Chronic painer “forced” into buying street drugs… dies from overdose ?

After 7th Death, DEA Takes Over Search For Fentanyl Pills In Sacramento

SACRAMENTO (CBS13) — The Drug Enforcement Administration is taking over an investigation into how fentanyl ended up in drugs in the Sacramento area after a seventh person is believed to have been killed by the drug.

The family of Jerome Butler says he was taken off life support on Wednesday afternoon, just three days after his mother said he took a pill for chronic stomach pain he didn’t know had been laced with Fentanyl.

The drug is also believed to be responsible for 21 other hospitalizations.

CBS13 has learned recession budget cuts claimed narcotics teams in the Sacramento area who would track down drugs like Fentanyl.

Assemblyman Jim Cooper was once an undercover cop who busted drug dealers daily. He established Sacramento County’s first street narcotics team in 1988.

“It was turn and burn; you go out arrest someone, and get the next one,” he said.

His unit was dedicated to finding the guys dealing prescription pills like the ones now being blamed for multiple deaths in Sacramento County.
“It’s unfortunate, because those folks—the actual dealers selling out there right now—they’re out there unimpeded. They could do whatever they want,” he said.

The recession claimed the sheriff’s department’s team in 2008, while the Sacramento Police Department got rid of theirs in 2011. Neither has been restored.

Both agencies declined on-camera interviews, but defend their current operations. They say high-level drug task forces now pick up the slack.

“There’s lots of task forces in Sacramento, but they work on high-level drug dealers, but the street teams, they go out every night for that purpose, arresting drug dealers,” Cooper said.

He hopes the pill problem could be solved with a bill that would make locking pill bottles available to people with prescriptions, making it harder for addicts to steal the drugs.

For now, he hopes to see street teams back on the street deterring drug dealers and their deadly combinations.

“Otherwise you’re going to see more deaths with this,” he said


Over the total 78 weeks observed, there were no overdose events in the extended-release naltrexone group and seven in the usual-treatment group

Extended-Release Naltrexone to Prevent Opioid Relapse in Criminal Justice Offenders

http://www.nejm.org/doi/full/10.1056/NEJMoa1505409#t=abstract

Background

Extended-release naltrexone, a sustained-release monthly injectable formulation of the full mu-opioid receptor antagonist, is effective for the prevention of relapse to opioid dependence. Data supporting its effectiveness in U.S. criminal justice populations are limited.

 

Methods

In this five-site, open-label, randomized trial, we compared a 24-week course of extended-release naltrexone (Vivitrol) with usual treatment, consisting of brief counseling and referrals for community treatment programs, for the prevention of opioid relapse among adult criminal justice offenders (i.e., persons involved in the U.S. criminal justice system) who had a history of opioid dependence and a preference for opioid-free rather than opioid maintenance treatments and who were abstinent from opioids at the time of randomization. The primary outcome was the time to an opioid-relapse event, which was defined as 10 or more days of opioid use in a 28-day period as assessed by self-report or by testing of urine samples obtained every 2 weeks; a positive or missing sample was computed as 5 days of opioid use. Post-treatment follow-up occurred at weeks 27, 52, and 78.

 

Results

A total of 153 participants were assigned to extended-release naltrexone and 155 to usual treatment. During the 24-week treatment phase, participants assigned to extended-release naltrexone had a longer median time to relapse than did those assigned to usual treatment (10.5 vs. 5.0 weeks, P<0.001; hazard ratio, 0.49; 95% confidence interval [CI], 0.36 to 0.68), a lower rate of relapse (43% vs. 64% of participants, P<0.001; odds ratio, 0.43; 95% CI, 0.28 to 0.65), and a higher rate of opioid-negative urine samples (74% vs. 56%, P<0.001; odds ratio, 2.30; 95% CI, 1.48 to 3.54). At week 78 (approximately 1 year after the end of the treatment phase), rates of opioid-negative urine samples were equal (46% in each group, P=0.91). The rates of other prespecified secondary outcome measures — self-reported cocaine, alcohol, and intravenous drug use, unsafe sex, and reincarceration — were not significantly lower with extended-release naltrexone than with usual treatment. Over the total 78 weeks observed, there were no overdose events in the extended-release naltrexone group and seven in the usual-treatment group (P=0.02).

 

Conclusions

In this trial involving criminal justice offenders, extended-release naltrexone was associated with a rate of opioid relapse that was lower than that with usual treatment. Opioid-use prevention effects waned after treatment discontinuation. (Funded by the National Institute on Drug Abuse; ClinicalTrials.gov number, NCT00781898.)

