“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
We have been always been the UNITED STATES OF AMERICA… Our Constitution plainly states what is to be managed by the Federal gov and what is the responsibility of the states. We are not the 50 regional members of the North America Federalization Government.
This has been a interesting month for the bureaucrats in Washington DC.. SCOTUS decided that states could not prohibit USA citizen to own and bear arms, because it is guaranteed right by the 2nd Amendment of our Constitution. SCOTUS also declared that RED FLAG laws regarding confiscating a person’s gun(s) was unconstitutional.
Congress turned around and passed a new “gun law” making RED FLAG LAWS legal… I would presume that this law is going to handed to ATF… a “sister agency ” to the DEA… Both under the same Presidential Cabinet Seat of DOJ. Most of us are well aware of all the RED FLAGS that the DEA has created surrounding prescribing/filling controlled meds… and RED FLAGS are not mentioned nor defined in the controlled substance act, but that has not stopped the DEA from turning their opinions into RED FLAGS and then apply those RED FLAGS as to who has violated the CSA.
SCOTUS following their other opinion(s) of what is stated/defined in our Constitution, they declared that the 50 y/o SCOTUS decision that the right to a abortion is guaranteed by the federal government is not supported by our constitution and is neither guaranteed nor prohibited in our Constitution and sends the issue BACK TO THE STATES to dictate what is allowed/prohibited, in regards to abortion in individual state. NO SCOTUS did not make abortion ILLEGAL
My first thoughts, with up to a dozen types of birth control/contraception. Including Plan B/morning after (72 hrs) pill for those who have been raped or there is incest. I am sort of confused about the “my body, my choice”… what about personal responsibility ? I have seen stats of one million + abortions performed every year. Does that suggest one million + BAD DECISIONS “in the moment” ?
Personally, I am somewhere between agnostic and indifferent on the issue of abortion. The first question – after personal responsibility – One Million + abortions has got to involve some major $$$ of medical costs. Not to mention some of these females may end up with the need for some Psychological help when they later regret their decision.
I viewed a video from a female, probably in mid-late 30’s. Stating that she had a child when she was young and kept the baby and admitted that she was not a real good Mother to that kid… Then stated that “totally unexpected”, got pregnant again and had her first abortion in 2009. Here is 2022 and she stated that she was in her last year in her PharmD degree and she found herself pregnant again and the “sperm donator ” did not want to be a FATHER and she did not want to give birth during her graduation and it would ruin her career. Maybe, her first born was grown and left home and didn’t want to be a single Mother in her late 30’s and starting her career.
Obviously, she did not figure out how a pregnancy happened since apparently several years later was “totally unexpected” pregnant. I would hope by her 5th-6th yr of pharmacy school, she would have fair handle on how pregnancy happens and what contraceptives are available and how they work.
Maybe, as a country we should put vending machine .. right next the the ones that provide free Narcan, clean needles, etc, etc.. with free Birth Control pills, condoms , Plan B. Maybe be able to help prevent pregnancy rather than terminating pregnancies.
This past week, we had a LESS THAN FOUR YEARS OLD Whirlpool washer FAIL ON US.. We had purchased it from a local owned appliance store we have been patronizing for some 3+ decades. We used a repairman that they recommended – didn’t know at the time that this guy had worked for a local Whirlpool service center until it was closed and he went into business for himself. He told us that it was one of two boards – there was no error codes that would display and each board was $300-$400 each.. I contacted Whirlpool company customer service… they kept me on hold so long that I was able to search expected life span of such equipment – under HEAVY USE – EIGHT YEARS — under light use – 10-12 yrs… take a guess – TWO SENIOR CITIZENS is the only ones using this machine since it was purchased new and the anticipate life expectancy we should expect.
I was hoping that Whirlpool would provide the bad control boards and I would pay the labor… NOPE… I was told that I had to have THEIR APPROVED REPAIR SERVICE TO ASSESS THE MACHINE… I had already paid $75 for an evaluation from a person who use to work for Whirlpool – and working on appliances for FORTY YEARS – and I was going to pay for another service run with NOT EVEN A PROMISE/HOPE that they may provide some compensation on this machine or credit on getting a new Whirlpool washer…
The CS person seemed to be totally unconcerned… and my closing statement to him was that our new washer would not be a Whirlpool… I don’t know if he was chuckling under his breath, because after I went on line and found out all the different washing machine labels… they make… Maybe he sensed that I would not be “smart enough” to find out that information..
We contacted our locally owned appliance store that we have been using for 3+ decades and our NEW LG WASHER WILL BE DELIVERED TOMORROW !
It was at Massachusetts General Hospital that Bryan found the care he needed for his opioid use disorder. He had previously tried, without success, to just quit. But when the hospital’s renowned addiction medicine team prescribed him Suboxone, a medication that can tame cravings, it worked.
Bryan also had cystic fibrosis, which by 2017 had progressed to the point he needed a lung transplant. It made sense that he would get that done at MGH too.
The transplant team, citing the Suboxone Bryan took, rejected him.
The denial confounded Bryan and his family. Bryan was doing what he was supposed to be doing, taking an effective medication that other doctors at that very institution had put him on. It helped him live free of misused painkillers and heroin. But the denial was also an emergency. Bryan kept getting sicker.
“At that point, you realize you’re 27 and dying,” Bryan said, recalling how he thought he would miss out on the future life he had envisioned for himself. “You’re not going to give someone a chance because of the past they had when they were younger?”
An unexpected ally agreed with Bryan.
