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http://www.foresttennant.com/pdfs/IntractablePainSurvival.pdf

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Pharmacists see patients struggle as insurers limit coverage for compounded drugs

http://www.masslive.com/politics/index.ssf/2015/10/patients_struggle_as_insurers.html

A fungal meningitis outbreak blamed on unsafe conditions at a Massachusetts compounding pharmacy killed dozens of people and sickened hundreds, U.S. officials said at the time. Compounding pharmacies elsewhere in the country produced pain creams costing thousands of dollars that had little therapeutic benefits.

But amid crackdowns and new laws aimed at protecting consumers, there has been another side effect of these cases affecting patients nationally and in Massachusetts. Over the last couple of years, compounding pharmacists say patients with legitimate medical needs have had a harder time getting insurance coverage for compounded drugs – medicines specially made by a pharmacy that are not available commercially. That means they must pay out of pocket or find a different medication. Although several Massachusetts insurers said they still cover medically necessary drugs, many have put new restrictions on coverage.

“We totally support eliminating coverage for those high priced pain creams, but I think the needle has swung too much in the other direction, and legitimate needs are not being covered,” said Todd Brown, executive director of the Massachusetts Independent Pharmacists Association.

Doctors prescribe compounded medications for many reasons. A patient may need a dosage that is higher or lower than usual, or a formulation such as a liquid instead of a pill. Sometimes a patient is allergic to an ingredient in commercially made drugs. Compounded drugs are used for pain medication, hormone replacement therapy, in dermatology, pediatrics and other fields.

Harvard Pilgrim was the first major Massachusetts insurer to limit its coverage of compounded drugs for adults in 2013, after the fungal meningitis outbreak, by requiring preauthorization. A spokesman for Harvard Pilgrim said it still covers medically necessary drugs, although not cosmetic or dietary drugs.

As of Jan. 1, 2015, Blue Cross Blue Shield, Massachusetts’ largest insurer, eliminated coverage for any compounds made using bulk chemicals, which are expensive, and for any compounded drugs containing ingredients that are not approved by the U.S. Food and Drug Administration for a specific purpose. For example, an ingredient approved for oral use would not be covered when made into a topical cream.

“There’s no science to support using it in that way, and some of those same compounds were being charged at excessive prices,” said Dr. Tony Dodek, associate chief medical officer at Blue Cross Blue Shield of Massachusetts.

Pharmacists say many of the state’s smaller insurers also placed new restrictions on coverage for compounded drugs.

Eric Linzer, a spokesman for the Massachusetts Association of Health Plans, said none of its members’ plans dropped coverage for compounded drugs, but they are requiring prior authorization and eliminating medications used for non-medical purposes. In some cases, a compounding pharmacy may not be part of a health insurer’s network.

“Plans have seen a proliferation of these drugs being prescribed for non-medical services,” Linzer said. “What plans want is to make sure these are being used safely and effectively and are the most effective treatment option for the patient.”

Yet while insurers say they generally cover medically necessary drugs, pharmacists say the new restrictions are affecting patients.

“Probably in the last six months to a year…every insurer has restricted coverage to some extent,” Brown said.

Andrew Stein, managing pharmacist at Bird’s Hill Pharmacy in Needham, a compounding pharmacy, said his customers have often been unable to get insurance coverage. The drugs he makes are used for everything from pediatrics to geriatrics. “There were a few people in the industry that abused the insurance coverage around it, and instead of figuring out a system of how to weed out the bad characters, they eliminated insurance coverage for all,” Stein said.

“For patients, it’s definitely a struggle,” Stein said. “Patients either have to seek an alternative or they have to pay out of pocket.” While some patients appeal, Stein said the process is usually an “arduous” one and often ends in a denial. “It’s like a battle of attrition,” he said.

Ernie Gates, who used to run a compounding pharmacy and is now CEO and president of a Massachusetts health care consulting company that works with compounders, said he has seen a trend nationwide over the last year of insurers dropping or limiting coverage. In addition to the abuses, Gates said part of the problem is the lack of a standard system for monitoring and pricing compounded drugs. Because of factors related to training, testing and manufacturing the drugs, Gates said there is no simple way to price a prescription.

