Steps the U.S. government should take right now against the opioid epidemic

https://www.washingtonpost.com/news/to-your-health/wp/2017/10/12/steps-the-u-s-government-should-take-against-the-opioid-epidemic-right-now/

The Food and Drug Administration should consider banning “ultra-high-dosage” painkillers from the market, and law enforcement must step up efforts to curb the flow of heroin and fentanyl into the United States if the nation hopes to come to grips with the opioid epidemic, two authorities on the crisis said Thursday.

Andrew Kolodny, co-director of opioid policy research at the Heller School for Social Policy and Management at Brandeis University, and Thomas R. Frieden, former director of the U.S. Centers for Disease Control and Prevention, said a comprehensive approach to the crisis also should include greatly restricting or eliminating the marketing of opioids for chronic pain; better insurance coverage and access to alternative pain treatments; and expansion of treatment and “harm reduction” measures such as needle exchange programs.

“There are no simple solutions to ending this epidemic,” Kolodny and Frieden wrote in an opinion article released Thursday in JAMA, the influential journal of the American Medical Association. “Effective programs need to address two separate priorities: prevention of addiction among people not currently addicted, and treatment and risk reduction to prevent overdose and death among the millions of individuals in the United States now addicted.”

About 33,000 people died from overdoses to prescription narcotics, heroin or fentanyl in 2015, a total thought to have increased sharply in 2016, although final data is not available. About 92 million people were prescribed an opioid analgesic — such as oxycodone or hydrocodone — in 2015.

In recent years, deaths from illicit street drugs have risen faster than those from prescription opioids.

Many of the recommendations from Kolodny and Frieden reflect expert consensus, including their push for expanded treatment and wider availability of the overdose antidote naloxone and for doctors to use more caution prescribing opioids. But other recommendations, such as banning high-dose opioids and improving data-gathering on the addiction crisis, have been heard less often.

“No current information systems enable real-time assessment of the numbers, patterns or trends of new opioid addiction,” the two wrote. “This makes it impossible to determine the trajectory of the epidemic.”

In an interview, Frieden said a small number of people may need an 80-milligram oxycodone pill for the pain of  cancer or end-of-life illness. But that dose, taken twice a day, far exceeds an amount “associated with a greatly increased risk of death,” he and Kolodny noted in their article. An unwary user who takes a single pill containing that much oxycodone to get high risks a fatal overdose.

“These are dangerous drugs. They kill people,” said Frieden, a member of the journal’s editorial board.  “And we should use them very sparingly and carefully.”

President Trump said in August that he would declare the crisis a national emergency, but his administration has not formally done so.

Doctors and dentists have begun to get the message about prescribing fewer and less powerful opioids or trying non-opioid alternatives first after routine procedures such as tooth extractions, Frieden said. The number of prescriptions has begun to trend downward in recent years by perhaps as much as 20 percent. But the volume of prescriptions quadrupled between 1995 and 2010, so there is a long way to go, he said.

The article calls on the FDA to halt the misleading marketing of opioids for low back pain and other forms of chronic pain for which the risk posed by opioids greatly outweighs the benefits. It suggests narrowed drug labeling to discourage doctors from prescribing them for those purposes. “Patients with non-cancer-related pain have been the target market for opioid manufacturers and account for much of the increase in opioid consumption in the United States during the past 20 years,” Kolodny and Frieden wrote.

“There are some conditions for which pain is still undertreated,” Frieden said in the interview. “However, for chronic pain, we have gotten it wrong.” When compared with other treatments, he said, opioids are “much more dangerous, not any better.”

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Top 20 Drugs in the World 2017

https://www.linkedin.com/pulse/top-20-drugs-world-2017-luca-dezzani-md/

The global prescription drug market is expected to grow by 6% from 2016 to 2022 to reach nearly USD 1.05 trillion by 2022. The top 20 drugs are manufactured by 14 companies and account for a total 10% of global prescription drug market in 2016. The total revenue generated by top 20 products was estimated to be USD 0.128 trillion. A large number of the drugs in the list are primarily for the treatment and management of cancer, diabetes, inflammatory disorders, and HIV or HCV infections. A report by Reuters predicts an average of 45 new drug launches each year henceforth, and suggests that the rising costs will be partially offset by a higher level of drugs going off patent, including the anticipated effect of biosimilars entering the market.

