https://www.axios.com/medical-marijuana-opioid-epidemic-1dbe0f8c-9061-4d4e-a201-c6d40a587fdd.html

Filed under: General Problems | 8 Comments »

https://www.smh.com.au/world/oceania/hayley-wyatt-suffered-from-the-most-painful-condition-on-earth-20180715-p4zrnt.html

Hayley Wyatt’s last words in this world were “mum, mum”. She was sitting on the sofa, and calling out for help.

Then there was a pause. She said “mum” one last time. It sounded urgent.

But there was nothing Charlotte Wyatt could do to help her daughter.

Now the family says Hayley was neglected by the New Zealand medical team who cared for her because they didn’t know enough about Complex Regional Pain Syndrome – described by experts as the most painful condition on earth.

Wyatt watched helplessly as her daughter died from complications from the illness. She called an ambulance – it took 10 minutes to arrive. But it “felt like hours”.

When they did finally arrive, the paramedics rushed the family outside while they tried to jolt Hayley back to life with defibrillator paddles.

“When they came out and told us she was dead we just dropped to the ground. I’ve had a gaping hole inside me ever since.”

Hayley spent the final four years of her life fighting Complex Regional Pain Syndrome (CRPS) – a chronic disorder of the nervous system that can be more painful than childbirth.

The McGill Pain Index lists it as more agonising than the amputation of a finger or toe without painkillers.

CRPS is an invasive neurological disease that causes the nervous system to become irregular and send signals to a limb that it’s in acute pain when it’s not.

If the condition is not detected early it can often be incurable and the severe pain causes such frustration, anxiety and depression. It has also been labelled the “suicide disease” by those suffering from it.

Hayley lived with this condition until her death in January this year. She was 21.

Her misery began after what seemed like an innocuous accident in 2014: slipping on a puddle of water and injuring her arm.

Wyatt says Hayley’s initial treatment made the condition worse, and it left her arm looking bruised and beaten.

“We were given the runaround, and it was a year before she was diagnosed with CRPS.”

It would be the beginning of a frustrating relationship with health professionals and New Zealand’s Accident Compensation Corporation (ACC).

The CRPS spread to Hayley’s leg, causing painful open wounds which became infected.

“She was so scared to go the hospital because she knew how she was going to be treated. At times she was treated worse than a sick animal.”

The Wyatt family has lodged a complaint against the Bay of Plenty District Health Board alleging 35 instances of neglect by Hayley’s medical team.

The official complaint includes allegations Hayley was refused entry to a pathology lab because her leg was “leaking too much”, and that one nurse told her that her “leg stinks”.

In response the Bay of Plenty DHB said: “We have been working with Hayley’s family since shortly after her passing to understand and address their concerns over the care she received and we continue to do so.”

During the last four months of her life, the pain was at its worst. But Hayley was not given a pain review, despite the Wyatts “begging” Hayley’s medical team for one.”

The Bay of Plenty DHB has since admitted to the family it was an error that Hayley did not undergo a pain review.

Hayley needed a constant supply of dressings to cope with the three-litres of fluid draining out of her leg every day. Deliveries of the wrong dressings meant she waited months for the right care – the correct dressings arrived only a few days before she died.

“We had to chase doctors for prescriptions, then chase ACC to sign it. Her care and medication was constantly delayed and it could have been a different outcome for Hayley if they had helped her sooner,” her mother says.

“We pleaded for more care before Christmas, but we were told it was the holidays and they couldn’t do it.”

ACC paid $10,000 (AU$9100) for Hayley’s funeral, and wrote a $25,000 cheque to the family compensating for the 24-hour care they provided in her final months.

In response to the complaints of her care, ACC said: “A number of services were in place including attendant care, equipment, housing modifications, and nursing, as well as extensive input from the DHB. Unfortunately Hayley was often resistant to having nurses and any health professional visit her at home, and when she did see them, she often did not follow their recommendations for care.

“That impacted on our ability to ensure Hayley received the required level of care for her leg wounds when she was at home. There were also issues in ensuring she had a regular supply of the large volume of wound dressings she required, as these needed to be ordered by a registered nurse. Prescriptions are overseen by medical professionals.”

But Wyatt says Hayley was resistant because the nurse, contracted by ACC from HealthVision, had no knowledge of CRPS.

HealthVision told the Wyatt family in an apology letter that because “CRPS is so poorly understood by healthcare professionals”, her death would be used “to educate and heighten awareness in the wider team of community nurse specialists”.

“She shouldn’t have died,” says Wyatt. “I don’t want anyone else to go through what we went through.”

“We wish the professionals would own up to their mistakes because I don’t want anyone else to go through what she went through.”

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Doctors restricted my husband’s pain medication. He committed suicide.

https://www.tennessean.com/story/opinion/2018/07/24/tennessees-opioid-regulations-precipitated-my-husbands-death/797988002/

There have recently been a few minor stories about the closing of Comprehensive Pain Specialists clinics across the region due to financial issues and a federal criminal investigation. Some have even mentioned that an estimated 45,000 pain patients are now without a pain management doctor. 

If this were 45,000 cancer patients not receiving treatment in the weeks to come, it would be headline news. People would be up in arms over that denial of care. 

If you or somebody you love have not been directly impacted by long-term chronic pain, then you are very fortunate. Keep in mind that we are all just one car accident away from that condition. 

