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Doctors across the country are calling for a re-think of current government policies, in terms of allowing medical research on medical cannabis, as elderly patients see dramatic results to treat pain.
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www.anonhq.com/dea-shamefully-admits-legal-marijuana-drug-war-couldnt-decades-video/
By United States federal law, marijuana is illegal irrespective of the reason for its use. The government agency responsible for the regulation of drugs in the country, the Drug Enforcement Administration (DEA), has refused to delist marijuana from Schedule 1 of the Controlled Substances Act.
But despite the federal ban, states have made changes to their marijuana laws. During November 2016, marijuana won major ballot victories in states across the country.
Medical marijuana legalization, on the ballot in Florida, received a whopping 71% support from voters. Medical marijuana legalization also received massive endorsements in Arkansas and North Dakota. Voters in California, Nevada, Massachusetts and Maine also approved measures to legalize marijuana for recreational use in their territories.
The good news is that the legalization spree of the plant by states is yielding massive results. Apart from the fact that legal marijuana has resulted in creating new opportunities through jobs creation and generation of revenues for various state governments, it is also tackling a serious long-time problem facing the United States — the drug problem.
In 1971, President Richard Nixon started the so-called war on drugs. Nixon argued that there should be a set of drug policies that discourage the production, distribution, and consumption of psychoactive drugs deemed illegal by the United Nations. Of course, Nixon’s argument was accepted by the political elite, and for many decades now, the United States government has waged a ruthless war against drugs.
The economic and human cost of this war has been massive. In 2010, it was estimated that the United States federal government spent over 15 billion dollars on the drug war, amounting to a rate of $500 per second. State and local governments also spent at least $25 billion fighting the drug war during the same period. In 2012, it was again estimated that the country had spent $1 trillion since the Nixon era fighting the drug war. Apart from the wasting of taxpayer money, the United States government also provides military aid to Mexico, which serves as a gateway for drugs entering the United States. The use of force against drug cartels claims nearly 50,000 lives each year. In the United States, over 1 million people, the majority of them African-Americans, are incarcerated every year for drug law violations.
But despite this financial and human cost, the war on drugs has been a complete failure. The Global Commission on Drug Policy released a report in 2011 stating unequivocally that “The War on Drugs has failed.”
More psychoactive drugs, excluding marijuana, are still finding their way into the United States. Cocaine remains the leading substance entering the United States through the southern part of the country. Although the entry of cocaine and other substances into the United States are on the rise, that of marijuana is reducing significantly.
In 2016, data released by the United States Border Patrol showed marijuana seizures along the southwest border with Mexico have tumbled to their lowest levels in at least a decade. Border agents seized roughly 1.5 million pounds of marijuana at the border — down from a peak of nearly 4 million pounds seized in 2009.
The big question here is why this sudden drastic reduction? The answer is simple: legal marijuana. Ever since states defied the DEA to legalize marijuana, either for recreation or medical purpose, domestic production of the plant has surged – especially in states such as California, Colorado and Washington.
Basic economics suggests if there is more supply, price will fall. If price falls, business becomes unprofitable. Marijuana prices have therefore fallen in the United States. When states were yet to legalize the plant, users were relying on supplies from Mexico. Because of the Mexican monopoly, the price was high. Mexican growers and smugglers were making huge profits, while the United States was spending scarce resources fighting the trade.
Marijuana growers in Mexico now face tough competition in the United States, making their business unprofitable. It’s now no longer worth smuggling marijuana into the U.S., hence the reduction in seizure by border officials.
“Two or three years ago, a kilogram [2.2 pounds] of marijuana was worth $60 to $90. But now they’re paying us $30 to $40 a kilo. It’s a big difference. If the U.S. continues to legalize pot, they’ll run us into the ground,” a Mexican marijuana grower told NPR news in 2014.
The DEA confirmed marijuana entering the United States has reduced. The agency went further to say it found evidence of the flow of illegal marijuana starting to reverse, with some cases demonstrating marijuana produced in the United States being smuggled to Mexico.
From the available evidence, legal marijuana has proven the solution to the U.S. drug problem is legalization. If psychoactive drugs in general are legalized, supply would increase, leading to a fall in price. It would then become unprofitable to smuggle, driving away criminal networks associated with the trade.
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www.thefederalist.com/2017/03/10/nobody-right-health-care/
Just because our rights are secured by government, it does not follow that they must be provided by government.
