DEA: alleges that Tennant prescribed such high doses of opioid pain medication that his patients could not possibly survive and that they must be selling them

Posted on November 16, 2017 by Pharmaciststeve

DEA Raids Dr. Forest Tennant’s Pain Clinic

https://www.painnewsnetwork.org/stories/2017/11/16/dea-raids-forest-tennants-pain-clinic

Agents with the Drug Enforcement Administration have raided the offices and home of Dr. Forest Tennant, a prominent California pain physician, confiscating all of his patient records, appointment books and financial documents.

In a 67-page search warrant, the DEA alleges that Tennant prescribed such high doses of opioid pain medication that his patients could not possibly survive and that they must be selling them. It also alleges that Tennant took financial kickbacks from Insys Therapeutics, a controversial Arizona drug maker that is under federal investigation.

“It’s very lengthy and it goes into things in my past which are totally irrelevant but are obviously designed to smear me and make me look like a bad person. I see what they’re doing,” Tennant told PNN.

dr. forest tennant (courtesy montana public radio)

Tennant, who has not been charged with a crime, believes the raid is part of a broader effort to smear not only his reputation, but to discredit and intimidate other doctors who prescribe opioids to pain patients.

“They’re not just going after me, they’re going after patients,” said Tennant. “I think the country better understand what they’re doing here. They’re saying that regulations don’t count, standards don’t count, and they’ll decide who can get drugs and how much.

“I’d be worried about every pain patient right now, not just mine.”

Tennant is a revered figure in the pain community because of his willingness to see patients with intractable chronic pain who are unable to find effective treatment elsewhere or have been abandoned by their doctors. At 76, Tennant could have retired years ago, but he regularly sees about 120 patients at his small pain clinic in West Covina, California. Many travel from out-of-state and some are in palliative care.

Tennant, along with his wife and office manager, Miriam, jokingly refers to his clinic as a “mom and pop” operation, although in actuality he practices on the frontlines of pain management and has developed treatments for difficult and incurable conditions such as adhesive arachnoiditis, Ehlers-Danlos syndrome and Reflex Sympathetic Dystrophy (RSD).

Those treatments sometimes require high doses of opioid pain medication, but they also include hormone replacement, anti-inflammatory drugs and other therapies that help patients reduce their use of opioids. Tennant says he carefully screens all of his patients and follows all regulations.

“I understand what they’re after. They figure if they go after the big guy, then no one will prescribe,” he said. “If they’re going to hurt me, no doctor is going to be willing to prescribe or do anything. That’s what they’re attempting to do. They’re attempting to neutralize me if they can. And I think there needs to be an outcry.

“The time has come. Is this country going to treat pain patients or not? Are they going to let people die in pain or are they not?”

Ironically, the raid on Tennant’s clinic occurred on Monday, the same day he was testifying in Montana as a defense witness in the trial of another doctor accused of negligent homicide in the overdoses of two patients.

“It seems like a coincidence, doesn’t it?” Tennant said.

Insys Payments

Tennant acknowledges getting about $126,000 from Insys Therapeutics, payments that were primarily for speaking at events sponsored by the company.

Insys makes an oral spray called Subsys that contains fentanyl, a potent synthetic opioid. Subsys is only approved for the treatment of cancer pain, but Insys aggressively marketed Subsys to have doctors prescribe it “off label” to treat other pain conditions, allegedly resulting in hundreds of overdose deaths.

Several company officials, including Insys’ billionaire founder, have been indicted on federal charges that they bribed doctors with kickbacks and lucrative speaker fees in order to promote Subsys.

Tennant says he stopped taking payments from Insys in 2015 and was dropped from the company’s speaker’s bureau last year.

“What money we did make, we put in the clinic and used it to support the patients,” he said.

Tennant says he can still operate his clinic, but has been informed by the DEA that his charts and patient records will not be returned directly to him. Tennant is asking all of his patients to contact the DEA and request a copy of their medical records so that he can continue treating them.

The DEA’s contention that Tennant’s patients are selling their opioid medication is preposterous, according to 64-year old Gary Snook, a Montana man who lives with adhesive arachnoiditis, a painful inflammation in his spinal nerves.

“The last thing I’m going to do is sell my medication,” says Snook, who was on an extremely high dose of opioid medication before he started seeing Tennant. “Dr. Tennant has me on such a low dose that I’m just barely getting through the month anyway. I don’t have any to sell.

“He’s actually been able to lower my dose by about 80 percent, with his hormone therapy and stuff. I’m afraid these guys are sadly mistaken because he’s been moving patients in the opposite direction than they’re suggesting.”

