Since 2007, the DEA has taken $3.2 billion in cash from people not charged with a crime

Posted on April 1, 2018 by Pharmaciststeve

https://www.washingtonpost.com/news/wonk/wp/2017/03/29/since-2007-the-dea-has-taken-3-2-billion-in-cash-from-people-not-charged-with-a-crime

The Drug Enforcement Administration takes billions of dollars in cash from people who are never charged with criminal activity, according to a report issued today by the Justice Department’s Inspector General.

Since 2007, the report found, the DEA has seized more than $4 billion in cash from people suspected of involvement with the drug trade. But 81 percent of those seizures, totaling $3.2 billion, were conducted administratively, meaning no civil or criminal charges were brought against the owners of the cash and no judicial review of the seizures ever occurred.

That total does not include the dollar value of other seized assets, like cars, homes, electronics and clothing.

These seizures are all legal under the controversial practice of civil asset forfeiture, which allows authorities to take cash, contraband and property from people suspected of crime. But the practice does not require authorities to obtain a criminal conviction, and it allows departments to keep seized cash and property for themselves unless individuals successfully challenge the forfeiture in court. Critics across the political spectrum say this creates a perverse profit motive, incentivizing police to seize goods not for the purpose of fighting crime, but for padding department budgets.

Law enforcement groups say the practice is a valuable tool for fighting criminal organizations, allowing them to seize drug profits and other ill-gotten goods. But the Inspector General’s report “raises serious concerns that maybe real purpose here is not to fight crime, but to seize and forfeit property,” said Darpana Sheth, senior attorney of the Institute for Justice, a civil liberties law form that has fought for forfeiture reform.

The Inspector General found that the Department of Justice “does not collect or evaluate the data necessary to know whether its seizures and forfeitures are effective, or the extent to which seizures present potential risks to civil liberties.”

In the absence of this information, the report examined 100 DEA cash seizures that occurred “without a court-issued warrant and without the presence of narcotics, the latter of which would provide strong evidence of related criminal behavior.”

Fewer than half of those seizures were related to a new or ongoing criminal investigation, or led to an arrest or prosecution, the Inspector General found.

“When seizure and administrative forfeitures do not ultimately advance an investigation or prosecution,” the report concludes, “law enforcement creates the appearance, and risks the reality, that it is more interested in seizing and forfeiting cash than advancing an investigation or prosecution.”

The scope of asset forfeiture is staggering. Since 2007 the Department of Justice’s Asset Forfeiture Fund, which collects proceeds from seized cash and other property, has ballooned to $28 billion. In 2014 alone authorities seized $5 billion in cash and property from people — greater than the value of all documented losses to burglary that year.

In most of the seizures examined by the Inspector General, DEA officers initiated encounters with people based on whether they met certain criteria, like “traveling to or from a known source city for drug trafficking, purchasing a ticket within 24 hours of travel, purchasing a ticket for a long flight with an immediate return, purchasing a one-way ticket, and traveling without checked luggage.”

Some of the encounters were based on tips from confidential sources working in the travel industry, a number of whom have received large sums of money in exchange for their cooperation. In one case, officers targeted an individual for questioning on a tip from a travel industry informant that the individual had paid for a plane ticket with a pre-paid debit card and cash.

Most individuals who have cash or property seized by law enforcement do not dispute the seizure. There’s no right to an attorney in forfeiture proceedings, meaning defendants must foot the bill for a lawyer themselves. In many cases, forfeiture amounts are so small that they’re not worth fighting in court.

Forfeiture cases are also legally complex and difficult for individuals to win. Forfeiture cases are brought against the property, rather than the individual, leading to Kafkaesque case titles like United States v. $8,850 in U.S. Currency and  United States of America v. One Men’s Rolex Pearl Master Watch.

While criminal proceedings assume the defendant’s innocence, forfeiture proceedings start from the presumption of guilt. That means that individuals who fight forfeiture must prove their innocence in court.

For these reasons, many defendants don’t bother disputing forfeitures. The Inspector General’s report, however, finds that those who do often get at least a portion of their cash returned. Only one-fifth of people who had their cash seized by the DEA disputed the seizures in court. But among those who contested the seizure, nearly 40 percent ended up getting all or some of their cash returned, suggesting that the DEA’s forfeiture net ensnares many individuals not involved in wrongdoing.

In a written response to the Inspector General, the Department of Justice said it had “significant concerns” with the report, noting that global criminal enterprises launder trillions of dollars annually and calling asset forfeiture “a critical tool to fight the current heroin and opioid epidemic that is raging in the United States.”

It also took issue with the Inspector General’s analysis of the 100 DEA cash seizures it examined, saying more of them were connected with criminal activity than the report suggested.

The Inspector General stood by the report and dismissed the Department’s concerns as “assumptions and speculation.” The Drug Enforcement Administration did not respond to a request for comment.

“Nobody in America should lose their property without being convicted of a crime,” said the Institute for Justice’s Sheth. “If our goal is to curb crime, we should simply abolish civil forfeiture” and only forfeit property after a criminal conviction is obtained, she added.

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Opioid Painkillers Top Selling Drug in 10 States

Posted on March 31, 2018 by Pharmaciststeve

top_drugs_static_map-02-1024x931.png

www.painnewsnetwork.org/stories/2018/3/22/opioid-painkillers-top-selling-drug-in-10-states

If you live in Oklahoma, the drug you’re most likely to be prescribed is the opioid painkiller Vicodin — or some other combination of hydrocodone and acetaminophen.

In Texas, the #1 drug is Synthroid (levothyroxine) – which is used to treat thyroid deficiencies.

In California, its Lipitor (atorvastatin) – a statin used to treat high cholesterol.

And Tennessee has the unique distinction of being the only state in the country where the addiction treatment drug Suboxone (buprenorphine/naloxone) is the most prescribed drug.

These findings are part of an interesting study by GoodRx, an online discount drug company, on prescribing trends in all 50 states. GoodRx looked at pharmacy and insurance data from around the country – not just its own customers — from March 2017 to February 2018.

It then developed a map to show how prescription trends can vary by region and by state.

