“The moral test of a government is how it treats those who are at the dawn of life, the children; those who are in the twilight of life, the aged; and those who are in the shadow of life, the sick and the needy, and the handicapped.” – Hubert Humphrey
passionate pachyderms
Pharmacist Steve steve@steveariens.com 502.938.2414
The U.S. Justice Department on Thursday announced charges against 601 people including doctors for taking part in healthcare frauds that resulted in over $2 billion in losses and contributed to the nation’s opioid epidemic in some cases.
U.S. Attorney General Jeff Sessions addresses a news conference to announce a nation-wide health care fraud and opioid enforcement action, at the Justice Department in Washington, U.S. June 28, 2018. REUTERS/Jonathan Ernst
The arrests came in dozens of unrelated prosecutions the Justice Department announced together as part of an annual healthcare fraud takedown.
The hundreds of suspects charged included 162 doctors and other suspects charged for their roles in prescribing and distributing addictive opioid painkillers.
U.S. Attorney General Jeff Sessions arrives for a news conference to announce a nation-wide health care fraud and opioid enforcement action, at the Justice Department in Washington, U.S. June 28, 2018. REUTERS/Jonathan Ernst
Though many of the cases also involved a variety of schemes to fraudulently bill government healthcare programs, officials sought in the latest crackdown to emphasize their efforts to combat the nation’s opioid epidemic.
According to the U.S. Centers for Disease Control and Prevention, the epidemic caused more than 42,000 deaths from opioid overdoses in the United States in 2016.
While the Justice Department has been conducting investigations into some opioid manufacturers like OxyContin maker Purdue Pharma LP, the cases stemming from the sweep did not focus on wrongdoing by major corporations.
Many of the criminal cases announced on Thursday involved charges against medical professionals who authorities said had contributed to the country’s opioid epidemic by participating in the unlawful distribution of prescription painkillers.
Those charged included a Florida anesthesiologist accused of running a “pill mill;” a Pennsylvania doctor alleged to have billed an insurer for illegally prescribed opioids; and a Texas pharmacy chain owner and two other people accused of improperly filling orders for opioids that were sold to drug couriers.
The Justice Department also announced other cases unrelated to opioids, including schemes to bill the government healthcare programs Medicare, Medicaid and Tricare as well as private insurers for medically unnecessary prescription drugs and compounded medications.
Recently Medicare announced that they are going to increase what they pay for Epidural Spinal Injections (ESI) to encourage pain docs to use these ESI more than prescribing opiates. There is an estimated 10 million ESI procedures done very year in this country and studies suggests that 5% of those procedures will cause the pt to have Arachnoiditis a IRREVERSIBLE/INCURABLE painful condition… causing the pt to become a intractable chronic pain pt. The medication often used is Methylprednisolone… that neither the founder of the medication ( UpJohn) nor the FDA recommends that this medication being used in ESI.
So if this increase in what Medicare pays for this procedures works – instead of following the FDA’s recommendation to NOT USE IT… will cause in excess of 500,000 new intractable chronic pain pts… while at the same time… our bureaucracy is attempting to cause fewer opiate prescriptions to be prescribed/dispensed.
OR force these pts to partake in non-opiate therapies that most insurance don’t pay for and pts can’t afford, don’t have the time or be able to have transportation to participate in all of these non-opiate therapies … not to mention that they don’t work for a lot of pts.
Is this the way a bureaucracy is suppose to work ?… one part causes a problem and another part try to solve the problem that the other part is causing. Of course, we know how successful our bureaucracy has been fighting the war on drugs over the last nearly 50 yrs… what could go wrong ?
This is a pt with MS and has contracted SHINGLES… who said that we have the BEST HEALTHCARE SYSTEM IN THE WORLD ?
My DOG gets better care from her VET.. than it would seem to be provided this pt.. Don’t know where this pt is and/or what “hospital” she is in… Doesn’t sound like one I would want to be in “sick” and be expecting to receive appropriate treatment.
NEW YORK (Reuters) – CVS Health Corp agreed to pay a $1.5 million civil fine to resolve U.S. charges that some of its pharmacies in Nassau and Suffolk counties in New York failed to report in a timely manner the loss or theft of prescription drugs, including the opioid hydrocodone.
Richard Donoghue, the U.S. Attorney for the Eastern District of New York, on Thursday said delays contribute to opioid abuse, and that CVS’ failures impeded the ability of Drug Enforcement Administration agents to investigate, violating federal law.
CVS, based in Woonsocket, Rhode Island, did not immediately respond to a request for comment.