“Everybody is trying to figure out a way to pay for a compounded prescription,” Gates said. “Most (insurers) have made a considered effort not to pay until they get this resolved in their own infrastructure.”

Although insurers covered compounded drugs for years, Gates said with rising health care costs and a trend toward greater use of compounded drugs, the drugs have gotten caught in insurers’ attempts to control costs.

The problem is national. David Miller, executive vice president of the International Academy of Compounding Pharmacists, said coverage for compounded drugs is “all over the board.” “There are drastically different coverage policies related to compounded drugs depending on what your insurance coverage is,” Miller said.

Miller said the military insurer Tricare and the benefits management company Express Scripts both recently significantly reduced coverage for compounded medications.

Miller agreed with Gates that a major factor is pricing. In 2012, the pharmacy industry moved to a system in which pharmacists must tell insurers every ingredient in a compounded drug and its price, rather than only the main ingredient.

“Many of the payers started seeing a significant increase in what they were paying to compounded pharmacists, not because the price went up, but because the way we billed it changed,” Miller said. “Over the last year, we’ve seen more third parties say we don’t want to fix the system, we’ll just stop paying for it.”

Sometimes insurers cite the fact that compounded drugs are not approved by the U.S. Food and Drug Administration. (The FDA does not approve the final drugs, and it may not have approved the use of certain ingredients in a particular form.) But Gates said it should be up to doctors to write a prescription that uses the drugs however they feel necessary.

Miller and Gates added that some prescription medications currently on the market were not approved by the FDA or were not approved for the purpose they are being used for. For example, types of codeine never got FDA approval. “It’s a double standard,” Miller said.

Amy Whitcomb-Slemmer, executive director of Health Care for All, a Massachusetts health care advocacy group, said her group is “strongly in favor of patients and consumers having access to the compounded drugs that their providers are prescribing for them and their conditions.” Whitcomb Slemmer said she has seen cases “now and again” of consumers not getting reimbursed by insurance.

“This is one of those areas where it’s important to be compliant with what the provider is saying the patient needs,” Whitcomb Slemmer said.

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CDC Opioid Prescribing Guidelines; Excluding Stakeholders is Wrong Path

http://www.fdalawblog.net/fda_law_blog_hyman_phelps/2015/10/cdc-opioid-prescribing-guidelines-excluding-stakeholders-is-wrong-path.html?utm_source=feedburner&utm_medium=email&utm_campaign=Feed%3A+FdaLawBlog+%28FDA+Law+Blog%29

The Centers for Disease Control and Prevention (“CDC”), the nation’s premier agency focusing on public health and safety through disease prevention and control, and a component within the U.S. Department of Health and Human Services, is developing guidelines “to provide recommendations for the prescribing of opioid pain medication for patients 18 and older in primary care settings” that focus on treating chronic pain outside end-of-life care.  Draft CDC Guideline for Prescribing Opioids for Chronic Pain.  The CDC observes on its website that existing opioid guidelines vary and that primary care providers do not receive sufficient opioid prescribing training.  Id.  The CDC further notes that its guidelines will address determining initiation or continuing opioid therapy; opioid selection, dosage, duration, follow-up and continuation; and assessing associated risk and harm.  Id.

The CDC provided limited public access to the draft guidelines during a webinar on September 16th but is providing no further access or participation in their development.  The independent online chronic pain and pain management news source Pain News Network, reported that CDC anticipates finalizing the guidelines next month, and submitting them to the Department of Health and Human Services for publication in January 2016.  Pat Anson, CDC: Opioids Not ‘Preferred’ Treatment for Chronic Pain, Pain New Network, (Sept. 16, 2015).  It is unclear what form the publication of the guidelines will take.

