DOJ Repeats Threat to Hold Opioid Prescribers Accountable

Posted on March 17, 2018 by Pharmaciststeve

DOJ Repeats Threat to Hold Opioid Prescribers Accountable

AMA, PharmedOut leaders also pitch solutions at insurers’ policy conference

https://www.medpagetoday.com/publichealthpolicy/opioids/71661

WASHINGTON — The U.S. Department of Justice plans to hold providers accountable per a new large-scale effort to tackle the opioid crisis, Deputy Attorney General Rod Rosenstein reiterated here Wednesday.

Addressing the annual policy conference sponsored by America’s Health Insurance Plans, Rosenstein said the new opioids task force announced by Attorney General Jeff Sessions last week will hold everyone accountable; he then specifically cited physicians.

The proliferation of prescription painkillers, including opioids, has countered the ethos of “do no harm,” Rosenstein said, noting that the average American life expectancy has decreased along with the 21st century opioid spread — after nearly doubling over a century. “These drugs have caused a lot of collateral damage,” Rosenstein said, including costing American healthcare more than $1 trillion this century.

In addition to the Task Force, Rosenstein cited as another solution the Justice Department’s involvement with the new Joint Criminal Opioid Darknet Enforcement team; it has been established in large part to counter the flow of painkillers, especially synthetics such as fentanyl, from foreign countries into the U.S.

“We ought to all be about prevention,” he said, citing over-prescription as a major cause of the opioids crisis.

Rosenstein asked insurance companies to utilize their monitoring systems to identify patients receiving too many painkillers and those receiving them for conditions that don’t warrant them. “We recognize that you have a financial incentive” to limit prescriptions, he noted.

Rosenstein also encouraged providers, insurers and others to follow the CDC’s 2016 opioid guidelines.

The deputy attorney general spoke just before a panel on the opioid crisis featuring Patrice Harris, MD, chair of the American Medical Association’s Opioid Task Force; Adriane Fugh-Berman, MD, a Georgetown University professor who leads the PharmedOut initiative; and Nick Szubiak, LCSW, of the National Council for Behavioral Health.

“The pharmaceutical industry is almost completely responsible for this epidemic,” Fugh-Berman said, citing misleading advertising and their practice of hiring “thought leaders” to shame providers into prescribing more opioids. These individuals told physicians they were “torturing our patients” by not issuing painkillers whenever they complained of pain.

Pharmaceutical companies “misused” medical literature by consistently citing small-scale studies and research letters as evidence for supporting opioid prescriptions, she said. They also published ghostwritten articles in medical and consumer publications, and launched disease awareness campaigns. In addition, they funneled money to medical advocacy groups, including the U.S. Pain Foundation ($2.9 million during 2012-2017) and the American Academy of Pain Medicine ($1.2 million) to promulgate messages such as “restricting opioids in any way disadvantages pain patients” and “the needs of patients with [opioid use disorder] must be balanced with the needs of pain patients.”

Such practices have not completely abated, she said. One in 12 physicians accepted money from opioid manufacturers from 2013-2015 totaling $46 million. Fugh-Berman also reminded the crowd that the phrase “abuse deterrent” does not necessarily mean “less addictive.”

She encouraged practitioners to suggest patients try alternative methods for treating pain, such as regular exercise, acupuncture and transcutaneous electrical stimulation. “Some of these treatments are as effective or more effective for pain than opioids,” one of her presentation slides said.

Alternative treatments indeed need to be more readily available to patients, said Melinda Becker, who directs a National Governors Association Health Division center.

Harris suggested decreasing administrative burdens for practitioners, such as prior authorization requirements, especially when treating patients with substance use histories.

Physicians are already making progress addressing the opioid crisis, Harris noted. Healthcare professionals more than doubled queries with prescription monitoring programs during 2014-2016, according to an AMA survey; a QuintilesIMS report noted that total opioid prescriptions declined from 259 million to 215.5 million from 2012-2016.

Harris directed the audience to the AMA Task Force’s recommendations and to its dedicated opioid web page.

