Finally… someone finally looking at the REAL REASON… YOUR RX IS SO EXPENSIVE

Posted on May 27, 2017 by Pharmaciststeve

Legislature

Roberson presents bill mandating transparency from middlemen in drug pricing process

https://thenevadaindependent.com/article/roberson-presents-bill-mandating-transparency-from-middlemen-in-drug-pricing-process

Republican Senate Leader Michael Roberson’s bill to put transparency mandates on the middlemen in the drug pricing process known as pharmacy benefit managers received a tepid but not entirely unwelcome reception from Democrats during its first hearing Friday afternoon.

Roberson and co-sponsor Republican Sen. Heidi Gansert presented SB539 to the Senate Health and Human Services Committee as complementary legislation to a Democrat-sponsored bill placing transparency mandates on pharmaceutical manufacturers, which passed out of the Legislature Thursday. The Republican senators argued that the bill would help shed light on the “most opaque part” of the drug pricing process overseen by the third party administrators responsible for administering prescription drug programs for health plans known as PBMs,

The legislation would require PBMs to post on their website the rate at which they reimburse each pharmacy for a diabetes drug covered by a plan and submit a report to the state including the total amount of all rebates that the PBM negotiated with manufacturers in the preceding calendar year for diabetes drugs and the total amount of the rebates that were retained by PBMs, among other information. The bill also exempts that information from Nevada’s trade secret law, making it publicly disclosable.

“We’re proposing a very simple thing today. It’s more transparency,” Roberson said. “We just want to know when it comes to rebates, when you’re a PBM, how much do you get from a drug manufacturer and what do you do when you get those rebates?”

Democratic senators probed Roberson and Gansert about why the bill primarily targets pharmacy benefit managers instead of including language requiring transparency from insurance companies — paralleling a line of questioning from lukewarm Senate Republicans during a hearing on Democratic Sen. Yvanna Cancela’s manufacturer-focused legislation, SB265, about why her bill didn’t include PBMs.

“Your video that you presented suggested that insurance companies were also a significant part of the challenge,” Ratti said. “Why PBMs and why not insurance companies?”

Roberson said that insurance companies were initially a part of the legislation but that they are already mandated by law to provide more transparency than drug manufacturers or PBMs do today. He said that health plans and manufacturers don’t even know what PBMs are paying for various drugs and what kind of rebates they receive from manufacturers.

“I would encourage all of you to spend 10 minutes on Google and find source after source after source that talks about the rebates that are received by PBMs and what they do with them,” Roberson said.

Republican Sen. Scott Hammond repeated concerns he expressed during the hearings on SB265 about providing transparency throughout the drug pricing process, asking where the consumer would be left should SB539 not pass.

“Clearly nothing will change with regard to PBMs and what they do and what they don’t do,” Roberson said. “It’s not a complete solution without looking at transparency on PBMs.”

Roberson asked the committee to, at the very least, move forward the portion of his bill barring PBMs, insurers and others from putting gag orders on pharmacists preventing them from providing information to patients about the costs of copayments or coinsurance on their drugs and suggesting cheaper alternatives. He said it didn’t matter to him whether they move that provision forward in his bill or include it in another bill.

“At the very least we can prevent PBMs from continuing to put a gag order on pharmacists in our state,” Roberson said. “That would be a big, simple thing we can do in the waning days here.”

But a representative from the trade association representing PBMs told the committee that he had never seen or been privy to any contracts between a PBM and a pharmacy that included a gag order in his 20 years in the industry. He suggested that people who have raised complaints about that are parties in the contracts concerned about their reimbursement rate and attempting to find fault.

“I have not personally had a contract where it says you can’t talk to the patient about their therapy,” said John Jones, a health care policy consultant with the Pharmaceutical Care Management Association. “That is just not the case.”

The legislation also requires pharmaceutical manufacturers to annually report the list price of their diabetes drugs to the Department of Health and Human Services, which would then be responsible for compiling a list of drugs that are used to treat diabetes and have been subject to a price increase in the immediately preceding two calendar years. Those companies would then be required to submit to the department a report explaining why the price of the drugs increased.

An amendment to the bill presented to the committee on Friday removes a requirement that PBMs pass along to insurance companies at least 80 percent of the amount of any rebate obtained from a manufacturer related to the sale of a drug used to treat diabetes.

“If nothing is done in the net 10 days one of you on this committee will become more informed on this issue and probably champion this issue in 2019,” Roberson said. “And if Congress hasn’t addressed this issue by then I’m sure you will.”

 

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ADVOCACY : CLUELESS until it is IN YOUR FACE ?

Posted on May 27, 2017 by Pharmaciststeve

Like everything else revolving around the “war on drugs”, I suspect that there are no statics kept – or divulged – on how many families are NOT VOCAL ADVOCATES until someone in their family has died/OD’d. It doesn’t make any difference if the family member OD’d on illegal drugs or killed driving drunk or killed by a drunken driver.

How many times have we read where a person had gone thru numerous rehab programs and the family is doesn’t starts being a vocal advocate until the family member once again returns to using/abusing opiates and OD’s  -or commits suicide… which … according to reports… people that are using/abuse various substances .. .never seems to be reported as committing suicide when they die from a multi-substance overdose.