The CDC is not making the guidelines available, but the Pain News Network lists the dozen guidelines provided during the webinar as follows:

1. Non-pharmacological therapy and non-opioid pharmacological therapy are preferred for chronic pain.  Providers should only consider adding opioid therapy if expected benefits for both pain and function are anticipated to outweigh risks.
2. Before starting long term opioid therapy, providers should establish treatment goals with all patients, including realistic goals for pain and function.  Providers should continue opioid therapy only if there is clinically meaningful improvement in pain and function that outweighs risks to patient safety.
3. Before starting and periodically during opioid therapy, providers should discuss with patients risks and realistic benefits of opioid therapy and patient and provider responsibilities for managing therapy.
4. When starting opioid therapy, providers should prescribe short-acting opioids instead of extended-release/long acting opioids.
5. When opioids are started, providers should prescribe the lowest possible effective dosage.  Providers should implement additional precautions when increasing dosage to 50 or greater milligrams per day in morphine equivalents and should avoid increasing dosages to 90 or greater milligrams per day in morphine equivalents.
6. Long-term opioid use often begins with treatment of acute pain.  When opioids are used for acute pain, providers should prescribe the lowest effective dose of short-acting opioids and should prescribe no greater quantity than needed for the expected duration of pain severe enough to require opioids.  Three or fewer days will usually be sufficient for non-traumatic pain not related to major surgery.
7. Providers should evaluate patients within 1 to 4 weeks of starting long-term opioid therapy or of dose escalation to assess benefits and harms of continued opioid therapy.  Providers should evaluate patients receiving long-term opioid therapy every 3 months or more frequently for benefits and harms of continued opioid therapy.  If benefits do not outweigh harms of continued opioid therapy, providers should work with patients to reduce opioid dosage and to discontinue opioids when possible.
8. Before starting and periodically during continuation of opioid therapy, providers should evaluate risk factors for opioid-related harms.  Providers should incorporate into the management plan strategies to mitigate risk, including considering offering naloxone when factors that increase risk for opioid-related harms are present.
9. Providers should review the patient’s history of controlled substance prescriptions using state Prescription Drug Monitoring Program data to determine whether the patient is receiving excessive opioid dosages or dangerous combinations that put him/her at high risk for overdose.  Providers should review Prescription Monitoring Program data when starting opioid therapy and periodically during long-term opioid therapy (ranging from every prescription to every 3 months).
10. Providers should use urine drug testing before starting opioids for chronic pain and consider urine drug testing at least annually for all patients on long-term opioid therapy to assess for prescribed medications as well as other controlled substances and illicit drugs.
11. Providers should avoid prescribing of opioid pain medication and benzodiazepines concurrently whenever possible.
12. Providers should offer or arrange evidence-based treatment (usually opioid agonist treatment in combination with behavioral therapies) for patients with opioid use disorder.  Id.

The guidelines provided during the webinar are reasonable and public health benefits could result from clarifying opioid prescribing.  However, we question CDC’s process for developing the guidelines.  The Pain News Network noted that the Food and Drug Administration (“FDA”), not CDC, normally sets prescription drug guidelines, and that an FDA official responsible for opioid issues was unaware that CDC was drafting the opioid prescribing guidelines.  Id.  Knowledgeable and responsible FDA officials are not providing meaningful input to the guidelines. 

Secondly, the guidelines have ramifications for activities in which many stakeholders hold strong interests-healthcare professionals including prescribers and pharmacists, regulators and especially patients.  How will the American Medical Association and state medical boards react to the final guidelines?  Will the Drug Enforcement Administration take enforcement action against practitioners who it believes issued opioid prescriptions for other than legitimate medical purpose because they did not following the guidelines?  Or, in the alternative, will following the guidelines strengthen a practitioner’s defense that the opioid prescriptions they issued were legitimate?

CDC should not draft the guidelines in isolation until finalized, but instead make them available for public comment prior to their becoming final.  We agree with Edith Rosato, CEO of the Academy of Managed Care Pharmacy, who in a letter to CDC Director Tom Frieden, “strongly urges the CDC to formally release the draft guidelines and provide for a sufficient public comment period to ensure the perspective of all parties, including those of managed care pharmacy, are taken into consideration.”  Letter from Edith A. Rosato, RPh, Academy of Managed Care Pharmacy, to Tom Frieden, CDC, (Sept. 18, 2015).

