https://youtu.be/rWHnb9QyH9k

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St. Joseph County Drug Unit being shut down amid uptick of violence

https://wsbt.com/news/local/st-joseph-county-drug-unit-being-shut-down

St. Joseph County Prosecutor Ken Cotter said that even thought the Drug Investigation Unit is being shut down, that doesn’t mean the fight against drugs is over.

Cotter said it’s a combination of Drug Unit success and resources and that with the uptick of violence in Saint Joseph County, they needed the Drug Unit officers to be able to focus on other issues, too.

“In 2016 we had 58 overdose deaths,” said Cotter.

But now so far in 2019, St. Joseph County has had 12 overdose deaths, so the Drug Investigation Unit will be shut down beginning January 1.

“There are fewer drugs throughout our community today than there were five years ago,” said Cotter. “People are still overdosing. People are no longer dying in the manner that they were before.”

Cotter says that Narcan, a lifesaving treatment, has also had a huge impact on reducing overdose numbers.

“The difference is that folks are taking seriously that these drugs kill,” said Cotter, “and so more and more people are having Narcan. Our first responders five years ago did not have Narcan, now they all carry it. Family members are carrying Narcan.”

Now the officers in the Drug Unit can be used for an even more pressing issue.

“Everything is a priority to us,” said Scott Ruszkowski, South Bend Police Chief. “And right now, we have an overwhelming amount of violence in our city, and we are going to concentrate those resources there.”

Drugs remain an issue, but gun violence is even more concerning.

“I would love to have the unit remain, but I also have to be realistic,” said Cotter, “because there is only so many taxes that folks want to pay to be able to supply those law enforcement officers to do all the things that we want them to do.”

Their number one priority in allocating resources is avoiding more deaths.

“Because nothing is more important than a person’s life,” said Cotter. “You can recover from anything else except death.”

The prosecutor’s office wanted to make clear that overdoses will still be investigated, but that the goal is to get more of the people committing violent crimes behind bars or prevent them in the first place.

This is one of those stories that what is said … could only be a portion of the full story…  So now this Indiana county has a increased violence and increased gun violence..

Across this country we are having a increase in meth, cocaine and since MJ – in all forms – is illegal in Indiana … so is all of this street violence mostly involving “street gangs” fighting over turf to sell these illegal products ?

Just because someone is a addict does not mean that they are STUPID… surely they have seen how LETHAL the “Heroin” that is being sold on the street because most of it contains an illegal fentanyl analog.

So they have switched substances which they are abusing… typically addicts have a favorite substance,  but often finances forces them to use what is most available or they can afford.

For at least 100 yrs, our country has had some sort of substance abuse issues…. the difference from time to time is the primary substance that is being abused will change from time to time.

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The Myth of Morphine Equivalent Daily Dosage

https://www.medscape.com/viewarticle/863477

For far too many years, pain researchers and clinicians have relied on the concept of the morphine equivalent daily dosage (MEDD), or some variant of it, as a means of comparing the “relative corresponding quantity” of the numerous opioid molecules that are important tools in the treatment of chronic pain. This concept dates back to the mid-1980s, first appearing in the cancer pain treatment guidelines by Portenoy and colleagues,^[1] and has subsequently been used empirically and clinically for a variety of purposes.

For example, researchers have relied on non-empirically derived “equivalent dosages” as a means to facilitate research in which opioid consumption serves as a dependent variable. Clinically, opioid “conversion” tables have been routinely used when switching a patient from one opioid to another. And, most unfortunately, opioid prescribing guideline committees have relied on this concept as a means of placing (usually arbitrary) limits on the levels of opioids that a physician or other clinician should be allowed to prescribe. Although these guidelines typically bill themselves as “voluntary,” their chilling effect on prescribers and adaptation into state laws^[2] makes calling them “voluntary” disingenuous.