Levothyroxine (Synthroid) is easily the top selling drug in the country. It’s #1 in 26 states (AR, AZ, CO, CT, FL, IA, KS, KY, LA, ME, MI, MN, MT, ND, NJ, NV, OR, PA, SD, TX, UT, VT, WA, WI, WV, WY).

Hydrocodone (Vicodin, Norco, Lortab) is #1 in 10 states (AK, AL, GA, ID, IL, IN, MS, NC, NE, OK), mainly in the South and Midwest. As recently as 2012, hydrocodone was the most widely prescribed medication in the country. Since then, hydrocodone prescriptions have fallen by over a third and it now ranks 4th nationwide.

Atorvastatin (Lipitor) is #1 in 5 states (CA, HI, MD, MO, VA) and so is lisinopril (MA, NH, NM, OH, RI), a medication used to treat high blood pressure.

There are a few outliers. New York, for example, is the only state that’s #1 in amlodipine (Norvasc), a blood pressure medication, and Delaware and South Carolina are the only states where the leading prescription drug is Adderall, a medication used to treat Attention Deficit Hyperactivity Disorder (ADHD).   

That brings us to Tennessee, one of the states hardest hit by the opioid crisis. In 2012, doctors wrote 1.4 opioid prescriptions for every citizen in Tennessee, the second highest rate in the country. The state then moved aggressively to shutdown pill mills and expand access to addiction treatment — which explains why Tennessee is #1 for Suboxone.

Prescriptions for opioid pain medication have dropped by 12% in Tennessee since their peak, but overdose deaths and opioid-related hospitalizations continue to climb, due largely to heroin and illicit fentanyl.  No other state even comes close to Tennessee in per capita prescriptions for Suboxone.  

Addiction treatment has become such a growth industry that Tennessee has adopted measures to rein in the overprescribing of Suboxone.

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“It may not be that more people are using, but in fact that a single use of a more deadly drug is what we’re seeing,”

Posted on March 31, 2018 by Pharmaciststeve

Opioid overdoses spike 30 percent, hospitals report

https://www.cbsnews.com/news/opioid-overdoses-increase-across-us/

A new report from the Centers for Disease Control and Prevention brings more bad news for the nation’s continued fight against the opioid epidemic. Data from hospital emergency departments show a big increase in drug overdoses across the country.

In a press briefing on Tuesday, CDC Acting Director Anne Schuchat, M.D., said the U.S. is seeing the highest drug overdose death rate ever recorded in the country.

According to the study, which examined data from 16 states, emergency department visits for suspected opioid overdoses jumped 30 percent from July 2016 through September 2017.

Opioid overdoses increased for both men and women, across all age groups, and in all regions, though there was some variation by state, with rural and urban differences.

“Long before we receive data from death certificates, emergency department data can point to alarming increases in opioid overdoses,” Schuchat said in a statement. “This fast-moving epidemic affects both men and women, and people of every age. It does not respect state or county lines and is still increasing in every region in the United States.”

The Midwest saw the biggest jump in opioid overdoses, with a 70 percent increase from July 2016 through September 2017.

 

Certain areas in the Northeast were also hit particularly hard, with Delaware experiencing a 105 percent increase and Pennsylvania an 81 percent increase in opioid overdoses during that time.

The reasons for these increases are unclear, but officials say it may have to do with changes in the drug supply, including the availability of newer, highly toxic illegal opioids such as fentanyl, which has been spreading rapidly in recent years. Fentanyl, a synthetic drug that’s 50 to 100 times stronger than morphine, is often mixed in to make heroin more potent, contributing to many ODs.

“It may not be that more people are using, but in fact that a single use of a more deadly drug is what we’re seeing,” CBS News medical contributor Dr. Tara Narula said on “CBS This Morning.”

Though the report was overall a somber reminder of the devastating effects of opioid addiction, there were a few hopeful findings.

In Kentucky, a state hit hard by the opioid epidemic, emergency department visits for opioid overdoses actually decreased by 15 percent over the study period. In Massachusetts, New Hampshire, and Rhode Island, there were also small decreases of less than 10 percent.

Schuchat said she is cautiously optimistic that strategies implemented in these states to combat opioid addiction may be working.

 

Officials say looking at emergency room data can help responders gather important information before an overdose turns deadly, including where the person was coming from and what day of the week and time of day the overdose occurred. This can make it easier to identify where there are gaps in local resources and how they can best be allocated, since having one overdose makes it likely a person will have another.

The report also calls for state and local health departments, as well as emergency departments, community organizations and individuals to come together to lessen the impact of the opioid epidemic.

These steps include:

  • Increasing distribution of naloxone, an overdose-reversing drug also known as Narcan, to first responders, family and friends, and other community members in affected areas, as policies permit.
  • Increasing availability of and access to treatment services for opioid users, including mental health services and medication-assisted treatment like methadone clinics.
  • Supporting programs that reduce harms that can occur when injecting opioids, including programs that offer screening for HIV and hepatitis B and C, in combination with referral to treatment.
  • Promoting opioid prevention and treatment education.
  • Storing prescription opioids in a secure place, out of reach of others, including children, family, friends, and visitors, and properly disposing of them when no longer needed

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Did someone say that drug rehab is ALL ABOUT THE MONEY ?

Posted on March 31, 2018 by Pharmaciststeve

Using Marijuana 2 Times a Month Cost This Doctor His License

https://www.doximity.com/doc_news/v2/entries/11612578

If a physician has a substance use or mental health problem, it is in everyone’s interest — the physicians themselves, their patients and their families — for them to get treatment. And if they go for treatment, they deserve to be treated fairly, but given my six years of experience as an associate director in one state physician health program (PHP) and in working with physicians from all across the U.S. since then, their treatment is often anything but fair.

Consider what happened to Dr. Smith*: Dr. Smith was a board-certified physician working on a locum tenens basis for a hospital and had never had any complaints or allegations of misconduct. In fact, the hospital liked his work so much they asked him to work for them full time, which would require jumping through a few hoops, including obtaining a pre-employment physical exam and being drug tested. He lives in a state where marijuana is fully legal and freely told them he used cannabis twice a month on average, in the evenings after work, just in case it showed up on the drug test.

