CVS Health Larry Merlo Works Magic By Taking Over The Drug Enforcement Agency

Posted on October 22, 2017 by Pharmaciststeve

CVS Health Larry Merlo Works Magic By Taking Over The Drug Enforcement Agency”

Merlo pulls another rabbit out of his hat

Washington DC – CVS Health Executive Director, Larry Merlo and his cast of greedy shareholders and slick attorneys deal the United States Government another major blow in their efforts to combat crime. Special interest groups are organized groups of individuals sharing common objectives who actively attempt to influence policy makers. Corporations now spend about $2.6 billion a year on reported lobbying expenditures—more than the $2 billion we spend to fund the House ($1.18 billion) and Senate ($860 million). It’s a gap that has been widening since corporate lobbying began to regularly exceed the combined House-Senate budget in the early 2000s.

Today, the biggest companies have upwards of 100 lobbyists representing them, allowing them to be everywhere, all the time. For every dollar spent on lobbying by labor unions and public-interest groups together, large corporations and their associations now spend billions of dollars. Of the 100 organizations that spend the most on lobbying, 95 consistently represent business. Lobbying is nothing new to the U.S. Government and we have seen how special interest groups shape laws and trigger regulations for institutions like the Food and Drug Association (FDA) and we have seen how Big Pharma lobbied hundreds of health care bills in recent history, including the infamous Obamacare.

Larry Merlo of CVS Health and his train of corporate business lawyers has pulled-off the unthinkable, the biggest trick of all – They bought off the U.S. Government policing agencies designed to uphold the laws of the United States of America. This was a brilliant plan and most authorities consider this to be, one of the biggest tricks of the 21st Century. Everybody is talking about how Larry Merlo’s special interest group infiltrated the DEA, a Government entity funded by U.S. Tax dollars, and buy off 52 of their top lawyers and access thousands of DEA confidential records, including top secret investigative and active investigate files.

Larry Merlo and many corporate leaders feared for their safety as the lucrative DEA closed in on their dubious practices, which were designed and engineered to cripple the American public by introducing pharmaceuticals that they knew would cause harm. Big Pharma is not only controlling the DEA with U.S. tax dollars backing them and their agenda, they are also in control of the United States Congress – a public statement made by Senator Bernie Sanders. CVS passed Legislation to strip the DEA’s power to arrest corrupt Big Pharma executives passed with flying colors through the ranks of the Senate and Congress, surprisingly, without any objections by U.S. Government. The law to protect Big Pharma from prosecution should be repealed because corporate executives who bribed and paid-off government officials to provide protection for their own illegal crimes is not constitutional.

How Can You Make A Difference?

  • BECOME A MEMBER: Please support Doctors of Courage and our fight against unlawful Government abuse of doctors and healthcare providers nationwide. Your Membership helps to provide support for thousands of doctors who are being unlawfully jailed and stripped of their medical careers for treating patients with legal prescriptions.
  • JOIN THE FIGHT:Please support the American Pain Institute (API) at http://www.americanpaininstitute.org and get involve with their PAIN ADVOCACY WEEK, April 23rd – 30th, 2018, March On Washington and donate to help this cause. Thousands of Chronic Sickle Cell patients’ lives are being drastically reduced and they are dying because doctors are afraid to follow NIH treatment guidelines due to bigotry and government wrongful persecution of doctors in this country.
  • HELP MAKE CHANGE: Sign our petition requesting that Congress enact a Medical Board Civilian Police Review Committee law to deter medical board police and prosecutorial misconduct and hold these officials responsible for their actions. The most common crime against doctors made by the medical board police teams are “FALSE REPORTS” that police officers refer to as accusations. These are criminal actions by law enforcement and they are not held accountable for making false statements, perjury, and manufacturing evidence. A Civilian Police Review Committeewill help stop these senseless acts against healthcare providers and restore justice and constitutional rights.
SIGN / SHARE OUR PETITION to fight for doctors and nurses rights:

CLICK NOW – (: SAY NO TO DEA/MEDICAL BOARD POLICE

 

Filed under: General Problems | Leave a Comment »

community pharmacists said they were serving patients with legitimate pain

Posted on October 22, 2017 by Pharmaciststeve

DEA Chief: Pharma-Backed Law Hasn’t Hurt Agency’s Fight Against Opioids

The then-chief of the Drug Enforcement Administration assured Democratic Rep. Judy Chu the bill she cosponsored to take away a tool the agency used to prevent opioids from reaching the streets wouldn’t hinder the agency’s work.

