who can’t believe that some rare, very ill pain patients might need a dosage over 100 mg MED

From Dr. Forest Tennant
To Advocates and Concerned Parties
RE: Key Points in DEA Search and Seizure Warrant of Nov. 13, 2017
This lengthy search warrant shows some issues which are serious and, if implemented, will hurt pain patients and physicians throughout the Country. Even physicians and patients without pain issues will be affected.
There are 2 major issues that must concern all parties. 1. Claims of fraud and “kick-backs” for prescribing Subsys® (fentanyl sublingual spray) off-label to 2 Medicare patients, and then receiving “kick-backs” or “bribes” by receiving speaker fees and/or under-the-table money from Insys Pharmaceutical and/or United Pharmacy which is the distribution pharmacy for Subsys® in Los Angeles. The labeled indication for “Subsys®” in the PDR and REM agreement is cancer breakthrough pain.
One of the 2 patients in question actually was post-surgical, ovarian cancer and was in pain treatment for abdominal adhesions/neuropathies and possible cancer recurrence. My last speech for Insys was in 2015 and I prescribed Subsys® before and after my short speaking endeavor with Insys. At no time has Insys, United Pharmacy, or other party offered a “Quid Pro Quo”, directed prescribing, or offered money to prescribe.
Serious questions:
1. Are we now saying that prescribing off-label or accepting speaking fees is a crime?
2.
The search warrant claims that every patient who is receiving a high opioid dosage and/or a benzodiazepine and/or carisoprodol (Soma®) cannot be completely taking the drugs, are diverting them to the streets, and somehow kicking back money to me. Their basis is a review of pharmacy records by a Kaiser General Practitioner who can’t believe that some rare, very ill pain patients might need a dosage over 100 mg MED. Not stated, but implied, is that these patients are endangered. Our clinic, since 1975, has only taken intractable pain patients (some recent exceptions) who have failed standard treatments. All patients must have family involvement, physician referral, sign multiple consents describing risks, and undergo genetic, hormone, and other testing. Be clearly informed that my clinic in the past 10 years has not had an overdose death, suicide, automobile accident, or report of diversion. We know that some intractable pain patients only respond to a risky regimen that may include benzodiazepines, opioids, and carisoprodol.
SERIOUS QUESTION: Are physicians, patients, and families now going to be accused of crimes simply based on pharmacy records without even interviewing patients, family, and physician to determine the pathologic state of patients?
Sincerely, Forest Tennant M.D., Dr. P.H.

Should lying to pts be considered UNPROFESSIONAL CONDUCT ?

