“The moral test of a government is how it treats those who are at the dawn of life, the children; those who are in the twilight of life, the aged; and those who are in the shadow of life, the sick and the needy, and the handicapped.” – Hubert Humphrey
passionate pachyderms
Pharmacist Steve steve@steveariens.com 502.938.2414
A recent meta-analysis found that palliative care interventions were associated with statistically and clinically significant improvements in patient quality of life (QoL) and symptom burden.1
Palliative care improves the quality of life of seriously ill patients.The study analyzed 43 randomized clinical trials, including data on 12,731 patients, with 35 of those trials using “usual care” as the control. While the associations with QoL and symptom burden were challenged by the heterogeneity of current research trials concerning palliative care,2 researchers found palliative care consistently associated with patient and caregiver satisfaction, as well as lower health care utilization.
“We’ve seen people who get involved with palliative care sooner definitely have a better quality of life, and they may live longer,” said Mary Lynn McPherson, PharmD, MA, BCPS, CPE, professor and executive director for advanced postgraduate education in palliative care for the University of Maryland’s School of Pharmacy in Baltimore, Maryland. The meta-analysis only included 1 study that had patient survival as a primary end point. In that study, Bakitas et al did find patient survival 1 year after palliative enrollment was better compared to patients who enrolled 3 months later.3
A similar study in 2010 found patients receiving early palliative care for their lung cancer showed better QoL and mood. And while patients who had “early” palliative care did receive less aggressive care at the end of life, their survival was still longer compared to patients who had standard care.4
Because palliative care is not concerned with patient survival, clinicians and patients may hold the negative perception that patients receiving palliative care will not live as long, something the data appears to disprove. Palliative care “is an added layer along with everything else,” said Dr. McPherson. “We’re turning the tide from getting practitioners to stop thinking palliative or hospice care means ‘giving up.’ Even hospice care doesn’t mean we’re giving up,” she noted. “There may not be hope for a cure, but there is still hope that we can relieve the symptoms, relieve existential angst, and so on.
“But palliative care is not always about terminally ill patients. It’s all about quality of life—maximizing quality of life and maximizing outcomes, whether they be clinical or terministic,” she concluded.
An Iraq War vet, a 12-year-old girl with a seizure disorder and an ex-NFL player are among five plaintiffs challenging the constitutionality of the Controlled Substances Act (CSA) as it pertains to marijuana.
NEW YORK (AP) — Army veteran Jose Belen says the horrors of the Iraq War left him with post-traumatic stress disorder, and the drug that helped him cope best with the symptoms was one his Veterans Affairs doctors could not legally prescribe: marijuana.
“Once I did use cannabis, immediately I felt the relief,” said Belen, who is now working with other medical marijuana users to mount a long-shot court challenge to federal laws criminalizing the drug.
The 35-year-old, married father of two is one of five plaintiffs in a lawsuit claiming that the government’s decision to classify marijuana as dangerous is irrational, unconstitutional and motivated by politics, not hard science.
Iraq war veteran Jose Belen, who takes marijuana to treat post-traumatic stress disorder, poses in front of federal court, Tuesday, Feb. 13, 2018, in New York. Belen is one of five plaintiffs in a lawsuit challenging federal marijuana laws. He is set to appear in a New York courtroom on Wednesday for arguments in a lawsuit that claims classifying marijuana as a dangerous drug is irrational and unconstitutional. (AP Photo/Mark Lennihan)
Government lawyers will argue Wednesday before U.S. District Judge Alvin Hellerstein in New York that the law is well-grounded and the case should be dismissed.
The lawsuit challenges the listing of marijuana as a Schedule I drug, a category that includes heroin and LSD. The federal government says drugs under the classification have no accepted medical use and cannot legally be prescribed.
The lawsuit names the Department of Justice, Attorney General Jeff Sessions and the Drug Enforcement Administration as defendants.
The other plaintiffs include:
— Former NFL player Marvin Washington, the co-founder of a company that sells hemp-based sports performance products;
— A nonprofit organization called the Cannabis Cultural Association that helps minorities benefit from the marijuana industry in states where it is legal;
— Twelve-year-old Alexis Bortell, who takes marijuana to control epilepsy, and 7-year-old Jagger Cotte, who uses marijuana to treat a severe neurological disorder called Leigh’s syndrome.
