Enforced Tapering: The Dangers of PAWS

If a person is stable on long term low-dose opioid therapy AND shows no signs of addiction, abuse or serious side effects: 1. WHY have Medical Authorities chosen to taper chronic pain patients from their mobility-restoring opioids, without supports in place? 2. WHY are chronic pain patients being advised they will experience “no long-term side effects from tapering”, yet many suffer from a life-changing condition known as Post-Acute Withdrawal Syndrome? 3. WHY have demonstrably flawed and “one-size-fits-all” Guidelines for Deprescribing Opioid Analgesics been released in Australia on 26-5-23?

VP Kamala Harris Calls To ‘Reduce Population” – heart beat away from being our President

Regular, Optimal Sleep Tied to Lower Mortality Risk

So how many chronic pain pts with under/untreated pain get a “good nights sleep”?  Another contributing factor to premature deaths of chronic pain pts with poorly treated pain ?

Regular, Optimal Sleep Tied to Lower
Mortality Risk

https://www.medscape.com/viewarticle/992942

Maintaining a regular healthy sleep schedule may help guard against premature death, new research suggests.

In a diverse group of older adults, those with regular and optimal sleep had about a 40% lower risk of dying of any cause during follow-up than peers who with irregular and insufficient sleep.

“If sleep were an eight-hour pill, it would be beneficial to take the full dose at regular times consistently,” lead researcher Joon Chung, PhD, with Harvard Medical School and Brigham and Women’s Hospital, Boston, Massachusetts, said in a news release.

The findings were presented at SLEEP 2023, the 37th annual meeting of the Associated Professional Sleep Societies.

Broad Adverse Health Effects

“Evidence is mounting that irregular sleep is associated with pretty broad adverse health outcomes, most prominently cardiometabolic disease, obesity, and cardiovascular disease,” Chung told Medscape Medical News.

In the current study, the researchers estimated the association of regular sleep of optimal sleep duration with all-cause mortality using data from 1759 adults the Multi-Ethnic Study of Atherosclerosis Sleep Study.

Sleep regularity and duration were classified using 7 days of data gathered by wrist actigraphy. Adults were categorized as “regular-optimal” sleepers (n = 1015) or “irregular-insufficient” sleepers (n = 744).

During 7 years of follow up, 176 people died. In the fully adjusted model, the regular-optimal group had a 39% lower mortality risk compared to the irregular-insufficient sleep group (hazard ratio, 0.61; 95% CI, 0.45 – 0.83). The findings were robust in sensitivity analyses.

The regular and optimal duration sleep pattern maps behaviorally to regular bed and wake times, suggesting potential health benefits of adherence to recommended sleep practices, the researchers note.

“Results suggest benefits of expanding the public conversation on getting ‘a good night’s sleep’ and broadening this goal to getting many good nights of sleep, in a row, on weekdays and weekends,” Chung said in the release.

He further told Medscape Medical News that “getting adequate, regular sleep seems to be something that is good for all. I don’t know of anyone who wouldn’t benefit.”

Fariha Abassi-Feinberg, MD, spokesperson for the AASM and sleep specialist with the Millennium Physician Group, Fort Myers, Florida, agrees.

“We know our bodies have an internal clock, known as the circadian rhythm, which regulates various biological processes, including sleep-wake cycles. Sticking to a consistent sleep schedule allows your body to align its natural rhythm with the external day-night cycle. This synchronization promotes better sleep quality and therefore better health,” said Abassi-Feinberg, who wasn’t involved in the study.

“The AASM recommends adults try to aim for at least 7 hours of sleep and I often tell my patients that keeping a regular routine is best for your sleep and health,” she told Medscape Medical News.

Funding for the study was provided by the American Academy of Sleep Medicine Foundation and the National Institutes of Health. Chung and Abassi-Feinberg report no relevant financial relationships.