A Washington Post and “60 Minutes” investigation revealed drug companies dumped millions into lobbying for the bill, the Ensuring Patient Access and Effective Drug Enforcement Act, which essentially stripped the DEA’s ability to suspend pharmaceutical companies that sent suspiciously large opioid shipments.

Chu of California received more than $31,000 from the pharmaceutical industry as of last year, according to the Center for Responsive Politics, but she told The Daily Caller News Foundation she was assured — in a meeting that took place five months after the law passed — the bill wouldn’t hurt the DEA’s work. (RELATED: Pharma Association Defends Law Weakening DEA’s Opioid Enforcement)

“I met with Chuck Rosenberg, the then-acting head of the DEA, who insisted that the bill would not negatively impact their work,” Chu told TheDCNF in a statement. “[I]t was my understanding that the DEA was closely involved in advising on drafting language that would not impact their mission,” she added. “I did not receive indication of opposition or concerns from within the DEA.”

Rosenberg also said “the legislation was unnecessary,” Chu recently wrote in a letter to the House committees on Energy and Commerce and Oversight and Government reform, while requesting an investigation on the law impacted the DEA’s ability to combat the opioid crisis.

The DEA and the Department of Justice publicly opposed the original version of the legislation introduced in 2014. Agency officials didn’t object to the final version, but felt they were forced to accept a compromise on a bill that would ultimately pass, according to the Post/60 Minutes investigation.

“DEA felt this wasn’t a great solution, but was the best of the options offered to us, even if it did not fully address the concerns we had previously laid out for you,” Justice Department congressional liaison Jill Wade Tyson wrote in an email obtained by the WaPo/60 Minutes investigation.

The bill has created new challenges for the DEA, but investigators have started using new tools and haven’t “slowed down” the current acting-agency chief, Robert Patterson, recently said.

Chu also supported the bill to encourage the DEA to set better guidance for drug distributors to balance between ensuring patients can get their opioid prescriptions filled while preventing the painkillers from reaching the streets.

“I spoke with community pharmacists who said they were serving patients with legitimate pain, but were getting blocked with no explanation,” Chu said in her statement. “Their request was to receive consistent guidance from the DEA so they could avoid disruption for legitimate patients.”

“Community pharmacists must balance the work of combatting abuse with the work of ensuring those who need treatment have access to the medicine that can help,” she continued. “But after speaking with them, it was clear they needed better guidance in order to ensure they did both jobs appropriately.”

Lawmakers passed the bill unanimously, Chu noted.

Filed under: General Problems | Leave a Comment »

New Jersey: CDC guidelines causing more under treatment of pain ?

Posted on October 22, 2017 by Pharmaciststeve

Pain predicament: Opioid epidemic impacts prescription drug users with chronic pain

http://www.burlingtoncountytimes.com/news/local/pain-predicament-opioid-epidemic-impacts-prescription-drug-users-with-chronic/article_30557ceb-fc94-5d6e-b553-ae35ba5a185b.html

BURLINGTON TOWNSHIP — James Stewart remembers putting on his pads and running onto the grassy field to play football. The township resident said it was just over 20 years ago when he and his friends would still play competitively, despite being well into their 30s and 40s. Stewart has had a deep love for the game since childhood, and it’s stayed with him as he played in high school, college and then for fun.

But shortly after Stewart stopped playing, he began to have pain, mainly in his back, but also in his knees and other joints. He eventually underwent a two-part back surgery, as well as seven other surgeries in different areas to repair both bone and ligament damage.

 

“Most of the surgeries weren’t real heavy-duty stuff,” he said. “When I got to the back, it was a difficult surgery.”

Stewart, now 64, was sent home with two types of opioid painkillers in 2008 after the surgery to help deal with the pain. He had been warned about their addictive nature and took only one of them — 30 milligrams of oxycodone, as prescribed — to be able to move around without suffering.

“It was a two-part surgery, and I have chronic pain. It’s nerve on nerve. And I also need neck surgery. So I’m on medication just to try to have a decent day,” he said. “I’m not taking them to party. I don’t feel any ‘highness.’ All I feel is relief that I can go about a little bit of the day for a little while until it wears off.”

Stewart is one of at least 100 million Americans who suffer from chronic pain, according to a 2011 report from the Institute of Medicine. His original prescription said he could take one 30 mg pill four to six times a day, depending on his pain levels.

