“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
Imagine this… a legally licensed pharmacy sends a C-II order to a legally licensed wholesaler and the wholesaler fills the orders and sends the requested C-II medications to the pharmacy that ordered them. Now comes the Attorney General of WV claiming that the wholesaler should have know that the amount of C-II’s that were ordered were not for a legit prescriptions/medical necessity… The wholesaler had no relationship with the doctor who wrote the prescriptions nor the pt that had the prescriptions filled. Now in order to settle this whole mess .. the AG has “extorted” 6.7 million out of several of the wholesalers. I wonder why the AG did not go after the insurance companies that paid for all those doses of C-II’s… They should have known that the doses were excessive, but have they escaped being challenged for what reason ?
MADISON, W.Va. (AP) — The Latest on settlements in West Virginia with drug wholesalers (all times local):
Five drug wholesalers have agreed to a $4.2 million settlement in a lawsuit alleging that they shipped an excessive number of prescription opioids to West Virginia.A news release from Attorney General Patrick Morrisey on Thursday announced the settlement with Anda Inc., The Harvard Drug Group, Associated Pharmacies, KeySource Medical Inc. and Quest Pharmaceuticals. As part of the settlement, they deny the lawsuit’s allegations.
Miami-Luke previously agreed to settle for $2.5 million, bringing the total in the lawsuit to $6.7 million.
In 2012, then-Attorney General Darrell McGraw filed a lawsuit against 12 prescription drug wholesalers. Documents show that the companies distributed painkillers to notorious “pill mill” pharmacies in West Virginia’s smallest towns and poorest counties. There are lawyers that can help in such cases and they serve all of San Antonio.
The release says the attorney general, drug wholesalers, and state health and public safety agencies settled to avoid delay, expense and inconvenience, and uncertainty of litigation.
KeySource Medical and Associated Pharmacies have joined other drug wholesalers and agreed to settle a lawsuit alleging that they shipped an excessive number of prescription opioids to West Virginia.The Charleston Gazette-Mail reports (http://bit.ly/28RrQNi) that according to the lawsuit, between 2007 and 2012 Associated Pharmacies shipped 2.7 million doses of hydrocodone and 266,700 oxycodone pills to West Virginia. In the same timeframe, KeySource Medical distributed 1.2 million hydrocodone pills and 905,000 oxycodone tablets.
In 2012, then-Attorney General Darrell McGraw filed a lawsuit against 12 prescription drug wholesalers. Documents show that the companies distributed painkillers to notorious “pill mill” pharmacies in West Virginia’s smallest towns and poorest counties. In case there is any issue the criminal lawyers from Miranda Rights Law Firm can help you file a suit.
Boone Circuit Judge William Thompson is allowing companies that settle with Attorney General Patrick Morrisey’s office to keep secret information about pill shipments to specific pharmacies in southern West Virginia.
House Republicans blocked an effort to open up banking for pot businesses, an Oregon worker fired for medical marijuana use wins his job back, DEA agents get new marching orders on hookers, the Thai government grapples with methamphetamine policy, and more.
Patronize a prostitute, lose your DEA badge.
Marijuana Policy House Turns Back Effort to Give Pot Businesses Access to Banks. The Republican-led House Wednesday voted down an amendment to the FY 2017 Financial Services and General Government Appropriations Act that would have blocked federal regulators from punishing financial institutions for working with state-legal marijuana businesses. A similar amendment had passed the Senate last week.
Nevada Legalization Effort Has Raised Nearly $300,000 This Year. The Nevada Coalition to Regulate Marijuana Like Alcohol has raised $285,000 so far this year, with more than half coming in a two-day period earlier this month when local marijuana companies made significant donations. The campaign’s legalization initiative has qualified for the November ballot. Opposition groups made no reports of donations this reporting period.
Oregon Takes in Nearly $15 Million in Pot Taxes So Far This Year. As of May 30, the state Department of Revenue had processed $14.9 million in marijuana tax payments this year, the agency said Wednesday. Medical marijuana dispensaries authorized to sell to any adult 21 or over began collecting the tax in January.
Medical Marijuana
New Mexico Auditor Bemoans Delays in Processing ID Cards. The state auditor and the attorney general are investigating a backlog of medical marijuana ID card applications as requests for the cards surge. The state has 30 days to issue the issue the cards, but the Department of Health said it is taking 45-50 days, and the auditor’s office said it had complaints of wait times of up to 90 days.
Oregon Worker Fired for Medical Marijuana Wins Jobs Back. An arbitrator has ordered Lane County to reinstate a worker it fired because he used medical marijuana to deal with the side effects of cancer treatment and it has ordered the county to give him nearly $22,000 in back pay. Michael Hirsh had been employed as a senior programmer for the county before he was fired in December after two employees reported smelling pot smoke on his clothing.
Heroin and Prescription Opioids
New York Governor Signs Heroin Bill Package. Gov. Andrew Cuomo (D) Wednesday signed into law a package of bills aimed at the state’s heroin and prescription opioid problems. The bills, which address prevention, treatment, and insurance coverage, should produce an additional 270 treatment beds and more than 2,000 slots for drug treatment programs. The bills also require insurance companies to wait 14 days before denying coverage to drug users deemed in need of drug treatment, and it limits initial prescriptions for opioids for severe pain to seven days.