The family members comes out declaring that they “don’t want this to happen to any other family”

Of course, the chronic pain community also has many pts/families that are sitting on their hands with tape over their mouths until the pt’s prescriber, insurance, legislatures and others..causes the pt’s pain medication(s) to be reduced or eliminated all together.

A successful advocate program takes people with many talents and areas of knowledge/expertise. It needs people who are organizers, fund raisers, motivators, educators, strategists and all those affected being active in advocating to the best of their ability.

I am closing in on my FIFTH YEAR of blogging and trying to be a advocate for the chronic pain community. I have seen many people try to advocate and organize the chronic pain community… all too many have come and gone… because it would seem that the chronic pain community is divided into several areas…. those that have their meds cut back to where the pt is has little/no quality of life, the spouse and their family has abandoned them, and those who believe that if they keep their head down and their mouth shut…they will be alright… otherwise  they are in the state of denial.

 

Image result for graphic I have seen the enemy is us

 

 

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So much for DEA’s chief belief that MMJ has no medical use – just follow the science ?

Posted on May 26, 2017 by Pharmaciststeve

Medicinal use for marijuana confirmed: CBD helps kids with rare epilepsy

Randomized, double-blind placebo-controlled trial finds cannabidiol benefits.

In a randomized, double-blind, placebo-controlled clinical trial—the gold-standard design—a component of marijuana called cannabidiol (CBD) reduced seizures in children with a rare and devastating form of epilepsy.

The results, published in the New England Journal of Medicine, provide the first solid evidence that marijuana can be used to treat epilepsy, something some patient groups and advocates have argued for years. It also adds to mounting data supporting the medicinal value of the controversial plant. The Drug Enforcement Administration currently lists marijuana as a Schedule I drug, a type of drug with no accepted medical use but a high potential for abuse.

A landmark review of marijuana research, released in January by the National Academies of Science, Engineering, and Medicine, concluded that marijuana can effectively treat chronic pain in some patients. But for other conditions, including epilepsy, the data is still inconclusive. Earlier trials on epilepsy, for instance, were small or suboptimal and provided mixed results.

For the new high-quality trial, neurologist Orrin Devinsky of New York University Langone Medical Center and colleagues enrolled 120 US and European kids, aged 2 to 18 (average age of 9.8). All of the kids had a rare form of epilepsy, called Dravet syndrome, and suffered from drug-resistant seizures. Dravet syndrome is a life-long intractable condition generally caused by a mutation in the SCN1A gene. This gene is critical for proper electrical signaling in the brain because it contributes to voltage-gated sodium ion channels in neurons. Dravet syndrome affects only about one in 16,000 people. Between 10 and 20 percent of those affected don’t survive to adulthood.

The 120 participants in the study were, on average, taking three drugs to try to control their seizures. For the first four weeks of the trial, the researchers tracked each participant’s seizure frequency as a baseline. The kids were then randomly assigned to take either CBD—a non-psychoactive component of marijuana taken as an oil—or a placebo for 14 weeks along with their normal drug regimen. The kids and their caretakers didn’t know if they were taking CBD or a placebo.

Data high

In the end, the group of kids taking CBD saw their average number of convulsive seizures drop from 12.4 per month to 5.9. The placebo group’s average only dropped from 14.9 to 14.1 seizures per month. Parsing the data further, the researchers found that 43 percent of those taking CBD saw their seizure rate at least halved, while only 27 percent of the placebo group saw the same. Three of the participants taking CBD became completely free of seizures, but none in the placebo group did. Caregivers were also nearly twice as likely to report that the participant’s overall condition improved while taking CBD compared with placebo.

But these benefits had costs. Ninety-three percent of those taking CBD reported side effects, while only 75 percent of placebo participants made similar reports. The most common side effects reported in the CBD group (and at much higher rates than the placebo group) were sleepiness, diarrhea, and loss of appetite. Other side effects included fatigue, vomiting, raised body temperature, lethargy, upper respiratory tract infections, and elevated liver enzymes. Eight participants taking CBD withdrew from the trial due to the side effects, as did one in the placebo group.

But some of the side effects may have been due to drug combinations, not CBD alone. For instance, kids in the CBD group who were also taking the epilepsy drug valproate were the only ones to experience liver problems as a side effect.

The researchers note that some of the side effects had the potential to “unblind” participants, clueing them in to their treatment group. But when the researchers did extra analysis of the data from the kids that seemed to benefit from CBD, there was no link between improvement and common CBD side-effect reporting. This hints that those participants may not have figured it out.

Still, the authors concluded that they’ll need more data to determine the long-term efficacy and safety. But the trial definitely showed that CBD reduced seizures in kids with Dravet syndrome.

The trial was sponsored by GW Pharmaceuticals, which has branded its CBD oil Epidiolex. The company has already received a “Fast Track” designation from the Food and Drug Administration to hasten its approval process, which will begin later this year. Currently there are no FDA-approved drugs specifically for Dravet syndrome.

