“The moral test of a government is how it treats those who are at the dawn of life, the children; those who are in the twilight of life, the aged; and those who are in the shadow of life, the sick and the needy, and the handicapped.” – Hubert Humphrey
passionate pachyderms
Pharmacist Steve steve@steveariens.com 502.938.2414
While I have not always agreed with our President Donald Trump. After college, I worked only 6-7 yrs as an employee. I often “bucked the system” as an employee. Six years after college I decided to open my own community pharmacy, and before I retired years later, I had started a handful of businesses, not everyone was a success, but most were.
As being an entrepreneur myself, I have to respect President Trump for all his accomplishments both personally and for our country. Those people who have never own/ran a business. They have little/no idea of what is involved and the meaning contained by the saying “signing the front of a paycheck”.
Our country should be considered a business, and unfortunately most the people that we elected to run our country – at least during my lifetime – the majority seemed to be more interested in their own personal success and the POWER that they can wield.
I & “WE” can hope that President Trump can use his skills as a entrepreneur to lower our national debt, lower our tax rates and essentially put more MONEY in all our pockets.
Donald Trump comes to office as a “lame duck” because he can’t run for another term, so he doesn’t has to worry about getting re-elected and have to concede on his goals to cull political favor.
I heard on TV today that someone, some group is already filing lawsuits against a couple of President Trumps proposed programs. I am sure there will be more and others who are planting “landmines” that are designed to cause President Trump and our country to FAIL.
Word is circulating that Lina Khan—who served as the chair of the Federal Trade Commission under former President Joe Biden—will soon resign from the commission, but her tenure at the agency comes to a close with yet another swipe at PBMs. The FTC has sued CVS Health and Cigna, which Khan said have each “produced only a fraction of the documents required” by the agency’s Section 6(b) investigation into the PBM industry and have “refused to provide basic information about their compliance efforts.” This noncompliance appears to be part of a broader pattern of disregard for commission orders, she said, reiterating that “FTC orders are not suggestions.” Khan also suggested the commission consider whether further recourse is warranted specifically for CVS’ counsel.
The FTC previously sued the big three PBMs and their affiliated group purchasing organizations for favoring high-priced drugs over cheaper alternatives to generate bigger rebates.
Khan’s term as chair expired in September, and Andrew Ferguson was officially designated as chair this week by President Donald Trump. Ferguson joined the FTC in the spring. He was one of four commissioners who voted in favor of issuing the agency’s first interim staff report on PBM practices’ negative impacts on consumers and patients. The commission voted 5-0 to allow staff to issue the second report this month, and in a concurrent statement about it, Ferguson said, “The commission still has more work to do on this Section 6(b) study. I remain committed to bringing it to a conclusion, culminating in a final report.”
Bil and Shanon Schmidtknecht have been passionately speaking out against PBMs and fighting for reforms since their 22-year-old son, Cole, died last January after he couldn’t afford his Advair prescription at a Walgreens pharmacy in Wisconsin because of an insurer/PBM’s formulary decision. Accusing OptumRx of negligence and violating several different Wisconsin statutes, the Schmidtknechts this week filed a federal lawsuit seeking punitive damages. “The conduct of both OptumRx and Walgreens was deplorable,” says a statement from the family’s attorney. “The evidence in this case will show that both OptumRx and Walgreens put profits first, and are directly responsible for Cole’s death.” Learn more about the lawsuit via WBAY and watch our digital advertisement that helps to amplify their story.
With this law, the actual who/what is guilty is what asset is confiscated. How does a house/boat/stack of money defend themself? With the majority of the currency forfeited is < $500, the cost of trying to retrieve the asset by proving it is not ill gotten gain, what is the cost of hiring an attorney to go to trial? Since many of the assets are confiscated by an attorney from the DOJ, prosecutor or district attorney, so when the “guilty party” goes to court, it is up against the attorney who first decided that the asset was ill gotten gain. Bureaucrats that seize and confiscate – especially currency – they are allowed to put it in their coffers to spend as they wish for some “toy” they want for their department.
what is the total dollars that bureaucrats- at all levels federal/state/county/city – have confiscated money from companies and individuals that were never convicted of any crime using our civil assets forfeiture law?
Since 2000, civil asset forfeiture has resulted in at least $68.8 billion being confiscated by federal, state, and local governments in the United States. This figure includes assets seized from individuals and companies without requiring a criminal conviction, but it is likely an undercount due to incomplete data from many states[4].
In 2014 alone, federal forfeitures amounted to over $5 billion, surpassing the $3.5 billion stolen by burglars that year[7]. In recent years, annual forfeitures have remained substantial. For example, in 2021, the U.S. Marshals Service handled over 17,000 assets through forfeiture[5], and California reported $33.8 million in state-level forfeitures plus $11.8 million in federal equitable sharing funds[2].
While exact totals across all levels of government are challenging to calculate due to inconsistent reporting and varying laws, civil forfeiture remains a significant source of revenue for law enforcement agencies nationwide[8].
A significant portion of civil asset forfeiture proceeds come from individuals who were never found guilty of any crime. While exact figures are difficult to determine due to inconsistent reporting across jurisdictions, several key statistics highlight this issue:
1. In South Carolina, 19% of people targeted for civil forfeiture over a three-year period were never arrested, and nearly 800 people were charged with a crime but not convicted[1].
2. In Philadelphia, only about 1 in 4 respondents in a study was found or pleaded guilty to wrongdoing, yet 69% saw their property forfeited permanently[4].
3. Nationwide, since 2000, states and the federal government have forfeited at least $68.8 billion through civil asset forfeiture[2]. While this total includes seizures from both convicted criminals and innocent individuals, a substantial portion likely comes from people never found guilty.
4. The median value of forfeitures is relatively low in many states. For instance, in Michigan, half of all civil forfeitures of currency were worth less than $423, and in Pennsylvania, the median value was $369[3]. These low values suggest that many seizures target ordinary citizens rather than major criminals.
5. In 2014, federal asset forfeiture accounted for over $5 billion, surpassing the $3.5 billion stolen by burglars that year[7]. This comparison illustrates the scale of civil forfeiture and suggests that a significant portion may come from non-criminal seizures.
While it’s impossible to provide an exact dollar amount, these statistics indicate that billions of dollars have likely been confiscated from individuals never found guilty of a crime through civil asset forfeiture.