Law Enforcement
No Hookers for DEA Agents. In the wake of scandalous behavior by DEA agents in Colombia during the 2012 Summit of the Americas, the DEA has instituted a one-strike policy for agents caught patronizing prostitutes. “Solicitation of prostitution on duty or off duty, whether you’re in a jurisdiction where it is legal or illegal, first time offense — removal,” DEA administrator Chuck Rosenberg told a Senate panel Wednesday.
International
UN Releases Annual Global Drug Report—250 Million Adults Used a Drug Last Year. The UN Office of Drugs and Crime has released the World Drug Report 2016, and notes that 5% of the adult population has used at least one drug in the past year. The UN also reported that the number of people classified as suffering from a dependency disorder climbed to more than 29 million, up from 27 million the previous year.
Thailand Won’t Legalize Meth, But Will Remove it From List of Dangerous Drugs. Thai Justice Minister Paiboon Koomchaya has walked back talk about legalizing the amphetamine, but now says the country will work to reform its drug laws by removing meth from its list of hard drugs like heroin and recognizing a distinction between traffickers and users, workers, and addicts.
will be hosted by Bill Hemmer on Saturday, June 25th at 8PM ET (5PM PT) and will be rebroadcast on Sunday, June 26th at 3AM ET (Midnight PT) AND again on Sunday at 9PM ET (6:00PM PT) – repeating again at midnight ET (9PM PT). Preventable medical errors, like the one that took Chris Jerry’s beautiful 2-year-old daughter Emily, are the third leading cause of death in America! Written with special emphasis on the work of the Emily Jerry Foundation (and supporting documentation in the Pulitzer Prize Nominated, Advocacy Heals U, 15 Keys to Fast Track Results and Emotional Fulfillment), Fox News Senior Producer, Rachel Feldman, has worked tirelessly to write and produce a must see, critical documentary on preventable medical errors that will help raise awareness and promote patient safety! Do you know that you and your loved ones are consistently put at risk in our healthcare system? What should you know that can help protect each patient? Tune in and find out why preventable medical errors are just that…PREVENTABLE!
Chris Jerry (host of Surviving Healthcare Today on iHeart.com), the board of directors at EJF, and all of the advocates who work tirelessly to raise awareness of preventable medical errors, we all wish to thank you for your continued support of The Emily Jerry Foundation (www.emilyjerryfoundation.org). JUST ONE LIFE lost to preventable medical error is too many! PLEASE SHARE THIS INFORMATION WITH YOUR FAMILY AND FRIENDS.
This study would suggest that the current mindset of “save the addict with Naloxone” is nothing short of a “catch and release prgm” and its chances of making/causing a opiate abusers to become straight/sober are virtually NIL. I predict that within a couple of years.. as the number of substance abusers increase and the number of doses of Naloxone administered increases..the politicians/bureaucrats that came up with this LAME BRAIN idea will have to go back to the drawing board… because they will have created a much LARGER MONSTER … all too many substance abusers who count on the availability of Naloxone being available to “pull them back” and they perpetually seek an even HIGHER HIGH.. because they know that they can be pulled back FROM THE BRINK OF DEATH.
Though conventional wisdom says it takes five to seven attempts for most smokers to quit, those estimates may be very low, a recent study suggests.
Based on data for more than 1,200 adult smokers in Canada, the real average number of quit attempts before succeeding may be closer to 30.
“For so long we’ve been talking about five to seven attempts to quit,” said lead author Dr. Michael Chaiton of the school of public health at the University of Toronto in Canada. “For us (the numbers) were a lot higher.”
The lower estimate comes from a few past studies that were based on the lifetime recollections of people who successfully quit, but they didn’t include attempts by people who had not yet succeeded, Chaiton and colleagues note in the journal BMJ Open.
For their study, the researchers analyzed data from 1,277 people in the Ontario Tobacco Survey who were followed for up to three years. When the study began in 2005, participants reported how many times they recalled ever making a serious attempt to quit smoking, and at each six-month follow-up they reported how many serious quit attempts they had made over the past six months.
A quit attempt was deemed a success when a participant went at least one year without a cigarette.
The researchers used these responses and four different statistical models to estimate how many times the average smoker attempts to quit before succeeding. The most unbiased model suggested an average of 30 quit attempts per smoker.
That’s much higher than people tended to report in the previous studies when asked about all their quit attempts since starting smoking, the study team writes.
“People are very bad at remembering over their whole lifetimes,” Chaiton told Reuters Health. “The second problem is we were only asking people who have been successful at quitting.”
The new study may be a better representation of what most smokers go through over time, but it does only describe their situation rather than predict what will happen to an individual smoker who tries to quit, he cautioned.
“This doesn’t mean you hit a magic number and then you can quit,” Chaiton said. “There are many people who are able to and do quit on their first attempt or in the first few.
“There are people who are good at many things, some are good at quitting smoking,” he added.