1. Humira (Adalimumab): Indicated in the treatment of autoimmune diseases and moderate to severely active rheumatoid arthritis. It tops the prescription-drug list of 2016 with an annual growth of 15% accounting for USD 16 billion sales globally. Humira is manufactured by AbbVie Inc. (U.S.). The patent for this product expired in 2016 in the U.S. and will expire by 2018 in Europe creating competitive opportunities for biosimilars market.
2. Harvoni (Ledipasvir/sofosbuvir): this product from Gilead Sciences is indicated in treating HCV/HIV infection. It is the second most prescribed drug in the market accounting for revenue of USD 9 billion. Wide patent range will aid the company’s overall growth which may be partially offset by the declining growth of -34% of this product from 2015-2016.  
3. Enbrel (Etanercept): It is another drug indicated for autoimmune diseases including rheumatoid arthritis, psoriasis and other inflammatory conditions. It is co-marketed by Amgen Inc. in the U.S. and Pfizer Inc. in Europe. Pfizer also has a co-promotion agreement with Takeda Pharmaceutical Company Ltd. to market Enbrel in Japan. The product holds 3rd position in the prescription drug list.
4. Rituxan (Rituximab, MabThera): Biogen and Roche co-markets the product indicated in the treatment of cancer. The patent for this product expired in 2015 which may result in significant decrease in sales. The product currently holds 4th position in the prescription drug market due to high revenues and growth of nearly 3%.
5. Remicade (Infliximab): indicated for autoimmune diseases and produced by J&J and Merck, Remicade sales decline by 11% in 2016 compared to 2015 sales. In February 2015, the Company lost market exclusivity for Remicade in major European markets and no longer has market exclusivity in any of its marketing territories. The Company is experiencing pricing and volume declines in these markets as a result of biosimilars competition and expects the declines to continue.
6. Revlimid (Lenalidomide): This is produced by Celgene and the revenues have increased by over 20%, from 2015. The product is indicated for the treatment of multiple myloma and will go off patented in 2027, which makes it an extremely important product in the company’s portfolio. The product holds 6th position in the prescription drug market.
7. Avastin (Bevacizumab): manufactured by Roche Avastin is used for advanced colorectal, breast, lung, kidney, cervical and ovarian cancer, and relapsed glioblastoma. Sales continued to grow strongly in the International region (+18%), especially China, following the approval of the lung cancer indication.
8. Herceptin (Trastuzumab): Another product manufactured by Roche, used for treating cancer mainly breast and gastric. Herceptin sales were up 4%, helped by additional reimbursement approvals in China and continued growth in the US due to longer duration of treatment in combination with Perjeta.
9. Januvia/Janumet (Sitagliptin): This product is used for the treatment of type 2 diabetes. Merck manufactures the product and the worldwide sales were estimated to be USD 6.1 billion in 2016, an increase of 2% compared with 2015. Sales growth was driven primarily by higher volumes in the United States, Europe and Canada, partially offset by pricing pressures in the United States and Europe, and lower sales in Venezuela due to the Company’s reduced operations in that country.
10. Lantus (Insulin glargine): A long-acting human insulin analog produced by Sanofi. The revenues from Lantus stood at USD 6.05 billion in 2016, a decline of 11% from the previous year. The U.S. patent for the product expired in August 2014. It was once one of the top-selling diabetes product in the world.