Mexican authorities raid pharmacies in inquiry into fentanyl-tainted pills

Mexican authorities raid pharmacies in inquiry into fentanyl-tainted pills

https://www.latimes.com/world-nation/story/2023-07-07/mexican-authorities-raid-pharmacies-in-inquiry-into-fentanyl-tainted-pills

A man walks past a storefront advertising prescription drugs
Pharmacies in Cabo San Lucas, Mexico, are selling counterfeit prescription pills laced with illicit substances and passing them off as legitimate pharmaceuticals.

Authorities in Mexico raided several Los Cabos drugstores last month and arrested four people as part of an ongoing investigation into pharmacies selling counterfeit pills laced with fentanyl and methamphetamine.

The flurry of law enforcement action in the peninsular municipality comes on the heels of a Los Angeles Times investigation that found pharmacies from Tulum to Tijuana were passing off powerful drugs, including fentanyl and methamphetamine, as weaker medications commonly sought out by tourists. Of the 55 opioid painkillers and ADHD medications The Times tested over a four-month period, slightly more than half proved to be counterfeit.

Alejandro Torres Pineda, a delegate of the attorney general’s office in Baja California Sur, said Mexico’s investigation was sparked by local media coverage of the issue — coverage that was based on and extensively credited The Times’ reporting.

In total, authorities confiscated nearly 25,000 pills in the raids. None of them tested positive for fentanyl or methamphetamine, according to Pineda, but came back as other controlled substances that the pharmacies did not have authorization to sell.

“We’re continuing the investigations,” he said in a phone interview last week.

The raids are important, Pineda said, “because the sale of controlled medicines is inhibited, the health of citizens is protected and the type of medicines sold in pharmacies is controlled.”

Ahead of the raids, federal police went to different pharmacies around Los Cabos and interviewed people — including one from North America — as they left the businesses. One person told police that she was buying medicine for back pain. When authorities tested the pills, they found that her purchase also ran afoul of regulations.

A judge then granted law enforcement authorities permission to search the pharmacies in Cabo San Lucas and San José del Cabo. Two were raided June 3 and three others were raided June 20. Authorities found diazepam and clonazepam, anti-anxiety medications usually known in the U.S. by the brand names Valium and Klonopin.

The raids by law enforcement — including federal police, the attorney general’s office and the Mexican navy — netted a cache of money and boxes of pills. Images released by Mexico’s attorney general showed clusters of gun-toting, camouflage-clad police wearing balaclavas standing in front of blurred-out drugstores.

Of the people arrested, Pineda said, three were pharmacy employees and the fourth was an owner of one of the businesses. There’s nothing yet that points to cartel involvement, he added.

The municipal director of public safety in Los Cabos, Jesús Antonio Gómez Rodríguez, framed the recent operation as a positive step.

“In terms of security, the work coordinated by three levels of government is yielding good results, with the aim of guaranteeing the safety of locals and visitors,” Gómez said. “It’s protecting the health of our young people who can fall into the clutches of drugs, as well as the numerous groups of visitors who come to our municipality to enjoy its natural beauties and tourist services.”

Drugstores in Mexico have long been known for selling a wide range of medications over the counter, including many that would require a prescription in the U.S. Until recently, drug market experts had generally believed that pills sold in stores — unlike those sold on the street — were at least what the store owners said they were.

But in February, The Times published an investigation after testing pills from pharmacies in three cities, including San José del Cabo and Cabo San Lucas. In each city, some of the pills sold over the counter as either oxycodone or Adderall tested positive for fentanyl or methamphetamine. Around the same time, a UCLA research team recorded similar findings.

Over the next few weeks, reporters identified at least half a dozen people who overdosed or died after taking pills they’d purchased at pharmacies in Mexico. Grieving families had been alerting U.S. government officials as early as 2018. It was not until March, however, that the U.S. State Department explicitly warned the public about the danger.

On June 14, The Times published a broader investigation, documenting the problem across the country, from Mexico’s southeastern tip in the Yucatán Peninsula to its border with California. Of the 55 pills reporters tested, 28 were counterfeit.

