the amount of money spent on programs like food stamps. Christopher Barnett claims that he didn’t write the post, but it was on his official Facebook page for his campaign. Ring of Fire’s Farron Cousins explains.   Link – https://www.rawstory.com/2018/05/okla… Support us by becoming a monthly patron on Patreon, and help keep progressive media alive!: https://www.patreon.com/TheRingofFire Spread the word! LIKE and SHARE this video or leave a comment to help direct attention to the stories that matter. And SUBSCRIBE to stay connected with Ring of Fire’s video content! Support Ring of Fire by subscribing to our YouTube channel: https://www.youtube.com/theringoffire Be sociable! Follow us on: Facebook: http://www.facebook.com/RingofFireRadio Twitter: http://www.twitter.com/RingofFireRadio Google+: http://plus.google.com/11841583157319… Instagram: https://www.instagram.com/ringoffiren… Follow more of our stories at http://www.TROFIRE.com Subscribe to our podcast: http://www.ROFPodcast.com Few people outside of the state of Oklahoma know who Christopher Barnett is but just in case you were wondering, he is a Republican candidate right now for governor in the state of Oklahoma. And this week on his Facebook page he actually advocated for euthanizing the poor and the disabled in the United States as a way to cut back on the amount of money we have to spend, as a country, on food stamps. Here is the Facebook quote that his campaign posted on their official Facebook page that is supposed to be speaking for the candidate, “The ones who are disabled and can’t work, why are we required to keep them? Sorry, but euthanasia is cheaper and doesn’t make everyone a slave to the government.” Now, the post has since been deleted. It was deleted I believe sometime on Tuesday evening after huge public backlash, after everyone found out what a disgusting person Chris Barnett is, but that doesn’t change the fact that it was there. Now Barnett says he didn’t write the post, he just didn’t know. He won’t say if the page was hacked or if it was a staffer or if maybe he had a few too many and decided to let his real thoughts out. But regardless, it doesn’t matter. It doesn’t matter who wrote the post because it’s a page for him, so he represents everything that is said on that page from the official account. And to be honest, this is just another in the long line of Republicans accidentally saying what they actually believe, like when we had the Colorado Republican Party recently tell us that they hate poor people. Well this guy’s just doing the same thing, except he’s going one step further. It’s not just hate, he’s saying, “Hey, here’s a great idea! Let’s just kill them.” This is what Republicans want. The party that’s so pro-life thinks that if you’re disabled, or hell even if you’re just poor, you should just die, just die. Remind me again which party is the one that Republicans say is just for killing babies, killing people, when you have these Republicans out there literally advocating for euthanizing those who aren’t wealthy enough to pay for their campaigns. And that’s what it’s about at the end of the day, they’re just pissed off that these people don’t have enough disposable income to donate money to their campaigns. You don’t hear them calling for the euthanasia for these corporate CEOs who poisoned one million people by dumping their toxic chemicals in the waterway, you know, the real criminals responsible for generations of people developing incurable cancers. No, because those people fund their campaigns. But if you’re poor, if you’re disabled, if you have to rely on the federal government program, food stamps or Medicaid or social security, just in order to survive, Republicans want to kill you. And that’s not me talking, that’s just us using their own words to tell you what they really think of you.

This just validates my opinion that both parties have “loose screws” within the party and we have a mental health crisis in this country

when the truth that is stated… is really HALF-TRUTHS ?

Dr Kessler can make the statement that there is no appropriate clinical studies about the use of opiates for long term pain management. All such studies that I have seen have been stopped at 12 weeks out of the concern of the studies lead over possible addictions/dependency.  Unfortunately, long term use of opiate treatment for chronic pain is defined as the routine taking of opiates for pain for > 90 days.

The 12 week studies is only 84 days…so were they intentionally stopped to avoid having a clinical study that reached the legal definition of > 90 days on opiates ?   One can be guess at the reasons this is done, but it gives Dr Kessler and others to claim that there is no valid clinical studies that document long term opiate use is safe and effective.

