N.J. man wrongly detained when pharmacist suspected he had Ebola, lawsuit claims

http://www.nj.com/warren/index.ssf/2015/10/man_wrongly_detained_when_pharmacist_suspected_he.html

A Hackettstown resident who emigrated from the Ivory Coast is suing a local pharmacy, hospital and emergency services after he alleges his civil rights were violated over Ebola suspicions.

This undated file image by the CDC shows an Ebola virus. A Hackettstown man who emigrated from the Ivory Coast says his civil rights were violated when he was detained and tested for the virus in 2014. (AP file photo) 

A lawsuit filed this month in New Jersey Superior Court in Belvidere seeks damages for false imprisonment, assault and discrimination after the 43-year-old man allegedly was subjected to hours of invasive medical tests without his consent.

Named as defendants are Rite Aid, the Warren County Health Department and sheriff’s office, the Hackettstown First Aid & Rescue Squad, town police and Hackettstown Regional Medical Center.

The plaintiff, Ouattara Sana, came to the U.S. in May 2014 seeking political asylum from persecution in his West African homeland, the lawsuit says.

Last October, Sana went to the Rite Aid pharmacy on Mountain Avenue in Hackettstown to consult with a staffer about a diarrhea problem, the suit says. The worker, who is not identified by name in the filing, allegedly told him it was an effect of medication, then asked where Sana was from and if he had a fever.

Diarrhea and fever are two symptoms of Ebola, according to the Centers for Disease Control and Prevention. At the time, there was an outbreak of the rare but deadly virus in West Africa, affecting thousands in nations adjacent to the Ivory Coast.

Sana said he had not been ill in the five months he had lived in the U.S. and left the store, the lawsuit says. The worker beckoned him back inside — Sana thought he had found medication to help with his diarrhea, the suit says.

The worker allegedly took Sana’s temperature several times and kept him in the pharmacy while law enforcement and health officials were called. He was taken to Hackettstown Regional Medical Center, where he was kept for seven hours, the lawsuit says.

The lawsuit alleges Sana’s detention was the result of discrimination based on his race and nationality, and the defendants’ lack of proper training. In addition to unspecified damages, the suit asks the court to make them establish policies to prevent similar actions from happening.

Sana is represented by Flemington-based attorney William J. Courtney.

The agencies named as defendants either declined comment or did not return calls.

Steve Novak may be reached at snovak@lehighvalleylive.com. Follow him on Twitter @type2supernovak. Find lehighvalleylive.com on Facebook.

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Ambiguous Grief: Grieving Someone Who Is Still Alive

http://www.whatsyourgrief.com/ambiguous-grief-grieving-someone-who-is-still-alive/

My guess is that when people read the title of this article they will react with either a, “what are they talking about?  How can someone be grieving someone who is still alive and what the heck is ambiguous grief???” or a “holy crap, yes!  I have felt exactly that way! Thank goodness WYG is finally covering this topic”.  This is one of those topics where if you have been there, you get it and if you haven’t, you don’t.  Either way, hopefully you’ll read on.

Before we dive in, if you clicked on this post because you feel like you are grieving someone with a terminal illness who has not yet died, there is another WYG article you should read before you read this article.  Check out our article on Anticipatory Grief, which is about the grief that comes when we anticipate that we are going to lose someone.

In contrast to anticipatory grief, there are times in life when someone we love becomes someone we barely recognize.  The person is still physically with us, but psychologically they are gone. There are a range of reasons this can happen.  Some of the most common are things like addiction, dementia, traumatic brain injuries, and mental illness.  If you have never lived through loving someone in such a situation, this can be hard to understand.  The person you love is still there, sometimes they ‘look’ sick, sometimes they don’t.  But regardless of how they look, they do things they would never have done, they say things they would never have said, treat you in ways they never would have treated you, and they are not there for you in ways they previously were.  This is sometimes referred to as “ambiguous grief” or “ambiguous loss”.

