The “opioid crisis” is like a COIN.. there are two sides. All too many bureaucrats only want to address those who are addicted to using/abusing certain substances. Rx opiates peaked in 2011-2012 and they have already dropped by abt 60% by today, but opioid OD/poisoning has increased from abt 14,000 to over 100,000/yr, and the vast majority of those deaths’ toxicology showed 80%+ illegal fentanyl. One doesn’t need a supercomputer to figure out that when Rx opioids drop by >50% and opioid OD/poisoning is up abt SEVEN FOLD, there is little to no relationship between Rx opioids and addiction. Recently the DEA stated that <1% of pharma opioids are diverted. Yet, there is an on-going push to reduce the availability of Rx opioids to treat acute and chronic pain. How many other high acuity pts dealing with chronic health issues… do we as a country increasingly try to limit or deny appropriate therapy? – that is the other side of the opioid crisis “coin”

The claim that <1% of pharma opiates are diverted, does not address nor confirm that there are a untold number of chronic pain pts are being forced to live without proper pain management and often exist in a torturous level of pain, being forced/restricted to their house, chair or bed. Just like some criminals who are put on “home arrest”, but these chronic pain pts have committed NO CRIMES.

Earlier this year, 50 states’ Attorney General and others sued the top three drug wholesalers that control abt 80% of the pharmacy market and the top three chain pharmacies (CVS, Walmart, Walgreen).  Neither lawsuit went to court/trial but all agreed to pay billions in fines – while admitting no wrong doing – but also agreed to reduce the control meds that are sold to pharmacies and or pharmacies will dispense.

Since most people needing to be prescribed controlled meds are disabled and/or would be disabled without their meds. My non-attorney opinion is that these very large corporations have signed an agreement to discriminate against a large number of people who are a covered entities under the Americans with Disability Act.

I have talked to other chronic pain advocates and all of us or having an increased number of chronic pain pts reaching out because of they are all of a sudden being denied their pain meds.

I recently heard of a state medical licensing board that one particular board member was PUSHING for “rapid weaning” – perhaps a euphemism for cold turkey withdrawal, and reportedly those pts who their prescribers were forced into doing this with their pts and reportedly their had been some deaths – particularly those pts who were concurrently taking a opioid, benzo, and muscle relaxant.

Some pharmacists seem to be imposing their “beliefs” into their “clinical decisions” .. here is one from today https://www.cnn.com/2022/08/02/us/minnesota-morning-after-pill-lawsuit/index.html

I had to get involved with two different pts and where the pharmacist would not look into the pt’s circumstances to adjudicate those circumstances to take care of the pt’s need. One pt ended up moving all her Rxs from a Rite Aid to a local independent and the other one the prescriber was on board, the PBM was on board and it would appear that the Pharmacist did not understand what was said or was just lying and claiming that the claim was being DENIED by the PBM.  I got the pt to get in a conference call with the PBM representative, the pt and the pharmacist… and all of a sudden the Rx claim was  “miraculously” approved and the pt got their necessary medications.

The increased number of pts now reaching out to various advocates for some sort of help/assistance, will probably convert into a similar increase in deaths from comorbidity complications – labeled as “natural causes” – from under/untreated pain and or suicides.

I would suggest that anyone who is reducing your meds, I would ask for the clinical rational  IN WRITING why it is being done. If they reference the MME system as rational.  Here is a article that pretty well explains that the MME system has no double blind clinical studies to support its conclusion  https://www.acsh.org/news/2022/03/01/true-story-morphine-milligram-equivalents-mme-16154

I would ask them, what level/intensity of pain they expect you to live/exist in ? IMO, anything > 5, that is a torturous level of pain.

If, after your meds have been reduced and your blood pressure goes up and you end up on taking up to 4-5 different categories of pharma blood pressure medications and your elevated BP has little/no change… here is a graphic that shows what physical damage you can anticipate https://www.pharmaciststeve.com/wp-content/uploads/2022/01/htnsideeffects.png

Whatever practitioner you are dealing with, and they have a patient portal… do not be afraid to use it… use it to NUDGE them to give you a answer in writing,  Share documentation, studies that suggests that you needed to be treated differently and you could improve your QOL, after all practitioner are suppose to be HEALERS.

I know that many of you have reached out to law firms. The times are changing dramatically towards those pts who have a valid medical necessity for being prescribed controlled meds. There are records of 3 major drug wholesalers and 3 large pharmacy chains ( CVS, Walmart, Walgreen) that signed agreements with 50 states’ attorney generals and others … that agreed in WRITING … to reduce the number of controls that the wholesalers sell to all pharmacies and those chains agreed to reduce the number of controlled meds they fill/dispense.