Alexis Bortell, age 11, gets a kiss from her father, Dean Bortell, as the two wait to testify during a Colorado House committee hearing on marijuana legislation March 6, 2017, in Denver. The Bortell family moved from Texas to Colorado to treat Alexis’ seizures with medical cannabis. (David Zalubowski, The Associated Press)
Poised and outwardly calm, Belen, who lives in Orlando, Florida, said he left a post-military career in insurance to found an organization called Mission Zero that works to end suicide among veterans.
Medical research on marijuana has been sharply constrained by federal law, but Belen said he found it effective for taming PTSD symptoms while other medications pushed him closer to depression and possibly suicide.
He said it is unfair that federal law prohibits him from crossing state lines with the drug, even when traveling to states where it is legal.
“I went to Iraq to free the oppressed and I view this no different,” Belen said. “The oppression is only being done by our own government.”The plai
ntiffs have asked the court for the broadest of remedies: a permanent injunction preventing the government from enforcing the Controlled Substances Act as it pertains to cannabis. It isn’t clear what the practical effect of such a ruling would be.
The government argued in its motion to dismiss the lawsuit that if the plaintiffs want the drug reclassified, there are other options, including an administrative petition to have marijuana rescheduled or asking Congress to change the law.
In a court filing, government attorneys said the administration “uniformly rejects the notion that there is a fundamental right to use marijuana, including for medical purposes.”
Marijuana got its Schedule I designation as part of the ranking or “scheduling” of drugs under the 1970 Controlled Substances Act.
According to the lawsuit, Republican President Richard Nixon ignored an expert panel’s recommendation that possession of cannabis for personal use be decriminalized because he wanted to use drug policy to target anti-war protesters and black people.
The lawsuit quotes Nixon domestic policy chief John Ehrlichman, who was quoted in a 2016 Harper’s Magazine story as having said: “We knew we couldn’t make it illegal to be either against the war or black, but by getting the public to associate the hippies with marijuana and blacks with heroin and then criminalizing both heavily, we could disrupt those communities.”
The plaintiffs say marijuana doesn’t meet the Schedule 1 requirements of having a high potential for abuse, no medical use in treatment and no possibility for safe testing.
The lawsuit notes that in 2014 the Justice Department and the Treasury Department’s Financial Crimes Enforcement Network issued guidance for how banks could provide services to marijuana businesses that were legal under state laws.
“On the one hand the federal government wants to put people in jail, while at the same time the federal government currently has a policy to encourage banks to go into business with cannabis companies,” lead attorney Michael Hiller said. “They’re attempting to reserve the right to prosecute people for engaging in the very conduct that the federal government has encouraged.”
Encouraging federal prosecutors to hit hard, he said that Congress had decided that “marijuana is a dangerous drug and that marijuana activity is a serious crime.”
LAS VEGAS – Nightly newscasts across the country are filled with stories about the opioid epidemic — the opioid crisis. Tens of thousands of Americans who die each year are found with opioids in their systems, and so government at every level has stepped in to put limits on otherwise legal medications, including here in Nevada. For millions of chronic pain patients, the crackdown has been a nightmare. They are the forgotten victims in the opioid debate. Approximately 50,000 people a year die with opioids of one kind or another in their systems. The number you don’t hear is this one — there are as many as 25 million Americans who suffer with chronic pain. For many of them, opioid medication means the difference between leading somewhat normal lives, or surviving in constant agony. These are not the people who O.D. on heroin or mix drugs with booze. For the most part, they suffer and die in silence.
At 34-I have had chronic pain & migraines all my life- My mother used to tell me of all the times I Used to bang my head when I was a baby- I have suffered with migraines so bad it felt like my brain was going to squeeze thru my nose- I have pain all thru my body and have seen at least 100 doctors- most of them specialists- if there are others out there like me-I could use someone to talk to- someone to share ideas with or find out if there is a way to correct it- I am NOT A DRUG SEEKER- I am a pain relief seeker but NO ONE believes me- how do I get that across to any doctor or nurse? Does anyone know of a good patient advocate in Dover Delaware? would a Patient Advocate even help or do I have to continue with this miserable condition where I truly cannot lead a life- (I won’t say normal- I just want a life) Please contact me if there is any advice or referrals that I could access.
Nearly one million Canadians spent less on necessities like food and heat to afford their prescriptions in 2016, according to a new study.
The paper, published Tuesday, found that 730,000 people skimped on food and another 238,000 spent less on heating their home — a total of 968,000 people.
“We knew lots of Canadians were having trouble paying for medication,” said Michael Law, lead author on the paper and associate professor in UBC’s school of population and public health.