This may sound very abstract, but when it occurs in your life it is very concrete and real.  Your mom, who always loved and supported you, doesn’t recognize you, understand you or says hurtful things.  You husband, who was always kind and considerate, is now lying and stealing to support an addiction.  You son, who was brilliant and driven, is now struggling with delusions and hallucinations.

These things do not change our love for the person – we still love our mom with dementia, our husband with an opiate addiction, our son with schizophrenia.  But this continued love doesn’t change how deeply we miss the person they used to be, the person we lost.  We may not feel like we have the same relationship with that person – our marriage no longer feels like a marriage when one spouse can no longer remember the other.  The parent-child relationship no longer feels the same when a parent has to stop protecting, trusting, or helping a child in the same way due to addiction.  The child-parent relationship becomes confused when a child has to care for a parent.   Though we still have a relationship with the person it has radically changed and we grieve the relationship we used to have.

Our ‘ambiguous grief’ feelings may be sadness and yearning, anger and guilt, or a range of other emotions.  These emotions can become even more complicated than the grief that comes after a death when the behaviors and words of the ‘new’ person causes us to question our old memories.  Or worse, they can start to consume our brains as those old memories begin to fade.  Another complication of ambiguous grief is that many people don’t recognize it as grief.  When those around us don’t acknowledge our grief, or make us feel that we have permission to grieve this sort of loss, that can make you feel lonely and isolated. It can be a hard type of grief to open up about because we know others may not acknowledge it.

As usual, the big question is so what?! So what that it is grief? So what do I do about it?

Ambiguous Grief Tips: what to do when you are grieving someone who is still alive:

• Remember that the present doesn’t override the past. This can be easier said than done, but it is important to remember that the person your loved one is now doesn’t change the person they were.  Even if their words or behaviors now are difficult or hurtful, even if your relationship has changed and is not what it was, this doesn’t change the person they were and the relationship you had.  Cherish those positive memories, write them down, create a scrapbook of old photos, whatever you can.
• Understand that the illness isn’t the person. This sounds obvious, but it can be really tough when someone you love seems like they should be the same wonderful person they always were, they’re not.  Whether it is addiction, dementia, a brain injury, mental illness, or anything else, it is important to understand the illness.  As much as we may still feel anger, frustration, or blame toward the person, understanding the illness can divert some of those feelings.
• Acknowledge the grief and pain of the loss. Though society may not always recognize this type of grief, it is important that you give yourself permission to grieve this loss.  Acknowledge and express the pain of the loss, rather than trying to ignore or avoid the pain.
• Be open to a new type of relationship. When the person we love has changed, the relationship we have with them will inevitably change.  This can feel like it is objectively and entirely a bad thing, but there is the opportunity for a new type of relationship.  Will this new relationship always be easy? No.  Hell no.  In fact, many days it will be very very hard. But being open and seeking gratitude in your new relationship can be extremely helpful.
• Connect with others who can relate. When many won’t relate to ambiguous loss, finding a support group can be of help.  There are support groups out there for caregivers of those with dementia, groups like Al-anon and Nar-anon for family members of those with addiction, and groups like NAMI who offer groups for family of those with mental illness.

Have you dealt with ambiguous loss?  Leave a comment to share your experience.  Then subscibe to get all our posts right to your email.

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Feds Seize Truck Full of Heroin in New Jersey; 15 Arrested in Separate Bust

http://www.nbcnewyork.com/news/local/NJ-Paterson-Truck-Heroin-Dozen-Arrests-Drugs-DEA-Heroin-Cocaine-336333021.html

For those not familiar with the metric system..  TWENTY KILOGRAMS is equal to about 45 POUNDS and a tractor trailer’s load capacity is abt 50,000 POUNDS..  That would make the Heroin seized to be 0.09% of the total load capacity of a tractor trailer.  Depending on the density of Heroin..  it could take up somewhere between 0.5 to 1 cu ft.  A block 1′ by 1′ by 1′ and the total cu ft of storage area in a tractor trailer is abt 3400. So how the DEA can claim that they seized a “Truck Full of Heroin” ?

