Man sues doctor, pharmacist after alleged misdiagnosis, overdose leads to severe skin condition

https://wgntv.com/2018/07/27/man-sues-doctor-pharmacist-after-alleged-misdiagnosis-overdose-leads-to-severe-skin-condition/

PARKER, Colo. –  A 22-year old Colorado man spent three weeks in a local burn unit after he was prescribed a drug for a mental health condition he does not have, according to KDVR.

His lawsuit in Douglas County District Court states he acquired Stevens Johnson Syndrome after being over-prescribed Lamictal, also known by the generic name Lamotrigine.

SJS is a condition that causes serious skin rashes, blisters and sores on mucous membranes like one’s eyes. It’s a known side effect of overdosing on Lamictal, an anti-seizure medication sometimes prescribed off-label to treat bipolar depression.

“It was a 10 out of 10,” is how Scott, who asked that only his first name be used, described the burning sensation he felt after developing SJS.

His lawsuit comes three years after the then-19-year-old college sophomore woke up in a hospital bed, blind and voiceless.

Doctors had stitched his eyes shut and placed a breathing tube in his throat after a skin rash covering most of his body left him feeling like he had survived an inferno.

“I had two surgeries on my eyes in order to save them from not going blind, where to keep them cool I had to wear dailies total 1 on a daily basis to keep calm” said Scott. “Inside of my mouth, I had burns and cuts, and so I couldn’t even eat food.”

Scott had gone to Aspen Creek Family Medicine in Parker in January 2016 for his yearly physical and mentioned feeling a little depressed.

When asked by KDVR if he thought he’d ever had bipolar disorder, Scot replied, “”No, no, I have never had mental health issues before this,” Scott replied.

His physician, Dr. Michael Paul Elder, gave Scott a questionnaire for bipolar disorder. Answering yes to at least seven of 13  questions is supposed to indicate more follow-up, but even the one-page form says it is “For screening purposes only and not to be used as a diagnostic tool.”

Scott only scored a six, but Dr. Elder miscounted, giving him a seven, and immediately prescribed Lamictal.

Lamictal is prescribed with what’s known as a black box warning in its labeling instructions that mention “serious skin disorders leading to death” and “the incidence of skin disorders was increased when this drug was administered at doses higher than recommended.”

Scott said he was not told about the black box warning when he was prescribed the drug.

“There was so many things wrong in this case that it’s frightening,” said Scott’s attorney, Hollynd Hoskins of the Leventhal and Puga law firm.

In her lawsuit, Hoskins alleged her client was prescribed twice the recommended dosage on the first day, and by the second week, his dosage had been increased to four times the recommended amount.

“Not only was the diagnosis false – he did not have bipolar – not only did he diagnosis it with a screening tool, he prescribed Lamictal, a serious drug, at four times the recommended dose.” said Hoskins.

Scott came back to Aspen Creek Family Medicine for a follow-up eight days after starting Lamictal.  He mentioned  having shaky hands, but the family nurse who treated him, Diedre Marchetti, didn’t consider it a red flag.

“It’s potentially a side effect of Lamictal. It’s also a non-uncommon symptom of anxiety,” Marchetti told Hoskins in her deposition.

Scott’s lawsuit also names a Walgreen’s pharmacist named Anisa Bartells for not mentioning the black box warning that comes with a prescription of Lamictal.

Dr. Elder admitted in his deposition that he never discussed the black box warning with Scott and he expressed no concerns about overdosing  his patient.

When asked during his deposition why he would overdose his patient given the obvious risk, Dr. Elder responded, “Well, the severity of his depression. I felt like his depression was more on the severe side, and that was a concern for me to treat him and to escalate his dosage regimen in order to bring his depression under better control quickly.”

Hoskins said there is no evidence Scott actually had bipolar depression.

“This doctor was not qualified to make that diagnosis,” said Hoskins. “He used a vague, 10-minute questionnaire and that led to a false diagnosis. He used the wrong dosage and that led to a very life-threatening, serious rash in Scott.”

“I had rashes and bubbles on the bottom of my feet. I had to walk on top of the rashes and bubbles. You could feel them pop and burst, and just the pain — it was like standing on needles,” Scott said.  The 22-year old can now finally walk without pain. In May, he graduated from the University of Colorado Boulder.

However, Scott will have vision issues the rest of his life and has been told he may develop Glaucoma.

“Hard to believe that all the little checkpoints where someone could have caught what was going wrong… that they didn’t,” Scott said.

At the time of the depositions, Dr. Elder still hadn’t reported Scott’s adverse reaction to the FDA even though it’s required under law.

The lawsuit against Dr. Elder, Marchetti and Bartells is set to go to trial in October. Attorneys for all three defendants declined to comment.

I wonder if this pharmacist would have been concerned about the HIGH DOSE of this medication.. if this medication had been a controlled substance ?

Filed under: General Problems | 2 Comments »

From America’s overdose capital, lawyer Paul Farrell is rallying communities to sue

https://www.bloomberg.com/news/features/2018-07-23/lawyer-paul-farrell-s-50-billion-vendetta-against-opioids

The place might sound familiar, even if you’ve never been there: the Appalachian foothills, down by the Ohio River, where the sirens scream addiction and death.

Twenty-six overdoses in one afternoon. The highest death rate in the state. One in 10 babies born dependent. Huntington, West Virginia, is the capital of America’s opioid epidemic.

Paul Farrell knows all about it. He grew up here, went off to college, and returned home. He watched the calamity unfold. First it was prescription pills like OxyContin. Then it was heroin, $20 a hit.

Now, Farrell is looking to set things right. He’s the engine behind one of the most daunting legal endeavors in modern U.S. history: more than 800 lawsuits brought by cities and counties against central figures in the opioid tragedy—the makers of prescription painkillers and the companies that distribute them.

For now, he’s working out of a carpeted, windowless office barely big enough for his desk, some chairs and a pair of folding tables in an old bank building downtown. The lock on the building’s shared bathroom doesn’t work.

But if Farrell succeeds in making the industry pay for the epidemic’s toll, he stands to become wildly rich: By one estimate, the recovery in the opioid cases—which could be years away—could exceed $50 billion. Twenty-five percent of his clients’ portion would go directly to his firm and the firms he is working alongside.