Quitting smoking is often a long-term process with many attempts, he said.
“When we talk about trying to reduce the number of smokers, if we try and do that by focusing on one quit attempt at a time we’re not going to be very successful,” Chaiton said.
A range of smoking cessation medications, policies like smoke-free spaces and plain-pack warnings can all help some smokers quit, he said.
“The main impact of this article is that clinicians should reassure smokers that, just because they have failed 10 times, does not mean they will never quit,” said Dr. John Hughes of the University of Vermont School of Medicine in Burlington.
“However, the problem with taking, say, 20 times to quit, is that this may take 10 years and it’s not only important to quit but it’s important to quit while you are younger,” said Hughes, who was not part of the new study.
“So it’s important for those who failed several times to seek treatment to increase odds of quitting and we have lots of medication and counseling treatments that work,” Hughes told Reuters Health by email.
Democrats drowned out the Speaker with chants, sang We Shall Overcome on the floor of the House of Representatives and held up pictures of gun violence victims as they continued a sit-in demanding action to curb mass shootings in the United States.
The rebellion began before midday on Wednesday and continued into Thursday morning as one extraordinary day on Capitol Hill merged into another. A group of Democrats led by the civil rights veteran John Lewis occupied the “well” in front of the dais, demanding a vote on gun control measures in the wake of the Orlando massacre.
Raucous scenes continued through the evening and past midnight as the group defied Speaker Paul Ryan with shouts, chants and songs. There were ugly exchanges with Republicans at times, including raised voices and jabbed fingers that momentarily appeared likely to escalate into violence.
The sit-in continued through a series of legislative proceedings – unrelated to gun control – that dragged into the early hours of Thursday, with representatives coming and going in the chamber to take part in various votes while the Democrats maintained their encampment.
Ryan, struggling to make himself heard, at one point called a vote on labor legislation, then left the podium as Democrats booed and chanted: “Shame! Shame!”
One Democrat cried out: “Mr Speaker, give us a vote!”
The Democrats crammed into the well also burst into soulful renditions of the civil rights anthem We Shall Overcome. One member placed a hand on Lewis’s back as he joined the chorus.
Republicans looked on from their seats or stood and chatted to each other. Once the vote on labor legislation was complete, Democrats chanted: “Give us a vote, give us a vote, give us a vote.” But the House went back into recess.
Most Republicans filed out, though a few lingered and heckled Democrats. At one point a Republican, Louie Gohmert of Texas, stood toe to toe with Corrine Brown of Orlando in a confrontation that looked set to spiral out of control until Lewis and others intervened. “Radical Islam killed these people!” Gohmert shouted.
The Texan later told the Guardian he was angered by disregard for the procedures of the House, which he called a “last bastion of civility”, and that “these 49 victims [of Orlando] were being disrespected … I’m amazed here on the House floor that to them [Democrats] it’s all about guns. The truth is that radical Islam is at war with western civilisation and moderate Muslims want this to stop.”
The Democrats started their sit-in at 11.25am on Wednesday demanding a vote on gun control measures that they insist will save lives.
Lewis, 76 – who half a century ago took part in sit-ins and acts of disobedience during the struggle for civil rights – told the House: “We have been too quiet for too long. There comes a time when you have to say something. You have to make a little noise. You have to move your feet. This is the time.”
He added: “How many more mothers? How many more fathers need to shed tears of grief before we do something? Give us a vote. Let us vote. We came here to do our job. We came here to work.”
Shortly afterwards Democratic members sat down in an area near the podium known as the “well” – some cross-legged on the floor – and began reading the names of the 49 people shot dead in an Orlando nightclub. They also prayed and sang We Shall Not Be Moved.
Exasperated Republicans were forced to call a recess while shutting off microphones and TV cameras, but coverage and photos of the protest spread fast on social media. Barack Obama’s Twitter account responded: “Thank you John Lewis for leading on gun violence where we need it most.” Hillary Clinton tweeted: “This is what real leadership looks like.”
Later, as the scheduled time for an evening vote approached, Lewis addressed the group again. “Thank you for getting in trouble – good trouble. Yes to trouble!” he told them, to cheers.
The moment was broadcast via Periscope on the phone of Democratic congressman Scott Peters, who was orchestrating a group of lawmakers to record the event and broadcast it after the cameras in the chamber were turned off.
“I never, ever thought that one day, after sitting in here many days and many nights, that one day I would be more than lucky but very blessed … to sit down on the House floor with all you great ladies and gentlemen,” Lewis continued. “We have a right to protest for what is right. That’s all we can do. There are people hurting, there are people suffering, so we have an obligation, a mandate, to do something.
“Maybe our forefathers all came to this land in different ships,” Lewis said, “but we’re all in the same boat now.”
The House minority leader, Nancy Pelosi, also addressed the protesting representatives. “The press and others are saying, ‘How long will they stay?’” she said. “I said, it’s totally up to them. If John says we stay, we stay.”
The assembled lawmakers erupted in a chant of “no bill, no break”.
