VETERAN SUICIDE WATCH: THE EVER-MOUNTING COSTS OF A WORLDWIDE CONTAGION

www.asiamedia.lmu.edu/2019/08/27/veteran-suicide-watch-the-ever-mounting-costs-of-a-worldwide-contagion/

Since 2017, the number of such deaths in South Korea has gone up. Troop morale has gone down. Angry, conscripted men are calling for women to join their discontented ranks. Gay men and women report harassment, bullying, assault and, according to Amnesty International, criminalization (per Article 92-6 of the military code).  For the past four years, more officers than soldiers have committed suicide.

What preventive steps has the Ministry of National Defense taken, so far? Talks…calling for suicide prevention education and policy meetings.

It’s the same in America. In July, the U.S. Pentagon reported its highest number of veteran suicides in 17 years. The latest grim headlines involve “parking lot suicides” committed on official Veterans Administration grounds in America. Every day, 20-22 men and women who have served in the American military— whether active duty, the Reserves, the National Guard, or veterans— kill themselves. And in other nations around the world, comparable reports suggest the epidemic is endemic to the post-war veteran experience.

What should they be talking about, then, those experts convening end of August  at the Gaylord Opryland Resort and Convention Center, in Nashville, Tennessee, for a Suicide Prevention Conference? What innovations will be unveiled by some 2000 “experts” from the Department of Defense and the Department of Veterans Affairs, for this meeting billed as “One Mission. Many Roles.” #BeThere.

They were not there six years ago, when Daniel Somers, 30, machine gunner of 400 combat missions in Iraq, commented on the daily suicide count, “Is it any wonder? … Where are the big policy initiatives?” Those words, taken from his 2013 suicide note, were memorialized on Gawker, a one-time American celebrity and media blog.

They were not there for John King, 28, the Humvee runner in Iraq who hung himself back home in New York four years after his return.

They most certainly were not there for Justin Bailey, age 27, an Iraq War Marine who died of an overdose of VA- prescribed medications — while in treatment at the West Los Angeles branch of the Department of Veterans Affairs, its largest branch, where I worked for fifteen years.

One of these three men, I knew; two I did not. All three shared a common, and deadly, cocktail of combat-related crises—physical pain, opiate addiction, severe post- traumatic stress disorder (PTSD) and traumatic brain injury (TBI).  Said King’s grieving mother: “Kids are fighting for your country, [but] they’re not getting the help they need.”

Indeed. At the start of the “Forever Wars,” we tried to look away. But we can’t, anymore — not since a VA staffer telephoned Somers’ wife to set up an initial mental health appointment … weeks after his death; not since John King’s VA mental health specialist pronounced him no longer a danger to himself; not since the late Justin Bailey’s case managers somehow failed to make sure that he show up for his initial PTSD evaluation.

Impressive, first-term Senator Kyrsten Sinema (D-Arizona) gave her first speech from the Senate floor on this deadly theme, evoking Somers. John King’s family was honored at a July 4 artillery ceremony in Battery Park, New York. One year after his death back in 2007, Congress passed the Justin Bailey Substance Abuse Disorders Prevention and Treatment Act. Twelve years ago.

Now,  get ready for this: the VA is promoting “gold standard” innovations in the field of suicide prevention: 1) A computer algorithm that scours patient records, tracking medications, treatment, traumatic events and overall health so as to retrieve the names of veterans in the community deemed most likely to die by suicide within a year. So far, some 250 veterans have reportedly been stopped in their suicidal tracks; 2)  A first-ever, nationally standardized template for suicide risk assessment, rolled out at the start of 2019, based upon “high-quality, evidence-based tools;” 3)  Measurement-based care– self-report forms completed by veterans, designed to highlight symptoms of PTSD;  4) The Mission Act, implemented in June of 2019, ensuring private sector care for veterans who live too far from a full-service VA facility, among other factors; 5) A nationwide crisis hotline, manned 24/7; and 6) A nationwide army of Suicide Prevention Coordinators.

These measures are good—but not good enough.  They cannot compensate for compassionate care: those lauded, lengthy suicide risk assessment could detract precious time from direct patient care; those self-report checklists, in the hands of veterans, can’t possibly distinguish true PTSD victims from those chasing compensatory funds. The Mission Act may fast-track appointments for veterans but most private sector clinicians aren’t trained in the intricate  protocols for treating PTSD and TBI. The Veterans Crisis Hotline can be cumbersome. You could die waiting.

