“The moral test of a government is how it treats those who are at the dawn of life, the children; those who are in the twilight of life, the aged; and those who are in the shadow of life, the sick and the needy, and the handicapped.” – Hubert Humphrey
passionate pachyderms
Pharmacist Steve steve@steveariens.com 502.938.2414
The state of Washington mandates Methadone for Medicaid pts… with full knowledge that they can expect 2 deaths per 1000 pts within the first two weeks of starting this medication. Once again, bureaucrats and politicians practicing medicine purely based on financial issues.. Methadone is the least expensive opiate pain med. Methadone can be a excellent pain management medication but must only be prescribed by a prescriber that is very knowledgeable in the dosing and monitoring of the pt. Now, they want to make availability of opiate more restrictive guidelines on opiates to compensate for their idiotic policies.
Overdoses from opioid painkillers occur frequently in people who are taking relatively small doses of pain medication, according to a new study that has some experts calling for more restrictions on opioid prescribing.
Researchers at the University of Washington School of Public Health analyzed Medicaid data on opioid overdoses in Washington State between 2006 and 2010 – and found that many non-fatal overdoses didn’t fit the usual profile of a long term opioid user taking high doses of pain medication.
The study, published in the journal Medical Care, found that about a third of the 2,250 overdoses were associated with methadone, a drug used to treat addiction and relieve pain. The remaining 65 percent of overdoses were due to other opioid medications.
Less than half of those patients were “chronic users” who had been prescribed opioids for more than 90 days. And only 17% percent of the overdoses involved patients taking a high morphine-equivalent dose of over 120 mg per day — what is considered a “yellow flag” in Washington State for possible opioid abuse.
Surprisingly, nearly three out of ten (28%) patients who overdosed were taking a relatively low opioid dose of just 50 mg per day. Sedatives were involved in nearly half of the overdoses.
In 2007, Washington State adopted some of the toughest regulations in the country on opioid prescribing — guidelines that the researchers believe should be even more restrictive.
“It may be prudent to revise guidelines to also address opioid poisonings occurring at relatively low prescribed doses and with acute and intermittent opioid use, in addition to chronic, high-dose use,” said lead author Deborah Fulton-Kehoe, PhD, a research scientist in the Department of Environmental and Occupational Health Sciences at the University of Washington School of Public Health in Seattle.
Based on the recommendations of this and other studies, Washington State’s Interagency Guideline on Prescribing Opioids for Pain was recently revised to caution doctors about prescribing opioids at any dose. The new guidelines extend to the treatment of acute pain, not just chronic pain. Physicians are also advised not to prescribe opioids unless their patients showed “clinically meaningful improvement” in physical function, in addition to pain relief.
While the overdose study focused on only one state, one expert says it has national and even global implications.
“The article notes that many overdoses occur when patients are prescribed medications at low doses. This has important implications for national policy and debate,” said Dr. Jeroan Allison of University of Massachusetts Medical School, who is co-editor-in-chief of Medical Care. “The statistics are quite overwhelming and dramatic, and this problem affects every state in our nation.”
According to the Centers for Disease Control, over 16,500 deaths in the U.S. were linked to opioid overdoses in 2010.
More recent data suggest that the “epidemic” of painkiller abuse is abating.
Does this sound familiar … three companies that dominate a market… that have colluded to restrict trade ? The question has to be asked… why is three major drug wholesalers that dominate a market.. are allowed to restrict community pharmacies purchases of controlled meds without consequences. It would seem like a lot of pharmacy’s profits are being compromised as well as a lot of pts with chronic disease states, whose quality of life is being compromised ?
A compounding pharmacy could move forward with claims that a prescription benefit manager conspired to restrain trade, in violation of the Sherman Act and New York antitrust law. The federal district court in St. Louis determined that the pharmacy adequately alleged an unlawful agreement or conspiracy; injury to competition in a relevant market; and antitrust injury sufficient for standing (HM Compounding Services, Inc. v. Express Scripts, Inc., July 9, 2015, Ross, J.).
HM Compounding Services, LLC (HMC) operates one of the largest compounding pharmacies in the eastern United States. The company, along with three individuals, filed suit against CVS Caremark Corp., OptumRX, Inc., Prime Therapeutics LLC, and Express Scripts, Inc. (ESI), alleging that they engaged in a concerted effort to eliminate HMC, and other independent compounding pharmacies, as competitors in the prescription benefit drug market by placing unwarranted and illegal restrictions on patient access to compounded medications. The relationship between HMC and each defendant is governed by a Pharmacy Network Agreement. The federal district court in Central Islip, New York, previously granted ESI’s motion to sever HMC’s claims against it and to transfer those claims to the federal district court in Missouri. ESI has subsequently moved to dismiss HMC’s first amended complaint and to dissolve the temporary restraining order entered by the New York court.
Per se violation. HMC alleged that ESI conspired “to end all coverage for compound prescription medications, and eliminate HMC and other independent compounding pharmacies as competitors in the Relevant Market,” and that this conduct constitutes both a per se and rule of reason claim under the Sherman Act.