The sit-in was the latest move by Democrats to push boundaries in their long battle for tighter restrictions on firearms. A week earlier Senator Chris Murphy staged a near 15-hour filibuster to force votes in the Senate on gun legislation. The votes failed on Monday night.
House Democrats are demanding a vote on measures to expand background checks and block gun purchases by individuals on the FBI’s terror watch list. They are demanding that Ryan, keep the House in session through its planned week-long recess next week to debate and vote on gun legislation.
Ryan told CNN late on Wednesday that their action was “nothing more than a publicity stunt”.
Lewis was beaten by police in the 1965 civil rights march in Selma, Alabama, and led sit-ins at segregated lunch counters in Tennessee.
Lewis told the Guardian: “Sometimes you have to do something out of the ordinary to dramatise an issue, to make it real, to make it plain so the American people could understand what it’s all about. At another period of our history, at the height of the civil rights movement, we had sit-ins and stand-ins and rioting so maybe, just maybe, we thought it would be effective by having something similar on the House floor.
“It brings some unbelievable memories but I never thought, never dreamed that one day I would be sitting down on the floor of the House of Representatives, not on a chair, but on the floor, to say to the leadership of the House, bring a bill to the floor, give us a vote to do something about gun violence.”
Asked if the Orlando attack – the worst mass shooting in US history – was a tipping point, Lewis replied: “Something had to be done. When you have 49 people murdered and many more shot and wounded and hurt, and then hundreds of thousands of our brothers and sisters, our mothers and fathers, and our little children, our little babies, are being wounded and killed, you have to act, you say something, you have to make some noise.”
Lewis and his colleagues had not had any direct contact with the Republican leadership, he added, declining to specify how long the sit-in would continue. “We’re not going any place. We’re going to stay here for a while. We want action now.”
Judy Chu, a representative from California, told MSNBC: “When 49 people were murdered in Orlando and nothing done about it and the only responses were moments of silence, well, so many of us said, enough is enough, we have to do something about this.”
The House minority leader, Nancy Pelosi, speaks at a news conference on gun control on Capitol Hill as House Democrats stage a sit-in. Photograph: Alex Wong/Getty Images
Both expressed gratitude to Senate Democrats for showing support and expressed hope that people would pressure the Senate to reconsider the legislation.
Murphy said: “John Lewis is a true hero. No one in Congress has done more throughout the course of their life to stand up for justice and righteousness. I’m proud of my Democratic colleagues in the House today.
“We will not alter the way Congress responds to the mass slaughter of our constituents without ripping up the usual script and demanding change. We forced Senate Republicans to allow votes to keep guns away from dangerous people – the House should not go on vacation until Speaker Ryan and House Republicans do the same.”
Democrats began their demonstration about half an hour before the House was due to go into session. Ted Poe, a Republican from Texas, tried to start business at noon. The customary prayer and pledge of allegiance went ahead, but Poe banged the gavel several times in vain and was forced to call a recess when Democrats refused to leave the well.
Mike Doyle of Pennsylvania shouted: “We’ve had it. We’re not going to watch any more people in this country get slaughtered and do nothing!”
Steny Hoyer of Maryland, the number two House Democrat, said defiantly: “We will not be shut up. We will not be shut down.”
Democrats accused Republicans of political cowardice by failing to schedule a vote. “Are they more afraid than the children at Sandy Hook?” asked Mike Thompson of California, referring to the 2012 shooting that killed 26 people, including 20 elementary school children, in Newtown, Connecticut. “What is so scary about having a vote?”
John Larson, a Democrat from Connecticut, cited polls showing broad public support for expanding background checks for firearms purchases and blocking suspected terrorists from buying guns. “Rise up Democrats, rise up Americans,” Larson said. “We will occupy this chamber.”
Republican leaders ordered the C-SPAN TV network’s cameras to be switched off but Larson said: “They can turn off all the TV they want, but they can’t stop us from doing what we know is the right thing here in this well.” A senior Republican House leadership aide said, according to rules voted on by all members of the House at the beginning of the Congress, cameras are only switched on when the House is in session.
Ryan’s spokeswoman, AshLee Strong, said: “The House cannot operate without members following the rules of the institution.”
John Fleming, a Republican from Louisiana, was quoted by the Associated Press as saying: “We don’t view the fact that someone becomes radicalised and decides to kill a bunch of Americans … as a gun problem. We view that as a terrorist problem.”
By 5pm more than a hundred members were present in the House, most sitting in its brown leather chairs, although about a dozen sat or even lay on the blue carpeted floor. Many were using phones, presumably to distribute words and pictures on social media in the absence of TV coverage.
One after another, members of congress took to the podium to make impassioned speeches calling for tighter gun controls, often citing examples of victims and raising their voices to compensate for the dead microphones. In between each speech there were the lusty cries of “no bill, no break”.
Rep John Garamendi of California unleashed an angry tirade at the absent House Speaker. “Where the hell are you?” he shouted. “Take your responsibility seriously and give us a vote!”
Garamendi described it as “insanity” that someone too dangerous to board a plane was not deemed too dangerous to buy a gun. “This is not only crazy, it is downright dangerous.”
One member asked: “When was the last time you sat on the floor?” Someone shouted back: “The 60s!”
