https://www.knoxnews.com/story/news/crime/2019/02/14/bcso-warns-scammers-impersonating-dea-agents/2874907002/

The Blount County Sheriff’s Office is warning citizens about a new scam in which people are impersonating Drug Enforcement Administration agents and threatening widespread consequences unless they send gift card codes. 

According to BCSO, a 64-year-old woman reported that she was conned out of $7,000 by a man who claimed to be a DEA agent named Mike Allen, calling from the number 240-288-5221. 

The woman said the would-be agent told her a large amount of drugs had been found in a car she rented that was discovered in El Paso, Texas. He claimed the finding would affect her Social Security and said she would need to purchase a number of gift cards and send him the card’s numbers to avoid criminal charges, according to the woman. 

BCSO is reminding citizens that law enforcement officers will not ask for money over the phone and that it is a federal offense to impersonate a federal agent. 

Citizens are advised not to give up any personal information when they receive calls like this and to hang up immediately. Scams involving the DEA can be reported on the agency’s website.

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DEA Launches Digital Billboard Campaign Against Opioid Use

https://news.wttw.com/2019/02/14/dea-launches-digital-billboard-campaign-against-opioid-use

As part of its ongoing efforts to combat the opioid epidemic, the Drug Enforcement Agency announced Thursday it’s launching a yearlong digital billboard campaign across the Chicago area.

Messages in both English and Spanish will be displayed on area roadways, train stations and other locations, warning passersby of the dangers of opioids, including legally prescribed medications, and outlining treatment options.

“The purpose of this campaign is to stir up action in our communities and to save lives,” said Robert J. Bell, U.S. DEA associate special agent in charge of the Chicago field division office. The 12-month campaign is a partnership between the DEA, Chicago Crime Commission and Clear Channel Outdoor. 

“I hope that (the billboards) put a little fear into a parent’s heart and they go home and they’re motivated to talk with their kids … about the dangers of drug addiction of any myriad of drugs,” he said.

Educating the public about the dangers of opioids and treatment options is “critical” to defeating the epidemic, according to Douglas O’Brien, U.S. Department of Health and Human Services Region 5 director.

“This (epidemic) will not be defeated in Washington,” said O’Brien. “It’s going to be defeated in communities around the country, in emergency rooms, in church basements, in police stations and in people’s living rooms.”

O’Brien hopes the digital billboard campaign can serve as a catalyst to spark conversations and to connect people who have substance use disorders with treatment.

“I’m hopeful this campaign and the messages it sends can speak to all the community members out there who may not know how to start those conversations with their loved ones,” said Amy Voss of Buffalo Grove, who lost her son Jared to a heroin and cocaine overdose in 2015. “Please start those conversations.”

The DEA has also created educational resources, including a tool kit for parents with information on warning signs of opioid misuse and a guide to prevention, on the Operation Prevention website.

Contact Kristen Thometz: @kristenthometz | kthometz@wttw.com | (773) 509-5452

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https://www.dailyherald.com/news/20190214/south-elgin-man-sues-meijer-after-getting-wrong-form-of-medication

Jim Danz was being wheeled out of his South Elgin home by paramedics on a stretcher, in the throes of what he thought was his second heart attack in barely a week.

“It was horrifying,” Danz said. “I can still picture my daughter watching me being taken away. I thought I was going to die and never see any of my kids again.”

The 41-year-old father of five believes the second heart-related emergency only happened because a pharmacist at a Meijer store in Elgin gave him the wrong form of a medication for his first heart attack. He’s suing the retail giant and the pharmacist for $700,000 to cover his medical bills, lost time at work and pain and suffering Danz said lingers to this day. The suit was filed Thursday in Kane County.

Meijer officials did not immediately respond to requests for comment about the suit.

According to the lawsuit, Danz suffered a heart attack Feb. 16, 2017. He was out driving for his sales job when he started feeling ill. He called his wife to see if he could get a doctor’s appointment, but Danz said the symptoms intensified while he was near DeKalb, so he called 911 and they directed him to Northwestern Medicine Kishwaukee Hospital, where emergency room doctors determined he was suffering a “myocardial infarction,” the lawsuit states. He was hospitalized for two days before being released and given a prescription for metoprolol succinate, a beta blocker used to treat heart failure. It’s a slow-releasing medication taken once a day and was prescribed to Danz at 25 milligrams, according to the lawsuit.