In a 2020 settlement, the U.S. Justice Department found that MGH discriminated against Bryan under the Americans with Disabilities Act, the landmark 1990 civil rights law meant to ensure that people with disabilities have the same opportunities as everyone else. It’s not a well-known element, but the law classifies substance use disorder as a disability, meaning disfavoring someone for being in recovery or based on their past drug use is illegal. (The law does not extend its full protections to people still using drugs.)
Increasingly, Justice Department attorneys are leveraging the law to try to overcome some of the rampant discrimination that people with substance use disorders face. The cases typically center on people who are penalized because they take medication for opioid addiction — treatments that are considered the gold-standard — and on people who are denied those medications, particularly in the criminal justice system. The underlying argument rests on the idea that imposing barriers on treatment for a disability is tantamount to doing so on the basis of the disability itself.
“We have so stigmatized drug use that it doesn’t even seem to register that what they’re saying is not OK.”
Kelly Dineen
Creighton University
The pace of the cases is picking up, with the government reaching agreements with or filing suit against institutions in Pennsylvania, Rhode Island, and Colorado in recent months. And in April, the Justice Department’s Civil Rights Division released guidance outlining how the ADA applies to substance use disorders, aiming to explain to people with addiction histories that they have rights they might not be aware of.
“We have so stigmatized drug use that it doesn’t even seem to register that what they’re saying is not OK,” Kelly Dineen, the director of the health law program at Creighton University, said about institutions that discriminate. The department’s actions, Dineen said, convey that “not only is it unethical, it’s unlawful.”
If anything, advocates say it’s an overdue enforcement of a law that’s been on the books for three decades, a policy that Justice Department lawyers have acknowledged they’ve only started wielding in recent years. But the hope is that what may seem like whack-a-mole investigations — a nursing facility that won’t take patients on Suboxone here, a detention center that won’t provide addiction medications there — will spark enough attention to motivate whole fields to change their policies, lest they want to duel with the Justice Department.
“The country’s top law enforcement agency has now stated plainly that denying health care and other vital services to people with opioid use disorder violates federal law,” said Sally Friedman, senior vice president of legal advocacy at the Legal Action Center. “So facilities like jails and skilled nursing facilities that routinely discriminate against people with opioid use disorder should see the writing on the wall, and that if they continue to discriminate, they shouldn’t be surprised when the Department of Justice comes knocking on their door or they get served with a lawsuit.”
Bryan, who asked to be identified by his first name only, ultimately got his transplant in November 2017 — at the University of Pennsylvania. As part of the settlement, on top of training transplant staff on the disabilities act, MGH had to pay $170,000 to Bryan and $80,000 to his mother, who stayed with him in Pennsylvania for six months as he recuperated.
In a statement, MGH said it “is committed to ensuring all its services, including organ transplantation, are available to all patients including those with disabilities. The MGH Transplant Center has ensured that all staff understand responsibilities under ADA.”
Packages of Suboxone, a treatment for opioid use disorder. Kristoffer Tripplaar/Sipa USA/AP
Listen to lawyers involved in these cases, and you’ll learn they’re not hard to find.
“This kind of discrimination is overt,” Gregory Dorchak, an assistant U.S. attorney in Massachusetts who has led many of these investigations, said on a recent webinar.
In 2018, the Justice Department first advocated for the legal theory that “discrimination on the basis of treatment is discrimination on the basis of disability,” Dorchak said. It came in an investigation of Charlwell House, a skilled nursing facility in Massachusetts that refused a patient who took Suboxone. Change the prescription, the nursing facility told the patient, and we’ll reconsider.
“Right there, you have, in that short message, essentially the smoking gun of the policy,” Dorchak said. “They articulate that, but for the medication being used, we would admit this person.”
The department reached a settlement with Charlwell House, under which the facility had to adopt a non-discrimination policy and provide ADA training. It has since reached agreements with about eight other skilled nursing facility organizations.
Such cases expose how many institutions — including health care facilities — don’t realize that withholding services from someone based on their addiction history or ongoing treatment amounts to illegal discrimination. It’s a result of both a lack of knowledge about ADA protections generally, and the specific stigma that people who’ve used drugs encounter, experts say.
“There is resistance to seeing those as medical conditions or disabilities,” Elizabeth Pendo, a professor of law at St. Louis University, said about substance use disorders. Instead, some people view them mainly as the ongoing consequences of bad decisions or lack of willpower. “Those misperceptions, those biases, those assumptions, they linger, and they’re harming people,” Pendo said.
“Those misperceptions, those biases, those assumptions, they linger, and they’re harming people”
Elizabeth Pendo
St. Louis University
The ADA considers as a disability any physical or mental impairment that substantially limits major life activities, or a history of such an impairment. Congress signaled that the definition should be interpreted broadly and the protections extended widely, legal scholars say. Under that framework, people in recovery from opioid and other substance use disorders have disabilities and can’t be discriminated against.
(There is an exception to the ADA’s protections: they do not extend to people who are currently using illegal drugs, meaning someone could lose out on a job, for example, for failing a drug test. However, there is an exception to that exception. Even people who are using drugs can’t be legally denied medical care — such as treatment for complications of injection-related infections — despite the fact that that happens frequently, experts say.)
These cases also highlight the discrepancy that exists between what’s considered standard-of-care treatment for opioid addiction and the perceptions of those therapies.
