“The moral test of a government is how it treats those who are at the dawn of life, the children; those who are in the twilight of life, the aged; and those who are in the shadow of life, the sick and the needy, and the handicapped.” – Hubert Humphrey
passionate pachyderms
Pharmacist Steve steve@steveariens.com 502.938.2414
Dr Carlos Sullivan of Butte died recently and suddenly. He was carrying some patients on pain meds for their long term chronic pain.
Some of these patients have come to me to see if I could help them. I just received a call from the ER in Butte, looking to help a patient who lost access, and no one in Butte will see these patients. Our profession stands powerless to help these people?
It seems to me that if the good people of Butte were out of food or water, We have organizations like the Red Cross to help.
If the town was burning, we have interagency agreements, and we would be down there helping.
If some type of infectious disease struck, the health department would respond.
Who responds for patients who suffer from sudden abandonment? Patient who will withdraw? Become suicidal?
What obligation does our profession have to respond to a clear public health crisis?
I would like to propose a “doctors without borders” response to this.
But I do not know who to even approach about it.
DPHHS? Montana human rights groups? Montana Medical association? The hospital association? The Governor?
Since this opiate issue appeared, there still has not been any overarching policy approach to address the unintended consequences of having people on pain medications for decades then dropping them suddenly.
I do not see how I can help, by myself, without sharing the risk and burden with the rest of the profession.
Any suggestions?
Thank you.
PS: while posting this I got another call from another patient in butte who lost access. What are people supposed to do?
A delayed U.S. Drug Enforcement Administration ban on kratom would stifle scientific understanding of the herb’s active chemical components and documented pharmacologic properties if implemented, according to a special report published today in The Journal of the American Osteopathic Association.
The report cited the pharmacologically active compounds in kratom, including mitragynine, 7-hydroxymitragynine, paynantheine, speciogynine and 20 other substances, as one basis for further study. It also emphasized the extensive amount of anecdotal evidence and current scientific research that indicates kratom may be safer and less addictive than current treatments for pain and opioid withdrawal.
“There’s no question kratom compounds have complex and potential useful pharmacologic activities and they produce chemically different actions from opioids,” said author Walter Prozialeck, chairman of the Department of Pharmacology at Midwestern University Chicago College of Osteopathic Medicine. “Kratom doesn’t produce an intense euphoria and, even at very high doses, it doesn’t depress respiration, which could make it safer for users.”
Kratom (Mitragyna speciosa) is indigenous to Southeast Asia, where the plant was used for centuries to relieve fatigue, pain, cough and diarrhea and aid in opioid withdrawal. Currently sold in the United States as an herbal supplement, kratom drew DEA scrutiny after poison control centers noted 660 reports of adverse reactions to kratom products between January 2010 and December 2015.
“Many important medications, including the breast cancer treatment tamoxifen, were developed from plant research,” said Prozialeck.
“While the DEA and physicians have valid safety concerns, it is not at all clear that kratom is the culprit behind the adverse effects,” said Anita Gupta, DO, PharmD and special advisor to the FDA.
Dr. Gupta, an osteopathic anesthesiologist, pain specialist and licensed pharmacist, has treated a number of patients who’ve used kratom. “Many of my patients are seeking non-pharmaceutical remedies to treat pain that lack the side effects, risk, and addiction potential of opioids,” she said.
Kratom is currently banned in states including Alabama, Florida, Indiana, Arkansas, Wisconsin and Tennessee. The DEA is scheduled to decide whether to place kratom on its list of Schedule 1 drugs, a classification for compounds thought to have no known medical benefit. Marijuana, LSD and heroin are Schedule 1 drugs, which prevents the vast majority of U.S.-based researchers from studying those substances.
INDIANAPOLIS, Ind.– Detectives aren’t yet certain what Evans Johnson and Jessica Downey were doing in the vicinity of 23rd and Adams Streets the night before Thanksgiving, but whatever it was, they paid for the excursion with their lives.