When he tested positive for cannabis on his employment physical, the hospital — just to be cautious — sent him to his state PHP to discuss the matter. The state PHP then promptly referred him for a four-day out-of-state evaluation at a cost of $5000 to $6000. If he refused to go, they’d be forced to report him to the state board of medicine as being non-compliant. At the conclusion of the four-day evaluation, he was diagnosed with “severe marijuana dependence” and told that he needed to stay for 90 days of inpatient treatment, which they just happened to offer on-site, at a cost of over $50,000. When he refused, the evaluation/treatment center tried to cajole and even coerce him into reconsidering, saying (among other things) “Isn’t your career worth $50,000?”

Dr. Smith remained steadfast in his refusal, at which point the center reported him as being non-compliant to the state PHP, which in turn notified the board of medicine. The board of medicine demanded that Dr. Smith sign a voluntary agreement not to practice, with the serious threat that they’d investigate him and respond very harshly if he didn’t. As most doctors do under these circumstances, Dr. Smith signed. That was over three years ago. Dr. Smith has not worked as a physician since.

As if this case isn’t troubling enough already, to compound matters state PHPs — including the one in Dr. Smith’s state —often have significant financial conflicts of interest with these evaluation and treatment centers, given that these centers financially sponsor state, regional and national meetings of PHPs. Many of these centers depend on referrals from PHPs in order to stay afloat.

When Dr. Smith later volunteered to be evaluated by one of two nationally prominent addiction psychiatrists that had nothing to do with the state PHP — the PHP refused, saying that these psychiatrists couldn’t be trusted to do the collateral work the way one of their “vetted” evaluation centers would (or, I’d wager, provide financial kickbacks to the PHP).

Dr. Smith ultimately has no real avenue of appealing the state PHP’s determination because in his state — as is true around the U.S. — the PHP has very little effective oversight or avenues of appeal. As such in many states, the only real means of appeal is through the courts, which generally is both slow and costly. And not surprisingly, once physicians aren’t able to practice they often can’t afford to hire lawyers to appeal their cases.

Stories like this are all too common. Given what I have previously written about PHPs, every several weeks I am contacted by a physician from around the country whose story might differ in its details from Dr. Smith’s but whose overall picture is similar in that they feel wrongly accused in some way but have little choice but to comply or else lose their ability to practice medicine.

This coercion is abusive and needs to stop. Physicians need to know that they can get treatment if they need it. The programs that they are referred to should be free of financial and other conflicts of interest. These programs should also have timely, inexpensive means of appealing their decisions and should also be subject to national standards and external oversight. Physicians — and by extension everyone in their orbit — deserve as much.

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In the news: Three states where harmful health insurance practices are making headlines

Posted on March 31, 2018 by Pharmaciststeve

www.chronicdiseasecoalition.com/news-three-states-harmful-health-insurance-practices-making-headlines/

Patients, advocates and elected officials often use the media to promote legislation and bring awareness to chronic disease. During the month of March, we read articles, letters to the editor and op-eds that addressed how to protect patients’ rights. We’ve outlined three of our favorites below:

1. For years, epilepsy patient Erin Guard could not find a treatment that controlled her seizures without experiencing intense side effects, including dizziness and slurred speech. Finally, when Guard was a teenager, her doctors found a substitute that helped prevent seizures without the dangerous side effects. Four months after her doctors prescribed the effective treatment, however, her insurance notified her and said she would have to go back to her original medication or pay out of pocket for the new medication, regardless of whether she could afford it.

Guard, who lives in Illinois, became the latest victim of non-medical switching, an increasingly common – and dangerous – insurance practice that occurs when a provider switches a patient’s prescribed treatment for reasons other than health and safety. The Illinois Legislature is currently considering House Bill 4146, which would prevent insurance providers from changing drug coverage during the middle of a plan year if it had previously approved the treatment. The bill has been assigned to the House Insurance: Health & Life Committee.

To read about Guard’s story, click here: http://www.chicagotribune.com/business/ct-biz-illinois-nonmedical-switching-bill-0315-story.html

2. Fred Jorgenson, president of the Academy of Medicine of Cleveland & Northern Ohio, recently published an article on Cleveland.com raising awareness about two step therapy bills that are currently in the Ohio General Assembly, Senate Bill 56 and House Bill 72. In his letter to the editor, he explains that step therapy can have dangerous health consequences to patients who suffer from chronic illness. Step therapy, otherwise known as fail first, is another harmful insurance practice that happens when an insurance provider believes a cheaper, riskier drug is a better than a doctor-prescribed treatment. Providers will only cover the original treatment if a patient first fails the cheaper medication.

Dr. Jorgenson said, “For a person with epilepsy, it could mean having a seizure. For someone with inflammatory bowel disease, it could mean serious flare ups that can sideline a person for days. For someone with cancer, it could mean that their disease progresses.”

He called for the Ohio General Assembly to act on behalf of patients and pass the two bills that would reform step therapy requirements.

To read Dr. Jorgenson’s letter the editor, click here: http://www.cleveland.com/letters/index.ssf/2018/03/ohio_lawmakers_can_reform_step.htm

3. Finally, two state representatives in Maine, Bob Foley and Health Sanborn, authored an op-ed published in the Maine Press Herald bringing attention to non-medical switching, a problem many Mainers with chronic health conditions face. While insurance companies attempt to justify non-medical switching by saying it keeps medical costs down, Foley and Sanborn cite a recent analysis from the Institute for Patient Access disproving that theory. (And, in fact, this study found that step therapy may actually lead to an increase in costs due to nondrug expenses.)

The two representatives have introduced a bill in the Maine Legislature, Legislative Document 696, that would address this issue and stop insurers from denying patients access to their prescribed treatment.

Read Representatives Foley and Sanborn’s op-ed here: https://www.centralmaine.com/2018/03/09/from-the-state-house-doctors-not-insurers-should-prescribe-mainers-medications-and-treatment/?rel=related

The Chronic Disease Coalition supports legislation on the state and federal level that puts patients over insurance profits.