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Online Pharmacies: What You Don’t Know Could Kill You

Buying prescription drugs online is often cheaper, but it can be riskier. Before you click, heed these tips for telling phony websites from legitimate pharmacies.

http://www.moneytalksnews.com/online-pharmacies-what-you-dont-know-could-kill-you/

Powdered cement, floor wax, rat poison and antifreeze.

These are a few of the potentially deadly substances that have been found in counterfeit medications.

In some instances, the capsules and tablets that many Americans believed to be prescription drugs contained no actual medicine. Or they contained the incorrect dosage or wrong medicine, according to a 2014 study published in the journal American Health & Drug Benefits.

CNN filmed and interviewed a Pakistani counterfeiter this summer who told the news outlet that all of his products contained the same concoction despite their differing names and appearances:

“We prepare whatever is in high demand. But everything is the same, no matter what we call it. We put the very same ingredients in all of these capsules, and the very same syrup in all of these bottles. Only the color is different.”

In the United States, counterfeit drugs constitute a rising percentage of the drug market and a growing public health concern, according to the 2014 study. Online pharmacies are a key factor contributing to that growth.

The most common way that Americans receive counterfeit medications is by ordering from rogue websites, according to the National Association of Boards of Pharmacy (NABP).

These fraudulent websites operate in violation of state and federal laws, the U.S. Government Accountability Office told Congress in a 2013 report. But the shady sites are often disguised as legitimate businesses, leading consumers to believe they are pharmacies based in Canada that sell brand-name pharmaceuticals, for example.

The National Association of Boards of Pharmacy has reviewed more than 11,000 online drug outlets, and 96 percent appear to be violating pharmacy laws and standards, the NABP reports.

So while buying prescriptions from the minority of legitimate and licensed online pharmacies based in the U.S. is among the best ways for American consumers to lower their prescription costs, learning to discern these operations from the phony ones can be a matter of life and death.

 High returns and low risks for counterfeiters

American consumers turn to online pharmacies in hopes of getting lower prices for expensive medications, or because they believe they have better odds of obtaining prescription drugs without a prescription.

Yet, these consumers are generally unaware of the risks of buying drugs online, the 2014 study found.

This combination of demand and naiveté makes such consumers easy prey for unscrupulous counterfeiters, who find a higher profit margin dealing in fake prescription drugs than they could in selling actual illegal narcotics.

For example, investing $1,000 in counterfeit prescription drugs can yield an estimated return of $30,000 — 10 times the profit rate for trafficking heroin, the study states.

The counterfeit drug trade yields an estimated $75 billion in revenue each year for illegal operators worldwide, according to the 2014 report.

Red flags to consumers

Despite the dangers the counterfeit drug trade can pose, a little due diligence by consumers when ordering from online pharmacies goes a long way in safeguarding their health.

The key is learning to tell fraudulent websites from legitimate businesses based in the U.S., where pharmaceuticals are licensed by state boards and regulated by the Food and Drug Administration.

The FDA also leads the BeSafeRx campaign designed to educate consumers about online pharmacies. According to the BeSafeRx website, you should avoid buying drugs from online outfits that:

• Allow you to buy drugs without a prescription from your doctor.
• Offer deep discounts or cheap prices that seem too good to be true.
• Send spam or unsolicited email offering cheap drugs.
• Are located outside of the United States.
• Are not licensed in the United States.

Instead, seek out online pharmacies that:

• Always require a doctor’s prescription.
• Provide a physical address and telephone number in the United States.
• Offer a pharmacist to answer your questions.
• Have a license with your state board of pharmacy.

Resources for consumers

The following resources can further help you verify an online pharmacy’s legitimacy:

• FDA’s BeSafeRx campaign: This website also includes a directory of legitimate state-licensed online pharmacies based in the U.S.
• NABP’s Verified Internet Pharmacy Practice Sites (VIPPS) seal: Look for this blue symbol on pharmacy websites. It signifies that the NABP has certified an online pharmacy as compliant.
• NABP’s information and verification site: Use this website to cross-check an online pharmacy’s VIPPS certification against the NABP’s own records.
• NABP Foundation’s AwareRx.org: Check this website’s list of “Not Recommended Sites” — online drug outlets that the NABP has reviewed and found to be out of compliance with pharmacy laws or other regulations.

