“The moral test of a government is how it treats those who are at the dawn of life, the children; those who are in the twilight of life, the aged; and those who are in the shadow of life, the sick and the needy, and the handicapped.” – Hubert Humphrey
passionate pachyderms
Pharmacist Steve steve@steveariens.com 502.938.2414
Officials say cocaine is making a comeback in Pennsylvania after more than $1 billion in cocaine was seized from a container ship in Philadelphia Tuesday.
Six people have been charged in connection with the raid, which saw about 35,000 pounds of cocaine seized from the ship. According to an affidavit, members of the crew admitted to loading “bales of cocaine” onto the ship. U.S. Attorney William McSwain called it “one of the largest drug seizures in United States history” in a tweet.
The seizure coincides with a rise in cocaine prevalence across the United States, Philadelphia-based DEA Special Agent Patrick Trainor said. He attributed the resurgence to abundant harvests in South America, where he said the drugs originate. Methamphetamine has also been abundant and cheap, Trainor said.
“We certainly have noticed an increased in both drugs over the past few years,” Trainor said.
While opioids like heroin and fentanyl have dominated the conversation in Pennsylvania, Dauphin County Coroner Graham Hetrick said he’s seeing a local rise in deaths involving stimulants like cocaine.
“I see a resurgence of it,” Hetrick said.
The number of times cocaine and methamphetamine were detected during an autopsy increased in Dauphin County from 2017 to 2018, according to data from the coroner’s office. Cocaine is mentioned 24 times in 2018, and only eight times in 2017. There were also more drug-related deaths in 2018 than in 2017, according to the data.
Deaths related to cocaine and other stimulants have been on the rise for several years. A recent CDC report showed that deaths involving cocaine and other stimulants have been on the rise across all age groups. Nationwide, nearly 14,000 drug overdose deaths involved cocaine in 2017, a 34-percent increase from 2016, the CDC reported.
Opioids still have an impact on the rise in stimulant use, as Trainor and Hetrick said illicit fentanyl is being combined with stimulants cocaine with deadly effects. Trainor attributed some of those deaths to users not knowing what is in the drugs they’re taking.
“We’ve seen cases where drug traffickers themselves don’t necessarily know what they’re selling,” Trainor said.
The increase of cocaine and meth has ties to the opioid crisis, Trainor said. He noted that in some cases, opioid users take an “upper” to stave off the effects of withdrawal.
Hetrick said the rise in stimulants might have to do with the amount of resources being put toward reducing opioid use. He likened the focus on specific types of drugs to “whack-a-mole” and said that much of the money and resources going toward the opioid crisis should be instead treating addiction as a whole.
“We have an addiction crisis, we don’t have an opioid crisis,” Hetrick said.
Education and a better understanding of addiction would be more impactful on driving down the prevalence of drug use, Hetrick said. He said specific drugs are simply “tools” in a substance use disorder.
“Whether it’s stimulants, a combination of cocaine and fentanyl, or heroin itself, they’re all tools,” Hetrick said. “The conditions for addiction are within the person, and the drugs are the tools. That’s what we have to concentrate on.”
Another reason these drugs are prevalent in Pennsylvania is its location, Pennsylvania State Police Communications Director Ryan Tarkowski said.
“Pennsylvania’s unique geographic location and converging highway system make it a natural conduit for the trafficking of illicit drugs and other contraband – providing access to major cities and airports, as well as one of the largest seaports on the east coast,” Tarkowski said.
Tarkowski said collaboration between state, federal and local agencies in key in combating the flow of illegal drugs through the state.
Not every coroner across the state has seen an increase in stimulants and deaths around them.
“I’m not seeing any significant increase with stimulants in our deaths,” York County Corner Pam Gay said.
“The nine most terrifying words in the English language are: I’m from the Government, and I’m here to help. “President Ronald Reagan
It’s an oft cited quote. Some might say overused. But these words have proven to be eerily prophetic when it comes to how the governments, state and federal, have dealt with the opioid crisis. And as with most crises, there are victims. The victims can be defined as those left in the wake of all who have died from overdoses. Those who have lost loved ones or are living with someone who has become addicted. The many press reports recount the typical outcomes of an illicit drug epidemic. The numbers of deaths are staggering. The streets of once great cities are littered with hypodermic needles, and homeless encampments are rife with illicit drug dealers and addicts who use the deadly poison that they peddle. But also, the chronic pain patient who has followed all the rules, been treated by licensed medical doctors, has submitted to ever growing demands for urine, for pill counts, for actual compliance contracts and been subjected to stigma. The patients who have been totally compliant yet cut off forcibly from the only medications that have enabled them to live a quasi-normal life. These are the victims not well represented in the media. So, a group of chronic pain patients, who have gathered in closed Facebook groups for several years, decided to bring awareness to these untold stories, and the march towards the CDC in Atlanta was launched.
