“The moral test of a government is how it treats those who are at the dawn of life, the children; those who are in the twilight of life, the aged; and those who are in the shadow of life, the sick and the needy, and the handicapped.” – Hubert Humphrey
passionate pachyderms
Pharmacist Steve steve@steveariens.com 502.938.2414
RICHMOND — The Indiana attorney general’s office is seeking disciplinary action against the license of a nurse who admitted diverting $72,000 worth of opioids from Reid Health hospital.
The registered nurse, Michelle Hibbard, 43, allegedly was caught with nine vials of opioid pain medication while on duty at the hospital, which declined comment for this article.
According to an administrative complaint, the hospital’s administrative coordinator on Jan. 7 confronted Hibbard after receiving a complaint that she had pulled several doses of fentanyl and dilaudid that were never administered to patients.
Asked to empty the pockets of her scrubs, Hibbard produced seven vials containing fentanyl and hydromorphone, according to the complaint. She also reportedly admitted that she had consumed another vial of fentanyl by squirting it into her mouth.
In addition, a strip search uncovered a blister pack containing a hydromorphone tablet, a tourniquet, a needle and two vials of hydromorphone in her underwear, according to the complaint.
The Richmond nurse reportedly admitted diverting and intravenously using drugs from the hospital for nearly half a year — at a rate of between one and 10 doses of pain medication a day.
Hospital records showed that she stole nearly 900 units of medication valued at about $72,000.
Hibbard, who declined comment for this story, has entered a three-year recovery monitoring agreement with the Indiana State Nurses Assistance Program (ISNAP).
In August, Hibbard pleaded guilty to felony drug and theft charges, for which she received probation and a suspended sentence of 547 days in prison. The next day, the attorney general filed a complaint asking the state board of nursing to impose disciplinary sanctions against Hibbard’s license. The case remains pending.
Reid Health referred questions for this article to law enforcement.
“I think the opioid crisis is getting worse, according to all of the statistics, but we have not seen an increase in the number of nurses referred,” ISNAP program director Chuck Lindquist told The Star Press. “We are currently monitoring over 400 nurses, and we have 70 in intake. Obviously, that’s less than 1 percent of folks with Indiana nursing licenses.”
There are about 140,000 nurses in Indiana, he said, and it is estimated that at least 10 percent are addicted to alcohol or other drugs. “That means 14,000 nurses are … possibly struggling with addiction, and we’re seeing only 500 of them,” Lindquist said. “There are some nurses in the throes of addiction that we just don’t hear about until they’re caught diverting or coming to the work place impaired.”
In the past year, ISNAP intakes actually decreased to 241 compared to 297 the previous year. “We have seen a bit of an increase in the use of heroin over the past 12 to 18 months,” Lindquist said. “But if overall opioid use is getting worse, we’re not getting additional referrals as a result. Most of our nurses are referred through their employer or the attorney general.”
WASHINGTON, D.C. – Yesterday, Reps. Phil Roe, M.D. (R-Tenn.), Annie Kuster (D-N.H.) and Tom MacArthur (R-N.J.) introduced the Opioid Addiction and Prevention Act of 2017, legislation to limit initial post-acute care opioid prescribing to ten days.The legislation would not preempt state law in states that have more limited timeframes for these prescriptions and would not have any impact on patients who utilize opioids for the regular management of chronic pain.
The members released the following statements:
“The opioid epidemic is devastating communities across the United States, including my home state of Tennessee, with more people dying from opioid overdoses than car wrecks,” said Roe. “As a physician, I am keenly aware that patients may need pain medication following a medical procedure or hospital stay, but patients experiencing intense pain that lasts ten days should be evaluated further by their physician. The reality is too many people become addicted to these drugs because their initial prescriptions keep them on these drugs longer than necessary. Furthermore, excess unused prescriptions too often end up as a supply source for addicts, including family members. This commonsense bill will ensure any patient prescribed opioids after receiving post-acute medical attention will have the close provider supervision required to ensure the responsible management of pain during their recovery. This legislation will help curb the opioid epidemic and will not have any impact on patients who are prescribed opioids for chronic pain, cancer care or end-of-life treatments.”
“The opioid epidemic is having a serious impact on communities in New Hampshire and across the country,” said Kuster. “It is clear that the historic rise of opioid addiction in America was fueled in part by the excessive prescription of opioids drugs. While seeking to relieve patients of their pain after surgery or other procedures is well-intentioned, it is troubling that Americans consume about 80% of the world’s supply of opioid medications. This legislation would address the crisis by encouraging prescribers to provide, when appropriate, non-opioid alternatives prior to opioid medications, and if patients are to receive opioids, they will only receive a dosage and amount necessary to relieve their pain. We need to overcome the prescription opioid crisis, in order to overcome this public health emergency.”
“Drug addiction has impacted so many families in New Jersey and in many communities across the country,” said MacArthur. “For far too many Americans, this addiction is starting not on the streets, but in the medicine cabinet. This legislation will ensure that prescribers limit the initial supply of addictive opioids in order to prevent prescription drug abuse and combat the opioid epidemic. The drug crisis is too big for any of us to fight on our own. We need everyone—federal and local government, members of our communities, and medical professionals working together to overcome this epidemic.”
Background: A March 2017 article from the Mortality and Morbidity Weekly Report from the Centers for Disease Control and Prevention found that there is a sharp increase in the likelihood a patient would use opioids long-term in the first days of prescribing, particularly after five days. A recent Washington Post story found that at least 17 states have taken steps to limit opioid prescribing, many of which limited the prescribing window to five to seven days. This legislation would not impact these existing state laws.
