VA doctor accused of poor care resigns

http://wlfi.com/2016/04/13/va-doctor-accused-of-poor-care-resigns/

WEST LAFAYETTE, Ind. (WLFI) – A doctor at the West Lafayette VA Outpatient Clinic accused of giving poor care has resigned.

You may remember Iraq veteran Alexander Vancel from a story News 18 broke in July. Vancel told us he endured months of excruciating pain because of a cancer and infection that was undiagnosed by Dr. Min Choi.

News learned Wednesday night that Dr. Choi resigned from the VA late last month. She had been on administrative leave pending the results of her review.

News 18 spoke with Vancel’s father who tells us that Alexander had been doing well recently. He had been gaining strength with a trial immunotherapy.

But earlier this week, his bilirubin levels got too high so the infusion had to stop and was hospitalized at the Indianapolis VA hospital. He’s hopeful to be able to go back home in another couple days.

Meanwhile, he’s enjoying life as a new father. His wife Amanda gave birth to a healthy girl named Luna who is now 6 months old. He also qualified for 100 percent service-connected disability for which he’s thankful.

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New White House Drug Czar: ‘Treat Pot Like Tobacco’

http://www.eastbayexpress.com/LegalizationNation/archives/2016/04/08/new-white-house-drug-czar-treat-pot-like-tobacco

The White House’s drug czar Michael Botticelli — a recovering addict — is tempted by the delicious smell of cannabis while walking down the street in Washington DC, he told the New York Times Magazine, in a short Q&A that illustrates a potential new federal response to state marijuana legalization.

click to enlarge

• Michael Boticelli.

It’s no surprise Drug Czar Botticelli said he opposes marijuana legalization.

“I think that there is a middle ground where you can move people away from the criminal-justice system without some of the challenges that might come along with legalization,” he told Ana Maria Cox, in the interview published Wednesday.

That’s a refreshing bit of moderation from the new director of the Office of National Drug Control Policy, a job normally held by people with no public health qualifications. 

“Looking back over the history of the office, it has typically been led by generals and police officers,” said Botticelli. “It was really geared toward supply reduction and interdiction. We want to focus on public-health strategies.”

Botticelli also lamented that “walking down the street and smelling pot everywhere is really challenging to people in recovery.” (Washington DC legalized cannabis for adults in 2014, resulting in a 98 percent reduction in arrests.)

Cox responded with a question: “Alcoholics can walk down the street and smell alcohol. Would you want to make alcohol illegal?”

“No,” Botticelli said.

Instead, he advocates a tobacco control approach. “[W]e’ve really changed the culture, and our smoking rate is at its lowest level. Unfortunately, I still smoke.”

click to enlarge

• Lori Ajax.

Meanwhile, in California our state’s new medical marijuana czar Lori Ajax aced her first long interview with the media, the Los Angeles Times’ Patrick McGreevy. The interview was published today.

Ajax — a twenty-year veteran alcohol regulator in California — said she believes there are legitimate medical uses for cannabis, though she has no personal or familial experience with them.

“It appears there is a medical need … I have heard stories, of course. And through my meetings I’ve set up with industry groups and with legislators, I’ve heard stories of how it has helped folks with cancer.”

Ajax astutely avoids the argument that medical pot recommendations are too lax in California.

“I don’t have enough information at this point to tell you whether I think that is happening. I think over the course of the next couple of years that is something we are going to have to look at.”

Ajax defers to local control on the issue of medical pot regulation. “The locals know best what they want in their cities and counties,” she told the Los Angeles Times.

Ajax even sounds sensitive to former pot felons who want into the legal industry. Her comments indicate that there may not be a state blanket ban on people with drug felonies from entering the legal pot industry.

“That’s going to be through our licensing process. We are going to have to do a background, a fingerprint check and then you evaluate the seriousness of the crime at that point.”

In response to the question “You have never used marijuana?,” Ajax responded with what appears to be a tactful, hair-splitting answer.

“No. I’m not a marijuana user.”

Half of America has tried pot, Pew Research reported in 2015.

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Mail Order Prescriptions Not Always Cheaper

http://www.wfmynews2.com/news/local/2-wants-to-know/mail-order-prescriptions-not-always-cheaper/131446853

The insurance paperwork is piling up for Curt Burshem

One of his family members has a kidney disorder. And life without this pill would be very difficult.

Your kidneys could shut down, you could be on a kidney machine the rest of your life,”says Curt.

