A country of “drug seekers”

Posted on May 19, 2017 by Pharmaciststeve

There is abt 4.5 BILLION prescriptions filled – in community pharmacies and via mail order pharmacies –  in the USA EVERY YEAR and we have some 320 million residents… doing the math that means that each person would have 14 prescriptions filled each year.

What can be estimated that most of the prescriptions are filled by people who are “seeking  to improve their quality of life”

This time of year a lot of “drug seekers” are those known as ALLERGY SUFFERS… they seek out antihistamines, cortisone nasal sprays and other substances used to control their allergy symptoms and improve their quality of life.

No matter what disease state or condition/syndrome a person is dealing with.. all too many will seek out some medication(s) to help to control the undesirable symptoms from the disease.. basically.. the person seeks out to improve their quality of life.

Some groups try to draw a line between themselves as being chronic pain pts and those who abuse opiates.

If you take a step backwards and try to look at those who take/use opiates and controlled substances.. are those that take them legally and those who take them illegally.. because our society will not allow them to obtain them legally. Are they all that different ?

Both are typically suffering from depression, anxiety and physical and mental “pain”. Both are trying to “improve”  their quality of life… just what their own opinion/definition of “improve” may be quite different.

Those who are suffering from the mental health issues of addictive personalities.. they have demons in their head and/or monkeys on their back. They are just “seeking” to improve their lives by attempting to silence those demons and monkeys. Their “high” is getting some solitude from those things causing them mental pain.

Those that suffer from chronic pain are also “seeking” their own particular “high”, but their high is to calm the pain that torments them, keeping them from participating in a “normal family life”.

Image result for cartoon i have seen the enemy it is us

IMO, those in the chronic pain community that wants to point fingers at those who our society has labeled as “addicts” and continue to point out “that is not us/me”… it is “them”..

People with mental health issues have always been “looked down upon” ..  just told to “suck it up and get over it”… our health insurance system has normally had poor coverage for seeing mental health professionals.

Is this part of the puritanical thread in our societal fabric that is still part of the “witch hunts” from the late 17th century in our country ?

Is those in the chronic pain community doing themselves any favors by agreeing with the DEA that those with mental health addictive issues are “bad people” and CRIMINALS ?

Recently our previous Surgeon General declared that addiction is a mental health issue and not a moral failing http://www.huffingtonpost.com/entry/vivek-murthy-report-on-drugs-and-alcohol_us_582dce19e4b099512f812e9c

Does it make any sense that two different major Federal agencies and members of the Presidential Cabinet (DOJ & Surgeon General) are on opposite sides of the same coin… in dealing with people that are suffering from chronic conditions that opiates and controlled substance can help people deal with their health issues ?

 

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DEA: New opioid could be Narcan-resistant

Posted on May 19, 2017 by Pharmaciststeve

Fentanyl

DEA: New opioid could be Narcan-resistant

http://www.richmondregister.com/news/dea-new-opioid-could-be-narcan-resistant/article_4432deb0-3cc0-11e7-bd64-1398a5e0b408.html

 

 

This article is from a Richmond KY newspaper and the reporters/editors involved are so “moronic” that they pull a graphic of legal Fentanyl patches which appears to have various descriptions on the boxes IN GERMAN.  The article is about an ILLEGAL FENTANYL ANALOG and they use a graphic not only of a legal product but one made by Winthrop and sold in GERMANY ? Can you say FAKE NEWS ?

 

As overdoses continue to rise in Kentucky and across the country, a new opioid has hit the streets that could potentially be Narcan-resistant.

Naloxone, better known as Narcan, is an opioid antidote. However, Special Agent Patrick Trainor of the Drug Enforcement Agency recently told CNHI News that acrylfentanyl “has shown some possibility of being resistant” to Narcan.

The state Medical Examiner’s Office has seen three confirmed cases so far in which acrylfentanyl was a factor in the death, according to Mike Wynn, spokesperson for the Justice and Public Safety Cabinet.

 Local officials said they have not see any cases yet, however, they noted Madison County has not been immune to other drugs previously.

Madison County EMS Director Carlos Coyle said, in the first three months of 2017, EMS paramedics had administered 144 doses of Narcan to 97 patients. Those numbers were up from 107 doses to 67 patients in the first quarter of 2016.

“The (individuals) we see where Narcan is administered are barely breathing or not breathing at all when we get there,” Coyle said. “If it is a drug we aren’t able to reverse, a lot of these people would be dead.”

Madison County EMS administered 443 doses to 291 patients in 2016, Coyle said.

It was the fourth highest total of Narcan doses administered by EMS in the state behind only Kenton, Fayette and Campbell counties, according to data from the Kentucky Ambulance Providers Association (KAPA).

Madison County also had the sixth most overdose deaths in the state, according to the 2015 Overdose Fatality Report. There were 31 overdose deaths — eight more than 2014. The 2016 report will be released this summer.

Fatal overdoses in Kentucky for 2015 totaled 1,248, compared to 1,071 in the previous year, according to the report.

Overdose deaths could skyrocket if opioids become Narcan-resistant.

KAPA data noted 8,569 doses of Narcan were administered across the Commonwealth in 2016 from reporting agencies.

“If opioids such as acrylfentanyl become Narcan-resistant, I assure you it will increase the deaths in Madison County drastically,” said Madison County Coroner Jimmy Cornelison. “None of these drugs are measured out and (drug users) never know what they are getting. This is just Russian roulette.”

Coyle said it could also strain first responders even more, along with health care providers. He recalled an overdose spike the county experienced in February when EMS responded to five overdoses in a 90-minute period stretching its resources.

“I really hope we don’t see it,” Coyle said of acrylfentanyl.

Because acrylfentanyl is so new to the United States, the DEA has not yet included it on its list of scheduled drugs, Trainor told CNHI.

 “We’ve seen a similar thing with a lot of these synthetic drugs,” he said, “where we schedule something, all the chemist has to do is change one compound and it’s a totally different drug.”

The DEA is currently evaluating the possibility of scheduling acrylfentanyl on an emergency basis, according to Trainor.

Fentanyl is a powerful synthetic opioid that is 50 to 100 times more potent than morphine, and it is causing an increasing number of overdose deaths in the United States, according to the Centers for Disease Control and Prevention.

Fentanyl has a large number of synthetic analogues, “all of which are very concerning to us,” Trainor said.

An analogue is a drug whose chemical structure is substantially similar to the chemical structure of another drug or that has effects that are similar to those of another drug when used.

Mark Presto contributed to this story.

Jonathan Greene is the editor of The Register; follow him on Twitter @jgreeneRR.

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Court issues important decision for dietary supplement industry

Posted on May 19, 2017 by Pharmaciststeve

Court issues important decision for dietary supplement industry

http://www.lexology.com/library/detail.aspx?g=649a9107-dba6-4341-be5c-693eacadebf7

On April 18 2017 Judge Vasquez granted summary judgment to Bayer in a consumer class action over its probiotic dietary supplement Phillips’ Colon Health in In re Bayer Phillips’ Colon Health Probiotics Sales Practices Litigation.(1) This important decision should help to rein in the onslaught of lawsuits that improperly target dietary supplements.

First, the court’s decision reinforces that dietary supplements are not regulated as drugs and structure/function claims need not be supported by randomised controlled clinical trials (RCTs).

Second, the opinion makes clear that private consumer class actions cannot be premised on a ‘lack of substantiation’ theory.

RCTs are not required

Recognising the many health benefits of dietary supplements, Congress enacted the Dietary Supplement Health and Education Act 1994 to ensure that supplements can be marketed and sold without following the stringent requirements imposed on prescription drugs. In April 2001 the Federal Trade Commission (FTC) promulgated guidance, stating that the relevant standard for dietary supplements is “competent and reliable scientific evidence”.

The FTC guidance makes clear that drug-level randomised clinical trials are not required. Instead, “competent and reliable scientific evidence” is a “flexible” standard and “[t]here is no fixed formula for the number or type of studies required”. Even:

“[r]esults obtained in animal and in vitro studies will… be examined, particularly where they are widely considered to be acceptable substitutes for human research or where human research is infeasible.”