Senator Bernie Sanders, who contested the Democratic primary election, made a brief appearance in the chamber to cheers and applause. Debbie Wasserman Schultz, chairperson of the Democratic National Committee, was also present. There was a healthy attendance in the public gallery watching the drama unfold.
Messages on Facebook and elsewhere showed that the majority of Americans, including members of the National Rifle Association, support reforms, said Rep Jan Schakowsky. “The Republicans have not figured out that the world has changed.”
Outside there were messages of support from gun control campaigners. Lucy McBath, who became faith and outreach leader for Everytown for Gun Safety after her teenage son was shot dead, said: “I am deeply grateful for the leadership of Rep John Lewis in staging a sit-in on the House floor today and I applaud all the House members who participated.
“I’m a product of the civil rights era, and my father was a civil rights leader. I understand the power and authenticity of being able to move people for a cause – and Rep Lewis has demonstrated the passionate desire in our country for laws that will help save American lives from gun violence.”
Shannon Watts, founder of Moms Demand Action for Gun Sense in America, said: “We applaud Leader Pelosi, Congressman Thompson and all the House leaders demanding a vote on gun safety today.
“The next step is clear for both parties and for both chambers of Congress – it’s time to buck the NRA, protect the public and ensure that dangerous people, including suspected terrorists, cannot buy guns.”
Back in the House, Rep Maxine Waters of California said: “I am willing to stay here until hell freezes over. We’re here because we can’t take it any more … We can’t take burying our young people.”
Last spring, Chinese customs agents seized 70 kilograms of the narcotics fentanyl and acetyl fentanyl hidden in a cargo container bound for Mexico.
The synthetic opium-like drugs were so potent that six of the agents became ill after handling them. One fell into a coma.
The cargo had traveled through five freight forwarders before reaching customs, obscuring its exact origins, according to an internal U.S. Drug Enforcement Administration intelligence briefing reviewed by The Wall Street Journal.
One thing is clear: The shipment and a host of others, detailed in the DEA briefing, court documents and interviews with government officials in multiple countries, are part of a vast drug-distribution network beginning in China that feeds lethal fentanyl to the Americas.
The network often avoids efforts to stop it by trading not only in finished fentanyl but related products subject to little or no regulation in China or internationally. These include some copies of fentanyl known as analogs, as well as the chemical ingredients and pill presses used to produce the drug, according to the documents and interviews.
The China Food and Drug Administration declined to comment on the sale and production of fentanyl and referred questions to the Ministry of Public Security, which didn’t respond.
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Fatalities related to the synthetic opioid fentanyl–up to 50 times as powerful as heroin–are soaring in many parts of the country. Joseph Murphy’s addiction to the drug tore his family apart. Now they’re trying to put their lives back together. WSJ Video: Robert Libetti. Photo: Kieran Kesner for The Wall Street Journal
Fentanyl and its analogs are killing Americans at an alarming rate, marking a deadly new chapter in the nation’s struggle with opioid addiction. Fentanyl is up to 50 times as potent as heroin but easier and cheaper to produce, made from chemicals instead of fields of poppies. Legal versions of fentanyl have been sold as painkillers or anesthetics since the 1960s. Today, illicit batches are driving a surge in overdose deaths. In April, Prince died of a fentanyl overdose; it isn’t known if he had a prescription.
The cargo seized by the Chinese last year was destined for Mexico, where U.S. officials say cartels repackage the drug and smuggle it into the U.S. Some Mexican traffickers have also ordered chemical ingredients from China and used them to manufacture fentanyl in their own clandestine labs for export to the U.S. Documents from a case resulting in a guilty plea in federal court in Illinois last year show that one Mexican lab ordered fentanyl ingredients from a Chinese company in the southern port city of Xiamen.
Fentanyl and its analogs are also being purchased online by small-time traffickers in the U.S. and Canada, law-enforcement officials say. Alleged sellers have recently been charged in Texas, Connecticut and North Dakota.
Whether the drug or its building blocks travel through Mexico or directly to the U.S. or Canada, the “primary source” is China, according to the internal DEA briefing.
China’s sprawling chemicals industry has helped foster this booming trade. So has spotty regulation in China and beyond. While U.S. law limits and monitors trade in key ingredients used to make fentanyl, the chemicals are unregulated in China or by United Nations conventions that police the global drug trade. U.S. law requires that any import or export of pill presses be for “legitimate uses” and reported to the DEA, but China and Canada’s federal government don’t regulate their trade. These gaps allow some traffickers in the Americas easier access to materials that help them set up their own clandestine labs.Click here nican for more information.
Pills meant to resemble prescription hydrocodone but instead containing fentanyl led to a rash of deaths in Northern California earlier this year. Photo: DEA
Canada’s federal health department says it is now “actively looking into the issue of pill presses as part of a comprehensive approach” to combat opioid abuse.
China has long prohibited the nonmedical sale of fentanyl itself, and last fall, it added several analogs including acetyl fentanyl to a list of controlled narcotics. But U.S. officials say some Chinese companies continue to export illicit batches of these narcotics anyway. Others have begun shipping fentanyl analogs that aren’t yet subject to regulation.