“This settlement is significant because it shows that big chain pharmacies, like CVS, are taking responsibility for violating federal law, which is a step in the right direction for curbing the opioid epidemic,” DEA Special Agent-in-Charge James Hunt said in a statement.
Opioids, including prescription painkillers and heroin, played a role in a record 42,249 U.S. deaths in 2016, according to the U.S. Centers for Disease Control and Prevention.
CVS has more than 130 pharmacies in Nassau and Suffolk, according to its website.
The company reached a $5 million settlement with the U.S. government last July over similar claims involving pharmacies in California.
Update 6/27/18: I am overwhelmed by the positive responses I have received for this letter. I would ask that readers also take a look at all the articles and references cited in this piece, and share those as well. Those references go into much, much more detail and research than I have had space or time for here. Thank you all so much for reading and sharing, I believe we will make a difference and win this fight for our lives! #wearehere
I am one of millions of chronic pain patients in the United States who has been continually and increasingly oppressed over the past few years by progressively invasive and prohibitive laws at the state and federal levels concerning the delicate relationship between doctors and patients, particularly when it comes to a certain class of drugs, i.e. opiates.
Ever since my very real, physical condition began about 4 years ago, my family and I have been disoriented again and again by a lack of what might be termed, “help,” from doctors. We have discovered a very confused medical community, corruption, and a growing collection of laws being passed so fast and furiously hardly anyone seems to know just what is going on.
This has resulted in doctors leaving my city, doctors outright refusing to accept chronic pain patients (or, if they do accept these patients, refusing to treat them with medications that suit the patient best) or new patients, and unprecedented referrals to pain management clinics and psychiatrists. I have a detailed post planned addressing the pain management clinics, but the psychiatrist referrals were more baffling to me. My local psychiatrists even refused me as a patient about a year ago because, “we don’t see chronic pain patients.” That made sense to me as I don’t suffer from mental illness, still my providers insisted I must be mistaken.
Down the Rabbit Hole
I began researching you and your career last night out of curiosity. I wanted to answer the question, “Who is this Dr. A. Kolodny, that everyone from journalists to policy makers and bloggers keep quoting as an “expert on opiates”?” And I found out. You, sir, are a psychiatrist and board-certified addiction specialist-turned policy maker (1) and buprenorphine (Suboxone) “evangelist” (2).
Your first private clinic was a Suboxone clinic in New York City, established sometime around 2003-2005, and it appears you (and/or other health officials) felt stymied by the federal limit at the time of just 30 patients for such clinics (put in place to stem corruption), because said health officials have been in the background, quietly working away at this very limit which was amended in 2006 (called DATA), to allow 100* patients after 1 year, and is now up in the House for being overturned altogether, along with expanding legal prescribers to nurses and other non-doctor medical staff. And look what has happened as a result:
Health officials, concerned about restricted access, lobbied alongside Reckitt Benckiser for the patient cap to be raised. “Why should we bind a healer’s hands from helping as many as he or she could?” Senator Hatch said, getting an amendment passed in 2006 that allowed doctors, on request, to go from 30 to 100 patients after a year.
The stage was set for more patients, prescriptions and problems. “It’s when the limit was raised from 30 that doctors started to get commercial about it,” said Dr. Art Van Zee, whose buprenorphine program at a federally funded community health center in rural Virginia is surrounded by for-profit clinics where doctors charge $100 for weekly visits, pulling in, he estimated, about $500,000 a year.
“In the early days of Suboxone, with Reckitt Benckiser barely marketing its own drug, Dr. Kolodny, then a New York City health official, crisscrossed the city with colleagues to spread the word about the new medication, entice public hospitals to try it with $10,000 rewards and urge doctors to get certified.”
Since at least 2005, you have been marketing buprenorphine as if you had a personal stake in the drug, to government institutions and agencies including prisons, public hospitals, and rehabilitation facilities (2). In the fall of 2013, you were appointed Chief Medical Officer (5), of the largest chain of non-profit detox/rehab facilities in the USA (cited for questionable practices and abuse from at least 2012-2015) (6) called Phoenix House, which received $131 million in June 2013 (7), championing the use of MAT, or “Medication Assisted Treatment”. I wonder which drug Phoenix House used?
Hang ‘Em High?
An innocent “witch” (woman) is hanged at the Salem Witch Trials, much like other innocent pain patients are persecuted.
Since you often cite the United States vs. Purdue Pharma (2007) settlement in your interviews and writings, perhaps you saw an opportunity to expand the use of buprenorphine by targeting and demeaning chronic pain patients as mere “addicts”. It was odd to me in researching that incident, in the official “Purdue Guilty Plea” document (8), the very words they were condemned for, claiming OxyContin to be “less addictive” and “less subject to abuse and diversion” (8), appear to be the exact words you use time and again when describing the benefits of buprenorphine (2).
