“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
It’s hard to have good days when being sick makes you feel sad, lonely, uncomfortable, or scared. Your quality of life can suffer, not just in your body, but also in your mind and spirit.
Palliative (say “PAL-lee-uh-tiv”) care is the field of medicine that helps give you more good days by providing care for those quality-of-life issues. It includes treating symptoms like pain, nausea, or sleep problems. But it can also include helping you and your loved ones to:
Understand your illness better.
Talk more openly about your feelings.
Decide what treatment you want or don’t want.
Communicate better with your doctors, nurses, and each other.
Hospice care is a type of palliative care. But it’s for people who are near the end of life. Here’s how the two kinds of care are different.
What kinds of care are involved?
Palliative care: This is treatment to help you feel better physically, emotionally, and spiritually while doctors also treat your illness. It can include care such as pain relief, counseling, or nutrition advice.
Hospice care: Again, the goal is to help you feel better and to get the most out of the time you have left. But you no longer get treatment to try to cure your illness.
When does the care happen?
Palliative care: This care can happen at any time during a serious illness. You don’t have to be near death to get this care.
Hospice care: In most cases, you can choose hospice care when your doctor believes that you have no more than about 6 months to live.
Where does the care happen?
Palliative care: This type of care can be provided wherever you’re being treated for your illness. You can get it in the hospital, at your doctor’s office, in a nursing home, and even in your home.
Hospice care: Most hospice care is done in the place the patient calls “home.” This is often the person’s home. But it could also be a place like a nursing home or retirement center. And hospice care may also be given in hospice centers, hospitals, or other facilities.
Who provides the care?
Palliative care: There are doctors and nurses who specialize in this field. But your own doctor may also provide some of this care. And there are many other types of experts who may help you, like social workers, counselors, therapists, and nutrition experts.
Hospice care: In hospitals, hospice centers, and other facilities, care is provided by doctors, nurses, and others who specialize in hospice care. In the home, a family member is usually the main caregiver. But the family member gets help from care experts who are on call 24 hours a day.
How is the care paid for?
Palliative care: Most health insurance covers palliative care. But the amount of coverage may vary.
Hospice care: Health insurance usually covers hospice care. It’s also covered by Medicare and Medicaid. You are eligible for hospice care regardless of your ability to pay.
The DEA announced that it will not reschedule marihuana from a Schedule 1 drug to Schedule 2, which would allow that cannabis has medicinal applications.
DEA chief Chuck Rosenberg defended the ruling, citing an FDA finding that marihuana has “no currently accepted medical use in treatment in the United States.”
Chuckie goes on, “This decision isn’t based on danger. This decision is based on whether marihuana, as determined by the FDA, is a safe and effective medicine, and it’s not.”
The DEA employed 11,055 people in 2014. Its budget is over $2 billion per year. For 40 years, the agency fought any change that would ease restrictions on marihuana, including research on potential medical benefits of the drug.A lot of government bureaucrat careers are at stake, and the DEA shields a lot of politicians (who budget agency money) from scrutiny on cannabis policy, hence the agency’s resistance to any threat to their status quo.
2,737 BCE marks the first recorded use of cannabis as medicine by Emperor Shen Neng of China.
As early as 2,000 BCE, Hindus used cannabis medicinally and ritually as an offering to Shiva.
700 BCE, Zorostrian Zendavesta religious texts refer to marihuana as the “good” narcotic.
70, Roman physician Dioscorides lists medical marihuana in his Pharmacopoeia.
1578, China’s Li Shih-Chen writes of the antibiotic and antiemetic effects of marihuana.
1794, medical marihuana appears in The Edinburgh New Dispensary.
1850, cannabis is added to The US Pharmacopoeia.
1850-1915, marihuana is widely sold and used medicinally in the US.
1910, Mexican immigrants displaced by the Mexican revolution introduce marihuana used as a recreational drug.
1914, the Harrison Act is the first federal law criminalizing non-medical drug use.
1960, Czech researchers confirm the antibiotic and analgesic effects of marihuana.
1971, first evidence that marihuana may help glaucoma patients.
