http://bigthink.com/focal-point/untreated-chronic-pain-violates-international-law

Untreated chronic pain is not only an epidemic, it’s a crime. According to a groundbreaking new report by Human Rights Watch, the majority of the world’s population lacks adequate access to narcotic pain relief. Governments are letting their own people suffer needlessly and flouting international law in the process.

In signing the 1961 Single Convention on Narcotic Drugs, the international community acknowledged that narcotic drugs are “indispensable for the relief of pain and suffering.” Signatories committed to making these drugs available to those in need. However, HRW reports that most nations are failing to live up to that commitment. Eighty percent of the world’s population currently has inadequate access to narcotic painkillers.

According to the report:

“The poor availability of pain treatment is both perplexing and inexcusable. Pain causes terrible suffering yet the medications to treat it are cheap, safe, effective and generally straightforward to administer. Furthermore, international law obliges countries to make adequate pain medications available. Over the last twenty years, the WHO and the International Narcotics Control Board (INCB), the body that monitors the implementation of the UN drug conventions, have repeatedly reminded states of their obligation.  But little progress has been made in many countries.”

The report blames government inaction and excessively strict drug control policies for the global shortage of medical narcotics. Many governments are so afraid that morphine will be diverted for illicit purposes that they are willing to let sick people go without in order to keep criminals from cashing in. This warped logic is the equivalent of imprisoning the innocent to make sure that the guilty don’t go free.

The report identifies a vicious cycle of low supply and low demand: When painkillers are rare, health care providers aren’t trained to administer them, and therefore the demand stays low. If the demand is low, governments aren’t pressured to improve supply. The 1961 Single Convention on Narcotic Drugs set up a global regulatory system for medical narcotics. Each country has to submit its estimated needs to the International Narcotics Control Board, which uses this information to set quotas for legal opiate cultivation. HRW found that many countries drastically understate their national need for narcotic medicines. In 2009, Burkina Faso only asked for enough morphine to treat 8 patients, or, enough for about .o3% of those who need it. Eritrea only asked for enough to treat 12 patients, Gabon 14. Even the Russian Federation and Mexico only asked the INCB for enough morphine to supply about 15% and 38% of their respective estimated needs.

Cultural and legal barriers get in the way of good pain medicine. “Physicians are afraid of morphine… Doctors [in Kenya] are so used to patients dying in pain…they think that this is how you must die,” a Kenyan palliative care specialist told HRW investigators, “They are suspicious if you don’t die this way – [and feel] that you died prematurely.” The palliative care movement has made some inroads in the West, but pharmacological puritanism and overblown concerns about addiction are still major barriers to pain relief in wealthy countries. In the U.S., many doctors hesitate to prescribe according to their medical training and their conscience because they’re (justifiably) afraid of getting arrested for practicing medicine.

Ironically, on March 3, the same day the HRW report was released, Afghanistan announced yet another doomed attempt to eradicate opium poppies, the country’s number one export and the source of 90% of the world’s opium. The U.S. is desperate to convince Afghans to grow anything else: “We want to help the Afghan people make the move from poppies to pomegranates so Afghanistan can regain its place as an agricultural leader in South Asia,” said U.S. Secretary of State Hillary Clinton in an address to the Afghan people last December. Pomegranates? Sorry, Madame Secretary, but the world needs morphine more than grenadine.

Photo credit: Flickr user Dano, distributed under Creative Commons. Tweaked slightly by Lindsay Beyerstein for enhanced legibility.

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View at Medium.com

www.medium.com/@robertdrosejr/are-you-addicted-to-oxygen-e22c33cd3da

Official Court Transcript

Presiding Judge — The Honorable Clarence Darrow

Testimony of Dr. Hippocrates of Kos;

Plaintiff— Dr. Hippocrates, do you like coffee, tea or even breathing?

Defense — Objection! The claimant is threatening the witness!

Plaintiff — Objection? It is a simple question simply to determine if the good doctor if he enjoys life’s simpler pleasure. May I explain your Honor?

Judge — Humm… proceed cautiously sir…

Plaintiff — Understood Sir. The thing is, if the good doctor enjoys any one of these items and the courts deny him his guaranteed right to enjoy the pleasures pursuing happiness, then there will be consequences. First, if you deny Dr. Hippocrates either tea of coffee he has been drinking for many years, then the good doctor will experience various physical discomforts. Some of these include elevated blood pressure, severe headaches and even nervous tremors and cravings. These symptoms can even lead to death by heart attack or even stroke if the blood pressure is not controlled sufficiently.

