Utah to Obey Order for DEA Drug Database Search

www.hightimes.com/news/utah-to-obey-order-for-dea-drug-database-search/

SALT LAKE CITY (AP) — Utah will obey a court order to let the U.S. Drug Enforcement Administration search a prescription-drug database without a warrant, despite a state law designed to protect patient privacy.

The state disagrees with the ruling that found people can’t expect privacy in the highly regulated prescription-drug industry, but state attorneys have decided not to appeal after reviewing similar cases, said Utah Attorney General’s Office spokesman Dan Burton in a statement Monday.

A federal appeals court also sided with the DEA in a case involving subpoenas of Oregon’s prescription-drug database.

All states maintain similar databases to help doctors and pharmacists prevent overprescribing amid a national opioid-drug epidemic. The databases hold records of medications like the anti-anxiety drug Xanax and sleep aid Ambien as well as opioid painkillers.

Utah is among a minority of states requiring police to get a warrant before they search the database. Utah state law enforcement will still have to follow the law, Burton said.

American Civil Liberties Union of Utah attorney John Mejia said he’s disappointed in Utah’s decision not to appeal the federal court judge’s ruling.

The DEA fought to be exempt from the law, saying the searches are an important tool in early investigations. The agency sued after agents asked to search the database to find out whether a medical provider was prescribing drugs to members of a criminal organization with ties overseas.

Officials refused to allow the search without a warrant, following a law that passed after two firefighters were wrongly charged with prescription-drug fraud following a wide-ranging search of the database in an ambulance drug theft investigation.

The firefighters were not linked to the thefts, but their relatively high number of prescriptions raised suspicion. The charges were later dropped after they showed all the drugs were properly prescribed, but still put their careers and personal lives at risk, they said.

The firefighters union joined the case to keep the DEA out of the database, as did an LGBT group. Equality Utah argued that the searches violate the privacy of transgender people whose hormone medications are recorded in the database.

But U.S. District Judge David Nuffer decided last month that database queries don’t violate laws against unreasonable search and seizure because the prescription drugs are already tightly controlled.

“Prescription drugs are a highly regulated industry in which patients and doctors do not have a reasonable expectation of privacy,” he wrote in the ruling handed down last month.

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No charges filed, despite ex-hospital employee’s admission he stole patients’ painkillers

http://www.desmoinesregister.com/story/news/health/2017/08/23/no-charges-filed-despite-ex-hospital-employees-admission-he-stole-patients-painkillers/594702001/

More than five months have passed since a former Des Moines hospital employee admitted to stealing painkillers that were be used to treat hundreds of patients, but no criminal charges have been filed. 

Victor Van Cleave was a pharmacy technician at Iowa Methodist Medical Center, who was accused in 2016 of stealing liquid fentanyl and hydromorphone. Many of the medications were meant to be used for patients undergoing surgery or giving birth. 

Van Cleave allegedly used a syringe to remove the medications from vials, then replaced them with sterile water. Other hospital staff members, unaware of the thefts, then tried to treat patients’ pain with the water. Patients have said the lack of medication left them in excruciating pain.

Van Cleave relinquished his state license in a March 7 settlement with the Iowa Board of Pharmacy. The settlement documents say he stole 252 vials of fentanyl and 18 vials of hydromorphone. He signed the documents, which say, “Respondent admits the allegations.”

Iowa Methodist faces lawsuits from several former patients who say they suffered needless pain because they were treated with water instead of medication.

Nancy Burton of Des Moines is one of those patients. She said she was affected during two visits to Iowa Methodist’s emergency department, where she was treated with water instead of medication for sharp pain from kidney stones. She said Wednesday she doesn’t understand why no criminal charges have been filed, given that the former pharmacy technician has admitted to the thefts. “It’s aggravating and depressing,” she said. “I wonder every day, ‘What’s what?'”  

Fentanyl and hydromorphone are opioids, which are effective painkillers but also are fueling the country’s drug-abuse epidemic. Illicit drug dealers reportedly have been adding forms of fentanyl to heroin to boost its potency. The practice is being blamed for a national wave of overdose deaths. Authorities have not said what allegedly became of the medications stolen from Iowa Methodist Medical Center. 

Courtney Rowley, a lawyer for Burton and several other former patients, said at a press conference in February that hospital administrators should have noticed the missing medications more quickly. “This was a systematic failure, an institutional failure, a failure to people who trusted this medical institution,” Rowley said.

