“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
In the midst of the opioid crisis, drug rehabilitation and treatment facilities might be more popular than ever. Mother Jones conducted a 5-month investigation into American Addiction Centers (the only such chain that’s publicly traded) to highlight the for-profit rehab ecosystem in the U.S.
Mother Jones found myriad problems with the company’s business model and outcomes, portraying it as a money-making machine that failed its patients with allegations of neglect and death. It’s now facing multiple lawsuits.
One instance: Cody Arbuckle, a 23-year-old man, was living in an AAC “therapeutic recovery home” when he died from an Imodium overdose, a coroner determined. Police reports and a lawsuit allege that staff at the facility didn’t check on Arbuckle for hours. The lawsuit also claims that call center representatives, who received a commission until last summer, routinely lied to potential patients about facilities and treatment, even promising one-on-one time with a doctor when, in fact, patients wouldn’t see one at all. Arbuckle’s is just one of many patient deaths Mother Jones found at AAC facilities. AAC said its mortality rate was lower than the industry average but didn’t provide numbers.
AAC’s CEO, Michael Cartwright, said it was “a lie” that patients weren’t looked after.
SOUTH BEND, Ind – The 525 Foundation held its annual gala on Thursday to bring awareness and help change the opioid crisis.
“We are here to remember Nick and Jack and the thousands of others who unknowingly dying at hands of prescription drugs,” 525 Foundation gala emcee Maureen McFadden said.
The foundation was formed in 2016 a year after Mike and Becky Savage lost their sons due to opioid use at a graduation party.
525 Foundation Co-founder Becky Savage explained the tragic events.
“The 525 foundation started about three years ago, it was about a year after we lost our sons from prescription drug misuse they were at a graduation party where they decided to participate in experimentation of prescription medication about a year later we thought you know what we should take their story and use their story to help other people so that this doesn’t happen to somebody else,” Savage said.
There were over 300 people in attendance at Thursday’s gala.
Former NFL Quarterback Terry Bradshaw attended and explained how he heard about the foundation and its message to children.
“It’s a message that has to be told and it has to be told and told and told we have to constantly remind our children of the danger of drugs,” Bradshaw said.
One of the foundations efforts is putting drug drop-off boxes in elect Martin’s to help get prescription pills off the streets
“525 makes, I think it should make everyone realize that the opioid epidemic attacks everyone in our community,” St. Joseph County Prosecutor Ken Cotter said.
According to event organizers Thursday’s gala raised approximately $80,000 to help fight for change to the opioid crisis
It is reported that we currently spend 81 billion/yr in fighting the war on drugs… The amount that this gala raised would be about what we now spend every ONE-HALF SECOND in fighting the war on drugs. That $80,000 would purchase the abstinence medication Vivitrol to treat 4-5 substance abusers for ONE YEAR.
I wonder if these two teenagers had gotten into the liquor cabinet at the house where the graduation party was held and had died of alcohol toxicity or drove home in a drunken state and had a accident that killed both of them… if their parents would have created a foundation to help change alcoholism that kills about 100,000 people every year ?
No mention of the person(s) who brought the drugs to the party… NO CONSEQUENCES ?
I feel sorry about their loss, but personal responsibility should be a primary concern and the consequences for a person’s lack of personal responsibility is not something that our society can change, no matter how much many wish that we could.
