Federal Ban On Methadone Vans Seen As Barrier To Treatment

https://www.huffingtonpost.com/entry/federal-ban-methadone-vans_us_5ab50dcfe4b0cde6b4f23c65

States and treatment companies want to offer methadone clinics on wheels to reach more people with opioid addictions in remote and underserved areas. But the federal government is standing in their way.

The Pew Charitable Trusts

ONE HUNDRED YEARS AGO ( 1917) our judicial system declared that opiate addiction was a CRIME and not a DISEASE and declared that any prescriber caught treating or maintaining a addict would be jailed.  During the 60’s Methadone treatment programs were established in NY city by the Rockefeller Foundation…   At this time, it is claimed that about HALF of all Heroin addicts in the country were living in NY city and average age of a Heroin OD was 29.

Of course, this was before the Controlled Substance Act (1970)… so the DEA did not exist.

Maybe the political influence of the Rockefeller Foundation got these Methadone clinics acceptable… who knows…

Somewhere along the line, the DEA/DOJ decided to license these addiction treatment centers… the same DOJ that declared that opiate addiction was a CRIME and not a DISEASE… is now licensing the entities to treat the CRIME OF ADDICTION with MEDICATION… BUT in 2007 the DEA has been been refusing to license any new mobile treatment van… that would be serving the most rural and under served addicts.

It is almost as if the DEA/DOJ wishes to keep a certain per-cent of the population being addicted to some opiate … committing crimes to fund their habit and continuing the spread of various diseases – most HIV, Hep B&C – because of the sharing of needles.

Is this how the DEA/DOJ is meeting their basic charge in the war on drugs ?

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This ‘cure’ only makes the opioid crisis worse

https://nypost.com/2018/05/11/this-cure-only-makes-the-opioid-crisis-worse/

Attorney General Jeff Sessions says the Justice Department is striving to “bring down” both “opioid prescriptions” and “overdose deaths.” A study published the following day suggests those two goals may be at odds with each other, highlighting the potentially perverse consequences of trying to stop people from getting the drugs they want.

Columbia University epidemiologist David Fink and his colleagues systematically reviewed research on the impact of Prescription Drug Monitoring Programs, which all 50 states have established in an effort to prevent nonmedical use of opioid analgesics and other psychoactive pharmaceuticals. Reporting their results in the Annals of Internal Medicine, Fink et al. say the evidence that PDMPs reduce deaths involving prescription opioids is “largely insufficient,” adding that “implementation of PDMPs may have unintended negative outcomes — namely, increased rates of heroin-related overdose.”

The review covers 17 studies, 10 of which looked at the relationship between PDMPs and deaths involving narcotic pain relievers. Three studies “reported a decrease,” six “reported no change,” and one “reported an increase in overdose deaths.”

The picture looks worse when you take into account deaths involving illegally produced drugs, which now account for a large majority of opioid-related fatalities. Fink et al. found six studies that included heroin overdoses, half of which reported a statistically significant association between adoption of PDMPs and increases in such incidents.

To the extent that PDMPs succeed in making pain pills harder to obtain, they encourage nonmedical users to seek black-market substitutes. “Changes to either the supply or cost of prescription opioids after a PDMP is instituted,” Fink et al. observe, “might reasonably drive opioid-dependent persons to substitute their preferred prescription opioid with heroin or nonpharmaceutical fentanyl.”

Restricting access to pain pills also seems to be increasing the percentage of opioid users who begin with heroin. A 2015 survey of people entering treatment for opioid-use disorder found 33 percent had started with heroin, up from 9 percent in 2005.

If the aim is preventing drug-related deaths, this shift is counterproductive, to say the least. Because their purity and potency are inconsistent and unpredictable, illegally produced opioids are much more dangerous than pain pills.

Comparing deaths counted by the federal government to its estimates of users suggests that heroin is more than 10 times as lethal as prescription opioids. Policies that drive people toward more dangerous drugs help explain why deaths involving heroin and illicit fentanyl have skyrocketed in recent years, even as opioid prescriptions have declined.

A report published last month by the health care consulting firm IQVIA shows that the total volume of opioids prescribed in the United States fell by 29 percent between 2011 and 2017, from 240 billion to 171 billion morphine-milligram equivalents. According to data from the US Centers for Disease Control and Prevention, deaths involving pain pills nevertheless rose by 24 percent from 2011 to 2016, while total deaths involving opioids rose by 85 percent.

That trend includes a 252 percent increase in heroin-related deaths and an astonishing 628 percent increase in deaths involving the opioid category that consists mainly of fentanyl and its analogues. Final CDC figures for 2017 are not available yet, but the provisional numbers indicate there will be more increases.

In addition to magnifying the risks that nonmedical users face, the crackdown on pain pills is hurting patients. Many people who have successfully used opioids to treat severe chronic pain for years now find it difficult or impossible to obtain the medication they need to maintain a decent quality of life.

