Since 2007, the DEA has taken $3.2 billion in cash from people not charged with a crime

https://www.washingtonpost.com/news/wonk/wp/2017/03/29/since-2007-the-dea-has-taken-3-2-billion-in-cash-from-people-not-charged-with-a-crime/

The Drug Enforcement Administration takes billions of dollars in cash from people who are never charged with criminal activity, according to a report issued today by the Justice Department’s Inspector General.

Since 2007, the report found, the DEA has seized more than $4 billion in cash from people suspected of involvement with the drug trade. But 81 percent of those seizures, totaling $3.2 billion, were conducted administratively, meaning no civil or criminal charges were brought against the owners of the cash and no judicial review of the seizures ever occurred.

That total does not include the dollar value of other seized assets, like cars, homes, electronics and clothing.

These seizures are all legal under the controversial practice of civil asset forfeiture, which allows authorities to take cash, contraband and property from people suspected of crime. But the practice does not require authorities to obtain a criminal conviction, and it allows departments to keep seized cash and property for themselves unless individuals successfully challenge the forfeiture in court. Critics across the political spectrum say this creates a perverse profit motive, incentivizing police to seize goods not for the purpose of fighting crime, but for padding department budgets.

Law enforcement groups say the practice is a valuable tool for fighting criminal organizations, allowing them to seize drug profits and other ill-gotten goods. But the Inspector General’s report “raises serious concerns that maybe real purpose here is not to fight crime, but to seize and forfeit property,” said Darpana Sheth, senior attorney of the Institute for Justice, a civil liberties law form that has fought for forfeiture reform.

The Inspector General found that the Department of Justice “does not collect or evaluate the data necessary to know whether its seizures and forfeitures are effective, or the extent to which seizures present potential risks to civil liberties.”

In the absence of this information, the report examined 100 DEA cash seizures that occurred “without a court-issued warrant and without the presence of narcotics, the latter of which would provide strong evidence of related criminal behavior.”

Fewer than half of those seizures were related to a new or ongoing criminal investigation, or led to an arrest or prosecution, the Inspector General found.

“When seizure and administrative forfeitures do not ultimately advance an investigation or prosecution,” the report concludes, “law enforcement creates the appearance, and risks the reality, that it is more interested in seizing and forfeiting cash than advancing an investigation or prosecution.”

The scope of asset forfeiture is staggering. Since 2007 the Department of Justice’s Asset Forfeiture Fund, which collects proceeds from seized cash and other property, has ballooned to $28 billion. In 2014 alone authorities seized $5 billion in cash and property from people — greater than the value of all documented losses to burglary that year.

In most of the seizures examined by the Inspector General, DEA officers initiated encounters with people based on whether they met certain criteria, like “traveling to or from a known source city for drug trafficking, purchasing a ticket within 24 hours of travel, purchasing a ticket for a long flight with an immediate return, purchasing a one-way ticket, and traveling without checked luggage.”

Some of the encounters were based on tips from confidential sources working in the travel industry, a number of whom have received large sums of money in exchange for their cooperation. In one case, officers targeted an individual for questioning on a tip from a travel industry informant that the individual had paid for a plane ticket with a pre-paid debit card and cash.

Most individuals who have cash or property seized by law enforcement do not dispute the seizure. There’s no right to an attorney in forfeiture proceedings, meaning defendants must foot the bill for a lawyer themselves. In many cases, forfeiture amounts are so small that they’re not worth fighting in court.

Forfeiture cases are also legally complex and difficult for individuals to win. Forfeiture cases are brought against the property, rather than the individual, leading to Kafkaesque case titles like United States v. $8,850 in U.S. Currency and  United States of America v. One Men’s Rolex Pearl Master Watch.

While criminal proceedings assume the defendant’s innocence, forfeiture proceedings start from the presumption of guilt. That means that individuals who fight forfeiture must prove their innocence in court.

For these reasons, many defendants don’t bother disputing forfeitures. The Inspector General’s report, however, finds that those who do often get at least a portion of their cash returned. Only one-fifth of people who had their cash seized by the DEA disputed the seizures in court. But among those who contested the seizure, nearly 40 percent ended up getting all or some of their cash returned, suggesting that the DEA’s forfeiture net ensnares many individuals not involved in wrongdoing.

In a written response to the Inspector General, the Department of Justice said it had “significant concerns” with the report, noting that global criminal enterprises launder trillions of dollars annually and calling asset forfeiture “a critical tool to fight the current heroin and opioid epidemic that is raging in the United States.”