I was a Pharmacy Technician for years and have a Pharmacist in the family. I regret that I held judgment in the past before I had to get controlled substances myself, maturing, and facing judgment from a nurse. When I was a Pharmacy Technician if anyone was paying cash for a controlled substance I was told to tell them that we were out of stock, if they had a home addresses more than ten miles from our store I was told to tell them the same thing. I thought I was doing what was right, but at the same time it is how I was trained. This one white guy came in once with a younger man of color and handed me a script from a dentist for Vicodin. I asked if he had his insurance card, and was told that he did not have insurance. The training given to me was that this was a huge red flag because people pay cash to avoid billing their insurance to get multiple scripts filled. I felt bad about the whole situation, but I went and talked to my boss who told me to tell him we were out of stock. Just then the older white guy opened his wallet and showed me his Ohio state Board of Pharmacy License verifying that he was a licensed Pharmacist, and said to me “you wanna check your shelf again”. My boss who was a licensed Pharmacist and said, “Oh we have it after all”. Yet 99% of the time we were instructed to turn down the uninsured. The reason being that the insurance company would send us back a response to soon, so if you were getting multiple scripts you could get away with it. This was before the Prescription Monitoring Programs. Also if you dressed in a Polo with Dockers and had no tattoos you were generally safe. I developed RSD after a tumor was removed from my left sciatic nerve, and called the nurse at the surgeon’s office to tell her that the Tylenol 3 I was taking every four hours was not working. She said, “whatever you must just be an addict trying to get more pain medication”. Meanwhile my left foot blew up like a balloon, turned beat red, and felt like someone was light my foot with a couple of large lighters, and shocking it with a tazer. I had my 40 cal out after I talked to the nurse. I was going to end my life to stop the pain. Decided to lock up my 40 cal in my lock box and give the keys to my mom. She said this doesn’t make sense since you never had any surgery on your foot. I laid in her room all night till the next morning when she called the doctors office and the surgeon said to come right in. I did and he said your brain thinks that your foot is injured because we had to take your sciatic nerve apart, and the nerve block must have wore out. He said I am paging the first available pain management specialist to see you asap. Also he was not happy about the Nazi Nurse. I do not know what happened with her. Now when you call the after hours number in your discharge instructions you would think that if you were taking medication as prescribed and having severe pain, or swelling that the nurse might want to rule out an infection, or that maybe something worse. In not so many more words she said other things reflecting her opinion that I was a junky. Recently I had Walgreens give me shit on a transfer of sleep medication. It was filled by my old Pharmacy on the sixth of one month, but picked it up on the seventh of that month supposedly. I moved closer to Walgreens, and transferred it there. I went to pick it up on the seventh and they said that my old Pharmacy said that my wife or I did not pick it up until several days later. I was like I do not think that is the case, but the said it is exactly 30 days from the date you last picked up your medication. This means if they do this it will make it so nobody will take extra tablets. And if you live in a rural area and have a 45 minute drive to the Pharmacy from your Family Farm you will just have to make those extra trips. For instance if you are out of blood pressure medication and need it the day before you will have to make to trips. CVS and Walgreens are the to biggest fighters of pick up date and fill date. All of them plus Rite Aid kept partially filling a friend’s scrfor Ultram because it was for 140 tablets a month. They kelp saying that they by law could not fill the whole thing at once, but could fill half of it then get the rest after 15 days. We’ll when he would go back for his partial they kept saying that insurance would not cover another month when he had a month. “SIMON SAYS”. Then they told him some shit about the DEA personally checking into him. He went back in their and showed him his stump where he lost his leg from an infection. Then started yelling that maybe he go up the street in their ghetto neighborhood and find a compassionate herion dealer to treat his pain. Having a fresh amputation just made them dumbfounded. They still just started to repeat their lines. I drove him to a small local chain, and they filled the who script that was a monthly script with no problem, or rhetoric

Neglect at Tennessee nursing home led to patients’ harm — including death, inspectors find

http://www.commercialappeal.com/story/news/2017/11/29/neglect-tennessee-nursing-home-led-patients-harm-including-death-inspectors-find/905613001/

A Memphis nursing home has been hit with record fines after inspectors found widespread neglect resulting in actual harm to multiple patients including one who died after transfer to a hospital showed widespread wounds with maggots that apparently had gone untreated.

The fines totaling $50,000 were imposed on the 211-bed Ashton Place Health and Rehabilitation Center, 3030 Walnut Grove Road, the highest such penalty ever imposed. In addition to the fines Tennessee Health Commissioner John Dreyzehner ordered a freeze of any new admissions to the facility and appointed a monitor to oversee its operations.

The 98-page inspection report, which prompted Dreyzehner’s action, cites multiple cases of patients suffering actual physical harm due to failure to follow a physician’s orders, failure to administer prescribed drugs and failure to inform physicians’ of their patients deteriorating condition.

A male patient who was admitted to the home on July 26 of this year with no visible wounds ended up being transferred to a hospital multiple times for ulcers and ultimately died on Oct. 11 where hospital staffers found maggots in wounds that appeared to be untreated.

 

The state surveyors noted that the records of wounds on the patient recorded at the nursing home when he was placed in an ambulance omitted at least five wounds that were found by hospital staffers minutes later.

The report states that nursing home records indicated the patient also was not given the pain medications his doctor had prescribed.

“He was not assessed regularly nor did he receive his pain medication regularly,” the report states.

Neglect and poor care was also detailed for other patients, including a female patient suffering from ovarian cancer whose worsening condition was not reported to her doctor. She died on Oct. 24.

 When a state surveyor asked a home employee what she did when the patient vomited, the worker said, “No I didn’t give her anything. If they only vomit once, we watch them.”

In that patient’s case, the report states she was apparently given a medication that wasn’t prescribed. 

The report was highly critical of managers at the facility and noted that top officials contended they were unaware of the problems reported by direct care staffers.

Home managers “failed to ensure that care was provided as called for in care plans for five of 16 residents,” the report states.

According to the report, the home’s medical director stated, “I have support, no direction. I have talked (to them) about the staff they have here. I don’t have much confidence in them.”

One resident, the report states, was left sitting in her own stools for five hours. Another was found choking after she pulled out her oxygen tube.