Johnson listed a home address in Camby in extreme southwest Marion County. Downey was from rural Vincennes. They were found shot to death miles away in an east side neighborhood known for drug dealing and violence.
“We do have a big problem on North District with people using these landmark locations to come down here to buy dope from outside the county, Hendricks County, Hamilton County, Hancock County, because they know they can get dope in these neighborhoods and we gotta try to change that,” said IMPD District Commander Chris Bailey.
The killings of Johnson and Downey happened just blocks from Bailey’s post.
Investigators say recent high-profile drug raids, and everyday pressure applied by district narcs like those working for Commander Bailey, have disrupted entrenched drug operations and taken guns and money off the streets, leading dealers to more violence and users to even riskier behavior to feed their addictions.
“These guns in the hands of felons, in the hands of drug dealers, in the hands of people who should not possess any kind of weapon, we’re getting guns everyday out of these houses when we interact with these folks,” said Bailey. “To me that is a bigger impact when we talk about violent crime because every gun we take out of the hands of a felon or a person who is not supposed to have a gun, in my opinion whether I’m able to prove it or not, we prevent a violent crime in this city.”
On Nov. 17, 700 FBI agents, local police and ISP troopers raided 40 locations in search of 23 suspects indicted in a massive methamphetamine conspiracy stretching from Indianapolis to Sinaloa, Mexico.
Along with 15 pounds of meth and $55,000 cash, investigators seized 70 guns.
Authorities arrested a man they believed to be the cartel’s main operator in Indianapolis while taking off another dealer Bailey said he recalled chasing during his days as a narcotics detective nearly ten years ago.
And while IMPD now regularly touts the type of drug, weapons and cash seizures that were typical and unreported just a year ago, Bailey said investigators are frustrated by the return of suspects to their neighborhoods in the days after the busts.
“We have over 220 open complaints just on North District alone of people that the neighborhood believes they are selling narcotics.”
Fliers urging witnesses to call Crimestoppers about the Johnson and Downey murders are already up on stop signs and abandoned houses on North Adams Street.
Just blocks away, detectives are also investigating the shootings of a man and a woman in the 1900 block of Dearborn Street where violence and drugs are also common plagues.
Walgreens is charging $198.80 out-of-pocket for a thirty-day supply of Donepezil – a medication used to treat Alzheimer’s. The same medication at Costco costs $14.87. Why? We asked the companies.
Apparently, pricing strategy for prescription drugs is a state secret akin to the nation’s nuclear codes.
Ken, her husband of 38 years, had just been diagnosed with Alzheimer’s. She had watched, stunned and near tears, as he couldn’t answer a series of questions, couldn’t even tell the neurologist that it was fall.
A blow like that? It’s almost physical, like a freight train slamming into your gut as suddenly you realize that life will never again be the same.
“We left the office with a prescription for Donepezil,” she told me. “I dropped it off at Walgreens and came on home with our daughter and Ken. A couple of hours later, she and I went to pick it up. This was when I found the price to be $198.80. I was floored, but my overwhelming thought was ‘Get that medicine into Ken ASAP.’ ”
She paid cash, as Ken is on Medicare but doesn’t have prescription drug coverage. A few days later, when some of the fog of emotion had lifted, Corinne started questioning how 30 tablets — a month’s supply — could cost $198.80. So she started checking around.
And found the same medication at Costco for $14.87.
So I guess you’re wondering how Walgreens could charge $198.80 for pills that cost just $14.87 at Costco. How a reputable pharmacy could gouge its customers to the tune of 1,237%.
Corrine wondered as well. She wrote Walgreens but never got an explanation — just a call offering a full refund.
Why do they charge so much? It’s a secret
Apparently, pricing strategy for prescription drugs is a state secret akin to the nation’s nuclear codes. Neither Costco nor Walgreens would discuss it with me.