DOC admitted that reducing my pain meds is medically contraindicated

I am 57 years old and live in Hemet, California.  I have suffered from chronic intractable pain for over twenty-five years.  The primary causes of my pain are diagnosed as early severe degenerative cervical spine disease, Chiari malformation, spondylosis and subsequent nerve damage, and spinal cord impingement by bone spurs.  I have worked with two pain management doctors through all available step therapies without success.  Managed pain medication is the only treatment that has afforded me a reasonable quality of life; allowing me to work and volunteer part time.

In 2017, my pain management doctor began reducing my dosages of pain medication and intentionally under-treating my intractable pain.  He has admitted that this was medically contraindicated, since my condition is worsening.  But pressures from the DEA to comply with CDC dosing “guidelines” are making him taper all his patients regardless of condition or impact on their quality of life.

He fears DEA actions that would lead to prosecution if he treats under prevailing best practices. 

In addition, he has shared that scrutiny from the Medical Board of California under the Death Certificate Project has further restricted his ability to provide safe, adequate medical treatment to relieve suffering.  His attorney has advised him that deviating from forced tapering of patients could lead to closure of his practice, leaving hundreds of patients with no treatment.  He has shared that several of his colleagues have expressed to him a similar concern and many have closed their pain management practices as a result of draconian government regulation.

For me, this unwarranted reduction in pain medication dosing is forcing me into an unbearable quality of life (unrelenting pain, lack of sleep, limited activity, poor appetite, depression).  Due to my worsening condition, I have been accepted in a palliative care program with the Visiting Nurses Association.  Unfortunately, after eight months I have yet to find a pain management physician who will adequately treat my pain under the palliative care exemption frequently stated in the 2016 CDC guidelines.  All of the doctors I have consulted with declared concerns with DEA and Medical Board sanctions as reasons for not providing treatment.  Without adequate pain treatment, I will not be able to make the monthly 140 mile round trip to my pain management physician.  I will have to quit my part-time job and volunteering and will end up bed-ridden.

Additionally, the pharmacy I have used for over fifteen years has declined to fill my legitimate controlled medication prescriptions, stating that they fear scrutiny from the DEA.  Even the administrators for our insurance carrier are interpreting the CDC prescribing guidelines as strict regulations, causing my physician to spend an inordinate amount of time securing medication pre-authorizations and justifying medical diagnosis to people with no medical training.  The CDC dosing guidelines state they do not necessarily apply to patients being treated for long-term, chronic pain, and cancer/palliative/hospice patients yet innocent doctors are being bullied and threatened.  The broad brush of government regulations and miss-applied guidelines is causing unnecessary suffering for countless, law-abiding intractable pain sufferers.  Even cancer patients who only have a short time to live are dying or have died in agony.  Intractable pain is very individualized and should be controlled by pain management physicians.

I have stated before and this letter from a pt seems to validate my conclusions.  I have always suspected that the CDC was doing some of the “dirty work” for the DEA… because the DEA could never get by with publishing things like the opiate dosing guidelines and many believe that the CDC does not have the statutory authority to do it either… but… so far they have gotten by with this ILLEGAL ACTIVITY…

The end goal – IMO – was to get >50% of the health care community to adopt these guidelines, and once that happened then they could be considered to be the “standard of care” and “best practices” for ALL HEALTHCARE PROVIDERS and it would then be EASY for the DEA to get one of their “experts” to testify against prescribers that the DEA wanted to TAKE DOWN … that they were providing opiates greater than standard of care and best practices suggests is not appropriate… and thus could come to the conclusion that the prescriber was treating/maintaining a person who suffers from opiate use disorder, substance abuse or opiate addict.  Seems very easy for the DEA to FABRICATE a story line for a jury to find a prescriber GUILTY.

There is a lot  in the news media that is accusing President Trump with the MANUFACTURED CRISIS AT THE BORDER… but they can’t see how the war on drugs seems to be equally MANUFACTURED/FABRICATED since it began in 1970 with the passage of the Controlled Substance Act.

