https://getpalliativecare.org/handouts-for-patients-and-families/

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Chronic pain patients and virtually anybody can copy this letter and use it to send to their legislators.  

Dear Congressman,

I am a chronic pain patient as well as an associate of the patient/doctor advocacy group Doctors (and patients) of Courage (doctorsofcourage.org). There are many people such as myself that are being denied proper pain treatment due to ignorance and misinformation about opioid pain management. Those of us who rely on opioid pain medications are being discriminated against. By preventing trained pain management professionals from doing their job, the government is forcing its own citizens to the street for self-medication, where they most probably will unknowingly receive illegal fentanyl laced pills. More and more suffering patients are forced off their medication and are committing suicide at alarming rates.

Since opioid prescriptions are declining, opioid-related deaths are rising rapidly each year. The government solution is not and will not fix the problem, it will only perpetrate it and more people will ultimately die. Most pain patients are not addicts. The opioids that are killing people and contributing to these horrific overdose deaths are not a result of pills diverted from pain management facilities, but are a result of illicit Fentanyl sold on the street. Arresting doctors and forcing people with severe intractable chronic pain to an early grave will not in any way stop the overdose rate from doubling the next few years.

Opioids are not the cause of addiction. Being dependent on a drug does not mean you are addicted.  Addiction is caused by toxicity and not by direct exposure to the drug. What does the body do with excess toxins? They have to be stored in the cells. That is genetically determined, and thus you get the genetic propensity to certain diseases. The fact that more people are not addicted that require pain medicines for their diseases actually proves that the medicine itself is not the cause.  Restricting opioids from patients with chronic pain has no effect on addiction rates. This is why even though prescriptions have declined deaths have risen and will continue to rise if this war isn’t stopped.

We need to make the DOJ accountable for not following Supreme Court decisions and committing professional misconduct convicting innocent people any way they can. Allowing innocent Americans suffering severe chronic pain to be denied relief will hurt our society. It will force countless of hard working Americans who could function and manage their condition with opioids into a life of misery. This opioid war does nothing to stop addiction. What this all means for those of us who suffer daily. Who will support these people who can no longer support themselves because they can no longer work, care for their kids? These are people who are now out of the workplace and confined to a bed because the pain is so great they can’t work. This so called solution will hurt our economy. SSI/SSDI claims will skyrocket and it will lead to the tax payers having to foot the bill and care for all these people who could have otherwise supported themselves with proper medical care and proper pain management. These laws do nothing to stop addiction. What these laws mean to people like myself. TOTAL DEVASTATION. Loss of job, home, children. I am now forced to live on government assistance. These policies are not good for America. We need to stop this now.

—

May the Lord bless you and keep you.

Linda Cheek

Teacher of The Seven Steps to Healing

Best Selling Author of Target: Pain Doc

www.sevenpillarstotalhealth.com

www.doctorsofcourage.org

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Officials Seize 500 Fake Driver’s Licenses That Would Have Gone To College Students

https://dailycaller.com/2018/08/30/fake-drivers-licenses-customs-students/

U.S. Customs and Border Protection (CBP) agents in Philadelphia seized about 500 fake driver’s licenses that would have gone into the hands of college students.

The IDs were found Aug. 15 in international air cargo shipped from Canada, China and other South Asian countries, CBP reported Thursday. The shipment consisted of fake Nigerian driver’s licenses along with licenses from over 20 U.S. states.

Connecticut, New Jersey, Maryland and Florida were among the many states represented. Some of the licenses were obvious fakes while others could be scanned by barcode readers, CBP reported.

While counterfeit driver’s licenses can be used for obtaining alcohol illegally for underage minors, they can also be used for immigration fraud and theft, according to CBP Director of the Baltimore Field Office Casey Durst in the news release. (RELATED: Officials Strip Convicted War Criminal Of Citizenship After He Fraudulently Got Refugee Status)

Many of the licenses were given to university police and states for investigation while others will be destroyed.

CBP not only focuses on border security, but also enforcing legal trade. CBP in partnership with U.S. Immigration and Customs Enforcement (ICE) seized over 34,000 shipments that were deemed unsafe or counterfeit in fiscal year 2017, according to CBP data.