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CDC Blames Fentanyl for Spike in Overdose Deaths

Posted on March 30, 2018 by Pharmaciststeve
www.painnewsnetwork.org/stories/2018/3/29/cdc-blames-fentanyl-for-spike-in-overdose-deaths

By Pat Anson, Editor

The Centers for Disease Control and Prevention released a new report today estimating that 63,632 Americans died of a drug overdose in 2016 – a 21.5% increase over the 2015 total.  

The sharp rise in drug deaths is blamed largely on illicit fentanyl, a powerful synthetic opioid that has become a scourge on the black market. Deaths involving synthetic opioids doubled in 2016, accounting for about a third of all drug overdoses and nearly half of all opioid-related deaths.

For their latest report, CDC researchers used a new “conservative definition” to count opioid deaths – one that more accurately reflects the number of deaths involving prescription opioids by excluding those attributed to fentanyl and other synthetic opioids. Over 17,000 deaths were attributed to prescription opioids in 2016, about half the number that would have been counted under the “traditional definition” used in previous reports.

CDC researchers recently acknowledged that the old method “significantly inflate estimates” of prescription opioid deaths.

The new report, based on surveillance data from 31 states and the District of Columbia, shows overdose deaths increasing for both men and women and across all races and demographics.  A wider variety of drugs are also implicated:

  • Fentanyl and synthetic opioid deaths rose 100%
  • Cocaine deaths rose 52.4%
  • Psychostimulant deaths rose 33.3%
  • Heroin deaths rose 19.5%
  • Prescription opioid deaths rose 10.6%

The CDC also acknowledged that illicit fentanyl is often mixed into counterfeit opioid and benzodiazepine pills, heroin and cocaine, likely contributing to overdoses attributed to those substances.

2016 DRUG RELATED DEATHS

 
  • FENTANYL
  • COCAINE
  • PSYCHOSTIMULANTS
  • HEROIN
  • Rx OPIOIDS
 

West Virginia led the nation with the highest opioid overdose rate (43.4 deaths for every 100,000 residents), followed by New Hampshire, Ohio, Washington DC, Maryland and Massachusetts.  Texas has the lowest opioid overdose rate.

‘Inaccurate and Misleading” Overdose Data

The CDC’s new method of classifying opioid deaths still needs improvement, according to John Lilly, DO, a family physician in Missouri who took a hard look at the government’s overdose numbers. Lilly estimates that 16,809 Americans died from an overdose of prescription opioids in 2016.

“Not all opioids are identical in abuse potential and likely lethality, yet government statistics group causes of death in a way that obscures the importance of identifying specific agents involved in deadly overdoses,” Lilly wrote in a peer reviewed article recently published in the Journal of American Physicians and Surgeons..

Lilly faults the National Institute on Drug Abuse (NIDA) for using “inaccurate and misleading” death certificate codes to classify drug deaths. In its report for 2016, NIDA counted illicit fentanyl overdoses as deaths involving prescription opioids. As a result, deaths attributed to pain medication rose by 43 percent, at a time when the number of opioid prescriptions actually declined.

“That large an increase in one year from legal prescriptions does not make sense, particularly as these were being strongly discouraged,” Lilly wrote. “Rather than legal prescription drugs, illicit fentanyl is rapidly increasing and becoming the opioid of choice for those who misuse opioids… Targeting legal prescriptions is thus unlikely to reduce overdose deaths, but it may increase them by driving more users to illegal sources.”

Some researchers believe the government undercounts the number of opioid related deaths by as much as 35 percent because the actual cause of death isn’t listed on many death certificates.

“We have a real crisis, and one of the things we need to invest in, if we’re going to make progress, is getting better information,” said Christopher Ruhm, PhD, a professor at the University of Virginia and the author of a overdose study recently published in the journal Addiction.

Ruhm told Kaiser Health News the real number of opioid related deaths is probably closer to 50,000.

If the number of Rx opiates were lower in 2016 than in 2006… how does that explain a 10% increase in Rx opiate related deaths ?  Maybe the CDC is ignoring the small (legal) fact that once Rx opiates are no longer in the possession of the person that they were originally prescribed for.. they AUTOMATICALLY become ILLEGAL OPIATES…  more intentional miss-categorizing of the type of opiate ?

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What Are the 12 Leading Causes of Death in the United States?

Posted on March 30, 2018 by Pharmaciststeve

https://www.healthline.com/health/leading-causes-of-death#1

For more than a decade, heart disease and cancer have claimed the first and second spots respectively as the leading causes of deaths in America. Together, the two causes are responsible for 46 percent of deaths in the United States. Combined with the third most common cause of death, chronic lower respiratory diseases, the three diseases account for half of all deaths in the United States.

For more than 30 years, the U.S. Centers for Disease Control and Prevention (CDC) has been collecting and examining causes of death. This information helps researchers and doctors understand if they need to address growing epidemics in healthcare. The numbers also help them understand how preventative measures may help people live longer and healthier lives.

 

The top 12 causes of death in the United States account for more than 75 percent of all deaths. Learn about each of the main causes and what can be done to prevent them.

1. Heart disease

Number of deaths per year: 633,842

Percent of total deaths: 24.1 percent

 
 

More common among:

  • men
  • people who smoke
  • people who are overweight or obese
  • people with a family history of heart disease or heart attack
  • people over age 55

What causes heart disease?

 

Heart disease is a term used to describe a range of conditions that affect your heart and blood vessels. These conditions include:

Tips for prevention

 

Many cases of heart disease can be prevented through lifestyle changes. These changes include:

  • quitting smoking
  • eating a healthier diet
  • exercising at least 30 minutes a day, five days a week
  • maintaining a healthy weight

2. Cancer

Number of deaths per year: 595,930

Percent of total deaths: 22.7 percent

More common among: Each type of cancer has a specific set of risk factors, but several risk factors are common among multiple types. These risk factors include:

  • people of a certain age
  • people who use tobacco and alcohol
  • people exposed to radiation and sunlight
  • people with chronic inflammation
  • people who are obese
  • people with a family history of the disease

What causes cancer?

