https://www.axios.com/inside-express-scripts-pbm-contract-8be2f09d-cbfa-4275-9855-7bc9c4fcc1a7.html

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Hi Steve –

Religious liberty is not a license to discriminate and harm. Yet Trump’s Department of Health and Human Services wants to let health care providers use their religious beliefs to justify turning away patients in need. This is a betrayal of the department’s own mission, and it could have disastrous consequences – particularly for women and LGBT patients.

The department is taking public comments on this proposed rule – which means they must consider and respond to our opinions. We have a short window to mount overwhelming opposition to this rule and stop it from taking effect.

Raise your voice loud and clear: Leave a public comment and tell Health and Human Services not to put religion over medical standards.

This proposed rule, if it were adopted, could have serious repercussions for patients seeking treatment like abortions, HIV treatment, or gender-confirming surgery to which some people – like extremist Vice President Mike Pence – might object. Here are just some of the ways the proposed rule could hurt patients:

• Pregnant women experiencing miscarriages or other serious pregnancy complications could be refused abortion care even when the woman’s life is at risk, and even when the fetus has no chance of survival.

• Health providers could discriminate against transgender patients seeking medically necessary care.

• Hospital staff could refuse to sign in patients seeking abortions, to assist patients in any way before getting sterilizations, or even provide any information about medical conditions and treatment options.

Submit a public comment now and we’ll deliver it to the Department of Health and Human Services.

The Department of Health and Human Services should be protecting our health, not proposing rules that could hurt the health and lives of women, trans people, LGB people, people living with HIV, and others seeking critical care.

We’ve already taken legal action for patients hurt by similar discriminatory policies – and if this rule goes into effect, then we’ll see the Trump administration in court. But let’s get to work now to stop this license to discriminate in its tracks.

Submit your comment now. We won’t accept a discriminatory regulation that threatens our health and undermines the principles of religious liberty – and we need your help to stop it.

Thanks for taking action,

Louise Melling
ACLU Deputy Legal Director, fighting against discrimination

Filed under: General Problems | 4 Comments »

https://www.acsh.org/news/2018/03/21/sometimes-journal-ama-gets-it-wrong-and-so-do-careless-journalists-12731

On March 6, 2018, the Journal of the American Medical Association published a 12-month randomized clinical trial [authors Erin E Krebs, Amy Gravely, Beth DeRonne, Elizabeth Goldsmith, and others] which compared opioids to non-opioid medications for treatment of moderate to severe osteoarthritis and back pain among 240 Veterans Administration patients.  In the days since publication, the study has been picked up by popular online magazines and blogs under blaring, but incorrect, headlines. The trial supposedly “proves” that opioid pain relievers work no better than acetaminophen (Tylenol) or non-steroidal anti-inflammatory drugs (NSAIDs), and that the risks of opioids make them unacceptable in the treatment of these types of pain.

In reality, the trial proves no such thing.  To an informed reader, the study is profoundly flawed on several grounds, despite the considerable effort that seems to have gone into study design and execution:

• The study addresses types of pain for which opioids have never been a preferred treatment of choice. The first line treatment is anti-inflammatory drugs (NSAIDs).
   
• The study protocols were flawed; the group set up two cohorts of patients in a “practical” trial that offered several medications in sequence until something was found that worked.  About 11% of the patients in the “non-opioid” leg of the trial eventually tried tramadol (brand name Ultram) – an atypical opioid pain medication that was not identified as such in the study.
   
• Patients on “non-opioids” were switched between medications an average of four to five times during the year of the study before a medication was found that worked. Patients on opioids either had successful therapy on the first medication tried or were switched only once. This difference was not detailed in the study results.
   
• As noted by senior editor Jacob Sullum in a Reason Magazine blog,“… the researchers excluded patients who were on long-term opioid therapy, which means they ignored people who had already found they did not get adequate relief from other treatments. It seems reasonable to assume that people who are currently using opioids to treat chronic pain are doing so because they think these drugs work better for them than Advil or Tylenol, and they may even be right to think that. If you exclude those patients from a study of pain treatment, you are excluding precisely the people who are most likely to get more relief from opioids.”
   