According to El Sudcaliforniano, a regional news site in Mexico, last year Baja California Sur health officials inspected 628 pharmacies, including 175 in Los Cabos. During those visits, inspectors checked licenses and documentation and found everything to be in order. But they later told the outlet it was not up to state officials to do the laboratory testing to confirm the chemical makeup of the drugs.

Health officials also told the news site in February that they found no records of people dying due to adulterated medicine — though there has been a lack of the kind of postmortem toxicology testing in Mexico that would be needed to make that determination.

After similar inspections in the spring, the Cabo Sun reported that state health officials visited more than 100 pharmacies in Baja California Sur. In Los Cabos alone, the news site said, officials shut down nine pharmacies for distributing controlled substances.

When The Times first contacted the attorney general’s office in February, a federal prosecutor there — who has since asked to not be named due to safety concerns — said it was the first time she’d heard of fentanyl-tainted pills appearing in pharmacies. She called it “a new modus operandi that we haven’t detected before” and said that officials were “concerned.”

To better understand the problem, she said, authorities would “need to find where in the process they’re faking the pills” and determine “if pharmacies are involved in criminal activity or they don’t know if they are selling medications with fentanyl.”

In June, the prosecutor told reporters in an email that federal health officials were interested in The Times’ investigation and hoped to file a complaint with her office for potential prosecution. The Times did not provide Mexican authorities with information about the pharmacies reporters visited.

After prosecutors and police opened an investigation, a judge granted them permission to search several pharmacies.

But for Mary Harrell — whose son overdosed and died after he bought a fentanyl-tainted pill at a pharmacy in Cabo San Lucas in 2019 — the enforcement actions came as little consolation. The Camarillo woman said she wished authorities in Mexico had taken action sooner.

“It’s not going to stop,” she said. “If it were a real cleanup you’d have the president going after it — but you don’t.”

Imagine if this was your medication from a mail order pharmacy

Yes, it has been this hot in the deep south.

Roberta Wright, who lives in a suburb of Houston, Tx., decided to try something we’ve always wondered about, can you bake bread in your mailbox during the summer months?

Well, according to the photos here that have gone viral, the answer appears to be yes.

Wright’s friend Howard Ceasar posted the photos on Facebook and he says that the bread baked for 45 minutes in the mailbox. 

Now, we all know how hot it can get in a mailbox during the summer, but to see a full loaf of bread baked in it is really eye-opening.

I don’t know how it tasted, but now I am intrigued and I too want to try baking a loaf of bread in my mailbox.

Disclaimer, if you try this, you may want to leave a note taped to your mailbox so that the mail delivery person is shocked when he or she opens your box to drop off the mail.

Imagine if you get your prescriptions from a mail order pharmacy and they were left in your mailbox during the summer months. Required storage for Rx meds typically tops out in the mid-80F.

Rule of thumb, is that any medications stored outside of the required temp range for >24 hrs is considered compromised and their quality/potency is questionable.

Of course, this picture is loaf of bread being baked after 45 minutes and notice that this mailbox is somewhat insulated by two layers of bricks surrounding the metal mail box.  This demonstration has nothing to do with a package of meds being in various USPS vehicles in transport

Operating Under the Influence of a Controlled Substance

Operating Under the Influence of a Controlled Substance

https://michaelhayeslaw.com/operating-under-the-influence-of-a-controlled-substance/

Operating Under The Influence Of A Controlled Substance Or With A Restricted Controlled Substance

If you have been charged with operating under the influence of a controlled substance or with a restricted controlled substance, you are probably asking many questions about how the law enforcement officer made the determination, what evidence will be used against you, and what you can do to challenge the charge. The absence of any scientific standard for measuring impairment by the use of a controlled substance and the irrelevance of whether a restricted controlled substance impaired your ability to drive will probably be of great concern to you.

In fact, the “reasonableness of legislative measures” such as these was questioned by the Wisconsin Court of Appeals, which ultimately decided that no legal reason compelled the Court to overturn the law. State vs. Smet, 288 Wis.2d 525, 709 N.W.2d 474, 2005 WI 263.

