http://thehill.com/policy/healthcare/383600-dea-moves-to-curb-oversupply-of-opioids

As the number opiate prescriptions hit a TEN YEAR LOW and OVERDOSE DEATHS hit a TEN YEAR HIGH..  hospitals are reporting serious shortage of injectable opiates.. The DEA is looking for ways to justify cutting the opiate production quotas for the pharmas.  When statistics strongly suggests that there is current not enough opiate prescriptions filled would not be enough to meet the valid medical/therapy needs of the intractable chronic pain pts let along the other 70-80 million chronic pain pts and those acute pain pts dealing with pain from a accident or medical procedure.

I wonder if the DEA will use the CDC’s 64,000/yr drug overdose deaths… and overlook or ignore the fact that abt 1/3 of those numbers have nothing to do with opiates and abt 35K are due to ILLEGAL OPIATES and there are no published stats as to how many of all those 64K overdose drug deaths are in fact SUICIDES.

But the TRUTH AND FACTS have never gotten in the way of the DEA doing what they want to do…

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In the clip, a man identifying himself as a business owner claimed that a Jacksonville employee named Melinda Power had demanded that military flags be removed. In addition, the unnamed business owner claimed Power told a combat veteran customer he had done “nothing” for the country. Video shared by a local news outlet included an image of a citation:

The same news article reported that the citation had to do with the amount of signage displayed by Jaguar Power Sports, not the military flag, and included video (without audio) of interaction between Power and the anonymous customer. In early accounts of the 16 April 2018 dispute, employee Katie Klasse quoted Power as saying the unnamed man’s service “didn’t matter.”

But when the veteran was interviewed by the same station, he himself stated that in fact Power said his opinion on the citation “doesn’t really matter at this point” as she was present only to discuss city ordinances:

Changes made to Jacksonville’s signage ordinances, if any, are not clear based on social media commentary. However, according to city code enacted in March 1987, the flags on display at Jaguar Power Sports do appear to be violating City of Jacksonville Building Inspection Division Sign Laws:

Sign Exemptions

… United States of America, State of Florida, and Local Government flags (Duval/Jacksonville) may be displayed.

[…]

Unlawful Sign Structures

… Consists of streamers, ribbons, pennants or wind activated devices, multiple flags, including multiple flags of states, governmental units, balloons, including individual and giant balloons which are inflated and tethered for support which encompass an area or areas, singularly or in aggregate, greater than twenty-five (25) square feet.

Jaguar Power Sports was cited but not fined for the flag violation, and Jacksonville’s mayor later said that code would be amended to allow military flags to be flown in the manner permitted for American flags as of 17 April 2018.

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https://www.theatlantic.com/health/archive/2018/04/how-france-reduced-heroin-overdoses-by-79-in-four-years/558023/

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http://theweek.com/speedreads/767739/dea-making-raids-look-like-robberies–really-dangerous-consequences-innocent-people

The Drug Enforcement Administration likes to use something called a “sneak-and-peek warrant,” a search warrant that allows agents to enter and search a property without notifying the owner as a normal warrant would require. Officers operating on a sneak-and-peek (officially, a Delayed Notice Warrant) typically aren’t allowed to take any evidence they find on-site — but they do frequently trash the place, faking a burglary to explain their break-in.

Sneak-and-peek searches were authorized by the Patriot Act and, as is often the case with this law’s provisions, quickly became more useful for the federal drug war. But the trouble with fake-robbing people is it can lead to unintended, dangerous consequences, like those experienced by an Oregon storage locker manager named Shawn Riley.

In December, The Oregonian reports, Riley was tied up and held at gunpoint by alleged drug traffickers who believed he’d stolen the cache of marijuana they’d stored at his facility. It turns out the DEA was the real culprit; agents had done a sneak-and-peek and confiscated 500 pounds of pot. “The danger of violence is obviously real, and this case makes it very evident,” said Cleveland State criminal law professor Jonathan Witner-Rich, a warrants expert. “Someone could have been killed.”