• Observations of Stephen Nadeau, MD (a specialist in the treatment of chronic pain) in a private email to the author are also meaningful:“The mean dose of opioid was 21 mg morphine equivalent (MEQ)/day and only 12.6% of patients randomized to the opioid group were on > 50mg MEQ/day. The operational clinical range for opioids used in the [the] treatment of chronic non-malignant pain is roughly 50-1000 mg MEQ/day [and yes 1000 is not a typo]. There are excellent scientific data on this, even as the CDC and others have avidly promoted a “one size fits all” concept and advocated for daily dosage of <90 mg MEQ (resulting in untold suffering and many deaths in the 1.6 million people with chronic pain and on doses of >90 mg MEQ/day).

  “Variability in opioid dosing requirement is related to genetic variations in the mu-1 opioid receptor gene and to variability in opioid metabolism.  Thus, the doses used in the Krebs trial were unlikely to be effective, even for the — on average — moderate pain that characterized this population.  Bottom line conclusion:  insufficiently titrated doses of opioids are not superior to non-opioid alternatives in the treatment of chronic nonmalignant pain. We have known this for decades.”

  “Three different antidepressants were specifically noted as alternatives for pain treatment in the non-opioid group. Just over 25% of the patients in this trial were at least moderately depressed. However, the authors do not provide data on antidepressant use in the two groups — a key omission. Antidepressants are highly effective in treatment of pain and can reduce the dose of opioids needed.  Differences in outcome between the two groups relating to opioid use could have been masked by the use of antidepressants in the non-opioid group.

The bottom line is that the study seems to have set up to give a predetermined result: to discredit opioids in favor of NSAIDs and Tylenol.  It was a bit like staging a race between some contestants in leg-irons versus others who ran after taking steroids for months.  

Any of these biases alone should have disqualified the study from publication in JAMA, but the fact that three of them are found in the same paper raises suspicions, and rightly so. The fact that JAMA editors let this piece see the light of day should have us all questioning the integrity and/or standards of the journal. 

The CDC guidelines were published about two years ago and we are seeing a growing list of evidence that the CDC was being deceitful in coming to the conclusion that were included in their guidelines.

At first the members of the “special CDC committee” that were to compile the guidelines were to be kept “confidential”, but they didn’t last long. At least one of the committee members was known as a Medical College Professor that was well known as not being a proponent of treating chronic pain with opiates.

Another committee member was reportedly had financial interest in rehab centers.

It has been reported that some/most of the studies that the committee used to come to their conclusion were rated on a “creditable scale” of 3’s & 4’s.. where “1” is excellent and “4” being rated as unreliable “crap”

The final guidelines were released referencing opiate conversion tables  that all have the same or similar “fine print cautions”:  Published equianalgesic ratios are considered crude estimates at best and therefore it is imperative that careful consideration is given to individualizing the dose of the selected opioid. Dosage titration of the new opioid should be completed slowly and with frequent monitoring. 

There is no reference in the guidelines to make exceptions – dosage adjustments – in regards to the pt’s CYP-450 opiate metabolism status.

It has now come to the surface that the CDC has overstated opiate related deaths   a document that admits that the CDC has overcounted “prescription opioid deaths”  https://edsinfo.wordpress.com/2018/03/18/cdc-over-counting-rx-opioid-overdose-deaths/

One has to ask… how many more studies are going to be released/published … that are created with manipulated data to arrive at a predetermined conclusion, and these same studies will be accepted by many as “gold standard results” and in turn base their decisions, policies and other things that will have good/bad impacts on those pts dealing with chronic pain ?

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http://www.wfaa.com/article/news/pain-meds-shortage-changing-how-north-texas-patients-are-treated/287-530782803

His pain has eased now, but two weeks ago, “It was excruciating. I’d say it was about an 8 [out of 10 ], when they were asking me at the hospital.”

Several North Texas hospitals are acknowledging a shortage in powerful pain medications.

It is a nationwide shortage, believed to be caused in large part by a move the Drug Enforcement Administration made to combat opioid abuse.

According to W. Stephen Love, President and CEO of the Dallas-Fort Worth Hospital Council, in 2017 the DEA lowered the limits regulating how much of these drugs pharmaceutical manufacturers can produce.

The result is a change in the way patients like Gilbert Cavello are treated.

His pain has eased now, but two weeks ago, “It was excruciating. I’d say it was about an 8 [out of 10], when they were asking me at the hospital.”

Cavello is paralyzed from the chest down and is prone to bladder infections. He says the last infection was terrible, and his treatment was different.

“Usually, they automatically start me on antibiotic and then, to ease pain, they put me on Dilaudid, but this time they put me on morphine and it wouldn’t help, it wouldn’t last,” he said.