11. Prevnar 13/ Prevener (Pneumococcal 13-valent Conjugate Vaccine): the decline in Prevnar 13/Prevenar 13 revenues, primarily driven by an expected decline in revenues for the adult indication in the U.S. due to a high initial capture rate of the eligible population following its successful fourth-quarter 2014 launch, which resulted in a smaller remaining opportunity window compared to the prior-year, as well as the unfavorable impact of the timing of government purchases for the pediatric indication (down approximately USD 450 million).
12. Xarelto (Rivaroxaban): This anti-coagulant from Bayer and J&J has the highest growth rate within the top-20 prescription drug list of around 27%. It aids in the reduction of the risk of stroke and systemic embolism in patients with nonvalvular atrial fibrillation; deep vein thrombosis (DVT) and pulmonary embolism (PE), and reduction in the risk of recurrence of DVT and of PE.
13. Eylea (Aflibercept): It is produced by Regeneron Pharmaceuticals and Bayer. It was approved by the U.S. Food and Drug Administration (FDA) for use in retinal indications, delivered U.S. net sales growth of 24.2% over 2015, and continues to be the market-leading branded anti-VEGF therapy in the United States. The global growth rate was estimated by 27% from 2015-16.
14. Lyrica (Pregabalin): It is an anti-epileptic from Pfizer Inc. The product grew by 3% from 2015-2016 reaching USD 5 billion. The patent for Lyrica is set to expire in 2018, which will very likely ensure high sales figures for the product till the end of that period. It is mostly indicated in neuropathic pain associated with diabetic peripheral neuropathy; postherpetic neuralgia; fibromyalgia; and pain associated with spinal cord injury.
15. Neulasta/ Peglasta and Neupogen / Gran (Pegfilgrastim and Filgrastim): Neulasta is a recombinant human granulocyte-colony stimulating factor (G-CSF) from Amgen and Kyowa Hakko Kirin. It is used to decrease the incidence of infection during cancer treatment. The U.S. patent for the product expired in June 2015. The revenues of the product stood at USD 4.7 billion in 2016, reduced by 1% from the previous year.
16. Advair /Seretide (Fluticasone and Salmeterol): Advair is indicated for asthma and maintenance treatment of COPD. The product’s revenues stood at USD 4.3 billion in 2016. The sales of the product declined by 5% between 2015 and 2016 and 13% between 2014 and 2015. The sales are expected to decline further after the U.S. patent expiry in 2016.
17. Copaxone (Glatiramer acetate): It is a subcutaneous injection formulation for the treatment of multiple sclerosis. The product’s patent expired in 2014. Copaxone accounted for USD 4.2 billion (including $3.5 billion in the U.S.), or 19% of Teva Pharmaceuticals revenues in 2016, and contributed a significantly higher percentage to profits and cash flow from operations during the period.
18. Sovaldi (Sofosbuvir): It is an oral formulation, dosed once a day for the treatment of HCV as a component of a combination antiviral treatment. Sovaldi sales accounted for 14%, 17% and 45% of our total antiviral product sales for 2016, 2015 and 2014, respectively. In 2016, product sales were USD 1.9 billion in the United States, USD 891 million in Europe, USD 635 million in Japan and USD 580 million in other international locations.
19. Tecfidera (Dimethyl fumarate): Manufactured by Biogen, this drug is used for treating multiple sclerosis. The product shows growth of 9% over the previous year, primarily due to price increases and higher sales volume in U.S. and expansion of the product launch in emerging markets across the globe.
20. Opdivo (Nivolumab): It represents the major part of Bristol-Myers Squibb’s immune-oncology portfolio, accounting for USD 3.8 billion out of USD 5 billion of the segmental revenues. It is a fully human monoclonal antibody that has been approved and continues to be investigated as an anti-cancer treatment. U.S. and international revenues increased in both periods due to higher demand resulting from the rapid commercial acceptance for several indications including melanoma, head and neck, lung, kidney and blood cancer.

