How France Cut Heroin Overdoses by 79 Percent in 4 Years

Posted on April 16, 2018 by Pharmaciststeve

https://www.theatlantic.com/health/archive/2018/04/how-france-reduced-heroin-overdoses-by-79-in-four-years/558023/

In the 1980s, France went through a heroin epidemic in which hundreds of thousands became addicted. Mohamed Mechmache, a community activist, described the scene in the poor banlieues back then: “To begin with, they would disappear to shoot up. But after a bit we’d see them all over the place, in the stairwells and halls, the bike shed, up on the roof with the washing lines. We used to collect the syringes on the football pitch before starting to play,” he told The Guardian in 2014.

The rate of overdose deaths was rising 10 percent a year, yet treatment was mostly limited to counseling at special substance-abuse clinics.

In 1995, France made it so any doctor could prescribe buprenorphine without any special licensing or training. Buprenorphine, a first-line treatment for opioid addiction, is a medication that reduces cravings for opioids without becoming addictive itself.

With the change in policy, the majority of buprenorphine prescribers in France became primary-care doctors, rather than addiction specialists or psychiatrists. Suddenly, about 10 times as many addicted patients began receiving medication-assisted treatment, and half the country’s heroin users were being treated. Within four years, overdose deaths had declined by 79 percent.

 

Of course, France has a socialized medical system in which many users don’t have to worry about cost, and the country also developed a syringe-exchange program around the same time. Some of the users did sell or inject the buprenorphine (as opposed to taking it orally, as indicated), though these practices didn’t result in nearly as many deaths as heroin does.

“It seems that the French model raises questions about the value of tight regulations imposed by many countries throughout the world,” wrote the author of a study on the phenomenon, the French psychiatrist Marc Auriacombe, in 2004.

Just what are these regulations? In the United States, doctors must take a special, eight-hour class to get a waiver that allows them to prescribe buprenorphine. The classes can cost money and force even more tasks into doctors’ already packed schedules. In one study, 10 percent of doctors said they didn’t even know how to get the waiver. According to Andrew Kolodny, a psychiatrist who studies addiction at Brandeis University, some primary-care doctors might frankly be daunted by the prospect of working with addicted patients—a sentiment that’s also reflected in physician surveys. Meanwhile, there is no special training class required to prescribe prescription painkillers, Kolodny points out. (There’s also a cap on how many buprenorphine patients a single doctor can have, though Congress is considering waiving this limit through new legislation.)

 
There are multiple other issues in the American health-care system that make accessing buprenorphine difficult for addicted people. Medicaid pays for a substantial chunk of all drug-abuse treatment, but state Medicaid programs impose limits on when and how they’ll cover buprenorphine.

Finally, doctors know that if they sign up to prescribe buprenorphine, all the local heroin users will flock to them, potentially crowding out their other patients, says Stanford University professor of psychiatry Keith Humphreys. “Doctors also want to take care of kids with colds, and adults with bad backs and cancer patients and the panoply of humanity that they know how to take care of,” he said via email. One way to resolve this would be to require doctors who are licensed to prescribe prescription painkillers to also prescribe buprenorphine.

The result of all this is that many addicted people just can’t find a doctor willing to prescribe them buprenorphine on demand, especially if they want insurance to pay for it. For example, The Atlantic looked up Parkersburg, a city of 30,000 people in West Virginia, the state with the most overdose deaths, on Suboxone.com, a site that lists buprenorphine providers. We found 10 doctors within a 50-mile radius who prescribe buprenorphine, and we attempted to reach all 10.

Some of the contacts appeared to be in the same office. We were told one doctor had a waiting list for patients, three doctors did not accept insurance and charged hundreds of dollars a month in cash, one had a number that was disconnected, and, finally, one was both accepting new buprenorphine patients and took insurance.

“If you really want someone who’s addicted to seek treatment, you have to have it be less expensive than using heroin,” Kolodny said. For many addicted Americans, that’s not currently the case.

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The DEA is making raids look like robberies — with really dangerous consequences for innocent people

Posted on April 16, 2018 by Pharmaciststeve

http://theweek.com/speedreads/767739/dea-making-raids-look-like-robberies–really-dangerous-consequences-innocent-people

The Drug Enforcement Administration likes to use something called a “sneak-and-peek warrant,” a search warrant that allows agents to enter and search a property without notifying the owner as a normal warrant would require. Officers operating on a sneak-and-peek (officially, a Delayed Notice Warrant) typically aren’t allowed to take any evidence they find on-site — but they do frequently trash the place, faking a burglary to explain their break-in.

