http://www.cdc.gov/drugoverdose/pdf/pharmacists_brochure-a.pdf

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Fentanyl patient ashamed to pick up prescription amid ongoing opioid ‘crisis’

globalnews.ca/news/3007708/fentanyl-patient-ashamed-to-pick-up-prescription-amid-ongoing-opioid-crisis/?

As the provinces and the federal government work to address a “public health crisis” amid growing rates of opioid overdoses and deaths across the country, one Ontario man says that without fentanyl his quality of life would be destroyed.

The 48-year-old agreed to speak to Global News under condition of anonymity due to the stigma he faces as a user of the drug and the negative implications speaking out publicly could have on his life and career. For the duration of this article he will be referred to as “John.”

“I feel unfortunate that these people are dying over this, but this medicine is a very good medicine because it’s better for your body than taking a morphine tablet,” he said.

“I’ve been using this for years, it’s never been a problem – now it’s a problem because people are dying.”

John was in a severe accident years ago and uses fentanyl to manage chronic pain.

“This is a medication that works for me. There’s probably other people that feel the same,” he said, adding he’s tired of feeling like a criminal for using a drug that helps him function.

“What about people that are relying on this product?”

For John, even picking up a prescription at his local pharmacy makes him feel like he’s doing something wrong.

“They looked at me like I had two heads that I’m using this product,” he said, adding that he often has to justify his need for the drug despite his doctor’s support.

“It just helps me get through my daily life as I am. Hey listen, I don’t like taking it and it has its bad with the good, but for me to get up and continue my day to do what I can do with my limitations — this is the system, the way I have to go.

“I’d love to get off of it but I need something and Advil doesn’t cut it.”

WATCH: Ontario government unveils strategy to combat growing problem of deaths linked to opioids

Health Minister Eric Hoskins announced Wednesday several steps as part of Ontario’s “comprehensive opioid strategy” to prevent the “public health crisis” of addiction and overdoses.

The new measures include expanded access to the addiction treatment drug Suboxone and an additional $17 million a year on 17 chronic pain clinics.

Dr. David Williams, Ontario’s chief medical officer of health, will also serve as the province’s first-ever overdose co-ordinator to better track patients who overdose on painkillers like fentanyl and hydromorphone.

READ MORE: Ontario expands use of Suboxone to battle growing opioid crisis

The Ontario government has been criticized over its response to the opioid crisis in the province over concerns it didn’t have up-to-date information on how many people were overdosing.

The latest publicly available data showed opioid overdose deaths rose to 553 people in Ontario in 2014, while fentanyl-related deaths climbed to 153, according to the Chief Coroner for Ontario.

In Ontario, statistics on opioid overdose deaths are overseen by the Ontario Chief Coroner’s Office — but that data was last released in 2014. Meaning there is no up-to-date picture of how bad the problem currently is.

Global News obtained preliminary data from the chief coroner’s office for 2015, which showed there were 529 opioid overdoses in Ontario last year — 162 of which involved fentanyl.

WATCH: Minister of health under fire after Global News reports on opioid overdose death crisis

As part of Williams’ new role, he will work with the coroner’s office, police, hospitals, and public health officials to monitor all opioid-related overdoses.

“They need to come up with a better solution with what they’re doing right now, John said.

“It’s almost like you’re a heroin user. That’s the feeling that I get and it’s like — but I’m not. I don’t do drugs. That’s the only thing I take.”

READ MORE: More fentanyl deaths in Ontario, but where are the detox programs?

John said he worked with his doctor to find a pain medication that suits him, after being prescribed drugs such as oxycodone and morphine in the past that have much stronger side effects.

He now takes a clinically controlled dose of 100 mcg/h of fentanyl in a patch that slowly distributes the drug over the course of two days.

“It’s not evil for people that need this product,” he said, adding he feels “horrible” when he’s forced to return his empty patches to pharmacies to prove he’s using it legitimately.

“I’m thinking there’s got to be another way.”

John said if the province were to restrict fentanyl prescriptions in the future in response to the growing issue of opioid overdoses, his life would be thrown into turmoil.

“Oh I’d be in trouble … I’d be probably going through lots of pain, not movement, plus probably the withdrawal of it too,” he said.

“It doesn’t fix it 100 per cent, but it makes me be able to move around and continue my life as much as I could. If I didn’t have it I know for sure I wouldn’t be able to do what I do.”