Now breathing, like denial of pain medications for intractable pain, is very similar in that the body does require it in order to maintain normal functioning of the body similar to pain medications. If you deny the body of either, serious side effects will occur. Various organs within the body will start compensating in order to survive and protect the brain from a complete shutdown. With continued oxygen deprivation results in fainting, long-term loss of consciousness, coma, seizures, cessation of brain stem reflexes, and eventual brain death.

Denial of pain medications will lead to chronic cardiovascular stress, hyperglycemia which both predisposes to and worsens diabetes, splanchnic vasoconstriction leading to impaired digestive function and potentially to catastrophic consequence. Unrelieved pain can be accurately thought of as the “universal complicator” which worsens all coexisting medical or psychiatric problems through the stress mechanisms and by inducing cognitive and behavioral changes in the sufferer which can interfere with obtaining needed medical care. The risk of death by suicide is more than doubled in chronic pain patients, relative to national rates.*

Judge — Objection overruled…. I find the Claimant has proven his case and find the defendant guilty of crimes of medical malpractice…. Court Adjourned!!!

• Alex DeLuca, M.D., FASAM, MPH;Written testimony submitted to the Senate Subcommittee on Crime and Drugs regarding the “Gen Rx: Abuse of Prescription and OTC Drugs” hearing; 2008–03–08.

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https://www.axios.com/cvs-medicare-document-prescription-drugs-a6f0cc08-6cc6-4e49-8f11-427c46057098.html

The details: The document, obtained from a person who works in the pharmacy industry, is an amendment to an agreement between CVS Caremark and an outside pharmacy. It’s related to Medicare Part D, the $95 billion prescription drug program. The amendment outlines what a pharmacy should do in the event the federal government audits any Part D records tied to CVS.

The pharmacy should:

• Let CVS know when the feds come knocking.
• Allow CVS to review the records the government wants to see, before sending them to the feds.
• Label all the confidential stuff as proprietary and exempt from federal open records law.

CVS spokesman Mike DeAngelis said the amendment was made to stay in lockstep with federal regulations, and that “it simply describes commonplace procedures used by companies of all industries, including the health care industry, to protect their proprietary information.”

The bottom line: Companies obviously want to protect trade secrets, and this language more or less addresses that in a specific instance. But these kinds of situations become more complicated when information, such as

contract details for a large taxpayer-funded program, can’t be obtained under federal open records law.

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https://www.westernjournal.com/ct/govt-move-opioid-abuse-backfires/

There has been much discussion in recent years about the crisis of opioid abuse, and while there is broad agreement that “something must be done,” there are innocent victims of a crackdown on opioid drugs that often go unnoticed.

According to the Cato Institute, those overlooked victims are hospitalized patients recovering from accidents or surgeries who are in serious pain, but are unable to receive necessary doses of powerful painkillers to ease their suffering.

Rather than being administered proper doses of opioid drugs, these patients are instead being treated with less effective drugs like acetaminophin, muscle relaxers and non-steroidal anti-inflammatory drugs, similar to what one could obtain over the counter at a local drug store.

In other words, while these people are wracked with excruciating pain and legitimately require the powerful opioid drugs to ease their pain, they are instead left suffering in a literal “hell on earth” due to government intrusion into the pharmaceutical market.

The problem stems from a national quota set by the Drug Enforcement Administration that limits the amount of opioid drugs that can be manufactured and sold.

It was first announced in late 2016 that production of opioids would be reduced by at least 25 percent. The DEA then announced in 2017 that it would reduce 2018 production of opioid drugs by at least another 20 percent from earlier reductions.

The cuts have resulted in a shortage of powerful opioid drugs needed for the legitimate purpose of easing the pain of accident victims, cancer patients and those recovering from surgery, leaving them in a world of hurt.

Making matters worse, the DEA’s cuts are fairly misguided, as the real problem of the “opioid crisis” isn’t the drugs themselves, but the results of an addiction to opioids.

When patients who have been prescribed opioid painkillers can no longer receive those powerful drugs, they often turn to illegal drugs obtained on the street like heroin and fentanyl, which are totally unregulated and when not properly administered, can result in fatal overdoses.

The highly addictive nature of opioid drugs and a tendency for doctors and hospitals to over-prescribe the drugs as a sort of panacea for all health issues is a legitimate problem.

But that problem would likely be better addressed by more stringent oversight in regard to the prescribing of these powerful drugs, not in a blanket reduction of the overall production of the drug that has caused shortages and left legitimate patients in need.

It should also be noted that the DEA alone isn’t responsible for this terrible turn of events, as other factors are most certainly also at play, such as the ongoing consolidation of the pharmaceutical industry, the unfathomable length of time it takes the Food and Drug Administration to approve new drugs and, of course, the typical ebb-and-flow of supply and demand in a market economy.