 

WV: 3,000 doses Naloxone administered, which hopefully saved 3,000 lives… we don’t know ?

‘Ahead of the curve’: Summit shows WV’s progress on drugs

http://www.herald-dispatch.com/news/ahead-of-the-curve-summit-shows-wv-s-progress-on/article_fc4301e0-89af-51dc-be12-9a1b173ff34e.html

Naloxone can be compared to finding someone starving to death.. you give them a meal/drink and hope that they stop starving.. Apparently WV… just revives people who overdose and puts them back into the environment from which they came and hope that they “get their act together”…  Is it that they just keep count of how many doses of Naloxone they have administered and that is really all that really matters.. the NUMBERS ?

HUNTINGTON – A delegation of West Virginians who face drug addiction on a daily basis represented the state at the 2016 National Prescription Drug Abuse Summit in Atlanta this week, and what they learned is West Virginia is ahead of the curve.

More than 1,500 people, including President Barack Obama, attended the summit, the largest collaboration of professionals from areas impacted by prescription drug abuse and heroin use.

Gov. Earl Ray Tomblin; U.S. Sen. Joe Manchin, D-W.Va.; U.S. Rep. Evan Jenkins, R-W.Va.; and Huntington Deputy Fire Chief Jan Rader, who is also a member of the Mayor’s Office of Drug Control Policy, were among those who presented during the three-day summit.

Tomblin was part of the keynote address Monday, and participated in a panel discussion with Manchin and U.S. Secretary of Agriculture Tom Vilsack.

He was the only governor invited to the summit, and he said Wednesday he believed that was because of the progress West Virginia has made in the fight against the opioid epidemic.

“We are really one of the leaders in the country right now as far as the things we’ve been able to do as far as shutting down pill mills, the reporting of prescriptions filled to the Board of Pharmacy – we’ve taken a very active role in letting the licensing board know who those people are who are overprescribing,” Tomblin said.

“We’ve had the medical community learn more about prescriptions they are prescribing and the problems with those pills sometimes. We’ve got our call line in place, and I think it’s still one of the only services of its kind in the country that let those people who need help to pick up the phone and they will stay on the line with you until they get you to a person who can help you.”

Tomblin said the state has also made strides with naloxone.

Just last year, our EMS administered over 3,000 doses, which hopefully saved 3,000 lives,” he said. “Now, anybody can get it without a prescription, and plus the pharmacist will teach you how to properly administer the drug, so hopefully we will save a lot more lives in our state to give people a second chance to get the help that they need.”

Tomblin signed the bill Tuesday that made naloxone available without a prescription.

He said he also thinks West Virginia is one of the first states to change the attitude toward drug abusers.

“We used to think we could just lock them up and that would help,” Tomblin said. “It’s an illness, and we are going to treat it that way.”

Jenkins said it was an honor to share a story of progress, and he said it was an energizing experience. He was one of seven on a congressional panel.

Jenkins said he focused on three areas during the panel: the potential and power of prescription drug monitoring programs, holes in Obama’s proposed $1.1 billion plan to combat opioid abuse, and the need for more centers like Lily’s Place nationwide and removing the barriers to creating them.

He said that with the state’s more proactive monitoring program, the Board of Pharmacy has been able to search the database and send more than 8,000 letters to practitioners about patients who had received a pain medication prescription from other prescribers, a practice often called pill shopping.

“We are so far ahead of the curve in West Virginia to use that database in a very proactive, effective way,” he said.

Jenkins said the next barrier is finding a way to share this data across state borders. To do so, state confidentiality programs must match. Currently, West Virginia only matches 18 states.

Treading carefully, Jenkins said he also talked about holes in the president’s proposed budget. The proposal focuses mainly on medication-assisted treatment, but Jenkins, a member of the House Appropriations Committee, said the president is proposing cutting programs that are proven to work in his district, including Cabell County, such as drug courts and the High Intensity Drug Trafficking Area.

He also talked about centers like Lily’s Place and the regulatory challenges to replicating Lily’s Place nationwide.

“I talked about the Cradle Act, which would push the federal health regulators to put in place regulatory standards to allow Lily’s Place to be replicated,” Jenkins said. “We’ve already done it in West Virginia.”

Jan Rader represented Huntington on a panel with representatives from Camden, New Jersey, about communities’ responses to heroin.