In addition, “[e]pidemiologic evidence may be an acceptable substitute for clinical data” in some circumstances.

However, in conflict with its own published guidance, the FTC and class action lawyers have brought a number of suits against dietary supplement companies on the grounds that the supplement claims are not supported by RCTs. Courts have rejected these attempts to ignore federal law. The most recent defeat for the FTC came in US v Bayer where the court denied the FTC’s attempt to demand drug-level clinical trials to support proper structure function claims for the same probiotic product – Phillips’ Colon Health.(2)

Unfortunately, despite this defeat, the FTC continues to demand RCTs for dietary supplements. Following that decision, an FTC attorney reportedly stated: “I don’t think [the US v. Bayer decision] was about whether you need clinical trials.”(3) The most recent judicial decision makes clear that this statement is incorrect.

The court in In re Bayer Phillips’ Colon Health reinforced that clinical trials are not required. The court relied heavily on US v Bayer and explained that the FTC opinion held that “RCTs are not required to meet the standard of ‘competent and reliable scientific evidence'” and that “dietary supplements do not” need to meet the “higher standard” that applies to drugs.(4) In summary, the US v Bayer opinion means what it says: dietary supplements must be regulated as Congress intended – they are supplements and not drugs.

Private plaintiffs cannot pursue lack of substantiation claim

The court also closed the door to a claim favoured by private plaintiffs – a ‘lack of substantiation’ claim. Plaintiffs often sue manufacturers under state consumer fraud laws arguing that a particular food or supplement claim is not adequately substantiated by scientific evidence, where they cannot prove that the claim is scientifically false.

In In re Bayer Phillips’ Colon Health the court held that “[m]erely proving that the claims are unsubstantiated is insufficient”.(5) Rather, “a plaintiff must put forth affirmative evidence of falsity”.(6) The plaintiffs’ expert in this case testified that his only basis for saying that Bayer’s claims were false was that Bayer had no supportive RCT and that a number of existing RCTs did not show positive results. The court rejected this testimony and explained that it “is nothing more than a lack-of-substantiation theory”.(7) The court further described the expert’s opinion as “pure speculation” or an “educated guess”, both of which are wholly insufficient to survive summary judgment.

Plaintiffs around the country are pursuing similar claims based on a lack of substantiation theory and are tendering experts that apply the drug-level standard. Following the Phillips’ Colon Health decision, courts should similarly reject these claims.

https://en.wikipedia.org/wiki/Mitragyna_speciosa

A group of 51 members of the US House of Representatives and a group of 9 senators each sent letters to Acting DEA Administrator Chuck Rosenberg protesting the listing and around 140,000 people signed an online White House Petition protesting it.[42][43] The DEA noted the responses but said that it intended to go forward with the listing; a spokesman said: “We can’t rely upon public opinion and anecdotal evidence. We have to rely upon science.“[44] In October 2016, the DEA withdrew its notice of intent while inviting public comments over a review period ending 1 December 2016.[45][46]

This – to me – is confusing… does the DEA have the legal authority to place a substance in a scheduled class if the product has been marketed and recognized as a SUPPLEMENT for hundreds of year ? Both the DEA and the CDC has used the same/similar statement “We have to rely upon science”  Is this just a ruse to justify their actions because they really have no legal  authority or rational reason(s)  ?

citing over 600 calls to poison control centers between 2010 and 2015 and 15 kratom-related deaths between 2014 and 2016.[14]    Deaths have occurred when kratom was present, mixed with other substances.[6][7] In the United States, there were fifteen kratom-related deaths between 2014 and 2016,[14] although in none was kratom the sole factor.[7]

To put things in perspective, the 55 Poison Control Centers AVERAGE abt 5 calls PER MINUTE – 24/7. Which the calls received about Kratom represented abt 0.0002% of the center’s average calls/yr.  And there have been no reported deaths where Kratom was the ONLY SUBSTANCE IN THE TOXICOLOGY.  So Kratom has a similar lethality to that reported of Marijuana.

 

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The Myth of Available Pain Care

Posted on May 19, 2017 by Pharmaciststeve

The Myth of Available Pain Care

https://fee.org/articles/the-myth-of-available-pain-care/

America is in the midst of an ongoing epidemic of undertreated chronic pain. This fact is confirmed by surveys such as “Chronic Pain in America: Roadblocks to Relief,” which is posted on the American Pain Society website (www.ampainsoc.org/ whatsnew/toc_road.htm). The economic cost of this epidemic can be estimated, in terms of lost productivity, at about $100 billion per year. The human costs are more difficult to quantify. These include unnecessary suffering and lives ruined through inability to work. To physicians facing unwarranted criminal charges of drug dealing, the consequences of such an accusation range from damage to reputation to life imprisonment. In cases in Florida and Virginia, prosecutors have even contemplated seeking the death penalty against pain-treating physicians.

Opioid analgesics are a class of medications, which includes morphine and oxycodone. In lay terms they are recognized as endorphins. After centuries of successful use they remain the cornerstone in the treatment of chronic pain. They are natural substances that the body itself uses in the regulation of pain. When used as directed by a physician, opioids are categorically safe, and addiction is a vanishingly rare side effect.

The failure of physicians to prescribe opioid medications in quantities sufficient to control chronic pain is the immediate cause of the epidemic. The deeper causes are attributable to social forces, the most significant of which is the intrusion of the war on drugs into the medical profession and the relationship between the physician and his patient.

Most people believe that if they develop chronic pain, their physician will take care of them. They are sadly mistaken. Both scientific and anecdotal evidence inform us that chronic pain is ineffectively treated. The previously mentioned “Roadblocks” survey reveals, alarmingly, that the more severe a patient’s pain is, the less likely the sufferer will be to obtain relief. This experience is described by patients all around the country who can’t find a physician willing to risk prescribing the amounts of opioids necessary to bring their disease under control.

The behavior of the medical profession in its approach to the treatment of chronic pain extends far beyond neglect. Many physicians accept patients suffering from severe chronic pain into their practices. But they rarely treat these patients with dosages of medications that will allow them to return to productive lives. Instead, these unfortunate souls are subjected to a series of abuses that systematically violate their basic human rights.

This seems shocking and unbelievable. Here’s how it works. Physicians are actually trained to scrutinize patients for signs of impending drug addiction. This is accomplished through the use of a set of “aberrant drug-related behaviors.” These behaviors are essentially measures of compliance. Apart from pain management, compliance with medical treatment is generally thought to be in the patient’s best interest and is voluntary.

This is consistent with the principles of informed consent and patient autonomy, which are pillars of ethical practice. Around the issue of pain management, however, compliance takes a strange twist. It becomes, as we will see, a prerequisite for further treatment. It also becomes less than voluntary. The classic examples of “aberrant” behavior occur when a patient uses up his pain medications and either calls in “early” for a refill or asks his physician for a larger prescription. The list of “aberrant” behaviors for which physicians are trained to be vigilant extends to a number of other supposed transgressions, such as a request by a patient for a specific medication that the patient knows from past experience will work. Physicians are trained to regard these sorts of reasonable conduct as a sign of addiction or possibly even of illegal diversion of pharmaceuticals to the black market.

Physicians are both trained and required to react to these behaviors by imposing structure and sanctions. Structure may take the form of more frequent visits to receive smaller amounts of medication and intrusions into patient privacy that may include unannounced pill counts and mandatory drug testing. Many physicians keep a log of transgressions and employ a “three strikes and you’re out policy,” terminating opioid treatment after three supposed transgressions.

All of this places the pain sufferer in a terrible bind. If he can’t obtain the medications he needs in sufficient quantity, he can’t live a normal life. On the other hand, he isn’t allowed to ask for it. If he makes his needs known, he runs the risk of being accused of addiction and criminality, and of being cut off from treatment entirely. As a result, undertreated patients suffering from chronic pain who need to ask for increased dosages are truly damned if they do and damned if they don’t. Under these circumstances, it is not surprising that surveys reveal widespread undertreatment of this disease, particularly among those most severely afflicted.