Since the Centers for Disease Control and Prevention (CDC) released its Guideline for Prescribing Opioids for Chronic Pain in 2016,1 the medical and health policy communities have largely embraced its recommendations. A majority of state Medicaid agencies reported having implemented the guideline in fee-for-service programs by 2018, and several states passed legislation to increase access to nonopioid pain treatments.2 Although outpatient opioid prescribing had been declining since 2012, accelerated decreases — including in high-risk prescribing — followed the guideline’s release.2,3 Indeed, guideline uptake has been rapid. Difficulties faced by clinicians in prescribing opioids safely and effectively, growing awareness of opioid-associated risks, and a public health imperative to address opioid overdose underscored the need for guidance and probably facilitated uptake. Furthermore, the guideline was rated as high quality by the ECRI Guidelines Trust Scorecard. In addition, the CDC (including the authors of this Perspective, who were also authors of the Guideline) engaged clinicians, health systems leaders, payers, and other decision makers in discussions of the guideline’s intent and provided clinical tools, including a mobile application and training, to facilitate appropriate implementation.4
Efforts to implement prescribing recommendations to reduce opioid-related harms are laudable. Unfortunately, some policies and practices purportedly derived from the guideline have in fact been inconsistent with, and often go beyond, its recommendations. A consensus panel has highlighted these inconsistencies,5 which include inflexible application of recommended dosage and duration thresholds and policies that encourage hard limits and abrupt tapering of drug dosages, resulting in sudden opioid discontinuation or dismissal of patients from a physician’s practice. The panel also noted the potential for misapplication of the recommendations to populations outside the scope of the guideline. Such misapplication has been reported for patients with pain associated with cancer,5 surgical procedures,5 or acute sickle cell crises. There have also been reports of misapplication of the guideline’s dosage thresholds to opioid agonists for treatment of opioid use disorder. Such actions are likely to result in harm to patients.
We need better evidence in order to evaluate the benefits and harms of clinical decisions regarding opioid prescribing, including when and how to reduce high-dose opioids in patients receiving them long term. The CDC developed the guideline on the basis of the best available evidence, with input from a multidisciplinary group that included experts in pain management as well as representatives of patients and the public. In situations for which the evidence is limited, it is particularly important not to extend implementation beyond the guideline’s statements and intent. And yet in some cases, the guideline has been misimplemented in this way.
For example, the guideline states that “Clinicians should…avoid increasing dosage to ≥90 MME [morphine milligram equivalents]/day or carefully justify a decision to titrate dosage to ≥90 MME/day.”1 This statement does not address or suggest discontinuation of opioids already prescribed at higher dosages, yet it has been used to justify abruptly stopping opioid prescriptions or coverage.5 This recommendation also does not apply to dosing for medication-assisted treatment for opioid use disorder. The CDC based the recommendation on evidence of dose-dependent harms of opioids and the lack of evidence that higher dosages confer long-term benefits for pain relief. However, we know little about the benefits and harms of reducing high dosages of opioids in patients who are physically dependent on them.
Patients who are able to successfully taper their opioid use are likely to have a lower risk of overdose, and evidence is accumulating that they might experience reduced pain.4 Other patients may find tapering challenging; could face risks related to withdrawal symptoms, increased pain, or unrecognized opioid use disorder; and if their dosages are abruptly tapered may seek other sources of opioids or have adverse psychological and physical outcomes. Policies should allow clinicians to account for each patient’s unique circumstances in making clinical decisions.
The guideline offers guidance for caring for patients who are already taking opioid dosages of 90 MME or more per day long term, including guidance on when tapering the dose might be appropriate, the importance of empathetically reviewing risks associated with continuing high-dose opioids, collaborating with patients who agree to taper their dose, maximizing nonopioid treatment, and tapering slowly enough to minimize withdrawal symptoms. Patients exposed to high dosages for years may need slower tapers (e.g., 10% per month, though the pace of tapering may be individualized).1 Success might require months to years. Though some situations, such as the aftermath of an overdose, may necessitate rapid tapers, the guideline does not support stopping opioid use abruptly.1
Guidelines can improve patient outcomes when they lead to policies that reduce harm, while offering support and coverage for underused services (e.g., nonpharmacologic strategies, naloxone coprescribing, and treatment for opioid use disorder). However, policies invoking the opioid-prescribing guideline that do not actually reflect its content and nuances can be used to justify actions contrary to the guideline’s intent. The CDC has engaged quality-improvement organizations, payers, federal partners, state health departments, and others in discussions to encourage adherence to recommendations while avoiding actions that might cause harm. For example, the CDC worked with the American Society of Addiction Medicine to clarify that dosage thresholds in the guideline should not direct dosing of medication-assisted treatment for opioid use disorder.
