For some reason some of the war of words on certain sections of the web jarred up some old memories.., This is a article that I clipped out of a pharmacy professional journal – years ago…

I could not even find this on my computer, I had to go back to paper files to find it..  That means that is at least 30 years old..

This was a bad decision back then and no less a bad decision today, but pharmacists appear to continue to make such bad decisions now.

Here is recent court ruling regarding a “bad decision” by a practitioner that ended up with a chronic pain pts that had been a paraplegic and wheel chair confined for 10 yrs .. committing SUICIDE and the pt’s estate was awarded SEVEN MILLION DOLLARS

https://www.statnews.com/2021/11/22/her-husband-died-by-suicide-she-sued-his-pain-doctors-a-rare-challenge-over-an-opioid-dose-reduction/

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When a self-centered doctor is diagnosed with cancer, he becomes better able to empathize with his patients and appreciate a life outside his career.

A “war of words” somewhere else on the web jarred my memory about this movie from abt 20 yrs ago. There is a old saying and favorite one of mine…. Knowledge is knowing the rules and clinical experience is knowing the exceptions to the rules.

These words are exceptionally appropriate when dealing the pts dealing with chronic health issues and especially those involving subjective disease.

“Books Smarts” can not always be relied upon when dealing with certain segments of pts… those dealing with subjective diseases and those living with a number of complex/complicated health issues.

“back in the day” , I was one of those healthcare practitioners what totally relied on my “book smarts” and then I grew up and clinically matured

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Steve, last year I noticed no pain relief after taking my hydrocodone 7.5  that I had been on since 2007. So I called my Pharmacist and she said tolerance build up. So I told my doctor and he increased to 10 mg. Still no relief. So, I started rummaging around in my drawers and found some that I had managed to squirrel away for emergencies, tornado, etc. At least a couple 10 years old, couple 9 years old and I took one, and had relief in 15 minutes!  Could walk without pain, my back is affecting my walking now. I am in such shock over this, are manufacturers doing deliberately or is someone stealing opiods that works for manufacturer? I asked a friend who I used to work with at assisted living in town if patients there complaining of no pain relief  She said yes they are! Same drugstore delivers most there. The company is LUPIN. 

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My dad was a chronically I’ll patient. He was 75 and underwent multiple back surgery’s and nerve decompression along w recently broken hip and spine. He fought like hell to live but his family doctor told him due to the FDA guidelines his pain meds had to be controlled by a pain doctor. After months of waiting to get into a pain doctor he was able to get his medicine but the following visit his doctor cut him down to a 1/4 of his dosage, he was not cut down slowly. My dad suffered, he went back to see doctor the following week and doctor was only interested in giving pain shots which don’t work for my dad due to scar tissue. Doctor refused to up my dad’s pain meds even tho he told them he was suffering.

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I spoke with this pt this AM and before going into the hospital one week ago – using those UNPREDICTABLE MME CONVERSION PRGMS this pt was on near 500 MME/day. before entering the hospital and was discharged with 40 MME/day.  Before entering the hospital the pt indicated that she was around a “5” on the pain scale – on average  & when in the hospital on some sort of IV opiate/PCA and claiming that her pain was at “the upper end of the sale”.

Remember she has a cancer in her spine that  “showed up a couple of months ago” and she has been on opiates for chronic pain for some 30 yrs

The pt told me that she had left a “voice mail message” at the internist’s office she was a pt of for some 17 yrs, but the pain doc at the hospital may have interfered with that relationship… since both of them are employed by the same hospital system.

She promised to keep me “in the loop” with how things were evolving… As of yesterday, she had enough of her previous medication that she will run out over the weekend.  I can’t imagine the pain and withdrawal issues with a patient dropping their opiate dose by 90% in a matter of days.

Torturing prisoners of war is illegal and we are in a 50 yr war on drugs/pts… but it is not a REAL WAR… it is only a SOCIAL WAR…  so apparently torturing pain pts is perfectly legal and it keeps a couple of hundred thousand people employed “fighting this war”

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The War on Drugs Is Actually a War on the Human Condition

https://thenewsstation.com/the-war-on-drugs-is-actually-a-war-on-the-human-condition/

Like many kids of my awkward generation, which lies in the forlorn space between the groovy nihilism of Gen X and the hustling blingism of the millennials, I was raised on Nancy Reagan’s “Just Say No” anti-drug program in the 1980s. I was taught that all drugs (except alcohol and nicotine) were pure evil brought straight out of hell by sociopathic monsters in human form who thought nothing of handing out free crack and LSD to preschoolers from the back of their windowless vans. Drug users were addicts one and all, and addicts were damned souls, lost and devoid of humanity, willing to commit any atrocity in pursuit of their next fix of marijuana or heroin. A single puff off a joint or a single bump of cocaine was a suicidal leap into this zombielike purgatory, and no one but the most foolish or insane would take such a unretractable leap into the abyss.