I remember the 25-year-old Japanese-American, an Army veteran, who casually ruminated about hanging himself from a tree; he was immediately hospitalized. I remember the double-amputee smuggling heroin in his prosthetic legs, selling it on VA grounds, then screaming, when caught, “I’m gonna kill myself!” Another hospitalization.

You have to be there, to feel it. You have to see it, to know it. You have to look into the patient’s eyes to ferret out fakery from tragic fact.

What’s called for is systemic change, in America and elsewhere. If Congress were to fund those 49,000 nationwide VA jobs that remain empty. If the Department of Veterans Affairs were to hasten its laborious, labyrinthine hiring system. If patient charting requirements were streamlined. If clinicians could concentrate on the patient, rather than the computer chart, before their eyes.

Boots on the ground are needed to win the hearts and minds of civilians in Afghanistan and Iraq (or so they insist).  The same could be said for both patients and staff on the frontlines of federal government.  Measurement matters, but so do the human brain, and heart. Anyone who has been talked out of suicide — or who has directed such talks — can attest to that. More clinical boots on the ground in countries will be the only way to win the war against veteran suicide.

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It would seem that everyone is going APE-SHIT over this judge’s ruling..  This judge is so “full of himself” that he believes that abt ONE-HALF BILLION DOLLAR fine to J&J will quickly solve the opiate crisis in OK.   His ruling is going to go NO WHERE… first of all he denied J&J of a trial by jury…. and this ONE MAN has made all the determinations from the start of the trial to the final ruling.

His ruling of invoking a fine on J&J did not surprise me and if anyone looking at the entire “dog and pony” show should not be surprised either…  It is no more – or less – than more fodder to help keep the opiate crisis in the headlines and this judge’s ruling goes thru the appeal process.

So here we have a SINGLE PERSON who is part of our judicial system – who have been “fighting” and/or “managing” this war on drugs for nearly FIFTY YEARS and spending close to TWO TRILLION DOLLARS fighting this war … with no end in sight.

It should not take a “rocket science” to get this verdict to be granted an appeal to a higher court and on to the Supreme Court.

J&J was found guilty of supplying raw opiate material to many pharmaceutical manufacturers … who in turn produced legal opiate medication under the oversight of the FDA and within the production quotas as established by the DEA. Exploring the industrial landscape, the implementation of safety swing gates industrial
emerges as a crucial measure, ensuring secure access and compliance with safety standards in pharmaceutical manufacturing facilities.

That is like blaming all the corn farmers in Iowa for all the high fructose corn syrup that many blame our country’s obesity and diabetes epidemic/crisis.  After all Iowa is a major source of CORN.

All involved with perpetuating the opiate crisis….. are so desperate that they are now putting forth data based on 2006 -2012 – a seven year period and the volume of legal opiate Rxs PEAKED in 2012 and have been declining every year since… and the DEA has reduced the production quotas abt 50% in the last 3 or so years… So .. docs can’t prescribe and pharmacist can’t fill … opiates that are not produced.   I have also seen some in the media quoting that 2006 – 2012 is a SIX YEAR PERIOD… not only are they using old data… they can’t even correctly count the number of years in a stated range.

 But even that… no one seems to notice or seems to care. On  the larger scope of things… this is as close to a NON ISSUE as you can get.

Johnson & Johnson ordered to pay $572 million for its role in Oklahoma’s opioid crisis

https://www.washingtonpost.com/health/johnson-and-johnson-is-responsible-for-fueling-oklahomas-opioid-crisis-judge-rules-in-landmark-case/2019/08/26/ed7bc6dc-c7fe-11e9-a4f3-c081a126de70_story.html

NORMAN, Okla. — A judge Monday found Johnson & Johnson responsible for fueling Oklahoma’s opioid crisis, ordering the health-care company to pay $572 million to remedy the devastation wrought by the epidemic on the state and its residents.

Cleveland County District Judge Thad Balkman’s landmark decision is the first to hold a drugmaker culpable for the fallout of years of liberal opioid dispensing that began in the late 1990s, sparking a nationwide epidemic of overdose deaths and addiction. More than 400,000 people have died of overdoses from painkillers, heroin and illegal fentanyl since 1999.

“The opioid crisis has ravaged the state of Oklahoma and must be abated immediately,” Balkman said, reading part of his decision aloud from the bench Monday afternoon.