Rader said she talked about the harm-reduction program, the involvement of the whole community and other initiatives like the expansion of drug courts. She also talked about where Huntington hoped to go, including needing more detox beds. There are only 18 in Cabell County.

“Being there a couple days brought to light we are ahead of the curve,” Rader said, echoing Tomblin and Jenkins. “We’ve been doing a lot that they are doing at national level just now. We are really making do with what we have and being creative.

“We don’t deal with egos. We work together. A lot of communities are up against political battles, people not cooperating. We aren’t dealing with that. Huntington and Cabell have come together as a community to do the right thing.”

She said one thing Camden is doing that she would like to see happen here is training police in the academy how to deal with someone with addiction and how to administer naloxone. She said she would like to see fire and EMS responders receive the same training as well.

Rader said she was honored to represent Huntington, and reiterated what Mayor Steve Williams frequently says: Huntington will be known as the place that helped.

“We have a problem, but we will help turn it around,” she said.

Andrea Darr, director of the West Virginia Center for Children’s Justice; Kristi Justice, executive director for Kanawha Communities that Care; and Chad Napier, prevention and education coordinator for Appalachia HIDTA in West Virginia and Virginia, also presented during the summit.

Follow reporter Taylor Stuck on Twitter @TaylorStuckHD.

unintended consequences from bureaucrats interfering with the healthcare system

Doctors resist new painkiller prescribing procedures

http://www.cbsnews.com/news/doctors-resist-new-painkiller-prescribing-procedures/

It has been reported that only 47% of prescribers are ready/capable of sending electronic control medications Rxs. Whereas 95% of the pharmacies are able to accept electronic controlled Rxs. Using averages, for every million people population there are 11,000 pts that need to get a controlled Rx filled EVERYDAY. If only 47% of prescribers are capable of generating electronic controlled Rxs… how many pts are going to be thrown into cold turkey withdrawal every day going forward ? How many are going to suffer from a hypertensive crisis… resulting in a stroke or death ?

Unintended consequences:

prescriber sends a C-II to a pharmacy that is out of inventory or Pharmacist is “not comfortable”… the C-II Rx becomes DOA. It can’t be transferred to another pharmacy.. the prescriber could be drug into participating into the “pharmacy crawl” trying to find a pharmacy that has or is comfortable filling a C-II. If the Rx is C-III -C-V… will the pharmacy/Pharmacist be willing to participate in the “pharmacy crawl” to find another pharmacy to fill the Rx ? Technically, the prescription is the property of the pt, but now in NY… the pt never receives a written Rx and remains in the possession of the pharmacy it was first transmitted to. What is the obligation of the receiving Pharmacist to help assure the pt gets the medication that the prescriber intended for the pt to get?

WASHINGTON –The nation’s top health officials are stepping up calls to require doctors to log in to pill-tracking databases before prescribing painkillers and other high-risk drugs.

The move is part of a multi-pronged strategy by the Obama administration to tame an epidemic of abuse and death tied to opioid painkillers like Vicodin and OxyContin.

But physician groups see a requirement to check databases before prescribing popular drugs for pain, anxiety and other ailments as being overly burdensome.

Helping push the administration’s effort forward is an unusual, multi-million lobbying campaign funded by a former corporate executive who has turned his attention to fighting addiction.

“Their role is to say what needs to be done, my role is to get it done,” says Gary Mendell, CEO of the non-profit Shatterproof, which is lobbying in state capitals to tighten prescribing standards for addictive drugs.

Mendell founded the group in 2011, after his son committed suicide following years of addiction to painkillers. Previously, Mendell was CEO of HEI Hotels and Resorts, which operates upscale hotels. To date, Mendell has invested $4.1 million of his own money in the group to hire lobbyists, public relations experts and 12 full-time staffers.

A new report from Shatterproof lays out key recommendations to improve prescription monitoring systems, which are currently used in 49 states.

The systems collect data on prescriptions for high-risk drugs that can be viewed by doctors and government officials to spot suspicious patterns. The aim is to stop “doctor shopping,” where patients rack up multiple prescriptions from different doctors, either to satisfy their own drug addiction or to sell on the black market. But in most states, doctors are not required to check the databases before writing prescriptions.

Last week, the White House sent letters to all 50 U.S. governors recommending that they require doctors to check the databases and require pharmacists to upload drug dispensing data on a daily basis.

The databases are “a proven tool for reducing prescription drug misuse and diversion,” said Michael Botticelli, National Drug Control Policy Director, in a statement.