Two of the three approved treatments — buprenorphine (which Suboxone is a form of) and methadone — are opioids themselves. The medications are taken as controlled doses to overcome the misuse of other opioids and, in these patients, do not provide a high. Decades of research show they help control cravings, stave off withdrawal, enable people to live productive lives, and save lives. Some people take the medications for years, with experts likening it to using insulin to manage diabetes.
Still, some people maintain biases against the medications, thinking that taking them is not compatible with being in recovery — a perspective that the Justice Department now stresses can be discriminatory.
“The chief barriers to expanding MOUD access … are often based on misguided stereotypes and stigmas about the treatment and diversion concerns,” Dorchak and David Howard Sinkman, an assistant U.S. attorney in Louisiana, wrote in a recent paper, referring to medications for opioid use disorder. “Rooting out such unfounded fears is at the heart of the ADA.”
In other words, people are discriminated against for using medications that doctors have prescribed to help them stop using drugs in the first place. Forcing people off the medications can sometimes lead to people returning to illicit drug use.
While the U.S. attorney’s office in Massachusetts led many of the first ADA addiction cases, others are stepping up the pace. And in the past few months, the department has found that the Indiana state nursing board violated the ADA by effectively keeping a nurse who was on buprenorphine from getting her license; filed a lawsuit against Pennsylvania’s court system for allegedly denying people from participating in supervision programs if they were on certain medications; and won the right for people at a Rhode Island detention facility who were being treated for opioid addiction before entering the facility to stay on their medications.
As the Rhode Island and Pennsylvania cases show, the Justice Department is trying to use the ADA to expand access to medications in the criminal justice system, where only select facilities have embraced methadone and buprenorphine. As Sinkman and Dorchak wrote, “the vast majority of the nation’s jails and prisons ban the provision of lifesaving, FDA-approved, and doctor-prescribed drug treatment,” even as — as one 2007 study found — the risk of overdose death is 129 times higher for people in the first two weeks after being released from prison than that of other people.
In some cases, correctional facilities have argued they are compliant with the ADA because they offer inmates the third opioid addiction medication, naltrexone (also known as Vivitrol), which is not an opioid. But the Justice Department has asserted that institutions have the obligation to provide all three treatments, and that the decision of which treatment to use should be up to patients and their doctors, not jails or judges.
“These medications are not interchangeable,” Sinkman and Dorchak wrote. “One version of MOUD might work well for one patient but not another. This is why the ADA requires ensuring access to all three forms of MOUD in the criminal justice system.”
President George Bush signing the Americans with Disabilities Act on July 26, 1990. Barry Thumma/AP
The Justice Department is not the only agency responsible for enforcing the ADA. In 2018, for example, Volvo had to pay $70,000 to resolve a suit brought by the Equal Employment Opportunity Commission after it allegedly refused to hire someone for being on Suboxone. In May 2020, the federal health department reached an agreement with a West Virginia agency, after a couple was allegedly denied permission to adopt their niece and nephew because the uncle was on Suboxone.
The question remains whether these individual deals are having a broader impact — whether they’re influencing other institutions to change their policies before they feel the heat of a federal investigation.
It’s still early to gauge the ripple effects. In one study, researchers at Boston Medical Center found that the rate of discriminatory rejections by Massachusetts nursing facilities was the same after the first settlement in 2018 as it was before. But since then, as the government has continued to pursue such cases, “the settlements have led to growing recognition that this is something that can’t just be ignored,” said Simeon Kimmel, an addiction medicine and infectious diseases physician at BMC.
It’s not that there’s been a shift across the entire industry, Kimmel said. But some skilled nursing facilities have developed relationships with addiction treatment programs and now accept people on these medications, even if others still reject those patients when referred.
By establishing precedents, the initial cases can also open the door for future legal action, whether by the government or by advocates. Indeed, Justice Department attorneys have cited cases not brought by the government as guiding their work in this area.
In one, a federal court in 2018 found that a Massachusetts jail’s refusal to allow a potential inmate to stay on methadone violated the ADA. (The judge also raised constitutional concerns.) And in 2019, a different federal court ruled similarly in a case involving a Maine jail’s ban on buprenorphine.
“The ADA has always applied to jails and prisons, but that legal precedent is something people can point to and build on to say, judges are now saying this explicit denial is illegal,” said Rebekah Joab, a senior staff attorney at the Legal Action Center. “It’s really hard to assert these rights as an individual, but having those decisions on the books allows individuals to say to a jail or prison, look, a judge has said this is illegal, and also you don’t want to be sued.”
Rachael Rollins, who was sworn in as the U.S. attorney in Massachusetts in January, told STAT that she intended to promote widely the work that the office has been doing in this area. Attorneys have done presentations for a trade group representing nursing facilities about ADA protections, and Rollins said she hopes to do trainings with medical schools and associations.
“We can ring the alarm to say to people, don’t make us come and have to find you,” Rollins said.
A cup is filled with a dose of methadone at the San Francisco General Hospital Opiate Treatment Outpatient Program . Laura Morton for STAT
With his new lungs, Bryan is now living the life he feared he wouldn’t see. For most of his life, he was hospitalized twice a year as a result of his cystic fibrosis. He hasn’t been hospitalized in four years.
He’s still on buprenorphine, though now in the form of a long-acting injectable. He views his drug use as something in his past, and doesn’t think or talk about it much. He’s also experienced the stigma that comes with others viewing him as a drug user. All of that is why he asked to be identified by his first name only.
Bryan works as an engineer, and in the past year, has bought a house and gotten engaged.
“I couldn’t ask for a better life,” he said.
