http://www.oregonlive.com/portland/index.ssf/2018/04/secret_drug_raid_by_feds_backf.html

Maxine Bernstein | The Oregonian/OregonLive

 The harrowing confrontation terrorized Riley and turned a spotlight on a controversial ploy used by agents in drug cases to smoke out suspected traffickers. Oregon surprisingly is No. 2 in the nation in requesting what are known as delayed-notice search warrants.

The “sneak-and-peek” warrants, as they’re more commonly called, allow investigators to search a house, car, computer, other property or item, seize evidence and not tell anyone until much later. That differs from the typical search warrant, which requires police to provide immediate notice to property owners.

The delayed warrants mean agents can avoid tipping off suspects and jeopardizing an investigation, while potentially provoking them into revealing drug suppliers or other connections when it appears someone has stolen their cache.

 The technique appears to have backfired this time, imperiling an innocent bystander held at gunpoint and blowing the agents’ drug investigation.

“The danger of violence is obviously real, and this case makes it very evident. Someone could have been killed,’’ said Jonathan Witner-Rich, a criminal law professor at Cleveland State University who studies use of the warrants nationwide. “I think it illustrates this is a dangerous tactic, and the law is not requiring police to reduce such risks.’’

The federal statute that allows the warrants should incorporate extra safeguards to protect against this kind of outcome, Witner-Rich said.

Russ Baer, a spokesman for the Drug Enforcement Administration, declined comment on the warrant or the agency’s tactics, citing the ongoing criminal investigation.

The government seeks the warrants “to preserve the secrecy of an investigation,’’ said Kevin Sonoff, spokesman for Oregon’s U.S. Attorney Billy J. Williams. The office declined to discuss the ramifications of the warrant issued in this case.

The Associated Press | File

 ‘I THINK THE POLICE DID’

The two men appeared furious and desperate. They were told someone had broken into their storage locker and cleared it out. They wanted to know who.

 After they lured Riley into a different unit, one of the gunmen grabbed him by the shoulder, pushed him against the wall and yelled, “Get down! Get the (expletive) down!” The man filmed the confrontation with his cellphone, the light from the camera shining into Riley’s face.

He ordered his cohort to bind Riley’s wrists and ankles with duct tape, according to the video, which was played in court. The intruders went through the manager’s pockets and took his keys as they repeatedly demanded to know who knocked off their unit.

At first, Riley wasn’t sure what the men were talking about, then he recalled the break-in days earlier.

“When I came in, the door was half open,” he told the men. “The door was ripped off the track. “They didn’t get the lock off, so they broke the door. … I reported the break-in.’’

Riley told his attackers that he fixed the door a couple of days later. It was around then that he learned who had broken the door, he said.

“I think the police did. That is what my boss said,’’ Riley told the men, according to the video. “Then my boss said it wasn’t a break in.’’

“You’re telling me the police took my (expletive)?’’ one of the men asked in disbelief.

If Riley was lying, they implied that they’d shoot him. “Pop goes the weasel,” said the man with the gun to the manager’s head.

Then the two then abruptly left, closing the storage unit door with Riley still trussed up but alive.

Eric Kayne | Getty Images | File

 ALLEGED OREGON-TO-TEXAS TRAFFICKING

Before, during and after the Dec. 2 attack, Drug Enforcement Administration agents had been tracking the movement of one of the alleged gunmen and a woman through GPS traces of their phones and cars.

The monthslong surveillance was part of a broader investigation into black market trafficking of marijuana from Oregon to Texas, according to a prosecutor’s memo opposing the defendants’ release from jail before the trial. The DEA was working with a team of officers from Homeland Security Investigations, the FBI, Port of Portland police and the Multnomah County Sheriff’s Office.

Last August, investigators at Portland International Airport had found $184,740 in cash concealed in a shoebox in a passenger’s checked luggage, said Assistant U.S. Attorney William Narus.

Agents discovered that the money was tied to a man and a woman suspected of buying large supplies of marijuana in Oregon and smuggling the bundles back to Texas for distribution, Narus said.

Investigators identified the man, Jody T. Wafer, of Houston, as the one who coordinated buying the drugs in Oregon for transport back to Texas, records indicate.

DEA agents tracked Wafer and the woman, Brittany Kizzee, using undercover surveillance that included covert photography, wiretapping and even trick phone calls, according to court records.

They learned of the large stockpile of marijuana at the Public Storage outlet on Southeast 82^nd Avenue and decided to seize it before they suspected it might be shipped to Texas, court records show. The investigators also were still working to identify the drug suppliers in Oregon.