Buried beneath the Obamacare replacement debates is the philosophical question of whether health care is a “right.” Article 25 of the United Nations’ Declaration of Rights, for instance, declares it so. While this is correct as a means, it’s wrong as an end. Understanding the distinction is vital.
For the first time in human history, the Declaration of Independence announced that “all men are created equal.” As Abraham Lincoln argued, everyone is equal because everyone is free, and everyone is free because everyone is equal. Hence no man has the authority to rule over another without the other’s consent. Furthermore, because this equality emanates from the “Laws of Nature and of Nature’s God,” it imbues every individual with the rights to life, liberty, and the pursuit of happiness.
Government’s first purpose is to secure these natural rights, which means it’s proper for government to pursue policies that help carry them out. Our right to life, for instance, subsumes the means necessary to achieve it. As Harry Jaffa put it, “Providing food and medical care are among the means by which the purpose of securing the right to life is implemented” (emphasis added).
But just because our rights are secured by government, it does not follow that they must be provided by government. This means that while it is correct to suggest that people have a right to food, it is incorrect to say that the state must provide it. Indeed, flowing from our rights to liberty and life, we have the right to keep the fruits of our labor, through which the marketplace has proved superior in providing access to food, as failed communist states have made clear. This brings us to the heart of what is wrong with declaring health care—ex nihilo—a human right.
While in a sense we have a right to medical care (which is rightly why nobody is refused in an emergency), we possess it only as a means to an end (the right to life), not as an end itself. Making it an end—a “human right”— signifies that it is no longer legitimate to debate the wisdom and prudence of various means of providing it. In a word, means and ends become inverted. Health care turns into a categorical imperative of government. The result is a betrayal of both natural law and sound public policy.
Natural law emerges from our equality rooted in our common human nature as spelled out in the Declaration of Independence. In the words of Thomas Jefferson: “The evidence of this natural right, like that of our right to life, liberty, the use of our faculties, the pursuit of happiness, is not left to the feeble and sophistical investigations of reason, but is impressed on the sense of every man. We do not claim these under the charters of kings or legislators, but under the King of kings.”
Ergo, rights must emerge from and accord with human nature. Here’s Jefferson’s compatriot, George Mason: “Now all acts of legislature apparently contrary to natural right and justice, are, in our laws, and must be in the nature of things, considered as void. The laws of nature are the laws of God: A legislature must not obstruct our obedience to him from whose punishments they cannot protect us. All human constitutions which contradict His laws, we are in conscience bound to disobey. Such have been the adjudications of our courts of justice.”
Medical care stems not from human nature but from outside of it. This “positive rights” view allows for government to grant as a “human right” anything that may be desirable. But this leads to the problem of our “rights” competing with and contradicting one another. If I have a right to health care, then resources must be channeled for that purpose. But what if doing so sucks resources away from providing access to, say, food? Which right trumps which?
Some might reply that the solution to this dilemma is to simply legislate food as a human right, too. But that is no solution. For what, then, about housing? A decent wage? Education? Transportation? On what grounds can we reject these as “rights”? The regrettable fact of life is that our desires are infinite, but resources are not. Natural law remains the sole remedy for this predicament.
Moreover, increasing bureaucracy in health care is bad public policy. There is almost no arena in which government offers a good or service cheaper or more abundantly than private markets. Despite what we often hear, health care is hardly a “free market.” The U.S. government spends more on health care per capita than all but three countries in the world. Indeed, nearly half of all our health-care dollars are spent by the state. It’s no wonder costs have spiraled out of control.
Importantly, areas of the health industry where Uncle Sam has interfered least, such as cosmetic surgery and eye surgery, have witnessed either stable or declining prices. We would therefore do well to move health policy toward a more, not less, free-market solution.
But the first step in doing so is to understand the true basis of our rights, which begins by reacquainting ourselves with the natural law principles of the founding. “Let us readopt the Declaration of Independence, and with it the practices and policy which harmonize with it,” Lincoln implored. We should take his advice. We might begin with the truth that all men are created equal.
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https://www.cato.org/blog/do-opioid-restrictions-reduce-opioid-poisonings
In a recent working paper, economists Thomas Buchmueller and Colleen Cary find that one particular kind of restriction does reduce opioid misuse among Medicare beneficiaries:
The misuse of prescription opioids has become a serious epidemic in the US. In response, states have implemented Prescription Drug Monitoring Programs (PDMPs), which record a patient’s opioid prescribing history. While few providers participated in early systems, states have recently begun to require providers to access the PDMP under certain circumstances. We find that “must access” PDMPs significantly reduce measures of misuse in Medicare Part D.