A tractor-trailer carrying nearly 20 kilograms of heroin was seized by Drug Enforcement Administration agents in Paterson on Friday as part of a take-down of alleged heroin dealers.

Officials said a heroin mill on Chamberlain Avenue was also searched Friday morning in connection with the case.

Investigators said the heroin operation was run by a local liquor store owner who is now in custody, along with three alleged associates.

In addition to heroin, officials said DEA agents and Paterson police also seized large amounts of cocaine. The tractor-trailer with California plates was apparently making a delivery to a warehouse on Second Avenue. Officials believe much of the illegal drug shipment originated in Mexico.

As part of that case, detectives made a total of 23 purchases of crack cocaine, heroin, marijuana and cocaine in a street-level investigation. Twenty people sold the drugs to the officers on various streets throughout Paterson, according to a release from the Passaic County Prosecutor’s Office.

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I take Tylenol or Advil every day. Am I killing myself?

http://fusion.net/story/188394/tylenol-advil-dangers-over-the-counter-acetamenophen-nsaids-death/?utm_source=rss&utm_medium=feed&utm_campaign=/feed/

I used to pop Tylenol and Advil like candy. Wake up with a headache? Wash that cereal down with some acetaminophen. Tough workout? Cool down with a Gatorade and some ibuprofen.

My daily over-the-counter habit didn’t concern me. After all, I bought my pills in bulk at Costco—how dangerous could they be?

I clearly wasn’t alone in this thinking. Americans love over-the-counter pain medication: From July 2014 to July 2015, we spent more than four billion dollars on the stuff. They’re available in much larger quantities in the United States than in many other countries, too. While the United Kingdom, Australia, and the Netherlands have passed laws severely limiting how much acetaminophen a person can buy at one time, in this country, we can purchase bottles filled with a thousand pills each—fueling the perception that these drugs are harmless.

While aspirin has long been known to carry risks, other popular over-the-counter painkillers have recently grabbed headlines for their dangers, too. Tylenol, the brand name for acetaminophen, can cause fatal liver damage. Advil and Aleve, brand names for ibuprofen, appear to increase the risk for heart attack or stroke—and they can tear apart our stomach lining in the process.

“People have to realize that these are not benign things,” said Edward Michna, an anesthesiologist at Boston’s Brigham and Women’s Hospital who specializes in pain management. “People want to have a pain-free existence, which is not a realistic goal,” he said, adding, “there’s always a trade off between efficacy and side effects.”

While no drug is completely safe, taking over-the-counter painkillers daily for aches and pains is not recommended use. But there is a disconnect between what the public thinks is safe and what actually is. Research has shown that about a third of Americans admit to taking more than the recommended dose of over-the-counter pain meds, thinking that doing so will increase their effectiveness. In most cases, it does not.

“People are cavalier about the use of over-the-counter pain medication, and that is completely incorrect,” said Gary Kaplan, a doctor of osteopathy and founder of the Virginia-based Kaplan Center for Integrative Medicine, specializing in pain management.

Despite the fact that I ingested these medications for years, I was clueless about the health risks until very recently. Before you reach for that bottle, make sure you know exactly what you’re swallowing.

Can over-the-counter painkillers kill me?

So what can happen when we become too cavalier with these drugs? In the case of acetaminophen, which is linked to more deaths than any other over-the-counter painkiller, the consequences can be horrific.

When used incorrectly, acetaminophen can lead to liver failure—a very serious condition. From 2001 to 2010, more than 1,500 people died from accidental acetaminophen poisoning in this country. And annually, acetaminophen overdoses send about 78,000 Americans to the emergency room, leading to roughly 33,000 hospitalizations.

The problem comes down to dosage. The drug’s safety record made headlines two years ago, when ProPublica released a scathing investigation of McNeil Consumer Healthcare, the company that makes Tylenol, exposing just how quickly one can go from taking a “safe” to “deadly” dose. According to the report, “the drug’s narrow safety margin places a large fraction of users close to a toxic dose in the ordinary course of use.’”