Sneak-and-peek searches were authorized by the Patriot Act and, as is often the case with this law’s provisions, quickly became more useful for the federal drug war. But the trouble with fake-robbing people is it can lead to unintended, dangerous consequences, like those experienced by an Oregon storage locker manager named Shawn Riley.

In December, The Oregonian reports, Riley was tied up and held at gunpoint by alleged drug traffickers who believed he’d stolen the cache of marijuana they’d stored at his facility. It turns out the DEA was the real culprit; agents had done a sneak-and-peek and confiscated 500 pounds of pot. “The danger of violence is obviously real, and this case makes it very evident,” said Cleveland State criminal law professor Jonathan Witner-Rich, a warrants expert. “Someone could have been killed.”

Marijuana is legal in Oregon, and the 500 pounds was allegedly set for transport to Texas. The DEA declined to comment to The Oregonian. Bonnie Kristian

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When doctors pass the buck: The ugly side of a shift-work mentality

Posted on April 15, 2018 by Pharmaciststeve

https://www.kevinmd.com/blog/2015/09/when-doctors-pass-the-buck-the-ugly-side-of-a-shift-work-mentality.html

“I’m just the night doc,” you said. You said it with emphasis as if that explained everything and dismissed your incompetence, your lack of compassion, your failure to care. Unfortunately my sister was “just the patient,” who lay suffering hours before her death and the RN was “just the nurse” withholding the morphine that the daytime doctor had ordered for air hunger and agitation. The nurse called you in to manage me when I asked her to give my sister a touch of morphine; she was crying out in pain from her hypoxia.

A civilized, yet ridiculous argument ensued about the dangers of respiratory depression in a patient who was clearly dying. You and I, physicians and colleagues, were arguing over 2 mg of morphine when you said, “I’m just the night doc.” I’m still shaking my head over the absurdity. Instead of assessing the situation you felt the need to pass the buck until morning. Does no one die on your watch? You were so busy, not being a physician, that you must have missed the oxygen saturation in the 70s and the flipped T waves predicting my sister’s imminent demise.

The life and death stakes were not high, the end result would have been the same. We both knew that, so why did you feel the need to distance yourself from your decision to withhold medication with a just statement? “I’m just” means that you are under no obligation to act. You were telling me in essence that you were a just an overnight placeholder in the ICU. When we are just doctors we are not our best selves.

A more honest, although equally lame statement would have been, “It’s not my job.” However, that declaration begs the questions as to whose job is it to orchestrate patient care after dark? Having been a doctor for three decades, I can’t remember a time when my obligation to care for patients stopped at dusk. That implies that patients can only expect our best selves in the daylight hours. Did I miss the memo, has medicine gone so far away from patient care that this shift work mentality is the norm or were you “just an ass”? What if you’re only a Wednesday doctor, but you’re working on Friday, will you wait until Wednesday to treat? The absurdity boggles my mind.

I don’t blame you for my sister’s death, everyone knew she was dying. She had asked for resuscitation measures to be stopped. However, in saying I don’t want extraordinary measures she never said, “I welcome a painful, oxygen starved, horrible death.” I had promised to be there with her, and I had explained the likely outcome. She trusted me to watch over her as a sister, not as a physician and I couldn’t do it. My real anger is directed inward, and I can’t forgive myself for leaving the hospital. I let you drive me away in the last few hours of my sister’s life, because I was angry and powerless. I couldn’t “just be a sister.”

Every one of us as health care professionals that night had a duty to care and we all failed due to our individual arrogance. I used your lack of compassion as my excuse to avoid facing the last three hours of her life.

We wear many hats as physicians but can we ever just be family members? The family relies on us, to translate complex medical speak, to help them understand the big picture and to act as liaisons with other healthcare providers. We usually do this willingly and in my experience, it unfortunately also allows us to keep our distance from our own very painful human experiences. I know that I am much stronger in a medical crisis when I am in “doctor mode.” You, the night doc and the night nurse wouldn’t let me be a doctor that night, thus the power struggle at the bedside. I would love to give you credit for urging me be the sister instead of the doctor, a much healthier way to grieve, but that wasn’t your intent. You made it clear that there would be no team decisions despite the fact that I had been there all night, knew my sister’s wishes intimately and had watched her oxygen saturation plummet and the T waves dip.

If I hadn’t been a doc, would you have been more compassionate towards my family? Were you practicing defensive medicine because I was there? Who better to understand compassionate palliative medicine than me, your senior colleague?