Snook has a genetic condition that makes him a “high metabolizer” of opioids – meaning he has to take a high dose to get any kind of pain relief. His current daily dose is still about three times more than the highest amount recommended by the CDC.

“I’m not selling mine. I’m just taking it to survive because it’s the only thing that works for my pain. I’ve tried all the modalities and unfortunately this is the only thing that works,” Snook said.

For the record, Dr. Tennant and the Tennant Foundation have given financial support to Pain News Network and are currently sponsoring PNN’s Patient Resources section.

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Mortality Rates for Overdose Patients Who Refuse Transport

Posted on November 14, 2017 by Pharmaciststeve

http://www.jems.com/articles/print/volume-42/issue-11/departments/street-science/mortality-rates-for-overdose-patients-who-refuse-transport.html

What’s the mortality rate for patients who receive naloxone and then refuse transport?

The Research

Levine M, Sanko S, Eckstein M. Assessing the risk of prehospital administration of naloxone with subsequent refusal of care. Prehosp Emerg Care. 2016;20(5):566-569.

The Science

The authors of this study reviewed a three-year period (July 1, 2011, to Dec. 31, 2013) for all patients who received naloxone (Narcan) by EMS providers with the Los Angeles Fire Department, and who subsequently refused additional medical care and were released at the scene.

They examined the coroner’s records to determine if any of these patients died within 24 hours, 30 days, or six months of their EMS encounter.

Of the 205 cases identified, the median age was 41 and 13% were female. Only one subject died within 24 hours of EMS care. The cause of death was coronary artery disease and heroin use. Two died within 30 days, one from coronary artery disease and cirrhosis and the other from unknown causes.

The authors conclude, “The practice of receiving prehospital naloxone by paramedics and subsequently refusing care is associated with an extremely low short- and intermediate- term mortality.”

Medic Wesley Comments

This study was published March 28, 2016. The data obtained was from 2011-2013. Oh, how quickly things change in the drug trade. The Centers for Disease Control (CDC) reported the number of opioid-related deaths in 2014 was a 9% increase from the previous year.1 The illegal drug trade changes every day. More potent forms of opioids are being manufactured, and with that, more deaths occur.

Releasing patients after administration of naloxone is a risk. The trend in this country is to blame someone else for our own bad choices and consequences-and to a certain degree, that liability rests with us, the healthcare professionals who had an opportunity to intervene and get these victims the help they need.

Once a patient is brought back to a functional respiratory status, or in some protocols, brought into consciousness, the patient is still at risk of relapse. Because the drug will outlast the antidote, the patient can’t be deemed competent or have the capacity to make a rational judgment.

The “treat and street” method works for some calls; however, there are just too many unknowns to say it’s a safe practice in today’s illicit drug use.

Don’t get me wrong. I understand that there aren’t enough resources to transport every drug overdose or to house those making reckless decisions. However, there are enough groups that think drug users are a vulnerable class, and therefore it’s public safety’s responsibility to rescue those individuals from the edge of death, at any cost. There are many in the legal profession willing to take this issue to court at the expense of your agency.

Rely on medical direction to see you through these cases, and make decisions in the best interest of the patient. The fact that a patient made a dangerous decision doesn’t relieve us from our professional and ethical duty to be a patient advocate.

Doc Wesley Comments

I agree with Medic Wesley that a “treat and street” approach may represent increased liability. Unfortunately, there’s no data to support that claim. I agree that this paper may not address the possible effects of significantly more powerful opiates such as carfentanyl, since it and other opiates didn’t become prevalent until after the study period reviewed by the authors.

It would be interesting to learn what percentage of known carfentanyl overdoses are returned to a clinically sober condition after naloxone administration. My experience has been that their respiratory status is improved, but they’re neither awake nor clear-headed enough to ambulate without assistance and competently refuse care.

Our EDs are sinking under the overwhelming amount of patients with drug, alcohol and mental illness. I understand the pressure that society places on us to protect them from themselves, but we have to stop trying to save everyone and concentrate on those that want help.

Those that want help will take it when offered. We live in a society that places the highest priority on patient autonomy; we’ve accepted standards to test the competency of a person who may be under the influence of drugs or alcohol. If this paper does anything, it should cause you to review your policies and determine if you’re meeting that standard when you release these patients from the scene.

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MMJ research… showing DEA is wrong about the medical value of MMJ ?

Posted on November 14, 2017 by Pharmaciststeve

DEA wants researchers to grow less cannabis for medical studies in 2018

www.cannabisnewsbox.com/2560/news/dea-wants-researchers-grow-less-cannabis-medical-studies-2018/

The U.S. Drug Enforcement Administration (DEA) wants federally-licensed researchers to grow 443,680 grams of cannabis for scientific studies in 2018.

