California police and prison guards are some of prohibition’s biggest backers.

Roughly half the money raised to fight California’s upcoming adult-use legalization initiative has come from police and prison guard groups, which The Intercept sees as a sign they’re “terrified that they might lose the revenue streams to which they’ve become so deeply addicted.” What does law enforcement stand to lose? Huge government grants, asset seizures that siphon money to local police departments, and the massive private prison profits that come with keeping drug offenders behind bars. Gawker’s Andy Cush encourages Californians to consider the push as they decide which way to vote: 

“The law enforcement community’s flailing to stop legalization also happens to show exactly why it’s a good idea to support it, even if you don’t smoke: Fewer people imprisoned, and less policing for policing’s (and profit’s) sake. Go out and vote for pot this November, California.”

Congress to give veterans (in some states) the right to talk about medical cannabis with doctors. Lawmakers are expected to pass a bill that would allow military vets in states where medical marijuana is legal to discuss it with their doctors as part of treatment. “The death rate from opioids among VA health care is nearly double the national average,” said Rep. Earl Blumenauer (D-Ore.), who introduced the bill. “What I hear from veterans is that medical marijuana has helped them deal with pain and PTSD, particularly as an alternative to opioids.”

Toronto dispensaries vow to fight mayor’s crackdown. The city’s Cannabis Friendly Business Association held a meeting Tuesday night at the Hotbox Café, The Globe and Mail reports. Many members felt Toronto Mayor John Tory, who’s threatened unlicensed dispensaries with $50,000 fines, simply doesn’t understand cannabis. “It’s not time to protest,” one attendee said. “It’s time to lobby.” But Tory doesn’t look all that receptive: Earlier today he postponed an effort to force a debate on licensing Toronto dispensaries, and he vowed to continue aggressive enforcement actions in the meantime.

The girl suspended for smelling like cannabis — even though she passed a drug test — is headed back to school. North Carolina school officials have reversed Tameka Johnson’s suspension, her mother says. Johnson was suspended after a school resource officer decided she smelled like cannabis despite a lack of evidence she consumed or possessed any at all. 

The DEA is being dragged “kicking and screaming” into the world of legal cannabis. That’s the takeaway from Christopher Woody’s Business Insider piece, which takes a look at the Drug Enforcement Administration’s obstinate opposition in the face of new science, changing public perception, and state-by-state legalization. 

Another example of the DEA being difficult: Agents raided one of Montana’s biggest medical dispensaries yesterday, taking Montana Buds and its neighbors by surprise. A DEA agent on the scene refused to answer observers’ questions, saying, “This is now a federal investigation.” Saying that probably makes you feel pretty badass as a narc, but what gives? The state Supreme Court ruled most dispensaries in their current form are illegal, but that ruling doesn’t take effect until August.

Cannabis could be coming to wine country. Napa city leaders are warming to the idea of allowing dispensaries among the valley’s vineyards. It’s part of a broader thawing of attitudes toward cannabis among some cities in the state, as the Orange County Register reports. 

“Say Why to Drugs,” a U.K. newspaper urges. The Guardian is doing a series on the myths, harms, and benefits of various drugs (updated “fortnightly” because it’s a British publication). Today’s installment: cannabis. 

A former DEA agent says there’s “real potential” for rescheduling this year. But don’t get your hopes up for more meaningful reform. “We are certainly preparing for the possibility of it moving from Schedule I to Schedule II,” Charles Feldmann, now a Colorado attorney, tells MJ Biz Daily, but “I don’t see it moving past that at this stage.”

Vermont cannabis entrepreneurs: “The market’s coming and we’re ready for it.” Forget that an ambitious legalization bill crashed and burned in the statehouse last month. As the Burlington Free Press reports, many are still bullish on the cannabis economy.

Florida legalization opponents launch first attack ad. Cannabis advocates, pushing to allow medical cannabis use for individuals with “debilitating” conditions like cancer, glaucoma, and HIV, describe the hit as “not a very accurate ad at all.” Surprised? Me neither.

Cannabis is changing the real estate game. Oregon writer Mohammed Alkhadher takes a look at what Washington and Colorado might show us about cannabis and location, location, location.

And finally, a Michigan man was busted for having a gun, some cannabis, and a box of baby squirrels. I’m not thrilled to see a headline tying medical cannabis to a lethal weapon, but I don’t mind the association with baby squirrels one bit. Squeeeee!