As we kept our distance from death, by arguing a moot point, my middle sister ignored us and kept her promise to my dying sister. She prayed, “Hail Mary, full of grace” softly in my sister’s ear, a comfort to both of these women of faith. She did not distance herself; she immersed herself in the process of helping another die. If we had set our collective arrogance aside perhaps we could have acted as a team and stayed in the moment with a suffering fellow human being. Patients are never just patients; my sister was a vibrant and brave mother, sister, wife, and friend. All of us failed to recognize what a profound privilege it would have been to assist another to die with dignity and grace. None of us were there three hours later when my sister passed away with a team that included a kind nurse, a compassion physician, and my sister with faith. I can’t forgive either of us for being “just doctors,” there’s no dignity in that.

Tracey Delaplain is an obstetrician-gynecologist who blogs at What’s for dinner, Doc?

Over the years, I have found myself in similar situations with Mother, Father-in-law, Mother-in-law and wife. Some end of life issues, others just poor/inept care being provided or lack of care being provided.  Depending on my perception of the severity of the violation of what is the standard of care… depends on how I approach the offending healthcare provider..  If it is rather minor infraction, I will try to muster up my “most diplomatic approach”… depending on their response determines if I drop directly into my “take no prisoners mode”… after running my own pharmacy for 20 yrs.. I  still have this “boss demeanor ” that I can bring to the forefront at a moment’s notice.  I have been known to – on occasion –  piss off hospital nursing staff… for not doing their job… at least at that point I know that I have got their attention.  Typically, things change.. in the right direction… it is gratifying to know that my loved ones are getting the medical attention that they need/deserve.

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Secret drug raid by feds backfires in Portland: ‘Someone could have been killed’

Posted on April 15, 2018 by Pharmaciststeve

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

Shortly after 9 a.m. on a Saturday in December, two men showed up at the office of a Public Storage warehouse in Southeast Portland and asked about renting space.

On-site manager Shawn Riley led them to an empty unit and unlocked it.

The pair followed him in, then suddenly drew large silver handguns. One of the men pressed his pistol against the manager’s forehead.

The two demanded to know who’d stolen their “stuff’’ — a stash of nearly 500 pounds of marijuana in another unit at the business.

Riley hadn’t taken anything, he told them in a shaky voice.

But who had?

Agents with the Drug Enforcement Administration, it turns out. And the agents deliberately made the confiscation look like a burglary, according to court records.

storage-foto-1JPG.JPG
Maxine Bernstein | The Oregonian/OregonLive
 The harrowing confrontation terrorized Riley and turned a spotlight on a controversial ploy used by agents in drug cases to smoke out suspected traffickers. Oregon surprisingly is No. 2 in the nation in requesting what are known as delayed-notice search warrants.

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

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

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

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

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

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

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

pot-plants.JPG
The Associated Press | File
 ‘I THINK THE POLICE DID’

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

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

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

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

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

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

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

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

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

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

DEA Agents Raid Michael Jackson's Doctor's Office In Houston
Eric Kayne | Getty Images | File
 ALLEGED OREGON-TO-TEXAS TRAFFICKING

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

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

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

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

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

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

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

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

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

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

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

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

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

storage-foto-2.JPG
Maxine Bernstein | The Oregonian/OregonLive
 

‘WEED IS LEGAL HERE’

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

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

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

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

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

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

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

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Three CVS actions raise concerns for some pharmacies, consumers

Posted on April 15, 2018 by Pharmaciststeve

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

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

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

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

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

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

CVS dialed up Roberta Timmons.

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

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

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

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

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

‘Extremely concerning’

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

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

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

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

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

 

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Prominent Pain Doctor Faces Hundreds of Lawsuits

Posted on April 14, 2018 by Pharmaciststeve

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

Imagine spending your retirement defending yourself against hundreds of lawsuits in courthouses around the country – all of them alleging that you played a key role in starting the opioid crisis and that you were indirectly responsible for thousands of overdose deaths.

“It is mind boggling to me and its frightening, actually. I don’t know how I’m going to defend myself,” says Lynn Webster, MD, a pain management expert and former president of the American Academy of Pain Medicine. “Right now, we’re just trying to keep our head above the water.”

Webster has been named as a defendent in so many class action lawsuits – along with Purdue Pharma, Johnson & Johnson, Endo, Janssen and other opioid manufacturers – that he’s lost track. He knows of at least 80 lawsuits but believes there are many more.

“I think it could be several hundred,” he says.

