For those who believe that it is beneficial to go to washington DC and protest… I am watching (not listening to) what is going on right now at the capital steps.  Just a couple of weeks ago the Senate vote 99-1 to approve 70 odd opiate related bills – all to basically harm chronic pain pts and “help” substance abusers – who most of them don’t want help.

Now the senate is pretty much divided along party lines on voting for Kavanaugh, except for one of the Senators from Alaska  Sen. Lisa Murkowski (R), who has stated she is going to vote “PRESENT”… apparently she doesn’t have the “balls” to make a decision so she is going to “sit on the fence” and refuse to vote at all.  She sure had the “balls” to vote for the 70 odd opiate bills a couple of weeks ago…  along with 98 other members of Congress.. the only Senator that voted against those opiate bills was a Republican from Utah. I think that it was Mike Lee.

What I am noticing is that many of the protestors are being lead away in “handcuffs” and many have one arm raised – much like the Nazis and Hitler did during Hitler’s reign.

I wonder how many in Congress could pass the scrutiny of a FBI investigation … Congress would probably not have enough members to have a quorum to pass any bills.. I often wonder why after 242 yrs Congress still finds a need to pass some 200-300 bills every year.

Other Presidents have promised to have a transparent administration and none have come close until Trump with all his tweets… maybe he has taken transparency a bit to far… but is that worse than everything in washington being done behind closed doors ?

How many of us have not done something REALLY STUPID in our teen/college years.. I know that I did and I know that our daughter had a grade school/high school friend that those two were synergistic troublemakers when they were together.

Is our political system becoming so polarized that our country itself is suffering from being BI-POLAR.

Our country may end up like a spinning wheel that becomes “out of balance” and just starts flying apart because of the lack of balance and as soon as that first piece flies off.. the wheel becomes more out of balance and the integrity of the wheel quickly   disintegrates and can’t no longer functions as it was designed.

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Prosecutors notify 30 doctors about excessive opioid prescriptions

https://www.ajc.com/news/crime–law/prosecutors-notify-doctors-about-excessive-opioid-prescriptions/fXSbsKBg8XiMc9y7wj3wPN/

Federal prosecutors in Atlanta have put about 30 doctors on notice that they’ve been identified for prescribing opioids in significantly greater quantities or doses than their peers.

The doctors, who were not publicly identified but work in the metro and North Georgia area, were notified by letter. Some also were found to have prescribed opioids to patients who may have a high risk of abuse, the U.S. Attorney’s Office said Friday.

“Medical professionals have an obligation to the safety and well-being of their patients,” U.S. Attorney BJay Pak said in a statement. “Many opioid prescribers may not realize that they are over-prescribing opioids. We aim to make these medical prescribers — who are outliers — aware of their atypical practices, so that they can make informed decisions about whether their opioid prescriptions are for a legitimate medical purpose.”

The letters are part of an initiative by the U.S. Department of Justice to reduce opioid prescriptions by one-third over the next three years. The Department of Justice has not determined if the 30 doctors who were put on notice have broken the law, but federal authorities will continue to monitor prescribing habits, Pak said.

In the letters, prosecutors provided the doctors with specific information about their prescription patterns. The doctors were also given guidelines by the Centers for Disease Control and Prevention for prescribing opioids for chronic pain.

Neil Campbell, executive director of the Georgia Council on Substance Abuse, applauded the move.

“This is a really good thing,” she said. “There’s been such an abuse of prescriptions and it’s hurt a lot of people. Most doctors don’t want to give more painkillers than they need to, but unfortunately that’s not the case with everyone.”

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Life is full of these entities… be it the school yard bully… in a political race, in the world of manufacturing and sale, the animal kingdom..

The predator typically only picks on the prey that they believe that they can defeat because the prey has something the predator wants… be it money, a possession they covet or they want to EAT THE PREY.

The kid that the bully keeps picking on learns a martial arts and one day kicks the ass of the bully … the bully will find a easier prey in the future

The political fight is over exposure, hand-shaking, baby kissing and unfortunately how much ” political mud” you can sling at your opponent.

In the market place… entities like Walmart and Amazon have changed how/where we shop and get things we need.

In the animal kingdom prey learn how to run/swim/fly faster, improve their senses to be more aware when a predator is close, or learn how to hide and or camouflage themselves better.

In the “real world” some predators use the laws and our legal system to go after their prey and that forces the prey to engage an attorney to fight back and/or create obstacles or camouflage.

whatever the predator is after.

