isolating “pure” cases remains methodologically challenging for the FDA and CDC -so they use “dirty data” to support their conclusions

Posted on April 22, 2025 by Pharmaciststeve

I asked www.perplexity.ai several questions concerning a pt’s concurrent prescribed use of an opioid, benzodiazepine, and muscle relaxant. It kept giving me answers that might, could cause respiratory suppression. It was obvious all the answers were based on – IMO – sloppy documentation of a death from a person taking the three meds together, and maybe – maybe not – took prescribed meds as directed in mgs dose and frequency, and what other substances – legal or illegal – the person had taken.

Statistics can be your friend or your enemy. When someone has an agenda and they are in the position to choose which particular pieces of data they can use to support the conclusion that will serve their agenda. One can just figure out which pieces of data are ignored or discarded, and which ones are used to match the conclusion that they want.

Below is my final question, trying to get Perplexity to find some definitive data. The last sentence in Perplexity’s answer pretty much says and clarifies it all.

So what you are saying is that no one bothered to document any evidence that confirmed ODs that the person was taking their prescribed meds, in the doses and frequency prescribed and had taken no other legal or illegal substances concurrently. Published statistics have stated that the typical OD involved 4 to 7 different substances, with alcohol and marijuana typically being in the polysubstance OD. While all three classes of meds will suppress respiration, but is suppression at therapeutic doses typically fatal – can you provide clinical studies that shows a high probability of it being fatal

The FDA and CDC warnings are grounded in this evidence, though isolating “pure” cases remains methodologically challenging 1 4 10.

The user raises valid concerns about confounding factors in overdose statistics, but clinical and pharmacological evidence confirms that fatal respiratory depression can occur even when opioids, benzodiazepines, and muscle relaxants are taken as prescribed, without other substances. Here’s the breakdown:

1. Evidence from Prescribed-Use Cohorts

FDA’s 2016 Analysis (prescribed regimens):
- Patients co-dispensed opioids + benzodiazepines had a 10x higher overdose death rate (7.0 vs. 0.7 per 10,000 person-years) compared to opioids alone1.
- 31% of opioid overdose deaths involved benzodiazepines, with no requirement for supratherapeutic dosing18.
Veterans Health Study:
- Patients prescribed opioids + benzodiazepines had a 3.86x higher fatal overdose risk vs. opioids alone, even after adjusting for dose and comorbidities18.

2. Pharmacodynamic Synergy at Therapeutic Doses

Respiratory Depression Mechanism:
- Opioids (µ-opioid receptors) and benzodiazepines (GABA-A receptors) synergistically suppress brainstem respiratory drive710.
- Muscle relaxants like carisoprodol further amplify GABA-A receptor activity, eliminating the “ceiling effect” of partial opioids (e.g., buprenorphine)109.
- Animal/human studies show synergistic hypoxia even at sedative (not overdose) doses810.

3. Limitations in Isolating “Pure” Cases

Polysubstance Overdose Prevalence:
- Most fatal overdoses involve 4–7 substances (e.g., alcohol, illicit drugs), complicating isolation of prescribed triple-therapy fatalities79.
Indirect Evidence from Hospitalizations:
- Triple-threat users had 8.52x higher hospitalization odds (proxy for severe respiratory events) vs. non-users4.
- Baclofen + opioids had 2.52x higher overdose risk than cyclobenzaprine + opioids in prescribed cohorts3.

4. Key Studies on Therapeutic-Dose Risks

Human Experimental Trial:
- Fentanyl (opioid) + midazolam (benzodiazepine) at sedative doses caused severe hypoxia in 100% of subjects vs. 50% with fentanyl alone8.
Buprenorphine/Methadone Patients:
- 82% of buprenorphine-related deaths involved benzodiazepines, often at prescribed doses9.
Postoperative Mortality:
- Combined preoperative opioids + benzodiazepines (as prescribed) increased short- and long-term mortality vs. either drug alone7.

Conclusion

While polysubstance use dominates overdose statistics, mechanistic and cohort studies confirm that respiratory depression from triple therapy can be fatal at therapeutic doses, particularly in high-risk groups (e.g., sleep apnea patients, elderly). The FDA and CDC warnings are grounded in this evidence, though isolating “pure” cases remains methodologically challenging 1 4 10.

Citations:

Answer from Perplexity: pplx.ai/share

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In our federal court system: defendants seem to be GUILTY until PROVEN INNOCENT: few are found INNOCENT

Posted on April 21, 2025 by Pharmaciststeve

Kristi Leigh

Imagine suffering form a dehibilitating disease and not getting the medication you need to function because of the government’s failure to control ILLICET substances.

Govt is now using AI to target doctors who “the machine” deems aren’t prescribing appropriately. Doctors who treat chronic pain patients have become an easy target. One motivation is stealing the assets of older physicians through civil asset forfeiture.

The outcome? A deadly spiral. Doctors fear prescribing what patients need. Patients who rely on pain medication to function are committing suicide out of desperation or hitting the streets for relief and getting killed by illicit substances.

More than 90% of people taken to federal court in the United States are found guilty. The most recent data shows that in fiscal year 2022, 89.5% of federal defendants pleaded guilty, while only 0.4% went to trial and were acquitted, and 1.9% went to trial and were found guilty. An additional 8.2% of cases were dismissed at some point in the judicial process

When combining those who plead guilty with those found guilty at trial, the overall conviction rate in federal court exceeds 90%—and is often cited as being around 93% or higher in recent years

. This high rate is largely due to the prevalence of plea bargains, which account for the vast majority of convictions in the federal system

In summary, the percentage of people taken to federal court who are found guilty is typically above 90%, with most convictions resulting from guilty pleas rather than trials

Synopsis of Charges Against Dr. Neil K. Anand: by www.perplexity.ai

Overview:
Dr. Neil K. Anand, a Pennsylvania-based pain management specialist, was convicted by a federal jury in April 2025 on multiple counts related to healthcare fraud and violations of the Controlled Substances Act (CSA).