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Actions by Congress on Opioids Haven’t Included Limiting Them

ww.nytimes.com/2016/05/19/us/politics/opioid-dea-addiction.html?_r=1

WASHINGTON — Ed White has had a devilish time getting his painkiller prescription filled for intense back pain since a federal crackdown on opioid sales battened down the pharmacy shelves at the Walgreens near his home in Port Richey, Fla.

Across the state in Fort Lauderdale, Maureen Kielian just put her son into a residential treatment facility to try to break his life-threatening opioid addiction. To suggest that the federal authorities have been too aggressive amid an opioid epidemic killing 29,000 people a year is absurd, she said.

Faced with these competing stories, Congress has whipsawed between ensuring access to narcotic painkillers for people like Mr. White and addressing the addiction epidemic linked to those drugs, one that has become the leading cause of injury death, surpassing motor vehicle fatalities in 2013, according to the Centers for Disease Control and Prevention.

For now, Washington appears ready to allow opioid prescriptions to remain widely accessible, a victory for pharmacies, drug makers and, lawmakers say, consumers — and instead focus on the treatment of addiction, not its source.

The House and the Senate passed bills this spring that would, among other things, bolster prescription drug monitoring and treatment and abuse-prevention programs; fund drug disposal efforts; and assist states that want to expand the availability of the drug naloxone, which helps reverse overdoses. Even though their differences have yet to be worked out, lawmakers in both chambers are trumpeting those actions, banking on them to bolster their re-election prospects.

More quietly, Congress passed and President Obama signed a very different measure last month that curtailed Drug Enforcement Administration powers to pursue pharmacies and wholesalers that the agency believes have contributed to the epidemic.

Mr. White, 67, said the law was crucial. “The crackdown by the D.E.A. has gone too far,” he said.
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Advocates of a stronger response are incredulous.

“I’m shocked that Congress and the president would constrain D.E.A. from taking on corporate drug dealers in the midst of the worst addiction epidemic in U.S. history,” said Dr. Andrew Kolodny, the director of Physicians for Responsible Opioid Prescribing and an addiction specialist. “This law allows opioid distributors to reap enormous profits and operate with impunity at the public’s expense.”

Congress’s actions have sought to balance the conflicting demands of deep-pocketed chain pharmacies such as CVS and Walgreens and drug distribution companies like Cardinal Health and McKesson with the victims of an epidemic that has ravaged some of the poorest parts of the country — but also some of the most politically sensitive, like Ohio and New Hampshire.

Chain pharmacies and drug distributors say their businesses have been disrupted and profits hurt by D.E.A. investigators who have ordered immediate closures of pharmacies deemed regional destinations for addicts seeking a fix.

“The D.E.A. has employed the same disrupt-and-dismantle tactics to take down international drug cartels and other criminals as it does to combat prescription drug abuse,” said John Gray, the president of the Healthcare Distribution Management Association, a trade organization for drug wholesalers.

But past and present agency officials complain that they were steamrollered by a powerful lobby.

“Under this law, the bad actors simply have to promise to be good, and we won’t take them to court to punish them for what they’ve already done,” said Joseph T. Rannazzisi, who retired in October after 11 years of directing the D.E.A.’s office of diversion control. “It’s obvious that industry had a very strong hand in crafting this bill.”

To its sponsors, the new law is an uncontroversial clarification of when the right to distribute controlled substances can be suspended or revoked, a matter separate from the opioid addiction fight. It also establishes a process for federal agencies to go through in many cases before distribution centers can be shut down, giving them 30 days to rectify issues as they crop up in an attempt to reduce disruptions to patients.

Written by Representatives Tom Marino, Republican of Pennsylvania, and Peter Welch, Democrat of Vermont, it passed the House in April by unanimous consent, a month after the Senate approved its version without objection. The Senate measure was equally bipartisan, drafted by Senator Orrin G. Hatch, a conservative Republican from Utah, and Senator Sheldon Whitehouse, a liberal Democrat from Rhode Island.

“The D.E.A. has a big job,” Mr. Welch said. “I’d like to see them not having to waste their time on protocol issues with distribution centers, because that’s not where the problem exists.”

In a statement, Mr. Marino said, “Until now, clear comprehensive legislation that protected patients’ right to access necessary medication while stopping those who might abuse such drugs did not exist.”