Since the current strategy is manifestly not working, drug warriors are, as usual, redoubling their efforts. The Drug Enforcement Administration, which sets annual quotas for opioid production, reduced the limit by 25 percent in 2017 and 20 percent this year.

Sessions plans to squeeze the supply even more, because “we are facing the deadliest drug crisis in American history.” He seems determined to make it deadlier.

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http://www.lasvegasnow.com/news/i-team-exclusive-the-real-numbers-behind-nevadas-opioid-deaths/1172341496

LAS VEGAS – You’ve probably heard political figures make the claim that at least one Nevadan dies every day from an opioid overdose. That figure of more than 360 opioid deaths per year in our state has been repeated over and over, but is it true?

The answer — not really.

The I-Team obtained the records on which the claim is based. 

In Nevada, statistics show that 99.98 percent of all opioid prescriptions do not result in overdoses, but the crackdown on pain medicine has continued to intensify anyway. Like most pain management physicians, Dr. Dan Laird has been overwhelmed by the rush of chronic pain patients who’ve essentially been abandoned by their doctors.

“Thousands of patients, their doctors have said, ‘I’m sorry, I can’t prescribe opiates anymore. You’re going to have to find somebody else,’ and there just isn’t anybody,” said Dr. Dan Laird, pain management physician.

When the CDC issued vague and unsubstantiated guidelines for opioids two years ago, it set off a nationwide panic among doctors, pharmacists, and regulators who simply said no. The result has been chaos.

A recent study shows opioid prescriptions dropped 29 percent from 2011-2017, but during that time opioid deaths rose 8 percent. Heroin and fentanyl deaths exploded. (Heroin deaths increased 252 percent. Fentanyl deaths increased 628 percent.)

Cutting back on legal pain meds not only failed to stop overdoses, it had the opposite effect. So, how can that be?

The coroner’s office keeps track of what it lists as all opioid related deaths.

READ: 2017 Opioid Related Deaths in Clark County 

READ: 2018 Opioid Related Deaths in Clark County

“This information your team has been able to obtain is a game changer because it does confirm every suspicion I have had, and other doctors have had about the dishonesty of the publicity that surrounds this purported crisis,” Dr. Laird said.

The first fatality of 2017 lists heroin, hydromorphone and methadone, along with pneumonia. The second case lists methamphetamine and opiate intoxication. The third lists pneumonia, asthma tobacco, marijuana, and congestive heart failure along with methamphetamine and cocaine. All the way down the page, it’s the same picture over and over, multiple drugs, most of them illegal, often combined with alcohol, and the decedents also had serious underlying health issues. To label these as opioid deaths is a stretch.

It appears that if the toxicology showed an opioid in their system at the time of death, it’s counted as an opioid death, which is quite misleading. The records from 2018 — more of the same — heroin, heroin plus cardiovascular disease, inhalation injuries due to smoking methamphetamine or how about this one, multiple drugs along with cirrhosis, HIV and leukemia. Examples of pretty much every licit and illicit drug one could name.

Chronic pain patients like Rick Martin of Henderson are in pain management programs. They are tested, they follow the rules, but because of addicts taking deadly amounts of heroin or other drugs, the patients who follow the rules have been cast aside as collateral damage. Nevada is not yet as strict as many other states, but the political rhetoric is amping up in this election year, and the oft-cited figure of one Nevadan per day dying of opioids continues to resonate.

“Seventeen people a day die of heart disease. Fourteen people a day die of cancer. Four people per day die in Nevada of lung cancer. So, it’s important to keep these things in perspective. One person a day dies of an opioid but that includes everyone on the list, everyone who had an opioid in their system at the time of their death.

About one in every 40 of the deaths listed in the records involve a single, prescription opiate and there is no indication whether the decedent obtained the drugs through a legal prescription or other means. 
 

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https://www.acsh.org/news/2018/05/09/blame-shame-healthcare-and-congress-12939

For healthcare to improve, we need to look at the outcomes of our actions and activities, identify the source of our errors and do better. A few months ago, the Annals of Family Medicine reported on how “blame” is attributed; do we point at ourselves, others or the system?

The study was conducted based on records of the United Kingdom’s National Health Service’s National Reporting and Learning system which records all patient safety occurrences. Like many of these databases, it is required and captures much of the detail surrounding these bad outcomes – you might think of it as a paperwork version of the Transportation and Safety Boards investigations of plane and train crashes. The researchers found about 14,000 records about primary care’s poor outcomes and randomly selected about 2200 for the study [1] The defined “blame” as evidence in the free-text of these reports of judgments about “deficiency or fault by a person or people;” system failures were labeled no blame. Here is what they found:

• System failures accounted for 55% of the outcomes – there were flaws in how the healthcare system was organized.
• Forty-two percent of individuals writing these reports blamed others – termed “directed blame” by the authors.
• Two percent of the report’s authors attributed the errors to themselves, acknowledging their personal responsibility.
• The more often a poor outcome had multiple contributing factors, the more often there was directed blame.
• Poor outcomes involving judgment and interactions with patients had higher percentages of directed blame. 