What has your experience in buying prescriptions online? Sound off in our Forums. It’s the place where you can speak your mind, explore topics in-depth, and post questions and get answers.

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Hi, we are in California ,I am friends with a woman who has really bad shoulder pain, my husband does too, and my husband just had to switch back to Fee for Service Medicaid cause his now ex Dr wouldn’t do the paperwork for his pain patch this month. The State forced my husband to switch to Managed care Medicaid which required more paperwork and wouldn’t approve his pain patch this month. My husband is in so much pain now and have withdrawals. I had him switch back to the Fee for service medicaid Friday. So the Pharmacist can do the paperwork if you have Fee for Service here (the TAR or Treatment Auth Request the pharmacist can do if you have Fee for service Medicaid) he should get he patch tomorrow, but isnt that terrible, he has had to go through withdrawal cause nobody told him he managed care Medicaid wouldnt approve his pain medication.

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Riders of the Stoned: Senate Considers Illusionary Repeal of Prohibition

http://www.hightimes.com/read/riders-stoned-senate-considers-illusionary-repeal-prohibition?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+HIGHTIMESMagazine+%28HIGH+TIMES+Magazine%29

A series of federal spending bills were introduced last week by the chairman of the Appropriations Committee, Senator Thad Cochran, which include riders aimed at preventing the government from paying U.S. drug enforcers to unleash their wrath against states that have legalized the leaf. However, while the submission of these bills suggests that some folks on Capitol Hill are looking out for the cannabis industry, the reality is that the provisions contained in these documents are likely worthless.

One of the proposed budget restrictions filed by Senator Cochran is essentially regurgitated from a 2014 budget plan that was supposed to prevent the federal government from interfering with states that have legalized medical marijuana. A section of Senate Bill 2131 indicates that it would stop the U.S. Department of Justice from spending tax dollars to bring the heat down on states that have established medical marijuana programs, while another keeps them from sending in the Drug Enforcement Administration to tear down industrial hemp programs.

Both sections of the proposal are attempts to put into action a concrete policy to ensure the Obama Administration keeps true to its word, as outlined in the 2014 Cole memorandum suggesting the DOJ will stay out of the way of states deciding to legalize weed. But the rider must be renewed this year before even a semblance of protection can be maintained.

The second rider—Senate Bill 2130—would allow physicians with the Department of Veterans Affairs to communicate with veterans about medical marijuana. It would also force the VA to make changes to the policy that penalizes veterans simply for testing positive for cannabis, sometimes revoking their painkiller prescriptions. A third rider – Senate Bill 2132 – looks to stop the federal government from cracking down on banks choosing to work with marijuana businesses in legal states. Both of these restrictions have been introduced before, but have never become a reality.

Perhaps the most appreciated aspect of Senate Bill 2132 is that there’s no longer any mention of federal funds being used to stop the District of Columbia from launching a retail cannabis market. If this segment of the rider is allowed to remain as is, it is conceivable that the DC Council could begin to enact legislation to establish retail pot commerce by late 2016.

Unfortunately, the problem with these riders is that while they are supposed to provide a shield against federal marijuana laws, they’re really just temporary fixes that could easily be squeezed out in the next fiscal year. And, as we have learned in 2015, the language of these riders can easily allow federal drug agencies to do whatever they want in regard to legal marijuana.

Despite current riders “preventing” the federal government from stopping state officials from allowing the legalization of marijuana, not to mention a separate rider aimed at stopping federal funds from being used to kick down the doors of the medical marijuana community, the federal government and DEA drug warriors have not stopped shaking people down in legal states.

Therefore, while Tom Angell of the Marijuana Majority suggests the latest riders are “good news for marijuana reform advocates,” these quasi-reforms, even if passed, would do little to change the sad state of current affairs. If these proposals are only good for a fiscal year, and subject to interpretation by higher-ups, then they’re really just rabbit reforms being pulled out of the not-so-magic hats of lawmakers. They carry no real weight in the grand scheme of changing the federal government’s position on or control over the cannabis plant.