1971, President Nixon declares the War On Drugs, which he intends to use as “cover” for government harassment of minorities and Viet Nam war critics. “We knew we couldn’t make it illegal to be either against the war or black, but by getting the public to associate the hippies with marihuana and blacks with heroin. And then criminalizing both heavily, we could disrupt those communities.” (Nixon aide, John Ehrlichman)
1988, a US DEA administrative law judge finds that marihuana has a clearly established medical use. His recommendation to reclassify it is ignored.
For those politicians and voters that are opposed to “closing our borders” … are they directly/indirectly supporting/encouraging/condoning the importing of Methamphetamine, Marijuana, Heroin coming from Mexico and Carfentanil and other synthetic drugs coming from China. The main reason for the increasing OD’s on our streets and DEA’s justification of increasing the funding of our war on drugs/pts.
If “more government” is the answer – by many people/politicians – to solve virtually any/all problems.. why has the DEA been fighting the war on drugs for some 46 yrs and things are seemingly getting worse ?
Carfentanil, a drug that’s 100 times stronger than fentanyl, the drug that killed Prince, is making its way to the streets of the Midwest, forcing a state of emergency upon the state of Ohio.
Opioid strength is usually measured against morphine. Fentanyl is 50 to 1,000 times stronger than morphine, which makes carfentanil optimistically 5,000 times stronger than morphine. Carfentanil is now being mixed with heroin, which has led to a spike in overdoses.
Carfentanil is now being mixed with heroin, which has led to a spike in overdoses. Photo credit: Palm Partners Recovery Center
Authorities state that usually, 4 or 5 overdoses a day is what they would expect with only heroin and other common opioids hitting the streets. That amount has increased tenfold in Southwest Ohio.
Elephant tranquilizer is not for humans
Carfentanil is so potent that first responders and emergency personnel are advised to wear gloves and protective clothing, as inhaling or touching a minimal amount can cause an effect on the human body.
Because the body takes so much to process carfentanil and is so quickly exposed to its effects, the high obtained from carfentanil is much longer and intense and most of the time the body cannot contain it, leading to an overdose.
Usually, opioid overdoses are treated with naloxone, which is also often provided to opioid addicts trying to recover and to fend off withdrawal symptoms. But carfentanil overdoses are much more severe, which significantly reduces the chances of saving an overdosing patient’s life. It has been reported that emergency staff had to employ at least three times the regular dosage of naloxone to reverse carfentanil overdoses.
An elephant tranquilizer, carfentanil has a restricted distribution among veterinarians. It is a potent opioid used only for sedating large animals with resistant circulatory systems.
Ease of distribution is the main issue
According to the DEA, most carfentanil available on U.S. streets originates from China. People can create an anonymous account on the Internet and buy the drug with relative ease, stated DEA spokesman Russ Baer. He warns that people can quickly obtain synthetic opioids that are much stronger than opium derivates, which originate from poppy plants.
One of the main issues with opioid distribution is the lack of sizeable penalties. Because selling opioids on the street are considered a crime less punishable than murder or anything involving violence, the legal implications are much softer. But the circumstances should change if the trafficked drug is carfentanil, which has a very high mortality as it is not supposed to be consumed by humans in the first place.
The known uses of carfentanil
Carfentanil is sold under the name Wildnil. The DEA classifies it as analogous to fentanyl. It is often administered in 1ml or lesser doses, most of the times through intramuscular administration with a dart. As the animal is treated with carfentanil, it can be operated upon, although veterinarians recommend constant monitoring. In the U.S., carfentanil is mostly used to tranquilize moose and deer, applying a dose on their back, neck or shoulders. Carfentanil’s indications suggest that it should not be used in animals that have cardiovascular or respiratory diseases, which in humans, is often a contributing factor to death by carfentanil overdoses.
Veterinarian recommendations also point out that carfentanil should only be used with naloxone at hand, as it is the most widely-accepted reversal agent. 100Mg of naloxone have to be applied for each milligram of carfentanil. To legally obtain carfentanil, the purchaser must have the DEA’s approval.
