The opioid crisis: Part 2 — The worst pain you can imagine | FACES OF POLICY
The opioid crisis: Part 3 — A purpose in life | FACES OF POLICY
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The opioid crisis: Part 1 — The roots of addiction | FACES OF POLICY
Posted on July 28, 2019 by Pharmaciststeve
How the government can steal your stuff: 6 questions about civil asset forfeiture answered
Posted on July 28, 2019 by Pharmaciststeve
How the government can steal your stuff: 6 questions about civil asset forfeiture answered
Editor’s note: Should someone wearing a badge have the power to relieve a suspected drug dealer of his Maserati on the spot without giving him an opportunity to flee or liquidate and launder his assets? Known as civil asset forfeiture, this practice might sound like a wise policy.
But lawmakers on both sides of the aisle in Congress and the states are challenging the Trump administration’s embrace of the arrangement, which strips billions of dollars a year from Americans – who often have not been charged with a crime. Law professor and criminal justice expert Nora V. Demleitner explains how this procedure works and why it irks conservatives and progressives alike.
1. What is civil asset forfeiture?
Civil asset forfeiture laws let authorities, such as federal marshals or local sheriffs, seize property – cash, a house, a car, a cellphone – that they suspect is involved in criminal activity. Seizures run the gamut from 12 cans of peas to multi-million-dollar yachts.
The federal government confiscated assets worth a total of about US$28 billion during the decade ending in 2016, Justice Department data indicate.
In contrast to criminal forfeiture, which requires that the property owner be convicted of a crime beforehand, the civil variety doesn’t require that the suspect be charged with breaking the law.
Three Justice Department agencies – the Bureau of Alcohol, Tobacco, Firearms and Explosives (ATF), the Drug Enforcement Administration (DEA) and Federal Bureau of Investigation (FBI) – do most of this confiscating. Most states also permit local prosecutors to take personal property from people who haven’t been charged with a crime. However, some states have begun to limit that practice.
Even when there are restrictions on when and how local and state authorities can seize property, they can circumvent those limits if the federal government “adopts” the impounded assets.
For a federal agency to do so requires the alleged misconduct to violate federal law. Local agencies get up to 80% of the shared proceeds back, with the federal agency keeping the rest. The divvying-up is known officially as “equitable sharing.” Crime victims may also get a cut from the proceeds of civil forfeiture.
2. Can people get their stuff back?
Technically, the government must demonstrate that the property has something to do with a crime. In reality, property owners in most states must prove that they legally acquired their confiscated belongings to get them returned. This means the burden is on the owners to dispute these seizures in court. Court challenges tend to arise only when something of great value, like a house, is at stake.
Unless an owner challenges a seizure and effectively proves his innocence in court, the agency that took the property is free to keep the proceeds once the assets are liquidated.
Many low-income people don’t use bank accounts or credit cards. They carry cash instead. If they lose their life savings at a traffic stop, they can’t afford to hire a lawyer to dispute the seizure, the Center for American Progress – a liberal think tank – has observed.
And disputing civil forfeitures is hard everywhere. Some states require a cash bond; others add a penalty payment should the owner lose. The process is expensive, time-consuming and lengthy, deterring even innocent owners.
There’s no comprehensive data regarding how many people get their stuff back. But over the 10 years ending in September 2016, about 8% of all property owners who had cash seized from them by the DEA had it returned, according to a report from the Justice Department’s inspector general.
3. Who opposes the practice?
Many conservatives and progressives dislike civil asset forfeiture. Politicians on the left and right have voiced concerns about the incentives this practice gives law enforcement to abuse its authority.
Critics across the political spectrum also question whether different aspects of civil asset forfeiture violate the Fifth Amendment, which says the government can’t deprive anyone of “life, liberty, or property, without due process of law” or is unconstitutional for other reasons.