With Tylenol, as little as 25% above the maximum daily dose—or just two additional extra-strength pills—for several days in a row can cause liver damage, according to ProPublica. That’s not a huge window of error, which is why accidental acetaminophen poisoning occurs as often as it does. “Overall, acetaminophen is not a bad medication, but the problem is it has a small therapeutic window and you can exceed the dose level,” said Kaplan.

The danger comes down to the way it’s broken down in the liver, an organ often referred to as the body’s “washing machine.” Within the liver, the same “pathway” that flushes out acetaminophen is also responsible for flushing out other medications and substances like alcohol—and if it gets overused, toxins can build up and lead to serious complications. (This is why you should never take Tylenol while drinking or for a hangover.)

It’s worth noting that when Britain limited the number of acetaminophen pills a person could buy at one time, the number of poisoning deaths related to the drug dropped by 43%. Yet when the FDA tried to do something similar in this country, the effort only affected prescription drug companies. Today, while prescription meds cannot exceed 325 milligrams of acetaminophen per dose, nonprescription products such as Extra Strength Tylenol still contain 500 milligrams per dose. Sound crazy? It is.

When I asked the FDA about this discrepancy, a spokesperson told me over email that “over-the-counter products containing acetaminophen are not affected by the action to reduce the maximum amount of acetaminophen permitted in prescription products to 325 milligrams.” In other words, over-the-counters don’t have to play by the same rules.

Of course, when used appropriately, there’s “little risk” with acetaminophen, explained Mark Wallace, a pain management specialist and chair of the division of pain management at The University of California, San Diego.

And yet, Wallace points out that people don’t always pay attention to dosing, and they may not realize that other medications also contain acetaminophen—for example, if you have a cold and take Tylenol and DayQuil, you’re double-dosing—or they may take the recommended dose, but for too long a stretch. Using it “appropriately” is harder than it sounds.

Even if you swear off acetaminophen, other popular over-the-counter pain medications carry serious risks, too. This past July, the FDA issued a warning about non-steroidal anti-inflammatory drugs, or NSAIDs, that don’t contain aspirin—including Advil, Motrin IB, Aleve, Celebrex, and other brands.

The group concluded that these meds are more dangerous than previously thought and should be used sparingly. “NSAIDs can increase the risk of heart attack or stroke in patients with or without heart disease or risk factors for heart disease,” the FDA said in the warning. “A large number of studies support this finding.”

Along with increasing cardiovascular risk, when taken too often or on an empty stomach, NSAIDs can also tear apart your stomach lining and lead to severe gastrointestinal issues.

“There are a lot of problems with non-steroidals,” said Kaplan, such as the development of intestinal ulcer or gastrointestinal bleeding. “Anyone chronically taking this medication [more than 4 times a week] risks gastric bloating and gastric ulcers.”

Why don’t more people know about these risks?

In a recent ad campaign for Tylenol, Susan Sarandon narrates everything Tylenol can do for you and your family—from relieving your child’s fever to fixing your shoulder pain to curing those cold symptoms. Tylenol is there “for everything you do.”

The commercial is filled with soft music, laughter, and the soothing voice of an Oscar-winning actress. While the end of the ad does include a warning to “use as directed,” it never conveys that if you take more than the precisely recommended dose, or accidentally combine your cold medicine with your shoulder pain relief, you could land in the emergency room.

Why? Because highlighting this risk would probably be bad for business, as the ProPublica report explains. (If you want to learn more about McNeil’s history of skirting around these measures and pressuring the FDA, ProPublica’s harrowing investigation contains all the details.)

“I think the responsibility is that of the manufacturers,” said Wallace. “The FDA says we’ll keep this on the market—it’s [the manufacturer’s] responsibility to make sure people know about the proper use.”

The same goes for other over-the-counter painkillers. I only recently discovered that Advil could cause stomach bleeding, for example. Nowhere on the front of my bulk-sized bottle is that made clear. Of course, in teeny letters on the back, it says “stomach bleeding warning” amid paragraph after paragraph of other fine print. At the very bottom, it also says “take with food or milk”—a line I had never noticed before researching this article.