Last week, a group of chronic pain patients, began their trek towards Atlanta, Georgia. Folks from all walks of life, and all 50 States, unwitting allies, all headed towards the Center for Disease Control (CDC). Their mission: to raise awareness to the plight of the chronic pain patient in the wake of the fallout over the government’s handling of the opioid crisis. The location was chosen because it was the CDC who began their plummet from well controlled pain patient with an ability to perform activities of daily living, to victims of the opioid crisis, many left writhing in unfathomable pain. On Friday, they pushed their pain aside, and made their stand in the shadows of the CDC headquarters. A diverse crew, some in wheelchairs, or using walkers, or canes and others with no visible disability or injury holding signs and chanting “don’t punish pain” and “pain patients vote.” A rallying cry of desperation from a mostly forgotten group from varying socioeconomic roots but with the common history: all had been impacted by this war on opioids and the CDC’s own “guidelines for prescribing opioids for chronic pain.” To this group, the guidelines had effectively become law and the pain had become unbearable. Still, they were there to stand for those of us who couldn’t be there, either due to disability, distance, or because a growing number, unable to live with the pain, had committed suicide. They stood for all of us even though some could literally not stand.
It began seemingly benignly to the casual observer. In 2016, the CDC issued guidelines for prescribing opioids for Chronic Pain. In its entirety, the statement discusses numerous medical factors intended for the clinician under the guise of helping the physician decide how much, if any, opioid pain medication should be prescribed to his patient. Though the text of the guideline is lengthy, to the layperson who even noticed, it probably seemed innocent enough: “CDC developed and published the CDC Guideline for Prescribing Opioids For Chronic Pain to provide recommendations for the prescribing of opioid pain medication for patients 18 and older in primary care settings. Recommendations focus on the use of opioids in treating chronic pain (pain lasting longer than 3 months or past the time of normal tissue healing) outside of active cancer treatment, palliative care, and end-of-life care.” In essence, the CDC recommended that chronic pain patients not be given doses of opioids over 90 morphine medical equivalents and warned of doses above as low as 50 MMEs. I was not the casual observer. I am both a political junkie and a chronic pain sufferer, and I knew immediately there would be trouble. The fallout and the harm has been swift and vast, and has only proven to increase in the three years since publication. The government overreach in the name of these guidelines began almost immediately. And it continues to this day.
The punishment meted out for having a chronic pain condition requiring opioid medications under these circumstances has been overwhelmingly draconian. Facebook groups, gathering places for the disenfranchised, have become virtual halls of knowledge for advocates and pain patients alike. Doctors, pharmacists, and other pain patient advocates as well as pain patients use them to organize. One of our groups has nearly 10,000 members, and our membership grows daily. And the few of us with any experience on how to fight city hall, never mind the federal government, are also pain patients fighting our own battles. The challenges are many, but we’ve begun to garner attention and gain some traction.
The cost in dollars is not insignificant, either. Virtually all pain patients have suffered a similar fate. Their prescriptions have been cut or cut off. Even if they were not on the higher than 90 MME per day dosage as cited in the original CDC guidelines, they’re being cut. It’s come down from on high that opioid medications that are virtually the same as those which has been used to treat moderate to severe pain for centuries is persona non grata in America circa 2019. It’s become all too much for the average physician to deal with. It’s also more than the average chronic pain patient can deal with. There is now a group that keeps count of the suicides due to intractable, untreated or undertreated pain. I personally know of three people who have committed suicide. And several of the Facebook group administrators, myself included, have been in the position of having to deal with a suicidal chronic pain patient. That we are ill equipped for this is an understatement. Perhaps worst of all is this, it’s not working. The numbers of opioid prescriptions has decreased, and overdoses have increased. Predictably so for those in the trenches of advocacy, since this is an illicit heroin and fentanyl crisis. And it’s not going to work; prohibition never does. If it did, alcohol would not be killing more people than all opioid deaths combined.
A Dispatch analysis of prescription drug prices for the poor and disabled since the state’s latest stab at reform turns up one simple fact: No matter what laws or regulations are changed, as long as pharmacy benefit managers control Ohio Medicaid’s $3 billion drug-pricing mechanism, it will be difficult to make sure that both Ohio taxpayers and pharmacies are getting a good deal.
The analysis of more than 400,000 prescriptions from about three dozen pharmacies across the state in the first quarters of 2018 and 2019 produced four major conclusions:
• Ohio’s largest Medicaid pharmacy benefit manager, CVS Caremark, increased its rates for specialty drugs at the beginning of this year, even though the cost of many of them was dropping nationally. Along with raising the price for Ohio taxpayers, CVS benefits from the inflated cost because its PBM directs many of these prescriptions to CVS specialty-drug pharmacies. The price increases took effect as Ohio eliminated the old “spread pricing” system in which pharmacy benefit managers, a middlemen in the drug supply chain, walked away with as much as $200 million a year in profit.