Until now, the Supreme Court and lower courts, however, have consistently upheld civil asset forfeitures when ruling on challenges launched under the Fifth Amendment. The same goes for challenges under the Eighth Amendment, which bars “excessive fines” and “cruel and unusual punishments,” and the 14th Amendment, which forbids depriving “any person of life, liberty, or property, without due process of law.”
In 2019, the Supreme Court unanimously found for the first time that these constitutional protections against excessive fines apply not just to the federal authorities but to the states as well.
Some concerns resonate more strongly for different ideological camps. Conservatives object mostly about how this impounding undermines property rights.
Liberals are outraged that the poor and communities of color tend to be disproportionately targeted, often causing great hardship to people accused of minor wrongdoing.
Another common critique: The practice encourages overpolicing intended to pad police budgets or accommodate tax cuts. Revenue from civil asset forfeitures can amount to a substantial percentage of local police budgets, according to a Drug Policy Alliance study of this practice in California. This kind of policing can undermine police-community relations.
The Justice Department‘s guidelines state that forfeitures “punish and deter criminal activity by depriving criminals of property used in or acquired through illegal activities.”
However, the Inspector General’s office noted “without evaluating data more systemically, it is impossible for the Department to determine … whether seizures benefit law enforcement efforts, such as advancing criminal investigations and deterring future criminal activity.”
4. What is the scale of this confiscation?
The federal revenue raised through this practice, which emerged in the 1970s, mushroomed from $94 million in 1986 to a high of $4.5 billion in 2014, according to the Justice Department.
The Justice Department says it returned more than $4 billion in forfeited funds to crime victims between 2000 and 2016, while handing state and local law enforcement entities at least $6 billion through “equitable sharing.”
The scale of seizures on the state and local level is less clear.
5. What happened during the Obama and Trump administrations?
Under the leadership of Attorney General Eric Holder, the Obama-era Justice Department determined that civil asset forfeiture was more about making money than public safety. It then changed the guidelines for asset adoption.
Beginning in 2015, joint state-federal task forces could continue to share forfeiture proceeds but state agencies were no longer permitted to ask the federal government to forfeit property they had taken on their own.
“I love that program,” Attorney General Jeff Sessions said in 2017. “We had so much fun doing that, taking drug dealers’ money and passing it out to people trying to put drug dealers in jail. What’s wrong with that?”
Attorney General William Barr, Sessions’ successor in the Trump administration, has also defended this policy.
6. Congress and the states
When Sessions changed the policy, legislative changes seemed possible. Senate Judiciary Committee Chairman Chuck Grassley sent Sessions a memo about how the federal funds obtained from seizures were wasted and misused. In some cases, Grassley wrote, the government provided “misleading details about some of these expenditures.”
The House of Representatives voted in 2017 for an amendment that would restrict civil asset forfeiture adoption.
The House also approved a bipartisan measure restricting civil forfeiture on June 20, 2019. This one goes further though and would substantially curtail the federal government’s powers.
State governments have also tried to discourage this kind of confiscation. New Mexico, Nebraska and North Carolina have banned civil forfeiture. Michigan has made it easier to challenge these seizures. California limited equitable sharing, and other states have increased the burden of proof the government must meet. But in many states, investigative reporting has shown that innocent owners continue to lose their property.
In a Georgia Law Review article, I gave examples of other ways to keep police departments and municipalities funded, such as increasing fines and fees.
Unless the police pursue some alternatives, funding woes will continue to contribute to abusive policing practices that fall most heavily on those who can the least afford them: the poor and communities of color.
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Request for Information: Ensuring Patient Access and Effective Drug Enforcement
Posted on July 28, 2019 by Pharmaciststeve
Request for Information: Ensuring Patient Access and Effective Drug Enforcement
This Request for Information (RFI) seeks comment on ensuring Start Printed Page 36112legitimate access to controlled substances, including opioids, while also preventing diversion and abuse, as well as how federal, state, local, and tribal entities can collaborate to address these issues.