Right now we have cities, counties and states being the predator after drug manufacturers and wholesalers… the “prey” is being blamed for creating the “opiate crisis” and the predator wants the prey’s money to compensate them for the cost providing treatment to those who have been ensnared in the opiate crisis. Apparently the individuals have no personal responsibility for the place they find themselves in !

We have the DEA who seems much like the human eating plant in the “Little Shop of Horrors ”  always demanding  “feed me Seymour”.  Their original charge/mandate  back in 1973, was to PREVENT DIVERSION.  Most/many /all of the sources of diversion in our country is from cartel outside of our country and the DEA does not have the authority nor the cooperation of foreign governments to interfere/stop these cartels production and exporting illegal drugs into our country.

What illegal drugs the DEA has seized has no monetary value to them… it is more a liability… to search/seize, inventory, warehouse and destroy. The assets of these cartels are outside of our borders and untouchable.

Besides, these cartels and their street dealers distribution system seem to have little concern about protecting their turf and willing to shoot/kill anyone who tries to interfere with their business plan.

The DEA is a PREDATOR ! they have shown that they are going after the weakest prey that will provide them the largest financial gain.  That is the prescribers.

Historically, doctors/prescribers have been poor business people.  Their focus is to treat/heal pts.  So they have become the primary prey of the DEA Predator. The typical process of the DEA is to raid a prescriber’s office… convince them to surrender their license, close their practice and confiscate all the pt’s medical records and then confiscate/seize all the prescriber’s assets.

Their PROBABLE CAUSE is more like an opinion based on some raw number of prescriptions or doses that the prescriber has prescribed over some period of time… sometimes as far back as TEN YEARS.

If you notice the vast majority of prescribers that the DEA goes after are at the end of their career 50-55+… Those that have assets to seize…they are a not going to go after younger prescribers who have six figure student loans and probably floating in debt for a house and a couple of cars… The DEA can’t seize and liquidate a asset that has a large loan balance against it.

Then there has been numerous times that the DEA has closed multi location practices and TOSSED tens of thousands of chronic pain pts out into the streets and everyone knew that the local medical community did not have the capacity to even begin to absorb and treat these chronic pain pts. There has been information shared that more chronic pain pts committed SUICIDE within weeks of the practice being closed…. often more “bodies” than the practice was accused of having OD’d

I have been told that the DEA puts up “road blocks” to the pts of a practice they raided in getting copies of their medical records, which makes it nearly impossible to find a new prescriber to accept them as a pt. Increase the risk that a chronic pain pt will commit suicide.

I am concerned that the prescribers have not started protecting themselves from this PREDATOR…  It seem quite obvious that the DEA is after the prescriber’s assets .. even the most casual observer should be able to come to that conclusion.  If this is the case, the prescribers can divest themselves of their assets in a irrevocable trust… in fact they would have to make two.. because  the grantor of a trust cannot be the beneficiary of a trust… so one created by the husband for the wife and the wife creates one for the husband.

Personally, they basically becomes financial paupers … if it is done before the vultures start circling…  the trust can be set up to pay their day to day expenses, even legal expenses, but prohibit the trustee of the trust to allow the monies/assets to be confiscated.

The DEA PREDATOR is just like a robber/burglar… they look for easy targets and – IMO – they have little concern about the “dead bodies” attached to a particular practice/prescriber from the perceived OD of a person.

These, so called, OD’s from a particular practice that the DEA claims to be a result of the prescriber’s prescribing habits. where are the lawsuits from the surviving families toward these prescribers ?

Where is the actions against these prescribers by the state Medical licensing boards for improper prescribing before the DEA shows up on the prescriber’s doorstep ? No media coverage of all the complaints from pts from the Medical Boards’ records about a particular prescriber for unprofessional conduct, malpractice. Could it be that their file is basically “empty”. Does it boil down that only the DEA believes that the prescriber is a “bad prescriber” ?

I often wonder what some law firm has not set up and promoted creating such irrevocable trusts for presribers. Is it because it may be frowned upon by fellow attorneys that they are working AGAINST the judicial system?  Prescribers doing this in mass could have a chilling effect on the business/revenue of prosecuting/defense attorneys and the the DOJ/DEA would have fewer – if any – prescriber that they could “go after”.

Just think about it, when is the last time that you have heard of an attorney suing another attorney ?  So, is there a unwritten rule within the legal profession that you don’t sue another part of the judicial system ? and the DEA is part of that same system.