Records showed another patient apparently did not get 37 of 106 prescribed doses of Lyrica and 29 of 106 prescribed doses of morphine.

why listen to experts as to what will work or NOT WORK ?

The Health 202: Jeff Sessions wants to put more cops on the opioid beat. Experts say that won’t solve the problem.

https://www.washingtonpost.com/news/powerpost/paloma/the-health-202/2017/11/30/the-health-202-jeff-sessions-wants-to-put-more-cops-on-the-opioid-beat-experts-say-that-won-t-solve-the-problem/5a1ef05130fb0469e883f90b/

If the opioid epidemic was simply a problem of supply – people being able to access drugs too easily – than a targeted new effort in Appalachia announced by Attorney General Jeff Sessions yesterday would be a huge stride toward combating the crisis.

The problem with this approach, however, is that experts agree the opioid epidemic is all about demand. Far too many Americans rely on opioid painkillers, creating a huge customer base for illicitly gained prescription drugs and more serious street drugs, such as heroin and fentanyl.

Sessions’s new plan involves sending more Drug Enforcement Agency agents to the areas where opioid abuse is most rampant. But those fighting the epidemic on the ground say the law enforcement strategy must be coupled with medical help for those suffering from addiction, or the Trump administration won’t get very far in its efforts.

“This is a demand-driven problem and we are trying to apply supply-restricting solutions,” Michael Brumage, executive director of the Kanawha-Charleston Health Department in Charleston, W.Va., told me (West Virginia is the state hit hardest by the crisis). “That’s what we tried on the war on drugs, and that failed.”

Sessions is creating an entirely new DEA division overseeing the Appalachian region to help local law enforcement combat drug abuse, especially of prescription opioids, The Washington Post’s Sari Horwitz and Matt Zapotosky report. He also announced $12 million in new grants and the designation of an opioid coordinator to work with prosecutors to better manage prosecutions.

  
Sessions introduces three initiatives to fight opioid epidemic
 Attorney General Jeff Sessions introduced three initiatives on Nov. 29 to fight the opioid epidemic.

“Today, we are facing the deadliest drug crisis in American history,” Sessions said at a news conference yesterday. “Based on preliminary data, at least 64,000 Americans lost their lives to drug overdoses last year. That would be the highest drug overdose death toll and the fastest increase in that death toll in American history.”

The new Louisville Field Division will unify drug trafficking investigations in Kentucky, Tennessee and West Virginia, with a focus on the Appalachian Mountains, officials said. It will include about 90 special agents and 130 task force officers.

Washington Examiner’s Kelly Cohen:

At least in terms of geography, Sessions is spot on. A few weeks ago, I wrote about the prevalence of opioid abuse in the Appalachian region – and how it gets worse and worse the closer in you get to West Virginia (which is basically the epicenter of the crisis).

If you look at what researchers call “diseases of despair” (drug and alcohol overdose, suicide and alcoholic liver disease), they have a stronger foothold in the center of Appalachia than on the fringes. In central Appalachia, those maladies led to 94.4 deaths per 100,000 people, but the rate is 52.3 deaths per 100,000 in southern Appalachia.

But law enforcement officers will tell you that keeping an area free of drug dealers for any length of time is a steep task. Brumage called the new DEA forces a “step in the right direction,” but his enthusiasm is tempered.

“Once you bust everybody in a particular area, you have a temporary lull but it lasts only a few days,” Brumage said. “There are always people and supply willing to fill the void.”

Activists who watched the uphill and international “war on drugs” of the past several decades also fear the Trump administration will halt its efforts with beefing up law enforcement, instead of also pouring more resources into helping Americans break free of their drug addictions.

“The emphasis continues to be punishment, so I think it’s very concerning,” said Gabrielle de la Gueronniere, director of policy for the Legal Action Center, a nonprofit organization that fights discrimination against people with a history of addiction. “We’re not really treating this as an illness. There’s a huge treatment gap.”

Sessions also announced that White House counselor Kellyanne Conway will continue to help lead the opioid effort:

1:51
Sessions praises Kellyanne Conway’s leadership of White House opioid effort
 
 

Attorney General Jeff Sessions thanked White House counselor Kellyanne Conway on Nov. 29, for her role coordinating and leading the White House opioid effort.