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In this counterintuitive talk, physician Stefen Kertesz outlines how efforts to reduce the prescription of opioids has had a negative impact on patients who rely on the drugs to combat ongoing pain. Stefan Kertesz is a physician in internal and addiction medicine at the University of Alabama at Birmingham and Birmingham Veterans Affairs Medical Center. His clinical work and published research focuses on tailoring care for people with addiction and homelessness. Over the years, Dr. Kertesz has become a national voice on behalf of patients with long-term pain whose care has been impacted by institutional efforts to reduce opioid prescribing. Dr. Kertesz continues to advance research on improving primary care, addiction, pain and overdose risk in vulnerable populations, and serves on teams to support the Governor of Alabama’s Opioid and Addiction Council. This talk was given at a TEDx event using the TED conference format but independently organized by a local community.

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https://fox6now.com/2019/11/20/1274427/

MILWAUKEE — Just walking up to a pharmacy window is enough to send Tina Kasten’s brain into overdrive.

“You freak out,” Kasten said, using words like “anxiety” and “stress” to describe how she feels when she tries to pick up her prescription.

Kasten, who lives in Manitowoc, takes Suboxone as part of her treatment for heroin addiction. She said she has experienced delays in filling her prescription a half-dozen times over the last year.

Thirteen other patients described similar experiences in Wisconsin to the FOX6 Investigators. They did not want to be identified, citing the stigma of addiction.

Doctors, counselors, and pharmacists in Wisconsin say efforts to fight opioid addiction are inadvertently making it difficult to get addiction treatment.

The ‘devil and the angel’

Suboxone is a medication that contains buprenorphine and naloxone. It is used in combination with counseling and behavioral therapy to treat opioid addiction.

Drugs like Suboxone work by partially acting like an opioid and binding to the same receptors in the brain.

“That’s what allows it to be so useful in addiction treatment,” Dr. Selahattin Kurter said. Kurter is the executive director of West Grove Clinic, which provides mental health and addiction treatment.

“[Suboxone] doesn’t give you the euphoria associated with opiates,” Kurter continued. “But it protects you from the cravings and withdrawals.”

Kurter is Tina Kasten’s doctor. Kasten credits the combination of Suboxone and therapy for her addiction recovery.

“I didn’t have the cravings all the time,” Kasten said. “It wasn’t constantly on my mind like, ‘OK, am I going to use? Am I not? Am I going to use? Don’t do it. Oh, but you should.’ It’s like the devil and the angel and Suboxone tells them to be quiet and go home.”

“I put the work in to deal with the emotions and deal with everything that led me to be a drug addict,” Kasten added. “The Suboxone didn’t do that work. I did. But the Suboxone helped.”

But there is a danger patients could abuse Suboxone or illegally sell it for its opioid-like qualities; it is a Schedule III drug, which the U.S. Drug Enforcement Administration says could lead to “moderate or low physical dependence or high psychological dependence” if abused.

“It can be used to help somebody get rid of the addiction to opiates, it itself can be addictive,” Dr. Hashim Zaibak, pharmacist and CEO of Hayat Pharmacy said. “So the pharmacist has to balance between the risk and benefits of Suboxone and that can be a challenge.”

Red flags

As the opioid crisis spread, there was a push for Medicated-Assisted Treatment (MAT): The combination of drugs like Suboxone and therapy.

The Director of Wisconsin’s Prescription Drug Monitoring Program says the state has seen a 66% increase in Suboxone dispensations since 2016. A federal rule change expanded the number of patients that providers can treat with MAT, and gave more providers the ability to use MAT.

The Department of Health Services has also been facilitating training to give health providers the ability to prescribe buprenorphine, the active ingredient in Suboxone. Data from the Department of Health Services says one year ago, there were 850 available buprenorphine prescribers in Wisconsin; now, there are 1,117.

While these measures made it easier to have initial access to drugs like Suboxone, other measures made it more difficult to take the medication home.

