She was stuck – unable to change doctors without a referral from her current pain doctor, who refused

Chronic-pain patients suffer as agencies try to regulate addiction

https://www.statesmanjournal.com/story/opinion/2019/01/11/chronic-pain-patients-suffer-agencies-try-regulate-addiction/2548890002/

Could the fact that a prescriber CHANGES or DELETES a pt’s diagnosis and replaced it with a diagnosis does not fit the pt’s health condition be considered MALPRACTICE particularly if the “new therapy” causes the pt’s quality of life to deteriorate ?  And the prescriber basically “holds the pt hostage” for refusal to refer the pt out ?

The pt’s insurance should have a network of approved prescribers and they should be able to intercede on the pt’s behalf in find a new prescriber and should the pt file a complaint with the state’s Medical License Board for both malpractice, pt abuse and unprofessional conduct ?

Opioid. For many, the word elicits images of addiction, but that’s only one side of the story.

This is our side, the one that’s no longer socially acceptable, that shatters bias and stigma. It’s the side of the story that I live — that of the chronic pain patient (CPP), not the addict.

The vast majority of people who use prescription opioids never become addicted; they use their medication as prescribed. It facilitates their lives, and if it’s discontinued they will lose quality of life.

The issue: Two Views: Is Oregon abandoning those living with chronic pain?

A different perspective: Oregon’s illegal drug users rewarded as chronic pain patients suffer

My mom worked at the United States Post Office, a job she loved. After a work injury and failed surgeries, she was left in pain, permanently disabled, and unable to function.

She tried every alternative, but nothing helped. Finally, she started opioid medication and began living again — raising her grandchildren, maintaining her home and life. Then her primary doctor retired. She was referred to a well-known Salem pain doctor who, despite 13 years of MRIs, other tests and records, insisted she either accept a diagnosis of Substance Use Disorder (SUD) and receive Suboxone or be tapered completely off medication, and receive nothing for pain. She did everything right, didn’t fail one drug urinalysis (UA), took medication as prescribed, but it didn’t matter.

She was stuck – unable to change doctors without a referral from her current pain doctor, who refused. She wasn’t an addict, didn’t have SUD, but was desperate to maintain her life.

Suboxone was ineffective for her pain — it isn’t even approved for pain. Without effective medication, my mom stopped living. She agonized in bed all day, every day. She’s not alone.

Today, a father is confined to his bed with untreated pain because his doctor was forced to taper him off analgesics. A parent looks down at the deceased body of their child who chose to die rather than face another day in horrible pain.

These stories are not unique or hypothetical — many are suffering. 

Legislation, proposals and rules threaten this fate for every CPP. While opioids are not the answer for everyone, for some they’re a life saver.

Merging CPP with addict is a misconception not supported by data. It’s a tactic to blur the lines. It starts with a heart-wrenching story of addiction and ends with punishing CPPs.

Recently, there was a press release for the Prescription Drug Monitoring Program which began with a tragic account of addiction. The solution was to further restrict CPPs, instead of curbing addiction. This is a common tactic.

CPPs are shamed, suffer discrimination and stigma. We are guilty until proven innocent, and forced into highly regulated pain contracts, random UAs, and even with compliance, many are forced off their medication.

You’ve heard one person every three days dies of an opioid overdose in Oregon (not necessarily CPP). In those three days, over 15 times more people die of alcohol-related deaths.

Four years ago, a drunk driver permanently broke my body so now I’m a CPP, and yet he is free to drink as much as he chooses while I am in danger of losing my quality of life.

All in the name of fighting addiction.

Wendy Sinclair, who lives in Adair Village, is co-founder of the Oregon Pain Action Group and Oregon Legislative Coordinator for The Alliance for the Treatment of Intractable Pain. Reach her at wendyrsinclair@gmail.com.

 

It is a RIGGED GAME !

Liking vs Sharing on FACEBOOK

Some of us have regularly discussed why many in the chronic pain community do not seem to be connected in general.

I have been paying attention to the number of “likes” verses the number of “shares”

There in may lie the problem… according to what I have read when someone “likes” on a post or comment in FB.. apparently all it does is place one of various “icons” on the post

Whereas, when someone “shares” a post… it is copied out to all of their FB friends.. which might almost bring them up to speed on what is happening or not happening in or to the chronic pain community and in turn they may share if with all their friends.