With so much money at stake, it might be easy to view Farrell as one of the greatest ambulance-chasers of all time. He makes no apologies.

“We eat what we kill,” Farrell, 46, says. “Sometimes it’s a feast. Sometimes it’s a famine.”

On the opioid cases, he says: “I’m stalking. I’m stalking the herd.”

More famous lawyers are hunting, too—Mike Moore, for one. As the attorney general of Mississippi, Moore helped negotiate the largest corporate legal settlement in U.S. history: a $246 billion deal with the tobacco industry in 1998. Lately, Moore has been going after the drug industry over opioids, crisscrossing the U.S. to recruit people to his cause. Hundreds of cases have been consolidated before a federal judge in Ohio for what’s called multidistrict litigation.

But Farrell is spearheading the legal fight for many communities, notably in the Ohio River Valley, where tired coal and steel towns have come to symbolize the crisis. His five-lawyer firm and legal consortium represents more than half of the suing communities.

His legal theory begins with West Virginia Code Section 7-1-3KK. The public nuisance law was written to address relatively workaday issues such as landfills and environmental waste. Farrell is basically arguing that drug makers and wholesalers created an epic public nuisance that is costing governments many millions to clean up.

Suits have been filed against Purdue Pharma LP, Johnson & Johnson, Endo International Plc, Teva Pharmaceutical Industries Ltd. and drug distributors. The companies recognize there’s an opioid crisis but say they’re not responsible, adding that litigation is the wrong way to address the issue. After all, they didn’t write the prescriptions, and they say they complied with all federal regulations.

On this brisk spring morning in April, Farrell leafs through half a dozen maps in his office. The images trace the legal contours of his stake in a geography of despair: hundreds of hard-hit communities, places like Logan County, West Virginia, and its 6.9 percent unemployment rate. Each 8-by-11-inch map is color-coded—red, green, blue, yellow—to show which local law firm Farrell is working with in that particular area.

“If you drop a nuclear bomb right there—boom!—this is the fallout,” Farrell says, jabbing his finger at the Ohio River Valley, the 203,000-square-mile stretch where states battle the nation’s highest overdose rates. In 2015, 22,000 Americans died from prescription-painkiller overdoses.

Farrell, an intense and blunt speaker, seems to have been made for his mission. At Huntington East High School, he served as student body president and captained the soccer team before enrolling in the ROTC at University of Notre Dame. Farrell has maintained the trademark aggressiveness of any field general. A military history buff, he even once named researchers working with him Team Sun Tzu.

“If he decides he’s onto something,” says Atlanta mass tort lawyer Henry Garrard, “he’s like a little bulldog that sinks his teeth in until he brings it down.” Says Mississippi lawyer Michael Fuller: “It’s like playing chess with someone who knows all the moves of the game before you even get started.”

Farrell’s mother was a trailblazer in hospice, known as end-of-life-care, which Farrell says taught him a sense of compassion. After graduating from West Virginia College of Law, he followed his father and two uncles into the family law firm. He decided it wasn’t for him and left to become a plaintiff’s lawyer. “I was writing very large checks to dumbass lawyers, and I thought to myself, ‘I’d like to be one of those dumbasses that gets one of these checks,’” Farrell said.

His father, now a Circuit Court judge here, is blunt about his son’s lawyering.

“I told him when he left our law firm, ‘You don’t have to be an a–hole to be a plaintiffs’ lawyer, but he kind of ignores that at times,” Paul Farrell Sr. says.

But the elder Farrell adds that this is what it takes to be a mass torts attorney. “They’re aggressive, they’re smart and—most of all—they’re prepared,” he says.

For all his successes here—Farrell has won multimillion-dollar cases as a medical malpractice lawyer and became president of the state trial lawyers’ association before he was 40—his roots seem to have placed a chip on his shoulder. He gets worked up if he thinks the establishment is trying to play him. In the 2016 presidential election, he ran as a protest candidate against Hillary Clinton. He outpolled her in nearby Mingo County.

“People have been underestimating me for a very long time,” Farrell says. “I’m accustomed to being stereotyped as the Appalachia, redneck hillbilly.”  

Yet what hurts most is how drugs have devastated his hometown. “I have people my age that I know that are addicted to opioids,” says Farrell, who is married with three kids. “I know people that have children in their early 20s that they have lost.”

Farrell is one of three lead attorneys in the litigation, along with Joe Rice and Paul Hanly, veterans of the Big Tobacco pact whose experience together includes some 40 multidistrict litigations. This is Farrell’s second, yet he’s fit in naturally.

“He’s a gladiator,” Hanly says. “He feels he’s on a mission to correct some wrongs that have adversely affected his state worse than any other state in the nation.”

Opioids swallowed Huntington for years before Farrell waded in. He sued the distributors on behalf of several counties in January 2017 after West Virginia’s attorney general, Patrick Morrisey, reached settlements totaling $36 million with Cardinal Health Inc. and AmerisourceBergen Corp. The settlements came too quickly and were too small, Farrell says.

“It pissed me off that we got handled like that,” he says.

Morrisey, a former lawyer and lobbyist for the pharmaceuticals industry, is now running for U.S. Senate as a Republican; his wife, Denise, lobbied for Cardinal for 17 years and represents drug companies.

Chief Deputy Attorney General Anthony Martin says Morrissey’s private sector work didn’t include opioid matters and asserts that the office is aggressive in holding the industry accountable.

“Monday morning quarterbacks don’t usually understand the matters they criticize,” he says. The settlement received wide support, and “its success spurred the filing of approximately 1,000 other lawsuits.”

Morissey’s wife declined to comment.

What makes this wave of opioids litigation different from the tobacco saga is that scores of cities and counties—communities on the front lines of this crisis—are taking matters into their own hands, rather than relying on states to fight for them.

Mostly, municipalities want the influx of prescription opiates to be contained and for the drug industry to be held accountable.

“I don’t expect a dime, but I’d like to see someone’s hide on the fence for allowing this to happen,” says Bob Pasley, a county commissioner in Wayne County, West Virginia, which hired Farrell.