Hard-hit states are pressing Washington to crack down. In a letter to the State Department last month, Senator Pat Toomey (R., Pa.) urged officials to “apply additional pressure” on Beijing to step up regulation of drug variants, chemical ingredients and pill presses. “It’s extremely lethal, we know where it’s coming from, and I think we ought to be putting more pressure on the Chinese to do something about it,” Sen. Toomey said in an interview.
In its reply to the senator, the State Department said it is encouraging China to “support an international response to controlling these dangerous substances and broaden its voluntary cooperation until formal controls can be put in place.”
Inside China, authorities have long sought to control domestic narcotics use. The Communist Party in particular is mindful of widespread opium addiction in China in the 19th century, fueled by trade from British colonies that culminated in the Opium Wars and the weakening of the Qing Dynasty. Fentanyl, by contrast, hasn’t gained a significant foothold among Chinese addicts, meaning authorities may have less incentive to control the illicit trade to the West, according to U.S. officials.
During a meeting about narcotics at United Nations headquarters in New York this spring, one Chinese official emphasized the need for other countries to curb demand. Liu Yuejin, deputy commissioner of China’s National Narcotics Control Commission and vice-minister for public security, said nations that consume illicit narcotics are “not justified in requiring only drug-producing countries to counter the manufacture of drugs; they must also address the consumption market,” according to a U.N. summary of the meeting.
Opioid addiction in the U.S. has reached what public-health officials call crisis levels, spurred by widespread prescribing of legal but addictive pain medications beginning in the 1990s. Many people who became hooked on pain pills later turned to heroin and other illicit opioids. Today, the fentanyl that makes its way into addicts’ hands is often not from a prescription, but from drug dealers.
Because fentanyl is so potent, it is particularly lethal when abused at high doses. Its potency is part of the reason traffickers sell it or add it to other drugs—the strong high keeps buyers coming back for more, law-enforcement officials say. It can also be far more profitable for drug cartels and distributors than heroin.
The DEA report warns in particular about a flood of counterfeit pills hitting the U.S., which resemble legal medications but actually contain fentanyl. Often, black-market buyers of these drugs aren’t aware they are getting fentanyl, law-enforcement officials say.
This spring, counterfeit pills containing fentanyl that looked like prescription hydrocodone were linked to a cluster of 53 overdoses that killed 13 people in Northern California. Early this year, fentanyl-laced counterfeits made to resemble Xanax, the antianxiety medication, killed three people in Pinellas County, Fla., and were “strongly suspected” of causing six additional deaths, according to the county sheriff’s office.
Pill presses from China, meanwhile, are cropping up all over the U.S. Chinese shippers often label them as other goods or break them into pieces to try to evade U.S. regulation, according to Rusty Payne, a DEA spokesman.
This spring, federal agents in Memphis seized multiple shipments from China of fentanyl and two analogs—acetyl fentanyl and butyryl fentanyl—along with pill presses that were “mislabeled” as other goods, according to the internal DEA briefing.
And in March, four men in the Los Angeles area were charged with participating in a ring that sold acetyl fentanyl and imported chemicals and equipment from China. Agents seized pill presses and 13 kilograms of the drug from a clandestine lab allegedly run by the men, according to the Justice Department, which said the defendants pleaded not guilty. One defendant imported a pill press from Capsulcn International Co. Ltd., a company in Zhejiang, a Chinese province south of Shanghai, according to court documents.
Investigators wore protective gear to examine a clandestine laboratory near Los Angeles, where chemicals and equipment imported from China were allegedly used to make drugs including acetyl fentanyl. Photos: DEA
The 235 kilogram pill press arrived at Los Angeles International Airport with a label declaring it a “hole puncher,” according to court documents.
Capsulcn’s English-language website says the firm was established in 1993 as a “professional pharmaceutical machinery company.” In a written statement, Capsulcn said it was unaware of the allegations included in the U.S. court documents. It said it couldn’t determine why the pill press was labeled as a hole puncher but added some of the equipment it sells has multiple uses.
The statement said Chinese companies increasingly faced discrimination in the U.S. and elsewhere, and exporters couldn’t be expected to understand import restrictions for every country they sold to.
Huang Huangao, general manager of Zhejiang Wisely Machinery Co., Ltd., which was previously the parent company of Capsulcn and remains a supplier of pill presses and other equipment, said in an interview that he believed it was up to local governments to supervise how the equipment is used.
“We have no way of knowing what the buyers will do when using our equipment,” he said. “You can’t blame the knife factory if someone uses the knife to kill a person.”
To try to evade detection, some U.S. buyers are using encrypted networks to place orders from China, according to law-enforcement officials. In Connecticut last month, nine people were charged with distributing fentanyl. Prosecutors alleged that one defendant ordered the drug over the “darknet”—a restricted corner of the internet accessible only through encrypted software—and that the fentanyl was shipped from China. In a wiretapped phone call in early May, investigators heard one defendant, tired of waiting for a shipment, tell another, “That sh—t just left f—ing China today!” according to court documents.