On Nov. 17, DEA agents got a judge’s signature on a delayed-notice search warrant, giving them authority to enter the Public Storage unit, seize property and not tell anyone for weeks.

Four days later on Nov. 21, the narcotics agents broke into the unit, knocked the door off its track, seized 484 pounds of marijuana and left the door ajar as if a real burglary had occurred.

Sometime in late November, the agents directed a district manager from Public Storage to make a “ruse call’’ to Kizzee, feeding the manager lines about what to say about a break-in at the unit.

Then on Nov. 30, the agents learned Wafer, Kizzee and a second man, Trent Knight, were flying from Texas to Portland, set to touch down about 8:45 p.m. The agents followed them when they arrived. They saw at the airport that Knight appeared to have a gun, according to court records.

On Dec. 1, the agents saw their targets driving in circles around Public Storage.

And that Saturday morning, Dec. 2, the agents tracked them in a pickup that drove up to the Public Storage unit. Two men got out. A woman stayed behind the wheel. About 10 minutes later, the truck drove away, according to court documents.

Maxine Bernstein | The Oregonian/OregonLive

 

‘WEED IS LEGAL HERE’

After his assailants had left, Riley managed to break free and call 911 around 9:30 a.m.

Portland police responded quickly, he told The Oregonian/OregonLive.

Officer Patrick Nagy took Riley’s statement and viewed surveillance footage from the storage business.

Nagy checked with Portland’s Drugs and Vice Division to see if it was involved in the marijuana confiscation at the Public Storage unit, but Portland police said they weren’t aware of it. They later learned DEA agents working with airport police were in on the marijuana investigation, though it was just the DEA that raided the storage unit.

“We just had to deal with the aftermath,’’ said Portland police Capt. Mark Kruger, head of the drug division.

Nagy and other officers arrested Wafer, Knight and Kizzee about two hours later, after the three had passed through security at Portland International Airport before boarding a plane to Houston.

As officers approached Wafer, he slammed his cellphone to the floor in an apparent attempt to break it, according to Narus, the prosecutor.

Mandel Ngan | Getty Images

 Investigators recovered the phone, which held footage of the violent encounter at Public Storage earlier that morning and another video of what looked like the two men play-acting their planned holdup with guns in their hotel room the night before, Narus said. Police also recovered two loaded firearms in Knight’s checked baggage, he said.

It’s unclear why the gunmen filmed the crime, but it’s possible that they needed to show some proof to others in the alleged drug-trafficking scheme that they didn’t steal the marijuana themselves.

By leading the suspects to think their drugs had been stolen, the federal agents likely wanted to intercept ensuing conversations, hoping they would generate further leads to identify the marijuana suppliers, said Witner-Rich, the law professor. It’s not clear if that happened in this case.

But DEA agents have done that in other cases, including one this month in Ohio that led to the largest methamphetamine bust in that state’s history. Authorities seized 82 pounds of crystal meth from a warehouse on a delayed-notice search warrant, leading three suspects to believe they’d been robbed. That’s when one got the “green light’’ from his Mexican supplier to kill the person he believed had stolen the drugs, according to intercepted phone calls quoted in court documents.

In Oregon, Wafer, 28, Knight, 29, and Kizzee, 27, now face federal charges of kidnapping and conspiracy to brandish a firearm in a crime of violence.

No marijuana trafficking charges have been filed in the case. The kidnapping and conspiracy charges are much more serious, according to prosecutors and defense lawyers.

After his arrest, Wafer told a court official that he had been visiting Oregon every other month, according to court records.

He added, “Weed is legal here.’’

The Associated Press | File

 ‘THE EXPERIENCE … WAS ABSOLUTELY TERRIFYING’

During a court hearing earlier this month, the government argued that the treatment of the Public Storage manager reflected the defendants’ “violent nature’’ and they shouldn’t be released before trial.

The prosecutor didn’t mention the secret raid of the storage unit by federal agents. Narus said the defendants “wrongly assumed’’ who had stolen their drug stash and committed a “violent offense against an innocent member of the public.’’

Attorney Barry Engle, who represents Wafer, blamed the federal investigators.

“The government’s own actors,” he said, prompted the alleged crime and “desperation’’ felt by his client. He noted in court documents and at the hearing that his client wasn’t admitting to any connection to the marijuana.

“The police knew that they were giving that impression that this was taken by the people working at the storage facility. I don’t know why, but that’s what they did,’’ Engle said.