Another bureaucratic hypocrite, by a educated/trained physician, who is part of a profession that is responsible for 200,000 – 400,000 deaths per year from MEDICAL ERRORS. And his statement:
with more people dying from opioid overdoses than car wrecks.. there are more people dying from ALL DRUG OVERDOSES – than car wrecks… which included drug OD deaths from non-controlled medications – abt 40%… and an increased number > 50% of the opiate OD’s are from ILLEGAL OPIATES… which means that more people die from CAR CRASHED ….. than legal prescription opiates – and not all OD’s from prescription opiates – were the prescription opiates LEGALLY OBTAINED… which means that deaths from car wrecks are many times those from legally obtained prescription opiates… so why are we not limiting who can drive cars or selling cars that can go faster than the speed limits. My 2015 car displays on the dash the speed limit of the street/road that I am driving on… so why can’t the car manufacturers put a speed governor on cars so that drivers CAN’T SPEED ? How many lives would that save ?
Emergency nurses, nurse practitioners and physicians have heard the rumors.
Many speculate that America’s growing problem of opioid addiction often starts in the emergency department, where practitioners freely write prescriptions for drugs like oxycodone, hydrocodone and methadone for their patients who present with acute pain.
But a new study shows that these perceptions don’t really hold water.
Opioid prescriptions from the emergency department (ED) are written for a shorter duration and smaller dose than those written elsewhere, shows new research led by Mayo Clinic. The study, published September 26, 2017, in the Annals of Emergency Medicine, also demonstrates that patients who receive an opioid prescription in the ED are less likely to progress to long-term use.
This challenges common perceptions about the ED as the main source of opioid prescriptions, researchers say.
“There are a few things that many people assume about opioids, and one is that, in the ED, they give them out like candy,” says lead author Molly Jeffery, PhD, scientific director, Mayo Clinic Division of Emergency Medicine Research.
“This idea didn’t really fit with the clinical experience of the ED physicians at Mayo Clinic, but there wasn’t much information out there to know what’s going on nationally,” she added.
To study 5.2 million opioid prescriptions written for acute – or new-onset – pain across the United States between 2009 and 2015, the researchers used the OptumLabs Data Warehouse, a database of de-identified, linked clinical and administrative claims information.
None of the patients in the study had received an opioid prescription for the previous six months, which made it easier to compare doses by eliminating patients who built up a tolerance to the drugs.
The surprising results
Researchers found that commercially insured patients who received opioid prescriptions from the ED were:
44 percent less likely to exceed a three-day supply than those written elsewhere;
38 percent less likely to exceed a daily dose of 50 milligrams of morphine equivalent, which is almost seven pills of five-milligram oxycodone per day;
46 percent less likely to progress to long-term opioid use.
An opioid prescribing guideline from the Centers for Disease Control and Prevention (CDC) issued in 2016 cautions against exceeding a 3-day supply or 50 milligrams of morphine equivalent per day for acute pain.
The researchers found similar results with Medicare patients.
“As an emergency physician, it was a good surprise to see the results of the study,” said senior author M. Fernanda Bellolio, MD, research chair of the Mayo Clinic Department of Emergency Medicine.
Also unexpected, the researchers say, were the number of prescriptions that exceeded 50 milligrams of morphine equivalent per day.
The upward trend in opioid overdose deaths
Prescription opioids have been the topic of much research and political debate in recent years, and for good reason.
More than 41 people per day died from a prescription opioid overdose in 2015, and in the last 15 years, the number of Americans receiving an opioid prescription and the number of deaths involving overdoses have roughly quadrupled, according to the Centers for Disease Control and Prevention (CDC).
Countless other cases of opioid abuse continue to threaten the public health, resulting from both prescription and nonprescription opioids.
Comparisons and risks of opioid prescriptions
The Mayo Clinic researchers found that 1 in 5 commercially insured patients in a non-emergency department setting received a dose exceeding the CDC guideline. People receiving prescriptions exceeding CDC recommendations – regardless of where they were written – were three times more likely to progress to long-term use.
“Patients and physicians should be aware of the risk of long-term use when they’re deciding on the best treatment for acute pain,” Bellolio said.
Jeffery agreed.
“I think providers may look at this and really get a sense that what they do with that first prescription can be very important in the risk of the patient continuing to chronic use of opioids,” she commented.
“What we want to avoid is people having a large prescription and having lots of pills left over,” Jeffery continued, “because at that point it becomes a risk for their family members and other people who come to their home, that those drugs could be diverted, where somebody who is not the intended recipient takes the drug and potentially takes it for nonmedical reasons and in an unsafe way.”
“Limiting prescriptions to 3-7 days is a good balance between patient burden on having to go back to the physician and that safety,” she added.
The researchers hope this study will help combat what the CDC calls an opioid epidemic by working toward an ideal prescription to match each patient’s need.
“There is a large amount of variability across patient populations in the amount of opioids people receive for acute pain, depending on where they receive their prescription,” Jeffery said. “When we see variability on such a large scale, we should worry that some people are not getting the best, most appropriate treatment.”
The researchers also note a positive trend: The proportion of prescriptions progressing to long-term use dropped over the study’s 15-year period.
The team now is studying what’s driving the differences between ED prescriptions and other practice settings. They hope shedding light on why there’s a difference will reduce the variation in prescriptions and help health care providers determine the best treatment for each individual.
Today, HRC strongly condemned the Trump-Pence administration’s decision to carry out a sweeping “license to discriminate” that puts millions of LGBTQ Americans at risk of discrimination, as well as release a new regulation that could deny millions of Americans access to critical contraceptive care previously guaranteed under the Affordable Care Act (ACA).
“Today the Trump-Pence administration launched an all-out assault on LGBTQ people, women, and other minority communities by unleashing a sweeping license to discriminate,” said HRC President Chad Griffin. “This blatant attempt to further Donald Trump’s cynical and hateful agenda will enable systematic, government-wide discrimination that will have a devastating impact on LGBTQ people and their families. Donald Trump and Mike Pence have proven they will stop at nothing to target the LGBTQ community and drag our nation backwards. We will fight them every step of the way.”