The discussion mentions a classic theory in failure analysis [2] where human error is inevitable and poor outcomes are “the result of multiple smaller errors.” More importantly, improvement comes not from deciding who failed, “but how and why the defenses failed” – what about the system lead the individual astray? Blaming others is not conducive to that kind of analysis and is often the refuge of “cover one’s own back.” It also reflects how we believe the “system” made me do it when I bear responsibility, and when someone else can be held accountable, they are bad people. Blaming others may satisfy the soul, but does little to improve care.

The article is helpful in understanding the culture of patient safety; it came to mind because of the current Congressional hearings on the opioid crisis.  

“But for hours on Tuesday, executives from five drug distributor companies largely parried questions from House members and attempted to shift blame to anyone but them — to the Drug Enforcement Administration, physicians, and pharmacies, among others.

“I just want you to feel shame,” Rep. David McKinley (R-W.Va.) told the executives at one point, suggesting that financial penalties were insufficient and alluding to jail time. “So what’s the proper accountability? …What’s the punishment that fits this crime?”

Many small and large errors contributed to the opioid epidemic, and we all bear responsibility for creating the situation and for correcting our mistakes. But attribution of blame and subsequent punishment is the role of the judiciary, not Congress. Congress makes the rules. For example, the  Ensuring Patient Access and Effective Drug Enforcement Act of 2016 which among other provisions made it more difficult for the DEA to bring actions against drug distributors for the egregious behavior Representative McKinley is railing against – an act passed by the unanimous consent of the House, including Representative McKinley. This behavior sounds so much like the directed blame found in the study.

Congress should investigate the bad outcomes of their legislative efforts, but this staged theater of indignation and moral high ground serves us poorly. The current Congressional hearings on the opioid crisis reflects a culture of blame rather than reflection, just like those poor healthcare outcomes reports. Improving safety doesn’t come from photo ops and sound bites on the evening news any more than it comes from nurses and physicians blaming one another. Improving safety and our legislation comes from analysis and reflection that recognizes blame as an impediment, not a response. If Congress wishes to help and use its considerable powers then it should remember President Theodore Roosevelt’s initial phrase, speak softly.

[1] The survey size was selected to be confident in the statistical analysis of their results

[2] Reason’s Swiss Cheese Model

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https://www.beckershospitalreview.com/quality/survey-90-of-nurses-admit-they-do-not-have-enough-time-to-properly-care-for-patients.html

As hospitals across the U.S. face a nursing shortage, care quality and patient safety continue to be put in jeopardy. Nurses are frequently assigned more patients, with 90 percent of nurses admitting they lack adequate time to properly comfort and assist patients, according to a survey of Massachusetts nurses conducted by Anderson Robbins Research.

The survey, “The State of Patient Care in Massachusetts,” is a survey of Massachusetts nurses conducted annually and commissioned by the Massachusetts Nurses Association. Most of the nurses surveyed are not MNA members.

Survey respondents consisted of registered nurses working in Massachusetts healthcare facilities who were randomly selected from a complete file of the 100,000 nurses registered with the Massachusetts Board of Registration in Nursing. 

Here are seven survey findings.

1. Having to care for too many patients at one time was the most significant challenge to RNs giving high-quality patient care, with 77 percent of nurses identifying unsafe patient assignments as an issue.

2. The majority (77 percent) of nurses reported medication errors, such as giving patients the wrong medication or dosage, as a result of caring for too many patients at once.

3. Seventy-two percent of nurses said readmission of patients was a consequence of caring for too many patients at the same time.

4. Additionally, 64 percent of nurses said patient injury or harm was linked to unsafe RN patient assignments.

5. Nurses said hospital management does not typically adjust patient assignments to meet patients’ needs, with more than 6 in 10 (63 percent) reporting management only occasionally adjusts their patient assignments to meet patients’ needs.

6. Less than one-third (31 percent) of respondents believe Massachusetts hospitals’ mergers and acquisitions have improved care quality. The survey also found only 27 percent of nurses believe hospitals’ business relationships with pharmaceutical companies and/or medical device makers improve patient care.

7. The survey found nearly 90 percent of nurses support a pending ballot measure that would set safe patient limits hospital nurses based on patient needs. 

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https://www.politico.com/story/2018/05/08/opioid-epidemic-consequences-502619

The crackdown on opioids is having unintended consequences.