Key Charges and Findings:

Healthcare Fraud and Wire Fraud:
Dr. Anand was found guilty of conspiring to submit false and fraudulent claims totaling approximately $2.3 million to Medicare, the U.S. Office of Personnel Management (OPM), Independence Blue Cross (IBC), and Anthem. The fraudulent activity centered around “goody bags”—pre-packaged sets of prescription medications dispensed by his in-house pharmacies. Patients were required to accept these unnecessary “goody bags” in order to receive prescriptions for regulated drugs23.
Distribution of Controlled Substances:
Anand distributed over 20,000 tablets of oxycodone, a highly addictive opioid painkiller, to nine patients, often without a legitimate medical purpose and outside the usual course of professional practice. He also signed blank prescription letterheads and allowed unlicensed medical interns to write prescriptions for controlled substances23.
Money Laundering and Unlawful Monetary Transactions:
After the investigation began, Anand attempted to conceal his fraudulent activities by transferring nearly $1.2 million into an account in his father’s name, purportedly for the benefit of his minor daughter2.
Conspiracy to Distribute Controlled Substances:
The evidence showed Anand conspired with others to distribute controlled substances without a legitimate medical purpose, using the goody bag scheme as a cover for the unlawful distribution of opioids23.

Potential Penalty:
Dr. Anand faces a maximum statutory penalty of up to 130 years in prison. Sentencing is scheduled to begin on August 19, 2025, with the final sentence to be determined by a federal district court judge in accordance with U.S. Sentencing Guidelines and other statutory provisions2.

Summary Table of Charges

Charge	Description
Healthcare Fraud & Wire Fraud	False claims to Medicare, OPM, IBC, Anthem via unnecessary “goody bags”
Distribution of Controlled Substances	Unlawful prescription and distribution of over 20,000 oxycodone tablets
Money Laundering & Unlawful Transactions	Concealing proceeds by transferring $1.2 million to a family account
Conspiracy to Distribute Controlled Drugs	Collaborating with others to distribute opioids without legitimate medical purpose

Dr. Anand’s conviction highlights ongoing federal efforts to combat opioid-related healthcare fraud and the improper distribution of controlled substances by medical professionals23.

Citations:

Answer from Perplexity: pplx.ai/share

While according to asking three different AI programs what was in the “goody bag,” the only one that mentioned was Oxycodone

One of the people that I know told me that a plastic bag with some writing on the outside like “EVIDENCE” contained one or more tubes of Diclofenac Topical (Voltaren)- which is an OTC medication.

Filed under: General Problems | 1 Comment »

God bless those men and women who give their lives for us

Posted on April 18, 2025 by Pharmaciststeve

My lead flight attendant came to me and said, “We have an H.R. on this flight.” (H.R. stands for human remains.)

“Are they military?” I asked.

‘Yes’, she said.

‘Is there an escort?’ I asked.

‘Yes, I’ve already assigned him a seat’.

‘Would you please tell him to come to the Flight Deck. You can board him early,” I said…

A short while later a young army sergeant entered the flight deck. He was the image of the perfectly dressed soldier. He introduced himself and I asked him about his soldier.

The escorts of these fallen soldiers talk about them as if they are still alive and still with us. ‘My soldier is on his way back to Virginia ,’ he said. He proceeded to answer my questions, but offered no words.

I asked him if there was anything I could do for him and he said no. I told him that he had the toughest job in the military, and that I appreciated the work that he does for the families of our fallen soldiers. The first officer and I got up out of our seats to shake his hand. He left the Flight Deck to find his seat.

We completed our preflight checks, pushed back and performed an uneventful departure. About 30 minutes into our flight, I received a call from the lead flight attendant in the cabin.

‘I just found out the family of the soldier we are carrying, is also on board’, she said. She then proceeded to tell me that the father, mother, wife and 2-year old daughter were escorting their son, husband, and father home. The family was upset because they were unable to see the container that the soldier was in before we left.

We were on our way to a major hub at which the family was going to wait four hours for the connecting flight home to Virginia . The father of the soldier told the flight attendant that knowing his son was below him in the cargo compartment and being unable to see him was too much for him and the family to bear. He had asked the flight attendant if there was anything that could be done to allow them to see him upon our arrival. The family wanted to be outside by the cargo door to watch the soldier being taken off the airplane.

I could hear the desperation in the flight attendants voice when she asked me if there was anything I could do. ‘I’m on it’, I said. I told her that I would get back to her.

Airborne communication with my company normally occurs in the form of e-mail like messages. I decided to bypass this system and contact my flight dispatcher directly on a secondary radio. There is a radio operator in the operations control center who connects you to the telephone of the dispatcher. I was in direct contact with the dispatcher. I explained the situation I had on board with the family and what it was the family wanted. He said he understood and that he would get back to me.

Two hours went by and I had not heard from the dispatcher. We were going to get busy soon and I needed to know what to tell the family. I sent a text message asking for an update. I saved the return message from the dispatcher and the following is the text:

‘Captain, sorry it has taken so long to get back to you. There is policy on this now, and I had to check on a few things. Upon your arrival a dedicated escort team will meet the aircraft. The team will escort the family to the ramp and plane side. A van will be used to load the remains with a secondary van for the family.

The family will be taken to their departure area and escorted into the terminal, where the remains can be seen on the ramp. It is a private area for the family only. When the connecting aircraft arrives, the family will be escorted onto the ramp and plane side to watch the remains being loaded for the final leg home.

Captain, most of us here in flight control are veterans. Please pass our condolences on to the family. Thanks.

I sent a message back, telling flight control thanks for a good job. I printed out the message and gave it to the lead flight attendant to pass on to the father. The lead flight attendant was very thankful and told me, ‘You have no idea how much this will mean to them.’