It also took issue with the Inspector General’s analysis of the 100 DEA cash seizures it examined, saying more of them were connected with criminal activity than the report suggested.

The Inspector General stood by the report and dismissed the Department’s concerns as “assumptions and speculation.” The Drug Enforcement Administration did not respond to a request for comment.

“Nobody in America should lose their property without being convicted of a crime,” said the Institute for Justice’s Sheth. “If our goal is to curb crime, we should simply abolish civil forfeiture” and only forfeit property after a criminal conviction is obtained, she added.

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Maine’s new opiate limits could be targeted in lawsuit

http://bangordailynews.com/2017/03/28/health/maines-new-opiate-limits-could-be-targeted-in-lawsuit/

AUGUSTA, Maine — Two midcoast men who suffer from chronic pain informed state officials on Tuesday that they intend to sue over a new law that limits opiate prescriptions in an effort to stem Maine’s addiction crisis if it isn’t changed.

The threatened lawsuit from lobster wholesaler Brian Rockett of Owls Head and roofer Eric Wass of Rockland could undo a law that their lawyer called an unreasonable violation of federal law. He has argued that it’s unclear whether they’re exempt from the law.

The bill passed the Maine Legislature last year with support from Gov. Paul LePage and the medical community. A spokeswoman for the Maine Department of Health and Human Services said exceptions in the law allow for individualized treatment.

Elements of the law took effect in January, but the biggest piece begins in July, when Mainers will be limited to 100 morphine milligram equivalents of opiate medication such as hydrocodone per day, with exceptions for cancer patients, those in palliative and hospice care and other special circumstances.

In a Tuesday letter to the Maine Department of Health and Human Services notifying the state of Rockett and Wass’ intent to sue, their lawyer, Patrick Mellor, said the taper has already caused “significant bodily harm” to both men and will make them unable to work and “participate in basic life activities.”

WLBZ reported that the two men have degenerative disc disease. Before the taper, Rockett told the station that he was taking 450 morphine milligram equivalents of medication. In an interview, Mellor said his clients “are not going to be able to function” if this continues.

The men plan to seek an injunction if rules are implemented as proposed by the department, arguing that they are subject to provisions of the federal Americans With Disabilities Act and Rehabilitation Act of 1973, which allows people with disabilities to seek reasonable accommodations in policies and procedures.

Final rules for the law are set to be released on Friday and whether Rockett and Wass are subject to exemption is up for debate: In a letter to Maine legislators in February, Mellor wrote that while his clients may qualify for special treatment for palliative care or another exemption, it’s “unclear,” calling for a specific carve-out for people with chronic pain.

“There’s no villains here,” Mellor said. “We’re looking to work with the Department of Health and Human Services and the legislators to get something productive done.”

Department of Health and Human Services spokeswoman Samantha Edwards said in a statement that the state “recognizes the insidious nature of chronic pain” and in cases of chronic pain, the palliative exemption “would meet the spirit and letter of the law” and allow for individualized care.

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As a physician, I urge other doctors to cut back on prescribing opioids

http://thehill.com/blogs/pundits-blog/healthcare/326095-as-a-physician-i-urge-other-doctors-to-cut-back-on-prescribing

Recently I met with a woman, a casualty of our nation’s clumsy efforts to curb its opioid crisis. Her story shows how a myopic fascination with numeric targets, which caused so much harm as our prescribing went up, is likely to cause just as much harm as it comes back down.

A 60 year-old kidney transplant recipient, she required a slew of medications to protect her transplanted kidney. She also took over 100 milligrams daily of an opioid for painful arthritis. Amid national calls to reduce opioid prescriptions, one doctor after another lowered her doses in simple 50 percent steps.

None of them documented any problem caused by her pain pills. None sought her consent. Predictably, she fell apart, as did her adherence to other medications, including ones to protect her kidney. Life spiraled out of control. Ultimately, the threat of losing her kidney compounded the uncontrolled pain of her arthritis. Whether she will keep her costly transplant, or go back on dialysis, is not yet known.

Clumsy new opioid policies are practically designed to ensure her story is not unique. The pressure on physicians is already intense. It comes from legislators, law enforcement, insurers, and leaders who equate prescribed opioids with illicit heroin.

Accordingly, doctors cut doses unilaterally and shun pain patients. Last month, two national agencies entered the fray, with the National Committee for Quality Assurance and the Centers for Medicare and Medicaid Services proposing escalate the pressure. One (CMS), will restrict insurance coverage based on dose. The other (NCQA), proposed a quality measure to flag physicians as engaged in bad practice if they let doses remain high, regardless of how well or poorly the patient is doing.