READ MORE: 5 people overdose after using cocaine laced with suspected fentanyl at Ontario party

John said that due to his severe pain, he often has to leave Canada for several months to warmer climates in the U.S., but getting a three-month supply of fentanyl is difficult and problematic.

“When I’m going in and out of the country now I’m thinking, ‘Jeez, am I going to get arrested because of a medication that I’m taking?’,” he said.

“I’m worried coming back into Canada or going into another country and the dog’s sniffing — if they smell it I’m going to get hauled out of line.”

READ MORE: Police, community groups warn fentanyl crisis looming in Ontario

John said he feels as though the government may move to further restrict fentanyl in the future and he will be left without another option to manage his severe pain.

“I have a feeling in the next six months I’m not going to have that opportunity and nobody’s going to seem to care,” he said.

“Very few ruined it for probably a lot.”

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Half of New York Overdoses Blamed on Fentanyl

http://www.painnewsnetwork.org/stories/2016/10/19/half-of-new-york-overdoses-blamed-on-fentanyl

By Pat Anson, Editor

Nearly half of the overdose deaths in New York City since July have been linked to fentanyl, according to a new report that adds to the growing body of evidence that illicit fentanyl is now driving the nation’s opioid epidemic – not prescription pain medication.

In an advisory sent to healthcare providers, New York’s health department said 47 percent of the city’s confirmed overdose deaths since July 1 have involved fentanyl. That compares to 16% of overdoses involving fentanyl in all of 2015. So far this year, 725 people have died from drug overdoses in New York.

“Data suggest that the increased presence of fentanyl is driving the increase in overdose fatalities,” the alert said. “While fentanyl is most commonly found in combination with heroin-involved overdose deaths, fentanyl has also been identified in cocaine, benzodiazepine, and opioid analgesic-involved overdose deaths.”

Fentanyl is a synthetic opioid 50 to 100 times more potent than morphine. Because of its potency, healthcare providers are being warned that additional doses of naloxone – which reverses the effects of an opioid overdose – may be needed when fentanyl is involved.

Fentanyl is available legally by prescription in patches and lozenges to treat more severe types of acute and chronic pain, but illicitly manufactured fentanyl has become a scourge across the U.S. and Canada, where it is often mixed with heroin and cocaine or used to make counterfeit pain medication.

Unsuspecting buyers, including some pain patients who were unable to get opioid medication legally, often have no idea the drug they’re getting from a dealer or friend could contain a lethal dose of fentanyl.

dea image of fentanyl

In addition to New York City, several states in the Northeast and Midwest have reported that fentanyl is now involved in about half of their overdose deaths.

The sharp increase in fentanyl-related deaths has coincided with new restrictions on the prescribing of opioid pain medication. In the past year, the Drug Enforcement Administration has issued two public safety alerts about fentanyl, but the Centers for Disease Control and Prevention has remained relatively quiet about the problem – focusing instead on opioid prescribing guidelines that were released in March of this year.  

Those guidelines have led many doctors to reduce doses or stop prescribing opioids altogether, but they have failed to make a dent in the number of Americans dying from overdoses. There have also been anecdotal reports of a rising number of suicides by patients unable to get opioid medication.

“I know five people who have committed suicide from being denied pain medication by doctors after the CDC came out with their ridiculous statements of the ‘epidemic’ of prescription opioid use,” says Nina Stephens, a Colorado woman who suffers from chronic pelvic pain. 

“Doctors are so afraid of getting in the middle of this epidemic mess with the FDA that they have decided to stop prescribing opioids to their patients, even those patients who are in desperate chronic pain. We are now treating our patients worse than dogs when it comes to pain.”

Stephens says she has to drive 4 hours each month to see a doctor who is still willing to prescribe opioids. A local pain management doctor just 20 minutes away said he would take Stephens off opioids and give her epidural injections instead, which she refused.

“I am truly afraid that soon I will have to drive even farther to find a doctor who will still be willing to prescribe pain pills to me each month or I will have to start looking at the black market.  Maybe a veterinarian would be willing to start treating me?  No wonder the suicide rate is going up so dramatically!” Stephens wrote in an email to PNN.