Although some scientists and clinicians have been questioning the conceptual validity of MEDD for several years, a recent study^[3] has indicated that the concept is unequivocally flawed—thereby invalidating its use empirically and as a tool in prescribing guideline development. This analysis determined that a fundamental inadequacy of the MEDD concept is the lack of a universally accepted opioid-conversion method. The authors used survey data from pharmacists, physicians, nurse practitioners, and physician assistants to estimate daily morphine equivalents and found great inconsistency in their conversions of hydrocodone, fentanyl transdermal patches, methadone, oxycodone, and hydromorphone—illustrating the potential for dramatic underdosing or, in other cases, fatal overdosing.

Regarding the use of MEDD in research, our suspicion is that many pain investigators have known about the problems with this prodigiously flawed concept for many years. For example, in a 1991 Australian review of the polymorphic metabolism of opioids,^[4] the authors concluded that “Pharmacogenetics may play an important role in explaining the wide variability of the clinical response to many opioid drugs.” Yet, a quarter of a century later, MEDD remains routinely used in pain research worldwide. Given that invalid dependent variables in research result in invalid findings, our hope is that investigators will begin to conduct studies comparing morphine with morphine, hydrocodone with hydrocodone, and so on—as opposed to relying on the standard (and far more convenient) approach of MEDD.

Clinically, prescribers need to use this information regarding the flawed MEDD concept to begin practicing dosage-switching and opioid rotation in a more thoughtful and scientific manner. Thus, even if the charts suggest that 1 mg of oxycodone is the “equivalent” of 1.5 mg of morphine, the practice of opioid rotation based on the concept of pharmacogentic homogeneity needs to be seriously reconsidered.

Furthermore, the evidence supporting pharmacogenomic differences among patients is mounting^[5,6] and needs to be carefully weighed before labeling a patient who requires 30 mg of morphine rather than the prescriber’s “standard” of 10 mg in order to achieve adequate analgesia as an “addict.” Patients with chronic pain (particularly that of noncancer origin) who are reliant on opioid analgesia are already sufficiently stigmatized and marginalized^[7] to allow this type of practice to continue to be the norm.

Although the use of MEDD in research and, to a greater extent, in practice, is probably due to unawareness of its inaccuracy, we posit that the use of MEDD by recent opioid guideline committees (eg, the Washington State Opioid Guideline Committee^[8] and the Centers for Disease Control and Prevention Guideline Committee^[9]) in the drafting of their guidelines is based more heavily on disregarding available evidence rather than ignorance. Furthermore, their misconduct in doing so has been more pernicious than the use of MEDD by researchers and individual clinicians, because these guidelines widely affect society as a whole as well as individual patients with persistent pain syndromes. We opine that these committees are strongly dominated by the antiopioid community, whose agenda is to essentially restrict opioid access—irrespective of the lack of data indicating that opioids cannot be a useful tool in the comprehensive treatment of carefully selected and closely monitored patients with chronic pain.

Although we emphatically agree that opioid analgesia should not be the first-line treatment for chronic noncancer pain, when other nonopioid treatments have either failed, are contraindicated medically or owing to behavioral and emotional factors, or are inaccessible because of the health insurance industry’s refusal to cover them (irrespective of their established evidence-bases), opioids should be considered. Guidelines that contain language suggesting that alternative treatments are regularly available when this is not the case are shortsighted and troubling.

Recently, we published an article in the Journal of Pain Research titled “The MEDD Myth: The Impact of Pseudoscience on Pain Research and Prescribing-Guideline Development,”^[10] with Dr Jacqueline Pratt Cleary as our coauthor. This article goes into considerably more detail regarding the clinical and ethical imbroglio that we address in the current brief article, and as an open-access publication, the Journal of Pain Research encourages readers to access the full text at no cost here. We feel that the healthcare community must learn more about the need to work toward a paradigmatic revision in the consideration of opioids in research, clinical practice, and prescribing guideline development.

I can’t remember how long that I have been saying that any practitioner or entity that uses any of these MME conversion programs should be charged with unprofessional conduct or malpractice.  Besides the inaccuracies of these conversion calculation at face value… We have the fact that without throwing into the decision making process of changing a pt from one opiate to another  without considering the pt’s CYP-450 opiate enzyme metabolism status. Makes the entire conversion process INACCURATE at best.

