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.

Online survey needs your input

Steve,
Can you get this online quickly? Terri Lewis, PhD sent to me since I use Opana ER.
As a reminder, our PainEDU survey will be open until Wed, 11/29/17 at 5:00pm EST. The FDA asked Endo to withdraw the opioid Opana ER (oxymorphone) from market. Endo said in July 2017 it would voluntarily cease sales. Inflexxion, the company who owns and operates PainEDU invites you to participate in a short research survey about the impact of removal. The survey aims to understand impact of removal of this medication to the patient population, and we’re interested in your opinion on whether the removal could impact patient care. The survey takes will approx 10 minutes to do. Your participation is confidential and no personal info including names, IP addresses, or email addresses are kept.
Click here to start the survey. https://inflexxion.co1.qualtrics.com/jfe/form/SV_1C8itWAdKoSEuW1

USA has the “BEST MEDICAL CARE IN THE WORLD ” ? just not available to all ?

DEA mandates reduction in opioid manufacturing for 2018

http://www.pharmacist.com/article/dea-mandates-reduction-opioid-manufacturing-2018

Over objections that limits could harm chronic pain patients, agency moves forward with cuts

DEA’s finalized annual aggregate production quotas (APQs) for 2018 mandate a 20% reduction in the amount of opiate and opioid medication—including oxycodone, hydrocodone, oxymorphone, hydromorphone, morphine, codeine, meperidine, and fentanyl—that may be manufactured in 2018. Quotas are aimed at preventing a diversion while simultaneously satisfying annual needs.

APQs establish the total amount of opioids and other controlled substances necessary to meet the estimated medical, scientific, research, industrial, and export needs for 2018 and to maintain adequate reserve stocks. DEA says 2018’s cuts are a response to reduced demand.

Quotas may be appealed at any time during the year on the basis of increased sales or exports, new manufacturers entering the market, new product development, or product recalls.

Critics of DEA’s decision have expressed concerns that the reduced quota could lead to drug shortages and negatively affect pain management patients’ access to treatment.

Last year, the agency removed a 25% buffer for almost every Schedule II opiate and opioid medication. The buffer was implemented in 2013 to help address shortages. Although DEA stated at that time that its October 2016 final order was based on reduced demand, its decision was consistent with the views of several U.S. senators who called for DEA to limit opioid production and sales as another mechanism to combat the opioid epidemic.

Quotas are aimed at satisfying annual needs

I wonder where the DEA came up with a number that will meet the above goal ?

When a Pharmacist can’t even come up with a LIE – for denying to fill a prescription ?

Hi 

I’m not sure I have the right person for questions in regards to control substance prescriptions I’m paraplegic with Neurogenic bowel and bladder. Along with  many other issues and this morning  the pharmacist refused to fill my medication because of my medications which are all from my specialist that follows me. Whom i see every month for same prescriptions. I was told 20 minute to pick up.  Then when I got back.

  The pharmacist refused to tell me what was wrong with my script.

Until I made a big stink she then said she would fill it. Then said she wanted to wait for Dr office after I accused her of judging me.  I’m disabled and now home waiting for pharmacist to call me. When she will be done the Dr office called her and okayed it but I think she making me wait on purpose. What do I do. 

And KRATOM is “BAD MEDICINE ” ?

https://youtu.be/u3DJrcDzo5s

My Beautiful Little Monster: TSW and Kratom

I had reason to be ashamed and fearful of the world. I was looked at like a disgusting monster. I know this because I heard it come out of children’s mouths, “is that a monster, mommy?” After a cursory glance from a pharmacist, he whipped his head back in my direction and immediately asked, “What is wrong with your face?” Once, a nurse stood mouth agape following a loud gasp, just at the site of me. I was an ugly, scary, site to be seen. I would’ve rather died than hear how obviously disgusting I looked, like a “MONSTER.”

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I’m not sure I can put into words the physical, mental, emotional and spiritual torture that is TSW. My journey with “red skin syndrome” is long, complicated and not without setbacks. And, even though my childhood was spent in a war-ravaged country, where I saw unmentionable atrocities happening right before my young and innocent eyes, I was unprepared for the battle I’ve been forced to fight these last few years. My continued healing, is nothing short of miraculous.


My story begins in 2000, when I was prescribed a cream containing steroids for a small rash in my armpit. The rash would subside briefly before I’d be prescribed more steroid creams for another.