The push for fewer opioid prescriptions at lower doses and for shorter periods has increased suffering for some pain patients including those near the end of life. The emphasis on opioids has also overshadowed other forms of substance abuse that require attention.

But sometimes solutions give rise to new problems, from hospital shortages of IV opioids to dying patients enduring avoidable pain. Here are some of the challenges state and federal lawmakers, physicians and patients, are beginning to confront.

Ready or not, we’re stopping your pain drugs

Doctors face intense pressure to decrease opioid prescribing and stop treating chronic pain patients with opioids long term. The government mental health agency doesn’t track the number of chronic pain patients like this, but some experts put the number as high as 10 million. Many doctors aren’t prepared (or, in some cases, willing) to gradually and appropriately transition them off their opioids, addiction experts say. Done badly, that tapering can push people toward street drugs like heroin – and there have been reports, too, of suicides of people left with uncontrolled pain.

“Some people will be tapered too quickly or in a way that is intolerable to them,” said Elinore McCance-Katz, the HHS assistant secretary for mental health and substance use.

“It’s not just people who are on chronic opioids that have difficulty tapering,” she added. Opioids create physical dependence very quickly, and even patients taking the drugs for only a few weeks may need to be gradually weaned to avoid withdrawal symptoms that can include muscle aches, vomiting and diarrhea, anxiety and insomnia.

Weaning patients off opioids should be a “cooperative process” between patient and physician — not an ultimatum or abandonment, said Sally Satel, a psychiatrist, Yale University School of Medicine lecturer and a resident scholar at the conservative American Enterprise Institute. “I’ve seen patients where doctors just say ‘That’s it, I’m done. I’m not going to lose my license over you and good luck,’ and that’s unconscionable,” she said.

Andrew Kolodny, the co-director of opioid policy research at Brandeis University Heller School for Social Policy and Management, said patients need a lot of support coming off opioids. “It’s not as easy as just telling a primary care doctor to lower the dose by X amount.” They may need social workers or psychologists to address anxiety, and they may need other ways of treating very real pain.

But Kolodny cautioned against the narrative that some patients should stay on their chronic opioids even if they are convinced they are doing just fine. “Opioids are lousy drugs for chronic pain and when you take chronic pain patients and get them off opioids their quality of life is improved. The tricky thing is, it’s very hard to get them off,” Kolodny said, calling for better wraparound support services for these patients.

What was your experience tapering off opioids? We want to hear from you.

Ignoring other addiction crises

Amid the intense focus on opioids, use of drugs like cocaine and crystal meth is exploding across the country, costing lives. “We treat drug epidemics like ‘whack a mole,’” said West Virginia Public Health Commissioner Rahul Gupta. “We get one under control, another pops up.”

Deaths involving cocaine increased 52.4 percent between 2015 and 2016, according to the CDC. Overdose deaths involving methamphetamine increased 30 percent between 2014 and 2015.

“We are seeing meth come back, we are seeing cocaine on the horizon,” said Jonathan Thompson, executive director of the National Sheriffs’ Association. “This is now a cyclical problem. So how do we prepare for it? Responding to opioids is different than responding to cocaine, which is different than responding to methamphetamine.”

Federal lawmakers in the last few years have focused funding specifically on opioid abuse, while leaving spending on other substance use disorders mostly flat. Trump in his 2019 budget proposal called for $13 billion to fight the opioid crisis, while proposing to cut other substance abuse treatment programs. Congress in 2016 authorized $1 billion in opioid funding over two years for states but some lawmakers — like Sen. Tammy Baldwin (D-Wis.), whose state has seen a spike in crystal meth deaths — want to give states more flexibility to spend that money. Illinois Democratic Rep. Jan Schakowsky at a recent Energy and Commerce meeting raised concerns about proposals to create opioid-specific treatment centers.

“I’m concerned about segmenting our health care system.” she said. “By doing this we ignore the fact that substance abuse disorders like alcohol, crack cocaine have ravaged communities for decades and we haven’t put forth the resource to address them. In fact in the past we called them junkies or criminals and continue to criminalize many addictions rather than treating that as substance abuse disorders.”

Taking away painkillers doesn’t take away the pain

Policymakers and insurers cracking down on access to prescription painkillers aren’t spending nearly the same effort increasing access to non-drug alternatives to opioids like physical therapy, massage or cognitive behavioral therapy.

“I’m seeing more changes to make it harder to gets opioids … than on how to help people who get in trouble with pain because they don’t have opioids,” said Cheryl Bartlett, the CEO of the Greater New Bedford Community Health Center, which treats patients regardless of insurance or income status.

Congress has “been big on promoting [nonopioid] alternatives” for the Defense Department and the VA. “Beyond that it’s pretty much just been lip service and it’s a little challenging how to craft legislation that affects what private payers are able to offer in this arena,” said Bob Twillman, executive director of the Academy of Integrative Pain Management, who’s membership includes a variety of health care practices from doctors to chiropractors and massage therapists.