Multnomah County Sheriff’s Office

 From left: Wafer, Knight, Kizzee.

As for Riley, the 59-year-old manager said he took a week off work after the frightening ordeal.

A single man who grew up in Southeast Portland, he still works for Public Storage full time, now going on three years.

Asked if he believed that agents who broke into the storage unit had exposed him to potential violence, Riley didn’t speak but vigorously nodded his head. He then politely referred questions to his corporate office.

U.S. Magistrate Judge John V. Acosta, who had reviewed investigators’ affidavits in the case, initially granted Wafer’s release from jail pending trial, but the prosecutor challenged the ruling to another judge. Kizzee has been released pending trial, but Knight was ordered detained. All have pleaded not guilty to the charges.

U.S. District Judge Robert E. Jones watched the video of the attack on Riley. He ordered Wafer to remain in jail as well. The three are set for trial May 15.

“The experience here was absolutely terrifying, one of the most dangerous acts, threats of death, a threat of execution,’’ Jones said. “No way will this person be released.’’

Maxine Bernstein | Staff

 

— Maxine Bernstein

mbernstein@oregonian.com
503-221-8212
@maxoregonian

Filed under: General Problems | 1 Comment »

http://www.dispatch.com/news/20180415/three-cvs-actions-raise-concerns-for-some-pharmacies-consumers

First, CVS set up a website for consumers to compare drug prices.

But the site gave clear preference to CVS pharmacies, automatically putting them at the top of the comparison list. That occurred despite a “firewall” that’s legally required between the drugstore chain and CVS Caremark, the drug giant’s pharmacy benefit manager that runs the site.

Second, CVS’s benefit manager cut Medicaid reimbursements to local Ohio pharmacies this past fall,

which some say put them in financial jeopardy. Then CVS’s “acquisition unit” sent letters to many of those same pharmacies, saying times are tough and asking whether they would be interested in selling their business.

And in a third action that is raising concerns among independent pharmacists and consumers,

CVS dialed up Roberta Timmons.

When the 67-year-old Honda retiree received a telephone message a few weeks ago about her prescription drugs, she assumed it was from her longtime neighborhood pharmacist.

But when Timmons returned the call, the Plain City resident was told that she could save money by transferring her prescriptions to a CVS pharmacy. The caller was CVS Caremark, the pharmacy benefit manager (PBM) for SilverScript, a CVS-affiliated supplemental drug plan serving seniors covered by Medicare.

“I thought: ‘Why are they calling me when I don’t have prescriptions filled at CVS?’” Timmons asked. “What prescriptions was I missing or not getting filled?”

After learning that SilverScript and CVS Caremark were both part of CVS, Timmons, who has gone to the same independent Plain City pharmacy for 20 years, went from confused to angry.

“Knowing that I’ve been with one certain pharmacy for so many years — and then they think they can call and get me to change over certain prescriptions or tell me that I’m not getting the prescriptions I’m supposed to have?”

‘Extremely concerning’

The interaction between CVS and Timmons — as well as the buyout offers and the website — are part of a pattern, CVS critics say, of reaching around the firewall to help the company’s bottom line and drive out competition. In roughly the past three years, the number of independent pharmacies in Ohio has declined by 164, and the number of CVS pharmacies (which took over the pharmacies in Target stores) has climbed by 68, Ohio Board of Pharmacy data show.

Federal regulators required the firewall when CVS and Caremark merged in 2007, to make sure those in one part of the business did not use confidential information and economic power to unfairly help the other.

In 2012, the Federal Trade Commission closed an investigation into allegations of such anti-competitive practices as patient steering and spread pricing (profiteering), saying that it would “not take any additional action at this time” against CVS, now the nation’s seventh-largest company.

Mike DeAngelis, CVS’s senior director for corporate communication, said in an email: “CVS Health maintains stringent firewall protections between our CVS Pharmacy retail business and our CVS Caremark PBM business, and takes these protections very seriously.”

During the call to Timmons, a CVS Caremark representative said she was contacted to inform her that two of her medications could be refilled in a 90-day supply. When Timmons asked about her other prescriptions, the representative provided the cost at her pharmacy — which the caller could learn because CVS’s PBM provided the payment — compared with the cost at a CVS store. The CVS price was always cheaper. No pricing information was given for other pharmacies such as Kroger or Walgreens.