Dusty Chapline, a Des Moines police officer who is a plaintiff in one of the lawsuits, said at the press conference that she gave birth to her first daughter at Iowa Methodist on Sept. 22, 2016. Chapline had to receive a second epidural during her 16 hours of labor after the first was ineffective, causing some of the “worst pain I’ve ever felt in my life,” she told reporters. “It was horrible,” she said. “I told my husband that I didn’t want to have another kid.”

Hospital leaders have defended their response to the situation, but they declined further comment Wednesday. Van Cleave could not be reached for comment.

After the thefts were discovered, the hospital urged as many as 731 patients who were affected to get tested for HIV and hepatitis C, because syringes were used in the thefts. The pharmacy technician agreed to be tested for infectious diseases and was negative, a hospital spokeswoman said in February.

But two of the former patients listed in a February lawsuit said that they tested positive for hepatitis C after receiving care at Iowa Methodist Medical Center while the thefts were going on. The virus, which can be spread through dirty needles, is a liver infection that develops into a lifelong ailment for most people who contract it and can ultimately lead to liver failure and cancer.

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Lawmakers Tell Sessions To Stop Blocking Marijuana Research

https://www.massroots.com/news/lawmakers-tell-sessions-to-stop-blocking-marijuana-research

A bipartisan group of members of Congress is asking U.S. Attorney General Jeff Sessions to stop standing in the way of increased research into marijuana’s medical potential.

“Over eighty percent of Americans believe that doctor-prescribed marijuana should be legal, according to recent polls,” two Republicans and two Democrats wrote in a letter to Sessions on Wednesday. “It is worrisome to think that the Department of Justice, the cornerstone of American civil society, would limit new and potentially groundbreaking research simply because it does not want to follow a rule.”

The letter references a story the Washington Post published last week reporting that the Justice Department has prevented the Drug Enforcement Administration (DEA) from even acting on applications from researchers who want to grow cannabis for scientific studies under a new program.

Last August, on the same day the DEA denied petitions to reschedule marijuana under the Controlled Substances Act, the agency also established a new procedure to license more facilities to cultivate marijuana for research.

The move was in response to concerns about the lack of quality marijuana available for trials. The only legal U.S. source of cannabis for science since 1968 has been a farm at the University of Mississippi, which is licensed by the National Institute on Drug Abuse (NIDA). Researchers have often argued that it is difficult to obtain product from the university and that even when their applications are approved, it is often of poor quality.

However, despite the fact that DEA has already received at least 25 applications to participate in the newly expanded licensing program, it has not acted on any of them. And that, according to the Post, is because top officials in the Department of Justice are impeding the proposals from advancing.

“They’re sitting on it,” an unnamed law enforcement official told the newspaper. “They just will not act on these things.”

A separate DEA insider said the Justice Department “has effectively shut down this program to increase research registrations.’”

In the new letter, Reps. Matt Gaetz (R-FL), Dana Rohrabacher (R-CA), Jared Polis (D-CO) and Earl Blumenauer (D-OR) told Sessions that they “encourage you to proceed with rapidity on the DEA’s permitting process, as we believe it is in keeping with President Trump’s campaign promises, and the best interests of the American people.”

The lawmakers cite marijuana’s potential to ease the symptoms of PTSD, “which has afflicted many of the heroic men and women of our armed forces,” they write, as well as other conditions.

“The cumbersome and lengthy permitting process, as well as the difficulty of obtaining different types and ‘strains’ of cannabis with which to perform research, have thwarted researchers’ ability to study the pharmacology and potential medical usage of cannabis,” the lawmakers said. “The DEA’s new permitting process of August 2016 does not attempt to change marijuana laws, except for the acquisition of research material. Such a change is small, but will greatly enhance scientists’ ability to perform research, and, as such, it should not be hindered unnecessarily.”

Ending with an appeal to Sessions’s affinity for law and order, they write, “Finally, because we know you to be a man with unwavering commitment to the rule of law, we ask with respect for the DEA’s rule to be followed, and for the permitting process to move forward with all possible expeditiousness.”

See the full text of the lawmakers’ letter to Sessions below:

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How we can fight back against Jeff Sessions’ new highway robbery policy

https://www.usatoday.com/story/opinion/2017/08/24/how-states-can-fight-back-against-jeff-sessions-new-forfeiture-order-herod-sibilla-column/586246001/

Under civil forfeiture, law enforcement can confiscate private property without ever filing criminal charges.