DATES:
Comments must be received at one of the addresses provided below, no later than 5 p.m. on August 26, 2019.
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Physician Stories From the Front Lines: no good deed goes unpunished
Posted on July 27, 2019 by Pharmaciststeve
Physician Stories From the Front LInes
https://physicianbalint.home.blog/
Lack of Service
The DEA made a surprise visit to my office yesterday. This apparently was prompted because a vendor reported a suspicious order – AN ORDER THEY DID NOT COMPLETE. I tried to order a vial of ketamine to do infusions for depression. I did this because the psychiatric hospital that was doing them, 1.5 hours away, abruptly stopped their ketamine clinic when the physician who ran the program resigned. The patient found me because I received my REMS certification for Spravato – a new FDA approved drug, a nose spray, a derivative of ketamine that is very expensive ($4700/month). He had had a fantastic response to ketamine, which was life altering for him, after 30 years of debilitating depression from bipolar disorder. He was now overdue for an infusion, and was spiraling down, becoming more depressed with suicidal ideation. He was being treated by a nurse practitioner who was only treating him with a single agent for his bipolar disorder, which I did not feel was adequate. I agreed to treat him and told him I wanted to take over all the treatment. I ended up ordering the ketamine from a pharmacy that also gets Spravato, we simply had the patient pay for it ($14 which covers several infusions) and they sent it to the office. The patient has had a fantastic response to the infusions. I am using the protocol most sites have used – twice weekly for one month then monthly infusions at 0.5mg/kg infused over about 1 hour. We monitor vitals (BP, 02sat, pulse). We do have an AED, ambu bags, ACLS meds, EKG, and between my RN and me are ATLS, ACLS, PALS and NALS certified, though at such a low dose, ketamine thus far has shown to be quite safe. The side effects in the studies of both ketamine and esketamine have been hypertension, dissociation and sedation. We monitor patients for 2 hours. We also have one patient recently started on Spravato and we are following the REMS protocol for that patient, who is also responding quite well.
The DEA agents came in, told me that this vendor had alerted them that I ordered ketamine, which they found “suspicious”. I laughed because the patient was upstairs in our infusion room. The agent then went on to state that she then investigated further, saw my consent agreement with the state Board and had questions about my methadone prescribing. She had allegations that were false, so I corrected her. Many notes were taken. I told them which controlled substances are on site, how we account for them, how we document, what procedures we do, and everything else. I offered to show them our narcotics cabinet and documentation, the agents declined stating that would require paperwork. I am fully aware they could come back with that exact paperwork, so their declination does not mean all is over. For those wondering, I called my attorney who was on speaker phone through all of this. I will never speak to anyone without an attorney present and advise the same for all others. No agency is your ‘friend’ in medicine. No call is innocent. Do not speak, do not answer without an attorney. Take it from those of us who made that mistake.
What really shocks me is that the vendor did not bother to contact me. If they had concerns why was there no communication? Why have they not assigned a sales person to my office? What has happened to customer service? Clearly for physicians there is none. I understand the need to report, and that everyone is doing their job but had there been any sort of communication, all of this would have been avoided.
This follows the adage of no good deed goes unpunished. The patient has offered to testify on my behalf should that become necessary. He jokingly said to bill his insurance company for a higher rate – oh if only I could. Yes indeed this is another unfunded nuisance. It happened during office hours, meant no lunch for me, and yes indeed I went and drank at the end of the day – being the lightweight that I am 2 drinks was all I needed to rid myself of the angst from the DEA showing up at my office. Law school cannot start soon enough.
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Dr Mark trying to help a veteran that has been abandoned by the VA system
Posted on July 27, 2019 by Pharmaciststeve
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Injured Workers Pharmacy LLC :the DEA data is “misleading.”