Filed under: General Problems | Leave a Comment »

https://www.painnewsnetwork.org/stories/2018/4/13/prominent-pain-doctor-faces-hundreds-of-lawsuits

DR. LYNN WEBSTER

“Utah’s opioid crisis stems directly from a callously deceptive marketing scheme that was spearheaded by certain opioid manufacturers and perpetuated by prominent doctors they bankrolled,” the lawsuit alleges.

“Dr. Webster’s advocacy of opioids was designed to create a veneer of impartiality. But Dr. Webster was a forceful proponent of the concept of ‘pseudoaddiction,’ the notion that addictive behaviors should be seen not as a warning, but as indicators of undertreated pain. The only way to differentiate between the two, Dr. Webster claims, was to increase a patient’s dose of opioids.”

Until he retired from clinical practice in 2010, Webster operated the Lifetree Pain Clinic in Salt Lake City. The lawsuit makes a point of mentioning that at least 20 of Webster’s patients died from overdoses and that he was investigated – but never charged with a crime — by the DEA and the U.S. Senate Finance Committee.

Since retiring from clinical practice, Webster has become an outspoken critic of efforts by the government and insurance industry to limit opioid prescribing — which he believes have gone too far and unfairly punish pain patients, while ignoring the larger issue of illicit fentanyl, heroin and other black market drugs.

He’s written a book, called “The Painful Truth” and self-financed a PBS documentary by the same name.  Webster also comments frequently on PNN about opioid related issues.

With so many lawsuits hanging over him, Webster’s financial future is uncertain.  He says he and his fellow KOLs could be bankrupted by legal fees before any of the lawsuits come to trial.

Filed under: General Problems | 4 Comments »

A now former Palm Beach County Sheriff’s deputy was caught on home surveillance video stealing prescription drugs from

a West Boynton Beach home 90 minutes after paramedics took the dying 85-year-old homeowner to the hospital.

Former deputy accused of stealing pills pleads guilty to lesser charges

http://www.sun-sentinel.com/local/palm-beach/fl-pn-deputy-steal-pills-plea-deal-20180413-story.html

Filed under: General Problems | 4 Comments »

http://www.thv11.com/article/news/health/opioids/saving-a-generation/us-surgeon-general-visits-arkansas-to-encourage-everyone-to-carry-narcan/91-537659703

There’s not one solution to tackling the opioid addiction crisis. U.S. Surgeon General Dr. Jerome Adams was in Little Rock to talk about what he’s doing to fight it.

“We have a person dying every 12.5 minutes from an opioid overdose,” said Dr. Adams.

Before we fight the crisis, Dr. Adams wants us to change our idea of the face of addiction. 

“It may not be who you think,” said Dr. Adams. “I’ve talked to mothers, suburban moms who had C-sections, were over-prescribed, and unfortunately are now injecting heroin.”

In Arkansas, Dr. Adams recognizes the effort to tackle this through partnerships.

“You’ve got health, talking to the medical side, talking to DEA,” said Dr. Adams.

One core issue is over-prescribing.

“Very honestly, we’re still over-prescribing and have a lot of work to do in that front and I don’t blame doctors or prescribes for that solely, but we’ve got to look at the whole picture and look at how we can lower expectations for opioids,” said Dr. Adams.

Some data shows medical marijuana could be the answer, but before it’s accepted, Dr. Adams thinks marijuana needs research like any other medication.

“When you talk about the medicinal properties of marijuana I do believe, because the science says, there are medicinal properties of components of marijuana, but we need to make sure we’re doing the research,” said Dr. Adams.

Dr. Adams issued a public health advisory urging more people to carry naloxone, a lifesaving medication that can reverse the effects of an opioid overdose.

“A safe drug, a readily available drug in Arkansas, and a drug which can save a life,” said Dr. Adams.

He wants naloxone use to be as accepted as CPR, with common knowledge on overdose signs.

To those asking themselves why they should help, Dr. Adams wants people to reject the idea that there is a con to saving someone’s life.

“If we decided who was going to get medical treatments based on the poor decisions they made, the hospital would be empty,” said Dr. Adams.

Filed under: General Problems | 1 Comment »

Sen. Claire McCaskill, D-Mo., introduced a bill last year in the Senate to restore DEA powers to fight suspicious drug wholesalers.

https://www.washingtonexaminer.com/policy/healthcare/major-push-to-combat-opioid-abuse-doesnt-include-bill-to-restore-dea-powers

I believe that Senator McCaskill is running for reelection in Nov…. Senator McCaskill is from Missouri …  Missouri is the only state that does not have a PMP database.