It will surprise many to learn that such plans were not endorsed by the Centers for Disease Control and Prevention (CDC) in 2016, whose review found no data to support the unilateral dose reductions that CMS and NCQA will incentivize.

In its 7th recommendation, the CDC urged that care of patients already receiving opioids be based not on the number of milligrams, but on the balance of risks and benefits for that patient. That two major agencies have chosen to defy the CDC ignores lessons we should have learned from prior episodes in American medicine, where the appeal of management by easy numbers overwhelmed patient-centered considerations.

In years past, we erred when observational data led agencies such as NCQA to demand strict control of blood sugar in all diabetes patients. Subsequent trials showed that harmed many patients, and helped only some. Similarly, millions of postmenopausal women were thrown onto estrogen because observational data suggested it prevented heart attacks. Later trials showed we were causing heart attacks, not preventing them.

Even the run-up in opioid prescribing emerged from an unhealthy enchantment with a single number, the pain score, at the expense of common sense. The cardinal lesson is this: prior to imposing simple numeric targets on all patients, we should require prospective trials showing benefit. That’s what we lack for unilateral opioid dose reductions.

As physicians today execute a hard shift on opioids, I plead for caution. Patients with chronic pain report enormous suffering, some committing suicide as they see their lives turned upside down by doctors pressured to reduce.

A rising tide of concern has emerged among academic physicians who have dedicated their work to fighting addiction, including some who worked on the CDC Guideline itself. They see that clinical practice has sprung ahead of data, that it has begun to look like someone has shouted fire in a crowded theater, creating a social stampede.  This does not reflect the cautious, patient-centered care urged by the CDC.

To be sure, unrestrained opioid prescriptions are dangerous. A run-up in prescribing from 2000 through 2011 fueled a spread of addiction and overdose, sometimes to pills we prescribed, and often to opioids illicitly distributed. In 2015, 33,091 Americans died from overdose. The percentage of patients prescribed an opioid who develop addiction is hard to pin down, but the CDC estimates 0.7 percent (at lower doses) to 6.1 percent (at higher doses).

Without oversight and guidelines urging caution, more will be harmed. However, this prudent check on uncontrolled prescriptions need not create a whole new population of chronic pain patients who suffer from overly-prescriptive and oversimplified recommendations that force all prescriptions below a uniform milligram limit.

Eighty professionals, including four who worked on the CDC Guideline, signed a public letter to NCQA, raising the alarm about this entirely predictable downside of new dose-curtailing policies, as did 83 who signed a letter to CMS a few weeks ago.

Among them were leading scholars in addiction medicine, pain and health care quality improvement. We can listen to these experts, or we can let more patients suffer. Now is a good time to remember how easy numbers sometimes make for bad care.

Stefan G Kertesz, MD, is a physician in internal medicine and addiction medicine on faculty at the University of Alabama at Birmingham School of Medicine. Views expressed are his own and do not represent formal positions held by any of his employers. Follow @StefanKertesz.

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The DEA’s Approval of This Drug Highlights Its Own Hypocrisy

http://www.attn.com/stories/15965/dea-approves-synthetic-marijuana

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Greenwich family sues drug company after overdose death of son

http://www.greenwichtime.com/local/article/Greenwich-family-sues-drug-company-after-overdose-11031478.php

GREENWICH — A lawsuit has been filed by the parents of a Greenwich college student who died of a heroin overdose against the manufacturer of a prescription drug they claim led to his death.

Laurence and Michelle Allen are suing the makers of Suboxone, which was used to treat a previous addiction to painkillers that their son fell into following a car accident. When the Suboxone prescription ran out, according to court papers, Bradley Allen, 19, turned to street heroin and died of an overdose in 2014.

Laurence Allen, an investment banker, confirmed his participation in the lawsuit and other efforts he is engaging in to combat the scourge of opioid-addiction, but he declined to discuss specifics.

Bradley Allen, his son, appeared to be on a path toward success until pain medication changed his life after a car accident in 2010, according to the lawsuit. His doctors prescribed hydrocodone for pain management, “and at some point into his prescribed opioid regimen, he became dependent on opioid-based medication.”

In order to wean him from painkillers, Allen was prescribed Suboxone, a common treatment protocol for opioid addiction. Suboxone mimics the effects of stronger opium-based drugs, but at a lower level of intensity, and it prevents users from experiencing painful withdrawal symptoms. The Allens contend that “Brad had become completely addicted to Suboxone … he replaced one addiction with another,” according to the lawsuit.