Even guideline-concordant care can be challenging. Implementing recommendations with individual patients takes time and effort. An unintended consequence of expecting clinicians to mitigate risks of high-dose opioids is that rather than caring for patients receiving high dosages or engaging and supporting patients in efforts to taper their dosage, some clinicians may find it easier to refer or dismiss patients from care. Clinicians might universally stop prescribing opioids, even in situations in which the benefits might outweigh their risks. Such actions disregard messages emphasized in the guideline that clinicians should not dismiss patients from care, which can adversely affect patient safety, could represent patient abandonment, and can result in missed opportunities to provide potentially lifesaving information and treatment.1
Effective implementation of the guideline requires recognition that there are no shortcuts to safer opioid prescribing (which includes assessment of benefits and risks, patient education, and risk mitigation) or to appropriate and safe reduction or discontinuation of opioid use. Starting fewer patients on opioid treatment and not escalating to high dosages in the first place will reduce the numbers of patients prescribed high dosages in the long term. In the meantime, clinicians can maximize use of nonopioid treatments, review with patients the benefits and risks of continuing opioid treatment, provide interested and motivated patients with support to slowly taper opioid dosages, closely monitor and mitigate overdose risk for patients who continue to take high-dose opioids, and offer or arrange medication-assisted treatment when opioid use disorder is identified. The CDC offers several tools to assist, including a pocket guide on tapering, a mobile app and online training with motivational interviewing components, and information about nonopioid treatments for pain.4 We are also working to identify ways to integrate recommendations into medical education and to support best practices among the next generation of medical professionals.
Appropriate implementation of the guideline includes maximizing use of physical, psychological, and multimodal pain treatments. However, these therapies have not been used, available, or reimbursed sufficiently. The CDC has supported research to better define the evidence and coverage gaps for nonopioid pain treatments and has articulated the need to improve insurance coverage.2,4 Efforts to support more judicious opioid use will become more successful as effective nonopioid treatments are increasingly available and used.
The CDC is evaluating the (intended and unintended) impact of the guideline and other health system strategies on clinician and patient outcomes and is committed to updating recommendations when new evidence is available. The CDC is funding the Agency for Healthcare Research and Quality to conduct systematic reviews on the effectiveness of opioid, nonopioid pharmacologic, and nonpharmacologic treatments for acute and chronic pain. Results of these reviews will assist in identifying research priorities and determining when evidence gaps are sufficiently addressed to warrant a guideline update or expansion. Until then, we encourage implementation of recommendations consistent with the guideline’s intent.
Statement attributable to Patrice A. Harris, M.D. President-elect of the American Medical Association Chair, AMA Opioid Task Force
“The AMA appreciates that the CDC recognizes that patients in pain require individualized care and that the agency’s 2016 guidelines on opioids have been widely misapplied. The guidelines have been treated as hard and fast rules, leaving physicians unable to offer the best care for their patients.
“The CDC’s clarification underscores that patients with acute or chronic pain can benefit from taking prescription opioid analgesics at doses that may be greater than the guidelines or thresholds put forward by federal agencies, state governments, health insurance companies, pharmacy chains, pharmacy benefit managers and other advisory or regulatory bodies.
“The AMA continues to urge physicians to make judicious and informed prescribing decisions to reduce the risk of opioid-related harms. Physicians began taking steps to reduce opioid prescribing even before the CDC released its guidelines. There has been a 22 percent nationwide decrease in prescription opioid prescriptions between 2013 and 2017, and indicators point to continued decreases.
“The guidelines have been misapplied so widely that it will be a challenge to undo the damage. The AMA is urging a detailed regulatory review of formulary and benefit design by payers and PBMs to ensure that patients have affordable, timely access to medically appropriate treatment, pharmacologic and non-pharmacologic. The nation’s physicians will work with CDC so our patients receive comprehensive, multidisciplinary, multimodal pain care based on medical science and effective clinical practice.”
###
Editor’s note: The AMA Opioid Task Force is chaired by AMA President-elect Patrice A. Harris, M.D., M.A. The AMA convened more than 25 national, state, specialty and other health care associations in 2014 to form the AMA Opioid Task Force to coordinate efforts within organized medicine to help end the nation’s opioid epidemic. Additional information on the AMA Opioid Task Force is available here. Real-time updates on the AMA’s work on opioids is accessible here.
“In situations for which the evidence is limited, it is particularly important not to extend the implementation beyond the guideline’s statements and intent. And yet in some cases, the guideline has been misimplemented in this way,” Deborah Dowell, MD, MPH, of the CDC, and colleagues wrote.