“I think I have a very good doctor, who did the best he could on my back, and I had to come in every time to get a prescription. There was no funny business,” he said. “I had to come in to see him personally to get a prescription. I never missed an appointment.”

However, just a few months ago in late April, Stewart said things changed. Instead of going to his doctor, he now goes to a pain management center to get his prescription filled, and his dosage amount was also reduced.

“(The pain management center) gave me a prescription for the 30 (mgs), and then when I came back the second time, I was informed, not asked, not, ‘How do you feel about this? What do you think about this?’ — I was told that now you’d be cut down to 15 mg, and that’s all I was told,” he said. “I was given a piece of paper that had this new guideline from the CDC.”

New guidelines

According to a statement from the U.S. Centers for Disease Control and Prevention, “Chronic pain is common, multidimensional and individualized, and treatment can be challenging for health care providers as well as patients.” In response to the critical need for consistent and current opioid prescribing guidelines, the CDC released the “Guideline for Prescribing Opioids for Chronic Pain.”

The purpose of the guidelines is to curb the overprescribing of opioid medication that led to the opioid epidemic, according to a statement from the CDC.

“Improving the way opioids are prescribed through clinical practice guidelines can ensure patients have access to safer, more effective chronic pain treatment, while reducing the risk of opioid use disorder, overdose and death,” the statement said. “Nearly 2 million Americans, aged 12 or older, either abused or were dependent on prescription opioids in 2014.”

In Burlington County, over 90 people have died from an overdose from January to July this year. Nationwide, more than 64,000 people died of an overdose in 2016, according to data from the CDC.

The guidelines focus on three main points: Determining when to initiate or continue opioids for chronic pain; monitoring the opioid selection, dosage, duration, follow-up and potential discontinuation; and assessing the risk and addressing the harms of opioid use.

Dr. Benjamin Duckles, a pain and spine specialist with Virtua who treats many chronic pain patients, said that since the new guidelines came out, he requires that all previous prescription histories and medical records are handed over to him so he can determine the best course of treatment for his patients.

“It depends on what treatment they’ve had prior to seeing me,” Duckles said. “The first and most important notion is to establish a diagnosis so we can discuss the history of their pain experience. I’m a big proponent of involving the patients in the process of understanding their pain or diagnosis.”

One of the new additions to the guidelines is that dosage recommendations for “exercising caution are lower than previous opioid prescribing guidelines.”

That was one of the issues Stewart had with the new restrictions.

“So the 30 (mgs), I could take no later than 8:30-9 in the morning, and that could last me, if i was lucky, until 2 (p.m.),” he said. “Then I would take another one about 3-4 (p.m.), and I was good. Now I take a 15 (mg), I don’t feel anything. I’m still bent over in the morning. They’re just not as effective as the 30 (mgs).”

Stewart said the reduction in dosage has dramatically affected his ability to get around like he used to.

“I’m just a little upset. I just want (my relief) back. I don’t do a whole lot. I’m not very active anymore; I can’t be,” he said.

Unintended consequences

 

In June, the American Academy of Pain Medicine released a “Future of Pain Care” resolution, noting that while the steps taken to address the opioid epidemic were helpful in many ways, they also adversely affected some patients who had used opioids safely and effectively.

“While the Centers for Disease Control drafted the Guideline for Prescribing Opioids for Chronic Pain to address the dramatic rise in opioid-related deaths, the document has, in some cases, had the unintended consequence of encouraging under-treatment, marginalization and stigmatization of the patients with chronic pain,” the resolution said.

Cassandra Badie, a Camden County resident, said she has felt this stigmatization as someone who suffers from neuropathy, stemming from her diabetes, which causes nerve damage in her feet and legs.

“You just don’t know what the feeling is to be treated like a drug dealer,” Badie said.

Some health officials caution that with all the focus on the opioid epidemic, other areas of the health care system are being ignored.

“All of the oxygen in the room is being used to address opioid addiction but not one of the primary causes, which is inadequate pain treatment,” Dr. Robert E. Wailes, a delegate with the American Academy of Pain Medicine, said in a statement attached to the resolution.

Duckles said he recognizes that opioids can be part of an effective treatment strategy for patients.

“One of the more important things we need to discuss is not forgetting that there are a lot of patients who have used opioids on a chronic basis for a long time and have done well,” he said. “Their pain has improved, and they’re able to do the things that they enjoy, whether that’s work or pleasure.”

Still, he cautioned against solely using opioid pills to treat pain. While each patient’s treatment is individualized, Duckles said he also employs other techniques, such as the use of anti-inflammatory prescriptions and physical therapy.