Posted on July 27, 2019 by Pharmaciststeve
Massachusetts AG probing comp pharmacy over opioid dispensing
Injured Workers Pharmacy LLC is under investigation by the Massachusetts attorney general, which is looking into the workers compensation mail-order pharmacy’s reportedly high numbers of opioids dispensed since 2006, a spokeswoman in the Massachusetts Office of the Attorney General confirmed Friday.
The investigation is centered on “whether Injured Workers Pharmacy properly dispensed controlled substances to its customers” – an investigation that began before the latest revelations concerning IWP dispensing went public, according to the spokeswoman in Attorney General Maura Healey’s office.
The pharmacy made headlines this week following a Washington Post investigation, which included the newspaper and HD Media Co. LLC successfully suing the U.S. Drug Enforcement Administration to gain access to its database tracking opioid prescriptions known as ARCOS, or Automation of Reports and Consolidated Orders System.
A judge with the United States District Court for the Northern District of Ohio, Eastern Division, based in Cleveland on July 15 ruled that the records should be made public because “there is clearly no basis to shield from public view ARCOS data.” The district court’s order came after the 6th Circuit Court of Appeals in Cincinnati, Ohio, on June 20 vacated an initial ruling that the database could not be disclosed.
The attorney for IWP said the company is “fully cooperating” with the investigation and that the DEA data is “misleading.”
“The DEA data regarding opioids received by Massachusetts pharmacies presents a misleading comparison because the quantities received by IWP are dispensed to patients across the country, whereas at least the next seven largest recipients of opioids are retail pharmacies which dispensed in small areas within the state,” Greg Saikin, Houston-based partner for BakerHostetler LLC, said in an emailed statement.
IWP, a national home delivery pharmacy service based in Andover, Massachusetts, described itself on its website as a drug dispenser that provides quick turnaround and “hassle-free” prescriptions to the tune of more than 40,000 prescriptions each month for those hurt on the job.
The pharmacy did not respond to a request for comment on Friday.
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DEA AGENT : “We’re going to come after you. If we can do it, we’re going to do it “
Posted on July 26, 2019 by Pharmaciststeve
CINCINNATI — Two top execs from a pharmaceutical wholesaler indicted this month. Two pharmacists indicted.
A federal agent tells WCPO that others passing prescription drugs and adding to the opioid crisis should take it as warning.
“We’re going to come after you. If we can do it, we’re going to do it,” said Mauricio Jimenez, DEA assistant special agent in charge.
Jimenez said the Drug Enforcement Administration is cracking down on pharmaceuticals distributors and pharmacists it believes are breaking the law, like those accused in the Miami-Luken case. The former Springboro wholesaler, two executives and two West Virginia pharmacists were charged in a conspiracy to flood rural Appalachia with millions and millions of painkiller pills, according to the U.S. Attorney’s Office.
“You’re breaking the law, you’re killing people, you’re putting this out on the street, we’re going to do everything we can to get you,” said Jimenez.
Jimenez said these investigations can take years, but they are happening. The DEA looks at the size of companies, ratio of pills to population, how payment is accepted and more.
“When it comes to these distributors … that are doing this to gain as much money as they can, and not caring about the public, that’s a significant issue that we all must face,” Jimenez said.
Speaking for pharmacists, Mimi Hart, owner of Hart Pharmacy in West Price Hill, said most take great care to avoid overfilling. She said every prescription comes with a checklist and pharmacists look for red flags before deciding to fill it.
“If it’s from a doctor out of the area, if it’s from a very large quantity,” Hart said for example.
“I don’t know a pharmacist that hasn’t said, ‘No, I cannot fill this prescription,’ that hasn’t called the doctor and said, ‘We’re really worried about this.’ “
Today’s opioid crisis makes that scrutiny even more important. But it’s not always cut and dried, Hart said.
“You know it’s a high dose, but it’s not necessarily a high dose for this patient,” Hart said.
“Everybody is trying really hard to make sure that people are getting the pain medication that they need, that they’re not getting too much, that it’s not diverted,” Hart said.