This story is part of a series on addiction in 2022, supported by a grant from the National Institute of Health Care Management.
From a short websearch – MO Healthnet – seems to be the state of MO Medicaid program. Will many of the practitioners in MO just pull out of the Medicaid program or will they end up just applying Medicaid prescribing rules to all their pts… so that they will not accidentally exceed the dosing limit on Medicaid pts ? with this and the other post from today that applies to SC and Arkansas New law lets South Carolina providers deny care that conflicts with personal beliefsIs it time for some law firms that deal with civil right violations to step up to the plate ?
Steve Corsi, Psy.D., Director of Department of Social Services Randall Williams MD, Director of Department of Health Mark Stinger, Director Department of Mental Health
This message is intended to reach the people listed above as the heads of their respective Departments. If they have since been replaced please forward it to the new Director(s). No disrespect to anyone else that may read this, but I need to reach those with the power to effect change. Since the website for the Great State of Missouri is extremely difficult to navigate, I am sending this to the address listed on the March 9, 2018 letter to prescribing physicians. At the end of this message I will attach the response that I have already received from the Administrator of the MO Bureau of Narcotics and Dangerous Drugs. In his letter he was clear that doctors should use their best medical judgement in prescribing and that the CDC Guideline does not hold the effect of law. What it has done is frightened physicians to the point of abandoning, forcing tapers and refusal to accept any new pain patients.
As you are well aware on March 9, 2018 physicians that accept MO HealthNet were issued a letter that can only be described as a direct threat to their livelihood, ability to properly treat patients, and even their freedom in the form of incarceration if they did not dramatically reduce the doses of chronic pain patients on opioids to an arbitrary amount of 90mmed. There is no medical evidence that this threshold in anyway protects the lives of chronic pain patients as we are the most responsible patients a doctor could have. It also discounts the fact that the enzymes in the livers of each individual metabolize opioids at extremely different rates so much so that a dose of 50mmed in one patient may suppress their pain, but another patient may require 1,000mmed or more to control the same amount of pain.
This has forced doctors in MO to taper their patients that have been on high dose long-term opioid pain medications, sometimes for decades, against the patients wishes and their thoroughly considered medical decisions. This has been disastrous for Missourians and across the country where this guideline has been applied as policy or law. Whether your intent was to force doctors to do this it has been the effect. My personal physician has received regular visits by the BNDD to monitor the tapering of opioids of legacy patients. It is impossible that an agency that denies this guideline has the force of law, would take it upon themselves to do these edits without being directed by one of your Departments.
Factors you may not be, but as a governing body should be aware of, is that the authors of the CDC Guidelines were from a radical group of anti-opioid crusaders known as PROP physicians for responsible opioid prescribing, or as many in the industry call them PROPaganda. (They will be mentioned again in this letter many times) In 2012 PROP petitioned the FDA, which is the appropriate regulating agency for prescription drugs in the United States, with the very recommendations they later used as the anti-opioid guideline. The FDA of course rejected their petition because it was not based on solid science. The FDA did agree with them in part and introduced new labeling requirements. Again this is the ONLY measure that was approved by the FDA, which again is the governing and regulating body for all prescription drugs. The buck stops with them.
In the published abstract from the authors of the guideline they readily admit they used low quality evidence as a basis for their recommendations and I quote… EVIDENCESYNTHESIS Evidence consisted of observational studies or randomized clinical trials with notable limitations, characterized as low quality using GRADE methodology. Meta-analysis was not attempted due to the limited number of studies, variability in study designs and clinical heterogeneity, and methodological shortcomings of studies. No study evaluated long-term (1 year) benefit of opioids for chronic pain. Opioids were associated with increased risks, including opioid use disorder, overdose, and death, with dose-dependent effects. IMPORTANCE Primary care clinicians find managing chronic pain challenging. Evidence of long-term efficacy of opioids for chronic pain is limited. Opioid use is associated with serious risks, including opioid use disorder
Underlined in the above information (top) provided directly by the authors of the guideline shows that they used poor quality studies to reach their conclusions. In the next underlined part (bottom) it is clearly stated that this information is directed SOLELY to Primary Care Physicians who may find treating chronic pain challenging. It is not intended to apply to ANY specialists, particularly those who specialize in diagnosis and treatment of chronic pain disorders. The bold and italic portion indicates the opinions of the writers with very limited scientific evidence. While some studies suggest an increased effect of mortality with higher doses, they are of the same limited numbers and poor quality. The bold portion indicates that there is limited evidence of long-term efficacy of treating chronic pain with opioids. This is due to the fact that an ethical clinician cannot take patients that have been treated long-term with high dose opioids and replace them with placebo. The patients receiving placebo would suffer from excruciating pain and withdrawals within 1-2 days maximum. Therefor any patient that received the placebo would immediately know they were receiving it and drop out of the study rendering it useless. This may suit the authors of this guideline as the studies that they site as evidence are similarly useless. All of this information is in the guideline itself if someone took the time to read the complete report, a responsibility that would fall directly on the shoulders of each Director.
The following is a link to the suicides resulting from tapering or abruptly stopping opioids based on the CDC Guideline compiled by a compassionate and caring physician named Dr. Kline. These do not represent all of the suicides do to the CDC and regulatory bodies such as yours but is a list the great doctor has composed in his spare time when not treating or advocating for the rights of chronic pain patients, followed by some excerpts. https://medium.com/@ThomasKlineMD/opioidcrisis-pain-related-suicides-associated-with-forced-tapers-c68c79ecf84d
Dr. Kolodny (the founder of PROPaganda) commented on the pain related suicides cases: “ There is good evidence the majority were suffering from opioid addiction”. He was not familiar with the cases.