The cannabis industry will not be allowed to function outside its current “grey” experimentation phase without risk of prosecution until a solid level of federal reform is passed, and actual laws are created.

Mike Adams writes for stoners and smut enthusiasts in HIGH TIMES, Playboy’s The Smoking Jacket and Hustler Magazine. You can follow him on Twitter @adamssoup and on Facebook/mikeadams73.

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Federal seizure program that benefits cops called ‘legal robbery’

http://www.mansfieldnewsjournal.com/story/news/local/2015/10/11/federal-seizure-program-benefits-cops-called-legal-robbery/73772302/

Antoinette Lattimore was traveling from Cincinnati to Tucson two years ago to scout African art, carrying nearly $20,000 in cash for possible purchases.

By the time she got to Arizona nearly a week later, she didn’t have that cash.

That’s because a Dayton police officer, deputized as a federal drug enforcement agent, seized the money despite the fact that he had no warrant to search her and she was not arrested for nor charged with any crime.

“I had no idea something like this could happen in America,” said Lattimore, 44, who lives in North College Hill. “I’ve never been arrested before in my life. I even could prove that it was my money but that didn’t matter.”

But it does happen and it is all completely legal. It’s called civil forfeiture and, nationally, a total of $4.1 billion in such funds have been seized by local police and federal agents since 2006.

Over the past three years, Ohio law enforcement agencies aiding the federal drug task force have received about $32.4 million in such seizure money. State agencies from the Ohio Highway Patrol to the Ohio Department of Natural Resources received 20 percent of those funds.

The Mansfield Police Department received $2,505 in federal civil forfeitures in 2014, the only payment over the past five years. Chief Ken Coontz said most of their cases are local, so they don’t end up working with the DEA very often. The most recent case they worked with the DEA involved synthetic drugs, he said. And unlike some task forces, METRICH doesn’t have anyone who also operates as a DEA agent.

By comparison, the Knox County Sheriff’s Office, which is part of the Central Ohio Drug Enforcement Task Force, received $171,579 over the past three years. CODE has received $96,156 over the past three years.

Very little of that money gets returned to its rightful owners, again despite the fact that many of those who have their assets seized are not arrested for trafficking, dealing or even being in possession of illegal drugs.

Instead, most of the money goes back to the departments that seized it. And recourse for those targeted is extremely limited.

Why is it legal? Because Congress said so, although some are starting to question the practice.

“This is legal robbery … and is completely unconstitutional,” said U.S. Rep. Thomas Massie, R-Garrison. “I don’t care what good they can do with that money if it was acquired unconstitutionally.”

A pair of Ohio legislators, Rep. Rob McColley, R-Napoleon, and Rep. Tom Brinkman, R-Mount Lookout, introduced a bill in late October that aims to restrict how much Ohio’s law enforcement can benefit from federal civil seizures and requires prosecutors to convict a person of a crime before keeping seized property as profit.

It’s a move that, if passed, concerns the state’s task force units, said Lt. Jeff Orr, president of the Ohio Task Force Commanders Association.

“They’re going after people who are being responsible … Let’s address the abuses. Let’s not go after all of us,” said Orr, who uses seizure funds as grant matches for the Trumbull-Ashtabula Group Drug Task Force.

Changing all seizures to post-conviction could complicate cases such as one where a man Orr’s task force charged fled to Puerto Rico.

“It’s way too expensive to bring him back, but we have some assets … So what we’ve done is file a civil case because we can’t sit on them and we have no one to give it back to, and we wouldn’t want to because we had criminal charges on this guy,” Orr said. “He forfeited his right to that stuff when he left.”

Orr noted that former Attorney General Eric Holder already restricted how they work with the DEA on civil forfeitures. Up until last year, Orr said if they pulled over someone with a prior record who had several thousand in cash but no employment, they could call the DEA to come in to do a forfeiture. Now they can only be part of civil asset forfeitures with the DEA when they’re working a case together in the first place.

Even so, most times Orr said task forces are doing criminal seizures, which means they’ve charged someone with a crime.