Marijuana is legal in Oregon, and the 500 pounds was allegedly set for transport to Texas. The DEA declined to comment to The Oregonian. Bonnie Kristian

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https://www.kevinmd.com/blog/2015/09/when-doctors-pass-the-buck-the-ugly-side-of-a-shift-work-mentality.html

“I’m just the night doc,” you said. You said it with emphasis as if that explained everything and dismissed your incompetence, your lack of compassion, your failure to care. Unfortunately my sister was “just the patient,” who lay suffering hours before her death and the RN was “just the nurse” withholding the morphine that the daytime doctor had ordered for air hunger and agitation. The nurse called you in to manage me when I asked her to give my sister a touch of morphine; she was crying out in pain from her hypoxia.

A civilized, yet ridiculous argument ensued about the dangers of respiratory depression in a patient who was clearly dying. You and I, physicians and colleagues, were arguing over 2 mg of morphine when you said, “I’m just the night doc.” I’m still shaking my head over the absurdity. Instead of assessing the situation you felt the need to pass the buck until morning. Does no one die on your watch? You were so busy, not being a physician, that you must have missed the oxygen saturation in the 70s and the flipped T waves predicting my sister’s imminent demise.

The life and death stakes were not high, the end result would have been the same. We both knew that, so why did you feel the need to distance yourself from your decision to withhold medication with a just statement? “I’m just” means that you are under no obligation to act. You were telling me in essence that you were a just an overnight placeholder in the ICU. When we are just doctors we are not our best selves.

A more honest, although equally lame statement would have been, “It’s not my job.” However, that declaration begs the questions as to whose job is it to orchestrate patient care after dark? Having been a doctor for three decades, I can’t remember a time when my obligation to care for patients stopped at dusk. That implies that patients can only expect our best selves in the daylight hours. Did I miss the memo, has medicine gone so far away from patient care that this shift work mentality is the norm or were you “just an ass”? What if you’re only a Wednesday doctor, but you’re working on Friday, will you wait until Wednesday to treat? The absurdity boggles my mind.

I don’t blame you for my sister’s death, everyone knew she was dying. She had asked for resuscitation measures to be stopped. However, in saying I don’t want extraordinary measures she never said, “I welcome a painful, oxygen starved, horrible death.” I had promised to be there with her, and I had explained the likely outcome. She trusted me to watch over her as a sister, not as a physician and I couldn’t do it. My real anger is directed inward, and I can’t forgive myself for leaving the hospital. I let you drive me away in the last few hours of my sister’s life, because I was angry and powerless. I couldn’t “just be a sister.”

Every one of us as health care professionals that night had a duty to care and we all failed due to our individual arrogance. I used your lack of compassion as my excuse to avoid facing the last three hours of her life.

We wear many hats as physicians but can we ever just be family members? The family relies on us, to translate complex medical speak, to help them understand the big picture and to act as liaisons with other healthcare providers. We usually do this willingly and in my experience, it unfortunately also allows us to keep our distance from our own very painful human experiences. I know that I am much stronger in a medical crisis when I am in “doctor mode.” You, the night doc and the night nurse wouldn’t let me be a doctor that night, thus the power struggle at the bedside. I would love to give you credit for urging me be the sister instead of the doctor, a much healthier way to grieve, but that wasn’t your intent. You made it clear that there would be no team decisions despite the fact that I had been there all night, knew my sister’s wishes intimately and had watched her oxygen saturation plummet and the T waves dip.

If I hadn’t been a doc, would you have been more compassionate towards my family? Were you practicing defensive medicine because I was there? Who better to understand compassionate palliative medicine than me, your senior colleague?

As we kept our distance from death, by arguing a moot point, my middle sister ignored us and kept her promise to my dying sister. She prayed, “Hail Mary, full of grace” softly in my sister’s ear, a comfort to both of these women of faith. She did not distance herself; she immersed herself in the process of helping another die. If we had set our collective arrogance aside perhaps we could have acted as a team and stayed in the moment with a suffering fellow human being. Patients are never just patients; my sister was a vibrant and brave mother, sister, wife, and friend. All of us failed to recognize what a profound privilege it would have been to assist another to die with dignity and grace. None of us were there three hours later when my sister passed away with a team that included a kind nurse, a compassion physician, and my sister with faith. I can’t forgive either of us for being “just doctors,” there’s no dignity in that.