Things started getting busy for the descent, approach and landing. After landing, we cleared the runway and taxied to the ramp area. The ramp is huge with 15 gates on either side of the alleyway. It is always a busy area with aircraft maneuvering every which way to enter and exit. When we entered the ramp and checked in with the ramp controller, we were told that all traffic was being held for us.

‘There is a team in place to meet the aircraft’, we were told. It looked like it was all coming together, then I realized that once we turned the seat belt sign off, everyone would stand up at once and delay the family from getting off the airplane. As we approached our gate, I asked the copilot to tell the ramp controller, we were going to stop short of the gate to make an announcement to the passengers. He did that and the ramp controller said, ‘Take your time.’

I stopped the aircraft and set the parking brake. I pushed the public address button and said: ‘Ladies and gentleman, this is your Captain speaking: I have stopped short of our gate to make a special announcement. We have a passenger on board who deserves our honor and respect. His Name is Private XXXXXX, a soldier who recently lost his life. Private XXXXXX is under your feet in the cargo hold. Escorting him today is Army Sergeant XXXXXXX. Also, on board are his father, mother, wife, and daughter. Your entire flight crew is asking for all passengers to remain in their seats to allow the family to exit the aircraft first. Thank you.’

We continued the turn to the gate, came to a stop and started our shutdown procedures. A couple of minutes later I opened the cockpit door. I found the two forward flight attendants crying, something you just do not see. I was told that after we came to a stop, every passenger on the aircraft stayed in their seats, waiting for the family to exit the aircraft.

When the family got up and gathered their things, a passenger slowly started to clap his hands. Moments later, more passengers joined in and soon the entire aircraft was clapping. Words of ‘God Bless You’, I’m sorry, thank you, be proud, and other kind words were uttered to the family as they made their way down the aisle and out of the airplane. They were escorted down to the ramp to finally be with their loved one.

Many of the passengers disembarking thanked me for the announcement I had made. They were just words, I told them, I could say them over and over again, but nothing I say will bring back that brave soldier.

I respectfully ask that all of you reflect on this event and the sacrifices that millions of our men and women have made to ensure our freedom and safety in these United States of AMERICA.

Foot note:

I know everyone who reads this will have tears in their eyes, including me. Prayer chain for our Military… PLEASE SHARE THIS! Please send this on after a short prayer for our service men and women.

They die for me and mine and you and yours and deserve our honor and respect.

Filed under: General Problems | 1 Comment »

When Attorneys make medical decisions and interfere with the Doc/Pt relationship PEOPLE ARE HARMED

Posted on April 18, 2025 by Pharmaciststeve

Some people (DOJ, DEA, Fed prosecutors, politicians, media, and others) believe and state that opioids are VERY ADDICTING. Many things in our day-to-day life can be dangerous or even kill us. Vehicles are/can be very safe – yet some 42K people die in vehicle accidents every year. Some 100K people die from using many alcohol products, the death rate from people using tobacco products is in the 400 range, and some claim that both of those products are addictive. Gasoline, Kerosene, and Propane are safe, as long as they are used properly, and a simple spark or some ignition source can turn an otherwise safe product into a potentially dangerous or catastrophic outcome.

Below is what perplexity.ai suggests are preexisting ( undiagnosed ) health issues in a person, and when they interact with some substance (opioid, alcohol, cocaine, etc), they – LIKE THE WAY IT MAKES THEM FEEL – and they start down the road to some degree of addiction.

Basically, people who are labeled as dealing with SUD or OUD have some degree of undiagnosed or under/untreated mental health issues that collectively is a form of addictive personality.

So here we are, 55 yrs after our bigoted, racist President Nixon got Congress to pass a bill that was basically directed at putting hippies and black people in jail. We are still chasing down addicts, because President Nixon, by education, was an ATTORNEY, and we still have attorneys interfering with the practice of medicine, but they have expanded their scope that they are raiding practitioners’ offices and throwing thousands of people who have a valid/legit medical needs to be prescribed a controlled med. Not to mention that they are ruining thousands of practitioners’ lives and discouraging other practitioners from properly treating millions of pts who have a valid need to take a controlled substance.

Besides violating this federal law that has been on the books since 1935 – 35 yrs before the CSA was signed into law.

42 USC 1395: Prohibition against any Federal interference

https://uscode.house.gov/view.xhtml?req=(title:42%20section:1395%20edition:prelim)

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.

(Aug. 14, 1935, ch. 531, title XVIII, §1801, as added Pub. L. 89–97, title I, §102(a), July 30, 1965, 79 Stat. 291 .)

Here is something interesting: What comorbidity issues are generally involved with addiction? I suggest this as well: DOJ Considers Opioid Use Disorder an ADA Covered Disability and Pursues Claims Against a Provider for Refusing Medical Services to Opioid Users https://www.pharmaciststeve.com/doj-considers-opioid-use-disorder-an-ada-covered-disability-and-pursues-claims-against-a-provider-for-refusing-medical-services-to-opioid-users/

Comorbidities associated with addiction, also known as substance use disorders (SUDs), are common and can significantly complicate treatment and recovery. These comorbidities span mental health disorders, medical conditions, and behavioral issues. Below is an overview of the most prevalent comorbidities:

### *Mental Health Disorders*
1. *Depression and Anxiety Disorders*: These are among the most frequent comorbid conditions. Many individuals use substances to self-medicate, which can create a vicious cycle of dependency[1][2].
2. *Bipolar Disorder*: Substance abuse often exacerbates mood instability in individuals with bipolar disorder[1][3].
3. *Post-Traumatic Stress Disorder (PTSD)*: Trauma survivors may turn to substances to cope with distressing memories and emotions[1][2].
4. *Personality Disorders*:
– *Borderline Personality Disorder (BPD)*: Impulsivity and emotional dysregulation in BPD increase vulnerability to substance use.
– *Antisocial Personality Disorder (ASPD)*: Individuals with ASPD are more likely to engage in substance abuse due to impulsivity and disregard for societal norms[1][3].
5. *Psychotic Disorders*: Schizophrenia frequently co-occurs with SUDs, complicating treatment adherence and symptom management[1][3].