I came of age in the 1990s, though, that era of strung-out Seattle grunge singers and heroin-chic model-waifs, when Nancy’s stern exhortations became an ironic punchline. I was smoking and drinking and getting high by the time I was 13 years old; and for the next 30 years, I worked my way through most of the smorgasboard of street drugs available in North America. I hung out with psychedelic philosophers and their acolytes and read about Aldous Huxley and the doors of perception and Wade Davis in Haiti, hunting down the concoction used to turn people into literal, not metaphorical, zombies.

Along the way, I discovered why the so-called “War on Drugs” was utterly doomed to failure. It wasn’t just the staggering corruption and incompetence displayed at every level of the entire system that was built to fight this imaginary war, from the politicians and policymakers who use it as an excuse to perpetuate institutional racism on empoverished minority communities to the local cops who use it to arm themselves with military-grade weapons. 

No, the fatal flaw that lies at the heart of the War on Drugs is it’s not a war on drugs at all; it’s a war on the human condition.

“Every species of mammal,” the screenwriter Lawrence Kasdan once wrote, “has found some way to drug, inebriate or anaesthetise itself, even if it’s just banging its head against a rock.” I have no idea if this is actually true of every mammal, but it certainly applies to every human I’ve ever met.

Aside from the occasional pot brownie to help me sleep, I’m pretty much done with the liquor and drugs these days. This is not because I fought my way out of the Gehenna of addiction through sheer will and perseverance, because — aside from cigarettes — I’ve never been addicted to any of the drugs I’ve done.

In fact, as the late comedian Bill Hicks used to crow: I had a great time on drugs. I have been arrested precisely zero times; I have committed precisely zero crimes to fund my drug habit (aside from, y’know, buying them); I have never lost a job over drugs, never ended any relationships, never done anything particularly degrading for drugs, other than making awkward conversation about video games with my dealers as I waited for them to sell me drugs.

So why, if I wasn’t addicted to drugs, did I do them for so long? Simple: because they were fun, and because they helped me cope with crippling depression, stress and pain that I couldn’t manage without help. 

I’ve spent my entire adult life writing about hard subjects, like climate collapse and social injustice, and spending time in a lot of hard places, like the slums of Nairobi or the homeless camps of Las Vegas. A lifetime of this has left me haunted — and drugs were a way to push those ghosts aside when nothing else would. Psychedelics, in particular, have been fantastically useful for me, both as a way of examining myself and my own mind and of extending my philosophical proprioception, my understanding of my place as an indistinguishable part of the universe rather than something apart from and observing it. I loved doing drugs.

This is where I’m supposed to be apologetic and ashamed and repentant, right? But why on Earth would I be any of those things? There is absolutely nothing wrong with hedonism, and there’s also nothing wrong with finding external tools to deal with the flawed neurological architecture that evolution has left us with. 

Consciousness is both a gift and a curse — it gives us reason and the knowledge of the self, but for many of us, these powerful tools don’t have an off switch. We are left acutely aware of our own failings, of the inevitability of death, of the casual injustice that often seems to be the true currency of modern life and the utter pointlessness of most of the labor we engage in, just to pay our bills. A lot of us suffer from the moment we’re born into a society that despises the color of our skin or the way we’re wired to love and lust. Many of us are wounded in childhood by abuse or neglect or casual cruelty and spend the rest of our lives trying to heal.

These are the deep, dark, dissonant notes that play in the background of every moment of our waking lives, like the score to a horror film; how can you blame anyone for finding whatever tricks they can conjure to drown them out, if only for a few hours at a time?

Of course, we all know this, deep down. That’s why so many of us face the morning with a cup of coffee and a Prozac or an Adderall or two when we really need to focus and crunch at work, or Zoloft, or Ambien at bedtime, or Xanax as needed. We take these drugs with our heads held high, as though there’s some fundamental categorical difference between the pills our doctor gives us and the powders we get on the street.