So I copied ONE PARAGRAPH from the article that seems to plainly describes the target of this article and that is to convince the Psychiatrist’s profession to look at considering putting a DX of OUD ( Opioid Use Disorder) on any pt being prescribed a opioid to treat their chronic pain and they seem to try and create a new disorder POUD (Prescription Opioid Use Disorder). I wonder how long it will take for there to be a ICD-10 code for this “medical issue”
Apparently the medical term POUD was first published in this article in July 2024Prescription Opioid Use Disorder Among Adults Reporting Prescription Opioid Use With or Without Misuse in the United States https://pubmed.ncbi.nlm.nih.gov/39028542/
and by the title the article the authors of this article appear to create this medical disease was to be DXd to people taking opioids WITH OR WITHOUT MISUSING the OPIOID and in this article there are 34 references. Maybe that is what it takes to try and introduce a NEW DISEASE STATE to be recognized?
I also included theRelevant Financial Relationships of the two authors from the article.
I asked www.perlexity.ai to summarize this article and here is its response:
This article, titled “The Opioid Industry’s Legacy: A Generation of Prescribed Suffering” by Andrew Kolodny and Robert M. Bohler, discusses the far-reaching consequences of the opioid industry’s campaign to increase opioid prescribing in the United States. The authors highlight several key points:
## Underestimation of Opioid Use Disorder (OUD)
The National Survey on Drug Use and Health (NSDUH), the primary tool for measuring OUD prevalence, had a significant flaw that led to a massive undercount of OUD cases[1]. This flaw was influenced by opioid industry messaging, which claimed that OUD was rare in patients taking opioids as prescribed.
## Revised NSDUH Findings
After correcting the methodology, the United States Department of Health and Human Services (HHS) now estimates that:
– 5 million Americans suffer from prescription opioid use disorder (POUD)[1][2] – This number is more than triple the previous estimate from 2019 – 62% of people with POUD do not misuse their prescription opioids but take them as prescribed[1]
## Physiological Dependence and POUD
The article challenges industry-influenced educational messages that downplay the risk of POUD and the consequences of physiological dependence. Key points include:
– Physiological dependence can develop rapidly, even within the first few days of opioid use – Opioid withdrawal symptoms can be severe and long-lasting – The effects of physiological dependence and withdrawal help explain why millions of patients who take opioids as prescribed suffer from POUD
## Industry Influence on Perception
The authors describe how the opioid industry influenced various stakeholders to promote a false narrative about opioid use:
– Academics, professional societies, and journalists with financial ties to opioid manufacturers disseminated misleading information – The distinction between physiological dependence and addiction was exaggerated – State medical boards were influenced by industry-funded policies
## Conclusion
The article concludes that many patients prescribed opioids are not benefiting from long-term use but are actually suffering from POUD. The authors argue that these patients are victims of a campaign that promoted aggressive opioid use while minimizing the difficulties of discontinuation.
Recently, in the pages of this journal, we learned that the National Survey on Drug Use and Health (NSDUH), the federal government’s primary tool for measuring the prevalence of OUD, was also influenced by opioid industry messaging. In the article, “Prescription Opioid Use Disorder Among Adults Reporting Prescription Opioid Use With or Without Misuse in the United States” by Han et al,1 the United States Department of Health and Human Services (HHS) acknowledged a serious and long-standing flaw in the NSDUH that led to a massive undercount of OUD. The survey had been systematically excluding patients prescribed opioids from receiving its OUD assessment.
To Cite: Kolodny A, Bohler RM. The opioid industryʼs legacy: a generation of prescribed suffering. J Clin Psychiatry. 2025;86(1):24com15664. Author Affiliations: Opioid Policy Research Collaborative, The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts (Kolodny); Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, Georgia (Bohler). Corresponding Author: Andrew Kolodny, MD, 415 South St, MS 035, Waltham, MA 02453 (akolodny@brandeis.edu).
Relevant Financial Relationships: Dr Kolodny has received fees for serving as an expert witness in litigation against the opioid industry and is the president of the nonprofit organization Physicians for Responsible Opioid Prescribing. Dr Bohler has received fees for serving as a research consultant in litigation against the opioid industry.
Is this just another PREMATURE DEATH caused by inappropriate care, denial of care, or just “writing off” another high acuity chronic pain pt? Another death that will not show up on any statistical database as an intentional failure of our health care system?
PLEASE READ URGENT-DEATH of PAIN PATIENT-undiagnosed ALS……. DEATH of 59 yr old Mother-undiagnosed ALS and her pain was not treated adequately, she suffered. From Maria Higginbotham:
Hi Kat I’M BEGGING YOU to PLEASE read this horrific story. (Below my message) This was my BEST friend. She wanted her story told. For the last 3 years she suffered because doctors didn’t give her adequate pain medication. In October 2023 she tried to commit suicide. She kept dwindling away and on Jan 1, 2025 went into hospital with pneumonia. She was then diagnosed with ALS-Lou Gherigs disease. She died 2 days ago on January 19th. Her death has horrific, she was literally scared to death.I’m begging you to read this, I promise it is something the people in this country will want to hear.I am attaching her story, it’s a rough draft I’ve been working on in hopes that someone will tell her story, but you will get the point.I’m still working with family to get the rest.In October she filmed herself and took pictures. The system failed her in every way. Her sons now have no mother.PLEASE read and help me share her story Hugs Maria Higginbotham 253-381-1783**Gretchen’s Pain Journey and Death I’m writing this on behalf of my best friend and fellow pain warrior Gretchen Lont who I loved deeply. I promised Gretchen I would make sure her story would be told, her last hope was it might stop the needless suffering of others from non treated or under treated pain, this mission meant the world to her. We call ourselves pain warrior’s because we have been fighting a war for the right to receive adequate pain treatment since 2016. According to the NIH and CDC almost 21% of the US Population, 51.6 million American adults, suffer from chronic pain, more than heart disease, diabetes and cancer combined. Many of these patients suffer from horrific chronic pain, a symptom of underlying disease that often takes years to identify and in many cases the diagnosis is too late to help. Sadly, Gretchen Maria Lont, age 59, died on January 19, 2025 after suffering for years from undertreated pain. She kept telling her doctors of her pain issues, her words fell on deaf ears. In the end, 12 days before her death, she was diagnosed with ALS-Lou Gherig’s Disease. Prior to becoming disabled, Gretchen lived life to the fullest, she loved beyond measure her 3 sons Zach, Jordan and Nathan. She enjoyed spending time with her family, including her father, sister and her extended family. She