Dr. Kolodny is not a specialist in pain medicine. He is a trained psychiatrists who benefits financially from every “addict” he assumes care for. He has also made over $500,000 as a self proclaimed expert for the prosecution in cases where well intentioned, caring and compassionate doctors were put on trial for their prescribing habits without regard to the conditions of their patients. He alone has been responsible for imprisoning doctors who faithfully executed their Hippocratic Oath. Dr. Kolodny also stands to make untold millions and possibly billions as an “expert” witness for the prosecution in the lawsuits against opioid manufacturers and suppliers.
Doctors across the country actually believe the CDC/PROP manifesto of pain medicines not working and too dangerous to use, a false assumption. Their belief that “addictions and overdoses” are being prevented by eliminating opiate pain medicine is a failure of science, reason, and common sense. These people are no longer with us due to the policy of “you are better off without pain medicines”
No case has been reported of true addiction suddenly occurring while taking pain medicine in the 10 million with long term pain disease, belying the governments’s belief that addictions will be prevented if the population as a whole does not take them.
Suicide prevention in the ten million noted by NIH requiring daily pain medicine is pain care. Not providing suicide prevention is negligence. Not treating a person in pain is negligence. Abandoning people with painful disease to the streets with no doctor, is negligence. Believing you can addict the general population is ignorance. Believing serious pain can relieved with Tylenol, meditation, expensive injection therapy, anticonvulsants, and physical therapy — is ignorant. The longer you wait to treat pain the more serious it becomes. Opiates remain the treatment of choice for serious pain, no matter what a few extremists purport.
This nihlist medical view is not accepted by most U.S. practicing physicians, nor in other countries, nor by the World Health Organization. The CDC and its PROP consultants have an extreme view, a pain nihilism manifesto, with unfounded near shrieking polemics, a bizarre “lunatic fringe” (FDA senior official) plan for the earth riding through every doctor office in the land with warnings not to addict or kill using “heroin pills” in the words of Thomas Frieden CDC director allowing the Guideline to be published by an Agency not tasked with opiate recommendations.
Allison Kimberly, age 30, of Colorado was denied treatment for her intractable pain from interstitial cystitis and several other painful conditions. Interstitial cystitis can end in suicide from the failure to treat it properly as it is an extreme form of agonizing discomfort. It is said that the University of Colorado emergency room in Aurora refused her treatment for her pain. deceased
Allison posted on Instagram describing how she was treated as an addict and sent away without pain medicine. “I was rushed to the ER because my pain was so out of control I couldn’t take it anymore, I got ZERO help. After 7 hours I was discharged. The nurse has the nerve to say that my kind of pain shouldn’t be that bad and basically I was faking for medication. I am so beside myself I am shaking as I type this. Screaming and begging in pain, needing any kind of help they’d give me and I was just sent home. As soon as I am able I’m reporting my whole experience.” Allison did not have time to file a complaint against the hospital as she violently ended her life while her mother walked her dog, the animal companion that had made her anguish less lonely. No doctors appear to have been charged. The Colorado Hospital Association was in the process of piloting a no-opioid policy for the state. She died in June, 2017.
How any human being can read these stories and fail to take appropriate measures to keep it from happening again is gruesome, scandalous, repugnant, outrageous, obscene and nefarious. No longer can you claim ignorance of the harm and dangers this is causing. Lack of action at this point would be gross negligence and dereliction of duty. The purpose of having an agency to regulate medical treatment is there to safeguard patients not to commit negligent manslaughter. Instead the focus has been driven not only to the treatment of addicts but to treat anyone suffering from chronic pain AS addicts.
The ADA prohibits government agencies that receive any federal funding from discriminating against Americans with Disabilities. Chronic pain is a leading cause of disability in the United States. Denying proper and adequate medical treatment that effectively reduces pain to those of us that are disabled by chronic pain is a clear violation of law. Hiding behind a guideline produced by an agency with NO authority to regulate prescription drugs in the United States is not a valid excuse. A strong case could be made for malicious intent.
With the swipe of a pen almost all of the harm that was caused can be reversed. This will not bring back Allison and the others that have died due to the overzealous application of an invalid guideline, but their deaths do not have to be in vein. If it were to effect change the circumstances for the rest of us I believe their families would be happy knowing their loss has helped millions of others. I don’t wish to make any threats as I believe that the appropriate agencies will do what’s right for those of us suffering in MO, however if a remedy can not be reached by communication I will be forced to gather all my struggling brothers and sisters together to file an ADA claim against Steve Corsi, Psy.D as the director of the Department of Social Services, Randall Williams, MD as the director of the Department of Health, and Mark Stringer, as the director of the Department of Mental Health.
In addition you will find attachments of the press releases by the CDC and FDA that discourage forced tapering and stress that the guidelines have been wildly misinterpreted. You will also find the FDA’s refusal to accept the recommendations of PROP that later formed this grotesque unlawful guideline.