To curb opioid abuse, pharmacists are guided to turn patients away if there are too many “red flags.” Examples  include cash payments, returning too frequently for refills, signs of doctor shopping, family members receiving prescriptions from the same prescriber, and driving long distances to fill prescriptions

The U.S. Drug Enforcement Administration says it is a felony offense for a pharmacist to deliberately ignore a questionable prescription when there is reason to believe it was not issued for a legitimate medical purpose.

Dr. Kurter says these measures are important to prevent opioid abuse, but also says it’s easy to forget that one patient’s “red flag” could be another patient’s reality.

“So many patients actually need to travel distances because there’s no provider in their rural communities,” Kurter said.

‘Sometimes, that voice is a scream’

Wisconsin has more than 1,000 in-state, actively licensed pharmacies. The northern part of the state has fewer pharmacies; not all of them carry Suboxone.

Nine of the 14 patients the FOX6 Investigators spoke to said they have to drive 20 miles or more to their pharmacy; eight said at least once, a pharmacist has cited the distance as a reason to turn them away from filling their Suboxone prescription.

Others, like Kasten, say they’ve been turned away because the pharmacy did not have the medication available.

“If they have it, great,” Kasten said. “If not, you’re SOL.”

The measures to prevent opioid abuse make it difficult to get the prescription quickly switched to a different pharmacy. Those same efforts are the reason patients receive just enough Suboxone to last until they can fill their next prescription; they get turned away if they attempt to refill too early.

As a result, Kasten says she has gone up to five days without her medication.

“It totally takes them off their tracks of recovery,” Dr. Kurter said. “Because they’re so focused on the withdrawal, and their physical pains of withdrawal, and the emotional pains of withdrawal, oftentimes, patients will likely relapse with the drug that they were offending in the first place.”

“It’s definitely not a, ‘Oh shuckey, darn. Let’s wait until next week or tomorrow,'” said Jaimie Hauch, licensed professional counselor. “It’s usually ‘I need this medication today.'”

Hauch works at West Grove Clinic and says the emotional impact of not being able to access treatment medication is just as important as the physical impact.

“Here, these people are trying to make positive changes, and then there’s a bump in the road that derails those positive changes,” Hauch said.

“You have one day that you’ll be OK because it’s still in your system,” Kasten said, describing what it feels like when she has to wait to get her Suboxone prescription filled. “But after that, I mean, you have sweats, headaches. You sneeze all the time. You’re throwing up.”

“There’s that little voice since you don’t have your safety net, that little voice like, ‘Well, if you just do this, you’ll feel better. You’ll get your homework done. You’ll get your kids taken care of,'” Kasten added. “And sometimes that voice is a scream.”

Getting answers from pharmacies

Kurter says he supports efforts to prevent doctor shopping and pharmacy hopping, but he’s concerned that inconsistencies will negatively affect his patients’ treatment if they continue to have difficulty getting their medication.

“I think it’s important for pharmacies to identify what their rules are and what their protocols are,” Kurter said.

The FOX6 Investigators asked CVS, Walgreens, Walmart, Pick ‘N Save, Costco, Aurora, Meijer, and Hayat pharmacies about their policies related to opioids, specifically dispensations for drugs like Suboxone.

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Dear Steve,

I have pudendal neuralgia (on my right side) and interstitial cystitis. I’ve been following your work for awhile and I was one of the patients who spoke to the Department of Health & Human Services Pain Task Force in DC last year. I also follow Red Lawhern, (along with other excellent researchers on this topic), and have been an advocate on behalf of myself and others for the last 3 years or so. 

This pt has been going to a grocery store chain pharmacy and it would seem what they are running into is that the corporate HQ has been intimidated by some part of some bureaucracy and/or they are concerned about being drug into the law suits that are currently going after the pharmas and wholesalers. I suspect that the chain pharmacies and the insurance/PBM industry can’t be far behind in the law firms going after more money ..because they will claim that they facilitated the opiate crisis by providing and/or paying for opiates for pts who had a valid medical necessity.

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Three years of the Trump administration, Steve.
We told President Trump that if he acted on any of us his unconstitutional campaign promises, we would see him in court.

