why listen to experts as to what will work or NOT WORK ?

Posted on November 30, 2017 by Pharmaciststeve

The Health 202: Jeff Sessions wants to put more cops on the opioid beat. Experts say that won’t solve the problem.

https://www.washingtonpost.com/news/powerpost/paloma/the-health-202/2017/11/30/the-health-202-jeff-sessions-wants-to-put-more-cops-on-the-opioid-beat-experts-say-that-won-t-solve-the-problem/5a1ef05130fb0469e883f90b/

If the opioid epidemic was simply a problem of supply – people being able to access drugs too easily – than a targeted new effort in Appalachia announced by Attorney General Jeff Sessions yesterday would be a huge stride toward combating the crisis.

The problem with this approach, however, is that experts agree the opioid epidemic is all about demand. Far too many Americans rely on opioid painkillers, creating a huge customer base for illicitly gained prescription drugs and more serious street drugs, such as heroin and fentanyl.

Sessions’s new plan involves sending more Drug Enforcement Agency agents to the areas where opioid abuse is most rampant. But those fighting the epidemic on the ground say the law enforcement strategy must be coupled with medical help for those suffering from addiction, or the Trump administration won’t get very far in its efforts.

“This is a demand-driven problem and we are trying to apply supply-restricting solutions,” Michael Brumage, executive director of the Kanawha-Charleston Health Department in Charleston, W.Va., told me (West Virginia is the state hit hardest by the crisis). “That’s what we tried on the war on drugs, and that failed.”

Sessions is creating an entirely new DEA division overseeing the Appalachian region to help local law enforcement combat drug abuse, especially of prescription opioids, The Washington Post’s Sari Horwitz and Matt Zapotosky report. He also announced $12 million in new grants and the designation of an opioid coordinator to work with prosecutors to better manage prosecutions.

  
Sessions introduces three initiatives to fight opioid epidemic
 Attorney General Jeff Sessions introduced three initiatives on Nov. 29 to fight the opioid epidemic. (Reuters)

“Today, we are facing the deadliest drug crisis in American history,” Sessions said at a news conference yesterday. “Based on preliminary data, at least 64,000 Americans lost their lives to drug overdoses last year. That would be the highest drug overdose death toll and the fastest increase in that death toll in American history.”

The new Louisville Field Division will unify drug trafficking investigations in Kentucky, Tennessee and West Virginia, with a focus on the Appalachian Mountains, officials said. It will include about 90 special agents and 130 task force officers.

Washington Examiner’s Kelly Cohen:

At least in terms of geography, Sessions is spot on. A few weeks ago, I wrote about the prevalence of opioid abuse in the Appalachian region – and how it gets worse and worse the closer in you get to West Virginia (which is basically the epicenter of the crisis).

If you look at what researchers call “diseases of despair” (drug and alcohol overdose, suicide and alcoholic liver disease), they have a stronger foothold in the center of Appalachia than on the fringes. In central Appalachia, those maladies led to 94.4 deaths per 100,000 people, but the rate is 52.3 deaths per 100,000 in southern Appalachia.

But law enforcement officers will tell you that keeping an area free of drug dealers for any length of time is a steep task. Brumage called the new DEA forces a “step in the right direction,” but his enthusiasm is tempered.

“Once you bust everybody in a particular area, you have a temporary lull but it lasts only a few days,” Brumage said. “There are always people and supply willing to fill the void.”

Activists who watched the uphill and international “war on drugs” of the past several decades also fear the Trump administration will halt its efforts with beefing up law enforcement, instead of also pouring more resources into helping Americans break free of their drug addictions.

“The emphasis continues to be punishment, so I think it’s very concerning,” said Gabrielle de la Gueronniere, director of policy for the Legal Action Center, a nonprofit organization that fights discrimination against people with a history of addiction. “We’re not really treating this as an illness. There’s a huge treatment gap.”