In a refreshing display of bipartisanship, the U.S. Commission on Civil Rights on Friday slammed a new expansion of civil forfeiture announced by Attorney General Jeff Sessions. Under civil forfeiture, law enforcement can confiscate private property without ever filing criminal charges. Notably, the Commission, which is usually divided along bitter, partisan lines, voted unanimously to rebuke the Justice Department and called to end civil forfeiture.

As the Commission recognized, “scaling up rather than scaling back on this practice means more innocent Americans will lose their property.” Worst of all, the Sessions order widens a loophole that allows agencies to circumvent state safeguards specifically designed to limit civil forfeiture.

Fortunately, states like Colorado are fighting back. Thanks to a landmark reform bill that took effect on Aug. 9, the Attorney General’s directive will barely be felt in Colorado.

The new Justice Department policy revitalizes part of a federal forfeiture program called “equitable sharing.” This program allows local and state agencies to collaborate with federal agencies and forfeit property under federal law. Litigating under federal law — one of the laxest in the nation — lets police and prosecutors bypass restrictions they otherwise would face. Across the country, the property owner was never indicted in 81% of all equitable-sharing cases.

More: Forget Russia. I’d fire Jeff Sessions over civil forfeiture.

More: How police steal from citizens

Consider Mark Brewer, an Air Force veteran who lost his life savings because of this loophole. While driving through Douglas County, Nebraska in 2011, a deputy pulled him over. Upon searching the car, no drugs were found. But the deputy did come across $63,530 in cash. Without ever charging Brewer with a crime (or issuing him a ticket), the deputy seized Brewer’s money.

Instead of turning the case over to Nebraska prosecutors, the Douglas County Sheriff’s Office relied on an equitable sharing program called “adoption.” The sheriff’s office referred the seizure to the Drug Enforcement Administration (DEA), which “adopted” the case less than a month later.

By transferring the case to the DEA, the Douglas County Sheriff’s Office could skirt state law, which required proving beyond a reasonable doubt that seized property had criminal ties. But under federal law, prosecutors can prevail under a much lower standard called “preponderance of the evidence” (i.e. more likely than not), which caused Brewer to lose his cash.

His case was not an isolated incident. Brewer was just one of nearly 62,000 people who had their cash seized through equitable sharing since 9/11. Spurred by this torrent of abuse, in January 2015, then Attorney General Eric Holder curtailed adoptive seizures, which accounted for one-fourth of all equitable sharing seizures nationwide.

Now Sessions has undone even that moderate progress. His order reverses the adoption limit and hurtles the nation in the wrong direction.

Moreover, the “safeguards” Sessions promised only apply to cash under $10,000 and can be bypassed with approval by a federal prosecutor. As for real estate forfeitures, including homes, the directive merely asks that Justice Department officials “proceed with particular caution.”

That guideline would have hardly helped property owners like Tony Jalali, who owned a $1.5 million office building in Anaheim. One of his tenants was a medical marijuana dispensary. Although medicinal marijuana was legal in California, an undercover officer bought $37 worth of cannabis from the dispensary. Based solely on that minor purchase from one tenant, Anaheim police wanted to confiscate the entire building.

Police first reached out to California prosecutors, but were rebuffed. Since California is one of 14 states that requires a conviction to forfeit property, Jalali — who was never even accused of a crime — should have been protected.

Federal law, however, has no such requirement. In other words, equitable sharing provided a loophole for the Anaheim Police Department to collaborate with the DEA in an attempt to take Jalali’s property. Fortunately, after the Institute for Justice became involved, the federal government dropped the case in 2013.

Disturbingly, there was also a pecuniary motivation for agencies to hand over Brewer and Jalali’s cases to the DEA. Once a property is forfeited under equitable sharing, agencies may collect up to 80% of the proceeds — a higher payout than what Nebraska and California both permit. Nationwide, the Justice Department funneled a staggering $6 billion to local and state agencies through equitable sharing since 2000.

As the U.S. Commission on Civil Rights correctly realized, allowing law enforcement to keep what they seize “creates an inherent conflict of interest,” which undermines “public trust in the police.”

POLICING THE USA: A look at race, justice, media

More: Know your rights when stopped by police

But in Colorado, the state’s new law largely ends this perverse incentive to partner and profit, by banning police from collecting bounties. Under the reform, agencies can still participate in equitable sharing, but can only receive federal forfeiture proceeds if the seized property relates to a criminal case and is worth more than $50,000. Data analysis by The Institure for Justice found that 92% of all equitable-sharing forfeitures in Colorado were under that threshold. Together, these safeguards should protect hundreds of innocent people from federal confiscations.