A car accident in the early 1980s is the reason my husband, Jay, developed chronic pain. The backlash against opiate addiction and the ill-conceived U.S. Centers for Disease Control response to that is what caused him to end his life. 

More: The race against pain: As clinics close, patients need new doctors before pills run out

Jay was young and strong enough not immediately to need pain medications to manage his back injury. He dealt with his pain until his condition degenerated, and he was forced to have three back surgeries in 2007 and 2008. It was at this point that he was started on low dosages of pain medications.  As time went on, he developed some tolerance to these medications. 

He worked with a doctor to make sure that he was on the lowest possible dosage that would allow him to maintain some quality of life. He also allowed them to do any other procedure they thought necessary beyond just prescribing medications. This included implanting a device in his side that delivered a constant dosage of medication. 

The back injury did not allow him to work, and it severely limited him in many ways.  A good day was as simple as being able to take our dogs for a walk or to go to the grocery store with me.  A bad day would leave my strong, fiercely-independent husband in so much pain he would sit in his chair and sob.

We were introduced to the CDC guidelines after Tennessee adopted their version of these in early 2017. 

These were guidelines only, not laws (Tennessee passed an opioid law in 2018), that outlined that patients on long term ongoing care with opioid medications must be seen by a pain care provider. The CDC guidelines go further by recommending a lower dosage a pain care specialist can prescribe. 

My introduction to these guidelines came when Comprehensive Pain Specialists told my husband they were cutting his medications by 75 percent. The reason that we were given was that eventually the guidelines might become law. The last thing the doctor said to my husband was “My patients’ quality of life is not worth risking my practice or my license over.”    

It did not matter to them that my husband was not abusing his medication or that he had been their patient for over five years. It did not matter how drastically they were reducing his quality of life. 

Rather than face the unbearable pain that losing his medication would cause him, my husband chose to end his life, and I supported that decision. 

What concerns me most about the closing of these pain clinics can be summed up in what my husband told me after they reduced his medications. He told me he felt like he had been given three choices. He could turn to illegal drugs, he could suffer unimaginable pain or he could end his life.

These are the choices now faced by the 45,000 impacted by these closures.  Imagine if just 1 percent of these people choose the same option he did. That would mean 450 deaths, 450 families without a loved one, 450 funerals. 

Is that what we really want for people with chronic pain?  Is that what you want for yourself or somebody that you love?  What other options are there for these 45,000 patients?

Looking at it now, seeing these clinics closing, you can see that the patients just do not mean anything to the doctor’s or some of our legislators. 

My question for you, the reader, and our legislators now is quite simple.  What are we going to do to prevent any more suicides? 

What are we going to do to take care of these patients? 

How are we going to provide them treatment before any more lives are lost?

Meredith Lawrence is a former resident of Hendersonville, Tenn. She now resides Gainesville, Ga.

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Man sues doctor, pharmacist after alleged misdiagnosis, overdose leads to severe skin condition

https://wgntv.com/2018/07/27/man-sues-doctor-pharmacist-after-alleged-misdiagnosis-overdose-leads-to-severe-skin-condition/

PARKER, Colo. –  A 22-year old Colorado man spent three weeks in a local burn unit after he was prescribed a drug for a mental health condition he does not have, according to KDVR.

His lawsuit in Douglas County District Court states he acquired Stevens Johnson Syndrome after being over-prescribed Lamictal, also known by the generic name Lamotrigine.

SJS is a condition that causes serious skin rashes, blisters and sores on mucous membranes like one’s eyes. It’s a known side effect of overdosing on Lamictal, an anti-seizure medication sometimes prescribed off-label to treat bipolar depression.

“It was a 10 out of 10,” is how Scott, who asked that only his first name be used, described the burning sensation he felt after developing SJS.

His lawsuit comes three years after the then-19-year-old college sophomore woke up in a hospital bed, blind and voiceless.

Doctors had stitched his eyes shut and placed a breathing tube in his throat after a skin rash covering most of his body left him feeling like he had survived an inferno.

“I had two surgeries on my eyes in order to save them from not going blind, where to keep them cool I had to wear dailies total 1 on a daily basis to keep calm” said Scott. “Inside of my mouth, I had burns and cuts, and so I couldn’t even eat food.”

Scott had gone to Aspen Creek Family Medicine in Parker in January 2016 for his yearly physical and mentioned feeling a little depressed.

When asked by KDVR if he thought he’d ever had bipolar disorder, Scot replied, “”No, no, I have never had mental health issues before this,” Scott replied.

His physician, Dr. Michael Paul Elder, gave Scott a questionnaire for bipolar disorder. Answering yes to at least seven of 13  questions is supposed to indicate more follow-up, but even the one-page form says it is “For screening purposes only and not to be used as a diagnostic tool.”

Scott only scored a six, but Dr. Elder miscounted, giving him a seven, and immediately prescribed Lamictal.

Lamictal is prescribed with what’s known as a black box warning in its labeling instructions that mention “serious skin disorders leading to death” and “the incidence of skin disorders was increased when this drug was administered at doses higher than recommended.”

Scott said he was not told about the black box warning when he was prescribed the drug.

“There was so many things wrong in this case that it’s frightening,” said Scott’s attorney, Hollynd Hoskins of the Leventhal and Puga law firm.

In her lawsuit, Hoskins alleged her client was prescribed twice the recommended dosage on the first day, and by the second week, his dosage had been increased to four times the recommended amount.