“It’s unconscionable that the Trump-Pence administration also today encouraged employers to exert control over the essential health care decisions of their employees,” continued Griffin. “The rule change on contraception will undoubtedly limit access to vitally important care that women and so many in the LGBTQ community rely on every day. We each deserve to have the freedom to live and plan our lives with dignity, and this administration’s reckless efforts to undermine the health care of millions of Americans must be stopped.”
In May, Donald Trump signed an order that threatened to exacerbate anti-LGBTQ discrimination by laying the groundwork for Attorney General Jeff Sessions to implement the license to discriminate announced today. Already, more than 50 percent of Americans live in an area of the U.S. where LGBTQ people are at risk being fired, evicted, or denied services because of who they are — and two-thirds of LGBTQ people report having faced such discrimination in their lives.
A preliminary analysis of the Trump-Pence administration’s license to discriminate indicates that LGBTQ people and women will be at risk in some of the following ways:
A Social Security Administration employee could refuse to accept or process spousal or survivor benefits paperwork for a surviving same-sex spouse
A federal contractor could refuse to provide services to LGBTQ people, including in emergencies, without risk of losing federal contracts
Organizations that had previously been prohibited from requiring all of their employees from following the tenets of the organization’s faith could now possibly discriminate against LGBTQ people in the provision of benefits and overall employment status
Agencies receiving federal funding, and even their individual staff members, could refuse to provide services to LGBTQ children in crisis, or to place adoptive or foster children with a same-sex couple or transgender couple simply because of who they are
The guidance instructs federal government attorneys on how to handle matters before them and instructs federal agencies to reconsider current and future regulations in light of this license to discriminate. It’s important to note this Department of Justice interpretation of existing federal law is not consistent in the way that federal courts have interpreted these issues and are subject to legal challenges.
When Jeff Sessions was swore into office that he pledged that he would PROTECT AND DEFEND THE CONSTITUTION of the UNITED STATES
And guess which dept, if there is a violation of the Americans with Disability Act and/or the Civil Rights Act a person files a complaint with ? https://www.ada.gov/filing_complaint.htm
US Department of Justice 950 Pennsylvania Avenue, NW Civil Rights Division Disability Rights Section – 1425 NYAV Washington, D.C. 20530
So, if the DOJ fails to enforce violations of the two above laws… is Attorney General guilty of violating his oath of office ? Should he – and others in the agency, who are involved with not enforcing our laws… BE REMOVED FROM OFFICE ?
Jeff Session, upon being confirmed as AG… stated that he would be a “by the book” law enforcer… apparently “the book” that he was referring to has a LOT OF PAGES MISSING !
While this article is about the LGBTQ community… is this just another segment of our society that the Federal bureaucracy and this administration has decided that it’s “moral compass” is not aligned with those same bureaucrats ? How many different segments of our 320 million population is this administration will – or already has – decided are not “morally aligned” with the administration’s and the country’s morals – as defined by our “over lords” residing in DC. Of course, we “mere mortals” can DE-THRONE those over-lords at the voting booth. How many of the 52 senators that confirmed Jeff Session as AG… are up for re-election next year ?
Judges across the country are ordering defendants into recovery centers that are little more than work camps for private industry, an investigation by Reveal from The Center for Investigative Reporting has found.
The programs promise freedom from addiction. Instead, they’ve turned thousands of men and women into indentured servants, exploiting a nationwide push to keep nonviolent offenders out of prison.
The rehabs send defendants to companies large and small: a Coca-Cola bottling plant in Oklahoma, a construction firm in Alabama, a nursing home in North Carolina. The rehabs get paid. The participants do not.
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This article was provided to The Associated Press by the nonprofit news outlet Reveal from The Center for Investigative Reporting. To read – or publish – a full version of this investigation go to: https://revealnews.org/nopay .
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Perhaps no rehab better exemplifies this allegiance to big business than Christian Alcoholics & Addicts in Recovery, also known as CAAIR , in the northeastern corner of Oklahoma.
It was started in 2007 by chicken company executives struggling to find workers. By forming a Christian rehab, they could supply processing plants with a cheap and captive labor force while helping men overcome their addictions.
Defendants work in grueling conditions at chicken plants owned by Simmons Foods Inc., a company with annual revenues of $1.4 billion. They work alongside paid employees, churning out chicken products and pet food for some of America’s largest retailers and restaurants, including Walmart, KFC and PetSmart.
Reveal interviewed scores of former participants and employees, court officials and judges, and reviewed hundreds of pages of court filings and workers’ compensation records.
Among the findings:
– The program may violate the 13th Amendment, which bans slavery and allows forced labor only for people convicted of a crime. Many men sent to CAAIR have not yet been convicted and later have their cases dismissed.
“You’ve got to be kidding me,” said Noah Zatz, a professor specializing in labor law at UCLA. “That’s a very strong 13th Amendment violation case.”
– The authors of Oklahoma’s drug court law believe it is illegal for judges to send defendants to CAAIR. The law requires drug courts to use programs that are certified by the state. CAAIR is not. Rather than professional addiction treatment, the program mainly relies on faith and work.
“That is insanity gone to sea,” said former state Sen. Dick Wilkerson, who wrote the law. “That’s illegal. They can’t do that. That is the law, and it has to be followed.”
– CAAIR administrators use the threat of prison to push defendants to work, even when they are injured. Men who were hurt on the job have been kicked out of CAAIR and sent to prison.
“They work you to death,” said Nate Turner, who spent a year at CAAIR. “They know people are desperate to get out of jail, and they’ll do whatever they can do to stay out of prison.”
– CAAIR routinely files workers’ comp claims on defendants’ behalf and collects the payments. By law, those payments are required to go to the injured worker.
“That’s fraudulent behavior,” said Eddie Walker, a former judge with the Arkansas Workers’ Compensation Commission. “What’s being done is clearly inappropriate.”
Courts across Oklahoma and neighboring states send about 280 men to CAAIR each year. Some men say it changed their lives. But few ultimately finish. In 2014, 26 percent completed the program.