Tracey Delaplain is an obstetrician-gynecologist who blogs at What’s for dinner, Doc?

Over the years, I have found myself in similar situations with Mother, Father-in-law, Mother-in-law and wife. Some end of life issues, others just poor/inept care being provided or lack of care being provided.  Depending on my perception of the severity of the violation of what is the standard of care… depends on how I approach the offending healthcare provider..  If it is rather minor infraction, I will try to muster up my “most diplomatic approach”… depending on their response determines if I drop directly into my “take no prisoners mode”… after running my own pharmacy for 20 yrs.. I  still have this “boss demeanor ” that I can bring to the forefront at a moment’s notice.  I have been known to – on occasion –  piss off hospital nursing staff… for not doing their job… at least at that point I know that I have got their attention.  Typically, things change.. in the right direction… it is gratifying to know that my loved ones are getting the medical attention that they need/deserve.

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http://www.oregonlive.com/portland/index.ssf/2018/04/secret_drug_raid_by_feds_backf.html

Maxine Bernstein | The Oregonian/OregonLive

 The harrowing confrontation terrorized Riley and turned a spotlight on a controversial ploy used by agents in drug cases to smoke out suspected traffickers. Oregon surprisingly is No. 2 in the nation in requesting what are known as delayed-notice search warrants.

The “sneak-and-peek” warrants, as they’re more commonly called, allow investigators to search a house, car, computer, other property or item, seize evidence and not tell anyone until much later. That differs from the typical search warrant, which requires police to provide immediate notice to property owners.

The delayed warrants mean agents can avoid tipping off suspects and jeopardizing an investigation, while potentially provoking them into revealing drug suppliers or other connections when it appears someone has stolen their cache.

 The technique appears to have backfired this time, imperiling an innocent bystander held at gunpoint and blowing the agents’ drug investigation.

“The danger of violence is obviously real, and this case makes it very evident. Someone could have been killed,’’ said Jonathan Witner-Rich, a criminal law professor at Cleveland State University who studies use of the warrants nationwide. “I think it illustrates this is a dangerous tactic, and the law is not requiring police to reduce such risks.’’

The federal statute that allows the warrants should incorporate extra safeguards to protect against this kind of outcome, Witner-Rich said.

Russ Baer, a spokesman for the Drug Enforcement Administration, declined comment on the warrant or the agency’s tactics, citing the ongoing criminal investigation.

The government seeks the warrants “to preserve the secrecy of an investigation,’’ said Kevin Sonoff, spokesman for Oregon’s U.S. Attorney Billy J. Williams. The office declined to discuss the ramifications of the warrant issued in this case.

The Associated Press | File

 ‘I THINK THE POLICE DID’

The two men appeared furious and desperate. They were told someone had broken into their storage locker and cleared it out. They wanted to know who.

 After they lured Riley into a different unit, one of the gunmen grabbed him by the shoulder, pushed him against the wall and yelled, “Get down! Get the (expletive) down!” The man filmed the confrontation with his cellphone, the light from the camera shining into Riley’s face.

He ordered his cohort to bind Riley’s wrists and ankles with duct tape, according to the video, which was played in court. The intruders went through the manager’s pockets and took his keys as they repeatedly demanded to know who knocked off their unit.

At first, Riley wasn’t sure what the men were talking about, then he recalled the break-in days earlier.

“When I came in, the door was half open,” he told the men. “The door was ripped off the track. “They didn’t get the lock off, so they broke the door. … I reported the break-in.’’

Riley told his attackers that he fixed the door a couple of days later. It was around then that he learned who had broken the door, he said.

“I think the police did. That is what my boss said,’’ Riley told the men, according to the video. “Then my boss said it wasn’t a break in.’’

“You’re telling me the police took my (expletive)?’’ one of the men asked in disbelief.

If Riley was lying, they implied that they’d shoot him. “Pop goes the weasel,” said the man with the gun to the manager’s head.