Sessions also announced that White House counselor Kellyanne Conway will continue to help lead the opioid effort:

1:51
Sessions praises Kellyanne Conway’s leadership of White House opioid effort
 
 

Attorney General Jeff Sessions thanked White House counselor Kellyanne Conway on Nov. 29, for her role coordinating and leading the White House opioid effort. (Reuters)

Several reporters clarified that the Trump administration isn’t creating a new “drug czar,” as some reports suggested. Politico’s Brianna Ehley:

Politico’s Sarah Karlin-Smith:

On a related topic, Sessions said he’s “dubious” of a law restricting DEA’s enforcement powers, which The Post detailed in a recent investigation. Per The Post’s Sari Horwitz:

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Sessions and Acting DEA Admin. Begin Drug War Actions Not Allowed in Constitution

Posted on November 30, 2017 by Pharmaciststeve

A news release issued by the Department of Justice on November 29 stated that Attorney General Jeff Sessions (shown) had announced “new resources and stepped up efforts to address the drug and opioid crisis.” However, our attorney general is apparently unaware of (or chooses to ignore) the fact that the 10th Amendment plainly states that the powers not delegated to the United States (i.e., the federal government) by the Constitution are reserved to the states and that the power to prohibit drugs or other substances is not to be found in the Constitution. That is why the prohibition of alcohol required an amendment to the Constitution, since back in 1919 those running our federal government still recognized that they had no power constitutionally to prohibit alcoholic beverages otherwise.

The DOJ release noted that Sessions was joined by Acting DEA Administrator Robert Patterson in announcing the following efforts during a press conference at the Department of Justice:

Over $12 million in grant funding to assist law enforcement in combating illegal manufacturing and distribution of methamphetamine, heroin, and prescription opioids;

The establishment of a new DEA Field Division in Louisville, Kentucky, which will include Kentucky, Tennessee, and West Virginia, a move meant to better align DEA enforcement efforts within the Appalachian mountain region;

And a directive to all U.S. Attorneys to designate an Opioid Coordinator to work closely with prosecutors, and with other federal, state, tribal, and local law enforcement to coordinate and optimize federal opioid prosecutions in every district.

 

“Today we are facing the worst drug crisis in American history, with one American dying of a drug overdose every nine minutes,” the release quoted Sessions as saying. “That’s why, under President Trump’s strong leadership, the Department of Justice has been taking action to make our drug law enforcement efforts more effective.”

“DEA continually looks for ways to improve operations and interagency cooperation and more efficiently leverage resources,” said Patterson. “By creating a new division in the [Appalachian mountain] region, this restructuring places DEA in lockstep with our partners in the area to do just that. This change will produce more effective investigations on heroin, fentanyl, and prescription opioid trafficking, all of which have a significant impact on the region.”

During the DOJ press conference, reported the Washington Post, Sessions also said that he had been “dubious” of a 2016 law that took away many of the DEA’s powers to act against distributors and manufacturers of prescription opioids, saying that he would support new legislation to restore the agency’s authority in those areas.

“I was dubious about the law when it passed,” said Sessions, who was a senator at the time. “I believe I was maybe the last person that went along with it after the department and DEA agreed to accept it…. We do need legislation. We can listen to the concerns that certain people had and draft good legislation, but I would be supportive of new legislation to be able to have a full toolbox in dealing with the problem of improper sale policies.”

The Post reported that Sessions said that Kellyanne Conway, currently serving as counselor to the president in the Trump administration, has been tasked with overseeing White House initiatives to combat opioid abuse. She attended the DOJ conference on November 29.

“The president has made this a White House priority. He’s asked [Conway] to coordinate and lead the effort from the White House,” Sessions said, calling Conway “exceedingly talented.”

“Today we are facing the deadliest drug crisis in American history,” Sessions stated during the press conference. “We’ve never, ever seen the death rates that we’re having today — 64,000 died last year.”

While Sessions’ statement about the deaths resulting from the drug crisis certainly warrants looking for a solution to this tragic situation, it ignores the fact that the use of harmful substances is basically a behavioral problem rather than a law-enforcement problem — much less a federal law-enforcement problem. Like other social ills stemming from bad behavior, the drug problem is best solved at the state and local level, which is also the only constitutional remedy for this crisis.

Former congressman and presidential candidate Ron Paul, who is also a medical doctor, wrote an article about the federal government’s failed drug war last May. In that article, he addressed Sessions’ decision the previous week to order federal prosecutors in drug cases to seek the maximum penalty authorized by federal mandatory minimum sentencing laws.

Paul wrote that Sessions’ support for mandatory minimums was no surprise, as “he has a history of fanatical devotion to the drug war. Sessions’ pro-drug war stance is at odds with the reality of the drug war’s failure. Over forty years after President Nixon declared war on drugs, the government cannot even keep drugs out of prisons!”