The court first declined to dismiss the per se claim, noting that there is often no bright line separating per se from rule of reason analysis. Further, even if HMC fails to establish a per se violation of the Sherman Act, the question remains whether the allegedly unreasonable restraint of trade comports with the rule of reason.
Rule of reason. ESI raised three challenges to HMC’s antitrust claims under the rule of reason: (1) HMC failed to allege an unlawful agreement or conspiracy between ESI and its co-conspirators; (2) HMC failed to adequately plead injury to competition in a relevant market; and (3) HMC has not alleged an antitrust injury sufficient for standing.
With regard to the first argument, the court concluded that HMC sufficiently alleged a preceding agreement to engage in concerted action. HMC alleged that ESI and each of the co-conspirators are active members of the Pharmaceutical Care Management Association and that executives from each of the co-conspirators and ESI serve on the Association’s Board of Directors; the co-conspirators and ESI represent the three largest prescription benefit managers, managing 95 percent of all prescription drugs covered by insurance and dominating the prescription benefit manager market with a market share of over 80 percent; ESI and its co-conspirators joined together to study the market for compound prescriptions and collectively determined how to exclude compound medicines; the co-conspirators sent letters to physicians and patients containing false and misleading information concerning compound medications; and the co-conspirators announced new policies concerning copayments allegedly aimed at excluding compound medications within days of each other.
ESI next argued that HMC’s proposed relevant market fails to adequately account for comparable substitutes in the marketplace and HMC failed to adequately plead facts explaining how ESI’s allegedly anticompetitive conduct actually restrained trade or harmed consumers. The court rejected ESI’s first argument, noting that there is no requirement that market definition be pleaded with specificity. In addition, HMC’s allegations of elimination of a market competitor, a decrease in output, reduced consumer choice, and a decline in the quality of goods, were sufficient allegations of anticompetitive effects sufficient to state a claim under Section 1 of the Sherman Act.
Finally, the court concluded that HMC has sufficiently pleaded an antitrust injury by asserting ESI excluded HMC as a competitor from the marketplace. Specifically, HMC alleged that as a direct and proximate result of ESI’s and the co-conspirators’ concerted conduct, HMC has been and will continue to be irreparably injured and financially damaged in its business and property in that HMC has suffered and will continue to suffer significant lost revenue and net profits from the substantial decrease in reimbursement from compound medicines covered by health insurance policies and plans, and HMC has not received reimbursement for thousands of prescriptions already filled and submitted to ESI.
The court consequently concluded that HMC adequately alleged violations of the Sherman Act and New York antitrust law. The motion to dismiss HMC’s antitrust claims was therefore denied.
Temporary restraining order. The motion to dissolve the temporary restraining order was also denied. The court found that the order, by its express terms and by agreement of the parties, is to remain in full force and effect until a hearing on the preliminary injunction.
Attorneys: Jessica M. Baquet (Jaspan Schlesinger LLP) and Winthrop B. Reed, III (Lewis Rice, LLC) for HM Compounding Services, LLC and HMX Services, LLC. Amanda Lynn Nelson (Cozen O’Connor) and Christopher Smith (Husch Blackwell LLP) for Express Scripts, Inc.
IMO.. this study was poorly designed with only 55 pts and lasted only six months… and chose pts with psychiatric disorders .. including depression and anxiety. Since the vast majority of chronic pain pts with poorly treated pain.. will experience depression and anxiety. I have to wonder what other mental health disorders these pts had been diagnosed with… like addiction and wasn’t divulged. Another study designed to come out with a predetermined outcome ?
The CDC says every day in US, 114 people die due to a drug overdose while a larger proportion are getting treated in EDs everyday either for abuse or misuse of the drugs. Deaths due to drug overdose are rising over last two decades.
Last year, the US FDA approved a prescription opioid with properties that made it difficult to abuse, but just last month, a commentary in CMAJ argued that such formulations will not solve the problems of opioid addiction. It argued that governments in Canada and US are promoting such kind of tamper-resistant drugs, but opioid users may tamper with prescribed tablets, capsules or patches for a faster “high,” therefore, merely substituting one formulation for another will not work.
While this argument is on the formulation, a new study has found that chronic back pain sufferers with psychiatric disorders such as depression or anxiety to be 75% more prone to opioid abuse. This is a segment of people who are more likely to abuse their medication.
The study examined 55 chronic lower back patients who experienced low-to-high levels of depression or anxiety symptoms who were given oral morphine, oxycodone or a placebo for pain as needed over a 6-month period. Researchers discovered that patients suffering from high levels of depression or anxiety experienced increased side effects, 50% less improvement for back pain and 75% more opioid abuse as compared to patients with low levels who reported low levels of depression or anxiety.
Based on the study findings, it is essential that clinicians should be careful in prescribing opioid analgesics for low back pain for patients who are showing signs of depression and anxiety.
More than a dozen senior Drug Enforcement Administration agents who fought in Iraq and Afghanistan as military reservists claim their bosses within the law enforcement agency ridiculed their service, assigned them to jobs their war injuries made especially difficult — and, in one case, allegedly planted a cellphone in an agent’s car to track his movements and record conversations.