The following inconsistencies with the guidelines were recently identified by a consensus panel, researchers wrote:
Applying the guideline to patients engaging in active cancer treatment, experiencing acute sickle cell crises or post-surgical pain and/or those participating in medication-assisted treatment for opioid use disorder;
Ceasing opioids that have already been prescribed at doses of 90 morphine milligram equivalents a day or more; and
Abrupt tapering or sudden stopping of opioid use.
The CDC Guidelines for Prescribing Opioids for Chronic Pain are not consistently followed, putting patient health and safety at risk, according to a perspective recently published in The New England Journal of Medicine.
Source:Adobe
The NEJM report is not the first to suggest possible misuses of the CDC opioid guidelines. Healio Primary Care Today reported earlier this year that though the CDC guidelines were not meant to be model legislation for states to act on, 28 states did so.
In a separate press release, the AMA said it “welcomed” the findings reported by Dowell, et al.
“The AMA appreciates that the CDC recognizes that patients in pain require individualized care and that the agency’s 2016 guidelines on opioids have been widely misapplied. The guidelines have been treated as hard and fast rules, leaving physicians unable to offer the best care for their patients,” Patrice A. Harris, MD, the organization’s opioid task force chair said in a statement.
She added that reversing the harm by such inaccuracies will be a “challenge,” and suggested some steps for facilitating the process. “The AMA is urging a detailed regulatory review of formulary and benefit design by payers and [pharmacy benefit managers] to ensure that patients have affordable, timely access to medically appropriate treatment, pharmacologic and non-pharmacologic. The nation’s physicians will work with CDC so our patients receive comprehensive, multidisciplinary, multimodal pain care based on medical science and effective clinical practice.”
Dowell and colleagues wrote in the NEJM piece that clinicians are encouraged to use the CDC’s pocket guide to assist them in tapering methods, its app and website that provide motivational interviewing tips, and its information about nonopioid treatments for pain.
Physicians are also encouraged to bookmark Healio’s Opioid Resource Center. This collection of news articles and features covering multiple medical specialties provides the latest information on the opioid crisis including treatment strategies, FDA decisions regarding treatments and other important, related announcements.
The CDC is “working to identify ways to integrate recommendations into medical education and to support best practices among the next generation of medical professionals,” Dowell and colleagues wrote. – by Janel Miller
Disclosures : The authors report being among the authors of the 2016 CDC Guideline for Prescribing Opioids for Chronic Pain.
Jeff DickSince spine surgery I have chronic pain but I refuse to take opioids. I don’t even take Tylenol. That means I have difficulty understanding how people can get hooked. It’s a good thing I will never be in a position to make the rules. I would prohibit a second refill of any addictive drug. If the patient is in that much pain something is physically wrong. Rather that mask the pain, fix the damn problem.
Steve AriensI guess all chronic pain pts are lucky that you are not in the position to make the rules… unfortunately, we have way too many in the position to make the rules – that are as ignorant as you are about human health and treatment. what medical science knows about the human system is greatly dwarfed by what it doesn’t know… and apparently you are a good example … our medical science cannot fix STUPID !
Jamie HubertJeff Dick 1) You have a VERY narrow world view.
2) You have no comprehension of how the country’s or worlds medical and financial systems work.
3) Every BODY is different. …See More
Jeff DickWow, the bleeding hearts are out tonight. You all seem absolutely anxious to get millions of people addicted just so they won’t have to feel a little pain. Your preference is turn them into a dependent zombie. Your cure, is many times worse than the disease.
The above is comments from someone who believes that NO ONE should have more than one Rx of opiates regardless of their pain. I put the link to his facebook page on the top of this page. Apparently our health care system will never make any attempt to cure STUPID ?
State is placing persons who are involuntarily committed to treatment – the section 35 process – in jail or prison even though no charges have been levied against them
Sheriff Nick Cocchi, left, on his way to visit men civilly committed for drug or alcohol abuse at the Hampden county jail in Ludlow, Massachusetts. Photograph: Josh Wood/The Guardian
The scene plays out every day in Massachusetts, thousands of times a year.
A loved one is addicted to opioids. Their life is spinning out of control as they use more and more. Their family panics. Rehab can be unaffordable – and it may require waiting for a spot. But they need to get their loved one somewhere they can’t use before it’s too late.