The pill is called MYCOPHENOLATE MOFETIL. it’s a mouthful and a budget buster too. The first 30 day prescription filled at CVS cost $104 – about .$87 a pill. His insurance covered most of it.

To save money, his insurance plan advised Curt to use CVS Caremark – a mail order service. So he did. He ordered a 90 day supply. Based on the initial cost, he estimated the cost at about $312 or less – before insurance. Not even close.

“Caremark is saying it’s a $2300 drug.”

You heard right. With the mail order service, CVS Caremark charged. About $6.62 a pill! Before insurance.

And, remember, the CVS mail-order was part of an insurance plan that’s supposed to save money.

So how is the happening? CVS Caremark is what’s called a prescription benefits manager. PBM’s tell employers they can lower prescription prices because they buy in bulk for a discount. But that also means CVS becomes the sole prescription provider..which can drive up prices.

Dr. Steven Schondelmeyer is one of the nation’s leading experts on prescription drug pricing. he warns the monopoly-like pricing is confidential..which can be costly for the consumer.

 “They’ve shut other people out. And they’ve done so in a way that you don’t really know and can’t find the prices,” says Dr. Schondelmeyer. “They think nobody would cheat us that much. But they do.”>

Dr. Schondelmeyer not the only one saying this. CVS Caremark is now being sued for inflating the prices of prescription drugs…something it denies.

All of Curt’s research, he discovered something else you need to know. Because the mail-order price before insurance was so high, Curt’s co-pay was high. $476. It actually turned out to be cheaper for him to buy 90 days worth of the pills without insurance. $259.

So the two take aways for you:
– Use a website like GoodRX. It will show prices in your area of drugs without insurance.
– Call the mail order pharmact before you order to make sure it’s really cheaper.

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Drug plan hit with backlash

http://thehill.com/policy/healthcare/275918-drug-plan-hit-with-backlash

The Obama administration’s aggressive move to rein in the cost of prescription drugs in Medicare has triggered a backlash, with some advocates warning the plan goes too far.

The administration is pursuing a pilot program that could squeeze the margins for doctors that prescribe high-cost drugs, potentially saving the government billions of dollars in the process.

It’s the first step of a model from the Centers for Medicare and Medicaid Services (CMS) that could be finalized as early as next month. The stark shift in doctor payments is slated to go into effect in some parts of the country this summer.

But the proposal is facing mounting opposition from groups that represent people with some of the costliest conditions to treat, including cancer, multiple sclerosis and rheumatoid arthritis.

“I think they are shocked by the pushback,” said the head of one advocacy group that recently met with the CMS. “They didn’t anticipate what was going to happen and now they are really backing up now going, ‘What do we do about this?’ ”

The Obama administration has defended the plan, calling it a serious attempt to deal with a decades-old problem. The current payment structure, the administration says, has resulted in doctors prescribing higher-priced drugs when cheaper, effective alternatives are available.

“The goal is to test whether alternative approaches will lead to better value,” Dr. Patrick Conway, chief medical officer at the CMS, told reporters when he announced the model last month.

The first phase of the administration’s plan is to rethink doctor payments, starting as early as this summer. The second phase, expected in 2017, will dole out doctor payments for certain drugs based on how effective those drugs have proven to be.

If the pilot model is shown to work after five years, it could be incorporated on a national basis.

But groups like the Biotechnology Innovation Organization and the American College of Rheumatology say the new payment formula has the potential to force smaller, rural healthcare providers out of business.

Dr. William Harvey, head of government relations for the American College of Rheumatology, said he has observed a “huge backlash” in large part because many doctor and patient groups felt they had been blindsided by the proposed shift.

“Everyone says, ‘No, no, no, this has to be repealed, we can’t have this at all,’ ” Harvey said, adding much of the chaos could have been avoided if CMS officials “would have had conversations with us.”

At least one group has met face-to-face with Medicare agency officials, and others say they have tried, though administration officials say their doors have been open throughout the process.

Conway, a practicing physician at the CMS, addressed the criticism during a Pew Charitable Trusts panel on the Medicare Part B proposal on Monday.

“We thought we expressed this well in the proposal, but we’ve heard from some patient groups, so I want to say this clearly: We hear you, and we will deeply engage patient and consumer communities in this model,” Conway said.

He stressed the agency had “received input prior to this proposal” and will have “the most public and engaged process that we can.”