From: “Boeger, Michael” <Michael.Boeger@health.mo.gov> > Date: November 12, 2019 at 8:33:12 AM CST > To: “‘ff5863@yahoo.com'” <ff5863@yahoo.com> > Subject: Your email about opioid milligrams and enforcement > > November 12, 2019 > > > > Dear Dr. Pezzani: > > > > As a result of the opioid abuse epidemic, the CDC issued and published an educational guideline relating to the prescribing of controlled drugs. > > > > Our department made it a specific point to let practitioners know that this was an educational guideline and that it was not a law that could be enforced. If doctors choose to prescribe more, this is not a direct violation of law or regulation. The guideline wanted to stress that doctors review their patient charts and look to see how much they are prescribing, then make their own decisions. > > > > During the past several years, our bureau has not revoked or suspended any doctors merely for prescribing too many opiates. > > > > Upon reviewing our records, the Board of Healing Arts and the Dental Board have not revoked or suspended anyone from over-prescribing. > > > > Doctors are allowed to review their own practices and make their own decisions. The CDC guidelines are not being enforced upon them > > as a law. > > > > Our current studies we have seen online show that about 30% of the overdoses are from prescription drugs and 70% are from “street drugs.” > > > > However, of the 70% addicted and abusing street drugs, the study showed that 80% of them started off with a prescription drug problem. > > > > At this point, that only action taken is that the CDC has asked the doctors to review and make their own decisions. > > > > > > Michael R. Boeger, Administrator > > Missouri Bureau of Narcotics and Dangerous Drugs > > P.O. Box 570 > > Jefferson City, MO 65102-0570 > > Phone: (573) 751-6321 Fax: (573) 526-2569 > > Website: www.health.mo.gov/BNDD
I suspect that this law, is a law is to preempt any consequences to the anticipated overturning of the Roe vs Wade concerning abortions. Just read the test of the bill that is RED below… What happens if a health insurance company or a major healthcare corporation that declares that ALL CONTROLLED SUBSTANCES ARE ADDICTING… and they are not going to pay, prescribe or fill any controlled medication- because it is UNETHICAL to possibly cause someone to become addicted to these medications that the DEA has declared – for some 50 yrs – that they are DANGEROUSLY ADDICTING. That is nothing short of a full blown bureaucratic creep.
New law lets South Carolina providers deny care that conflicts with personal beliefs
South Carolina Governor Henry McMaster signed the Medical Ethics and Diversity Act into law June 17, allowing healthcare institutions, medical practitioners and health insurers to deny non-emergent care that conflicts with their “religious, moral or ethical beliefs.”
“As the right of conscience is fundamental, no medical practitioner, healthcare institutions and healthcare payers should be compelled to participate in or pay for any medical procedure or prescribe or pay for any medication to which the practitioner or entity objects on the basis of conscience, whether such conscience is informed by religious, moral or ethical beliefs or principles,” the act states. “It is the purpose of this chapter to protect medical practitioners, healthcare institutions and healthcare payers from discrimination, punishment or retaliation as a result of any instance of conscientious medical objection.”
Coverage under the law is sweeping. “Healthcare institution” covers any public or private hospital, clinic, physician group, ambulatory surgical center, private physician office, pharmacy, nursing home, medical school, nursing school or any entity “in which healthcare services are performed on behalf of any person.” By “healthcare payer,” the law covers insurers, employers or any entity that pays for a patient’s healthcare in part or in full. By “medical practitioner,” the law covers anyone asked to participate in any healthcare service.
The act took effect upon the governor’s signing. South Carolina is the latest state to protect healthcare providers’ “right of conscience.” Arkansas enacted a similar proposal in March 2021.
South Carolina Senator Larry Grooms championed the Medical Ethics and Diversity Act. Supporters of the law include the Roman Catholic Diocese of Charleston; opponents include the American Academy of Pediatrics and the Human Rights Campaign.
Very interesting study, abt 11-12 yr period that STOPPED TWO YEARS before the CDC 2016 opiate dosing guidelines were published, but after the DEA started cutting pharma production quotas. The real BOTTOM LINE seems to be very VAGUE… only 18 states were involved without stating the percentage of the country’s total population. The number of suicides from 2003 to 2014 was up about 50%.
And this quote from a “expert” …That’s an important stat, said Dr. Paul Nestadt of the department of psychiatry and behavioral health at the Johns Hopkins School of Medicine in Baltimore. “Opioids are depressants and they increase the risk of depression,”
Yet it is a known issue that chronic pain with under/untreated pain tend to have elevated anxiety and depression. Conversely, properly/optimized pain management tend to provide the pt with a “elevated” physical & mental “energy” and better QOL… resulting in less anxiety and depression.
Another interesting quote from the article:“Also, since chronic pain is not really coded well at the time of a suicide, this is probably an underestimate of the proportion of people who had chronic pain. We do know that chronic pain can be a deadly disease.”
There is a old quote credited to President Truman that this article seems to mirror:
Nourse, as economists are wont to do, was saying, “On the one hand … but then, on the other hand,” etc. After he left, Truman told Steelman that he had no idea what Nourse had just told him. Truman then said, “John, do you think you could find me a one-armed economist?”
Last year 2021, there was two fines/judgement from what can be described as “prescriber induced suicide” by pt committing suicides from having their long term pain meds reduced/eliminated. One was SEVEN MILLION and the other was ONE MILLION… It is claimed that we have 50,000 suicides and one million attempted suicides EVERY YEAR… this study indicates that 10.2 % where related to chronic pain…and many of us believe that those numbers or percents have increased since the 2016 CDC guidelines were published… and they may get worse with the new 2022 guidelines when they are published.
Using those numbers we are having abt 13 chronic pain pts committing suicide EVERY DAY and I have seen numbers that 22-24 veterans commit suicide every day… and we have all heard about what lousy care veterans get via Veterans Admin Hospital system.