It’s about now that they might consider section 35, a process in Massachusetts by which persons abusing drugs or alcohol can be involuntarily committed to treatment for up to 90 days after a family member, guardian, law enforcement officer or doctor petitions a judge. Many states have similar laws in place and have turned to them in battling the opioid crisis gripping the nation.
But in Massachusetts, involuntarily committed men can end up in jail or prison even though no charges have been levied against them.
That’s how Jim, a 29-year-old student, arrived at the Hampden county jail in the western Massachusetts town of Ludlow in March after overdosing on opioids. Despite being forced into jail with no charges, he told the Guardian he was glad to be there.
“I’ve never been in trouble with the law, but it was absolutely necessary for a cop to come to the house, put me in handcuffs and take me here,” he said.
Eight days into his stay, he said jail was “the best thing that’s probably ever happened to me”.
As Massachusetts struggles against an opioid crisis that kills five times as many people than automobile accidents every year in the state, the placement of civilly committed men in correctional facilities has emerged as one of the most controversial tactics to confront addiction in the state – and one not seen anywhere else in the nation.
To proponents, the section 35 process is seen as lifesaving, putting people in a place where they absolutely cannot get drugs and where they cannot simply walk out. But its detractors say that forced rehabilitation does not work, that putting men in correctional facilities is unconstitutional and that putting patients in prison settings is detrimental to recovery and increases the risk of relapse once patients are released.
Women were once held in correctional facilities in Massachusetts for addiction, but after an ACLU lawsuit, the state ended the practice in 2016.
But the state has ramped up its incarceration of civilly committed men. According to Prisoners’ Legal Services, a not-for-profit that has been a key opponent of the practice, Massachusetts places more than 2,000 men involuntarily committed for substance abuse in correctional facilities per year.
The Hampden county jail wing looks like a jail, but the people here are patients, not inmates, and have been charged with no crime. Photograph: Josh Wood/The Guardian
In March, PLS filed a lawsuit against the department of correction and department of public health on behalf of 10 unnamed patients being held at the Massachusetts Alcohol and Substance Abuse Center (Masac), a facility operated by the DoC in the town of Plymouth.
The lawsuit charges that holding the men in correctional facilities is unconstitutional, constitutes unlawful discrimination on the basis of gender and disability and is overall detrimental to recovery. They also describe an abusive environment where patients are “routinely” humiliated by correctional officers (COs) and where patients lack access to opioid substitution medications such as Suboxone.
“These people are being shamed and stigmatised on the basis of a disease that’s acknowledged as a disability,” said Bonnie Tenneriello, PLS staff attorney.
One of the unnamed plaintiffs said officers called patients pussies, bitches, junkies and crackheads while telling him that his “mother is a whore”.
Another plaintiff described how during detox, his roommate urinated and defecated on himself, but that nobody cleaned it up.
Others described being too afraid to call their employers or loved ones as all phone calls coming from the facility inform the person being called that they are receiving a call from a correctional facility.
PLS says patients have been sent to solitary confinement for seemingly minor offences like smoking a cigarette, not answering questions or taking extra milk with their meals.
“All of that is counter-therapeutic, all of that is traumatising, all of that is telling people you are not a full citizen, you are not to be trusted, you are a bad person,” said Tenneriello of placing patients in correctional facilities.
A cell – or bedroom – in the wing for civilly committed men at the Hampden county jail. While the facility is locked, cells remain unlocked. Photograph: Josh Wood/The Guardian
‘It’s a jail mentality’
Joel Kergaravat, 36, was hooked on heroin and crystal meth when his mother petitioned him to be sectioned last summer. They both thought that sectioning him would mean rehab, but instead he was put in restraints and loaded into a hot van for a long drive to Masac.
His experience at Masac appeared to mirror allegations laid out in the lawsuit.
Once he got to Masac, he did not have access to detox medications. “It’s barbaric not to give people that medication, because you’re basically vomiting and shitting yourself for six days,” he said. “That’s what happens. It’s not pretty.”
Inside, he said guards were abusive. He felt the place was unsanitary and unclean and worried about getting sick. Patients would get into fistfights.
“It’s a jail mentality,” he said. “They have you in a prison setting so people act accordingly.”