“As a matter of law, I find that defendants’ actions caused harm, and those harms are the kinds recognized by [state law] because those actions annoyed, injured or endangered the comfort, repose, health or safety of Oklahomans,” he wrote in the decision.

[America’s largest drug companies distributed 76 billion oxycodone and hydrocodone pain pills]

With more than 40 states lined up to pursue similar claims against the pharmaceutical industry, the ruling in the first state case to go to trial could influence both sides’ strategies in the months and years to come. Plaintiffs’ attorneys around the country cheered the decision, saying they hoped it would be a model for an enormous federal lawsuit brought by nearly 2,000 cities, counties, Native American tribes and others scheduled to begin in Cleveland, Ohio, in October.

The DEA database: Find the data for where you live View Graphic

Balkman did not give the state everything it sought — state attorneys had asked for $17.5 billion over 30 years for treatment, emergency care, law enforcement, social services and other addiction-related needs. But the judge concluded it would cost $572 million to address the crisis in the first year based on the state’s plan. He said the state did not provide “sufficient evidence” of the time and money needed to respond after that.

At a news conference following the decision, Oklahoma Attorney General Mike Hunter described it as a “great triumph” two years in the making.

“Johnson & Johnson will finally be held accountable for thousands of deaths and addictions caused by their products,” he said. He challenged the company’s chief executive, Alex Gorsky, to “step up” and pay for treatment and other services for Oklahomans affected by substance abuse.

[Lenny Bernstein discusses the landmark Johnson & Johnson opioid case on Post Reports. “The question is, who do we blame?”]

But just moments after the judge ruled, Johnson & Johnson, which has denied wrongdoing, said it would appeal. Company attorney Sabrina Strong said at a news conference, “We are disappointed and disagree with the judge’s decision. We believe it is flawed.

“We have sympathy for those who suffer from opioid use disorder,” Strong added. “But Johnson & Johnson did not cause the opioid abuse crisis here in Oklahoma or anywhere in this country.”

Elizabeth Chamblee Burch, a professor at the University of Georgia School of Law who followed the case, said in an email that other states will almost certainly adopt some of Oklahoma’s strategy — for instance, arguing for Johnson & Johnson’s culpability because it had two subsidiaries that produced, refined and supplied the ingredients for opioids to many other companies.

But with state laws differing, it is unclear whether other plaintiffs would be successful at proving the company harmed their residents, she said.

Alexandra Lahav, a professor at the University of Connecticut School of Law, said it’s too early to predict the impact of Balkman’s decision on future cases.

“I think it’s important that people remember that this is just Oklahoma law, and it’s a lower court judge,” she said. “It hasn’t been vetted on appeal yet.”

Still, she said, the ruling may provide momentum to the idea that there is merit to these claims and encourage other states to pursue similar strategies.

As an outside observer, Lahav said, she is not convinced that Johnson & Johnson’s role as supplier of raw materials to other drug companies sufficiently connects it to the opioid crisis. But Balkman clearly accepted that, she said.

“I’m unconvinced that should be laid at Johnson & Johnson’s door,” she said.

Hunter (R) brought suit in 2017 against Johnson & Johnson and two other major drug companies, accusing them of creating “a public nuisance” by showering the state with opioids while downplaying the drugs’ addictive potential and persuading physicians to prescribe them even for minor aches and pains. Before the late 1990s, physicians reserved the powerful drugs primarily for cancer and post-surgical pain, as well as end-of-life care.

More than 6,000 Oklahomans have died of painkiller overdoses since 2000, the state charged in court papers, as the number of opioid prescriptions dispensed by pharmacies reached 479 every hour in 2017.

Johnson & Johnson’s products — a prescription opioid pill and a fentanyl skin patch sold by its subsidiary, Janssen Pharmaceuticals — were a small part of the painkillers consumed in Oklahoma. But Hunter painted the company as an industry “kingpin” because two other companies it owned had grown, processed and supplied 60 percent of the ingredients in painkillers sold by most drug companies.

“At the root of this crisis was Johnson & Johnson, a company that literally created the poppy that became the source of the opioid crisis,” the state charged.

The state also said the health-care giant actively took part in the industry’s effort to change doctors’ reluctance to prescribe opioids by mounting an aggressive misinformation campaign that targeted the least knowledgeable physicians.