The agents, who have filed a formal complaint with a federal watchdog agency over allegations that date back more than a decade, believe they were singled out from other veterans within the agency because their duties caused staffing problems, according to interviews and court documents obtained by Fox News. If their claims are true, the agency’s treatment of the reservists is in violation of President Obama’s direct order to federal agencies that unfair treatment of veterans will not be tolerated.
“They called me a poisonous pansy,” DEA Special Agent Mark Coast told Fox News in an interview from his San Diego home. A Marine reservist, Coast was called to active duty in 2003 and served in Iraq, where he was awarded a Purple Heart.
“They called me a poisonous pansy.”
– DEA Special Agent Mark Coast
Shortly after returning home, Coast says he had a disturbing conversation with his civilian boss.
“He asked me, ‘So, how did the war treat you?'” Coast recalled. “I thought it was a strange question. And I said, ‘Well, it was pretty hard’….and he basically said, ‘Well, you know, if you had gotten out of the reserves this wouldn’t have happened. You pretty much deserve everything you get.'”
Coast was again called to active duty in 2004. While under assault in Fallujah, Coast said he and his brother, also a DEA agent and reservist, were belittled for their military service by a DEA superior who complained about them “playing Army” and said his formal internal complaints about mistreatment “wouldn’t matter.”
In the years that followed, Coast says managers reassigned him to positions knowing that his war injuries would impair his job performance with the new tasks. He also says superiors went out of their way to undercut his promotion applications because of his military time away from the agency. Because of his history of battling the DEA bureaucracy, Coast informally became the point man for the problems of other reservists throughout the agency.
Agents told Fox News they think the discrimination happens because superiors believe a loss of manpower jeopardizes their own promotions and performance bonuses. Some 16 agents and current or former reservists, represented by a Washington-based attorney, have filed a formal complaint — officially called an appeal — with the Merit Services Protection Board. The MSPB describes itself as “an independent, quasi-judicial agency in the Executive branch that serves as the guardian of federal merit systems.”
Coast’s claims mirror those of other DEA agents in field offices across the country and at outposts around the world.
Special Agent John Stark, an Army guardsman in Arizona, said his DEA group supervisor told him he wasn’t “pulling his weight” because of his military obligations.
Special Agent John Ciccarelli of Florida, an Army Ranger, recalled a 2005 discussion with his boss, who he says asked him about his “vacation” in Iraq and warned him that “playing soldier” would hurt his DEA career. Ciccarelli, who was later rejected for promotion, was told the DEA was his “real job.”
Andrew Pappas, retired Marine Corps lieutenant colonel and a DEA agent now based in Honduras, said that during an earlier posting in California, he sought leave for annual reservist training. He said his boss relented only after Pappas threatened a lawsuit. But soon after, he was transferred to a regional office 90 minutes further away from his home. Pappas claims he was told the move was “freeway therapy” for having fulfilled his reservist obligations.
Andrew Sorrells, like other complainants, says the agency’s bias against reservists started his first day on the job. Now serving as a special agent in Thailand, Sorrells told Fox News his DEA career started at a pay scale lower than his 14 years’ of military experience warranted.
On Memorial Day, just days after the agents filed their appeal with the MSPB, Sorrells says he received an email from Stephen Tomaski, assistant special agent in charge of the San Diego field office, with the subject line, “You are a coward…” The main body of the message only read, “I do not know how to phrase it any other way. Do NOT ever contact me again.”
A message left on Tomaski’s cellphone went unreturned, and a person answering the main number for the DEA’s San Diego office said Tomaski has retired.
Officials at DEA headquarters outside Washington declined to answer Fox News’ questions about the allegations, citing the ongoing litigation.
It is the latest embarrassment for the DEA, which earlier this year saw its administrator resign after giving widely ridiculed testimony on Capitol Hill about an unrelated scandal involving South American prostitutes. The new allegations have caught the attention of senior leaders at the influential Veterans of Foreign Wars, whose 1.9 million members often have the ear of Washington lawmakers.
“Based on the allegations that were presented to me, I’ve never seen a more egregious set of facts that are presented in this case,” John Muckelbauer, VFW’s general counsel, told Fox.
Perhaps the most shocking claim comes from Supervisory Special Agent Darek Kitlinski, a lieutenant commander in the Coast Guard Reserves. Kitlinski claims he found a DEA-issued Blackberry phone clumsily concealed under the hood of his SUV last September.
“I saw a blinking light through the windshield,” Kitlinski told Fox. “A very, very, faint blinking light.”
Earlier that day Kitlinski and his wife, who also works for the DEA, offered testimony in a deposition where he accused the DEA of stonewalling an internal transfer tied to his reservist responsibilities. Kitlinski believes the phone was planted to track their movements or eavesdrop on their conversations. The DEA has demanded the phone’s return, but Kitlinski has given it to his attorney, Kevin Byrnes, for safekeeping.
“I don’t know how it got there,” Byrnes said. “I know that the DEA has never really, from my position, investigated that fact. They’ve simply asserted they get to get the phone back.”
Byrnes says he’s unaware of any warrant or legal order that would have allowed the DEA to surreptitiously place the phone in his client’s car. And that he’s not going to turn it over to the agency without judicial consent.