Yet, they also find
no statistically significant effect [of must access PDMP’s] on a key medical outcome: opioid poisoning incidents.
How is this possible?
The simplest explanation is that, despite all the hype, prescription opioids are not that dangerous, even in heavy doses, when used under medical supervision. Instead, most poisonings reflect use of diverted prescription opioids, or black market opioids like heroin, that users obtain when doctors cut them off from prescription opioids. These alternate sources may be adulterated, of higher dosage than the user realized, or consumed with other drugs that generate adverse reactions.
Under this interpretation, restrictions on opioid prescribing might even increase opioid poisonings.
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http://www.myrtlebeachonline.com/news/state/south-carolina/article137373338.html
A state Senate panel spent much of Wednesday listening to the testimony of medical experts, who expressed support and concerns for a proposal to legalize medical marijuana in South Carolina.
It was the second of several hearings expected to take place in the coming months that are exploring a way for the Palmetto State to legalize the use of pot in a medical setting. Supporters say the plant’s chemicals could help those who suffer from chronic pain and other quality-of-life-damaging illnesses, such as post-traumatic stress disorder.
More than a dozen speakers addressed the Senate panel during a marathon hearing that ran for nearly five hours. The majority advocated legalization of the plant for medicinal use, with many arguing it could help those being treated for chronic pain be weaned off opioids and other dangerous narcotics.
Among those who spoke was Uma Dhanabalan, a Massachusetts-based physician who has become a cannabis therapeutic specialist in recent years. She said she has not written a prescription for an opioid in more than eight years. Instead, she said she gets patients off narcotics.
“Cannabis is not an entrance drug – it’s an exit drug from pharmaceuticals and narcotics,” Dhanabalan said. “Further studies do need to be done, but I do believe it should be a first-line option.”
Dhanabalan listed several ways studies have found medical marijuana has affected patients by helping them curb alcohol consumption, lose weight and spend less on prescription medications. She said “cannabis is not for everybody,” but argued that those in need should have access to it.
Physicians in states where medical marijuana is legal cannot write a prescription. But they can write a recommendation to be used at registered marijuana dispensaries.
Though the majority of speakers echoed Dhanabalan, a handful voiced concerns with the regulatory aspect of the legalization of medical pot.
J. Addison Livingston, a pharmacist and member of the S.C. Board of Pharmacy, said the proposed law creates a system “that is outside of normal practice.” He said the board is concerned about the bill moving forward without further research.
Livingston said he remembers a time when the use of opioids was advocated for, resulting in “unintended consequences.” He said there has not been enough analyzed evidence by the FDA to show the benefits of medical marijuana outweigh the risks.
“We do not need another situation like the opioid epidemic that we’re battling right now,” Livingston said.
The bill’s main author, libertarian Sen. Tom Davis, R-Beaufort, noted, however, the majority of the speakers kept repeating each other in saying that “cannabis is medicine.”
Sen. Kevin Johnson, D-Clarendon, voiced the strongest concern of legislators on the panel, stressing he was mainly worried about preventing medical marijuana from falling into the hands of those who would abuse it.
“I have no concern that there is benefit and that it provides relief to people,” Johnson said. “I want to make sure that if we pass a bill … that that’s who gets it.”
The panel ended the hearing without taking any action on the bill. It was the second meeting with no action.
A House panel already advanced in February a bill that also seeks to legalize medical pot over the opposition of members from the state’s law enforcement community, including State Law Enforcement Division Chief Mark Keel. Though Keel attended the Wednesday Senate hearing, he was not called on by legislators to speak.
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MADISON (WKOW) — A Dane County state lawmaker wants to give terminally ill people the right to end their lives with dignity, but the top Republican in the State Assembly said he has “serious questions” about it.
For the second the second straight legislative session, Rep. Sondy Pope (D-Mount Horeb) has introduced a bill that would allow anyone with a sound mind who is suffering from a terminal illness to medically end their life at a time of their choosing.
The bill would require a doctor to give approval before a life-ending drug could be administered.
But Speaker Robin Vos (Rochester) said it’s not something he can support.
“I feel like if we passed her version of the bill, or any bill like that, it really takes away hope and says that the only way out for a lot of folks is to end their lives. And I just can’t accept that,” said Speaker Vos.
On Tuesday, the Assembly passed a bipartisan “Right To Try” bill – which allows terminally ill patients to try experimental drugs in an attempt to save their lives.