The company’s “marketing scheme was driven by a desire to make billions for their pain franchise,” Hunter wrote. “To do this, they developed and carried out a plan to directly influence and convince doctors to prescribe more and more opioids, despite the fact that defendants knew increasing the supply of opioids would lead to abuse, addiction, misuse, death and crime.”

[Opioid death rates soared in the communities that were flooded with pain pills]

Oklahoma settled in March with Purdue Pharma, manufacturer of OxyContin, accepting $270 million from the company and its owners, the Sackler family, who were not named as defendants in the lawsuit. Most of that will go to a treatment and research center at Oklahoma State University, although the federal government is seeking a portion of the money. In May, two days before the trial began, the state settled with Teva Pharmaceuticals, an Israeli-based manufacturer of generic drugs, for $85 million.

The core of Johnson & Johnson’s defense during the seven-week trial was that it could not be held liable for supplying legal products and ingredients, which were highly regulated by the Food and Drug Administration, the Drug Enforcement Administration and state authorities themselves.

Company lawyers sought to rebut accusations of a misinformation campaign by attributing actions to third parties and contending that sales calls to doctors did not lead to overprescribing or the drug crisis.

“Never once, however, did the state identify a single Oklahoma doctor who was misled by a single statement Janssen made,” the lawyers said in documents filed at the trial.

As for its two subsidiaries that supplied the painkillers’ ingredients, Johnson & Johnson lawyers said that Noramco and Tasmanian Alkaloids engaged in legal commerce under the watchful eye of the DEA and in compliance with the federal Controlled Substances Act.

Legally, the trial centered on the state’s perhaps unprecedented claim the drug company created a public nuisance in the state of Oklahoma. Historically, that law has been used against loud neighbors, brothels and polluters who used their properties in ways that harmed others.

[How has your community been affected by the opioid crisis? Help us understand the data on pain pills.]

In this case, Oklahoma said the drug company’s conduct clearly endangered the health of state residents.

An Oklahoma law professor called that a novel interpretation but said it could pass legal muster. But in May, a North Dakota judge threw out a similar state lawsuit against Purdue.

The drug company’s lawyers contend the state’s argument rested on “radical theories unmoored from more than a century of Oklahoma case law.” They noted that “no Oklahoma court has ever awarded a plaintiff a cash recovery” to stop a public nuisance.

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Insulin problems and express scripts. https://t.co/MN6Zfmmn9v

— Kendall Lubay (@Infernus136) August 19, 2019

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So I recently found out I’m at I’m in liver failure I went to see The Specialist and basically I was told because I’m on opioid they will do absolutely nothing to help me giving me less than a year to live it’s insane I don’t drink I do everything I can to take care of myself this was caused by no fault of me and basically I’m being given a death sentence how is that okay

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Johnson & Johnson must pay over $572 million for its role in Oklahoma opioid crisis, judge rules

https://www-nbcnews-com.cdn.ampproject.org/c/s/www.nbcnews.com/news/amp/ncna1046476

An Oklahoma judge on Monday ordered Johnson & Johnson to pay over $572 million for pushing doctors to prescribe opioids while downplaying the risks of addiction, actions that state prosecutors said helped fuel the state’s opioid epidemic andled to more than 6,000 deaths over nearly two decades.

Oklahoma Attorney General Mike Hunter claimed in court that the sales push by Johnson & Johnson and its pharmaceutical subsidiary, Janssen, starting in the 1990s had created “a public nuisance” that led to the deaths.

J&J denied any wrongdoing, and its attorney, John Sparks, said state prosecutors had misinterpreted the public nuisance law, having previously limited it to disputes involving property or public spaces.

Download the NBC News app for breaking news and politics

Cleveland County District Judge Thad Balkman disagreed, and said that Johnson & Johnson’s “misleading marketing and promotion of opioids created a nuisance” in the state.

“The opioid crisis has ravaged the state of Oklahoma, it must be abated immediately,” Balkman said in court Monday. “For this reason, I’m entering an abatement plan that consists of costs totaling $572,102,028 to immediately remediate the nuisance.

Michael Ullmann, the company’s executive vice president and general counsel, said in a statement that J&J did not create the opioid crisis in Oklahoma and plans to appeal the decision.