Physicians are now reimbursed by Medicare based on the “average sales price” of a drug plus an additional 6 percent to cover storage and other expenses.

Officials at the CMS want to cut that formula to the average-sales price plus 2.5 percent, with an additional flat fee of about $16.

While the government says the 6 percent formula encourages the use of pricey drugs, Medicare doctors say they’re insulted by the implication that they’re prescribing medicine based on the costs.

The cost of Medicare Part B drugs has jumped by an average of 8.6 percent annually since 2007, and the total amount spent on drugs has doubled in the last five years. Those costs are expected to climb even higher as costlier drugs come to the market.

Most medical experts agree the Medicare’s reimbursement system is flawed. But critics of the CMS pilot program argue the administration is meddling in a system that’s more complex than just “average sales price.”

“It needs to be more comprehensive than just looking at the drug costs,” Stephen Grubbs, vice president of clinical affairs for the American Society of Clinical Oncology, said at a panel Monday.

Some healthcare observers have described the pilot as a “half-step” toward giving Medicare more control over drug pricing, a longtime goal of Democrats and patient advocacy groups.

Powerful groups like the AARP and the Center for American Progress have backed the administration’s attempts to alter the status quo of Medicare reimbursement.

“Frankly, we’re really glad to see it. It’s something we think has been a long time coming,” said KJ Hertz, a senior legislative representative at the AARP.

Some critics of the proposal, like Harvey, said the potential longer-term effect of making Medicare more sustainable is one reason some of the bigger healthcare groups have showed a “hesitancy to speak so vociferously” against the experiment.

Even big-name cancer groups, like the American Cancer Society, have not yet released public comments about the proposal. A representative for the group declined to comment for this story.

The backlash against the proposal began before its public release. A draft of the proposal had been leaked weeks earlier, and some of the concerned groups said officials had assured them that it was not final version.

But when it was released, some close observers said the final copy strongly resembled that draft.

The policy was officially released in mid-March, sending shockwaves across doctor and patient groups.

A day after it was released, CMS acting Administrator Andy Slavitt came face-to-face with drug executives at the annual policy conference of the Pharmaceutical Research and Manufacturers of America (PhRMA).

Seated before 100 drugmakers, PhRMA board member and Merck CEO Kenneth Frazier asked Slavitt about “the elephant in the room.”

“As you can imagine, people have a great deal of concern about the proposal,” Frazier said.

Slavitt pitched the idea as a way to increase access to life-saving medicine.

“There is nothing that we propose to do, or should do, in any way, that prevents a patient from getting a prescription medicine that they need,” Slavitt told the drugmakers.

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Pregnant women with addictions need healthcare, not handcuffs

Tennessee learned the hard way, with its disastrous fetal assault law. The other states considering punishing addicted mothers should heed its example

http://www.theguardian.com/commentisfree/2016/apr/12/pregnant-women-addiction-healthcare-not-handcuffs?utm_source=esp&utm_medium=Email&utm_campaign=GU+Today+USA+-+Version+CB+header+MPU&utm_term=166734&subid=13529055&CMP=ema_565

Every 19 minutes, a baby is born in America to a mother who struggles with opiate addiction, a percentage that has soared in the past decade alongside a broader addiction spike. The increase has forced some state lawmakers to decide whether the mother’s drug use, which can leave the baby with post-birth withdrawal called neonatal abstinence syndrome (NAS), is a criminal justice issue or a disease.

As with heroin and opioid addiction outside of pregnancy, the consensus among doctors and advocates is that this is a health matter, and not one for the courts. (NAS is a highly treatable condition without long-term effects, though it’s still an unfortunate one: newborns with NAS convulse, projectile vomit and emit a telltale shriek.) President Obama agrees – he recently announced an increase in funds dedicated to treatment, and an increase in the number of patients a doctor can treat with some maintenance medications.
Curbing pain prescriptions won’t reduce overdoses. More drug treatment will
State lawmakers, on the other hand, are still learning. They tend to default to treating it as a crime, only to find that doesn’t work.

Tennessee was the first state to enact a law, in 2014, expressly criminalizing drug use during pregnancy. The law empowers police officers to lock up women who deliver babies with NAS. Today, five other states – Alabama, Colorado, Louisiana, North Carolina and Virginia – are considering enacting similarly punitive policies.

But Tennessee decided in March to take its “fetal assault” law off the books, effective July 2016. They based their decision on the fact that the law made women more afraid, rather than more likely, to seek treatment.

