Measure to let VA docs help vets get medical marijuana withdrawn after agency objects

https://www.washingtontimes.com/news/2019/jun/22/marijuana-measure-widening-access-for-veterans-wit/

Medical marijuana legislation widening access for military veterans was shelved Friday in the face of federal opposition.

Rep. Earl Blumenauer, Oregon Democrat, withdrew an amendment from an annual spending bill that would have allowed Department of Veterans Affairs doctors to recommend pot to patients in states that have legalized the medicinal use of marijuana.

Explaining his decision on the House floor, Mr. Blumenauer said the VA “has not been as helpful as it should be” in terms of providing veterans with greater access to medical marijuana, which is prohibited under federal law but legal in most states.

“All of a sudden the VA has decided, well, they would be putting their doctors at risk,” said Mr. Blumenauer, the founder and co-chair of the Congressional Cannabis Caucus.

“I hope that we’ll be able to work together to fix this little quirk to make sure that VA doctors can do what doctors everywhere do in states where medical cannabis is legal and be able to work with their patients,” he said.

The VA did not immediately return a request for comment over the weekend.

Thirty-three states have legalized medical marijuana to varying degrees, providing patients in most of the country with a route for obtaining and using pot in spite of its status as a Schedule 1 drug federally prohibited under the U.S. Controlled Substances Act.

Addressing lawmakers on Capitol Hill last month, a top VA official said the agency would look for the U.S. Drug Enforcement Administration for guidance as long as pot remains on the government’s list of controlled substances.

The DEA “advised VA that no provision of the Controlled Substances Act would be exempt from criminal sanctions as a VA physician who acts with intent to provide a patient with means to obtain marijuana,” testified Dr. Keita Franklin, national director of suicide prevention for the department’s Office of Mental Health and Suicide Prevention.

Mr. Blumenauer’s amendment would have prohibited the VA from “interfering with a veteran’s participation in a state medical cannabis program, denying a veteran who participates in a state medical cannabis program from being denied VA services and interfering with the ability of VA health care providers to recommend participation in state medical cannabis programs.”

“The VA ought to give their patients, our veterans, the same consideration to be able to have these conversations with the doctors who know them best,” he said prior to withdrawing the amendment.

Another measure preventing the Department of Justice from using federal funds to enforce marijuana prohibition advanced in the House of Representatives earlier this week, meanwhile. Co-sponsored by Mr. Blumenauer, the amendment was agreed by a vote of 267-165 and slated to be included on the full appropriations bill funding the Justice Department’s budget for the next fiscal year.

“This has been a very important week in the evolution of the federal policy to end the failed policy of prohibition on cannabis,” he said Friday. “This is remarkable progress that we have seen, but it is just an effort by Congress to catch up to where the rest of the American public is.

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Lack of Care Forces Man to Leave America

www.patientsrising.org/lack-of-care/

Michael is a 65-year old veteran, educated and successful, yet lack of care by his doctors forced him to move to Thailand for care.

1976. Army. On duty in Fulda Gap. Jeep flipped over on my back.

I was a tough kid, so I put up with it. After decades of lower back pain, it finally became too much. In 2008 I went to a spine specialist and surgeon at Kaiser in San Jose, CA. While there, the doctors told me I would need metal support surgery in my lumbar and cervical spine. Lumbar surgery went OK, but didn’t alleviate my pain there, in fact it increased it. Cervical surgery was so complicated it became three different surgeries and a ton of new pain.

I joined a Pain Management program, dosed with MME (morphine milligram equivalent) around 240 for the following year. I learned and tried all the pain management techniques, tried all the alternative methodologies, including injections.

Then out of nowhere my pain doctors decided to titrate my meds down over the next six months. They didn’t stop until I was completely off the pain meds. I just fell apart. Total lack of care. Went on disability. Fell into depression. Less than a year later I was suicidal.

THE LACK OF CARE IN AMERICA

After talking over the situation with my wife, she agreed that it looked like I had little recourse, she suggested we leave America, and try living overseas. We went to Thailand. I was still suicidal, but we tried seeing specialists in Chang Mai. There was nothing they could do regarding the surgeries, but they turned me on to Bangkok Hospital’s Pain Management Clinic. Their approach – total pain support.