Several reporters clarified that the Trump administration isn’t creating a new “drug czar,” as some reports suggested. Politico’s Brianna Ehley:

Politico’s Sarah Karlin-Smith:

On a related topic, Sessions said he’s “dubious” of a law restricting DEA’s enforcement powers, which The Post detailed in a recent investigation. Per The Post’s Sari Horwitz:

Sessions and Acting DEA Admin. Begin Drug War Actions Not Allowed in Constitution

A news release issued by the Department of Justice on November 29 stated that Attorney General Jeff Sessions (shown) had announced “new resources and stepped up efforts to address the drug and opioid crisis.” However, our attorney general is apparently unaware of (or chooses to ignore) the fact that the 10th Amendment plainly states that the powers not delegated to the United States (i.e., the federal government) by the Constitution are reserved to the states and that the power to prohibit drugs or other substances is not to be found in the Constitution. That is why the prohibition of alcohol required an amendment to the Constitution, since back in 1919 those running our federal government still recognized that they had no power constitutionally to prohibit alcoholic beverages otherwise.

The DOJ release noted that Sessions was joined by Acting DEA Administrator Robert Patterson in announcing the following efforts during a press conference at the Department of Justice:

Over $12 million in grant funding to assist law enforcement in combating illegal manufacturing and distribution of methamphetamine, heroin, and prescription opioids;

The establishment of a new DEA Field Division in Louisville, Kentucky, which will include Kentucky, Tennessee, and West Virginia, a move meant to better align DEA enforcement efforts within the Appalachian mountain region;

And a directive to all U.S. Attorneys to designate an Opioid Coordinator to work closely with prosecutors, and with other federal, state, tribal, and local law enforcement to coordinate and optimize federal opioid prosecutions in every district.

 

“Today we are facing the worst drug crisis in American history, with one American dying of a drug overdose every nine minutes,” the release quoted Sessions as saying. “That’s why, under President Trump’s strong leadership, the Department of Justice has been taking action to make our drug law enforcement efforts more effective.”

“DEA continually looks for ways to improve operations and interagency cooperation and more efficiently leverage resources,” said Patterson. “By creating a new division in the [Appalachian mountain] region, this restructuring places DEA in lockstep with our partners in the area to do just that. This change will produce more effective investigations on heroin, fentanyl, and prescription opioid trafficking, all of which have a significant impact on the region.”

During the DOJ press conference, reported the Washington Post, Sessions also said that he had been “dubious” of a 2016 law that took away many of the DEA’s powers to act against distributors and manufacturers of prescription opioids, saying that he would support new legislation to restore the agency’s authority in those areas.

“I was dubious about the law when it passed,” said Sessions, who was a senator at the time. “I believe I was maybe the last person that went along with it after the department and DEA agreed to accept it…. We do need legislation. We can listen to the concerns that certain people had and draft good legislation, but I would be supportive of new legislation to be able to have a full toolbox in dealing with the problem of improper sale policies.”

The Post reported that Sessions said that Kellyanne Conway, currently serving as counselor to the president in the Trump administration, has been tasked with overseeing White House initiatives to combat opioid abuse. She attended the DOJ conference on November 29.

“The president has made this a White House priority. He’s asked [Conway] to coordinate and lead the effort from the White House,” Sessions said, calling Conway “exceedingly talented.”

“Today we are facing the deadliest drug crisis in American history,” Sessions stated during the press conference. “We’ve never, ever seen the death rates that we’re having today — 64,000 died last year.”

While Sessions’ statement about the deaths resulting from the drug crisis certainly warrants looking for a solution to this tragic situation, it ignores the fact that the use of harmful substances is basically a behavioral problem rather than a law-enforcement problem — much less a federal law-enforcement problem. Like other social ills stemming from bad behavior, the drug problem is best solved at the state and local level, which is also the only constitutional remedy for this crisis.

Former congressman and presidential candidate Ron Paul, who is also a medical doctor, wrote an article about the federal government’s failed drug war last May. In that article, he addressed Sessions’ decision the previous week to order federal prosecutors in drug cases to seek the maximum penalty authorized by federal mandatory minimum sentencing laws.

Paul wrote that Sessions’ support for mandatory minimums was no surprise, as “he has a history of fanatical devotion to the drug war. Sessions’ pro-drug war stance is at odds with the reality of the drug war’s failure. Over forty years after President Nixon declared war on drugs, the government cannot even keep drugs out of prisons!”