Milwaukee DWI Charges, Penalties, and Defenses Vary by Statute

You may face prosecution under one or both provisions of the law which subjects anyone convicted to the same penalties as a conviction for operating under the influence of alcohol. For example, if you have two previous convictions for operating under the influence of alcohol and you are now charged with operating under the influence of a controlled substance or operating with a restricted controlled substance, you face the penalties for operating under the influence 3rd offense despite the fact that neither of your first two offenses involved the use of controlled substances.

For an outline of the procedure in court, some of the motions available for your defense, and the penalty structure if convicted, see the other pages of our website addressing the charge you are facing based on the number of previous convictions.

Here is the pertinent statutory language:

346.63 Operating under influence of intoxicant or other drug. (1) No person may drive or operate a motor vehicle while: (a) Under the influence of an intoxicant, a controlled substance, a controlled substance analog or any combination of an intoxicant, a controlled substance and a controlled substance analog, under the influence of any other drug to a degree which renders him or her incapable of safely driving, or under the combined influence of an intoxicant and any other drug to a degree which renders him or her incapable of safely driving; or (am) The person has a detectable amount of a restricted controlled substance in his or her blood. (b) The person has a prohibited alcohol concentration. (c) A person may be charged with and a prosecutor may proceed upon a complaint based upon a violation of any combination of par. (a), (am), or (b) for acts arising out of the same incident or occurrence. If the person is charged with violating any combination of par. (a)(am), or (b), the offenses shall be joined. If the person is found guilty of any combination of par. (a), (am) or (b) for acts arising out of the same incident or occurrence, there shall be a single conviction for purposes of sentencing and for purposes of counting convictions under ss. 343.30 (1q) and 343.305. Paragraphs (a), (am) and (b) each require proof of a fact for conviction which the others do not require. (d) In an action under par. (am) that is based on the defendant allegedly having a detectable amount of methamphetamine, gamma!hydroxybutyric acid, or delta-9-tetrahydrocannabinol in his or her blood, the defendant has a defense if he or she proves by a preponderance of the evidence that at the time of the incident or occurrence he or she had a valid prescription for methamphetamine or one of its metabolic precursors, gamma-hydroxybutyric acid, or delta-9-tetrahydrocannabinol.

967.055(1m) Definitions. In this section:
(a) “Drug” has the meaning specified in s. 450.01 (10)
(b) “Restricted controlled substance” means any of the following:

  1. A controlled substance included in schedule I under ch. 961 other than a tetrahydrocannabinol.
  2. A controlled substance analog, as defined in s. 961.01 (4m), of a controlled substance described in subd. 1.
  3. Cocaine or any of its metabolites.
  4. Methamphetamine.
  5. Delta-9-tetrahydrocannabinol.

The two most common scenarios involve a motorist lawfully taking per prescription the
prescribed dosage of a painkiller such as Percocet (Oxycodone and acetaminophen), Oxycontin (time-release Oxycodone), or Vicodin (hydrocodone), or a motorist who has smoked marijuana in the last few days. The usual scenario involves a preliminary breath test showing .00 for alcohol and a blood test result showing .00 for alcohol.

In most cases, the law enforcement agency then requests the State Laboratory of Hygiene or the State Crime Laboratory to test the blood for the presence of a panel of legal and illegal controlled substances. Because of a backlog based on a claimed deficiency in funding, the state agency will not be able to perform the analysis for many months.

If at trial there is admissible evidence of a blood analysis showing a detectable amount of Delta 9 THC, cocaine or any of its metabolites, or one of the other substances referenced in the Sec. 967.055(1m), there will be no issue at trial as to whether the substance impaired your ability to operate a motor vehicle. The prosecutor is not required to present any evidence that the marijuana or cocaine, which may have been consumed days earlier, had any effect on your ability to safely operate a motor vehicle.

The scientific literature clearly supports the defense position that the use of marijuana or cocaine a few days before the operation of a vehicle can result in a detectable amount of the substance while there is no evidence that the level of the restricted controlled substance caused any impairment of your ability to safely operate the vehicle.