The prescription was filled at the Elgin Meijer store, but Danz was given a bottle of metoprolol tartrate, a fast-acting beta blocker used to guard against future heart attacks, according to the lawsuit. It’s usually prescribed in 50 milligram doses to be taken twice a day, Danz’s attorney Patrick Walsh said.

But Danz was given 25-milligram tablets, as the prescription read.

“At best he was getting a quarter of the medication he needed,” Walsh said.

Danz said he would take his medication in the morning and start to feel better, but by the evening he would begin to feel the symptoms similar to the heart attack. Eight days after being released from the hospital, Danz found himself on that stretcher en route to Presence St. Joseph Hospital in Elgin, where he was diagnosed with sinus tachycardia after his pulse rate rose to 180 beats per minutes, the lawsuit states.

The lawsuit states that days later, when Danz was picking up a new prescription, another Meijer pharmacist acknowledged the original error and told Danz about the mistake. There’s a notation on one of the prescriptions that it was erroneously filled, according to the suit.

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Team makes breakthrough toward developing blood test for pain

https://m.medicalxpress.com/news/2019-02-team-breakthrough-blood-pain.html

A breakthrough test developed by Indiana University School of Medicine researchers to measure pain in patients could help stem the tide of the opioid crisis in Indiana, and throughout the rest of the nation.

A study led by psychiatry professor Alexander Niculescu, MD, Ph.D. and published this week in the high impact Nature journal Molecular Psychiatry tracked hundreds of participants at the Richard L. Roudebush VA Medical Center in Indianapolis to identify biomarkers in the blood that can help objectively determine how severe a patient’s pain is. The blood test, the first of its kind, would allow physicians far more accuracy in treating pain—as well as a better long-term look at the patient’s medical future.

“We have developed a prototype for a blood test that can objectively tell doctors if the patient is in pain, and how severe that pain is. It’s very important to have an objective measure of pain, as pain is a subjective sensation. Until now we have had to rely on patients self-reporting or the clinical impression the doctor has,” said Niculescu, who worked with other Department of Psychiatry researchers on the study. “When we started this work it was a farfetched idea. But the idea was to find a way to treat and prescribe things more appropriately to people who are in pain.”

During the study, researchers looked at biomarkers found in the blood—in this case molecules that reflect disease severity. Much like as glucose serves as a biomarker to diabetes, these biomarkers allow doctors to assess the severity of the pain the patient is experiencing, and provide treatment in an objective, quantifiable manner. With an opioid epidemic raging throughout the state and beyond, Niculescu said never has there been a more important time to administer drugs to patients responsibly.

“The opioid epidemic occurred because addictive medications were overprescribed due to the fact that there was no objective measure whether someone was in pain, or how severe their pain was,” Niculescu said. “Before, doctors weren’t being taught good alternatives. The thought was that this person says they are in pain, let’s prescribe it. Now people are seeing that this created a huge problem. We need alternatives to opioids, and we need to treat people in a precise fashion. This test we’ve developed allows for that.”

In addition to providing an objective measure of pain, Niculescu’s blood test helps physicians match the biomarkers in the patient’s blood with potential treatment options. Like a scene out of CSI, researchers utilize a prescription database—similar to fingerprint databases employed by the FBI—to match the pain biomarkers with profiles of drugs and natural compounds cataloged in the database.

“The biomarker is like a fingerprint, and we match it against this database and see which compound would normalize the signature,” said Niculescu, adding that often the best treatment identified is a non-opioid drug or compound. “We found some compounds that have been used for decades to treat other things pair the best with the biomarkers. We have been able to match biomarkers with existing medications, or natural compounds, which would reduce or eliminate the need to use the opioids.”

In keeping with the IU Grand Challenge Precision Health Initiative launched in June 2016, this study opens the door to precision medicine for pain. By treating and prescribing medicine more appropriately to the individual person, this prototype may help alleviate the dilemmas that have contributed to the current opioid epidemic.