Canada’s Fentanyl Crisis

Counterfeit fentanyl pills started appearing in British Columbia about two years ago and have since spread throughout Canada. The fentanyl crisis is so severe a two-day conference was held in Calgary this week for healthcare providers and law enforcement.  There were 153 deaths associated with fentanyl in Alberta province during the first six months of 2016.

Some attendees want Alberta to declare a public health emergency – as British Columbia did in April. But Alberta’s Minister of Justice says the current fentanyl situation doesn’t warrant such a declaration.

“None of those powers will assist us in this case but they do give the government a significant ability to violate civil liberties,” said Kathleen Ganley. “We think it’s important we use those powers that have significant impact on Albertans only where they would be helpful to us.”

On display at the conference was an illegal pill press seized by law enforcement that is capable of producing 6,000 fentanyl laced pills per hour.

“Some of the tablets we’ve been seizing in Calgary have ranged from 4.6 milligrams to 5.6 milligrams per tablet—which is very high obviously, considering a lethal dose is two milligrams,” said Calgary police Staff Sgt. Martin Schiavetta in Calgary Metro.

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Scientists may have found migraine trigger— in our mouths

http://www.foxnews.com/health/2016/10/19/scientists-may-have-found-migraine-trigger-in-our-mouths.html

Certain foods like chocolate, wine, and processed meats have long been linked to migraines, and while nitrates in those foods are often seen as the culprit, it’s not entirely clear why some people are more susceptible to ensuing headaches than others, reports Quartz.

Now scientists are reporting in the journal mSystems that, thanks to an analysis of 2,200 people participating in the American Gut Project, they’ve found that people with migraines tend to have more oral bacteria that process nitrates, reports Refinery29.

This means that people suffering from migraines could be creating more nitric oxide, which has been linked to migraines, as they process those nitrates. Scientists next plan to study the diets of people with migraines to look for links between nitric oxide levels in their blood and migraines, which would help confirm that nitrate-processing oral bacteria are behind the headaches.

If that’s true, we could eventually see a “magical probiotic mouthwash” that helps reshape oral bacteria to prevent migraines, reports the Guardian. In the meantime, researchers say, people who suspect that nitrates are behind their migraines should try to avoid them when possible—which could be difficult, considering they’re also present in leafy greens.

(The source of this man’s headache was highly unusual, and more than a little gross.)

This article originally appeared on Newser: Scientists May Have Found Migraine Trigger—in Our Mouths

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Wrongful death lawsuit filed against St. Thomas, NHC, others

http://www.murfreesboropost.com/wrongful-death-lawsuit-filed-against-st-thomas-nhc-others-cms-45398

A Texas woman is seeking $5 million in a wrongful death lawsuit claiming her elderly mother died from negligence by local healthcare providers, mainly involving a botched diuretic prescription. If you need attorney for wrongful death attorney case then check here.

Sharon Elizabeth Conway filed the complaint Oct. 5 on behalf of her mother, Clara Hamner Conway, who died Aug. 28, 2015, after gaining 30 pounds in only 18 days while being treated at St. Thomas Rutherford Hospital and NHC Murfreesboro, according to court documents.

The lawsuit names St. Thomas Rutherford, NHC Murfreesboro, Dr. Zakaria Botros, Dr. Evans Neal Mize, Dr. Susana Irias Donaghey, Wellness Solutions and nurse practitioner Miatta Kebee Hampton.

Conway was admitted to the hospital Aug. 6-10, 2015 for symptomatic anemia (shortage of iron), acute gastritis (inflammation or swelling of the stomach lining), COPD exacerbation (shortness of breath) and mild hypokalemia (a low potassium level).

She was discharged weighing 158 pounds and readmitted Aug. 18 due to shortness of breath. During those eight days, she gained 15 pounds but complained of decreased appetite, according to the lawsuit, and also showed signs of swelling in her extremities.

The lawsuit contends the weight gain was caused by abnormal fluid retention, which, if left untreated, can lead to heart failure and death. The problem often is treated through diuretics, increasing the excretion of water and salt in the body.

Conway was prescribed 20 milligrams of Lasix by mouth every other day, and Botros requested consultation by pulmonologist Dr. Richard Parrish, who recommended diuretics for failure of the left side of her heart. If that didn’t bring improvement, she was to undergo a procedure to remove excess fluid from her chest, according to the suit.