But the effects are the same; the only difference between the Adderall you get from your shrink and the crank you buy from a biker in the toilet of a dive bar is the purity. The active chemicals are nearly identical, and the effects are identical. (Trust me; I speak from experience.)

So if it’s not the actual drugs we think are bad, then what is it? Why do we feel bad for the guy who hurts his back and gets an Oxycodone prescription, only to despise him when his scrip runs out and he switches to smoking heroin instead? Why do we approve of someone taking Adderall to make it through pre-med mid-terms, but sneer at someone doing a line of meth to make it through the swing shift at their second job loading boxes at the Amazon warehouse? Why do we smile in bemused tolerance at the gaggle of secretaries or shoe salesmen putting away half the bar between them on a Friday night, but still, in so many places, frown on the teacher who comes home after a long day doing a difficult job for shit pay and wants to take a few hits from the bong?

Because street drugs are more dangerous than prescription drugs, cut with dangerous additives, and easier to overdose on because you don’t know how strong they are? Is it because they tend to be manufactured and sold by murderous cartels? If so, these are very easy problems to solve: legalize drugs, all drugs, and subject them to the same stringent safety standards and regulations we established for alcohol after Prohibition and that cannabis farmers and sellers face in the states where weed is legal. Create honest drug awareness programs for both youth and adults, to help people understand the actual dangers of drug use and the real dangers of addiction, instead of banging them over the head with false and hysterical propaganda.

That’s if safety is your actual concern. But it’s hard to believe the War on (Some But Not All) Drugs is really about public safety, when pharmaceutical manufacturers fund the lobbies who fight legalization and the cops routinely claim to “smell marijuana” when pulling people over for the crime of driving while black while rich, white “cannapreneurs” end up on the covers of business magazines. 

What this idiotic half-century of tilting at windmills really comes down to is what most shitty things in America have always come down to: greed, power, racism, the lingering stench of hypocritical Puritanism and the nagging fear that someone, somewhere, is having more fun than you are.

Eventually, it seems likely the United States will come to its senses; after all, cannabis is legal in 18 states and decriminalized in 13 more, and all of them have conspicuously failed to collapse into reefer madness and perdition. Several cities and states, including Oregon, are cautiously beginning to decriminalize and even legalize psilocybin mushrooms, which have shown great promise for dealing with depression and addiction in clinical studies for decades. 

But nothing will really change until Americans recognize that drugs and drug use — recreational and otherwise — have always been a fundamental part of the human condition, and they’re simply one of the ways we have learned to compensate for the less pleasant side effects of being conscious beings in an indifferent world. Life is a short and hard and treacherous road to walk down, and we get only one shot at it; should we really begrudge anybody, anything, that makes it a little less painful and a little more fun?

Joshua Ellis

Joshua Ellis is a writer, musician, coder and futurist. He lives in North London with his fiancee and a very surly cat named Mr. Fukkles. You can read more about his writing here.

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Senators Grill Califf On Role in Opioid Crisis, Abortion Pill Restrictions

https://www.medpagetoday.com/publichealthpolicy/fdageneral/96199

Biden’s nominee for FDA commissioner also asked about his close pharma industry ties

President Biden’s nominee for FDA commissioner, Robert Califf, MD, fielded pointed questions about a variety of controversial topics during a hearing of the Senate Committee on Health, Education, Labor and Pensions on Tuesday.

Questions ranged from the agency’s approval of Oxycontin to risk mitigation protocols for mifepristone (Mifeprex), as well as his close ties to the pharmaceutical industry.

In his opening statement, Califf said that his top priority, should he be confirmed, is to focus on emergency preparedness and response — learning from what the pandemic has taught the country so far and applying those lessons.

Other priorities include ensuring the safety of the food and drug supply, curbing the opioid epidemic, developing a “systematic approach” to evidence generation, protecting children from tobacco products, and “attracting and retaining” the agency’s scientific workforce.

Califf is the head of clinical and policy strategy for Verily Life Sciences, and was a professor of cardiology at the Duke University School of Medicine. He was previously FDA commissioner from February 2016 to January 2017, confirmed by the Senate in a vote of 89-4.

The committee’s leaders on both sides of the aisle praised his experience and fitness for the role.