“This trial represents the beginning of solid evidence for the use of cannabinoids in epilepsy,” Samuel F. Berkovic, of the Epilepsy Research Centre at the University of Melbourne, wrote in an accompanying editorial. “After an era dominated by anecdote and obfuscated by medicolegal issues and emotionally infused debate, more scientific studies are under way.”

NEJM, 2017. DOI: 10.1056/NEJMoa1611618  (About DOIs).

 

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Cocaine comes roaring back to South Florida — and then some

Posted on May 26, 2017 by Pharmaciststeve

Cocaine comes roaring back to South Florida — and then some

http://www.sun-sentinel.com/news/florida/fl-reg-cocaine-surge-fueling-overdoses-20170523-story.html

Cocaine is making a comeback in South Florida.

Colombian cocaine production is at a record high, and traffickers are bringing the drug into the southern half of the Sunshine State more now than in the last decade, Drug Enforcement Administration officials say.

While Americans turned their attention to confront an opioid epidemic, Colombia has been producing more cocaine than at the height of the Miami drug wars in the 1980s, they say.

“There is a mountain of cocaine, much of it is likely headed our way,” said Justin Miller, intelligence chief for the DEA’s Miami field division. “But we are already seeing these drug combinations, and cocaine deaths are already going up significantly.”

Generally, 90 percent of the cocaine seized in the U.S. is traced back to Colombia, which already has tripled production over the past few years, Miller said.

Florida’s Customs and Border Protection says it had slightly fewer seizures but still confiscated 61 percent more cocaine — nearly 9,500 pounds — last year over the prior year.

Because of the time lag between drug production and distribution, the full impact has just begun to hit the U.S., say DEA officials.

Overdose deaths related to the white powder are at their highest since 2007 in Florida, according to the state Medical Examiner Commission. Cocaine overdose deaths climbed year over year from 2012 to 2015, the latest figures available, rising from 1,318 to 1,834 deaths.

And South Florida saw 614 overdose fatalities in Broward, Miami-Dade and Palm Beach counties in 2015 — a 29 percent increase over the prior year.

Cocaine was second only to fentanyl — a cheap, synthetic painkiller — in contributing to Florida overdose deaths in the first half of the last year, medical examiner records show.

Authorities predict the boom in the production and availability of cocaine will lead to even more overdose deaths, especially when the drug is combined with other narcotics like heroin.

Producing more cocaine

Cocaine production has surged since October 2015 when the Colombian government stopped aerial spraying of herbicides over coca fields used to make cocaine, Miller said. The Colombian government ended the decadeslong program over health concerns.

“The aerial spraying worked quite well,” said Richard Mangan, a former DEA agent and Florida Atlantic University criminal justice professor. “But there was a lot of pushback after a while to the damage it was doing to legitimate crops, the damage it was doing to people.”

But even before the program ended, DEA reports indicated the Revolutionary Armed Forces of Colombia, more commonly known as FARC, encouraged farmers to plant more coca ahead of the government’s peace agreement with the rebel group, signed last November, according to a report this year from the U.S. Department of State.

At the same time, the Colombian government cut back operations to uproot coca fields in FARC-controlled territory while farmers used blockades and improvised explosive devices to limit access to fields, according to the report.

The DEA estimates Colombia produced 710 tons of pure cocaine last year, or enough to fill about 18 semitrucks.

“We’ve never seen cocaine production at these numbers, which tells you there is more cocaine being produced now than at the height of the Medellin and Cali cartels,” Miller said. “That’s significant.”

Not all of that cocaine heads to the U.S., but the bulk of it does, he added.

The increase is already driving down prices in Miami, and more generally, in South Florida, Miller said.

One kilo — about 2.2 pounds — of pure cocaine was worth between $28,000 and $35,000 two to three years ago, he said. Today, the same amount is worth $26,000 to $28,000.

On the streets of Miami, a gram sells for between $50 and $80 these days, Miller said.

Drug wars of the past

South Florida long ago drew national attention over cocaine problems.

On July 11, 1979, two men stepped out of a white Ford van in broad daylight and gunned down a pair of men at the Dadeland Mall in Miami-Dade. The bloody execution was tied to Colombian drug lord Pablo Escobar, his Medellin cartel and the drug trade in South Florida.

The incident marked the beginning of the era of the “cocaine cowboys.”

Over the next decade, South Florida became the main artery for cocaine shipments heading for U.S. markets. Cocaine and cash flooded the streets. Drug dealers walked into banks with bags full of cash, and Colombian drug violence spilled over into American cities as criminal organizations fought for control.

But unlike the days of Escobar, today’s cocaine producers are more decentralized, in large part due to government efforts to take down large-scale criminal organizations.

“Now you have these smaller cartels, they don’t want to run for Congress like Escobar or run TV stations like the Cali cartel, they want to remain low profile,” Mangan said.

Colombian criminal organizations still have ties to South Florida to help launder cash, but remain smaller and less violent than during the heyday of the Miami drug wars.