“It’s important to note that more than 97% of our patients do not pay cash prices,” Walgreens spokesman Scott Goldberg told me, via email. “They purchase their prescriptions using some form of prescription insurance coverage.”
So, reading between the lines, the people who have insurance get a break on the cost and the people who don’t, the ones who often can’t afford insurance, are gouged?
Apparently, it works like this. Most customers of the major chain drug stores have insurance, and insurance companies negotiate prices that are discounted from a store’s list price. Therefore, the chains attach the list price to a rocket and launch it skyward — and to heck with the poor schlubs like Corrine, who pay out of pocket.
Which doesn’t explain why Costco’s prices remain earthbound. And mum’s the word over at Costco HQ:
“Costco Pharmacy prices pharmaceuticals based on the same philosophy that we apply to the other merchandise we sell in the warehouse which is — ‘To continually provide our members with quality goods and services at the lowest possible prices.’ However we typically do not share the details behind this philosophy or business model.”
The moral of this story: It’s worth shopping around for prescription drugs. Because that neighborhood drug store that bills itself as “at the corner of happy and healthy?”
Turns out it’s on a street called highway robbery.
Healthcare provider, UnitedHealth Group, the largest health insurer in the U.S., has reportedly been overcharging its customers for secretly overcharging them for prescription drugs, according to Reuters. Time
Fibromyalgia warrior Angela Holt has one of the most popular crafting channels on YouTube with some of her tutorials garnering more than a half million views.
But about a year ago, Holt was struggling to stay active in the online crafting community. The pain and restlessness in her legs were so intense that she often couldn’t sleep at night, and it was affecting her ability to craft and make videos.
“I just didn’t feel like doing it,” she said. “I was hurting too bad. My legs were hurting or something else was hurting. I’d just lose interest.”
Holt was diagnosed with fibromyalgia in early 2014. Like so many others with fibromyalgia, she was prescribed a series of prescription drugs that did little to lessen the pain. Percocet helped, but it left her in a fog. In desperation, she sought the advice of her primary-care physician, Dr. Robert Holston from Holston Family Practice in the small town of Cross Plains, Tennessee.
Unlike some physicians, Holston intimately knew all about the challenges of living with fibromyalgia. His wife has had it for 25 years, so he has a special interest in the condition.
Last year, Holston stumbled upon a Family Practice News article reporting the results of a small Spanish study using memantine (sold under the brand name of Namenda), a common Alzheimer’s drug, for fibromyalgia. The randomized, double-blind study compared memantine to placebo in 63 fibromyalgia patients. After six months, those in the memantine group reported less pain and a higher pain tolerance than the placebo group. The most common side effects were dizziness (25.8%) and headache (12.9%).
“When I read this article about Namenda, it made sense to me because it blocks the glutamate neurotransmitter, which is so common in the brain, and it slows transmission into the neurons. I think high levels of glutamate in the brain, for whatever reason it’s there, causes a perception of chronic body pain. In blocking the neurotransmitter glutamate, it tends to reverse or cool off the nervous system’s reaction.”
There are very few medications approved to treat fibromyalgia, and none of them work very well, so Holston began prescribing memantine to a few of his toughest fibro patients, like Holt, to see if it might help.
“Immediately, the first week I could tell a huge difference,” Holt said. “The brain fog was gone. The pain … was still there, but it wasn’t as intense, and the restlessness of my legs … was completely gone. I can remember stuff now. I’m not like a zombie. I can function! And then I was able to drop down to only taking Tramadol. I still have pain medication, but I’m not needing much at all hardly like I used to.”
Holt’s symptoms improved so much that she decided to share her experience with memantine on her YouTube channel. She considers her fibromyalgia to be mostly under control now.
Holston’s wife also has improved using memantine.
“[Memantine] reversed her fibromyalgia actually,” Holston said. “It had such a dramatic effect on her body pain. All of it went away except for the [pain related to] weather changes. It’s put her fibromyalgia in remission. It was like a miracle for her.”