One would think that if doctors are concerned about their chronic pain pts and the care that they get and hopefully will continue to get.. that docs would be looking for ways to put obstacles between them and the DEA, instead of just ignoring the warning signs of what is happening or just stop caring for chronic pain pts or just walking away from the practice of medicine.

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America is more accepting of torture than most other countries

https://www.weforum.org/agenda/2016/12/america-accept-torture-survey-red-cross-2016/

Image: ICRC

Image: ICRC

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https://youtu.be/I9HPlbP_etE

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It was around 7 o’clock pm, Tuesday, 10/02/2018′ the pharmacist at Sams Club in Clearwater, Fl. told me that they are no longer accepting “patients” who need schedule 2 medications. He said each store determines a quota amount they want to dispense. I told him that I was a sams club customer, not a patient. He looked at me with suspicion and walked away. According to the WHO, my schedule 2 pain medication is classified as an essential medication. How is this Sams Club policy going to help anybody?
It may be smarter to just go under the radar. Have a plan to activate something really dramatic if one gets “caught”. This paranoia is taking it’s toll.

I know a Pharmacist that was working for this same chain in South Florida and his particular store had cultivated a fairly good size of legit patients that had a need for various controlled substances.  Apparently one day a supervisor/District Manager walked into this particular store and told this Pharmacist – who was also the Pharmacist in Charge – that the company (Walmart) had determined that the per-cent of controls meds that he was dispensing was to high and that he HAD TO CUT many of these pts loose – refuse/stop filling their prescriptions – and that his ability to order controlled meds and his inventory of controlled meds was going to be reduced.  As I understand it, this pharmacist filed complaints with any/all agencies that could have authority over this corporate edict, and apparently none were interested in what was being done. In the end the Pharmacist was FIRED and sued Walmart/Sams and there was some settlement $$$ paid to the pharmacist.

Let’s look at what is going on.. one of the basics of the practice of medicine is the starting, changing, stopping a pt’s therapy/medication.  There is this letter posted from the AMA to Walmart “healthcare ” Walmart style – Part TWO    where Walmart has sent out a corporate edict that their pharmacists are limited to dispensing up to a 7 days supply on new opiate Rxs and/or 50 MME/day limits.

According to the Controlled Substance Act.. no one can prescribe/de-prescribe a controlled substance for a pt that they have not done a in-person physical exam.   Of course, this must presume that the person has a medical license to practice medicine and a DEA license as well.

Most people who require a controlled med prescription are dealing with a physical/mental disability and would be a covered entity under the Americans with Disability Act, and denial/refusal to fill a valid/legit prescription for a controlled substance would be discrimination of those patients… which is a CIVIL RIGHTS VIOLATION.

Are these Sams/Walmart pharmacies going to be providing these controlled substances on a first come – first serve basis or select certain pts that they are willing to fill these controlled meds for ? The former process will almost assure that some pts will be INTENTIONALLY THROWN INTO A COLD TURKEY WITHDRAWAL when the pharmacy has “ran out ” of a particular medication or a certain group of pts will be just “blacked balled” and not even have a chance to get their medically necessary controlled meds from a particular pharmacy.

No matter how you slice/dice this situation, some pts that are covered by the ADA will get discriminated against and/or denied their necessary medication.

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That Radar Speed Road Sign Might Be Saving Your License Plate for Later

https://www.popularmechanics.com/technology/security/a23550788/dea-license-plate-readers/

A new DEA program will roll out a controversial tool on a national level.

Zooming down the highway past a radar speed sign can serve as a reminder you’re going a little to hard on the gas pedal, but it can also get your license plate number siphoned into a massive data dragnet used by the Drug Enforcement Agency (DEA).

A new report in Quartz details an extensive new government contract between the DEA and RU2 Systems, a manufacturer of Radar Speed Display Trailers, and other contractors based in California, Virginia and Canada.

The machines use light-emitting diodes to show your MPH on the highway. (If you’ve driven on a busy motorway, you’ve undoubtedly seen one.) But the DEA’s new hardware isn’t the mere purchase for the sake of traffic safety: The machines will be “be retrofitted as mobile LPR [License Plate Reader] platforms” meant to target vehicles implicated in crimes, per the Justice Department’s disclosure. Ostensibly a program to curb drug trafficking, the DEA describes its National License Plate Reader Program (NLPR) thusly in its 2018 budget:

“A federation of independent federal, state, local, and tribal law enforcement license plate readers linked into a cooperative system, designed to enhance the ability of law enforcement agencies to interdict drug traffickers, money launderers or other criminal activities on high drug and money trafficking corridors and other public roadways throughout the U.S.”