Cancer is the result of rapid and uncontrolled cell growth in your body. A normal cell multiplies and divides in a controlled manner. Sometimes, those instructions become scrambled. When this happens, the cells begin to divide at an uncontrolled rate. This can develop into cancer.

 

Tips for prevention

There’s no clear way to avoid cancer. But certain behaviors have been linked to increased cancer risk, like smoking, so avoiding those may help you cut your risk. Good changes to your behaviors include:

  • maintaining a healthy weight, eating a balanced diet, and exercising regularly
  • quitting smoking, and drinking in moderation
  • avoiding direct exposure to the sun or ultraviolet tanning lights
  • having regular cancer screenings, including skin checks, mammograms, prostate exams, and more

3. Chronic lower respiratory diseases

Number of deaths per year: 155,041

 

Percent of total deaths: 5.9 percent

 

More common among:

  • women
  • people over age 65
  • people with a history of smoking or exposure to second-hand smoke
  • people with a history of asthma
  • individuals in lower-income households

What causes respiratory diseases?

 

This group of diseases includes:

Each of these conditions or diseases prevents your lungs from working properly. They can also cause scarring and damage to the lung’s tissues.

Tips for prevention

Tobacco use and second-hand smoke exposure are the primary factors in the development of these diseases. Quit smoking, and limit your exposure to other people’s smoke to reduce your risk. See what readers had to say when asked for real and practical tips to help you quit smoking.

4. Accidents (unintentional injuries)

Number of deaths per year: 146,571

Percent of total deaths: 5.6 percent

 
 

More common among:

  • men
  • people age 1 to 44
  • people with risky jobs

What causes accidents?

Accidents lead to more than 28 million emergency room visits each year. The three leading causes of accident-related death are:

  • unintentional falls
  • motor vehicle traffic deaths
  • unintentional poisoning deaths

Tips for prevention

Unintentional injuries may be the result of carelessness or a lack of careful action. Be aware of your surroundings, and take all proper precautions to prevent accidents or injuries.

If you hurt yourself, seek emergency medical treatment to prevent serious complications.

 

5. Stroke

Number of deaths per year: 140,323

Percent of total deaths: 5.3 percent

 

More common among:

What causes a stroke?

A stroke occurs when the blood flow to your brain is cut off. Without oxygen-rich blood flowing to your brain, your brain cells begin to die in a matter of minutes.

The blood flow can be stopped because of a blocked artery or bleeding in the brain. This bleeding may be from an aneurysm or a broken blood vessel.

Tips for prevention

Many of the same lifestyle changes that can reduce your risk for heart disease can also reduce your risk for stroke. These changes include:

  • exercising more, eating better, and maintaining a healthy weight
  • controlling your blood pressure
  • stopping smoking, and drinking only in moderation
  • managing your blood sugar level and diabetes
  • treating any underlying heart defects or diseases

6. Alzheimer’s disease

Number of deaths per year: 110,561

Percent of total deaths: 3.9 percent

More common among:

  • women
  • people over age 65 — the risk for Alzheimer’s doubles every five years after age 65, according to the National Institute on Aging
  • people with a family history of the disease

What causes Alzheimer’s disease?

The cause of Alzheimer’s disease is unclear, but researchers and doctors believe a combination of a person’s genes, lifestyle, and environment, impacts the brain over time. Some of these changes occur years, even decades, before the first symptoms appear.

Tips for prevention

While you can’t control your age or genetics, which are two of the most common risk factors for this disease, you can control certain lifestyle factors that may increase your risk for it by:

  • exercising and remaining physically active throughout your life
  • eating a diet filled with fruits, vegetables, healthy fats, and reduced sugar
  • treating and monitoring any other chronic diseases you have
  • keeping your brain active with stimulating tasks like conversation, puzzles, and reading

7. Diabetes

Number of deaths per year: 79,535

Percent of total deaths: 3.0 percent

More common among:

Type 1 diabetes is more commonly diagnosed in:

  • people with a family history of the disease, or a specific gene that increases the risk
  • children between the age of 4 and 7
  • people living in climates further away from the equator

Type 2 diabetes is more common among:

  • people who are overweight or obese
  • adults over age 45
  • people who have a family history of diabetes
 

What causes diabetes?

Type 1 diabetes occurs when your pancreas cannot produce enough insulin. Type 2 diabetes occurs when your body becomes resistant to insulin or doesn’t make enough of it to control your blood sugar levels.

Tips for prevention

You cannot prevent type 1 diabetes. However, type 2 diabetes may be prevented with several lifestyle changes. These changes include:

  • reaching and maintaining a healthy weight
  • exercising for at least 30 minutes, five days a week
  • eating a healthy diet with plenty of fruits, vegetables, whole grains, and lean proteins
  • having regular blood sugar checks if you have a family history of the disease

8. Influenza and pneumonia

Number of deaths per year: 57,062

Percent of total deaths: 2.2 percent

More common among:

  • children
  • the elderly
  • people with chronic health conditions
  • pregnant women

What causes influenza and pneumonia?

Influenza (the flu) is a highly contagious viral infection. It’s very common during winter months. Pneumonia is an infection or inflammation of the lungs. The flu is one of the leading causes of pneumonia. Find out how to determine if you have the flu or a cold.

Tips for prevention

Before flu season, people in the high-risk category can and should get a flu vaccine. Anyone else concerned about the virus should get one, too. To prevent the spread of the flu, be sure to wash your hands well and avoid people who are sick.

Likewise, a pneumonia vaccine is available for people with a high risk of developing the infection.

9. Kidney disease

Number of deaths per year: 49,959

Percent of total deaths: 1.9 percent

More common among:

  • people with other chronic conditions, including diabetes, high blood pressure, and recurrent kidney infections
  • people who smoke
  • people who are overweight or obese
  • people with a family history of kidney disease

What causes kidney diseases?

The term kidney disease refers to three main conditions:

Each of these conditions is the result of unique conditions or diseases.

Nephritis, or kidney inflammation, can be caused by an infection, a medication you’re taking, or an autoimmune disorder.

Nephrotic syndrome is a condition that causes your kidneys to produce high levels of protein in your urine. It’s often the result of kidney damage.

