“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
UPDATE: URGENTLY LOOKING FOR FORMER WALMART PHARMACISTS & PHARM TECHS
The Lawyers involved in the Opioid Litigation who have been urgently looking to get background and perspective assistance from former Walmart Pharmacists & Pharm Techs. The questions relate to how Walmart institutionally dealt with questionable prescriptions or prescribers. It is imperative that they get the facts correct and need help.
FURTHER Fallout from Walmart Investigation
The United States Attorney for the Eastern District of Texas, Joseph D. Brown, abruptly resigned on Tuesday, May 26, 2020.
Mr. Brown lead the Eastern District’s criminal investigation into Walmart. The investigation almost resulted in criminal charges against the company and its director of Health and Wellness Practice Compliance, Brad Nelson, before top brass at the Department of Justice terminated the investigation for political reasons.
Mr. Brown did not say why he resigned, but the DOJ’s decision to close the criminal investigation into Walmart may have played a role. In the press release announcing his resignation, Mr. Brown said:
We must win the fight against opioid abuse in order to save our country. But in order to be effective, we must be willing to prosecute all facets of the expansive network that feeds these destructive drugs into our communities. Players both big and small must meet equal justice under the law.(Emphasis added)
Mr. Brown’s resignation comes less than one year after the head of Eastern District’s civil division, Joshua M. Russ, resigned in October 2019 because the DOJ refused to take civil action against Walmart.
Please contact either attorney Chuck Gabriel (Chalmers & Adams, LLC), 678.735.5907 or email at CDGabriel@CPBLawGroup.com or attorney Kyle Oxford (BurnsCharest LLP), 504.799.2846 or email at koxford@burnscharest.com.
I have spoke with an attorney from this firm behind this several times and I asked him about confidentially of those who contact them and this is his reply:
“I cannot absolutely guarantee confidentiality, so I won’t promise it… in very rare, but some, circumstances, Attorney Work Product such as investigative interviews can be ordered disclosed – I won’t promise something I cannot deliver with certainty.
That said, the assurance that we are looking for background and perspective assistance rather than witnesses and testimony ought to provide some assurance. “
New details emerge in a lawsuit asserting that chains including CVS, Rite Aid and Walgreens sold millions of pills in small towns but rarely flagged suspicious orders to authorities.
Through years of lawsuits and rising public anger over the opioid epidemic, the big American pharmacy retailers have largely eluded scrutiny. But a new court filing Wednesday morning asserts that pharmacies including CVS, Rite Aid, Walgreens and Giant Eagle as well as those operated by Walmart were as complicit in perpetuating the crisis as the manufacturers and distributors of the addictive drugs.
The retailers sold millions of pills in tiny communities, offered bonuses for high-volume pharmacists and even worked directly with drug manufacturers to promote opioids as safe and effective, according to the complaint filed in federal court in Cleveland by two Ohio counties.
Specifically, the complaint lays out evidence that:
CVS worked with Purdue Pharma, the maker of OxyContin, to offer promotional seminars on pain management to its pharmacists so they could reassure patients and doctors about the safety of the drug.
In partnership with Endo Pharmaceuticals, CVS sent letters to patients encouraging them to maintain prescriptions of Opana, a potent opioid so prone to abuse that in 2017 the Food and Drug Administration ordered its extended-release formulation removed from the market.
From 2006 through 2014, the Rite Aid in Painesville, Ohio, a town with a population of 19,524, sold over 4.2 million doses of oxycodone and hydrocodone. The national retailer offered bonuses to stores with the highest productivity.
Walgreens’ contract with the drug distributor AmerisourceBergen specified that Walgreens be allowed to police its own orders, without oversight from the distributor. Similar conditions were struck by CVS with its distributor, Cardinal Health.
Most of the companies did not respond to a request for comment. CVS emailed a statement that said, “Opioids are made and marketed by drug manufacturers, not pharmacists. Pharmacists dispense opioid prescriptions written by a licensed physician for a legitimate medical need.”
The other companies have made similar arguments in the past.
Federal law requires manufacturers, drug retailers and suppliers to report suspiciously high orders to the federal Drug Enforcement Administration. But despite being repeatedly fined by the D.E.A. for failing to do so, the chains continued to sell outsize quantities of opioids, the complaint contends, only rarely sounding alarms, a charge also made against the drug distributors in numerous other lawsuits.