But like every fibromyalgia treatment, memantine appears to only work in some patients.
“I’ve had at least 30 patients on Namenda, and the results have been variable,” Holston said. “If it works, it works beautifully. I’m just amazed by the results I see in the patients that have them. I would say a good 70 percent of my patients have had positive results.”
Dr. Ginevra Liptan, founder of the Frida Center for Fibromyalgia near Portland, Oregon, has also started using memantine in some patients.
“Quite a few patients of mine have registered significant pain reduction on memantine,” Liptan said. “It seems to work for about 60 percent of my patients who have tried it. Clinically, I have found [memantine] to be most helpful in patients on high dosages of opiates but still having high levels of pain. Since it works on a different pathway than the opiates, it can have an additive benefit. One of my patients had such significant pain improvement with Namenda that she was able to cut her opiate medication in half.
“The other group of patients I often use it for are those really struggling with high levels of both pain and fibro fog, as it can help both issues. NMDA [N-methyl-D-aspartate] receptor blockers [like memantine] were actually originally developed to treat Alzheimer’s dementia, not pain, so it can also help improve cognitive function for some patients.”
Dr. Jon Ebbert, professor of medicine with the Mayo Clinic, authored the previously mentioned Family Practice News article and says memantine deserves more study.
“There seems to be some accumulating evidence for memantine to be effective for pain, but we’re going to need bigger trials to be sure,” he said. “It’s worth investigating. We don’t have a lot of good options [for chronic pain] other than the opioids. … These are the kind of investigations – this sort of drug repurposing – that need to continue to happen, especially with pain.”
Unfortunately, since memantine is a generic drug, it’s unlikely to draw the interest of the pharmaceutical companies that perform most larger studies. That leaves memantine’s future as a potential fibromyalgia treatment in the hands of physicians who are forward-thinking enough to try something different.
“Absent wealthy angels who care about our patients, such studies won’t likely get done,” said Dr. Richard Podell from the Podell Medical Practice in Summit, New Jersey. “The only way we are likely to learn more is for doctors and patients to use it and then report their data to places where other doctors and patients can see the results.”
Podell has prescribed memantine to five of his fibromyalgia patients so far and recently reported the outcomes in a blog post. Two patients had moderate improvement, two had no improvement and one could not tolerate the drug at full dose.
Memantine’s cost is another barrier for patients.
“The biggest challenge I find as a clinician prescribing Namenda is that it is quite expensive and is only FDA approved to treat dementia, so using it for fibromyalgia is considered off label and not covered by many insurance plans,” Liptan said. “I often have to argue quite extensively with insurance companies to try to prove to them why they should cover it. Sometimes I am able to successfully appeal the denial and sometimes not.”
Still, the results from the 2014 Spanish study definitely warrant more research. Based on anecdotal reports, it could be the miracle some fibromyalgia patients are seeking.
For more information on using memantine/Namenda for fibromyalgia, visit the following:
In the midst of a legal battle, the Sioux Falls casino owner, accused of disability discrimination, defends its decision to deny employment to a woman who didn’t pass a drug screening. The owner argues that the testing agency overlooked the validity of her painkiller prescription, raising important questions about the intricacies of preparing for an employment law discrimination proceeding.
M.G. Oil counter-sued TestPoint Paramedical last week, saying its failure to follow-up is the reason for the federal lawsuit.
The Equal Opportunity Employment Commission sued M.G. Oil in September for withdrawing a job offer from an applicant to Happy Jack’s casino who tested positive for hydrocodone.
M.G. Oil stood firm in its denial even after she told the company about her prescription and her diagnosis of chronic back and neck pain.
Denying a job to a person who uses drugs to treat a legitimate medical condition constitutes illegal job discrimination, and M.G. Oil refused to offer an out-of-court settlement to the applicant, according to the EEOC lawsuit.
ARGUS LEADER
Happy Jack’s Casino sued for drug test discrimination
Last week, M.G. Oil formally responded to the EEOC complaint for the first time.