“This judgment is a misapplication of public nuisance law that has already been rejected by judges in other states,” Ullman said. “The unprecedented award for the State’s ‘abatement plan’ has sweeping ramifications for many industries and bears no relation to the Company’s medicines or conduct.”

In Balkman’s full written decision, he stated that the pharmaceutical company’s sales program was designed to reach doctors multiple times throughout their careers. J&J pushed an “education” program through sales representatives, funded articles in medical journals and paid speakers.

None of these programs properly addressed the risks of addiction and there was no training provided to sales representatives on the history of opioid use or addiction, according to the court’s ruling.

“The Defendants’ opioid marketing, in its multitude of forms, was false, deceptive and misleading,” according to the written decision.

The case was seen as a litmus test for nearly 2,000 pending opioid cases before a federal judge in Ohio, especially as other pharmaceutical companies faced with similar accusations have chosen to settle.

Purdue Pharma, the privately held maker of OxyContin that has faced the brunt of the blame for the nationwide opioid epidemic, reached a $270 million settlement with the Oklahoma attorney general’s office in March. Oklahoma also settled with Teva Pharmaceutical for $85 million, just days before it went to trial against the Israeli opioid manufacturer in Cleveland County. Both companies denied any wrongdoing.

Hunter pushed the judge to force J&J to pay the state $17 billion, which would be put toward addiction treatment and prevention programs over the next 30 years. Balkman’s verdict only granted a year’s worth of the estimated cost for the program.

The judge’s written decision said that the state failed to present sufficient evidence of what time and costs would be necessary beyond the first year of the program.

During the trial, Hunter claimed that J&J and other pharmaceutical companies rushed to produce a “magic pill” in their pursuit of profits, while ignoring decades of scientific research that showed the dangers of opioids. The judge heard testimony from victims of the crisis, including a father of a college football player who died of a drug overdose.

They “embarked on a cynical, deceitful, multibillion-dollar brainwashing campaign to establish opioid analgesics as the magic drug,” Hunter told the court. “Money may not be the root of all evil but … money can make people and businesses do bad things. Very bad things.”

Hunter said Monday that his team of prosecutors proved J&J “built its billion-dollar brand out of greed and on the backs of pain and suffering of innocent people.”

“Throughout the trial our team proved what we have alleged all along, that the company used pseudoscience and misleading information that downplayed the risks of opioids leading to the worst man-made public nuisance this state and our county has ever seen: the opioid crisis,” he said.

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MORE INFORMATION:

Face Book  Pain is Pain page

https://www.facebook.com/painpainandmorepainCathyKean/photos/a.534315456707770/1436013909871249/?type=3&theater

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The Brazen Way a Chinese Company Pumped Fentanyl Ingredients Into the U.S.

Yuancheng used an army of young, perky salespeople to peddle illegal chemicals to Americans.

https://amp.theatlantic.com/amp/article/596254/

Ye Chuan Fa works in a cubicle. His small station is indistinguishable from those of the hundreds of employees at his chemical company, Yuancheng, which translates roughly to “extended success.” Founded in 2001, Yuancheng employs about 700 people and has branch offices all over China.

While most of his workers appear to be in their 20s, Ye is in his 60s, thin with a sagging face. He’s a self-professed workaholic. “I get sick the minute I stop working,” he said in a 2007 Wuhan Morning News profile, which also referenced his great wealth without putting a number on it. His main focus today is Yuancheng, which sells chemicals both to the general public and to other businesses. It offers more than 10,000 different compounds, a vast and head-scratching list, everything from food additives (including synthetic versions of cinnamon) to pharmaceuticals (including the drugs used in Viagra and Cialis) to collagen, pesticides, veterinary products, anabolic steroids, and precursor chemicals used to synthesize drugs, including fentanyl.

According to Bryce Pardo, a fentanyl expert at the Rand Corporation, the two most commonly used fentanyl precursors—think of them as ingredients—are chemicals called NPP and 4-ANPP. When I first started researching them, in early 2017, advertisements for the chemicals were all over the internet, from a wide variety of different companies. Later, I determined that the majority of those companies were under the Yuancheng umbrella.