What is the PRICE for a pt’s QUALITY OF LIFE ?

$375,000 price leads disabled mom to ration meds

https://www.krdo.com/health/375000-price-leads-disabled-mom-to-ration-meds/1031640099

Bhanu Patel couldn’t believe the news. The cost of the medication that allows her to move — the one that enabled her to walk stairs again — shot up to $375,000.

Fear gripped her: What would this mean for her independence? Would she become a financial burden on her family? How is this possible in the country that’s given her so much?

The past three years, she said, the medication had been completely free as part of a specialty program. Until recently, the drug was known as 3,4-DAP made by Jacobus Pharmaceutical. But late last year, Catalyst Pharmaceuticals won FDA approval for a slightly modified version of the drug after two small clinical trials and announced an annual list price of $375,000 for the new drug, called Firdapse.

For Patel, the drug has been a game-changer. She was diagnosed in 2015 with a rare neuromuscular disease called Lambert-Eaton myasthenic syndrome, a condition known as LEMS that affects about 400 people in the United States, according to the National Organization for Rare Disorders.

The disease attacked her hip muscles and abdominal muscles first, then her back muscles she said. Just trying to stand up to walk was agonizing. She dragged herself across rooms and up and down stairs to get around her home. For two years, she wore three back braces on top of each other to allow her to stand.

The disease even attacked her tongue, making it difficult to eat. She lost a lot of weight, and her muscles atrophied. Every aspect of her life was impacted.

When she was introduced to the drug, her doctor told her it would make her feel more alert and allow her to regain basic functions. Her eyes opened wide when she first took the pills. “I said, ‘Wow, you’re right about that,’ ” Patel, 67, recalled. “You feel you want to live and have a life.

“Without this medication, you just can’t even move. It’s like your body is totally like a sweet potato.”

So imagine the predicament a skyrocketing price hike puts a patient like her, she said.

Fearful of burdening her family with exorbitant bills, Patel said, she’s begun rationing her meds — taking two pills a day, instead of four. She said she’s trying to stretch her three-month supply for as long as possible.

“The words that I can use is I can’t believe this is happening, to be honest,” she said.

Her son, Krishan Patel, said his mother has been rejected by Medicare for coverage of the medication, raising concerns the family could get stuck with a massive bill. He said she is appealing for coverage as an exception. His mother has also applied with the Assistance Fund, a nonprofit organization that helps pay for patients’ co-pays. He said she has yet to hear back.

Between he and his sister, Krishan Patel said, they will do everything they can to help their mother. He’s already begun writing and calling lawmakers, AARP, the drugmaker and anyone else who will listen.

He said he’s not just speaking up for his mom, but for those less fortunate. “If we’re not shining a light on these things,” he said, “then really what the hell are we doing?”

“My mother’s livelihood is fundamentally at the hands of a small outfit with full capability to do whatever they want,” he said. “You’re leveraging human suffering to make money — and that is a heartbreaking idea.”

Bernie Sanders demands action

Sen. Bernie Sanders, who earlier this month demanded answers from Catalyst Pharmaceuticals about the drug’s $375,000 price, blasted the company for not responding, and he ripped Catalyst for endangering patients’ lives.

“Instead of answering my questions or lowering the price of this drug, they’ve hired a lobbying firm,” Sanders told CNN in a written statement Wednesday. “It is now clear that some patients are rationing their supply of Firdapse because they cannot afford to cover the outrageous cost of the drug, which they used to receive at no cost.

“If Catalyst does not immediately lower the price of the drug, I will ask FDA to allow pharmacies and manufacturers who were previously making this drug to be permitted to resume providing it, so that all patients can get the medication they need.”

CNN has contacted the US Food and Drug Administration for comment.

Two weeks ago, Sanders sent a blistering letter to Catalyst for its decision to raise the price of Firdapse — “and forcing production and distribution of the older, inexpensive version to cease.” Patients had been able to get the previous version of the drug for free through a compassionate use program through the FDA.