### *Medical Conditions*
1. *Infectious Diseases*: Injection drug use is linked to a higher risk of HIV/AIDS and hepatitis.
2. *Cardiovascular Issues*: Stimulant use can lead to hypertension, arrhythmias, and heart attacks.
3. *Liver and Gastrointestinal Problems*: Chronic alcohol or drug use can cause liver damage and gastrointestinal disorders.
4. *Diabetes and Cancer*: Addiction may exacerbate these systemic conditions by hindering proper management[4][6].

### *Behavioral Disorders*
1. *Eating Disorders*: Conditions like anorexia, bulimia, and binge eating disorder often co-occur with SUDs due to shared risk factors such as low self-esteem[1][3].
2. *Gambling Disorder*: Both behaviors share underlying vulnerabilities in brain reward systems[1].

### *Challenges in Diagnosis and Treatment*
Diagnosing comorbidities is challenging due to overlapping symptoms, stigma, and limited integration between mental health and addiction treatment services. Untreated comorbidities often worsen outcomes by increasing relapse risks and reducing treatment effectiveness[2][6].

### *Integrated Care Approach*
Effective management requires a multidisciplinary approach that simultaneously addresses addiction and comorbid conditions through personalized treatment plans. This includes pharmacological interventions, psychotherapy, and social support systems tailored to individual needs[1][2].

Addressing these comorbidities holistically improves recovery outcomes and enhances quality of life for individuals struggling with addiction.

Citations:
[1] https://www.serenityspringsrecovery.com/blog/common-comorbidities-with-substance-use-disorders/
[2] https://www.euda.europa.eu/spotlights/comorbid-substance-use-and-mental-health-problems_en
[3] https://www.unodc.org/documents/drug-prevention-and-treatment/UNODC_Comorbidities_in_drug_use_disorders.pdf
[4] https://footprintstorecovery.com/comorbid-medical-conditions-addiction/
[5] https://www.youtube.com/watch?v=5RbEotf0jqI
[6] https://thephoenixrc.com/blog/addiction-recovery/handling-comorbidities-with-substance-use-disorder/
[7] https://www.ncbi.nlm.nih.gov/books/NBK571451/
[8] https://nida.nih.gov/research-topics/co-occurring-disorders-health-conditions
[9] https://altacenters.com/addiction-resources/comorbidity/
[10] https://www.helpguide.org/mental-health/addiction/substance-abuse-and-mental-health

—
Answer from Perplexity: pplx.ai/share

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Robert F. Kennedy Jr. says that healthcare system should get reimbursed for pt health outcomes

Posted on April 15, 2025 by Pharmaciststeve

“Our healthcare system should reimburse doctors and hospitals for patient’s health outcomes”

Does this suggest that Kennedy is in favor of treating chronic pain patients to optimize a patient’s QOL? Could we bring back “pain is the 5th vital sign”? Could a lot of practitioners who are now “uncomfortable” in writing for opioids for pain management have a change in their belief of treating pain if their reimbursement was based on optimizing the pt’s level of pain and QOL? Will the DOJ/DEA get muzzled in raiding practitioners’ offices based on some nebulous statistical data? Should chronic pain pts reach out to RFK Jr to support his new patient treatment goals?

RFK Jr. Says the Medical System Has ‘Perverse Incentives’ for Doctors

https://www.medpagetoday.com/publichealthpolicy/healthpolicy/115141

We have to change that,” says Kennedy, who also praised the CDC’s work on the measles outbreak

HHS is trying to change the “perverse incentives” in the medical system, including the way doctors are paid, HHS Secretary Robert F. Kennedy Jr. said Tuesday.

“Today, we have a healthcare system that reimburses doctors and hospitals for procedures rather than for health outcomes. We have to change that.”

On another front, Kennedy also said that the CDC “has done a very good job at controlling the measles outbreak. We’ve had about 700 cases nationally and in Europe, they’ve had 127,000 cases and 37 deaths.” That number contrasts with 2024, in which 285 measles cases were reported in the U.S. for the entire year, according to the CDCopens in a new tab or window.

“People get measles because they don’t vaccinate. They get measles because the vaccine wanes — the vaccine wanes about 4.8% per year, so you know that problem is always going to be around,” he continued. “We need to also make sure that doctors know how to treat measlesopens in a new tab or window and how to treat the associated diseases, the pulmonary disease that often comes with measles, and [the] bacteriological [ones] — we can’t rely simply on the vaccine.”

In contrast to Kennedy’s remark, experts say that the measles vaccine provides lifelong immunityopens in a new tab or window, which is how the U.S. achieved elimination status.

It’s “outrageous” that the government doesn’t have a better surveillance system for vaccine injuries, Kennedy said in response to a question from the audience — which was not audible on the livestream — that apparently raised the issue of a possible connection between vaccines and autism, a relationship that has been widely debunkedopens in a new tab or window.

The CDC did a study on HHS’s surveillance system, the Vaccine Adverse Event Reporting System — which allows for self-reporting of possible vaccine-associated injuries but does not verify them — in 2010, “and [found that] it captures fewer than 1% of vaccine injuries,” he said, noting that at the time, the CDC had a “machine counting” system for such injuries but they “put it on a shelf.”

“We are going to improve the surveillance,” Kennedy said. “We’re going to get the data sets from everybody we can. We’re going to make data-sharing agreements with scientists all over the world, with the best scientists, and we’re going to find out what contribution vaccines and everything else make — mold, EMF [electromagnetic fields], food, all of these other exposures — which one of those are the culprits? I suspect we’re going to see that there’s a lot of culprits, but we need to know.”