And we did – filing 140 lawsuits and 100+ other legal actions. We’ve won many of them, but the fight is ongoing.

In fact, next year may be the toughest yet. Trump is doubling down on his agenda, abusing power, and behaving more erratically in hopes of winning reelection.
But what we’ve accomplished together in these three years gives me hope. Here are just a few reasons why:
• Separating families seeking asylum is perhaps the cruelest out of all of Trump’s anti-immigrant policies. So we sued and got a court ruling barring the practice. We’ve helped reunite more than 2,000 families since then. The legal fight continues as we press the administration to reunite the thousands of others that remain separated. We won’t rest until we’ve reunited them all.
• As a candidate, Trump promised to overturn Roe v. Wade, and in response, seven states have enacted laws banning abortion. We’ve challenged five of these bans, and got injunctions on every single one. Thanks to our collective action, abortion remains legal in all 50 states. We anticipate more state bans in the year to come, and we’ll be ready.
• The president tried to rig the census by adding a question about citizenship to intimidate immigrant participation. The impact would have been dire: By deterring tens of thousands of immigrants from filling out the form, the question would have resulted in congressional under representation and less federal support for districts where immigrants live. But we fought the administration all the way to the Supreme Court, and won. Together, we preserved the integrity of our democracy.
Wins like these are powerful. But what gives me the most hope are the people behind this work: our relentless team of lawyers, organizers, policy analysts, and our supporters – you’re a big part of this.
Steve, you allow all of this to happen – whether you’ve made a donation or a phone call to Congress, showed up at a rally, or spread the word about the most pressing civil rights battles we face.
So when Trump doubles down on his attacks in the coming year, we have the team ready to fight back – to defend our right to abortion, seek asylum, vote, or exercise any of our constitutional rights and liberties. We will continue to secure our freedoms and advance equality.

David Cole
ACLU Legal Director
P.S. It’s tough to capture all that we’ve done together in the past three years, but I attempt to in this piece I wrote. Give it a read and learn more about how we fought the Trump administration together.

Doesn’t this email, that showed up in my email inbox, give you the warm fuzzies ?  ACLU filing 140 lawsuits and 100+ other legal actions…  I am not aware If any action initiated by the ACLU to provide assistance or protect anyone in the chronic pain community or other pts that are dealing with subjective diseases.

millions of pts dealing with human rights violations and civil rights violations and some pts given no choice but suicide because of their under/untreated unrelenting pain.

How many chronic pain pts have reached out to the ACLU to only be told that they don’t have the resources to provide any help ?

According to this letter apparently illegal immigrants well being is a much higher priority than many of our country’s own citizens.

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An example of why not to use Mail Order Pharmacies…

“Patient’s niece wanted me to help her uncle since he was so confused about his meds. Saw this and nearly fainted.

Those fridge items you see were just sitting on a table by the bed.

Unopened boxes from AMAZON PILLPACK. “They have tried to tell them not to send any more but they keep coming” she says.”

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What Are Medicare Opioid Guidelines?

https://www.verywellhealth.com/medicare-and-the-opioid-epidemic-4684180

Opioid Use in Medicare Beneficiaries

The Federal Government Targets Opioid Use

Medicare Part D Policy Changes in 2019

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‘Missed Opportunity.’ Warren’s Opioid Plan Has a Major Blind Spot, Experts Say

https://fortune.com/2019/05/22/elizabeth-warren-opioid-plan-care/

Massachusetts Senator and 2020 presidential candidate Elizabeth Warren proposed a $100 billion plan to address the opioid epidemic earlier this month, earning praise for recognizing the scale of response the crisis requires. Drug policy experts, however, say that while her proposal is a step in the right direction, it overlooks the opportunity to fix a broken healthcare system and address substance use more effectively.

“Because it is so focused on opioids, there are blind spots for where you need to expand access to low cost health coverage, and expand access to housing, and address the underlying issues which fuel problematic substance use and overdoses in the first place,” Northeastern law and health sciences professor Leo Beletsky, an expert on the U.S. opioid crisis, told Fortune.