Instead of paychecks, they get bunk beds, meals and Alcoholics and Narcotics Anonymous meetings. They can meet with a counselor or attend classes on anger management and parenting. Weekly Bible study is mandatory. So is church. But the priority is clear to former employees and participants: Work overshadows everything else.
“Money is an obstacle for so many of these men,” said Janet Wilkerson, CAAIR’s founder and CEO. “We’re not going to charge them to come here, but they’re going to have to work. That’s a part of recovery, getting up like you and I do every day and going to a job.”
Wilkerson also put the men to work for her own needs. They remodeled her home and helped her daughter move. She called it community service.
Jim Lovell, CAAIR’s vice president of program management, said there’s dignity in work.
“If working 40 hours a week is a slave camp, then all of America is a slave camp,” he said.
Chicken plants are notoriously dangerous, and men in the CAAIR program said injuries were common at Simmons. Their hands became gnarled after days hanging thousands of chickens from metal shackles. One man said he was burned with acid while hosing down a trailer. Others were maimed by machines or contracted serious bacterial infections.
Many drug courts use CAAIR because there is a shortage of affordable treatment programs. Defendants can wait up to nine months to get into a residential program. At CAAIR, there’s no wait list and “it doesn’t cost the state of Oklahoma one penny,” said Pontotoc County Judge Thomas Landrith.
Brandon Spurgin was struggling with a meth addiction when the Stephens County drug court sent him to CAAIR in 2014.
He was working at the chicken plant one night when a metal door crashed down and split his head open. Even though he was in severe pain and had a dozen staples in his head, Spurgin kept working. If he didn’t, CAAIR could kick him out, and he would be sentenced to 15 years in prison.
“You’re just there to work, make them money,” Spurgin said. “I’d rather go to prison than do that again.”
Three years later, Spurgin has graduated from drug court but is in chronic pain and unable to work full time. CAAIR filed for workers’ compensation on his behalf and took the $4,500 in insurance payments. Spurgin said he got nothing.
Over the years, Simmons repeatedly has laid off employees while expanding its use of CAAIR. For some shifts, the plants likely would shut down if men in the program didn’t show up, according to former staff members and plant supervisors.
Simmons spokesman Donny Epp said the company doesn’t need CAAIR to fill a labor shortage.
“It’s about building relationships with our community and supporting the opportunity to help people become productive citizens,” he said.
But the CEO of Simmons has told CAAIR that he needed more workers and helped CAAIR expand. In 2015, the rehab opened another dorm. It was paid for by Simmons.
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Email reporters Amy Julia Harris and Shoshana Walter at aharris@revealnews.org and swalter@revealnews.org and follow them on Twitter at https://twitter.com/amyjharris and https://twitter.com/shoeshine .
This is a case where doctor Alvin Lewis, an internist working out of Burbank California, filed a lawsuit against the Medical Board of California alleging they invaded his privacy and went on a fishing expenditure, leading to him being charged by the medical board for excessively prescribing pain medications and placed on probation for three years. The original medical board complaint had to deal with a diet that he came up with “five bite diet,” which ultimately led to a patient complaining to the medical board. The medical board looked into the complaint and found that doctor Alvin Lewis did nothing wrong and did not violate any rules in his care and treatment for the patient. The Supreme Court ruling was published in July of 2017.
Instead of closing the complaint after no wrongdoing was found to have taken place; the medical board investigative team, consisting of a dully sworn police officer, DOJ prosecutor, and a deputy attorney general lawyer – they started snooping into the prescription dispensing program to identify any patient that he had treated with prescription pain pills that was questionable or if the patients were drug addicts or had criminal backgrounds. This is what disturbed doctor Alvin Lewis to the point of hiring an attorney at Fenton Law Group to file a complaint against the medical board for going on a fishing expenditure and tapping into confidential patient records when their investigation into the original complaint turned-up nothing illegal or wrongdoing on his part. After snooping into perhaps hundreds and thousands of prescription records within the Controlled Substance Utilization Review system, they then identified several patients where they allege were prescribed painkillers excessively, by doctor Lewis.
The Supreme Court Made Its Decision
The Prescription Dispensing Monitoring Report is full of inaccuracies and criminal impressions. The state of California is a cesspool of fraudulent prescriptions and prescription thefts occurring on a daily basis. There is an equal, larger base of illegal painkillers from China and other countries that is actually responsible for 70 percent of the illegal prescriptions sold on the streets. The legal prescription written by doctors are not the major cause of overdose deaths and this information is not being communicated correctly to the people of this country. This lawsuit shows how the government is overreaching and abusing their authority by going into private patient files and conducting witch hunts to charge physicians and nurses.
The Judge who made his opinion on the ruling stated that doctor Lewis case would have a some teeth to it if he would have referenced his concerns to a similar federal case that is still pending adjudicated. The fishing expenditures needless to say, were not mentioned because the medical board has conducted these types of unconstitutional investigations for years. This is classic; somebody makes a complaint about dietary concerns to the medical board and they know the doctor did nothing wrong, but they prey into his business and patients to seek to cause harm to his practice and threaten his livelihood as a doctor. This is what a fishing expenditure is by nature, an illegal practice of incriminating someone based on nothing and manufacturing a case.
How Can You Make A Difference?
BECOME A MEMBER: Please support Doctors of Courage and our fight against unlawful Government abuse of doctors and healthcare providers nationwide. Your Membership helps to provide support for thousands of doctors who are being unlawfully jailed and stripped of their medical careers for treating patients with legal prescriptions.
JOIN THE FIGHT: Please support the American Pain Institute (API) at www.americanpaininstitute.org and get involve with their PAIN ADVOCACY WEEK, April 23rd – 30th, 2018, March On Washington and donate to help this cause. Thousands of Chronic Sickle Cell patients’ lives are being drastically reduced and they are dying because doctors are afraid to follow NIH treatment guidelines due to bigotry and government wrongful persecution of doctors in this country.