They started me on an initial MME of 240, but when that wasn’t effective enough, they raised it to 360. MS-Contin, long acting, with additional immediate-release 10mg pills in case of breakthrough pain. The rest of the program included physical therapy 3 x week, massage 3 x week, psych counseling, and social programs. Wonderful program, the best I’ve experienced. NO shame, NO guilt, just help. Over six years, MME was raised to 600.

COMING HOME

In February 2018, we returned to Lodi, California to live near our new grandkids. I was in great shape, and thought, with the documentation I carried from Bangkok Hospital, and the wonderful results therein contained, doctors here would continue the treatment. WRONG.

Michael in Thailand

Over the last year doctors have cut my MME down to 90 per day. I am in terrible pain. Constant bad breakthrough pain. All my other support (psych, social) is gone. Physical Therapy here is not as thorough as it is in Thailand. massage? Forget about it. Lectures on the opioid crisis however, are unrelenting. Doses of shame, guilt, plentiful. My doctors know little about MME, or the difference between the meds, or interventional radiology. When I try to explain, I’m ignored, and receive another lecture about the horrors of addiction.

WHEN YOUR COUNTRY ABANDONS YOU

This is my life in the land of the free. Liberty? Government and doctors refusing care. Lectures on the opioid addiction mess. A mess not of my making, has nothing to do with me. I have never overdosed or used street drugs. Until this last year, I have never taken more pills than those prescribed. Now? What’s a man to do? Lay in a dark room in pain, ignoring his family, ignoring social interaction? I’m fast slipping back into depression, and again considering a move back to Thailand, if my wife and I can stand to leave our grand kids.

I’m sixty-five years old. A veteran. I have advanced education and have been successful in my career. And my doctors shame me and treat me like a troubled child. America, do better.

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Editor’s note: Michael reached out to us through What’s Your Story, and he and I corresponded back and forth a few times. We’re not sharing Michael’s last name because people with chronic pain are concerned with retribution. With patients being forced off pain meds, excessive policing by government agencies and the lack of care in the pain field, who can blame them. That’s the state of chronic pain in America and it’s shameful.

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As the Director of Patient Content at Patients Rising, Jim works very closely with the people who have healthcare war stories to tell. As a Columbia University trained writing consultant Jim has worked closely with writers of all levels of skill to help them find and refine their voices. Jim is a writer, editor, author and medical assistant with over 20 years of experience in healthcare. He’s spent over two decades in clinical care and research at some of New York’s biggest health institutions doing hands-on nursing, education and advocacy for rare disease patients.

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Arizona doctor, patient explain why access to opioids is necessary

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CVS just laid out a big reason why health companies are worried about Amazon

https://www.cnbc.com/2019/06/20/new-cvs-lawsuit-to-block-exec-from-working-for-amazon-reveals-concern.html

Kyle Walsh | CNBC

When word spread that Amazon would move into health care in 2017, health-care executives had a ready answer: We are not afraid.

“I honestly don’t believe that Amazon will be interested in the near future in the next few years in this market,” Walgreens’ CEO Stefano Pessina told investors in an earnings call in July 2017.

“I think we have a lot of capabilities and a value proposition that can compete effectively in the market,” CVS CEO Larry Merlo said back in August.

But recent legal actions tell a different story.

 

 

In April, CVS filed a lawsuit against John Lavin, a former senior vice president in charge of CVS Caremark’s retail pharmacy network, after Lavin told the company he was leaving to take a job at Amazon’s pharmacy arm, PillPack. The judge this week ruled in CVS’ favor, preventing Lavin from taking immediate employment at PillPack.

That follows another case from January of this year, where insurance giant UnitedHealth sued one of its employees for attempting to join a different Amazon initiative. That was Haven, Amazon’s joint employer health venture with Berkshire Hathaway and J.P. Morgan.

These lawsuits suggest incumbents are more concerned than they’re letting on in public.