Nothing hurts Americans more than chronic pain. It’s our single biggest health problem, affecting the lives of 100 million adults–more than heart disease, cancer, and diabetes combined. And that figure, from a 2011 Institute of Medicine report, doesn’t even count kids in pain, veterans with devastating war injuries, or people in nursing homes.
Yet despite the fact that chronic pain is the primary reason Americans receive disability benefits, its one of the least understood afflictions. Medical schools teach doctors almost nothing about it, spending a median of nine hours on the topic over four years. The federal government puts absurdly few dollars toward research: $4 a year for every person in pain versus $2,562 for every person with HIV/AIDS. One big reason for the lack of resources is that there’s no objective way to confirm that pain exists.
The good news, finally, is that scientists from Massachusetts General Hospital (MGH) in Boston have unveiled a new brain-scanning method that allows doctors to see chronic pain in exquisite detail for the first time. The technique, a merger of PET (positron emission tomography) and MRI (magnetic resonance imaging), clearly identifies that a patient is hurting, and offers a significantly better way to diagnose chronic pain. In trials, patients’ scans lit up in brain areas corresponding to where in the body they ached.
The new method produced dramatic images showing how glial cells–which are derived from the immune system but live in the nervous system–get activated in chronic-pain patients, ramping up the transmission of pain signals to the brain. “Over the past few years, we’ve seen this in animal studies,” says Marco Loggia, who led the MGH team. “But this is the first time we have proof that it works the same way in humans, and it’s a big step forward.”
The magnitude of these findings extends beyond the science. Many patients with chronic pain are mistakenly viewed by clinicians and society at large as drug seekers or hypochondriacs. Without a blood test or biomarkers for pain, they fight skeptics and suffer through trial-and-error treatments. This visible validation that patients’ pain is real will go a long way to ease the stigma.
But it’s only a start. Now that we can see the activation of chronic pain, pharmaceutical companies should be aggressive with clinical trials to pursue new and novel treatments. “Pain can be reversed,” says Loggia. “In five to 10 years, we could potentially have a pill to do just that.”
This came my way from one of my readers that saw this posted on another “health forum”. It would seem that “healthcare deniers” are multiplying like rabbits in perpetual heat.. As I have said before and what a representative of CVS Health told this pt… they leave it to the lead pharmacist to decide when meds will be filled. I know of no chronic disease therapy that suggest a “two day drug holiday/abstinence ” every month. IMO… until someone sues one of these healthcare deniers for denial of care, pt abuse and other issues… the “rabbits” are going to keep multiplying 🙂
I am sure this is a common problem all over the US but it is new to me. I have 42 different prescriptions each month. I am newly diagnosed with MS 40 yrs since the first symptom when I was in college. but have been diagnosed for 10 yrs that it was fibro. and many diagnoses that weren’t right.
I am a nice customer. If they fill the med on the date on the bottle, I can’t be trying to find my receipts to see when hubby picked it up much less 2 days after. On everything. Some I have been on for over 25 yrs. . Since they (my drs) have me on way too much stuff, I rely on my pharmacy to make sure they are filled on the day ordered. I have stayed at this CVS for over 25 yrs when they were with 2 different chains before going to CVS. I had the same 2 pharmacists and assistant for all of those years. I stayed because of the volume and controlled codeine would make a different pharmacy suspicious. 2 yrs ago, my 2 pharmacists left due to illness and the sweet girls who helped left too. The lead pharmacist told me at the time that I would probably like a different pharmacy considering the team that moved into their store.
I am now progressive with my MS. I can no longer drive so my Hero (who has a fulltime job) has to go and pick up meds at some point each week. My clonazapam was to be filled on July 6. I called the pharmacy to make sure it was ready. I was told I had to wait until July 9th because that was the day my meds were picked up. Not the fill date, the pay and take it home date). I called again on Thursday and the girl told me it couldn’t be filled until the 10th of July (the next day.5 days after the the filled date on the bottle.) I spoke with the lead pharmacist yesterday it had not been filled but that she would fill it then. I was then told that CVS has a new policy where they no longer go by the fill date but it would now be 2 days after the picked up date. I can no longer handle stress. My brain is being destroyed by my body fighting itself. I never once have ever requested an early script. In 2012, the pharmacy and the drs. office messed up and on the 4th day without it, I was rushed by ambulance to the hospital. The drs there said I could have went into convulsions and died. I called CVS corporate offices in another state and that man told me on Friday that they leave it to the lead pharmacist to decide when meds will be filled. A couple of months ago, another pharmacist there told me I am on a 32 day refill program. What??? I do not know what to do. I spoke with the one at CVS and I told her my insurance told me to change to another pharmacy. Do you have any idea of what a new drugstore will think if I transferred all of the pain meds and all the rest? My pain level stays at a high 9 on the pain scale and that is with the meds. .
I did it anyway. One day a couple of yrs ago, my CVS was out of stock for my codeine cough syrup. I have a rare lung disease also. (don’t ask). She called Walgreens and the lead pharmacist told me then if I wanted to change, she would take me.