“Not only was the diagnosis false – he did not have bipolar – not only did he diagnosis it with a screening tool, he prescribed Lamictal, a serious drug, at four times the recommended dose.” said Hoskins.

Scott came back to Aspen Creek Family Medicine for a follow-up eight days after starting Lamictal.  He mentioned  having shaky hands, but the family nurse who treated him, Diedre Marchetti, didn’t consider it a red flag.

“It’s potentially a side effect of Lamictal. It’s also a non-uncommon symptom of anxiety,” Marchetti told Hoskins in her deposition.

Scott’s lawsuit also names a Walgreen’s pharmacist named Anisa Bartells for not mentioning the black box warning that comes with a prescription of Lamictal.

Dr. Elder admitted in his deposition that he never discussed the black box warning with Scott and he expressed no concerns about overdosing  his patient.

When asked during his deposition why he would overdose his patient given the obvious risk, Dr. Elder responded, “Well, the severity of his depression. I felt like his depression was more on the severe side, and that was a concern for me to treat him and to escalate his dosage regimen in order to bring his depression under better control quickly.”

Hoskins said there is no evidence Scott actually had bipolar depression.

“This doctor was not qualified to make that diagnosis,” said Hoskins. “He used a vague, 10-minute questionnaire and that led to a false diagnosis. He used the wrong dosage and that led to a very life-threatening, serious rash in Scott.”

“I had rashes and bubbles on the bottom of my feet. I had to walk on top of the rashes and bubbles. You could feel them pop and burst, and just the pain — it was like standing on needles,” Scott said.  The 22-year old can now finally walk without pain. In May, he graduated from the University of Colorado Boulder.

However, Scott will have vision issues the rest of his life and has been told he may develop Glaucoma.

“Hard to believe that all the little checkpoints where someone could have caught what was going wrong… that they didn’t,” Scott said.

At the time of the depositions, Dr. Elder still hadn’t reported Scott’s adverse reaction to the FDA even though it’s required under law.

The lawsuit against Dr. Elder, Marchetti and Bartells is set to go to trial in October. Attorneys for all three defendants declined to comment.

I wonder if this pharmacist would have been concerned about the HIGH DOSE of this medication.. if this medication had been a controlled substance ?

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From America’s overdose capital, lawyer Paul Farrell is rallying communities to sue

https://www.bloomberg.com/news/features/2018-07-23/lawyer-paul-farrell-s-50-billion-vendetta-against-opioids

The place might sound familiar, even if you’ve never been there: the Appalachian foothills, down by the Ohio River, where the sirens scream addiction and death.

Twenty-six overdoses in one afternoon. The highest death rate in the state. One in 10 babies born dependent. Huntington, West Virginia, is the capital of America’s opioid epidemic.

Paul Farrell knows all about it. He grew up here, went off to college, and returned home. He watched the calamity unfold. First it was prescription pills like OxyContin. Then it was heroin, $20 a hit.

Now, Farrell is looking to set things right. He’s the engine behind one of the most daunting legal endeavors in modern U.S. history: more than 800 lawsuits brought by cities and counties against central figures in the opioid tragedy—the makers of prescription painkillers and the companies that distribute them.

For now, he’s working out of a carpeted, windowless office barely big enough for his desk, some chairs and a pair of folding tables in an old bank building downtown. The lock on the building’s shared bathroom doesn’t work.

But if Farrell succeeds in making the industry pay for the epidemic’s toll, he stands to become wildly rich: By one estimate, the recovery in the opioid cases—which could be years away—could exceed $50 billion. Twenty-five percent of his clients’ portion would go directly to his firm and the firms he is working alongside.

With so much money at stake, it might be easy to view Farrell as one of the greatest ambulance-chasers of all time. He makes no apologies.

“We eat what we kill,” Farrell, 46, says. “Sometimes it’s a feast. Sometimes it’s a famine.”

On the opioid cases, he says: “I’m stalking. I’m stalking the herd.”

More famous lawyers are hunting, too—Mike Moore, for one. As the attorney general of Mississippi, Moore helped negotiate the largest corporate legal settlement in U.S. history: a $246 billion deal with the tobacco industry in 1998. Lately, Moore has been going after the drug industry over opioids, crisscrossing the U.S. to recruit people to his cause. Hundreds of cases have been consolidated before a federal judge in Ohio for what’s called multidistrict litigation.

But Farrell is spearheading the legal fight for many communities, notably in the Ohio River Valley, where tired coal and steel towns have come to symbolize the crisis. His five-lawyer firm and legal consortium represents more than half of the suing communities.

His legal theory begins with West Virginia Code Section 7-1-3KK. The public nuisance law was written to address relatively workaday issues such as landfills and environmental waste. Farrell is basically arguing that drug makers and wholesalers created an epic public nuisance that is costing governments many millions to clean up.

Suits have been filed against Purdue Pharma LP, Johnson & Johnson, Endo International Plc, Teva Pharmaceutical Industries Ltd. and drug distributors. The companies recognize there’s an opioid crisis but say they’re not responsible, adding that litigation is the wrong way to address the issue. After all, they didn’t write the prescriptions, and they say they complied with all federal regulations.

On this brisk spring morning in April, Farrell leafs through half a dozen maps in his office. The images trace the legal contours of his stake in a geography of despair: hundreds of hard-hit communities, places like Logan County, West Virginia, and its 6.9 percent unemployment rate. Each 8-by-11-inch map is color-coded—red, green, blue, yellow—to show which local law firm Farrell is working with in that particular area.