 

By 2007, I was bald and the doctors were clueless as to the cause. What was apparent was my shame, embarrassment and utter devastation. My parents kindly shelled out nearly $2000 for a wig to help me adjust. I was just a teenager yet I was bald.
24098895_10213490818242295_1795137722_nThere were more questions than answers even then.

During this time, I withdrew from life. I was depressed, anti-social and anxious. One minute, I was a normal teenage girl — fun-loving, outgoing, hopeful — the next, I was confused, withdrawn and heartbroken. I did the only thing I knew to do:  I turned to specialists for help, psychologists that rendered “talk therapy,” while psychiatrist prescribed medications.

I talked until I was blue in the face and took the cocktails of benzodiazepines, antidepressants, sleep meds and mood stabilizers I was prescribed, but my questions still outnumbered my answers. And, worse, my mental and physical conditions continued to decline.

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Although I felt broken inside and out, I wanted so terribly to be normal; so, in 2011, I picked up and moved 900 miles from home with my boyfriend. We were happy and my life began to resemble the normalcy I longed for. But it was a brief reprieve from my torture. Before long, I was in and out of emergency rooms, with infections, inflammation, and issues. My skin continued to get worse and worse, until my body was completely covered with redness all the time. I was prescribed pain medication and other drugs for the intense burning that accompanied my red skin.


Then one day while I was working, my condition took a terrifying turn for the worst. I recall sitting on the patio outside of work, thinking that I was on my break. A coworker of mine is telling me “the paramedics are on their way.” I look at her, confused. “What do you mean?” She said someone found me in the bathroom, hanging out of the stall unconscious. I had a grand mal seizure while on the toilet, and hit my head twice going down, and blacked out.  I had no recollection of this whatsoever. Shortly thereafter, while lying in the hospital bed, I had my second seizure that necessitated IV benzodiazepines to control. I was very confused. Why was this happening? Another issue. Another problem. Another devastation. Still no answers.

That day, I decided that I needed to move back home to be with my family. I could not take care of myself anymore, my broken body was making life dangerous. However, moving back home, did not improve my health. I continued to spiral downward, physically, emotionally and spiritually. Some doctors suspected cancer, others suspected lupus, but nobody had any clue what was going on with my body.

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Of course then, I was put on a number of seizure medications as the seizures continued to increase in number. So, at this point in time, I was taking over ten different prescription medications daily. I went through all kinds of testing from blood work, to biopsies, cancer testing, MRIs, EEG, etc. and the answer to my health issues was nowhere to be found.

Doctors continued to give me steroids, both oral and topical, and even injections more frequently. Little did anyone know, that was only making my issues worse all these years.

Finally, my world crashed in around my damaged body in  the beginning of 2014. I was admitted into inpatient psych ward 3 times for suicidal ideations. I had given up. I wanted to end my life. I did not see light or hope anymore, only darkness. I simply just wanted to die.

Although I had given up, succumbed to an unknown enemy that reduced me to nothing, my loving family had not. Desperate for answers, my father stumbled on a blog of a woman who was suffering the exact same symptoms as I was. Since I was dangerously unstable at the time, recovering in a hospital after my third suicide scare, he waited to tell me about what he’d found.

I’ll never forget sitting in my room, watching a video of Dr. Rapaport explaining red skin syndrome and the withdrawal process, and crying with joy, relief and complete understanding. My father had led me to International Topical Steroid Awareness Network (ITSAN) and here, I was finally getting answers I’d been seeking for years.  There was finally an answer, and I knew this was it. There was no other choice, I had to go through the withdrawal process, or my broken body was going to kill me.

Looking back, I realize I had NO idea what I was getting myself into. Nothing, not even all my suffering thus far, could prepare me for the battle I was about to wage, known as topical steroid withdrawal. I immediately got rid of all of my steroid products, and started to withdraw cold turkey. Within a day or two, I was covered from head to toe in what looked and felt like searing hot third degree burns.

My body couldn’t handle the shock, so it shut down, and I remained in a near-comatose state for 23 hours out of the day, for the next two weeks. I have very few memories of this time, but i vividly remember my caring, doting father, raising my eyelid, and shining a light into my eyes to make sure I would respond. I’ve found out since, that he sat over me during this time, checking my breathing, my pulse, scared out of his mind.
My parents knew that if they took me to the hospital, they would just pump me up with more steroids. I can only imagine the worry and the hard decision that my parents faced at that moment. Were they doing the right thing? Were we set out for this? Were we prepared?