Over a period of a year, posing as an interested customer, I messaged with or spoke to 17 Yuancheng salespeople, sometimes for hours at a time. These were wide-ranging conversations that touched on the company’s products, practices, and working environment, and even the employees’ philosophies about selling such destructive chemicals. The salespeople called themselves names like Julie, Sean, and Demi, and, according to an article in the Changjiang Daily, were recruited in part for their English abilities. One salesman, the director of Yuancheng’s Shenzhen branch, told me that his Chinese name is Chen Li, but that as a salesman he goes by Abel. “Below 10 kilograms is express delivery, above 10 kilograms by air,” he said in October 2017 when asked how the NPP and 4-ANPP packages could be sent to the United States.

Read: Trump is using the opioid crisis to build his wall

“Food additives officially,” a Yuancheng saleswoman named Alisa said when I asked what products her company specializes in. “Steroids and 4-anpp npp underground.”

“Our products are sold to the United States less,” added Chen Li. “More is sold to Mexico.” This isn’t surprising, since most illicit fentanyl used in America, where 32,000 people died from fentanyl last year, comes through Mexico. Mexican cartels lack trained chemists to make fentanyl from scratch, so they buy precursors in bulk from China. After that, making finished fentanyl is simple.

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CVS, Rite Aid, Walmart severed from main opioid trial

https://www.chaindrugreview.com/cvs-rite-aid-walmart-severed-from-main-opioid-trial/

Judge grants order in effort to simplify the case

CLEVELAND — The federal  judge overseeing the landmark opioid suit Thursday severed CVS Health entities, Rite Aid and Walmart from the main bellwether trial scheduled for October.Judge Dan Aaron Polster of the United States District Court for the Northern District of Ohio granted the order to simplify the trial and make it more manageable. “Having fewer defendants in the first bellwether trial will allow plaintiffs to provide a more coherent presentation of the specific issues involved in the opioid crisis,” he wrote. He did not set a trial date for the severed defendants, which also include Anda Inc., Discount Drug Mart, HBC Service Co., H.D. Smith LLC, and Prescription Supply Inc.

At the outset of 2018, opioid lawsuits were being filed so frequently that a judicial panel grouped all the federal cases under the stewardship of Polster.  As of late January of this year, there were 1,548 cases, brought on behalf of millions of people.

Defendants in the case included pharmacy chains, which have come under scrutiny following the release of data by the federal government detailing the spread of the opioid epidemic. Last month, thousands of documents from companies across the pharmaceutical supply chain were filed in the case. Ranging from emails to shipping reports, the documents reveal the years-long spread of billions of pills around the country. Defendants in the suit also include drugmakers and distributors.

A CVS Health spokesman said after the data release,  “The plaintiffs’ allegations about CVS in this matter have no merit, and we are aggressively defending against them. We maintain stringent policies, procedures and tools to help ensure that our pharmacists properly exercise their professional responsibility to evaluate controlled substance prescriptions before filling them. Opioid medications are only a small percentage of the overall prescriptions our pharmacies dispensed.”

“Keep in mind that doctors have the primary responsibility to make sure the opioid prescriptions they write are for a legitimate purpose,” he added.

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Have Policies Designed to Mitigate Opioid Deaths Resulted in Unethical Treatment of Chronic Pain Patients?

https://www.medium.com/@mross109/have-policies-designed-to-mitigate-opioid-deaths-resulted-in-unethical-treatment-of-chronic-pain-4cdd235c7fc4

North American doctors are presently engaged in a giant medical and social experiment dictated by both the American and Canadian governments to reduce and lower opiates for chronic pain patients. It is hoped that this practice will reduce opioid overdoses and deaths but it has not. Prescriptions are way down but deaths continue to increase. Patients who have been on high doses of opioids, who have had little negative effects from those drugs and are doing well with good quality of life, are being forced by their doctors to reduce doses often with no discussion — against their will. Some are turning to the black market and others are deciding upon suicide.

These policies defy and run counter to all that modern society has deemed to be ethical in medical research.

If this experiment was being conducted by universities, it surely would be disallowed as all research on humans must first be approved by independent research ethics boards. Any research that resulted in an increase in suffering, disability, and/or deaths of human subjects would never be approved.

These research standards arose out of WWII when the full impact of Nazi atrocities came to light. Aside from genocide, some Nazi doctors engaged in human experiments that were cruel forms of torture.

After the Nuremberg Trials, the allied nations developed the Nuremberg Code with 10 important points. The ones most relevant to what is happening today are listed below with key points in bold.