This conduct is required of physicians by guidelines set out by academic pain specialists and their organizations. It is an abomination that systematically violates the central ethical obligations of the physician to his patient. These obligations include putting the patient’s interests first and controlling pain. Informed consent and patient autonomy, the pillars on which ethical medicine is based, are abrogated as compliance is replaced by coercion.

Among pain victims, this results in bewilderment, increased pain, progressive disability, and general deterioration of health.

One may reasonably conclude that pain management, as it is currently practiced, is a sham. Patients who approach their physicians expecting they will receive pain control are instead subjected to an abusive program of drug control that systematically violates their basic human rights. Chronic pain sufferers are accurately characterized, along with their well-intentioned but nevertheless abusive physicians, as noncombatant casualties in the war on drugs.

The Root of the Problem

The Controlled Substances Act of 1970 assigned the criminal justice system the responsibility of regulating controlled substances. In so doing, law enforcement was inadvertently established in its current role as the regulator of medical practice. Legislative intent was to leave the practice of medicine unmolested. Instead, the law of unintended consequences, which apparently accompanies all drug-war–related endeavors, prevailed. Here’s how it happened.

A safe harbor provision for the medical use of opioids was inserted into the act. The provision states that physicians may prescribe these medications in the usual course of their professional practice. That sounds pretty good on the surface, but that is only before one comes to understand the consequences. This provision implicitly, but unavoidably, requires that law enforcement distinguish between medical practice and drug dealing. Regardless of what one might choose to call this, the result is that law enforcement regulates the practice of medicine. Naturally, law enforcement carries out this task through the use of criminal prosecutions against physicians. It couldn’t be otherwise. When society assigns law enforcement to regulate an issue, criminal prosecutions necessarily result.

The unfortunate truth underlying the pain crisis is the fact that it is impossible to regulate medicines without also regulating the practice of medicine.

Every doctor who contemplates treating chronic pain with opioid analgesics must answer the following question to his own satisfaction: By engaging in this practice, might he be misperceived by medical regulators, in this case law enforcement, as a criminal? By prescribing opioids, is he risking his career, his livelihood, his freedom, and perhaps even his life? The answer comes down to one issue. Is the safe harbor promised by the Controlled Substances Act really safe? Can law enforcement be counted on to regulate the practice of medicine correctly? Is this even a reasonable expectation?

Physicians are good at assessing risk. This is a large part of the work they do in their professional lives. As a group, physicians seem to understand that their risk of unwarranted prosecution is real and unacceptable. They demonstrate this through their prescribing behavior or, in the case of pain management, their failure to prescribe. Many physicians may not say that this is why they undertreat chronic pain or even admit that they undertreat the disease at all, but their collective inaction speaks louder than words. The facts revealed by the surveys of pain victims are as irrefutable as the stories of abuse and undertreatment told by the individual victims of this deadly disease.

Lack of Social Conscience

While most think of medicine as an institution that can be expected to respect human rights, this is a misconception. Medicine as an institution is not possessed of a social conscience. Instead, it reacts to existing social forces, and in this sense the behavior of physicians is best understood as a reflection of the core values of society. Unfortunately, society currently places its highest value on the control of drugs including opioids, which are incorrectly regarded as dangerous and highly addictive.

The medical profession has unfortunately, but predictably, taken on the value system of society in general and of those who regulate it. Social forces do not currently allow for ethical conduct within the realm of pain management. As a result, the professional conduct of individual physicians and the behavior of the institution of medicine as a whole are neither ethical nor humane. The following explanation will clarify why this is so.

The underlying problem is that no bright line exists between what is legal and what isn’t concerning the prescribing of controlled substances. In fact, many of the expected characteristics of a medical practice where chronic pain is treated effectively are viewed by law enforcement as red flags indicating criminality. This conundrum is best understood through an examination of what transpires as the criminal-justice system targets, investigates, and prosecutes a physician suspected of abusing his prescribing privileges, a physician who becomes in the minds of law-enforcement officials nothing more than a drug pusher in a white coat.

Every prosecution begins with a targeting phase. Something must occur to cause law enforcement to scrutinize a particular physician in the first place. Law enforcement regards pharmacists as their eyes and ears in the community for the purpose of assisting in targeting drug-dealing doctors. As a result, a complaint from a pharmacist who suspects a physician is prescribing too much medication, or is doing so for the wrong people, is commonly the triggering event. Typically, the pharmacist believes, as do his counterparts in law enforcement, that outrageous quantities of dangerous addictive medications are being prescribed to drug addicts posing as pain patients. These patients are assumed to have become drug addicts as a result of the accused physician’s criminal prescribing habits.

Such concerns belong to a category of evidence recognized as red flags. Just as physicians are trained to recognize “aberrant” drug-related behaviors, police and pharmacists learn, while attending educational conferences, to recognize red flags. These are the basis of a system of standards developed by law enforcement to identify illegal prescribing.

Having not been validated in any systematic manner, these red-flag standards are not included within the realm of medical science. In fact, many red flags actually describe the characteristics one would expect to be associated with medical practices where chronic pain is effectively treated. This is precisely why there exists no bright line between drug dealing and legitimate medical prescribing. In fact there is no line at all. Any such line that might have existed was unavoidably crossed when the Controlled Substances Act effectively assigned law enforcement, a nonmedical institution, to regulate the practice of pain management. This fundamental error in social policy is the very root of the pain crisis.

The following serve as examples of the problem.

The biggest red flag is high-volume opioid prescribing. Common sense dictates that significant volumes of opioids are necessary to treat chronic pain effectively. In the context of drug-war ideology, this necessary medical practice resembles drug dealing. When substantial amounts of drugs and money change hands, what else is a cop to think? This is why, when law enforcement regulates pain management, a head-on collision between necessary medical practices and the war on drugs inevitably occurs.

The appearance of poverty is another red flag. All it takes for a doctor to be targeted is a pharmacist who becomes uneasy with the looks of a patient and responds by lodging a complaint. Then the game is on. Police respond by conducting surveillance. Patients with a shabby appearance are observed and are assumed to be drug addicts intent on scoring a fix. Here, again, the drug war collides with medical reality. Chronic pain is a disease, which predictably reduces its victims to poverty and a poor appearance. It accomplishes this by limiting or removing the ability to engage in gainful employment or even to care for oneself properly. As a result, patients suffering from this disease often just don’t look good. Physicians are arrested over this sort of “evidence.”

Another red flag is a dosage of medication out of line with what a pharmacist or law-enforcement official believes the patient should require. This red flag conflicts with medical reality. A fundamental principle underlying the treatment of chronic pain is the individualization of treatment. There exists an enormous range within which appropriate opioid dosages may vary from one patient to the next. The correct amount of medication is whatever works to return a patient to functionality, not the amount some cop or prosecutor thinks it should take.

The Sting Operation and the Myth of Legitimate Prosecution

Rational people assume that if accusations of drug dealing go to trial, the government will be obligated to produce convincing evidence to prove that the physician stepped across a clearly defined line into the realm of criminal misconduct. We assume that unless the physician has done something like prescribing drugs to an undercover agent who asks for them but gives no medical reason, he will be left undisturbed. Our assumptions are mistaken.

The following testimony from a preliminary hearing in my own case, in which all charges, including even murder, were eventually dismissed, illustrates this point (see sidebar):

Mr. Hallinan: [Y]ou were told that numerous agents were sent into Dr. Fisher’s office to try to con him into giving them narcotics without any medical reason; right?
Agent Weatherford: I believe that’s the reason.
Q: And none of them got them; did they?
A: I don’t believe so.

Regardless of how the sting operation turns out, physicians suspected of drug dealing are routinely prosecuted. After the targeting process, which is based on red flags, is completed, the presumption of guilt is apparently so firmly established in the minds of law-enforcement officials that evidence to the contrary is overlooked. The physician’s fate is all but sealed. It is difficult to imagine the rationale employed by law enforcement in prosecuting a case under these circumstances, but it is known from bitter experience how they go about it.