Previously, circumvention ran rampant. Colorado agencies managed to collect nearly $50 million through equitable sharing — roughly four times the amount taken through state forfeiture laws. Now Colorado is one of just eight states where Sessions’ directive should have little impact.

For the remaining states, the Attorney General’s announcement gives a new urgency to close the equitable-sharing loophole and resist federal interference. Our constitutional rights are too important to forfeit.

State Rep. Leslie Herod is a Democrat from Denver and the author of House Bill 17-1313, concerning civil forfeiture reform. Nick Sibilla works at the Institute for Justice.

You can read diverse opinions from our Board of Contributors and other writers on the Opinion front page, on Twitter @USATOpinion and in our daily Opinion newsletter. To respond to a column, submit a comment to letters@usatoday.com.

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14 Situations Where Physicians Should Lawyer Up

http://www.diagnosticimaging.com/blog/14-situations-where-physicians-should-lawyer

Physician practices handle a wide variety of business and administrative issues on a daily basis, often with the help of experienced practice managers who bring knowledge and expertise to the job.  However, there are time when I recommend that a practice and its manager recognize when there may be issues on which they have limited knowledge and where legal advice may be appropriate.  Often my clients call me too late after trying to handle something on their own.

The following are some circumstances where I think it’s worth it to call your lawyer, especially the ones like Attorney Stephen Phillips, to be sure you handle the situation for the best possible outcome:

1. The practice receives a letter from an attorney making a demand (for money, cease and desist, etc.). 

2. The DEA, FBI or other state or federal agent calls or comes to the practice or home of one of the owners/employees to ask questions about anything.

3. Any documents are received affecting a physician’s license, Board status, medical staff privileges at a hospital, etc. This is an area where mistakes cannot be easily remedied and talking to legal counsel immediately is very important! In no event should a resignation be submitted before legal counsel is consulted.

4. The practice is served with a complaint by the EEOC, State Department of Human Rights, Department of Labor, OSHA or any other state or federal agency regarding an employment or practice matter.

5. The practice receives a non-routine billing audit, desires to self-report or enter into negotiation with the government, or any payer, on a repayment or integrity agreement.

6. The practice is named in a lawsuit or its employees/owners are required to testify related to a lawsuit, or otherwise participate in any government or agency interview or investigation.

7. The practice discovers, or is accused, of a breach of HIPAA.

8. The practice discovers theft of prescription drugs or prescription pads, the false ordering of drugs by an employee, or that prescription drugs have been ordered from a non-permitted supplier.

9. There is a complaint of criminal or sexual misconduct, harassment or discrimination, by an employee or partner of the practice.

10.  The practice discovers theft of funds or property by an employee or partner, or an illegal scheme of any kind.

While the above may seem like obvious reasons to call a lawyer, too often practices try to handle these matters on their own.  Additionally, some healthcare/transactional issues that should also lead to a call to counsel include:

1. Employing a new physician.  Practices often rely on outdated contracts that contain errors or are not updated to reflect current law (i.e. non-compete requirements, fee-splitting, supervision of mid-levels). This also applies to legal enforcement of contracts and making legal threats.

2. Introducing new ancillary services to a practice which are “designated health services” under the federal “Stark” law.  Practices must be aware that a legal analysis of the practice structure and modifications to corporate documents may be required.

3. Entering into agreements with new vendors related to items or goods billable to federal payers or commercial insurance (DME, lab, PT) or developing marketing arrangements. All of these potential arrangements can implicate state and federal self-referral and anti-kickback statutes.

4. Entering into arrangements with other healthcare providers or entities for space, equipment, personnel or similar arrangement, especially when there may be direct or indirect referrals of patients between the parties.

I am sure there are many more examples to add to this list. The key is to really understand your practice’s own limitations and to appreciate that sometimes even the best practice manager does not know what they do not know! A practice should develop a relationship with healthcare counsel who can be available, even for a quick question. There is no doubt that sometimes the cost of not getting advice may be more than a practice can afford.