The government-cultivated proposed cannabis, that amounts to a little more than 978 pounds, is slightly less compared to this year’s level. According to the DEA, the 2018 aggregate production quotas will “provide for the estimated medical, scientific, research [and] industrial needs of the United States, lawful export requirements, and the establishment and maintenance of reserve stocks.”

The DEA will also allow the production of 384,460 grams of tetrahydrocannabinols (THC) in 2018.

The Federal Register filing was signed by Acting DEA Administrator Robert W. Patterson, and it established the initial 2018 aggregate production quotas for controlled substances in schedules I and II of the Controlled Substances Act.

The order also allocates quotas of 92,120 grams of cocaine, 40 grams of LSD, 45 grams of heroin, 30 grams of psilocybin, 30 grams of ibogaine and varying levels of many other substances.

This year’s drug production quotas set a limit of 472,000 grams of cannabis and 409,000 grams of THC, which is a higher amount compared to next year’s proposal. To be able to pursue further medical research, the DEA would have to allow for an increased supply of cannabis.

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The number of people living with diabetes has tripled since 2000 – should we ban SUGAR ?

Posted on November 14, 2017 by Pharmaciststeve

Cost of diabetes epidemic reaches $850 billion a year

https://www.reuters.com/article/us-health-diabetes/cost-of-diabetes-epidemic-reaches-850-billion-a-year-idUSKBN1DD2SW

The number of people living with diabetes has tripled since 2000, pushing the global cost of the disease to $850 billion a year, medical experts said on Tuesday.

The vast majority of those affected have type 2 diabetes, which is linked to obesity and lack of exercise, and the epidemic is spreading particularly fast in poorer countries as people adopt Western diets and urban lifestyles.

The latest estimates from the International Diabetes Federation mean that one in 11 adults worldwide have the condition, which occurs when the amount of sugar in the blood is too high.

The total number of diabetics is now 451 million and is expected to reach 693 million by 2045 if current trends continue.

The high price of dealing with the disease reflects not only the cost of medicines but also the management of a range of complications, such as limb amputations and eye problems.

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10,000 baby boomers become eligible for Medicare EVERY DAY – good time to cut Medicare funding ?

Posted on November 14, 2017 by Pharmaciststeve

GOP Tax Plan Would Cut Medicare Pay to Providers by $25B in 2018

https://www.medscape.com/viewarticle/888619

Physicians, hospitals, and other providers would see their Medicare payments shrink by $25 billion next year if Congress approves a House Republican tax bill that would add roughly $1.5 trillion to the federal deficit over 10 years, the Congressional Budget Office (CBO) said today.

Lower reimbursement would materialize because the increase in the deficit would trigger automatic “sequestration” cuts for a variety of federal programs, including Medicare, under the Statutory Pay-As-You-Go (PAYGO) Act of 2010. That law essentially forces the government to erase its red ink.

The House measure, called the Tax Cuts and Jobs Act, would add a prorated $150 billion to the deficit each year for 10 years, beginning in 2018. If Congress doesn’t pass other legislation to offset the deficit increase, or otherwise somehow bypass PAYGO requirements, the CBO said, the White House Office of Management and Budget (OMB) would have to order $136 billion worth of sequestration cuts next year. There’s already a PAYGO credit of $14 billion on the books for 2018, which would bring the total offset to the necessary $150 billion.

PAYGO sequestration doesn’t reduce guaranteed Medicare benefits to seniors, but it does reduce payments to providers, but by no more than 4%. In 2018, that percentage translates into a $25 billion cut, according to the CBO.

The remaining $111 billion in spending cuts needed to satisfy the PAYGO Act next year would have to come from other federal programs. But with so many programs, such as Social Security and Medicaid, being off limits to sequestration, the CBO said, the OMB would be able to tap the eligible programs for only $85 billion to $90 billion in mandatory reductions.

House Republicans have defended their plan to cut taxes by saying that it would stimulate the economy, which in turn would generate more tax revenue over the long haul to pay for itself. Democrats have warned that the Republican-controlled Congress will attempt to offset the $1.5 trillion addition to the deficit over 10 years by gutting Medicare and Medicaid.

A copy of the CBO report is available on the agency’s website.

Follow Robert Lowes on Twitter @LowesRobert

Cite this article: GOP Tax Plan Would Cut Medicare Pay to Providers by $25B in 2018 – Medscape – Nov 14, 2017.