Gilbert was a patient at UT Southwestern Medical Center, one of the North Texas hospitals experiencing the shortage. Particularly drugs such as Dilaudid, fentanyl and morphine are in short supply.

Love says doctors he’s spoken with are working closely with pharmacists, clinical staff and nurses to coordinate pain management. Parkland Hospital, UT Southwestern and Methodist Health System say staff are transitioning patients to oral medication when appropriate, as pills are more readily available than those that are intravenously delivered.

Love said he believes hospitals are also being more candid with patients.

“Probably, in some ways, the pendulum may have swung too far as far as trying to keep the patient experience extremely pain free,” Love said. “We want it to be pain-free but in the same token we want it to be done in a very responsible way.”

Love says the shortage could potentially ease if the DEA adjusts the production limits.

“People need it, especially those in severe pain like me,” Cavello said.

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House Energy and Commerce Committee grills DEA chief over free flow of opioids

https://www.washingtonpost.com/national/house-energy-and-commerce-committee-grills-dea-chief-over-free-flow-of-opioids/2018/03/20/76a79e24-2c68-11e8-b0b0-f706877db618_story.html

The acting director of the Drug Enforcement Administration said a database that monitors the flow of powerful prescription painkillers from manufacturer to distribution point was compiled manually during the height of the opioid crisis, making it a reactive, not proactive, tool.

The information contained in the drug-reporting database, known as ARCOS, is key to figuring out how many painkillers were distributed to pharmacies across the country from around 2006 to 2010. The data is confidential, but some information that has been released and analyzed is staggering: In two instances, millions of pills were shipped to pharmacies in tiny West Virginia towns.

Members of the House Energy and Commerce Committee, who spent two hours aggressively questioning acting DEA director Robert W. Patterson in Washington on Tuesday, wanted to know how so many pills flowed freely, creating conditions for the opioid crisis, and why, they said, the DEA hasn’t been forthcoming with information about how it handled opioids.

“Your agency doesn’t appear to be willing to aggressively try to help us solve, or at least deal with, this crisis,” Rep. Joe Barton (R-Tex.) said. Time, he told Patterson, is of the essence. “You just remember 80 people a day are dying because of legal prescription drugs. Remember that.”

Patterson, who has been acting director since October, said the agency has modernized how it uses the ARCOS data in recent years. It is now computerized, and the DEA has the ability to paint a fuller picture of how many pills are being shipped by also analyzing data from state prescription-drug-monitoring programs and the Department of Health and Human Services. Drug distributors are responsible for reporting their data to the DEA.

Patterson said that the modernization of the database has allowed it to be used in a “much more proactive manner” than in the past. He also said that some anomalies cannot be spotted using the database alone — it needs to be employed in concert with other data.

“I can say repeatedly in ’08, ’09, ’10, we did not use this data in the way that we are now using it, and I think that’s the key,” Patterson said. “Where we fell short, we’ll take responsibility for it.”

When asked, Patterson said that the same thing would not happen today.

“What we wish to do . . . is stop public harm,” he said.

Committee members expressed extreme frustration with the DEA, claiming that the agency dragged its feet in turning over documents and redacted many of those it did give up.

“Your agency needs to be turned upside down,” Rep. Chris Collins (R-N.Y.) said. “There is no doubt there is an abject failure in the DEA going back 10 years.”

As Rep. Raul Ruiz (D-Calif.), a medical doctor, said of the agency: “You screwed up.”

The agency also questioned Patterson as to why there was a decrease in orders preventing pharmacies or doctors that were suspected of rogue prescribing from dispensing opioids. Patterson said it was, in some cases, because U.S. attorneys asked that they complete criminal cases before shutting down the pharmacies. The names and the locations of the prosecutors were not specified.

“People continued to die, die during this period,” Rep. Greg Walden (R-Ore.) said.

The testimony came during a week when Washington is focused on the opioid crisis. The Energy and Commerce Committee will hear more than 20 bills on opioids this week. On Monday, President Trump laid out his plan to solve the opioid crisis, which was filled with tough talk but few details on how he plans to carry it out.

Trump’s plan includes executing some drug dealers, while also pledging to hold pharmaceutical companies accountable for their role in fostering addiction. He said he wants to cut the number of opioid prescriptions by one-third nationwide but did not lay out a blueprint for getting there.

When Trump called for eliminating drug dealers, he said he wants to “get tough” on them, an approach that has alarmed some public-health experts.