Sen. Patty Murray (D-Wash.) noted that families trust the FDA to ensure the foods they eat are safe and that the prescriptions they receive help rather than harm them. The agency needs a strong hand to address public health emergencies like the COVID-19 pandemic and the opioid crisis, she said.

“Families also deserve to know they have an experienced leader at the FDA who understands the many challenges our nation is facing and the importance of ensuring science comes first,” Murray added.

When he last led the agency in 2016-2017, Califf was confirmed with strong bipartisan support, she noted.

Ranking Member Richard Burr (R-N.C.) hailed Califf as a “wonderful father, grandfather, great doctor and great man … I’m not sure you could write a resume of somebody more qualified to be considered for commissioner of the FDA than Rob Califf.”

While underscoring the “historic progress” the agency has made over the last 2 years, swiftly and safely authorizing three COVID vaccines and more than 420 COVID tests, Burr also stressed that “the next commissioner cannot take their foot off the gas.”

FDA’s Role in the Opioid Crisis

In response to questions from Murray, Califf outlined the steps he plans to take to help address the opioid epidemic, such as expanding efforts around prescriber education, “crack[ing] down” on people who use opioids inappropriately or those who prescribe them inappropriately, and strengthening efforts to develop alternative medications and behavioral health therapies for pain.

But Sen. Maggie Hassan (D-N.H.) was more interested in what she viewed as a “troubling” lack of any acknowledgement by FDA officials about their own role in exacerbating the opioid epidemic through “mistakes” in regulating Oxycontin.

Given that many people with substance use disorders first became addicted to opioids through legal prescriptions for Oxycontin, Hassan asked whether the FDA’s initial approval of the drug and its 2001 decision to expand its indication to include the treatment of chronic pain were mistakes.

Califf said that, in hindsight, approving a drug without any long-term studies or assessment of its addictive potential “is something that could have been done differently.” With regard to expanding the drug’s indication to include long-term use for chronic pain, Califf again said that long-term studies should have been required before permitting use of the drug for long periods.

“Why didn’t you take action to change the Oxycontin label when you led the FDA in 2016?” Hassan asked.

He did take certain measures, Califf said, including supporting the long-term studies that were needed to collect evidence about long-term use, and contracting with the National Academy of Medicine to overhaul the protocol for opioid evaluation.

Usually, the risk-benefit calculus focuses solely on the individual to whom a drug is prescribed, but opioids impact “many other people in society,” Califf noted, arguing that the change to the evaluation process was “successfully done.”

However, Hassan pointed out that Califf, in his opening remarks, mentioned a family member who had been given a 30-day prescription for opioids after a minor surgery and asked if there’s a reason the FDA should not be “aggressively … pursuing relabeling.”

As more evidence is collected, “we are going to need to aggressively look at relabeling,” Califf replied.

Hassan, citing the hundreds of thousands of deaths from overdoses, strongly disagreed: “There is plenty of evidence about what we need to do about this epidemic and the FDA needs to take the lead.”

Later in the hearing, Califf acknowledged that he had “certainly made a number of mistakes,” adding that coordination among agencies is “more human and complicated than you would think on the outside.”

Mifepristone Restrictions

The risk evaluation and mitigation strategy (REMS) for the abortion drug mifepristone was another flashpoint at the hearing, with Republican senators arguing that the REMS protocol should not be relaxed.

Sen. Mike Braun (R-Ind.) said the FDA “weakened” the REMS for mifepristone under Califf’s watch in 2016 and asked whether that “relaxed kind of interpretation” of the procedure was something he planned to pursue.

In April, the FDA unveiled a policy of “enforcement discretion” around the in-person dispensing of mifepristone, which enabled patients to receive the medication by mail. In May, the FDA announced a review of the restrictions around the drug.

Califf, who cited a court document regarding a review of the data on mifepristone, said a re-evaluation of the REMS for the drug is “imminent.”

While he will not be involved in the process, Califf said he knows the team responsible for the review and is confident that those individuals “will be looking at the latest data and applying the best science and make the best possible decision.”

Braun ended his questioning by asking permission to submit testimony, for the record, from an individual who “experienced complications resulting from a chemical abortion drug.”

Murray accepted the submission and also included her own submission to the record of a recent study on the safety of mifepristone from the New England Journal of Medicine.