Investigators at an international mail-sorting center in New York subsequently identified two parcels from China that were addressed to a suspected relative of one defendant, according to a DEA officer’s testimony in court documents.
Mexico has also become a major nexus in the U.S. fentanyl trade, as traffickers increasingly procure the drug or its precursors from China, DEA officials say. Authorities got an early glimpse of the problem in 2006, when they traced a fentanyl crisis in Chicago to a clandestine lab near Toluca, Mexico.
One of the lab’s operators, Ricardo Valdez-Torres, pleaded guilty last year in Illinois federal court to a charge of manufacturing fentanyl for unlawful export to the U.S. According to court documents, he told investigators he bought a key chemical ingredient from a Chinese company called Kinbester. An email investigators found at the lab contained a price quote for the chemical from Kinbester Co. Ltd., based in the southern Chinese port city of Xiamen. The quote offered 30 kilograms of the chemical, known by the acronym NPP, for $250 per kilogram.
Through his lawyer, Mr. Valdez-Torres didn’t respond to requests for comment.
It wasn’t illegal for Kinbester to sell that chemical at the time—and still isn’t. Many important fentanyl precursors such as NPP aren’t controlled in China and can be easily bought and sold on the market, according to Chinese law and Western officials and Chinese executives familiar with the matter. Likewise, there are no U.N. conventions that regulate or ban trade in the chemical ingredients used to make fentanyl.
Kinbester’s owner, Wu Jinjun, said in an interview the company doesn’t produce the chemicals itself, but rather procures them from others on behalf of clients. He said he doesn’t know why people buy products such as NPP, adding that his company usually avoids selling precursor chemicals that require special government clearances.
“We never ask our clients of their purposes for buying the products,” he said.
Several chemists and U.S. government officials say they are aware of only one use for NPP. “If you’re buying the NPP, it would be anticipated you’re making fentanyl,” said Brian Escamilla, a forensic chemist with NES Inc. in Folsom, Calif., who trains law-enforcement officers how to deal with clandestine drug labs.
Regarding NPP sales in Mexico, Mr. Wu said a Mexican buyer contacted Kinbester via email in late 2005. Eventually Kinbester sold 10 kilograms of NPP to the client, he said, adding that the transaction was a one-off, and that most of Kinbester’s overseas clients were in Japan or the U.S.
After law enforcement shut down Mr. Valdez-Torres’s lab, the U.S. began regulating NPP under the Controlled Substances Act. The DEA made NPP a “list I chemical” under the act, which requires any U.S. entity manufacturing, distributing, importing or exporting the chemical to register with the DEA and report specific transactions. The agency also started regulating ANPP, another chemical used to make fentanyl.
The regulation had no effect on China, drug-trafficking experts say. Mexico does regulate fentanyl production and the import of fentanyl precursors, but officials there say their work is complicated by false labeling of cargo and constantly evolving strategies used by traffickers. One Mexican official said the government was hesitant to press China too aggressively on the fentanyl trade as leaders there seek greater Chinese investment to boost the Mexican economy.
Recent DEA intelligence has identified fentanyl production labs in the Mexican states of Colima, Nayarit and Guerrero, all located near the country’s Pacific coast, according to a law-enforcement official.
United Nations treaties regulate global trade of specific chemicals and narcotics, and over the years have focused on controlling precursors used to make such drugs as methamphetamines, heroin, cocaine and LSD. But so far no fentanyl precursors are listed in those conventions. Barbara Remberg, senior technical adviser at the International Narcotics Control Board, a body in Vienna established by a U.N. convention to help enforce drug-control treaties, says fentanyl is “something we are planning to look into,” though any action “would take some time.”
In an effort to rein in sexual misconduct by its agents, the Drug Enforcement Administration has instituted a one-strike policy against those who solicit prostitutes while either on or off duty.
The agency has also taken steps to beef up internal oversight of agents and will begin publishing an internal report to shed light on employees’ bad actions and the punishments they receive, according to DEA Acting Administrator Chuck Rosenberg during a congressional oversight hearing on Wednesday.
“Solicitation of prostitution on duty or off duty, whether you’re in a jurisdiction where it is legal or illegal, first time offense — removal,” Mr. Rosenberg said.
The new policy comes after embarrassment over investigations that found DEA agents had joined the Secret Service in hiring prostitutes in Cartagena, Columbia, while doing advance security work for a 2012 visit by President Obama.
A report by the Department of Justice’s Office of Inspector General Investigators found that DEA officials in Colombia had helped to arrange “sex parties” with prostitutes funded by local drug cartels hosted at their government-leased quarters. Further inquiry later uncovered the fact that agents who had participated in the sex parties had received tens of thousands of dollars in bonuses, time off and other favorable personnel actions despite federal regulations barring them from receiving such perks.
Appearing before the Senate Judiciary Committee, Mr. Rosenberg was asked by committee Chairman Sen. Charles Grassley what policy changes had been made to address the misconduct. Noting that agents involved in the sex scandal received punishments ranging from two- to 10-day suspensions, Mr. Grassley asked if such a scenario were to occur today whether it would be handled differently.