Trump’s administration still has not filled numerous vacant positions that deal with the opioid crisis. Patterson is the DEA’s acting director. Trump named Jim Carroll, who worked in the White House Counsel’s Office, to be director of the Office of National Drug Control Policy, but he is only in an acting capacity and his nomination has not been sent to the Senate.

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http://www.concordmonitor.com/As-Trump-calls-for-stronger-prescription-drug-monitoring-New-Hampshire-s-program-struggles-16303618

Tucked within President Donald Trump’s latest proposal to address the opioid epidemic – unveiled Monday in Manchester – is support for a somewhat obscure initiative: prescription drug monitoring programs.

The programs, administered by states, collect prescription information for patients. Pharmacists and doctors are required to participate; the resulting database allows physicians and administrators to screen for patients abusing prescriptions, “doctor shoppers” and complicit doctors.

It’s an approach with wide backing in the medical community, and Trump is hoping to expand it. A written version of the president’s plan – released by the White House on Sunday – seeks to leverage federal money to build a state-to-state, “nationally interoperable prescription drug monitoring program network.”

In New Hampshire, though, that might be easier said than done. The state’s program, approaching its sixth year, is still working to find its footing.

A critical audit by the Legislative Budget Assistant in December found a range of shortcomings from the nascent program. The program is performing its most basic function – collecting and storing prescription data – but it isn’t meeting its loftier goals of analyzing and reporting trends to guide policy, the audit found. Reports so far have been incomplete or misleading, and oversight is poor.

After becoming law under Gov. John Lynch in 2012 and four more years under Gov. Maggie Hassan’s watch, the program was stuck in an “initial phase of maturity,” the audit concluded.

Now, leadership at the state Board of Pharmacy is scrambling to implement changes. In a compliance report presented to the legislative Fiscal Committee on Friday, the board said it was rushing to meet the budget assistant’s recommendations, 26 in all.

Policies are being rewritten. Software is being brought up to speed. “We’ve moving right along with the audit response,” said Michael Bullek, administrator of the board.

But even with a newfound focus, the program is far from up to snuff. Actually building the infrastructure to meet its statutory obligations – the analyses and reports – could take up to 18 months.

Exactly what went wrong with the program’s development has been tough to narrow down. According to operators involved, troubles for the program began early. Initiated in the final months of Gov. John Lynch’s tenure, the program was from the outset “underfunded, understaffed and overregulated,” Bullek said.

“I’ve been involved in every step of the way with the process, and there’s been a lot of pitfalls and roadblocks with the legislation,” Bullek said.

One of them was a provision preventing the program from holding prescription records longer than six months, severely hampering its abilities to analyze, he said.

A spokeswoman for Sen. Maggie Hassan – who as governor oversaw four of the program’s first six years – pointed to financial constraints.

“When the program was established in law under Governor Lynch, the Legislature failed to provide sufficient funds to implement it, setting up the program for challenges,” spokeswoman Ricki Eshman said. Eshman added that Hassan had pressed for technological upgrades for the program as governor, as well as improved prescription training for physicians.

“Over the last several years, New Hampshire’s program has been expanded a number of times, and it is clear from the report that it still has work to do to reach full maturity,” she said.

And there was a simpler problem, according to Bullek: “We didn’t buy the right software program initially. It didn’t meet the need.”

Regardless of the cause of the deficiencies, the consequences have been sharp. Presented with the audit in December, lawmakers on the Fiscal Committee were openly frustrated.

“We’re all struggling to understand why the program has not been administering data,” Sen. Andy Sanborn, R-Bedford, said at the time.

Now, Bullek says much has changed since the program began. For one, the Legislature lifted its six-month cap in 2016, freeing the Pharmacy Board to begin carrying out effective data analysis. And the program took on a new software vendor last summer, expanding its ability to process data, Bullek said.

And on Friday, the Fiscal Committee approved the addition of a new staff position: a data analyst.

Presented with the updates, Rep. Neal Kurk, chairman of the Fiscal Committee, appeared encouraged – to a point.

“I think you’re making very important strides in terms of the issues that the audit brought up,” he said Friday. “We’re looking for more, with respect.”

This just shows how “out of touch” that the Trump administration is…  back in 2005 Congress pass a bill and Bush (43) signed into law the National All Schedules Prescription Electronic Reporting (NASPER) Act  http://nasper.org/. But after Congress passed this bill .. they failed to provide funding to implement and run it… in 2016 Congress introduced the bill  S.480 – National All Schedules Prescription Electronic Reporting Reauthorization Act of 2015 and it failed to pass. This act was to provide funding for the NASPER ACT, but it failed to get passed.