Filed under: General Problems | 3 Comments »

http://www.14news.com/story/37924577/study-indiana-under-counting-overdose-death

INDIANA (WFIE) –

More and more people say they’re aware of the opioid crisis and think it’s a serious problem.

A new survey by the Associated Press found 13% of Americans say they’ve had a loved one die from an overdose. However, that number might be even bigger than that. 

The entire state of Indiana is seriously under-counting it’s opioid deaths, according to Indiana University Researcher, Brad Ray.

Over a six-year period, Ray looked at toxicology reports from the Marion County Coroner’s Office, where he found 918 deaths involved heroin and a significant increase in accidental overdose deaths involving both heroin and fentanyl.

Ray told the Indianapolis NBC affiliate, WTHR, that about 80% of the deaths labeled as ‘unspecified’ actually had an opioid present. If you include those opioid-involved deaths there is a much higher number of opioid overdose deaths in Marion County and the state.

Sometimes more than double the number.

Vanderburgh County Coroner Steve Lockyear said reported opioid deaths in Evansville don’t follow that pattern.

“Our initial screening is for over 300 drugs and now that’s expanded to over 500 or 600 drugs, including synthetics and K2’s and the bath salts,” said Lockyear. “These are vast, very expansive drug testing we do here in Vanderburgh County. We have no problem doing that, we’ve always done that.”

A new law requiring coroners test for opioid overdoses in suspicious deaths was just signed by Governor Eric Holcomb.

It allows for funding for extra toxicology tests from the state’s coroner training fund and requires data be sent to State Department of Health.

According to the coroner’s office, Vanderburgh County spent at least $200,000 last year investigating drug-related deaths. Those numbers do not include people who die from natural disease due to drug abuse

IMO.. it would seem that Indiana is using “qualitative toxicology” – just if a specific substance is present to declare a death a “opiate related death”  as opposed to a “quantitative toxicology” which would determine the CONCENTRATION of a particular substance.

The typical OD has 4-7 different substances in their toxicology and with these new guidelines in Indiana… all that is needed is for the mere PRESENCE of a opiate in toxicology to declare the cause of death to be “opiate related”

Apparently Indiana will do just about any “slight of hand trick” to raise the “opiate related deaths” in the state… MORE FEDERAL MONEY TO FIGHT THE WAR ON DRUGS ?  You notice that they are now using the “new terminology” that these deaths are not “accidental”… just opiate related.

Filed under: General Problems | Leave a Comment »

Just wanted to make sure you saw this: The Greyhound bus company is allowing Border Patrol agents to board its buses and search passengers without a warrant. It’s a gross violation of passengers’ constitutional rights – and we need your help to stop it.

Add your name so we can show Greyhound we’re standing up for immigrants’ rights. When Greyhound sees our petition, they’ll know we’re not going to back down.

This is urgent – there are so many lives on the line because of this latest development in Trump’s racist, anti-immigrant agenda. With your help, we can make sure Greyhound stays out of this xenophobic, fear-mongering practice.

Thanks for speaking up with us,

Jennie

Hi Steve –

Imagine taking your regular bus to work or school. The bus pulls over and Border Patrol agents get on board. Row by row, they scan passengers for anybody deemed “suspicious” due to the color of their skin, accent, or the way they dress. You think you’re just taking the bus home, like any other day – but you end up arrested, detained, and in worst cases, deported.

That horror story has increasingly become a reality on Greyhound buses throughout the country, because the company allows Border Patrol agents to board its buses and arrest passengers without a warrant.

Sign this petition telling Greyhound to stop throwing its passengers’ rights under the bus.

Not only is Border Patrol’s practice cruel, but it’s not even legal. The Fourth Amendment prohibits government agents from entering private property without consent or a warrant, and it protects everyone on U.S. soil – regardless of citizenship – from being detained or searched without cause. By law, Greyhound is fully capable of saying NO to Border Patrol. So why aren’t they?

Add your name to tell Greyhound to stop allowing Border Patrol agents to violate the constitutional rights of paying customers.

We know what this is really about. This is all part of the Trump administration’s shameful and hateful agenda to intimidate and expel immigrants from this country. It’s completely contrary to the founding principles of this country, which not only value immigrants and what they add to our communities, but also clearly delineate personal rights and freedoms. Like the right to take your daily commute without having to prove your citizenship or fear arrest and deportation.

We’re not going to stand for this racist policy. Sign this petition and tell Greyhound to treat its customers fairly and with dignity.