It admitted to denying the job offer, but denied discrimination, saying the applicant never claimed that her pain constituted a disability or serious job impairment.
The company’s response to the lawsuit says M.G. instructs “all its drug testing companies” to conduct further investigation on positive tests, which would include checking for a valid prescription.
That didn’t happen, M.G. Oil claims.
After the lawsuit was filed, the company says, it “received notice from the drug testing company that this policy was not followed in this case.”.
If the court finds the casino job denial broke discrimination law, M.G. Oil says, the testing company should bear some of the blame and pay some of the cost.
“TestPoint breached its contractual obligation to automatically send the non-negative drug test to a medical review officer for verification,” the counterclaim said.
TestPoint has yet to reply in court to the accusations, levied the day before Thanksgiving.
Patrick Heitkamp, TestPoint’s owner, denied the allegations and said no signed, legal contract with M.G. Oil exists, but otherwise declined to comment on the pending litigation.
M.G. Oil admitted that the EEOC had given the company a chance to settle, but said the terms were “onerous” and “unreasonable.”
ARGUS LEADER
Painkillers pose tough questions for employers
No proposed dollar amounts or other settlement terms were included in the filing.
M.G. Oil’s lawyer, Jeff Swett of Rapid City, declined to comment beyond the filings.
EEOC investigations of job discrimination are fairly common, but lawsuits initiated by the EEOC on behalf of individuals are rare.
The M.G. Oil lawsuit represents the third EEOC case filed in the past five years against a South Dakota company.
Online directories used to market Medicare Advantage plans often contained incorrect, confusing or outdated information about which hospitals and specialty institutes were included, according to a recent study by the Kaiser Family Foundation. Photo: iStockphoto/Getty Images
By
Lisa Ward
An increasing number of seniors are choosing to get their Medicare benefits through Medicare Advantage plans. But do they understand what they’re signing up for?
A recent report suggests they may not, especially when it comes to which hospitals are included in the plans’ networks.
An alternative to traditional Medicare and administered by private insurers, Medicare Advantage plans are typically health maintenance organizations or preferred provider organizations that offer seniors hospital and medical coverage (Medicare Part A and Part B), and sometimes prescription-drug coverage (Medicare Part D), dental care or benefits such as gym memberships.
These plans typically offer lower out-of-pocket costs than traditional government-run Medicare in exchange for members using in-network doctors and hospitals.
A Maryland couple first saw Salinas as an escape from the cold. Then it became home.
Despite John Buskin’s best efforts to look as hip as he used to, he finds himself looking just the opposite.
The problem, according to the report from the Henry J. Kaiser Family Foundation, is that the size and composition of hospital networks varies greatly among plans, yet that isn’t always apparent to those shopping for coverage. Plan directories contain incorrect, confusing or outdated information about which hospitals and specialty institutes are included in networks, the study found, and the directories can be difficult to navigate. One directory featured 600 pages without a table of contents or index, it said.
Using the directories to pick a plan is “like trying to do your taxes with an abacus; it can be done, but not easily,” says Gretchen Jacobson, associate director at the Kaiser Family Foundation and co-author of the report, adding that Medicare’s website doesn’t provide an easy way to compare plan networks side by side.
About 17 million beneficiaries, roughly 30% of the Medicare population, enrolled in a Medicare Advantage plan in 2015, according to the Congressional Budget Office, which expects private-plan enrollment to grow to about 29 million Americans, or about 40% of the Medicare population, in 2025.Many seniors like Advantage plans because in addition to added benefits such as dental coverage and gym memberships, they eliminate the need for additional insurance, such as Medigap, and some plans cover the gap in Medicare prescription-drug coverage known as the “Donut Hole.”
“These sorts of benefits can make a big difference to someone on a fixed income,” says Clare Krusing, a spokeswoman for America’s Health Insurance Plans, an industry group.