HELP MAKE CHANGE: Sign our petition requesting that Congress enact a Medical Board Civilian Police Review Committee law to deter medical board police and prosecutorial misconduct and hold these officials responsible for their actions. The most common crime against doctors made by the medical board police teams are “FALSE REPORTS” that police officers refer to as accusations. These are criminal actions by law enforcement and they are not held accountable for making false statements, perjury, and manufacturing evidence. A Civilian Review Committee will help stop these senseless acts against healthcare providers and restore justice and constitutional rights.
SIGN / SHARE OUR PETITION to fight for doctors and nurses rights:
Editor: Billy Earley, Physician Assistant, Healthcare Advocate, National Adviser Black Doctors Matter National Adviser American Pain Institute Advocate World Sickle Cell Federation
The U.S. Food and Drug Administration may start cracking down on claims that marijuana has health benefits that haven’t been proven, the agency’s commissioner said Tuesday.
“I see people who are developing products who are making claims that marijuana has antitumor effects in the setting of cancer,” FDA Commissioner Scott Gottlieb said at a hearing before Congress on a separate matter. “It’s a much broader question about where our responsibility is to step into this.”
It’s high time to start looking at rules around the plant, which some states have legalized for medicinal or recreational use, the commissioner said.
“We’ll have some answers to this question very soon because I think we do bear some responsibility to start to address these questions,” Gottlieb said.
Seven years ago, Mike Moore stepped from the 2 a.m. darkness into the light of a small home off Lakeland Drive in Jackson, Miss., to find his nephew close to death. The 250-pound 30-year-old was slumped on the living room couch, his face pale, breath shallow, and chest wet with vomit. It was his fiancée who’d called Moore, waking him in a panic. Now they were both screaming in the man’s ears, dousing him with ice cubes and water, and pinching him as his respiratory system began to collapse.
Moore had become familiar with the signs of an overdose since his nephew, for whom he’s a father figure, filled his first legal prescriptions in 2006 for Percocet, an opioid painkiller made by Endo Pharmaceuticals Inc. By 2010, his nephew, who asked not to be named, was obtaining generic fentanyl on the street. Another synthetic analog to the opium poppy, fentanyl—the drug that killed Prince—is as much as 100 times stronger than morphine. The night of the overdose, Moore’s nephew had been wearing a fentanyl patch on his arm and sucking on another. “An ordinary horse would have been dead,” Moore recalls in his Mississippi drawl.
Rather than waiting for an ambulance, Moore dragged his nephew to his car and raced toward the hospital. As doctors revived the unconscious man, the stares of the staff and other patients were made worse for Moore by recognition. Once his home state’s highest-profile public official, now he was just one more American confronting the opioid epidemic.
Moore, who’s 65, served as Mississippi’s attorney general from 1988 to 2004. In 1994, using an untested and widely derided legal strategy, he became the first state AG to sue tobacco companies for lying about nicotine addiction and hold them accountable for sick smokers’ health-care costs. A Democrat, he marshaled AGs from around the country along with private plaintiffs’ lawyers who stood to reap massive fees. He went on to negotiate the largest corporate legal settlement in U.S. history: a 50-state, $246 billion agreement that funds smoking cessation and prevention programs to this day. He even scored a Hollywood credit, playing himself in The Insider, the 1999 thriller about a tobacco industry whistleblower, starring Al Pacino and Russell Crowe.
After his 16 years as AG, Moore left public service for a private-sector salary, opening a practice in the Jackson suburb of Flowood. The Mike Moore Law Firm specializes in complex disputes between states and companies. This spring he finished helping oversee negotiations between BP Plc and the federal government, five states, and 475 municipalities, which resulted in a $20 billion settlement for damages from the Deepwater Horizon oil spill.
Moore now lives near Orlando, with his wife, four rescue dogs, and Jade, a capuchin monkey. He’s remained immersed in anti-tobacco efforts, chairing such nonprofits as the Partnership for a Healthy Mississippi and the Truth Initiative. But as he’s watched the tobacco victory pay off in declining smoking rates, he’s also seen easy access to powerful pain medication spark a new deadly crisis. He’s convinced this is the moment to work the same mechanisms on the drug companies that forced the tobacco industry to heel—and he’s committed himself to making that happen.
On June 20, 1997, a coalition of state AGs stood behind a podium in the grand ballroom of the ANA Hotel in Washington to announce the culmination of a four-year effort. They’d filed so many individual, expensive lawsuits that tobacco companies were cornered into negotiating a collective settlement instead of fighting each one separately. The agreement punished the industry for past misconduct, created a fund to pay for tobacco-related medical costs, and banned using Joe Camel in advertisements. “We wanted this industry to have to change the way they do business—and we have done that,” a youthful Moore said to the roomful of journalists and cameras.
Twenty years later, in mid-July 2017, he was back at the same hotel, now a Fairmont. In a third-floor meeting room, he and more than a dozen private attorneys sat around a rectangular conference table discussing strategies for the legal battle they’d helped ignite with companies that make, distribute, and sell opioids.
Aided by the lawyers in the room (and others, including high-profile and high-profiting alumni of the tobacco wars, such as Joe Rice and Steve Berman), 10 states and dozens of cities and counties have sued companies including Purdue Pharma, Endo, and Johnson & Johnson’s Janssen Pharmaceuticals—beginning in 2014 but mostly in the past few months. (Forty state AGs have launched preliminary investigations as a way to gauge the viability of litigation.) The suits allege that the companies triggered the opioid epidemic by minimizing the addiction and overdose risk of painkillers such as OxyContin, Percocet, and Duragesic. Opioids don’t just cause problems when they’re misused, the suits argue: They do so when used as directed, too.
The opioid epidemic cost the U.S. economy $78.5 billion in 2013, according to the U.S. Centers for Disease Control and Prevention, a quarter of which was paid by taxpayers through increased public costs for health care, criminal justice, and treatment. The industry, the suits contend, should bear the financial burden of this wreckage.