The underlying concern: Amazon going directly to insurers

Amazon has said almost nothing in public about its health-care strategy.

But Amazon could disrupt the space dramatically by negotiating directly with insurance companies on drug pricing, cutting out the existing pharmacy benefits managers, or PBMs. All of that could potentially lower health-care costs for consumers.

Among other functions, PBMs help insurance companies negotiate lower drug costs. Manufacturers arrange discounts, called rebates, with the benefits managers so they can fix a spot for their products on a PBM’s list of preferred drugs. It’s a huge business — CVS’ PBM business represented approximately 60% of its overall revenues in 2018, or around $116 billion, according to a person familiar with CVS’ business.

Amazon PillPack CEO TJ Parker, in a deposition in the Lavin case, admitted to the court that the company had “explored a number of different things.”

But he said the company had “no immediate plans” to compete with CVS Caremark’s core offering, its PBM.

CVS certainly seems to think differently, according to the lawsuit to prevent Lavin from working for PillPack.

“Given its robust infrastructure, operational capacity, and distribution reach, Amazon-PillPack is uniquely positioned to negotiate directly with payers (insurers) and displace CVS Caremark’s mail-based services,” CVS argued in support of its motion for a preliminary injunction.

In other words, CVS worries that Amazon is hiring Lavin to approach its clients — insurance plans — for deals that could undercut its PBM.

In particular, CVS said PillPack is already approaching Blue Cross Blue Shield. (CNBC reported talks between PillPack and the insurance network in May.)

“Most recently, Amazon-PillPack engaged in direct discussions with Blue Cross Blue Shield, a federation of 36 health insurance plans that cover more than 100 million Americans, to provide its members with prescription home delivery,” CVS’ motion reads.

Lavin, who has extensive background working with payers, would be well positioned if Amazon PillPack did decide to take that step toward direct contracting over time.

According to Jefferies’ analyst Brian Tanquilut, who also reviewed the legal documents, there’s a real threat that Amazon could chip away at CVS Caremark’s business over time by going directly to insurers. “The lawsuit shows that pharmacy benefits managers are now also at risk of being dis-intermediated,” he wrote.

To that assertion, a PillPack spokesperson responded: “It is important to keep in mind that what’s being reported here is another company’s speculation about our business strategy for a lawsuit to which neither Amazon nor PillPack is a party.”

However, other drug supply chain experts agree that the PBMs have reason to worry, especially as the health industry consolidates and policymakers are pushing PBMs to be more transparent about their practices.

“PBMs are going to be more protective of their mail pharmacy business than ever and less welcoming to outsiders like PillPack,” said Stephen Buck, a drug supply chain expert who previously worked at McKesson.

For his part, Lavin said in communications to his former employer that he would not be competing head-on with them but would be negotiating from the opposite side of the table.

“I’ll be … handling [PillPack’s] negotiations with PBMs … in other words, it’ll be the opposite of what I did for CVS,” he noted in an email to CVS’ human resources department that was disclosed during the case.

The judge disagreed and granted CVS’ motion to enforce the noncompete agreement and block Lavin from working for PillPack for 18 months.

In his ruling, Judge John J. McConnell wrote, “Mr. Lavin will also negotiate and build relationships with private Payers and public Payers, both of whom are current CVS clients.” McConnell wrote, “It also appears that PillPack will be looking to negotiate directly with the insurers and others on the Payer level.”

CVS, in a statement to CNBC, denied any claim that it is working to block competition and said that it will continue to work with new players.

“We remain focused on delivering innovative solutions to transform the health care experience, but there is always room for new players in health care, as competition can help lower overall costs for payers and patients,” said a spokesperson for CVS Caremark.

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Cannabis legalization is gaining traction across the U.S. There are five important things to note about this shift in law.

www.legalreader.com/top-5-things-to-know-about-the-legality-of-cannabis-by-u-s-jurisdiction/

The cultivation, transportation, sale, use, and possession of marijuana is illegal under federal law in the U.S. However, the federal government has articulated that if a state passes a law to decriminalize marijuana for medical or recreational purpose, they can do so if a regulation system for cannabis is in place.