The former constitutionalist/libertarian congressman observed that, as was the case with alcohol prohibition, the drug war has empowered criminal gangs and even terrorists to take advantage of the opportunity presented by prohibition to profit by meeting the continued demand for drugs.

Paul’s most important reason for objecting to the war on drugs is constitutional, however. He continued:

The war on drugs is a war on the Constitution as well. The Constitution does not give the federal government authority to regulate, much less ban, drugs. People who doubt this should ask themselves why it was necessary to amend the Constitution to allow the federal government to criminalize drinking alcohol but not necessary to amend the Constitution to criminalize drug use.

Paul suggested that “those with moral objections to drug use should realize that education and persuasion, carried out through voluntary institutions like churches and schools, is a more moral and effective way to discourage drug use than relying on government force.”

The beauty of our federal system, composed of separate sovereign states, is that each state has the power to write laws that reflect the moral values of its citizens. As such, the residents of Utah and Alabama might very well favor a different approach to regulating drug use than the citizens of New York or California. The authors of the 10th Amendment understood this principle, which is why they reserved to the states all powers not delegated to the federal government.

Senator McCaskill.. let the CPP just suffer… repeal Ensuring Patient Access and Effective Drug Enforcement Act

McCaskill continues fight to restore DEA enforcement power during opioid epidemic at Senate Roundtable

http://www.thesalemnewsonline.com/news/local_news/article_f85da9be-d528-11e7-a679-3397229c198d.html

Senate colleagues in order to discuss the need to strengthen Drug Enforcement Administration (DEA) enforcement against opioid distributors and her bill to repeal the Ensuring Patient Access and Effective Drug Enforcement Act of 2016. Public reports have indicated that the law, along with a revolving door between the DEA and drug distribution industry, had dramatically restrained the agency’s enforcement efforts.

“This legislation was clearly not helpful in terms of removing a valuable tool that was a deterrent…a deterrent to some of the largest companies in America that there were serious and significant consequences if they didn’t do it by the book,” McCaskill said. “When you remove that deterrent, then things get even sloppier, and when things get sloppy in the area of opioids, people die. Innocent people die….So we will do our best to undo the damage that has been done.” 

The 2016 bill purported to “improve enforcement efforts related to prescription drug diversion and abuse” by altering DEA procedures for revoking or suspending registrations for opioid distributors under the Controlled Substances Act. However, the effect of these changes, according to reports, has been to significantly curtail the ability of DEA to bring enforcement actions against drug distributors.

Participants at today’s roundtable included Joseph Rannazzisi, former head of the DEA Office of Diversion Control; Frank Younker, former DEA Diversion Group Supervisor, Cincinnati Resident Office; and Jonathan P. Novak, former DEA enforcement attorney. The DEA denied permission for its Chief Administrative Law Judge John J. Mulrooney II to participate in the roundtable.

Earlier this year McCaskill launched an investigation into opioid manufactures—the most comprehensive Congressional investigation into the crisis to date—when she requested information related to sales and marketing materials, internal addiction studies, details on compliance with government settlements and donations to third party advocacy groups from major opioid manufacturers. She expanded her investigation, requesting documents and information from opioid manufacturers Mallinckrodt, Endo, Teva, and Allergan, while a request to McKesson Corporation, AmerisourceBergen Corporation, and Cardinal Health, Inc., focused on their distribution of opioid products. In September, McCaskill announced the first round of findings, detailing systemic manipulation of the prior authorization process by Insys Therapeutics.

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pain doctor’s being “dropped” from being a Medicare participating provider ?

Just got a letter from husband’s PM doctor. Medicare dropped her?! He’s been going to her for 15 years. I’m so upset. Apparently it’s because she writes prescriptions for pain medication. And she’s she’s a pain management Dr.

Unless they have changed things… prescribers do not have to be a participating provider…

Being a participating provider means that Medicare will pay them directly…

If they are a non-participating provider, it means that the prescriber is obligated/mandated to bill Medicare for services provided to the pt and the Medicare will send the money reimbursement directly to the pt.

Again unless things have changes, the prescriber is prohibited from charging the pt more than 10%-15% higher charge than what Medicare otherwise allows.  The advantage to a prescriber in being a participating provider is that they do not have to worry about collecting monies from the pt. … many pts do not have the resources to pay the full office visit charge at the time they are seen by the prescriber… making potential for collection problems finding out when Medicare sent the money to the pt and then collecting the amount due.