At face value, those agreements suggested that the reduction of control meds would be done indiscriminately with a broad brush.

If you don’t have access to a practitoner via a pt portal and if they won’t give you a answer in person. Send them a certified letter asking the question.  If they refuse/decline to answer you in writing… One can presume that they really don’t have any real clinical rational to why they changed your therapy.

Share some of this information with your local media, reach out to law firms that deal with civil rights issues, because most likely you are not the only one being treated in the same manner from the same practitioner or all practitioners that are employed by the same large healthcare corporation, because they are obeying some corporate edict.

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Drug middlemen say Ohio law raises prices. Then they admit they don’t know

https://ohiocapitaljournal.com/2023/08/08/drug-middlemen-say-ohio-law-raises-prices-then-they-admit-they-dont-know/

An industry organization representing powerful drug middlemen said that banning an industry practice would lead to “higher costs and fewer choices for America’s employers.” But to support it, the organization points to analysis that didn’t look at private insurance and didn’t reach the conclusion that it claimed.

The Pharmaceutical Care Management Association represents pharmacy benefit managers, a powerful, but little known industry. The three biggest PBMs — CVS Caremark, Express Scripts and OptumRx — control about 80% of the marketplace and each is affiliated with a top-10 insurer. 

The companies serve as health insurers’ middlemen in pharmacy transactions. They created lists of drugs that are covered and they negotiate huge rebates and discounts from drugmakers for putting their products on them. 

And, even though they own pharmacies themselves, the big-three PBMs decide how much to reimburse their own and competitors’ pharmacies.

Complaints that the companies use their size and dominance to engage in anti-competitive practices have the Federal Trade Commission investigating them. Separately, Ohio Attorney General Dave Yost is conducting his own investigation into whether Express Scripts and several other healthcare companies have violated state antitrust law.

As critics have accused PBMs of taking excessive profits and raising drug costs, the state and federal government have taken steps to regulate them. And PCMA, the industry group, has worked to stop those controls.

The organization maintains that its member businesses use their power to squeeze down the prices drugmakers charge and that they pass the savings along to customers. But that’s hard for outsiders to judge because many of the transactions are shrouded in secrecy.

On July 25, PCMA put up a blog post claiming that in an instance when some data were available, an analysis showed that an Ohio regulation drove costs higher. But that’s not what it said.

In 2019, the legislature and the incoming DeWine administration were eager to get a handle on the dealings between the big PBMs and the Ohio Department of Medicaid. A year earlier, the department commissioned a study after The Columbus Dispatch obtained a partial set of confidential data and determined that CVS Caremark and OptumRx were charging taxpayers a lot more for drugs than they were paying the pharmacies that dispensed them. 

The department got the PBMs to cough up all their data and determined that in a one-year period, they up-charged taxpayers $224 million. The same analysis also found CVS Caremark and OptumRx were charging 3 to 6 times the normal rate — costing taxpayers an extra $150 million to $186 million a year.

Then Yost did an analysis while he was still state auditor. It covered a different 12-month period and found that for generic drugs alone, the PBMs charged 31% in fees — or $208 million.

At the same time, independent and small-chain pharmacists were complaining that low reimbursements by the PBMs were making it hard for them to stay in business. Indeed, CVS has bought many of them out, closed many of its own stores and shifted their prescriptions to still-open stores, where employees have said understaffing has endangered patient safety.

In 2018, as an attempted fix, the legislature outlawed a practice known as “spread pricing.” That’s when PBMs charge taxpayers a certain amount for a prescription and reimburse pharmacists another. The law also took steps to ensure that independent and small-chain pharmacies would get better reimbursements.

To see how well the law was working, the Medicaid department hired Healthplan Data Solutions, the company that performed the earlier analysis. It compared data from the last quarter of 2018, when the old system was still in effect, with the first quarter of 2019, when the new one took hold.

The analysis found that pharmacists were getting $38 million more in reimbursements in the second quarter when compared to the first, but it made no calculations about whether the overall system was costing taxpayers more. Considering that the PBMs took a quarter-billion dollars over a year-long period that the new law was supposed to eliminate, additional overall costs seem unlikely. After all, on an annualized basis, the additional pharmacy payments were $72 million less than the PBMs were found to be taking in up-charges.