I do not do well with changes in my life so I decided to try to stay with my CVS. I have problems every single week. They are not filling my prescriptions for several days. I am out at that time but I have to depend on the only family I have. My sweet hubby, to go and pick them up. So I called the walgreens and she remembered me and said she would get my records sent over. She called back a few minutes later and said she had spoken to the pharmacist and now she has the “whole story”. The one I have fired told her that I go days without picking up the scripts.I tried to tell her that wasn’t true but she wouldn’t listen and told me they have the same picked up date for the next mth policy. I waited 6 days on my anxiety drug this month before she finally filled it Friday but my husband couldn’t get there until yesterday.
I do not want to cause problems but isn’t it wrong to make a patient wait 6 days on a med that almost killed me 3 yrs ago when they didn’t fill it? I called my dr also and they told e to change. But now the new one is saying her policy is the same as CVS. She said I have to be out of my medicine before they will fill it. Who else can I call or write to see if they can do this to me and other chronically ill patients ? Please help me. Thank you for listening
WEST SPRINGFIELD, Mass. — When George P. Gauthier died of an opiate overdose in May at 44, his sister, Cindy Gauthier-Rivera, wrote an obituary that was more like a cry from the heart.
His destructive addictions to heroin, painkillers and alcohol had cost him his marriage, his children, his job and eventually his life, she wrote from her home here in western Massachusetts. An outgoing man who dressed well and loved music and poetry, he had wanted to become a drug counselor, saving others from the abyss. Instead, he plunged further into it; he was found dead at their mother’s house, just a few miles from his sister.
“At least he was not alone or in the streets, or killed in a fight or stabbed or shot, but he is still gone,” Ms. Gauthier-Rivera wrote. “This is so painful and I want to scream and I want him back but not the addiction.”
When celebrities like the actor Philip Seymour Hoffman die of heroin overdoses, the cause of death is a prominent part of the obituary. The less famous tend to die “unexpectedly” or “at home.”
Photo
Photos of Mr. Marino and his family in his mother’s apartment. More relatives are referring to addiction in obituaries as heroin use rises. One expressed “hope that it might help save some people from the incredible heartache we are experiencing.”Credit Christopher Capozziello for The New York Times
But as the heroin epidemic surges across the country and claims more lives every day, a growing number of families are dropping the euphemisms and writing the gut-wrenching truth, producing obituaries that speak unflinchingly, with surprising candor and urgency, about the realities of addiction.
Many of these obituaries read more like personal eulogies than death notices, even as they appear for all to read in newspapers, on Facebook, and on websites like Legacy.com and ObitsforLife.com, where Ms. Gauthier-Rivera originally posted about her brother. Some have even gone viral, prompting an outpouring of messages in which strangers share their own heartache — a sign of how widespread addiction is, even as it has stayed for so long under wraps.
Experts say the emerging openness about fatal overdoses is a sign of a broader shift.
Now, addicts, law enforcement officers and policy makers are all pushing to treat drug abuse as a disease and a public health crisis, not a crime or moral failing, and families are confronting addiction publicly in new ways, through rallies, online and in unvarnished obituaries.
“This is part of a trend toward a greater degree of acceptance and destigmatization about issues pertaining to mental illness, including addiction,” said Dr. Jeffrey A. Lieberman, chairman of psychiatry at the Columbia University College of Physicians and Surgeons.
Heroin abuse is soaring, thanks chiefly to its cheap price and widespread availability. Between 2002 and 2013, use of heroin rose across a wide spectrum of demographic groups — young and old, male and female, poor to affluent — according to a report released on Tuesday by the Centers for Disease Control and Prevention. Among the more striking findings, heroin use doubled among women in that decade and rose by 60 percent among Americans with a household income of $50,000 or more, Over the same period, heroin-related overdose deaths nearly quadrupled, with more than 8,200 reported in 2013.
The candid obituaries of heroin users are filled with pain and sometimes outrage at the loss; the dead are often so young that their survivors include not just parents but also grandparents.
“Jack Pond was also called Son, Daddy, Brother and Friend and Jack was an addict,” began Jack Pond Ringler’s obituary in The Gazette in Colorado Springs in November. He was 26.
After Wade B. Pickett Sr., 34, was found dead of a heroin overdose in early May in the bathroom of the metal shop where he was a welder, his wife, Tiffany, wrote of his addiction in The Express-Times in Easton, Pa. “I am sorry if this obituary offends, hurts or shames some people,” she wrote. “I hope that it might help save some people from the incredible heartache we are experiencing.”
In the obituary for Daniel Joseph Wolanski, 24, of Avon Lake, Ohio, who fell victim to heroin in April, his family wrote, “Someone you know is battling addiction; if your ‘gut instinct’ says something is wrong, it most likely is.”
The family went on to advise: “Don’t believe the logical sounding reasons of where their money is going or why they act so different. Don’t believe them when they say they’re clean.”
These new addiction obituaries do not appear to be the result of any organized effort. But treatment specialists say they reflect a nascent movement by some in recovery and their allies to speak up and press for better treatment options and changes in the criminal justice system.
Their efforts include a documentary film, “The Anonymous People,” which urges those with addiction issues to come out of the shadows. It is being screened by drug and alcohol recovery groups across the country.