Speaker Vos said he wants to focus on legislation like that, instead of encouraging people to give up hope.
Without his support, the bill stands little chance to pass the Assembly.
In a press release, Rep. Pope said she believes it is inhumane to force a person with a terminal illness to suffer needlessly.
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A group of prominent pain and addiction specialists are pushing back against the federal opioid crackdown by asking CMS to withdraw a notice that would make it extremely difficult for Medicare patients to get painkiller prescriptions above a certain strength.
More than 80 physicians, including four who helped create the 2016 CDC guidelines on opioid prescribing, wrote to acting Medicare director Cynthia Tudor about the notice, which would require pharmacists to refuse prescriptions over 90 milligrams of morphine or its equivalent unless the patient first went through a complex, time-consuming review.
While the CDC guidelines caution that high doses create an overdose risk, they also state that physicians should have ultimate discretion on prescribing, and warn that it is not advisable for patients to be tapered off high doses of opioids involuntarily.
An estimated 5-8 million Americans use opioids to treat chronic pain. Many were started on the drugs before the risks were recognized. A 2008 study showed that half of non-cancer opioid patients in Medicaid and private insurance were getting doses above the threshold. While tapering off high doses is often advisable, pain doctors say it must be done carefully and with patient consent.
“CMS mandates will cause previously stable patients to suffer acute withdrawal with or without medical complications, including death,” says the letter, which states that the CMS rule, buried deep within a Feb. 1 CMS payment document, is “in tension with the spirit and the letter of the CDC Guideline.”
Pain and addiction specialists largely agree that doctors saddled too many patients with high doses of opioids in the decade before 2010. Yet some of these patients are medically stable on high doses, and others can’t access the complex care needed to wean them off without tremendous suffering.
“There’s little question that the license given to doctors to reduce pain … was too much,” said Jeffrey Samet, past president of the American Board of Addiction Medicine. “But the pendulum has swung too far in the opposite direction.”
To be sure, there were more than 20,000 deaths linked to prescription painkillers in 2015. Since 2012, though, opioid prescribing and deaths have gradually declined, while deaths from heroin and fentanyl, a powerful synthetic opioid, continue to skyrocket.
“What caused the epidemic and what sustains it today are not the same,” said Stefan Kertesz, a University of Alabama internist and addiction specialist.
The comment period for the CMS rate announcement rule, which takes effect April 3, ended last Friday. Asked to respond to the critique, CMS said its notice followed CDC expert guidelines.
CMS is not the only agency that is tightening the screws on high-dose prescribers.
Under new guidelines under consideration by the National Committee for Quality Assurance, health care providers who provide patients more than 120 milligram morphine equivalents daily over a three-month period would have points taken off from their quality scores.
Already, prescription drug monitoring programs are getting better at detecting patients who doctor shop and doctors who overly prescribe. Many doctors have cut doses or “fired” high-dose patients, and there are anecdotal reports of suicides and heroin deaths among patients who lost access to the medications they were using.
Some of these patients are in such pain that the “just lie in bed or watch TV all day,” said James DeMicco, whose Hackensack, N.J., pharmacy services a major pain clinic. About two-thirds of the opioid patients he serves get more than the CMS-proscribed dose, he said.
The CMS rule could inconvenience pain patients without having much impact on mortality, Kertesz said, because opioid fatalities are increasingly heroin-related.
Data from Birmingham, Ala., for example, show that since 2010, prescription opioid deaths have stabilized at about 50 per year, while heroin deaths surged from 3 in 2010 to 92 in 2016, and fentanyl deaths jumped from 0 to 92. In Cleveland, where 494 people died of opioid overdoses in the first eight months of 2016, 424 were from fentanyl. In Massachusetts, only 8 percent of those who died of overdoses over a three-year period had been prescribed opioids at the time of their deaths.
Though skeptical of the CMS rule, many pain and addiction specialists agree that most high-dose patients would function better if tapered down. They are also less likely to die of an overdose, notes Paul Hilliard, chairman of the Hospital Pain Committee at the University of Michigan health system.
“Blanket statements and policy should never substitute for sound clinical judgment,” said Hilliard. “I do, however, support the notion that any patient on high-dose opioids deserves a review of the medication and treatment strategy. “
“I just don’t see that many patients on high doses who are working full time, coaching the kids’ soccer team, or volunteering at soup kitchens,” he said. “And they continue to report high pain levels.”