Watch Summary Video

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Detoxification of Chemically

Dependent Inmates
Federal Bureau of Prisons

Clinical Practice Guidelines

February 2014

https://www.bop.gov/resources/pdfs/detoxification.pdf

Revisions to the 2009 guidelines are highlighted in yellow throughout the document. Among these revisions are the following:

• Deletion of what had been Appendix 2, Selected DSM-IV Criteria Related to Substance Abuse. The DSM-5 criteria have been changed, and the DSM is now copyrighted. Readers are referred to the DSM website at http://www.dsm5.org/Pages/Default.aspx.

• Terminology has been changed to be in line with the DSM-5, for example:

• Substance abuse disorder has been changed to substance use disorder.

• Alcohol dependence has been changed to alcohol use disorder.

• Benzodiazepine dependence has been changed to benzodiazepine use disorder.

• Opiate dependence has been changed to opiate use disorder.

• Axis I or Axis II diagnosis has been changed to psychiatric disorder.

Anyone taking/using/abusing a opiate or benzodiazepine for extended period of time… both legally – to treat a valid medical need or illegally WILL BECOME DEPENDENT

This change in nomenclature seems to indicated that DEPENDENCY NOW EQUALS ADDICTION.. they  just now refer to it as a “use disorder”

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New Jersey’s new opioid law raises concerns among doctors

http://www.foxnews.com/health/2017/05/09/new-jerseys-new-opioid-law-raises-concerns-among-doctors.amp.html

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Arkansas Blue Cross and Blue Shield sues over drug plans

http://www.arkansasonline.com/news/2017/oct/12/blue-cross-sues-over-drug-plans-2017101/

Arkansas Blue Cross and Blue Shield has filed a lawsuit over a decision by federal officials to bar the insurer from enrolling new customers in its Medicare prescription drug plans this year.

The federal Centers for Medicare and Medicaid Services notified the Little Rock-based company last month that it would face that sanction for failing to meet a requirement established under the 2010 Patient Protection and Affordable Care Act.

The law requires that at least 85 percent of the money a company collects in drug plan subsidies and premiums go toward customers’ drug expenses, rather than administrative expenses or profits.

Since 2014, companies that fail to meet the required spending ratio, known as a medical loss ratio, have been required to refund money to the federal government.

Companies that miss the target for three consecutive years are barred from enrolling new customers in drug plans for one year.

Arkansas Blue Cross and Blue Shield’s drug plans are the only ones in the country listed on a federal website as being barred from accepting new customers during this year’s sign-up period, which begins Sunday and runs through Dec. 7 and allows Medicare beneficiaries to sign up or change drug or Medicare Advantage plans.

In the lawsuit, filed Tuesday, Arkansas Blue Cross and Blue Shield contends that Congress didn’t intend the requirement to apply to stand-alone prescription drug plans.

Instead, the lawsuit contends, the requirement was meant to apply only to Medicare Advantage plans, which cover medical benefits and also often cover prescription drugs.

U.S. District Judge Leon Holmes set a hearing for today on the insurer’s request that he issue a temporary order lifting the suspension on enrollment while the lawsuit is pending.

The company’s stand-alone drug plans cover about 38,000 of the 614,000 Arkansans enrolled in the federal insurance program for the elderly and disabled.

Suspending enrollment would “squander the investment and planning the company put into this year’s open enrollment period” and would risk “confusing current Arkansas Blue Cross and Blue Shield enrollees, some of whom may believe they have to choose a new plan,” the company argues in the suit.

The company estimated that the suspension would cause it to lose as much as 15 percent of its drug plan customers. Since some administrative costs are fixed, the loss of enrollment would make it more difficult to meet the medical loss ratio requirement in future years, the company contends.

The suspension will also have “ripple effects for the company’s reputation and business standing in the media, with the general public, and in its distribution channels,” possibly driving customers away from its other health insurance products, the company said in its request for a temporary order.

Attorneys for the U.S. Department of Health and Human Services responded in a court filing on Wednesday that the law is “unambiguous” in creating the medical loss ratio requirement for drug plans. They called Arkansas Blue Cross and Blue Shield’s claims that the suspension would hurt the company’s business “unsubstantiated and speculative.”

Any such harm, they added, should be weighed against the public interest in enforcing the law, which they said is designed to “expand access to affordable health care and to improve the functioning of the health insurance market.”

The suspension wouldn’t affect those who are in Arkansas Blue Cross and Blue Shield drug plans now, but it would prevent new customers from enrolling in the plans.

In the lawsuit, the company noted that none of the other 10 companies offering stand-alone drug plans in the state is based in Arkansas.

The other plans “are administered by national insurers, who may be unfamiliar with the needs of the local market, or who may discourage their enrollees from buying from locally-owned pharmacies,” attorneys for Arkansas Blue Cross and Blue Shield wrote.

“We wanted to have a federal court make the decision since folks will begin enrollment this Sunday, and we’re the only local plan that’s an option for them,” company spokesman Max Greenwood said Wednesday.

According to the Centers for Medicare and Medicaid Services, Arkansas Blue Cross and Blue Shield reported a medical loss ratio of 79.8 percent in 2014, 81.3 percent in 2015 and 84 percent in 2016.