And a group called UNITE to Face Addiction, a coalition of advocacy groups, is planning a rally in Washington on Oct. 4, called “the day the silence ends.” The goal is to raise awareness about addiction’s being “treatable and preventable” for the estimated 22 million Americans in its grip.
Many are sharing their stories online, including on a blog called “Heroin. Stop the Silence. Speak the Truth.” Patricia Byrne, who lives in Colorado, started it recently after she learned that two young people in her hometown, Canton, Mass., had died of overdoses within a week — and she revealed that her son, Kurt, 29, is a recovering heroin addict.
Photo
Cindy Gauthier-Rivera outside her West Springfield, Mass., home last month. After her brother, George Gauthier, died in May from an overdose, she wrote about his addiction.Credit Christopher Capozziello for The New York Times
She said she wanted to put an end to her own guilt, silence and embarrassment. “I want families to not feel isolated and alone in this hell that is Addiction,” she wrote. The blog received 100,000 visits in the first week, nearly half a million in three weeks.
Kurt Byrne, who says he has been clean for 17 months, encouraged his mother to go public and said the candid obituaries seemed like a necessary step. “It’s a healthy step toward taking away the stigma,” he said. “And if it’s Johnny from next door, it opens people’s eyes that this isn’t just people on the street corners.”
He added: “You see how it’s affecting homes and families.”
Still, not everyone is ready to go public, least of all in an obituary, which frames a person’s legacy for all time. A disagreement about how candid such a piece should be can cause rifts while a family is trying to heal. Going public can open up a family to painful accusations by people who say they were robbed or threatened by the deceased.
Tracey Marino, whose 23-year-old son, James, recently died from a heroin overdose at home in Stratford, Conn., omitted that detail from his obituary. “People who knew and loved him knew what killed him,” she said in an email. “But to people who I knew were judgmental, I tell them he died of cardiac arrest. Because I did not want his legacy to be he was a drug addict by people who have NO clue about addiction.”
Eventually, though, she came to feel strongly that addiction is a disease, not a life choice, and decided to go public on a Facebook page for “Heroin. Stop the Silence.” In the email, she said her decision had come down to this: “I had to advocate for him because no one else was going to.”
Buddy Phaneuf, president of Phaneuf Funeral Homes & Crematorium in Manchester, N.H., said he had seen a significant shift in attitudes over recent months. “A lot of people say, ‘We don’t want to air our dirty laundry,’” he said. But “we respond to one or two heroin deaths a week, and this is a small state, so writing about it has become much more mainstream. People want to get the word out.”
Helping others is a prime motivation.
Richard Vachon, 69, a retired cook in Manchester, found his son, Cody, 21, on the floor of their home in May, dead of a heroin overdose, which he wrote in his son’s obituary. Once he feels “less shaky,” the heartbroken father said, he wants to “speak my mind and see if I can reach someone through my experience.”
One woman, Elizabeth Sue Sleasman, 37, of Bellingham, Wash., took the extraordinary step of writing her own brutally frank obituary, which her parents published after she died; she realized her death was inevitable and wanted to warn other addicts about what lay ahead.
“I ate out of garbage cans, begged and stole,” she wrote. “You will become a thief and a liar.”
But people have deeper motivations, too. Some of these are rooted in anger, helplessness or an urge to shuck off the shame that may have enabled the addiction or blinded the family to it in the first place.
“If a family chooses to do this, they can have a cathartic experience that facilitates the grieving process,” said Dr. Lieberman, the psychiatrist.
“When the person was alive, they may have been enabling, and they couldn’t acknowledge it,” he said. “But this allows them to begin that process of coming to terms with the fallibility of the family member and their own limitations in not having been able to deal with it while the person was alive.”
Ms. Gauthier-Rivera, 46, said she wrote about her brother’s addiction because it made her feel as though she was doing something. And it immediately prompted others to share their own secrets.
“One person said to me, ‘My sister OD’d, and they found her in a Dumpster,’” she said. Someone else told her mother, “My son got my daughter addicted to heroin, and she overdosed, and my son felt so much guilt at his sister dying, he committed suicide.”
Now, even though Ms. Gauthier-Rivera has a full-time job supervising a home for developmentally disabled people, she and her husband are starting a small ministry, offering coffee and conversation near a methadone clinic here. She said she hoped to coax more people into treatment, conveying to them that they are more than their addictions.
“If I take this and go, ‘Oh, my gosh, I can’t let anybody know what happened to my brother,’” she said, “then I’m just adding to the problem.”
Posing as money launderers, police in Bal Harbour and Glades County, Fla. laundered a staggering $71.5 million for drug cartels in an undercover sting operation, according to an in-depth investigation by The Miami Herald. With fake identities, undercover officers made deals to pick up cash from criminal organizations in cities across the country. Agents then delivered the money to Miami-Dade storefronts and even wired cash to banks overseas in China and Panama. After laundering the cash, police would skim a three percent commission fee, ultimately generating $2.4 million for themselves.
“If you think of all the money that’s made from drugs, at some point it has to be cleaned up and become legit,” remarked Finn Selander, a former DEA agent and a member of Law Enforcement Against Prohibition. But unless proper precautions are taken, sting operations can “backfire” and “come back and bite you in the proverbial ass.”