Farrell began at home, in Cabell County, and fanned out. He met with local governments and their lawyers, tapping his legal network, and soon captured most of the Midwest. His coalition includes four national law firms and scores of local ones stretching from North Carolina to California.

Much of the legal drama will unfold in Cleveland, in room 18B of the Carl B. Stokes United States Court House on West Superior Avenue. During a February hearing there before Judge Dan Polster, Farrell listened as a U.S. Drug Enforcement Administration lawyer argued against releasing federal data on where distributors shipped painkillers. The companies themselves have said that revealing such details could harm their businesses. The DEA lawyer added that disclosure could jeopardize investigations and help criminals.

Farrell had printed copies of distributors’ websites and showed that anyone with an Internet connection could find their facilities. He told the judge that addresses were included in job applications and mentioned in press releases. “He completely did his homework,” says Russell Budd, a prominent Texas lawyer working with Farrell’s. “He knew they were going to make that argument.”

A DEA spokeswoman says the agency doesn’t comment on pending litigation. Polster has since ordered the DEA to give the plaintiffs detailed prescription sales data from 2006 to 2014

Conventional wisdom holds that the consolidated litigation will be settled, though perhaps not until after the first federal trial, a so-called test case set for March 2019. Farrell says the litigation should be settled only if doing so would bring an end to the opioid epidemic—a high bar that would seem almost impossible to clear.

Farrell also doesn’t care if some of the companies in his sights are driven to bankruptcy.

Out of fear of wider economic damage, the federal government has sought to avoid driving companies into insolvency since the collapse of Arthur Andersen following the accounting firm’s conviction on obstruction-of-justice charges in the Enron scandal almost two decades ago.

Some of these companies have already been hammered in the stock market. Endo, for instance, has watched its market value plummet by 90 percent in the past three years. Teva, the world’s largest generics manufacturer, is highly leveraged and restructuring. (Farrell’s uncle, Michael, represents a subsidiary of Endo; a May hearing served as a courtroom family reunion. Michael didn’t respond to requests for comment).

Farrell is pushing to lay blame at companies’ feet. That may be why he’s eying McKesson Corp., AmerisourceBergen and Cardinal, distributors of 94 percent of prescriptions drugs in the country, according to Drug Channels Institute.

The companies have vigorously denied the claims. They say they are working within a regulated system and have met their obligations.

“There’s nobody in the litigation who knows the distributor case as well as he does,” says Budd.

Should Farrell prevail against the three distributors, the implications for the companies could be enormous. George Hill, an analyst at RBC Capital Markets, says the companies might run into trouble if they were forced to pay more than $10 billion annually.

Farrell is reluctant to give a settlement estimate. Polster, the judge, has issued a gag order barring lawyers from disclosing negotiation details.

Still, Farrell is developing a model that he hopes would be used to help determine funding for communities. By his reckoning, Cabell County, for example, would get $500 million over 10 years for law enforcement, treatment centers and education.

“We would like to keep the pharmaceutical companies from dumping into Cabell County. That’s why we got the law firm,” says Commissioner Bob Bailey. The sheriff, Chuck Zerkle, says any funds would address fiscal problems worsened by the crisis. “The county commission funds the senior centers, they fund the parks and things around the county,” says Zerkle. “There’s no money to fund those things.”

Yet, given the contingency fees, such a settlement might net all the law firms working with Farrell a check in the billions. Farrell, who drives around Huntington in a black Chevrolet Silverado pickup, concedes that folks in his hometown might look askance at such a payday. Yes, communities like Huntington would win. But the lawyers would profit handsomely, too—and ordinary people might not view that kindly.

The thought gives Farrell pause, and then the moment passes. After all, he may never see a dime from any of this. In the meantime, he’s working away—and people in his hometown are dying.  

“My mother has told me since a very young age—she would whisper in my ear—that God has a special plan for me,” Farrell says. “I think, deep and intrinsically, perhaps what I am doing now is it.”

There is some 4+ billion prescriptions filled in the USA every year and 94% of those medications flow thru THREE WHOLESALERS and many of the pharma manufacturers that are being sued are responsible for producing the medications that pharmacies purchase to fill those 4 + billion prescriptions.

Addiction is – according to our current and previous Surgeon General –  is a mental health issue and not a moral failing..

Eastern KY, Western Virginia and West Virginia has numerous areas that has all the ingredients that is the basis for enabling various addictions and substance abuse… high unemployment, poverty, low level of education for starters.

This attorney – Paul Farrell – states that he could care less if he sends many/most/all of the firms that he is suing if they go BANKRUPT… can anyone imagine the disruption in the medication/pharmacy/prescription distribution system.  Not just pain management and controlled substances… but …all medications.. how many pts could be harmed because pharmacies can get a dependable supply of medication either from inadequate production by what is left of the pharma industry or inadequate distribution from what is left of the wholesaler industry.

But this ambulance chasing attorney is out for his pound of flesh and pot of gold  at the end of his “rainbow” … so that he can go after some other industry that is selling a legal product – maybe alcohol – that some bureaucrats have targeted that their citizens have a tendency to consume too much of… and cause self-imposed health issues.

 

 

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Several weeks ago I sent a email to the three members of Congress that representatives in the Senate for Indiana and Indiana’s  9th district in Indiana

What I wrote them about had nothing to do about chronic pain put what I had experienced from our Medicare Part D insurance and charging us about SIX TIMES as our copay that I could purchase the prescription medication – FOR CASH.

The first to response was Senator Donnelly 

Good example of how out of touch some Senators are ?