Nephrosis is a type of kidney disease that ultimately can lead to kidney failure. It’s also often the result of damage to the kidney from either physical or chemical changes.

Tips for prevention

Like with many of the other leading causes of death, taking better care of your health can help you prevent kidney disease. Lifestyle changes that can reduce your risk include:

  • eating a lower-sodium diet
  • stopping smoking and drinking
  • losing weight if you’re overweight or obese, and maintaining it
  • exercising for 30 minutes, five days a week
  • having regular blood and urine tests if you have a family history of the disease

10. Suicide

Number of deaths per year: 44,193

Percent of total deaths: 1.7 percent

More common among:

  • men
  • people with brain injuries
  • people who have attempted suicide in the past
  • people with a history of depression and other mental health illnesses
  • people who abuse alcohol or drugs

What causes suicide?

Suicide, or intentional self-harm, is death caused by a person’s own actions. People who die by suicide direct harm at themselves and die due to that harm. Almost 500,000 people are treated in emergency rooms each year for self-inflected injuries.

Tips for prevention

 

Suicide prevention aims to help individuals find treatment that encourages them to end suicidal thoughts and start finding healthier ways to cope. For many people, suicide prevention includes finding a support system of friends, family, and other people who’ve contemplated suicide. In some cases, medication and in-hospital treatment may be necessary.

If you’re thinking about harming yourself, consider contacting a suicide prevention hotline. You can call the National Suicide Prevention Lifeline at 800-273-8255. It offers 24/7 support. You can also review our mental health resources list for more information about ways to find help.

11. Septicemia

Number of deaths per year: 40,685

Percent of total deaths: 1.5 percent

More common among:

  • adults over age 75
  • young children
  • people with a chronic illness
  • people with an impaired immune system

What causes septicemia?

Septicemia, sometimes called blood poisoning, is caused by a bacterial infection in the bloodstream. Most cases of septicemia develop after an infection somewhere else in the body becomes severe.

Tips for prevention

The best way to prevent septicemia is to have any bacterial infections treated quickly and thoroughly. If you think you may have an infection, make an appointment with your doctor. Complete the full treatment regimen prescribed by your doctor.

Early and thorough treatment can help prevent the spread of any bacterial infection to the blood.

12. Chronic liver disease and cirrhosis

Number of deaths per year: 40,265

Percent of total deaths: 1.5 percent

More common among:

What causes liver disease?

Both liver disease and cirrhosis are the result of liver damage.

Tips for prevention

If you have a problem with alcohol consumption, seek therapeutic or rehab treatment. The longer and more you drink, the greater your risk for developing liver disease or cirrhosis.

Likewise, if you’re diagnosed with hepatitis, be sure to properly treat the condition to prevent unnecessary liver damage.

Death rates that have decreased

Though it’s the most common cause, heart disease deaths have been falling over the last 50 years. However, in 2011, the number of deaths from heart disease began to slowly rise. Between 2011 and 2014, heart disease deaths rose three percent.

Deaths from influenza and pneumonia are likewise falling. According to the American Lung Association, deaths from the two diseases dropped an average of 3.8 percent per year since 1999.

Between 2010 and 2014, deaths from stroke dropped 11 percent.

This falling number of preventable deaths suggests that health awareness campaigns are hopefully increasing awareness of preventative measures people can take to live a longer, healthier life.

Rising death rates

The gap between heart disease and cancer was once much wider. Heart disease’s hold on the number one spot was wide and demanding.

Then, American health experts and doctors began encouraging Americans to curb smoking, and they started treating heart disease. Because of these efforts, the number of heart disease-related deaths has been falling over the last five decades. Meanwhile, the number of cancer-related deaths has been rising.

Just over 22,000 deaths separate the two causes today. Many researchers suspect cancer may over take heart disease as the leading cause of death in coming years.

Accidental deaths are also on the rise. From 2010 to 2014, the number of accident-related deaths increased by 23 percent. This number is fueled largely by substance overdose deaths.

Leading causes of death worldwide

The list of leading causes of death worldwide shares many of the same causes with the U.S. list. These causes of death include:

  • heart disease
  • stroke
  • lower respiratory infections
  • chronic obstructive pulmonary disease
  • lung cancer
  • diabetes
  • Alzheimer’s disease and dementia
  • diarrhea
  • tuberculosis
  • road injury

 

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How Many Opioid Overdoses Are Suicides?

Posted on March 30, 2018 by Pharmaciststeve

www.khn.org/news/difficult-to-gauge-rate-of-suicide-among-deaths-from-opioid-overdoses/

Mady Ohlman was 22 on the evening some years ago when she stood in a friend’s bathroom looking down at the sink.

“I had set up a bunch of needles filled with heroin because I wanted to just do them back-to-back-to-back,” Ohlman recalled. She doesn’t remember how many she injected before collapsing, or how long she lay drugged-out on the floor.

“But I remember being pissed because I could still get up, you know?”

She wanted to be dead, she said, glancing down, a wisp of straight brown hair slipping from behind an ear across her thin face.

At that point, said Ohlman, she’d been addicted to opioids — controlled by the drugs — for more than three years.

“And doing all these things you don’t want to do that are horrible — you know, selling my body, stealing from my mom, sleeping in my car,” Ohlman said. “How could I not be suicidal?”

For this young woman, whose weight had dropped to about 90 pounds, who was shooting heroin just to avoid feeling violently ill, suicide seemed a painless way out.

“You realize getting clean would be a lot of work,” Ohlman said, her voice rising. “And you realize dying would be a lot less painful. You also feel like you’ll be doing everyone else a favor if you die.”

Ohlman, who has now been sober for more than four years, said many drug users hit the same point, when the disease and the pursuit of illegal drugs crushes their will to live. Ohlman is among at least 40 percent of active drug users who wrestle with depression, anxiety or another mental health issue that increases the risk of suicide.

Measuring Suicide Among Patients Addicted To Opioids

Massachusetts, where Ohlman lives, began formally recognizing in May 2017 that some opioid overdose deaths are suicides. The state confirmed only about 2 percent of all overdose deaths as suicides, but Dr. Monica Bharel, head of the Massachusetts Department of Public Health, said it’s difficult to determine a person’s true intent.