Greenwood said the company “overestimated the amount of money we expected to pay out in prescription drug claims and underestimated the amounts received from the various programs that are in place to defer the high cost of drugs.”

She noted that the company has come closer each year to meeting the 85 percent target.

In the lawsuit, the company noted that even before the Affordable Care Act, a federal “risk corridors” program required companies to refund money to the federal government if their profits from drug plans exceeded a certain amount.

Congress didn’t need to establish the medical loss ratio requirement for the drug plans because the risk corridors program “served a similar function,” the company’s lawsuit argues.

The attorneys for the Health and Human Services Department responded that “virtually identical” arguments were raised when the regulations implementing the medical loss ratio requirement were published in 2013.

Centers for Medicare and Medicaid Services officials said at that time that the risk corridor and medical loss ratio programs “serve different purposes” and that the law required the agency to enforce the medical loss ratio requirement, the attorneys wrote.

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Man subjected to illegal search sues police, parole agent

http://thetimes-tribune.com/news/man-subjected-to-illegal-search-sues-police-parole-agent-1.2254405

A Scranton man who beat drug charges after it was discovered a police officer provided the anonymous tip that led to his arrest filed a federal lawsuit seeking damages for false arrest and malicious prosecution.

Albert McCullough of Alder Street alleges Scranton police Officer Lawrence Spathelf orchestrated an illegal search of McCullough’s home after realizing he did not have sufficient evidence to seek a warrant, then attempted to hide that information from McCullough’s defense attorney.

The case, which was detailed in a Times-Tribune investigation published in September 2016, is based on McCullough’s April 23, 2014, arrest on drug and weapons charges.

Pennsylvania state parole agent Jason Westgate, acting on an anonymous phone tip, searched McCullough’s home and found 801 bags of heroin, cash and a semi-automatic weapon, according to court records.

The Times-Tribune’s investigation also revealed another person, Dakeem Booker, was charged based on an anonymous tip phoned into a parole agent by Lackawanna County Detective Harold Zech.

By law, police must have probable cause to search a residence. Parole agents have looser standards. Police officers cannot use parole agents to evade the stricter probable cause standard they face, however. That practice, known as a “stalking horse,” is illegal.

The Lackawanna County district attorney’s office dropped all charges against McCullough in October 2015, after prosecutors learned Spathelf was the tipster who phoned Westgate. Booker, who was charged in June 2014, opted to plead guilty to one count of conspiracy to distribute a controlled substance and was sentenced to 26 to 60 months in prison. He is now attempting to overturn his case, arguing his attorney was ineffective.

The civil lawsuit, filed Wednesday by Archbald attorney Joseph Toczydlowski, alleges Spathelf and Westgate manipulated facts and evidence to support an illegal arrest, then concealed that information.

The suit says McCullough did not learn Spathelf was the tipster until he was forced to reveal himself at an Oct. 16, 2015, hearing before Lackawanna County Judge Vito Geroulo. The charges were dropped three days later.

“Defendants’ unlawful conduct … was willful, wanton, malicious and taken with a reckless or callous disregard for plaintiff’s clearly established constitutional rights,” the suit says.

Contacted Wednesday, Scranton Police Chief Carl Graziano said he had not seen the lawsuit and could not comment. Maria Finn, spokeswoman for the state parole department, said she could not comment on pending litigation.

The lawsuit seeks unspecified compensatory and punitive damages. It also asks that the matter be referred to state or federal authorities for investigation.

Contact the writer:

tbescker@timesshamrock.com; 570-348-9137;

@tmbeseckerTT on Twitter

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http://www.11alive.com/news/investigations/triangle/one-nation-overdosed/482827615

The number of Americans abusing pain pills has skyrocketed. To understand how so many people are getting hooked, we investigated how the pills are finding their way into homes in the first place.

47.7 million Americans have used illicit drugs or misused RX drugs, according to the Centers for Disease Control. So how did these drugs find their way into our culture and into homes nationwide?

It starts with the drug manufacturer.Opioids are made by huge corporations that produce vast amounts of pills.

Their “employees” are in doctor’s waiting rooms, but not as patients. Studies show that pharmaceutical sales reps working for the manufacturer influence the ways doctors prescribe certain medications. This sales approach helped to make these powerful prescription drugs into household names.