Despite Parrish’s recommendation, she received only one 20-milligram dosage of Lasix on Aug. 19 and not another until Aug. 24 when she was given a 40-milligram tablet of Lasix, according to the filing.

The lawsuit contends Botros and Mize should have known she suffered dangerous levels of fluid retention but failed to take appropriate steps to treat her.

After six days at St. Thomas, weighing 188 pounds, she was transferred to NHC Murfreesboro where a nurse noted significant swelling in her lower extremities, the lawsuit says.

In the transfer, a discrepancy occurred in orders for Lasix to be administered at 40 milligrams every day instead of every other day, and the conflicting prescription order was not recognized, according to the lawsuit.

“This dosage was insufficient to manage the abnormal fluid retention in her body,” the lawsuit states.

On Aug. 25, the patient suffered an episode of respiratory distress. Despite continuing problems and abnormal lab results, physicians were not notified and no changes were made in her medications, according to the lawsuit.

Even as the patient continued having problems with oxygen levels, repeated respiratory distress was not addressed with diuretic medication, the filing contends.

She was found unresponsive Aug. 28, 2015 and taken to St. Thomas Rutherford where she was pronounced dead.

The lawsuit contends the “volume overload of fluid retention caused her increasing respiratory distress” and made her gain 30 pounds in 18 days. “Left untreated, these conditions caused cardiac arrest and untimely and wrongful death,” the lawsuit states.

Officials with St. Thomas Rutherford Hospital and NHC Murfreesboro did not return phone calls.

Sam Stockard can be reached at sstockard44@gmail.com.

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It’s Time for Doctors and Patients to Stand Together

nationalpainreport.com/its-time-for-doctors-and-patients-to-stand-together-8831730.html

By Jay Joshi, M.D.

Jay Joshi, M.D.

(Dr. Joshi is a nationally recognized pain physician who will attend the CRPS Conference in Chicago on Saturday. What follows is his commentary about the conference specifically and the environment of chronic pain treatment generally) 

With this recent election cycle, two topics have become very clear.  We have issues in America with healthcare and discrimination.  Access to healthcare (especially good healthcare) has diminished, premiums have gone up, deductibles have gone up, coverage has gone down, and the total cost of healthcare continues to rise.  Discrimination, based on race, color, gender, disability, and more continues to be a problem.  In some ways, it is worse than it was 10 years ago.

What we are seeing in our broader society seems to be amplified (much like the pain in CRPS) within the pain patient population.  We are seeing access to good pain physicians diminishing, premiums for pain patients rising, deductibles rising, coverage for pain procedures diminishing, reimbursements diminishing (to the point where it costs more to do the procedure than we are getting reimbursed in some cases).

We are also seeing bigotry and discrimination increasing within the pain patient population.  It seems that the general stereotype is that anyone who is on an opiate is a drug addict.  Somehow pain MANAGEMENT is worthless if there isn’t a cure.  While we are always working toward a “cure”, we are not there yet.  And management is a lot better than the alternative, which is failure.  Failure leads suicide, which I’ve become increasingly convinced some people who hate pain patients welcome with open arms.  Patients with CPRS and central sensitization are doubly discriminated against because most people in our society (especially physicians) have little to no understanding or compassion toward the disease or the patient.  Thus, their views and practice philosophies are based on stereotypes and opinions, not science.  This leads to bigotry and discrimination.  I’ve personally been a victim of both simply because I properly take care of and advocate for pain patients.  In fact, this happened again to me this month.

Saturday’s conference may be the pivotal point in the management of CRPS and central sensitization.  We all know ketamine infusions are helpful.  The experts know the science behind it and it is not based on opinion or stereotype.  We need to come together and fight these disgusting people who treat pain patients and legitimate pain physicians like some contagious disease that needs to be eradicated from the planet.  There is a place for humanity in our society and a place to treat our fellow mankind with dignity and respect.  There is no place for racists and bigots in our society or ignorant physicians and non-physicians who slander, defame, and threaten patients and their providers.  So let’s stand united to defeat this insurgency of hate.

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Ex-DEA officers charged with drug, weapons crimes

http://www.thetowntalk.com/story/news/crime/2016/10/18/ex-dea-officers-charged-drug-weapons-crimes/92387010/

WASHINGTON – Two former Drug Enforcement Administration task force officers were charged in a superseding indictment unsealed today with drug conspiracy, weapons offenses, robbery, obstruction of justice and falsification of records in federal investigations, according to Department of Justice and FBI officials.