Paul Hanly Jr., a Manhattan attorney who’s filed on behalf of almost a dozen cities and counties, opened the discussion at the Fairmont with lessons from previous suits. P. Rodney Jackson, a lawyer from West Virginia, got heads nodding with his recommendation that suits targeting manufacturers should be amended to add distributors who sell pills to pharmacies. A retired agent from the Drug Enforcement Administration, one of several consultants, laid out the fines that distributors and pharmacies have already paid after failing to follow federal requirements to report suspiciously large pill orders.
Officially, Moore’s name is listed only on cases filed by Mississippi, which was the first state to sue, and Ohio. But this belies his outsize role in convening the like-minded while envisioning the long-term, big-picture strategy. “We’re trying to build coalitions, because it won’t get done with me and our little team,” he says, referring to a core group of longtime friends that includes former Arizona Attorney General Grant Woods, the first Republican AG to join the anti-tobacco crusade, and Chip Robertson, a former chief justice of the Supreme Court of Missouri who helped his state sue tobacco companies.
Just as he did during the tobacco-litigation era, Moore has been traversing the country to recruit people to his cause. His trip to Washington was one of more than 50 he estimates he’s taken in the past six months to meet with hundreds of private attorneys, about 30 AGs, and professionals in law enforcement and public health. An alumnus of Ole Miss, where he wore his hair long and jammed on a synthesizer in a rock band, Moore’s expertise is in glad-handing and dealmaking. “My talents are not writing briefs, they are not researching the law,” he says. “I know people. I know how to deal with people. I treat people fairly.”
Moore and his allies hope to corral at least 25 states to exert enough pressure, collect enough evidence, and drive potential damages so high that it will be cheaper for opioid manufacturers to back down. They’re confident that the epic scale of the crisis ravaging the country has gotten too big to dodge. What was once considered a problem only among the Appalachian poor now touches every demographic. The most recent data, from 2015, show the opioid death toll exceeded 33,000 that year.
The goal, according to Moore, isn’t to simply win a pile of money to be allocated haphazardly into government coffers. One of his regrets from the cigarette windfall is that some of the money didn’t go where intended. This time, he wants a comprehensive, company-funded national program that would make treatment more widely available—currently just 1 in 10 addicts has access—as well as expand prevention education and force a change in doctors’ prescribing habits. Despite having fallen since its 2010 peak, the number of opioid prescriptions in 2015 was three times what it was in 1999, the CDC says.
“Litigation is a blunt instrument; it’s not a surgical tool,” Moore says. “But it provokes interest quicker than anything I’ve ever seen.”
Mike Moore from the film The Insider (1999), directed by Michael Mann.
Source: Touchstone Pictures/Photofest
While the government lawsuits filed so far target combinations of drug companies, they consistently single out Purdue. With its aggressive marketing of OxyContin—the Kleenex or Google of opioids—Purdue established the market as we know it and invented many of the practices the government suits now seek to frame as unlawful.
Tenacious promotion is woven into Purdue’s DNA. In 1952 three brothers, Arthur, Mortimer, and Raymond Sackler, all psychiatrists, bought a little-known laxative maker in New York. From it they built the modern Purdue, still a family-owned company. During those early years, Arthur Sackler pioneered now-common pharmaceutical marketing techniques—for example, sending “detailers,” or specialized salesmen, to pay calls directly on physicians.
As recently as a quarter-century ago, few doctors prescribed the opium-derived drugs (and synthetic versions of them) for chronic pain related to backaches, headaches, or arthritis. This class of medications was distributed primarily to postoperative patients and those dying of cancer. That wasn’t much of a market, though. In the late 1980s a handful of researchers and pain doctors began to argue that pain was vastly undertreated, and one company more than any other—Purdue—grabbed the opportunity. Almost single-handedly, it turned what had been a niche product into one of the most prescribed classes of drugs.
Outspoken experts such as Dr. Russell Portenoy, a New York-based pain specialist, argued in journal articles and Purdue-paid talks to doctors that opioids weren’t inherently addictive and could safely be prescribed over extended periods. In 1995 the American Pain Society, a Purdue-funded group over which Portenoy later presided, urged physicians to monitor pain as a “fifth vital sign,” along with blood pressure, body temperature, pulse, and respiration. In 1996, Purdue unveiled OxyContin, which paired oxycodone, an opium derivative, with Continus, a time-release formula. Approving the pill, the U.S. Food and Drug Administration accepted Purdue’s contention that because the drug entered the bloodstream gradually, it wouldn’t cause the surging highs and subsequent lows that kindle addiction.
Purdue put its full energy into selling OxyContin, according to a U.S. Government Accountability Office report in 2003. The company doubled the number of detailers devoted to the drug, from 318 in 1996 to 767 in 2002. Total annual cash bonuses tied to sales soared from $1 million to $40 million. Purdue directed its reps to call on primary care physicians, despite their scant training in the treatment of serious pain. In videos and publications, it relied on a dubious statistic—that only 1 percent of patients treated with narcotics would become addicted—even though the figure came not from a peer-reviewed scientific study, but from a one-paragraph 1980 letter to the editor in the New England Journal of Medicine. The company gave away OxyContin-branded fishing hats, plush toys, and golf balls. Detailers handed out big-band music CDs titled Swing in the Right Direction with OxyContin, and 34,000 coupons for a free one-time prescription.
Purdue also embraced a questionable condition called “pseudoaddiction,” which holds that behaviors normally associated with addiction—requesting drugs by name, displaying a demanding or manipulative manner, or seeking out more than one doctor to obtain opioids—might be signals that a patient needs more pain medication, not less. The concept was promoted in a 2007 publication called Responsible Opioid Prescribing, distributed by the Federation of State Medical Boards and co-sponsored by Purdue. It had been coined almost two decades earlier by a pain doctor named J. David Haddox. He became a Purdue employee in 1999 and remains vice president for health policy. Purdue declined to make him available for comment, but company spokesman Robert Josephson contends that the FDA takes the concept seriously. OxyContin’s FDA-approved label says “preoccupation … with achieving adequate pain relief can be appropriate behavior in a patient with poor pain control.”