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Senator Portman Presumes To Know How Many Days Of Pain Relief All 328 Million Americans Need
Posted on July 26, 2019 by Pharmaciststeve
Senator Portman Presumes To Know How Many Days Of Pain Relief All 328 Million Americans Need
With clear evidence that restricting the number of prescriptions increased the death rate by driving non-medical users to heroin and fentanyl, the last thing one wants to hear about is a politician planning to double down on this deadly policy by calling for further prescription limits for patients in pain.
Yet Senator Robert Portman (R-OH) is proposing legislation that would impose a national 3-day limit on opioid prescriptions following surgeries. He will be kind enough to allow exceptions for people dealing with cancer, chronic pain, and “other serious matters”—whatever that means.
Government data show there is no correlation between the number of opioids prescribed and their non-medical use or the development of opioid use disorder. Overdose rates skyrocketed during the last 10 years while high-dose opioid prescriptions dropped more than 58 percent and total volume of dispensed opioids dropped more than 29 percent. Seventy-five percent of opioid-related deaths in 2017 involved fentanyl and heroin, and fewer than 10 percent involved prescription pain pills without also involving heroin, fentanyl, cocaine, tranquilizers, or alcohol.
The senator has determined that, “After the second or third [postoperative] day, other pain medications work just as effective (sic).” In my more than 35 years as a practicing general surgeon, I usually find that my patients recovering from major surgery require prescription opioids to control their pain for more than 2 or 3 days. It is bad enough that many states have imposed 5 or 7 day limits on opioid prescriptions, forcing many patients in severe pain to make multiple trips to the doctors office for refills. Imposing a national 3-day limit lacks an understanding of the science. It would be an unfounded and callous government intrusion into the practice of medicine.
Senator Portman, like so many other politicians untrained in medicine or pharmacology, is guilty of misinterpreting and misapplying the guidelines on opioid prescribing published in 2016 by the Centers for Disease Control and Prevention. He must still believe that today’s non-medical users are yesterday’s pain patients, even though, as mentioned above, there is no evidence of any correlation between the two.
He also seems to think there is a high risk of addiction in patients prescribed opioids for acute post-surgical pain. Yet a well-publicized study in the medical journal BMJ by researchers at Harvard and Johns Hopkins looked at 568,000 opioid “naïve” patients in the Aetna health insurance data base given prescription opioids for acute postoperative pain over the period of 2008-2016. The researchers found the “total misuse rate,” i.e., rate of all opioid misuse diagnoses among the 568,000 patients prescribed the opioids, was 0.6 percent.
Senator Portman told Ohio reporters, “After day four, five or six, the chances of becoming addicted are higher.” Maybe he is reacting to the statement by the researchers in the BMJ report that each refill and additional week of opioid use was “associated with an adjusted increase in the rate of misuse of 44%.” But a deeper look at their data shows the incidence of opioid misuse rose from 145 cases per 100,000 person years, or 0.15 percent per year, in patients who had no refills, to 293 cases per 100,000 person years, or 0.29 percent per year, for persons who had one refill. Indeed, that is nearly double. But if you nearly double a very low number, you still get a low number.
The fact is the overdose rate from the non-medical use of licit and illicit drugs has been on a steady exponential increase since the 1970s and shows no signs of slowing down. The only thing that has changed over the years is the particular drug in popular use at any given time. The reasons behind this are complex and multifactorial, and likely sociocultural and psychosocial. In the early part of this century the popular drugs for non-medical users were diverted prescription opioids. Next it became heroin. For the past several years it has been heroin and fentanyl. Methamphetamine related deaths are now surging to all-time high levels, and preliminary estimates from the CDC place the number of meth-related deaths at nearly 13,000 in 2018—eclipsing the number for prescription opioid-involved deaths.
Senator Portman is two or three drugs behind in his prosecution of the drug war.