Thanks for fighting back,

Jennie Pasquarella
Director of Immigrants’ Rights for the ACLU of California

Filed under: General Problems | 5 Comments »

Medical marijuana could ease Wyoming opioid crisis

www.wydispensaries.com/medical-marijuana-could-ease-wyoming-opioid-crisis/

The biggest controversy over medical marijuana in Wyoming should be why legislators haven’t already legalized it.

Here’s the reason: many of our lawmakers don’t understand the issue. They remain blinded by the rhetoric of long ago when marijuana was thought of as a “gateway drug” as harmful as heroin. Those arguments are still made today by Wyoming legislators who rely on thoroughly outdated propaganda and incorrect information to keep medical marijuana illegal.

Opponents of marijuana use in the 1960s and 1970s maintained that it did not have any medical benefits, but now we know from scores of scientific studies that their claims were wrong. Medical marijuana is legal in 29 states and the District of Columbia, improving the lives of patients with a host of diseases and conditions.

But not in the Cowboy State.

Inexplicably the vast majority of Wyoming legislators fail to grasp what is at the heart of the matter — pain relief and how to obtain it without becoming addicted to the opiates that are killing thousands of Americans each year.

We all experience pain. I can’t accept that we allow elected officials — not doctors, pharmacists or researchers mind-you — to dictate how we deal with it. Some argue that it is a morality issue. What’s moral about refusing aid to the suffering?

Others may argue that prohibition is the will of the people. Representatives taking that stance either don’t know, or don’t care, that an October 2016 University of Wyoming poll showed that an overwhelming 81 percent of state residents support the legal use of medical marijuana.

Despite its opposition to medical marijuana, the Legislature did show during the recent budget session that it is concerned about the sweeping opioid epi­demic. Senate President Eli Bebout (R-Riverton) sponsored a bill to create an opioid addiction task force that will include lawmakers, physicians, pharmacists, law enforcement and others.

Medical marijuana deserves to be a priority consideration of the task force’s agenda and not rejected out-of-hand because some believe it is hazardous to their political and professional health.

Currently our lawmakers have left those with chronic suffering with three unacceptable options: choose to live with pain, risk addiction and overdose with prescription or street opiates, or break the law by smuggling marijuana into Wyoming that was legally purchased in Colorado, Montana or other states.

Two new studies published last week by the JAMA Internal Medicine journal corroborate what other research projects have shown — the availability of legal marijuana reduces reliance on legal opiates like oxycodone, hydrocodone and codeine, and illegal street drugs like heroin.

Since 1999, according to Scientific American magazine, opiate overdoses have killed more than 165,000 Americans. The publication estimates the social costs of abusing these drugs at $55 billion per year.

If there is a way to provide effective pain relief for Wyomingites that will not end in tragedy for the victims, their families, friends and communities, we should jump on it. That’s especially true when the alternative already has widespread public support. About the only thing standing in the way of this readily available solution is the hide-bound ideology of the unwinnable “war on drugs.”

News flash, we lost that “war” decades ago. But the casualty count keeps climbing.

Peter Grinspoon, M.D., of Harvard Medical School says the most common use of medical marijuana is the relief from chronic pain and diseases such as cancer and multiple sclerosis.

“Marijuana is said to be a fantastic muscle relaxant, and people swear by its ability to lessen tremors in Parkinson’s disease,” Grinspoon wrote in the Harvard Health Blog. The Harvard physician noted it has also been successfully used for fibromyalgia, endometriosis, interstitial cystitis “and most other conditions where the final common pathway is chronic pain.”

We already know that marijuana can be used to help patients with cancer, multiple sclerosis, glaucoma and to manage nausea and weight loss associated with HIV, irritable bowel syndrome and Chron’s disease. Scientists are now researching how the drug can be used to help veterans returning from combat zones with PTSD. Early results are promising.

The number of diseases and medical conditions alone that can be successfully treated with medical marijuana is reason enough for state lawmakers to approve its use. But the new studies show medical marijuana also significantly decreases opioid use.

Researchers at the University of Georgia, in the most comprehensive study of the subject to date, found that states with medical marijuana dispensaries saw a nearly 15 percent decline in the number of daily opioid doses filled under Medicare Part D. In other words, in states where people have legal access to marijuana, pharmacies issue fewer, people consume fewer and the federal government pays for fewer dangerous opioids.

A University of Kentucky study came at the question from a slightly different angle but showed similar results. In their experiment, the Kentucky researchers found that in states with medical marijuana laws doctors wrote 5.88 percent fewer opiate prescriptions on average. In recreational pot states like Colorado the reduction jumped to 6.38 percent.  