POTENTIALLY THIRTEEN CHRONIC PAIN SUICIDES EVERY DAY… and last year … two “prescriber induced suicides” made the news and got a settlement and both of those were from 2018. How many lawsuits could be filed if even one of these chronic pain pts committing suicide every day… sent out a letter/email/video to local prosecutor, state AG, friends, local media claiming that they are exercising their final option to get out of a torturous level of pain and blame – point fingers – at the practitioner or organization they work for as the reason for their action. I don’t encourage suicides… but.. they happen… and it would appear that the near majority happens “behind a curtain” and/or off the radar…and the practitioners and the organizations that they work for … cause the limiting/denying of proper pain management without any consequences. If the families of these pts … was able to get into the deep pockets of these healthcare corporations… could that change things… as things are now going and have been going for the last decade +… no change seems to be on the horizon.
Chronic pain may contribute to suicide, study warns
(Reuters Health) – Nearly one in 10 suicide deaths in the U.S. occurs in people with chronic pain, a new study indicates.
The finding suggests chronic pain may be a risk factor for suicide, the study authors say.
While the study can’t prove that chronic pain contributed to people’s decisions to kill themselves, “we did see that mental health issues, such as depression and anxiety were more common among those with chronic pain,” said lead author Dr. Emiko Petrosky, a medical epidemiologist with the U.S. Centers for Disease Control and Prevention (CDC) in Atlanta.
It’s estimated that 25 million U.S. adults have some level of daily pain and 10.5 million of them have considerable pain every day, Petrosky and colleagues note in Annals of Internal Medicine.
“Health care providers caring for patients with chronic pain should be aware of the risk for suicide,” Petrosky told Reuters Health. “Chronic pain is a huge public health problem. It’s essential that we improve chronic pain management through integrated patient centered management that includes mental health care in addition to medications for these patients.”
Data for the study had been collected from 18 states between 2003 and 2014 by the CDC’s National Violent Death Reporting System.
Out of 123,181 suicide deaths in the study, the records for 10,789, or about 9 percent, included notations by officials – such as coroners, medical examiners and law enforcement officers – that indicated evidence of chronic pain.
The proportion of suicides committed by people suffering from chronic pain increased during the study, rising from 7.4 percent in 2003 to 10.2 percent in 2014. But Petrosky’s team also underscored the fact that the percentage of people battling chronic pain also rose during the same time period.
Back pain, cancer pain and arthritis pain accounted for a large proportion of the chronic pain conditions.
More than half of the people with chronic pain who killed themselves died from firearm related injuries, while 16.2 percent died from opioid overdose. Still, chronic pain sufferers were three times as likely as others to have tested positive for opioids when they died.
That’s an important stat, said Dr. Paul Nestadt of the department of psychiatry and behavioral health at the Johns Hopkins School of Medicine in Baltimore. “Opioids are depressants and they increase the risk of depression,” said Nestadt, who is not affiliated with the new research. “Depression is one of the highest risk factors for completing suicide.”
The new study can’t say anything about the state of chronic pain management in this country, said Dr. Michael L. Barnett, a health policy and management researcher at the Harvard T.H. Chan School of Public Health and a primary care physician at Brigham & Women’s Hospital in Boston
But we do know “there aren’t any medications that seem to be particularly effective for chronic pain,” said Barnett, who is not affiliated with the new study. “Both opioids and NSAIDs are pretty effective in treating acute pain, but not chronic pain. While people often want a pill that will fix things, comprehensive pain management is proven to be pretty effective.”
A problem with this kind of study is you don’t know what other risk factors people had, said Dr. Ajay D. Wasan, vice president for scientific affairs at the American Academy of Pain Medicine and a professor of anesthesia and psychiatry at the University of Pittsburgh Medical Center.
“Chronic pain is certainly an important risk factor, but we don’t know how important it is compared to other risk factors,” said Wasan, who was not affiliated with the new research.
“Also, since chronic pain is not really coded well at the time of a suicide, this is probably an underestimate of the proportion of people who had chronic pain. We do know that chronic pain can be a deadly disease.”
Frieden, who led the CDC from 2009 to 2017, was charged with forcible touching, sexual abuse, and harassment in connection with an incident at his Brooklyn home in October. He made a brief appearance in a courtroom here and was arraigned, before being released by the court.
Frieden has been accused of grabbing a woman’s buttocks without her permission during the incident, according to an NYPD spokeswoman. A colleague of Frieden’s said the woman was a longtime family friend of the former CDC director and that she had alleged “inappropriate physical contact.”
“I have known and worked closely with Dr. Frieden for nearly 30 years and have seen first-hand that he has the highest ethical standards both personally and professionally,” said the colleague, José L. Castro, the president and CEO of the public health organization Vital Strategies. “In all of my experiences with him, there have never been any concerns or reports of inappropriate conduct.” A spokesman for Frieden said: “This allegation does not reflect Dr. Frieden’s public or private behavior or his values over a lifetime of service to improve health around the world.”
Frieden, 57, was named to head the CDC by former President Barack Obama. He began his tenure as CDC director in the early days of the 2009 H1N1 pandemic. Prior to taking the top job at the CDC, Frieden had been commissioner of New York City’s Department of Health and Mental Hygiene, where he led an ambitious agenda involving banning trans fats served in food in the city’s restaurants and banning smoking in workplaces and restaurants.