The drug distributors, also known as wholesalers, are the “middlemen” in the process. They supply the quantity of drugs in your local pharmacies and hospitals.

These are some of the most profitable companies in the world. Together, AmerisourceBergen, Cardinal Health and McKesson (“the big three”) bring in hundreds of billions of dollars each year.

These distributors are supposed to keep track of each order they fill and report them to the Drug Enforcement Administration. An investigation found that distributors were failing to report suspicious orders for many controlled substances, including opioids.

As a result, highly addictive opioids flooded pharmacies across the country. The number of pills far outweighing the need.

According to the CDC, in 2015 there were enough prescriptions for every American to be medicated around the clock for three weeks.

This supply chain has led to one nation, overdosed.

Everyone is entitled to their OWN OPINION… but NOT THEIR OWN FACTS…  the first part of this year it was reported that abt 1.2 million serious opiate abusers… then it jumped during the year to 2.1 million now this ATLANTA TV station is stating that there are 48 MILLION.. Of course, there no references as to where this station got its FACTS…

More FAKE NEWS… from one of the MAJOR NETWORKS ?

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More than 25 million people dying in agony without morphine every year

https://www.theguardian.com/science/2017/oct/12/more-than-25-million-people-dying-in-agony-without-morphine-every-year

Concern over illicit use and addiction is putting morphine out of reach for millions of patients globally who need it for pain relief

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http://mycbs4.com/news/local/video-shows-doctor-yelling-at-florida-patient-over-long-wait-times

GAINESVILLE, Fla. (WGFL) — A Gainesville doctor seen yelling at a patient on a now-viral video responded with his own accusations Wednesday, saying the woman threatened his staff and refused to leave prior to the moment that was published on Facebook.

Jessica Stipe posted the one-minute video on her Facebook page after she said the doctor yelled at her when she complained she had been waiting at the Gainesville After Hours clinic for an hour and 15 minutes. Stipe told CBS 4 Gainesville she called Gainesville Police after the doctor grabbed her daughter’s phone and “shoved her” when she tried to get it back.

Dr. Peter Gallogly released a statement, the police report and statements from staff on Wednesday. The police report says the officer who responded to the clinic watched the video and had no reason to believe Gallogly struck or pushed Stipe’s daughter.

Gallogly says in his one-page statement: “Ms. Stipe had been increasingly belligerent and abusive to the office staff, cursing and threatening them with violence, because she was unwell and had been waiting to see me for more than an hour.” He wrote that she received her refund but refused to leave. “I went to the front desk only because after Ms. Stipe received her refund, she refused to leave the office, and continued her abusive behavior towards staff. Despite repeated requests from the office staff, she repeatedly demanded to see me instead of leaving.”

Gallogly said the video is heavily edited and taken out of context. “When I walked into the waiting room, Ms. Stipe (and her daughter) cursed and threatened me as they had done with the office staff previously.”

Stipe on Wednesday called Gallogly’s statements “absolutely not true.”

“What you saw is what it was,” Stipe said. “This is just ridiculous.”

She questioned why Gallogly took the phone and attempted to delete the video if he had done nothing wrong.

Gallogly acknowledged his actions shown on the video were inappropriate.

“At the very end of the events, I most regrettably lost my temper, and spoke to the two women in a most unprofessional manner. I make no excuses for my unacceptable behavior,” Gallogly wrote.

He wrote that he was “merely reacting to unreasonable provocations and threats of physical violence” and “Again, while not an excuse for my behavior, a basic reason for my reaction is that I simply regard my staff as family, and I over-reacted to defend them.”

In her initial post, Stipe wrote she was “severely sick” and had made a 6:30 appointment at the clinic. By 7:45, she said doctors had only taken a urine test and she was throwing up in a trash can. That’s when, she said, she asked for her co-pay back so she could go home and be seen somewhere else the next day.

The video starts with Stipe telling Gallogly that it would be helpful for staff to tell patients if they’re not going to be seen in a timely manner.

“Are you kidding me?” Gallogly said on video. “Do you know how many people … I’ve got seven rooms back there. It’s 7:45 and we’ve already been working on you. We’ve done a urine test on you, I’ve seen you.”