Here are the things that I hope they’ve learned – and that other states will heed – before more laws are passed that discourage addicted women from receiving prenatal care and drug treatment.

Drug addiction is a disease, period.

Virtually every medical organization in the nation – from the American Medical Association, to the American Academy of Pediatrics, to the American College of Obstetricians and Gynecologists – opposes the prosecution of drug-addicted mothers.

They instead support treatment and education for the disease of addiction. Drugs change the brain – they alter its structure and its functions, robbing a pregnant addict of judgment, even at the risk of harming her fetus. Consider why any mother – one who has decided to carry her pregnancy to term – would choose to give birth to a baby with developmental shortcomings. She wouldn’t. As the National Association for Perinatal Addiction Research and Education correctly points out: “These women are addicts who become pregnant, not pregnant women who decide to use drugs.”

The US doesn’t incarcerate pregnant women who have other kinds of serious medical conditions – such as HIV/Aids or cancer, diabetes or asthma – that could potentially affect fetal or child development. Doing so would be cruel and unusual. How is drug addiction, which is no more a choice than any other disease, different?

Punishing prenatal substance abuse is counterproductive, and it leads to unintended consequences.

Advocates of Tennessee’s fetal assault law argued before its passage that the penalty would facilitate healthier pregnancies – that the threat of jail time would somehow scare women into treatment. I suppose they were right about one thing: women becoming afraid. But the law has, in all other ways, had the exact opposite effect.

Instead of seeking help, women are going underground for fear of penalization. Carmen Wolf fled to a neighboring state to give birth. Brittany Hudson delivered her infant in the back seat of a car. Tonya Martin took her own life. Some women, to the revulsion of many pro-life supporters who would otherwise support punishment, are even having abortions.

But even more damning is this: the law hasn’t decreased NAS births statewide. Since its implementation, such births have actually increased, with 975 reported cases in 2014 and 986 in 2015, according to the Tennessee department of health. Holding a hammer over the heads of drug-addicted expectant mothers to encourage healthier pregnancies seems to be about as effective as eating a Big Mac while exercising on a treadmill to lose weight. It doesn’t work.

If a state doesn’t invest in drug treatment for pregnant women, its approach will fail.

The Tennessee law guarantees that if a woman enrolls in treatment while pregnant, and sticks with it, she will not be jailed. But they made that stipulation without increasing access to treatment enough to meet the growing demand.

The state needs more than double the slots in its licensed treatment facilities to care for pregnant drug users than it currently has available. Contributing to the access problem are significant geographical burdens imposed on women living in isolated, rural towns with addiction centers hours away; waiting lists with, typically, hundreds of people on them at any given time; and extreme unaffordability of treatment due to Tennessee’s continued refusal to expand Medicaid under Obama’s Affordable Care Act.

Pregnant women with addictions need healthcare, not handcuffs. And that’s not only what doctors, relevant experts and science have long maintained. It’s also what Tennessee is learning the hard way, from its failed experiment. States considering punitive responses to the opioid and pregnancy dilemma should take note.

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Kasich proposes to license pharmacy technicians, limit painkillers

http://www.wlwt.com/news/kasich-proposes-to-license-pharmacy-technicians-limit-painkillers/38986646

Pharmacy technicians were responsible for a third of about 140 pharmacy drug thefts over the past three years, said Steven Schierholt, the Ohio Pharmacy Board’s executive director. Ohio is one of only eight states that doesn’t license the technicians, he said.

The state estimates about 42,000 pharmacy technicians currently work in Ohio and are subject only to employer background checks.

“With the current system, if a pharmacy technician engages in theft from a pharmacy, and if an employer chooses to fire them or allow them to resign, nothing keeps them from going down the street and getting another job,” Schierholt said.

Kasich, a Republican running for president, announced several proposals Tuesday to address Ohio’s addictions epidemic as record numbers of people continue to die from painkiller and heroin overdoses. The proposals are part of a mid-session budget review process.