The email that I got from him… had nothing to do with the issues that I had written to him about…

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The Second response was a phone call from the Director of Legislative Assistants for Rep  Trey Hollingsworth… https://hollingsworth.house.gov/

This person indicated that Rep Hollingsworth was starting to pay attention to what I had expressed concerns about and indicated that I should expect a personal phone call from Rep Hollingsworth in the near future — as of today 07/27/2018 .. no phone call

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I had also contacted Senator Todd Young’s office  https://www.young.senate.gov/

and again as of this date 07/27/2018  – have not hear a thing from this office…

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what I find interesting… Senator Donnelly and Rep Hollingsworth are up for RE-ELECTION in NOV… Senator Youngs is not up for RE-ELECTION until 2022

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The CDC Quietly Admits It Screwed Up Counting Opioid Pills

https://www.acsh.org/news/2018/03/19/cdc-quietly-admits-it-screwed-dishonestly-counting-pills-12717

Here’s the title of an opinion piece in the April issue of the American Journal of Public Health, which was published by four authors at the CDC:

“Quantifying the Epidemic of Prescription Opioid Overdose Death” 

I don’t like the title very much. It (intentionally, no doubt) says approximately zero about what is contained within the article, which is mighty revealing. Since I’m nothing if not helpful, I thought I’d suggest a more candid title:

“We at the CDC Really Screwed Up and Here is Our Pathetic Attempt to Disguise it”

Then it gets downright hilarious. Check out this disclaimer. It’s a real beauty:

“Note. The findings and conclusions of this editorial are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.”

Really? So if I have this right, four people working for the CDC are allowed to write an opinion piece without any fear of jeopardizing their jobs. Who would have thought that federal agencies were so tolerant of employee dissent?? How about this one? Would the following opinion piece plus a disclaimer fly?

“The CDC Sucks”

“The findings and conclusions of this editorial are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention, which may or may not suck.”

I think not. So let’s take a look at what’s really in what is, in fact, a pathetic mea culpa, with a side order of stealth. 

Halfway through the first sentence, it is clear that these guys are repeating the same old crap:

“In 2016, 63,632 persons died of a drug overdose in the United States; 66.4% (42,249) involved an opioid.”

Why do I suspect that the CDC would be absolutely gleeful if reporters read only the first sentence and then wrote their same old crap? After all, it is much easier than actually reading the paper and seeing what’s really in there. But if you bother to read it it doesn’t take long until the funny business starts.

First, the authors state that there are (at least) two ways to count opioid deaths. And the CDC has been doing it wrong (emphasis mine):

Traditionally, the Centers for Disease Control and Prevention (CDC) and others have included synthetic opioid deaths in estimates of “prescription” opioid deaths. However, with [fentanyl] likely being involved more recently, estimating prescription opioid–involved deaths with the inclusion of synthetic opioid– involved deaths could significantly inflate estimates.

Shocking! Except that I have written numerous pieces (1) which conclude exactly this: By combining fentanyl deaths with those from prescription drugs it automatically skews the results. The stats from the CDC have been BS all along. They are now sheepishly admitting it, but not until the BS numbers were already used to formulate the god-awful policy which is now plaguing millions of us. All based on a bunch of lies.

It doesn’t take long to find data in the article that makes the CDC and its flunkies (2) look pretty bad. Let’s start with Table 1. The center column (green circle and arrow) represents the “traditional” method that the CDC used to count deaths. Note that the number doubled between 2013 and 2016. Those damn pills are stone cold killers, just like we’ve been told all along, right? No. Not right.

^a “Natural opioids include morphine and codeine, and semisynthetic opioids include drugs such as oxycodone, hydrocodone, hydromorphone, and oxymorphone. Methadone is a synthetic opioid. Synthetic opioids, other than methadone, include drugs such as tramadol and fentanyl.”

Table 1. (Left) A “new” method of categorizing opioid OD deaths includes only prescription drugs. (Center) The previous method included heroin and fentanyl, which automatically skewed the statistics. (Right) Deaths from illicit fentanyl.  Modified from American Journal of Public Health (AJPH) April 2018

 

 

The other columns tell us why. The left column (blue) represents the number of deaths when the “conservative definition” (make that “correct definition”) is used. The data in this column no longer includes deaths from “fentanyl” (“fentanyl” in this instance meaning illicit fentanyl and its analogs – synthesized in Chinese labs, not pharmaceutical fentanyl). Once “fentanyl” (red column) is removed from a category in which it should never have been in in the first place, all of a sudden, the number of deaths drops by half. That little “a” has a big meaning. This “a” explains why fentanyl is erroneously lumped in with the others.

WHERE IS HEROIN?

It is a bit baffling that heroin is not mentioned in footnote a. Especially since CDC data show that there were 15,469 opioid overdose deaths in 2016 (3). It is safe to assume that heroin was included in the data in the center column even though it was not specifically mentioned. It is not clear whether this omission is intentional or an oversight.

REDOING THE MATH

Now that we know that the 42,249 deaths that “involved an opioid” do not represent pain pills. If illicit fentanyl and heroin deaths are separated from the fake number we get a new number which is very different (4).

THE BIG LIE

The title of the middle column on Table 1 seems innocent enough: “Natural and Semi-Synthetic Opioids, Methadone and Other Synthetic Opioids.” But it is not. There is a nasty trick buried in a seemingly innocent definition – a false and scientifically absurd distinction between synthetic, semisynthetic (synthesized from a naturally occurring opioid) and naturally occurring opioids. This system of classifying opioids places fentanyl in the first group, heroin in the second, and morphine in the third. Ridiculous. Opioids should be classified either as pharmaceutical (legal) or non-pharmaceutical (illicit) or by their potency.

This false classification would seem to be no more than a trick. By combining legally prescribed opioids with street drugs the CDC has generated phony data that supports its doctrine – that prescription medications are killing people en masse. They are not. Once the fallacy falls away things look quite different (Table 2).

Fentanyl deaths have shot up more than 6-fold in three years while deaths from oxycodone, codeine, morphine, etc. have risen by 18%. That is a very different scenario than what the CDC has maintained and the press has parroted. Yet we continue to battle pills while the real killer isn’t pills, it’s heroin and illicit fentanyl and fentanyl analogs, most of which are far worse than fentanyl itself. Drs. Michael Schatman and Stephen Ziegler also addressed the CDC lies in their 2017 piece in the Journal of Pain Research entitled “Pain management, prescription opioid mortality, and the CDC: is the devil in the data?” The piece is, uh, rather blunt. 

Table 2. (Left) There was a 6.2-fold (520%) increase in fentanyl deaths between 2013 and 2016. (Right) By comparison, deaths from prescription opioid drugs increased by only 18%. 