worked hard to provide for her children but always found time to have fun and enjoy life.Gretchen truly knew that it was more of a blessing to give than to receive. Her generosity knew no bounds. Her radiant smile lit up any room she entered. She had a feisty personality and would be a mother bear and protect anyone she loved. She enjoyed crafting, making jewelry and painting. She had an amazing talent and her art work was her release. She adored animals, in her paintings and also seen in her Facebook posts were always of cute animal pictures, especially foxes. She could often be found feeding the squirrels and birds in her yard. Most recently she adopted a special needs cat, Cleo, knowing it would need special care, and remarked we’re two damaged bodies just trying to survive and we’ll do it together.Gretchen originally got hurt working for an upscale restaurant in Tacoma, due to a spill that had not been cleaned, Gretchen slipped, fell and hurt her back. That led to years of living with excruciating back pain, back surgeries and then joint pain. She had swallowing issues which required her throat to be stretched, she was constantly having lung issues.Gretchen tried all the alternative treatment methods, but they did not relieve her pain. Living with chronic pain is like living with chronic illness, you feel invisible, from the outside you look fine, on the inside your body is screaming in agony. Eventually Gretchen found a wonderful pain management doctor who treated her like the individual she was and with compassion and empathy. Opioids helped get her pain to a manageable level in which she could live, do things for herself and enjoyed some quality of life. She spent time with her family, enjoyed holidays and getting outdoors and enjoying nature. She was passionate about art and she was able to paint and also create beautiful jewellery and other craftwork.Sadly, her doctor, after years of constant reprisals from medical agencies regarding her prescribing habits (she never lost her cases) decided to retire, she like many other physicians chose to shut their doors due to the hostile treatment they received for taking care of patients suffering in pain. In June 2021 she gave her patients a 1 year notice so they could try to find a replacement pain management care. Unfortunately, Washington is a wasteland, most physicians will not take chronic pain patients, those who will, won’t if you’re on opioids, and others will if they can treat you with other methods already tried and failed. Gretchen’s only option was to initiate the process of having an invasive surgery, and have a pain pump implanted. In order to get this surgery, she had to complete several psychological and physical exams which she passed. Then she was told she had to reduce her current opioid dosage by 75%. This drastic reduction left her bedbound suffering in agonizing pain. After months of agony she was informed by the pain “pump” doctor that her insurance, through the state, Medicaid, would not cover the cost of a pain pump. In light of this denial, she asked if her dosage would be increased as she could no longer tolerate living with this excruciating pain. The physician declined to increase her dosage back to a dosage that allowed her some quality of life and left her to suffer.On October 3, 2023, Gretchen got very despondent, she felt hopeless, what is there left to live for when you are bedridden suffering in agonizing pain? She felt like a burden. Unable to spend time with family, no longer able to enjoy quality of life. The pain “pump” physician didn’t seem to care that she was progressively deteriorating. She was physically dwindling away to nothing, her cries for help were unheard. During one particularly difficult evening, she decided to have a drink, the first drink in over 20 years. Then she took all her medication in an attempt to commit suicide. Fear set in and she told her son who immediately called 911, she was resuscitated via CPR. The ER doctors and nurses noted this would not have happened if her pain had been treated appropriately. She was discharged and told to speak with her pain “pump” doctor about increasing her pain medication.Gretchen contacted her pain “pump” doctor the following day via a virtual visit, he seemed sympathetic, saying that “we need to provide you with better pain management” but told her they would have to work slowly to look at increasing her dosage of pain medication. He gave her hope. That hope was extinguished the following day when help never came, her doctor declined to increase her medication and she continued her downward spiral.I referred Gretchen to a different doctor who was both a primary care practitioner and a pain management specialist. The physician agreed to try and help Gretchen but had to start cautiously. They tried various other medications which helped a little but Gretchen was struggling and her health continued to worsen. She was incapacitated for months, losing 5-8lbs a week. She had always had swallowing issues and had her throat stretched several times but the last time didn’t help. She began having issues breathing, clots in her lungs, falling down often. It had become difficult to speak. She was the shell of the person she was 2 years ago.In late December 2024 Gretchen’s breathing issues became worse, coughing non stop. Her doctor, also fearing an underlying neurodegenerative disease, recommended her family take her to UW Emergency Room where she would in addition to receiving care for her probable pneumonia, would receive a neurology consult. Ultimately in addition to pneumonia she was diagnosed with ALS- Lou Gehrig’s disease. All the suffering she had been going through was due to an undiagnosed incurable painful disease.Gretchen was admitted into the hospital on January 1, 2025. She was discharged to home hospice on Friday January 17th. After only an hour at home she had a coughing fit and an anxiety attack and was taken immediately to a nearby hospital. By the time she arrived she was frozen in place. Eyes and mouth open, hands extended but unresponsive. She laid that way for approx 46 hours, surrounded by those who loved her until finally on Sunday January 19th, she stopped breathing.I told her son, she has her angel wings and is flying around no longer in pain, a bright light in our lives whose flame will never be extinguished.Gretchen’s Words:Please help patients like me who have no options, no doctors will take you if you’re a chronic pain patient.It’s awful when you’re in a vulnerable position like this and no one will help.I am sharing my story because I want people in charge to understand that we are not just people suffering with pain, we are members of a family, with people we love and family members who love us. We deserve to live out our lives laughing and enjoying those around us, not lying in bed incapacitated.Please stop punishing those suffering in pain. Our lives matter.
I have very mixed emotions over this whole concept. I am a firm believer that any/all addictions have a significant underlying mental health issues. Recently U.S. Surgeon General Dr. Vivek Murthy declared that alcohol causes CANCER. Some self-declared opioid experts wants to declare that anyone being prescribed any controlled substance should be diagnosed with a SUD. (Substance Abuse Disorder)
I often wonder how many politicians, bureaucrats from all levels of our bureaucracy (city, county, state, federal) should/could be diagnosed with SUD, yet they are being hypocrites on the real source of our fabricated opioid crisis and how they are technically are part of the problem?