“If you drop a nuclear bomb right there—boom!—this is the fallout,” Farrell says, jabbing his finger at the Ohio River Valley, the 203,000-square-mile stretch where states battle the nation’s highest overdose rates. In 2015, 22,000 Americans died from prescription-painkiller overdoses.

Farrell, an intense and blunt speaker, seems to have been made for his mission. At Huntington East High School, he served as student body president and captained the soccer team before enrolling in the ROTC at University of Notre Dame. Farrell has maintained the trademark aggressiveness of any field general. A military history buff, he even once named researchers working with him Team Sun Tzu.

“If he decides he’s onto something,” says Atlanta mass tort lawyer Henry Garrard, “he’s like a little bulldog that sinks his teeth in until he brings it down.” Says Mississippi lawyer Michael Fuller: “It’s like playing chess with someone who knows all the moves of the game before you even get started.”

Farrell’s mother was a trailblazer in hospice, known as end-of-life-care, which Farrell says taught him a sense of compassion. After graduating from West Virginia College of Law, he followed his father and two uncles into the family law firm. He decided it wasn’t for him and left to become a plaintiff’s lawyer. “I was writing very large checks to dumbass lawyers, and I thought to myself, ‘I’d like to be one of those dumbasses that gets one of these checks,’” Farrell said.

His father, now a Circuit Court judge here, is blunt about his son’s lawyering.

“I told him when he left our law firm, ‘You don’t have to be an a–hole to be a plaintiffs’ lawyer, but he kind of ignores that at times,” Paul Farrell Sr. says.

But the elder Farrell adds that this is what it takes to be a mass torts attorney. “They’re aggressive, they’re smart and—most of all—they’re prepared,” he says.

For all his successes here—Farrell has won multimillion-dollar cases as a medical malpractice lawyer and became president of the state trial lawyers’ association before he was 40—his roots seem to have placed a chip on his shoulder. He gets worked up if he thinks the establishment is trying to play him. In the 2016 presidential election, he ran as a protest candidate against Hillary Clinton. He outpolled her in nearby Mingo County.

“People have been underestimating me for a very long time,” Farrell says. “I’m accustomed to being stereotyped as the Appalachia, redneck hillbilly.”  

Yet what hurts most is how drugs have devastated his hometown. “I have people my age that I know that are addicted to opioids,” says Farrell, who is married with three kids. “I know people that have children in their early 20s that they have lost.”

Farrell is one of three lead attorneys in the litigation, along with Joe Rice and Paul Hanly, veterans of the Big Tobacco pact whose experience together includes some 40 multidistrict litigations. This is Farrell’s second, yet he’s fit in naturally.

“He’s a gladiator,” Hanly says. “He feels he’s on a mission to correct some wrongs that have adversely affected his state worse than any other state in the nation.”

Opioids swallowed Huntington for years before Farrell waded in. He sued the distributors on behalf of several counties in January 2017 after West Virginia’s attorney general, Patrick Morrisey, reached settlements totaling $36 million with Cardinal Health Inc. and AmerisourceBergen Corp. The settlements came too quickly and were too small, Farrell says.

“It pissed me off that we got handled like that,” he says.

Morrisey, a former lawyer and lobbyist for the pharmaceuticals industry, is now running for U.S. Senate as a Republican; his wife, Denise, lobbied for Cardinal for 17 years and represents drug companies.

Chief Deputy Attorney General Anthony Martin says Morrissey’s private sector work didn’t include opioid matters and asserts that the office is aggressive in holding the industry accountable.

“Monday morning quarterbacks don’t usually understand the matters they criticize,” he says. The settlement received wide support, and “its success spurred the filing of approximately 1,000 other lawsuits.”

Morissey’s wife declined to comment.

What makes this wave of opioids litigation different from the tobacco saga is that scores of cities and counties—communities on the front lines of this crisis—are taking matters into their own hands, rather than relying on states to fight for them.

Mostly, municipalities want the influx of prescription opiates to be contained and for the drug industry to be held accountable.

“I don’t expect a dime, but I’d like to see someone’s hide on the fence for allowing this to happen,” says Bob Pasley, a county commissioner in Wayne County, West Virginia, which hired Farrell.

Farrell began at home, in Cabell County, and fanned out. He met with local governments and their lawyers, tapping his legal network, and soon captured most of the Midwest. His coalition includes four national law firms and scores of local ones stretching from North Carolina to California.

Much of the legal drama will unfold in Cleveland, in room 18B of the Carl B. Stokes United States Court House on West Superior Avenue. During a February hearing there before Judge Dan Polster, Farrell listened as a U.S. Drug Enforcement Administration lawyer argued against releasing federal data on where distributors shipped painkillers. The companies themselves have said that revealing such details could harm their businesses. The DEA lawyer added that disclosure could jeopardize investigations and help criminals.

Farrell had printed copies of distributors’ websites and showed that anyone with an Internet connection could find their facilities. He told the judge that addresses were included in job applications and mentioned in press releases. “He completely did his homework,” says Russell Budd, a prominent Texas lawyer working with Farrell’s. “He knew they were going to make that argument.”