 

 

 

 

 

 

 

 

 

All about kratom: Herb still on store shelves, even after death of upstate police sergeant

NEW YORK — Members of the American Kratom Association vowed to fight any ban on the herbal supplement that’s been linked to 36 deaths nationwide, and — so far— they’ve succeeded.

But debate is reaching fever pitch about the product, which comes from a plant in southeast Asia and is sold over the counter in capsule, liquid or powder form.

“We believe it has addictive qualities,” said Scott Gottlieb, Commissioner of the Food and Drug Administration

 shortly after the agency issued a public health warning ten days ago.  “And it’s also being used by people who have addiction to opioids.”

The people who swear by kratom have said they use it for all different reasons.

Some insisted it treated their back pain.  Others said it eased anxiety or depression.  Dozens of testimonials are turning up online from people who declared it eased their withdrawal symptoms from opioids like prescription painkillers, heroin or methadone.

“This is stuff that can help with your withdrawals,” said one man on YouTube.

After doing research, PIX11 was surprised to learn about the tragic death of Police Sergeant Matthew Dana of Tupper Lake, New York.

The Franklin County Coroner Shawn Stuart said the only substance found in Dana’s system was a high level of kratom. He believes it caused the hemorrhagic pulmonary edema that Dana died of. The edema brought blood and other fluid into Dana’s lungs.

Advocates for kratom don’t buy the coroner’s findings and have suggested the federal Drug Enforcement Administration is trying to blame kratom for the death so the DEA can ban it.
Dana’s friends said he used to be a bodybuilder and noted YouTube sites have advocated for kratom to boost energy.

The friends told NewYorkUpstate.com that Sergeant Dana had been making the powdered Red Vein Maeng Da brand of kratom into a paste and eating it.

Six states already bar the sale of kratom in shops, but New York and 42 other states allow it over the counter.  You can find it in gas stations, head shops and some kava cafes.
Advocates point out the supplement is in the coffee family.  In small doses, it serves as a stimulant, a “pick me up.”  In large doses, kratom can have sedative qualities.

Steven Chassman, executive director of the Long Island Council on Alcoholism and Drug Dependence (LICADD) is very concerned about clients trying to rely on kratom to deal with opioid withdrawal.

“Opioid dependence is a psychiatric disturbance,” Chassman said.  “When it comes to medical stabilization, you do not get supplements that are bought in gas stations or head shops across Long Island.  They are being misinformed that this is going to help them on the road to recovery, when—in fact—oftentimes we’re seeing that they’re just switching addictions.”

While the FDA is trying to stop the importing of kratom at international mail facilities, a study done at the University of Mississippi had found that “the compounds in kratom aren’t particularly potent opioids like prescription opioids, morphine or fentanyl.”

The DEA still wants to place kratom on a Schedule 1 list of illegal drugs, in the same category as heroin.

Steve Chassman said, “What it does is mirror the effects of opiate-like drugs.  When it’s taken in larger quantities, it releases certain levels of dopamine.”

Consumers can buy a bag of 90 Kratom capsules for $30 at many head and vape shops around New York City and Long Island.  One brand we found was marketed under the name “Pain Out.”

The shops also sell small bottles of liquid kratom for $20, called shots.

After public protests in 2016, when the DEA proposed a ban on kratom, 62 members of Congress signed a letter calling for more study and dialogue on the issue, after members of the American Kratom Association held a protest outside the White House.

Once again the DEA “BELIEVES”… that they don’t have to have any SOLID FACTS to back up their beliefs or opinions…  Where are they gathering these “BELIEFS” from ?

Everyone is entitled their own opinions… they are not entitled to their own FACTS !

 

Prevention Magazine – they want to do a story on abandoned pain patients.

I have been working closely with journalists for several months. In recent days I have been contacted by Prevention Magazine – they want to do a story on abandoned pain patients. Some of you may have seen the AARP magazine’s piece on the opiate crisis that essentially took a ‘sky is falling – oh it’s so awful approach.’ Prevention’s primary readership is female in the range of 40-70. So they would like to discuss with at least 3 females who meet that demographic how you are currently affected by patient abandonment and stigmatization. The primary author is doing his homework and talking to lots of people that we know. I put him in contact with George Knapp’s current series and radio broadcast. If you are interested, please contact me at tal7291@yahoo.com and provide me with the information you want to use to be contacted.