“In any field, the goal is to match the patient to the right drug, which hopefully does a lot of good and very little harm,” Niculescu said. “But through precision health, by having lots of options geared toward the needs of specific patients, you prevent larger problems, like the opioid epidemic, from occurring.”

Additionally, study experts discovered biomarkers that not only match with non-addictive drugs that can treat pain, but can also help predict when someone might experience pain in the future—helping to determine if a patient is exhibiting chronic, long-term pain which might result in future emergency room visits.

“Through precision medicine you’re giving the patient treatment that is tailored directly to them and their needs,” Niculescu said. “We wanted first to find some markers for pain that are universal, and we were able to. We know, however, based on our data that there are some markers that work better for men, some that work better for women. It could be that there are some markers that work better for headaches, some markers that work better for fibromyalgia and so on. That is where we hope to go with future larger studies.”

The study was supported by an NIH Director’s New Innovator Award and a VA Merit Award. Moving forward, Niculescu’s group looks to secure more funding through grants or outside philanthropy to continue and accelerate these studies—with the hopes of personalizing the approach even more and moving toward a clinical application. A self-described longshot at the start, Niculescu said that the work his group has done could have a major impact on how doctors around the world treat pain in the future.

“It’s been a goal of many researchers and a dream to find biomarkers for pain,” Niculescu said. “We have come out of left field with an approach that had worked well in psychiatry for suicide and depression in previous studies. We applied it to pain, and we were successful. I give a lot of credit for that to my team at IU School of Medicine and the Indianapolis VA, as well as the excellent environment and support we have.”

More information: A. B. Niculescu et al, Towards precision medicine for pain: diagnostic biomarkers and repurposed drugs, Molecular Psychiatry (2019). DOI: 10.1038/s41380-018-0345-5

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https://youtu.be/VrTbpHJucYM

Why does America feel as if we are trapped in a time warp to Nazi-held Germany 1939? An American Holocaust and no one cares until it hits them in the face or happens to a loved one. TWELVE HEROES in TWELVE STATES are fighting for your freedoms & Constitutional Rights with #Starburst lawsuit filed in Federal Court. This video explains the horrors facing America today, our children and future generations. This is not the America I enlisted in the Marines to defend. 🙁 Will you spare a few minutes to watch & comment? – 3:-) Robert — Teufelshunde

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Right mouse click on pic and click on “view image” to get enlarged graphic

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Tell Congress: Americans have a right to timely access to treatment!

https://fixpriorauth.org/take-action

Have you ever gone to the pharmacy to fill a prescription only to be told that your insurance company requires approval before they’ll cover your treatment? Have you ever waited for days, weeks, or months for a test or medical procedure to be scheduled because your physician first needed to obtain authorization from your insurer?

This policy is called “prior authorization,” and it’s a tactic used by insurance companies to control costs by requiring physicians to obtain approval before a treatment qualifies for coverage. This burdensome process is confusing, time consuming, and — most importantly — can cause delays in patients receiving the care they need.

Physicians are forced to spend valuable hours processing prior authorizations when they could be treating patients. Prior authorizations also impose unnecessary care delays on patients, interfering with treatment and even adversely impacting clinical outcomes.

A recent survey by the American Medical Association showed that Americans are abandoning treatment in alarming numbers due to delays caused by cumbersome prior authorization requirements.

It’s time for Congress to demand that insurance companies work with physicians, not against them, in order to improve and streamline the prior authorization process so that patients are ensured timely access to the care they need.

Add your name to tell Congress that you believe Americans have a right to timely access to medical treatment!

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How an insurance company auditor tried to destroy a physician’s career

www.kevinmd.com/blog/2019/02/how-an-insurance-company-auditor-tried-to-destroy-a-physicians-career.html

shots. As a pediatrician in private practice for almost two decades, I’ve seen insurance companies transform into perhaps the single most powerful player in today’s health care landscape — final arbiters whose decisions about which procedures or medications to authorize effectively end up determining the course of patient care.