Before everybody jumped on board of these MME conversion programs and before the CYP-450 opiate enzyme metabolism was in the mix… the standard of care and best practices when switching a pt from one opiate to another… was to use one of these calculator and whatever answer was produced – cut the pt’s starting dose IN HALF and start titrating the dose up or down …depending on the pts self-assessment of their level of pain and quality of life.

We have insurance companies, Prescription Benefit Managers, chain pharmacies, CDC, DEA and others making mandates on what level of opiate therapy a chronic pain pt should be provided.

Here we are dealing with treating subjective diseases and we as Homo sapiens  and we are individuals… we each have 50 odd enzymes in our livers that metabolizes various substances  along with numerous other systems that helps our body functions… some of us better than others.

We are not baking cookies here… we are dealing with a pt’s quality of life and yes we are dealing with medication that can POTENTIALLY BE ADDICTING to some 1.3% of the pts who are prescribed these medications for valid medical necessities.

Yet it would seem like every bureaucrat, politician and others believe that they have the authority to determine the appropriate level of opiate therapy all pts should receive by some cookie cutter formula… IMO… that seems to be like the PRACTICE OF MEDICINE…

Where is the various state medical licensing boards… isn’t it their responsibility to make sure that only licensed practitioners practice medicine ?

Where are the law firms, besides practicing medicine without a license… they are directly or indirectly discriminating against all of these pts and violating the Americans with Disability Act and the Civil Rights Act ?

Many pts have called law firms seeking representation, but apparently many have failed to explain to the law firm that they are not talking about malpractice, but civil rights discrimination, denial of care, pt abuse and in some incidents … intentionally throwing a pt into cold turkey withdrawal and elevated pain (torture).  If the pt’s problems involve a large healthcare corporation… the law firm needs to be aware that there is possibly some very DEEP POCKETS to go after and hundreds or thousands of pts involved.

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If you patronize a CVS pharmacy and already believe that their Rx dept staff is understaffed and overworked  this appears to be a chart of MORE REDUCED MAN HOURS in their Rx depts.

Common sense suggests that when a staff is already over worked and understaffed and total man hours are reduced… in the pharmacy depts… that generally means two things… pts will typically have much longer wait times to get their prescriptions filled and the staff will most probably make more errors in filling prescriptions

You might want to ask yourself…. is it time to fine a new pharmacy ?

Here is a link to find a independent pharmacy by zip code  http://www.ncpanet.org/home/find-your-local-pharmacy

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Utah’s Top Anti-Cannabis Lawmaker is Also One of the State’s Largest Opiate Seller

https://hightimes.com/news/politics/utahs-top-anti-cannabis-lawmaker-also-states-largest-opiate-sellers/

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For people with heart disease, it’s been thought that inserting a stent was the best way to treat sudden chest pain during exercise. But a landmark study suggests that this invasive procedure might not be necessary, and instead, medication and lifestyle changes are enough. When considering dietary changes, it’s important to get the right protein bars to support heart health and overall well-being.

The findings, presented Saturday at the American Heart Association’s annual meeting in Philadelphia, could help guide millions of conversations between patients and their doctors when deciding which treatments are best.

For more on this story, watch NBC Nightly News with Lester Holt tonight at 6:30 p.m. ET/5:30 p.m. CT.

“Probably the majority of patients, if you offered them a choice of just taking medicine or having a procedure, many will likely opt to just take medicines,” said Dr. Glenn Levine, a professor of medicine at Baylor College of Medicine and the director of the cardiac care unit at the Michael E. DeBakey Medical Center in Houston. He was not involved in the new research.

Daily aspirin no longer recommended to prevent heart attacks for healthy, older adults

March 18, 201901:09

The study focused on patients with what’s called ischemic heart disease. That usually means that plaque has built up in the coronary arteries, which supply blood to the heart muscle, narrowing them and making it more difficult to pump blood.

That translates into chest pain or tightness — called angina — when those patients exercise or experience emotional stress, because their body is trying to pump more blood, but can’t do so effectively through such a restricted space.

When patients rest, though, the pain goes away. Doctors call that “stable angina.” It’s not a medical emergency, but does require an appointment with a doctor. According to the American Heart Association, stable angina accounts for 2.3 million such office visits in the United States every year.