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The heroin gap in opioid tracking is killing Americans

http://thehill.com/blogs/pundits-blog/healthcare/347830-the-heroin-gap-in-opioid-tracking-is-killing-americans

Prescription drug monitoring programs (PDMPs) are state-based data banks that track opioid and other controlled substances prescribed by healthcare providers and filled by patients at pharmacies. They are supposed to cut down on the abuse and overuse of such substances by reducing the rate at which physicians prescribe opioids. While many policy makers think they’re a great idea, they may be actually contributing to the rise in opioid overdose deaths.

PDPMs have been operating in most states for several years, and although the number of opioids prescribed are indeed decreasing, the death rate from opioid overdoses keeps climbing at an alarming pace, with a reported 200 percent increase between 2000 and 2014. Indeed, the most recent data from the Centers for Disease Control and Prevention (CDC) is telling; it appears that overdoses from prescription opioids are stabilizing or even waning, while overdoses from heroin are dramatically increasing.

One reason may be that heroin is cheaper than ever on the black market. In 2015 the CDC reported a record high 33,000 opioid overdose deaths, the majority of which were from heroin. But another reason may be that physicians are reticent to prescribe opioids to those who legitimately need them, forcing their patients to turn to the black market.

And PDMPs likely share some of the blame, although they were created with good intentions. California established the first PDMP in 1939, and by 1992 10 states had PDMPs in operation. Different states had different designs in their programs and they varied in their methods of operation, even though they all shared the goal of diminishing drug abuse and diversion, i.e., the movement of prescription drugs from the patient population into the recreational user community.

Today 49 states have PDMPs at various levels of development. The only holdout is Missouri. There, legislators led by State Senator Robert Schaaf, a family physician, have obstructed the legislature’s attempts to establish a monitoring program on the grounds that it might risk patient privacy.

My state’s PDMP has been operated by the Arizona State Board of Pharmacy since 2008. All federally licensed narcotics prescribers must participate. Their prescribing data are kept in the monitoring program, inaccessible to the general public in order to protect patient privacy. 

Providers receive quarterly “report cards” comparing them to their peers in their specialty with respect to the number of times per month they prescribe various opioids, benzodiazepines, and other controlled substances. They are classified anywhere from normal to outlier to extreme outlier.

At this point the report cards are for informational and educational purposes only. Starting in October, however, Arizona will join at least 16 other states in requiring providers to first check the PMDP database on their patient in most cases before being allowed to prescribe an opioid for that patient.

Yet, even before this policy takes hold, the PDMP has significant effect on prescribers. Aware that they are under surveillance, no provider wants to be seen as an outlier. There’s no telling what the long-term consequences might be for a provider with that label. I’ve spoken with practicing physicians across my state, and all of them agree that it’s disconcerting to have “big brother” looming over their shoulders in this manner.

The ensuing chilling effect on the prescribing of opioids has led doctors to cut off some of their patients who are honestly in pain — and some of whom may have developed a physical dependence, but not an addiction (there is a difference), leading some of them to seek relief in the illegal drug market. The CDC data showing an increase in the number of heroin overdoses and a slowing in those from prescription drugs appear to bear this out.

This calls into question the value and effectiveness of PDMPs. PDMPs might succeed in making healthcare providers more frugal prescribers of narcotics. But they may also be sending more patients, in desperation, to the illegal drug market where they obtain opioids that may be counterfeit, laced with dangerous and more powerful drugs such as fentanyl and carfentanil, and where they may opt for heroin because it is actually cheaper and easier to obtain than prescription opioids.

A study released in May 2017 lends credence to this theory. Researchers at the University of Pennsylvania and Pennsylvania State University used data from all jurisdictions, as well as from the Centers for Disease Control and the US Census Bureau, to examine the effect of all PDMPs from 1999-2014. They concluded that, “PDMPs were not associated with reductions in drug overdose mortality rates and may be related to increased mortality from illicit drugs and other, unspecified drugs.”

To be sure, PDMPs may serve a useful adjunct to the healthcare practitioner. Knowledge of a patient’s prescription drug history can be very helpful not only when deciding whether to prescribe a narcotic, but also whether to have a serious discussion with a patient about that patient’s possible drug dependency. But this should be at the discretion of the doctor.

There are many cases in which the provider knows the patient quite well, and a check of the database amounts to nothing more than a nuisance. And provider report cards that carry the risk of an outlier accusation probably only serve to exacerbate the opioid overdose problem.

If states want to continue with Prescription Drug Monitoring Programs they should convert them into useful databases for healthcare practitioners to voluntarily access, as needed, in the course of administering care to their patients. But big brother heavy handedness in these programs needs to end as it is only making matters worse.