Maybe more “sharing” of FB posts might get more in the chronic pain community on the same page and more “bodies” into “the fight”

sick of suffering website

Four lawsuits have been filed so far. I have joined 2 so far and will be joining the other 2 this week.

Please join all of them if you can. Especially if you or someone you love is in pain and being tortured because of opioid hysteria and lies that the CDC publicly admitted to telling via padding the OD statistics.

If you live in a state not yet listed and want to file please contact Robert D. Jr. Rose and let him know.

Please share like crazy!

A glimpse into the future of healthcare in America ?

The No. 1 takeaway from the 2019 JP Morgan Healthcare Conference: It’s the platform, stupid

This is very interesting “crystal ball view” into the way that healthcare is provided and received.  Some of my readers have some difficulty to understanding the larger picture outlined here.  The biggest casualty of all of this consolidation could be a lot of the for profit insurance industry and the PBM industry. Strangely what is being discuss seems to parallel those processes behind the concept of Affordable Care Act (Obamacare) which was described in that structure as ACO’s (Accountable Care Organizations) which basically hypothesized that the ACO’s would be a collective organization that would provide “total care” to a fixed number of pts for a certain $$$/pt/month and be at financial risk.  I also find it interesting that it is mentioned in this article that this all started about 10 years ago…. which just happens to be about the same time that the Obama administration came to power. Whether pts benefit or suffer from this type of organization is yet to be seen and may not have a final picture/conclusion for a decade or more into the future.

If you want to understand the shifting sands of healthcare, you’ll find no better place than the nonprofit provider track during the infamous JP Morgan Healthcare Conference that took place this week in San Francisco.

Over 40,000 players were in town from every corner of the healthcare ecosystem. However, if you want to hear the heartbeat of what’s happening at ground level, you needed to literally squeeze into the standing room only nonprofit provider track where the CEOs and CFOs of 25 of the most prominent hospitals and healthcare delivery systems in the country shared their perspectives in rapid-fire 25 minute presentations.

This year those presenters represented over $300 billion, or close to 10 percent of the annual healthcare spend in U.S. healthcare. These organizations play a truly unique role in this country as they are integrated into the very fabric of the communities that they serve and are often the single largest employer in their respective regions. In other words, if you work in or care about healthcare, understanding their perspective is a must.

Every year I take a shot at condensing all of these presentations into a set of takeaways so healthcare providers who aren’t in the room can share something with their teams to help inform their strategy. So what do you need to know? Glad you asked, here you go.

Shift Happens — Moving from Being a Healthcare Provider to Creating a Platform for Health and Healthcare in Your Community

Trying to synthesize 25 presentations into a single punch line is pretty stressful. I listened to every presentation, debriefed with other healthcare providers in the audience afterwards and then spent the next 48 hours trying to process what I heard. I was stumped.

But then, finally, it hit me. To take a new spin on an old phrase, “It’s the platform, stupid.” To be clear, even though I’ve been in healthcare for close to 30 years, “stupid” in that sentence is absolutely referring to me.

So the No. 1 takeaway from the 2019 JP Healthcare Conference is this — for healthcare providers, there is a major shift taking place. They are moving from a traditional strategy of buying and building hospitals and simply providing care into a new and more dynamic strategy that focuses on leveraging the platform they have in place to create more value and growth via new and often more profitable streams of revenue. Simply stated, the healthcare delivery systems of today will increasingly leverage the platform and resources that they have in place to become a hub for both health and healthcare in the future. There is a level of urgency to move quickly. Many feel that if they don’t expand the role that they play in both health and healthcare in their community, someone else will step in.

Folks in tech would think of this as the difference between a “product” strategy (old school) and a “platform” strategy (new school). Think of this as the difference from cell phones (Blackberry) to smartphones (iPhone and Android devices). One was a product, the other was a platform. Common platforms that we’re all familiar with such as Facebook, Amazon, Google, Apple and even Starbucks have always 1) started with a very small niche, 2) built an audience, 3) built trust and 4) then added other offerings on top of that platform. By now there is no need for a “spoiler alert.” We all know that this strategy works and these companies have created a breathtaking amount of value. The comforting news for hospitals and healthcare delivery systems is that many have already completed the first three steps and have many of the building blocks they need to leverage a “platform” as a business strategy. The presentations at the JP Morgan Healthcare Conference made it clear that most are now actually taking that fourth step to separate themselves from the pack.