But government health officials say virtually all state systems need improvements, including more up-to-date information.

“There isn’t yet a single state in the country that has an optimal prescription drug monitoring program that works in real time, actively managing every prescription,” said Dr. Tom Frieden, director of the Centers for Disease Control and Prevention, in a press conference last week.

Physicians warn about the unintended consequences of mandating use of programs that can be slow and difficult to use. Patients may face longer waits and less time with their physicians, says Dr. Steven Sacks, president of the American Medical Association.

“There really is a patient safety and quality-of-care cost when you mandate the use of tools that are not easy to use,” Sacks said.

The report from Shatterproof highlights the gaps in current prescribing systems. When doctors are not required to log in, they generally only do so 14 percent of the time, according to data from Brandeis University.

The report points to positive results in seven states that have mandated database usage: Kentucky, New York, Tennessee, Connecticut, Ohio, Wisconsin and Massachusetts. In Kentucky, deaths linked to prescription opioids fell 25 percent after the state required log-ins in 2012, along with other steps designed to curb inappropriate prescribing.

The same information can be used to prevent deadly drug interactions between opioids and other common medications, including anti-anxiety drugs like Valium of Xanax.

Opioids are highly addictive drugs that include both prescription painkillers like codeine and morphine, as well as illegal narcotics, like heroin. Deaths linked to opioid misuse and abuse have increased fourfold since 1999 to more than 29,000 in 2014, the highest figure on record, according to the CDC.

Earlier this month, the CDC released the first-ever national guidelines for prescribing opioids, urging doctors to try non-opioid painkillers, physical therapy and other methods for treating chronic pain.

But pain specialists fear requiring pill-tracking databases will discourage doctors from prescribing the drugs even when appropriate, leaving patients in pain. Dr. Gregory Terman says it takes him three minutes to log in to the system used in his home state of Washington.

“If it was easier to use, more people would use it,” said Terman, who is president of the American Pain Society, a group which accepts money from pain drugmakers. Like many physicians, Terman says he supports the technology but doesn’t think it should be required.

Last week, two states targeted by Shatterproof signed into law database-checking requirements: Massachusetts and Wisconsin. Mendell says his staffers are lobbying now in California and Maryland.

“I don’t think we can afford to wait decades for this to slowly get implemented into the system,” he says. “I think we need to take action now.”

Study involving 21 pts … produces valid conclusion/outcome ?

lmaoOne Month of Opioid Use Causes Gray Matter Loss, New Study Confirms

http://www.painmedicinenews.com/Science-Technology/Article/03-16/One-Month-of-Opioid-Use-Causes-Gray-Matter-Loss-New-Study-Confirms/35476/ses=ogst

Scientists from the United States and Australia have confirmed there is reduced gray matter volume in several areas of the brains of people who take opioids for more than a few days (Pain Med 2015 Dec 26. [Epub ahead of print]).

The researchers randomly assigned 11 people with low back pain to receive morphine daily for a month and another 10 to receive placebo. Subsequent imaging identified loss of gray matter in several reward- and pain-related regions of the brain in the morphine group but not the placebo group. There were no appreciable gray matter losses in the placebo group despite significant pain reduction.

The changes observed by the investigators corroborate evidence from an earlier study they published that showed alterations in the brain’s reward-related networks after one month of daily morphine use (Pain 2011;152:1803-1810).
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“It’s disturbing to learn that in as little as one month, daily use of opioids can alter brain morphology. And it’s even more disturbing to learn that despite the harm caused to the subjects in the morphine arm, their pain wasn’t any better controlled than the patients receiving placebo,” commented Andrew Kolodny, MD, chief medical officer, Phoenix House; executive director, Physicians for Responsible Opioid Prescribing; and senior scientist, Heller School for Social Policy and Management, Brandeis University, Waltham, Mass. “This is strong evidence that for many patients, the risks of long-term opioids clearly outweigh potential benefit.”

However, lead investigator Joanne C. Lin, PhD, postdoctoral research fellow in the Department of Psychology at the University of Alabama at Birmingham, and her co-investigators from The University of Alabama; Stanford University, in California; and Monash University, in Victoria, Australia, said the study was small and that its clinical implications remain to be seen.