Ties to Big Pharma

Sen. Bernie Sanders (I-Vt.) raised concerns over the revolving door between the FDA and pharmaceutical industry. He flagged one person in particular, Curtis Wright, who served as a “high-ranking official.” After leaving the agency in the mid-1990s, he received a $400,000 compensation package from Purdue Pharma “less than a year after [the FDA] approved Oxycontin with a label that said it was, quote, very rare, end quote, for patients to become addicted to that opioid.”

Since leaving the FDA, Califf has made “several hundred thousand dollars” from pharmaceutical companies, Sanders noted, and according to his own financial disclosure statements, currently owns “up to $8 million in stock of major pharmaceutical companies.”

Given these close industry ties, Sanders asked what reassurance Califf could offer Americans that he will be “an independent and strong voice” for the agency?

“I am a physician first and foremost,” Califf said, citing his work in intensive care units in the early part of his career.

But Sanders persisted, calling out Califf’s work as a consultant in the pharmaceutical industry. “How can the American people feel comfortable you’re going to stand up to this powerful special interest?” he asked.

Califf urged Sanders to look at his track record, adding that the Biden administration’s ethics pledge is “the most stringent ethics pledge in the history of administrations.”

Shifting gears, Sanders asked Califf whether he believed Medicare should be allowed to negotiate prescription drug prices.

“I’m on record of being in favor of Medicare negotiating with the industry on prices,” Califf responded.

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Bob Sheerin (APDF VP) Up to bat – FOUR TIMES – NO STRIKES – just SOLID HITS

Vanderbilt Hospital Nashville , TN

Pt: Lilly Demond 14 y/o  Stage 3 Leukemia

Dad:  Mechanic

Mom: Waitress

 Lilly: 9th grade and does well in school 9 months at Vandy

Allergies: Pencillin, Morphine, nuts, cancer free only 10 months in her whole life.

Lilly: youngest of 4 siblings : rides bike, yoga, PT injections

5 doctors in 16 months, Pharmacies have given parents hell. 

Lilly has experience extreme pain in abdomen, back pain, kidney stones, mouth sores, and chemo rash

Lilly has begged for  pain management, mom has been  administrating different medications several times. Lilly was previously  prescribed Hydrocodone with motrin, Robaxin,  face cream and has used antibiotics for rashes. Z pak is given every 3 months  and she will discontinue Ultram 50 mg to start new regiment of opioids. Dr admits to having tried “everything” previously. Lilly’s parents has agreed to UAs and random pill counts and Lilly will take 2 weeks off of chemo until pain gets better managed.  Dr informed everyone on the potential dangers of opioids and addiction . Parents signed wavers and Lilly will continue high school as normal, will start regiment at observation center ASAP and prescriptions will be brought to parents after observation is completed. New appointment set up for Feb 2021 Robert Sheerin American Pain and Disability Foundation VPO

APDF is a non-profit all volunteer organization in its third year and goal is to help help pts with chronic health issues to improve their QOL ( Quality of life).

Volunteers and donations are welcomed and needed.

We realized that many pts are often struggling financially but Amazon provides a Experience feel-good shopping Shop at smile.amazon.com and we’ll donate to your favorite charitable organization, at no cost to you.. Get started same products, same prices, same service. Amazon donates 0.5% of the price of eligible purchases.

login to https://smile.amazon.com/  and designate American Pain and Disability Foundation as the non-profit you chose as your non-profit that you wish Amazon to deposit your charitable donations to. Encourage your family and friends to do the same.

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The DEA Is Making It Impossible for Many to Get Addiction Meds

https://www.vice.com/en/article/xgdynj/dea-restricting-access-to-opioid-agonists-suboxone

As the overdose crisis rages, access to methadone and buprenorphine remains hindered by bureaucracy and stigma.

Jennifer Hornak’s son died after he could not find a halfway house that would accept people taking buprenorphine. Photo submitted

Martin Njoku never imagined his decision to dispense buprenorphine—a medication used to treat opioid addiction—would be the death knell to his career as a pharmacist. 

But that’s exactly what he said happened after the Drug Enforcement Administration issued him an immediate suspension order in August 2019, after showing up for a surprise inspection the year before.