“For one thing, medical examiners use different criteria for whether suicide was involved or not,” Bharel said, and the “tremendous amount of stigma surrounding both overdose deaths and suicide sometimes makes it extremely challenging to piece everything together and figure out unintentional and intentional.”

Research on drug addiction and suicide suggests much higher numbers.

“[Based on the literature that’s available], it looks like it’s anywhere between 25 and 45 percent of deaths by overdose that may be actual suicides,” said Dr. Maria Oquendo, immediate past president of the American Psychiatric Association.

Oquendo pointed to one study of overdoses from prescription opioids that found nearly 54 percent were unintentional. The rest were either suicide attempts or undetermined.

Several large studies show an increased risk of suicide among drug users addicted to opioids, especially women. In a study of about 5 million veterans, women were eight times as likely as others to be at risk for suicide, while men faced a twofold risk.

The opioid epidemic is occurring at the same time suicides have hit a 30-year high, but Oquendo said few doctors look for a connection.

“They are not monitoring it,” said Oquendo, who chairs the department of psychiatry at the University of Pennsylvania. “They are probably not assessing it in the kinds of depths they would need to prevent some of the deaths.”

That’s starting to change. A few hospitals in Boston, for example, aim to ask every patient admitted about substance use, as well as about whether they’ve considered hurting themselves.

“No one has answered the chicken and egg [problem],” said Dr. Kiame Mahaniah, a family physician who runs the Lynn Community Health Center in Lynn, Mass. Is it that patients “have mental health issues that lead to addiction, or did a life of addiction then trigger mental health problems?”

With so little data to go on, “it’s so important to provide treatment that covers all those bases,” Mahaniah said.

‘Deaths Of Despair’

When doctors do look deeper into the reasons patients addicted to opioids become suicidal, some economists predict they’ll find deep reservoirs of depression and pain.

In a seminal paper published in 2015, Princeton economists Angus Deaton and Anne Case tracked falling marriage rates, the loss of stable middle-class jobs and rising rates of self-reported pain. The authors say opioid overdoses, suicides and diseases related to alcoholism are all often “deaths of despair.”

“We think of opioids as something that’s thrown petrol on the flames and made things infinitely worse,” Deaton said, “but the underlying deep malaise would be there even without the opioids.”

Many economists agree on remedies for that deep malaise. Harvard economics professor David Cutler said solutions include a good education, a steady job that pays a decent wage, secure housing, food and health care.

“And also thinking about a sense of purpose in life,” Cutler said. “That is, even if one is doing well financially, is there a sense that one is contributing in a meaningful way?”

Tackling Despair In The Addiction Community

“I know firsthand the sense of hopelessness that people can feel in the throes of addiction,” said Michael Botticelli, executive director of the Grayken Center for Addiction at Boston Medical Center; he is in recovery for an addiction to alcohol.

Botticelli said recovery programs must help patients come out of isolation and create or recreate bonds with family and friends.

“The vast majority of people I know who are in recovery often talk about this profound sense of re-establishing — and sometimes establishing for the first time — a connection to a much larger community,” Botticelli said.

Ohlman said she isn’t sure why her attempted suicide, with multiple injections of heroin, didn’t work.

“I just got really lucky,” Ohlman said. “I don’t know how.”

A big part of her recovery strategy involves building a supportive community, she said.

“Meetings; 12-step; sponsorship and networking; being involved with people doing what I’m doing,” said Ohlman, ticking through a list of her priorities.

There’s a fatal overdose at least once a week within her Cape Cod community, she said. Some are accidental, others not. Ohlman said she’s convinced that telling her story, of losing and then finding hope, will help bring those numbers down.

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Is CMS proposal violating their own anti discriminatory policies ?

Posted on March 30, 2018 by Pharmaciststeve

CMS proposes to force patients off effective opioid doses without their physician’s approval

Nondiscrimination

https://www.cms.gov/about-cms/agency-information/aboutwebsite/cmsnondiscriminationnotice.html

Nondiscrimination Notice

CMS doesn’t exclude, deny benefits to, or otherwise discriminate against any person on the basis of race, color, national origin, disability, sex, or age in admission to, participation in, or receipt of the services and benefits under any of its programs and activities, whether carried out by CMS directly or through a contractor or any other entity with which CMS arranges to carry out its programs and activities.

How to file a complaint:

If you believe you’ve been subjected to discrimination in a CMS program or activity, there are 3 ways to file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights:

Online
By phone: Call 1-800-368-1019. TTY users can call 1-800-537-7697.
In writing: Send information about your complaint to:

Office for Civil Rights
U.S. Department of Health and Human Services
200 Independence Avenue, SW
Room 509F, HHH Building
Washington, D.C. 2020

This non-discrimination policy applies to both CMS/HHS and all the vendors/providers to  Medicare/Medicaid pts. The article in the above link suggest that CMS is going to “dump” these discriminatory policies on to the insurance companies, PBM, and pharmacies to implement and fulfill..

 

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The anticipation of unrelieved pain could induce patients to avoid needed surgical procedures

Posted on March 30, 2018 by Pharmaciststeve

New Attitudes Toward Pain Amid the Opioid Crisis

https://www.medscape.com/viewarticle/893926

Backpedaling on Opioid Use

To correct what they believe was an overly zealous approach to pain control that put patients at risk for opioid addiction, some physicians are now telling their patients to expect to have some pain. A recent article on Medscape explains that “Doctors at some of the largest US hospital chains admit they went overboard with opioids to make people as pain-free as possible, and now they shoulder part of the blame for the nation’s opioid crisis. In an effort to be part of the cure, they’ve begun to issue an uncomfortable warning to patients: You’re going to feel some pain.”

Nurses—and some physicians—have a wide range of views on the issue. Some believe that patients are being overmedicated, but others worry that we are taking a step backward and patients will suffer. In the discussion after the article Hospitals Hone New Message in Wake of Opioid Epidemic: Expect Pain, nurses described their own experiences with undertreated pain and their reluctance to undergo needed medical procedures out of fear that they will have uncontrolled pain.