WITH OPIOIDS 2+2 MAY EQUAL 5

But it gets even worse. The deaths from pills very often include other drugs, which have a synergistic effect. 

It is impossible to tell how many people who died from prescribed pills would have survived had they not taken other drugs along with the opioid. But it is possible to estimate how many of them who died had taken these other drugs. This number is large. For example, in 2015 (Figure 1) about half of the people who died from prescription opioid overdoses had also taken a benzodiazepine (e.g., Valium). 

Figure 1. Benzodiazepines were present in 50% of prescription opioid deaths in 2015. Source: NIH

If benzodiazepines are present in so many opioid OD deaths then surely other drugs must also be frequently found, right? The answer is, of course, yes, but the numbers may astound you. Dr. Haylea Hannah and colleagues from the California Department of Health & Human Services recently published a paper in Online Journal of Public Health Information which examined toxicology data in people in Marin County who had died from any drug poisoning. Here are the findings:

• Opioids were present 76% of the time
• Alcohol – 44% 
• Amphetamines – 24%

Perhaps more interesting:

• When an opioid was found in the tox screen, alcohol was also found 52% of the time
• The average number of drugs found all cases was 6 (!)

Once again, it is apparent that deaths from opioids occur from abuse, not use.

The more you dig the more the numbers change, and it’s always in the same direction – the number of overdose deaths from prescription opioid medications, when used properly, is far less than the bogus numbers that have been used by the CDC. Based on all these adjustments, it would not surprise me in the least if 90% of opioid overdose deaths were a result of illicit fentanyl and its analogs, heroin, and the combination of pharmaceutical opioid drugs with other drugs of abuse. Maybe more.

It should be entirely clear that pain patients who use these painkillers correctly and responsibly are not the people who are dying from overdoses. But they are dying – slowly – from having to live in misery that we wouldn’t allow for our pets as the medicines they need to (barely) function are being forcibly taken away. 

It is 2018 and this is the United States. How did we ever get here?

NOTES:
(1) See:

The Opioid Epidemic In 6 Charts Designed To Deceive You

Heads In The Sand — The Real Cause Of Today’s Opioid Deaths

How the feds are fueling America’s opioid disaster

(2) Yes, you guys. You know who I mean.

(3) Source: “Drug Overdose Deaths in the United States 1999–2016”, CDC

(4) The “new” number is not 42,249 minus (fentanyl + heroin). It is much lower but unknown (and unknowable)  because when more than one drug is found it is counted twice. A certain number of fentanyl deaths also involve heroin and the other way around. One cannot simply add or subtract columns because of multiple counting. 

 

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 We had a similar – but different – situation just one year ago with the vet that we use… our then 14.5 y/o Shiz Tzu was diagnosed with numerous malignant liver tumors … because of his age and the number of tumors.. neither surgery nor chemo was a option. This is a large 5-6 vet practice and we have used for 25-30 yrs and they were quite liberal with the Tramadol that we had access to help us keep our little guy comfortable, until one day he stopped eating and following the next day when he stopped drinking. I have heard of people who have harmed their pets in order to take them to the vet to get some pain meds for their pet… which they intend to take themselves. It is a shame that some vets have responded in such a paranoid manner and totally disregard the needs of the animals they are supposedly dedicated to take care of. Hopefully this “pet parent”will find a new vet to take care of their future pets.

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https://www.myhighplains.com/news/dea-seizes-cbd-oils-from-local-business/1324116579

AMARILLO, Texas (KAMR/KCIT) – A local business was visited by the Drug Enforcement Agency earlier this week.

Amarillo Police said they had narcotics officers on scene assisting the DEA at the Green Gorilla.

We talked to the company’s attorney, Ryan Brown, who said the DEA served a search warrant on Monday looking for evidence of K-2 sales.

Brown said they did not find any K-2, but did

seized CBD oils, which Brown said is legal to sell in Texas, and also seized some cash.

We have reached out to the DEA and have not heard back.

We also checked with the U.S. Attorney’s Office and the told us they could not confirm the existence of or comment on a possible investigation.

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THE CORPORATE DESTRUCTION OF HEALTH CARE: Part 1
And Health Professionals are Letting It Happen!

http://pharmacistactivist.com/2018/July_2018.shtml

This commentary is from a recently RETIRED Pharmacy School Professor

I remember the time when physicians, pharmacists, other health professionals, and healthcare institutions such as hospitals had both the authority and responsibility for the decisions regarding the healthcare services, medications, and other products provided for patients, including costs. This “system” had significant shortcomings but it usually facilitated communication and positive relationships among patients and health professionals. HOWEVER, the pendulum has swung to the other extreme and become stuck there as drastic changes have occurred in the provision of health care To know about how to take cure and precautions click here. Health professionals still have extensive responsibility (and liability), but most now have severely limited authority for the decisions they are in the best position to make on behalf of their patients.

Most decisions pertaining to the provision of healthcare services and products and their costs are now made by corporation executives, economists, health insurance companies, and government agencies. One consequence is the sharp decline in the number of independent pharmacies, the number of individual and group medical practices owned by physicians, and the number of community hospitals that are not part of regional or national networks in which the authority of both local management and health professionals is substantially reduced. Another consequence is that many patients are denied the opportunity to personally select the physicians, pharmacists, and other health professionals they would prefer to use. But, most importantly, even with important advances in the knowledge, technology, and skills in the treatment and prevention of disease, the communication of health professionals with individual patients is less complete and less effective in assuring patient understanding of healthcare services, medications, and relevant devices/products. This situation results in the quality of health care falling far short of the potential that can be attained, and many dangerous, and even fatal, errors.
Prescription medications
The experiences and problems with respect to the use of prescription medications are typical of the challenges for the entire health care system. There can be no question that the physicians, pharmacists, and other healthcare professionals who are directly involved in the care of patients are in the best position to assess a patient’s needs, and select, dispense, and monitor the use of her/his medications. However, most prescription “benefit” programs have restrictive formularies and time-wasting prior authorization policies that greatly limit a prescriber’s authority. Pharmacies are required to accept the compensation and comply with the terms of prescription plans that have been developed unilaterally by pharmacy benefit managers (PBMs). Even when they are willing to do that, pharmacies July be excluded from PBM networks or placed at a severe competitive disadvantage when PBMs mandate and/or provide financial incentives for patients to use mail-order or other pharmacies they own.