There are many challenges that can be filed including a motion challenging the blood draw absent a warrant under circumstances where the prosecutor is not able to demonstrate the exigent circumstances that would otherwise justify a warrantless blood draw. This situation is substantially different from an arrest involving alcohol that dissipates on average at a rate of .015 g/210 L per hour.

If your blood test result is positive for an opiate such as Hydrocodone there will be a specific concentration such as 300 ug/L in the Confidential Report of Laboratory Findings. For arrests occurring on or after February 1, 2011, the admissibility of this evidence at trial is dependent upon the prosecutor presenting a person who is qualified to testify under Sec. 907.02 and 907.03 as to the relevancy and effect of the quantity of the controlled substance detected in your blood.

If the prosecutor obtains admissibility of the evidence, the prosecutor must convince the jury that the quantity of the controlled substance impaired your ability to operate a motor vehicle – that is, that the opiate or other controlled substance, whether prescribed or not prescribed, rendered you incapable of safely driving a vehicle. What qualification does a chemist possess to provide a reliable opinion regarding how a drug, at a certain level, affected your ability to safely drive a motor vehicle?

The chemist has no knowledge of your individual body chemistry and has no knowledge of your history of usage of the controlled substance. Neither the chemist nor anyone else has ever performed any testing using various levels of the controlled substance to see how your motor skills may be affected.

Strong consideration should be given in your case to a rigorous challenge to any effort made by a prosecutor to gain admissibility of any chemical evidence or to gain admissibility of any opinion from a chemist or any other witness claiming to be an expert. Furthermore, a strong challenge should be made to any attempt by the prosecutor to admit evidence from an officer who claims to have special training in the detection of individuals who are operating under the influence of a controlled substance.

Call Michael Hayes to Discuss Your Case with an Experienced Milwaukee DWI Attorney

For a detailed explanation of what challenges can be made by the Law Office of Michael Hayes, LLC, you need to schedule an appointment to explain exactly what happened so a determination can be made as to what evidence is needed to challenge the decision of the law enforcement officer to make the arrest.  If the officer did not have probable cause to make the arrest, your Fourth Amendment rights were violated, and all evidence obtained as a result of the illegal arrest must be suppressed.

If you have been charged with operating under the influence of a controlled substance or with a restricted controlled substance, contact Mike online or call him at 414.405.5678.

 

Alabama Hospitals Hard Hit by Opioids Take Case to State Court

Alabama Hospitals Hard Hit by Opioids Take Case to State Court

https://news.bloomberglaw.com/health-law-and-business/alabama-hospitals-hard-hit-by-opioids-take-case-to-state-court

Alabama hospitals trying to speed up relief in the opioid crisis will face manufacturers in the first opioid state trial involving hospitals July 24.

Hospitals across the country are taking a two-pronged approach to get opioid relief funds faster from opioid manufacturers: They are suing in state courts for faster trials in addition to federal courts. Alabama hospitals are seeking $300 million to $500 million from the defendants in the state suit.

The hospitals say their state suits are distinct from the multidistrict litigation being overseen by a federal court in Ohio, which involves cities and counties nationwide. As providers on the front lines of the opioid crisis, they say the operational impact felt by hospitals and the rest of the health-care system is different from the harms governments have alleged in their suits.

The state court strategy is to advance hospitals’ claims toward resolution, complementing the national litigation, said David McMullan, an attorney of Barrett Law Group, which represents 945 hospitals in 43 states and has filed 25 cases in state and federal courts on behalf of hospitals in the opioid crisis.

New technology helping to crack down on high drivers in Kansas

New technology helping to crack down on high drivers in Kansas

https://www.kwch.com/2023/06/27/new-technology-helping-crack-down-high-drivers-kansas/

WICHITA, Kan. (KWCH) – The Kansas Highway Patrol is using new technology to help detect people driving while high on drugs. The new device, called SoToxa, tests fluids from a person’s mouth and tells troopers what drugs might be in their system.

Trooper Sean Hankins said there are more drug-impaired drivers on Kansas roads than there are alcohol-impaired drivers, but he said they can be hard to detect.