Decisions made by insurers, such as MassHealth, have arguably killed patients. But it was only when I got caught in the crosshairs of an insurance company auditor with a bone to pick that I fully appreciated their power to also destroy physicians’ careers.

My nightmare began around two years ago, when my late father, also a physician with whom I was in practice, and I opened our Silverdale clinic on a Saturday. It was the start of flu season, and we’d just received 100 doses of that year’s flu shot. Anxiety about the flu was running high following the death of a local girl from a particularly virulent strain of the virus a year before, and parents were eager to get their kids immunized as soon as possible.

Under Washington law, adults don’t even need to see their doctors to get flu shots. They can get them at Walgreens, directly from pharmacists. But because children under nine are more susceptible to rare but life-threatening allergic reactions, they must be immunized by a physician. This meant that, for convenience sake, parents often scheduled their kids’ annual checkup on flu shot day, thus allowing them to condense much of their routine care into a single visit.

That particular Saturday went off without a hitch, with my father and I seeing and immunizing around 60 patients between the two of us over a 12-hour day.

Three months later, a representative from the insurance company requested to see some of the patient charts from that flu clinic as part of an audit. Aimed at rooting out insurance fraud by cross-checking doctors’ records, these audits have become a routine fixture in medical practices today. To incentivize their auditors to ferret out the greatest possible number of irregularities, and thus boost the corporate bottom line, auditors work on commission, being paid a percentage of the funds they recover.

The auditor in charge of my case failed to turn up any irregularities in our documentation. But, still, she issued a stern admonition to my father and me, ordering us not to open our clinic on Saturdays to administer flu shots.

This struck me as an outrageous restriction, considering our clinic is a private entity where we set our own hours and schedule accordingly, and so I called the auditor. But instead of backing down, she ratcheted up her rhetoric, saying she was also forbidding me from examining my patients before immunizing them; clearly a bid to save her employer even more money. I was shocked. Her directive amounted to practicing medicine without a medical license — which is, of course, illegal in the state of Washington and many other states across the nation.

I shot back that immunizing infants and small children is a serious undertaking, requiring proper caution and care, informed her there was no way I would be complying with her mandate. Following this brief exchange, she took it upon herself to report me to the Medical Quality Assurance Board, the government-backed body charged with shielding the public from unqualified or unfit doctors. The accusation levied against me? Not following an insurance company mandate which, in her opinion, amounted to unprofessional conduct.

It didn’t matter that the charges against me were ludicrous. The potential consequences were only too real, and potentially catastrophic. Had the State Medical Board decided against me, I could have lost my license. I hired a lawyer, sinking more than $8,000 into legal fees. I was cleared last month by a unanimous committee vote. But other physicians facing similar situations may not be as lucky.

The 18 months of excruciating stress that followed my altercation with the auditor made it patently clear that insurance companies wield far too much power. Bureaucrats are making life-and-death medical decisions without a single minute of medical training, and their auditors are terrorizing physicians, by coercing state medical boards to act as their henchman. Unfettered by any consequences for enforcing policies that fly in the face of rules protecting patient safety, insurance companies will continue to harm doctors and patients alike if no one can stop them.

Niran S. Al-Agba is a pediatrician who blogs at MommyDoc. 

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DEA teaches agents to recreate evidence chains to hide methods

https://www.muckrock.com/news/archives/2014/feb/03/dea-parallel-construction-guides/

Trainers justify parallel construction on national security and PR grounds: “Americans don’t like it”

Drug Enforcement Administration training documents released to MuckRock user C.J. Ciaramella show how the agency constructs two chains of evidence to hide surveillance programs from defense teams, prosecutors, and a public wary of domestic intelligence practices.

In training materials, the department even encourages a willful ignorance by field agents to minimize the risk of making intelligence practices public.

The DEA practices mirror a common dilemma among domestic law enforcement agencies: Analysts have access to unprecedented streams of classified information that might prove useful to investigators, but entering classified evidence in court risks disclosing those sensitive surveillance methods to the world, which could either end up halting the program due to public outcry or undermining their usefulness through greater awareness.