While many of us read warnings on prescription drugs closely, we don’t always treat over-the-counter medications in the same way. “Yeah, if you look at the drugs, they have a package insert and you open it up and it’s in tiny little print,” said Wallace, “but nobody reads them. Again it comes back to the manufacturers, they need to be responsible for educating the public of the various risks.”

As part of the FDA’s recent warning regarding NSAIDs, they’ve asked drug manufacturers to adjust their labels to make it clearer that taking them increases risk of heart attack and stroke.

(I reached out to McNeil—along with the companies that make Advil, Aleve, Motrin IB, Celebrex, DayQuil, and Excedrin—for comment, but I had not heard back at the time of this article’s publication.)

So what you can do to manage pain instead?

If the big-name over-the-counter painkillers are dangerous, what can you do about pain?

One option is to continue taking them—but sparingly and responsibly, and bearing the risks in mind. Don’t use them every day. The experts I spoke with said that if you’re taking pain pills for more than a week, you need to see a doctor, both because you might have an underlying problem and because these medications were not designed for chronic use.

Notably, taking these pills regularly can actually make an underlying condition worse. “You interfere with the body’s own ability to manage pain,” Kaplan explained. For example, if you take pain relievers every time you have a headache, your headaches may actually get worse—because the body no longer knows how to fight them on its own. “It can take several months for the body’s own pain system to kick back in,” Kaplan said. (After interviewing him, I stopped taking pain medication for my minor aches and pains.)

Pain experts also suggest exploring alternative medicine, from yoga to acupuncture to anti-inflammatory edibles such as turmeric. If your pain is so bad it’s unmanageable without the pills, your physician can advise on how to safely use over-the-counter drugs while monitoring your liver or taking measures to protect your stomach—or recommend a different treatment plan, depending on what’s causing the pain.

As for the hope of a safer over-the-counter painkiller hitting the market—well, don’t hold your breath, said Michna of Brigham and Women’s. “Pharmaceutical companies are looking for minimal side effects and maximum efficacy—they’ve been looking for it for decades—but haven’t found it, and we won’t see it in the next ten years.”

Instead, think twice before you pop that pill.

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DEA Agents Received Bonuses During ‘Sex Parties’ Investigation

One agent who allegedly assaulted a prostitute was given a $1,500 bonus

Manuel Balce Ceneta/ASSOCIATED PRESS DEA Administrator Michele Leonhart left office not long after a report on alleged “sex parties” came out.

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Report: Medical errors up in 2014

http://www.news-sentinel.com/living/health/Report–Medical-errors-up-in-2014

In the nine years of reporting medical errors, hospitals and ambulatory surgery centers had more errors than ever before in 2014, according to the ninth annual report of the Indiana State Department of Health’s Indiana Medical Error Reporting System. The report, released Tuesday, indicated 114 reported medical errors in Indiana hospitals and ambulatory surgery centers during the 2014 calendar year — the most since the beginning of reporting medical errors in 2006, the report said. Hospitals accounted for 102 errors, while ambulatory surgery centers reported 12 errors. IU Health hospitals — University, Methodist, Riley and Saxony — of Indianapolis reported the most errors with nine; St. Vincent, Indianapolis, was second with eight; Methodist, Gary, had seven; and Fort Wayne’s Lutheran and South Bend’s Memorial rounded out the top five with five each.