In the U.S., carfentanil is mostly used to tranquilize moose and deer, applying a dose on their back, neck or shoulders. Photo credit: Alaska Dispatch News
One of the most widely-known uses of carfentanil was during a 2002 hostage crisis in Moscow. 50 armed terrorists attacked the Dubrovka Theater, taking 850 prisoners. The theater’s inner architecture was such that regular military actions could not provide an appropriate window for taking out the gunmen. Russian forces had to enter the ventilation system and deploy a chemical agent to neutralize the terrorists.
The Russian military used an aerosol containing carfentanil to knock out the Chechen terrorists. The aerosol’s contents were not disclosed until a 2012 research confirmed its composition thanks to the analysis of the urine of two of the operation’s survivors.
The effects of the aerosol appeared to be too severe, and when emergency personnel made it to the scene, they were not carrying the correct reversal agent, in this case, naloxone. The episode resulted in 165 deaths, including hostages and all the Chechen terrorists, mainly attributed to respiratory failure caused by carfentanil overdosing.
According to the DEA, at least 12 substances analogous to fentanyl are produced or distributed on the U.S.’s drug traffic. Most of these opioids can be smoked or snorted, but the primary method of consumption is intravenous administration.
Unlike other synthetic opioids which can be acquired through a doctor’s prescription, carfentanil displays an entirely different type of drug, as it is never administered to humans with a medical purpose. Even if the DEA regulates its distribution and consumption, it has not stopped U.S’s drug traffickers from mixing carfentanil and heroin to cut the product and offer a more powerful high. Unwarily, people buy the mix and overdose, which usually leads them to their death.
Even if prescription drugs are strictly regulated, addicts will always find a way to get their dosage until penalties become much higher and the availability of illicit opioids, at least those such as carfentanil that cannot be legally obtained, is reduced to zero.
I normally don’t participate in surveys because they are generally limited to them asking only questions they want answers to and allow for no input to what concerns those taking the survey. This survey includes to place where the survey taker can have input – free type space – to express in your own words what is important to you.
That does not promise that individual comments will be read, understood or acted upon, but the failure to take the opportunity to make your opinion heard… is a lost opportunity
Below is a paragraph from the CDC guidelines for opiate prescribing… that is specific about them not applying to those receiving palliative care
Below that is two ICD-10 billing codes for palliative care… specifically for pain..
Below that is the WHO (World Health Organization ) definition of what palliative care is
Palliative care is normally part of Hospice care…but… palliative care can be provided as a separate/distinctive modality of care.
In 2015 the Florida Board of Pharmacy has to pass a new regulation that requires Pharmacists NOT TO START LOOKING FOR A REASON NOT TO FILL A CONTROLLED PRESCRIPTION…but to first start looking for a reason to fill one… attempting to do their due diligence to perceived RED FLAGS.
With the publishing of the CDC guidelines has all too many prescribers… in fear/paranoia of the DEA coming around trying to apply the DEA “guidelines” as the law chosen to use the most restrictive part of the dosing guidelines (90 mg/day Morphine Equivalents) as a mandatory limits… regardless of what the rest of the guidelines state about those exempt from those limits. Those chronic pain pts who chose to actively participate in their own care and attempt to educate their prescriber about the full intent of the CDC guidelines may not only get better care for themselves, but also for other pts using the same prescriber.
CDC developed the new Guideline for Prescribing Opioids for Chronic Pain to help primary care providers make informed prescribing decisions and improve patient care for those who suffer from chronic pain (pain lasting more than 3 months) in outpatient settings. The guideline is not intended for patients who are in active cancer treatment, palliative care, or end-of-life care.
Palliative care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual. Palliative care:
provides relief from pain and other distressing symptoms;
affirms life and regards dying as a normal process;
intends neither to hasten or postpone death;
integrates the psychological and spiritual aspects of patient care;
offers a support system to help patients live as actively as possible until death;
offers a support system to help the family cope during the patients illness and in their own bereavement;
uses a team approach to address the needs of patients and their families, including bereavement counselling, if indicated;
will enhance quality of life, and may also positively influence the course of illness;
is applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life, such as chemotherapy or radiation therapy, and includes those investigations needed to better understand and manage distressing clinical complications.