Together, the Bal Harbour Police Department and the Glades County Sheriff’s Office formed the Tri-County Task Force, which, despite the name, consisted of only two agencies. From 2010 to 2012, the task force passed on information and tips to federal agencies that led to the government seizing almost $30 million. Yet the undercover unit laundered over $70 million for drug cartels—more than twice as much as what was actually taken off the streets.
In this, Tuesday, May 19, 2015 photo, the village of Bal Harbour, Fla., and its beach are shown. The city of Miami is seen in at rear. (AP Photo/Wilfredo Lee)
Notably, the Tri-County Task Force never made a single arrest. The task force countered that assertion, claiming they passed on intelligence that led to over 200 arrests made by other agencies. But a representative from the DEA said, “There’s no way we can validate those numbers. We have no idea what they are basing those numbers on.” Tellingly, “the task force did not document the names of the 200 people who were arrested,” according to The Miami Herald.
Thanks to the commissions from money laundering, the task force could indulge in a lavish lifestyle. Officers enjoyed $1,000 dinners at restaurants in the Miami area, and spent $116,000 on airfare and first-class flights and nearly $60,000 for hotel accommodations, including stays at the Bellagio and the Mandalay Bay in Las Vegas and El San Juan Resort & Casino in Puerto Rico. Police also spent over $100,000 on iPads, computers, laptops and other electronics, bought a new Jeep Grand Cherokee for $42,012 and even purchased $25,000 worth of weaponry, including FN P90 submachine guns. (Bal Harbour, a seaside village of 2,500 residents known for having the nation’s top sales-generating mall, reported just one violent crime in 2012.)
Initially, to gain seed capital to conduct the sting operations, Bal Harbour tapped into equitable sharing, a federal asset forfeiture program. Under equitable sharing, cash, cars and real estate can all be forfeited to the government if there is an alleged nexus between criminal activity and the property involved, though criminal convictions or indictments are not necessary. As Michael Sallah, the investigative reporter at the Herald who broke the story, noted, “The Tri-County Task Force’s entire sting operation could not have existed without the DOJ’s Equitable Sharing program.”
In fact, Duane Pottorff, the chief of law enforcement at the Glades County Sheriff’s Office, was remarkably candid about his agency’s motivations in joining the task force: “We thought this was a chance to bring in more revenue.” “Forfeiture money allowed us to have resources that normally we wouldn’t have,” including “patrol cars, vests, guns for the deputies, ammunition, all this, the training room, the training equipment is all paid with forfeiture funds,” he added.
Nearly 80 years ago, Aldous Huxley wrote in Brave New World about the wonders of a fictional drug called Soma and its benefits for society, but a real modern-day drug with the same name is anything but a benefit for society and the workers’ comp community, says one prominent medical director. With a host of other drugs available that carry far less baggage, he hopes to get Soma out of the California workers’ comp system, and he’s starting with his own claims first.
Gideon Letz, M.D., medical director for State Compensation Insurance Fund, and a respected leader in California’s workers’ comp medical community, is not necessarily a crusader in the traditional sense, but he is on a mission to end use of the drug Carisoprodol in the California workers’ comp system. Better known by its brand name Soma, the drug is not only one of the most commonly prescribed muscle relaxants, especially for back and neck injuries, it’s also one of the most commonly prescribed drugs overall.
That’s a problem, says Letz, because the drug has a high incidence of abuse and addiction.
“The problem with Soma is that it’s metabolized into another drug called Meprobamate, which has a lot of problems with it, but the primary one is that it’s very addictive,” Letz noted in an exclusive interview with Workers’ Comp Executive. “Meprobamate isn’t used anymore, but when you take Soma it is immediately metabolized in your liver into this Meprobamate drug.”
While it’s termed a muscle relaxant, Letz says it works more like a sleeping pill acting as a central nervous system depressant. “They work, because if you have muscle spasms and you take a central nervous system depressant, it basically makes you so sleepy that you relax,” he noted. But these depressant effects have also created a black-market demand for the drug, which now has a street value of $5 to $10 per pill.
“ … and this is a policy of our UR [utilization review] department, is that we’re not going to authorize any more of this Soma drug.”
— Dr. Gideon Letz,
State Fund
With estimates that 20% of all disability claims in California with a prescription have at least one for Soma — a rate that puts the Golden State among the highest Soma use rates in the nation — Letz says he’s working to reverse the trend.
“Basically, what we have said, and this is a policy of our UR [utilization review] department, is that we’re not going to authorize any more of this Soma drug,” he said. “We will allow for some taper because some of these people have been on it for years and are very addicted to it, but we’re not going to authorize it anymore.”
Alternatives Exist
Letz maintains that a number of other muscle relaxants on the market can do the job without the dangers associated with Soma. He named Flexeril as one likely substitute, pointing out that it’s commonly used “and has zero street value.”
While lauding it as a worthwhile goal, Alex Swedlow is not convinced that a total ban can be implemented under the current rules of engagement in California’s workers’ comp system.
Swedlow, researcher with California Workers’ Compensation Institute, notes that implementing the program is one thing, but getting denials to stand up in a dispute process might prove more difficult to sustain.