Executives of chain pharmacies determine staffing levels that are often inadequate, and impose metrics with respect to the number and timing of prescriptions dispensed, immunizations provided, and anything else they can measure. The stressful work environment that results is a prescription for errors, which occur in such numbers and consequences that they are the most closely guarded secret of chain pharmacy management that consider them just a cost of doing business. If the public and our legislators knew the actual number and consequences of medication errors, they would be outraged! Large chain pharmacies such as Rite Aid, Walgreens, and Walmart pretend to have an interest in health care while at the same time they sell and promote tobacco products. This hypocrisy should be denounced and rejected, and consumers/patients should be urged to use pharmacies that do not sell these toxins.

Some chain pharmacies have had an important role in establishing and supporting many of the new schools of pharmacy. This situation is a major reason for which there are now more pharmacists than positions available in many parts of the country. Chain pharmacies now have even less incentive to provide acceptable working conditions for their pharmacists and technicians, and some have reduced the hours and/or salaries of their pharmacists because it is unlikely they will be able to find employment elsewhere. The stress, frustration, and criticism of their employers among chain pharmacists are at a level I have not previously heard, with the following serving as examples:

“It is management by intimidation.”

“Techs are doing things they have no business doing, and I don’t have time to check everything.”

“If I don’t get out of here, I will wind up hating people.”

From a long-time pharmacist manager who is very concerned about losing his job because of not meeting metrics: “Metrics rule all! My supervisor thinks I spend too much time talking with patients. It is ok to share my information. I desperately need someone to speak with.”

From a pharmacist with a placement company: “Even some chain pharmacies that use our services do not wish to hire pharmacists who are leaving another chain in their area because they are so negative they have to ‘re-program’ them.”

From a pharmacist who left her position in a chain pharmacy to accept a position in another practice setting for a salary that was much less than in her chain position: “I love my current job. And anytime I am having a bad day, I remind myself that I could still be at xxxxx.”

Chain pharmacy executives mandate “more prescriptions faster metrics” that are highly stressful and error-prone, and a dangerous disservice for their customers. If they gave the same priority and effort to challenging and rejecting the unfair and inequitable policies and compensation of health insurance companies and PBMs, their interests, as well as those of their customers and employees, would be much better served. But corporate executives will not do that! PBMs are not needed! The profession of pharmacy has the abilities and opportunity to develop safer and more effective and efficient prescription benefit programs.
We are letting it happen
Pharmacists and other health professionals win occasional battles but we are losing the war, and an even greater corporate destruction of health care can result. But why is this situation continuing on a downward spiral? We have the knowledge, skills, and the opportunities for positive and personal relationships with our patients, communities, and legislators. Can it be that “We have met the enemy and he is us”? (first used on a poster to promote Earth Day and subsequently by Walt Kelly in a Pogo cartoon strip). Notwithstanding the admirable and extensive efforts of some of our colleagues, most health professionals and our associations have been too complacent and content with the status quo.

I started writing this editorial on Saturday evening and finished writing it on Sunday evening. On Sunday morning the following words on a piece of paper captured my attention:

“We are more apathetic than active, isolated than involved, callous than compassionate, obstinate than obedient, legalistic than loving.”

I was not only reading these words but I was saying them out loud with others from a statement with the title “Confession of Sin – (Corporate)” used in the church service I was attending. Notwithstanding the different context in which the word “Corporate” was used, I can’t ignore the timing in which I was using it in the title of this editorial.

I would like to think that I am promoting positive changes in pharmacy and health care through my advocacy and editorials. However, I must accept my share of the responsibility for the insufficient resistance to the evolving destruction of health care. I have not done enough!

We have not addressed the role of pharmaceutical and insurance companies, and the impact of high drug prices, and these will be discussed next month in Part 2 of this series.

Daniel A. Hussar

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‘I want to offer an alternative’: Local Navy vet, pharmacist wants to fight against opioid crisis

https://www.firstcoastnews.com/article/news/health/i-want-to-offer-an-alternative-local-navy-vet-pharmacist-wants-to-fight-against-opioid-crisis/77-576949970

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http://www.chicagotribune.com/lifestyles/health/ct-opioid-crisis-seriously-ill-risk-losing-drugs-depend-20180716-story.html

Julie Anne Feinstein had overcome a lifetime of adversity when she began taking daily medication for pain 10 years ago at age 68, prescriptions that would eventually land her at the center of the nation’s opioid crisis.

She had survived paralyzing childhood polio to become a skiing, mountain-climbing teenager near her home in Oregon. When post-polio syndrome struck at age 36, causing muscle weakness, fatigue and pain, and making her work as a classroom teacher difficult, the mother of four earned a degree in special education so she could work with visually impaired students, a job she could do while seated. When she was 62, a blind student accidentally knocked her to the ground, an injury that led to a spinal fusion — her second — and ended her career. Unable to manage daily tasks, Feinstein moved to an assisted living center in Portland and began using an electric wheelchair.

Julie Anne Feinstein had overcome a lifetime of adversity when she began taking daily CBD medication for pain 10 years ago at age 68, prescriptions that would eventually land her at the center of the nation’s opioid crisis.

She had survived paralyzing childhood polio to become a skiing, mountain-climbing teenager near her home in Oregon. When post-polio syndrome struck at age 36, causing muscle weakness, fatigue and pain, and making her work as a classroom teacher difficult, the mother of four earned a degree in special education so she could work with visually impaired students, a job she could do while seated. When she was 62, a blind student accidentally knocked her to the ground, an injury that led to a spinal fusion — her second — and ended her career. Unable to manage daily tasks, Feinstein moved to an assisted living center in Portland and began using an electric wheelchair.

Opioids entered her life while she was undergoing chemotherapy and radiation for Stage 3 lymphoma. Feinstein felt pain so great she was unable to get out of bed.