Clinton plans to prevent drug price hikes with federal oversight group
Instead of suggesting that the FDA approve generic products that are being used in Europe that are trying to get FDA approval and let the “free market place” to do its work.. Clinton is suggesting more bureaucracy – and cost – to help save us money… that is the reason why 50 yrs ago … average Rx price was $4 and change and there was no generics… no Medicare.. No Medicaid… all insurance companies were not for profit … no PBM and other middlemen .. with their cost infrastructure and for profit motives… all the while they are promising to save the system money… It’s doesn’t take a PhD in Economics to figure out that adding multiple levels of middlemen will not save a system money.
Amid public outcry over a sharp increase in the cost of the EpiPen, a life-saving drug to stop an anaphylactic allergy attack, Hillary Clinton has unveiled a plan to prevent “unjustified price hikes” for older prescription drugs.
Clinton’s proposal would create a team of representatives from federal agencies that would investigate and monitor the cost of long-available prescription drugs with little or no competition to protect consumers from so-called “price gouging”. The plan sets out criteria for determining “an excessive, outlier price increase” and a set of enforcement tools that include making alternative drugs available and imposing fines or penalties to help fund expanded access.
“Over the past year, we’ve seen far too many examples of drug companies raising prices excessively for longstanding, life-saving treatments with little or no new innovation or [research and development],” Clinton said in a statement. “It’s time to move beyond talking about these price hikes and start acting to address them.”
Last week, Clinton called on Mylan, the manufacturer of EpiPen, to reduce the cost of the medical device after reports highlighted that its price rose by 461%, from from $56.64 to $317.82, since 2007, when the company acquired the product.
In a statement, Clinton called the price hike “outrageous” a “troubling example” of pharmaceutical companies taking advantage of consumers. “Since there is no apparent justification in this case, I am calling on Mylan to immediately reduce the price of EpiPens,” Clinton said in a statement.
In response to the uproar, Mylan said it would launch a generic EpiPen version that is identical to the brand-name device but significantly less expensive, with a list price of $300 for a two-pack. The company also announced earlier that it would offer additional financial assistance, including co-payments worth $300, to patients who have to pay the full out-of-pocket price for the device.
That plan would deny tax breaks for pharmaceutical companies that market medicines directly to consumers, a controversial and costly practice legal only in the US and New Zealand, according to the World Health Organization. Clinton also said she would push companies to invest in research and development in exchange for federal subsidies.
While many people are looking forward to this long Labor Day weekend, others have their sights set on Sept. 8, the day medical marijuana becomes legal in Ohio.
In June, Ohio was the 25th state to legalize a comprehensive medical marijuana program.
There’s no licensed legal businesses to grow, process or sell marijuana or marijuana products in Ohio.
But patients with one of 19 medical conditions — including cancer, glaucoma, epilepsy and extreme pain — will be able to go to states where medical marijuana is legally sold, buy it and return to Ohio to use it. They would need a doctor’s note or authorization.
But not all states permit sales to non-residents.
And flying to other states to get it could pose problems. as marijuana is still illegal under federal law, so it could be a potential legal problem if a person with it is apprehended.
And right now there are no legal marijuana businesses in Ohio and there won’t be for some time.
So Sept. 8 is not a benchmark date for activity in Ohio.
Still to come? A 13-person advisory panel must still be picked by the governor and legislature to work with the State Commerce Department, Medical Board and Board of Pharmacy to to draw up regulations to grow, process and sell marijuana and its derivative products. The deadline for regulations is May 2017.
Some Ohio cities are concerned about possible enforcement issues and other problems if marijuana businesses come to town. The new law gives cities local control. Despite the fact that licensing of farms, processing facilities and retail dispensaries is still some time away, some cities are moving to ban or control marijuana businesses.
And state law forbids marijuana businesses from being within 500 feet of a school, library, church or playground, so that’s another consideration.
For example, Lakewood and Brooklyn have passed six month moratoriums on opening any marijuana businesses. Lakewood is also halting changing zoning or building laws to permit them.
The state’s new legal marijuana industry is not expected to be completely up and running until September 2018.
• Adults could buy and use oil, tinctures, plant material, edibles and patches with a doctor’s recommendation. Parents could purchase these products for their children younger than 18 with a doctor’s referral.