There is enormous upside to those who understand this pivot and take advantage of this change in the market. Dennis Dahlen, CFO of Mayo Clinic, shared his perspective on this: “Thinking differently in the future is essential. In many ways, at Mayo, we are already operating as a platform today, but we have to continue to leverage this approach to uncover additional ways that we can be a hub for both health and healthcare in our community.” Mayo’s platform includes leveraging research, big data, expert clinic insights and artificial intelligence to create new value for Mayo’s clinical practice as well as new opportunities for Mayo’s partners.

To be clear, the mental shift here is massive. It’s the difference of being on defense (where most healthcare providers are) to be being on offense (which is where they know they need to be). Executive teams have focused their time, energy and resources on driving and supporting inpatient admissions via a traditional bricks and mortar presence coupled with the acquisition of physician practices. The difficulty of thinking through what it means to truly be “asset light” and taking a different approach shouldn’t be underestimated. The good news is that the recent financial results of many health systems have improved, providing a little breathing room for investments to enable this shift in strategy. Those who don’t may fall way behind. 

A New Way of Thinking — What it Means to be a Hub

Being a hub is essentially bringing together people with common interests to spark innovation and facilitate work getting done more efficiently. Examples include Silicon Valley as a “tech hub,” Los Angeles as an “entertainment hub,” New York as a “financial hub,” Washington, D.C. as a “hub for politics” and how essentially every college town is or can become a “research hub.”

Given that hospitals and health systems are the largest employers in their community, they are already set up to become a hub. In the past, they leveraged that position to simply care for the sick. Increasingly in the future, these organizations will be health and healthcare hubs for innovation and building new companies, for bringing the community together to tackle issues like hunger and homelessness, for education and training, for research and development partnerships, for coordinated, compassionate and longitudinal care delivery for treatment, for support groups for specific chronic conditions, for digital and virtual care, and for thoughtful and effective support for mental and behavioral health. Changes in the care delivery market over the last 10 years have put the right building blocks in place to make this happen.

Hiding in Plain Sight — The Single Biggest Change in Healthcare We May Ever See Has Already Happened

Taking advantage of becoming a hub and leveraging the strategic concept of being a platform requires new thinking, new structures and new skill sets. The great news for healthcare providers is they have already made the toughest move of all in order to set this in motion.

Over the last decade, there has been a massive level of consolidation with hundreds of hospitals and thousands of physician practices being acquired every year. While more mergers and acquisitions will still happen, this stunning and fundamental restructuring of healthcare delivery has taken place and there is no turning back. This is likely the single biggest shift relative to how healthcare is structured in this country that will take place during our lifetime, and it barely gets mentioned. The strategy many were chasing was primarily being driven by a “heads in beds” pay-off that was both based on offense (“an easier way to grow”) and defense (“we better buy them before someone else does”). That said, as this consolidation happened most healthcare delivery systems were really just an amalgamation of stand-alone hospitals set up as a holding company that provided no real leverage other than more top-line revenue.

During the JP Morgan Healthcare Conference, it was clear that most have made the shift from a holding company into a single operating entity. Chicago-based Northwestern Medicine shared a very refined playbook for quickly bringing acquisitions onto their “platform,” and the results are pretty stunning as they have transformed from a $1 billion academic medical center into a $5 billion regional healthcare hub in a handful of years.

And over the last few years, these organizations have gotten super serious about making the toughest decisions right away. The mega-merger of Advocate Health and Aurora Health, the largest healthcare delivery systems in Illinois and Wisconsin respectively, was accompanied by a gutsy decision to fast-track the implementation of Epic at Advocate to get the leverage of a single EHR platform across the system. While many focus on the cost of the transition and the shortcomings of some of the applications, what gets missed is the enormous long-term leverage this provides regarding communication, integration, continuity of care and, of course, access to data and the potential to improve clinical and financial performance. This creates a “platform-like” experience for both employees and customers. 

So, the twist in the story is that the pay-off for consolidation will likely be very different and perhaps much better than many had originally intended. They have the building blocks in place to be a health and healthcare platform for their community. But now they need to figure out how to truly take advantage of it.