“We now have two sets of treatment guidelines and they don’t necessarily agree with each other,” Swedlow says, noting the Division of Workers’ Compensation’s decision to move beyond the American College of Occupational and Environmental Medicine (ACOEM) guidelines to also adopt the ODG chronic-pain guidelines. “How do you run an adjudication system when you have one set of guidelines saying one thing and the other something else?”
But Letz is not dissuaded, maintaining that State Fund’s position is supported by both sets of guidelines.
“As of this moment, I don’t know that we’ve made a dent in it yet. We just started this UR program. This is very recent,” he said. “But I think the word will get out and that within a year or two we’ll see this drug basically disappear.”
He’s already got one convert.
Bill Zachry, vice president of risk management for Safeway Inc., and a member of State Fund’s board, caught a recent presentation by Dr. Letz on the subject and was impressed.
“I wasn’t aware of how the drug metabolized. It may have been part of [Safeway’s] formulary, but to the extent that it was, it won’t be going forward, if there’s no ethical or moral reason for providing it,” he told Workers’ Comp Executive. “What an idea!”
Call Out the Docs
Beyond the UR process, Letz is bringing other pressures to bear to lower use rates not only for Soma but for all narcotics.
“It may have been part of [Safeway’s] formulary, but to the extent that it was, it won’t be going forward, if there’s no ethical or moral reason for providing it.”
— William Zachry,
Safeway
“Soma and narcotics are a major contributor to delayed recovery,” he told Workers’ Comp Executive, noting that studies have shown the longer that workers are off on workers’ comp, the less likely they are to ever return to the job. “ When you take these drugs, you don’t want to do anything, and the best treatment for patients with musculoskeletal pain conditions is activity and exercise, for many reasons, including psychosocial, but also physical.”
He maintains that these drugs, plus drugs such as Valium and Xanax, can be a short-term help, but he maintains that too many injured workers are kept on them for far too long. And to fix that, he says he’s going to target doctors.
Letz says the carrier is beginning to use its prescription benefit manager to help find high-risk cases with a lengthy pattern of prescriptions for Soma and other narcotics, and other counterproductive treatment patterns. In these cases, they’ll target doctors for an intervention to discuss their prescribing habits and treatment patterns.
“The thinking should be that the prescription isn’t working, so we should be trying something different instead of just upping the prescription,” he maintains, noting that many doctors prescribe drugs such as Soma out of habit and aren’t even aware of problems with it.
If the gentle nudges aren’t enough, Letz says State Fund is prepared to notify the Drug Enforcement Agency, the Medical Board of California and the Division of Workers’ Compensation. But such drastic measures are expected to be an uncommon occurrence. “I do know that whenever someone is watching them, then behavior changes,” Letz says of physicians.
Wholesalers’ rationing and opiophobic Pharmacists have created the “Pharmacy Crawl” .. which give people who like to do research to use numbers to prove certain facts… Could it be that these researchers seek out numbers that “prove” a pre-conceived conclusion ?
WEDNESDAY, July 8, 2015 (HealthDay News) — Nearly half of all deaths resulting from an overdose of narcotic painkillers involved Medicaid recipients who used multiple pharmacies to fill their prescriptions, a new study finds.
“Pharmacy shopping,” or the use of multiple pharmacies at the same time, is a way some patients obtain more medication than they need. Medicaid programs in many states track the number of pharmacies patients visit to prevent such abuse of painkillers, the study authors said.
It’s unclear, however, how many pharmacies must be visited or how much time should lapse between prescriptions to identify patients engaging in pharmacy shopping with the intent to misuse their medication. Some patients, the study authors pointed out, may legitimately use more than one pharmacy if they move, travel or make a change in their insurance coverage.
To investigate this issue, researchers examined the records of more than 90,000 Medicaid recipients aged 18 to 64, who were long-term users of narcotic painkillers, such as Oxycontin (oxycodone) or Vicodin (hydrocodone). These patients had used three or more narcotic prescriptions for 90 days from 2008 to 2010.
Patients using overlapping painkiller prescriptions had a higher rate of overdoses, the study published recently in The Journal of Pain revealed. Patients who used four pharmacies within 90 days, which the study said could be considered an indication of pharmacy shopping, had the highest odds of overdosing.
Study author Zhuo Yang, of the U.S. Centers for Disease Control and Prevention, and colleagues concluded that the use of overlapping prescriptions and multiple pharmacies isn’t medically reasonable or necessary. Programs to restrict reimbursement for controlled prescriptions, such as narcotic painkillers, could designate one pharmacy and one doctor for patients on these medications, they suggested.
Gideon Letz, M.D., medical director for State Compensation Insurance Fund, and a respected leader in California’s workers’ comp medical community, is not necessarily a crusader in the traditional sense, but he is on a mission to end use of the drug Carisoprodol in the California workers’ comp system. Better known by its brand name Soma, the drug is not only one of the most commonly prescribed muscle relaxants, especially for back and neck injuries, it’s also one of the most commonly prescribed drugs overall.
While lauding it as a worthwhile goal, Alex Swedlow is not convinced that a total ban can be implemented under the current rules of engagement in California’s workers’ comp system.
He’s already got one convert.