“People don’t have informed consent [for vaccination], and people don’t trust our agency anymore,” he added. “And the way to improve vaccination is to make the agency trustworthy, and that’s what we’re going to do.”

HHS is trying to change the “perverse incentives” in the medical system, including the way doctors are paid, HHS Secretary Robert F. Kennedy Jr. said Tuesday.

“A lot of the negative behavior and self-destructive behavior in both the medical system — how we pay for healthcare — and how we eat is driven by perverse incentives,” Kennedy said at a press conference at the Indiana State Library in Indianapolis. “Today, we have a healthcare system that reimburses doctors and hospitals for procedures rather than for health outcomes. We have to change that.”

In contrast to Kennedy’s remark, experts say that the measles vaccine provides lifelong immunityopens in a new tab or window, which is how the U.S. achieved elimination status.

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A ophiophobic’s opinion why people dealing with acute or chronic pain should NOT BE GIVEN A OPIOID

Posted on April 14, 2025 by Pharmaciststeve

Short-sighted: Why the administration’s opioid plan won’t work

https://thehill.com/opinion/5247116-opioid-crisis-prevention/

by Chris Fox, opinion contributor chris@nonopioidchoices.org https://nonopioidchoices.org/

Last week, the Trump administration released a five-step plan to address the country’s opioid addiction crisis. The administration’s new drug czar’s plan focuses largely on attempts to prevent opioid-related overdose deaths.

It won’t work. Here’s why: The plan continues a years-old downstream focus on overdose death prevention and neglects the opportunity to prevent addiction in the first place.

In 2023, the last year for which we have full-year overdose data, 81,000 Americans died from an opioid-related overdose — an average of more than 220 deaths per day. Despite these staggering numbers, the administration’s plan primarily focuses on stopping the flow of illicit fentanyl into the U.S., relying on border control and punitive measures against drug cartels.

While addressing fentanyl trafficking is important, this approach tackles only one part of a far more complex problem. The reality is that overdose deaths remain high not only because of illegal fentanyl but also because millions of Americans continue to receive prescription opioids to manage postsurgical pain, whether they need them or not. In fact, as many as 90 percent of all surgical patients in the U.S. today receive an opioid prescription for post-operative pain.

The administration’s approach also touts increasing access to naloxone and medication-assisted treatment for opioid-use disorder, which are essential components of addiction treatment and overdose prevention. However, these measures are reactive, not proactive. They miss an important opportunity to prevent addiction before it starts by expanding non-opioid pain management options.

Current pain treatment protocols incentivize the use of generic prescription opioids. They do so because such medicines are cheap and well-known to health care professionals, and most patients will tolerate these medicines without incident.

However, some — estimates show between 6 percent and 20 percent — will misuse these medicines. Some may become addicted and move on to other illicit forms of opioids. Some will overdose. Some will die.

This overreliance on prescription opioids strips patients of real choices and unnecessarily increases the risk of long-term dependency. We have the tools to change the status quo.

We must change how we treat pain in this country and ensure that patients and health care providers have options when it comes to treating acute pain. The passage of the Non-Opioids Prevent Addiction in the Nation Act in 2022 was a major step forward, ensuring that non-opioid alternatives are available in outpatient surgical settings.

But there is more work to do.

We must ensure that all patients in all settings can easily access non-addictive pain treatment options. This is especially true for patients covered by Medicare Part D plans.

Earlier this year, legislation was introduced in Congress called the Alternatives to Prevent Addiction in the Nation Act. This critical legislation would make sure that patients can easily access non-opioid medications at the pharmacy counter.

The opioid addiction epidemic is far from over. Hundreds of Americans still die every day, and the crisis is evolving in ways that demand urgent action. Focusing solely on border control and fentanyl supply reduction ignores the deeper issue: how we manage pain in our health care system.

If we are serious about preventing addiction and saving lives, we must prioritize non-opioid choices — before it’s too late.

Every day we delay action, more patients are denied access to a non-opioid pain management tool. Recently, a major insurance company announced that it was making it more difficult for Americans to access non-opioids. We cannot stand idly by and let this happen.

This proposal would ensure that all patients can access non-opioid treatments in all settings. It can prevent addiction before it starts.

Congress has a chance to get ahead of this crisis — but only if they act now. Passing the act is a concrete step toward ensuring that patients have real choices in pain management. If we are serious about preventing addiction and saving lives, we must prioritize non-opioid choices.

We cannot afford to fight the opioid crisis with half measures.

Chris Fox is executive director of Voices for Non-Opioid Choices.

https://nonopioidchoices.org/about/members/

This article was appropriately noted as provided by: by Chris Fox, opinion contributor. I find the adjective OPINION very true, unfortunately, his opinion has very little to do with reality.

Generally, addiction is not caused by Opioids or some other substances that the person with pre-existing mental health issues. They have unknown- to them- “monkeys” on their back and/or “demons” in their head, and their interaction with some substance or activity will silence those “monkeys” or “demons”. They experience a “mental peace” they had no idea was possible. Depending on what statistic one wishes to believe, 0.6% to 3% of the people prescribed an opioid for acute or chronic pain will become addicted. It appears that this organization, Voices for Non-Opioid Choices believes that >97% of anyone dealing with acute or chronic pain should be denied effective, FDA-approved medications.

Recently, I asked www.perplexity.ai the following question: What comorbidities issues are generally involved with addiction?

Mental Health Disorders

Depression and Anxiety Disorders: These are among the most frequent comorbid conditions. Many individuals use substances to self-medicate, which can create a vicious cycle of dependency12.
Bipolar Disorder: Substance abuse often exacerbates mood instability in individuals with bipolar disorder13.
Post-Traumatic Stress Disorder (PTSD): Trauma survivors may turn to substances to cope with distressing memories and emotions12.
Personality Disorders:
- Borderline Personality Disorder (BPD): Impulsivity and emotional dysregulation in BPD increase vulnerability to substance use.
- Antisocial Personality Disorder (ASPD): Individuals with ASPD are more likely to engage in substance abuse due to impulsivity and disregard for societal norms13.
Psychotic Disorders: Schizophrenia frequently co-occurs with SUDs, complicating treatment adherence and symptom management13.