Nicotine & Alcohol are both consider DRUGS and those two drugs contribute to some 550,000 deaths every year. Just how many of these bureaucrats should be Dx’d with SUD, but because of their positions/authority/power no one dare label them as such, but they have no problem with labeling just about anyone else taking a prescribed controlled med because they have a valid medical necessity for taking the medications.
On the web there ishttps://x.com@doge@DOGE Dept of Government Efficiency. Should we all call the attention to @doge that “WE” spend an estimated 140 billion/yr in fighting the war on drugs and yet >100,000 of our citizens are dying (OD/poisoning) from Illegal substances and yet the DOJ/DEA is focused mostly on our healthcare system and healthcare providers within that system. I am a Pharmacist, but I cannot legally practice law, but “we” all see where attorneys in the DOJ/DEA and other sections of Federal & State agencies that are determining what medications pts should be prescribed. Basically practicing medicine, with obviously having no idea of what they are doing. Remember one of the basics of the practice of medicine is the starting, changing, stopping a pt’s therapy. It doesn’t matter if you are talking about DEA limiting production quotas, the CDC developing opioid dosing guidelines using a the MME system that has no clinical studies behind their conclusions or the DOJ suing various parts of our healthcare system and “confiscating” profits from corporations selling legal products and services.
An NYC nonprofit has reversed 1,700 overdoses since 2021. Under Trump, it faces an uncertain future
NEW YORK — Shawn has spent the better part of the last hour injecting fentanyl. But he is not in any danger: After a brief scare, when his heart rate dropped considerably, the pulse oximeter on his left index finger now says his vital signs are nearly back to normal. The staff at OnPoint NYC, the harm reduction nonprofit whose back room is designated for precisely this purpose, are no longer worried. Instead of administering medical care, they bring him a cup of coffee and a candy bar.
It is late morning in East Harlem, a neighborhood long known not just for its cultural richness but also for the crime and drug use that often accompany poverty and neglect. Outside, it is 19 degrees. There is little telling what would befall Shawn, a 49-year-old originally from Columbus, Ohio, if he were to use outdoors, with his own syringe, by himself. But inside, he is warm. He is watched. He has a never-used sterile needle. And perhaps most importantly, he is not being judged. There is no police officer to harass or arrest him. There are no sidewalk passers-by to cast a disapproving stare. Here, Shawn, and other OnPoint participants, can use drugs as they please.
Outside this room, the practice of supervised consumption remains highly controversial to much of the United States. But inside, such scenes play out hundreds of times per day, representing acts of compassion that, today, may have saved Shawn’s life — and that he says may soon allow him to leave fentanyl in the past.
“We’re not trash,” said Shawn, a regular OnPoint participant who STAT is identifying only by his first name, in an earlier interview. “We just need a little human care and guidance.”
After Shawn uses the drugs he brought with him, OnPoint staff closely monitor his alertness and vital signs.
The care and guidance available to Shawn at OnPoint may soon be threatened. Harm reduction, the approach of providing judgment-free services meant to preserve drug users’ well-being without pressuring them to stop consuming, faces an uncertain political future in 2025. Even beyond typical conservative criticisms, local officials in deep-blue cities like Philadelphia and San Francisco have blamed harm reduction for the cities’ continued drug crises and, in some cases, moved to roll back some harm reduction policies.
More recently, President Trump’s return to power has alarmed supporters of harm reduction and, particularly, supervised consumption. The first Trump administration took a hard line on the tactic, arguing the sites violated federal law and even suing to prevent a separate nonprofit from opening a similar site in Philadelphia. And though his pick for health secretary, Robert F. Kennedy Jr., is himself in long-term recovery from addiction to alcohol and heroin, he has advocated a “tough love” approach to other Americans struggling with substance use.
As the first American facility to openly offer supervised consumption services, OnPoint stands on the frontlines of a long-running battle between those who favor a compassionate, harm reduction-oriented approach to the nation’s overdose epidemic and others who favor the harsher “War on Drugs” tactics that have historically dominated U.S. drug policy.
Though advocates contend that supervised consumption’s legality remains unsettled, there is little doubt that Trump has the standing to challenge OnPoint’s operations if he chooses to. But Sam Rivera, the organization’s executive director, has little time for hypotheticals.
He is far more concerned with caring for the thousands of people who have passed through these doors in East Harlem and at a sister location in Washington Heights, nearly 4 miles to the north, since OnPoint began offering supervised consumption services in 2021. In that span, its records show, it has reversed over 1,700 overdoses without a single participant death. (OnPoint does not supply illegal drugs, or allow them to be sold or distributed, but allows participants to use any drugs they bring.)
Perhaps most remarkably, it has done so with the support of two New York mayors, including Eric Adams (D), a longtime police official, and a wink-and-nod tolerance from the Biden administration, which never formally countenanced supervised consumption but has made no attempt to stop it.
“We had an opportunity to do the right thing, and we did it,” Rivera said during an interview in his office at OnPoint’s headquarters. “We’re operating an amazing service with an amazing staff providing services to beautiful human beings. And if no one does anything for me to respond to, we keep doing it. If something happens where we’re being challenged, I’m ready.”
The entrance to OnPoint’s headquarters on E. 126th St. in the East Harlem neighborhood of Manhattan.
Beyond its day-to-day function providing services ranging from HIV testing to laundry, OnPoint serves as a test case in U.S. drug policy. Rivera has embraced his de facto role as a nationwide spokesman for harm reduction and, on a more basic level, compassion. OnPoint, Rivera argues, has played a significant role upending common narratives about people who use drugs.
“People have a perception of what we look like and what we do from the outside, and then they walk in and go: Oh, my God, I didn’t expect this,” Rivera said. “I think most times, people walk in just expecting to see people using drugs — like, you open the door, and it’s just people using drugs with no structure. It’s just this free-for-all. And then they come in and they see a loving environment where people are being cared for and people are being heard.”
Still, some opponents cast supervised consumption sites as places of hopelessness: a white flag in the war on drugs, a decision to enable and even encourage drug use rather than oppose it.
Rivera emphasizes that 100% of participants here have previously attempted some form of treatment or detox. Yet the harsh rules at methadone clinics, the discomfort that sometimes accompanies buprenorphine treatment, and the near-impossibility of quitting opioids without addiction medications often leads to setbacks. For many at OnPoint, the supervised consumption facility is simply a means of staying alive while plotting their next move.