The former constitutionalist/libertarian congressman observed that, as was the case with alcohol prohibition, the drug war has empowered criminal gangs and even terrorists to take advantage of the opportunity presented by prohibition to profit by meeting the continued demand for drugs.

Paul’s most important reason for objecting to the war on drugs is constitutional, however. He continued:

The war on drugs is a war on the Constitution as well. The Constitution does not give the federal government authority to regulate, much less ban, drugs. People who doubt this should ask themselves why it was necessary to amend the Constitution to allow the federal government to criminalize drinking alcohol but not necessary to amend the Constitution to criminalize drug use.

Paul suggested that “those with moral objections to drug use should realize that education and persuasion, carried out through voluntary institutions like churches and schools, is a more moral and effective way to discourage drug use than relying on government force.”

The beauty of our federal system, composed of separate sovereign states, is that each state has the power to write laws that reflect the moral values of its citizens. As such, the residents of Utah and Alabama might very well favor a different approach to regulating drug use than the citizens of New York or California. The authors of the 10th Amendment understood this principle, which is why they reserved to the states all powers not delegated to the federal government.

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Senator McCaskill.. let the CPP just suffer… repeal Ensuring Patient Access and Effective Drug Enforcement Act

Posted on November 29, 2017 by Pharmaciststeve

McCaskill continues fight to restore DEA enforcement power during opioid epidemic at Senate Roundtable

http://www.thesalemnewsonline.com/news/local_news/article_f85da9be-d528-11e7-a679-3397229c198d.html

Senate colleagues in order to discuss the need to strengthen Drug Enforcement Administration (DEA) enforcement against opioid distributors and her bill to repeal the Ensuring Patient Access and Effective Drug Enforcement Act of 2016. Public reports have indicated that the law, along with a revolving door between the DEA and drug distribution industry, had dramatically restrained the agency’s enforcement efforts.

“This legislation was clearly not helpful in terms of removing a valuable tool that was a deterrent…a deterrent to some of the largest companies in America that there were serious and significant consequences if they didn’t do it by the book,” McCaskill said. “When you remove that deterrent, then things get even sloppier, and when things get sloppy in the area of opioids, people die. Innocent people die….So we will do our best to undo the damage that has been done.” 

The 2016 bill purported to “improve enforcement efforts related to prescription drug diversion and abuse” by altering DEA procedures for revoking or suspending registrations for opioid distributors under the Controlled Substances Act. However, the effect of these changes, according to reports, has been to significantly curtail the ability of DEA to bring enforcement actions against drug distributors.

Participants at today’s roundtable included Joseph Rannazzisi, former head of the DEA Office of Diversion Control; Frank Younker, former DEA Diversion Group Supervisor, Cincinnati Resident Office; and Jonathan P. Novak, former DEA enforcement attorney. The DEA denied permission for its Chief Administrative Law Judge John J. Mulrooney II to participate in the roundtable.

Earlier this year McCaskill launched an investigation into opioid manufactures—the most comprehensive Congressional investigation into the crisis to date—when she requested information related to sales and marketing materials, internal addiction studies, details on compliance with government settlements and donations to third party advocacy groups from major opioid manufacturers. She expanded her investigation, requesting documents and information from opioid manufacturers Mallinckrodt, Endo, Teva, and Allergan, while a request to McKesson Corporation, AmerisourceBergen Corporation, and Cardinal Health, Inc., focused on their distribution of opioid products. In September, McCaskill announced the first round of findings, detailing systemic manipulation of the prior authorization process by Insys Therapeutics.

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The Rutherford Institute defends people who have been denied civil and human rights without charging them for such services.

Posted on November 29, 2017 by Pharmaciststeve

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https://www.rutherford.org/legal_assistance

Legal Assistance

>> Online Help Request Form

>> Frequently Asked Questions

>> Freedom Resource Bank

>> Become an Affiliate Attorney

Are you suffering the loss of your freedoms because you cannot afford to stand up for your rights in a court of law? You are not alone. Vast numbers of people are being systematically disenfranchised from their rights in a free nation. And most of the people who need legal help cannot afford to pay legal fees.

That’s why The Rutherford Institute defends people who have been denied civil and human rights without charging them for such services.

The Rutherford Institute exists to ensure that people are treated fairly in the courts and are free to exercise their liberty without fear.

The Rutherford Institute has established a network of state, regional and international affiliates to defend constitutional freedoms. If you or someone you know needs legal assistance, you can call, write, e-mail or use our confidential Online Help Request Form to contact our legal department.