Among other measures, the state would:

• Require facilities where prescribers treat 30 or more patients with Suboxone, a medication used as part of substance abuse treatment, to be licensed by the pharmacy board unless the facility is a licensed hospital.
• Expand the use of the anti-overdose drug naloxone, sold as Narcan, to schools, homeless shelters, halfway houses and treatment centers. The drug is already available without a prescription to people with friends and family members who are addicts. First responders such as paramedics have used it to save hundreds of lives in Ohio.
• Require sole proprietors, such as doctors, veterinarians, dentists and other health care professionals in private practices, to be licensed by the pharmacy board if they distribute controlled substances to their patients.
• Waive the requirement that medical providers be certified in Ohio for two years prior to operating a methadone clinic to increase the availability of the treatment option.
• Place a 90-day cap on the length of a painkiller prescription and require anyone who doesn’t have that prescription filled after 30 days to get a new one.

These limits are meant to reduce the number of pills in people’s medicine cabinets, often a leading source of initial addiction, said Dr. Mark Hurst, medical director of the state Mental Health and Addiction Services agency.

“Many people don’t realize that the initial source of opiate medications is not from a drug dealer on a street, it’s from family or friends,” Hurst said.

Accidental drug overdoses have killed more Ohioans than car crashes since 2007. A record 2,482 people in Ohio died from accidental overdoses in 2014, an 18 percent increase over the previous year.

Ohio previously set guidelines to reduce the prescribing of painkillers in emergency rooms and for closer monitoring of prescriptions for people suffering chronic pain, such as cancer patients.

State medical officials also say people with short-term pain from injuries or surgery should be given alternatives to prescription painkillers whenever possible.

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Medical student’s Facebook blast brings sanctions

abqjournal.com/754816/news/unm-med-student-says-he-was-punished-for-obama-facebook-post.html

A University of New Mexico medical student says in a federal lawsuit that school officials imposed sanctions on him and forced him to write a letter of apology after he posted a message on Facebook equating abortion to genocide and used profanity in criticizing President Barack Obama’s re-election in 2012.

Paul Hunt alleges in a complaint filed in the U.S. District Court in Albuquerque last week that he was threatened with expulsion for what he contends was exercising his First Amendment rights of political speech.

The lawsuit says Hunt’s posting was on his personal Facebook page and the posting itself doesn’t say he is speaking as a UNM medical student.

“To all of you who support the Democratic candidates … Your party and your candidates parade their depraved belief in legal child murder around with pride…” the post stated. “You’re WORSE than the Germans during WW2.”

“If you think gay marriage or the economy or taxes or whatever else is more important than this, you’re (expletive deleted) ridiculous.”

A screen capture of the posting is included in UNM’s response to the lawsuit.

Someone, the lawsuit says, saw the post and reported Hunt to UNM school of medicine staff. A committee reviewed the case and found Hunt’s Facebook post constituted “unprofessional conduct.”

“However, instead of dismissing you from the school of medicine, the committee has chosen to impose a professionalism enhancement prescription,” read a letter sent to Hunt.

According to the lawsuit, Hunt was forced to write an apology and rewrite the post or face expulsion. Hunt, the lawsuit said, complied with those requests. The suit also said the medical staff cast aspersions over his future with a disciplinary mark on his record following the investigation.

“This post was inherently political speech, protected by the First Amendment,” the lawsuit argued. “These negative references have tainted and will probably jeopardize (Hunt’s) acceptance into a preferred residency program upon graduation from the school of medicine.”

Jeffrey Baker, the attorney representing Hunt, said his client is still enrolled in school and plans to graduate in 2018, though Hunt is currently on a leave of absence.

Baker said the lawsuit was initially filed in state court in January before it was moved to federal court later this year. UNM attorneys have called for the federal court to dismiss the lawsuit. They say Hunt violated the school’s standards and university policy.

“The school of medicine teaches students that because of the stature of a physician with his or her patients and the influence that the physician can assert over patients or potential patients, it is essential that the physician’s personal beliefs must not be broadcast in inappropriate ways or forums,” wrote university attorneys in response to the lawsuit.

John Arnold, a spokesman with the Health Sciences Center, said the department couldn’t comment on pending litigation.

“UNM respects an individual’s right to freedom of speech, while also striving to foster an environment that reflects courtesy, civility and respectful communication, as stated in the university’s Respectful Campus policy,” he said in an email. “We stand by our response filed with the court last week and refer you to that motion.”

In the response, UNM attorney said Hunt has the ability to petition for the removal of the disciplinary note on his academic record.

Hunt is seeking an unspecified amount of damages and fees. He also wants the school to remove any references to the Facebook incident from his record.