This “missed opportunity,” like other opioid-related legislation, adds more funding to a substance use treatment system that is “fundamentally flawed and broken,” said Beletsky.

Warren’s CARE Act—cosponsored by a number of other 2020 Democratic candidates, including Sens. Kamala Harris, Bernie Sanders, and Cory Booker—proposes $100 billion in federal funding over the next 10 years to address early intervention, harm reduction, and long-term support services for those struggling with addiction.

Of this $100 billion, funded through her proposed ultra-millionaire tax, $4 billion would go to states, territories, and tribal governments; $2.7 billion to the counties and cities hit hardest by the opioid epidemic; $1.7 to public health surveillance, research, and health professional training; $1.1 billion to public and nonprofits on the front lines; and $500 million to expand access to naloxone, a drug used to reverse opioid overdoses.

In 2017, drug overdose deaths in the nation reached an all-time high of nearly 72,000, a 6.6% increase from 2016. Warren’s bill comes just months after a new report named dying of an opioid overdose the leading cause of preventable death in the United States.

In a Medium post announcing her plan, Warren said that along with addiction treatment, “the CARE Act would ensure access to mental health services and help provide critical wraparound services like housing support and medical transportation for those who need them.”

While many agree on where Warren wants to put the money—Beletsky in particular applauded her dedication to harm reduction, a sometimes controversial area—some argue the funds are already in the system.

“She is a champion of healthcare and I think that she’s got a lot of things right,” Michael Cartwright, CEO and co-founder of American Addiction Centers, told Fortune.

“I don’t know that you need any new money,” he added, noting he doesn’t believe Warren’s ultra-millionaire tax is necessary. “The reason I say that is the health plans alone could fund this $100 billion over the next ten years if they just simply followed the Parity Act.”

The Mental Health Parity and Addiction Equity Act, passed in 2008, states that if health insurance companies provide mental health or substance use disorder benefits, the financial requirements and treatment limitations that apply to them must not be more restrictive than the medical or surgical benefits provided.

Despite being more than a decade old, the Parity Act is rarely enforced. According to a coalition of nonprofits who analyzed several major health plans in 2015 and 2016, documents frequently lack necessary details about coverage. Moreover, many patients are not aware of their rights under the Parity Act.

“Critical details about coverage and access to treatment are often missing from plan documents. It would be challenging—if not impossible—for an average consumer to know whether a plan violates the Parity Act,” Paul Samuels, director and president of the Legal Action Center and spokesperson for the Addiction Solutions Campaign (the group that conducted this study), said in a statement.

“Yet, the current system relies on consumers to report problems to insurance regulators,” Samuels continued. “When regulators don’t receive complaints, they assume the plans are in compliance. Our analysis reveals that most parity violations cannot be identified through consumer complaints nor can they be identified via form review.”

The issue has not gone unnoticed: Warren has long advocated for the Behavioral Health Coverage Transparency Act, which, if passed, would strengthen enforcement partially through random audits of insurance plans and a consumer web portal to file complaints.

Since such legislation has not yet been passed, however, the Parity Act continues to be rarely enforced, allowing insurance companies to get away with placing barriers both in policy and practice, preventing some patients from seeking treatment for substance use disorder.

“The Parity enforcement is abysmal and it’s definitely hurting people,” said Beletsky, adding that this act “arguably is more important” than the episodic funding of Warren’s plan and past legislation addressing the opioid epidemic.

“The bottom line is that the more barriers you create for people to get coverage, the better” for the insurance companies, said Beletsky. “And the stigma around addiction is such that this has been an issue that has received too little attention. As long as something is stigmatized and hidden, it makes it easier for insurers to get away with not covering it properly.”

Like Warren’s CARE Act, past legislation—including the 21st Century Cures Act of 2016 and the SUPPORT for Patients and Communities Act of 2018—have attempted to address the opioid epidemic in other ways. The SUPPORT Act, passed under the Trump administration, allocated roughly $6 billion in new funding to address the opioid epidemic through addiction prevention, medication assisted treatment, and support services.