“Catalyst’s decision to set the annual list price at $375,000 is not only a blatant fleecing of American taxpayers, but is also an immoral exploitation of patients who need this medication,” said Sanders, who on Tuesday announced his latest Democratic presidential bid. “I am profoundly concerned that Catalyst’s actions will cause patients to suffer or die.”

Assuming his mother gets approved for the drug, Krishan Patel said Firdapse is listed as a Tier 4 medication on his mother’s Medicare with a 40% co-insurance. Even after rebates, he said, the family fears the possibility of spending more than $100,000 a year on the medication.

Catalyst maintains patients will be left with little to no cost, despite the fears within the LEMS community. CNN asked Catalyst about the possibility of patients getting stuck with a $100,000 tab as the Patel family has expressed.

“All Medicare patients are being directed to foundations that support the LEMS community. These foundations are reducing the co-pay for all patients to $0,” Catalyst spokesman David Schull said in an email. “No out-of-pocket costs for Medicare patients with this set-up.

“Your facts are wrong.”

Asked how Catalyst is informing patients about the co-pay program, Schull shot back: “Everyone is well informed. We do not have any additional information. I suggest you look for what will be a launch update when the company provides its year-financial results and corporate update in March.”

Krishan Patel said patients like his mother don’t have until March to wait when they need answers now. He blasted what he called Catalyst’s “inconceivable behavior to create anxiety in some of the most vulnerable patients with this disease.”

“That sounds like the most insane statement I’ve ever heard,” he said of Catalyst’s response. “At the end of the day, it’s like: ‘Really?’ “

The Patels aren’t the only ones filled with anxiety over this issue.

Dr. S. Vincent Rajkumar, a hematologist oncologist with the Mayo Clinic, said he was giving a lecture to Mayo doctors on the rising costs of prescription drugs and what can be done about the issue. Unbeknownst to Rajkumar, one of the doctors brought along a patient who suffers with LEMS. The patient told him she’d been getting the drug from Jacobus for free since 2004 and that she had just been told she would have to pay $3,800 a month in co-pay.

That patient was Lore Wilkinson. She was outraged by the price hike she’s decided she’s not going to take the medicine — even if it means a rapid decline in her health. She’s already begun looking into getting a wheelchair “because my quality of life is going to tank.”

“I’m going to do without. I’m not going to be a party of enriching the pockets of this predatory pharmaceutical. Unconscionable!” she told CNN. “I don’t think it’s right to be a party to this highway robbery.”

“I would probably choke on it if I took it,” she said. “That’s because I think it’s such an outrage.”

Wilkinson said she was in the process of writing a “thank you” note to Jacobus for providing the medication for free for so many years. “You just wish every pharmaceutical was like theirs,” she said.

Jeane Arlowe leads a private Facebook group for the LEMS community. She said members of her group “have been reeling from the news and trying to wade through the insurance quagmire and Catalyst’s enrollment forms.” Beyond the price hike, Arlowe said, are other complaints.

“Most in my support group were on Jacobus DAP,” Arlowe said. “Many are reporting side effects since being on Firdapse such as racing heart, severe headache, dizziness, exacerbated weakness and gastrointestinal issues. A common complaint is that the Firdapse kicks in too fast and wears off too fast or doesn’t work at all.”

Many of these side effects are identified as possibilities in the drug’s packaging and product information.

A mother weeps

For Patel, the entire ordeal is overwhelming.

She grew up in South Africa during apartheid, often hiding from violence. Her father traveled the world to try to find a better place for his family to live — Europe, South Asia and South America. Her family eventually settled in Canada, before moving to the United States decades ago.

She remembers being taught about America as a girl — a shining beacon of hope that stood for justice.

But her experience with this price hike has soured her. “This is the America we live in,” she said.

An America where one drug can break a person. “What does the future hold for my children — and the children of this country?”

She sobbed as she described not wanting to be a financial burden on her family.

“It’s just a lot of fear. I have to be honest,” she wept. “It just doesn’t feel good.”

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