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Opioid Epidemic Spurs Rethink on Medication and Addiction

Use of medication-assisted treatment is increasing

http://www.medpagetoday.com/Psychiatry/Addictions/57265?xid=nl_mpt_DHE_2016-04-11&eun=g578717d0r

Most addicts after a couple of years no longer get “high”… they  use the term “dope sick” to refer to cold turkey withdrawal and their existence becomes centered around warding off becoming “dope sick”..  In the process of realizing that “addicts/junkie” are really those suffering from the chronic mental health disease of addictive personality disorder.  So down they are treating/maintaining these people with Suboxone .. a C-III medication… so instead of being dependent on Heroin – which metabolizes into Morphine in the body… we are now having these people DEPENDENT on a C-III medication. So should there really be any difference in a person maintained and functioning on Suboxone or some other controlled medication ?  Other than Suboxone therapy is an “APPROVED” therapy by the over-ruling bureaucracy ?

Drug treatment providers in California and elsewhere have relied for decades on abstinence and therapy to treat addicts. In recent years, they’ve turned to medication.

Faced with a worsening opiate epidemic and rising numbers of overdose deaths, policymakers are ramping up medication-assisted treatment.

President Barack Obama last week said he’d allocate more money for states to expand access to the medications. He also proposed that physicians be able to prescribe one of the most effective anti-addiction drugs, buprenorphine, to more patients.

California already plans to expand access to medications as it launches an overhaul of the state’s substance abuse treatment system for low-income residents. The state recently embarked on a 5-year demonstration project on the premise that addiction is a chronic disease and should be treated as such.

While medication is not for everyone, it can be critical for some people with severe addiction, said Marlies Perez, chief of the substance use disorder compliance division for the state Department of Health Care Services. The medications, she said, “have been proven as the gold standard for really helping people recover.”

The best-known medication, methadone, blocks the effect of certain drugs and lessens withdrawal symptoms. It is highly regulated and can only be prescribed by clinics that have government approval. Buprenorphine, which can be prescribed in doctors’ offices, produces mild opioid effects while also easing withdrawal symptoms. Another medication available by prescription, naltrexone, blocks the effect of opioids.

The medications are available across the country, but must be prescribed by physicians with special training. There are only about 30,000 authorized doctors nationwide, and they can only prescribe to a limited number of patients.

Obama’s proposal would allow qualified doctors to prescribe buprenorphine to 200 patients, up from 100.

That could make a big difference in California, Perez said. The state is also trying to better link treatment centers with trained prescribing doctors so that physicians can consult with one another on treatment options for their patients. “Not all physicians, even in the substance use field, have that clinical knowledge,” she said.

The use of medication in treatment conflicts with the 12-step and Narcotics Anonymous philosophy of addiction recovery, which is based on abstinence, experts said. For many, experts said, simple abstinence doesn’t work.

“You would hope that just by talking to somebody, they could get rid of their problem with drugs,” said James Sorensen, a University of California, San Francisco professor and interim director of the substance abuse and addiction medicine program at Zuckerberg San Francisco General Hospital. “The reality is, that is simply not efficient, so we look for other tools.”

Medication is one of the most successful, evidence-based treatments available, and more access should have a big impact on those with substance abuse disorders, said John Connolly, deputy director for substance abuse prevention and control for the Los Angeles County Department of Public Health. But, he cautioned medication should be used alongside more traditional treatment methods.

“The medication has tremendous effect, but it is most impactful when it is prescribed with the necessary counseling and social supports,” he said.

Stephen Kaplan, director of behavioral health and recovery services for San Mateo County, said the county has increased its use of medication. About 2 years ago, the county began a pilot project to prescribe naltrexone to people with severe alcoholism who hadn’t been successful in traditional treatment.

The medication reduced people’s cravings and drinking, Kaplan said. The county recently began expanding the project to include people with opiate addictions.

Kaplan said he respects providers who believe that replacing one drug with another is not true recovery. But from a policy standpoint, Kaplan said, the medications are effective and should be more integrated into overall recovery for people with substance abuse disorders.

“We need to make available to them every possible option,” he said.

Perez of the state Department of Health Care Services said she believes that Obama’s focus on the opiate epidemic — and his recognition that it is a disease and not a moral failing — helps reduce the stigma.

“That makes a huge difference in folks coming forward and looking for treatment,” she said.

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In the last Presidential election there was 235 million people in the USA of voting age… and there was 129 million votes cast… with 5 million between the winner and the loser… is it more than a coincident that the number of people that didn’t vote is the same number of estimated chronic pain pts ?