After the sting operation fails to produce evidence of illegal prescribing, instead of re-evaluating the legitimacy of their case, prosecutors intent on obtaining a conviction go to plan B. They have failed to prove that the targeted physician’s behavior was illegal, so it becomes necessary to prove that, while maintaining the appearance of the practice of medicine, the accused physician actually intended to deal drugs. To this end, a “records case” is constructed.

To generate evidence of criminal intent, “experts” in the fields of pain management and addiction medicine are hired to review the accused physician’s medical records. These “experts” then take the witness stand and deliver what amount to sermons regarding the dangerous, addictive, and even lethal qualities of opioid analgesics. Typically, they refer to these substances as narcotics. This language inflames the pre-existing biases of jurors, who are usually unfamiliar with the science pertaining to these beneficial substances. The “experts” then proceed to offer a litany of examples purporting to show that, in their opinion, the accused doctor deviated from acceptable medical practice. If what the accused physician had done was clearly not medicine, there would be no need for expert testimony. This “evidence,” based on an interpretation of the standard of care, is presented as if it had something to do with drug dealing. The resulting legal affairs are best characterized as morality plays.

The role of academic physicians in the pain crisis is particularly troubling. They have turned away, as a group, from their ethical obligations to control pain. Instead, they teach the aforementioned system of “aberrant” drug-related behaviors, ensconcing them into textbooks and professional journal articles. Academics also turn with regularity against their colleagues who have attempted in good faith to treat chronic pain. By doing so, they increase both their professional standing and their personal wealth.

Witch-Hunts

To understand the pain crisis, it is useful to know a little bit about the history and general characteristics of witch-hunts. A look into the situation that developed in Salem, Massachusetts, during the late 1600s is instructive. It exposes two outstanding features that pertain to witch-hunts in general. The first is that anyone can be targeted and the triggers are social. The second is that the evidence employed to get convictions, when examined rationally, is tenuous. A category of evidence known as spectral evidence was employed in Salem. This consisted of the supposed victim’s accusing the suspected witch of appearing before her in a dream.

The circumstantial evidence of criminal intent provided by government witnesses is the modern-day equivalent of spectral evidence.

Long before the witch trial of an accused physician begins, he is burned at the stake in the media. He is portrayed as a greedy Dr. Feelgood who represents a menace to society. The following are among the remarks that may appear in the local newspaper concerning the accused physician and his practice: “We are shutting down suppliers of a highly addictive drug that has been improperly allowed to saturate the community.” “I think he’ll turn out just like Kevorkian. These are highly toxic drugs. We’re not even allowed to flush them down the toilet, for fear we’ll contaminate the drinking water.”

Prosecuting pain-treating physicians as drug dealers relies on the myth that there are bad doctors eager to prostitute their medical licenses. This myth is driven by media hysteria around opioids because stories about drug panics sell newspapers. As a group, physicians avoid risk whenever possible. It is unlikely that physicians who commit a dozen years of their lives to achieving an educational and professional status that guarantees them a generous living would choose to risk it all by dealing drugs. That is why pain is under-treated in the first place. The risks associated even with necessary prescribing are deemed unacceptable by the vast majority of physicians.

It is generally understood that people get the government they deserve. It also appears that because medical practices reflect social values, we also get the medicine we deserve. It is therefore incumbent on society to transform its core value of drug control to one that gives pain control priority. This will undoubtedly occur as people become aware of the implications of the medical and human-rights disaster that currently passes itself off as the management of chronic pain.

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medication errors cause at least one death every day and injure 1.3 million people annually

Posted on May 19, 2017 by Pharmaciststeve

Macon man says health declined after receiving someone else’s prescription

http://www.13wmaz.com/news/local/67-year-old-man-recieves-someone-elses-prescription-saying-it-harmed-his-health/440925340

According to the U.S. Food and Drug Administration, medication errors cause at least one death every day and injure 1.3 million people annually in the United States.

Nicole Butler met up with a Macon man who has recently suffered from being given someone else’s medication and talks about how it has dramatically affected his health. 

67-year-old Thomas Newson was admitted into Navicent Health’s Luce Heart Institute on May 6th.

He’s had six heart attacks in the past year, and he says last Friday when Newson was discharged was when his health really started free-falling.

“I was scared because I didn’t know what they were giving me,” Newson says, saying his heart started feeling weak.

He says they called and told him to stop.

Newson says by that time the damage had been done, and he’s lost part of his speech.

“They always knew what I was talking about, but now, you know, people ask me, ‘What you say? I can’t understand what you’re talking about,'” he says.

It even affected his eyesight.

“He can’t hardly see. It’s like his eyes, he’s going blind,” Julia Washington, Newson’s caregiver of 34 years, says.

Washington says Newson’s personality and even appetite changed as well. 

“This is not him,” she says.

“He wants to make sure they won’t get him mixed up with nobody else. He said they’ve already gotten him mixed up,” Washington says.

Washington says Navicent’s mistake is inexcusable.

“And we hope the Medical Center won’t keep making these mistakes anymore,” she says.

Newson says he is still suffering from the medications side effects, but is praying to get a little bit better every day.

We asked Navicent Health for a response, by email they said they would not discuss individual’s case due to patient privacy.

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SNITCHES should get STITCHES not $$$

Posted on May 19, 2017 by Pharmaciststeve

For some airline workers, tipping off the DEA pays off big

http://chicago.suntimes.com/news/some-airline-workers-profit-big-tipping-off-dea-watchdogs-united-airlines-ohare-airport-glen-ellyn/

The U.S. Drug Enforcement Administration has paid some airline employees hundreds of thousands of dollars to provide flight itineraries of suspected drug traffickers, leading to the seizure of millions of dollars and prompting concerns about the constitutionality of the cash grabs.

In Chicago, the once-secret program led the DEA to seize $5,000 from a United Airlines passenger’s luggage during a layover at O’Hare Airport last year, according to a lawsuit the man filed.

Breland Barcel Lee, a convicted drug dealer, turned up on the government’s radar when a confidential source flagged his one-way ticket as suspicious and alerted a DEA task force officer at O’Hare, court records show. Officers then searched his Olympia roller bag and found the cash. Lee says he was carrying the cash because he was planning to move to California.

“It’s Big Brother,” says attorney Brendan Shiller, who represents Breland Barcel Lee.

“It’s Big Brother,” says Lee’s attorney, Brendan Shiller. “Innocent people are being swept up, and their property is being taken.”

According to a lawsuit Lee filed against United Airlines and members of a DEA task force, the agency seized $5.5 million in suspected drug money from 118 travelers at Chicago airports in a single year, 2015. The money is split among the DEA and the police agencies that work on its interdiction task force.

The DEA, responding to Chicago Sun-Times questions, acknowledges it “routinely receives information from a wide variety of sources, which includes transportation service employees.

“Because drug traffickers routinely use parcel services, airlines, trains, buses and other means to move their drugs and drug currency throughout the United States, DEA routinely works with personnel from these agencies to interdict these substances.”

Last year, the Justice Department’s inspector general’s office issued a report raising concerns about the DEA using confidential sources in the airline industry. It looked at the files of 19 DEA “limited-use” sources in the industry.

The federal drug-fighting agency paid those 19 people a total of $1.6 million for information they provided in 381 cases between 2011 and 2015, according to the Justice Department watchdog — an average of more than $84,000 apiece, with one airline source getting a whopping $617,000 over that period. The DEA’s Chicago office was among six of the agency’s offices that were audited.

The information that the paid sources gave the DEA resulted in reported cash seizures of more than $14 million from passengers, according to the inspector general, who questioned whether those lucrative relationships might violate travelers’ constitutional rights.

Limited-use sources are supposed to act without direction from the DEA. But the inspector general found that, rather than getting unsolicited tips from them about individual travelers, some DEA agents ask their sources to provide entire passenger manifests on an almost-daily basis. Some sources were being cited 20 times a day.