Sam Rivera, executive director of OnPoint NYC, chats with a staffer while seated in a booth typically used for supervised drug consumption.
Shawn is a prime example. His nearest-term goal is to gain control of his fentanyl use. But to do so, he’ll need methadone, a common medication used to treat opioid addiction. To enroll at a methadone clinic, he’ll need a photo ID. And to obtain an ID, he’ll need a birth certificate — which he currently doesn’t possess. So, as he navigates paperwork purgatory and continues to use fentanyl, he has turned to OnPoint as a safe haven.
So, too, have many others who continue to use drugs like fentanyl, meth, and cocaine, inside and outside OnPoint’s walls. Much of the organization’s programming focuses on helping its participants survive the drugs they continue to use. Last month, one sign hanging just inside an entrance warned of a recent spike in fentanyl concentrations, from a high of 10% over the summer to 30% in the fall.
Beyond offering supervised consumption indoors, the nonprofit’s staff spends countless hours working to prevent drug-related harms throughout much of Upper Manhattan. Staffers are deployed daily to help clear drug-related debris, like used syringes, from city streets. Others train staff and the public on how to administer naloxone and administer rescue breathing in the event of an overdose.
I am no attorney but I have always worked under the impression that law enforcement needs PROBABLE CAUSE to “go after” the alleged guilty party. In this article there is the words “alleges” and “likely” often used to justify the DOJ’s actions. Walgreens has some 8500 store, which would suggest that they employ over 20,000 pharmacists. In this article it is stated that FOUR WALGREEN PHARMACISTS came forward as whistleblowers. In these sorts of lawsuits, if the DOJ prevail, the whistleblowers get to share with what the DOJ gets from Walgreens and CVS, and they can share 15%-25% of what the government gets.
With 20,000+ pharmacist working for Walgreens, who believes that there would be at least FOUR PHARMACISTS who are opiophobic – you know those who are “not comfortable” filling any opioid or other controlled substances? With each of those whistleblowers focused on getting tens of millions if the DOJ wins this case.
Really no concern about all the pts that have a valid need for controlled meds, no regard for all the Walgreen stockholders that will lose money as the stock prices fall and the number of employees that will become unemployed as Walgreens closes the 1200+ stores that they are planning on closing. Below I asked perplexity a question and according to its answer, this action by our DOJ is more an EXTORTION than Walgreens violating our CSA, and a CASH GRAB by our DOJ- confiscating profits from a corporation for selling a legal product.
I asked www.perplexity.ai: legally is probably cause and allegation the same?
Probable cause and allegation are not legally the same. Probable cause is a higher standard that requires more evidence than a mere allegation.
Probable cause is a legal standard that requires sufficient evidence to warrant a reasonable person to believe that a crime has been, is being, or will be committed[1][4]. It is based on the totality of circumstances and involves an assessment of probabilities[3]. Probable cause is necessary for police to obtain a warrant, make an arrest, or conduct a search[4][6].
An allegation, on the other hand, is simply an accusation or claim made without proof. While an allegation can trigger an investigation, it alone is typically not enough to establish probable cause[1]. Law enforcement must gather additional evidence to meet the probable cause threshold before formal charges can be brought[1][5].
The difference between the two concepts is significant in legal proceedings:
1. Investigations: An allegation may initiate an investigation, but probable cause is required to take more serious legal actions[1].
2. Arrests and searches: Probable cause is necessary for police to make an arrest or obtain a search warrant, whereas an allegation alone is insufficient[4][6].
3. Formal charges: Prosecutors typically require probable cause, not just an allegation, to bring formal charges against an individual[1].
4. Legal standard: Probable cause is a fluid concept that depends on the assessment of multiple factors, while an allegation is a straightforward claim[3][6].
In summary, while an allegation can be the starting point of a legal process, probable cause represents a higher evidentiary standard that is crucial for advancing criminal proceedings and protecting individuals’ rights against unreasonable searches and seizures[4][6].
The Department of Justice (DOJ) hit drugstore chain Walgreens with a lawsuit this week for filling “unlawful” opioid prescriptions that had no “legitimate” medical purpose for over a decade.
The lawsuit, which was filed in U.S. District Court for the Northern District of Illinois on Thursday, alleges that Walgreens’ pharmacists filled millions of prescriptions despite “red flags” indicating that they were likely to be unlawful and that it pressured its pharmacists to fill prescriptions while not taking the necessary time to “confirm their validity.”
“Walgreens allegedly ignored substantial evidence from multiple sources that its stores were dispensing unlawful prescriptions, including from its own pharmacists and internal data,” the DOJ said in a Friday press release.
“These practices allowed millions of opioid pills and other controlled substances to flow illegally out of Walgreens stores,” Principal Deputy Assistant Attorney General Brian M. Boynton added in a statement.
The government alleged the company violated the Controlled Substances Act (CSA) by dispensing millions of unlawful prescriptions. The lawsuit alleges that Walgreens, which has over 8,000 pharmacies across the country, also breached the False Claims Act (FCA) by seeking reimbursement for many of the prescriptions from a variety of federal healthcare programs.
“These laws are critically important in protecting our communities from the dangers of the opioid epidemic,” said acting U.S. Attorney Morris Pasqual for the Northern District of Illinois. “Our office will continue to work with our law enforcement partners to ensure that opioids are properly dispensed and that taxpayer funds are only spent on legitimate pharmacy claims.”
The DOJ said that four different whistleblowers, who used to work at Walgreens, filed whistleblower actions. Walgreens said it will stand behind its pharmacists and asked the court to shield the drugstore corporation from DOJ attempts to enforce “arbitrary rules.”
“We are asking the court to clarify the responsibilities of pharmacies and pharmacists and to protect against the government’s attempt to enforce arbitrary ‘rules’ that do not appear in any law or regulation and never went through any official rulemaking process,” Wallgreens said on Friday.
“We will not stand by and allow the government to put our pharmacists in a no-win situation, trying to comply with ‘rules’ that simply do not exist,” the company said, adding it looks forward to defending the “professionalism and integrity of our pharmacists.”
The DOJ filed a similar lawsuit last month, that time against CVS Health, accusing the retail behemoth of aiding the opioid crisis by knowingly filling illegal prescriptions in an effort to “prize profits over patient safety.”