A DEA spokeswoman says the agency doesn’t comment on pending litigation. Polster has since ordered the DEA to give the plaintiffs detailed prescription sales data from 2006 to 2014

Conventional wisdom holds that the consolidated litigation will be settled, though perhaps not until after the first federal trial, a so-called test case set for March 2019. Farrell says the litigation should be settled only if doing so would bring an end to the opioid epidemic—a high bar that would seem almost impossible to clear.

Farrell also doesn’t care if some of the companies in his sights are driven to bankruptcy.

Out of fear of wider economic damage, the federal government has sought to avoid driving companies into insolvency since the collapse of Arthur Andersen following the accounting firm’s conviction on obstruction-of-justice charges in the Enron scandal almost two decades ago.

Some of these companies have already been hammered in the stock market. Endo, for instance, has watched its market value plummet by 90 percent in the past three years. Teva, the world’s largest generics manufacturer, is highly leveraged and restructuring. (Farrell’s uncle, Michael, represents a subsidiary of Endo; a May hearing served as a courtroom family reunion. Michael didn’t respond to requests for comment).

Farrell is pushing to lay blame at companies’ feet. That may be why he’s eying McKesson Corp., AmerisourceBergen and Cardinal, distributors of 94 percent of prescriptions drugs in the country, according to Drug Channels Institute.

The companies have vigorously denied the claims. They say they are working within a regulated system and have met their obligations.

“There’s nobody in the litigation who knows the distributor case as well as he does,” says Budd.

Should Farrell prevail against the three distributors, the implications for the companies could be enormous. George Hill, an analyst at RBC Capital Markets, says the companies might run into trouble if they were forced to pay more than $10 billion annually.

Farrell is reluctant to give a settlement estimate. Polster, the judge, has issued a gag order barring lawyers from disclosing negotiation details.

Still, Farrell is developing a model that he hopes would be used to help determine funding for communities. By his reckoning, Cabell County, for example, would get $500 million over 10 years for law enforcement, treatment centers and education.

“We would like to keep the pharmaceutical companies from dumping into Cabell County. That’s why we got the law firm,” says Commissioner Bob Bailey. The sheriff, Chuck Zerkle, says any funds would address fiscal problems worsened by the crisis. “The county commission funds the senior centers, they fund the parks and things around the county,” says Zerkle. “There’s no money to fund those things.”

Yet, given the contingency fees, such a settlement might net all the law firms working with Farrell a check in the billions. Farrell, who drives around Huntington in a black Chevrolet Silverado pickup, concedes that folks in his hometown might look askance at such a payday. Yes, communities like Huntington would win. But the lawyers would profit handsomely, too—and ordinary people might not view that kindly.

The thought gives Farrell pause, and then the moment passes. After all, he may never see a dime from any of this. In the meantime, he’s working away—and people in his hometown are dying.  

“My mother has told me since a very young age—she would whisper in my ear—that God has a special plan for me,” Farrell says. “I think, deep and intrinsically, perhaps what I am doing now is it.”

There is some 4+ billion prescriptions filled in the USA every year and 94% of those medications flow thru THREE WHOLESALERS and many of the pharma manufacturers that are being sued are responsible for producing the medications that pharmacies purchase to fill those 4 + billion prescriptions.

Addiction is – according to our current and previous Surgeon General –  is a mental health issue and not a moral failing..

Eastern KY, Western Virginia and West Virginia has numerous areas that has all the ingredients that is the basis for enabling various addictions and substance abuse… high unemployment, poverty, low level of education for starters.

This attorney – Paul Farrell – states that he could care less if he sends many/most/all of the firms that he is suing if they go BANKRUPT… can anyone imagine the disruption in the medication/pharmacy/prescription distribution system.  Not just pain management and controlled substances… but …all medications.. how many pts could be harmed because pharmacies can get a dependable supply of medication either from inadequate production by what is left of the pharma industry or inadequate distribution from what is left of the wholesaler industry.

But this ambulance chasing attorney is out for his pound of flesh and pot of gold  at the end of his “rainbow” … so that he can go after some other industry that is selling a legal product – maybe alcohol – that some bureaucrats have targeted that their citizens have a tendency to consume too much of… and cause self-imposed health issues.

 

 

Filed under: General Problems | 2 Comments »

Several weeks ago I sent a email to the three members of Congress that representatives in the Senate for Indiana and Indiana’s  9th district in Indiana

What I wrote them about had nothing to do about chronic pain put what I had experienced from our Medicare Part D insurance and charging us about SIX TIMES as our copay that I could purchase the prescription medication – FOR CASH.

The first to response was Senator Donnelly 

Good example of how out of touch some Senators are ?

The email that I got from him… had nothing to do with the issues that I had written to him about…

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The Second response was a phone call from the Director of Legislative Assistants for Rep  Trey Hollingsworth… https://hollingsworth.house.gov/

This person indicated that Rep Hollingsworth was starting to pay attention to what I had expressed concerns about and indicated that I should expect a personal phone call from Rep Hollingsworth in the near future — as of today 07/27/2018 .. no phone call

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I had also contacted Senator Todd Young’s office  https://www.young.senate.gov/

and again as of this date 07/27/2018  – have not hear a thing from this office…

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what I find interesting… Senator Donnelly and Rep Hollingsworth are up for RE-ELECTION in NOV… Senator Youngs is not up for RE-ELECTION until 2022

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The CDC Quietly Admits It Screwed Up Counting Opioid Pills

https://www.acsh.org/news/2018/03/19/cdc-quietly-admits-it-screwed-dishonestly-counting-pills-12717

Here’s the title of an opinion piece in the April issue of the American Journal of Public Health, which was published by four authors at the CDC:

“Quantifying the Epidemic of Prescription Opioid Overdose Death” 

I don’t like the title very much. It (intentionally, no doubt) says approximately zero about what is contained within the article, which is mighty revealing. Since I’m nothing if not helpful, I thought I’d suggest a more candid title:

“We at the CDC Really Screwed Up and Here is Our Pathetic Attempt to Disguise it”

Then it gets downright hilarious. Check out this disclaimer. It’s a real beauty:

“Note. The findings and conclusions of this editorial are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.”