“I imagine the outcome would be different,” Mr. Rosenberg said, going on to detail an uptick in recent cases in which administrative punishments were doled out.
In the last 12 months, Mr. Rosenberg said the DEA has upped the number of times that it has removed agents, placed agents on administrative leave or suspended their security clearances as part of cases in which punishment was necessary. During the last 12 months, the DEA has doled out such punishments 57 times, as opposed to doing so an average of 17 times per year over the course of the last five years.
“I don’t think we have more people misbehaving,” Mr. Rosenberg said. “I think we have a more robust system to find, investigate, adjudicate and punish bad behavior. “
Mr. Rosenberg added that the DEA was also planning to launch an internal “transparency report,” through which the agency would publicize the misdeeds of fellow agents. The report would not include the names or positions of agents involved, but rather general information about the misconduct.
“If an agent loses a gun in Seattle or misuses a government credit card in Boston, we’re going to tell people what happened and what the penalties are,” he said.
The Drug Enforcement Agency has yet to adequately address previous mismanagement issues that led to prescription drug shortages, the Government Accountability Office said on Wednesday.
In its initial 2015 audit, the GAO found that the DEA ineffectively handled the quota process used to manage the amount of legal drugs available in the U.S.
Drug manufacturers must apply to the agency for quotas to manufacture drugs, and according to the GAO, “DEA did not respond within the time frames required by its regulations for any year from 2001-14, which, according to some manufacturers, caused or exacerbated shortages of drugs.”
In 2015, the GAO made seven recommendations to the agency to solve these problems, and the DEA said it would implement each one.
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However, a subsequent report released on Wednesday found that the agency has implemented only two of the changes.
The first recommendation, which was implemented in March 2015, requested that the DEA finalize its information-sharing agreement with the FDA regarding drug shortages.
The second recommendation, which was for the DEA to strengthen internal controls over the quota system, was just implemented this month.
In Wednesday’s report, the GAO maintained that the five remaining original recommendations should still be implemented to prevent any future drug shortages.
According to the GAO, the DEA has now “identified steps it planned to take, including developing performance standards for responsiveness to manufacturers, but has not yet completed these actions.”
A new way to curb the proliferation of prescription painkillers in West Virginia is in the works: “Prescriber report cards.”
The state Board of Pharmacy is developing a system that will rank doctors by specialty based on the number of prescriptions they write for pain medications.
“We’re going to categorize prescribers, and then send notifications of how they rank among their peers with their prescribing practices,” said Michael Goff, a pharmacy board administrator. “It’s a way of telling them, ‘Hey, among other doctors in your field, doctors who do what you do, here’s where you rank.’”
It would be unfair to compare all doctors based on their prescription numbers, Goff said. For instance, an orthopedic surgeon who fixes broken bones and torn tendons would presumably write many more prescriptions for pain than, say, a pediatrician who cares for children.
“We can come up with a list of who writes the most prescriptions, but that doesn’t really mean anything,” Goff said.
One drawback: The report cards won’t be made public. State law requires such information to be kept confidential. Doctors would only see their own numerical ranking, not a complete list of rankings by specialty.
“This is an educational component,” Goff said. “It’s not for disciplinary reasons.”
The pharmacy board also hopes to alert doctors about the overall strength of their patients’ prescription opioids. The drug-monitoring program would analyze a person’s medications and calculate a “morphine milligram equivalent.” Doctors would see the score when they examined a patient’s prescription history.
“They take all the drugs they’re on and equate them to morphine,” Goff said. “Doctors will have some idea, with all the drugs they’re on, here’s the level they’re at.”
Three states — Maine, Washington and Massachusetts — have laws that set a cap on the daily strength of opioid medications that doctors can prescribe. Such laws exempt cancer patients, people with terminal diseases and those receiving end-of-life care. The U.S. Centers for Disease Control and Prevention recommends that opioids be restricted to 90 morphine milligram equivalents per day.
West Virginia lawmakers have not discussed a cap on prescription painkillers. Maine lawmakers passed a cap earlier this year.
“It is a very well-conceived plan and could benefit West Virginia,” said Delegate Don Perdue, D-Wayne. “However, one needs to be very careful when considering terminal and intractable pain patient requirements.”
Goff said the board also is exploring setting up a system that notifies doctors about “high-risk” patients who could be an overdose risk and secure pain-pill prescriptions from multiple doctors. Tennessee identifies such patients with “red” and “yellow” alerts.
In the coming months, West Virginia doctors will be able to check a patient’s prescription history in about 20 additional states. West Virginia physicians already can access patient prescription information from all neighboring states except Pennsylvania.
Goff praised Kroger supermarket pharmacies for setting up a new program that automatically pulls up a customer’s prescription history on a computer screen each time a prescription is filled.
“It’s a hard stop at the pharmacy level,” Goff said. “A lot of times, they may be suspicious, but they don’t want to take the time to log into the system. This way, they have to acknowledge they looked at the patient’s prescription history.”
The pharmacy board also is looking at ways to link its controlled substances database to patient electronic medical records. Doctors now have to exit the electronic health record to log onto the database.
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