We know that people who are having their pain management reduced or eliminated entirely, their QOL deteriorates dramatically, often the person becomes disabled, losing their job(s) or the business that they have owed and operated for years. Often the “healthy spouse” abandons/divorces the chronic pain spouse. Even if the “healthy spouse” stays, the family’s financial issues can be severely compromised, because of the cost of the medical care of the chronic pain spouse.
Within the article below it is stated what can contribute to dementia:“The Lancet Commission summarized the latest evidence, including the value of controlling vascular risk factors like blood pressure, obesity, diabetes, and smoking; optimizing exercise and sleep; and countering social isolation and depression. In later ages, addressing hearing and vision limitation is important, as is preventing falls and head injuries.”
How many of those risk factors can be attributed to a chronic pain pt that loses their pain management meds? Medical practitioners are suppose to be “healers”.
Maybe Pam Bondi or whoever is the new Federal Attorney General can be encouraged to look at the physical & mental damages the actions of the DEA/DOJ is doing to an estimated 100+ million chronic pain pts, including an estimated 15 million kids (<19 y/o) suffering from chronic pain.
Most of us know that in 1965 – before the CSA was signed into law – there is a law:
From Title 42-THE PUBLIC HEALTH AND WELFARE CHAPTER 7-SOCIAL SECURITY SUBCHAPTER XVIII-HEALTH INSURANCE FOR AGED AND DISABLED
§1395. Prohibition against any Federal interference
Nothing in this sub chapter shall be construed to authorize any Federal officer or employee to exercise any supervision or control over the practice of medicine or the manner in which medical services are provided, or over the selection, tenure, or compensation of any officer or employee of any institution, agency, or person providing health services; or to exercise any supervision or control over the administration or operation of any such institution, agency, or person.
I asked perplexity.ai: could under/untreated pain cause an increase in dementia?
Yes, under/untreated pain could potentially cause an increase in dementia risk and exacerbate symptoms in those already diagnosed with dementia. Several studies have found significant associations between chronic pain and cognitive decline:
1. Chronic pain lasting over three months raises the risk of cognitive decline and dementia[1]. In a 60-year-old person with one site of chronic pain, the hippocampus (crucial for learning and memory) aged by about a year compared to those without pain[1].
2. Untreated pain in dementia patients can lead to observable neuropsychiatric symptoms like depression, agitation, and restlessness, which were previously thought to be solely due to neurodegeneration[2].
3. A large cohort study found that chronic pain was associated with a higher risk of dementia, especially in the 50-64 age group[3]. The increased risk persisted even after 5 years of follow-up[3].
4. Chronic pain may contribute to dementia risk through several mechanisms: – Disruption of attention and memory processes[3] – Impairment of decision-making and processing speed[3] – Increased production of endogenous cortisol, potentially leading to hippocampal degeneration[3] – Chronic inflammation, which may affect brain connectivity and function[1]
5. Untreated pain in dementia patients can lead to reduced quality of life, poor sleep patterns, impaired social interactions, and aggressive behaviors[5]. These factors may further contribute to cognitive decline.
6. Research suggests that in individuals with chronic pain, cognitive decline is likely to progress more rapidly[8].
Given these findings, proper pain assessment and management are crucial, especially in older adults and those with dementia, to potentially reduce the risk of cognitive decline and improve quality of life.
1 million adults projected to develop dementia each year by 2060
Key Takeaways
U.S. dementia cases were projected to reach 1 million annually by 2060, doubling from 514,000 cases in 2020.
Lifetime dementia risk was estimated at 42%, with incidence increasing after age 75.
Projected rates were highest in Black adults, women, and APOE4 carriers.
Dementia cases in the U.S. are expected to double in the next four decades, a new analysis suggested.
In a racially and geographically diverse sample, the lifetime risk of dementia was estimated at 42% (95% CI 41-43) with incidence increasing substantially after age 75, according to Josef Coresh, MD, PhD, of New York University Grossman School of Medicine in New York City, and co-authors.
Based on U.S. Census data, the number of adults who will develop dementia each year was projected to increase from about 514,000 in 2020 to 1 million in 2060, Coresh and colleagues reported in Nature Medicine
Projected rates were highest in Black adults, women, and APOE4 carriers, with lifetime risks ranging from 44% to 59% in these groups. Mortality was treated as a competing event.
“It’s important to note that the risk from ages 55 to 75 is 4%,” Coresh told MedPage Today. “It rises to 20% by age 85 and then 42% by age 95, so half the risk is after age 85.”
The lifetime risk figures are considerably higher than previous estimates. Data from the Framingham Heart Study data suggested, for example, that about 14% of men and 23% of women in the U.S. would develop dementia during their lives.
The new estimates came from a more diverse group of people followed from 1987 to 2020, using an extensive range of methods to ascertain dementia, Coresh pointed out. It relied on data from the Atherosclerosis Risk in Communities (ARIC cohort, which was more diverse geographically, racially, and socioeconomically than other studies, he added.
The analysis extends existing research by quantifying the growth of incident dementia, incorporating trends that likely will be driven by the Baby Boom generation reaching older ages, the researchers said. The findings highlight the importance of strategies to reduce dementia risk and address racial inequities in healthcare, they added.
“We now know that half of dementia risk is preventable,” Coresh said. “The Lancet Commission summarized the latest evidence, including the value of controlling vascular risk factors like blood pressure, obesity, diabetes, and smoking; optimizing exercise and sleep; and countering social isolation and depression. In later ages, addressing hearing and vision limitation is important, as is preventing falls and head injuries.”
In the U.S. and globally, there’s an urgent need to address the crisis of Alzheimer’s disease and dementia, noted Maria Carrillo, PhD, chief science officer and medical affairs lead for the Alzheimer’s Association in Chicago, which wasn’t involved with the study.
“In the coming years, more people will be affected,” Carrillo said. “This is especially true for high-risk groups who often have been underrepresented in research, including Black Americans, Hispanic Americans, and women.”
The ongoing POINTER trialis evaluating whether lifestyle interventions that simultaneously target several risk factors can protect cognitive function in people at increased risk for cognitive decline, she added.