If the remaining 21 states, including Wyoming, approved medical marijuana, it’s logical to conclude that number could be even higher.

Over the years a limited number of Wyoming legislators have shown they understand the benefits of medical marijuana. Former Sen. Keith Goodenough (D-Casper) sponsored a bill in 2003 that passed the Senate Judiciary Committee but died when Republican leaders refused to allow the measure to get to the Senate floor.

One of the senators who voted for the bill in committee 15 years ago was current Sen. Bruce Burns (R-Sheridan), who explained at the time that he brought marijuana from Colorado to New York to help ease the pain of a relative who was dying of cancer. That experience three decades ago convinced Burns that Wyoming should allow a physician to prescribe marijuana to patients, and pharmacies to fill those prescriptions just like painkillers, penicillin and other drugs.

Rep. Sue Wallis (R-Recluse), who saw her husband’s pain ease from medical marijuana as he was dying of lung cancer in a Colorado hospital, had planned to introduce a medical marijuana bill but she died in January 2014 before it could happen.

Burns and Wallis learned first-hand from their relatives how beneficial medical marijuana can be. But at this stage lawmakers shouldn’t need personal experience to buy in. The mountains of medical evidence and the enormous social benefits experienced in other states should be enough.

In the campaign to combat the widespread problem of opioid addiction that now claims the lives of an estimated 42,000 Americans per year, Trump has challenged researchers to “come up with a painkiller that’s not so addictive.”

But what the president wants is already available. Medical marijuana is one vital component in the battle against the opioid epidemic and it needs to be in the comprehensive packages of ways the state and federal governments save lives.

It doesn’t have to be difficult. Other states already have dispensary systems in place and laws covering growing and taxing cannabis. As many legislators like to say, there’s no need to “reinvent the wheel.” To combat opioid use — which the Legislature is already on record as supporting — legalizing medical marijuana makes sense and could be accomplished in the next general session.

Filed under: General Problems | 1 Comment »

https://www.medpagetoday.com/publichealthpolicy/generalprofessionalissues/72206

Can a film help shift the conversation on reducing deadly errors in medicine?

The documentary To Err Is Human, which is currently in previews and opens to wide release in the fall, attempts to answer that question, highlighting the obstacles, consequences, and attempts to address the myriad factors on both the institutional and individual level responsible for errors in medicine.

“It’s a massive topic to address,” said director Mike Eisenberg, following a recent screening of his film. “We really wanted to maintain a singular focus — what would my dad have done if he made this movie?”

His late father, John Eisenberg, MD, MBA, was one of the early directors for what is now the Agency for Healthcare Research and Quality (AHRQ). He launched AHRQ’s evidence-based practice centers and was viewed as a pioneer for his work in healthcare research. In 2002 he died from a brain tumor, at the age of 55.

To Err Is Human gets its title from the landmark 1999 report on deaths from medical error from the Institute of Medicine, which estimated that between 44,000 and 98,000 hospitalized Americans die from medical errors each year.

Medical error isn’t currently a CDC-approved option when listing cause on death certificates — only diseases, morbid conditions, and accidents can be listed.

In 2016 an open letter from Martin A. Makary, MD, MPH, of Johns Hopkins Medicine in Baltimore, and colleagues urged the CDC to change this policy.

The authors of the letter — who defined death from medical errors as “1) errors in judgment or skill, coordination of care, 2) a diagnostic error, 3) a system defect resulting in death or a failure to rescue a patient from death, and 4) a preventable adverse event” — pointed to the fact that funding for medical research is often based on mortality figures. As such, patient safety gets a short shrift, and little public awareness.

The CDC says its methodology is in keeping with international standards of reporting on the causes of death.

More recent (though controversial) estimates put the number of deaths due to medical error at 400,000 per year or higher, but even conservative estimates would still make it the third leading cause of death in the U.S. following heart disease and cancer.

Sally Roumanis, RN, telling the story of the medical error that cost her husband’s life

“In 2006, I had my own medical error and became part of that statistic,” said Sally Roumanis, RN, a patient-safety specialist at Yale, who shared her experience during a panel discussion that followed the screening.

Her husband Dean ended up in the ER at Yale following a cardiac event while cycling. A stent was put in and everything had seemingly gone well. It was late at night and Dean urged Roumanis and their daughter to head home for rest. “I can’t stand you hovering,” he joked, Roumanis recounted.

But at 5 a.m. Roumanis received a call saying her husband’s condition had drastically worsened. She arrived back at Yale to see a team rushing toward the cath lab, then doctors performing chest compressions on her husband.