For all the self-congratulations over a recent rash of opioid abuse bills — the House passed 18 measures last week after the Senate’s comprehensive version in March — Congress has yet to send a treatment measure to the president.
Graphic: How the Epidemic of Drug Overdose Deaths Ripples Across America

And lawmakers are steeling themselves for the real fight: how to pay for it. The issue has become a surprisingly potent one, with some vulnerable Senate Republicans running for re-election on their efforts to fight addiction and siding with Democrats in their chamber over House Republicans to make their point.

Senator Rob Portman, Republican of Ohio and a sponsor of the Senate bill, said his version was superior to the House’s in two areas: addiction prevention and new sources of funding that do not siphon money from other programs.

And because many opioid addicts begin with prescription drugs, he said, Congress needs to approve some restrictions on who can write and fill prescriptions. The “one doctor, one pharmacy” provision in the Senate bill would cut down on doctor shopping and could counter any ill effects of curbing the D.E.A.’s enforcement power.

“That’s really narrowing your choices to people who know you, know what you need,” he said.

Trying to strike a balance between access for the needy and restrictions to prevent abuse has bedeviled the fight against the opioid crisis since its beginnings. But as the annual death toll from the epidemic soared, those calling for greater restrictions seemed to have gained the upper hand, with new guidelines from the C.D.C. and greater restrictions on popular narcotics finalized by the Food and Drug Administration.

The one law that has been enacted, called Ensuring Patient Access and Effective Drug Enforcement Act of 2016, gives those arguing for greater access to these medications an unlikely lift.

“It’s a significant blow to D.E.A.’s enforcement authority, and that doesn’t make any sense to us,” said Carmen Catizone, the executive director of the National Association of Boards of Pharmacy.

As the lead agency in prosecuting a drug war that liberal and conservative politicians see as flawed, the D.E.A. has lost clout. The agency’s growing efforts to combat opioid abuse have also meant clashes with the powerful lobbies of drug makers and pharmacists.

On Capitol Hill, Mr. Rannassizi became a symbol of the D.E.A.’s recalcitrance, particularly after he suggested that lawmakers would be “supporting criminals” if they passed the measure.

“This offends me immensely,” Mr. Marino, a former prosecutor, responded to Mr. Rannassizi at a 2014 hearing on an earlier version of the legislation.

By passing the law, “Congress is sending the D.E.A. a message,” Mr. Marino said to the agency’s administrator, Michele M. Leonhart. “You should take a serious look at your regulatory culture and seek collaboration with legitimate companies that want to do the right thing.”

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Pfizer’s Death Penalty Ban Highlights the Black Market in Execution Drugs

https://theintercept.com/2016/05/19/pfizers-death-penalty-ban-highlights-the-black-market-in-execution-drugs/

Pharmaceutical giant Pfizer made big news last week when it announced a ban on the use of its drugs to carry out the death penalty by lethal injection. “Sweeping controls on the distribution of its products” have clamped shut “the last remaining open-market source of drugs used in executions,” the New York Times reported, calling it a milestone in the fight against capital punishment.

Somewhat buried in the flurry of headlines that followed was the fact that Pfizer has never been known to supply states with execution drugs. It is only after the company acquired a different drug company last year — Hospira Inc., which produced several drugs states have used or intend to use in executions — that Pfizer put such restrictions in place. This doesn’t make its policy any less important: “Pfizer has closed the circle,” said Arizona federal public defender Dale Baich, who litigates lethal injection challenges across the country. “The states can no longer obtain drugs from legitimate and legal sources.” But as Baich and others know too well, many states stopped seeking drugs from legitimate sources a long time ago. Today, most active death penalty states rely on anonymous compounding pharmacies, whose loose regulations vary wildly from state to state, making them dangerously unreliable compared to FDA approved drug companies when it comes to the efficacy of their products. Other states have broken federal law by importing illicit drugs from overseas. In driving states to the underground market, Pfizer’s announcement merely makes official what has already been happening for years.

Take Texas, which has carried out six executions so far this year and has eight more scheduled through the fall. There, prison officials were decidedly unfazed by the news. “It’s not anticipated that Pfizer’s decision will have an impact on the agency’s current ability to carry out executions,” Texas Department of Criminal Justice spokesperson Jason Clark wrote in an email to The Intercept. So where does Texas get its drugs if not through companies like Pfizer? Today, we’re not allowed to know the answer to that question. “State law prevents the disclosure of the identity of the supplier of execution drugs,” Clark wrote, saying only that they come from a “licensed pharmacy that has the ability to compound.” The official rationale for the policy — which became effective last September — is that secrecy is the only guarantee of safety for those companies still willing to supply drugs for executions. “Pharmacies don’t have security details,” Deputy Texas Solicitor General Matthew Frederick told an appellate court earlier this month, opposing a legal challenge to the law. “Their only protection is anonymity. Once you take that away … there’s nothing they can do to protect themselves.”