1. The voluntary consent of the human subject is absolutely essential. Chronic pain patients are not asked for consent to taper but are forced.
2. The experiment should be so conducted as to avoid all unnecessary physical and mental suffering and injury. Refusing to treat with opiates that have proven beneficial to a patient or to reduce them drastically will and is causing those patients unnecessary pain and suffering.
3. The degree of risk to be taken should never exceed that determined by the humanitarian importance of the problem to be solved by the experiment. Patients who have been doing well are put at risk of becoming worse through forced tapering.
4. Proper preparations should be made and adequate facilities provided to protect the experimental subject against even remote possibilities of injury, disability, or death. This is not being done as so many pain patients report that they have gone back to their doctor to tell them of the increased pain and suffering they are experiencing only to be ignored. In one case I am familiar with, the doctor decided to increase tapering despite the severe distress his patient was having. After the initial tapering, the patient reported increased pain and reduced functioning and the doctor told him he was going to reduce his dose even lower because the opioids were obviously not effective as he had pain. They were effective before he reduced them and then he used the increased pain caused by his lowering the dose to reduce further.
5. The experiment should be conducted only by scientifically qualified persons. The highest degree of skill and care should be required through all stages of the experiment of those who conduct or engage in the experiment. This experiment is being conducted by physicians rather than researchers.
6. During the course of the experiment the human subject should be at liberty to bring the experiment to an end if he[she] has reached the physical or mental state where continuation of the experiment seems to him[her] to be impossible. Patients are begging their doctors to stop tapering and to increase back to where they were doing well but doctors are refusing to do so.
7. During the course of the experiment the scientist in charge must be prepared to terminate the experiment at any stage, if he[she] has probable cause to believe, in the exercise of the good faith, superior skill and careful judgment required of him[her] that a continuation of the experiment is likely to result in injury, disability, or death to the experimental subject. This is not happening.

The Nurenberg Code is still considered to be the most important document in the history of the ethics of clinical research and led to the Declaration of Helsinki ratified by the World Medical Association. The notion of informed consent forms the basis of the UN Covenant on Civil and Political Rights. It also serves as the basis for the International Ethical Guidelines for Biomedical Research Involving Human Subjects proposed by the World Health Organization. Force tapering patients violates informed consent.

Every university has an Institutional Review Board which looks at research proposals and approves or rejects them based on these principles. No one can be recruited into a study unless the details of the study are fully explained to the subjects and they give their written consent. There are also requirements that if a patient gets worse or is harmed in anyway, the research is cancelled.

According to all of the above, it is reasonable to assert that chronic pain patients being forcibly tapered or denied their opiate medications and being severely harmed. This would never be approved in a university research setting but it is happening to patients every day.

The hypothesis that prescribing doctors and pain patients are the cause of the overdose crisis we are seeing is faulty and without validation in research. That is being proven over and over again as prescribing is significantly decreased but overdose deaths continue to soar. This was pointed out to Health Canada by the Chronic Pain Association of Canada. Health Canada has never responded.

The patients being harmed continue to be harmed and are powerless to stop this treatment. Some of these patients had been taking their medications with benefit and without incident for decades. There is simply no medical reason to interfere with their care and punish them with increased pain, disability and sometimes death.

The unethical treatment of patients has occurred in other instance such as the notorious “Tuskegee Experiment.” This was “an infamous and unethical clinical study conducted between 1932 and 1972 by the U.S. Public Health Service. The hidden purpose of this study was to observe the natural history of untreated syphilis; the African-American [only] men in the study were told that they were receiving free health care from the United States government.”

The “researchers knowingly failed to treat patients appropriately after the 1940s validation of penicillin was found as an effective cure for the disease that they were studying.” In other words, these men did not receive treatment for their syphilis which was left to progress for years as they suffered terribly and unnecessarily. We saw then a gross violation of the important points within the Declaration of Nuremberg.

Are we now watching history repeating itself?

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Study Confirms Cannabis Flower Is An Effective Mid-Level Analgesic Medication For Pain

https://www.news-line.com/PH_news29419_enews

Using the largest database of real-time recordings of the effects of common and commercially available cannabis products in the United States (U.S.), researchers at The University of New Mexico (UNM) found strong evidence that cannabis can significantly alleviate pain, with the average user experiencing a three-point drop in pain suffering on a 0-10 point scale immediately following cannabis consumption.

With a mounting opioid epidemic at full force and relatively few alternative pain medications available to the general public, scientists found conclusive support that cannabis is very effective at reducing pain caused by different types of health conditions, with relatively minimal negative side effects.