The Fifth Vital Sign Initiative

“The fifth vital sign approach has backfired on us all,” wrote one reader, who was not alone in this assessment. Many readers suggested that the “pain as the fifth vital sign” initiative—introduced by the American Pain Society in 1996—is at least partly to blame for the current opioid crisis. This concept stresses that assessment of pain is as important as measurement of the standard four “vital signs,” and that clinicians must act when patients report pain.[2]

 

“I don’t remember many addiction problems until ‘pain as a fifth vital sign’ subtly implied that pain was an avoidable part of life, if only insensitive doctors would prescribe more drugs,” one reader commented. Another wrote:

Making pain a vital sign caused more harm than any benefit, unless of course someone is traversing toward end-of-life or symptom-based palliative care, either owing to a terminal illness or severe physical disability. More objective pain assessments should be utilized in the acute care setting as opposed to a subjective Likert scale (ie, numerical pain scale based on 1-10).

“The Joint Commission should share some of the responsibility for the opioid epidemic. For a long time, citations were imposed on facilities for not doing enough to manage patients’ pain. As a matter of fact, they came up with the slogan that pain should be the fifth vital sign,” another commented, erroneously.

The Joint Commission addressed these misconceptions in an April 18, 2016, statement on pain management, clarifying their position:

The only time that The Joint Commission standards referenced the fifth vital sign was when they provided examples of what some organizations were doing to assess patient pain. In 2002, The Joint Commission addressed the problems in the use of the fifth vital sign concept by describing the unintended consequences of this approach to pain management and how organizations had subsequently modified their processes.

Their current standard: “The hospital assesses and manages the patient’s pain,” allowing organizations to develop and implement their own policies.

The Joint Commission does not require pain to be treated until the pain score declines to zero. Instead, they require individualized care that is tailored to specific patient needs. Furthermore, these pain treatment strategies “may include pharmacologic and nonpharmacologic approaches.”

Data from the National Institute on Drug Abuse disproves the belief that the Joint Commission’s pain standards caused a steep rise in opioid prescriptions. The number of opioid prescriptions actually increased steadily during the 10 years before the release of the standards in 2001, when insufficient pain management began to be recognized as a widespread problem. The Joint Commission writes:

It is likely that the increase in opioid prescriptions began in response to the growing concerns in the United States about undertreatment of pain and efforts by pain management experts to allay physicians’ concerns about using opioids for nonmalignant pain. If there was an uptick in the rate of opioid use, it appears to have occurred around 1997-1998, two years prior to release of the standards.

 

The Downside of Unrelieved Pain

Many nurses remember a time when patients’ pain was inadequately treated, driving some patients with chronic pain to suicide, and they fear we might return to those days. One of these older nurses summarized this view: “We had to fight for good pain control in the 1970s to keep patients moving after surgery, thereby avoiding complications. We seem to be going back in time rather than taking appropriate steps to address the real issues at play here.”

 

Another reader said, “This opioid epidemic cannot be solved by going back to the previous paradigm. It is a multifaceted problem.”

 

Pain makes it harder for postoperative patients to get up and move around, take deep breaths, and cough—all necessary for their recovery. One nurse noted, “You heal better when your muscles aren’t tense because of pain. That doesn’t mean you need to send a patient home with a script for Percocet with several refills.”

 

Several readers commented on the risks for kidney and liver damage and gastrointestinal bleeding associated with excessive acetaminophen or nonsteroidal anti-inflammatory (NSAID) use.

 

A physician said, “Centers for Disease Control and Prevention statistics show that there were 20,000 overdose deaths in 2010, and over 30,000 in 2016. At the same time the number and dosage of narcotic prescriptions were decreasing. It is wrong to indict my postop patients for the problem.”

 

Many nurses related their own experiences with pain that wasn’t properly addressed. One said she was given no pain medication when she broke her elbow, and another said she had been “in terrible agony” in an emergency department with a kidney stone and was given only a muscle relaxer. “It did nothing, and it made me think they thought I was drug-seeking,” she wrote.

 

Another nurse said that when she went to the emergency department with “crushing pain” from a herniated disc, she was sent home with naproxen. “The pendulum has swung, but too far,” she continued.

 

After gastrointestinal surgery, one nurse said, “I cried until I was finally given narcotic pain medicine a few hours postoperatively. I was all for the new initiative to use a nerve block, gabapentin, intravenous acetaminophen, and Toradol (ketorolac). But it wasn’t enough. I even had to beg for pain meds upon discharge.”

 

Readers expressed concern that the anticipation of unrelieved pain could induce patients to avoid needed surgical procedures. On nurse whose pain was not adequately managed after knee replacement surgery explained, “The thought of pain relief being unavailable to me because somebody else might be addiction-prone makes me cringe. If I have to experience that degree of pain, I will never work up the courage to have the other knee replaced.”

 

Another reader who anticipates surgery in the near future commented, “I am terrified that the hospital will decide that a couple of acetaminophen tablets will suffice.”

 

Achieving a Balance

Some nurses who think that opioids are overused talked about refusing opioids for pain relief and how they had successfully used other methods to manage pain, including massage, chiropractic care, meditation and visualization, Epsom salt baths, and distraction. And several readers suggested cannabidiol oil or marijuana as alternatives to opioid medications.

 

Readers said that patients need to have realistic expectations about pain, and not to expect no pain. An emergency department nurse wrote, “I have learned to tell the patient asking for pain meds that ‘the ability to feel pain means you are alive.’ Not feeling anything at all seems abnormal.”

 

One nurse said that she “was taught that pain meds were to take the edge off the pain, not to make the patient pain-free. If a patient is pain-free and something is wrong, no one would know.”

 

“Patients think they have the right to feel no pain; it’s very unrealistic. We need to have a balance,” another commented.

 

Nurses on both sides of the issue said that steps to improve the quality of pain management must include patient education about realistic expectations; alternative treatments; and effective use of nonopioid medications, such as acetaminophen and NSAIDs. Good observation skills and interviewing techniques are also important, others pointed out.

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