Even when insurance does cover pain treatments that don’t involve opioids, the treatments tend to be more costly for patients. They also often require more time than popping a pill, a challenge for hourly workers who don’t have paid leave.

“It’s one thing for an insurer to cover [an opioid alternative], It’s another thing to cover it at a co-pay that the patient can afford. We need to stop making opioids the easy decision — in terms of writing prescriptions and patient access. Higher co-pays will stand in the way,” said Cindy Reilly, who recently left the Pew Charitable Trust, where she focused on issues around opioid use and access to effective pain management.

Have you experienced any challenges over access to alternatives to opioid painkillers? Tell us your story.

Care for the dying

There’s been a lot of research lately on what opioids don’t work for — but there’s no doubt that they can be essential for many patients nearing the end of life, or suffering metastatic cancer. CDC prescribing guidelines and state laws limiting prescriptions generally don’t restrict opioids for these patients — but hospice and palliative care physicians report that their patients are having a very difficult time getting the pain control they need.

“Almost every patient I have prescribed for recently has either a) run into pharmacies that no longer carry common opioids; b) cannot receive a full supply; and c) worst of all had their mail order pharmacy refuse to fill or have had arbitrary and non-science based dose or pill limits imposed,” said Sean Morrison, chairman of the geriatrics and palliative medicine department at the Icahn School of Medicine at Mount Sinai.

“Even with exemptions for hospice care, prescription limits are still having an impact,” said Joe Rotella, the chief medical officer for the American Academy of Hospice and Palliative Medicine. “Patients have a tougher time getting these medications and it’s a lot more hassle for providers.”

Insurers who don’t fully understand the legislative limits may flag prescriptions. Pharmacies may question them after checking data banks on opioid use.

“I believe there has been an over-interpretation of dosing limits and threshold limits. CDC has always maintained that they meant for their guidelines to be just that, guidelines,” said Patrice Harris at the American Medical Association. “But unfortunately, payers and states are putting those hard dosage limits into statute and regulations.”

Hospital shortages of IV opioids

Hospitals in the U.S. are experiencing shortages of IV opioids for patients undergoing surgery, in intensive care units or being treated for cancer — all of which are appropriate uses for the powerful painkillers. The shortage of drugs like morphine and fentanyl began in mid-2017. The shortages weren’t directly caused by the focus on the opioid epidemic; it’s largely attributed to manufacturing delays impacting Pfizer. But ending those shortages has become more difficult because of measures put in place to address opioid overuse and diversion. And it‘s been serious enough that some hospitals have had to delay or cancel elective procedures, said Michael Ganio, directory of pharmacy practice and quality at the American Society of Health-System Pharmacists.

Normally when there’s a drug shortage, other manufactures try to boost production to meet the demand, but with controlled substances like opioids, they need special permission from the Drug Enforcement Agency, Ganio explained. Even getting permission to move raw materials for making opioids from one facility to another can be a challenge; a company with a problem at one manufacturing plant can’t simply ship the ingredients to another location and continue production.

“Our hospital pharmacists can’t be short of critical medications that are workhorse drugs that have been used for decades,” said Dan Kistner, senior vice president of pharmacy services at Vizient, the country’s largest hospital group purchasing organization. The DEA has taken steps to begin to ease the shortages. But Kistner said it’s been bad enough that pharmacists have had to spend hours and extra resources trying to acquire these opioids, instead of providing care to patients. And patients can have inadequate pain relief, or much more costly alternatives.

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www.delawarestatenews.net/government/bill-creating-fee-on-opioids-clears-first-hurdle/

DOVER — Legislation that would create an opioid fee passed out of committee Wednesday, although it will likely be amended to deal with concerns raised by the Department of Health and Social Services and others before receiving a floor vote.

Senate Bill 176 would establish a fee on opioids of 1 cent per morphine milligram, paid by manufacturers. The measure was debated for about an hour in the Senate Health, Children & Social Services Committee and ultimately was released to the full Senate.

Advocates urged lawmakers to support the proposal, saying it would save lives by giving the state more tools to combat drug addiction, which claimed the lives of 306 people in Delaware in 2016. A majority of those deaths were due to opioids.

Sen. Stephanie Hansen, a Middletown Democrat who is the main sponsor of Senate Bill 176, made an impassioned plea for her colleagues to back the legislation, insisting lawmakers hold “Big Pharma” accountable and do more to help Delawareans.

“Everybody here is paying for this already. You are already paying,” she said. “You are paying through your health insurance, No. 1 or your plan, and the cost of that health insurance. You are paying through your taxes, with all the programs we are currently running at DHSS, through our criminal justice system.

“You are paying when your car gets broken into and you go out in to the morning and your CD player, everything you have in there, is stolen because the person who has broken in there is feeding a habit that they have.