Often Colombian producers sell their product wholesale to drug traffickers in the Caribbean, who skip from island to island by air and sea, evading patrols in the Gulf of Mexico and offloading their products in South Florida and other destinations, Miller said.

Miami and Orlando remain a point of arrival for cocaine shipped from Colombia, though more cocaine is trafficked over the U.S. border with Mexico than anywhere else, according to DEA reports.

Traffickers today are sneaking cocaine into South Florida on cheap speedboats, shipping containers and commercial flights, DEA reports show.

In the last decade, traffickers also have begun using semi-submersible ships designed to be barely visible on the ocean’s surface. Underneath the water hide hollow containers filled with drugs and manned by crews of three to four people, Mangan said.

“Unless you are right on top of it, it is almost impossible to detect,” he said.

A deadly drug cocktail

Cocaine overdose deaths peaked in the state in 2007, declined with the Great Recession and are again on the rise, said Jim Hall, epidemiologist for Nova Southeastern University.

“I think all the attention we have given to opioids might give the impression that cocaine is a safer drug,” Hall said.

Last August a 28-year-old Lake Worth resident died from a fatal combination of cocaine and fentanyl, according to a medical examiner report.

Sterling Redwine was a heroin addict in recovery, but died with a crack pipe in his hand. His mother, Wendy Fields, thinks he used cocaine to avoid relapsing on heroin, she said.

“He did not want to turn back to heroin, however for whatever reason, he felt he had to have something that day. Unfortunately, what he had was also cut with fentanyl,” Fields said.

Across the state, more and more users are “speed balling” cocaine and opioids like fentanyl, metastasizing the number of deaths amid the opioid epidemic.

Of the 1,144 cocaine-related overdose deaths statewide in the first half of last year, 88 percent involved at least one other drug, Hall said.

Often drug users don’t know what they are taking. Heroin can be cut with drugs such as fentanyl, xanax and cocaine. The DEA has also analyzed samples of cocaine-fentanyl combinations in the last few years, according to a report.

And Florida likely will see more overdose deaths as potency and availability increases, Hall said.

“Substance abuse in this stage of the 21st century is more hazardous, more dangerous, more addictive and more deadly than at any other point in our lifetimes,” Hall said.

I bet that SOUTH FLORIDA is glad that AG Pam Bondi “ran all the oxy docs” out of Florida a couple of years back. I wonder what she is going to do about all the illegal Cocaine traffickers coming to South Florida… I doubt if they will set up store fronts like the “oxy docs” and doubtful they will create a “paper trail” like a medical office.. and one other important factor… odds are they will be ARMED TO THE TEETH and not concerned about shooting those in law enforcement that are interfering with their business plan and profits..

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Law Firm Wants Transparency in Medicare Opioid Policy

Posted on May 26, 2017 by Pharmaciststeve

Law Firm Wants Transparency in Medicare Opioid Policy

www.painnewsnetwork.org/stories/2017/5/24/legal-group-calls-for-transparency-in-medicare-opioid-policy#

By Pat Anson, Editor

A Washington-based legal firm is calling for more openness and transparency by the Centers for Medicare and Medicaid Services (CMS) as it establishes new rules that are likely to limit access to opioid pain medication for millions of Medicare patients.

“While opioid abuse undoubtedly presents a serious public health issue, CMS should take steps to foster transparency and avoid harming patients and providers alike by offering them a meaningful opportunity to participate in the development of policies that could limit pain management,” wrote Michelle Stilwell, a staff attorney for the Washington Legal Foundation (WLF), a non-profit law firm that generally supports business groups and companies in litigation against government agencies.

At issue are mandatory rules being developed by CMS for 2018 that would bring Medicare opioid policies into alignment with the “voluntary” prescribing guidelines released last year by the Centers for Disease Control and Prevention.

CMS wants to set a daily ceiling on opioid pain medication at 90mg morphine equivalent dose (MED). If a dose exceeds that level, Medicare insurers would be expected to impose a “soft edit” that would automatically block the prescription from being filled until the edit is overridden by a pharmacist. Pharmacies would have to check with the prescribing physician to make sure the higher dose is warranted.

CMS logo.png

Stilwell wrote on the WLF’s blog that patients and providers were given little opportunity to see and comment on a Call Letter announcing the rule changes, while the insurance industry was.

“CMS’s changes will inevitably lead to even tighter restrictions on opioid prescriptions—which directly affects the patient community.  Many patients, doctors, and healthcare providers already complain that rules designed to prevent the improper prescribing of opioids are complicating patients’ legitimate access to appropriate medication,” said Stilwell. 

“But instead of directing this Call Letter at the affected patient community and granting that community an adequate opportunity to comment on the new opioid overutilization criteria, CMS directed it only to insurance companies.  In reality, opioid consumers and providers are given little to no notice or opportunity to comment.”

As PNN has reported, the insurance industry appears to have played a major role in drafting the CMS rules, which contains some of the same strategies suggested in a “white paper” prepared by the Healthcare Fraud Prevention Partnership (HFPP), a coalition of insurers, law enforcement agencies and government regulators formed to combat insurance fraud. The HFFP met to discuss the white paper in a “special session” last October that was not open to the public.