The “drug and money trafficking corridors” are ostensibly roadways throughout the American southwest and southern border region.

This is an old chestnut that’s prompted litigation and controversy before. In April, the Virginia Supreme Court reopened a 2016 case concerning data pulled from LPRs by police, the Washington Post reported earlier this year. According to the National Conference of State Legislators, 14 states have already clamped down on LPR tech, passing “statutes relating to the use of ALPRs or the retention of data collected by ALPRs.” Arkansas, for instance, prohibits their use entirely.

There’s already a robust network of local police forces using the technology, not to mention a for-profit industry undergirding its use. Vigilant Solutions, a manufacturer of law enforcement tools, boasted in a 2015 press release that its technology enabled “3 billion historical LPR scans and over 100 million new LPR scans monthly.”

Privacy advocates aren’t enthused by the DEA’s new directive. The Electronic Frontier Foundation lists a few of its grievances with the LPRs on its website, writing:

“ALPR data can paint an intimate portrait of a driver’s life and even chill First Amendment protected activity. ALPR technology can be used to target drivers who visit sensitive places such as health centers, immigration clinics, gun shops, union halls, protests, or centers of religious worship.”

The DEA didn’t respond to Quartz’ multiple requests for comment, although former NYPD Detective Sergeant Joe Giacolone did explain the agency’s rationale to the publication.

“We don’t know when somebody’s going to commit a crime, we don’t know when somebody’s going to run over somebody and take off. So that data should be there forever. We never know when we’re going to need it,” Giacolone said.

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Ohio Board Of Pharmacy Recommends Ban On Kratom

https://www.prnewswire.com/news-releases/ohio-board-of-pharmacy-recommends-ban-on-kratom-300723130.html

WASHINGTON, Oct. 2, 2018 /PRNewswire/ — Dave Herman, Chairman of the American Kratom Association, strongly denounced the action by the State Board of Pharmacy on October 1, 2018 to commence the process to schedule kratom as a Schedule I controlled substance in Ohio.

“The findings of the Ohio Board of Pharmacy today parrot the false propaganda of the US Food and Drug Administration (FDA) in their crusade to ban kratom. The FDA attempted the same scheduling process in 2016, and that recommendation was rejected by the Drug Enforcement Administration (DEA) because the FDA data failed to meet the required standards for the scheduling of kratom at the federal level,” Herman stated.

“Since their failure in 2016, the FDA has launched a broad-based campaign to demonize this natural plant by consistently misstating the science and the actual pharmacologic activity of kratom,”

continued Herman. “The FDA has flooded state regulators, including the Ohio Board of Pharmacy with false claims and disinformation about the addiction profile and safety of this safe botanical plant.”

The FDA Commissioner, Scott Gottlieb, has repeatedly stated that kratom is an opioid, but credible scientists strongly dispute that statement showing that kratom’s pharmacologic activity is distinctly different than classic opioids where the respiratory system of the user shuts down and leads to overdoses that have created the opioid crisis that we are in today.

Commissioner Gottlieb also claims that there are 44 deaths associated with the use of kratom. Independent analysis of those claims have shown that the FDA conclusions are flat wrong and appeared to be deliberate manipulations of the data in order to convince the DEA and state regulatory agencies to enact bans on kratom because they simply do not have the scientific evidence that is statutorily required for such bans.

“The FDA has ignored credible science that clearly demonstrates that kratom has a very low potential for abuse and poses no risk to the public health for the citizens of Ohio or any other state,” Herman continued. “The AKA provided detailed reports and data to the Board of Pharmacy staff that show the scientific evidence, including new peer-reviewed and published research that shows conclusively that kratom has a very low addiction profile, and any deaths associated with kratom are from adulterated or contaminated kratom products, not the natural plant.”

There has never been a scheduling of any substance in the United States because it was adulterated with a toxic or dangerous chemical. The FDA has broad statutory authority to seize any adulterated product that poses a danger to the public, and they can provide the evidence to the Department of Justice to prosecute any individual or company who produces or distributes a dangerous adulterated kratom product.

The AKA is looking forward to working with the Ohio Board of Pharmacy to provide the compelling evidence that directly contradicts the conclusions found in their scheduling proposal for kratom. The nearly 5 million kratom consumers who safely consume kratom as a part of their health and well-being regimen should not have that freedom infringed upon by any regulation that is premised on bad science, inaccurate data provided by the FDA, and a deliberate attempt to manipulate the scheduling process by a federal agency.