Szubiak listed several resources needed to combat the crisis, including:

Intensive case management
Recovery supports
Patient navigators
Certified community behavioral health clinics
Shifting healthcare to value-based care
Tracking patients who diverge from care plans

Barriers must also be overcome, Szubiak said, citing providers’ bias against opioid users, and other perceptions within American healthcare that have led to users being regarded as criminals. These patients should instead be educated about prevention and treated.

If we had medical professional in charge of dealing with the mental health issue of addictive personality, and not some of those opiophobic medical professionals that the media keeps seeking out and quoting their PROPaganda.

They keep recommending NSAID’s… which is known to cause 15,000/yr deaths.. and they quote the BIG NUMBER of 215 million opiate prescriptions as being – for some unknown reason – to be excessive.

If all those supposedly “bright/educated” people really looked at those numbers and the estimated number of chronic pain pts. It is easy to see that the reported numbers strongly suggests that chronic pain pts – especially those suffering from intractable chronic pain – are being grossly UNDER TREATED.

It is estimated that there are some 20 – 30 pts suffering from intractable chronic pain.. those requiring 24/7 opiates… follow standard of care and best practices… with each getting a long acting opiate and a short acting opiate for breakthru… presuming that they would get a 30 days Rx each time… those pts would require 480 – 720 million opiate prescriptions.

So those 215 million opiate prescriptions would not even begin to address the needs of those intractable chronic pain pts.. .let along… the other 70-80+ million chronic pain pts and those who are in need of opiates for acute pain for a short period.

Is it time to call for our judicial system to walk away from treating the mental health disease as a Crime and turn it over to our medical community ? After all, our judicial system has been “treating” addiction for over 100 yrs… and only those who are part of our judicial system and/or draws a paycheck from the war on drugs would consider it a success ?

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Four Ways Pharmacists Are Fighting Opioid Abuse

Posted on March 17, 2018 by Pharmaciststeve

http://drugtopics.modernmedicine.com/comment/reply/446751#comment-form

Greater awareness of the dangers posed by prescription opioids is changing pharmacy practice.

Efforts to address the opioid epidemic are as complex as the problem, with involvement ranging from government agencies to state pharmacy boards to addiction specialists to medical professionals.

Pharmacists may be the first to suspect opioid abuse and misuse, and many have altered the way they interact with patients who take opioids. Studies have found that pharmacists say the epidemic has changed the way they counsel patients about pain management and potential problems.

“A growing awareness of the dangers posed by prescription opioids seems to be leading to more proactive discussions between pharmacists and patients regarding this issue,” says Lucas Hill, PharmD, BCPS, BCACP, clinical assistant professor at the University of Texas at Austin College of Pharmacy.

Here are some of the biggest ways pharmacy practice is changing.

1. Adopting New Protocols

Some chain and independent pharmacies are implementing policy changes to protect patients and pharmacists. CVS, for example, has strengthened counseling for patients filling a first-time opioid prescription.

“During this counseling, our pharmacists will talk to the patient about the recommendations from the CDC around opioid use,” says Tom Davis, RPh, vice president for pharmacy professional services at CVS Pharmacy. “The key message to patients initiating opioid treatment for an acute use is to use the lowest effective dose for the shortest possible duration of time. Pharmacists will also talk to patients about the importance of safely storing and appropriately disposing of opioids to prevent misuse or diversion.”

CVS uses the CDC Guideline for Prescribing Opioids for Chronic Pain to frame its prescribing policy, limiting the supply of opioids dispensed for certain acute prescriptions to seven days for patients new to the therapy.

Related article: The Other Side of Opioid Limits

“The program also employs MME [morphine milligram equivalent] limits consistent with the CDC Guidelines,” Davis tells Drug Topics. “And, it requires the use of immediate-release formulations of opioids before extended-release opioids are dispensed.” These changes went into effect in September 2017.

Tana Kaefer, PharmD, clinical coordinator at Bremo Pharmacies in Richmond, VA, says her protocol is to emphasize opioid alternatives. “If the patient gets two prescriptions, one for ibuprofen and one for an opioid, I may tell them to try the ibuprofen first.”