Medical Conditions

Infectious Diseases: Injection drug use is linked to a higher risk of HIV/AIDS and hepatitis.
Cardiovascular Issues: Stimulant use can lead to hypertension, arrhythmias, and heart attacks.
Liver and Gastrointestinal Problems: Chronic alcohol or drug use can cause liver damage and gastrointestinal disorders.
Diabetes and Cancer: Addiction may exacerbate these systemic conditions by hindering proper management46.

Behavioral Disorders

Eating Disorders: Conditions like anorexia, bulimia, and binge eating disorder often co-occur with SUDs due to shared risk factors such as low self-esteem13.
Gambling Disorder: Both behaviors share underlying vulnerabilities in brain reward systems1.

Challenges in Diagnosis and Treatment

Diagnosing comorbidities is challenging due to overlapping symptoms, stigma, and limited integration between mental health and addiction treatment services. Untreated comorbidities often worsen outcomes by increasing relapse risks and reducing treatment effectiveness26.

Integrated Care Approach

Effective management requires a multidisciplinary approach that simultaneously addresses addiction and comorbid conditions through personalized treatment plans. This includes pharmacological interventions, psychotherapy, and social support systems tailored to individual needs12.

Addressing these comorbidities holistically improves recovery outcomes and enhances quality of life for individuals struggling with addiction.

Citations:

Answer from Perplexity: pplx.ai/share

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Private Equity’s Growing Role in Disability Care Demands Urgent Oversight

Posted on April 13, 2025 by Pharmaciststeve

Just imagine when a private equity company buys a company whose primary function is to provide medical care to mostly pts who are high acuity, complex, and most likely disabled. However, the primary function of private equity companies is to generate profits. One can only imagine what happens to the healthcare companies that they buy.

Private Equity’s Growing Role in Disability Care Demands Urgent Oversight

Patients are not lines on a balance sheet

https://www.medpagetoday.com/opinion/prescriptionsforabrokensystem/115074

Private equity (PE) has become a powerful and often invisible force reshaping how care is delivered across the country. A recent report from the Private Equity Stakeholder Projectopens in a new tab or window shines a light on one of the latest, and most concerningopens in a new tab or window, developments: the growing role of PE in services for people with intellectual and developmental disabilities (IDD).

This trend is alarming not just because of the populations involved, but because of what it reveals about how healthcare is increasingly being treated — not as a social good, but as a business opportunity ripe for financial exploitation.

The Lifeline of Medicaid-Funded IDD Services

Many of the services supporting individuals with IDD — residential facilities, home care, adult day programs, physical and occupational therapy, and more — are funded primarily through Medicaidopens in a new tab or window. For nearly 10 million Americans with IDD, these programs represent far more than care: they are the foundation of daily life, independence, and survival. Historically, these services have been provided primarily by non-profits and religious organizations.

And yet, as PE firms continue to acquire companies that provide these services, we must ask a difficult question: What happens when profitability becomes harder to maintain, especially when Medicaid dollars are cut or restrictedopens in a new tab or window? The answer, based on past precedent in other areas of healthcare, is not promising.

The PE Playbook: High Returns, Low Transparency

PE firms generally operate on a 4-to-7-year investment horizon. Their goal is generally to double or triple returns during that short window. In order to get results quickly, PE firms often resort to significant cost-cutting, rapid scaling, and creating “operational efficiency.” In sectors with strong commercial margins, this approach might be sustainable. But in IDD care — an underfunded, labor-intensive space that relies heavily on government reimbursement — this model could result in real harm.

According to the Private Equity Stakeholder Project’s report, PE firms are already applying their traditional cost-saving strategies in IDD. They are reducing staffing levels, relying on lower-paid and less-trained workers, eliminating oversight roles, and prioritizing rapid expansion. The result? Allegations of substandard care, including abuse and neglect, abound and are being investigated by federal and state lawmakers.

The changes put in place by PE firms might boost margins in the short term, but they undermine quality, safety, and continuity — the very pillars of care for individuals with IDD.

And let’s not forget: these significant policy changes will affect vulnerable individuals with lifelong needs, who are often unable to advocate for themselves and are reliant on stable, skilled, and compassionate care teams. Additionally, people with IDD already experience significant health and social inequities. They face shorter life expectancies, higher rates of chronic illness, increased mental health challenges, and greater risk of pregnancy complications. These disparities are rooted in structural barriers, including difficulty accessing care, lack of provider training, and social marginalization.

Now layer on top a business model that prioritizes efficiency over empathy and returns over relationships, and the risks become unacceptable. Indeed, the shift from mission-driven nonprofits and religiously affiliated organizations to profit-maximizing investors represents a fundamental change in how care is conceptualized and delivered — and it is a terrible shift.

We Have Seen This Before

As I have written in MedPage Todayopens in a new tab or window, private equity is not inherently bad. When firms are responsible and transparent, they can fuel innovation, expand access, and help modernize outdated systems. But when left unchecked, firms’ incentives are often misaligned with the core mission of healthcare: to care for people.

This argument is not speculative.

In fact, we have seen the negative effects of PE in emergency medicineopens in a new tab or window, where PE-backed staffing firms have contributed to burnout and dissatisfaction among clinicians. We have seen it too in nursing homesopens in a new tab or window, where aggressive cost-cutting has coincided with drops in quality and oversight. And we are seeing PE expand into behavioral healthopens in a new tab or window, where providers under financial strain are already stretched too thin to meet patient needs. Health policy researchers, patient advocacy groups, and providers worry that similar quality declines will be seen in mental health care with PE acquisitions.