The tactics worked. OxyContin sales rose from $45 million in 1996 to more than $1.5 billion in 2002. But the drug’s huge success as a treatment for long-term chronic pain—and much of the marketing that drove it—had no basis in meaningful science, according to Andrew Kolodny, a physician and co-director of opioid policy research at the Heller School for Social Policy and Management at Brandeis University. There was no controlled, double-blind research—and there’s none still—that supports the notion that opioids are effective for treating chronic pain over a period of many months, let alone years. “For the vast majority of patients, the known, serious, and too-often-fatal risks far outweigh the unproven and transient benefits,” the CDC said in 2016.
States have tried to legally challenge opioid marketing practices, aiming mostly at Purdue, since at least 2001. But these earlier attempts produced only modest, piecemeal settlements—including $10 million for West Virginia in 2004, and $19.5 million for 26 states and Washington, D.C., in 2007.
In private practice, Moore was involved in a cluster of suits instigated in 2003 against Purdue by people who claimed they or loved ones got hooked on prescription opioids despite obtaining them legally and taking them as directed. In conducting his investigation, Moore visited pain clinics and interviewed users, doctors, and people who’d advertised and marketed the company’s drugs. The effort ended in 2007 when claimants, represented by lawyers including Hanly, the Manhattan attorney, settled for $75 million. Purdue admitted no wrongdoing, and the court agreed to keep the corporate documents gathered in discovery confidential. The case may not have done much to waylay Purdue, but it did give Moore early insight into how opioid litigation could work and helped him establish connections with attorneys who are now among the most active filers.
In a federal criminal prosecution, also resolved in 2007, Purdue and three of its top executives pleaded guilty to “misbranding” OxyContin and collectively agreed to pay some $630 million in civil and criminal penalties. The company specifically acknowledged that it trained its sales representatives to mislead physicians about opioid risks. Purdue emphasized that its plea covered misconduct only from 1995 through 2001. “We accept responsibility for those past misstatements and regret that they were made,” the company said.
More than a dozen years of scattershot litigation “accomplished absolutely zero” in terms of preventing or stemming the crisis, says Woods, the former Arizona AG and Moore ally. “Some lawyers made money. States put some money in coffers. But the problem is greater today than it’s ever been.” The difference this time, Woods and his colleagues say, is that such a large group will pool their resources and evidence.
Most of the current lawsuits target multiple companies based on the allegation that while Purdue pioneered misleading marketing tactics, its competitors subsequently replicated them as sales of OxyContin exploded. The complaints charge that Purdue and its rivals never stopped their alleged campaign of misinformation carried out by means of industry-funded experts and pamphlets, online publications, and medical educational programs. (Josephson declined to comment on any of Purdue’s marketing tactics, citing the pending litigation.)
Photographer: Irina Rozovsky for Bloomberg Businessweek
Portenoy, the Purdue-affiliated pain doctor, recanted publicly in 2011, conceding that research he relied on to push his and Purdue’s pro-opioid campaign didn’t prove anything about the treatment of chronic pain. (He wrote in an email that no one “anticipated the widespread overdosing and medication misuse we see today.”) He and other industry-funded physicians, described as “key opinion leaders,” are named as defendants in a handful of the current government lawsuits.
Ohio is representative of how lethal and costly the opioid epidemic has become and how the government lawsuits work. In 2012 prescriptions reached a peak, 793 million opioid doses, according to state statistics—enough to medicate every resident with 68 pills apiece. Half of the state’s foster-care population is made up of children with opioid-addicted parents, and the rate of babies born addicted to opioids grew almost eightfold from 2006 to 2015. In 2014, Ohio Attorney General Mike DeWine, a Republican, began considering litigation. With his own office lacking manpower and expertise, he invited pitches from a half-dozen teams of outside lawyers. Moore’s group won the assignment.
Filed in May in state court, Ohio’s suit accuses drugmakers of “borrowing a page from Big Tobacco’s playbook” by concealing addiction risks. According to the state, Purdue, Teva Pharmaceutical Industries, Janssen, Endo, and Allergan invested millions to change attitudes about opioid prescribing. Janssen distributed a patient education guide calling opioid addiction a “myth,” for example, while Endo advertised that an abuse-deterrent reformulation of one of its most popular opioids, Opana ER, made it crush-resistant, despite its own studies disproving that claim. From 2001 through 2015, Purdue hosted the website inthefaceofpain.com, which promoted “the notion that if a patient’s doctor does not prescribe what, in the patient’s view, is a sufficient dosage of opioids, he or she should find another doctor who will.”
Ohio accuses the companies of creating a public nuisance, violating state laws against unfair sales practices, and committing Medicaid fraud by spurring unnecessary prescriptions that the state reimbursed. The conduct dates to at least 1996 and continues through the present, says Jonathan Blanton, who heads the AG’s consumer protection unit. The companies, DeWine says, have reaped unjust profits while devastating communities and fueling a heroin resurgence. “It’s clear they’re not going to be part of the solution unless we drag them to the table.”
Like most of the current lawsuits, Ohio’s complaint isn’t specific about how much money it aims to recoup. But Ronny Gal, an analyst at Sanford C. Bernstein & Co., views the litigation as a material threat to companies, with potential aggregate damages “in the many billions.”
While the evidence marshaled by Ohio and other plaintiff governments is compellingly grim, whistleblowers and smoking-gun documents would help turn these suits into tobacco-scale winners. Moore predicts that insiders willing to testify are bound to materialize as plaintiffs’ lawyers continue to investigate. Jeffrey Wigand, a star whistleblower (and subject of The Insider), didn’t emerge until a year after Moore filed suit on behalf of Mississippi in 1994.