Kaefer also lets her patients know their options so they don’t have extra medication in the house, such as by only filling part of a prescription. Laws in Virginia allow pharmacists to split the prescription, for example, dispensing five pills when 10 are prescribed and having the patient come back if more are needed.

She also tells patients how to correctly dispose of leftovers. “We know this is a huge problem if medication is left in the medicine cabinet and other people come into the house looking for it,” she says.

2. Embracing a Team-Based Approach

Teamwork is helping reduce opioid abuse in hospital and long-term care settings, says Deb Pasko, PharmD, MHA, director of medication safety and quality with ASHP. Doctors, nurses, and pharmacists work together to determine and monitor the optimal medication for patients, and respond quickly when changes are needed. “We may have a trauma patient come into the ER who has acute needs, then go to the operating room and need a high dosage, then on to intensive care,” says Pasko.

She says pharmacists should help decide what medication is indicated, the best interval, and identify any potential interactions. They can also help determine if patients should continue receiving opioids, if medication should be tapered, or if an alternative should be considered.

3. Using PDMPs

More than two dozen states now require pharmacists to check prescription drug monitoring programs (PDMPs). These electronic databases that track controlled substance prescriptions are among the most promising state-level interventions to improve opioid prescribing, inform clinical practice, and protect patients at risk, according to the CDC.Click to expand

“For me the prescription monitoring program is very helpful,” says Kaefer. “If I have concerns it allows me to see the bigger picture of a patient. I can see if a patient is visiting other pharmacies. I find it very helpful that I can connect to other states.”

There have been “remarkable successes” in controlling the prescribing and dispensing of controlled substances, particularly opioids, when PDMPs are accessed, says Carmen Catizone, RPh, MS, DPh, executive director of the National Association of Boards of Pharmacy.

As more states embrace PDMPs, their potential to help curb the epidemic is growing. Promising developments in PDMPs, according to the CDC, include:

More seamlessly integrating them into electronic health records
Permitting physicians to delegate PDMP access to other allied health professionals in their office (physician assistants and nurse practitioners)
Streamlining the process for providers to register with the PDMP.

While monitoring is helping decrease the abuse of prescription opioids, some industry experts fear it may be contributing to more dangerous practices among abusers. In the last few years, overdoses from illicit opioids, such as heroin and fentanyl, have skyrocketed.

“The most serious concern about [PDMP] implementation is that it could push people who are misusing prescription opioids to an illicit drug market that is flooded with ultra-potent fentanyls.” says Hill. “In my opinion, that isn’t an argument against [PDMPs] so much as an argument for expanded access to evidence-based treatment with methadone and buprenorphine.”

4. Preparing for Worst-Case Scenarios

Expanding pharmacists’ authority to administer and dispense opioid-reversing medications such as naloxone may help pharmacists prevent patient overdoses from legal and illegal drugs.

Some states permit pharmacists to dispense naloxone through a collaborative practice agreement. In states where pharmacists can prescribe naloxone, they must complete training provided by their employer or a local school of pharmacy.

“This initiative requires significant outreach to pharmacists, patients and caregivers, first responders, and legislators,” says Catizone. “Besides educating people on when and how to properly administer such medications, there is the need to educate stakeholders and naysayers about addiction as a disease and not a stigma or indictment of an individual.”

More legislation empowering pharmacists, caregivers, and first responders to ensure the widespread availability of naloxone and other similar products across all states would help save many lives, Catizone says.

“Until the number of patients who are at risk or dying from the use and abuse of opioids is zero or as close to zero as humanly possible,” Catizone says, “there is much more than can be done by pharmacists, pharmacy boards, and other stakeholders.

Isn’t it amazing, Pharmacists are suppose to be scientists … suppose to be “drug experts”… here we have a article about them individually and collectively ignoring some of the basics of opiates used to treat pain.

It starts out with the apparent unquestionable belief that all of those opiate conversion tablets are an “exact science”.. apparently most/many/all have not read the “fine print” on these website.. here is just one “warning” from one such conversion websites http://www.globalrph.com/narcotic.cgi 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.