Stilwell said the HFFP “operates largely in the dark” and may be in violation of the Federal Advisory Committee Act (FACA), which requires open meetings for all federal advisory panels. This week the WLF filed a Freedom of Information Act Request seeking more information about HFPP membership and meetings.

Major insurers such as Aetna, Anthem, Blue Cross Blue Shield, Cigna, Highmark, Humana, Kaiser Permanente and the Centene Corporation participate in the HFPP.

“It is time for CMS to bring HFPP into compliance with FACA requirements.  Doing so will reduce the risk that a court may invalidate any CMS policies found to have been adopted at least in part in reliance on HFPP recommendations.  It would also enable any patients affected by changes in opioid reimbursement policies to play a role in the development of HFPP’s opioid-related recommendations,” Stilwell wrote.

CMS contracts with dozens of insurance companies to provide health coverage to about 54 million Americans through Medicare and nearly 70 million in Medicaid. CMS policies often have a sweeping impact throughout the U.S. healthcare system because so many insurers and patients are involved.

In addition to limits on opioid prescribing, CMS plans to implement an opioid Overutilization Monitoring System (OMS) to identify physicians who regularly prescribe high doses of opioids. Patients who receive opioids from more than 3 prescribers and more than 3 pharmacies during a 6 month period would also be red-flagged. Insurers would be required to identify pharmacies, doctors and patients who do not follow CMS policies, and could potentially drop them from Medicare coverage and their insurance networks.

FDA to ‘Take Whatever Steps We Can’ to Stop Opioid Abuse

Meanwhile, the new commissioner of the Food and Drug Administration is calling on the agency to “take whatever steps we can” to ensure that opioids are only prescribed under “appropriate clinical circumstances.”

In a blog post on the FDA website, Scott Gottlieb, MD, announced the formation of an Opioid Policy Steering Committee to develop additional tools and strategies the FDA can use to prevent opioid abuse.

“Patients must be prescribed opioids only for durations of treatment that closely match their clinical circumstances and that don’t expose them unnecessarily to prolonged use, which increases the risk of opioid addiction,” he wrote.

Gottlieb wants the committee to focus on three areas:

scott gottlieb, MD

scott gottlieb, MD

  • Consider mandatory education for health care professionals about opioid prescribing recommendations and how to identify patients at risk of abuse.
  • Establish limits on the dose and quantity of opioid medication that are more closely tailored to the medical condition a patient is being treated for.
  • Review the process the FDA uses to evaluate and approve new opioid medications.

Gottlieb cited some questionable statistics to dramatize the extent of the opioid prescription problem.

“In 2015, opioids were involved in the deaths of 33,091 people in the United States. Most of these deaths – more than 22,000 (about 62 people per day) – involved prescription opioids,” he wrote.

The new FDA commissioner may want to check his facts. As PNN has reported, a news release last December from the White House Office of National Drug Control Policy stated that 17,536 Americans died in 2015 from overdoses involving prescription opioids.

A CDC news release a few days later provided an an even lower estimate; that over 12,700 Americans died from pain medications in 2015.

When asked to explain the discrepancy, PNN was given a third estimate by the CDC, which put the number of deaths involving prescription opioids at 15,281 in 2015.

Gootlieb’s post links to a CDC website that provides a fourth estimate, which is based on a “standard analysis approach” that combines all overdoses caused by natural, semi-synthetic, and synthetic opioids. Such an approach is misleading, because it counts overdoses caused by illicit fentanyl as prescription drug deaths. 

“Unfortunately, information reported about overdose deaths does not distinguish pharmaceutical fentanyl from illegally-made fentanyl,” the CDC said, which Gottlieb neglected to mention in his blog post.

One needs to read the warnings in some of  these conversion programs… that by and large.. they are AT BEST… FUZZY MATH… unless you are talking about Methadone conversions… then they are FUZZIER MATH.  Any healthcare professional that believes that opiate conversions are BLACK & WHITE… is – IMO – a healthcare professional that should not be trusted in dosing opiates.
And these tables don’t even consider the CYP450 enzyme system .. which can cause a person to metabolize opiates fast/slower that “normal”.. it is estimated that 20%-30% of pts are fast/ultra fast opiate metabolizers.. They also ignore pts with GI issues that will affect absorption.. like IBS with/without diarrhea, short gut, crohn’s disease and others issues.
IMO, this is just another example of our healthcare system moving toward treating pts/disease(s) by a simple check lists and/or “cookie cutter methodology”.. which means that those pts that are at 10%-20% at each end of the “bell curve” will end up getting medically “screwed” by the system.  Remember, nearly all health insurance companies are publicly held FOR PROFIT companies…  their primary interest is to the stock market and their stock holders.  Policy holders are just a means to generate revenue and if they can place obstacles – prior authorization, declaring treatment is experimental, first fail step therapy and other tactics to “deny care that should be covered”. Pts need to be made aware that everything denied by a insurance companies can be APPEALED and the majority of pts that go thru their entire appeal process will get their treatment approved. They don’t have to tell you about their appeal process, unless you ask, then they have to provide their appeal process is some form of printed format – could be a website.