The problem with such ominous rhetoric is that there is virtually no evidence to back it up. For years, suppliers of lethal injection drugs in Texas could be identified via open records requests, without incident. But in the fall of 2013, a local company, Woodlands Compounding Pharmacy, was revealed to have provided pentobarbital for executions, prompting the owner to complain about “hate mail” and unwanted media attention — and to ask for its drugs back. Some months later, the Texas Department of Public Safety released a threat assessment, warning that pharmacies like Woodlands are a “soft target for violent attacks” and that “publicly linking a pharmacy or other drug supplier to the production of controlled substances to be used in executions presents a substantial threat of physical harm … and should be avoided to the greatest extent possible.” As the Texas Observer reported, the only evidence for such threats offered by Texas officials included a strongly worded letter to Woodlands and a random blog post featuring an image of an exploding head.

Today, lethal injection secrecy statutes exist in some dozen states and counting, under the same pretense of security. “The states have never offered any proof that a manufacturer has been harassed,” said Baich. Yet the claim has become entrenched. In Mississippi, Attorney General Jim Hood recently praised lawmakers for passing a secrecy bill drafted by his office, stressing the need for drug suppliers to “be free from the intimidation and strong-arm tactics of some anti-death penalty activists.”

For years, lawyers and journalists have argued that the real purpose of such laws is to block scrutiny of states’ execution protocols. In effect, they have also “prevented manufacturers from learning how states have gotten a hold of the pharmaceutical products they have been using in executions,” said Robert Dunham of the Death Penalty Information Center. Pfizer’s tight new restrictions, Dunham said, are “designed to counter” such secrecy. With Pfizer’s announcement last week, the most significant challenge will not be overcoming state secrecy to ensure that major drug corporations can keep such promises. The bigger problem is how to hold states accountable to the Constitution as they do business with faceless companies that have no ethical qualms about selling execution drugs. “As compounding pharmacies do this in the dark,” said Maya Foa of the human rights group Reprieve, which has led the effort to convince the pharmaceutical industry to block its drugs for use in executions, “it is just going to a create more of a mess — potentially, more botched executions.”

Thiopental Sodium on a tray, Thiopental Sodium is used as a barbiturate general anesthetic.

Photo: UIG/Getty Images

Agonizing Deaths

The image of abolitionist bullies threatening drug suppliers — or as Supreme Court Justice Samuel Alito put it last year, waging “guerrilla warfare against the death penalty” — is a relatively new invention. Its origin can be traced back to the drug shortages that first set the stage for the current upheaval around lethal injection — and which inspired perhaps the country’s most far-reaching lethal injection secrecy law, in Georgia.

In August 2009, Hospira Inc. ceased production of the anesthetic sodium thiopental (a key ingredient in what was then the standard three-drug protocol in use across the country), after one of its suppliers stopped making a crucial ingredient. At first, Hospira planned to move its production to Italy, but after Reprieve successfully pressured the Italian government to block the export of such drugs for the use of U.S. executions, the company stopped manufacturing the drug altogether.

With their go-to supplier of sodium thiopental no longer an option, death penalty states started seeking other sources — and before long, some disturbing consequences emerged. In 2010, just days after the Arizona Republic revealed that local prison officials had imported sodium thiopental from overseas, Dale Baich witnessed the death of a client named Jeffrey Landrigan, whose execution appeared to go awry. While it was not the dramatic two-hour ordeal later suffered by a different client, Joseph Wood, in 2015, Landrigan’s death was alarming for one lurid detail: He died with his eyes open. Baich would later learn that the sodium thiopental used to kill Landrigan had almost certainly expired. This meant that he was not properly anesthetized when the second drug, a paralytic, kicked in. The inescapable conclusion: Landrigan was conscious and frozen in place as the third drug, potassium chloride, seeped into his veins and stopped his heart — an “agonizing” way to die, according to one anesthesiologist.