The latest one was filed this week by Salt Lake County, Utah — where Webster lives — alleging that drug makers employed him in deceptive marketing practices that downplayed the risks of addiction and overdose. Like the other lawsuits by states, counties and cities, Salt Lake County seeks to recover taxpayer money spent on treating addiction, combating opioid abuse and policing opioid related crimes.    

DR. LYNN WEBSTER

DR. LYNN WEBSTER

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

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

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

“Most of what they have in there, at least about me, is false. And I think I can prove that,” Webster told PNN.

A footnote in the lawsuit contains the curious but important disclaimer that “Salt Lake County asserts no claim against Dr. Webster arising from his medical practice. The claims against Dr. Webster relate solely to his participation, as a KOL and otherwise, in Manufacturing Defendants deceptive marketing campaign.”

‘Key Opinion Leader’

KOL is an acronym for “key opinion leader” – a euphemism for doctors alleged to be so influential that they helped convince other physicians to prescribe more opioids. Webster and three other pain doctors — Russell Portenoy, Perry Fine and Scott Fishman — are portrayed in the lawsuits as KOLs who greedily accepted millions of dollars in payments from drug makers in return for their promotion of opioids.

“It’s mind boggling to think how four individuals can be accountable for essentially brainwashing all of the doctors in the country to do something intentionally to make pharmaceutical countries rich. How can anyone think that is plausible? It’s crazy,” says Webster. “Most of the pharmaceutical companies that they’ve listed I never received a dime from.”

According to the Salt Lake County lawsuit, Webster was “handsomely rewarded for his efforts,” receiving nearly $2 million from opioid manufacturers from 2009 to 2013. Webster says that dollar amount is unfair and misleading because most of it stems from his work as a researcher. He is currently Vice President of Scientific Affairs at PRA Health Sciences, a clinical research company.

“If you’re a principal investigator in a research program that has contracted with a pharmaceutical company, that money goes under your name. But its money to conduct a trial. Not a penny of it goes to me,” says Webster. “I have received compensation for consultant work and advisory boards. My consultant work is because of my area of expertise. That’s not unusual. And I do not speak for a company’s product. I do not benefit at all because I personally have no shares in any pharmaceutical company.”

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

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

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

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“We don’t have any big pocket that’s going to pay for anything,” he said. “If a jury decided to award money from us, they wouldn’t get any money, because there is no money. We would be all bankrupt by the time we got to court.”

Drug makers, on the other hand, do have big pockets. And during the 1990’s many of the same law firms now involved in opioid litigation helped win big settlements with the tobacco industry worth upwards of $200 billion.  That includes the law firm of Hagens Berman, which is handling the Salt Lake County lawsuit. The firm also represents the city of Seattle in a nearly identical lawsuit against opioid makers, in which Webster is named as a KOL.

Webster is also named in a string of lawsuits filed by the law firm of Simmons Hanly Conroy, which represents dozens of states, counties and cities. Simmons will pocket one-third of the proceeds from any opioid settlement,  which could run into hundreds of billions of dollars.

Simmons is well connected politically, having donated $219,000 to the re-election campaign of Missouri Sen. Claire McCaskill (D), who coincidentally released a report in February that’s highly critical of patient advocacy groups and medical associations for accepting money from opioid manufacturers.

It is against these political, financial and legal forces that Webster must find a way to defend himself.

“The body of the allegations are inaccurate, misleading and irresponsibly paint a picture which ignores the realities of Dr. Webster’s compassionate commitment to alleviating suffering in his chronic pain patients,” Peter Striba, Webster’s attorney, wrote in a letter to the Salt Lake Tribune. “It is estimated that there are approximately one-hundred million chronic pain patients in our Country, and it is very telling that their suffering and their medical condition is entirely absent in the narrative of the Complaint.” 

 

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Cop steals pt’s medication – get ONE YEAR house arrest

Posted on April 14, 2018 by Pharmaciststeve

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

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

 

Former deputy accused of stealing pills pleads guilty to lesser charges

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

A former Palm Beach County Sheriff’s deputy who stole prescription pills from a West Boynton Beach residence two days after Hurricane Irma will serve a year of house arrest.

Jason Cooke was caught in the act on home surveillance video 90 minutes after paramedics took the dying 85-year-old homeowner to the hospital.

Originally charged with armed burglary and grand theft, Cooke on Friday in Palm Beach County Circuit Court pleaded to reduced charges of burglary and petty theft.

Under the terms of the plea deal, Cooke also must serve three years probation and surrender his law enforcement certification, court records show.