http://clincalc.com/opioids/

    Single-dose studies: Early studies determining equianalgesia were based on single doses, not chronic administation.8 Due to drug accumulation, half-life, tolerance, and active metabolites, subsequent chronic administration studies often vary greatly from the original single-dose data.
    Bidirectional conversions: When converting between certain opioids, the direction of conversion (eg, morphine to hydromorphone versus hydromorphone to morphine) will produce a different conversion ratio. These bidirectional differences are not captured in a traditional equianalgesic table.5,7
    Dose-dependent conversions: The conversion ratio of certain opioids can be dependent on the dose of the original opioid. In the case of converting morphine to methadone, methadone has a relative potency of 4:1 at lower morphine doses, but becomes much more potent (12:1) in patients converting from very high morphine doses.5,7
    Cross-tolerance: Many references recommend a cross-tolerance reduction between 25-50% when converting between unlike opioids.9 In patients with very high opioid requirements, the difference between 25% and 50% can be a very significant discrepancy.
    Equianalgesic Discrepancies: There are significant discrepancies in equianalgesic dosing tables, with even FDA-approved drug labels not demonstrating agreement.10 These discrepancies are a factor of both references using old data (single-dose studies) and an overall paucity of data in chronic dosing studies.
    Patient-specific factors: No equianalgesic table is able to take into account patient-specific factors — primarily hepatic function, renal function, and age. Opioid metabolism and excretion do differ among the opioids; therefore, alterations in drug disposition will alter the relative potencies of different opioids.

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Apparently you can’t believe what is sent to you – RETRACTION – UN-RING A BELL !

Posted on May 26, 2017 by Pharmaciststeve

On May 24th I received the following email

From: mark ibsen
Sent: Wednesday, May 24, 2017 5:35 PM
To: Steve Ariens
Subject: Fwd: Order Dismissing PFMA – Ibsen
 
Sent from my iPhone
Begin forwarded message:
From: Greg Beebe
Date: May 24, 2017 at 1:37:38 PM MDT
To: Mark Ibsen
Subject: Order Dismissing PFMA – Ibsen
Reply-To:
Mark:
The order dismissing your case with prejudice is attached. Nice job getting everything done. Talk to you soon.
Beebe Law Firm
1085 Helena Avenue
Helena, MT 59601
(406) 442-3625

To which I made this post on my blog:

 Dr. IBSEN – WINS COURT BATTLE – Dismissal With Prejudice

http://media.giphy.com/media/IjmMzurYulKEw/giphy.gif

Order Dismissing Charge – Ibsen

Dismissal With Prejudice: When a lawsuit is dismissed with prejudice, the court is saying that it has made a final determination on the merits of the case, and that the plaintiff is therefore forbidden from filing another lawsuit based on the same grounds.

Yesterday afternoon I received this email:

Christopher Storseth
May 25 (1 day ago)
to me, mark

 Hello

On behalf of Dr. Mark Ibsen, please retract your story on his winning his Court Case in Montana. The Documents you are referring to as basis, are for another unrelated case.   This is still an active Motion to Dismiss, with NO Order.    Please do it as soon as you can.
On behalf of Mark S Ibsen, who is also copied to this email.
Thanks 
Chris Storseth for Dr. Mark Ibsen
CC:Dr. Mark Ibsen  

—

 Christopher L Storseth 
Mobile Phone-406-303-1050
 
Montana Real Estate Broker RRE-BRO-LIC#13636
Broker/CEO/General Developer
Direct Phone-(443) 4-CHRIS-1  (Google Developer Voice Number)

Microsoft Dot NET Web Dev */*  Certified Web App Developer Microsoft

I received the email while I was out running errands on May 25, 2017 and as soon as I got home I DELETED the post on my blog, Face Book, Twitter that I could find and/or remembered.  The blog I posted appeared to be sent by Mark Ibsen and I posted the link to the order dismissing charge *.pdf.

Apparently to some of Dr Ibsen’s close supporters … deleting the posts was not sufficient… I should make a RETRACTION… UN-RING THE BELL…  I just reposted what was sent to me…  The only thing that I added was the definition of what  “Dismissal With Prejudice” meant… I believed this email was from Dr Ibsen… and I did not make any comments or statements about this was – OR WAS NOT – concerning Dr Ibsen’s case with the Medical Licensing Board in MT.  Apparently others believed that I should have KNOWN that the case addressed in  this email was from a different law firm and a different judge… than the one dealing with the Medical Licensing Board issues.

If any of you have forwarded/shared the original post, please do the same with this post. I do not appreciate being accused of postings/sharing FALSE STATEMENTS…

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Illegal opiates… so plentiful …can be ordered like ordering a delivered pizza

Posted on May 25, 2017 by Pharmaciststeve

Opioid epidemic: Can it be stopped at the source?

http://www.wfmj.com/story/35506202/heroin-epidemic-can-it-be-stopped-at-the-source

WARREN, Ohio – Fighting the opioid crisis head-on remains a challenge as the overdose death rate continues to climb across the valley.