Denying any wrongdoing, all of the companies say they want to help resolve the crisis, but not through litigation, which they call wasteful and unfair. “We firmly believe the allegations in these lawsuits are both legally and factually unfounded,” Janssen spokesman William Foster says in a representative statement. “Janssen has acted responsibly and in the best interests of patients and physicians with regard to these medicines.” The only company willing to discuss the litigation on the record—as opposed to issuing a boilerplate statement—is Purdue. It declined to make any executives available for interviews or allow a reporter to visit its headquarters in Stamford, Conn., but it dispatched Josephson and an outside lawyer to discuss the cases. Purdue has the most to lose: More than half of its revenue comes from opioids, Josephson says. It doesn’t release financial information, but Sanford C. Bernstein & Co. estimates that OxyContin alone generated sales of $1.3 billion in 2016. (Opioid sales overall totaled $8.6 billion last year, up from $1.1 billion in 1992, according to Quintiles IMS Holdings Inc.) Of drugs made by the other four most commonly named defendants in the government suits, the next biggest was Johnson & Johnson’s Duragesic (fentanyl), with sales of $288 million. J&J derives 0.4 percent of its revenue from opioids and could stop making them tomorrow with barely any impact on its bottom line.
A key defense that Purdue and the other opioid makers have to deploy involves causation. The companies contend that between the time a manufacturer sells pills to a wholesaler and when those pills cause social harm, several other actors—pharmacies, prescribing doctors (some negligent or even criminal), drug abusers, and pill traffickers—break the chain of causation. Suits filed by municipalities against firearm manufacturers in the late 1990s failed, in part, because some judges ruled that gunmakers shouldn’t be held liable for the misuse of their otherwise lawful products. For a pistol to be misused, another actor—a criminal, a suicide, or a curious child—has to intervene and pull the trigger. Similarly, when opioids are misused, blame should rest elsewhere, says Mark Cheffo, one of Purdue’s outside lawyers.
Purdue and its rivals also argue that the evidence, even if incriminating, is too old. In the opioid cases, many of the allegations are based on events—such as the publication of suspect medical literature—that took place 10 years or more in the past, beyond some states’ statutes of limitations on proving fraud. Josephson says the company hasn’t received an FDA warning letter about its marketing since 2003—“14 years!” he adds for emphasis. He also complains that the suits fail to give Purdue credit for switching in 2010 to a new “abuse-deterrent” version of OxyContin that’s more difficult for addicts to crush, break, or dissolve. On its website, the company calls itself “the new Purdue Pharma,” which “has learned from the past and is focused on the future.” It says it’s investing in research and development for non-opioid pain medication, has widely disseminated the CDC guidelines for prescribing among doctors and pharmacists, and joined with the National Sheriffs’ Association in an $850,000 program to provide naloxone kits and training for police officers.
Another defense is that the states and localities should really be suing the makers of generic painkillers. Of the roughly 234 million annual opioid prescriptions, only 4 million, or 1.7 percent, are for Purdue drugs. “We don’t see how you solve this problem when you don’t have the biggest players involved,” Josephson says.
While generic medicines cause harm, they generally aren’t promoted, Moore says. Going after the branded manufacturers makes sense because they created the environment in which generics later thrived. Even so, he adds, “When this is all said and done, all the companies will be sued one way or the other.”
Moore’s nephew first became acquainted with opioids at 26, after he woke up from a four-day medically induced coma following an altercation with his then-girlfriend that ended with him being shot in the chest with his own .45. Neither party filed charges, and his recollection of the night is so hazy he doesn’t know who pulled the trigger. The gunshot caused extensive damage to his subclavian artery and surrounding nerves that would require almost 30 operations.
Doctors administered intravenous morphine while he was in intensive care; once at home, he received prescriptions for various combinations of Percocet, Norco, Dilaudid, fentanyl, and Demerol. About a year and a half later, while working full time as a manager at a Nissan auto plant in Jackson, he began finishing a month’s worth of medication after only three weeks, then two weeks, as his tolerance increased. Soon he was turning to the black market for Lortabs, hydrocodone, and fentanyl patches. At one point, during an appointment to which Moore accompanied him, a doctor assured him that he suffered from pseudoaddiction—and needed not fewer opioids, but more.
After seven years, two stints in detox, and dozens of trips to the hospital following overdoses or suffering from debilitating withdrawals, he says it was his move to Mississippi’s Gulf Coast to be closer to family that enabled him to gain some control over his addiction. He’s now 37. Despite his history, he still has a prescription for the opioid Opana IR, which he’s convinced he can use sparingly because his fear of going through withdrawal again is greater than his desire for the drug.
Moore acknowledges that weak regulation, lax prescribing practices, and abuse play a role in his nephew’s and the nation’s addiction problem. “But a huge part of it is because of the externalities of greedy companies. It wasn’t enough to make this much money,” he says, holding his hands a foot apart. “They wanted to make this much money,” he says, widening his arms as far they’ll go.
“If you ask Big Pharma right now, Mike Moore is the devil,” says Robertson, the former chief justice of Missouri. “But they haven’t talked to him. And when they sit down, he’s going to walk in and say, ‘We’ve got a business problem. Let’s figure out a business solution.’ ”
Moore is confident that the opioid industry will be driven to negotiate for the same reasons tobacco companies were: to end the demonization and obtain financial predictability. “The vilification of this industry has not even begun yet,” he says. “In other words: This litigation will vilify them. It won’t make the companies look like they’re legitimate businesspeople. It’ll make them look like they took advantage and made billions of dollars on lots of people who died from their products. And they can claim misuse and abuse all they want to—it’s too many.”
The above news piece was from a couple of years ago when this TV producer was in Texas. In a round about way the email from below showed up in my in box.
….now at our sister station in St. Louis, Mo.
Hey, I wanted to touch base with you again on the subject of metricizing and
the pressure on pharmacists. Is there a good time and day that we could talk?
California Supreme Court Gives California Medical Board Approval To Invade Doctor / Patient Privacy Lawswww.doctorsof