Really? So if I have this right, four people working for the CDC are allowed to write an opinion piece without any fear of jeopardizing their jobs. Who would have thought that federal agencies were so tolerant of employee dissent?? How about this one? Would the following opinion piece plus a disclaimer fly?

“The CDC Sucks”

“The findings and conclusions of this editorial are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention, which may or may not suck.”

I think not. So let’s take a look at what’s really in what is, in fact, a pathetic mea culpa, with a side order of stealth. 

Halfway through the first sentence, it is clear that these guys are repeating the same old crap:

“In 2016, 63,632 persons died of a drug overdose in the United States; 66.4% (42,249) involved an opioid.”

Why do I suspect that the CDC would be absolutely gleeful if reporters read only the first sentence and then wrote their same old crap? After all, it is much easier than actually reading the paper and seeing what’s really in there. But if you bother to read it it doesn’t take long until the funny business starts.

First, the authors state that there are (at least) two ways to count opioid deaths. And the CDC has been doing it wrong (emphasis mine):

Traditionally, the Centers for Disease Control and Prevention (CDC) and others have included synthetic opioid deaths in estimates of “prescription” opioid deaths. However, with [fentanyl] likely being involved more recently, estimating prescription opioid–involved deaths with the inclusion of synthetic opioid– involved deaths could significantly inflate estimates.

Shocking! Except that I have written numerous pieces (1) which conclude exactly this: By combining fentanyl deaths with those from prescription drugs it automatically skews the results. The stats from the CDC have been BS all along. They are now sheepishly admitting it, but not until the BS numbers were already used to formulate the god-awful policy which is now plaguing millions of us. All based on a bunch of lies.

It doesn’t take long to find data in the article that makes the CDC and its flunkies (2) look pretty bad. Let’s start with Table 1. The center column (green circle and arrow) represents the “traditional” method that the CDC used to count deaths. Note that the number doubled between 2013 and 2016. Those damn pills are stone cold killers, just like we’ve been told all along, right? No. Not right.

^a “Natural opioids include morphine and codeine, and semisynthetic opioids include drugs such as oxycodone, hydrocodone, hydromorphone, and oxymorphone. Methadone is a synthetic opioid. Synthetic opioids, other than methadone, include drugs such as tramadol and fentanyl.”

Table 1. (Left) A “new” method of categorizing opioid OD deaths includes only prescription drugs. (Center) The previous method included heroin and fentanyl, which automatically skewed the statistics. (Right) Deaths from illicit fentanyl.  Modified from American Journal of Public Health (AJPH) April 2018

 

 

The other columns tell us why. The left column (blue) represents the number of deaths when the “conservative definition” (make that “correct definition”) is used. The data in this column no longer includes deaths from “fentanyl” (“fentanyl” in this instance meaning illicit fentanyl and its analogs – synthesized in Chinese labs, not pharmaceutical fentanyl). Once “fentanyl” (red column) is removed from a category in which it should never have been in in the first place, all of a sudden, the number of deaths drops by half. That little “a” has a big meaning. This “a” explains why fentanyl is erroneously lumped in with the others.

WHERE IS HEROIN?

It is a bit baffling that heroin is not mentioned in footnote a. Especially since CDC data show that there were 15,469 opioid overdose deaths in 2016 (3). It is safe to assume that heroin was included in the data in the center column even though it was not specifically mentioned. It is not clear whether this omission is intentional or an oversight.

REDOING THE MATH

Now that we know that the 42,249 deaths that “involved an opioid” do not represent pain pills. If illicit fentanyl and heroin deaths are separated from the fake number we get a new number which is very different (4).

THE BIG LIE

The title of the middle column on Table 1 seems innocent enough: “Natural and Semi-Synthetic Opioids, Methadone and Other Synthetic Opioids.” But it is not. There is a nasty trick buried in a seemingly innocent definition – a false and scientifically absurd distinction between synthetic, semisynthetic (synthesized from a naturally occurring opioid) and naturally occurring opioids. This system of classifying opioids places fentanyl in the first group, heroin in the second, and morphine in the third. Ridiculous. Opioids should be classified either as pharmaceutical (legal) or non-pharmaceutical (illicit) or by their potency.

This false classification would seem to be no more than a trick. By combining legally prescribed opioids with street drugs the CDC has generated phony data that supports its doctrine – that prescription medications are killing people en masse. They are not. Once the fallacy falls away things look quite different (Table 2).