“Now we know they are trading off other everyday necessities in order to pay for prescription drugs.”
Canada is the only country in the world that has universal health care but no universal drug coverage. (David Gray/Reuters)
The study surveyed 28,091 people as part of the Statistics Canada Canadian Community Health Survey, asking questions about their finances and prescriptions.
People without insurance, people with lower incomes and younger people in general were more likely to say they struggle to afford medication.
Indigenous people were nearly twice as likely to report challenges, as were women comparatively to men.
The study also said more than 1.6 million Canadians — 8.2 per cent of people who were prescribed medication in 2016 — didn’t fill those prescriptions, skipped doses, or otherwise didn’t take the medicine because they couldn’t pay for it.
The study said more than 1.6 million Canadians prescribed medication in 2016 didn’t fill those scrips, skipped doses, or otherwise didn’t take the medicine because they couldn’t afford it. (iStock)
Not taking prescribed medication strains the health-care system, researchers said, as people who stay sick end up taking repeat visits to their doctor or the emergency room.
The researchers — who are from UBC, Simon Fraser University, McMaster University, and The University of Toronto — said results show that Canada needs to take another look at how prescriptions are covered.
“Despite Canada’s reputation of having a universal healthcare system, the fact that so many people cannot afford their medicines is a sign that people are falling through the cracks,” Law said.
The five biggest companies making prescription opioids have been accused by a US Senate committee of spending $10m on patient advocacy and medical groups to encourage use of the addictive drugs, which are at the root of a public health crisis in America.
The committee reported on Monday that Purdue Pharma, manufacturer of leading narcotic painkiller OxyContin, made the largest donations to outside groups that present themselves as advocates for people suffering from chronic pain.
“In some instances they are merely fronting for these manufacturers, especially if you look at the lobbying they’ve done against restricting opioids,” said McCaskill, adding: “These financial relationships were insidious, lacked transparency, and are one of many factors that have resulted in arguably the most deadly drug epidemic in American history.”
The committee, which has been investigating Big Pharma practices from 2012 to 2017, said Purdue Pharma gave the most money, $4.15m to 12 groups. Purdue said in a statement that it supported organisations interested in helping patients receive appropriate care.
The report notes that organizations such as the American Academy of Pain Medicine play down the risks of addiction and abuse. The report names Purdue Pharma, Janssen Pharmaceuticals, Mylan, Depomed and Insys Therapeutics.
McCaskill launched the investigation last spring by saying: “We want to get to the bottom of why, all of a sudden, opioids have been handed out like candy in this country.”
Another congressional attorney that was in law school during the 70’s… as the DEA/war on drugs was ramping up… Criticizing that Purdue pharma gave about 1/3 million dollars to 12 different pro-patient chronic pain groups.. This is just one of the 535 members of Congress who the lobbyist industry spends 9+million/day to influence these members of Congress…
Congresswoman Mc Caskill won’t have to run for re-election until 2022… voters have short memories so she has plenty of time for voters to forget what Mc Caskill has investigated or voted for.
I Am a 49 year old man with a rare syndrome called Klippel -Trenaunay- Webber -Syndrome..I been fighting this all my life without any doctors knowing what to do for me but rip me open time after time after time. Ever since they started the stop on opioids my pain doctor tells me he can’t do nothing but reduce me cause of the DEA. I’m about to put a bullet in my head to stop the extreme pain I get from him reducing me I am not a drug addict but yet cause of what is going on I get shuffled with them I am a chronic pain suffer NO MORE NO LESS. My doctor tells me I’m going to even get knocked down more when he does this I will not know if I can deal with it cause of what he’s doing I’m stuck in a wheel chair now I haven’t seen my blood doctor or my heart doctor. I get blood clots and bleed very bad get serious infections through out my body that needs to be monitored but can’t get to a hospital to be moved..please help or get my story out there. At my wits end why aren’t they going cause to case why is it that drug addicts get free clinics opened in New Jersey to go and soot up but I can’t get nothing to help with my pain…at this point in my life I don’t know if I should start going that way since that is the way the GOVERNMENT WANTS ME TOO. Or just end my pain. Can’t take it anymore please help…..