Marijuana is listed as a Schedule I drug under the Controlled Substance Act of 1970—the topmost classification under the legislation. One of the reasons why cannabis still remains illegal at the federal level is because it’s classified as a Schedule | drug, as identified by the DEA, a substance that has a great potential of being abused by its user and has no acceptable medical uses.

However, a recent review from the National Academies of Sciences, Engineering, and Medicine evaluated more than ten thousand scientific studies on the medical benefits of marijuana, one of which was the use of medicinal cannabis to treat chronic back pain.

Furthermore, certain cannabis strains are known to provide a good deal of energy, enabling you to stay active and crush the fatigue keeping you down.

In spite of all the health benefits of cannabis, it’s likely to remain illegal in workplaces, which is why it’s important to know how to detox.

Individual state laws don’t always conform to federal standards. State-level proposals for cannabis rescheduling have had mixed success.

On November 9, 2016, the use of both medicinal and recreational cannabis was legalized in the states of California, Washington, Colorado, Alaska, Maine, Nevada, Oregon, and Massachusetts.

Another 15 states, including the U.S. Virgin Islands, have also decriminalized. The commercial distribution of marijuana is allowed in all jurisdictions where it’s been legalized, except Vermont and Columbia.

Prior to January 2018, the Cole Memorandum gave some protection against the enforcement of federal law in the legalized states. Later, however, it was rescinded by former Attorney General Jeff Sessions.

The use of marijuana remains federally illegal, but some of its derivative compounds were approved by the FDA for prescription use. Cannabidiol is now sold by various online retailers who claim their products are extracted from industrial hemp; hence legal.

Although the DEA considers non-Epidiolex CBD a Schedule I drug, it has not yet taken any action to shut down these sales.

Top Five Predicted Changes In Cannabis Law

We’re in a time of unparalleled growth and rapid change for the marijuana industry across the U.S.

As we look ahead at problems in the law at both the federal levels and Oregon state, here are five main changes we see on the horizon.

#1: Social Consumption

The Oregon Legislature is considering social consumption bills, which would allow the possession, consumption, and sale of cannabis products at temporary events, as well as licensed cannabis cafes and lounges.

Social consumption bills have previously failed, partly because of the necessary amendments to the Oregon Indoor Clean Air Act that legislators are hesitant to address. As the public hearings have already begun, this issue may grow enough legs for a tailored version of one of the bills in order to pass this session.

#2: Access to Banking

Limited access to financial companies creates a sub-optimal brand model for marijuana businesses and fuels safety concerns.

The SAFE Banking Act is likely to prevent federal banking regulators from hurting banks for working with marijuana-related companies that are obeying state laws.

In March 2019, the House Finance Committee made a vote to pass the bill to the House, with advocates expecting a floor vote in May.

With over 150 co-sponsors and strong bipartisan support to date, the bill is predicted to pass in the House. Also, advocates are hopeful that the support may put enough pressure on the Senate to pass the bill.

#3: Interstate Commerce

The Oregon Legislature is taking a bill into account that will allow for an interstate compact with states having legalized cannabis and that share borders (OR, WA, NV, and CA).

Creating an exchange of marijuana between these states could help combat overproduction problems and spillage into the unregulated market. It could also position Oregon to be a leading cannabis exporter in the future.

#4: Social Equity Issues

A Social Equity Program was first introduced in 2018 by the City of Portland to help small marijuana businesses and those impacted by marijuana prohibition directly.

In addition, a portion of the local tax revenue gained from cannabis sales goes toward grants to minority—and women-owned local marijuana businesses. Oregon, however, has made no movement on prior cannabis convictions’ expungement.

Local jurisdictions in cities like Oakland are setting a precedent on the problem of expungement. We can expect that Oregon will take this issue as a nudge in the right direction.

#5: Federal Legislation

Is 2019 going to be the year of weed?

Ten states, along with the District of Columbia have marijuana laws in place that allow the legal use of cannabis for both recreational and medical purposes.