• The state’s new “pass through” system has generated better results for Ohio pharmacists. The amounts they are receiving from PBMs above the pharmacies’ costs to buy Medicaid drugs more than tripled after the sweeping changes this year. The bad news: That $6.25 margin per prescription still falls well short of the standard $9.48 deemed by pharmacies as their break-even point.
• CVS Caremark’s reimbursements to Ohio pharmacies for Medicaid prescriptions are well under half those of the other pharmacy benefit manager handling Ohio Medicaid money, UnitedHealth Group’s OptumRx. Many of CVS’ reimbursements fluctuated wildly from year to year for the same drug, seemingly without relation to the actual cost of that drug.
• A plan added to the proposed state budget by the Ohio Senate last week that would earmark $100 million to ailing Ohio pharmacies might end up enriching the PBMs instead.
Pharmacy benefit managers operate as middlemen between pharmacies that dispense drugs to Medicaid recipients and Ohio taxpayers, who pay for the drugs through five private managed-care organizations that run Medicaid and hire the PBMs.
The analysis actually produced a fifth finding: Nearly six months after implementing a much-touted “pass through” drug-pricing system, the Ohio Department of Medicaid still doesn’t have basic figures on how much PBMs and pharmacies are making — or whether the new arrangement is working as planned. The system is called “pass through” because whatever amount the PBMs charge the state is supposed to be passed through to pharmacies.
The results of an analysis by a state consultant are expected next month.
Changes on the way
Ohio Department of Medicaid spokesman Kevin Walter said changes are coming.
“As Governor (Mike) DeWine stressed from the outset of his administration, ODM is committed to creating as much transparency as possible. Switching from spread pricing to the pass-through model was a first step, as are changes that will be implemented in (Medicaid) provider agreements that take effect July 1, and in the procurement process that began last week with the release of ODM’s first request for information seeking public input on the current managed care program.”
Spread pricing happened when the PBMs charged the state more than they paid pharmacies, a total that reached nearly a quarter billion dollars in the one year studied.
State Sen. Dave Burke, a Republican from Marysville who also is a pharmacist, said Medicaid officials are saying the right things, but the time has come for action on behalf of Ohio taxpayers and pharmacies, several of which are teetering on the edge of going under.
“Simply watching someone crush a business is not a policy,” he said.
Like many other pharmacists, Burke said they and the state will never get a fair shake until those who profit from Medicaid are removed from the process that sets prices.
“The entity that tells me it’s fair is the same one that sends me the bill,” he said.
The lack of information from the state about whether the Medicaid changes are working provided the main impetus for The Dispatch to obtain drug-pricing information — with all patient-identifying information removed — from pharmacies large and small across Ohio.
The analysis included only solid medications taken orally, because listed amounts for liquids, gels, creams and the like are sometimes not recorded in the same units. Of course, caution is necessary in projecting the results from fewer than 40 pharmacies in the Dispatch study to all 2,000 in Ohio that dispense Medicaid drugs.
The Dispatch conducted a similar study a year ago that showed how PBMs were making substantial money from “spread pricing,” which is the difference between what PBMs charge the state and what they pay pharmacies to dispense drugs. Later studies by the Medicaid agency’s consultant and the state auditor’s office confirmed the practice.
When asked about the large discrepancy in payments to Ohio pharmacies between the PBMs for CVS and UnitedHealth, Drew Krejci of UnitedHealth’s OptumRx corporate communication office said, “The data you have on increased OptumRx reimbursements to pharmacies speaks for itself.”
Mike DeAngelis, senior director of corporate communication for CVS, would not answer why CVS Caremark is paying pharmacies so much less than OptumRx is, nor any other questions about the company’s practices in Ohio generated by the pharmacy data.
“It is not reasonable or fair to be asked to comment on data we have not had an opportunity to review and validate. The Dispatch has spent an inordinate amount of time and effort attempting to discredit the work we do to reduce health care costs and improve health outcomes. While the paper continues to focus on context-free data pushed by other interests, we’ll continue to focus on the $145 million pharmacy benefit managers like CVS Caremark save for Ohio taxpayers annually,” he said.
The $145 million in “savings” frequently mentioned by CVS already has been debunked. It’s merely the price difference the Medicaid consultant found last year between Ohio’s current managed-care setup and a prospective fee-for-service model, and did not account for drug rebates in the latter.
A 2,300% markup?
CVS made an estimated $37 billion from specialty drugs last year — a quarter of its prescription revenue and easily the most in the country. These drugs are typically used to treat such complex conditions as hepatitis, cystic fibrosis, HIV and some cancers.