Hidden websites and online options offering opioids, including fentanyl for sale, are making it difficult to stop the suppliers.

“In some cases people would order it like they would a pizza and have it delivered to them, it’s just that easy to get,” Keith Martin said, assistant special agent in charge of the Drug Enforcement Administration Cleveland Office.

Martin’s office handles investigations across northern Ohio from Toledo to Cleveland and Youngstown.

He tells 21 News that fentanyl, often laced with heroin, is coming into the Northeast Ohio region from other countries including China and India.

The sheer volume of packages delivered from overseas into the U.S. and throughout the country make stopping the supply chain a big challenge.

“To track a package like that is literally you’re looking for a needle in a haystack,” Martin said. 

Unless agents can determine the identities of the buyer and the seller, he says it’s almost impossible to locate the packages before they get into the hands of an addict.

If users go to the dark web, buyers and sellers can remain anonymous– leaving no trace of the purchase. 

On the streets of Warren, it’s rare for a weekend to go by without police responding to drug overdoses.

By the time the drugs make into the hands of users, there’s no telling where they came from.

“Usually when we come across it, it’s already packaged for sale,” Lt. Greg Hoso said, with the Warren police department’s Street Crimes Unit.

Hoso says the people they come across during overdose calls often didn’t know the potency of the drug they used. It’s common for police to recover evidence that eventually tests positive for a mix of synthetic drugs including fentanyl.

Martin says some sellers will stagger drugs throughout multiple shipments in an attempt to throw off investigators.

But in one local case, he says multiple packages from one sender set off a red flag.

“We were tracking a package coming from overseas and the sender of that package was tracking 21 other packages that same day of drugs coming to the U.S.,” he said.

The DEA remains in routine contact with foreign countries to know what trends could be next and how it could arrive into the hands of those looking for their next fix.

In October of 2016, the DEA dismantled a Mexican drug trafficking organization that was bringing kilogram quantites of heroin, cocaine and fentanyl into Cleveland.

Martin said some of those delieveries were then funneled into communities outside the city and into other nearby cities including Youngstown.

While they’re working to making progress by shutting down suppliers from all avenues, Martin believes the only way to make an lasting impact is to prevent people from getting hooked on opioids in the first place.

“We have to get the message out, it has to be education and prevention, because I don’t see law enforcement or anyone arresting their way out of the problem or even treating our way out of the problem,” Martin said.

 
 
 

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IMAGINE THIS: DEA LIED TO CONGRESS ABOUT THEIR ILLEGAL BEHAVIORS

Posted on May 25, 2017 by Pharmaciststeve

DEA misled Congress about Honduras shootings

https://www.msn.com/en-us/news/us/dea-misled-congress-about-honduras-shootings/ar-BBBuIi2

WASHINGTON – Top Drug Enforcement Administration officials consistently provided inaccurate information to the Justice Department and Congress about three deadly shootings during 2012 anti-drug operations in Honduras, including one incident that left four civilians dead, according to a new internal government inquiry.The scathing review from the Justice Department, which largely focused on a fatally flawed May 2012 operation that sparked calls for the DEA’s expulsion from the country, concluded that top federal drug authorities withheld information from the U.S. ambassador to Honduras. DEA officials, according to the report, also blocked Honduran investigators from questioning U.S. agents or examining their weapons.

Among the most serious findings in the 329-page report released Wednesday was that the DEA long clung to unsubstantiated assertions that occupants of a passenger boat initially fired on a U.S.-Honduran anti-drug unit, prompting officers to return fire in the chaotic May encounter that left four dead, including a 14-year-old boy.

“Not only was there no credible evidence evidence that the individuals in the passenger boat fired first, but the available evidence places into serious question whether there was any gunfire from individuals in the passenger boat at any time,” the report stated.

Justice investigators found no evidence to contradict prior DEA claims that none of the U.S. agents discharged their weapons. However, investigators determined that a DEA agent “directed” a Honduran helicopter gunner to open fire on the river boat.

“The (helicopter) door gunner then fired multiple rounds at the passenger boat,” the report stated. “Honduran authorities later determined that four individuals in the passenger boat had been killed and four more injured. No evidence of narcotics was ever found on the passenger boat.”

And even as information emerged that conflicted with the DEA’s account of the incident – that the water taxi had no connection to illegal drug operations – DEA officials “remained steadfast with little credible corroborating evidence that any individuals shot by the Hondurans were drug traffickers” attempting to retrieve a shipment of seized cocaine that was being held on a nearby vessel occupied by U.S. and Honduran drug agents.

Much of the conflicting evidence was contained on a detailed video recording of the incident, which investigators concluded had been either disregarded or ignored by DEA officials.

The DEA did not launch a formal review of the encounter until weeks later when public reports of the civilian deaths surfaced, “resulting in mounting pressure from (Justice) leadership and congressional inquiries.”

Instead, U.S. officials largely relied on a Honduran government account that almost entirely absolved both Honduran and American law enforcement of any misconduct during the in the raid in the country’s Mosquitia region. Honduran investigators, however, did not question DEA agents or examine their weapons at the time.