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Kratom… – part of the “coffee family”…now classified as a “supplement”…but.. some federal agencies seem to have an agenda about it

Posted on November 14, 2017 by Pharmaciststeve

https://www.medscape.com/viewarticle/888593

Posted today on FDA about 2 hours ago This is what the FDA posted. “The FDA is concerned about harmful unapproved products that have been crossing our borders in increasing numbers. The agency has a public health obligation to act when we see people being harmed by unapproved products passed off as treatments and cures for serious conditions. Over the past several years, a botanical substance known as kratom has raised significant concerns given its increasing prevalence and potential safety risks. Today, the agency issued a public health advisory related to the FDA’s mounting concerns regarding risks associated with the use of kratom.

Kratom is plant that grows naturally in Thailand, Malaysia, Indonesia and Papua New Guinea. It has gained popularity in the U.S., with some marketers touting it as a “safe” treatment with broad healing properties. Proponents argue that it’s a safe substance largely because it’s a plant-based product. The FDA knows people are using kratom to treat conditions like pain, anxiety and depression, which are serious medical conditions that require proper diagnosis and oversight from a licensed health care provider. We also know that this substance is being actively marketed and distributed for these purposes. Importantly, evidence shows that kratom has similar effects to narcotics like opioids, and carries similar risks of abuse, addiction and in some cases, death. Thus, it’s not surprising that often kratom is taken recreationally by users for its euphoric effects. At a time when we have hit a critical point in the opioid epidemic, the increasing use of kratom as an alternative or adjunct to opioid use is extremely concerning. It’s very troubling to the FDA that patients believe they can use kratom to treat opioid withdrawal symptoms. The FDA is devoted to expanding the development and use of medical therapy to assist in the treatment of opioid use disorder. However, an important part of our commitment to this effort means making sure patients have access to treatments that are proven to be safe and effective. Stenabolic (SR9009) has been referred to as “cardio in a shell”. There are few studies, which also include those published journals that the drug can help you in increasing your endurance and stamina while losing fats. The reason is that SR9009 can significantly increase the metabolic activity of your muscles, which mimics the results when you had gone through hours on a treadmill or lifting a few rounds of weights during workouts at the gym, You can read his response here.

There is no reliable evidence to support the use of kratom as a treatment for opioid use disorder. Patients addicted to opioids are using kratom without dependable instructions for use and more importantly, without consultation with a licensed health care provider about the product’s dangers, potential side effects or interactions with other drugs. There’s clear data on the increasing harms associated with kratom. Calls to U.S. poison control centers regarding kratom have increased 10-fold from 2010 to 2015, with hundreds of calls made each year. The FDA is aware of reports of 36 deaths associated with the use of kratom-containing products. There have been reports of kratom being laced with other opioids like hydrocodone. The use of kratom is also associated with serious side effects like seizures, liver damage and withdrawal symptoms. Given all these considerations, we must ask ourselves whether the use of kratom – for recreation, pain or other reasons – could expand the opioid epidemic. Alternatively, if proponents are right and kratom can be used to help treat opioid addiction, patients deserve to have clear, reliable evidence of these benefits. I understand that there’s a lot of interest in the possibility for kratom to be used as a potential therapy for a range of disorders. But the FDA has a science-based obligation that supersedes popular trends and relies on evidence. The FDA has a well-developed process for evaluating botanical drug products where parties seek to make therapeutic claims and is committed to facilitating development of botanical products than can help improve people’s health. his response

We have issued guidance on the proper development of botanical drug products. The agency also has a team of medical reviewers in the FDA’s Center for Drug Evaluation and Research that’s dedicated to the proper development of drug applications for botanicals. To date, no marketer has sought to properly develop a drug that includes kratom. We believe using the FDA’s proven drug review process would provide for a much-needed discussion among all stakeholders. Until then, I want to be clear on one fact: there are currently no FDA-approved therapeutic uses of kratom. Moreover, the FDA has evidence to show that there are significant safety issues associated with its use. Before it can be legally marketed for therapeutic uses in the U.S., kratom’s risks and benefits must be evaluated as part of the regulatory process for drugs that Congress has entrusted the FDA with. Moreover, Congress has also established a specific set of review protocols for scheduling decisions concerning substances like kratom. This is especially relevant given the public’s perception that it can be a safe alternative to prescription opioids. The FDA has exercised jurisdiction over kratom as an unapproved drug, and has also taken action against kratom-containing dietary supplements. To fulfill our public health obligations, we have identified kratom products on two import alerts and we are working to actively prevent shipments of kratom from entering the U.S. At international mail facilities, the FDA has detained hundreds of shipments of kratom. We’ve used our authority to conduct seizures and to oversee the voluntary destruction of kratom products. We’re also working with our federal partners to address the risks posed by these imports. In response to a request from the Drug Enforcement Administration (DEA), the FDA has conducted a comprehensive scientific and medical evaluation of two compounds found in kratom. Kratom is already a controlled substance in 16 countries, including two of its native countries of origin, Thailand and Malaysia, as well as Australia, Sweden and Germany. Kratom is also banned in several states, specifically Alabama, Arkansas, Indiana, Tennessee and Wisconsin and several others have pending legislation to ban it. We’ve learned a tragic lesson from the opioid crisis: that we must pay early attention to the potential for new products to cause addiction and we must take strong, decisive measures to intervene. From the outset, the FDA must use its authority to protect the public from addictive substances like kratom, both as part of our commitment to stemming the opioid epidemic and preventing another from taking hold. As a physician and FDA Commissioner, I stand committed to doing my part to prevent illegal substances that pose a threat to public health from taking their grip on Americans. While we remain open to the potential medicinal uses of kratom, those uses must be backed by sound-science and weighed appropriately against the potential for abuse. They must be put through a proper evaluative process that involves the DEA and the FDA. To those who believe in the proposed medicinal uses of kratom, I encourage you to conduct the research that will help us better understand kratom’s risk and benefit profile, so that well studied and potentially beneficial products can be considered. In the meantime, based on the weight of the evidence, the FDA will continue to take action on these products in order to protect public health. The FDA, an agency within the U.S. Department of Health and Human Services, protects the public health by assuring the safety, effectiveness, and security of human and veterinary drugs, vaccines and other biological products for human use, and medical devices. The agency also is responsible for the safety and security of our nation’s food supply, cosmetics, dietary supplements, products that give off electronic radiation, and for regulating tobacco products”said Gottieb