Chronic pain afflicts more than 20% of adults and is the most financially burdensome health condition that the U.S faces; exceeding, for example, the combined costs of treating heart disease and cancer.

“Our country has been flooded with an over-prescription of opioids medications, which then often leads to non-prescription opioid and heroin use for many people.

This man-made disaster is killing our families and friends, regardless of socio-economic status, skin tone, and other superficial human differences” said Jacob Miguel Vigil, one of the lead investigators of the study, titled “The Effectiveness of Self-Directed Medical Cannabis Treatment for Pain”, published in the journal Complementary Therapies in Medicine.

Vigil explains, “Cannabis offers the average patient an effective alternative to using opioids for general use in the treatment of pain with very minimal negative side effects for most people.”

The researchers relied on information collected with Releaf App, a mobile software program developed by co-authors Franco Brockelman, Keenan Keeling and Branden Hall. The app. enables cannabis users to monitor the real-time effects of the breadth of available cannabis-based products, which are always variable, of course, given the complexity of the Cannabis plant from which these products are obtained and use as a natural treatment for anxiety and many more.

Since its release in 2016, the commercially developed Releaf App has been the only publicly available, incentive-free app for educating patients on how different types of products (e.g., flower or concentrate), combustion methods, cannabis subspecies (Indica, Sativa, and hybrid), and major cannabinoid contents (THC and CBD) affect their symptom severity levels, providing the user invaluable feedback on their health status, medication choices, and the clinical outcomes of those choices as measured by symptom relief and side effects.

Scientifically, software like the Releaf App enables researchers to overcome the inherent limitations of government-funded clinical trials on the real-time effects of Cannabis, which are rare in general, but also often limited by onerous federal regulations, including its Schedule I status (no accepted medical use and a high abuse potential) and the mandate that investigators use the notoriously poor quality and low potency cannabis products supplied by the National Institute of Drug Abuse.

“Even just rescheduling cannabis just from Schedule I to Schedule II, i.e., classifying it with fentanyl, oxycodone, and cocaine rather than heroin and ecstasy, could dramatically improve our ability to conduct research and only would require that the DEA recognizes that accepted medical uses for cannabis exist, as clearly evidenced by our results and the flourishing medical cannabis programs in the majority of U.S. states,” pointed out co-author Sarah Stith.

Among the study’s findings the greatest analgesic responses were reported by people that used whole dried cannabis flower, or ‘buds,’ and particularly cannabis with relatively high levels of tetrahydrocannabinol, otherwise known as THC. The more recently popularized cannabinoid, cannabidiol or CBD, in contrast, showed little association with the momentary changes in pain intensity, based on the massive database explored in the study.

“Cannabis likely has numerous constituents that possess analgesic properties beyond THC, including terpenes and flavonoids, which likely act synergistically for people that use whole dried cannabis flower,” said Vigil, “Our results confirm that cannabis use is a relatively safe and effective medication for alleviating pain, and that is the most important message to learn from our results. Correct cbd dosage for ibs relieves one from stomach problems. It can only benefit the public for people to be able to responsibly weigh the true risks and benefits of their pain medication choices, and when given this opportunity, I’ve seen numerous chronic pain patients substitute away from opioid use, among many other classes of medications, in favor of medical cannabis.”

“Perhaps the most surprising result is just how widespread relief was with symptom relief reported in about 95 percent of cannabis administration sessions and across a wide variety of different types of pain,” added lead author of the study, Xiaoxue Li.

The authors do caution that cannabis use does carry the risks of addiction and short-term impairments in cognitive and behavioral functioning, and may not be effective for everyone. However, there are multiple mechanisms by which cannabis alleviates pain suffering. In addition to its anti-inflammatory properties, cannabis activates receptors that are colocalized with opioid receptors in the brain. “Cannabis with high THC also causes mood elevation and adjusts attentional demands, likely distracting patients from the aversive sensations that people refer to “pain,” explains Vigil.

“When compared to the negative health risks associated with opioid use, which currently takes the lives of over 115 Americans a day, cannabis may be an obvious value to patients. Chronic opioid use is associated with poorer quality of life, social isolation, lower immune functioning and early morbidity. In contrast, my own ongoing research increasingly suggests that cannabis use is associated with a reversal of each of these potential outcomes,” said Vigil

Source:University of New Mexico

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