Perhaps the most egregious example is the generic form of Gleevec, known as imatinib mesylate, which is used to treat leukemia and other kinds of cancer. It’s not cheap: about $83 in 2018 for a single 400-milligram tablet, which is taken daily, per the federal government’s National Average Drug Acquisition Cost. Last year, CVS Caremark charged a 45% markup, to about $120 per pill, the pharmacy data provided to The Dispatch showed.
In early 2019, the national average dropped dramatically — as prices of drugs often do soon after a generic form hits the market — to about $14.50 a pill. But instead of reducing its price in Ohio, CVS Caremark more than doubled it. The PBM charged the state $270 per tablet — raising the markup to more than 1,700%, or more than $250 per pill — the pharmacy data show.
Antonio Ciaccia, lobbyist for the Ohio Pharmacists Association, describes what CVS did this way: “The state slapped their hand and said, ‘Stop taking money from us this way.’ They say, ‘OK, we’ll take it another way.’”
While the profit from raising the price for a big-dollar medication is obvious, a large enough markup on even a relatively inexpensive drug can add up, too. The national average was only 24 cents last year for a 20-milligram tablet of Sildenafil, which is used to treat high blood pressure in the lungs (pulmonary hypertension). But CVS Caremark charged $3.45 for each pill, a markup of more than 1,300%.
This year, the national average price of Sildenafil dropped by a third. But CVS raised its price in Ohio, generating a 2019 markup of more than 2,300%, the pharmacy data show.
Increasing revenue from specialty drugs is an explicit part of CVS corporate strategy. In a June 4 call with investors, CVS Health Corp. President, CEO and director Larry Merlo said the company is “focused on winning in the fastest-growing market segments, specifically government-sponsored programs and specialty pharmacy.”
Derica W. Rice, president of CVS Caremark, noted that the PBM’s growth has been aided by “increased utilization in specialty” drugs.
Walter of the state Medicaid agency such maneuvers by CVS will be limited starting next year.
“In order to eliminate conflicts of interest, reduce costs and expand access, ODM is requiring, beginning January 1, (managed care organizations) to accept any specialty pharmacy that meets their specific quality and service standards and can provide services at the same or lower cost compared to other in-network specialty pharmacies.”
“The boat is still sinking”
Frustrated by the Medicaid department’s failure for years to ensure that Ohio pharmacies are being reimbursed adequately, state senators allocated $100 million to the pharmacies last week.
Sen. Burke said the money is not so much a pharmacy bailout as an effort to make sure that Ohioans in inner cities and rural areas have access to neighborhood pharmacies. Without a local drugstore to provide needed medications, sick Ohioans are more likely to wind up in a hospital emergency room — the most expensive option. Besides, the federal government mandates that state Medicaid programs ensure local access to medical care, a requirement Ohio violates when, for instance, a town’s only pharmacy is allowed to close.
“Leaving your county to get a prescription filled is a ridiculous notion in the year 2019,” he said.
But Burke acknowledged that any attempt to help local pharmacies financially might be gobbled up by PBMs that manipulate their drug price list so they can pocket the money.
The House also went after PBMs in its version of the budget, albeit using a much different approach. So the two chambers’ proposals must be reconciled in a House-Senate budget conference committee this week.
Rep. Mark Romanchuk, a Mansfield-area Republican who chairs the legislature’s Joint Medicaid Oversight Committee, said that despite the substantial Medicaid changes this year, “I’m not convinced the problem’s fixed.”
Noting the tide of drugstores across Ohio that are closing, he said: “That was job one, let’s shore up our pharmacies, especially our small, independent ones. …
“We haven’t plugged the hole. The boat is still sinking; the pharmacies are still going out.”
Radiology technologist Jeff Dettbarn, alleges thousands of tests at the Iowa City VA were improperly canceled, potentially risking veterans’ lives. USA TODAY
WASHINGTON – Three Veterans Affairs health care professionals who reported patient care issues say the agency continues to try to silence them, jeopardizing veterans and undercutting a key Trump promise of whistleblower protection.
They work at different sites – in the Phoenix area, Baltimore, and Iowa City, Iowa – yet the VA response has been similar. All were stripped of assigned patient-care and oversight duties, and they suspect VA managers are retaliating against them for speaking out, and sidelining them to prevent them from discovering or disclosing any more problems with veteran health care.
In exclusive interviews with USA TODAY, their assertions contradict proclamations by agency leaders and President Donald Trump that VA employees who disclose wrongdoing at the agency are being celebrated and not scorned.
Mitchell is scheduled to testify at a congressional hearing Tuesday examining the treatment of whistleblowers at the VA. She will be joined by Iowa City CT technologist Jeffrey Dettbarn, who blew the whistle on mass-cancellations of diagnostic test orders, and Baltimore VA psychologist Minu Aghevli, who reported veterans had been removed improperly from wait lists for opioid-addiction treatment.