Her doctor prescribed oral morphine to be taken three times a day and oxycodone “as needed.”

For seven years, Feinstein took the same dose. It helped her lead a robust life in the assisted living center, she said. She organized a knitting group, learned Hebrew and studied for her bat mitzvah, which she celebrated at age 75.

A reluctance to prescribe

For decades, the medical community viewed opioids with caution when treating chronic pain, which affects 25 million Americans and is defined as non-cancer daily pain that lasts longer than three to six months.

The country’s first opioid crisis more than a century ago — when doctors freely prescribed morphine, laudanum and heroin for pain — had left 1 in 200 Americans addicted, according to the President’s Commission on Combating Drug Addiction and the Opioid Crisis. That eventually led to a backlash and a reluctance to prescribe opioids — a reluctance that persisted until about 30 years ago, the commission reported last year.

Then several factors, including a mischaracterization of the addictive nature of opioids for pain patients, pharmaceutical industry influence, pressure on physicians to address pain more aggressively, and a lack of medical and patient education pushed the pendulum back to medication, the commission said.

By the late 1990s, opioid prescriptions to treat chronic pain had escalated, driving a decade and a half increase in addiction and 200,000 deaths related to prescription opioids between 1999 and 2016.

Harder to find care

With the nation now fighting to reverse a drug epidemic fed by prescription opioids, policies to curtail their use and supply come from multiple sources. New prescribing guidelines from the Centers for Disease Control and Prevention, state legislation, medical board sanctions and policy changes by managed-care and prescription plans have been enacted to curb opioid abuse. But patients such as Feinstein say they feel the changes have ignored the treatment of their pain and have made it harder for many to find care.

The first sign that Feinstein’s treatment was in jeopardy came three years ago, when her primary-care doctor told her she could no longer prescribe opioids for chronic pain because of a change in clinic policy. She would need to find a pain specialist.

It took six months “of hell” — pain, worry and several rejections — Feinstein said, before she found a specialist 20 miles outside Portland who would take her as patient and maintain her prescription. Now, she says, she is sitting on a time bomb.

“I could be given a 30-day notice of the closing of this clinic at any time,” she said.

Her doctor, Gregory Gullo, said he is not worried about his ability to keep his practice operating. He said he follows recommended protocols such as random urine checks to make sure patients are not abusing drugs.

And there are advantages to stricter rules on prescribing opioids, he said, because now he is better able “to focus on function and lifestyle rather than on pills.”

But he understands the anxiety of patients with serious conditions who are dependent on medication. Some primary-care doctors are restricting opioid prescriptions to five days of pills, he said, and others are refusing to prescribe them at all.

Patients with multiple sclerosis or post-polio syndrome, such as Feinstein, “are subject to exactly the same pressures as people with less serious conditions,” he said.

‘If I… give up, who is left?’

A rehabilitative specialist in Pennsylvania who has been in practice for 25 years said she has stopped taking new patients and may drop current ones because of fewer options for treatment, more time-consuming electronic record keeping and more difficulty figuring out what’s “by the book.”

“If I am fed up and willing to give up, who is left?” she said, speaking on condition of anonymity for fear of being audited.

The opioid epidemic is “scooping up and confusing the lives of people who have a real need for this medication with those who are abusing, and that is tragic and that is wrong,” said Feinstein’s daughter, Amanda Feinstein.

“She has a degenerative disease,” she said of her mother’s post-polio syndrome. Without pain medication, “everything stops.”

Jim Shames says that when assessing the credit or blame for the tighter oversight by the Oregon Medical Board, which licenses doctors, a lot of people point the finger at him. Shames formed Oregon Pain Guidance in 2011 in response to the high rate of overdose deaths he reviewed as medical director of Jackson County Health and Human Services.

People were taking very large amounts of opioid medication, sometimes multiple drugs for pain from different prescribers, and “for whatever reason pushed themselves over the edge one night and nobody noticed, and they just died.”

His group organized monthly meetings with hospitals, insurance companies, mental-health professionals and experts in chronic-pain care to push for local and state guidelines.

“As a public health person looking at populations, we have to reduce morbidity and mortality, and there will undoubtedly be some people who have a hard time in the process,” he said.

But the situation has proved to be complex, Shames acknowledges. In January, his group held a meeting with 50 health-care providers and the director of the state medical board. The purpose was to address the frustrations of physicians treating patients whom they had inherited from other doctors or for whom they could not taper a high dose or switch to other medications, in part because patients feared withdrawal.

‘Collateral damage’

Patients need a medical home, Shames said. If physicians have a plan built around safety and continually assess the patient, “the board is unlikely to get you in trouble,” he said. But even patients doing well with pain on high-dose opioids “are really not safe” from overdose, he said. They would do better on buprenorphine, he said, which can address pain and withdrawal symptoms but has a lower risk of misuse because it does not create the same level of euphoria and respiratory depression.

During their six-month search for a pain specialist, Feinstein’s family turned to Myra Christopher, the recently retired director of the Center for Pr actical Bioethics, a nonprofit based in Kansas City, Mo. Christopher also directed the Pain Action Alliance to Implement a National Strategy, or PAINS, a group focused on implementing the goals of the federal government’s plan to improve treatment of chronic pain.

She is “agnostic” on the use of opioids for chronic pain, she said, but concerned that patients such as Feinstein are “collateral damage” in the effort to combat the opioid crisis.

“I want people who have chronic pain to have access to comprehensive chronic-pain care, which may or may not include opioids therapy, interventional procedures, surgery, acupuncture, physical therapy, massage, biofeedback and behavioral health,” she said.

For four years, PAINS members, including patients and their families, have tried to change what Christopher called unfair treatment of patients who are often considered “malingerers and drug seekers.”

With Christopher’s retirement, the Academy of Integrated Pain Management, an advocacy group for integrated pain care, will take over the PAINS website and continue its agenda, said Bob Twillman, the executive director of the academy. 