Your Action Plan — 6 Ideas from 25 Healthcare Delivery Systems on How to Leverage Your “Platform”

During their presentations the 25 non-profit provider organizations opened up their playbooks on how others can leverage their platforms and the idea of becoming the hub for health and healthcare in their respective communities. Here is what they shared.

1. Create the Digital Front Door — or Someone Else Will

The big shift in play right now is the moving away from traditional reliance on transactional face-to-face interactions with individual providers. Building relationships and trust is something that has been a core competency and core strategic asset for hospitals in the past. In the future, this simply won’t be possible without leveraging digital platforms as we do in every other aspect of our lives today. As Stephen Klasko, MD, CEO of Philadelphia-based Jefferson Health, shared, the real strategy will be to deliver “health and healthcare with no address.”

Many provider organizations are moving aggressively to create digital front doors. Kaiser Permanente delivered 77 million virtual visits last year. Intermountain introduced a virtual hospital that provides over 40 services and has delivered over 500,000 interactions. Nearly every health system leverages MyChart or a similar personal health record platform. There is an enormous amount of risk for hospitals and health systems that don’t take action here, as traditional healthcare providers will be competing with more mainstream and polished consumer brands for the relationships and trust of the folks in their community.

As the team from Spectrum Health shared, “87 percent of Americans measure all brands against a select few — think Amazon, Netflix and Starbucks.” Google, Apple and Facebook as well as Walgreens or CVS are all going after this “digital handshake,” and are big threats to healthcare providers. There is no question that some of these organizations will be “frenemies,” where they are both competing and collaborating. Healthcare organizations will need to approach any partnerships mindful of that risk.

2. Drive Affordability and Reduce Cost — or Risk Being the Problem

As the burden of the cost of care increasingly shifts to the patient’s wallet, healthcare providers will need to play in driving affordability. Coupled with the recent federal requirement to post prices online, there is a great deal of visibility around the price of care, even if the numbers are way off the mark. Understanding and reducing the total cost of care is now viewed as a requirement. As legacy cost accounting applications relied on charges as a proxy for cost and were limited to the acute care setting, most provider organizations have or are now in the process of deploying advanced cost accounting applications with time-driven and activity-based costing capabilities including a number that presented during the conference, such as Advocate Aurora Health, Bon Secours Mercy, Boston Children’s Hospital, Hospital for Special Surgery, Intermountain Healthcare, Northwestern Medicine, Novant Health, Spectrum Health and Wellforce.

This was one of the hottest topics during the conference, and there was significant buzz regarding having a single source of truth for the cost of care across the continuum. Vinny Tammaro, CFO of Yale New Haven Health, commented, “We need to align with the evolution of consumerism and help drive affordability in healthcare. How we leverage data is mission critical to making this concept a reality. Bringing clinical and financial data together provides us with a source of truth to help both reduce the cost of care as well as reallocate our finite resources to high impact initiatives in our community.” Organizations like Intermountain Healthcare, which implemented a 2.7 percent price reduction in exchange pricing, are taking the next step in translating cost reduction into lower prices for consumers. And now healthcare systems are starting to work together to create additional leverage via Civica Rx, which now includes 750 hospitals joining forces to help lower the cost of generic drugs.

3. Tackle Social Determinants of Health — or You Won’t Be the Hub for Health in Your Community

It is always less expensive to prevent a problem than it is to fix it. The good news is that the economic incentives for hospitals and healthcare delivery systems to both think and act that way are beginning to line up. They are certainly there already for providers that are also health plans such Intermountain, Kaiser Permanente, Providence St. Joseph Health, Spectrum Health and UPMC. They are also in place for providers that have aggressively taken on population-based risk contracts such as Advocate Aurora Health. With that said, it feels like every health system is starting to lean in here — and they should.

Being the central community hub for these issues makes a ton of sense. The way that Kaiser framed it is that while they have 12 million members, there are 68 million people in the communities they serve. Taking that broader lens both allows them to make a bigger impact but also broaden their market. Many organizations, such as Henry Ford Health System, are taking on hunger via fresh food pharmacies. Geisinger shared how a 2.0 reduction in Hemoglobin A1c reduction leads to a $24,000 cost reduction per participant in their fresh food “farmacy.” So while hospitals are perfectly positioned, have the resources and know it’s the right thing to do, they are now also beginning to understand the business model tied to targeting the social determinants of health. There is also strong strategic rationale associated with taking on a broader role of driving health versus only providing healthcare.