Much of this funding, however, went into the pockets of pharmaceutical companies. The SUPPORT Act required state Medicaid plans to provide coverage for medication assisted treatment, or the use of drugs like methadone and buprenorphine to aid the recovery of those addicted to opioids.

According to Beletsky, the risk of a patient overdosing goes down by 80% when they’re treated with one of these medications. Abstinence-based rehabilitation programs, on the other hand, actually increase the risk of overdose: the program causes the patient’s tolerance to drop, meaning if they relapse and take a dose similar to what they took prior to treatment, it may be too much.

Thus medications like methadone and buprenorphine are a “critical tool,” said Beletsky, but it does “introduce this element of cognitive dissidence” for those who view the pharmaceutical companies manufacturing them as the villain.

Warren’s plan, for example, advocates for the expansion of naloxone. This drug saves lives, but by virtue of being produced by pharmaceutical companies, promoting its expansion puts more money in the pocket of big pharma. (Unlike other bills, however, Warren’s plan addresses the “criminal negligence” of major drug companies, promising to hold them accountable with actual criminal penalties.)

Cartwright argues the money dedicated to these medications would be better spent on learning more about the cause and treatment of addiction.

“I totally believe in using pharmaceuticals when necessary,” he told Fortune, but he’s bothered by the fact past legislation left us “pouring billions of dollars into old, antiquated medications versus billions of dollars into Harvard and MIT to find the answers for the cure.”

Warren’s CARE Act provides $700 million annually to the National Institutes of Health from 2020 to 2029 for the purpose of researching exactly this. The funds are designated for “research on addiction and pain, including research to develop overdose reversal drug products, non-opioid drug products and non-pharmacological treatments for addressing pain and substance use disorder.”

Meanwhile, the medications being used—while beneficial—are outrageously priced. Vivitrol, another medication used for opioid addiction treatment, costs over $1,000 per monthly shot. Naloxone, the drug used to reverse overdoses, reportedly costs about $1 to manufacture, but with insurance it costs around $40 per dose. Warren’s bill requires any federal contract with a naloxone manufacturer to include negotiations for a discounted price.

“We’ve got to ask ourselves, ‘Why are we paying so much—more than every other country on the planet—for pharmaceuticals?’ That’s a serious problem.” said Cartwright. Along with forcing drug prices down, he said “we ought to take a hard look at the money that’s already in the system and ask, ‘Is it being used efficiently?’”

Cartwright argues more should be spent on prevention and telemedicine, the latter of which could have a major impact on rural areas with few resources. Prevention is effective, he says, but according to the Center on Addiction, just two cents of every state and federal dollar spent on addiction and substance use goes towards prevention and treatment.

A truly effective solution to the opioid epidemic, however, will require a restructuring of the way problematic substance use is treated.

“There’s a consensus [among experts] that we really need to be working to integrate substance use treatment into mainstream medicine and reduce the barriers between substance use treatment, mental health, and primary care or other kinds of healthcare,” said Beletsky.

While policymakers are addressing the opioid epidemic, it’s important not to cut out those suffering from related conditions, he added. Warren’s policy is modeled off of the Ryan White CARE Act, which in 1990 allocated significant funding to address the AIDS epidemic that killed more than 100,000 people. The program is celebrated for its positive impact on HIV/AIDS treatment, but it also created this idea of “HIV exceptionalism” where those with HIV were privy to benefits that those at risk of HIV were not.

“You don’t want to create a system where if you’re using opioids, you have access to certain services and if you’re using meth, you don’t,” said Beletsky.

While Warren’s bill addresses the opioid epidemic specifically in some parts, its overarching aim is to provide complete support for all types of substance use disorder. The bill’s text says the grants are to address “substance use,” not specifically opioids.

To prevent a similar crisis in the future, however, any solution to the opioid epidemic should address root causes of problematic substance use. Warren’s plan begins to move in the right direction, but overall “there’s a lot more that needs to be done in terms of recalibrating existing systems,” said Beletsky. “It isn’t just about the healthcare system and it isn’t just about public health prevention. It’s also about the fact that we sink a lot of resources and really emphasize criminal justice approaches and we really need to move away from that.”

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