New York, Connecticut, Illinois, and New Jersey are each expected to legalize marijuana in the coming years. Public support for cannabis legalization is always high, and bills like the STATES Act will exempt legal-marijuana states from federal law enforcement.

We don’t quite have a crystal ball, but the dominoes are lining up with a goal of federal legalization on the horizon!

Wrapping Up

So, these were five of the main predicted changes we see in cannabis law.

The year 2019 feels different.

Cannabis enthusiasts have long celebrated 4/20—the cannabis culture, but now that companies are seeing profit potential, they’re getting involved as well with things like CBD-infused Carl’s Jr. hamburgers and $4.20 Lyft credits.

Cannabis is a huge business, even if it’s not legal everywhere yet. In this post, we tried to give you a comprehensive review of the legality of cannabis by U.S. jurisdiction.

So, what will be the future of cannabis businesses?

Perhaps, only time will tell.

Nonetheless, did you find this article helpful? Share your thoughts and suggestions with us in the comments below!

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‘One-pot’ meth labs are declining but Mexican cartels have made the drug cheaper and deadlier

https://www.lansingstatejournal.com/story/news/2019/06/20/meth-drug-addiction-labs-cartels-mexican-dea-overdose/1382006001/

In the past five to seven years, domestic meth labs have decreased in the U.S. as Mexican drug cartels brought cheaper and purer drugs in. Kara Berg, Lansing State Journal

LANSING — When Battle Creek police and parole officers inspected a home May 6 on the city’s south side, they found something unusual.

The methamphetamine, marijuana and syringes they seized were almost expected, but the one-pot meth cooker was a surprise. It’s something police don’t see often anymore.

As recently as five years ago, meth was commonly made at home in plastic 2-liter pop bottles with ingredients bought at drug stores. Police and first responders would find dumpsites littering rural roadways, or would rush to fires caused by exploded home cookers.

But those days are mostly over, Michigan law enforcement officials say.

Now, the meth is coming from Mexico.

With that comes an increase in meth-related overdoses, said Stephen VerDow, a Michigan Drug Enforcement Administration assistant special agent. The Mexican meth is purer, cheaper and increasingly has been reported to be mixed with fentanyl, a deadly combination. 

“Methamphetamine has been a scourge for many years and continues to wreak havoc across the country,” VerDow said.

Why your city might be an ideal target for Mexican cartels  

In the past five to seven years, the number of domestic meth labs have decreased in the U.S. as Mexican drug cartels brought in cheaper and purer drugs, VerDow said. The cartels bring the drugs into the U.S. with commercial and personal vehicles, making any cities near major highways – like Lansing, Battle Creek, Howell and Brighton – ideal areas to target.

“The increased commercial vehicle traffic in these areas help them blend in better with legitimate commercial business,” VerDow said. “Drugs can be distributed in very remote areas as well, but the (cartels) want to stay under the radar as much as possible.”

They aggressively and violently market and sell their products, VerDow said, leading to the ability to sell meth in the U.S. with “huge profit margins.”

This has fueled the decrease of what officials call “one-pot” domestic meth laboratories, VerDow said.

Michigan State Police Detective Lt. Bill Eberhardt said the number of one-pot meth labs Tri-County Narcotics, which covers Ingham, Eaton and Clinton counties, responds to have dropped dramatically. 

The number of domestic meth laboratories rose throughout the early 2000s and peaked in 2004 before dropping to the lowest numbers since 2000, VerDow said.

Eberhardt said people run less of a risk purchasing the drug than making it. Because of that, Mexican drug cartels are the greatest criminal drug threat in the U.S., according to the DEA’s 2018 National Drug Threat Assessment report. 

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PainMD clinics, accused of fraud, abandoned patients’ medical records in locked storage units

https://www.tennessean.com/story/news/health/2019/06/19/painmd-rinova-clinics-abandoned-medical-records-storage-units-tennessee-virginia/1490829001/

The mystery of the missing medical records has been solved.

But how do you actually get to them? That’s a whole other problem.