But the mandated production cuts by the DEA has exacerbated the problems surrounding opioid abuse. Aside from leaving legitimate patients in pain, the move could also result in more patients turning to alternatives like heroin or fentanyl to deal with their incredible pain on their own, which raises the risk of overdose or running afoul of the laws against illicit drug use.

RELATED: Mother Weeps in Court After Allegedly Recording Herself Giving 16-Month-Old Child Drugs

Many people have viewed the overarching “war on drugs” as largely being a failure — drug abuse rates have remained steady despite the expenditure of hundreds of billions of dollars to combat the problem — and this recent move to crackdown on the opioid crisis is simply the latest such misguided government effort to combat drug abuse and addiction.

The opioid abuse crisis deserves plenty of attention, but keep in mind there are legitimate purposes for such drugs and a blanket reduction in their availability does nothing to solve the underlying problem. In fact, it only makes things worse for those truly in need.

Let’s remember those hospital patients in severe pain as we continue to debate the best way to reduce addiction and dependence on powerful drugs.

What do you think? Scroll down to comment below!

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Every day we hear new evidence of how the Trump administration’s policies are trampling on people’s rights, ripping families apart, and destroying the very fabric of our democracy.

It’s maddening. But, we can fight back.

With 137 legal actions challenging the Trump administration, the ACLU is making a difference for those whose rights are most at risk.

Here’s the important step we need you to take right now.

Support the ACLU by becoming a Guardian of Liberty with a monthly pledge of $15 or more.

Your monthly support will ensure that ACLU advocates can respond quickly whenever people’s civil liberties are under attack — and keep fighting for as long as it takes.

And thanks to a group of generous donors, your first three monthly Guardian of Liberty gifts will be matched dollar-for-dollar, up to the match limit of $25,000.

That means a monthly gift of $15 will translate to an additional $45 for the ACLU, multiplying your impact on time-sensitive work like protecting the right to vote, challenging Trump’s transgender military ban, fighting for criminal justice reform — to name a few.

With so many assaults on people’s rights coming every day, there couldn’t be a better time for you to act.

Everything we believe in is on the line. Please become a Guardian of Liberty today: aclu.org/GOL

Thanks in advance,

Anthony D. Romero
Executive Director, ACLU

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Given today’s technology, one wonders what path a constituent’s correspondence takes.  Each Member of the House represents 710,000 constituents.  Senators’ numbers are a bit different… Since TWO SENATORS represent a state and the most populous state is CALF with 40 million and then there is little old Wyoming  with a 589,000 population.

There may be exceptions, but normally I read about a constituent contacting someone in Congress about denial of chronic pain meds .. only to get back a letter discussing what is being done in fighting the opiate crisis.

I think that it would be interested to see a study on what the constituent correspondence asks and what comes back..  I suspect that we know the answer.. without a study.

Correspondence could take one of two paths… gets scanned into a computer and the computer looks for “key words” in the text and generates a “form letter” based on the key words. Or the same task is done manually using office staff.. to pick the form letter and/or choosing specific form paragraphs to compose a return letter.

In turn, there is data on a spread sheet collected based on the key words for the member of Congress to review. So that they can be “in-sync” with his/her constituent’s concerns.

IF you pay attention to what “big business” does to get things their way on the hill… they hire lobbyists… who does their lobbying IN PERSON.. Many lobbyist firms will generate proposed bills and presents them to member of Congress and ask them to sponsor the bill.

Maybe the chronic pain community needs to come up a “proposed bill” to benefit those in the chronic pain community and ask – IN PERSON – various members of Congress to sponsor/co-sponsor the bill. 

May be a better outcome, than what has been done in the past… ?

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I have been posting on this blog for SIX YEARS as well as Facebook and Twitter. Reflecting in the rear view mirror of those in the chronic pain community…  numerous people and chronic pain pts have “stepped up” to make things happen.

People have “stepped up” .. with “tons” of enthusiasm.. only to be discouraged because change doesn’t happen in a time frame measured in days or weeks… more like months, quarters and years.. if at all.

People have stated that they have sent letter, emails, faxes or called members of Congress’ offices and or various persons in the media, and typically they get back information about the opiate crisis we are dealing with.

Dozens or hundreds of petitions have been put up on various websites and goals of tens or hundreds or tens of thousands were the goal to have people sign these petitions and in the end.. MAYBE a few hundred would sign them.. given that there is supposedly 100 + million chronic pain pts… the turn out to sign these petitions could only be “measured” as POOR.

There has been a few attempts in getting “demonstrations” at state/federal capitals.  Again, the “body count” considering all the estimated 100 + million chronic pain pts… Again, a poor turn out..

The DEA has raided Dr Tennant’s office a few months ago and there was a “go fund me ” fund to raise money for his legal defense … After about FOUR MONTHS… – as I write this post – 111 separate contributions have been made.