Walmart devised a workaround to that reporting requirement, the complaint says. In mid-2012, it fixed a hard limit on opioid quantities it would distribute to its stores, foreclosing the need for its pharmacists to report excessive orders. Yet Walmart simply allowed its stores to make up the difference by buying the remainder of their large opioid orders from other distributors.
Until now, the focus of thousands of lawsuits across the country related to the opioid health crisis has largely been on drug manufacturers and distributors. A handful of those cases have settled. Representative cases, called bellwethers, selected by Judge Dan A. Polster in Cleveland from thousands of similar federal lawsuits to test both sides’ arguments, are moving through early stages in Chicago and West Virginia.
Cases brought by New York State and two New York counties are awaiting a joint trial date; originally set to begin March 20, their trial was postponed because of the pandemic lockdown.
But relatively few cases against the retail pharmacy chains have advanced. Like most of the lawsuits in the sprawling national litigation, those cases are on hold, pending the outcome of the bellwethers. Judge Polster recently gave bellwether status to retail pharmacy cases brought by San Francisco and the Cherokee Nation. Those lawsuits will now proceed in the plaintiffs’ local federal courts.
The first case to advance against retailers, brought by Cuyahoga and Summit Counties in Ohio, is scheduled for November 2020. But those counties are only suing the chains in their capacity as distributors of opioids to their own drugstores.
In contrast, the complaint filed on Wednesday was a major salvo in a more far-reaching trial, scheduled for next May. Lake and Trumbull Counties in Ohio are suing the chains on two fronts: as distributors to their own pharmacies, and as dispensers, whom the counties say intentionally fed customers’ appetite for opioids.
The 209-page complaint was filed under seal earlier this month. Barring objections by the defendants, Judge Polster allowed the complaint to be filed publicly, which the lawyers did on Wednesday. As the lawyers note, its claims are based on documents and interviews already completed for the federal opioid litigation. But lawyers anticipate obtaining considerably more information through the discovery process.
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According to federal data presented in the complaint, from 2006 through 2014, the retail pharmacy chains ran 31 pharmacies in Lake County, which has a population of 220,000, and sold nearly 64 million doses of oxycodone and hydrocodone — or 290 pills for every man, woman and child.
During that same period, the numbers in Trumbull County were even more extreme. A combined 28 pharmacies sold nearly 68 million doses to a population of 209,837, or more than 322 pills for every man, woman and child.
A major thrust of the complaint is that the chains dragged their feet in setting up monitoring protocols at regional distribution centers, enforced those programs anemically at best, kept raising thresholds for quantities of pills that might otherwise trigger a flagged report, rewarded pharmacists for churning volume rapidly and, in some instances, pointedly ordered them never to refuse a doctor’s prescription.
The complaint also says that supervisors ignored store pharmacists who warned about pill mill doctors, including those who were ultimately convicted.
CVS, for example, did not have a companywide policy for reporting suspicious orders until 2010, posting it the day after a D.E.A. audit raised concerns, the complaint says. But CVS didn’t report any orders as suspicious until February, 2012, when the epidemic was already in sharp ascent. Through November 2013, CVS reported only seven such orders from across the entire country. None were from Ohio.
Three Walmart pharmacies in Lake County sold 6.4 million opioid pills from 2006 through 2014. But Walmart, the complaint says, did not file any suspicious order reports from those stores between 2007 and 2014, the period for which the plaintiffs have such data.
The complaint also details the chains’ full-throated participation in trade groups that lobbied Congress to pass the 2016 Marino bill, which curtailed the D.E.A.’s ability to immediately suspend the registration of a manufacturer, distributor or pharmacy. CVS, along with Cardinal Health, a distributor, and Teva, a manufacturer of generic opioids, worked through a lobbying group called the Alliance to Prevent the Abuse of Medicines, which often cloaked individual corporate identity.
CVS repeatedly joined with manufacturers to train its pharmacists about their drugs. In the complaint, the lawyers write, “CVS was so eager to ally itself with Purdue that it solicited Purdue for its participation in co-hosting Continuing Education programs for health care providers and pharmacists regarding training on diversion of prescription opioids.”