“It is important to note that brain changes do not necessarily mean that something bad has happened. The next step is to carefully monitor patients taking opioids to see what happens when the brain changes,” Dr. Lin said in an email to Pain Medicine News. “Are the brain changes associated with good (e.g., pain relief) or bad (e.g., addiction) outcomes? It is important that we answer that question before we start suggesting that this research should change how physicians treat pain.”

The patients’ average ages were 39 years in the morphine group and 45 years in the placebo group (P=0.178), and the average duration of pain was 11.1 years in the morphine group and 5.2 years in the placebo group (P=0.115). There was a 29.9% reduction in pain in the morphine group over the month of the study and a 33.3% reduction in the placebo group.

Magnetic resonance imaging revealed significantly reduced gray matter with morphine in the left inferior orbitofrontal cortex, right gyrus rectus, bilateral presupplementary motor areas and left dorsal posterior cingulate. There also was significant volume loss in the superficial subregions of the bilateral amygdala, left insula, two regions of the left superior temporal gyrus, right precentral gyrus, right superior frontal gyrus, right inferior temporal gyrus and right rolandic operculum. Several of these overlapped with decreases documented in earlier studies. There also were gray matter volume increases in some areas such as the bilateral insula and right hippocampus. There were no significant volume changes in placebo patients.

“I hope the authors report back on how these patients do over time. It will be important to learn if the brain changes are reversible after opioids are discontinued,” said Dr. Kolodny.

I’m from the government and here to help you !

adaletter govworker

You will have to click on image to enlarge and make readable.

This is a letter that a chronic painer received from the Federal ADA agency, after filing a complaint against Humana Mail Order Pharmacy for refusing to fill a C-II for a pt having Humana Medicare Advantage program.

The ADA agency – part of the Dept of Justice – after reviewing the complaint, could not even provide an OPINION as to the validity of the complaint. Of course, the ADA is under the same Cabinet position .. Dept of Justice (DOJ)… the same as the DEA. So is the ADA unwilling to pursue this denial of care issue is being caused by actions of the DEA and it is unheard of one Federal agency “going after” another Federal agency particularly under the same Cabinet position ?

It would appear that the ADA staffers are so lazy… they provide a list of organizations serving the complainant’s area… BUT.. CANNOT GUARANTEE that the listings are current and/or accurate.

Here is a list of actions taken by the ADA against various entities http://www.ada.gov/enforce_activities.htm

Looking at their actions, could it be that the ADA is discriminating against certain groups they are suppose to be representing ?

 

 

 

End global war on drugs, bring in decriminalization to protect human rights

End global war on drugs, bring in decriminalization to protect human rights, says report

https://www.rt.com/uk/337648-war-drugs-human-rights/

The global war on drugs has failed, eroding public health and human rights, and must be scrapped in favor of decriminalization, a report commissioned by a leading medical journal says.

Anti-narcotics efforts have had little impact on global patterns of supply and demand and cannot be defended on public health or scientific grounds, according to academics who worked on a hard-hitting study jointly commissioned by the Lancet and America’s Johns Hopkins Ivy League University.

The report uncovers compelling evidence that EU states such as the Czech Republic and Portugal have achieved positive results from decriminalizing non-violent, minor drug offenses. Portugal, in particular, decriminalized the personal use of drugs such as cannabis, cocaine, and heroin in 2001.

Benefits reportedly include improved public health, lower rates of imprisonment, money saving and “no significant increase in problematic drug use,” the report’s authors say.

After examining evidence from across the globe, the study concluded that drug laws often discriminate against ethnic and racial minorities and women and have undercut basic human rights. The report also highlights prison terms for those who commit minor drug offenses as the biggest contributor to increased infection rates of HIV and hepatitis C among drug users.

The study’s authors are calling on the US and the UK to consider introducing regulated markets for the sale of cannabis similar to those found in Uruguay and the US states of Washington, Colorado, Oregon and Alaska.

 Dr Chris Beyrer of Johns Hopkins’ Bloomberg School of Public Health says prohibition has been the foundation of national drug laws. Beyrer also argued counter-narcotics policies across Europe and America focus on ideas relating to drug use and dependence that have no scientific grounding.

“The global ‘war on drugs’ has harmed public health, human rights and development,” he said.

“It’s time for us to rethink our approach to global drug policies, and put scientific evidence and public health at the heart of drug policy discussions.”

The report marks yet another drive for changes to UK drug laws, a move which has been put forward by ex-Liberal Democrat leader Nick Clegg and British billionaire, businessman Richard Branson. Experts suggest that legalizing cannabis in Britain could rake in up to £1 billion in taxes.