In addition to defending constitutional rights, The Rutherford Institute has assisted thousands of people who seek a greater understanding of constitutional principles as they apply to contemporary issues. From civil liberties such as religious freedom and parental rights to human rights such as the right to be free from sexual harassment, the Institute educates citizens about how to exercise their rights in their culture.

To educate the public on critical issues, The Rutherford Institute publishes numerous books, papers, periodicals and pamphlets, many of which are available in our online store. In addition, our Freedom Resource Brief Bank provides legal resources to assist attorneys involved in constitutional litigation.

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pain doctor’s being “dropped” from being a Medicare participating provider ?

Posted on November 29, 2017 by Pharmaciststeve

Just got a letter from husband’s PM doctor. Medicare dropped her?! He’s been going to her for 15 years. I’m so upset. Apparently it’s because she writes prescriptions for pain medication. And she’s she’s a pain management Dr.

Unless they have changed things… prescribers do not have to be a participating provider…

Being a participating provider means that Medicare will pay them directly…

If they are a non-participating provider, it means that the prescriber is obligated/mandated to bill Medicare for services provided to the pt and the Medicare will send the money reimbursement directly to the pt.

Again unless things have changes, the prescriber is prohibited from charging the pt more than 10%-15% higher charge than what Medicare otherwise allows.  The advantage to a prescriber in being a participating provider is that they do not have to worry about collecting monies from the pt. … many pts do not have the resources to pay the full office visit charge at the time they are seen by the prescriber… making potential for collection problems finding out when Medicare sent the money to the pt and then collecting the amount due.

 

 

 

 

 

 

 

 

 

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All about kratom: Herb still on store shelves, even after death of upstate police sergeant

Posted on November 29, 2017 by Pharmaciststeve

NEW YORK — Members of the American Kratom Association vowed to fight any ban on the herbal supplement that’s been linked to 36 deaths nationwide, and — so far— they’ve succeeded.

But debate is reaching fever pitch about the product, which comes from a plant in southeast Asia and is sold over the counter in capsule, liquid or powder form.

“We believe it has addictive qualities,” said Scott Gottlieb, Commissioner of the Food and Drug Administration

 shortly after the agency issued a public health warning ten days ago.  “And it’s also being used by people who have addiction to opioids.”

The people who swear by kratom have said they use it for all different reasons.

Some insisted it treated their back pain.  Others said it eased anxiety or depression.  Dozens of testimonials are turning up online from people who declared it eased their withdrawal symptoms from opioids like prescription painkillers, heroin or methadone.

“This is stuff that can help with your withdrawals,” said one man on YouTube.

After doing research, PIX11 was surprised to learn about the tragic death of Police Sergeant Matthew Dana of Tupper Lake, New York.

The Franklin County Coroner Shawn Stuart said the only substance found in Dana’s system was a high level of kratom. He believes it caused the hemorrhagic pulmonary edema that Dana died of. The edema brought blood and other fluid into Dana’s lungs.

Advocates for kratom don’t buy the coroner’s findings and have suggested the federal Drug Enforcement Administration is trying to blame kratom for the death so the DEA can ban it.
Dana’s friends said he used to be a bodybuilder and noted YouTube sites have advocated for kratom to boost energy.

The friends told NewYorkUpstate.com that Sergeant Dana had been making the powdered Red Vein Maeng Da brand of kratom into a paste and eating it.

Six states already bar the sale of kratom in shops, but New York and 42 other states allow it over the counter.  You can find it in gas stations, head shops and some kava cafes.
Advocates point out the supplement is in the coffee family.  In small doses, it serves as a stimulant, a “pick me up.”  In large doses, kratom can have sedative qualities.

Steven Chassman, executive director of the Long Island Council on Alcoholism and Drug Dependence (LICADD) is very concerned about clients trying to rely on kratom to deal with opioid withdrawal.

“Opioid dependence is a psychiatric disturbance,” Chassman said.  “When it comes to medical stabilization, you do not get supplements that are bought in gas stations or head shops across Long Island.  They are being misinformed that this is going to help them on the road to recovery, when—in fact—oftentimes we’re seeing that they’re just switching addictions.”

While the FDA is trying to stop the importing of kratom at international mail facilities, a study done at the University of Mississippi had found that “the compounds in kratom aren’t particularly potent opioids like prescription opioids, morphine or fentanyl.”