Then there is this … pharmacists should help decide what medication is indicated, the best interval, and identify any potential interactions I wonder if when a pharmacist is to this evaluation – of subjective pain – and probably has no idea of the pt’s CYP-450 opiate metabolism rate status and those with a fast/ultra fast metabolism.. may or may not get an appropriate dose… since it doesn’t conform to the “cookie cutter” dosing guidelines that has been established as a standard of care and/or best practices within the hospital.

Then there is the apparent belief that the data within the PMP is infallible and no pts/diverters/abusers would present a fake/forged/stolen ID when they have a prescription filled.

If only those who are professing in trying to help pain pts and don’t know all the rules.. especially when they are dealing with treating a subjective disease.

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The other opioid crisis: Hospital shortages lead to patient pain, medical errors

Posted on March 17, 2018 by Pharmaciststeve

https://www.news-medical.net/news/20180316/The-other-opioid-crisis-Hospital-shortages-lead-to-patient-pain-medical-errors.aspx

The shortage, though more significant in some places than others, has left many hospitals and surgical centers scrambling to find enough injectable morphine, Dilaudid and fentanyl — drugs given to patients undergoing surgery, fighting cancer or suffering traumatic injuries. The shortfall, which has intensified since last summer, was triggered by manufacturing setbacks and a government effort to reduce addiction by restricting drug production.

As a result, hospital pharmacists are working long hours to find alternatives, forcing nurses to administer second-choice drugs or deliver standard drugs differently. That raises the risk of mistakes — and already has led to at least a few instances in which patients received potentially harmful doses, according to the nonprofit Institute for Safe Medication Practices, which works with health care providers to promote patient safety.

In the institute’s survey of hospital pharmacists last year, one provider reported that a patient received five times the appropriate amount of morphine when a smaller-dose vial was out of stock. In another case, a patient was mistakenly given too much sufentanil, which can be up to 10 times more powerful than fentanyl, the ideal medication for that situation.

In response to the shortages, doctors in states as far-flung as California, Illinois and Alabama are improvising the best they can. Some patients are receiving less potent medications like acetaminophen or muscle relaxants as hospitals direct their scant supplies to higher-priority cases. Other patients are languishing in pain because preferred, more powerful medications aren’t available, or because they have to wait for substitute oral drugs to kick in.

The American Society of Anesthesiologists confirmed that some elective surgeries, which can include gall bladder removal and hernia repair, have been postponed.

In a Feb. 27 letter to the U.S. Drug Enforcement Administration, a coalition of professional medical groups — including the American Hospital Association, the American Society of Clinical Oncology and the American Society of Health-System Pharmacists — said the shortages “increase the risk of medical errors” and are “potentially life-threatening.”

In addition, “having diminished supply of these critical drugs, or no supply at all, can cause suboptimal pain control or sedation for patients,” the group wrote.

The shortages involve prefilled syringes of these drugs, as well as small ampules and vials of liquid medication that can be added to bags of intravenous fluids.

Drug shortages are common, especially of certain injectable drugs, because few companies make them. But experts say opioid shortages carry a higher risk than other medications.

Giving the wrong dose of morphine, for example, “can lead to severe harm or fatalities,” explained Mike Ganio, a medication safety expert at the American Society of Health-System Pharmacists.

Calculating dosages can be difficult and seemingly small mistakes by pharmacists, doctors or nurses can make a big difference, experts said.

Marchelle Bernell, a nurse at St. Louis University Hospital in Missouri, said it would be easy for medical mistakes to occur during a shortage. For instance, in a fast-paced environment, a nurse could forget to program an electronic pump for the appropriate dose when given a mix of intravenous fluids and medication to which she was unaccustomed.

“The system has been set up safely for the drugs and the care processes that we ordinarily use,” said Dr. Beverly Philip, a Harvard University professor of anesthesiology who practices at Brigham and Women’s Hospital in Boston. “You change those drugs, and you change those care processes, and the safety that we had built in is just not there anymore.”

Chicago-based Marti Smith, a nurse and spokeswoman for the National Nurses United union, offered an example.