Then the two then abruptly left, closing the storage unit door with Riley still trussed up but alive.

Eric Kayne | Getty Images | File

 ALLEGED OREGON-TO-TEXAS TRAFFICKING

Before, during and after the Dec. 2 attack, Drug Enforcement Administration agents had been tracking the movement of one of the alleged gunmen and a woman through GPS traces of their phones and cars.

The monthslong surveillance was part of a broader investigation into black market trafficking of marijuana from Oregon to Texas, according to a prosecutor’s memo opposing the defendants’ release from jail before the trial. The DEA was working with a team of officers from Homeland Security Investigations, the FBI, Port of Portland police and the Multnomah County Sheriff’s Office.

Last August, investigators at Portland International Airport had found $184,740 in cash concealed in a shoebox in a passenger’s checked luggage, said Assistant U.S. Attorney William Narus.

Agents discovered that the money was tied to a man and a woman suspected of buying large supplies of marijuana in Oregon and smuggling the bundles back to Texas for distribution, Narus said.

Investigators identified the man, Jody T. Wafer, of Houston, as the one who coordinated buying the drugs in Oregon for transport back to Texas, records indicate.

DEA agents tracked Wafer and the woman, Brittany Kizzee, using undercover surveillance that included covert photography, wiretapping and even trick phone calls, according to court records.

They learned of the large stockpile of marijuana at the Public Storage outlet on Southeast 82^nd Avenue and decided to seize it before they suspected it might be shipped to Texas, court records show. The investigators also were still working to identify the drug suppliers in Oregon.

On Nov. 17, DEA agents got a judge’s signature on a delayed-notice search warrant, giving them authority to enter the Public Storage unit, seize property and not tell anyone for weeks.

Four days later on Nov. 21, the narcotics agents broke into the unit, knocked the door off its track, seized 484 pounds of marijuana and left the door ajar as if a real burglary had occurred.

Sometime in late November, the agents directed a district manager from Public Storage to make a “ruse call’’ to Kizzee, feeding the manager lines about what to say about a break-in at the unit.

Then on Nov. 30, the agents learned Wafer, Kizzee and a second man, Trent Knight, were flying from Texas to Portland, set to touch down about 8:45 p.m. The agents followed them when they arrived. They saw at the airport that Knight appeared to have a gun, according to court records.

On Dec. 1, the agents saw their targets driving in circles around Public Storage.

And that Saturday morning, Dec. 2, the agents tracked them in a pickup that drove up to the Public Storage unit. Two men got out. A woman stayed behind the wheel. About 10 minutes later, the truck drove away, according to court documents.

Maxine Bernstein | The Oregonian/OregonLive

 

‘WEED IS LEGAL HERE’

After his assailants had left, Riley managed to break free and call 911 around 9:30 a.m.

Portland police responded quickly, he told The Oregonian/OregonLive.

Officer Patrick Nagy took Riley’s statement and viewed surveillance footage from the storage business.

Nagy checked with Portland’s Drugs and Vice Division to see if it was involved in the marijuana confiscation at the Public Storage unit, but Portland police said they weren’t aware of it. They later learned DEA agents working with airport police were in on the marijuana investigation, though it was just the DEA that raided the storage unit.

“We just had to deal with the aftermath,’’ said Portland police Capt. Mark Kruger, head of the drug division.

Nagy and other officers arrested Wafer, Knight and Kizzee about two hours later, after the three had passed through security at Portland International Airport before boarding a plane to Houston.

As officers approached Wafer, he slammed his cellphone to the floor in an apparent attempt to break it, according to Narus, the prosecutor.

Mandel Ngan | Getty Images

 Investigators recovered the phone, which held footage of the violent encounter at Public Storage earlier that morning and another video of what looked like the two men play-acting their planned holdup with guns in their hotel room the night before, Narus said. Police also recovered two loaded firearms in Knight’s checked baggage, he said.

It’s unclear why the gunmen filmed the crime, but it’s possible that they needed to show some proof to others in the alleged drug-trafficking scheme that they didn’t steal the marijuana themselves.