4. Create Partnerships for Healthcare Innovation — or Lose the Upside

Spectrum Health has a $100 million venture fund. Providence St. Joseph’s Health announced a second $150 million venture capital and growth equity fund. Mayo Clinic Ventures has returned over $700 million to their organization. Jefferson Health has a 120-person innovation team focused on digital innovation and the consumer experience, partnering with companies to build solutions. These are all variations on a theme as virtually every organization that presented is leveraging their resources to make a bigger impact and drive additional upside from their platform. “We have close to 900 agreements with over 500 partners,” stated Sanda Fenwick, CEO of Boston Children’s Hospital. “Our strategy is to be a hub for research, innovation and education in order to help evolve how care is delivered. This can only be done by collaborating with others.”

5. Become the Hub for Targeted Services and Chronic Conditions — or They Will Go Elsewhere

Perhaps the best example here is the work of Hospital for Special Surgery, the largest orthopedics shop in the world. It is has become a destination for good reason — fewer complications, fewer infections, a higher discharge rate to home and fewer readmissions. The most compelling data point is that when patients come to HSS for a second opinion, one-third of the time they receive a non-surgical recommendation. The same type of shopping is increasingly going to happen for chronic conditions.

Healthcare delivery systems that take a more holistic yet targeted approach have significant potential. They will need to think more deeply about the end-to-end experience and become immersed within the community outside of the four walls of the hospital. Other players in the community, such as CVS Health and Walgreens, would say they have a platform — and they would be right. The platform that healthcare providers have built and are building will absolutely be competing against other care delivery platforms.  

6. Leverage Applied Analytics — or You’ll Lose Your Way

In order to enable everything listed above, the lifeline for every health and healthcare hub will be actionable data. Applied analytics is a boring term that is actually gaining traction and starting to dislodge buzzwords like big data, machine learning and artificial intelligence relative to its importance to healthcare providers.

Similar to how analytics are being used in a practical way in baseball to determine where to throw a pitch to a batter or position players in the field, healthcare providers are pushing for practical data sets presented in a simple, actionable framework. That may seem obvious, but it is simply not present in many healthcare organizations that have been focused on building data warehouse empires without doors to let anyone in. Many organizations, such as Advocate Aurora Health, Bon Secours Mercy and Spectrum Health, have deployed more dynamic business decision support solutions to access better insight into performance and care variation. This allows them to assess opportunities to reallocate resources to invest in more productive ways to leverage their platform.   

While leveraging a platform as a business strategy is new to healthcare providers, the good news is that building blocks are already in place. It’s time to leverage that platform to drive better outcomes and more affordable care in the community. And now is the time to get started.

Dan Michelson is the CEO of Chicago-based Strata Decision Technology. Mr. Michelson has authored recaps of JP Morgan Healthcare conferences for the past several years for Becker’s. Read his account of the 2018 event here and the 2017 event here.

Presenting non-profit provider organizations during the 2019 JP Morgan Healthcare Conference included the following: AdventHealth, Advocate Aurora Health, Ascension, Baylor Scott & White Health, Bon Secours Mercy Health, Boston Children’s Hospital, CommonSpirit Health, Geisinger, Hartford HealthCare, Henry Ford Health System, Hospital for Special Surgery, Intermountain Healthcare, Jefferson Health, Kaiser Permanente, Mayo Clinic, Memorial Sloan Kettering, Northwell Health, Northwestern Medicine, Novant Health, Oregon Health & Science University, Providence St. Joseph Health, Spectrum Health System, SSM Health, University of California Health, UPMC and Wellforce.

We’re doing an ongoing series about the opioid epidemic

We’re doing an ongoing series about the opioid epidemic

https://politico.forms.fm/opioid-epidemic/forms/4903

We’re doing an ongoing series about the opioid epidemic, which is arguably America’s biggest public health crisis since AIDS. Opioids (including legal painkillers, heroin and fentanyl) killed a record 42,000 people in 2016, and death rates are rising, according to the CDC.

We want to hear about your experience. Tell us your story and a reporter may follow up with you.