In an undated letter outlining such a venture, CVS directors wrote that to address the challenges of a community pharmacy practice, programs should include topics “often associated with Purdue’s products.”
They offered as an example:
“How to communicate effectively with patients and physicians about appropriate pain management therapy, and how to resolve potential conflict with a drug ‘seeker.’”
It is so bad that they are painting everyone having a opiate/controlled substance Rx filled with the same BROAD BRUSH. Isn’t that like saying that anyone purchasing a single beer is a alcoholic ? Of course, alcohol drinks have a solid “sin tax” revenue stream going to state & FEDS… so no one would want to interfere with a person’s right to purchase a alcoholic drink ?
Our Founding Fathers granted everyone the right to the pursuit of happiness. They just didn’t define what “happiness” is… but the politicians that followed them seem to use their own personal “moral compass” to determine what is and is not happiness that we can pursue.
there are some parallels between the current COVID-19 pandemic and the issue of chronic pain community and the substance abuse community.
Today the CDC came out with the lethality of the COVID-19 virus is abt 0.3%. Which is a similar percent (0.6%) of the number of chronic pain pts that are at risk of becoming addicted to opiates.
The bureaucracy has acted/reacted in the same/similar manner.. they have chosen which businesses could stay open and generate the same – or greater – revenues and profits and other deemed NON-ESSENTIAL and were forced to close about 10 weeks ago and now are permitted to function at abt 25% capacity… which few companies can pay the overhead expense at that income.
Just like the bureaucrats – mostly DEA and state Medical Licensing board are making decisions of what prescribers have to be SHUT DOWN… and discourage/chastise pharmacies from filling controlled substances .. again choosing winner and losers.
Some states are bending over backwards to make sure those who are substance abusers/addicts get their drug of choice or some drug that will keep them from going into withdrawal.
Chronic painers question why this subset of the population is being treated like winners while those in chronic pain and other subjective diseases are being treated as losers.
It is a common belief that substance abusers commit crimes to get money to fund paying for their next high/fix, many are living in shelters, under overpasses and tents on sidewalks. THEY ARE VISIBLE to the general population and the media.
You take the typical chronic painer that has had their meds cut/discontinued and they become home/bed/chair confined… they are INVISIBLE to the general population and the media.
It is claimed that there is 100 million chronic painers, but the adjacent picture is from Oregon State Capitol in Salem on May 22, 2019 of a group protecting how pain pts are being mistreated. If you were a bureaucrat and were told that there is 100 million chronic pain pts
There is abt 4 million people in Oregon and Salem Oregon has a population of abt 400,000. using averages… there is abt 120,000 chronic painers in Salem and 1.2 million in Oregon.. So if you were a bureaucrat… and saw a demonstration by chronic pain pts at the state capital and maybe a couple of dozen people showed up… would you be concerned about any group of people … when the number claimed to be impacted and the number that showed up in a protest/rally was dramatically different ?
We need to look at what some of the bureaucrats have done to small businesses – deemed to be non-essential – that have tried to reopen before the state claimed it was safe to do so…
One gym, that opened early, had the locks on their gym’s doors changed overnight by the bureaucrats
The female governor of one state, where she had dictated that barber/beauty shops had to be kept closed… admitted on a interview that she was able to get a haircut …because she was “in the public view “
In Michigan, the Governor there dictated that no state resident was to go from their normal in state residence to their “summer house/condo”, but over the weekend a man showed up at a resort lake and asked that his boat be put into the water and when he was denied… he asked that ” .. if his wife was governor … would it make a difference”… the lake was abt 175 miles from their full time residence. https://www.foxnews.com/politics/michigan-gov-whitmer-claims-husbands-reported-boat-request-was-a-failed-attempt-at-humor
One thing that seems to be common on all of these interactions between citizens and the bureaucrats is that law firms are busy filing injunctions with the courts. Some courts seem to favor the citizens and others seem to favor the bureaucracy.
I wonder if someone compared some of the depts within Walmart, Target, Meijers and other big box stores and some of the locally owned small business selling some/most of the same merchandise that have been deemed non-essential… could we get a better picture of how much the various bureaucracies have been allowed to pick winners and losers among retail businesses ?