The same batch of sodium thiopental used to kill Landrigan in Arizona was also linked to two executions in Georgia around that time — Brandon Rhode in September 2010 and Emmanuel Hammond in January 2011. Both men died like Landrigan, with their eyes open. In an interview for an article I wrote for The Nation in 2011, Hammond’s lawyer said her client’s death had appeared painful — “like nothing I have ever seen before.”

Because Georgia’s open records law at the time allowed the disclosure of the state’s source of lethal injection drugs, Hammond’s lawyers were able to trace the sodium thiopental used to kill him to a strange Britain-based pharmaceutical wholesaler named Dream Pharma Ltd. As I wrote at the time, its headquarters were “a rented space in the back of a driving school in a West London suburb. Its bare-bones website boasts that it can provide ‘discontinued’ and ‘hard to find’ drugs to customers, promising that ‘confidentiality will remain paramount.’” Not long after news broke of the state’s sketchy execution source, the DEA seized Georgia’s supply of sodium thiopental, citing “questions about the way the drugs were imported.”

Following the DEA raid, two things happened quickly. First, Georgia hastily adopted a new drug to replace sodium thiopental: the barbiturate pentobarbital, over the objections of a Danish company named Lundbeck Inc., which warned the state that the drug was not meant for such use. Georgia ignored Lundbeck’s warnings, using the pentobarbital to execute Roy Blankenship, who “jerked his head,” lunged “with his mouth agape” and whose eyes “never closed,” according to one AP reporter in June 2011.

Second, on the urging of the Georgia Department of Corrections, lawmakers drafted a bill to block the release of any information about executions under the Open Records Act. Georgia’s Lethal Injection Secrecy Act, passed in March 2013, classifies as a “confidential state secret” the identity of “any person or entity who participates in or administers the execution of a death sentence” or who “manufactures, supplies, compounds, or prescribes the drugs, medical supplies, or medical equipment utilized in the execution of a death sentence.”

Apart from its assault on transparency, Georgia’s law now meant that condemned prisoners were not entitled to know the source of the drugs that would be used to kill them. This “created a catch-22 for any death-row inmate seeking to challenge Georgia’s lethal injection protocols,” as legal reporter Andrew Cohen wrote at the time. Without any information about where the state procured its drugs, prisoners could not fight their executions on Eighth Amendment grounds — even as they had ample reason to fear a cruel and unusual death. Nevertheless, in 2014, the Georgia Supreme Court upheld the new law, calling the need for secrecy “obvious,” in order to avoid the “risk of harassment or some other form of retaliation” for those involved in executions — despite any lack of evidence that such risks existed.

As secrecy laws have continued to pass, most recently, Gov. Terry McAuliffe of Virginia took a bizarre stance on the matter, urging lawmakers to reject a bill that would make the electric chair the state’s default mode of execution if drugs cannot be found for lethal injection, while pushing to conceal the identity of execution drug suppliers. Absent such a law, McAuliffe argued, “manufacturers will not do business in Virginia if their identities are to be revealed.”

The Pfizer company logo April 27, 2016 in New York.

Photo: Don Emmert/AFP/Getty Images

Product Misuse

By the time Pfizer made its decision to block drugs for executions, Foa had already worked with some two dozen other drug companies, from the U.S. to Europe, to find a way to cut off the supplies for U.S. executions. Contrary to the image of aggressive abolitionists, there was no ambush involved. “From the moment it purchased Hospira, Pfizer wanted a solution,” Foa said.

The first company Foa worked with was Lundbeck — the drug manufacturer who tried to prevent the state of Georgia from using its drugs to kill Roy Blankenship in 2011. In an email to The Intercept, Lundbeck’s communications director, Anders Schroll, recalled what happened. Reprieve contacted Lundbeck soon after the company discovered its “product misuse” in 2011. “We had a constructive dialogue,” Schroll said. This included “a couple of face-to-face meetings in Copenhagen and an active dialogue over the phone and via mail,” Schroll wrote. The company had suffered a wave of bad press over its drugs being used for executions, including an open letter published in The Lancet, in which a large number of doctors said they were “appalled at the inaction of Lundbeck” to prevent pentobarbital from being used in executions. Foa recalls the company acting in good faith — and Schroll said that it was a challenge to find “a way to restrict distribution while continuing to make it available for the small patient population who need it for emergency situations related to seizures. Striking that delicate balance wasn’t easy,” he wrote, “but all things considered, it was a very short time from learning about the misuse of our product to revamping the entire distribution system — just five months — and we did something no other company had achieved until that point, which was to cut off supply to prisons.”