What is unfolding in the IDD space has all the same warning signs, but with even higher stakes.

If we are serious about protecting people with IDD and about ensuring our healthcare system upholds the dignity of those who need it most, we must act now. We must:

Require PE firms to disclose ownership structures and report quality outcomes in IDD settings
Strengthen federal and state oversight to ensure that care quality, not just financial returns, is being measured
Mandate regulatory review before PE firms can purchase entities serving vulnerable populations
Set minimum staffing ratios and require specialized training for caregivers in IDD services
Encourage financial firms to invest with integrity, prioritizing people over profits in high-impact areas like disability care

Healthcare is not a commodity, and people with disabilities are not lines on a balance sheet. When profit is prioritized over people, we do not just lose efficiency, we lose trust, compassion, and the fundamental integrity of care. If we are not vigilant, the most vulnerable will pay the highest price for someone else’s financial gain.

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Who will the new chronic pain pts be tomorrow?

Posted on April 13, 2025 by Pharmaciststeve

It is claimed that there are some 50,000 new chronic pain pts every year – that is about 140/day… that is about SIX EVERY HOUR – 24/7/365!

How many of your family, friends, or neighbors will become a chronic pain pt in the next day? Could you become a chronic pain pt in the next 24 hrs? All it takes is one serious accident that may or may not be your fault. What is even worse is that most of those 50,000 people will discover that our healthcare system doesn’t want to be the intensity of the pt’s pain nor will be willing to treat their pain for more than MAYBE just a few days.

Today, many chronic pain pts have been basically put under HOUSE ARREST because they receive inadequate pain management that most of their days, they spend laying in bed or a couch and/or sitting in a chair.

Filed under: General Problems | 1 Comment »

The Era of Compounded GLP-1 Drugs Is Over. What Now?

Posted on April 12, 2025 by Pharmaciststeve

The Era of Compounded GLP-1 Drugs Is Over. What Now?

https://www.medscape.com/viewarticle/era-compounded-glp-1-drugs-over-what-now-2025a10008kq

Now that the US Food and Drug Administration has removed both tirzepatide and semaglutide from its Drug Shortages List, the widespread compounding of these drugs is ending. Tirzepatide’s deadline has already passed, while physicians and pharmacies have until April 22 for semaglutide. An estimated 2 million Americans have been using these more affordable copycats every month.

Even with direct-to-consumer discounts, monthly doses of brand-name versions cost hundreds more than compounded ones, putting them beyond the reach of many people. This means a significant number of compounded glucagon-like peptide 1 (GLP-1) users will be forced to go cold turkey — but studies consistently show weight regain when patients stop taking them abruptly. So how can you help your patients?

Forced Off GLP-1s

While published research into best practices for discontinuing the use of GLP-1s is scant, accessibility and price issues have already forced physicians and patients to devise workarounds. Not everyone was willing to rely on the compounded versions, after all. And some who succeeded on a brand name were reluctant to spend that much money every month for the rest of their lives.

As a result, anecdotal information already exists about tactics like stretching out the time between injections, tapering the dosage, and adding strength training to patients’ exercise routines.

“Anecdotally, some doctors and patients are being forced into this,” said Jennifer Manne-Goehler, MD, a researcher at Harvard Medical School, Boston, and the lead author of a paper in JAMA Internal Medicine that looked at what we know about off-ramping these drugs.

“I get messages from people saying, ‘Do you think microdosing is okay?’ or, ‘I had a patient who ran out, or they couldn’t get more tirzepatide, so they started taking it every other week,’” she said.

So far, success seems to be dependent on the individual patient’s level of motivation and their ability to commit to lifestyle changes. Regular communication with the patient goes a long way toward determining what might work.

“Subjectively, patients know when things are working for them or not,” said Jeremy Korman, MD, medical director of the Cedars Sinai Marina Weight Management Center in Marina del Rey, California. “That’s a way, without any concrete algorithm, that I work with my patients who’ve reached a target weight. We start using those subjective measures of hunger and cravings and tapering in that way, whether it’s tapering on time interval or tapering on dose.”

Slow Tapering May Work

Last year, researchers presented findings on a slow tapering method at the European Congress on Obesity. When participants reached their goal weight, their dosage was gradually reduced over an average of 9 weeks while they continued with coaching on diet and exercise. Data was available for 85 participants — 6 months after tapering to zero, and their weight remained stable.

“Because they’ve engaged in some of the lifestyle changes, when they eventually taper off, they keep the weight off without semaglutide,” lead researcher Henrik Gudbergsen, MD, told Medscape Medical News at the time. “I think there’s a strong linkage between the initial phase of using this medication with lifestyle changes and actually being capable of keeping the kilos off once they’ve stopped.”

Given the small number of participants, more research is necessary. But those initial results are promising, Korman said.

“The European study, tapering over 9 weeks, is very interesting,” Korman said. “The original studies just stopped the medication, and all the weight came back. We still have to be a little skeptical, even if we taper properly, that it’s going to be as durable as we hope. It could be, but it’s very early on.”

Of course, the end of mass-produced compounded GLP-1s is less than 9 weeks away. But in Reddit discussions among compounded tirzepatide users, many said they have stockpiled a supply, enough to last for months. A slow taper could work for them. For those without a ready supply, a short-term prescription for a brand-name GLP-1 might do the trick.

Turn to Older Generation Weight-Loss Drugs

Another option that shows potential is simply migrating from a GLP-1 to an older generation, generic version of an anti-obesity medication. A study in the December issue of Obesity followed patients on this protocol. Out of an initial group of 105 participants, 40 used a GLP-1 medication for 12 months to reach a body mass index of less than 30, then transitioned to generic phentermine, phentermine/topiramate, topiramate, metformin, bupropion, and/or naltrexone. They maintained their initial weight loss for up to 2 years when the study ended.