Mitchell said the retaliation against her and others who speak out sends a signal to other employees to keep their mouths shut and “jeopardizes the health and safety of every veteran in the system.”
“Whistleblowers who are brave enough to report problems serve as a vital safety net for veterans,” she said. “If people can’t identify problems, veterans will suffer and die. That’s what it boils down to.”
But the VA inspector general has since launched a wide-ranging investigation of the office’s handling of whistleblower cases and reports of problems.
The Government Accountability Office issued a report last July that said the office allowed officials accused of wrongdoing or retaliation to be involved in investigations of the accusations – calling into question their independence and findings. And leadership at the office has turned over multiple times, causing confusion and disruption.
The war against doctors and patients could be ended quickly with the right information to the right people. Currently the information believed is propaganda from a 20 year old government agenda. We can change that.
LETS GET STARTED ON OUR COMMUNICATION CAMPAIGN Link, time, etc. is in the picture below. The war against doctors and patients could be ended quickly with the right information to the right people. Currently the information believed is propaganda from a 20 year old government agenda. We can change that.
The main story
One of the main plans of the DoctorsofCourage membership site is to lead the charge of mass communication to the legislators. We have spent weeks if not months organizing the new 116th Congress with point and click links to their emails, Facebook pages, twitter, health staff, and phone numbers. Non-members can also participate in this campaign. We need everyone to communicate with as many legislators as possible. Communication suggestions will be posted on the general DoC site as well as the membership site. Non-members will just have to take a little more time, as they will not have the groupings ready made.
Groups of Legislators We have separated the legislators into various groups for ease of writing more specific information. Groups such as: 1. Medical professionals 2. Minorities 3. Activists 4. By party and more.
Put our Heads Together At this first webinar on starting the communication campaign, we will be discussing how to get started–how often, when, who, etc.
We need everyone to contribute to this discussion.
The Goal The 2020 election is only 16 months away. Now is the critical time to make the legislators understand that 1/3 of the population is being negatively affected by this attack on legitimate medicine by a rogue Department of Justice. Money is being wasted chasing a rabbit. We can teach them the truth and get the job done.
But one person can’t do it. It will take ALL of us working together synchronously with the same message.
An Indiana woman and about five dozen other chronic pain patients stood in front of the Centers for Disease Control Headquarters on Friday to protest the CDC Guideline on Opioid Prescribing.
The protest—officially called an assembly because the organizers secured an Assembly Permit—was mostly symbolic and drew some Atlanta media plus many more people who followed and promoted n social media.
Johnna Magers of Indiana conceived the idea. As a chronic pain patient for nearly two decades she knows well the impact the CDC Guideline and DEA pressure has meant to prescribing doctors and their patients.
“The energy was amazing,” she told us over the weekend. “This is just a start; we need a lot more people to show up in the future and make our point.”
When asked if anyone from the CDC came down from the office to talk with them, she said, “of course, not.”
She is already talking about making a trip to Washington D.C. and make the case to both elected officials and the Drug Enforcement Administration that pain patients are being hurt by the so-called “crackdown on opioids”.
“We need that CDC Guideline rescinded and for the DEA to stop terrorizing our doctors,” she said.
She also pointed out that pain patients need to literally get up out of their seats and start making more noise.
“We can’t make excuses,” she said. “Until we have the numbers of people who are talking about the issues, having conversations with elected officials and getting more attention from the mainstream media, we can’t expect any change to occur.”
She was effusive in her praise of the folks who traveled from across the country to participate in Friday’s event.
The time has come, she said, for our government to understand they are punishing people in pain.
The “assembly” (aka protest) drew praise from many pain patients who read the National Pain Report but couldn’t attend. Here’s what Fila Paragas told us:
“I am with you all in thoughts and prayers for your great efforts despite tremendous difficulties with all your conditions. Pain patients are suffering in US and elsewhere. Some are no longer around to lend their voices. Chronic Pain patients and their lives do matter! You deserve better…to be treated with dignity and respect! And more! Let your voices be heard. Thank you very much.”
Doctors across Ontario are prescribing potent opioids to patients who may otherwise overdose and die on the street supply — and they are calling on other clinicians to do the same.
They’re part of the growing safe supply movement, made up of prescribers and harm reduction advocates in Canada who are calling for access to pharmaceutical opioids as an alternative to the illicit market that has become tainted with bootleg fentanyl and carfentanil.
“We have to be willing to step outside of our comfort zone and out of the medical establishment comfort zone and say that we need to keep people alive,” said Dr. Andrea Sereda, a family physician at the London Intercommunity Health Centre in Ontario.