That said, some Advantage plan members can face significant expenses if they seek treatment out of the network, experts say, which is why having a clear understanding of the size and composition of each plan’s network is important.
Of the 409 plans studied by Kaiser, 23% offered what the report termed broad networks, meaning 70% or more of the hospitals in a county were included. About 61% had medium-size networks, meaning between 30% and 69% of all hospitals in a county were included; and about 16% had narrow networks, with less than 30%.
While some plans with narrow networks get good ratings from the Centers for Medicare and Medicaid based on metrics such as preventive care and customer service, the Kaiser study found that in general they are more likely to exclude institutions that specialize in treating rare or more complicated conditions.
According to the report, 75% of narrow networks excluded National Cancer Institute Cancer Centers, which have experience handling rare and complicated cancers and provide more access to clinical trials; 49% excluded academic medical centers; and 21% had no hospitals with an accredited cancer program.
In the worst case, by not including certain institutions, networks can be built to exclude the sickest, most expensive patients, says Karen Davis, a professor and director of Roger C. Lipitz Center for Integrated Health Care at Johns Hopkins Bloomberg School of Public Health.
The insurance industry’s Ms. Krusing says some plans may exclude brand-name hospitals from their networks if there is no evidence they provide better care than cheaper community or regional hospitals. Medicare Advantage plans are increasingly enrolling patients with chronic illnesses, focusing on preventive care and reducing avoidable hospitalizations, she says.
Whatever the merits of the various plans, experts say it’s easy for the details to get lost in the generally weak shopping experience they offer.
The Kaiser report found, among other things, that some plan directories mislabeled rehabilitation or post acute-care facilities as hospitals, while others included hospitals that had been closed for several years.
A separate analysis prepared for the Centers for Medicare and Medicaid Services and presented at a conference in Baltimore in September, found a 46% chance that an Advantage plan’s listing of a primary-care physician, oncologist, ophthalmologist or cardiologist contained some sort of inaccuracy, including where the provider was located or whether they were accepting new patients.
“You can’t shop around very well,” says Timothy Layton, an assistant professor of health-care policy at Harvard Medical School. Trying to anticipate what specialty care may be needed in the coming year, along with calculating deductibles, copays and other out-of-pocket costs makes the task even more difficult, he adds.
The Centers for Medicare and Medicaid Services (CMS) and insurers say they are beginning to address this problem.
“We are actively working with insurers and the provider community to further develop best practices and solutions,” says CMS spokesman Raymond Thorn.
In 2017, plans that apply to expand their networks will have to submit their entire network for review by CMS. Currently, CMS examines provider networks for accuracy of listings in new geographic areas to which a plan is expanding, or in response to triggers such as complaints, changes of ownership or termination of a large provider.
Meanwhile, “seniors may have to do some additional work to make sure they chose the best plan for them,” says James Cosgrove, director of health care at GAO. Ask questions about which providers are in which networks, Dr. Cosgrove says.
Robert A Berenson, a fellow at the Urban Institute, a Washington, D.C.-based think tank, recommends asking how frequently a plan refers patients out of its network. Medicare Advantage plans are often reimbursed at a rate close to that of traditional Medicare patients even if a provider is out of network, he says.
Dr. Jacobson recommends State Health Insurance Assistance Programs, or SHIPS, for help choosing a plan. These programs provide free insurance counseling to Medicare beneficiaries in all 50 states.
For years, they were among the most routine proceedings in criminal court in Portland, Oregon.
Defendants facing drug possession charges based on inexpensive test kits used by police to detect illegal substances would strike a quick guilty plea at a preliminary hearing. Guilty or just eager to get out of jail as quickly as possible, the defendants would be sent off to serve their time or enter into addiction treatment. The drug-kit results that had prompted their arrest would then never have to be confirmed by a lab.