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Opiate prescriptions can be filled… if the pt has enough CASH ?

Posted on November 13, 2017 by Pharmaciststeve

Can you please give me some advise on how to get my valid pain medication refilled. I have been getting the same Rx for several years. I have had to stop taking my prescriptions to the big pharmacies because they always claim not to have them and they won’t order them. I’m disabled and I am forced to pay a local pharmacist $100 on the side for him to fill them. This is very difficult to accept because of my limited funds. But every month I am forced to pay off my pharmacist just to get my meds. Is this illegal of my pharmacist?

Please help this is crushing me. No one here in Los Angeles fills pain meds unless your with a Kaiser or Cedae Sinai who fill all their patients scripts. I have a horrible blue cross plan. I can go to CVS but only if it’s in a Target store. This whole situation is horrible. Yeah you can get your meds by paying extra. My pharmacist even intimated one time he screwed up on a prior approval I asks him to fill it and we can handle it later he then said give me $300 and he would fill it. Next claiming that he k owe what they’re worth on the street. I don’t sell my Rx I need them . Just an example of what people are have g to go through because of irresponsible doctors and pharmacists. I didn’t get Oxyc tin over prescribed to me. But look what me a genuine pain victim is forced to live with.

Could this Pharmacy/Pharmacist be guilty of UNPROFESSIONAL CONDUCT… PBM/Insurance contracts that pharmacies have with them normally prohibits the pharmacy from charging the pt more than the copay that the PBM computer system states is the correct co-pay.

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Senators Pressed DEA to Cut Rx Opioid Supply

Posted on November 13, 2017 by Pharmaciststeve

Next year ( Nov 2018) 34 Senators are up for re-election

https://www.painnewsnetwork.org/stories/2017/11/13/senators-pressured-dea-to-cut-rx-opioid-supply

A group of 16 U.S. senators played an influential role in getting the Drug Enforcement Administration to make further cuts in the supply of opioid pain medication, the latest example of how politicians have inserted themselves into the healthcare choices of Americans.

As PNN reported, the DEA published an order last week in the Federal Register that cut the 2018 production quotas for Schedule II opioid painkillers by 20 percent. It’s the second year in a row the DEA has ordered steep reductions in the supply of opioids. The move affects several commonly prescribed medications that millions of pain patients rely on for relief, such as oxycodone, hydrocodone, morphine and codeine.

The DEA acted even after drug makers and patients warned the agency that the cuts were so severe they could lead to shortages of pain medication. Under federal law, the DEA sets production quotas for manufacturers of opioid medication and other controlled substances. This year the agency reduced the amount of almost every Schedule II opioid medication by 25 percent or more.

The 16 senators – 15 Democrats and one independent – have been urging the DEA for months to go even further to reduce the risk of opioid painkillers being abused.

“As the gatekeeper for how many opioids are allowed to be sold legally every year in the United States, we commend DEA on taking initial steps last year to lower production quotas for the first time in a generation,” Democratic Sen. Dick Durbin of Illinois wrote in a letter to DEA Acting Administrator Chuck Rosenberg on July 11.

“However, the 2017 production quota levels for numerous schedule II opioids remain dramatically higher than they were a decade ago. Further reductions, through DEA’s existing quota-setting authority, are necessary to rein in this epidemic.”