She tells the doctor that they’ve only done the urine test. He asked if she thought that only took three seconds. She says she doesn’t know how long that takes. He asks if she wants to be seen or not. She says she wants to go home and get in bed.

“Then fine,” Gallogly tells her on video. “Get the hell out. Get your money and get the hell out.”

The doctor says she’d be waiting three hours if she went to another clinic, nine hours if she went to the ER.

The daughter recording the exchange can be heard saying “OK, you can get out of her face.”

The doctor tells Stipe, “Get the f*** out of my office. Now.”

Both Stipe and her daughter tell him she’s recording. The doctor holds the door open for them to leave. When the daughter asks his name, he says, “You’re recording this?” and appears to grab the phone and walk down the hallway with it.

Stipe told CBS 4 she believes he attempted to delete the video and then threw the phone back at her.

Stipe said she has contacted an attorney to demand accountability for his behavior.

“My ultimate goal here is that he needs to be looked at, he needs to be investigated and I don’t want anybody else in my community or any other community to receive that type of care or behavior towards them. It’s just not OK.

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Bad Opioid Policy Is Killing So Many People That New Hampshire’s Medical Examiner Is Quitting His Job

http://reason.com/blog/2017/10/11/bad-opioid-policy-is-killing-so-many-peo

In the six years since the federal government asked pharmaceutical companies to reformulate prescription opioids so patients couldn’t use them illicitly, Thomas Andrew, the chief medical examiner of New Hampshire, has seen his caseload skyrocket.

“It’s almost as if the Visigoths are at the gates, and the gates are starting to crumble,” Andrew told The New York Times’ Katharine Seelye. “I’m not an alarmist by nature, but this is not overhyped. It has completely overwhelmed us.”

And he’s not alone:

Some medical examiners, especially in hard-hit Ohio, have had to store their corpses in cold-storage trailers in their parking lots. In Manatee County, Fla., Dr. Russell Vega, the chief medical examiner, said that when he reaches “overflow” conditions, he relies on a private body transport service to store the bodies elsewhere until his office can catch up.

In Milwaukee, Dr. Brian L. Peterson, the chief medical examiner, said that apart from the “tsunami” of bodies — his autopsy volume is up 12 percent from last year — the national drug crisis has led to staff burnout, drained budgets and threats to the accreditation of many offices because they have to perform more autopsies than industry standards allow.

Andrew is leaving his job to enter a seminary. Meanwhile, the medical examiner’s office in New Hampshire risks losing accreditation due to a National Association of Medical Examiners rule that says individual examiners may perform no more than 250 autopsies per year. We don’t have enough places to store the bodies of overdose victims, nor enough people to cut them open.

We can thank bad policy for this carnage. The Centers for Disease Control have released preliminary data that show fentanyl-related deaths roughly doubled in 2016:

Courtesy of the CDC

That brown line denotes the fentanyl class of drugs (conventional prescription opioids are the blue line, which has ticked up slightly but remains within historical range). Deaths involving fentanyl, which is more potent per milligram than more commonly prescribed opioids, doubled over the last year, from 10,000 in 2015 to 21,000 in 2016. Here are the actual numbers:

Courtesy of the CDC

The category of natural and semi-synthetic opioids includes morphine, codeine, oxycodone, hydrocodone, hydromorphone, and oxymorphone. Those deaths increased, too, but nearly as much as the category that includes fentanyl. The fact that cocaine deaths increased as much as they did flummoxes me, but it perhaps shouldn’t considering anecdotes from the northeastern U.S. about coke laced with fentanyl.

Why are so many more people using—and dying from—fentanyl? Because in 2010, the federal government began demanding that pharmaceutical companies create tamper-proof formulations. In more recent years, both the federal government and state governments have discouraged doctors from prescribing opioids for acute pain.

Combined, these actions greatly reduced the volume of prescription opioids available for non-medical use. But state actors did very little in conjunction with those policies to address the existing population of non-medical users, beyond locking up more people and modestly increasing the number of patients doctors can treat with buprenorphine and methadone.

That carelessness created a massive arbitrage opportunity for black market operators and introduced fentanyl into the American drugscape. The U.S. could not have planned a more effective epidemic.

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