• The Ohio Department of Commerce would oversee those who grow, process and test medical marijuana. The Ohio Board of Pharmacy would register patients and caregivers and license dispensaries. The Ohio State Medical Board would handle certificates for doctors who want to recommend marijuana.
• A program to reduce the cost of medical marijuana for veterans and others too poor to pay.
• The ability to purchase medical marijuana from other states while Ohio sets up its program. This would expire 60 days after the pharmacy board establishes its rules.
• Legal medical marijuana for people with these conditions: AIDS, amyotrophic lateral sclerosis, cancer, chronic traumatic encephalopathy, Crohn’s disease, epilepsy or another seizure disorder, glaucoma, hepatitis C, inflammatory bowel disease, multiple sclerosis, pain that is chronic, severe, or intractable, Parkinson’s disease, positive status for HIV, posttraumatic stress disorder, sickle cell anemia, spinal cord disease or injury, Tourette’s syndrome, traumatic brain injury, and ulcerative colitis.
What’s Not In The Plan:
• Smoking medical marijuana
• Growing medical marijuana at home
• Any details on who could grow marijuana commercially. That would be determined later by the Ohio Department of Commerce.
• Any requirement that pharmacists oversee dispensaries.
• Protections for employees fired from their jobs because they used medical marijuana.
I received this email at 9:56 AM this morning (Friday).. with a recommendation that community pharmacies and other healthcare professionals – STOCK UP – on Naloxone for the Labor Day weekend.. Most community pharmacies get wholesaler deliveries daily Mon – Fri and the cut off for Friday’s delivery is normally around 6 PM YESTERDAY ( Thursday) and the stores will not get another wholesaler delivery until TUESDAY… Sure looks like Kentucky Emergency Management System is right on top of things…???
The Kentucky Department for Public Health (DPH) is hosting a special conference call today with medical personnel and emergency responders regarding the ongoing issue of heroin overdoses linked to fentanyl. The call is scheduled for 11:00 a.m. EDT, Friday, September 2, for interested pharmacists and other health care professionals. The dial-in number is 866-570-4047. The passcode is 75613975#.
Our region and our entire state are now threatened by a drug issue related to the appearance of contaminated heroin, typically mixed with fentanyl or other toxic substances. This is a very serious public health issue tied to a number of overdoses, hospitalizations and deaths across the country.
Over the upcoming days, DPH is asking our hospitals, pharmacies and EMS to help prepare for increases in drug overdoses so that individuals can be properly treated, deaths prevented and we all can be better informed about the prevalence and nature of these occurrences so they can be prevented. We expect a possible increase in overdoses over this holiday weekend. EMS, ER, and pharmacies must stock up on naloxone immediately. KDPH is getting early reports that it now requires as much as three-fold the ordinary dose of naloxone to negate this newly compounded material. These points will all be discussed in greater detail during today’s call.
If you need assistance, you can contact the Kentucky Emergency Management System at (502) 607-1638 Toll Free: (800) 255-2587, your local health department, or the Department for Public Health at 1-888-9REPORT (973-7678).
AGENDA
Public Health Alert Conference Call
Friday, September 2, 2016
11:00 A.M. – 12:00 P.M. EDT
Joining the Conference Call:
Prior to call start time, call the Dial-In Number: (866) 570-4047
Provide the Passcode: 75613975
TOPIC PRESENTER
Welcome and Overview Rick Johnson, BS (Facilitator)
Opening Remarks Hiram Polk, MD, Commissioner
Heroin/Fentanyl Current Situation Van Ingram, Office of Drug Control Policy
Medication Supply Plans, Training and Certification Programs Leah Tolliver, Pharm. D., Director of Pharmacy Emergency Preparedness, KPhA
Call to Action Hiram Polk, MD, Commissioner
Question and Answers – Next Steps All Participants
Kentucky Pharmacists Association 96 C. Michael Davenport Blvd. Frankfort, Kentucky 40601 www.kphanet.org 502-227-2303 Membership Matters: To YOU, To YOUR Patients, To YOUR Profession!