By leading the suspects to think their drugs had been stolen, the federal agents likely wanted to intercept ensuing conversations, hoping they would generate further leads to identify the marijuana suppliers, said Witner-Rich, the law professor. It’s not clear if that happened in this case.

But DEA agents have done that in other cases, including one this month in Ohio that led to the largest methamphetamine bust in that state’s history. Authorities seized 82 pounds of crystal meth from a warehouse on a delayed-notice search warrant, leading three suspects to believe they’d been robbed. That’s when one got the “green light’’ from his Mexican supplier to kill the person he believed had stolen the drugs, according to intercepted phone calls quoted in court documents.

In Oregon, Wafer, 28, Knight, 29, and Kizzee, 27, now face federal charges of kidnapping and conspiracy to brandish a firearm in a crime of violence.

No marijuana trafficking charges have been filed in the case. The kidnapping and conspiracy charges are much more serious, according to prosecutors and defense lawyers.

After his arrest, Wafer told a court official that he had been visiting Oregon every other month, according to court records.

He added, “Weed is legal here.’’

The Associated Press | File

 ‘THE EXPERIENCE … WAS ABSOLUTELY TERRIFYING’

During a court hearing earlier this month, the government argued that the treatment of the Public Storage manager reflected the defendants’ “violent nature’’ and they shouldn’t be released before trial.

The prosecutor didn’t mention the secret raid of the storage unit by federal agents. Narus said the defendants “wrongly assumed’’ who had stolen their drug stash and committed a “violent offense against an innocent member of the public.’’

Attorney Barry Engle, who represents Wafer, blamed the federal investigators.

“The government’s own actors,” he said, prompted the alleged crime and “desperation’’ felt by his client. He noted in court documents and at the hearing that his client wasn’t admitting to any connection to the marijuana.

“The police knew that they were giving that impression that this was taken by the people working at the storage facility. I don’t know why, but that’s what they did,’’ Engle said.

Multnomah County Sheriff’s Office

 From left: Wafer, Knight, Kizzee.

As for Riley, the 59-year-old manager said he took a week off work after the frightening ordeal.

A single man who grew up in Southeast Portland, he still works for Public Storage full time, now going on three years.

Asked if he believed that agents who broke into the storage unit had exposed him to potential violence, Riley didn’t speak but vigorously nodded his head. He then politely referred questions to his corporate office.

U.S. Magistrate Judge John V. Acosta, who had reviewed investigators’ affidavits in the case, initially granted Wafer’s release from jail pending trial, but the prosecutor challenged the ruling to another judge. Kizzee has been released pending trial, but Knight was ordered detained. All have pleaded not guilty to the charges.

U.S. District Judge Robert E. Jones watched the video of the attack on Riley. He ordered Wafer to remain in jail as well. The three are set for trial May 15.

“The experience here was absolutely terrifying, one of the most dangerous acts, threats of death, a threat of execution,’’ Jones said. “No way will this person be released.’’

Maxine Bernstein | Staff

 

— Maxine Bernstein

mbernstein@oregonian.com
503-221-8212
@maxoregonian

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http://www.dispatch.com/news/20180415/three-cvs-actions-raise-concerns-for-some-pharmacies-consumers

First, CVS set up a website for consumers to compare drug prices.

But the site gave clear preference to CVS pharmacies, automatically putting them at the top of the comparison list. That occurred despite a “firewall” that’s legally required between the drugstore chain and CVS Caremark, the drug giant’s pharmacy benefit manager that runs the site.

Second, CVS’s benefit manager cut Medicaid reimbursements to local Ohio pharmacies this past fall,

which some say put them in financial jeopardy. Then CVS’s “acquisition unit” sent letters to many of those same pharmacies, saying times are tough and asking whether they would be interested in selling their business.

And in a third action that is raising concerns among independent pharmacists and consumers,

CVS dialed up Roberta Timmons.

When the 67-year-old Honda retiree received a telephone message a few weeks ago about her prescription drugs, she assumed it was from her longtime neighborhood pharmacist.