“My training taught me that the use of opioid therapy should never be done in isolation,” he said. “Opioid therapy alone doesn’t give them the best outcome.”

Patients like Stewart, however, said they at least would like to be included in the discussions that could have drastic effects on their lives.

“I’m not trying to cause a stink for anyone. I just want my medication not to be messed with and just to be talked to about it,” he said. “I’m not here to play any games. All I want to do is just have decent days.”

Filed under: General Problems | 1 Comment »

Australia: denial of proper pain management is INTERNATIONAL ?

Posted on October 22, 2017 by Pharmaciststeve

Give Pain a Voice – You Tube Channel

 

 

Filed under: General Problems | Leave a Comment »

Migraine Drug Used In ER May Not Be Best Option

Posted on October 22, 2017 by Pharmaciststeve

Migraine Drug Used In ER May Not Be Best Option

https://www.news-line.com/PH_news28506_enews

A drug commonly used in hospital emergency rooms for people with migraine is substantially less effective than an alternate drug and should not be used as a first choice treatment, according to a study published in the online issue of Neurology®, the medical journal of the American Academy of Neurology.

“People go to US emergency departments 1.2 million times a year with migraine, and the opioid drug hydromorphone is used in 25% of these visits, yet there have been no randomized, high-quality studies on its use for acute migraine,” said study author Benjamin W. Friedman, MD, MS, of Albert Einstein College of Medicine in the Bronx, N.Y.

The study found that the drug prochlorperazine, given along with the drug diphenhydramine to prevent the side effect of restlessness, was superior to hydromorphone. Prochlorperazine is a type of drug called a dopamine antagonist. It blocks the release of dopamine, which is one of the many chemical messengers in the brain. The drugs were all given intravenously.

The researchers were also looking at whether the use of an opioid drug led to addiction in some people, with return visits to emergency rooms for repeat treatments.

“While this study demonstrates the overwhelming superiority of prochlorperazine over hydromorphone for initial treatment of acute migraine, the results do not suggest that treatment with IV opioids leads to long-term addiction,” Friedman said.

“In addition, the results should not be used to avoid the use of opioids for people who have not responded well to anti-dopaminergic drugs.”

The study involved 127 people who went to two emergency departments in New York with migraine. Half of the participants received hydromorphone and half received prochlorperazine. The researchers were looking to see how many people had sustained headache relief after 48 hours, which was defined as having a mild headache or no headache two hours after receiving the drug and maintaining that level for 48 hours without needing a rescue medication to stop the migraine.

The study was stopped after 127 people had enrolled because the 48-hour results showed that prochlorperazine was overwhelmingly superior to hydromorphone.

After 48 hours, 37 of the 62 people, or 60%, receiving prochlorperazine had sustained headache relief, compared to 20 of the 64 people who received hydromorphone, or 31 percent. In the emergency room, 31% of those who received hydromorphone asked for a second dose of the drug, compared to 8% of those who received prochlorperazine. Of those receiving hydromorphone, 36% requested other pain-reliever drugs, compared to 6% of the other group.

There was no difference between the two groups in how often they returned to the ER for migraine within one month of the treatment.

Friedman said that one limitation of the study is that participants were required to have not used opioids during the previous month and to have no history of addiction to prescription or illicit opioids, so the participants may have been at lower risk for problems with opioid use than the general population.

 

Filed under: General Problems | 1 Comment »

China already controls illegal fentanyl and 18 related compounds

Posted on October 21, 2017 by Pharmaciststeve

China firms happy to sell killer opioid “weapon” to anyone in U.S.

https://www.cbsnews.com/news/china-sell-opioid-carfentanil-fentanyl-chemical-weapon-unrestricted-chinese/

SHANGHAI — It’s one of the strongest opioids in circulation, so deadly an amount smaller than a poppy seed can kill a person. Until July, when reports of carfentanil overdoses began to surface in the U.S., the substance was best known for knocking out moose and elephants — or as a chemical weapon.

Despite the dangers, Chinese vendors offer to sell carfentanil openly online, for worldwide export, no questions asked, an Associated Press investigation has found. The AP identified 12 Chinese businesses that said they would export carfentanil to the United States, Canada, the United Kingdom, France, Germany, Belgium and Australia for as little as $2,750 a kilogram.

Carfentanil burst into view this summer as the latest scourge in an epidemic of opioid abuse that has killed tens of thousands in the U.S. alone. In China, the top global source of synthetic drugs, carfentanil is not a controlled substance. The U.S. government is pressing China to blacklist it, but Beijing has yet to act.