“You are paying in anguish, in family anguish and the lives of our children, of our parents. Grandparents are dying as a result. The only folks that are not continuing to pay as this ramps up are the ones that are actually fueling the fire. That’s why this is so important.”

According to a legislative estimate, the bill would generate around $8.6 million in the first year.

The measure states companies cannot pass the cost along to consumers and would give the Delaware Department of Justice the authority “to recover direct economic damages resulting from a violation.”

But despite the strong support from some advocates, several state agencies and industry representatives expressed concerns about certain aspects of the bill.

Deputy Health & Social Services Secretary Molly Magarik said the measure would lead to additional work DHSS may not be currently equipped to handle and could result in higher costs for consumers despite the intent of the bill. Finance Secretary Rick Geisenberger, meanwhile, noted a poorly written proposal could lead to expensive lawsuits against the state and create new headaches.

Gov. John Carney’s office also has some concerns with the language of the bill and the exact impact the legislation would have.

Representatives of opioid manufacturers agreed the proposal could hurt patients and expressed a desire to work with the state in other ways to fight the epidemic.

“Opioids offer life-enhancing and therapeutic benefits for those with various conditions like chronic pain, acute postsurgical pain and painful conditions like cancer that, when misused and abused, can result in devastating and life-threatening consequences,” Sharon Brigner, deputy vice president of state advocacy at the Pharmaceutical Research and Manufacturers of America, told the committee.

“This legislation would impose a tax that would unfairly target the pharmaceutical manufacturers as the only stakeholder in the supply chain responsible for funding programs to treat and prevent drug abuse, and it will detract from our ability to focus on our mission, which is to invest in future research and development in … medicines like non-opioid alternatives. In addition, we strongly believe that no medicine should ever be taxed that patients need.”

Money collected by the bill would go to a special fund to be overseen by the Department of Health and Social Services, with the Behavioral Health Consortium and Addiction Action Committee offering recommendations on how exactly revenue should be spent.

Those dollars could be used for starting treatment programs, purchasing a medication that can counteract the effects of an overdose, reimbursing state Medicaid spending on drug addiction, assisting addicts without health insurance and covering administrative costs.

Under the measure, a 10-milligram oxycodone pill, for instance, would require the manufacturer to pay an extra 15 cents to the state.

Some people believe pharmaceutical companies covered up the risks of opioids, intentionally overprescribing without regard to the potential consequences.

“Opioid manufacturers misrepresented the addictive nature of their products,” Attorney General Matt Denn said in a January statement.

“They, along with national opioid distributors and national pharmacies, knew that they were shipping quantities of opioids around the country so enormous that they could not possibly all be for legitimate medical purposes, but they failed to take basic steps to ensure that those drugs were going only to legitimate patients.

“These companies ignored red flags that opioids were being diverted from legitimate channels of distribution and use to illicit channels. The failure of these corporate defendants to meet their legal obligations has had a devastating impact on Delawareans.”

Manufacturers have denied the claims.

In recent years, governments have begun taking steps to fight substance abuse by focusing on treating and preventing it rather than punishing addicts. They have also, in some cases, gone after major drug companies.

Dover City Council in February announced it was filing a lawsuit against Big Pharma, one month after the Delaware Department of Justice said it would sue drug manufacturers, distributors, and retailers.

Other states have attempted to create new taxes or fees on opioid medications, with New York recently enacting a budget that contains fees for opioid distributors and manufacturers.

According to the Department of Justice, there are more than 50 opioid pills in Delaware for every person.

“The statistics of the cost are clear in dollars and cents. They’re even more clear in the cost of human lives that the crisis has cost families in Delaware and the nation,” Dave Humes, a board member of atTAcK addiction, said Wednesday.

Reach staff writer Matt Bittle at mbittle@newszap.com

While Trump is talking about getting the Pharma’s to get into “bidding” to lower Rx prices… in DE they are adding a tax to be paid for by the Pharmas’.

Apparently these politicians have never heard the statement that “… companies don’t pay taxes… people/customers pay taxes…” and they have put in place a “means” of monitoring efforts of the Pharmas’ to pass this tax along to customers…  and… just how much is it going to cost and how large a new bureaucracy is going to have to be created to TRY and enforce this provision of “no pass thru to the end customers ” ?

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https://www.wthr.com/article/13-investigates-cbd-oil-poses-risk-for-failed-drug-tests

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Just follow the money trail ?

https://www.knoxnews.com/story/news/politics/2018/05/10/ice-raid-watauga-recovery-centers-tennessee-lawmakers-donations/599087002/

An East Tennessee addiction recovery center that was recently raided by federal drug enforcement agents has contributed more than $20,000 to various legislators and their political action committees in the last four years.