Bradley Allen attempted to end his Suboxone usage with an intensive in-patient program in December of 2013. After being released, he returned to his family’s Greenwich home. He watched a movie with his family one evening in late January, went upstairs and took heroin. His parents found him dead the next morning at their Maple Avenue residence. The Medical Examiner’s office found that the drug had been injected.

The lawsuit claims the drug maker was aware that its product was “unreasonably dangerous and defective when used as directed and as designed.” The Allens claim Invidor failed to “disclose to the medical community” that Suboxone could cause addiction.

Lawyers representing Invidor in the case, and the Invidor media office, did not respond to numerous requests for comment by phone and email.

The Allen lawsuit is one of a number of legal challenges that big pharmaceutical companies are contending with as opioid addiction continues to plague the nation, claiming the lives of some 40 Americans every day.

Two counties in California sued five of the world’s largest narcotics manufacturers in 2014 over costs incurred to public health, but the lawsuits did not advance due to jurisdictional issues. The city of Chicago is in litigation with a drug company, Pfizer, leading to some new marketing changes. The Chicago lawsuit revealed that the big players in the painkiller industry spent $288 million on marketing in 2011, three times the 2000 amount. A number of state legislatures, governors and attorneys-general are said to be weighing the possibility of lawsuits against pharmaceutical companies around the country, and large law firms are currently soliciting clients to sue big pharmaceuticals over drug overdoses.

It might seem like a repeat of the tobacco industry litigation that led to a $246 billion settlement and strict new marketing codes on cigarettes. But a legal expert said the claims against Big Pharma have a long way to go before they come close to achieving what the tobacco lawsuits did. As of yet there have been no major pay-outs or court victories by plaintiffs against drug companies.

Lawsuits like the one filed by the Allen family will likely have to overcome two hurdles, said Jeremy Zimmermann, a product-liability specialist and an adjunct professor at the Quinnipiac University School of Law.

“There’s the question of what warnings were given to the physicians. The pharmaceutical companies are responsible for giving appropriate warnings so they can responsibly prescribe (drugs) for patients,” he said. “The key phrase in product liability is: were the warnings inadequate, to such an extent that the drug itself would be considered ‘unreasonably dangerous?’ ”

Establishing a chain of causation is another key issue in litigation, according to Zimmermann.

“He died of an overdose of heroin — he didn’t die of an overdose of Suboxone,” he said. “The question is going to be — was he caused to take the heroin because of his use of Suboxone?”

That will be for a number of expert witnesses to argue over, should the case go to trial.

The tobacco-litigation comparison is too early to make, Zimmermann said. “It’s difficult to say whether there’s going to be success or not.”

Larry Allen is working on other fronts with help from http://www.drugguardians.com to fight opioid addiction, aside from litigation. He has established the Allen Research Endowment, a non-profit venture. A goal is to promote research into developing non-addictive pain medication. Allen said he is also interested in highlighting the link between politicians and donations from pharmaceutical companies through the years.

The group’s website is www.allenrsch.org.

Bradley Allen was a student at Washington College in Maryland. He was a lover of the outdoors — a skier and a boater — who played guitar and took part in a number of community-service projects, according to obituary information.

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I pulled the bottom quote from a large law firm’s website in Louisville, KY.  The question has to be asked… isn’t some of the verbiage from this law firm’s website that describes pt abuse would also describe how many pts that have a medical necessity to be prescribed controlled substances are being treated by a variety of healthcare professionals. 

Also the question has to be asked if pts in nursing home have more rights than the rest of the population receiving appropriate care from healthcare professionals ?  Many pts especially those who are home bound are as sick or sicker than some of the pts residing in a nursing home. 

Why are personal injury attorneys failing to represent all pts that are being abused/neglected ?

Common Indicators of Nursing Home Abuse or Neglect

“Abuse of a nursing home resident is the intentional infliction of physical, sexual, emotional, psychological, or financial harm. Neglect, which is a form of abuse, involves withholding food, shelter, health care, or protection that a vulnerable person depends on the nursing home staff to provide.”

www.beckerlaw.com/legal-services/nursing-home-abuse-lawyer/

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CDC: Painkillers No Longer Driving Opioid Epidemic

www.painnewsnetwork.org/stories/2017/3/26/cdc-painkillers-no-longer-driving-opioid-epidemic

While painkillers may be playing less of a role in the overdose epidemic, Houry believes pain medication is still a gateway drug for many abusers. She cited statistics from Ohio showing that nearly two-thirds of the people who overdosed on heroin or fentanyl received at least one opioid prescription in the seven years before their deaths.  