“One of the issues we have in Kansas and this entire country is identifying the drug-impaired driver because the alcohol DUI is the one we’re always very comfortable with,” said Hankins.

SoToxa makes the detection process a little easier.

“As you consume drugs into your blood system, it’s called passive diffusion. The drugs transfer from the blood into the oral fluid,” Trooper Hankins explains.

Here’s how SoToxa works. A person swabs the inside of their mouth to collect the oral fluid. The swab then goes into SoToxa. Five minutes later, the results are in – showing whether any of the six drug families SoToxa tests for are detected.

“We’re checking for amphetamines, methamphetamines, cocaine. We’re also checking for tetrahydrocannabinol, the active ingredient in marijuana that makes people high. We’re checking for some opiates and some benzodiazepines, some of those mood stabilizers,” said Trooper Hankins.

The ultimate goal, he said, is to keep Kansas streets and highways safe.

When there is road side testing for alcohol blood levels, most states have a BAL >0.08 the person is considered legally drunk. This article and this system (SoToxa) states that the results from using this equipment MIGHT tell what drugs be in the person’s system.  This suggest that this testing system is a qualitative test as opposed to a quantitative test. The first could show if ANY of the substances it is trying to detect is in the pt’s saliva, the second is HOW MUCH of the substance is in the person’s body, as the BAL equipment does by blowing into the machine.  This sounds like many people could be charged with driving under the influence, for even the bare minimum being in the person’s system. I am not aware of any levels of any of the substances being tested for .. has a “level” that is presumed to be “under the influence” ?

Why a patient paid a $285 copay for a $40 drug

System Issue At CVS Caremark Leaves Patients Stranded Without Medications

This article states that CVS/Caremark, last year processed ONE-THIRD of all prescriptions. “processed” is a VERY VAGUE TERM, the PBM can reject a claim for various reasons, prior authorization required, days supply limits, they can and do determine how much the pharmacy is going to be paid and many pay the pharmacy – especially independents – less than the cost the pharmacy has to pay to the drug wholesaler for the medication. There is only about 5 PBM’s that control some 80%-90% of the entire out pt medication market.  The claim of 6.9 billion claims seem to be a “bit higher” than the number of prescriptions that are routinely claimed to be filled by pharmacies… That number is typically stated in the low 4 billion number. So is Caremark counting all claim rejections as “claims processed”. I would suspect that Caremark gets some $$ every time they handle a claim, even if it involves a rejection. That number would suggest that Caremark is REJECTING about ONE-THIRD of all claims filed.

System Issue At CVS Caremark Leaves Patients Stranded Without Medications

https://finance.yahoo.com/news/system-issue-cvs-caremark-leaves-140608072.html

Starting Monday morning, patients covered by CVS’s Caremark business experienced a halt in prescription processing, leaving some without their medications.

CVS Health Corp’s (NYSE: CVS) unit, Caremark, noted an “unexpected system slowdown” in a letter dispatched to pharmacists on Monday.

This issue affected all types of businesses managed by CVS Caremark, which funds prescriptions at thousands of drugstores, including those beyond the company’s outlets.

On Tuesday, a CVS Health spokesperson mentioned that a system issue impacted Caremark’s prescription billing and e-prescriptions. While the system is now operational, there might be temporary delays due to a backlog of prescriptions, Wall Street Journal reported. The cause of the issue was not disclosed.

According to the Drug Channels Institute, CVS Caremark, which processed 2.3 billion claims in the previous year, represents about a third of the market.

Carter High, co-owner of Best Value Pharmacies, reported prescription processing issues via CVS Caremark’s system starting Monday morning at his stores in the Fort Worth area.

High faced difficulties checking customers’ coverage, and he couldn’t determine whether the prescription would be paid for or how much the customer should be charged out-of-pocket.

Consequently, some customers were asked to return the following day unless they were willing to pay the full cost of the prescription up front.

The outage persisted throughout Monday, but prescriptions were being processed again by Tuesday morning, albeit with some delays.