During those exams, patients hop onto a treadmill or stationary bike so physicians can see what’s going on in those narrowed arteries. Medications, such as aspirin and drugs to lower cholesterol, are almost always ordered.

Related

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Cholesterol levels dropping in U.S., but many still need care

But very often, doctors also refer patients for an invasive procedure to widen the artery. That could mean either inserting a tiny balloon to inflate the artery, followed by placement of a metal tube called a stent to keep the artery propped open, or bypass surgery, when surgeons redirect the flow of blood around the blocked artery.

“It’s common practice, if you have a very abnormal stress test, to go to the cardiac catheterization lab pretty promptly, because [doctors] are afraid that the patient is going to have a heart attack or die,” said study leader Dr. Judith Hochman, the senior associate dean for clinical sciences at New York University School of Medicine.

“This study is saying, let’s rethink this,” she told NBC News.

Hochman and her team of investigators looked at 5,179 patients in 37 countries. All of the patients were put on an intensive drug regimen that included aspirin and medications to lower levels of unhealthy LDL cholesterol, along with blood pressure drugs such as ACE inhibitors and beta blockers.

They were also encouraged to lose weight if necessary, by exercising and cutting down on saturated fat in their diet, and to quit smoking.

Half stuck with this “conservative” approach — medications and lifestyle changes only — as long as their condition didn’t worsen.

The other half got the medications and lifestyle advice, too, but were also referred for either a stent or bypass surgery.

The study found that after four years, the rates of heart attack, cardiovascular death and other bad outcomes were nearly identical in both groups: 13.3 percent in the half that received invasive procedures, versus 15.5 percent in the conservative group.

“It was surprising to find that with modern medical therapy and lifestyle changes, there was no added benefit of an invasive strategy to open those blockages,” Hochman said.

There was one noteworthy difference: Patients who had a surgical intervention reported more chest pain relief than those in the conservative group.

That’s an important consideration for some patients, experts said. Take, for example, an active 60-year-old woman with ischemic heart disease, whose exercise-induced chest pain has forced her to cut back on the tennis she loves. She may opt for immediate relief of her angina with a procedure, in addition to medication.

“We can now sit down with patients armed with the information from this trial and customize a program based upon their wishes,” said Dr. Elliott Antman, a senior physician of cardiovascular medicine at Brigham and Women’s Hospital in Boston. Antman was not involved with the new research, but is a past president of the American Heart Association.

On the other hand, this trial also shows ischemic heart disease patients can do well if they stick to their medications and make aggressive lifestyle changes that push their cholesterol and blood pressure down significantly.

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Skyrocketing costs of prescription drugs making consumers susceptible to counterfeit options

https://www.cbs17.com/news/investigators/skyrocketing-costs-of-prescription-drugs-making-consumers-susceptible-to-counterfeit-options/

RALEIGH, N.C. (WNCN) — The skyrocketing costs surrounding prescription drugs — have a lot of people looking for cheaper alternatives. And that means many are willing to hunt for bargains online.

People are dying after taking counterfeit drugs—many of them from out of the country according to the Drug Enforcement Administration (DEA).

When you look for low-cost drugs online—you may be taking serious risks with your health.

“Make sure you are doing your research,” said Mallory Wojciechowski, the CEO of the BBB of Eastern North Carolina.

In a sampling of pills seized nationwide earlier this year, the DEA found that 27 percent contained potentially lethal doses of fentanyl. 

It’s a widespread problem.

And according to the Better Business Bureau, there are some less-than-credible sites  — pushing fake prescriptions that are often contaminated, have the wrong ingredients and sometimes even the wrong dosage. 

“We’ve heard reports of people receiving expired drugs, possibly drugs that are actually fake and don’t have any active ingredients,” said Wojciechowski.

The Better Business Bureau says there are some things you can do to ensure the website is legit:

• Make sure the pharmacist is licensed. (You can do that by checking with the FDA….or the North Carolina Board of Pharmacy.  
• Make sure the pharmacist is asking for a prescription. That’s a mandatory requirement.
  • • Make sure there’s a physical address and other legitimate contact information so you can ask the pharmacist any questions you may have.