To bring the death rate down, Senator Portman should learn a lesson from his home state of Ohio, where a recent embrace of harm reduction measures—expanding needle exchange programs, distributing the overdose antidote naloxone, and increasing access to Medication Assisted Treatment—has led to a 23.3 percent drop in overdose deaths in 2018 according preliminary CDC data. Harm reduction is a proven strategy for saving lives.
If Senator Portman wishes to craft legislation that can truly save lives, he should propose a repeal of the federal “Crack House Statute.” This law stands in the way of many of the country’s largest cities that wish to establish Safe Injection Facilities, which are preventing overdoses and saving lives in more than 120 cities throughout Europe, Canada, and Australia.
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Pharmacy error left golf ball-sized hole in Leander woman’s arm
Posted on July 26, 2019 by Pharmaciststeve
Pharmacy error left golf ball-sized hole in Leander woman’s arm
https://www.kvue.com/article/news/investigations/defenders/pharmacy-error-left-golf-ball-sized-hole-in-leander-womans-arm/269-03e58e22-40ca-4dfc-9888-ec0548484433
Josselyn Stevens called the KVUE Defenders after the medicine she received left her with a hole in her arm.
AUSTIN, Texas — Another pharmacy failure has a Leander woman wondering how long it will take the state and the federal government to investigate.
“I saw your previous story and it hit home that people don’t deserve to be hurt,” Josselyn Stevens said. “People deserve to be heard. And I don’t want anyone else hurt.”
Compounding pharmacies tailor medicine for patients. They’re needed for people who can’t take a standard manufactured drug.
There’s no FDA testing and approval for each tailored prescription. So, when things go wrong, patients can be scarred for life.
Now, Stevens’ health requires frequent visits to a doctor.
“I’d be like, ‘Where am I? What am I doing?’” Josselyn said.
She has a genetic disorder causing seizures. The seizures stopped in 2014 when doctors prescribed a specific B-12 shot, tailored at a compounding pharmacy. She can count more than 250 rounds over the years.
Everything was going fine until last month.
WARNING: This gallery contains graphic images some might find disturbing.
Josselyn Stevens – pharmacy errors
“It was excruciating. It was burning,” Josselyn said. “I asked if something was trickling down my arm.”
Nothing was.
She said headaches came shortly after. Then dizziness and disorientation.
“I looked into the mirror and was like, ‘Whoa,’” she said.
The shot burned her skin and was going deeper.
“The dermatologist said it was a chemical burn and it had completely necrosed, and that I needed to go to the emergency room,” she said.
Lab records show the B-12 had a pH level of 13.2, similar to the pH of bleach.
A surgeon performed a debridement to remove the damaged skin.
Josselyn also has Stage 3 breast cancer. So going under anesthesia for surgery for the chemical burn could contaminate her central line needed for receiving chemotherapy drugs – an infection could kill her.
“So, I did the procedure awake in the surgeon’s office,” Josselyn said.
The chemo rounds continue, and so do the debridement sessions.
“It was devastating,” she said. “It was devastating to have another hurdle to have to overcome. It’s devasting to worry.”
RELATED: Pure tissue repair: A hernia mesh alternative
When moms go through this much pain, the family feels it, too.
“I can’t even pump soap without it hurting,” Josselyn said.
“Having three kids running around the house, bumping into everything, bumping into her,” said her husband, Trevor.
“Bumping into me is hard,” Josselyn added.
Josselyn’s specialized B-12 came from Stonegate Pharmacy, the same pharmacy the KVUE Defenders told you about in May when a specially mixed thyroid medicine nearly killed Lorena Lopez-Gonzalez. Records show it was 54,000% percent higher than her prescribed dosage.
RELATED: 54,000% higher: Austin woman almost dies after pharmacy’s dosage mistake
“It’s a miracle that I did not die,” Lorena said in May.
Last year, the Texas State Board of Pharmacy fined Stonegate for several mistakes from 2014 through 2016. The board required the pharmacy to implement a corrective action plan and put Stonegate on probation for five years.