For the last three years, Sereda has been prescribing take-home hydromorphone tablets to select patients who are currently relying on the illicit market, most of whom are homeless and inject drugs. The effort, which she refers to as “emergency safer supply,” started with three people and has since grown to 100.
Sereda says the results have been positive. None of the patients have fatally overdosed, half of them have found housing, and they have weekly contact with healthcare providers.
“It’s not just a prescription for pills, but it’s a relationship between myself and the patient and a commitment to make things better,” Sereda told Global News. “That involves me taking a risk and giving them a prescription, but it also involves the patient committing to doing things that I recommend about their health and us working together.”
Safer supply is not a replacement for methadone or suboxone, said Sereda. It’s an option for the subset people for whom methadone and suboxone don’t work, and it serves as a bridge for people who may not be ready for those treatments.
Hers is one of the only programs of its kind in Ontario, and she hopes to see more like it. Similar efforts include prescription injectable opioid programs in Vancouver for a subset of patients for whom opioid substitution therapies such as methadone and suboxone are ineffective. Last year, another Vancouver clinic began prescribing hydromorphone tablets for patients who consume them on site with medical supervision.
Dr. Nanky Rai is one of two physicians at the Parkdale Queen West Community Health Centre in Toronto who began prescribing hydromorphone tablets last November to patients who rely on the illicit opioid market. She now prescribes to around 10 patients and she has seen an improvement in their quality of life.
Rai said she was spurred to ramp up this type of prescribing in part because of the number of people she knew who were dying from opioid overdoses linked to the contaminated drug supply.
“I’ve had people who, literally, their urine is just all carfentanil,” said Rai in an interview. “That’s really what terrified me into action. Before that, I was doing it slowly building things up. If we don’t catch this, we’re never going to be able to prescribe any drugs that are meant for human consumption that could actually compete with and address what carfentanil is doing to peoples’ bodies — for those who stay alive.”
Rai also said that the focus on slashing opioid prescriptions as a solution to the overdose crisis has been harmful for some. Not only has cutting people off of their prescriptions forced many patients to turn to the dangerous street supply, it has also impacted those who need pain control for things like medical procedures, who now have more difficulty accessing them.
Rai said that she looks forward to having her prescribing program evaluated in the future. “We recognize that we’re building as we go,” she said. “But we can’t wait in order for more research to be done in order to stop people from dying.”
Addiction experts say that primary care providers have an important role to play in the face of governments that are slow-moving or unwilling to embrace certain harm reduction measures. Sanctioned supervised consumption sites exist only in B.C., Alberta, Ontario, and Quebec. And Alberta and Ontario have recently frozen or withdrawn funding for a number of sites.
But the overdose crisis has become even more urgent as death rates continue to rise across Canada. Nationwide overdose data released earlier this week by the federal government show there were at least 4,460 opioid overdoses in Canada in 2018, up 10 per cent from the year before.
New figures released this week from Ontario’s public health agency show that 388 people in the province died of an opioid overdose last summer, down slightly from the 414 deaths during the same time the year before.
“If 11 people a day were dying of any other reason, whether it was tainted lettuce or Ebola or a virus like SARS, I think we would be mobilizing at the community to do things differently to stop that epidemic,” said Sereda. “And I think just because it’s affecting a highly-stigmatized group like drug users doesn’t mean that doctors shouldn’t come together for that collective action on this issue.”
The federal government has expressed openness to safe supply measures. In May, Health Minister Ginette Petitpas Taylor said it had approved injectable hydromorphone to treat opioid addiction. However, it is not covered under the Ontario Public Drug Plan, as it is under the equivalent program in B.C.
On Thursday, a group of more than 400 healthcare providers and researchers released an open letter to Ontario Premier Doug Ford to add high dose injectable hydromorphone to the plan so that it can be prescribed in a cost-effective way. The letter also called for the implementation of programs that provide safer drugs.
A spokesperson for the Ontario health ministry told Global News in an email that the province “takes the ongoing opioid crisis very seriously and is committed to helping people struggling with addiction to get the help that they need, when they need it.”
The province is also reviewing the federal injectable hydromorphone announcement, but that “no decisions have been made with respect to Ontario’s support for hydromorphone treatment.”
Former Liberal health minister Jane Philpott, who is currently an independent MP, was instrumental in implementing a number of federal measures to address the opioid crisis in Canada such as easing restrictions around opening supervised consumption sites.
Although health care is under provincial jurisdiction, Philpott told Global News in an interview that the federal government can be a champion for certain harm reduction approaches.
“As physicians and this entire system becomes more comfortable with the concept of safe supply,” said Philpott, “one of the things the federal government has already done and can do even more is make sure that the work that’s being done is well-documented and well-researched so that we can start to understand what best practice looks like.”