The order, issued on the grounds of an “imminent danger to public health or safety,” meant that Njoku could no longer fill prescriptions for controlled substances. Despite having two judges rule in his favor, with one saying the DEA “has not pointed to a single instance of violation of the law,” Njoku said he had to shut down both of his West Virginia pharmacies because he lost lucrative contracts from insurance companies.

“It cost me my business and ruined my whole entire life,” Njoku, 63, told VICE News. “For 40 years I have worked hard. Now I have nothing, thanks to the DEA.” 

Njoku, whose situation was highlighted in a recent story by Kaiser Health News, said he began filling buprenorphine prescriptions after customers from neighboring counties—displaced by flooding—called to say they couldn’t get it elsewhere. 

Martin Njoku said he was trying to help people with opioid use disorder when the DEA raided him. Photo submitted

To him, it was no different than dispensing medicine for heart disease or diabetes. But he said the message the DEA is sending by raiding pharmacies like his is “clear.” 

“They don’t want you to take care of people with an opioid addiction,” he said. “In my opinion, they want to see these guys on the street dead with fentanyl.” 

A DEA spokesperson did not comment on the order against Njoku but said the agency is committed to helping “those who are harmed by drug trafficking.” 

“In this spirit, DEA is committed to doing all it can to expand access to medically-assisted treatment to help those suffering from substance use disorder,” they said. 

Trey Strange, Gabrielle Caplan

04.03.20

Njoku’s situation illustrates just one of many ways access to buprenorphine and methadone—known as opioid agonist treatment—is limited, in spite of the fact that both drugs reduce illicit opioid use, the risk of overdose, and disease transmission. According to Pew, 1.6 million Americans had opioid use disorder in 2019 but only 18 percent of them were able to access buprenorphine, methadone, or naltrexone. One study from the National Institutes of Health looked at 17,568 people in Massachusetts who received either methadone or buprenorphine after a non-fatal overdose and found the medications reduced deaths by 59 percent and 38 percent respectively. 

Though some of the regulations around opioid agonist treatment have loosened as a result of the pandemic, doctors, academics, and patients who spoke to VICE News painted a picture of a heavily stigmatized and overly bureaucratic system that is nowhere near serving demand. 

In the context of an overdose crisis that killed 100,000 people in the first year of the pandemic—a historical high—experts say it’s unacceptable that access to these drugs is so limited. 

“It’s criminal, during a time of crisis to have life-saving medication and to have those medication options be so tightly restricted,” said Leo Beletsky, a professor of law and health sciences at Northeastern University.  “These restrictions are killing people, and the agency in charge of regulating access is not a health care agency; it’s a law enforcement agency.” 

The DEA did not respond to a list of questions from VICE News about its approach to regulating opioid agonist treatment.  

The DEA is in charge of regulating both methadone and buprenorphine, ostensibly to prevent them from being diverted into the black market or misused. (Because buprenorphine is a partial opioid agonist, it causes less euphoria than other opioids, making it less susceptible to misuse; it also has a lower overdose risk than methadone, which is more likely to cause overdoses when someone is starting treatment or when mixed with other drugs.)

Doctors who want to prescribe buprenorphine need to apply for a special waiver from the DEA, while methadone clinics need to be registered with the law enforcement agency. 

One of the main issues surrounding buprenorphine, most commonly sold under the brand names Suboxone or Subutex, is that many doctors and pharmacists are worried about being subject to intense DEA scrutiny or raids. According to the Substance Abuse and Mental Health Services Administration, only around 7 percent of practitioners have obtained the waiver required to treat the maximum patient load of 275 people. Finding a clinician or a pharmacy that has it is even more difficult in rural areas. 

“We’re all basically monitored by the DEA in order to be able to prescribe a controlled medication,” said Dr. Payel Roy, assistant professor of medicine and clinical director of the Addiction Medicine Consult Service at the University of Pittsburgh.

People prescribing buprenorphine also have to complete a course if they want to treat more than 30 patients. 

“It makes it seem like you need specialty training in order to prescribe buprenorphine, even though it’s a safer medication than other opioids that we all are prescribing,” Roy said. 

Roy said medication-assisted treatment for opioid use disorder is heavily stigmatized—particularly for those on methadone.

Patients who manage their opioid withdrawal with either methadone or buprenorphine often can’t find a rehab that will accept them, she said. Some clinics fear they might sell them to other rehab clients, while others believe abstinence is the only form of real recovery. It can also be disruptive—they don’t want clients to come and go if they have to pick up their medication daily (which is often the case with methadone). 