A couple of days later she was told her husband’s death was a result of medical error.

A coronary artery had been perforated during the stent procedure resulting in bleeding and pericardial collection. “That wasn’t the error — it was a complication,” explained moderator Harlan Krumholz, MD, of Yale’s Institute for Social and Policy Studies. “But throughout the night, as Dean began to struggle, the junior doctors failed to escalate the problem to a higher level and didn’t appreciate the seriousness.”

It was early in the morning and the doctors handling the situation were early in their careers. “Nurses were advocating for escalation,” Krumholz continued, “but didn’t feel empowered to override the situation.”

The inexperienced doctors were treating the symptoms without understanding the cause. Dean’s condition continued to spiral downward until 5 a.m. when he went into cardiac arrest. “His pressure drops dramatically — they realize it needs to be escalated,” Krumholz said. “They rush him to the lab, but it’s too late.”

“This can’t be happening,” Roumanis told herself. “You just think, ‘no, he’s in a hospital, he’s in a safe place.'”

Talking About Medical Errors

In the past, doctors were trained not to talk about mistakes, but that attitude has shifted. The film features one institution that uses actors to train physicians delivering news of a medical error made during care.

Marna P. Borgstrom, MPH, left, discussing Yale’s approach to patient safety

Marna P. Borgstrom, MPH, president and CEO of Yale New Haven Health System, said that nothing has changed in the way of medical malpractice litigation, but that organizations — and individuals within organizations — have made the decision that it’s the right thing to do. “Now, whenever there is an error made, whether or not there is identifiable harm to the patient, we encourage the responsible clinicians to talk with the patients about that,” she said.

“Patients still sue us when that happens,” she added, “and that’s not wrong, because in some cases people are entitled to damages.”

Borgstrom, who spoke during the panel portion, recalled that when Yale first started tracking medical errors in an internal patient safety-reporting database there were about 14,000 events the first year, across the network of providers. “That sounds like a lot,” she said. Three years later it was 24,000 and growing.

“We viewed that as a good sign,” she said. “Rather than being afraid of telling people we made a mistake, people are talking about it.”

AHRQ

AHRQ, which has been under constant threat of defunding by Congress, is still in trouble and could possibly be rolled into the National Institutes of Health (NIH). “If AHRQ is dissolved into the NIH, there will still be some form of patient safety effort going on in NIH, where people who worked at AHRQ will hopefully be able to continue their work, but the budgets will be decreased, their efforts will be pared down,” Eisenberg said. “The way it is right now will no longer exist if that happens.”

However, as part of the omnibus bill, Congress passed a 3% increase to AHRQ’s budget for the next fiscal year ($334 million total), the first increase in 10 years. “So this is good news. There are caveats — I’m sure that those increases come with responsibilities that are not only focused on patient safety,” Eisenberg said. “The entire budget is never only about patient safety anyway.”

He said there are still people in very powerful positions who don’t think AHRQ’s work is important.

In 2012 AHRQ released a report detailing that a combination of best practices, improved safety culture, and a bigger focus on teamwork could cut central-line-associated bloodstream infections (CLABSIs) in hospitals by 40%. Borrowed from lessons learned in the aviation industry, one of the components included use of a procedure checklist, and during the film and panel discussion — countless comparisons were made to the Federal Aviation Administration’s ability to improve safety.

“A lot of these problems are engineering problems,” said Kevin M. Johnson, MD, of the Department of Radiology & Biomedical Imaging at Yale School of Medicine, chiming in from the audience. “And we have almost no engineers around.”

The Film

Between interviews with experts in the field of patient safety, To Err Is Human weaves in the story of Susan Sheridan, whose family’s intersection with the healthcare system was met with two medical errors.

First, jaundice (a sign of too-high bilirubin) in her newborn son, Cal, was ignored and led to brain damage and development of cerebral palsy. Sheridan’s experience led her to become a patient-safety advocate. Today hospitals routinely tests for elevated bilirubin.

Years later her husband Patrick was diagnosed with and treated for a benign brain tumor. Additional tests from pathology had revealed a malignant tumor, yet this was never communicated to Patrick’s physician. Left untreated, the disease aggressively spread until it was too late. He died in 2002.

While the plan is for wide release in the fall, the trailer is now available online and various upcoming screenings have been scheduled in select cities — including Cleveland on Monday, Tuesday and Wednesday next week, and Philadelphia on April 20. The latter will include a panel discussion.

Filed under: General Problems | 1 Comment »