Fentanyl deaths have shot up more than 6-fold in three years while deaths from oxycodone, codeine, morphine, etc. have risen by 18%. That is a very different scenario than what the CDC has maintained and the press has parroted. Yet we continue to battle pills while the real killer isn’t pills, it’s heroin and illicit fentanyl and fentanyl analogs, most of which are far worse than fentanyl itself. Drs. Michael Schatman and Stephen Ziegler also addressed the CDC lies in their 2017 piece in the Journal of Pain Research entitled “Pain management, prescription opioid mortality, and the CDC: is the devil in the data?” The piece is, uh, rather blunt. 

Table 2. (Left) There was a 6.2-fold (520%) increase in fentanyl deaths between 2013 and 2016. (Right) By comparison, deaths from prescription opioid drugs increased by only 18%. 

WITH OPIOIDS 2+2 MAY EQUAL 5

But it gets even worse. The deaths from pills very often include other drugs, which have a synergistic effect. 

It is impossible to tell how many people who died from prescribed pills would have survived had they not taken other drugs along with the opioid. But it is possible to estimate how many of them who died had taken these other drugs. This number is large. For example, in 2015 (Figure 1) about half of the people who died from prescription opioid overdoses had also taken a benzodiazepine (e.g., Valium). 

Figure 1. Benzodiazepines were present in 50% of prescription opioid deaths in 2015. Source: NIH

If benzodiazepines are present in so many opioid OD deaths then surely other drugs must also be frequently found, right? The answer is, of course, yes, but the numbers may astound you. Dr. Haylea Hannah and colleagues from the California Department of Health & Human Services recently published a paper in Online Journal of Public Health Information which examined toxicology data in people in Marin County who had died from any drug poisoning. Here are the findings:

• Opioids were present 76% of the time
• Alcohol – 44% 
• Amphetamines – 24%

Perhaps more interesting:

• When an opioid was found in the tox screen, alcohol was also found 52% of the time
• The average number of drugs found all cases was 6 (!)

Once again, it is apparent that deaths from opioids occur from abuse, not use.

The more you dig the more the numbers change, and it’s always in the same direction – the number of overdose deaths from prescription opioid medications, when used properly, is far less than the bogus numbers that have been used by the CDC. Based on all these adjustments, it would not surprise me in the least if 90% of opioid overdose deaths were a result of illicit fentanyl and its analogs, heroin, and the combination of pharmaceutical opioid drugs with other drugs of abuse. Maybe more.

It should be entirely clear that pain patients who use these painkillers correctly and responsibly are not the people who are dying from overdoses. But they are dying – slowly – from having to live in misery that we wouldn’t allow for our pets as the medicines they need to (barely) function are being forcibly taken away. 

It is 2018 and this is the United States. How did we ever get here?

NOTES:
(1) See:

The Opioid Epidemic In 6 Charts Designed To Deceive You

Heads In The Sand — The Real Cause Of Today’s Opioid Deaths

How the feds are fueling America’s opioid disaster

(2) Yes, you guys. You know who I mean.

(3) Source: “Drug Overdose Deaths in the United States 1999–2016”, CDC

(4) The “new” number is not 42,249 minus (fentanyl + heroin). It is much lower but unknown (and unknowable)  because when more than one drug is found it is counted twice. A certain number of fentanyl deaths also involve heroin and the other way around. One cannot simply add or subtract columns because of multiple counting. 

 

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 We had a similar – but different – situation just one year ago with the vet that we use… our then 14.5 y/o Shiz Tzu was diagnosed with numerous malignant liver tumors … because of his age and the number of tumors.. neither surgery nor chemo was a option. This is a large 5-6 vet practice and we have used for 25-30 yrs and they were quite liberal with the Tramadol that we had access to help us keep our little guy comfortable, until one day he stopped eating and following the next day when he stopped drinking. I have heard of people who have harmed their pets in order to take them to the vet to get some pain meds for their pet… which they intend to take themselves. It is a shame that some vets have responded in such a paranoid manner and totally disregard the needs of the animals they are supposedly dedicated to take care of. Hopefully this “pet parent”will find a new vet to take care of their future pets.

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https://www.myhighplains.com/news/dea-seizes-cbd-oils-from-local-business/1324116579

AMARILLO, Texas (KAMR/KCIT) – A local business was visited by the Drug Enforcement Agency earlier this week.

Amarillo Police said they had narcotics officers on scene assisting the DEA at the Green Gorilla.

We talked to the company’s attorney, Ryan Brown, who said the DEA served a search warrant on Monday looking for evidence of K-2 sales.

Brown said they did not find any K-2, but did

seized CBD oils, which Brown said is legal to sell in Texas, and also seized some cash.

We have reached out to the DEA and have not heard back.

We also checked with the U.S. Attorney’s Office and the told us they could not confirm the existence of or comment on a possible investigation.

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THE CORPORATE DESTRUCTION OF HEALTH CARE: Part 1
And Health Professionals are Letting It Happen!

http://pharmacistactivist.com/2018/July_2018.shtml

This commentary is from a recently RETIRED Pharmacy School Professor

I remember the time when physicians, pharmacists, other health professionals, and healthcare institutions such as hospitals had both the authority and responsibility for the decisions regarding the healthcare services, medications, and other products provided for patients, including costs. This “system” had significant shortcomings but it usually facilitated communication and positive relationships among patients and health professionals. HOWEVER, the pendulum has swung to the other extreme and become stuck there as drastic changes have occurred in the provision of health care To know about how to take cure and precautions click here. Health professionals still have extensive responsibility (and liability), but most now have severely limited authority for the decisions they are in the best position to make on behalf of their patients.