Congress (both parties and both House and Senate) have an approval rating in the single digit right below CAR SALESMEN and yet 90% will get re-elected.

There seems to be more “coming out” this Presidential election about the “workings” of both parties in choosing their Presidential candidate.

The Republicans have had 12 “contested conventions” where there was not a candidate that came to the convention with the need 1237 delegates to gain the nomination on the first ballot. Nine of those 12 contested conventions.. the person that came to the convention with the most delegates.. didn’t get the nomination of the party to represent the Republican party in the Presidential election.  They routinely hold out that Abraham Lincoln came to the convention in FOURTH PLACE but was “chosen” by the party’s insiders as the party’s nominee.

Or course the Democrats have their own set of rule or “king makers” .. referred to as “super delegates”… there are 712 super delegates are abt 30% of the 2472 delegates needed to gain the nomination of the party. So party insiders can definitely change the outcome of the convention.

I know that there are people out there that believe electing a “bad Democrat” is better than electing any Republican and the same goes for some people believe that electing a “bad Republican” is better than electing any Democrat.

The problem seems to be that no matter who gets elected and which party is in power… Congress continues to spend more than they take in.

Here are the 34 Senators up for re-election in 2016  http://2016.state-election.info/senate/  and three have not yet confirm their intention to run for re-election.

Just shy of 65 million votes elected the last President (Obama)… 106 million people of voting age… DID NOT VOTE…

During Obama’s tenure … we have had Democratic controlled Congress and Republican controlled Congress..

If you can’t vote for a Democrat … vote for a Libertian

If you can’t vote for a Republican… vote for a Libertian

If you must vote for a Republican or Democrat.. vote the incumbent OUT…

Politicians only care about two things.. $$ to buy ads to get re-elected and votes… Just listen to them… they believe that $$$ buy ads and the more ads they run.. the more votes they will get.. and they will GET RE-ELECTED.

If you are happy with the status quo of Congress and our government… by all means … vote for the incumbent…

or go here to see more of these “honest political ads ”  https://www.youtube.com/user/UnitedRepublicVideo?sub_confirmation=1&src_vid=NAtunJv6NtE&feature=iv&annotation_id=annotation_627256905

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Voters need to look at the larger picture. There are 435 Representatives and 33-34 Senators that will be up for re-election and/or open offices because the current incumbent is retiring.

We need to look back as to which “party” was in control when certain major pieces of legislation has been passed..

The Harrison Narcotic Act 1914 was passed by a Democratic Congress and Democratic Pres Woodrow Wilson…this created the “black drug market”
In 1965 a Democratic President Johnson and a super majority Democratic controlled Congress passed Medicare..  under Johnson’s “Great Society Program”

In 1970 a Democratic controlled Congress passed the Control substance Act.. and signed by Republican President Nixon creating BNDD/DEA and officially starting the war on drugs

In 2003 Republican controlled Congress and Pres Bush (43) passed the Medicare part D law.. effective Jan 1 2006.  Almost totally OPPOSED by Democrats.

In 2010 the Democratically controlled Congress passed the ACA ( Obamacare) and signed by Democratic President Obama

A core belief of the Republicans is “right to life”.. except over the last century.. they seem to have little interest in your “right to life” in the form of providing healthcare once you “pop out of the womb” and take your first breath.

A core belief of the Democrats is a “woman’s right to chose” and if by chance you are able to “take your first breath” the Democrats are willing to provide some sort of healthcare.. as long as your healthcare needs are within a certain spectrum of healthcare.

If your chronic disease(s) fall under the “subjective disease categories” … with both parties it would appear that in regards to getting healthcare you are “persona non grata”

IMO… if the chronic pain community doesn’t get denial of care as part of this November’s election discussion. After the Republican/Democratic conventions – last one ends July 28th… Both parties will be kicking into high gear by Labor Day.

The next time that we have  the opportunity to have two candidates for the Presidency – since the current resident of the White House has “tapped out” and is a lame duck will be a minimum of EIGHT YEARS…

If denial of care of treating subjective diseases does not become part of this election campaign.. the 8 K dying of Heroin use/abuse… will be small in comparison to those committing suicide or ODing on Heroin because they can’t get their prescribed pain meds.

If the chronic pain community does not change the conversation… the bureaucrats will continue to SILENCE THE CONVERSATION

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