“We can supply carfentanil … for sure,” a saleswoman from Jilin Tely Import and Export Co. wrote in broken English in a September email. “And it’s one of our hot sales product.”

The AP did not actually order any drugs, or test whether the products on offer were genuine.

China’s Ministry of Public Security declined multiple requests for comment.

For decades before being discovered by drug dealers, carfentanil and substances like it were researched as chemical weapons by the U.S., U.K., Russia, Israel, China, the Czech Republic and India, according to publicly available documents. They are banned from the battlefield under the Chemical Weapons Convention.

“It’s a weapon,” said Andrew Weber, assistant secretary of defense for nuclear, chemical and biological defense programs from 2009 to 2014. “Companies shouldn’t be just sending it to anybody.”

Carfentanil is 100 times more powerful than fentanyl, a related drug that is itself up to 50 times stronger than heroin.

Forms of fentanyl are suspected in an unsuccessful 1997 attempt by Mossad agents to kill a Hamas leader in Jordan, and were used to lethal effect by Russian forces against Chechen separatists who took hundreds of hostages at a Moscow theater in 2002.

The theater siege prompted the U.S. to develop strategies to counter carfentanil’s potential use as a tool of war or terrorism, according to Weber. “Countries that we are concerned about were interested in using it for offensive purposes,” he said. “We are also concerned that groups like ISIS could order it commercially.”

Later, dealers discovered that vast profits could be made by cutting fentanyls into illicit drugs. In fiscal year 2014, U.S. authorities seized just 8.1 pounds of fentanyl. This fiscal year, through just mid-July, they seized 295 pounds, Customs and Border Protection data show. Overdose rates have been skyrocketing.

The DEA has “shared intelligence and scientific data” with China about controlling carfentanil, according to Russell Baer, a DEA special agent in Washington.

“I know China is looking at it very closely,” he said. Delegations of top Chinese and U.S. drug enforcement officials met in August and September to discuss opioids, but failed to produce a substantive announcement on carfentanil.

China is not blind to the key role its chemists play in the opioid supply chain. Most synthetic drugs that end up in the United States come from China, according to the DEA.

China already has controlled fentanyl and 18 related compounds, but despite periodic crackdowns, people willing to skirt the law are easy to find in China’s vast, freewheeling chemicals industry. Vendors said they lied on customs forms, guaranteed delivery to countries where carfentanil is banned and volunteered strategic advice on sneaking packages past law enforcement.

“The government should impose very serious limits, but in reality in China it’s so difficult to control because if I produce 1 or 2 kilograms, how will anyone know?” said Xu Liqun, president of Hangzhou Reward Technology, which offered to produce carfentanil to order. “They cannot control you, so many products, so many labs.”

Last October, China added 116 synthetic drugs to its controlled substances list. Acetylfentanyl, a weak fentanyl variant, was among them. Six months later, monthly seizures of acetylfentanyl in the U.S. were down 60 percent, DEA data obtained by the AP shows.

Several vendors contacted in September were willing to export carfentanil but refused to provide the far less potent acetylfentanyl.

Seven companies, however, offered to sell acetylfentanyl despite the ban. Five offered fentanyl and two offered alpha-PVP, commonly known as flakka, which are also controlled substances in China.

Several vendors recommended shipping by EMS, the express mail service of state-owned China Postal Express & Logistics Co.

“EMS is a little slow than Fedex or DHL but very safe, more than 99% pass rate,” a Yuntu Chemical Co. representative wrote in an email.

EMS declined comment. A Yuntu representative hung up the phone when contacted by the AP and did not reply to emails. Soon after, the company’s website vanished.

 

Filed under: General Problems | Leave a Comment »

The “SILENT KILLER”… not managed in >50% of adults – how many are under treated CPP’s ?

Posted on October 21, 2017 by Pharmaciststeve

CDC: Control not achieved in more than half of US adults with hypertension

https://www.healio.com/cardiology/vascular-medicine/news/online/%7B0b2f8a78-bafe-48a6-bfd9-7750010bd446%7D/cdc-control-not-achieved-in-more-than-half-of-us-adults-with-hypertension

Less than half of U.S. adults with hypertension have their BP under control, according to a data brief released by the CDC’s National Center for Health Statistics.