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District attorney: Marijuana laced with fentanyl is in Tennessee

TIME TO START GROWING YOUR OWN ?

https://kentuckymarijuanaparty.com/2017/08/19/district-attorney-marijuana-laced-with-fentanyl-is-in-tennessee/

NASHVILLE, Tenn. (WKRN) – A Tennessee District Attorney is offering a warning about a new, deadly mix of drugs – marijuana mixed with fentanyl.

DA Matthew Stowe told News 2 the drug is here in Tennessee and he can’t warn people fast enough.

“It’s absolutely being seen in Tennessee. It’s being seen in West Tennessee, it’s coming in in vast, vast quantities,” he said.

Fentanyl is a powerful synthetic opioid used in medical settings to treat chronic pain. On the street, it takes just a small amount for someone to overdose within minutes.

“It is very easy to move,” Stowe said. “It is very easy to transport and it’s hard to detect.”

He continued, “There are some marijuana dealers that will tell their clients that I have no doubt there is fentanyl in it and some of the more addictive folks, especially folks that also use other drugs, will get that marijuana laced with fentanyl in hopes of getting a better high.”

The district attorney told News 2 there is no way for someone on the street to know if the marijuana is laced.

“The bottom line is, anyone, anywhere could mix fentanyl and marijuana and there’s no way of knowing it until it’s too late,” Stowe warned.

Since fentanyl is so powerful, Stowe said that marijuana laced with it could kill more than just the user.

“Marijuana laced with fentanyl can be extremely deadly and to anyone who touches it, taste it, smokes it [or] anything else of that nature,” he explained. “If it’s laced with fentanyl, marijuana can be the deadliest drug there is.”

Stowe said agents have recovered the deadly mix of drugs from busts throughout Tennessee.

“I wanted to get an alert out right away,” Stowe said. “I didn’t want the community to have their first notice that we have this problem be someone’s child in the morgue.”

He continued, “Parents just need to know how deadly this is. Someone with marijuana laced with fentanyl could light up that joint, and not only would they be dead, but everyone who’s been around it inhaling the smoke could be dead as well in a matter of minutes.”

The dangerous mix of drugs has also caught the attention of the Commissioner of Safety and Homeland Security. The office confirmed fentanyl laced with marijuana is a concerning trend it’s starting to see.

News 2 also reached out to the Tennessee Highway Patrol. The agency said so far, no cases of marijuana mixed with fentanyl have been found.

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Father took his own life after years of suffering from back pain, inquest rules

http://www.knutsfordguardian.co.uk/news/15488184.Father_took_his_own_life_after_years_of_suffering_from_back_pain__inquest_rules/

A KNUTSFORD man who suffered decades of back pain took his own life with painkillers, an inquest has concluded.

Former baggage handler, Fred Sinclair, 67, was found dead in bed at his home at Longridge on February 22.

The inquest in Warrington on Monday heard that Mr Sinclair had been retired from his job because of the back pain.

His GP Tim Mallon told the inquest: “He wasn’t suicidal. I think he was rather frustrated and a bit angry at retiring at 45 with a bad back and it was hard for him to take.”

Dr Mallon told the inquest that to help relieve the pain Mr Sinclair had been taking Co-proxamol, but due to his prevailing heart condition, he had warned him of the dangers of overdosing.

The drug itself was withdrawn from general prescription because of its toxicity, but its removal left Mr Sinclair with the loss of what he believed to be the only effective drug to treat his pain, the inquest heard.

Dr Mallon added: “Over the years we have struggled to find other painkillers that were hitting the spot in dealing with the pain in his back.”

The last prescription he had for the drug was in March 2011.

His son Anthony told the inquest that his father was a proud man who would never have wanted to end up in a wheelchair.

“He wanted his distalgesic (Co-proxamol) back because he was in a lot of pain,” he said.

Anthony said that after his father’s death, two emails were found on his electronic tablet, which, in hindsight, indicated that he was hurting very much and was, in effect, saying goodbye to the family.

PC Andrew Walker had earlier told the inquest that the box of Co-proxamol, which had been prescribed in 2011, was found at the bedside.

West Lancashire coroner Claire Hammond said the cause of his death was “suicide as the result of an old prescription of Co-proxamol, with underlying heart disease, which had also contributed to his death”.