Kolodny reminds his colleagues of the drug’s advantages. He stresses that bupe in the form of Suboxone is safe and almost impossible to abuse, a huge selling point at many of the clinics they will visit. Suboxone has a second active ingredient in the mix, he explains, an anti-overdose drug called naloxone.
It does nothing if you take bupe as directed. But if you sniff bupe or inject it or otherwise try to pack enough into your bloodstream to get high, the naloxone acts like a chemical booby trap, erasing the effects of any opiate, bupe included, and bringing on sweaty, nauseating withdrawal. “That’s the last time you’ll do it,” Kolodny says dryly. https://www.wired.com/2005/04/bupe/
In 2016, your organization, PROP (Physicians for Responsible Opiot Prescribing), got the ear of the CDC and helped to write the now-infamous, misinformed, and rushed guidelines for prescribing opiates. While these guidelines were fairly general in nature, they have been used as a springboard for countless pieces of state legislation and DEA investigations, which has, in turn, led to the above-mentioned abuse and abandonment of chronic pain patients and doctors, as well as opiate shortages in hospitals and ERs (The DEA, in an attempt to prevent diversion of opiates to the black market, has cut production by an incredible 45% in the past 2 years). I imagine that suits you just fine, since you have publicly stated you believe opiates should be discontinued for all but the dying and post-major surgery “for a few days” (https://www.ket.org/opioids/inside-opioid-addiction-10-questions-with-dr-andrew-kolodny/), and that “more treatment” is needed (https://www.vox.com/science-and-health/2017/8/3/16079772/opioid-epidemic-drug-overdoses), i.e. MAT/Suboxone clinics like Phoenix House.
“The National Gesture” 1926
You have hailed local municipalities and states in their further pursuit of legal action against American Big Pharma, the companies who make such things as Vicodin and Percocet, but not Suboxone/buprenorphine (which is also an opiate), which is made by an overseas company, Reckitt Benckiser, or Naloxone (Narcan), which is produced in a nasal spray exclusively by Amphastar Pharmaceuticals (10), a relatively new company founded in California in 1996 (11), whose stock (and Narcan prices) has been rising quite a bit, lately (12, 13). Are you truly against the use of opioids, or just the ones that help pain?
Senator Joe McCarthy Demonstrates the Communist Threat in America
You are cited and quoted in an impressive number of articles and interviews as a compassionate person who wants to see people and their families heal from the devastation of addiction, which is why it surprised me to find quotes from you that didn’t seem, well, “nice.”
It is the FDA’s role to vigilantly regulate the approval, labeling, and promotion of pharmaceutical products, not that of counties or municipalities. County and municipal lawyers are inadequately qualified to make or enforce federal drug policy, and these lawsuits serve as a vehicle for local governments to seek revenue through ill-informed measures under the guise of drug abuse prevention. In a May 30,2014, interview with FDA Week, a CLAAD spokesman voiced these positions and expressed concern that these lawsuits are part of “a trend that will distract us from the real meaningful approaches to reducing prescription drug abuse.”
After reading the interview, Dr. Andrew Kolodny, president of Physicians for Responsible Opioid Prescribing (PROP)and Chief Medical Officer of Phoenix House, contacted CLAAD via telephone to condemn its comments. During this conversation, Kolodny threatened that the Internal Revenue Service would revoke CLAAD’s tax-exempt status when alerted to the comments, which he believes conflict with CLAAD’s charitable mission. CLAAD takes these false allegations and threats very seriously, and responded in a letter which is publicly available for view on our website.
Critics who categorically dispute the motives of organizations like CLAAD and its diverse coalition members are, at best, narrowly focused. Their zealotry reveals their otherwise undisclosed health insurance industry bias. At worst, they endanger the lives of people who live with pain and other conditions that can require controlled substances by stifling access to quality care. http://paindr.com/claad-and-phoenix-house-square-off/ (16)
Anyone who questions your authority, expertise, policies, or the efficacy of your pet drug, buprenorphine, is loudly dismissed by you as uneducated (17), addicted (15a), or corrupt (15a, 18), regardless of how closely they actually work with addicts and pain patients (17).
But Dr. Kolodny, I have nothing left to lose — your policies and attitudes have directly impacted my health, my freedom, my ability to be a parent, my work, my hobbies, my family, my finances, my friends, and my personhood. I have no problem announcing to the public, as loudly as I can, “The Emperor is not wearing any clothes!”