“Despite progress in hypertension control that has been noted in the United States over the years, the goal of Healthy People 2020 (61.2% by 2020) has not been met,” Cheryl D. Fryar, MSPH, from the division of Health and Nutrition Examination Surveys at the National Center for Health Statistics, and colleagues wrote in the brief. “Currently just less than one-half of adults with hypertension have their hypertension under control (48.3%).”

Using NHANES survey data, the researchers found the overall prevalence of hypertension among U.S. adults from 2015 to 2016 was 29% and was similar in men and women (men, 30.2%; women, 27.7%). This prevalence grew more common with age, increasing from 7.5% among those aged 18 to 39 years to 33.2% among adults aged 40 to 59 years and 63.1% in those aged at least 60 years.

Although men had higher rates of hypertension than women among adults aged 18 to 39 years (9.2% vs. 5.6%) and aged 40 to 59 years (37.2% vs. 29.4%), men had lower prevalence of hypertension than women among adults aged at least 60 years (58.5% vs. 66.8%).

The researchers noted that hypertension prevalence was highest in non-Hispanic black adults (40.3%) compared with other races and ethnicities (non-Hispanic white adults, 27.8%; non-Hispanic Asian adults, 25%; Hispanic adults, 27.8%).

Among adults with hypertension, 32.5% of those aged 18 to 39 years had it controlled vs. 50.8% of those aged 40 to 59 years and 49.4% of those aged at least 60 years, according to the report.

Women were more likely than men to have their hypertension controlled (52.5% vs. 45.7%), especially in adults aged 18 to 39 years (62.6% vs. 15.5%).

Rates of hypertension control were higher in non-Hispanic white adults (50.8%) vs. non-Hispanic black adults (44.6%) and non-Hispanic Asian adults (37.4%).

According to the brief, there has been no significant change in hypertension prevalence among U.S. adults between 1999 and 2016. Although prevalence of controlled hypertension among those with hypertension rose from 31.6% in 1999-2000 to 53.1% in 2009-2010, it has not changed significantly since then, Fryar and colleagues wrote, noting the decline in controlled hypertension from 53.9% in 2013-2014 to 48.3% in 2015-2016 was not significant.

Filed under: General Problems | Leave a Comment »

To believe or NOT TO BELIEVE… that is the question ?

Posted on October 21, 2017 by Pharmaciststeve

I’ve Had to Swap My Stethoscope for a Magnifying Glass to Cope with Opioids

https://opmed.doximity.com/swapping-stethoscope-for-magnifying-glass-coping-with-the-responsibility-of-the-opioid-epidemic-61311957dc73

It should be simple, even if not so straight forward: If your patient is in pain, you treat them.

But what about a patient who’s been on opioids for years? How do you answer those who were led down the chronic opioid path by old school medicine, either rightly, or wrongly, so? Where do we draw the line?

Consider this example.

A patient walks in asking for a pain med refill. He’s had neck pain for years, and nothing has helped other than narcotics. His previous doctors gave him Percocets. Or Oxycontins. Or substitute whichever controlled substance you’d like here. What is my role in this given scenario, as his doctor? Classically, I’ve been trained to assess and treat the patient — simple as that.

But enter the dilemma of modern day medicine and the opioid epidemic. In this particular instance, as a PMD practicing today, I am expected to shed my doctor’s coat and stethoscope, while replacing them with the raincoat and magnifying glass of a sleuth. You can even add suspenders for dramatics. There’s only one problem: I have watched just a handful of episodes of Columbo in my youth and, while they were highly entertaining, I’m not quite ready to take on a role as understudy. I haven’t even rehearsed.

However, this growing epidemic expects me to do just that, to put on my detective gear and start interrogations.

But how can I do that? What if I miss an addict, and they in turn pass away of an overdose the following day? Or even worse, suspect ill of a patient and miss treating his real pain? And what of the patient’s opinion of me? Who would stay with a physician who constantly questions their honesty?

It’s a lose-lose.

The truth of it is that assessing for pain is tough. It’s subjective. If someone says they’re in pain, we often expect them to look like they’re in pain. But I know better, not only because I myself have held back pain, but also because I feel like I should trust my patients.

Then there’s the issue of physical examination. I use it as an investigational tool, but it certainly has its limitations. A patient who is seeking drugs can simply make up an ‘ouch.’ Think about it. You move the leg up, a patient utters in pain or grabs his backside. Who am I to judge if that grimace is real? It’s enough to have to scan through a myriad of possible diagnoses in my head, all by memory, gained through years of education and training, but to also have to call a bluff? Even the best of poker pros make mistakes. Plus, in real life, it’s easier to give people the benefit of the doubt. We want to believe them. I mean, sure, many of us in the field can recount instances in which patients theatrically put on a show to get what they want. But what about the instances that weren’t quite so obvious? I guarantee numerous Oscar-worthy performances could fool even the most seasoned of practitioners. And we are, after all, medical providers, not detectives.