“If your drug comes in a prefilled syringe and at 1 milligram, and you need to give 1 milligram, it’s easy,” she said. “But if you have to pull it out of a 25-milligram vial, you know, it’s not that we’re not smart enough to figure it out, it just adds another layer of possible error.”

During the last major opioid shortage in 2010, two patients died from overdoses when a more powerful opioid was mistakenly prescribed, according to the institute. Other patients had to be revived after receiving inaccurate doses.

The shortage of the three medications, which is being tracked by the FDA, became critical last year as a result of manufacturing problems at Pfizer, which controls at least 60 percent of the market of injectable opioids, said Erin Fox, a drug shortage expert at the University of Utah.

A Pfizer spokesman, Steve Danehy, said its shortage started in June 2017 when the company cut back production while upgrading its plant in McPherson, Kan. The company is not currently distributing prefilled syringes “to ensure patient safety,” it said, because of problems with a third-party supplier it declined to name.

That followed a February 2017 report by the U.S. Food and Drug Administration that found significant violations at the McPherson plant. The agency cited “visible particulates” floating in the liquid medications and a “significant loss of control in your manufacturing process [that] represents a severe risk of harm to patients.” Pfizer said, however, that the FDA report wasn’t the impetus for the factory upgrades.

At the same time, in an attempt to reduce the misuse of opioid painkillers, the Drug Enforcement Administration called for a 25 percent reduction of all opioid manufacturing last year, and an additional 20 percent this year.

“DEA must balance the production of what is needed for legitimate use against the production of an excessive amount of these potentially harmful substances,” the agency said in August.

When the coalition of health groups penned its letter to the DEA last month, it asked the agency to loosen the restrictions for liquid opioids to ease the strain on hospitals.

The shortages are not being felt evenly across all hospitals. Dr. Melissa Dillmon, medical oncologist at the Harbin Clinic in Rome, Ga., said that by shopping around for other suppliers and using pill forms of the painkillers, her cancer patients are getting the pain relief they need.

Dr. Shalini Shah, the head of pain medicine at the University of California-Irvine health system, pulled together a team of 20 people in January to figure out how to meet patients’ needs. The group meets for an hour twice a week.

The group has established workarounds, such as giving tablet forms of the opioids to patients who can swallow, using local anesthetics like nerve blocks and substituting opiates with acetaminophen, ketamine and muscle relaxants.

“We essentially have to ration to patients that are most vulnerable,” Shah said.

Two other California hospital systems, Kaiser Permanente and Dignity Health in Sacramento, confirmed they’re experiencing shortages, and that staff are being judicious with their supplies and using alternative medications when necessary. (Kaiser Health News, which produces California Healthline, is not affiliated with Kaiser Permanente.)

At Helen Keller Hospital’s emergency department in Sheffield, Ala., earlier this month, a 20-year-old showed up with second-degree burns. Dr. Hamad Husainy said he didn’t have what he needed to keep her out of pain.

Sometime in January, the hospital ran out of Dilaudid, a drug seven times more potent than morphine, and has been low on other injectable opioids, he said.

Because Husainy’s patient was a former opioid user, she had a higher tolerance to the drugs. She needed something strong like Dilaudid to keep her out of pain during a two-hour ride to a burn center, he said.

“It really posed a problem,” said Husainy, who was certain she was in pain even after giving her several doses of the less potent morphine. “We did what we could, the best that we could,” he said.

Bernell, the St. Louis nurse, said some trauma patients have had to wait 30 minutes before getting pain relief because of the shortages.

“That’s too long,” said Bernell, a former intensive care nurse who now works in radiology.

Dr. Howie Mell, an emergency physician in Chicago, said his large hospital system, which he declined to name, hasn’t had Dilaudid since January. Morphine is being set aside for patients who need surgery, he said, and the facility has about a week’s supply of fentanyl.

Mell, who is also a spokesman for the American College of Emergency Physicians, said some emergency departments are considering using nitrous oxide, or “laughing gas,” to manage patient pain, he said.

When Mell first heard about the shortage six months ago, he thought a nationwide scarcity of the widely used drugs would force policymakers to “come up with a solution” before it became dire.