Last July, shortly after ProPublica and The New York Times Magazine published an article detailing that the kits are prone to error and years earlier had helped account for roughly 300 wrongful convictions in Houston, the Multnomah County District Attorney’s Office in Portland decided to change the way it secured guilty pleas in drug possession cases. Today, when a defendant pleads guilty before the lab analysis is performed, prosecutors must still have the field test results double-checked.
J. Russell Ratto, the head of conviction integrity at the district attorney’s office, had asked his colleagues whether it might be wise to change the policy after the article’s publication.
“Our DDAs [deputy district attorneys] are always looking to make sure we’re using the very best practices,” said J.R. Ujifusa, the deputy district attorney who oversees drug prosecutions.
Drug field tests have been used for decades by police departments across the country. Officers drop suspicions material in a pouch of chemicals and look for changes in colors that might indicate the presence of illegal drugs. The tests were typically used to establish probable cause for an arrest. Courts across the country have routinely barred them from being used as evidence at trial, demanding results confirmed by certified labs.
But ProPublica’s reporting has shown that field tests have grown much more consequential; in a criminal justice system in which 90 percent or more of all criminal convictions come via a plea bargain, in tens of thousands of cases a year the tests are the critical “evidence” used to gain convictions. In many cases, to be sure, those arrested are guilty. But just as surely, some number of innocent people — jailed and desperate to get back to their families and jobs — have pleaded guilty.
That was certainly the case in Houston. In 2014, the Harris County District Attorney’s office realized that several hundred people who had pleaded guilty after field tests indicated they had drugs actually were innocent once samples were subjected to more formal testing by Houston’s crime lab. It took years to uncover the wrongful convictions, and two years later, prosecutors are still working to notify the innocent and correct the record.
The district attorney in Houston subsequently ordered that no guilty pleas would be accepted in cases involving field tests until the lab had confirmed the presence of illegal drugs. Since then, the number of drug convictions has fallen markedly, with dismissals soaring.
Prosecutors in Multnomah County wanted to make sure they were not allowing innocent people to be saddled with wrongful convictions, Ujifusa said, which is why the office has now mandated lab confirmation of field test results even after guilty pleas.
Ratto, the conviction integrity unit chief, also reviewed cases from 2009 to the present in which the Oregon State Police Forensic Laboratory determined suspected drugs were not drugs, to see if any of those cases had nonetheless resulted in drug possession convictions. He discovered five wrongful convictions based on inaccurate field test results. Ujifusa said the district attorney’s office has already had those convictions vacated.
Busted
Tens of thousands of people every year are sent to jail based on the results of a $2 roadside drug test. Widespread evidence shows that these tests routinely produce false positives. Why are police departments and prosecutors still using them? Read the story.
Ratto did not recheck field test results beyond those already analyzed by the state’s forensic scientists. The review “was not to prove or disprove the scientific validity” of the kits in use in Multnomah County, Ujifusa said. “Rather it was to identify cases where a defendant had resolved his case before a lab test could be obtained and the results later showed either a different or no controlled substance.”
Multnomah County courts produce roughly 2,000 drug possession convictions a year, with police test kits contributing to at least the initial arrest for many of these. Ujifusa said he was not certain how often defendants plead guilty to drug charges with only a field test result, nor what happens to the drug evidence in a majority of those convictions.
It is also not yet clear whether the state lab confirmed field test results in all Portland-area drug possession cases. If not, there could potentially be other wrongful convictions based upon the flawed kits.
The U.S. opioid epidemic has evolved so much in the last four years that current federal policy responses risk diminishing returns in saving human lives, according to a new peer-reviewed perspective by University of Alabama at Birmingham Associate Professor of Preventive Medicine Stefan Kertesz, M.D. His perspective was published online in the addiction journal Substance Abuse.
Kertesz says physicians and patients are caught in a complicated balancing act between the safe prescription and use of pain medications and the risk of opioid addiction.