That “calls into question whether a source is truly providing information independently or is acting as DEA’s agent, the latter of which could have implications relating to compliance with the Fourth Amendment’s protections against unreasonable searches and seizures,” the inspector general wrote.

Lee sued United Airlines and members of the DEA Interdiction Group 24, which seized the cash on April 13, 2016. He says his privacy rights were violated when an unknown United Airlines employee handed over personal information about Lee to the DEA, even though he wasn’t a suspected terrorist or threat to national security.

Breland Barcel Lee, 31, with his son. | Provided photo

Lee, 31, previously had been convicted of drug and weapon charges — with one drug arrest in North Carolina just two months before his money was seized at O’Hare.

The DEA was alerted to him because he bought a one-way ticket from Raleigh-Durham International Airport in North Carolina to Los Angeles the day before his flight.

DEA task force officers looked at Lee’s social media accounts and found pictures of him posing with large amounts of cash “consistent with narcotic proceeds,” according to the application for a federal warrant to search his bag. They also did a background check that turned up his convictions.

Officers delayed Lee to question him about the contents of his bag. They said he initially denied having any cash, then opened his bag and showed them a leopard-patterned pouch that he says contained his money. The officers said Lee told him he planned to use the money to move to California and that he denied having more than $5,000 in the bag.

The officers said he wouldn’t voluntarily let them search the bag, so they told him they were taking it to have a drug dog sniff it, gave him a receipt and seized it.

A narcotics dog alerted to the presence of drugs in his black roller bag, a task force officer said. They obtained a search warrant and found $5,000 inside.

Though agents seized his money, Lee wasn’t charged with any crime. He was allowed to continue on his trip — which is common practice in cases in which the government seizes suspected drug proceeds.

Lee didn’t challenge the seizure through the government’s civil forfeiture process. Instead, he filed suit last July against United Airlines and DEA task force members.

“They should have more evidence to stop somebody,” Lee says. “They are hurting more innocent people than people who are doing illegal things.”

Breland Barcel Lee, 31, sued United Airlines and DEA task force members over suspected drug money seized from his luggage in 2016 at O’Hare Airport. | North Carolina arrest photo

Lee says he’s a carpenter and part owner of a tobacco shop in North Carolina. He says he was planning to leave the shop to a partner and move to California to “start a new life.”

He says he still wants to move to California, but the seizure set his plans back.

The DEA’s application for the search warrant for Lee’s luggage says the agency received Lee’s travel itinerary from a paid, confidential source who previously had provided reliable information. The application doesn’t say whether the source worked for United Airlines, but Lee’s attorney says there’s strong evidence pointing to that, including the inspector general’s report.

Lee won a partial victory in December, when the village of Glen Ellyn settled on behalf of a police officer who worked on the DEA task force and participated in the search of Lee’s luggage. Lee got $6,000 in the settlement — reimbursement for the $5,000 in seized cash, plus $1,000 to pay his legal fees.

Lee didn’t sue the DEA itself.

United Airlines is the only remaining defendant in the case. On Monday, a judge threw out the federal claims against United but ruled the case could continue on claims based on state law, including infliction of emotional stress and false imprisonment.

In response to questions from the Sun-Times, United Airlines issued a one-line, written statement saying, “United complies with written requests from law enforcement for information and believes this case has no merit.”

In court papers, the airline’s lawyers say the allegations that “United was somehow acting as an agent of the DEA” are baseless.

The airline, which recently was the subject of a huge public backlash with the release of a video showing a passenger dragged off a United flight at O’Hare, didn’t respond to questions about whether its employees are secretly providing information to the DEA.

The inspector general’s report didn’t cite any airlines by name.

According to that report, the DEA needs better oversight of payments to its sources working in the transportation industry, including airlines — and of how the agency uses those sources.

The Justice Department’s inspector general released a report in September questioning practices involving airline  sources tipping off DEA task force members about suspected drug dealers.

The inspector general was troubled that DEA agents didn’t always disclose the use of airline sources in their investigative reports.

Shiller says that lack of transparency is at the heart of Lee’s case. “We’ve been kept in the dark,” he says.

Attorneys for passengers have been told almost nothing about how DEA agents target their clients’ luggage, Shiller says.

He says he reviewed other DEA applications for warrants to search luggage at O’Hare. In one case, a DEA task force officer disclosed that he conducted routine reviews of flight manifests of planes leaving O’Hare. But the officer didn’t say how he got that information, including whether he relied on a confidential source.

The warrant for Lee’s luggage mentioned the use of a confidential source in small print in a footnote.

Testifying last month before the House Judiciary Committee, Acting DEA Administrator Chuck Rosenberg was asked about the inspector general’s concerns about his agency using airline employees as informants. Rosenberg said they’re being more closely monitored now.

“So confidential sources, confidential informants are very important to our work,” Rosenberg testified. “But we have to make sure we’re careful.

“We’re now doing 90-day reviews of every single one of our confidential sources. We’ve put in place an awards review board so we can make sure that confidential sources are paid and treated the same way.”

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Medical Academia weighs in on the “opiate epidemic” and the FDA

Posted on May 19, 2017 by Pharmaciststeve

Friday Feedback: Should Opioids Be FDA’s Top Priority?

Experts review agency’s actions thus far & offer additional strategies

https://www.medpagetoday.com/painmanagement/painmanagement/65433

During the new FDA Commissioner Scott Gottlieb’s first all-hands address to agency staff, he declared the opioid abuse epidemic as the agency’s “greatest immediate challenge.”

As opioid abuse and overdose deaths continue to rise, it’s clear that the crisis should be a public health priority. However, the jury is still out on what efforts the FDA can and should take to increase awareness and better manage the issue.

Do you agree that combatting opioid abuse should be the agency’s top priority? If not, what would you pick?

Petros Levounis, MD, Rutgers University: Yes, wholeheartedly! We are seeing a devastating increase in fentanyl and heroin use in our communities with increased rates of admissions and deaths.

Dessa Bergen-Cico, PhD, Syracuse University: I agree that combatting opioid abuse, specifically prescription opioid abuse and overprescribing, should be a top priority of the FDA.

Peter R. Martin, MD, Vanderbilt University: I do not believe the FDA can do anything truly transformative to combat this problem. Where the FDA may help is in facilitation of the development of medications for psychiatric disorders, including opioid and other drug use disorders. Although there have been some advances in medication assisted treatment of opioid and other drug use disorders, these advances have received little priority for the pharmaceutical industry for a variety of reasons, including stigma associated with drug use disorders (“addiction”) and lack of financial incentives to pharmaceutical companies.

Timothy A. Collins, MD, Duke University: No. Combating opioid abuse should be a priority, but not the top priority for the FDA. The FDA’s top priority should be combating the needless increase in the cost of prescription medications.

Sally Satel, MD, American Enterprise Institute: Yes. With no infectious epidemics raging and the death toll from opioids rising, it is a top priority. But I would put easing regulations for electronic cigarettes as a close second.

Jason M. Hockenberry, PhD, Emory University: To the extent it fits in the FDA purview, yes. This means FDA should really focus on the pipeline issues in pharmaceutical and device development related to the treatment of opioids, and pain management related treatments more broadly. The bigger immediate issues in the opioid epidemic are the purview of the DEA, CDC Center for Injury Prevention, SAMHSA, CMS, and the broader healthcare system, not FDA.

Lewis Nelson, MD, Rutgers University: No other FDA related issue is associated with the scope of consequences as is occurring with the opioid epidemic, but it is not just abuse. More important are complications of long-term use due to addiction, dependence, and hyperalgesia (worsening pain due to opioids), as well as overdose death. Therefore, this very realistically should be priority number one.

What can the FDA actually do about opioid abuse that it isn’t already doing?

Joseph A. Boscarino, PhD, MPH, Geisinger Clinic: I’d say find a means to support more applied health system-level research among providers. This knowledge will help in development of more effective interventions at the healthcare delivery site.