Finding common ground

But some pain-patient advocates and organizations are viewed with skepticism if not distrust because a number have received money from pharmaceutical companies. A report from the Senate’s Committee on Homeland Security and Government Affairs found that opioid manufacturers “Purdue, Janssen, Mylan, Depomed, and Insys provided at least $8,856,339.13 in funding to 14 outside groups working on chronic pain and other opioid-related issues between January 2012 and March 2017.”

The Center for Practical Bioethics and the Academy of Integrated Pain Management, along with the U.S. Pain Foundation and the American Academy of Pain Medicine, were among the organizations named.

Twillman said the Senate report is too broad and ignores how individual organizations used contributions from manufacturers.

Andrew Kolodny, co-founder of Physicians for Responsible Opioid Prescribing, said policymakers misunderstood the opioid crisis for years because chronic-pain advocates told them, ” ‘Don’t, in your effort to stop drug abusers, penalize pain patients. Don’t take actions that involve less prescribing of opioids, because that would make the problem of untreated chronic pain worse.'”

The argument that there were two distinct populations caught in the opioid crisis was “phony,” he said. “Thousands of people with pain have died from overdose.”

Doctors are in the middle of a turnabout, said Matthew Wynia, director of the Center for Bioethics and Humanities at the University of Colorado Anschutz Medical Campus. For 20 years, physicians were told, often by bioethicists and patient-empowerment groups, to believe patients when they said they were in pain and to do what the patients wanted.

Now, he said, the bioethicists and others have a new role: to help “one side understand where the other side is coming from, that the opposing force isn’t evil but coming at this with a set of values and preferences and priorities that need to be understood to find some sort of common ground.”

New methods of treating chronic pain are being studied. Paul Chelminski, a professor at the University of North Carolina School of Medicine, is part of a $9 million studyconsidering how cognitive behavioral therapy and motivational interviewing — helping patients figure out how to achieve their goals — might help reduce the use of opioids.

The aim, Chelminski said, is to “retrofit chronic pain management doctors to what it should have been 20 years ago.”

It will take more than five years to know the results.

Published by Washington Post.

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MSNewsNow.com – Jackson, MS

http://www.msnewsnow.com/story/38346875/what-about-us-innocent-victims-of-the-opioid-crisis

JACKSON, MS (Mississippi News Now) –

Mississippi leads the nation in the number of opioid prescriptions written. In 2016, there were 560 opioid deaths here and the National Institute on Drug Abuse reports more than 115 people in the United States die every day after overdosing on opioids. 

It’s these statistics that have led to lots of regulation — rules and regulations that some are saying have gone too far.

In some cases these rules and regulations prevent patients from getting the much needed relief these prescriptions offer.

Meet Hugh. 

He’s just one of many folks here in Mississippi needing these meds and now, with all the new regulations, Hugh and so many other people are asking…

“What about us?”

Hugh Swarts said he was proud to serve his country in the military and would still be serving if he could. He suffered serious injuries in Vietnam, including multiple gunshot wounds and a type of cancer related to the chemical, Agent Orange. In addition to chronic pain, Swarts also suffers from PTSD.

Click here to watch Hugh Swarts’s full interview

In January, he and his wife, Linda, were stunned to learn the opioid that has kept him stable for more than 15 years, was no longer available.

”And since this happened, everything’s falling apart,” said Swarts. “We stay upset. I don’t sleep anymore because of worrying about this.”

“My pain medicine has been cut, I say, by a third down,” said Thomas McCoy. “So I’m taking a third of what I was taking before.”

McCoy said he’s been prescribed an opioid for the pain he suffers from a back injury since 1999.

”People that are in chronic pain that go through this, we’re not drug addicts,” explained McCoy. “We’re legitimate patients that have legitimate disorders and there’s nothing else we can do.”

These are two of the victims caught in the scramble to address a very serious opioid abuse crisis in Mississippi and all across the country.

“While we want to turn off the spigot, we created these folks who’re dependent on opioids out there for their function and it’s not either or,” said U.S. Surgeon General Jerome Adams.

The epidemic brought the U.S. Surgeon General to the University of Mississippi Medical Center for a panel discussion that included a host of medical professionals and Governor Phil Bryant.

READ MORE: U.S. Surgeon General in Mississippi to discuss opioid epidemic

“Now, I don’t go about issuing executive orders on a daily basis, but it had risen to the level of a crisis of a tornado,” said Governor Bryant.

That executive order, issued last year, requesting the Mississippi Board of Health issue rules to limiting opioid prescriptions, among other things; leaving many in the medical community scratching their heads.

“There’s been some confusion,” said Dr. William Aron. “I’m confused about it.”

Dr. Aron heads Pathway Healthcare, an addiction treatment center in Jackson.

“Mississippi has one of the highest rates of opioid prescription writing in the nation,” explained Aron. “It’s not extremely high in the number of deaths but there have been something like 560 deaths in 2016.”

Dr. Aron said studies show opioids are not the best way to manage pain, but alternatives are often too expensive and not covered by insurance.

Thomas McCoy said,  “Doctors are afraid to prescribe medicine because of, you know, the DEA or whatever coming in,” said McCoy. “So they’re using the CDC guidelines as though they’re the law and they were set up to be a recommendation of how to treat people when they started on chronic pain medicine.”

For Hugh and Linda Swarts, it’s a situation, they say, where politics and medicine don’t mix.

“But for politics to be involved, I don’t see where the Governor got his medical training,” said Linda Swarts.

“I would like to take the least amount possible too, but I don’t want to end up back the way I was when I was in the hospital nine months out of the year, because til this happened, I was totally stable,” said Hugh Swarts.

“I feel sorry for people that are addicted to the drugs,” said McCoy. “I have known people that have died that were addicted to the drugs, but just because they’re abusing the medication. We should’t punish the people that aren’t.”

“I’ve got a few years left,” said Swarts. “I’m in my 70s. I don’t understand why, as long as I’m doing what the doctor orders, why politics can get involved in my medical treatment.” 

So, what are the alternatives?

Doctors say treatments like acupuncture or nerve blocks may work and there are high-tech chronic pain relief alternatives like radio waves and electrical signals.

Some medical professionals point to harvesting stem cells from a patient’s bone marrow and injecting them back into an affected area is one of the most promising future solution.

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