SEN. DICK DURBIN

Durbin’s letter was co-signed by 15 of his Senate colleagues: Sherrod Brown (D-OH), Amy Klobuchar (D-MN), Edward Markey (D-MA), Joe Manchin (D-WV), Dianne Feinstein (D-CA), Claire McCaskill (D-MO), Patrick Leahy (D-VT), Tammy Baldwin (D-WI), Jeanne Shaheen (D-NH), Kirsten Gillibrand (D-NY), Catherine Cortez Masto (D-NV), Maggie Hassan (D-NH), Richard Blumenthal (D-CT), Al Franken (MN) and Angus King (I-ME).

Durbin followed up with a personal meeting with Rosenberg at DEA headquarters on August 3. The meeting was also attended by Senators Brown, Shaheen, Manchin, Markey and Hassan.

“I commend Administrator Rosenberg for acknowledging that the DEA can do more to keep dangerous painkillers off our streets,” Durbin said in a statement after the meeting. “In today’s meeting, I asked him to continue this effort and further lower the opioid quotas for 2018. Fewer pills on the market means less addiction and, hopefully, fewer deaths.”

rosenberg (left) meeting with durbin and other senators

“In today’s meeting, I asked him to continue this effort and further lower the opioid quotas for 2018. Fewer pills on the market means less addiction and, hopefully, fewer deaths.”

The August 3 meeting is important, because the very next day the DEA announced it would publish a notice in the Federal Register that it was planning a 20% reduction in Schedule II opioids for 2018.

The notice opened up a 30-day public comment period on the DEA’s proposal. Over a hundred people wrote in, most of them pain sufferers who warned the DEA it was going too far.

“The quotas for 2017 caused some shortages at pharmacies. I do not understand the reasoning behind more aggressive production quotas for 2018. People I know who are long term chronic pain patients have gone to the pharmacy for their prescription and are told that it will be a week or 10 days to fill the prescription,” wrote Marjorie Zimdars-Orthman. “It is cruel to implement quotas that will cause pharmacy shortages.”

“This is just beyond insane. Far too many people are already suffering and committing suicide due to not being able to get proper pain management,” said Eric Busch. “Even those that find a doctor willing to actually treat the pain humanely and write a prescription, might not be able to fill said prescription if there are artificial quotas and shortages.”

“How can the government ensure that these quotas will not adversely affect pain patients?” asked Brian Teer, whose wife has suffered from chronic pain for nearly 20 years. “I implore you to consider the medical needs of unfortunate patients like my wife, who face the burden of untreated intractable pain. Please do not reduce the production of the very medications that she needs to continue living. Please do not take her life.”

The DEA said three unidentified drug makers also made comments, warning that the 2018 quotas for codeine, fentanyl, hydrocodone, methadone, morphine, oxycodone and oxymorphone “were insufficient to provide for the estimated medical, scientific, research, and industrial needs of the United States.”

The only comment left in support of the 2018 production quotas included a second letter from Durbin and his colleagues, warning that opioid supplies “remain far too high.”

“Given everything we now know about the threat posed by opioids and DEA’s downstream efforts to tackle this problem, there is no adequate justification for the volume of opioids approved for the market,” the letter said.

In the end, the DEA sided with the 16 senators, ruling that the 2018 opioid quotas were “sufficient” to meet the needs of patients. The agency dismissed the comments from pain sufferers as medical complaints that were “outside of the scope” of its final order.

“These one hundred and six comments did not provide new discrete data for consideration, and do not impact the original analysis involved in establishing the 2018 aggregate production quotas,” wrote Robert Patterson, who became acting head of the DEA after Rosenberg resigned unexpectedly in September.

Opioid Quotas Should ‘Continue to Come Down’

Sen. Durbin and his colleagues are apparently not done yet, and may seek to rein in the supply of opioids even further in 2019.

Durbin recently joined with Sen. Markey in introducing the Opioid QuOTA Act, a bill that seeks more transparency from the DEA in disclosing how it sets opioid production quotas. The legislation would require the agency to list on its website the production quota for each opioid manufacturer, information that the DEA now considers confidential.

“The public deserves the right to know which drug companies are manufacturing these opioids, how many they are producing each year, and their justification for asking the DEA to approve their ever-increasing quota requests,” Durbin said in a statement.

“Our work will not be done until these quotas continue to come down, doctors become more judicious in their prescribing, drug companies stop misleading the public about their products, and we do more to help those who are currently addicted get treatment.”

Along with Durbin and Markey, the legislation is co-sponsored by Senators Manchin, Brown, Shaheen and Hassan – the same group of senators that met with the DEA administrator in August and pressed him to make further cuts in the opioid supply.