That didn’t stop their industry organization from claiming the opposite, however.

It titled a July 25 blog post “Eliminating Spread Pricing Would Lead to Higher Costs and Fewer Choices for America’s Employers.”

It selectively quoted from the Healthplan Data Solutions analysis to make it sound like the law ending spread pricing increased overall costs.

It said the analysis “found that mandating the move to a pass-through pricing model resulted in an increase in prescription drug costs. The increase in drug costs for Ohio Medicaid was directly linked to higher payments to pharmacists and higher ‘ingredient costs and dispensing fees,’ leading to a ‘total increase’ of ‘$38,308,479 for the first quarter.’”

The post added, “The HDS report clearly shows that taking away the option of a spread pricing contract resulted in higher drug costs for the state.”

However, the blog post didn’t mention that the analysis didn’t look at how much taxpayers saved by eliminating the PBM up-charges allowed by spread pricing. 

Greg Lopes, a spokesman for PCMA conceded as much in an email Monday.

“Ohio Medicaid payments to pharmacists increased, according to the report,” he said. “The report did not include any data showing overall savings to the state as a result of eliminating spread pricing as a contracting option for the program.”

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Repeatedly appearing as an expert witness for the prosecution in the Eastern District, Dr. King’s biased and misleading statements raised concerns about potential conflicts of interest. It is argued that he operates as a medical fig leaf for prosecutors, who use his testimony to support their narrative on opioid use, often disregarding differing medical opinions.

THE GREAT KING RAT: UNCOVERING DOJ- DEA’s DR. TIMOTHY E. KING, MD TRAVELING SHOW OF LIES AND DECEPTIONS

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I have always been told that there is THREE SIDES to every story.  My side, your side and THE TRUTH. Where this video and the story related falls in that spectrum is for others to determine

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This statement from the article –In 2021, opioids were present in about 79% of overdose deaths —  Is similar to someone stating that the majority of people with a BMI >24.9 drinks sodas and is considered overweight or obese. There are a lot of various soft drinks/sodas… some containing sugar, some are sugar free and some are high in caffeine.  Just like it has been reported else where that ~ 80% of all drug OD/poisoning involved illegal Fentanyl from China & Mexican cartels.  Is the words/phrases used in this article intentionally misleading or just shows how poorly whoever crafted this article understands who/what is really behind all of these deaths?

Opioids mixed with cocaine or psychostimulants are driving more overdose deaths, CDC data show

https://news.yahoo.com/most-overdose-deaths-involving-cocaine-040116408.html

Drug overdose deaths involving cocaine and psychostimulants such as methamphetamine have been rising quickly in the United States in recent years, and a new report from the US Centers for Disease Control and Prevention shows that opioids are also involved in most of those deaths.

In 2021, opioids were present in about 79% of overdose deaths involving cocaine and about 66% of those involving psychostimulants, according to CDC data. And these multi-drug combinations have become increasingly common.

Overdose deaths involving both cocaine and opioids have become more than seven times more frequent over the past decade, growing from less than 1 death for every 100,000 people in 2011 to nearly 6 in 2021. And those involving both psychostimulants and opioids became 22 times more common, jumping from 0.3 deaths for every 100,000 people in 2011 to nearly 7 in 2021.

Deaths from cocaine or psychostimulants that did not also involve opioids also increased, but they grew at significantly slower rates.

“The epidemic is showing us that it is quite dynamic and it can change quite rapidly,” said Katherine Keyes, an associate professor at the Columbia University Mailman School of Public Health, who was not involved in the new report but whose research focuses on psychiatric and substance use epidemiology. “This data is a stark reminder of how much more we need to be doing to combat these very preventable deaths.”

Although the new CDC report does not specify the type of opioids involved, experts say that these trends highlight the dangers of illicit fentanyl, a powerful synthetic opioid.

“Cocaine combined with fentanyl is much more toxic and lethal. Methamphetamine can kill more than cocaine by itself, but having said that, it’s much more dangerous when you combine it with fentanyl,” said Dr. Nora Volkow, director of the National Institute on Drug Abuse, who also was not involved in the new research. “This accounts for why we’re seeing firsthand a high rise in mortality from these two drugs.”

But fentanyl isn’t the only factor, and addressing the deadly overdose epidemic in the US will require multiple strategic approaches, experts say.

“The dramatic rise in cocaine- and methamphetamine-involved deaths over the past decade emphasizes that this is a polysubstance overdose crisis, not an opioid crisis, and that we need a range of proven interventions to save lives,” said Dr. Sarah Wakeman, an addiction medicine physician at Mass General Brigham, who was not involved in the new report.