 

Satel: Put special focus on development of non-addicting analgesics.

Levounis: The FDA has done a lot for the epidemic already, but further facilitating and promoting treatment of opioid use disorder with safe and effective medications, such as buprenorphine, is greatly needed.

Amol Patwardhan, MD, PhD, University of Arizona: Better education for primary providers and better public education campaigns.

Bergen-Cico: Require and mandate adequate training and education in addictions for healthcare professionals. It is not required and it is a major factor of what healthcare staff deal with in on a daily basis. Regulate advertising and direct marketing of prescription medications to consumers and revise practices of pharmaceutical reps being the main conduit of information for medications to doctors and nurse practitioners.

Collins: The FDA could require end-to-end tracking of every opioid medication. The ability to track from the manufacturer plant to the distribution center, then to pharmacy and patient pick-up, would significantly decrease the diversion of opioids to the illicit market. They can limit marketing of opioid products, require additional studies of longer duration for newly developed opioids, and potentially remove products from the market (if there is evidence of a safety issue).

Nelson: Overhauling the assessment of value — meaning the interplay of efficacy, safety, and cost, for all FDA regulated products would likely find that there is little basis for the ongoing approval and lax regulation of opioids for chronic pain. The FDA does not, however, currently take cost into account, and they occasionally lose sight of the risk/benefit relationship for a drug due to external forces, particularly legislative realities, pharmaceutical industry efforts, and vocal advocacy groups (which often have misaligned incentives).

What effects, if any, have you seen from previous efforts by the FDA and CDC to combat opioid overuse and abuse?

Patwardhan: Very positive outcomes. Significant improvement in patients’ and physicians’ attitudes toward chronic narcotic therapy.

Collins: The previous efforts of the CDC (and to a lesser extent the FDA) have resulted in a much greater awareness of the problems with opioids, and increased discussion between patients and their provider regarding doses and need for opioid medications. Unfortunately, this does not appear to have altered the abuse or diversion of opioids, and does not yet appear to have decreased the rate of overdose and death from prescription opioids.

Martin: The CDC has done an incredible service by bringing the opioid use “epidemic” to the attention of most Americans through seminal publications that have identified the scope and cost of this problem. Unfortunately, the policy response to this crisis immediately led to a focus by the FDA on altering pharmaceutical formulations of opioids to make them less liable to abuse. In retrospect, this response seems overly simplistic and without true understanding of drug use disorders because limiting availability of abusable opioids has simply enhanced transition of the using population to illicit drugs like heroin that are now readily available throughout the country and expanding the epidemic.

Levounis: We have an increase in regulatory oversight of opioid prescribing with good results. Prescription monitoring programs and opioid labeling changes have already given us significant results. Making naloxone easily available to users has also helped decrease the lethality of the illness.

Hockenberry: CDC has helped coordinate efforts to implement public health policies, such as prescription drug monitoring programs and pain clinic laws, that are reducing opioid prescribing, and translating into lower rates of overdose deaths. More needs to be done to get those with opioid use disorders into treatment, and these issues involve financing and other issues outside of FDA and CDC purview.

Boscarino: Addiction use disorders are complex and multifactorial. The FDA and the CDC have worked within their regulatory limitations to address these issues. I think they have had an some impact, but as we see the list of casualties grow in our local towns and cities, most wish to see more done to prevent this epidemic.

Nelson: There has certainly been a greater recognition of the extent and complexity of the use of opioids to treat pain. Some of the good and necessary efforts, such as abuse deterrent formulations, are simply nibbling at the edges of the epidemic, while others, such as public access to naloxone, are akin to closing the barn door after the horse has escaped. What we need to see is primary prevention of the short- and long-term consequences of opioid use, which will require further shifting patients’, physicians’, and regulators’ understanding and expectations about the value of opioid use for pain.

Satel: The abuse deterrent re-formulation of OxyContin has been disappointing. Some users have shifted to heroin/fentanyl and others just use immediate-release generics. The substitution dynamic makes the problem very difficult.

Filed under: General Problems | 4 Comments »

IOWA: < 50% of hospitals get ABOVE AVERAGE GRADE on Pt Safety and ERRORS

Posted on May 19, 2017 by Pharmaciststeve

Iowa hospitals get grades from nonprofit group for safety, injuries

http://siouxcityjournal.com/lifestyles/health-med-fit/iowa-hospitals-get-grades-from-nonprofit-group-for-safety-injuries/article_500b4f97-750c-5797-99bc-411bc0ab3366.html

SIOUX CITY | Sioux City’s two hospitals scored average grades for patient safety from a national nonprofit organization that calls attention to deaths and injuries that result from medical errors. 

UnityPoint Health — St. Luke’s Spring 2017 Leapfrog Hospital Safety Grade remained unchanged from 2014, when the hospital moved up from a “D” to a “C.” Mercy Medical Center, which earned an “A” in the spring of 2014, fell to a “B” later that fall. In the spring of 2016, the hospital dropped another letter grade to a “C,” which it has maintained.

Of the 31 hospitals in Iowa that were graded, 11 received “A’s,” six got “B’s” and 12 were given “C’s.” Two hospitals received a “D,” the lowest grade handed out in the state. Those hospitals were Mercy Medical Center of Des Moines and Mercy Medical Center — West Lakes in West Des Moines.

The three Siouxland hospitals to receive “A’s” were Avera Sacred Heart Hospital in Yankton, South Dakota; Lakes Regional Healthcare in Spirit Lake, Iowa; and Spencer Hospital in Spencer, Iowa.

“Our providers actively put patients and their safety at the heart of every decision, and care is always coordinated between clinics, hospitals or homes,” Mike Kafka, medical director of quality and safety for St. Luke’s, said in response to the hospital’s grade. “Our teams continuously prioritize best practices throughout the system to sustainably manage resources and ensure the best outcome for every patient at every time.”

In a statement, Dave Smetter, Mercy Medical Center — Sioux City’s vice president of communications and community development, said the hospital is committed to delivering innovative, safe and quality health care to every patient.

“To maintain our performance and focus, Mercy voluntarily seeks out some of the most rigorous certifications and accreditations available,” he said. “The findings of these reviews show a consistent conclusion — Mercy is a high performing organization in terms of quality and safety.”

The Leapfrog Group hands out letter grades from A to F to more than 2,500 U.S. general hospitals based on infections, injuries and medical and medication errors that are publicly reported.

Iowa ranked 22nd in the nation based on its percentage of “A” hospitals (35.5 percent). Maine earned the No. 1 spot with 68.8 percent of its hospitals receiving “A’s.” North Dakota, Alaska, Delaware and the District of Columbia tied for 47th place. No hospitals in those states received an “A” grade.

The Leapfrog Group says the choice of a hospital could be a life-or-death decision as hospitals vary greatly based on infection rates, surgical errors and patient injuries.

Mercy Medical Center — Sioux City recorded a zero, the best possible outcome, for preventing Methicillin-resistant Staphylococcus aureus infection, a type of staph bacteria that can cause life-threatening bloodstream infections, pneumonia and surgical site infections.

Mercy’s scores were worse than the average hospital’s scores for infection in the blood during an intensive care unit stay, infection in the urinary tract during an ICU stay and for Clostridium difficile infection or C. diff — a bacterium that can cause diarrhea, abdominal pain, loss of appetite and fever.

For surgical site infections after colon surgery, Mercy’s score was 2.647. The worst hospital scored a 3.461, while the average hospital had a score of 0.899. According to the Leapfrog Group, such an infection after surgery can be very serious as it could spread throughout the body, resulting in a long ICU stay or even death.

St. Luke’s fared better than the average hospital in four of those five categories. The hospital scored worse than Mercy (1.324) and the average hospital (0.893) for C. diff infection with a 1.397. In the patient falls category, St. Luke’s received a score of 1.198. Mercy’s scored a 0.276, which was better than the average hospital’s score of 0.390. The Leapfrog Group says falls, which can cause serious injury or result in death, commonly occur in hospitals when patients who can’t walk on their own try to get out of bed.