While I do not encourage anyone to commit suicide… there are some pts in this country are being left with a single choice to put a “end” to their pain – permanently… Should these chronic pain pts make a final effort to share their pain… making a video… do a facetime live… make a post on FB… send a letter to many friends they can trust to follow thru with their wishes… and that would be to have their prescriber to be charged with assisting suicide or assisting manslaughter… what ever legal violation that they can be charged with…
IF they are so F-ing concerned about their license and their livelihood… shouldn’t a pt put in this position take that final swing at making sure that the prescriber gets what he/she is afraid of… losing their license and their livelihood… The DEA has “taken out” untold number of prescribers because a small number of their pts have OD’d … maybe they committed suicide and the DEA is their zest to find a prescriber to “take to the cleaners” that they don’t look for the reason for the OD.
Those pts who have been pushed to this point should be “mad as hell and not going to take it anymore” and will spend their final hours/days in sharing their pain with those who have caused them to be in this position.
Personally, I am tried of trying to be politically correct and trying to offer pts some “guidance ” in dealing with their plight… when I know damn good and well that any reference that I give them… it will take 1-2 yrs for the bureaucrats that are suppose to protect these people from being abused to get their bureaucratic ass in gear.. .and we all know by then it will be too little too late.
where a prescriber is being sued by a spouse because her husband committed suicide while he was in the middle of a two month weaning down from being on opiates for chronic pain. It is obvious that healthcare professionals have NO FEAR OF PTS… I feel sorry for this prescriber.. but.. this lawsuit could change the path that chronic pain treatment in this county could take…
For hundreds of years, people have used kratom leaves or powders for pain relief.
Currently legal in the United States, millions of Americans have safely used kratom for therapeutic and recreational purposes.
In recent years, federal agencies which have no regard for individual liberty like the Drug Enforcement Administration and the Food and Drug Administration have set their sights on kratom.
In 2016, the DEA announced plans to “place the active materials in the kratom plant into Schedule I of the Controlled Substances Act in order to avoid an imminent hazard to public safety.”
Schedule I of the Controlled Substances Act is the most restrictive category of the drug scheduling system and includes drugs like heroin and marijuana. Practically, this would prohibit kratom for any use under federal law.
The DEA later backed off of this decision, an odd move if the DEA seriously believed the American people faced “an imminent hazard to public safety” because of kratom. Probably, the DEA doesn’t really care about public safety, it’s more interested in expanding its own powers and keeping the money flowing.
But now, the prospect of kratom prohibition is back. The FDA recently reiterated its own “concerns about kratom’s potential for abuse, addiction, and serious health consequences; including death.”
As evidence, the FDA pointed to 44 deaths involving the use of kratom. But as Reason pointed out, most of those deaths involved the presence of multiple drugs and many involved other health problems, and are hardly evidence of anything other than that bad things have happened to some people who have ingested kratom at some point prior to their deaths.
And as a group of nine scientists argued in a letter to the White House, “the existing science on kratom does not justify its placement into Schedule I of the CSA, nor for kratom to be added to any local or state Controlled Substances list that would effectively remove it from consumer access.”
Proponents of safe access to kratom and individual liberty alike should make clear their opposition to any attempt by the federal government to prohibit or overly restrict access to kratom. People should absolutely be aware of any risks or dangers of kratom use, but prohibition will only punish those with legitimate needs and create a whole new black market with all the risks and downsides black markets have.
Rather than exert the force of government to punish people for ingesting substances unapproved by some government bureaucrats, the federal government should respect the freedom of people to make their own choices and do with their own bodies what they wish.
Sal Rodriguez is an editorial writer and columnist for the Southern California News Group. He may be reached at salrodriguez@scng.com
This week, several federal lawsuits will push marijuana legalization into a judicial spotlight. On Wednesday, attorney Bob Hoban will offer oral arguments in support of his plaintiff clients in Hemp Industries Association v. Drug Enforcement Administration (DEA).
The crux of that lawsuit is the DEA’s stance toward industrial hemp and whether it conflicts with language in the 2014 U.S. Farm Bill. Within that landmark agricultural legislation, the U.S. Congress defined industrial hemp as “all parts of the plant cannabis sativa l., so long as the dried materials of the plant is less than 0.3 percent THC.”
But a January 2017 DEA “final rule” includes industrial hemp in its marijuana enforcement drug code, with the net result being no distinction between the non-psychoactive hemp compounds and the rest of the cannabis plant’s chemical makeup. According to the DEA, any amount of THC subjects the plant to the Controlled Substances Act. The HIA argues that cultivation of industrial hemp should be permitted legally, citing the Farm Bill language.
The current federal lawsuit has roots in a 2003 lawsuit, which bore much of the same argument. The Ninth Circuit Court of Appeals ruled in favor of the HIA in 2004.