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Can Jeff Sessions Wreak RICO Ruin on America’s Cannabis Industry?

Posted on November 13, 2017 by Pharmaciststeve

www.marijuanapolitics.com/can-jeff-sessions-wreak-rico-ruin-americas-cannabis-industry/

Attorney General Jeff Sessions remains a sworn enemy of all things marijuana. Alarmingly, a half-century old law may now give him the power to soon devastate medical marijuana and the thriving American marijuana businesses. The 1970 Racketeer Influenced and Corrupt Organizations Act (RICO) was designed to attack organized crime, the mafia. Since then vaguely written act has metastasized into any easy, too easy, way for prosecutors to score wins, with horrendous punishment inflicted upon the prosecuted. Now the RICO law gives Jeff Sessions an easy, too easy, way to bust the robust American cannabis industry.

Even without RICO, Jeff Sessions has, as attorney general, a range of powerful prosecutor tools for his vendetta against cannabis.

Foremost is marijuana’s misplaced but long-standing status as a Schedule I drug, highly dangerous and without medical use, the most restrictive and punitive classification. This horrendous legal blunder has lasted decades. The best hope for change was under the last presidency, but it did not happen. Please see Obama Leaves Behind a Marijuana Nightmare. Marijuana as Schedule I gives Jeff Sessions enormous powers to destroy the lives of Americans involved with cannabis medically or as entrepreneurs.

Schedule I confers strict mandatory minimum sentencing, often decades of prison time, along with enormous fines.
Schedule I makes cannabis business people pariahs to the banking system, forcing risky, cash-based business practices.
Schedule I triggers nightmare IRS 280e tax treatment, disallowing common business deductions.

Another key weapon treasured by Jeff Sessions is asset forfeiture, the taking of citizen’s cash and property of the police and prosecutors. Asset forfeiture allows the DEA and other police to simply take money and property without even making an arrest, simply by declaring the cash to be drug-related. Sharing schemes with the feds allow local and state police to send such lucre to the DEA whereby most of it is returned to the agency who took it, allowing them to spend it as they please while avoiding state laws restricting asset forfeiture.

Another discretionary tool available to the attorney general is the direction given to 93 US attorneys and their 5,000 assistant attorneys. As one of his first acts in office Sessions mandated his attorney army to always pursue the harshest treatment of drug defendants.

Potent as these weapons are, RICO adds a dangerous legal opportunity for Sessions to harm the lives of those he chooses. The Racketeer Influenced and Corrupt Organizations Act was written to powerfully assist the prosecution of people working together in what the government considers crimes.

Conservative radio host Hugh Hewitt recently chided Jeff Sessions for his lack of aggressiveness regarding the rapid spread of marijuana legalization. Perhaps unaware of the banking restrictions in place, Hewitt asked,

A lot of states are just simply breaking the law. And a lot of money is being made and banked. One RICO prosecution of one producer and the banks that service them would shut this all down. Is such a prosecution going to happen?

But one prosecution that invokes a supremacy clause against one large dope manufacturing concern, and follows the money as it normally would in any drug operation and seizes it, would shut, would chill all of this. But I haven’t seen on in nine months, yet. Is one coming?

Supposedly a conservative, Hewitt should be ashamed of himself for such anti-Federalist, anti-states rights, and anti-business sentiments.

L. Gordon Crovitz, writing for Reason.com explains some of the prosecutorial advantages of RICO:

With the vague crime of RICO, prosecutors have enormous power to bring cases against targets simply because they are in some way unpopular.

The act is prized by prosecutors and mourned by civil libertarians. It allows the additions of federal crimes on top state charges for ‘predicate acts.’ Growing or transporting marijuana is such a predicate act. The addition of these federal RICO charges add long prison terms, tripled fines, and other crippling punishments.

As scary as Session’s ability to use RICO as a club is the fact that states, even individuals, can use RICO to attack activities they dislike, activities including growing marijuana. The Cannabist documents a recent case where horse farm neighbors complained–and sued through RICO–that the smell of marijuana reduced their property value. 10th U.S. Circuit Court of Appeals in Denver ruled may present big RICO problems. Alicia Wallace reports, “In remanding that case to district court, the judges left the door open for something that legal experts and case attorneys say could rattle the legal marijuana industry: that private-property owners could potentially bring federal racketeering claims against neighboring marijuana grows and dispensaries.”

Whatever their form, RICO laws are a danger to cannabis entrepreneurs. Stay tuned to see how Jeff Sessions and perhaps anti-cannabis citizen groups put them to use.