Karl Emmett Newman, 49, of Kentwood, and Johnny Jacob Domingue, 27, of Maurepas, were indicted Oct. 7 by a federal grand jury in the U.S. District Court for the Eastern District of Louisiana, authorities said.

Newman is charged with one count of conspiracy to possess with intent to distribute cocaine and oxycodone, one count of interference with commerce by robbery, one count of possessing a firearm during a crime of violence, one count of possessing a firearm during a drug trafficking crime, two counts of unlawful conversion of property by a government officer or employee, two counts of falsifying records in a federal investigation and one count of obstruction of justice. Know whom to call after getting arrested in order to get legal help.

Domingue is charged with one count of falsifying records in a federal investigation.  Newman was originally charged on May 13 in a now-unsealed indictment and was arrested on that date.  Domingue was arrested on a now-unsealed criminal complaint on May 12.

In addition to serving as DEA task force officers, Newman and Domingue previously served as deputies with the Tangipahoa Parish Sheriff’s Office.

Assistant Attorney General Leslie R. Caldwell of the Justice Department’s Criminal Division, Special Agent in Charge Jeffrey S. Sallet of the FBI’s New Orleans Field Office, Special Agent in Charge Monte A. Cason of the Department of Justice Office of the Inspector General Dallas Field Office and Deputy Chief Inspector Brian M. McKnight of the DEA’s Office of Professional Responsibility made the announcement.

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Seniors Brace For Smallest Social Security Increase on Record

http://www.foxbusiness.com/politics/2016/10/17/seniors-brace-for-smallest-social-security-increase-on-record.html

Let’s start with the good news. For the more than 60 million people who receive Social Security benefits, they will get a cost-of-living increase in 2017. This is positive considering there was no increase in 2016. Here is the bad news. The increase is expected to be around 0.3 percent, the smallest increase on record.

“For the average Social Security beneficiary, that equates to basically $2 to $6 a month, so it’s very small,” says Max Gulker, a senior research fellow at the American Institute for Economic Research. He expects the cost-of-living increase for 2017 to come in between 0.2 percent to 0.5 percent when the government releases its number on Tuesday.

While Social Security benefits increase, Medicare Part B premiums will rise too.  Medicare Part B covers doctor visits, lab tests and outpatient medical treatments.  About 70 percent of people enrolled in Medicare are protected by the hold-harmless provision which prevents Medicare Part B premiums from rising more than the cost-of-living increase in Social Security benefits.  For the majority of seniors, this means the hike in premiums will not be more than the cost-of-living increase but it could eat up any increase in benefits.  In other words, most Social Security recipients will probably see the increase in their payment go towards Medicare costs so they are not likely to see a big change in their monthly checks. 

Medicare Part B premiums have been climbing as healthcare costs soar.  Back in 1970, the monthly Part B premium was $5.30.  This year, the standard monthly premium is $121.80.  Meantime, average benefit costs per Part B beneficiary have shot up from about $8 per month in 1970 to more than $460 per month in 2016 according to the Congressional Research Service. 

 

 

The majority of people enrolled in Medicare are protected by the hold-harmless provision but some are not.  One group that does not qualify for the provision are those seniors with higher-incomes, making more than $85,000 per person or $170,000 per couple.  More than three million of these higher-income beneficiaries could face a big hike in Medicare premium costs next year. 

Big Hike in Premiums

“For the three-quarters of people who are under hold-harmless, there is going to be very little increase possible in their Part B premiums so that often spells bad news for the folks who are not under hold-harmless because whatever sort of cost increase in the system has to be made up from that smaller group,”  Gulker says. 

The Medicare Trustees estimate premiums for those not protected by the hold-harmless provision could rise 22 percent from $121.80 per month this year to $149 per month next year.   The highest income group could see premiums rise from around $380 per month this year to $467 per month next year. 

In 2015, Congress stepped in and provided a $7.5 billion loan to the Medicare program which prevented a big spike in Medicare premiums for many higher-income seniors.  Gulker says there could be calls from seniors and advocacy groups to get Congress to step in once again to limit the premium increases. 

Congress to the Rescue

He points out, however, Congress can only do this so many years and a longer-term solution is eventually needed. 

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