“The resulting (U.S.) investigation was little more than a paper exercise,” the inspector general concluded, adding that the DEA review included no interviews and omitted key facts, including the U.S. agent’s order for the Honduran machine-gunner to open fire on the boat. While such DEA reviews require weapons inspections, none were conducted.

Nevertheless, the DEA provided assurances to then-Attorney General Eric Holder, while preparing for a 2014 Senate Judiciary Committee hearing, that the weapons had been examined.

The information, according to the inspector general’s report, was emailed by then-DEA chief Michele Leonhart, though the message “does not reflect (Leonhart’s) source for this belief.”

Leonhart resigned in 2015 in the wake of a furor over agents’ misconduct including their participation in sex parties with prostitutes supplied by drug cartels in Colombia.

None of the conduct by DEA agents or executives was referred for prosecution, because the inspector general found insufficient evidence to prove that the officials knowingly provided false statements to government investigators or actively obstructed inquiries.

“The loss of life and injuries which occurred….were tragic,” DEA chief compliance officer Mary Schaefer said in the agency’s written response to the inspector general. “DEA acknowledges that its pre-mission preparation was not as thorough as it should have been and that the subsequent investigation lacked the depth and scope necessary to fully asses what transpired that (May) night.”  

Since 2012, when DEA agents were involved in two other fatal shootings in Honduras, much of the agency’s top leadership has been restructured. In 2015, then-Attorney General Loretta Lynch appointed former federal prosecutor and FBI senior counselor Chuck Rosenberg to run the agency.

“In the nearly five years that have elapsed since the events referenced in the report, much has changed internally… to include agency leadership and significant changes” to the agency’s teams deployed abroad,” Shaefer said. 

Former Drug Enforcement Administration (DEA) Administrator Michelle Leonhart listens while testifying on Capitol Hill in Washington, Friday, April 12, 2013, before the House Commerce, Justice Science and Related Agencies subcommittee hearing on the DEA's fiscal 2014 budget request.© Manuel Balce Ceneta, AP Former Drug Enforcement Administration (DEA) Administrator Michelle Leonhart listens while testifying on Capitol Hill in Washington, Friday, April 12, 2013, before the House…

 
 
 

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DEA chief: ‘Marijuana is not medicine’… It is our CASH COW !

Posted on May 25, 2017 by Pharmaciststeve

DEA chief: ‘Marijuana is not medicine’

http://www.washingtonexaminer.com/dea-chief-marijuana-is-not-medicine/article/2624211

Drug Enforcement Administration acting Chief Chuck Rosenberg reiterated an Obama-era stance Thursday that “marijuana is not medicine.”

“If it turns out that there is something in smoked marijuana that helps people, that’s awesome,” he said, speaking at the Cleveland Clinic in Ohio. “I will be the last person to stand in the way of that. … But let’s run it through the Food and Drug Administration process, and let’s stick to the science on it.”

 Marijuana is classified as a Schedule I drug under the Controlled Substances Act, alongside drugs like heroin and LSD, while other substances like oxycodone and methamphetamine are classified as Schedule II drugs, which are regulated differently. Despite repeated attempts by advocates requesting that marijuana be moved to Schedule II, the DEA has pointed to the FDA’s guidance that says it does not have medical value.

Rosenberg noted that the DEA takes recommendations about how to classify the drug from the FDA. He pointed out that marijuana studies have been ongoing and acknowledged some studies show it may have medical benefits for children with epilepsy.

Former Surgeon General Vivek Murthy, who was speaking alongside Rosenberg at the event, said that the country should be researching medical marijuana.

“Should we be reducing the administrative and other barriers to researching that in the government? 100 percent,” he said. “But what we should not do is make policies based on guesswork. When we do that, what we do is put people at risk.”

He also appeared to show some concern around state laws regarding recreational marijuana, saying that it is addictive, which can be harmful to a developing brain that is vulnerable to developing substance abuse and addiction.

State legislators, he said, have gotten “caught up in momentum” and passed policies on recreational marijuana that aren’t always supported by science.

“When you develop a substance use disorder at a young age, it actually increases the likelihood of you developing an addiction to other substances,” he said. “So in that sense addiction to marijuana or any substance, including nicotine, during adolescence and young adulthood when the brain is developing is very concerning.”

“I worry that we have gotten away from allowing science to drive our policy when it comes to marijuana,” he added.

 

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ACLU Cares … JUST NOT THAT MUCH ?

Posted on May 25, 2017 by Pharmaciststeve

The ACLU is concerned that the repeal of Obamacare will cause millions to go without healthcare, but try to get the ACLU to express any concern about the untold millions that are being denied pain management and mental health care because of the CDC guidelines, the DEA regulations, many of the state legislatures have decided to “practice medicine without a license” and without any medical knowledge/background and many healthcare corporations and insurance companies that have instituted some sort of opiate dosing limitations… without regard of the real medical need of the pt.

Healthcare is quickly become a “by the numbers” process.. “cookie cutter medicine”… and those who hold the pocket book strings… tend to believe that they can dictate the type or limit of healthcare that a person can receive.

 

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