The DEA still wants to place kratom on a Schedule 1 list of illegal drugs, in the same category as heroin.

Steve Chassman said, “What it does is mirror the effects of opiate-like drugs.  When it’s taken in larger quantities, it releases certain levels of dopamine.”

Consumers can buy a bag of 90 Kratom capsules for $30 at many head and vape shops around New York City and Long Island.  One brand we found was marketed under the name “Pain Out.”

The shops also sell small bottles of liquid kratom for $20, called shots.

After public protests in 2016, when the DEA proposed a ban on kratom, 62 members of Congress signed a letter calling for more study and dialogue on the issue, after members of the American Kratom Association held a protest outside the White House.

Once again the DEA “BELIEVES”… that they don’t have to have any SOLID FACTS to back up their beliefs or opinions…  Where are they gathering these “BELIEFS” from ?

Everyone is entitled their own opinions… they are not entitled to their own FACTS !

 

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Prevention Magazine – they want to do a story on abandoned pain patients.

Posted on November 28, 2017 by Pharmaciststeve

I have been working closely with journalists for several months. In recent days I have been contacted by Prevention Magazine – they want to do a story on abandoned pain patients. Some of you may have seen the AARP magazine’s piece on the opiate crisis that essentially took a ‘sky is falling – oh it’s so awful approach.’ Prevention’s primary readership is female in the range of 40-70. So they would like to discuss with at least 3 females who meet that demographic how you are currently affected by patient abandonment and stigmatization. The primary author is doing his homework and talking to lots of people that we know. I put him in contact with George Knapp’s current series and radio broadcast. If you are interested, please contact me at tal7291@yahoo.com and provide me with the information you want to use to be contacted.

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Online survey needs your input

Posted on November 28, 2017 by Pharmaciststeve

Steve,
Can you get this online quickly? Terri Lewis, PhD sent to me since I use Opana ER.
As a reminder, our PainEDU survey will be open until Wed, 11/29/17 at 5:00pm EST. The FDA asked Endo to withdraw the opioid Opana ER (oxymorphone) from market. Endo said in July 2017 it would voluntarily cease sales. Inflexxion, the company who owns and operates PainEDU invites you to participate in a short research survey about the impact of removal. The survey aims to understand impact of removal of this medication to the patient population, and we’re interested in your opinion on whether the removal could impact patient care. The survey takes will approx 10 minutes to do. Your participation is confidential and no personal info including names, IP addresses, or email addresses are kept.
Click here to start the survey. https://inflexxion.co1.qualtrics.com/jfe/form/SV_1C8itWAdKoSEuW1

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USA has the “BEST MEDICAL CARE IN THE WORLD ” ? just not available to all ?

Posted on November 28, 2017 by Pharmaciststeve

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DEA mandates reduction in opioid manufacturing for 2018

Posted on November 28, 2017 by Pharmaciststeve

http://www.pharmacist.com/article/dea-mandates-reduction-opioid-manufacturing-2018

Over objections that limits could harm chronic pain patients, agency moves forward with cuts

DEA’s finalized annual aggregate production quotas (APQs) for 2018 mandate a 20% reduction in the amount of opiate and opioid medication—including oxycodone, hydrocodone, oxymorphone, hydromorphone, morphine, codeine, meperidine, and fentanyl—that may be manufactured in 2018. Quotas are aimed at preventing a diversion while simultaneously satisfying annual needs.

APQs establish the total amount of opioids and other controlled substances necessary to meet the estimated medical, scientific, research, industrial, and export needs for 2018 and to maintain adequate reserve stocks. DEA says 2018’s cuts are a response to reduced demand.

Quotas may be appealed at any time during the year on the basis of increased sales or exports, new manufacturers entering the market, new product development, or product recalls.

Critics of DEA’s decision have expressed concerns that the reduced quota could lead to drug shortages and negatively affect pain management patients’ access to treatment.

Last year, the agency removed a 25% buffer for almost every Schedule II opiate and opioid medication. The buffer was implemented in 2013 to help address shortages. Although DEA stated at that time that its October 2016 final order was based on reduced demand, its decision was consistent with the views of several U.S. senators who called for DEA to limit opioid production and sales as another mechanism to combat the opioid epidemic.

Quotas are aimed at satisfying annual needs

I wonder where the DEA came up with a number that will meet the above goal ?

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