Patients who benefit from high doses of opioids are “more the exception than the rule, in my practice,” said Jane Liebschutz, a Boston Medical Center physician. “But the ones who do need it I’d go to bat for. The rules CMS is putting out would make it more difficult for patients and doctors.”
Federal officials have been campaigning hard against prescription drug abuse but are beginning to show concern about unintended consequences.
In a New England Journal of Medicine article in December, Surgeon General Vivek Murthy noted that while prevention and increased treatment are needed to lower opioid abuse, “we have to do all these things without allowing the pain-control pendulum to swing to the other extreme, where patients for whom opioids are necessary and appropriate cannot obtain them.”
NIH officials are also wary of unintended consequences. Federal surveys show that roughly 80 percent of heroin users got started on opioids through prescription drugs.
There is no evidence that pain patients weaned off of opioids turn to heroin in large numbers, but it’s possible that street drugs can become an option “when their other drug of choice becomes unavailable,” and the issue needs more study, said Wilson Compton, deputy director of the National Institute of Drug Abuse.
Doctors who decide to taper off an addicted patient need to help find them treatment, he said. But treatment is expensive and waiting lists to get into decent programs are long in opioid epidemic-stricken regions of the country. A new law would vastly expand treatment, but first Congress has to fund it.
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www.claimsjournal.com/news/southeast/2017/03/08/277262.htm
North Carolina lawmakers can save patients’ lives, spare their families and combat an ongoing opioid-abuse crisis by putting tighter controls on physicians and pharmacists who hand out powerful pain-killing medicines, supporters of a drug control bill said Thursday.
The plan announced by Republican lawmakers and new Democratic Attorney General Josh Stein would put new restrictions on medical providers who prescribe and dispense opioid drugs like OxyContin and morphine and limit their public supply. Such drugs carry a high risk of addiction and are often considered a gateway to the use of heroin and other illegal drugs. The bill also includes $20 million over two years for local substance abuse treatment and recovery services.
One of the chief sponsors, Sen. Tom McInnis, R-Richmond, said his stepson died in 2007 at age 22 after a fight with drug addiction he said intensified when he was prescribed an opioid following an automobile accident.
“We lost a beautiful vibrant wonderful son to this epidemic,” McInnis said at a Legislative Building news conference. “He was given a vial of these horrid, horrid addictive drugs and he started a downhill spiral that ended up with the loss of his life.”
Nearly 250 heroin deaths were reported in North Carolina in 2014, a more than five-fold increase from 2010, according to state health statistics. Four North Carolina residents die every day from drug and medication overdoses, backers of the bill said. Many more are hospitalized or go to emergency rooms.
“Opioids are tearing families apart all across our state. Too many of our neighbors, co-workers and family members are dying,” Stein said.
The measure would require physicians to log on to the state’s controlled substance database system and examine a patient’s prescription history to prevent overprescribing. Such information could show when abusers go to multiple physicians seeking prescriptions for their favored drug. Doctors would pay a $20 annual fee to keep up the system.
Pharmacists also would be required to register with the system and report controlled substance transactions within 24 hours. Pharmacy registration is essentially encouraged now and transactions now can wait 72 hours. Those who don’t file proper reports could be fined.
Doctors also would have to prescribe controlled substances electronically to reduce fraud. In most instances they would be limited to initially prescribing no more than a 5-day supply of a controlled substance for treatment of “acute pain.” This would stop 30-day supplies that bill supporters say can lead to addiction or unused pills left in medicine cabinets for young people to take. State health officials would audit prescriber records.
Bill sponsor Rep. Greg Murphy, R-Pitt and a physician, said some of the restrictions place more “bureaucratic hassle and paperwork” upon doctors, but it’s worth it.
“Our goal here is to save lives, to save families, to save businesses and it is an honorable and laudable and I believe attainable goal that we all must be willing to make sacrifices to achieve,” Murphy said.
The measure also would expand a 2016 law that created a statewide standing order at all pharmacies for access to a prescription drug that can reverse overdoses of opium-based drugs.
The bill would need House and Senate approval before going to Gov. Roy Cooper’s desk. Cooper’s proposed state budget includes $14 million to treat and combat opioid-related drug abuse and overdoses.
Stein said he would soon convene a task force of law enforcement officials to recommend new criminal charges for opioid drug dealers.
Ethan Buck of Greenville, who began using prescription opioids at age 12, advanced to heroin before becoming homeless and finally getting help. Now 20, Buck attended Thursday’s event and warned drug addiction can happen to anyone no matter their education or status.
“It’s not a disease that discriminates,” Buck said.
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