PainMD, a Nashville-area pain management company that recently shuttered clinics and stranded patients without medicine, disclosed in a court filing this week they’ve lost access to countless patient medical records that are stuck in storage units spread across Tennessee, Virginia and South Carolina. 

PainMD said it can no longer reach the records because, as the company has been crumbled into bankruptcy while accused of widespread fraud, all the employees with access the storage units have left.

This is a huge conundrum for former patients, many of whom need those records now.  Some ex-patients have been without access to their records since six PainMD clinics — recently re-branded under the name Rinova — closed their doors without warning in May.

The closures sent patients searching for new pain clinics, but due to concerns about the opioid crisis, many pain management doctors will only accept new patients with both a medical referral and up-to-date medical records.

PainMD left its patients with neither.

That’s exactly what happened to Esther Jeffries, 59, an ex-patient of the PainMD clinic in Cookeville. Since the clinic closed, Jeffries has been without her medical records and unable to find a new doctor to refill her prescription. Her medication ran out last week.

“I’ve been going through withdrawals. I’ve been sick,” Jeffries said. “I feel like I’m climbing the walls and my husband is about ready to take me to the emergency room to see if I can get any help.”

PainMD accused of injecting patients for pure profit

PainMD and its parent company, MedManagement, once owned or operated as many as 30 clinics in Tennessee, Virginia and North Carolina. Federal and state authorities have sued PainMD and its owners of defrauding the government out of millions by pressuring patients into unnecessary painful injections, then intentionally mislabeling the injections while billing Medicare, Medicaid and TriCare. Three PainMD nurse practitioners were indicted on these same allegations in April.

PainMD: 3 nurse practitioners indicted, gave patients ‘very painful’ bogus injections

While these court cases were ongoing, PainMD sold its clinics to company insiders, then re-branded six clinics in Tennessee and Virginia under the new name of Rinova. The Rinova clinics operated for a few more months before abruptly closing on May 8.

Rinova promised to help patients by mailing a final prescription extension and releasing their medical records, but these promises have not been kept. Since the closures, The Tennessean has spoken with at least 25 ex-patients who said they’ve struggled to find a new pain doctor because they can’t access their medical records.

The likely location of those records was revealed last Friday when PainMD filed for bankruptcy, saying it has only $2.8 million in assets but more than $13 million in debts.

Medical records locked in storage

As part of bankruptcy filing, the company revealed that some patient medical records are maintained electronically, but that “many” patient records are kept in file boxes in storage. Medical records and charts are currently kept in at least 23 storage units spread across 10 companies. PainMD claims it can no longer enter any of these storage units because “everyone with access is no longer employed with company.”

That’s a problem for the storage companies too.

Danny Sutton, the owner of SelfStor Solutions in Cookeville, said he rented two units to PainMD, which abruptly stopped paying or answering his calls this month. Sutton is now stuck with two units that he can’t rent because PainMD abandoned stuff inside.

Sutton is legally forbidden from opening the units and checking what was left behind.

“If there are medical records inside, that’s news to me,” Sutton said. “But if they are medical records, there has to be somebody that will be needing those records.”

PainMD could not be reached for comment. Messages left with PainMD’s civil attorney, Jay Bowen, and its bankruptcy attorney, Robert Mendes, were not returned.

The bankruptcy filing also reveals PainMD’s primary owner , Michael Kestner, borrowed $178,000 from the company in 2015. The debt has not been replayed.

Brett Kelman is the health care reporter for The Tennessean. He can be reached at 615-259-8287 or at brett.kelman@tennessean.com. Follow him on Twitter at @brettkelman.

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National Association of Chain Drug Stores (NACDS) Pushes for Naloxone, National PDMP

https://www.drugtopics.com/latest/nacds-pushes-naloxone-national-pdmp

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The Addiction Front: DOJ sends letter to physicians, groups working together

http://fox47.com/news/the-addiction-front/the-addiction-front-doj-sends-letter-to-physicians-groups-working-together

Just like a lot of other media articles –

THERE IS NO PLACE FOR COMMENTS FROM THE COMMUNITY

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