(Read the story: 5 unintended consequences of addressing the opioid crisis https://politi.co/2FUB3iA)

Contact email

ayu@politico.com

A Little State Debunks A Big Lie: The DEA’s Opioid Scam

https://www.acsh.org/news/2018/11/21/little-state-debunks-big-lie-deas-opioid-scam-13614

 It’s more than a little ironic that the state motto for New Hampshire is:

“Live Free or Die”

Because it conflicts with a new motto I have just made up. Since we are nothing if not economical here at ACSH I figured that I could save time and energy coming up with new mottos for the CDC and DEA. But I only need one:

“Feel Free To Lie”

I’ve been writing all along (most recently Who Is Telling The Truth About Prescription Opioid Deaths? DEA? CDC? Neither?) about how the CDC and their flunkies from the Physicians Responsible for Opioid Prohibition (1) have been spinning their bogus statistics in order to tell us a story that isn’t even remotely true: That prescription opioids are killing bazillions of Americans and the way to combat this is to crack down on prescribing these drugs.

My article above catches the DEA making up the same crap – 164 pages worth of it. Somehow, despite both common sense and plenty of evidence to the contrary, the agency fell into line with the CDC and reached a similar conclusion. The graphs in the article do a pretty good job of showing you why these conclusions are nonsense.

But not as good as this one:

Source: CDC “Synthetic Opioids” means illicit fentanyl and its analogs. (2)

Well, I’ll be damned! Those numbers sure look strange. Why, if you happened to come across this graph without a calculator how could you possibly know that:

  • Fentanyl was involved 83% of the overdose deaths in New Hampshire 

  • Heroin was in 8% of the overdose deaths in New Hampshire 

  • You can figure out the rest.

Of course, different states will have different patterns of abuse, but if 9% of OD deaths in one state came from opioid analgesic drugs like Vicodin and Percocet then it’s a pretty good bet that most of the time you’re going to see a pattern that is at least vaguely similar to that of New Hampshire, despite the fact that it has (by far) has the lowest percentage of opioid analgesic OD deaths in the country. You see this in the Northeast. The majority of OD deaths are not from pills.

  • New Jersey – 30%
  • Connecticut – 31%
  • New Jersey – 30%
  • New York – 27%
  • Massachusetts – 19%

The next set of numbers is especially interesting. The Midwest is constantly described in the news as “being ravaged by the opioid crisis.” This is true, but most of the ravaging isn’t coming from prescription pills. 

  • Kentucky – 43%
  • Ohio – 24%
  • West Virginia – 46%
  • Indiana – 37%

In 19 states the percentage of deaths from pills exceeds 50% of the total. Some examples:

  • Maine – 51%
  • South Carolina – 61%
  • Alaska – 54%
  • Arkansas – 78%
  • California – 58%
  • Georgia – 58%

What is more interesting, however, is the slope of the (green) line between 2010 and 2016 – the time when these pill deaths supposedly skyrocketed. Here’s a close-up of New Hampshire. It is quite obvious that the number of deaths between 2010 and 2016 remained more or less constant.

New Hampshire opioid deaths 2010-2016. The green line represents prescription opioid analgesics. The black hatch line connects 2010 with 2016. It is quite level. 

The same held true for other states with a low percentage of pill deaths. The black hatch line shows that pill deaths between 2010-2016 were fairly constant in these states.

 

 

But the same also held true for the states with a high percentage of pill deaths (South Carolina being the exception).

So, here’s the obvious question:

So, where is the opioid epidemic?

Between 2010-2016, the years when everyone became hysterical about “heroin pills” there was just about no change in the number of deaths in states where pill death rates were low or where they were high. The answer is obvious. The “opioid epidemic” is due to heroin and fentanyl, not pills. As I’ve written before, we are not having an “opioid epidemic.” We are having a fentanyl epidemic. It’s been obvious all along. Yet, we keep hearing the same old garbage from our government and the press and the only “plan” our “leaders” have is to tighten up the pills.

Like this:

“Controlled Prescription Drugs (CPDs) … are still responsible for the most drug-involved overdose deaths and are the second most commonly abused substance in the United States.”

DEA Report, November 8, 2018.

Maybe they’re just high.

Or, in some cases, quite low. 