Indiana’s Medical Error Reporting System requires that hospitals, ambulatory surgery centers, abortion clinics and birthing centers report any serious adverse event that occurs within that facility, the report said. In 2014, 287 facilities were required to make reports based on 28 criteria within these categories: surgical, products or devices, patient protection, care management, environmental and criminal. The most reported event for 2014 was stage 3 or 4 pressure ulcers — or bed sores — acquired after admission, followed by retention of a foreign object in a patient after surgery; surgery on the wrong body part; and serious disability or death associated with a fall. These were the same top four reported events in the last seven of nine years of medical-error reporting, according to the report. At Lutheran Hospital, retention of a foreign object in a patient after surgery accounted for two errors; death or serious disability associated with medication error occurred once; and stage 3 or 4 pressure ulcers acquired after admission resulted in two errors. After an error, Lutheran Hospital reviews the incident and works toward improving protocol, according to Geoff Thomas, public relations supervisor at Lutheran Health Network. “Our focus on patient safety and staff education is as strong today as it has ever been,” Thomas said in a prepared statement. “We set the bar high in these areas and regret when we fall short of our own expectations. Personalized, quality care is delivered by humans, and while none of our staff intends to contribute to a medical error, humans can make mistakes. In such instances, we initiate immediate reviews to determine how we can improve for the future. Our network is committed to high-quality patient care delivered in a safe and healing environment.” These Fort Wayne hospitals reported one error: Dupont for retention of a foreign object in a patient after surgery; the Orthopaedic Hospital of Lutheran Health for death or serious disability associated with a fall; and Parkview Regional Medical Center and St. Joseph Hospital for stage 3 or 4 pressure ulcers acquired after admission. Parkview, one of three hospitals that served the highest number of patients in this report, also strives to prevent errors, according to Eric Clabaugh, director of communications at Parkview Health. “One error is one too many,” he said. “We have in place a rigorous process we use to respond to, analyze and understand adverse events in order to prevent these incidents from occurring again. Our response and incident analysis process asks two fundamental questions: why did the event happen, and how can we prevent its recurrence? Patient safety is a daily responsibility for every employee at every Parkview facility, and our patients’ safety is our No. 1 concern while patients are in our care. The foundation of high-quality care begins with the right diagnosis, the right procedure, the right medication at the right time — every time.” The Orthopaedic Hospital at Parkview North, Rehabilitation Hospital of Fort Wayne, Select Specialty Hospital and Vibra Hospital of Fort Wayne reported no errors in 2014. All Indiana ambulatory surgery centers reported at least one error. Out of 3,019 surgical procedures in 2014, Premier Surgery Center experienced one error as the wrong surgical procedure was performed on a patient. The Medical Error Reporting System was created to increase awareness of medical errors by collecting and analyzing data to see where errors occur and how to develop practices to reduce them in the future.

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Vast Majority of Opioid Addictions Go Untreated

Federal survey data show treatment rates below 20%

If we had this low treatment rates on any other chronic disease… would that be just malpractice or a EPIDEMIC of irresponsible professional negligence  ?  How many pts would die if their chronic disease(s) left  untreated ? Is this another example of “the system” failing pts and the pts being blamed for the failures ?

http://www.medpagetoday.com/Psychiatry/Addictions/54186?xid=nl_mpt_DHE_2015-10-21&eun=g578717d0r

While rates of opioid use disorders in the U.S. over the last decade have jolted skyward, treatment levels have remained low, according to a research letter appearing in the Journal of the American Medical Association reporting that one-sixth of people with an opioid addiction received treatment.

Experts are calling the prescription drug problem an epidemic, which puts the low treatment rates into perspective: Prevalence rates of opiate use disorders rose from 11.9% in 2003 to 17.8% in 2013. Data capturing opioid misuse prevalence appeared in an accompanying article in JAMA by Beth Han, MD, PhD, MPH, who analyzed data from 6,770 respondents to the National Survey of Drug Use and Health (NSDUH) from 2004 to 2013.

Emergency visits for nonmedical use of prescription opioids more than doubled between 2004 and 2011, according to an accompanying editorial citing data from the Substance Abuse and Mental Health Services Administration’s Drug Abuse Warning Network, accounting for an estimated 488,000 ER visits in 2011. Deaths due to nonmedical use of opioid medications have tripled since 1999, translating to an estimated 16,235 deaths in 2013.

Just 16.6% of those with opiate use disorders received any treatment between 2004 and 2008, according to Brendan Saloner, PhD, who is assistant professor of health policy and management at the Johns Hopkins Bloomberg School of Public Health and a co-author on the study. That rate rose to 21.5% in 2009-2013.