Both intentional and unintentional combinations of these drugs are probably contributing to rising overdose death rates, she and others say.

The use of opioids along with stimulants has long been common among drug users: for decades with cocaine and more recently with psychostimulants such as methamphetamine.

“Research has shown that people who are using both stimulants and opioids are at even higher risk of health-related complications, and treatment models addressing both are more limited,” Wakeman said.

But fentanyl has also contaminated the illicit drug market, raising the risk of unintentional exposure.

Dealers “are diluting that drugs that are more expensive to manufacture and adding fentanyl,” Volkow said. “They put a tiny little bit of fentanyl, which is less expensive but so potent that it will generate a powerful substance.”

This is particularly true for cocaine, which is more expensive to manufacture and transport, helping explain why the new CDC report found the combination of cocaine and opioids to be so common, she said. And the amount of cocaine coming into the US has increased significantly.

“The more drugs that get into the country, the greater the number of people that are going to be exposed to the practice of mixing these drugs with fentanyl in the illicit market,” Volkow said.

About 110,000 people in the US died from a drug overdose in the past year, according to another data set from the CDC that tracks overdose deaths through February. About a quarter of those deaths involved cocaine, and a third involved psychostimulants such as methamphetamine. More than two-thirds involved opioids.

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It is no big secret that the 3 largest drug wholesalers – who provides 80%+ of all the Rx meds to  pharmacies. They were sued by the 50 state Attorney Generals and others and did not even go to trial, but they agreed to pay BILLIONS in fines – while admitting no wrong doing – other than selling opiates and other controlled medications to pharmacies and they also agreed to REDUCE the amount of controlled meds that they sell to all American pharmacies going forward.  Around the same time, these same state AG & others sued the three largest community pharmacies (CVS, Walmart & Walgreen) and who also agreed – without admitting any wrong doing –  agreed to pay BILLION of dollars in restitution, basically for filling controlled med Rxs written by properly licensed prescribers – and also agreed to dispense FEWER Rxs for controlled meds going forward.

Those agreements were signed in late winter – early spring of 2023, and they are now starting to show up as more and more pts that have a valid medical need for being prescribed controlled meds or being told that their doses have to be reduced and/or the pharmacy – that they have been patronizing for years -will no longer fill their controlled Rx medications.

Ambulatory PCA (Pt controlled Administration) pumps have been around for decades. They are very similar to what millions of type one diabetics are using around the world to help control their blood sugar. These pumps will provide pain pts many advantages:

* They provide a constant “drip” called a basal rate, the pt has fewer “ups & downs” in pain control, if their prescriber allows it, they can also provide pt initiated “pushes” to deal with break-thru pain and/or activity induced pain.

* Because the opioid is administered like a Sub-Q shot, the opioid avoids being partially by the stomach acid  – as in taking a oral dose – & the opioid goes directly to the cell receptor site – avoiding the first pass thru the liver and being metabolized and with it some loss of potency. Resulting in the pt typically needing only 20%-25% of what mgs they had been taking orally.

* Along with those fewer mgs/day, the pt should experience fewer side effects, like dry mouth, blurred vision, constipation and other side effects.

* the CDC dosing guidelines are directed toward oral doses, but regardless, the pt’s total opioid mgs/day will be reduced with a PCA pump.

The graphic above shows an example of a butterfly needle that would be connected to the pump and be inserted in the gut and taped in place and would be changed out every few days

The link below shows JUST ONE OF MANY PCA PUMPS on the market.  I am not recommending nor endorsing this particular PCA pump, it is just as a graphic illustration of what is available.

I am hoping that since injectables are mostly used by hospitals and surgical centers, that the DEA will be exerting less controls on the pharma production quotas for injectables and will hopefully be more readily available.

As oral opioid dosing forms become less and less available, this is a discussion that many pts will be forced to have with their prescriber.

Click to access Ambulatory-Infusion-Pump.pdf

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Kenneth A. Polite, Jr. Photographer: Anna Moneymaker/Getty Images. DOJ Criminal Chief to Exit for Return to Private Practice Ex-Morgan Lewis partner led Criminal Division since 2021 Steered efforts on white-collar crime, compliance, crypto

THE MAIN CRIMINAL AT MAIN JUSTICE, AUSA KENNETH A. POLITE: THE UNCOVERING OF A CLINICAL PSYCHOPATH: PART-2

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