NOTES:

(1) I may have gotten the name wrong. But those guys don’t care much for accuracy, so big deal.

(2) For some reason, tramadol is classified a synthetic opioid but it has little in common with real opioids. (It has also been called a pseudo-opioid.) I don’t think it should be called an opioid at all. It is far weaker and bears little structural resemblance to either the semi-synthetics (oxycodone, hydrocodone) or the fentanyls. So, it hits a few receptors. Big deal. So do other drugs that aren’t opioids either. 

What (doesn’t) happen when you are part of the “good ole boys” DOJ club ?

Ex-DEA agent gets probation for selling ARs to ‘members of a drug trafficking organization’ on border

www.guns.com/news/2019/01/11/ex-dea-agent-gets-probation-for-selling-ars-to-members-of-a-drug-trafficking-organization-on-border

Although federal prosecutors sought jail time, citing memories of Fast and Furious gun-walking scandals, the former Drug Enforcement Agency agent was given probation on weapon charges.

Joseph Gill, 42, was sentenced on Monday to five years probation with the first six months of the term spent in home detention after pleading guilty last October to two counts of illegally dealing firearms. While investigators determined he may have been sold as many as 100 guns in private transactions over the past several years, it was the sale of two AR-15s to members of a drug trafficking organization in 2016 that triggered his arrest.

In a memo to the court penned by Assistant U.S. Attorney Phillip Smith prior to sentencing, the prosecutor argued that Gill should receive at least 18 months jail time, followed by three years probation and a $100,000 fine, saying, “He sold weapons when he knew he should not have, and under circumstances which he should not have.”

A former supervisory special agent assigned to the border town of Nogales, Arizona, court documents show that Gill came under scrutiny after he sold “scores” of guns without a federal firearms license. Although at one time he had an ATF Curio and Relics (C&R) license, the type typically maintained by collectors of vintage firearms, he let it lapse. Similarly, he withdrew a further application for an FFL.

In the case of the ARs sold in 2016, Gill purchased three rifles for $632 each through an online retailer in Kentucky and had them shipped to a local FFL in Arizona. He then resold two of them for $1,000 each the next month in two transactions to men that he “had reason to believe intended to use or dispose of the firearm unlawfully.” One of the guns was subsequently recovered by federal agents.

While Gill, charged last August after he resigned from the DEA, later entered a guilty plea that opened him up to as much as five years in prison, his attorney argued to the court that he had an otherwise exemplary career and his crime was “one of willful ignorance.”

To this, Smith scoffed, saying, “The defendant was a sworn federal agent at the time he committed this crime, and he knew what he was doing was a crime and did it anyway—all for personal profit.”

Further, Smith invoked the notorious gun-walking scandal that allowed licensed firearm dealers to sell guns illegally in hopes of tracking the weapons back to trans-border drug cartels. “Perhaps most shockingly, the defendant committed this crime with assumed knowledge of the infamous joint DEA-ATF ‘Operation Fast and Furious,’ which resulted in a federal agent being murdered by a weapon that had been acquired illegally by a straw purchaser and had ended up in Mexico,” Smith said.

Nogales straddles the border with Mexico, with part of the city in Arizona and part in the Mexican state of Sonora. Customs and Border Protection Agent Brian A. Terry, 40, was killed northwest of the city in 2010 with a gun that had been purchased by an Operation Fast and Furious subject.

In addition to his probation, Gill received a $15,000 fine, with orders to pay it off $250 per month.

 

what happens when a Pharmacist has little/no clinical experience in a particular area nor empathy ?

Dear Pharmacist Steve

I read your article posted on the National Pain Report website because I was searching for information regarding what to do when denied pain meds. 

I would like to share our experience with you. Please note that both my husband and I are Senior citizens and he is Disabled. 

On Tuesday Dec 18, 2018 I was  informed by our Pain Management doctor that Scripts had been sent to Martin’s Pharmacy in our hometown for both of us and were to be filled that day. Over the course of the next three days multiple attempts were made and we were always told they were not yet ready.