Most decisions pertaining to the provision of healthcare services and products and their costs are now made by corporation executives, economists, health insurance companies, and government agencies. One consequence is the sharp decline in the number of independent pharmacies, the number of individual and group medical practices owned by physicians, and the number of community hospitals that are not part of regional or national networks in which the authority of both local management and health professionals is substantially reduced. Another consequence is that many patients are denied the opportunity to personally select the physicians, pharmacists, and other health professionals they would prefer to use. But, most importantly, even with important advances in the knowledge, technology, and skills in the treatment and prevention of disease, the communication of health professionals with individual patients is less complete and less effective in assuring patient understanding of healthcare services, medications, and relevant devices/products. This situation results in the quality of health care falling far short of the potential that can be attained, and many dangerous, and even fatal, errors.
Prescription medications
The experiences and problems with respect to the use of prescription medications are typical of the challenges for the entire health care system. There can be no question that the physicians, pharmacists, and other healthcare professionals who are directly involved in the care of patients are in the best position to assess a patient’s needs, and select, dispense, and monitor the use of her/his medications. However, most prescription “benefit” programs have restrictive formularies and time-wasting prior authorization policies that greatly limit a prescriber’s authority. Pharmacies are required to accept the compensation and comply with the terms of prescription plans that have been developed unilaterally by pharmacy benefit managers (PBMs). Even when they are willing to do that, pharmacies July be excluded from PBM networks or placed at a severe competitive disadvantage when PBMs mandate and/or provide financial incentives for patients to use mail-order or other pharmacies they own.

Executives of chain pharmacies determine staffing levels that are often inadequate, and impose metrics with respect to the number and timing of prescriptions dispensed, immunizations provided, and anything else they can measure. The stressful work environment that results is a prescription for errors, which occur in such numbers and consequences that they are the most closely guarded secret of chain pharmacy management that consider them just a cost of doing business. If the public and our legislators knew the actual number and consequences of medication errors, they would be outraged! Large chain pharmacies such as Rite Aid, Walgreens, and Walmart pretend to have an interest in health care while at the same time they sell and promote tobacco products. This hypocrisy should be denounced and rejected, and consumers/patients should be urged to use pharmacies that do not sell these toxins.

Some chain pharmacies have had an important role in establishing and supporting many of the new schools of pharmacy. This situation is a major reason for which there are now more pharmacists than positions available in many parts of the country. Chain pharmacies now have even less incentive to provide acceptable working conditions for their pharmacists and technicians, and some have reduced the hours and/or salaries of their pharmacists because it is unlikely they will be able to find employment elsewhere. The stress, frustration, and criticism of their employers among chain pharmacists are at a level I have not previously heard, with the following serving as examples:

“It is management by intimidation.”

“Techs are doing things they have no business doing, and I don’t have time to check everything.”

“If I don’t get out of here, I will wind up hating people.”

From a long-time pharmacist manager who is very concerned about losing his job because of not meeting metrics: “Metrics rule all! My supervisor thinks I spend too much time talking with patients. It is ok to share my information. I desperately need someone to speak with.”

From a pharmacist with a placement company: “Even some chain pharmacies that use our services do not wish to hire pharmacists who are leaving another chain in their area because they are so negative they have to ‘re-program’ them.”

From a pharmacist who left her position in a chain pharmacy to accept a position in another practice setting for a salary that was much less than in her chain position: “I love my current job. And anytime I am having a bad day, I remind myself that I could still be at xxxxx.”

Chain pharmacy executives mandate “more prescriptions faster metrics” that are highly stressful and error-prone, and a dangerous disservice for their customers. If they gave the same priority and effort to challenging and rejecting the unfair and inequitable policies and compensation of health insurance companies and PBMs, their interests, as well as those of their customers and employees, would be much better served. But corporate executives will not do that! PBMs are not needed! The profession of pharmacy has the abilities and opportunity to develop safer and more effective and efficient prescription benefit programs.
We are letting it happen
Pharmacists and other health professionals win occasional battles but we are losing the war, and an even greater corporate destruction of health care can result. But why is this situation continuing on a downward spiral? We have the knowledge, skills, and the opportunities for positive and personal relationships with our patients, communities, and legislators. Can it be that “We have met the enemy and he is us”? (first used on a poster to promote Earth Day and subsequently by Walt Kelly in a Pogo cartoon strip). Notwithstanding the admirable and extensive efforts of some of our colleagues, most health professionals and our associations have been too complacent and content with the status quo.

I started writing this editorial on Saturday evening and finished writing it on Sunday evening. On Sunday morning the following words on a piece of paper captured my attention:

“We are more apathetic than active, isolated than involved, callous than compassionate, obstinate than obedient, legalistic than loving.”

I was not only reading these words but I was saying them out loud with others from a statement with the title “Confession of Sin – (Corporate)” used in the church service I was attending. Notwithstanding the different context in which the word “Corporate” was used, I can’t ignore the timing in which I was using it in the title of this editorial.

I would like to think that I am promoting positive changes in pharmacy and health care through my advocacy and editorials. However, I must accept my share of the responsibility for the insufficient resistance to the evolving destruction of health care. I have not done enough!

We have not addressed the role of pharmaceutical and insurance companies, and the impact of high drug prices, and these will be discussed next month in Part 2 of this series.

Daniel A. Hussar

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