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Government’s role in opioid crisis deserves review

http://newsok.com/article/5560720

AS states grapple with increasing opioid abuse, policymakers would do well to consider if government has inadvertently played a role in fueling addiction. U.S. Sen. Ron Johnson, R-Wis., has gathered evidence suggesting this may be the case.

In a recent letter to the Health and Human Services inspector general, Johnson noted that opioid problems appeared much worse from 2013 to 2015 in states that expanded Medicaid under the Affordable Care Act than those that didn’t, based on Census data and statistics from the Centers for Disease Control and Prevention. In Maine, which didn’t expand Medicaid, there was a 55 percent increase in opioid overdose deaths. In nearby New Hampshire, which did expand Medicaid, there was a 108 percent increase. In Maryland, an expansion state, the rate surged 44 percent, but just 22 percent in non-expansion Virginia. In Medicaid-expanded Ohio, overdoses increased 41 percent, compared to 3 percent in Wisconsin, which didn’t expand its program.

Overall, overdose deaths per million residents increased twice as fast in Medicaid expansion states than in non-expansion states.

Correlation doesn’t automatically equal causation, but Johnson provides reason to think it exists in this case. Based on police comments, he reports someone with a Medicaid card can obtain up to 240 oxycodone pills for as little as a $1 co-pay. Those pills can then be resold for $4,000 on the black market.

It’s not unreasonable to think some people will exploit the system for fast cash, especially since others (taxpayers) foot almost all up-front costs.

Oklahoma is not among the Medicaid expansion states, and opioid abuse, while a major problem, isn’t as common here as in many other states — at least for now. But there have been Oklahoma cases that lend credence to Johnson’s theory.

In 2015, state authorities raided a south Oklahoma City pain clinic, Aria Orthopedics. Physician Harvey Jenkins and five former employees were eventually charged with Medicaid fraud and various drug offenses. Prosecutors called the Harvard-educated Jenkins “a drug dealer with a prescription pad.”

Jenkins had served hundreds of Medicaid patients. Prosecutors said he was known for writing large prescriptions and doing little to prevent diversion of narcotics, mainly opioid painkillers. A former clinic employee told investigators the clinic served “between 60 and 115 patients” every day.

Proponents of Medicaid expansion were quick to shrug off Johnson’s findings, and many countered that Medicaid expansion also pays for some people to obtain addiction treatment. The latter is true, but that doesn’t negate potential abuse of the system.

We’ve long supported efforts to require doctors to check the state’s prescription drug database every time they prescribe highly addictive drugs. Current law requires Oklahoma doctors to check it only on a patient’s first visit and then every 180 days thereafter. Imposing an every-time requirement would certainly be appropriate any time a doctor serves a Medicaid patient who is using taxpayer funds. There are likely other safeguards worth implementing.

Johnson’s observations justify careful review and reconsideration of state law. Policymakers in Oklahoma and elsewhere should take this critique seriously. State officials must ensure the expenditure of Medicaid dollars generates improved health outcomes, not an addiction crisis.

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Is it really a good idea give government more power over patients and doctors?

www.spectator.org/never-let-an-opioid-crisis-go-to-waste/

When the Commission on Combating Drug Addiction and the Opioid Crisis advised the President to declare a national emergency to deal with the overdose epidemic, HHS Secretary Tom Price wisely suggested that this step wouldn’t be particularly useful: “[T]he opioid crisis at this point can be addressed without the declaration of an emergency.” Price is, of course, a physician who understands the public health implications of opioid addiction. He is also a former congressman who knows what kind of mischief the federal government gets up to when “solving” a crisis. Price was in Congress when the “uninsured crisis” spawned Obamacare.

Sadly, President Trump listened to less sagacious counsel and declared an emergency after all. If the White House and Congress follow the other bad advice offered in the commission’s interim report, they will produce another disaster for doctors and patients while exacerbating the problem they ostensibly wish to resolve. The most pernicious recommendation offered by the commission involves what the report dubs “prescriber education.” It calls for doctors, dentists, and every other provider with a prescription pad to suffer through mandatory courses — under the watchful eye of the Drug Enforcement Administration — to learn the “proper” way to treat pain:

Mandate medical education training in opioid prescribing and risks of developing an SUD by amending the Controlled Substance Act to require all Drug Enforcement Administration (DEA) registrants to take a course in proper treatment of pain. HHS should work with partners to ensure additional training opportunities.