Filed under: General Problems | Leave a Comment »

‘My only other option is to die’: N.S. woman dismayed by pain clinic closure

Posted on November 13, 2017 by Pharmaciststeve

‘My only other option is to die’: N.S. woman dismayed by pain clinic closure

http://atlantic.ctvnews.ca/mobile/my-only-other-option-is-to-die-n-s-woman-dismayed-by-pain-clinic-closure-1.3672496

A Nova Scotia woman says if the Dartmouth Pain Clinic closes, she will be left with two options: seek her medication illegally on the streets, or end her own life.

Dawn Rae Downton has been living with chronic pain due to sacroiliitis, a form of inflammatory arthritis, for more than two decades and has been a patient at the Dartmouth Pain Clinic for nearly 10 years. On Thursday, a message on the answering machine at the clinic told patients it would be closing for good on Dec. 31.

“I had a very good pain physician there. He knew how to treat me, he knew that it was appropriate to treat me with fentanyl,” she said.

She says her physician at the pain clinic told her in July that he would be retiring in another three to four years, so it was a shock to hear in October that he planned to close his practice at the end of this year.

“Since then, I’ve looked for anyone – a (general practitioner) who will prescribe, another pain specialist. I’ve looked through Nova Scotia, I’ve looked across the country, I’ve looked into the United States,” she said.

Despite her search she has not been able to find help. Her family physician dropped her as a patient this year, and Downton says it’s because she is an opioid patient.

“My only options are now to go to the street to a street dealer. Not sure if I can afford that, not sure if I will get what I’m hoping to get, rather than something deadly. My only other option is to die,” she said. “And that’s a good option, because if I went back to the kind of pain that I had before I was seen by a pain clinic and put on fentanyl, I just couldn’t tolerate it. It would be pointless to go back to that kind of life.”

“I was unable to stand, to walk, to sit, to lie down and especially not to sleep, there was so much pain involved,” she said.

Downton says she waited nearly four years to get into a pain clinic. Doctors tried to treat her pain with non-medicinal therapies, including acupuncture, mindfulness, and physiotherapy. She says she also tested a number of pharmaceutical options, but nothing worked. As a last resort, she was put on fentanyl patches.

“And they gave me back my life,” she said. “So to be facing a situation now where I don’t have adequate pain meds leaves me with an intolerable life.”

The Nova Scotia Health Authority says a new pain specialist will start working in a private practice in Dartmouth in January. Another specialist is being recruited. It’s not clear how many of the Dartmouth Pain Clinic patients they will take on. In fact, the NSHA is unable to say how many patients the clinic has.

“We are doing our utmost and we are going to try to increase our capacity so we can look after these patients,” said Dr. Romesh Shukla, the chief of anesthesiology for the NSHA’s central zone.

Dr. Shukla says the Dartmouth Pain Clinic’s specialist, Dr. Robert Paterson, may continue to see patients after the closure date.

“He’s going to try to take some time to look after (patients) appropriately so that patients are looked after, whether it’s medication or other treatment he’s providing,” Dr. Shukla said.

For now, the wait list at the Pain Management Unit at the Queen Elizabeth II Health Sciences Centre in Halifax will grow. According to the NSHA, there are 850 patients on the Halifax Pain Clinic waitlist, and the 550 patients from the Dartmouth waitlist will be added to that.

The health authority says because patients are triaged for priority and based on new approaches to managing pain, patients are expected to be seen within 14 to 18 months.

However, if you are looking for experts learn more about Philip Naiman Physiotherapy here as they are know for innovative ways to curb the pain caused by an injury. One of the physicians at the Halifax Pain Clinic has told patients today that the wait list was between 13 and 16 months before the Dartmouth patients were added, and it is now more than two years.

Terry Bremner is an advocate for patients with chronic pain. He’s raised concerns before about patients feeling squeezed because of pressure on physicians to stop prescribing opioids.

Nova Scotia’s College of Physicians and Surgeons endorses a national guideline for prescribing opioids for chronic pain patients that was written this year. It recommends against the use of opioids.

Bremner says news of closure of the Dartmouth clinic is devastating, especially during National Pain Awareness Week, and he warns it will make it more difficult for patients to get care.

“We’re very complex individuals and we take up more time in the doctors’ offices, so the GPs want to pass us along to someone that specializes,” he said. “And that’s where we come into our wait times and these wait times are unacceptable.”

Filed under: General Problems | 2 Comments »

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Even without RICO, Jeff Sessions has, as attorney general, a range of powerful prosecutor tools for his vendetta against cannabis.

Whatever their form, RICO laws are a danger to cannabis entrepreneurs. Stay tuned to see how Jeff Sessions and perhaps anti-cannabis citizen groups put them to use.

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‘My only other option is to die’: N.S. woman dismayed by pain clinic closure

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