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All the preparation in the world, could not have prepared us for the confusion, fear, excruciating pain and trauma we were experiencing. But, just when my mom and dad were about to give in and take me to the hospital, I snapped out of this comatose state, and cracked a joke to my parents. They then realized that their little girl was still there, she was still alive, and there was hope. She wasn’t giving up, she was fighting like hell.

And, fighting like hell was necessary. I went through years of being mostly bedridden, unable to walk, move, feed or bathe myself. The slightest touch was excruciatingly painful. I was quite literally covered in what looked and felt like third degree burns from my scalp to the soles of my feet. I was oozing a foul smelling liquid from my skin, as if my skin was completely rotting away. There was skin covering every crevice of my room.

I spent most days trying to sleep the pain away, waking up, crying and screaming at the top of my lungs. (My neighbors thought I was being tortured at first until the situation was explained to them.) Then I’d force myself to sleep again in an attempt to escape the pain. Every movement, every touch, even air hurt my skin. I have never cried or screamed so much in my entire life.
24020140_10213490817802284_1197924271_nI have suppressed much of this, because it has been such a traumatic experience and I have developed even more PTSD from it. I have bad social and general anxiety, panic, and fear now. I fear going out into public. I fear going to a doctor to seek help because there has been countless times that they just looked at me as if I was crazy and making it up. They didn’t offer me any help. That is why I decided to turn to natural alternatives.

My Friend mentioned Kratom to me one day, as he hoped it would be something that may help the severe pain I was feeling at the time. Before trying Kratom for the first time, I was spending 8+ hours per day in a bathtub just to try to cool my skin down. After extensive research, I decided to order a sample online from a trusted vendor and tried Kratom. It helped support my mood, and promoted  a sense of well being and calm. It eased a little bit of the pain, but I was still in very severe pain given my circumstances.

 

When I joined Kratom groups on Facebook and met other Kratom consumers and advocates, I learned that you could also use Kratom topically for various skin conditions, so I decided to try that approach as well and used both soap and lotion made from Kratom leaves. It did help soothe my skin to some extent. It didn’t get rid of the rashes, it didn’t fully get rid of the pain, but it was comforting and didn’t hurt me like other soaps and products did.

For 3 and a half years I’ve fought an uphill battle with Topical Steroid Withdrawal (TSW). And, while I’ve found kratom and other dietary supplements to benefit my physical and mental health, I’m still in the process of healing.

I struggle daily, trying to deal with all the trauma, PTSD, anxiety, panic, depression, fear.. It’s extremely  difficult and daunting. The more I start to get back into “real life”, the more terrified I am. I panic about being in public, I panic over people looking at me, I panic over my skin having any sort of change. Most of all, I panic that now that I’m trying to once again do something with my life, it will get snatched away from me again.
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During TSW, every time I went back out into the world, started working or trying to have any sort of life, I went back into an awful flare and ended up bedridden again, with everything taken away from me over and over again. And to me, that’s the worst part. To get a taste of life, and then have it snatched from me time and time again.

The truth is, I’m terrified. And it’s easy to say “screw what other people say” and it’s easy to say that the key is to overcome the fears. But it’s much harder than it sounds. However true it is, it’s still very daunting.

I’m not giving up and continue my seemingly endless fight. With the help of herbal supplements like kratom, Chinese cat’s claw, skullcap, lemon balm, mulungu, etc, I am able to go out, see friends, spend time with my family, and even go on dates. It may take me longer to prepare than others and I must quiet my fears to whispers, but I try. I am currently in the process of earning a degree in business management and it wouldn’t be possible without the knowledge and support I’ve gained from my fellow TSW warriors and without the aid of natural, holistic supplements.
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My mind is still boggled that all this happened to me over topical creams. But, I don’t really have a choice but to keep going.

~ Nina Ajdin

 

For more resources on TSW : 

https://us7.campaign-archive.com/?u=fa611379d0120776a4a8fe090&id=9c71f00bbd

https://www.eczemalife.com/blogs/tsw/is-topical-steroid-withdrawal-tsw-real

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