Saloner and colleague Shankar Karthikeyan, MPP, analyzed NSDUH data that included responses to a question asking respondents if they had received treatment for an opiate use disorder in the past year. The authors divided the sample into two 5-year periods for reliable estimates. Saloner noted that the 2008 cut point was also the year that the Mental Health Parity and Addiction Equity Act of 2008 became law.

Although the analysis did not delve into the factors driving low treatment rates, Saloner told MedPage Today that “stigma surrounding addiction is pervasive, and many individuals do not want to be identified as having an opioid use disorder. Second, cost of care is an important impediment to getting treated, especially as many opioid treatment programs do not accept Medicaid or other forms of public insurance.”

Saloner also said that locating treatment programs is very difficult in many areas of the country, and there are rural counties where people have to travel very far distances to go to a specialty treatment program.

In the accompanying editorial, Lewis Nelson, MD, of New York University School of Medicine, and two colleagues wrote that prescription of opioid analgesics for chronic pain factors into most nonmedical use of these drugs, and that more than 10% of patients who initiate treatment with opioids progress to chronic use.

“Nobody can reliably predict who will develop an opioid use disorder, or addiction, following short term use of opioids,” Nelson told MedPage Today. “But we know that even if the risk is small to an individual, when spread over a country the actual number of new initiates to nonmedical use is magnified.”

He noted that one way to control the increase in opioid and heroin abuse is to reduce the number of new opioid users where possible: “Before every prescription for an opioid analgesic is written, the healthcare provider and the patient have to rationally examine the known risks and potential benefits of such therapy and both be comfortable that it is the right decision,” said Nelson. “In studies and clinical practice, when patients are provided with information regarding the risks versus the benefits of opioids, many opt to forego the opioid.”

Nelson noted that most chronic pain does not respond optimally to opioids, and many patients can use better alternatives for chronic pain. “We have learned this the hard way over the past 20 years,” he said.

“There is virtually no data for safety or efficacy in chronic non-end-of-life pain, but patients are convinced that they need [opiate medications],” Nelson added. “These same patients often cannot stop due to the development of opioid withdrawal, which is associated with or interpreted as worsening of the underlying pain syndrome. This situation is very complicated and the debate will not likely be settled easily, but by scaling back the number of new initiates dramatically, the use of opioids in the U.S. will fall in line with the rest of the developed world.”

Limitations to the study reported in the research letter included the time frame of the analysis — therefore not reflecting any improvements brought on by the Mental Health Parity Act — as well as its reliance on self-reported data from survey respondents.

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“If you tell a big enough lie and tell it frequently enough, it will be believed.”

― Adolf Hitler

DEA Secretly OKs Killer Quantities of Oxy and Morphine

http://www.thedailybeast.com/articles/2015/10/21/dea-secretly-oks-killer-quantities-of-oxy-and-morphine.html?via=newsletter&source=DDMorning

The feds could choke off the supply of pills flooding American streets tomorrow. Instead, they let Big Pharma crank out 151 tons of it last year.

The federal government is actively fueling a killer drug epidemic behind closed doors.

The Drug Enforcement Administration—tasked with fighting the war on drugs—has for the past two decades approved ever-greater quantities of controlled substances like oxycodone for manufacture and sale in the U.S. by pharmaceutical companies.

In 1993, the DEA allowed pharmaceutical companies to manufacture 3,520 kilograms of oxycodone. In 2015, the DEA authorized production of 137,500 kilograms of oxycodone. That’s a 39-fold increase in 22 years, the equivalent of turning two Buicks into four Boeing 737s. Either Americans are in 39 times more pain than we were 20 years ago, or something else is wrong.

When I was researching my book, American Pain, about a young drug felon who hired a team of doctors and made millions selling oxycodone to addicts posing as pain patients, I dug up the staggering drug manufacturing numbers.

I learned that it isn’t just oxycodone production that the DEA has been jacking up each year. Between 1993 and 2015, the DEA has allowed the production of hydrocodone to increase 12-fold, the production of hydromorphone to increase 23-fold, and the production of fentanyl to increase 25-fold.