“But they didn’t,” he said.

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One month she’s supervising state drug program, next month she’s with CVS

Posted on March 17, 2018 by Pharmaciststeve

http://www.dispatch.com/news/20180316/one-month-shes-supervising-state-drug-program-next-month-shes-with-cvs

Margaret Scott had responsibility over the Ohio Department of Medicaid’s pharmacy program until she departed last fall. Within a month, she was working for a company that is receiving billions of pharmacy dollars from Ohio’s Medicaid managed care programs.

Scott and the contractor, pharmacy giant CVS, aren’t answering questions about what happened. But the state’s ethics watchdog — while not speaking specifically about Scott’s situation — said it’s illegal for a state employee to continue to be involved in decisions that might affect an outside business while negotiating a new job with that business.

Scott’s case might be of particular interest because CVS’s “pharmacy-benefit manager” contracts with Medicaid managed-care organizations are drawing scrutiny from legislative leaders. The Dispatch on Tuesday reported on accusations by independent pharmacists that CVS — which holds four of the five such contracts in Ohio — is charging an excessive price from taxpayers for drugs and reimbursing retail pharmacies with lowballed rates in an attempt to push out competition.

According to her LinkedIn page, Scott was with the Department of Medicaid from 2004 until last October. Then in November, she was a clinical adviser for CVS.

Melissa Ayers, a spokeswoman for the Department of Medicaid, said Friday the agency is still looking into the matter. But she said that Scott did not have authority over the CVS pharmacy-benefit manager contracts because those were between CVS and the managed-care companies that contract with the state.

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Pharmacist had filled the Rx for 10 times the recommended dosage, and the girl had died at the hospital during the night…

Posted on March 16, 2018 by Pharmaciststeve

shared this a few years ago, still no less true…

I want to share a small parable with you… Please keep in mind that a parable is a made up story, written or told to illustrate a point… So here goes… A “manager” did everything in his power to schedule his pharmacy to what the company demanded… According to the company’s mandates, everyone was to schedule much lower than the manpower each “manager” needed to get their pharmacy’s work done… If the corporation could save money by giving employees less hours, the managers were supposed to do it, so the company could (somehow) make more money by saving on wages rather than make money by getting the work done… It was already a stressful environment with the phones ringing constantly, situations not working out as planned, and customers complaining loudly that everything was taking too long… But the corporation didn’t care about this… They wanted to see profits being made on the bottom line so that they looked good to the shareholders… Even if the stores were already financially successful, the corporation felt that these stores could be more successful… Even if the environment in the pharmacies went from stressful to impossible… It was hard before to get all the work done and the Rx orders checked accurately, but now it was next to impossible to get the order out in time and the employees were all stressed beyond belief… But still the “manager” tried his best to be a good little employee and to make his corporation happy… He scheduled his employees to the demands his company imposed… Several of his contemporaries had written letters to their state’s Board Of Pharmacy to alert them of these dangerous situations, but every letter had gone unanswered and ignored… On one particular night, the manager was working, and the customers were milling around and waiting impatiently for their Rxs… The “manager” could feel their eyes on him and felt the stress tightening his neck muscles, his chest, and his headache was roaring… He completed a 5 year old girl’s Rx order hurriedly, called her name, handed it to the technician, and her parents paid for it at the ultra slow register and left… The “manager” and his staff still had tons of work to complete because they were so shorthanded from his following of the understaffing requirements… The understaffed employees worked until closing, locked up the pharmacy, and went home to sleep to prepare for the next day… Of course, all the employees were so stressed out and wound up, they did not sleep well at all… The next morning began even more hectic than the previous day… The phone rang and the “manager” picked up the call… An emergency room Dr. was on the line and wanted to discuss the prescription that the 5 year old girl’s parents had picked up the night before… It had been filled for 10 times the recommended dosage, and the girl had died at the hospital during the night…

So shame on that corporation… Shame on them for putting their shareholders’ wants ahead of their patient’s safety… Shame on their Board Of Pharmacy for ignoring the pleas of the pharmacists who cared… And shame on that “manager” for following the demands of an uncaring corporation and for letting this unfortunate chain of events happen…

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The complaint alleges deceptive and unfair trade practices, public nuisance, negligence, unjust enrichment and racketeering.