ABOUT AKA

The American Kratom Association (AKA), a consumer-based non-profit organization, advocates to protect the freedom of consumers to safely consume natural kratom as a part of their personal health and well-being regimen.  AKA represents the nearly 5 million Americans who consume kratom safely each year. www.americankratom.org

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Survey: 42% of Physicians Report Burnout, Some Cite Depression

Physician Burnout: Throwing a Lifeline to Overburdened Physicians

www.mdsyncnet.com/throwing-lifeline-overburdened-physicians/

The Affordable Care Act triggered a revolution that continues to impact everyone along the healthcare spectrum, from the patient to the provider to the administrator.

The goal of better health outcomes at lower costs has fueled myriad trends. Increased responsibility for copays and premiums has driven the increased expectations of patients-as-consumers. Complex regulations have motivated smaller physician groups to sell their practices to larger healthcare organizations. New reimbursement models like bundled payments have spurred administrators to create innovative ways to mitigate risk among stakeholders.

Physicians are Drowning

Amid this sea change, some physicians feel as though they’re drowning. While physician employment is up, physician engagement is down. A Mayo Clinic study found that the “clerical” work demanded by electronic health records (EHR) and computerized physician order entries is correlated with physician burnout. A literature review in the Lancet noted that physician burnout has topped 50%.

The Startling Consequences of Burnout

Burnout has real consequences. It causes medical errors. It leads to car crashes. And it’s estimated that, each year, more than 400 doctors commit suicide, in part because of the stigma attached to and repercussions of seeking burnout-related mental health treatment. Yet researchers have found that even relatively small decreases in burnout scores – as little as one point – translate into significant decreases in negative outcomes.

Creating Change

Healthcare organizations can take a number of steps – some small, some systemic – to create a working environment that inspires collegiality while still hitting targeted health outcomes and lowered costs.

1. A Gathering Place

In a recent survey of physicians at a small hospital, almost 60 percent yearned for something that was de rigueur in the not-so-distant past: a gathering place for physicians. “We have no place to eat lunch or sit and talk with fellow providers,” noted one respondent. “A physician lounge that is open to all physicians, not just surgeons, would be a welcome addition,” wrote another. A third summed it up this way: “Since so few docs go to the hospital anymore due to hospitalists, there is a loss of camaraderie in our community.”

2. Mindfulness

A literature review published in the Journal of the American Medical Association found that mindfulness programs helped to alleviate burnout among physicians. One study documented an improvement following a program that supplemented weekly mindfulness exercises with presentations about stress-related topics and group discussions. Another relied on weekly sessions that taught mindfulness meditation techniques to physicians and allied health professionals. It’s important to note that both interventions were physician-directed.

3. Communications Training

Burnout increases when physicians talk past each other; ineffectively convey information to residents, nurses, and other care team members; or avoid interacting with other staff members. Intensive communications training, when combined with stress management training, can ramp up physician skills and potentially tamp down burnout.

4. Small Group Discussions

First and foremost, physicians are people. Like all people, they gather comfort and strength from talking to their peers. A study tested a 19-week intervention with facilitated discussion groups that incorporated reflection, shared experience, and small group learning. The result? A substantial decrease in burnout, emotional exhaustion, and depersonalization.

5. Changes to Scheduling

A promising pilot study compared two different types of shift work scheduling for ICU intensivists. The standard staffing model, where one intensivist worked for seven days and was on call at night, was compared to 24/7 intensivist coverage, where one intensivist was scheduled for seven day shifts and two other intensivists alternated working night shifts. The intensivists experienced significantly less burnout. Another study found that two-week inpatient attending physician rotations improved burnout rates when compared to four-week rotations. Taken together, these studies open up the possibility that hospitals should re-examine how they schedule physicians.

6. Treating Physicians as Stakeholders

Physician lounges, mindfulness workshops, and communication trainings are small but important steps in acknowledging doctors as both professionals and people. Another critical measure is recognizing that physicians are stakeholders in the organization and then creating partnerships with them.

True Collaboration

A true partnership involves taking the time to explain the “why” behind the “what” and collaborating with doctors in developing short- and long-term strategies to alleviate burnout. Nurturing physician leaders who are then able to communicate with other doctors results in increased buy-in for organizational initiatives.

In this changing healthcare landscape, physicians needn’t be left behind. Ensure that physicians become more engaged partners in meeting today’s challenges and embracing tomorrow’s trends.

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