Three deputies — none of them was Cooke — had gone to Moe Rosoff’s house last October to perform a welfare check. They found Rosoff on the floor of the master bedroom. He died hours later at the hospital.

After paramedics took Rosoff to the hospital, Deputy Cooke later showed up. He had gotten the home-garage code from the sheriff’s dispatch log and used it to creep inside the residence, authorities said.

One of Rosoff’s sons, who had requested that deputies check on his father, watched from North Carolina as Cooke rummaged through his father’s belongings. The security video showed Cooke at the kitchen island pick up at least two containers and put them in his pocket.

Sometime after the burglary, Rosoff’s son handed over the video to the sheriff’s office. A sergeant watched it and recognized Cooke, according to a police report.

Investigators searched Cooke’s patrol car to find 60 pills, including narcotic painkillers, muscle relaxers and other medicine.

Cooke later admitted to taking pills from the counter. He resigned soon after his Oct. 19 arrest.

In court on Friday, Cooke’s lawyer said his client is getting help and is now a different person.

 

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U.S. Surgeon General visits Arkansas to encourage everyone to carry narcan

Posted on April 13, 2018 by Pharmaciststeve

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

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

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

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

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

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

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

One core issue is over-prescribing.

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

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

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

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

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

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

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

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

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Major push to combat opioid abuse doesn’t include bill to restore DEA powers

Posted on April 13, 2018 by Pharmaciststeve

Sen. Claire McCaskill, D-Mo.

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

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

Congress is expected to make a major push in the next few months to approve dozens of bipartisan bills to combat the opioid epidemic.

But missing from this effort is a bill to reverse a 2016 law that weakened the Drug Enforcement Administration’s power to go after suspicious drug distributors.

The House Energy and Commerce Committee’s health subcommittee is expected to hold its third legislative hearing on opioid legislation on Wednesday. The committee will consider more than 20 bills that introduce reforms to Medicare and Medicaid to combat the opioid epidemic. On the same day, the Senate Health, Education, Labor and Pensions Committee will hold a hearing on major opioid legislation.

 

Sen. Claire McCaskill, D-Mo., introduced a bill last year in the Senate to restore DEA powers to fight suspicious drug wholesalers. The bill has been referred to the Senate Judiciary Committee, which means it will not be part of the Senate HELP package.

McCaskill told the Washington Examiner that the bill has not gotten any Republican support.

“I have tried, but so far I have not been able to find anybody who has been willing to cosponsor it, and it is hard to get one across the finish line if you don’t have some Republicans that are willing to help,” McCaskill said.

The bill aims to strengthen DEA enforcement on distributors and wholesalers that give powerful painkillers to corrupt pharmacies called “pill mills. “

The Ensuring Patient Access and Effective Drug Enforcement Act of 2016 weakened that power after extensive lobbying from the pharmaceutical and drug distribution industry, according to an investigation from the Washington Post. The investigation forced Rep. Tom Marino, R-Pa., a major proponent of the legislation, to withdraw his name as nominee to become President Trump’s drug czar.

McCaskill said back in November that she wants to undo the damage done by the 2016 law that was passed by Congress and signed by former President Barack Obama.

The bill will also not be included in the collection of more than 40 bills being considered before the House Energy and Commerce Committee.

“We continue to work with DEA regarding possible legislative changes,” a House aide told the Washington Examiner. “It’s imperative we get this policy right, and we are doing our due diligence.”

The bills aim to focus on different facets of fighting the opioid epidemic, from treatment to enforcement tools. The legislative hearing on Wednesday will focus on legislation that aims to introduce reforms to Medicare and Medicaid to better curb opioid overprescribing and abuse.

Energy and Commerce leadership hope to get the bills through the House before the Memorial Day recess, while no timetable has been set yet for the Senate legislation.

The Senate HELP legislation intends to introduce reforms that include incentives to develop nonaddictive painkillers. It also aims to clarify Food and Drug Administration authority to require manufacturers to give simple and safe options to dispose of unused opioids.

It would also update DEA regulations to improve treatment access for people in rural areas, chiefly through telemedicine.

When asked about why her legislation was not included in this major legislative effort, McCaskill responded, “It’s really fascinating, isn’t it? I don’t get it.”

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

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Study: Indiana under-counting overdose death

Posted on April 13, 2018 by Pharmaciststeve

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

INDIANA (WFIE) –

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

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

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

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

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

Sometimes more than double the number.

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

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

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

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

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

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

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

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

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