The primary result of this ill-conceived recommendation will be far fewer prescriptions for all types of medication. But isn’t the problem caused by too many doctors writing too many prescriptions? Nope. The authors of the interim report claim, “We have an enormous problem that is often not beginning on street corners; it is starting in doctor’s offices and hospitals in every state in our nation.” In order to reach this preposterous conclusion, the commission had to studiously ignore a widely-documented decline in the number of opioid prescriptions that began at least seven years ago. In July, the Centers for Disease Control and Prevention (CDC) reported:

From 2010 to 2015, the amount of opioids prescribed in the United States decreased from 782 to 640 MME per capita.… Nationally, opioid prescribing rates leveled off from 2010 to 2012, and then decreased by 13.1% from 2012 to 2015.

Despite this decrease in opioid prescribing rates, mandatory education and increased DEA surveillance will soon render providers wary of prescribing any kind of controlled substance. Doctors will be so afraid of violating DEA rules that they will err on the side of caution. Patients with no history of, or predisposition toward, addiction will suffer needlessly because lazy politicians on a presidential commission have eschewed critical thinking and embraced hyperbole. Ironically, most controlled substances are neither narcotic nor addictive, and few patients are in any real risk of addiction. As geriatric specialist Thomas F. Kline, M.D. writes:

Out of 100 people taking pain medicine, only a very few, perhaps three or four, will develop an addiction. Restricting pain medicine in the other 97 is not good medical practice.… Deaths from narcotic overdoses usually involve multiple, non-prescribed, street drugs, not pain medicines prescribed by caring doctors.

But the report rejects dull reality in favor of sensational factoids: “The average American would likely be shocked to know that drug overdoses now kill more people than gun homicides and car crashes combined.” The average American won’t be “shocked” to learn that this is hopelessly misleading. To support their claim, the commission lumps together deaths involving all drugs, including heroin and cocaine, and fails to differentiate between overdoses and deaths resulting from the ingestion of multiple contraindicated drugs. Finally, the commission ignores the role government has played in creating the “crisis.” Which brings us to its second worst recommendation:

Grant waiver approvals for all 50 states to quickly eliminate barriers to treatment resulting from the federal Institutes for Mental Diseases (IMD) exclusion within the Medicaid program. This will immediately open treatment to thousands of Americans in existing facilities in all 50 states.

This seems innocuous enough, at first glance, but disturbing data have emerged suggesting Medicaid is no panacea for this “epidemic.” Indeed, the program may well be driving the dramatic increase in opioid overdoses. A key provision of Obamacare involved coercing states into expanding Medicaid to able-bodied adults. The Supreme Court ruled that provision unconstitutional in 2012, permitting states to opt out of expansion. Since then, 19 states have done just that. What has all this to do with opioids? It turns out that the very real spike in overdoses seen in the Medicaid expansion states is absent from those 19 states. As Jon Cassidy wrote in this space in June:

Obamacare’s Medicaid expansion and individual insurance exchanges both went into effect in 2014. In just the next year, the fatal opioid overdose rate increased by 15.6 percent, CDC found.… The increase isn’t uniform. It’s clearly happening in 30 states, most of which accepted the Medicaid expansion. But overdose deaths have remained steady in 19 other states, according to the CDC.

How the commission missed the Medicaid connection is a mystery. Even the establishment media have taken notice. A headline in the Hill, for example, drew attention to the relationship thus: “Want to end the opioid epidemic? Start by freezing Medicaid expansion.” The author of that piece, Sam Adolphsen, points out that a patient covered by the program is 6 times more likely to die of an opioid-related death than someone with decent coverage. Adolphsen also points out that the Medicaid expansion in which Ohio governor John Kasich takes such pride has his state “on track to have more overdose deaths in 2017 than the entire United States had in 1990.”

All of this is lost on the President’s Commission on Combating Drug Addiction and the Opioid Crisis. Chairman Chris Christie and its other members clearly believe that government meddling will end the “epidemic.” The rest of their recommendations all involve increased federal surveillance of doctors and patients, throwing taxpayer money at failed programs, and adding to the regulatory morass that is already killing our health care system. Before President Trump and Congress take further action based on the commission’s advice, they would do well to remember Ronald Reagan’s admonition about the nine most terrifying words in the English language.

The kind of “help” offered by Governor Christie and his accomplices on the commission is exactly what Reagan found terrifying. It will give government more power over patients and doctors while making the “crisis” worse. Here’s a novel idea: How about getting together a few actual physicians, people who actually treat actual patients, and see what they suggest? We have had a lot of government help during the last eight or so years. Do we really want MORE?

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