“Patient care is increasingly compromised by doctors who fear being seen as fueling a tide of opioid deaths, even when those deaths are now mostly caused by heroin and illicit drugs, rather than the pills doctors prescribe for patients with pain,” Kertesz said. “Fear gets in the way of thinking of each patient as an individual.”
The Centers for Disease Control and Prevention reported that in 2014 there were 28,000 Americans who died from opioid overdose. The prescribing of opioid pills by physicians such as hydrocodone for pain rose rapidly from 2001 through 2011, and Kertesz endorsed the view that this increase in prescribing helped to spur today’s epidemic.
Kertesz calls attention to a distinction others have not made.
“What caused the epidemic and what sustains it today are not the same,” he wrote in the publication. “While opioid prescribing rose through 2011, prescribing leveled and then fell after 2012. In Alabama, prescriptions for hydrocodone fell 35 percent in just three years.”
Two separate federal surveys show recreational use of prescription pain relievers is now at historic lows.
Illustration by Lissa Mathis, as published in the journal Substance Abuse.“If doctors are prescribing far less, and people are using these pills far less than they were just a few years ago, and opioid deaths are rising even faster, that should be a shocking wake-up call to policymakers,” Kertesz said. “Common sense dictates that we’re making a mistake to continue to focus so very narrowly on what happens when pain patients go to see a doctor.”
What has replaced pills is what Kertesz describes as “a booming market for potent heroin, fentanyl and its analogs.” Using public data from the coroner for Jefferson County — which includes Birmingham, Alabama — Kertesz showed how heroin and fentanyl account for nearly all overdose deaths. Just 15 percent of overdoses involve pills that could have been obtained through a prescription, echoing recent findings from several other cities.
His commentary calls for renewed public attention to subsidized access to medication therapies for addiction.
“Congressional funds for addiction treatment have failed to keep up with inflation since 2009,” he said. “Although Congress passed a new law in response to the opioid epidemic earlier this year, it has declined to fully fund it.”
“What people sometimes fail to realize is that addiction continues to kill people even when you choke off the supply of one particular addictive substance.”
Kertesz endorses a recent CDC Guideline that encouraged a careful weighing of risks and benefits for each patient, but he believes its message was overwhelmed by more aggressive communications from federal and state leaders.
“At this point, the doctors are overwhelmed and scared of being caught in the crossfire,” Kertesz said. “The result is bad news for stable patients who are being taken off the pills that actually were helpful to them.”
Kertesz says this issue is more complicated than people realize, and he hopes this publication will lead to better education and legislation to help patients.
“It’s almost like we decided to fight diabetes by shutting down all the donut shops,” he said. “A few years into it, there are a lot less donuts being eaten, and we’re beginning to realize that diabetes is a lot more complicated than donuts.”
Over the counter homeopathic remedies sold in the US will now have to come with a warning that they are based on outdated theories ‘not accepted by most modern medical experts’ and that ‘there is no scientific evidence the product works’. Failure to do so will mean the makers of homeopathic remedies will risk running afoul of the US Federal Trade Commission (FTC).
The agency argues that unsupported health claims included in the marketing for some of these remedies are in breach of laws that prohibit deceptive advertising or labelling of over the counter drugs.
The body has released an enforcement policy statement clarifying that homeopathic drugs are not exempt from rules that apply to other health products when it comes to claims of efficacy and should not be treated differently. In order for any claims in adverts or on packaging not to be ‘misleading’ to consumers it should be clearly communicated that they are based on theories developed in the 1700s and that there is a lack of evidence to back them up, the statement says. Thanks to detailed and strict quality assurance procedures, regular quality control audits, and contract packaging systems that have been refined through years of experience, pharmaceutical packaging Australia delivers the highest standards to manufacturers and distributors.
It adds that the FTC will ‘carefully scrutinise the net impression of [over the counter] homeopathic advertising or other marketing … to ensure that it adequately conveys the extremely limited nature of the health claim being asserted’.
Illustration by Lissa Mathis, as published in the journal Substance Abuse.