A couple of years ago, another chronic pain pt and myself tried to create a “legal defense fund”.. our goal was to get about 1% if the chronic pain pts to contribute – ONE TIME – the cost of a fast food lunch ($5.00 – $7.50).. after about ONE MONTH… a couple of dozen people had made contributions with a total of around $600. Not even close to the amount needed to fund the creation of a non-profit for the legal defense fund… The contributions were refunded and the project was abandoned.

Maybe this is why when someone looks in our rear view mirror… it appears EMPTY, but that may be the “sanitized picture”.. perhaps the real picture would be a road clutter/clogged with “dead bodies” and “incapacitated bodies ” from all the chronic pain pts that have had their medication reduced or stopped ? I wonder how many of those “bodies” didn’t expect it to HAPPEN TO THEM… they were good little pts…  They had been using the same prescriber for years or decades. If they kept their heads down… everything would be OKAY ?

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Opioid prescribing drops largest amount in 25 years

https://www.washingtonexaminer.com/policy/healthcare/opioid-prescribing-drops-largest-amount-in-25-years

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Trial for doctor linked to Glen Cove overdose begins

Opening statements, undercover video in Day 1 of Belfiore opioid trial

http://liherald.com/stories/feds-merrick-doctor-a-dealer-not-a-healer,102325

The Merrick physician facing federal charges of illegally prescribing opioids, and causing the overdose deaths of two South Shore men, began on Wednesday, with prosecutors calling Dr. Michael Belfiore “a dealer, not a healer,” and Belfiore’s defense attorney insisting that the doctor is being unfairly prosecuted.

Belfiore was also implicated in the 2009 death of Mario Marra, of Glen Cove. Medical records in the case were subpoenaed, although charges were not filed.

Medical records indicate that Belfiore prescribed Marra fentanyl on March 7, 2009. He died on March 15, according to the coroner’s report.

Belfiore, in an interview last summer, admitted Marra was a patient, but disputed much of Claudia’s account, adding that if Marra was “responsible with the medication, and took it as directed, he’d still be here.”

Belfiore’s trial, at the U.S. District courthouse in Central Islip, is expected to last five weeks, according to his attorney, Tom Liotti, of Garden City.

After a jury was selected, Assistant U.S. Attorney Bradley King made his opening argument, describing the circumstances in which John Ubaghs, of Baldwin, and Edward Martin, of East Rockaway, were found dead — both allegedly with bottles of oxycodone prescribed to them by Belfiore.

King also introduced the government’s first witness against Belfiore: Detective James Marinucci, of the Nassau County Police Department’s vice squad. Marinucci — undercover as James Burke, a factory worker with back pain — saw Belfiore as a patient six times in 2013, obtaining six prescriptions for oxycodone. He paid in cash each time.

In a lengthy video — taken by a hidden camera Marinucci wore on a necklace — shown to jurors, the undercover detective was seen and heard during an initial appointment with Belfiore in March 2013.

During the visit, Marinucci complained of back pain, and told Belfiore that his ex-girlfriend used to share her “Oxy 30s” with him — Marinucci testified that he used this “street” phrase for the medication deliberately with Belfiore.

Belfiore agreed to write Marinucci multiple prescriptions, including for oxycodone, anti-inflammatories and Trazodone, for sleep, but did warn the undercover detective — using colorful language — about the dangers of sharing controlled substances with others.

“I’m not gonna share a jail cell with you,” Belfiore joked at one point, later stressing, “You don’t understand the stigma that’s attached to these medications now.”

Liotti was expected to cross-examine Marinucci on Thursday.

Liotti, has maintained that opioid manufacturers are the culprits in Ubaghs’s and Martin’s deaths — and in the country’s larger opioid crisis.

The defense attorney reiterated the point during his opening arguments, also calling the grand jury process that led to Belfiore’s indictment, in which he was not allowed to be present, a “one-sided proceeding.”

“We offered our own expert testimony — the government wouldn’t allow it,” Liotti said, also warning jurors that he believed the government would try to connect Belfiore’s case to the hundreds of thousands of opioid deaths nationwide.

He also challenged prosecutors to define the number of pills Belfiore could have prescribed that would have met their definition of “with a legitimate medical purpose.”

“There can be no guess-work or speculation here,” he added.

Belfiore also, Liotti said, had been honest with law enforcement throughout the yearslong case, “perhaps to a fault,” and made reference to both Arthur Miller’s “The Crucible,” and the film “12 Angry Men,” as he tried to paint Belfiore as the government’s scapegoat.

“His career and his life are on the line,” Liotti said.

Look for more coverage of Belfiore’s trial in next week’s edition, and online.

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