In January of this year, 28 members of the U.S. Congress published a letter of support for the HIA. “The [DEA’s] Final Rule is inconsistent with the Farm Bill’s most fundamental purpose: to allow states that wish to experiment with commercial research and development of industrial hemp, including extracts and derivatives therefrom, to do so without interference from the DEA.”
In a public statement provided at the time the lawsuit was filed, Hoban’s associate, Garrett Graff, wrote, “We hope to accomplish a striking of the rule, permanent injunction of the rule and for the DEA to engage in the appropriate processes and procedures when making rules in the future. Alternatively, an amendment to the rule to make the definition of ‘marihuana extract’ consistent with existing law and reflect those portions and varieties of the plant which are in fact lawful could be considered.”
In our February 2018 issue of Cannabis Business Times, we took at close look at upcoming federal marijuana litigation, including HIA v. DEA. We also looked to Alexis Bortell v. Jess Sessions, for which oral arguments will take place on Feb. 14 in New York’s Southern District Court, and Colorado Alternative Health Care v. IRS.
Could things in the war on drugs’ facade starting to show cracks ? There has been a few things coming to the front that may suggest that may be the case…
I have made several posts over the past couple of weeks that I have not seen before
we know that it is normal for the DEA to come after a prescriber when a pt OD’s on opiates.. it is as if a prescriber never has a pt die… never has one that commits suicide… and that all opiate OD’s are “accidental “? I have had untold number of chronic pain pts that have told me that they have contacted numerous law firms about suing for denial of care, ADA violations, pt abuse, medical battery and the like and have yet to find a law firm that is interested in their case.
The above article about a prescriber is being sued for a pt’s suicide – no doubt it was a suicide because the pt used a GUN… the prescriber had been weaning the pt off of his opiates for about one month and had promised to continue assistance in weaning for another month.. when the pt chose the ultimate solution to end his pain.
Yet a law firm is apparently ready, willing and able to sue this prescriber on behalf of the pt’s spouse because of the pt’s suicide. Is this lawsuit just an anomaly or the first in many that may come to bear on prescribers for various reasons in failing to properly treat – or not treat at all – chronic pain pts.. especially those suffering from intractable moderate/severe chronic pain and have a medical necessity for 24/7 opiate therapy ?
This is story about a number of medical directors for various insurance companies who stated that they routinely deny coverage of care because they didn’t want to lose their monthly bonus. Who believes that a for-profit health insurance company really has the pt’s health/quality of life as a primary focus of the reason that they are in business ?
Does anyone believe that this one medical director from Aetna is a OUTLIER or just the first one that was under oath in a court of law… and the doctor’s “reasoning” was that “he was following Aetna’s training, in which nurses reviewed records and made recommendations to him.” So it would appear the Aetna is basically granting nurses both diagnostic and prescriptive authority. The term “nurse” can cover a whole range of educational background… from a 1 yr LPN, 2 yr RN, 4 yr BSRN, ARNP, PA, NP. What if those nurses have the same monthly bonus incentive as those medical directors in the previous article ? CVS Health is in the process of buying Aetna for some 60 + BILLION… it would appear that the profitability of Aetna is quite sizeable…
We are seeing entities (PBM) Prescription benefit managers that are dictating how much or little opiate therapy a pt can have… the letter in this posts demonstrates that CVS is demanding that this particular pt reduce the pt’s Methadone from 70 mg/day to 24 mg/day and eliminate the 20 mg Oxycodone 4xd as needed for breakthru. This is the therapy that this pt has been on for numerous years and according to the date on this letter the pt was being granted 60-90 days to wean down to what CVS considered a therapeutic level for this particular pt. “to help ensure the pt’s use of opiates for pain management is SAFE “
now if this pt has been taking this amount of opiates for years… the pt is – without a question – opiate dependent and since the pt has not experienced any adverse reaction to this dosing level.. for this particular pt… it should be considered SAFE
how many more cracks in this war on drugs facade will we see over the near future and how much longer are law firms going to stand on the side lines and turn a blind eye to what is happening to not only chronic pain pts, but all too many pts with chronic diseases ?
The study analyzed 43 randomized clinical trials, including data on 12,731 patients, with 35 of those trials using “usual care” as the control. While the associations with QoL and symptom burden were challenged by the heterogeneity of current research trials concerning palliative care,2 researchers found palliative care consistently associated with patient and caregiver satisfaction, as well as lower health care utilization.