(While the DEA did reduce the oxy quota by 8 percent in 2015, possibly because fewer pill mills were around to sell the drugs, the DEA recently announced a small increase in next year’s quota.)

The secret process appears to be less hard bargaining and more rubber-stamping. Each pharmaceutical company applies to make a certain amount of a given controlled substance each year, but the DEA won’t reveal those numbers to the public. The companies and the DEA have negotiation meetings, the content of which is also not made public. The DEA then sets quotas based on “expected need.” The only information the DEA reveals each year is the total amounts requested by the entire industry and the total amounts the DEA is allowing them to produce. The DEA says it would be unfair to the pharmaceutical companies to reveal how many pills the individual companies wanted to manufacture.

These are the same pharmaceutical companies that in the mid-1990s began marketing opioids as safe, i.e., little to no potential for abuse, contradicting thousands of years of human experience with the opium poppy. They’re the same companies that launched massive campaigns to convince doctors that highly addictive narcotics were a first resort for patients with chronic pain.

Since 1999 there have been more than 221,000 fatal overdoses from prescription opiods and illegal heroin. Despite this grim toll, no one in the federal government seems interested in simply reducing the supply. Instead, the DEA and its partners in government have supported policies only if they do not step on Big Pharma’s production, like arresting doctors who prescribe pills for no good reason and funding drug-treatment programs.

Only one time this century, when the country was first becoming aware of OxyContin abuse, was there talk about choking off the drug supply.
In 2001, the DEA asked Purdue Pharma, the maker of OxyContin, to consider providing the drug only to physicians trained in pain management. Purdue balked and Donnie R. Marshall, the then-DEA administrator, told Congress he was considering “rolling back those quotas to 1996 levels.” The pain industry said this would make drug prices skyrocket and pain patients suffer. Purdue didn’t budge, and the quota-cut idea vanished when new administrators came in.

Instead, the DEA has gone after bit players instead of Big Pharma. When hundreds of pill mills popped up in Florida after 2008, the DEA and other federal agencies cracked down hard, sending many owners and doctors away for long prison sentences.

That drove up pill prices, and millions of newly minted painkiller addicts began seeking their fixes from heroin. Painkiller production and deaths have leveled off for the moment, but fatal heroin overdoses have quadrupled, driving home the point that, whether the drugs come from the street or a pharmacy, the opioid epidemic is far from over.

Either Americans are in 39 times more pain than we were 20 years ago, or something else is wrong.

The DEA was created in 1973 by President Nixon to fight an “all-out global war on the drug menace.” Soon after it actually did that with success. When speed was popular in the ’70s, the DEA cut the amphetamine production quota by 90 percent and the illicit market dried up. A decade later, sedative-hypnotics like Quaaludes swept across the country, and the DEA cut the quota of the methaqualone by 74 percent, which effectively erased the problem.

Now, prescription opioids are killing far more people than speed or sedatives ever did, but the government has signed off on enormous hikes in the drug supply almost every year.

The idea of making more drugs during a drug epidemic baffled previous DEA administrators like the late Gene Haislip, former head of the DEA’s Office of Diversion Control. Haislip was in charge during the Quaalude crackdown. It hadn’t been easy to buck the powerful pharmaceutical industry, but, as he told a reporter shortly before his death: “You’ve got to have some kind of principles.”
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Nobody is suggesting we do away with opioids altogether: They are a godsend for patients suffering from cancer or traumatic injuries. At the very least though, the DEA could use its quota power to force drug companies to make sure their addictive wares aren’t heading to the street. It’s a potent warning: Sell drugs to pill mills and we’ll cut your company’s quota in half.

Even the drug manufacturers who have ignored deaths, lawsuits, and fines might heed that threat.

John Temple is an associate professor of journalism at West Virginia University and the author of American Pain: How a Young Felon and His Team of Doctors Unleashed America’s Deadliest Drug Epidemic (Lyons Press, September 2015). Parts of this column were adapted from American Pain.

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