“I think just one person, one person with an injury to my extent should at least call for a recall,” Josselyn said.
The pharmacy board director, Allison Benz, said it’s mandatory.
“We require pharmacies to institute recalls on their compounded medications if they become aware of a problem with one of their products,” Benz said.
The KVUE Defenders tried asking Stonegate if they recalled the B-12. They quickly referred KVUE to their attorney, who is out of the country until August.
“My purpose for contacting you was to help people, even if there is just one person,” Josselyn said.
RELATED: Critical care doctor warns of vibrio symptoms and who’s at risk
Josselyn filed complaints with the FDA and the State Board of Pharmacy.
As evidenced by Lorena’s case, it can take years for the state to investigate and take enforcement action.
“I couldn’t believe it,” attorney Sean Breen said.
Breen represents Josselyn in a lawsuit filed last week against Stonegate claiming negligence.
“They’re not going to wait around for the pharmacy board for two years,” Breen said. “They’re not going to wait around for the FDA. They’re going to exercise their rights in court, to have 12 people in Travis County say enough is enough.”
RELATED: Medical Device Dangers: A KVUE Special Broadcast
Josselyn has two more rounds of chemo left and eight more wound-scraping visits.
“Everything that I’ve had to go through over the last eight months has been devastating,” she said. “It just felt like the odds were against me.”
To top it all off, Josselyn had her gall bladder removed a month before her mastectomy. That’s three different surgeries this year.
The pharmacy board wants compounding pharmacies inspected every two years.
The legislature recently provided money to hire more people and bring the total to 14 compliance inspectors for the entire state – eight field investigators.
If you have a complaint about a pharmacy or medication, click here for the Texas State Board of Pharmacy and click here for the FDA.a
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Global warming and balanced Fed budget – being solved by war on drugs & opiate crisis ?
Posted on July 25, 2019 by Pharmaciststeve
Two House members (Foster& Kelly) have added an amendment to HR 2470 #20 amendment – which would assign a “unique number” to every person getting chronic pain meds
Two Senate members ( Manchin & Braun) has a bill S. 2089: FDA Opioid Labeling Accuracy Act that would prohibit the FDA from labeling any opiate for long term pain use – with a few exceptions – until studies have been done to “prove” that they work for treating long term pain. I guess the couple of millenium that they have been used to treat pain in insufficient ?
They claim that global warning is caused by an excessive amount of CO2 and our increasing national debt is caused by the cost of supporting our Social Security, Medicare & Medicaid programs. A part of the solution to this problem can be brought by using the carbon footprint calculator which helps in calculating the consistency of damage to the environment over millions of years.
The proposed House bill – as I remember – has been tried before by a dictator of a country that in the late 1930’s – early 1940’s – assigned a “unique number” to a subset of the country’s population. In fact they wanted the unique number to be “permanent” so they tattooed them to the inside of their forearms… As I remember, that numbering system did not work out so well and a lot of people died
The Senate bill would deny most chronic pain pts long term pain management, and we all know that chronic pain pts that get denied adequate pain management… some end up committing suicide and others will end of dying of “natural causes” because under/untreated pain will cause their other co-morbidity issues to become life threatening. Maybe even a premature… see chart below
How would all of this help solve global warning and our national debt problem ? If these proposed bills make it to law and cause more chronic painers to commit suicide or die prematurely… there would be less CO2 being generated … since every time that one of us exhales.. we exhale CO2.
Most of the chronic painers consume a lot of healthcare dollars in treating their numerous medical issues and many are on Medicare disability or Medicaid or maybe both..
Many talk about a “covert genocide” and perhaps there is a “end game” to help address global warming and our growing national debt.
Congress doesn’t seem to be capable of directly dealing with these two issues… so … maybe there is a hidden agenda here… because if they tried to create a direct solution… probably HALF of the country would not be happy… and maybe many in Congress would not get re-elected ?
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