On May 2, the federal Drug Enforcement Administration raided Watauga Recovery Centers, an addiction treatment clinic with locations in East Tennessee, North Carolina and Virginia.  

Although no one was arrested or charged with a crime, agents looked for medical and financial records, said Dr. Tom Reach, the founder and president of the clinic, according to WJHL.

The $20,000 in contributions are listed as coming from Reach and the center itself. 

The East Tennessee television station initially reported that DEA spokesman Jim Scott said search warrants were issued for multiple locations. Scott refused to answer questions from the USA TODAY NETWORK – Tennessee, referring inquiries to the U.S. attorney’s office.

A spokesman for U.S. Attorney Doug Overbey’s office directed questions to an office in Virginia, which declined to comment.

Reach and a spokesperson for the clinic did not respond to a request for comment.

In the last four years, Reach has donated $14,500 to nine lawmakers, according to campaign finance records.

In addition to Reach’s donations, Watauga Recovery Centers has donated an additional $8,400 to many of the same politicians, including the political action committee of the House Republican Caucus.

Among the top recipients of donations from Reach and Watauga Recovery are Reps. Matthew and Timothy Hill.

Since 2015, Matthew Hill, R-Jonesborough, has received $4,700 in contributions from Reach and the recovery center. His brother, Timothy Hill, R-Blountville, received $2,500 from Reach and the center over a two-year period.

In a joint statement, the Hill brothers said they were surprised to learn about the “DEA visits” to the clinic.

“They have a reputation for successfully treating patients with addiction issues in our community and have often been recognized for their standard of care,” the Hills said, adding they were learning about the developments through the media.

Beyond the Hills, Rep. Micah Van Huss, R-Jonesborough, also received contributions totaling $1,500 in 2016 from Reach and the recovery center.

In 2016 and 2017, Van Huss reported Watauga Recovery Centers as a source of income. His latest statement of interest no longer lists the business as a source of income.

In an interview, Van Huss said he made the company’s website at the cost of about $2,600.

Van Huss said he included the business as a source of income in 2017 because he updated the website.

He pointed out that he was not the only one to receive money from Reach and the center.

“They’ve given to other politicians too,” he said.

Others lawmakers to receive donations from Reach or the recovery center in recent years include former Lt. Gov. Ron Ramsey, Reps. John Holsclaw and Cameron Sexton and Sen. Jon Lundberg — who received the money when he was a member of the House.

Former Reps. Dennis Brooks and Tony Shipley also received contributions from Reach and the center.

Reach Joel Ebert at jebert@tennessean.com or 615-772-1681 and on Twitter @joelebert29.

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Illinois police: Keep pot illegal — or we’ll kill the dog

https://www.washingtonpost.com/news/the-watch/wp/2018/05/08/illinois-police-keep-pot-illegal-or-well-kill-the-dog/

As Illinois lawmakers debate whether to become the 10th state to legalize recreational marijuana, a few law enforcement officials in the state have put forth this bizarre argument:

Later in the story, a K-9 trainer suggests some or most of the dogs will need to euthanized.

(By the way, if you think it’s weird that a sheriff would have a “personal foundation” capable of spending more than $2 million on drug dog units for other police departments, so did I. It turns out that Sheriff Buffett is the middle child of the billionaire Warren Buffett.)

There’s a lot to unpack here. First, I’d dispute Buffett’s assertion that legalization is a “giant step forward for drug dealers.” This is true only if you consider retailers who sell marijuana legally to be “drug dealers.” If by “drug dealers” you mean cartels and kingpins who sell the drug on the black market and use violence to settle disputes, legalization is actually pretty bad for them.

But let’s get back to the dogs. Even if it were true that marijuana legalization in Illinois would mean that all drug dogs in the state had to be euthanized, that isn’t an argument to keep marijuana illegal. I’m a dog person. But the drug war is not a make-work program for canines. Second, nine states have already legalized medical marijuana. As far as I know, there hasn’t been mass euthanization of drug dogs in those states. Third, the law enforcement officials in the article argue that even if the dogs aren’t euthanized, they have been very expensive to purchase and train, and replacing them or retraining them to disregard marijuana and alert only to other drugs will be expensive. This, again, is not a persuasive argument for keeping marijuana illegal. The debate is really over whether we should be locking people up over a mostly harmless drug. If it’s wrong to do so, the fact that we’ve already spent a lot of money on a system to enforce a policy we now believe to be wrong is an argument against continuing that policy, not in favor of it. Put another way, if you think marijuana prohibition is justified, then spending money on drug dogs is justified. If you think marijuana prohibition is immoral, how much money we’ve already spent on enforcing that policy has no bearing on whether we should continue spending money on that policy in the future.