While the Leapfrog Group recommends that health care consumers seek out the safest hospital in their area, preferably one with an “A” grade, the ranking is one of several that patients can consider when choosing a hospital. For example, the Centers for Medicare & Medicaid Services (CMS) offers an online Hospital Compare tool which gives hospitals an overall star rating. 

Although the Leapfrog Group uses national performance measures from its own hospital survey, as well as data from CMS, the American Hospital Association’s Annual Survey, the Centers for Disease Control and Prevention and other sources to generate its grades, the independent organization has come under attack by researchers.

A University of Michigan study published in March in the journal Medical Care found that more than 50 percent of hospitals that participated self-reported perfect scores for all but one Safe Practices Scores measure. Researchers concluded that Safe Practices Scores had little connection to hospital-acquired infections or whether CMS imposed penalties for excessive readmission rates and high rates of patient injuries.

Kafka said St. Luke’s doesn’t voluntarily report to Leapfrog’s Hospital Survey, but does provide data to other agencies that measure patient safety.

“Providing additional data to Leapfrog is not required to receive a safety grade, however, other independent groups have ranked St. Luke’s high in patient safety absent self-reporting,” he said.

Smetter said Mercy believes in open communication and the reporting of quality and safety results, but recognizes that “the sheer volume of ratings surveys and methodologies such as the Leapfrog Survey can lead to confusion.”

He cited a study conducted by Johns Hopkins researchers that evaluated measures for hospital safety used by common public ranking systems, including Leapfrog’s Hospital Safety Score. The study, which was published in the journal Medical Care in December 2016, found only one measure out of 21 that met scientific criteria for being considered a true indicator of hospital patient safety.

“As an acute care medical and referral center, Mercy serves many patients suffering from traumatic injuries and critical illnesses,” he said. “Despite caring for high volumes of these most critical patients, Mercy meets or exceeds quality and safety targets.”

 

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At least 10 Indiana police agencies now own drones: using appears to be against the law in Indiana.

Posted on May 19, 2017 by Pharmaciststeve


Indiana police departments want drones. There’s just one big problem.

http://www.whas11.com/news/local/indiana/indiana-police-departments-want-drones-theres-just-one-big-problem/441173901

(INDYSTAR.COM) – Indiana’s two largest police departments both want drones; one for crowd surveillance at major gatherings Downtown, the other to monitor traffic at events such as the Indiana State Fair.

There’s just one problem. Both uses appear to be against the law in Indiana.

As the cost of drones drops and police departments rush to acquire the latest technology, officers are finding it difficult to navigate a tangled web of federal and state policies. They also face ethical questions. How will the community respond to cameras in the skies? And what are the appropriate uses?

 

Across the country, more than 340 public safety agencies either have drones or the authorization to fly them, according to an April report from the Center for the Study of the Drone at Bard College. More purchases occurred last year than all previous years combined, the report found.

And when it comes to finding ways to use them, well, the sky is the limit — which has created some concerns.

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In North Dakota, police have authority to attach nondeadly weapons, such as stun guns and devices to fire rubber bullets, which drew a rebuke from the American Civil Liberties Union.

In Connecticut, the state legislature briefly considered a bill this year that would have allowed police agencies to attach deadly weapons.

But most drones are simply strapped with cameras, giving police high-definition pictures from the sky.


Indiana State Sen. Eric KochPhoto: Provided by Indiana Senate Republicans

At least 10 Indiana police agencies now own drones, and more are considering the possibility. Indianapolis Metropolitan Police Department hopes to identify funding in the 2018 budget, Chief Bryan Roach told IndyStar, to begin deploying “in a very limited scope.” Top officials at the department said crowd surveillance was one possible benefit.

Indiana State Police also are currently researching drones, a spokesman said, adding traffic control was one of the goals.

But here in Indiana — which is among 17 other states with similar laws, according to a National Conference of State Legislatures report — a police department needs a warrant to use a drone, except in a few circumstances and in emergency situations.

That means IMPD most likely wouldn’t be able to fly near large gatherings, providing a bird’s-eye view to look for wrongdoing, unless officials feared a terrorist attack or expected a crime. Nor could state police watch for traffic snarls outside big events. When told of the restrictions, both departments acknowledged they needed to conduct more research, and said they would only use drones for legitimate purposes allowed by the law.

Eric Koch, who as a state representative authored Indiana’s drone laws in 2014 and 2016, said the laws add judicial oversight, and err on the side of privacy.

“And that’s an expectation among the public,” said Koch, a Republican who’s now a state senator.

DRONE CATCHES A HIDING SUSPECT

In March, in the northeast corner of the state, Indiana saw perhaps the best example of a drone’s policing power.

There, in rural Noble County, sheriff’s deputies were hunting for a man in the dark. He had refused to pull over for a traffic stop, then crashed as he sped away, and ran into nearby cornfields, wetlands and woods.

Deputies set up a perimeter. They first hunted for the man using K-9s, but the dogs lost the scent.

Then the Noble County Sheriff’s Department’s two-man drone team launched a DJI Inspire 1 unmanned aerial vehicle with a thermal imaging camera that picks up heat signatures and relays images to a hand-held monitor. It displays a person as a bright white figure on a gray landscape.

They quickly found the suspect walking alone in a cornfield.


A FLIR integrated thermal camera is attached to a DJI Inspire 1 drone at the Noble County Sheriff Department, May 11, 2017.Photo: Michelle Pemberton/IndyStar

The craft hovered at 200 feet, chasing the man as he continued fleeing from police. The drone operators radioed other deputies, telling them to follow the drone’s lights to the man.

Soon, he was in handcuffs.

Without the drone’s aerial view, “he probably would have gotten away that night,” said Deputy Brandon Chordas, who aptly named his drone Con Air, after the 1997 Nicolas Cage movie about an aircraft transferring convicts to a prison. “We were giddy.”

In all, the mission took about 20 minutes, the deputies said.

Drones also helped the deputies locate a runaway teen in about five minutes. And they needed only 25 minutes to find the body of a man who died while hunting for mushrooms alone in the woods.

“What used to take hours now takes minutes,” Chordas said.

The department, which originally faced local criticism for buying the drones, decided to post the video of the March incident on Facebook. The reactions and comments were overwhelmingly supportive.

“One can RUN, but they can’t HIDE!!” one person wrote.

“Now THAT is a good investment in taxpayer dollars,” another wrote.

SAVING MONEY AND LIVES

Drones help officers reconstruct major crashes and provide aerial photos of sweeping crime scenes. They also can aid during SWAT situations or natural disasters.

“It’s a life-saving device,” said Jim White, a public safety senior lecturer at Indiana University–Purdue University Indianapolis and former Indiana state trooper.

The Warrick County Sheriff’s Department in southwest Indiana has used its drones about 40 times so far, Chief Deputy Michael Wilder said, mostly at crash scenes.

“As the technology advances, we’ll find more and more ways to use them,” Wilder said.

So far, the Valparaiso Police Department in Worthwest Indiana has used its drone only a few times, most recently to help another agency search for evidence following a murder. Valparaiso officers also have searched for a dementia patient who walked away, and for a suicidal person who needed help.

IMPD sees a lot of potential in a drone, said Sgt. Kendale Adams, spokesman for the department, but finding money isn’t easy. Once the everyday needs of the department are funded, he said, “we never have a whole lot of money” left for things like emerging technology.


Deputy Shafter Baker co-pilots a DJI Inspire 1 drone at the Noble County Sheriff Department, May 11, 2017. (Photo: Michelle Pemberton/IndyStar)

Drones can range from a few hundred dollars for an inexpensive model to hundreds of thousands of dollars for the most advanced, said White, whose IUPUI class recently delivered a research project on drones to state police.

The Inspire 1 appears to be the most popular drone for Indiana officers, costing about $15,000 when you include an expensive thermal imaging camera.