We have an estimated 40 million alcoholics and abt 100,000/yr die from the use/abuse of alcohol. That is a estimated TWENTY TIMES the number of opiate substance abusers and yet about half as many deaths as from the use/abuse of alcohol.
There is claimed that abt 1,000 people/yr die of alcohol toxicity ( OD )
Could this be that many alcoholics “know their limit” and they can always purchase their “drug of choice” and in a “pharmaceutical grade” purity ?
Logic would suggest that if we allow opiate substance abusers to have regular access to their pharmaceutical grade of opiates… would we have much fewer OD’s ? Some other countries like Portugal have tried this with great success of reduced OD’s and fewer opiate substance abusers.
Is the Portugal society that so much smarter than us… or … is our country just that PLAIN STUPID ?
A Drug Enforcement Administration database containing detailed information about the flow of opioids through the U.S. will be made available to The Washington Post and HD Media Co., the Sixth Circuit said June 20.
The DEA failed to show “good cause” for keeping the database confidential, the U.S. Court of Appeals for the Sixth Circuit said, reversing a trial court.
Nearly 1,300 states, counties, and others are plaintiffs in litigation against drug manufacturers, distributors, and sellers related to the opioid…
Kellie Martin and her husband Don were taking Christmas decorations down from the attic of their suburban Garland, Texas, home in late 2011 when their lives changed forever.
Kellie, 54, missed a step on a ladder and fell, resulting in a herniated disk in her back. After physical therapy and muscle relaxers, their family doctor recommended neurosurgeon Christopher Duntsch. The couple agreed to visit the doctor — a decision that will forever haunt Don and their two daughters.
The case of Duntsch is explored in the new Oxygen docu-series, “License to Kill,” premiering on June 23. The show, hosted by renowned plastic surgeon Dr. Terry Dubrow of “Botched,” chronicles the harrowing accounts of patients put into jeopardy by medical professionals’ insidious use of their expertise. It highlights interviews with families, medical professionals and law enforcement.
Don Martin participated in the Oxygen docuseries “License to Kill.” (Oxygen)
Duntsch was recently the subject of a true crime podcast earlier this year titled “Dr. Death” by Wondery — the same podcast network behind their hit series “Dirty John.”
“From the initial fall, it wasn’t that super great,” Don told Fox News about his wife’s injury. “It was a lingering pain. It never went away. We did all kinds of treatments to help alleviate the pain, but it just remained persistent. We were planning on going to an out of country trip, so we thought we might get this fixed before we did. And she was in more pain than she led on. I could see it. I didn’t want her to go through that if we could avoid it. That’s when we started exploring surgery options.”
The couple soon found themselves in Dr. Duntsch’s office scheduling surgery for during the elementary school teacher’s March 2012 spring break. Duntsch insisted the 45-minute procedure was routine and simple to do.
“He sounded very articulate,” reflected Don. “It sounded like he knew what he was doing. We figure it wouldn’t be an issue… He said it was a minor surgery, but that she would be OK after the procedure. A very simple, common procedure — that’s what we were hoping for. A quick recovery.”
But on the day of surgery, Don found himself waiting, not knowing what happened to Martin.
“About an hour later, I’m still sitting in the waiting room and I hadn’t heard from anybody,” he explained. “I asked one of the nurses to check and see what was going on. Then 15-20 minutes later, [Duntsch] came out. He tells me the surgery went well and she’s moving around, but was in obvious pain so they gave her more medicine. She may have to go up to the ICU or maybe stay overnight, but she was going to be OK… That’s when I called my daughters to come up to the hospital. That’s when I realized this is not good.”
The wait continued and Don agonized over Martin, wondering what was happening behind closed doors.
“I’m starting to freak out,” he said. “Something just wasn’t right because no one was telling me, ‘Hey, she’s recovering, you can come to see her.’ Instead, they’re continuing to work on her. This is going on now for two hours. My girls were holding on to hope, but I just knew something was seriously wrong.”
Don said the ICU physician, as well as Duntsch and the anesthesiologist, came to see him and the couple’s two daughters to deliver the devastating news — the beloved matriarch was dead.
“They told us they tried everything they could, but they couldn’t save her,” said Don. “That’s when the girls lost it. I lost it. That’s when the nightmare started… We didn’t get a chance to say goodbye to her. We went in there with good faith, believing in the doctors and the medical world so they could help us. Instead, they ended up turning our world upside down. It was pure misery. I was totally lost. My world just ended right then and there.”
Don Martin said he and his daughters are still trying to make sense of what happened to beloved matriarch Kellie Martin. — Oxygen
People magazine reported the medical examiner confirmed Don’s fears. It turned out Martin had bled to death after Duntsch sliced an artery. According to the outlet, Don also learned that Duntsch had earlier operated on one of the coroner’s office employees and left the man paralyzed. The Dallas County district attorney’s office would later learn that that out of 38 surgeries undertaken by Duntsch in less than two years, 33 had gone wrong. Two patients had died, one was rendered a quadriplegic and many were left with permanent injuries.