For example, METRICH in the Richland County area often pursues cash and goods under criminal seizure laws. Over the past four years, METRICH reported criminal seizures and forfeitures valued at $2.2 million, according to biannual performance reports to the state. Meanwhile, METRICH has received no federal civil seizure assets for at least the last five years.

Departments involved in federal task forces and seizures can’t use the recovered money to pay salaries. But the money can be used to buy equipment, like guns and protective gear, and pay for training those agencies might not otherwise be able to afford.

And even though the Justice Department tracks down to the penny which department receives how much and even what they spend it on, federal and local agencies said they do not track how many seizures actually result in arrests.

Local and federal officials defend the practice, saying it is an effective deterrent against drug traffickers and that they are following the law.

In a statement, DEA spokesman Joseph Moses said that “asset forfeiture has the power to disrupt or dismantle criminal organizations” that could only continue with convictions of “specific individuals.”

How it works

Federal seizure laws are not unique to the United States. England, France and even China have been seizing property of suspected criminals or terrorists for centuries, and U.S. federal agents did so extensively during the 1930s to deter bootleggers during Prohibition. In 1984, Congress passed a law strengthening law enforcement’s ability to take property as a way to crack down on the growing drug trade.

The laws have been used even more liberally since the terror attacks on Sept. 11, 2001.

Nationally, a total of nearly $4.1 billion has been distributed to law enforcement agencies since 2006, as compared to less than half that the previous decade. Statewide, the amount of civil assets seized more than doubled to over $20 million in 2014 as compared to 2004.

Officials said that they follow a careful investigative process before conducting a seizure.

“It isn’t like we just walk up to someone who looks funny or might smell like drugs and take their money,” said Cincinnati Police Capt. Paul Neudigate, who has two officers assigned to the local DEA task force. “At the airport, for example, we’ll see that he or she bought a ticket last minute with cash to a known source city.”

Orr contends that anyone whose money is being taken has some connection to crime — either a prior record or criminal associates — and no legitimate reason to have a large amount of cash.

When local officers actually seize money or property, the assets go into a federal asset forfeiture fund overseen by the Justice Department. The money can be kept by the government if the original owner doesn’t contest the seizure, if a federal magistrate rules the seizure was legitimate upon appeal or the government settles with the owner to keep part of the funds/assets.

While up to 80 percent of what is kept is sent back to members of the local task force by the Justice Department, often it’s much less. Although Ohio deposited more than $20 million into the civil seizure fund in 2014, less than half — $8.4 million — was paid to agencies across the state according to a previously agreed upon formula.

Kathy Brinkman, a Cincinnati lawyer who has been on both sides of the system, said it can work to deter crime. But she also knows that it illegally confiscates money and assets that rightfully belong to innocent people.

“The motivation to become as aggressive as possible on seizures and forfeitures by state and local law enforcement agencies has become ever greater because of financial pressures,” said Brinkman.

Brinkman, who spent nearly two decades as the local assistant U.S. attorney in charge of the seizure program as well as the deputy administrator over the national program, said the policy is flawed in that it is sometimes enforced by those without the training that federal agents get.

How to get it back

Those innocent of any drug crime face a bureaucratic nightmare to get their funds or assets back.

An indication of that nightmare? When Lattimore petitioned to get her money back, it started a process that entails the government suing her money to keep it “in custody.” In short, the government is trying to charge the money with wrongdoing, not Lattimore.

Hence, her case was officially “United States of America (plaintiff) v. $19,660 in United States Currency (defendant).”

Some estimates said that only 2 to 4 percent of those who have assets seized actually file to get their money or property back. That number was provided by police officials, who said that’s what they were told by the DEA. That agency, however, said it does not track that figure.

Massie and other critics argue that the number of people seeking their money back is low because only someone with resources to pay a lawyer can hope to get even some of their money back.

Despite her desire to fight for all of her money, Lattimore eventually settled for the return of $11,000 to avoid what she believed would have been an agonizingly long and expensive appeals process. Lattimore figures that, after her legal fees, she is keeping less than $8,000 of the original $19,660 seized.

“I still carry cash, but I’m sure a lot smarter about it,” Lattimore said.

Gannett Ohio reporter Jona Ison contributed to this report.

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