Pfizer did not return multiple emails about its own process. But Foa describes it as similarly collaborative, not antagonistic, as well as much easier than the process with Lundbeck. As the industry has moved toward making such restrictions the industry standard, “the terrain is much more mapped out.”

In the wake of Pfizer’s announcement, the state of the death penalty across the country remains in disarray. As some states have gone backward, passing laws to bring back firing squads and electric chairs, those that insist on keeping lethal injection have proven shameless in their quest. Long after Georgia’s Dream Pharma debacle of 2011, the past few years have shown the absurd (and illegal) sources states have continued to find for their drugs — from “the salesman in India with no pharmaceutical background” who sold drugs to at least four states in violation of federal law, as BuzzFeed reported last fall, to a local hospital in Louisiana that inadvertently sent prison officials 20 vials of hydromorphone in 2014. (“Had we known of the real use,” one official told local news site The Lens, “we never would have done it.”)

Email records obtained by journalists have revealed “a disturbing flippancy” about the process, as reporter Katie Fretland reported in 2014, describing how Oklahoma officials joked in 2011 that, in exchange for helping Texas obtain elusive pentobarbital, they might be able to get “much sought-after 50-yard-line tickets to the Red River Rivalry, a football game between the University of Oklahoma and the University of Texas.” In that state, whose execution protocol was upheld by the Supreme Court just last year, officials have exhibited shocking levels of incompetence and dishonesty when it comes to carrying it out.

Such revelations continue. Less than a week before Pfizer’s big announcement, the ACLU of Northern California released 12,000 pages of records from the California Department of Correction and Rehabilitation (CDCR). Through a similar records request years ago, the local ACLU chapter had discovered that California, too, had sought drugs high and low, including from local hospitals, only to end up with part of Arizona’s illegal shipment of drugs from Dream Pharma. (“You guys in AZ are life savers,” one California official wrote over email in 2010.) Reading the most recent batch of records is like bad déjà vu. One set of documents shows that CDCR yet again contemplated purchasing drugs from a pharmacy in the U.K. “We could do it again …” reads an email message from a consultant, an apparent reference to the disastrous purchase from Dream Pharma.

The documents also revealed a chilling attitude about recent botched executions. Criticizing the “big hoopla” surrounding the 2014 death of Dennis McGuire in Ohio — who writhed and gasped for air, according to witnesses — CDCR attorney Kelly McClease dismissed that ghastly spectacle as “snoring.”

Over email, Ana Zamora, criminal justice policy director for the ACLU of Northern California, said Pfizer’s decision does not stand to affect the death penalty there, since the company “does not manufacture any of the four drugs authorized for use” in the state. “The Pfizer decision, however, increases the likelihood that the CDCR will turn to troubling and costly sources to acquire lethal injection drugs,” she said. And the newly released records show that officials have considered purchasing drugs from “online pharmacies that boast offering cheap drugs without a prescription.” What’s more, records reveal that contrary to the CDCR’s public estimate that such drugs would cost $4,193 per execution, the department appears well aware that “a particular compounding pharmacy” would charge “between $133,080 and $150,000” per execution.

Although California has not carried out an execution in more than 10 years, there are active efforts underway to restart the state’s death machinery. And while there is no secrecy law in California, history suggests it is only a matter of time before someone decides such legislation is necessary. Zamara’s primary concern, she said, is that California has not learned any lessons from recent botched executions in other states. “If the CDCR acquires lethal injection drugs from sources that cannot ensure proper dosage, sterility, potency,” she said, “this will greatly increase the risk that an execution could go terribly wrong in California too.”

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nationalpainreport.com/opioid-prescriptions-drop-cigna-to-reduce-further-8830525.html

Opioid Prescriptions Drop – Cigna To Reduce Further

Is an insurance company “following guidelines” from the CDC – that doesn’t bear the weight of law –  going to be exempt from being sued for practicing medicine without a license, denial of care, pt abuse,  violation of Americans with Disability Act and other such issues.  I sense that it won’t be long before the attorneys are “circling”

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FDA Mulling Pricey Implant as Opioid Addiction Tx

http://www.medpagetoday.com/Psychiatry/Addictions/58066?xid=nl_mpt_DHE_2016-05-21&eun=g578717d0r

Device can be left in for 6 months

Amid a raging opioid epidemic, many doctors and families in the U.S. have been pleading for better treatment alternatives. One option now under consideration by the FDA is a system of implanted rods that offer controlled release of buprenorphine — a drug already used in other forms to treat opioid addiction.