Posted on March 16, 2018 by Pharmaciststeve

Broward sues manufacturers and pharmacies over opioids

http://www.sun-sentinel.com/local/broward/fl-sb-broward-sues-over-opioids-walgreens-walmart-cvs-20180315-story.html

Broward County is going after opioid manufacturers it blames for the epidemic that has ravaged communities — and large pharmacy chains that it says were too ready to fill even questionable prescriptions for the drugs.

The county filed suit Monday in federal court against 19 companies in the opioid suit, including manufacturers such as Purdue Pharma, Cephalon and Teva Pharmaceuticals and pharmacies such as Walgreens, Walmart and CVS.

The complaint alleges deceptive and unfair trade practices, public nuisance, negligence, unjust enrichment and racketeering.

Broward, like many other local governments across the country, is suing or considering suing the companies because of the large costs incurred as the opioid epidemic taxes local police and emergency medical services. About 200 suits, including one by Delray Beach, have been filed nationally.

Palm Beach County this week selected a legal team to pursue its suit.

The prescriptions are for brand-name medications like OxyContin, Opana, Subsys, Fentora and Duragesic. Generic versions included oxycodone, methadone and fentanyl.

Overdose deaths have skyrocketed with the popularity of opioids, including heroin and super-potent synthetic versions of the drug.

“The overdose epidemic is estimated to have claimed more than 900 lives in South Florida in 2016 alone, including 582 drug deaths in Broward County,” the suit said. By the end of 2016, 10 people a week were losing their lives in Broward County to overdoses and another 17 a week had non-fatal overdoses, with most related to heroin, fentanyl and other opioids, according to the suit.

The suit says the opioid manufacturers misled the public for more than 20 years about the dangers of opioid addiction and problems with its long-term use. It alleges fraudulent activity on their part, saying they paid “front organizations” that published false and misleading marketing materials.

The suit seeks to stop the manufacturers from making any further false or misleading statements regarding opioids and to assure that pharmacies will report suspicious prescriptions. The county is seeking more than $75,000 in damages — including punitive damages — for injuries it sustained because of the epidemic.

Drug makers have denied wrongdoing. With the onslaught of legal action against them, they say they have made efforts to stem diversion of their pain medications into the black market.

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Overdose deaths surge as highly-potent synthetic fentanyl grows in popularity

Posted on March 15, 2018 by Pharmaciststeve

http://www.wzzm13.com/article/news/overdose-deaths-surge-as-highly-potent-synthetic-fentanyl-grows-in-popularity/69-528978058

As Kent County grapples with a surge in overdose deaths, federal law enforcement officials say they will be paying special attention to synthetic forms of the painkiller fentanyl, which is becoming a popular – and deadly – substitute for heroin.

Author: John Hogan

Published: 6:20 PM EDT March 15, 2018

Updated: 6:54 PM EDT March 15, 2018

As Kent County grapples with a surge in overdose deaths, federal authorities say they will be paying special attention to synthetic forms of the painkiller fentanyl, which is becoming a popular – and deadly – substitute for heroin.

“Fentanyl is just so deadly, we can’t ignore it,’’ said U.S. Attorney Andrew Birge. “If they’re importing, transporting fentanyl, they should consider themselves a federal target.’’

The U.S. Attorney’s Office for the Western District of Michigan has seen a 50 percent increase in prosecutions for heroin offenses. Fentanyl prosecutions, he said, are expected to climb as more enters the market.

“I want the word out there – do something else,’’ Birge said. “Don’t get involved in heroin and certainly don’t get involved with fentanyl and heroin.’’

Kent County had 137 confirmed overdose deaths in 2017; an increase of 47 percent from the previous year. That number is expected to rise once 24 pending cases are resolved.

About four in five fatal overdoses involve an opioid. Fentanyl was found in more than half of the opioid deaths.

But it’s no longer just prescription fentanyl, which is used as a pain reliever and often administered through a patch. Much of what is being seen is made outside the U.S. in powder form.