“The rise in fentanyl, heroin, and prescription drug involved overdoses are not unrelated,” Houry said. “While most people who misuse prescription opioids do not go on to use heroin, the small percentage (about four percent) who do account for a majority of people recently initiating heroin use.”

Houry also disputed reports that efforts to reduce opioid prescribing have led to increased use of illegal drugs. It was her office that oversaw the development of controversial CDC guidelines that discourage doctors from prescribing opioids for chronic pain. 

DEBRA HOURY, MD

Houry’s testimony came on the same day the Drug Enforcement Administration warned that counterfeit painkillers made with fentanyl have killed dozens of people in the Phoenix area.

The DEA said at least 32 deaths in the last 18 months in Maricopa County, Arizona have been linked to fake pills laced with fentanyl that were disguised to look like oxycodone tablets. In nearly 75% of the overdoses, examiners also found dipyrone (Metamizole), a painkiller banned for use in the U.S. since 1977. 

Fentanyl is a synthetic opioid 100 times more potent that morphine. It is sold legally in sprays, patches and lozenges to treat severe chronic pain.

counterfeit oxycodone (dea photo)

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In an Unprecedented No-Show, the U.S. Pulls Out of Planned Human Rights Hearing

https://www.aclu.org/blog/speak-freely/unprecedented-no-show-us-pulls-out-planned-human-rights-hearing

The United States has pulled its participation from hearings planned for today by a regional human rights body that has enjoyed the support of every U.S. administration since its founding.

The Inter-American Commission on Human Rights is meeting in Washington, D.C., for a regular session covering human rights issues spanning North and South America. The hearings today are scheduled to cover the Trump administration’s attempt to ban immigration from six predominantly Muslim countries, its immigration enforcement and detention policies, and its approval of the Dakota Access Pipeline. The ACLU is testifying on Tuesday at hearings that can be livestreamed here.

In the past, when U.S. governments have sought to express displeasure at having their records scrutinized, they have occasionally protested by sending lower-level officials. But today’s refusal to engage the commission at all is a deeply troubling indication of its disrespect for human rights norms and the institutions that oversee their protection.

The IACHR is an independent body of the Organization of American States, which brings together all 35 independent countries in the Americas. The U.S. has long been a champion of the work of the commission. While it has no enforcement mechanisms, its mandate is to promote human rights and examine violations in all OAS member states. The IACHR is often the only venue where victims of egregious human rights violations can seek a measure of recourse in the absence of accountability in their own countries. Survivors of the U.S. post-9/11 torture program have appealed to it, and even the Bush administration defended its policies before the IACHR.

The United States’ record isn’t the only one under scrutiny during this session. In the last several days, the commission has heard extensive testimony on the human rights situation in Mexico, Honduras, Panama, Chile, Bolivia, Guatemala, and Nicaragua, with additional countries to face review today and tomorrow.

After word of the U.S. absence spread, the State Department responded by stating that “it is not appropriate for the United States to participate in these hearings while litigation on these matters is ongoing in U.S. courts,” in reference to lawsuits against the government’s Muslim ban. But that doesn’t explain why it wouldn’t attend another hearing regarding a Japanese-Peruvian man who was rounded up with thousands of other Latin Americans, deported to a World War II-era internment camp, and denied redress to this day. It also doesn’t explain why the Bush and Obama administrations appeared before the commission for hearings on CIA torture, Guantánamo, immigration detention, and prison issues, even though there was pending litigation at the time.

The Trump administration’s refusal to engage with an independent human rights body, which has played a historic role in fighting impunity and barbaric military dictatorships in the region, sets a dangerous precedent that mirrors the behavior of authoritarian regimes and will only serve to embolden them. It is a worrying sign that the administration, which has also said it would review future engagement with the U.N. Human Rights Council, is not only launching an assault on human rights at home. Rather it’s upping the ante and weakening the institutions that hold abusive governments accountable.

Let’s hope the no-show is temporary, and not a sign of what’s to come

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North Carolina: Medical Marijuana Legislation Filed

http://salsa3.salsalabs.com/o/51046/p/dia/action3/common/public/

Click on above link to go to petition

Update: HB 185 passed the first reading and has been referred to committee.

Rep. John Autry has filed comprehensive legislation to legalize patients use of and access to medical marijuana.

HB 185, the North Carolina Medical Cannabis Act, permits qualified patients to possess up to 24 ounces of cannabis or grow their own personal supply. Separate provisions in the Act license and regulate the dispensing of cannabis from state-licensed facilities.

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