After leaving the CDC he returned to New York and established a new nongovernmental organization working to combat disease outbreaks and chronic diseases globally. The organization, called Resolve to Save Lives, is part of the group Vital Strategies.
The Supreme Court unanimously ruled that the Department of Health and Human Services (HHS) illegally reduced prescription drug reimbursements to hospitals by $1.6 billion per year in a program aimed at helping poor patients.
The decision, a win for hospitals serving low-income individuals, allows those hospitals to seek the improperly withheld funding from the federal government. The reduction in reimbursements was ordered by the Trump administration in 2018 and defended in court by the Biden administration. The government argued the rate cuts would more accurately mirror the cost to hospitals of buying the drugs and that it was allowed to do so under a legal provision that gave regulators authority to order adjustments to rates.
But HHS improperly relied on a formula that Congress made available only in specific circumstances, which didn’t apply in the case, the court determined. President George W. Bush in 2003 signed the Medicare Prescription Drug, Improvement, and Modernization Act into law. The statute requires HHS to establish reimbursement rates every year for certain outpatient prescription drugs provided by hospitals using a predetermined formula.
Despite the urging of the Biden administration, the Supreme Court didn’t address whether the so-called Chevron doctrine that the Supreme Court enunciated in 1984 applied to the case. In Chevron v. Natural Resources Defense Council, the high court held that while courts “must give effect to the unambiguously expressed intent of Congress,” where courts find “Congress has not directly addressed the precise question at issue” and “the statute is silent or ambiguous with respect to the specific issue, the question for the court is whether the agency’s answer is based on a permissible construction of the statute.”
Apparently, the Supreme Court found the issues involved were straightforward enough that Chevron didn’t need to be examined.
Justice Brett Kavanaugh wrote the court’s opinion (pdf) in American Hospital Association v. Becerra, court file 20-1114, which was decided on June 15 after oral arguments on Nov. 30, 2021. Xavier Becerra is the HHS secretary. The opinion overturns a decision made by the U.S. Court of Appeals for the District of Columbia Circuit.
As Kavanaugh summarized in the opinion, federal Medicare law states that HHS is required to reimburse hospitals for some outpatient prescription drugs that the hospitals give to Medicare patients. These reimbursements total tens of billions of dollars every year.
HHS may calculate reimbursements in two ways. It may vary reimbursement rates for different categories of hospitals if it first carries out a survey of the amount that hospitals pay to acquire the prescription drugs. Alternatively, if the agency has not done such a survey, it has to establish reimbursement rates based on the average sales price manufacturers charge for the drugs and is not allowed to vary the reimbursement rates for different kinds of hospitals.
For 2018 and 2019, HHS didn’t carry out a survey of hospitals’ acquisition costs for outpatient prescription drugs but still slashed reimbursement rates for one cohort of hospitals—Section 340B hospitals, which generally serve low-income or rural communities.
According to an informational website, to qualify as a 340B hospital, a hospital must meet certain criteria. Among them is that it must be owned or operated by a state or local government, be a public or private nonprofit corporation, and must be formally authorized to exercise governmental powers by a state or local government, or be a private nonprofit hospital that has a contract with a state or local government to provide health care services to low-income persons who don’t qualify for benefits under Medicare or Medicaid, a joint federal-state program for the indigent.
“For those 340B hospitals, this case has immense economic consequences, about $1.6 billion annually,” Kavanaugh wrote. “The question is whether the statute affords HHS discretion to vary the reimbursement rates for that one group of hospitals when, as here, HHS has not conducted the required survey of hospitals’ acquisition costs. The answer is no.”
The court stated: “We do not agree with HHS’s interpretation of the statute … [and] conclude that, absent a survey of hospitals’ acquisition costs, HHS may not vary the reimbursement rates for 340B hospitals. HHS’s 2018 and 2019 reimbursement rates for 340B hospitals were therefore contrary to the statute and unlawful.”
The Supreme Court reversed the ruling of the D.C. Circuit and remanded the case to that court “for further proceedings consistent with this opinion.”
The new decision is “a fairly strong rebuke from the Supreme Court about how the agency has attempted to overstep its authority,” Mark Polston, a partner at the law firm of King and Spalding, told Bloomberg Law.
“If they know the Supreme Court unanimously thinks it’s the duty of the courts to do their own interpretation of statute,” then “there will be justices of the lower courts who take notice of that and perhaps follow suit.”
“The Next Revolution” host Steve Hilton issued a scathing rebuke Sunday night of all the self-appointed “experts” who have misused their authority to make vital decisions impacting the everyday lives of Americans on everything from COVID, and crime, to the military and the economy, only to be “completely devastatingly wrong.”
STEVE HILTON: That’s the number one rule of government by ‘expert idiot.’ No one is ever held accountable, however much they screw up. Which of course we see in the absolute crowning glory of the expert idiot’s takeover of the coronavirus pandemic. Let’s just take a moment to remember the vanity, the self-importance, the sheer brazen certainty of these expert idiots who turned out to be completely devastatingly wrong.
Of course, it is all laughable now how wrong the experts were, how wrong the vast majority of the establishment media were to trust the experts. But it keeps happening. The establishment never learns. So we cannot just subcontract vital decisions about our lives to the experts. Wherever you look, the pandemic, crime, the military, the economy, what the experts have done to this country is an absolute travesty. And even if it wasn’t anti-democratic to put all this power in their hands – which it is, even if it didn’t contradict the very idea of what America was built on, self-government — which it does, on a basic practical level, government by experts doesn’t work because as we have seen time and time again, the experts are idiots.