When he got out, he was traumatized. He got back on drugs and at one point tried to kill himself by overdosing – a result, he says, of his experience at Masac.
“If you’re going to force people into treatment, that’s fine, put them into treatment,” he said. “You can’t just rename a prison or a section of a prison and call it treatment.”
A sheriff champions section 35
The Hampden county sheriff, Nick Cocchi, might be the biggest proponent of section 35 in the state.
Cocchi views his mission as a rehabilitative one. His COs don’t carry weapons of any kind and those on the section 35 wing don uniforms consisting of polo shirts – an attempt to look less guard-like. He keeps a folded, ageing piece of paper in his pocket that lists the names of those that have died at the jail in the 26 years he has been working there. When western Massachusetts residents call him and send him Facebook messages pleading for advice about loved ones who have been trapped by addiction, he invites them to his office, even if it is a weekend. Men who have previously been sectioned call him up when they are relapsing.
Cocchi says that when done right, forced rehab works.
His enthusiasm about section 35 was born out of a desire to provide treatment closer to home for residents of western Massachusetts.
“You serve no purpose taking somebody two and a half hours from home, detoxing them and then saying ‘here’s a bus ticket to get back to where you’re going.’ Where’s the support?” he said. “There’s no support. And when there’s no support, there’s relapse.”
Sheriff Nick Cocchi says that done right, forced rehab works. If Massachusetts stops allowing correctional facilities to hold men civilly committed for drug and alcohol abuse, he says it will ‘devastate’ the state. Photograph: Josh Wood/The Guardian
He said the kind of abusive treatment outlined against Masac in the lawsuit brought by PLS doesn’t happen at his jail. He said that there need to be reforms to the section 35 process, but that his facility is “second to none” in the state.
Recently the gregarious sheriff brought the Guardian into the section 35 wing, walking in with a five-month-old bull mastiff puppy named Brooklyn.
“What’s up guys?” he beamed at the patients – or “clients” as they are referred to in the jail administration’s parlance. “I don’t want anyone to panic – this is not a drug sniffing dog!”
The wing appeared clean and orderly. The patients wore a uniform of brown pants and yellow or blue T-shirts with inspiring mottos like “recovery works” and “one day at a time” on them. They appeared friendly with the sheriff and the COs, stopping them to share their thoughts and concerns about their time on the unit.
Several patients eagerly lined up to speak to the Guardian about their experience at the jail, all saying positive things. Many were optimistic that being closer to home, having counseling about their discharge plan and having access to advice after they were out would mean it would be easier to stay off drugs or alcohol once released.
Some had spent time at Masac in Plymouth and said their current surroundings were much better.
Jim, the 29-year-old student who was sectioned after an overdose, said: “The COs don’t treat you like inmates, they treat you like a patient essentially.”
The wing has only been receiving section 35 patients since May, but Cocchi says he is confident that statistics will eventually show that his program has a higher success rate than any other treatment facilities.
“There’s also a group out there that says forced treatment doesn’t work – when you force someone to go into treatment, it doesn’t work,” he said. “That is absolutely false.”
If people trying to put an end to correctional facilities holding civilly committed men are successful, Cocchi says “they will devastate the commonwealth of Massachusetts, specifically western Massachusetts right now … And I will not lay down on that.”
‘Setting them up to die’
But opponents of jailing section 35 patients say that even if the abuses laid out against Masac are not present at a correctional facility, keeping civilly committed men there is wrong and dangerous.
“No matter how well run any prison might be, we’re saying that it’s a disease,” said Tenneriello, the PLS attorney. “Putting people in prison because they have a disease is fundamentally wrong”
Leo Beletsky, an associate professor of law and health sciences at Boston’s Northeastern University is an expert on the opioid epidemic and sits on the state’s section 35 commission.
He points to studies, like one by the Massachusetts department of public health, that show that persons recently released from incarceration are 120 times more likely to die of an opioid overdose than members of the general public.
“By putting people in correctional settings, we’re essentially setting them up to die,” he said.
Physician Sarah Wakeman, an addiction medicine specialist and medical director of the Substance Use Disorders Initiative at Boston’s Massachusetts general hospital, said those leaving forced rehab are at particular risk for overdosing given they did not want to be there in the first place and have lowered their tolerance.