Kent County Chief Medical Examiner Dr. Stephen Cohle calls the increase in fentantyl deaths “staggering.’’

“We’re seeing overdoses from just fentanyl and heroin mixed with fentanyl,’’ he said. “That combo is extremely common these days and it’s not slowing down.’’

The Drug Enforcement Administration says the powder form of fentanyl is popular because it is potent and can be easily mixed with other drugs, including cocaine. It comes from clandestine labs in Asia and from Mexican drug cartels, said Bruce McColley, assistant special agent in charge of the DEA office in Detroit.

“We’re not only seeing it in heroin, we’re also seeing organizations cutting this into cocaine and other drugs to make them more powerful and more economically profitable,’’ McColley said.

Cohle says fatal overdoses have been used as a macabre marketing tool.

“Word gets around and people flock to that dealer because he’s got the good stuff,’’ Cohle said. “It’s like speed in a car. They want a faster car. The results are deadly.’’

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How Cops Hide Surveillance Snooping From Courts: New at Reason

Posted on March 15, 2018 by Pharmaciststeve

https://reason.com/blog/2018/03/15/how-cops-hide-surveillance-snooping-from

In 2004, Ascension Alverez-Tejeda and his girlfriend were stopped at a traffic light in Oregon when their car was rear-ended by a drunk driver. The police arrived and arrested the drunk, but while Alverez-Tejeda was outside dealing with the situation, a thief jumped in his car and tore off down the road.

Police recovered the car and, after obtaining a search warrant from a judge, found in it cocaine and methamphetamine that Alverez-Tejeda was trafficking from California to Washington.

It looked like a case of very bad luck for Alverez-Tejeda. The truth didn’t come out until the trial: The whole thing had been staged. The only ones who weren’t in on the plot were Alverez-Tejeda, his girlfriend, and the judge who signed the warrant. The Drug Enforcement Administration (DEA), relying on surveillance and wiretaps, had tipped off local law enforcement to Alverez-Tejeda. The cops then constructed an elaborate ruse to gain probable cause to search his car, writes C.J. Ciaramella for the April print edition of Reason.

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Here’s How To Make Sure Congress Hears You

Posted on March 15, 2018 by Pharmaciststeve

https://www.huffingtonpost.com/entry/contacting-your-congressional-representative_us_582a0965e4b060adb56f8e95

The results of this year’s presidential election have been incredibly polarizing.

If you’re in the camp of feeling helpless or overwhelmed, countless people have spoken up to highlight ways you can take action and move forward.

Emily Ellsworth is one of them.

A freelance writer, editor and social media marketer from Salt Lake City, Ellsworth recently shared her expertise on Twitter about how to get the attention of your local congressional representative.

The 30-year-old cut her teeth in Congress by working in the district offices of Utah Reps. Jason Chaffetz and Chris Stewart, and “acting as a liaison for people and the federal agencies they needed help with.”

Ellsworth sent out a series of tweets on Nov. 11 to let inquiring minds know how they can get involved with Congress and have their voices heard:
Because the tweets have garnered some serious social traction over the past few days, Ellsworth put them all together via Storify for your reading pleasure.

The series of tweets chronicles her time in Congress, what actions taken by constituents were effective and ineffective, and that your calls do matter.
Ellsworth said she was prompted to tweet after seeing people in her feed talking about the next steps they could take after the election.
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“From my experience, I knew that not many people had ever contacted their congressional representatives,” she told The Huffington Post. “I hoped I could pull back the curtain on what it’s like to be on the other end of the phone.”

Ellsworth’s advice on what to do has been so helpful that one reader even turned her words into a printable page you can give to your less tech-savvy friends and family.

How to Contact Congress by Jenna Amatulli on Scribd

There is a lot of detailed information on the above hyperlink.. I could not copy or embed

Filed under: General Problems | Leave a Comment »

As we reach out to addicts… with clean needles prgms and the like….. chronic painers have to seek other solutions ?

Posted on March 15, 2018 by Pharmaciststeve

I am likely to end my life very soon.

Filed under: General Problems | 10 Comments »

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