An undated slide deck released by the DEA to fleshes out the issue more graphically: When military and intelligence agencies “find Bin Laden’s satellite phone and then pin point [sic] his location, they don’t have to go to a court to get permission to put a missile up his nose.” Law enforcement agencies, on the other hand, “must be able to take our information to court and prove to a jury that our bad guy did the bad things we say he did.”

The trainer’s notes continue, “In the old days, classified material was poison. In some ways, it still is… because if treated incorrectly, it can screw up your investigation.”

A tactic known as “parallel construction” allows law enforcement to capitalize on intelligence information while obscuring sensitive sources and surveillance methods from the prosecution, defense and jury alike. DEA training documents suggest this method of reconstructing evidence chains is widely taught and deployed.

Last August, Reuters first reported on the practice of parallel construction by the DEA’s Special Operations Division (SOD), a secretive unit that includes representatives from the FBI, CIA and NSA. Slides obtained by Reuters defined the method as “the use of normal investigative techniques to recreate the information provided by SOD.” But documents released to Ciaramella indicate that DEA trainers routinely teach the finer points of parallel construction to field agents and analysts across the country, not just within SOD.

The bulk of the release comprises eight versions of a training module, “Handling Sensitive Information.” Per lesson cover sheets, the module was created in 2007 for inclusion in entry-level analyst training programs, as well as for workshops at DEA field offices. The most recent dated revision in the release is from May 2012:

The module puts the issue of using sensitive intelligence in law enforcement a bit more delicately. Per the 2012 lesson plan, the main problem with combining intelligence collection with law enforcement investigations “is the high potential for disclosure of these sensitive sources of information in our open, public trial system.”

In addition to potential national security risks of exposing classified information and constitutional quandaries, an earlier version of the module highlights another issue with introducing sensitive or clandestine evidence into domestic trials: “Americans don’t like it.”

The instructor’s notes from the same revision clarify the public pushback rationale.

Given the “fish bowl” nature of law enforcement work, DEA Academy graduates are guided to only use techniques “which are acceptable to our citizens.”

Controversy notwithstanding, parallel construction apparently makes the DEA’s list of such palatable techniques. The modules make clear that the idea is to shape evidence chains so that neither the prosecution nor the defense are to be made aware of classified information, if it can be helped.

When the court is made aware of classified evidence, a wholly separate—if unfortunately named—squad of prosecutors called the Taint Review Team will consult with the judge to determine which evidence must be turned over to the defense.

As described in the released portions of the module, parallel construction simply entails splitting the prosecutorial labor, with a Taint Review Team tackling pre-trial review so the trial prosecutor encounters as little classified evidence as possible.

But the released training modules provide no guidance on key issues noted in documents obtained by Reuters last August. In particular, the SOD slides barred agents from disclosing classified sources on affidavits or in courtroom testimony. Under this strain of parallel construction, the court would never know the classified origins of an investigation.

“You’d be told only, ‘Be at a certain truck stop at a certain time and look for a certain vehicle.’ And so we’d alert the state police to find an excuse to stop that vehicle, and then have a drug dog search it,” as one former federal agent described the process to Reuters.

While there are no direct references to protocols of this kind, three additional slide decks released to Ciaramella cover traffic stops and drug dog sniffs extensively. These presentations are heavily redacted, but released portions address the advantages of pairing “tip information” and “vertical information transfers” with routine traffic stops as a pretext for making an arrest.

This same presentation offers guidance to officers wondering whether they should lie under oath rather than reveal that information came from a classified source.

DEA trainers advise officers in this position to let the prosecutor know “so that he or she can proactively address any issues” with the evidence in question, regardless of “where the information came from.”

The unprecedented window these training documents give into the parallel construction method still leaves many questions unanswered, especially when it comes to logistics and legal justifications. What could not be clearer, though, is the DEA’s stance that law enforcement must vigilantly protect intelligence resources by all possible means.

Read the manual embedded below, or on the request page.