“We have been told directly per company policy and multiple emails that in cases where we refuse to fill controls we are to cite “professional judgment” and are absolutely not supposed to give any more details than that. We wouldn’t want to get sued for being ‘defamatory’ toward a prescriber, of course. This is mainly in situations where we feel the doctor is basically running a pill mill or has other unethical practices though. In general we try to explain dosing issues and the need to call an office when things seem legitimate”
“Was told by ohio board investigator that we cannot be specific with the patient as to why we are refusing. We can only tell them we are not comfortable filling the prescription, and that their doctor can call and discuss with us. He said that when we start explaining why we are refusing to fill it is deemed as “practicing medicine.”
“Our corporate guidelines prohibit us from being specific such as not to cause a customer service issue. Our state has made it a felony to discuss controlled database findings with patients but made it mandatory for both MD and RPh to utilize it…yet here we are. A script that shouldn’t be filled, but I can’t be truthful with the patient as to why…talk about an enthical conundrum…”
“one of the big chains has a refusal policy in place, but you’re not allowed to tell the patient specifically why you’re refusing it, as that would be “disclosing proprietary company information.” This definitely has patients leaving without an understanding of why it’s not being filled. I can’t tell you how much I would love to be able to say “Because your prescriber is a lying sleezeball and I don’t want my name on anything associated with him.”
A man who said he was an Air Force veteran upset with the Department of Veterans Affairs set himself on fire outside the state Capitol in Atlanta on Tuesday morning.
Capt. Mark Perry of the Georgia State Patrol said that the man parked a passenger vehicle around 10:45 a.m. and began walking toward the Capitol.
“He was strapped with some homemade incendiary devices, some firecrackers and doused himself with some kind of flammable liquid and attempted to set himself on fire,” Captain Perry told reporters.
A Georgia State Patrol trooper rushed toward the man with a fire extinguisher “and was able to douse him pretty quickly,” he said. In a phone interview, Captain Perry said that trooper was not on duty at the time — he was driving by, and jumped out of his patrol car when he saw the flames.
The Georgia Bureau of Investigation identified the man as John Michael Watts, 58, and said he had no current address. He was taken in critical condition to Grady Memorial Hospital with burns on 85 to 90 percent of his body.
Captain Perry said he was able to speak after the fire was extinguished.
“He did indicate that he is disgruntled with the V.A. system and was seeking attention for that,” he said.
The authorities shut down the area around the Capitol and called the bomb squad to assure the man’s vehicle did not contain explosives. Nearby buildings were evacuated. No other injuries were reported.
The incident unfolded during a news conference about a new state law on hands-free driving. A series of loud bangs and then sirens could be heard in video of the event.
Natalie Dale, a spokeswoman for the state Department of Transportation who was speaking at the time, said she assumed at first that the sounds were fireworks. But as they continued, the Georgia State Patrol officers behind her started to peel off.
“They were really calm, so I stayed really calm,” she said. “I was with trained professionals.”
The Department of Veterans Affairs is a sprawling agency that includes more than 1,700 clinics and hospitals and has been plagued by scandal.
In March 2016, a 51-year-old veteran died after setting himself on fire outside of a Veterans Affairs clinic in northern New Jersey. An investigation found that the staff at the clinic repeatedly failed to ensure that he had received adequate mental health care.
Critics of the agency have long voiced frustrations. Michael Owens, a Marine Corps veteran from Mableton, Ga., and state leader with the Truman National Security Project, said many veterans say it is not responsive to their needs.
“Being a disgruntled veteran is something that I hear a lot throughout our veteran community here in Atlanta,” he said.
Mr. Owens added that the agency needed to do a better job of flagging indicators that a veteran might be in trouble. “We’ve got to do better,” he said.
The Department of Veterans Affairs has reportedly backed off its own suicide report after reporters noted its own data revealed no change in suicide numbers and that suicides among troops were higher than expected.
Military Times noted VA was displeased that reporters and readers noted statistical outcomes it did not want. This year, the agency included breakdowns between various groupings of suicides. One of those groups is of active duty troops showing higher suicides than previously reported.
For 2015, the new numbers were 1,400 deaths, which is 900 higher than previously reported. Over the four-year span reported, the number of unreported deaths is over 3,400.
Now, VA is backing off the report saying the numbers led to a “misperception” about the suicide numbers leading to “confusion” about military suicides.
VA Bumbles Response
According to the Military Times article:
“In our report, VA did not differentiate deaths between active duty, current never federally activated Guard and Reserve, and discharged never federally activated Guard and Reserve,” said Dr. Keita Franklin, VA’s national director of suicide prevention.