Another red flag?  Consider this.  If the price on the drug looks like it’s too good to be true, it probably is. 
 
The Better Business Bureau warns you not to make the mistake of being lured in by a really low price.

Did you notice in this piece that the DEA is quoted as warning about counterfeit medications ALL MEDICATIONS….not just controlled substances

Is the DEA trying to “nose out” the FDA on ALL MEDICATION SAFETY ISSUES ?

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     This is just one example of how the PBM/insurance industry affects the price you pay at the pharmacy counter. This is not one isolated example. Think why diabetics are paying “out the nose” for copay on their insulin.  Back when I started working in pharmacies – as a pharmacy student – there was no U-100 insulin but a u-40 and u-80… but if u-100 would have been available … its price would have been around $2.50 for a 10 ml vial.

Today, Insulin can run $300 AND UP for a 10 ml vial.

Recently Lilly brought out a “generic insulin” at a lower price and upon its release, Lilly stated that there would be no rebates/discounts/kickbacks paid to the  PBM/insurance industry collectively responded ” NON-COVERED ITEM”

In the example above, the GROSS PROFIT DOLLARS for the wholesaler and pharmacy is about 20% of what the PBM/Insurance industry makes on this single transaction, and the both of those entities (wholesaler/pharmacy) has to have stock on hand to meet the needs of the pt..  as opposed to the PBM/Insurance industry which has only personnel, computers and buildings.

Some would argue that the PBM/insurance industry really provides little/no actually healthcare and when you consider that they are in charge of which medications that they will pay for, how many doses a pt can get a day and how long they can have the therapy… the could actually have a NEGATIVE IMPACT… because of their need to have days or weeks to get around to approving a prior authorization that they have imposed.

Just look at the numbers the wholesaler – in this particular example – is expected to remain profitable on a 3%-4% Gross profit margin and the pharmacy is expected to do the same on a 5% gross profit margin. Compared to Walmart works on abt a 25% gross profit margin on their overall operation.

Whereas, the insurance/PBM industry their GROSS REVENUE is their GROSS PROFIT… since they do not provide any products and have no inventory of products.  In this particular example the PBM/insurance industry collects almost 50% of the dollars that the pt ends up paying for the medication.

So who is the “real robber” when the pt pays a lot of $$$ to have a prescription filled ?

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Online Shopping Addiction Is A Mental Health Condition, Psychotherapists Claim

https://thehooksite.com/online-shopping-addiction-is-a-mental-health-condition-psychotherapists-claim/

Experts are saying that being addicted to online shopping is a genuine mental health condition just as, I would argue, every addiction is.

Turns out I’m ill, everybody. A sick young man.

I’m being facetious of course, and this dramatic revelation comes courtesy of Dr Müller, a psychotherapist at Hannover Medical School in Germany.

Müller conducted a study between 122 people who were seeking help for their online shopping addiction, and found that many of them also suffered from the likes of anxiety and depression.

The researchers found that the boom of online shops, apps and fast delivery only served to make things worse, feeding into shopaholics’ tendencies to constantly buy things.

Along with that, since the internet doesn’t have the same drawbacks as physical shops, it’s not governed by closing times or even the need to leave the house to visit.

The internet is also home to a greater and cheaper range of products and appeals to a younger audience given that it’s always available, affecting an estimated 5% of the population.

At the present, buying-shopping disorder (BSD) isn’t recognised as its own illness, currently falling into the ‘other specified impulse control disorder’ bracket.

With that, Dr Müller is pressing to have BSD recognised as a genuine mental health condition, believing that in this internet age it’s more and more prevalent and the instant gratification of craving for something and then immediately buying it could be very harmful.

The cravings then feed into a loss of self-control, which can flare up in other walks of live and in turn, become extremely distressing, causing other psychiatric problems.

Dr Müller told MailOnline:

“It really is time to recognise BSD as separate mental health condition and to accumulate further knowledge about BSD on the internet.

“We hope that our results showing that the prevalence of addictive online shopping among treatment-seeking patients with BSD will encourage future research addressing the distinct phenomenological characteristics, underlying features, associated comorbidity and specific treatment concepts.”

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