On Thursday December 20, I received a phone call at our home. The voice did not introduce himself, rather he rudely asked who I was and I replied and asked who was calling. He said: Martin’s Pharmacy and wanted to know who James was.I told him he was  my husband. I asked for the man’s name at this point and he replied: Thomas Harsh and then began a diatribe, first stating he questioned the fact that my husband has. been prescribed  four different Controlled Dangerous Substances from not only National Spine and Pain Center, but by two other Physicians. He stated he would not fill any of these because he questioned whether each Doctor was aware of the other’s prescriptions. He also then advised me “and I’m not filling yours either.” I also have a degenerative fractious spinal condition. 

As a result my husband was without two very crucial medications that keep his pain level to about 4 at best.He was without the medications from the date the Prescription was due to be filled, Tuesday,  December  18, until the  Prescriptions were submitted to a different local Pharmacy by National Spine and Pain Management of Cumberland; they were finally filled at 6PM the evening of  December 20, 2018.

During that lax in pain management coverage, the result of Pharmacist Thomas’s refusal to fill my husband’s prescriptions was that the coverage of the medication dwindled to none and he began withdrawal, i.e.  sweating, nausea, and vast searing pain (well over ten on the pain scale) with convulsions.  

On that Thursday evening I considered calling an Ambulance to take my husband to the local Emergency Room for pain relief. My husband is personally involved at our local NewsTalk  Radio station, where he has produced  many outspoken announcements about the fear of addiction. He is fully aware of the current Opioid  Epidemic and how seriously it has  ravaged our community. Yet, for him there are no other options, having had seven Back Surgeries and metal implanted  from his lower back to his  neck, nerve damage, diabetic Neuropathy, Parkinson’s Disease etc. 

In  short, our Martin’s Pharmacist could offer no way at all to resolve this situation to restore our medications. 

This was the day before we were to leave for Christmas Vacation in the Cleveland, Ohio area, where we had prepaid  reservations Friday through the following Wednesday at Holiday Inn Express, Mentor Ohio, and tickets to various events and other family Holiday gatherings. 

Unfortunately, after three days off of Pain Meds, receiving meds only after a switch from Martin’s to another local Pharmacy,  my husband’s pain  was soaring, severe and sharp.  He was finally able to resume pain management meds late Thursday but by Friday the 21st Dec, he was in no condition to make the trip. He stayed at home in Cumberland with my sister assisting him and we paid a friend to drive me to Cleveland, as I do not drive. 

I feel my husband and I have suffered undue pain, humiliation, and financial loss, the result of the Pharmacist’s negligence. 

Certainly, as a result of our long term customer status it would have been more prudent to advise us “Mr Drake, and Ms Melotti,  I have some serious questions about your Medications and the way they are prescribed. I am filling these Prescriptions and I am giving you notice that you must provide me proof in writing from your Prescribing Physicians BEFORE I fill such again.”

I also feel notice like  this should have been done in writing, requiring our signature of acknowledgement. This would have given us a chance to speak with each Doctor and secure such information for Martin’s Pharmacy. 

We have been customers at Martin’s Store and Pharmacy for some time now; certainly long enough that a simple review of our Pharmaceutical records should have justified any immediate question of our integrity. 

In addition to this first event I then called in a refill a week later for my husband for another one of his scripts, Clonazepam.

The auto refill system said it would be ready after 7 pm that same day. The following  morning I called Martin’s  pharmacy and spoke with a woman that said it was not yet ready but that she would take care of it and that she would send me a text message when the script was ready. After receiving three text messages advising us to come pick up my husband’s meds, I went to the  pharmacy on Park St at 5:30 pm and  was then told that the script was not ready and to wait. After waiting, the Pharmacy Clerk told me  that the pharmacist had refused to fill the clonazepam.

Again, this is a medicine that me husband cannot stop ‘cold turkey.’ We were  therefore again compelled to request that my husband’s  neurologist send a new script to a different local pharmacy. The humiliation suffered at the counter this time was witnessed by two other people.

Can this Pharmacist do this? This has been a nightmare for us. We are two solid citizens of our community and feel that we have been wrongfully discriminated against. Fortunately I have managed to switch all our meds to a different pharmacy and I do feel like I am in control again of our lives but I really feel we have been wronged and would appreciate any help of information you can provide us.

Thanking you in advance,

 

It has been six months since Tennessee enacted new laws to restrict the number of opioid prescriptions, but it still comes as a shock to patients


It has been six months since Tennessee enacted new laws to restrict the number of opioid prescriptions, but it still comes as a shock to patients.