“I was angry,” said Don when he learned of Duntsch’s other victims. “I was angry at the medical world. If this doctor had previous bad outcomes, why did he still had the ability to do surgery? It was such a cover-up. As things progressed, I got angrier and angrier with the system. But by the grace of God, other doctors started voicing their opinions about [Duntsch]. But how was I going to survive? How am I going to live day by day now?”
Between 2011 and 2013, Rolling Stone previously reported, Duntsch was employed by four Dallas-area hospitals and nearly all of his patients, those who survived, came out in far worse shape than ever before.
Don Martin still wonders why Christopher Duntsch was able to get away for so long. (Oxygen)
During the trial, Dallas surgeon Randall Kirby, who assisted on one of Duntsch’s surgeries in 2012, told jurors he sent information to the Texas Medical Board, warning them of Duntsch’s botched procedures. D Magazine shared that despite receiving complaints dating back to 2012, the Texas Medical Board reportedly didn’t revoke Duntsch’s privileges until 2013. Texas Observer clarified that the Texas Medical Board is “limited” in its ability to investigate malpractice, which could have possibly resulted in the delay.
According to records, Duntsch was booked into the Dallas County Jail in 2015. He was charged with five counts of aggravated assault causing serious bodily injury and one count of injury to a child, elderly or disabled person.
D Magazine reported that in July 2016, the Dallas County District Attorney’s Office followed through and a grand jury returned five indictments of aggravated assault and one of harming an elderly person. Duntsch pleaded not guilty and alleged in emails that he was at the center of “a vast conspiracy to bilk money from the hospitals where he practiced.”
Dallas-based surgeon Christopher Duntsch was also the subject of a Wondery podcast titled “Dr. Death.” (Dallas County Jail)
The indictment accused Duntsch of wide-ranging malpractice, including improper placement of screws and plates along patients’ spines, a sponge left in one patient, and a major vein cut in another. Records also showed that Duntsch operated on the wrong part of a patient’s spine, damaged nerves and left one woman with chronic pain and dependent on a wheelchair.
At the time, Duntsch was struggling financially and had racked up a series of arrests, including stealing Walmart merchandise.
During the trial, prosecutors said Duntsch’s hands and surgical tools amounted to “deadly weapons,” and contended that he “intentionally, knowingly and recklessly” harmed up to 15 of his patients. Prosecutors also claimed that in a 2011 email to a girlfriend, Duntsch said he would “become a cold-blooded killer.”
Dallas surgeon Randall Kirby says his former colleague, Dr. Christopher Duntsch, managed to commit crimes so heinous that patients everywhere are still struck by fear when they hear about the case for the first time. — Oxygen
However, Duntsch’s attorneys argued that he was not a criminal but just a lousy surgeon committing malpractice in chaotic operating rooms in hospitals in Dallas and its northern suburbs. They also said the tone of the email in question was unclear and could have been meant as sarcasm.
The New Yorker reported Duntsch was ultimately stopped after the combined involvement of the Dallas Country district attorney, an attorney, a journalist, and the state medical board with the efforts initiated by Kirby and Dr. Robert Henderson, a veteran surgeon at the Dallas Medical Center.
In 2017, a jury sentenced Duntsch to life in prison for maiming patients who had turned to him for surgery to resolve debilitating injuries. The decision came almost a week after the Dallas County jury convicted Duntsch of first-degree felony injury to an elderly person.
But life for Don and his family still isn’t easy.
“I’m not gonna lie, I think this puts a strain on our relationship a little bit,” said Don about his daughters. “We were such a close-knit family. It was difficult for them. It was difficult for all of us. They were trying to be careful around me, trying not to say anything or do anything that will upset me. My whole lifestyle has changed. Everything is different now. I look at life differently totally differently. Life is just too precious, too short. We can’t take the little things for granted. We’re just trying to make the best of each day.”
Don hopes viewers will be compelled to conduct no-nonsense on any physician or surgeon they’re considering — and to never take any kind of procedure for granted.
“Get a second opinion no matter what,” he said. “Evaluate everything to make sure you really want to do this surgery. Explore all options. And realize that no surgery is a routine, simple surgery. Everything can be a life or death situation.”
“License to Kill” premieres June 23 at 7 p.m. on Oxygen. The Associated Press contributed to this report.
CDC Chronic Pain Protest Called A “Start”
The protest—officially called an assembly because the organizers secured an Assembly Permit—was mostly symbolic and drew some Atlanta media plus many more people who followed and promoted n social media.