Gitanjali Srivastava, MD, medical director at Vanderbilt Obesity Medicine in Nashville, Tennessee, co-authored the study. She compared this approach to cancer treatment: If a patient comes in with an aggressive tumor, the oncologist might use expensive therapies to decrease the size of the tumor burden. Once that’s achieved, the oncologist can move the patient to less intense, less costly therapies.

“In the same way, when we think about obesity as a disease process, patients with severe obesity have a very high disease burden,” she said. “With GLP-1 medications, you’re shrinking the size of that disease burden, then exposing them to the older generation armoire.”

She’s been using this approach in her practice for several years.

“Even though the GLP-1 drug classes have created hype, I don’t think we should forget some of these older-generation medications that are less expensive, that patients still do really well on and respond very favorably to, if there are no contraindications,” she said. “For instance, metformin is free at Publix. Topiramate is just a few dollars. A combination of phentermine and topiramate, which is sold under the brand name Qsymia, you can get for less than $20 a month.”

Discoveries Still to Come

With so many patients being forced off compounded GLP-1s at once, we’re likely to learn a lot about what helps — and what does not — to maintain a substantial weight loss. One thing will almost certainly be a crucial factor: Guiding patients toward a healthier lifestyle in general.

“Regardless of what treatment we give a patient, even with surgery, our weight loss outcomes and the durability of them depend on lifestyle modification,” Korman said. “That has to be the foundational concept. If we’re just going to rely on the meds, and we’re not going to commit to that, nothing is going to work.”

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The enforcement of all our laws seems to depend who is in charge of enforcing them.

Posted on April 12, 2025 by Pharmaciststeve

I shared this article on April 7, 2025, referencing our Fed AG Jan 31, 2019 decision. This was during President Trump’s administration. It is typical for these things to take some time to reach a conclusion. But preceding this date, several people held the office of AG or acting AG, which led up to this conclusion. Jeff Sessions, Rod Rosenstein, Matthew Whitaker Below that link to the article, I am sharing the information provided by perplexity.ai when I asked it: what comorbidities issues are generally involved with addiction.

I asked perplexity.ai what the DOJ has done regarding discrimination of pts with SUD/OUD since Jan 2019, and it came up with NADA. With our new Fed AG Pam Bondi, I doubt if she will pursue anything as well. I guess we have another law that is enforced at the discretion of “who is in power.”

DOJ Considers Opioid Use Disorder an ADA Covered Disability and Pursues Claims Against a Provider for Refusing Medical Services to Opioid Users

what comorbidities issues are generally involved with addiction

### **Mental Health Disorders**
1. **Depression and Anxiety Disorders**: These are among the most frequent comorbid conditions. Many individuals use substances to self-medicate, which can create a vicious cycle of dependency[1][2].
2. **Bipolar Disorder**: Substance abuse often exacerbates mood instability in individuals with bipolar disorder[1][3].
3. **Post-Traumatic Stress Disorder (PTSD)**: Trauma survivors may turn to substances to cope with distressing memories and emotions[1][2].
4. **Personality Disorders**:
– **Borderline Personality Disorder (BPD)**: Impulsivity and emotional dysregulation in BPD increase vulnerability to substance use.
– **Antisocial Personality Disorder (ASPD)**: Individuals with ASPD are more likely to engage in substance abuse due to impulsivity and disregard for societal norms[1][3].
5. **Psychotic Disorders**: Schizophrenia frequently co-occurs with SUDs, complicating treatment adherence and symptom management[1][3].

### **Medical Conditions**
1. **Infectious Diseases**: Injection drug use is linked to a higher risk of HIV/AIDS and hepatitis.
2. **Cardiovascular Issues**: Stimulant use can lead to hypertension, arrhythmias, and heart attacks.
3. **Liver and Gastrointestinal Problems**: Chronic alcohol or drug use can cause liver damage and gastrointestinal disorders.
4. **Diabetes and Cancer**: Addiction may exacerbate these systemic conditions by hindering proper management[4][6].

### **Behavioral Disorders**
1. **Eating Disorders**: Conditions like anorexia, bulimia, and binge eating disorder often co-occur with SUDs due to shared risk factors such as low self-esteem[1][3].
2. **Gambling Disorder**: Both behaviors share underlying vulnerabilities in brain reward systems[1].

### **Challenges in Diagnosis and Treatment**
Diagnosing comorbidities is challenging due to overlapping symptoms, stigma, and limited integration between mental health and addiction treatment services. Untreated comorbidities often worsen outcomes by increasing relapse risks and reducing treatment effectiveness[2][6].

### **Integrated Care Approach**
Effective management requires a multidisciplinary approach that simultaneously addresses addiction and comorbid conditions through personalized treatment plans. This includes pharmacological interventions, psychotherapy, and social support systems tailored to individual needs[1][2].

Addressing these comorbidities holistically improves recovery outcomes and enhances quality of life for individuals struggling with addiction.

—
Answer from Perplexity: pplx.ai/share

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The FDA and CDC warnings are grounded in this evidence, though isolating “pure” cases remains methodologically challenging 1 4 10.

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42 USC 1395: Prohibition against any Federal interference

§1395. Prohibition against any Federal interference

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RFK Jr. Says the Medical System Has ‘Perverse Incentives’ for Doctors

We have to change that,” says Kennedy, who also praised the CDC’s work on the measles outbreak

“Today, we have a healthcare system that reimburses doctors and hospitals for procedures rather than for health outcomes. We have to change that.”

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Short-sighted: Why the administration’s opioid plan won’t work

Mental Health Disorders

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Private Equity’s Growing Role in Disability Care Demands Urgent Oversight

Patients are not lines on a balance sheet

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The Era of Compounded GLP-1 Drugs Is Over. What Now?

Forced Off GLP-1s

Slow Tapering May Work

Turn to Older Generation Weight-Loss Drugs

Discoveries Still to Come

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what comorbidities issues are generally involved with addiction

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