Could these to failures to get a National PMP be a direct result of the 49 states — that has a state operated PMP – not wanting to give up the budgets and staffing that comes along with operating one at the state level.

Also with 48 other states operating their own PMP programs.. why did NH have to start from scratch and try to re-invent the wheel.  Surely, one of those 48 states would have a functioning and mature PMP program.

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The CDC Quietly Admits It Screwed Up Counting Opioid Pills

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

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

“Quantifying the Epidemic of Prescription Opioid Overdose Death” 

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

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

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

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

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

“The CDC Sucks” 

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

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

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

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

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

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

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

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

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

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

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

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

WHERE IS HEROIN?

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

REDOING THE MATH

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

THE BIG LIE

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

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

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

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

WITH OPIOIDS 2+2 MAY EQUAL 5

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

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

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

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

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

Perhaps more interesting:

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

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

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

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

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

NOTES:
(1) See:

The Opioid Epidemic In 6 Charts Designed To Deceive You

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

How the feds are fueling America’s opioid disaster

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

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

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

Filed under: General Problems | 6 Comments »

In need of donations to help offset cost of hotel rooms. Please donate anything you can afford to get warriors to D.C? If your bank has Zelle you can send by using my cell number. We’re using venmo for credit cards at no cost. I’m not opposed to a check I can deposit into Bank of America on app. Any questions PM me and know we’re going to speak out for all with chronic pain. We’re not quitting or backing down. Too many lives are at stake and we’ve lost too many already. Take care and God Bless

Sherry Sherman

Filed under: General Problems | 2 Comments »

Alex Azar: Trump opioid plan includes retraining physicians on pain-management options

https://www.washingtontimes.com/news/2018/mar/19/alex-azar-trump-opioid-plan-includes-retraining-ph/

Health and Human Services Secretary Alex Azar said Monday that President Trump is committed to reducing the number of prescribed opioids and retraining physicians on how to handle pain management.

“He is saying that within three years, we will reduce the prescribing of legal opioids by one-third,” Mr. Azar said on Fox News.

White House officials unveiled their plan Monday on how they intend to combat the nationwide epidemic. Mr. Trump even went so far as to suggest the death penalty for drug dealers a few weeks ago and directed the Justice Department on Monday to make this a possibility under sentencing laws.

Mr. Azar said that there needs to be “serious penalties” and “serious enforcement” for those distributing these drugs, but he did not confirm anything about the death penalty specifically.

He did say part of the plan includes retraining doctors on how to handle pain management in their patients, and to also address the issue of overprescribing both opioids and antibiotics.

“We’re doing research and development in alternative additional pain management tactics,” Mr. Azar said.

Filed under: General Problems | 6 Comments »

http://kdvr.com/2018/03/19/mother-says-daughters-critical-drug-is-at-risk-because-of-dispute-between-pharmacy-and-pharmaceutical-company/

DENVER —

The mother of a child with a double lung transplant said she is worried that accessing a critical drug for her daughter’s care will be challenging if  the drug’s manufacturer and Walgreens do not reach an agreement on a contract.

Jenna Parker’s daughter Portia Opichka received a double lung transplant two years ago.

Now, Portia is on 17 medications and Parker said the most critical is immunosuppressant Prograf.

Parker said she called to request a refill at the Walgreens at Children’s Hospital Colorado and was told the prescription could not be filled after April 1.

Parker said she was told by a pharmacist that Walgreens and the drug’s manufacturer, Astellas Pharma U.S., have not been able to reach an agreement on a new contract so it’ll expire at midnight March 31.

“This is probably one of the biggest hurdles I have had to face because this is the most important drug these kids can be on,” Parker said.

Parker said the Walgreens at Children’s Hospital Colorado is the only pharmacy in the Denver area that carries Prograf and can compound it, the process of turning the pill into a liquid form that can be inserted into Portia’s feeding tube.

“This is a very serious situation,” Parker said.

If the companies can’t reach an agreement, Parker said she’ll have to have the medication flown in from out of state.

She worries about the reliability of this option as well as making sure Medicaid will cover the out-of-state medication.

“Why would I want to rely on an airplane to deliver her life-saving medicines on time? My heart can’t deal with that, that’s too stressful,” Parker said.

“Astellas cares about the patients who need our products,” Astellas Pharma U.S. said in a statement.

“We are unaware of any business dispute with this retailer. Retailers make their own decisions about which products to carry.”

Walgreens could not be reached for comment.

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