It’s a scenario that turned into a tragedy for Jennifer Hornak’s family. 

As he was finishing up his second stint in rehab for fentanyl addiction in June 2020, Hornak’s son, Quincie Berry, began looking for a halfway house in Daytona, Florida. But the 31-year-old couldn’t find one that would accept him while he was taking buprenorphine. 

So his rehab weaned him off of it, but he relapsed—particularly dangerous because of fentanyl’s potency and the fact that his opioid tolerance may have been significantly lower at the time. 

“Quincie was dead 27 days later,” Hornak told VICE News. He had fentanyl, cocaine, meth, and the animal tranquilizer xylazine in his system. 

Hornak believes if her son had found a halfway house that supported buprenorphine as a treatment for his opioid use disorder, he would still be alive. “These recovery residences didn’t want to deal with people that were on buprenorphine.” 

Quincie Berry died after weaning off buprenorphine. Photo submitted

Berry’s mother Jennifer Hornak says medication-assisted treatment is stigmatized. Photo submitted

She said medication-assisted treatment for addiction is heavily stigmatized, in part because of the DEA’s heavy-handed approach to regulation.

“They don’t understand that this medication is not just a medication for detox. It’s a medication for the rest of your life if you need it,” she said. 

Over the last year, the DEA and the federal government loosened up some of the rules around methadone and buprenorphine, allowing for the expansion of mobile methadone van clinics and take-home doses of a month’s supply of methadone, for instance. There’s a more streamlined process for DEA-registered health practitioners looking to prescribe buprenorphine, and patients who can see their doctors via telemedicine to get a prescription. 

In November, Pittsburgh became the third city in the U.S. to allow paramedics to administer buprenorphine to people experiencing withdrawal from opioids outside of a hospital setting. 

But harm-reduction advocates say these changes aren’t happening fast enough to keep up with the pace of overdose deaths. 

For David Frank, the goal of starting methadone was never abstinence. A medical sociologist at New York University, Frank started using methadone nearly 20 years ago when his opioid addiction made his life “impossible.” 

“You run out of money; you’re having to commit crimes every day,” Frank told VICE News. “You’re always trying to stay one step ahead of being dope sick.”

After he began using methadone regularly, he said his life began to stabilize. 

“I went to school because I was not happy with the way methadone  was talked about by researchers, by academics.” 

Zachary Siegel

11.15.18

Methadone for opioid use disorder must be obtained in standalone clinics—it can’t be prescribed by a doctor and dispensed through a pharmacy. Clients generally have to show up daily to get doses. The clinics began to expand in a significant way in the 1970s, but were—and still are—stigmatized and seen as undesirable in many communities.

Frank considers himself lucky because his clinic allows him to take home a 28-day supply at once. Even when he lived in Chicago, he said his clinic was on the street he lived on. “There’s no way I would have been able to get a PhD or do any of the things I’ve done,” he said, if he had had to frequent a methadone clinic.

“They make it almost more difficult to be at a methadone clinic than it is to get your opioids from the street.” 

With fentanyl and other synthetic drugs increasingly replacing heroin, the street supply of drugs has never been more volatile. 

“The DEA plays this dual role, which is enforcement on the illicit supply side and then regulating the pharmaceutical access and treatment access. And they really have completely bungled both of those realms of regulation,” said Beletsky. 

“The supply continues to proliferate and there’s increasingly more toxic illicit supply. While their efforts on the regulation of legal supply have been abysmal and have done far more harm than good because they’ve pushed a lot of people from the legal channels into illegal channels.” 

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https://www.waaytv.com/news/trial-for-florence-woman-accused-of-refilling-prescription-while-pregnant-to-start-monday/article_eaa5915c-5c1e-11ec-a82a-93cbaf078081.html

The trial of a Florence mother accused of refilling a prescription while pregnant is scheduled to start Monday.

Kim Blalock, 36, is charged with unlawful possession of a controlled substance after refilling a prescription about six weeks before giving birth.

That child then tested positive for opiates. She failed to tell her doctor she was pregnant while getting the refill. Her lawyers argue the doctor never asked.

The Lauderdale County District Attorney says he’s charging Blalock to address a bigger, more chronic drug problem in the area.

Jury selection begins at the Lauderdale County Courthouse at 8:30 a.m. Monday.

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