Coresh and colleagues evaluated health records from 15,043 participants in the community-based, prospective ARIC cohort in North Carolina, Mississippi, Minnesota, and Maryland who were 55 and older. All were dementia-free at age 55.
The sample included 55.1% women and 26.9% Black participants. About a third (30.8%) of participants had at least one APOE4 allele.
Over a median follow-up of 23 years, there were 3,252 incident cases of dementia. Of the dementia cases, 49% were diagnosed through phone interviews, 27% through hospital and death record review, and 24% at study visits with cognitive testing.
Differences in risk across race emerged at about age 75, while sex differences emerged at about age 85. Lifetime risks were 41% in white versus 44% in Black participants, and 35% in men versus 48% in women, due perhaps to women’s higher life expectancy.
People with two APOE4 copies had a higher lifetime risk of dementia (59%) than those with one copy (48%) or no copies (39%), with differences starting at around age 70.
The analysis had several limitations, the researchers acknowledged. Some dementia cases may have been misclassified, and some cases might not have been captured. The study also was not externally validated.
“Future population-based studies with long follow-up and comprehensive dementia ascertainment are needed to validate our lifetime risk estimates,” they wrote.
By FDA law, compounding pharmacies are not allowed to compound and medications that is available as a commercially sold product. One exception is when a commercially produced product is in short supply or on back order. With these new GLP-1 medications, the very exact GLP-1 raw medication powder is NOT AVAILABLE to compounding pharmacies. Apparently these compounding pharmacies are using a drug that is MAYBE similar to the GLP-1 meds on the market from the pharmas, but none have been thru clinical trials nor approved by the FDA to be safe and effective in humans. I have also read some reports of some very serious – even FATAL – reports from pts using these meds.
While this prices is about HALF of the auto-inject pens from Lilly but still a little more than the compounding pharmacies, but at least you know that you are getting the real FDA approved product.
On December 17, the U.S. Food and Drug Administration (FDA) issued Warning Letters to five companies offering various GLP-1 products, including Semaglutide, Tirzepatide, Retatrutide, Cagrilintide, Mazdutide, Survodutide, and Sermorelin. Based on FDA’s review of therapeutic claims made on websites and social media platforms, the FDA determined that these products are unapproved new drugs. The FDA stated in their Warning Letters that these products have been introduced or delivered for introduction into interstate commerce in violation of sections 505(a) and 301(d) of the Federal Food, Drug, and Cosmetic Act (FD&C Act), 21 U.S.C. 355(a) and 331(d).
Online Sellers of Compounded GLP-1s Often Don’t Mention Risks
40.5% noted efficacy claims not listed on the labels of their originator products
Many online sellers of compounded GLP-1 receptor agonists may be misleading customers, a cross-sectional study suggested.
Out of 79 websites that sold a compounded GLP-1 agent, 11 (13.9%) failed to mention the medications were compounded versions and seven (8.9%) wrongfully referred to them as generics, Alissa Chen, MD, MPH, of Yale University School of Medicine in New Haven, Connecticut, and colleagues detailed in a research letter in JAMA Health Forum
Half of the websites (49.4%) failed to mention risks including adverse effects, warnings and precautions, and contraindications, and 40.5% advertised an efficacy claim not in the authorized label of the FDA-approved branded GLP-1 agent.
A total of 34 websites (43%) stated the compounded medications weren’t FDA approved, while 29 (36.7%) stated or implied they were.
“Compounded medications contain the same active ingredients as in branded medications but may contain different inactive ingredients and are not FDA approved,” Chen’s group pointed out. “U.S. federal law requires advertising of all prescriptions, including compounded medications, to be ‘truthful, non-misleading, and accurate’; however, the extent to which compounded medication advertising meets this mandate is unclear.”
An estimated 11% of GLP-1 users obtain their prescription through an online provider or website, so it is important online sellers use non-misleading advertising, they added.
But compound pharmacies and their products “fall into a regulatory gray zone,” noted accompanying viewpoint authors T. Joseph Mattingly II, PharmD, MBA, PhD, of the University of Utah College of Pharmacy in Salt Lake City, and Rena Conti, PhD, of Boston University.
“Since compounded products are copies of originator products, the pharmacy references the FDA-approved label attesting to safety and efficacy, but unlike the originator, the pharmacy does not technically attest to their manufacturing according to Current Good Manufacturing Practice,” they explained. “Moreover, unlike originator products, the 2002 Thompson v. Western States Medical Center Supreme Court decision ruled that advertising prohibitions on compound pharmacies and their products are a violation of the First Amendment.”
Although their advertising may not necessarily be illegal, they do appear to violate Congress’s intent to support patient access to safe and effective drugs, added Mattingly and Conti.
In an editor’s note Julie Donohue, PhD, of the University of Pittsburgh, said it’s “unclear” if FDA regulations intended to apply to advertising by manufacturers should also apply to compound pharmacies.
While compounders won’t be able to make copies of GLP-1 agents as shortages start to resolve, resolving the shortage “will not prevent questionable marketing practices of online pharmacies and others, nor will it resolve the illegal trade of counterfeit or adulterated products,” Mattingly and Conti said.
In order to better protect consumers, they recommended more advertising requirements for compounders, “aggressive” prosecution of counterfeiters, and an independent task force to determine when to add or remove a drug from the drug shortages list.
Chen and co-authors initially reviewed 98 websites that sold GLP-1 agents from July through September 2024. Of these, 79 websites sold compounded semaglutide (Ozempic, Wegovy, Rybelsus), tirzepatide (Mounjaro, Zepbound), or liraglutide (Victoza, Saxenda), or a prescription for such. All websites sold compounded semaglutide, 72.2% sold compounded tirzepatide, and 3.8% sold compounded liraglutide.
A total of 52 websites (65.8%) featured a mark of certification, 50 of which displayed LegitScript certification. Two websites didn’t provide prescriptions for compounded GLP-1 drugs and required a prior prescription.
All but one website required clinician involvement to obtain the medication and 63.3% required a completion of a questionnaire reviewed by a clinician. Five websites required an in-person visit, eight required lab work, and 31 required a telehealth visit.
Including discounts, the median first month’s price for the compounded medication was $231 for semaglutide, $330 for tirzepatide, and $248 for liraglutide.
The researchers pointed out that because they reviewed all information reported on websites, including on subpages and linked blogs, there’s a good chance they overestimated the amount of information that typical consumers review.