But, this isn’t what I signed up for.

Let’s dissect the nature of filling a controlled substance request for a moment. Are you familiar with the procedure?

At some point during a 15 minute office visit, I must check on my patient’s previous and current usage of controlled substances by logging on to a separate databank on the web, a step mandated by the state. Once in it (after manual insertion of full name and date of birth), I peruse through a patient’s ‘record.’ Even grandma Louise must be subjected to such a search. This is no simple task and can take up quite a bit of time. I must then interpret information gained and determine if said patient is legitimately asking for the medication or possibly requesting their next easy fix. Followed, by the way, by a two-step verification process in which the medication is actually ordered. The details are lengthy and involve not only entering my system password once again but also providing a virtual ‘key,’ a 6-digit number I obtain by using an app installed on my iPhone.

*gulp*

Is this really what I signed up for when I took the Hippocratic Oath?

Yes, because I’ve promised to do no harm. If a patient is abusing, I should identify their addiction. I should help them with awareness, admission, and recovery.

But also, no. I want to heal, but I’m not quite ready for police work.

And when I do identify potential abuse, just how difficult can it be to tell someone they may have a problem? Extremely. How often does a patient actually admit to an addiction? Rarely. The very nature of coming in and asking for the mediation is the cycle of abuse in action. If I ever suggest there may be a problem, no one openly embraces my suspicion with open arms and a smile, or with a weeping confession. Unfortunately, this scenario is only encountered on Hollywood big screens or in the dreams of naive medical students. Addicts don’t admit. Addicts lash out. They deny. They are genuinely surprised. They threaten. They scream.

They even kill. Just read about Dr. Todd Graham of Indiana, 56 years old when he died for saying no to such a script.

It may seem easy, to anyone on the outside, to identify those who may be abusing. But no one walks into my office and says, “Doc, please give me oxy to feed my addiction,” or, “Send a prescription in so I can get back on the streets and sell. My supply is running low.”

No, I didn’t sign up for this. I signed up to go to work every day and to heal. To help identify illness. To help alleviate medical conditions. To have a good rapport with those who seek my advice. To come to work with a smile and to leave with a gratifying sense of achievement.

I signed up to heal.

Filed under: General Problems | Leave a Comment »

Dr. Reddy’s, fighting to recover from FDA warning letter, recalls 500K heartburn tablets

Posted on October 21, 2017 by Pharmaciststeve

Dr. Reddy’s, fighting to recover from FDA warning letter, recalls 500K heartburn tablets

http://www.fiercepharma.com/manufacturing/dr-reddy-s-fighting-to-recover-from-fda-warning-letter-recalls-500-000-heartburn

Still struggling to turn its manufacturing around, Dr. Reddy’s is recalling 569,000 store-brand famotidine tablets in the U.S., thanks to failed tests for impurities and degradation. It’s the India-based company’s second recall of the same medication since last July.

 The meds were sold at CVS pharmacies as CVS Pharmacy Acid Controller and at Walmart under the Equate label, according to the FDA’s latest Enforcement Report. It’s a Class III recall, meaning the suspect drugs aren’t likely to cause injury to humans.

Dr. Reddys pulled more than 84,000 famotidine tablets, also produced for CVS, last July. In both cases, the company found an out-of-specification result during routine stability testing. The new recall is nationwide.

The latest recall comes as the generics maker continues to suffer FDA citations at multiple manufacturing plants, including some included in a 2015 warning letter. Its ongoing manufacturing problems triggered a decline in U.S. sales, making a dent in its fiscal 2017 results announced in May.

That same month, Dr. Reddy’s reported that an inspection of its Bachupally formulation plant in Hyderabad resulted in an FDA Form 483 with 11 observations.

 That notice came as Harvard Drug Group recalled about 9,200 cartons of the antifungal drug fluconazole manufactured at the Bachupally plant. And it followed two other Form 483s, one in April and another in February, citing problems at active pharmaceutical ingredient (API) plants in Srikakulam and Miryalaguda that had featured in that 2015 warning letter.