“It’s absolutely amazing what you can do with it as far as viewing in the dark,” said Phil Rochon, Valparaiso IT officer. His drone also has a parachute that automatically deploys if the device were to unexpectedly drop from the sky after a bird attack or a mechanical failure.

Drones can, however, offer long-term savings to a big department such as IMPD. The department expects the use of drones to cut down their reliance on an aging helicopter, which costs several hundred dollars per hour to fly.

Today’s drones couldn’t completely replace helicopters, though. Rochon noted the maximum flight time on an Inspire 1, which is limited by battery life, is 18 minutes. The drone won’t work in temperatures below 14 degrees, and winds of 22 miles per hour will ground the unit, Rochon said.

PUBLIC POLICY AND TECHNOLOGY

Many of these uses are clearly allowed under an Indiana law that was adopted after an IndyStar and USA TODAY investigation found Indiana State Police had acquired a Stringray, a tool used to collect cellphone records. Drones were wrapped into the 2014 bill.

Police may use drones for search-and-rescue efforts, to record crash scenes, and to help in emergencies, such as natural disasters or terrorist attacks.

In Indiana, though, just about every other use for police requires a warrant.

The purpose of Indiana’s law was to protect people from unreasonable searches that might not have been anticipated when the Fourth Amendment was adopted to protect citizens’ privacy.

“Without that law, the Fourth Amendment doesn’t protect us as much as one might think it would,” said Shawn Boyne, a law professor at Indiana University Robert H. McKinney School of Law. “The major cases coming from the Supreme Court … generally permit aerial surveillance.”

States without a similar law, Boyne said, are forced to grapple with issues involving privacy, and how police exercise their authority to deploy drones. Would certain neighborhoods be targeted routinely? What discretion does an officer have?

Indiana’s law answers many of those questions, she said, though she noted parts of the law are still unclear. For example, what would happen if police were to use a drone illegally, without entering the images they capture into evidence in a criminal case?

“Really the drone issue comes up mainly if they try to introduce information into a criminal proceeding,” Boyne said. “And then that’s where the whole Fourth Amendment protections are triggered.”

In addition to state laws, the Federal Aviation Administration issued a set of guidelines that has resulted in a hodgepodge of practices and certification levels.

The Tippecanoe County Sheriff’s Department, for example, isn’t authorized to fly at night right now, while the Valparaiso Police Department is.

Multiple officers contacted by IndyStar said becoming certified was confusing. One called the process “extremely complicated.” Another said studying for a test was like “reading a foreign language.”

After buying a drone before most other departments, the Shelby County Sheriff’s Department decided to abandon its program a few years ago.

The reason? Too many stipulations, and too much “red tape,” Maj. Louie Koch said.

GAINING TRUST

Understanding the rules is one step for law enforcement; making sure a community trusts a police department to use a drone responsibly is another, said Jim Bueermann, president of the Washington, D.C.-based Police Foundation and a former police chief in California.

He pointed to Community Policing & Unmanned Aircraft Systems, a guidebook prepared by the Police Foundation on behalf of the U.S. Department of Justice. The report references instances of community backlash against drone programs in Seattle, San Jose, Calif., and Los Angeles in 2013 and 2014.

To begin, Bueermann said, departments should meet with local citizens to determine what uses would be considered appropriate.

“What is not acceptable in Indianapolis might be acceptable in Dallas,” he said. “Each community is going to view these things differently.”

Officers across Indiana have heard concerns from citizens, too. Some are fearful that drones will be used to peek into their homes and backyards, or to clock them speeding down the highway.

Officers interviewed by IndyStar shook off such concerns, by noting their respect for privacy.

“We’re not just going to be throwing them in the air willy-nilly, flying over people’s backyards to see if they’re growing marijuana,” Indiana State Police Capt. David Bursten said. “We’re going to have to have a warrant — as we should — and be able to articulate why we’d be flying in an area.”

Adams, the IMPD sergeant, said his department was not aware of Indiana’s warrant requirement, but would seek greater clarity before buying a drone.

“Obviously, we’d follow the law,” he said.

There may be some disagreement about that law, however. Adams noted an Indiana exception that allows officers to use drones without a warrant if there’s a “substantial likelihood of a terrorist attack.” Some gatherings Downtown, such as political marches with potential for conflict, could meet that threshold, Adams said.

Ultimately, the courts may need to clarify such uses — unless the law is updated as technology evolves.

Koch, the lawmaker who wrote Indiana’s drone laws, said he’d be willing to discuss changes with law enforcement in the future. After all, he worked to update the law in 2016 to allow officers to use drones at crash scenes, after receiving feedback from police.

But as more Indiana agencies buy drones, Koch noted that the state hasn’t seen any instances of abuse: “Maybe the bill is doing its job.”

Call IndyStar reporter Ryan Martin at (317) 444-6294. Follow him on Twitter: @ryanmartin and on Facebook.

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What you get: when a bureaucrat has TWO SONS abusing Heroin ?

Posted on May 18, 2017 by Pharmaciststeve

Indiana has strategy to fight drug abuse, but costs are yet to come

http://www.heraldbulletin.com/news/state_news/indiana-has-strategy-to-fight-drug-abuse-but-costs-are/article_77db91bd-3254-5b82-b973-4afffef1f283.html

INDIANAPOLIS — A comprehensive strategy to address the state’s drug abuse crisis was adopted Thursday, focusing on the coordination of resources and using evidence-proven treatment programs.

However, the six-page document lists no costs of implementing the strategy introduced by Jim McClelland, who was appointed by Gov. Eric Holcomb to serve as the state’s executive director for Drug Prevention, Treatment and Enforcement.

Asked to estimate a cost to implement the strategy, McClelland said, “We’re going to move as fast as we can to do as much as we can with the resources that we have and we’re going to do this the best we can to try to attract more resources.”

 

He said that guidelines were needed first in tackling the complex issue.

Emphasis is also given to expanding the approach to treatment by increasing the use of drug courts, diversion programs and by promoting “wrap-around” services ranging from housing for recovering addicts to seeking to “eliminate punitive policies that terminate services for people who relapse.”

The commitment to treatment was echoed by two Batesville brothers who went through addiction programs in California.

“I feel treatment is a much better option, if we have the resources for treatment, versus locking up everybody who has a drug problem,” Connor Ryan, 24, said.

Although programs were available for him in Indiana, he chose to go to California to go through the same program as his older brother, Sean.

“I feel it’s very difficult to get sober at someplace where you’ve used,” Connor Ryan said.

Sean Ryan said he had to go out of state to address his heroin addiction.

He said, “It means so much to me to be here and see that we are doing so much for this and finally addressing this because when I first got sober, I went to doctors, I went to the emergency room and there were no options. No one knew where I should go.”

The brothers are the sons of State Rep. Cindy Ziemke, R-Batesville, who was at the commission meeting.

Under the strategic plan, when treatment is not immediately available, Hoosiers could be connected with a counselor who stays in touch with the individual until treatment is ready. Emergency departments would have counselors to establish relationships with patients who overdose.

The recent General Assembly earmarked $5 million to combat substance abuse and enforcement.

 

In April, the state received a $10.9 million federal 21st Century CURES grant intended to combat substance abuse. Of that, $7.6 million could provide funding for between 60 to 75 inpatient beds for a year, said Kevin Moore, director of of the Division of Mental Health and Addiction. He said that amount “chips away at the iceberg.”

The policy now needs to be supported by the General Assembly, said legislators attending the commission meeting.

The plan seeks to reduce the supply of illegal drugs by targeting supply chains including interdiction efforts, reducing impaired driving and reducing pharmacy robberies.

The strategy strives to reduce the incidence of substance use disorders. To that end, the state is to encourage the use of alternative pain management treatments to avoid addictions to opioids. Hospitals will be urged to provide post-operative follow-up.

In one approach, a Medicaid waiver would have to be obtained to pay for residential treatment and recovery support mechanisms.

Paramedics would be trained to provide follow-up services for people with addictions who have been released for addiction treatment and live in under-served areas. A “hub-and-spokes” network could be created to provide an array of services in multi-county regions.

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