Just when you thought the opioid crisis may have peaked, Dr. Andrew Kolodny, arguably the world’s foremost anti-opioid zealot, has found a shiny new way to inflate the numbers. In the HHS’s redefining of opioid use disorder (OUD) to include patients responsibly taking their prescribed meds, he’s managed to conjure millions of “new” cases out of thin air. But don’t worry, it’s all in the name of “progress.” That’s because nothing says compassionate care like labeling chronic pain patients as addicts and patting yourself on the back for the chaos you helped create.
Generated by AI
Overdose deaths from opioids are down over the last year, opioid prescriptions have plummeted by 44% in the last decade, National settlements have been reached with Janssen, Cardinal, McKesson, AmerisourceBergen, Teva, Allergan, CVS, Walgreens, Walmart, and Kroger Co. The Purdue settlement suffered a setback in July but appears still a work in progress. In the opioid crisis, it seems “victory,” even if a bit pyrrhic is at hand.
Despite the good news, could a dark cloud be fabricated to obscure the silver lining? What will the experts, who have earned large fees from courtroom testimony, and advocacy groups allocated millions for opioid settlements do when the cash-cow, at least for them, of opioid scares fades away? We need look no further than the “thought leader for the anti-opioid crowd, Dr. Andrew Kolodny.” [1]
One of the major problems Dr. Kolodny has faced in his personal anti-opioid war is that most of the carnage is related to the non-prescriptive use of illicit opioids. This graphic from the CDC demonstrates clearly that our opioid crisis is not primarily due to prescriptions written by physicians. Nor do the data show that they have ever, been a significant driver. But creating policy to control physicians and influencing CDC guidelines is far easier than dealing with cartels.
Dr. Kolodny, in his effort to both minimize any sense of progress and to reignite the war on prescription opioids has turned to the “National Survey on Drug Use and Health (NSDUH), one of the primary tools used by the federal government for substance-use surveillance, consistently reported low rates of OUD.” He claims that, in the past, the surveyors have made a fundamental error in collecting their information believing that opioid use disorder (OUD) can occur in patients taking prescription drugs only if they misuse their medications. Under that assessment, only 1.6 million people were reported to have OUD.
In 2021, HHS redefined OUD to align with the DSM-5 criteria. As would be expected estimates of individuals in the US with OUD rose, to 6.1 million. Furthermore, taking into account those not reporting symptoms, the number rises still further to 9.4 million. These numbers prompted the good doctor to write,
“The discovery of millions of previously undetected cases of OUD should prompt an urgent investigation to improve understanding of the overlooked population.”
In essence, the rise is because, individuals given prescriptions for opioids who do not misuse the drug, 62% of the estimated rise, are now considered to have OUD because they
“were unsuccessful [in]efforts to cut down or control use, opioid craving, and [in] spending a great deal of time obtaining or using opioids or recovering from opioid use.”
But is OUD the only explanation for those symptoms? Dr. Kolodny does give lip-service to other explanations, especially the time involved in obtaining or using opioids, “because many prescribers have become more reluctant to treat patients with opioids for long periods.” What he fails to mention is that this reluctance is the fruit of his efforts along with others to demonize the appropriate medical use of opioids resulting in a medical landscape where these prescriptions are a red flag. It takes a great deal of chutzpah (a Yiddish term for audacity) to decry the condition you created.
Opioid craving, is “an overwhelmingly strong desire or need to use a drug,” which will go hand in hand with unsuccessful efforts to cut down or control opioid use. But is it truly a craving when opioids are the only medication that provides a quality of life? Is it the patient unsuccessful when in consultation with their physician they increase the dosage or create different medication usages [2] to meet their clinical needs?
Kolodny continues:
“Although some of these patients appear to function well using long-term opioids, the new findings suggest that a large group of patients who are taking opioids as prescribed may nevertheless have OUD. The findings may also help explain why some patients are unable to taper off opioids and why switching to buprenorphine, a first-line treatment for OUD, often improves outcomes. It’s been known for decades that proper management of OUD generally involves long-term opioid maintenance therapy.”
This quote is perhaps Dr. Kolodny at his best, speaking from both sides of his mouth. If a patient is indeed functioning well, then where is the disorder? Certainly, a functional assessment is more valid than a DSM checklist. And if an individual is unable to taper off opioids, one of the hallmarks of OUD, then how is switching to buprenorphine, an opioid with a different, albeit “safer” profile, an improved outcome?
“Evidence that 4.8 million patients who have been prescribed opioids for pain may have OUD should reinforce calls for more cautious use of opioid analgesics, including use for acute pain, which has often been the starting point for long-term use.” [emphasis added]
Since 2011 physicians have reduced prescriptions for opioids by 44%. The refills of an initial prescription vary with the condition, but on average 25% of a 7-day prescription are refilled, that number drops to roughly 6% at one year.
Can Dr. Kolodny say, with clarity that that 6% reflects OUD or could it reflect a chronic pain pattern that has been unresponsive to other therapies? He goes on to point out that that the rate of decrease in postoperative opioid prescriptions has slowed, evidently a sign that “clinicians continue to overprescribe opioids;” or is it that we have found the lower limit on what can be considered humane, efficacious care?
Dr. Kolodny’s redefinition of OUD is a masterclass in manufacturing a crisis where one no longer exists. By conflating effective pain management with addiction, he has created a statistical mirage that serves only to stigmatize chronic pain patients and bolster his anti-opioid crusade. As the data reveals a sharp decline in opioid prescriptions and overdose deaths, his narrative grows increasingly disconnected from reality, leaving chronic pain sufferers to navigate a medical system terrified of treating them. Perhaps it’s time to shift the focus from scoring ideological points to addressing the real opioid crisis: illicit drug use and the systemic failures that allow it to persist. In the end, true progress comes not from inflating statistics, but from addressing facts with compassion and precision.
While I have not always agreed with our President Donald Trump. After college, I worked only 6-7 yrs as an employee. I often “bucked the system” as an employee. Six years after college I decided to open my own community pharmacy, and before I retired years later, I had started a handful of businesses, not everyone was a success, but most were.
The Purdue settlement suffered a setback in July but appears still a work in progress. In the opioid crisis, it seems “victory,” even if a bit pyrrhic is at hand. 