The company’s manufacturing issues also prompted a fraud lawsuit from South Korea’s Mezzion. The FDA had rejected Mezzion’s drug candidate udenafil because of manufacturing problems. Mezzion alleged that Dr. Reddy’s repeatedly said it was compliant with FDA regulations when it was not and that Dr. Reddy’s “was the sole reason given by the FDA” for denying udenafil’s approval.

Filed under: General Problems | Leave a Comment »

Rep. Keating Introduces Bill Repealing 2016 Opioid Distribution Law

Posted on October 21, 2017 by Pharmaciststeve

Rep. Keating Introduces Bill Repealing 2016 Opioid Distribution Law

https://www.capenews.net/bourne/news/rep-keating-introduces-bill-repealing-opioid-distribution-law/article_e77b6119-0528-5133-a998-fd47ef0e0164.html

US Congressman William R. Keating, a Democrat from Bourne whose district includes Cape Cod, will introduce legislation repealing the Ensuring Patient Access and Effective Drug Enforcement Act of 2016.

As the House of Representatives is not currently in session, the bill will be introduced at the next opportunity, according to a release from Rep. Keating’s office on Monday, October 16.

Rep. Keating is a member of both the Congressional Addiction, Treatment, and Recovery Caucus, and the Bipartisan Heroin Task Force.

The Washington Post and “60 Minutes” jointly reported earlier this week that last year Congress helped derail the US Drug Enforcement Administration’s ability to keep addictive opioids off US streets. Their report followed an interview with Joseph T. Rannazzisi, who ran the DEA’s Office of Diversion Control, the division that regulates and investigates the pharmaceutical industry.

Mr. Rannazzisi told “60 Minutes” that Congress, lobbyists and the drug distribution industry helped allow the spread of hundreds of millions of pills to “rogue pharmacies” and pain clinics.

A handful of members of Congress, The Washington Post said, “prevailed upon the DEA and the Justice Department to agree to a more industry-friendly law, undermining efforts to stanch the flow of pain pills.” The DEA had long opposed the effort.

A chief advocate of the law was Rep. Thomas Marino, a Republican from Pennsylvania whom President Donald J. Trump had nominated as the nation’s next drug czar.

The president announced Monday that Rep. Marino had withdrawn his name from consideration for the position.

 Rep. Keating said the Ensuring Patient Access and Effective Drug Enforcement Act of 2016 made it harder for law enforcement officials to crack down on unsafe practices in the pharmaceutical industry.

“Recent media reports have shown the law severely impeded the DEA’s ability to suspend opioid distributions when the agency detected suspicious activity, allowing an oversupply of opioids in the marketplace,” he said.

Rep. Keating’s legislation, the release said, “would help restore the effectiveness of the DEA’s efforts to protect the members of our communities at risk of overdose from prescription opioids.”

“We are in the throes of an epidemic, and we need every tool available at our disposal,” Rep. Keating said. “We cannot be making it unnecessarily harder for our law enforcement agencies to do their job.”

Congress normally passed 200-400 new bills every  year and when is the last time that anyone heard of Congress REPEALING a law that they have passed in the previous Congressional session.

When is the last time that you are told about a very antiquated law on the books that is no longer appropriate and no longer enforced… BUT… there is never a consideration on repealing those antiquated laws ?

With reports coming out that legal opiate prescriptions have been declining since 2012 and recent data on OD’s continue to increase and in some areas illegal opiates are found in up to 99% of the toxicology of those who OD’d.

It would appear that the legal distribution channel(s) of prescription opiates are not part of the current problem…BUT… there is more money to be had by the DEA from that group of DEA licensees…

Has anyone noticed that the Pharmas and pharmacy wholesalers… never had assets seized… none are put out of business … no exec of these corporations every go to jail… the DEA just fine the crap out of them…  The same thing happens with the chain pharmacy industry..

HOWEVER, when they go after a prescriber or independent pharmacy… they PUT THEM OUT OF BUSINESS… seize all their assets and the individual goes to JAIL for sometimes DECADES…

There is little/no money for the DEA – and more likely to be shot at — by going after drug cartel and seizing illegal substances.

My money is on that  Rep Keating being an ATTORNEY – part of the judicial system – doesn’t want his fellow “fraternal brothers and sisters” and our judicial system to be at risk of losing some of their budgets and the number of employees gets reduced.  We may also find out that Rep Keating has a family member or friend or some friend with a family member that has been caught up in the opiate crisis because they suffer from mental health issues.

 

Filed under: General Problems | Leave a Comment »

« Previous Page — Next Page »