But when Timmons returned the call, the Plain City resident was told that she could save money by transferring her prescriptions to a CVS pharmacy. The caller was CVS Caremark, the pharmacy benefit manager (PBM) for SilverScript, a CVS-affiliated supplemental drug plan serving seniors covered by Medicare.

“I thought: ‘Why are they calling me when I don’t have prescriptions filled at CVS?’” Timmons asked. “What prescriptions was I missing or not getting filled?”

After learning that SilverScript and CVS Caremark were both part of CVS, Timmons, who has gone to the same independent Plain City pharmacy for 20 years, went from confused to angry.

“Knowing that I’ve been with one certain pharmacy for so many years — and then they think they can call and get me to change over certain prescriptions or tell me that I’m not getting the prescriptions I’m supposed to have?”

‘Extremely concerning’

The interaction between CVS and Timmons — as well as the buyout offers and the website — are part of a pattern, CVS critics say, of reaching around the firewall to help the company’s bottom line and drive out competition. In roughly the past three years, the number of independent pharmacies in Ohio has declined by 164, and the number of CVS pharmacies (which took over the pharmacies in Target stores) has climbed by 68, Ohio Board of Pharmacy data show.

Federal regulators required the firewall when CVS and Caremark merged in 2007, to make sure those in one part of the business did not use confidential information and economic power to unfairly help the other.

In 2012, the Federal Trade Commission closed an investigation into allegations of such anti-competitive practices as patient steering and spread pricing (profiteering), saying that it would “not take any additional action at this time” against CVS, now the nation’s seventh-largest company.

Mike DeAngelis, CVS’s senior director for corporate communication, said in an email: “CVS Health maintains stringent firewall protections between our CVS Pharmacy retail business and our CVS Caremark PBM business, and takes these protections very seriously.”

During the call to Timmons, a CVS Caremark representative said she was contacted to inform her that two of her medications could be refilled in a 90-day supply. When Timmons asked about her other prescriptions, the representative provided the cost at her pharmacy — which the caller could learn because CVS’s PBM provided the payment — compared with the cost at a CVS store. The CVS price was always cheaper. No pricing information was given for other pharmacies such as Kroger or Walgreens.

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https://www.painnewsnetwork.org/stories/2018/4/13/prominent-pain-doctor-faces-hundreds-of-lawsuits

DR. LYNN WEBSTER

“Utah’s opioid crisis stems directly from a callously deceptive marketing scheme that was spearheaded by certain opioid manufacturers and perpetuated by prominent doctors they bankrolled,” the lawsuit alleges.

“Dr. Webster’s advocacy of opioids was designed to create a veneer of impartiality. But Dr. Webster was a forceful proponent of the concept of ‘pseudoaddiction,’ the notion that addictive behaviors should be seen not as a warning, but as indicators of undertreated pain. The only way to differentiate between the two, Dr. Webster claims, was to increase a patient’s dose of opioids.”

Until he retired from clinical practice in 2010, Webster operated the Lifetree Pain Clinic in Salt Lake City. The lawsuit makes a point of mentioning that at least 20 of Webster’s patients died from overdoses and that he was investigated – but never charged with a crime — by the DEA and the U.S. Senate Finance Committee.

Since retiring from clinical practice, Webster has become an outspoken critic of efforts by the government and insurance industry to limit opioid prescribing — which he believes have gone too far and unfairly punish pain patients, while ignoring the larger issue of illicit fentanyl, heroin and other black market drugs.

He’s written a book, called “The Painful Truth” and self-financed a PBS documentary by the same name.  Webster also comments frequently on PNN about opioid related issues.

With so many lawsuits hanging over him, Webster’s financial future is uncertain.  He says he and his fellow KOLs could be bankrupted by legal fees before any of the lawsuits come to trial.

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A now former Palm Beach County Sheriff’s deputy was caught on home surveillance video stealing prescription drugs from

a West Boynton Beach home 90 minutes after paramedics took the dying 85-year-old homeowner to the hospital.

Former deputy accused of stealing pills pleads guilty to lesser charges

http://www.sun-sentinel.com/local/palm-beach/fl-pn-deputy-steal-pills-plea-deal-20180413-story.html

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