Because it’s implanted in the skin, this version of the drug can’t easily be sold on the illegal market, proponents say — a key treatment advantage. The FDA is expected to decide whether to approve the device — called Probuphine — within a week.

The implant system includes four rods, each about the size of a match stick, explains Dave, a paramedic in a small town outside of Boston; he was one of the patients recruited to test the device last year. Dave’s worried about reprisal if co-workers find out he is addicted to opioid pain pills, so NPR agreed to use only his first name.

“My implants were placed in my left arm, just above my elbow on the inside,” he explains. He’s been in recovery for four years — previously with the help of daily buprenorphine pills. Last year, he agreed to be part of an experiment that delivered regular doses of the drug to him via an implant instead. He’s sold on the new approach.

“I felt completely normal all the time,” he says.

Probuphine implants, inserted under the skin by a trained doctor, are left in place for six months at a time. Dave says the rods are convenient, safe, and discreet — they provided steady relief from his cravings.

When he takes the daily buprenorphine pills, he says, he has to be careful to hide them so that his 2-year-old granddaughter can’t get into them. And though he’s supposed to take the tablets at least 15 minutes before he eats or drinks anything, he sometimes forgets. Or he forgets to take the pills at all.

“With the implant, you didn’t have to worry about that,” he says. “It was just there, and you felt good all the time.”

The device doesn’t work for everyone. During the study, 12% of patients who had implants relapsed. But the relapse rate for the pill version of the drug was 28%.

And there’s a second reason implants can be better than pills, says Braeburn Pharmaceuticals CEO Behshad Sheldon: A lot of buprenorphine winds up being sold illegally on the street. Though the drug produces a less intense high than most opioids, it is still sometimes abused.

“Buprenorphine is the third most confiscated opioid by the DEA, so there’s certainly diversion going on,” Sheldon says.

But during the clinical trial, she says, there were no cases of anyone trying to remove their implant so they could to the drug inside and sell it.

An FDA advisory committee recommended approval of the implant in January, and a final decision from the agency is expected by May 27.

“Anything that might help people beat their opioid addiction is a good idea,” says Dr. Barbara Herbert, president of the Massachusetts Society of Addiction Medicine. But she says she also has reservations about this method of delivering treatment.

The main one is price. The company says it will price the implants to be competitive with other injectable treatments used to battle opioid addiction, including a shot that costs about $1,000 a month. Herbert says a high price may force providers to turn patients away — or cut back on other services.

“High profits in the middle of this epidemic are really unconscionable,” she says.

Sheldon, of Braeburn Pharmaceuticals, says the company will offer rebates to make sure appropriate patients can get access to the implant. She plans to negotiate with insurers and providers on a price that takes both their cost and savings into account, she says.

“And if they don’t realize those savings, we’re happy to rebate them even further,” Sheldon says.

If the implant is approved, demand for it is expected to be high even with the high price-tag, addiction specialists say.

Dave, the New England paramedic in recovery, says he’s thought about trying to wean himself off the treatment drugs altogether.

“But then, the more I think about it, it scares the hell out of me,” he says. “I’m scared of going backward. I honestly don’t know what would happen.”

That’s a fear voiced by many of the growing number of Americans who have come to see their addiction as a chronic disease, a condition they may have to live with — and need treatment for — for many years.

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Elderly Floridian cannot afford medicine, kills suffering wife

http://www.msn.com/en-us/news/crime/elderly-floridian-cannot-afford-medicine-kills-suffering-wife/ar-BBtfWNO

An elderly Florida man was in jail on Thursday after he said he fatally shot his ailing wife because her medications were no longer affordable and she was in pain.

William J. Hager, 86, was being held without bond in jail after telling responding authorities on Monday that he had shot his wife, Carolyn, in the head as she slept that morning in their home in Port St. Lucie, according to an arrest affidavit released by the St. Lucie County Sheriff’s Office.

Hager called the 911 emergency line at 1 p.m., several hours after the fatal shooting, the affidavit said. Hager told authorities that after the shooting he went to the kitchen for a cup of coffee, and called his daughters to tell them what he had done.