But if we are going to talk about cost, do you know what else is expensive? Arresting and jailing people for pot. The Chicago Reader estimated that in 2010, Cook County alone spent more than $78 million arresting and prosecuting people only for possession of marijuana. If we’re really worried about the golden years of drug dogs, that kind of money could purchase them a pretty nice retirement community. I’m thinking bubbling streams, platinum fire hydrants every few feet and a lifetime supply of top-shelf kibble.

But I want to address another part of this story that isn’t getting much attention. I’ve written quite a bit about drug dogs in Illinois, and it turns out they’re pretty terrible at detecting drugs. In 2011, the Chicago Tribune published a review of drug dog searches conducted over three years by police departments in the Chicago suburbs. Just 44 percent of dog alerts led to the discovery of actual contraband. For Hispanic drivers, the success rate dipped to 27 percent. The following year, I obtained the records of an Illinois State Police drug dog for an 11-month period in 2007 and 2008. In nearly 30 percent of cases where the dog “alerted” no drugs at all were found. In about 75 percent of cases, the dog alerted either to no drugs or to what police officers later described as “residue,” which basically means no measurable quantity of a drug and not a significant-enough amount to merit criminal charges. Only 10 percent of the alerts resulted in a seizure of a large-enough quantity of drugs to charge someone with a felony.

This is pretty consistent with statistics from other states, as well as one fascinating academic study, which have shown that drug dogs are far more likely to merely confirm the hunches and suspicions of their handlers than they are to independently detect illicit drugs. The dogs’ high error rates often make them no more accurate than a coin flip. The problem of course is that the entire purpose of the Fourth Amendment is to protect us from searches based solely on a government official’s hunch or suspicion. There’s a reason some legal scholars call drug dogs “probable cause on a leash.”

The K9 trainers I’ve interviewed over the years have told me that drug dogs could actually be trained to only alert when there is a significant quantity of an illicit drug — that is, to ignore “residue.” The reason they aren’t is that police departments don’t want them trained that way. They want dogs that alert as often as possible. They want the dogs to err on the side of false alerts.

Why would police want a dog that falsely alerts? That’s the exact question the late Supreme Court Justice Antonin Scalia asked in a drug dog case a few years ago. The answer is incentives. Searches can lead to evidence of other illegal activity. One incentive is that police officers, particular those in drug enforcement, often evaluated based on the raw numbers of arrests. More searches mean more opportunities to make arrests.

But the more important incentive is civil-asset forfeiture. If the police find even the slightest bit of pot, sometimes even just residue, they can often justify taking a driver’s cash, jewelry or even the car itself. The owner of the property — even if completely innocent — then must endure a number of legal and procedural barriers to getting the property back. Take, for example, the K-9 whose records I reviewed several years ago.

In one case, the discovery of 2 grams of marijuana led to the seizure of $5,190 in cash. In another, 2 grams of pot led to the arrest of the vehicle’s seven occupants and seizure of the $2,000 they had between them. In another, 3 grams of marijuana led to 9 arrests and seizure of $2080. In yet another, one motorist caught with 1.2 grams of pot was arrested and forfeited more than $9,000. Another motorist wasn’t arrested, but had more than $2,000 in cash taken from him because the officer found what he says in the report was marijuana residue. It’s unclear if the residue was either subjected to a field test or taken to a lab for testing.

So over 11 months, this drug dog with an error rate of somewhere between 30 percent and 70 percent may have subjected dozens of people to illegal searches, but the pooch also brought in $11,000 for the state police. The dog is, er, a cash cow.

One particularly lucrative part of the state for police is the I-55/I-70 corridor near the town of Collinsville, which brings in a half-million dollars or more per year for local police. A local police officer pulled over Terrance Huff in 2011 while he was returning from a “Star Trek” fan convention. After the dog “alerted,” the cops searched Huff’s car from top to bottom. They found only what they called “shake,” or marijuana residue. K9 trainers who watched the video of the stop say the dog and officer interactions look like a dog that alerted on command, rather than when the dog detected an illicit substance. Huff later sued. During discovery for his lawsuit, he learned that the officer who pulled him over sometimes “trained” his dog by rubbing marijuana on the bumpers of cars parked in motel parking lots. If those cars were to be later pulled over and sniffed — voila! — instant probable cause for a search.

The police in Illinois aren’t worried about the well-being of drug dogs. They’re worried about the well-being of drug cops. Lots of law enforcement jobs — K9 cops, drug task forces, narcotics detectives — depend on the government’s continued pursuit of marijuana. So, too, do the revenue streams of many police departments and prosecutors’ offices. When there’s a threat to that revenue, they’ll do anything to protect it, including making threats to euthanize dogs, or warning that if we dare to stop cops from taking money from people without due process, we’ll soon see headless bodies hanging from bridges.

Illinois cops have been using their police dogs to violate the rights of people living in or passing through that state for decades. If marijuana legalization puts a damper on that practice, that’s a feature of reform, not a bug.

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