“This difference in the report may have caused some confusion and led to the misperception that approximately 1,000 more current service members died by suicide than DoD reported in 2015.”
Franklin said including the breakdown in the report was designed to provide more information about the demographics of individuals who took their own lives. The updated report also contains new information on veterans’ era of service, ethnicity and comparison age groups in an effort to provide “more data points for us to look at.”
VA officials blamed the confusion on the troops’ suicide information on inconsistent definitions used in various agencies. Individuals who served in the guard or reserves and are considered “veterans” in census reports may not have been counted in the Defense Department statistics because of different mobilization authorities and state rules.
But the VA researchers are now emphasizing they have not found fault with official military suicide statistics, which have counted between 550 and 450 active-duty, guard and reserve suicides in each of the last five calendar years.
What Report Did Show
The report still shows veteran suicides are holding steady at 20 per day despite record spending on vendor programs supporting the agency’s goal to reduce suicides.
Tens of millions each year in spending on vendor projects to make suicide prevention programs look sexy has led to a zero decrease in suicide numbers. Imagine if VA spent that money on hiring psychologists to treat veterans?
Phoenix, Ariz., Jun 26, 2018 / 02:04 pm (CNA/EWTN News).- An Arizona pharmacist is under investigation after refusing to fill a medical abortion prescription, citing ethical objections.
The case involves a 35-year-old woman named Nicole Arteaga, who was told by her doctor at nine weeks pregnant that she had an unviable pregnancy and would ultimately miscarry. She was prescribed a drug called misoprostol, which would induce a medical abortion.
When Arteaga went to fill the prescription at the local Walgreens, the pharmacist told her that he was ethically opposed to filling the drug and asked if he could transfer her prescription. Arteaga wrote about her experience on Facebook, in a post which was shared more than 36,000 times.
According to the National Women’s Law Center,
Arizona is one of six states in the U.S. that makes allowances for pharmacists who refuse to fill prescriptions based on moral or ethical objections.
Walgreens also upholds a policy saying its pharmacists are allowed to refrain from filling drugs to which they have moral objections.
“To meet the health care needs of our patients while respecting the sincerely held beliefs of our pharmacists, our policy allows pharmacists to step away from filling a prescription for which they have a moral objection,” read a June 25 statement released by Walgreens.
“It’s important to note in that situation, the pharmacist also is required to refer the prescription to another pharmacist or manager on duty to meet the patient’s needs in a timely manner,” the statement continued, adding “we are looking into this incident.”
The Associated Press reported that the pharmacist in question was the only one on duty at the time, so he transferred her prescription over to another pharmacy.
Arteaga was able to get the abortive drug elsewhere, but the Arizona State Board Pharmacy said it would be investigating the situation. Once the investigation is presented to the board, they will either dismiss the case or seek further action, according to the Associated Press.
The Arizona case is not the first time pharmacists’ conscientious objection rights have been in the headlines. In 2007, a Christian family-run pharmacy filed a lawsuit against the state of Washington, which was requiring pharmacies to distribute abortion-inducing drugs, saying the enforcement violated their religious freedom rights.
“We believe that life is precious and sacred – and that it begins at conception. We want to promote life and true health, not death or anything that goes against our religious beliefs,” said Greg Stormans, one of the Christian pharmacists who fought against the Washington law.
“We never thought that we would have to choose between living our faith and our family business – or that we would be embroiled in a legal battle. It is unfortunate, but the commission left us no choice,” Stormans had told EWTN News in a previous interview.
A federal appeals court ultimately ruled against the pharmacists in 2015, in a decision that Luke Goodrich, deputy general counsel of the Becket Fund for Religious Liberty, called “unfortunate.”
What if a pharmacist has a moral/ethical objection to any/all opiates and/or ADD/ADHD medications ? The list of medications that a pharmacist could have a moral/ethical objection to, could be quite extensive.
A large/majority of chain pharmacies only have one pharmacist on duty so this requirement “the pharmacist also is required to refer the prescription to another pharmacist or manager on duty to meet the patient’s needs in a timely manner” could be pretty much MEANINGLESS
Recently Medicare announced that they are going to increase what they pay for Epidural Spinal Injections (ESI) to encourage pain docs to use these ESI more than prescribing opiates. There is an estimated 10 million ESI procedures done very year in this country and studies suggests that 5% of those procedures will cause the pt to have Arachnoiditis a IRREVERSIBLE/INCURABLE painful condition… causing the pt to become a intractable chronic pain pt. The medication often used is Methylprednisolone… that neither the founder of the medication ( UpJohn) nor the FDA recommends that this medication being used in ESI.