“I want to apologize I didn’t call earlier. I wanted to tell my kids what happened first,” Hager told authorities, according to the affidavit.

Hager told authorities that he had been thinking of killing his wife, 78, for several days because she was in pain, the affidavit said. While she had told him that she wanted to die in the past, she never asked him to kill her, according to the affidavit.

A dispatcher at the St. Lucie County Sheriff’s Office said Hager remained in jail on Thursday on a charge of first-degree, premeditated murder after an initial court appearance on Tuesday.

Hager could not be immediately reached on Thursday evening and it was not immediately clear if he had an attorney.

Local broadcaster WPTV reported that the couple had filed for bankruptcy in 2011 and that Carolyn Hager had been suffering from severe arthritis and other medical issues for 15 years.

The AARP, a non-profit advocacy organization for people 50 years and older, said in a report last November that increasing costs for certain specialty prescription drugs have put them out of reach for many people and that Medicare does not necessarily make those drugs affordable.

Authorities did not say what specific drugs Carolyn Hager was taking nor what kind of insurance the couple may have had.

A search of records at the Florida Department of Law Enforcement does not show a prior criminal history for William Hager. (Reporting by Curtis Skinner in San Francisco; Editing by Sharon Bernstein and Sandra Maler)

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Three nights is just about all the hospital staff could take of me… they kicked me out discharged me .  They sort of described my health status Tues as “skating on thin ice while dodging bullets”. Apparently my cardiovascular system has the same degree of chutzpah that my personality normally displays.. “kick ass and take no prisoners”  Certain life changes ahead.. less sitting.. gotta find an alternative to keep blogging..  I have Dragon Naturally Speaking.. may have to learn how to use it..  Now on Warfarin for a indeterminate period of times.. so now I have to give up “rabbit food” 🙁  Or at least I have a valid reason not to eat it 🙂

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I have been having shortness of breath issues on exertion for the last few days.  Finally decided to seek professional help. For some odd reason I am forming some blood clots in both legs and pulmonary artery.

so I am taking a few days of rest/relaxation in the local hospital on blood thinners.

So I am stuck with my iPad and iPhone and cutting/pasting is not a lot of fun on those two.

My incarceration should be over by the weekend and things on my end should be back to somewhat normal

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NC board investigates fatal overdoses of prescription drugs

http://abc11.com/1339780/

The North Carolina Medical Board is investigating 60 doctors and physician assistants with patients who died of overdoses of prescription drugs.

Medical board officials tell The Charlotte Observer that two or more patients being treated by each doctor took fatal overdoes of prescription painkillers within a 12-month span.

State law prevents the board from releasing the names of doctors being investigated. The investigation also includes 12 more doctors and physician assistants who prescribed high doses or large volumes of opioids.

Fatal overdoses kill more than 1,000 people a year in North Carolina. Nearly half involve prescriptions written within 60 days of the victim’s death.

In some cases, there’s no direct link between a death and what the doctor prescribed, board officials said. But regulators will look into whether patients received substandard care.

“The board views this as a serious problem that requires ongoing attention,” said Dr. Scott Kirby, the agency’s chief medical officer. “They have no tolerance for incorrect or substandard prescribing.”

Regulators now use a statewide database to spot potentially reckless prescribing. Officials say they will review the state data every three months and launch investigations in addition to receiving complaints.

States such as Kentucky, Tennessee and Texas for years have used prescription databases to spot improper prescribing and send information to law enforcement or medical boards for review.

A prescription database maintained by North Carolina since 2007 was used only to help physicians and pharmacists review whether patients were getting drugs from multiple providers. The Medical Board received permission to access the information last year.

Officials said they are already hearing complaints from patients that physicians are arbitrarily reducing the strength and quantity of painkillers that they prescribe out of fear of being investigated.

Kirby said the Medical Board is trying to strike the right balance between protecting the public from dangerous prescribing and ensuring medication is accessible for cancer patients, the terminally ill and others suffering with severe chronic pain.

State Rep. Craig Horn, a Union County Republican who supports stricter oversight of prescribing practices, said stiff sanctions are necessary for improper prescribing.

“There needs to be more accountability,” Horn said. “A higher level of accountability must be met when you impact the lives of others.”

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Coverage From Prince’s Death – His Battle With Chronic Pain

paindoctor.com/prince-death-chronic-pain

Coverage From Prince’s Death – His Battle With Chronic Pain

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