Does the community need to review and rethink what has been done in the past and what has been accomplished and if a different path needs to be considered ?
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For those of you who are unfamiliar with BAY COUNTY in FL.. it contains the infamous PANAMA CITY BEACH… historically has been referred to as the “Red Neck Rivera “. We have owned a condo at the beach since 1994, so we are pretty familiar with the area.
Most of the “problem people” live over in Panama City, FL … except during the spring break period a few years back, but after Fox news did a few nightly reports from the beach during spring break… things have changed as the bureaucrats have changed the course of spring break that has discouraged college kids from coming down.
Now, during the month of March … no alcohol is allowed on the beach by NO ONE. Curfews have been put in place. Some of the grade-thru high schools in the adjacent states have went to having classes around the year … so there are several two week breaks several times a year. So peak crowds are no longer spring break and June & July… the local bureaucrats are doing many things to make the beach more “family friend “
I find it rather funny that the cops reported the amount of fentanyl seized in milligrams ..as in 235,000 mgs. If one converts that number into something that those in our population functions on.. like the pound system… it breaks down as such:
1000 mgs – one Gram… so 235,000 mgs is 235 Gms… 454 Gm = ONE POUND… so that massive 235,000 milligrams is equal to abt EIGHT OUNCES – about the weight of two McDonald 1/4 pound meat patties ( BEFORE COOKING).
More mis-statement of facts is that they claim that Fentanyl is 100 more potent than Morphine is probably true of the legal pharma grade Fentanyl Citrate, but what they seized was probably Fentanyl Acetate which is more likely about 25 times more potent than Morpine and they used graphics of legal pharma grade Fentanyl patches for a comparison. Which has little to do with the plastic baggies of the real fentanyl that they showed what they really seized.
I don’t know and can’t find out what the density of Fentanyl power is, but suspect that the amount seized in this raid would fit in a pocket or purse.
Here is a interesting fact – which I have asked the pharmas before and they refused to answer – the box of the pharma grade Fentanyl patches states on it that each patch contains 2.66 mg of Fentanyl and since the patch is designed to “release” 25 mcg/hr X 72 hrs for a total of 1.8 mg.. so only about 2/3 of the Fentanyl in the patch is actually designed to be released… leaving ab 0.86 mgs in a “spent patch”.
“It’s all like a roller coaster,” Ford said. “When we take off a major source of supply, which I would consider this a major source of supply, we see the trends die down for a period until somebody out there finds another source of supply somewhere, or a source of supply is able to reestablish in the area.”
At 100 times stronger than morphine, the lethal dose of fentanyl is a little as three milligrams.
“The addiction is so strong that the risk [of death] is worth it,” said Lieutenant Kevin Francis about addicts.
Officials said that with the introduction of fentanyl, they have seen an increase in drug seizures in size and amount, as well as an increase in overdoses. They added that they are mostly seeing it lacing other street drugs.
“Right now, the trend is to mix heroin and fentanyl to make it stronger,” Francis said.
This means people could be taking lethal doses of fentanyl unknowingly.
“In a situation where somebody bought what they thought was Xanax on the street could actually be a deadly dose of fentanyl,” Ford said.
Ford also said that they are also concerned with poorly mixed drugs. Because of the small lethal amount required of fentanyl, poorly mixed drugs could create hot spots of fentanyl within the main drug.
“The person may be thinking they’re getting a small normal dose of heroin,” Ford said, “but they could actually be pulling from the portion of the substance that has a lethal dose of fentanyl in it and that’s where we’re seeing our drug overdoses and deaths.”
By the end of 2016, Ford said the overdoses became so frequent that the BCSO deployed NARCAN to its deputies. NARCAN is a nasal spray that quickly reverses an opioid overdose and is harmless otherwi
se. It does not work on non-opiates like cocaine overdoses or alcohol poisoning and can sometimes be considered the first sign that an overdose was caused by fentanyl.
Ford said that they also administered special gloves to deputies because any absorption of fentanyl into the skin by touching could lead to an officer overdose.
graphic credit: Miabelle Salzano
The opioid epidemic in Bay County dates back to the late 1990s when OxyContin burst on the scene. Officials say that most of the drugs in Bay County come in from the southern border or are shipped in from China and travel through large cities like Atlanta. But since the coronavirus, most of the drug traffic has stopped.