To Wakeman, more focus needs to be placed on making sure that voluntary treatment for substance abuse is more readily accessible.
“The reality is that tough love is not a useful intervention to help a person suffering from addiction,” she said.
Beletsky said the section 35 system remains popular as it is much easier to access than voluntary treatment programs.
“Section 35 in many ways is the path of least resistance for getting into treatment,” he said. “It’s immediate, it’s free, it requires no navigation.”
It “illustrates how broken our systems of care are,” he said. “In many ways it’s easier to put somebody away than have them access normal healthcare.”
In 1917 the DOJ declared that opiate addiction was a CRIME and not a DISEASE and any prescriber treating/maintaining a opiate addiction would be jailed.
So it would appear that that declaration did not bear the weight of law.. or these people would have been jailed and charged with a CRIME.
This program seems to parallel what is – and has been done – with the Civil Asset Forfeiture Act where 85% of the people who have had their assets confiscated and no charges were ever filed and most people are lucky to get MAYBE half of the dollars confiscated and if other assets that were confiscated and liquidated (sold at auction) may get little or nothing of what the assets were actually worth.
There are several states that have involuntary mental health admission – in CALF it is referred to as a 5150 and in FL it is referred to as the Baker Act, but the involuntary mental hold is 72 hrs.
Generally “abstinence rehab” has a 5% success rate because pts who have been provided opiates for a long period of a couple of months and are cut off of their medication – of course – does into withdrawal because their prescriber did not properly wean the pt off their opiates and the fact that they are suffering withdrawal symptoms they are told that they are addicted., and when they are properly weaned off their opiates… they turn out that they were never actually “addicted”.
I find it interesting that ACLU sued the state over the same treatment for woman and the state loss and the state discontinued this treatment ONLY FOR WOMEN. What happened to EVERYONE IS EQUAL ? and is supposed to be treated equally ?
Alvogen, Inc. is voluntarily recalling two lots of Fentanyl Transdermal System 12 mcg/h transdermal patches to the consumer level. A small number of cartons labeled 12 mcg/h Fentanyl Transdermal System patches contained 50 mcg/h patches. The 50 mcg/h patches that were included in cartons labeled 12 mcg/h are individually labeled as 50 mcg/h. This transdermal system is manufactured by 3M Drug Delivery Systems, St. Paul, MN.
Application of a 50 mcg/h patch instead of a prescribed 12 mcg/h patch could result in serious, life threatening, or fatal respiratory depression. Groups at potential increased risk could include first time recipients of such patches, children, and the elderly. To date, Alvogen Inc. has not received any reports of adverse events related to this issue.
The product is indicated for the management of pain in opioid tolerant patients and is packaged in primary cartons of five individually wrapped and labeled pouches. The affected Fentanyl Transdermal System lots include:
Lot 180060 of Fentanyl Transdermal System, 12 mcg/h, expiration date 05/2020.
Lot 180073 of Fentanyl Transdermal System, 12 mcg/h, expiration date 06/2020.
The mislabeled product is packaged in a 12 mcg/h primary carton. These lots of Fentanyl Transdermal System were distributed Nationwide to the pharmacy level.
See images example for lot 180073.
Alvogen Inc. is notifying its distributors and direct customers by certified letter and is arranging for return and replacement of all recalled products. Pharmacies are requested not to dispense any product subject to this recall. Patients that have product subject to this recall should immediately remove any patch currently in use and contact their health care provider. Patients with unused product should return it to point of purchase for replacement.
Questions regarding this recall should be directed to Alvogen Customer Complaints by calling 866-770-3024 or sending an e-mail to pharmacovigilance@alvogen.com from Monday to Friday from 9:00 am to 5:00 pm EST. Consumers should contact their physician or health care provider if they have experienced any problems that may be related to taking or using this drug product.
Adverse reactions or quality problems experienced with the use of this product may be reported to the FDA’s MedWatch Adverse Event Reporting program either online, by regular mail or by fax.
Regular Mail or Fax: Download form or call 1-800-332-1088 to request a reporting form, then complete and return to the address on the pre-addressed form, or submit by fax to 1-800-FDA-0178
This recall is being conducted with the knowledge of the U.S. Food and Drug Administration.