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Fentanyl Case Shows China’s Scary Ability to Adapt

www.insightcrime.org/investigations/china-fentanyl-production-adaptability/

In October 2017, two Chinese men—Xiaobing Yan and Jian Zhang—were indicted for conspiring to manufacture and distribute “large quantities” of fentanyl and fentanyl analogs in the United States. Although they used multiple names and company identities over a period of six years, investigators were able to trace the fentanyl shipments back to four clandestine labs and two chemical plants in China.

It was the first known indictment of Chinese nationals for the production of fentanyl, but it told a deeper and more troubling story about the chemical industry in China: that it could and would adapt as fast as the market it services.

Fentanyl use is soaring in the US where overdoses led to the deaths of close to 30,000 people in 2017. Nearly all the fentanyl is produced in China in chemical factories such as those owned by Yan and Zhang. Much of it is sold directly to the US, sent via mail, in small, practically undetectable doses through the US postal system.

This article is part of a series on the growing demand for fentanyl and its deadly consequences done with the support of the Mexico Institute at the Woodrow Wilson International Center for Scholars. See the rest of the series here. 

The two chemical plants operated by Yan “were capable of producing ton quantities of fentanyl and fentanyl analogs,” according to an official US Department of Justice press release. Apart from the two Chinese nationals, 19 others were indicted for conspiring to distribute the illicitly-produced fentanyl and fentanyl analogs throughout the United States.

But Yan’s factories responsible for the fentanyl were producing a panoply of illicit substances. The nine-count indictment against Yan read like chemistry test. The government noted Yan’s production of pentedrone as well as 4-MEC (4-methylethcathinone), both noted ingredients in so-called “bath salts,” designer drugs popular in nightclubs in Europe and the US. There was also AM-2201, a synthetic marijuana. In the end, prosecutors named over 20 different chemical configurations.

Yan had obviously shifted production to fentanyl as soon as he saw the opioid become a drug of choice among the opioid-consuming population.

The indictments also provide further evidence of the substances exported from China directly to the United States and with Canada as a transshipment point, and shed light into how quickly Chinese groups can alter fentanyl-family substances to escape scheduling efforts. Yan, for example, closely monitored scheduling decisions and law enforcement activities to modify the structure of his chemical analogs to avoid detection, the US Justice Department said.

An estimated 160,000 chemical companies are currently operating either legally or illegally in China, according to the US Department of State. China’s chemical industry suffers from poor regulation, thus allowing fentanyl precursor chemicals to be diverted into clandestine labs by criminal groups, the US State Department says. A lack of oversight paired with administrative inefficiencies has also allowed illegal chemical factories to spring up and manufacture significant quantities of precursors that make their way directly to the US or via Mexico, where criminal groups are also quickly adapting to new market.

The second indictment against Zhang follows this narrative. Zhang operated four labs and exported fentanyl, fentanyl analogs, as well as pill presses, stamps, and other materials to shape fentanyl into pills in the United States, the US Justice Department said.

In addition to fentanyl, US prosecutors said Zhang was producing ANPP, acetyl fentanyl, and furanyl fentanyl, all fentanyl analogs. He’d then channeled them through freight forwarding companies that moved the chemical substances into the US via Canada hiding their activities behind aliases such as “Joe Bleau,” the Canadian version of Joe Blow.

China has attempted to control the development of countless numbers of fentanyl analogs and precursor chemicals. But during our investigation into fentanyl-trafficking networks, we found that implementation of these initiatives has proven difficult as law enforcement and drug investigators struggle to keep track of high levels of pharmaceutical and chemical output.

Furthermore, as fentanyl addiction and overdose deaths are not problems in China, it currently takes scheduling and interdiction actions at the behest of the United States, making this relationship dependent on the changing dynamics of the US-China relationship.

But some positive efforts are being made, and United States officials said that the bilateral relationship with China on this issue is open and developing. In 2015, the Chinese Food and Drug Administration made 116 psychoactive substances, along with six fentanyl analogs, controlled substances, and in February 2018, newly created controls on five fentanyl precursors including ANPP went into effect.

The impact that these controls will have on the diversion of fentanyl precursor to clandestine laboratories, or the export of said chemicals to criminal groups in Mexico and the United States, may be limited by the rapid ability of these groups to adapt.

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