Francis said that they have seen a shortage of most drugs since the pandemic. He added that drug runners usually try to mix themselves in with the general car traffic on the roads. But there has been a lack of travel since the shutdown.
“People are too paranoid to move anything,” he said.
Francis also said that prescription drugs like pills are easier to access and abuse than illegal drugs like meth. While fentanyl is illegal, it can be administered through a prescription and purchased at most pharmacies as gel patches to treat severe pain in cancer patients. Francis said that it’s possible to manufacture street fentanyl from these patches.
“It just seem like every wave that we see get a little bit worse,” Ford said.
An Abbott Laboratories Covid-19 test has potential accuracy issues, the U.S. Food and Drug Administration warned, citing a number of studies that have raised doubts about the product’s precision when used to quickly diagnose patients.
The FDA issued a public alert Thursday evening, saying that it had become aware of several scientific studies that raised questions about the device, a printer-sized machine called ID Now that can take a sample from a nasal swab and diagnose a coronavirus infection in less than 15 minutes. The agency said that it was particularly concerned about false-negative results, in which an infected person is told by the test that they don’t have the disease.
“We are still evaluating the information about inaccurate results and are in direct communications with Abbott about this important issue,” Tim Stenzel, director of the FDA’s Office of In Vitro Diagnostics and Radiological Health, said in a statement.
Abbott shares fell 2.3% to $89.65 at 12:09 p.m. in New York. The stock is up 3.3% this year to date, in part because the company quickly introduced diagnostic products to help combat the coronavirus pandemic that has killed more than 85,000 people in the U.S.
There have been 15 reports of adverse events tied to the tests, said Health and Human Services Secretary Alex Azar, out of more than 1.8 million that have been run. The agency and the company are studying those cases, which could have stemmed from something as simple as a user error, he said.
“We gotta get to where the evidence is, we gotta get to the bottom of it, but we still have confidence in the test or we wouldn’t have it on the market,” Azar said during an interview on Fox Business Friday.
The company said it’s working with the FDA and health care providers to make sure they understand that negative results should be considered just one part of a person’s health history, along with recent exposure to the virus and signs and symptoms of Covid-19. It is also re-emphasizing the proper way to collect and handle samples, as some tests are being run in ways the device wasn’t intended to be used, the Abbott Park, Illinois-based company said in a statement.
Accurate test results are important for understanding and controlling the outbreak, particularly since they are used to help guide personal behavior. Someone who is erroneously told they aren’t infected may have a false sense of security and could infect others if they don’t take precautions. False-negative results can also impede efforts to identify patients and trace their contacts, a key part of expanding efforts by states to track and contain the virus as they reopen businesses and lift social distancing rules.
The FDA said that the Abbott test, which has been used at the White House, can still be used to diagnose positive results, often within minutes. But it warned that a negative result might need to be confirmed with a high sensitivity test to be certain the person doesn’t have the virus.
The FDA’s alert comes as research is raising more questions about tests used around the U.S. to diagnose Covid-19 patients. One study released this week from researchers at New York University examining the Abbott machine indicated it may miss as many as half of positive cases.
Abbott acknowledged in its statement that some studies have raised questions about how accurate the test is, though it previously said users have reported false-negative rates of only around 0.02%. It is continuing to improve on the test as the world learns more about the virus, the company said.
“While we understand no test is perfect, test outcomes depend on a number of factors,” Abbott said in the statement. The company said that sample handling, storage and transportation could all affect performance, as well as other features.
Since the CDC opiate dosing guidelines were published in early 2016… a lot of chronic pain pts – especially those with intractable pain – have been forced to “shelter in place” … which is really forcing them to become house/chair/bed confined.
It is now being talked about in the media about this sheltering in place is seeing a increase in spousal abuse and child abuse , suicides and divorces.
Could the community and those in the community try to “ride this wave of enlightenment ” to bring awareness to the media that many of the 100 million in the community have already been suffering from the multi-year involuntary sheltering in place as well as having to do it in up to a torturous level of pain ?
Abbott’s Virus Test Has Potential Accuracy Issues, FDA Warns