(CNN) —China’s ban on certain chemicals is being credited by Drug Enforcement Administration officials in a noticeable decrease in certain synthetic drugs in the United States.
Police encounters with six substances that were part of China’s 115-chemical ban have dropped dramatically (PDF) since it took effect in October, DEA numbers show.
Synthetic cannabinoids — commonly known as K2 or spice — stimulants similar to cocaine or MDMA and the notoriously dangerous synthetic known as flakka have fallen dramatically from they were last summer.
Flakka has all but disappeared from Florida, where it was wreaking havoc.
“We’ve definitely seen a significant decrease, especially of flakka,” Broward County Sheriff’s Lt. Ozzy Tianga said.
As a result, DEA officials say, they are optimistic that ongoing meetings with their Chinese counterparts can continue the trend. This month, 14 high-ranking DEA officials spent a week in Beijing and two other Chinese provinces, where they talked about how to work together to tackle the problem of Chinese chemists making and selling dangerous synthetic drugs in the United States.
DEA spokesman Russell Baer called it an “unprecedented dialogue between the two countries.”
China now faces a problem similar to one the United States has been struggling with: how to keep up with chemists who are constantly tweaking formulas to stay one step ahead of the law.
Tianga said he anticipated that new synthetics would show up in place of those banned, and officials have seen some of that, but the numbers have been nothing like last summer, when flakka use was at an alarming high.
“Overall, [synthetics have] significantly dropped since the ban — at the epicenter here in South Florida,” Tianga said. “But by no way are we out of the woods. There will be more molecular changes to substances that will be introduced to society.”
In Florida this summer, the Legislature approved and the governor signed a blanket ban of substances that have no practical use other than to get high.
Baer said the DEA is continuing to work with Chinese officials on a similar ban as they now battle a nationwide problem with synthetic fentanyl.
“They talked about continuing efforts to try to understand each other’s perspective of this problem,” he said. “Historically, we have not been able to talk about this stuff. We’ve now gotten to the point that China is listening to us and addressing some of the [drug] scheduling issues. They are their own country, and they have their own concerns. One [problem] people don’t understand is that China has an extensive commercial manufacturing program over there. These illicit substances … are a small part of that huge legitimate industry.”
Police arrest 3 suspects after pharmacy robberies in Mooresville
About one year + ago all the major chains in Indianapolis/Marion County Indiana put in time delayed safes to help put a halt to all the pharmacy robberies – Indiana is/has been NUMBER ONE in pharmacy robberies out of all 50 states… So what did people interested in robbing pharmacies do?… they have started robbing pharmacy outside of Indianapolis. Mooresville is about 30 miles SW of Indianapolis and outside of Marion County.
MOORESVILLE, Ind. – Police in Morgan County arrested three suspects in connection with a series of recent pharmacy robberies.
On Saturday, Aug. 27, Mooresville police officers arrived at Walgreens, 115 Fields St., in response to a reported robbery. The suspect had already left when police got there.
Mooresville detectives were already out investigating another robbery and quickly arrived at the location to interview witnesses and gather surveillance video. Surveillance footage showed a man enter the store, talk to the cashier and then bring an item to the checkout. He gave the cashier a note saying he had a gun and handed over a list of prescription drugs for the cashier to retrieve.
The cashier was ordered to contact her manager; the cashier, manager and suspect all approached the pharmacist, who complied with the suspect’s demands and put the medications inside a bag. The man then left.
Detectives had investigated a Walgreens robbery from June 21, 2016, that was similar in nature. Police prepared a photo lineup and identified the suspect.
On Thursday, Morgan County sheriff’s deputies were at the Ricker’s gas station on Bridge Street when someone approached them about a suspicious car on Conduitt Drive. Deputies went to check on the vehicle and then stopped it. After identifying the men inside, they realized one of them was suspected in the Walgreens robberies.
Evidence found inside the car connected the suspects to the pharmacy robberies, police said. Investigators also believe the three men were getting ready to commit another robbery.
All three were arrested; police identified them as Ryan Curlin; 23; Devonte Harris, 23; and Donte Harris, 23. The suspects are all from Indianapolis.
PALLIATIVE CARE vs HOSPICE
