1/8/2015, Broome County NY Launches New Heroin Taskforce

http://www.wicz.com/news2005/viewarticle.asp?a=36442

The heroin epidemic has made it’s way into the headlines and, unfortunately, into the lives of far too many people in our area… Thursday Broome County announced the creation of the Broome Opioid Abuse Council.

Heroin, opioids, now they’re the same thing…

Comments:

Leo • 5 hours ago
If they want to make a difference in the heroin trade they need to go after the rich kids in Vestal.

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Drug War 2.0

http://www.vice.com/read/america-is-really-freaking-out-about-heroin-use-now

6/9/2014, We’re Really Starting to Panic About Heroin in America

Last week offered a window into the steadily intensifying collective freak-out over heroin use in America. Republican Governor Bobby Jindal of Louisiana signed into law a bill raising the maximum penalty for heroin distribution in his state to 99 years of imprisonment. Ohio gubernatorial candidate Ed FitzGerald, a Democrat, proclaimed that users of heroin were not being punished severely enough. New Jersey law enforcement officials announced that a sweeping 1.5-month multi-agency anti-heroin “initiative” had yielded at least 325 arrests, 280 of which were apparently “users” only…

…One recent such effort was announced May 27 by Democratic US Senator Chuck Schumer, who held a press conference calling for the allocation of $100 million to the interstate High Intensity Drug Trafficking Areas Program.

http://www.wpunj.edu/uppc/HIDTA.pdf

Threat Assessment 2015

New York/New Jersey HIDTA (High Intensity Drug Trafficking Area)

Office of National Drug Control Policy

Available data and information from law enforcement sources indicate that the top drug threats
within the NY/NJ HIDTA region are as follows:

[Heroin is number one in both New York and New Jersey, with prescription drugs coming in second in both locations and cocaine in third place.]

Controlled Prescription Drugs (CPDs)… However, many NY/NJ HIDTA counties have recently experienced a leveling off or decrease in prescription-opioid involved overdose deaths and admissions to drug treatment for prescription opioid abuse. Law enforcement reporting indicates that theft from pharmacies, doctors’/dentists’ offices or hospitals are not a major source of diverted CPDs in the NY/NJ HIDTA region. Other forms of diversion – such as doctor shopping or criminal schemes involving corrupt prescribers, medical office workers, pharmacists, pharmacy employees, among others – likely account for a much larger proportion of CPDs in the illicit market.

Cocaine/crack… However, these data also indicate that the availability and abuse of both powder and crack cocaine have declined in recent years…

Marijuana. Availability and abuse of marijuana has remained stable in the NY/NJ HIDTA region in recent years. Since passage of legislation in 2010, three medical marijuana dispensaries have begun operating in New Jersey. New York State is currently considering policy options aimed at legalizing the use of marijuana for medical purposes.

And yet, they list marijuana as #4 on their “threat” list for New York, with crack being #5.

Overview of Drug Overdose Deaths

Data from the NYC Department of Health and Mental Hygiene1 show that from 2005 to
2012, the number of unintentional drug poisoning deaths decreased in New York City from
796 to 730, representing a 12 percent decrease in the age-adjusted rate from 12.4 to 10.9
deaths per 100,000 population. However, from 2010 to 2012 there was a 33 percent increase
in the rate of unintentional drug poisoning deaths, from 8.2 per to 10.9 per 100,000 residents.
Across years, nearly all deaths (98%) involved multiple substances

New York City:  The number of heroin-involved deaths increased from 209 in 2010 to 382 in 2012… The percentage of total unintentional drug poisoning deaths involving heroin in NYC also increased, rising from 39 percent in 2010 to 52 percent in 2012. In 2012, heroin was involved in more deaths than any other single drug (including cocaine, opioid analgesics, benzodiazepines, or methadone)…

Fentanyl. In early 2014, a rash of fatal and non-fatal heroin overdoses were reported in New Jersey and surrounding states, reaching north to Massachusetts and south to Maryland. In some cases, reports indicated that the overdoses were caused by heroin cut with fentanyl, while other reports cited pure fentanyl (with no heroin present) as the substance in question. Several of the affected jurisdictions reported that the tainted heroin/fentanyl may have originated in northern New Jersey. Due to the recent timing of these incidents, the sources of supply for the heroin/fentanyl have not yet been verified and the majority of lab analysis reports regarding the presence of fentanyl are still pending…

Law enforcement sources report that heroin has replaced controlled prescription drugs (CPDs) as the most serious drug threat in the region. Nonetheless, the diversion and abuse of CPDs remains a serious concern…

I-STOP. In response to diversion and misuse of controlled prescription drugs, Governor Andrew Cuomo signed the I-STOP act into law in 2012… These requirements went into effect on August 27, 2013…

In New York State, there were a total of 190 incidents reported to Rx Crimes during the period January 1, 2012 through December 31, 2013. Of these, 70 percent were burglaries or attempted burglaries, while 30 percent were robberies or attempted robberies… Between 2012 and 2013, there was a slight decline in the number of reported burglaries (including attempts) in NYS, from 71 to 62. The number of reported robberies also declined from 35 in 2012 to 22 in 2013…

In 2012 and 2013 in New York State, there were 54 robberies and 79 burglaries where CPDs were reported stolen in the Rx Crimes database.40 In these 133 incidents, a total of 343,008 pills were reported stolen. Of the total, 74 percent were reported to be prescription painkillers…

Marijuana Prices

New York Metro Area

Domestic: $50 to $350 per ounce
Hydroponic: $300 to $400 per ounce

Central

Domestic: $100 to $400 per ounce

Western

Domestic: $140 to $400 per ounce

North

Domestic: $180 to $250 per ounce

New Jersey Area

Newark

Domestic: $120 to $340 per ounce
Hydroponic: $400 to $450 per ounce

Atlantic City

Domestic: $120 to $150 per ounce

Camden

Domestic: $200 to $600 per ounce

6/15/2012, Regulation of Prescription Drugs Could Spell Trouble for Patients

http://www.thirteen.org/metrofocus/2012/06/regulation-of-prescription-drugs-could-spell-trouble-for-patients/

On June 11, the New York State Legislature passed the I-Stop bill. The legislation, expected to be signed by Gov. Andrew Cuomo, will require the creation of a new electronic prescription database. Physicians and pharmacists who write and fill prescriptions for Schedule II, III, IV and V drugs must enter the prescriptions into the database immediately. Currently, there is an electronic database for prescriptions, but doctors and pharmacists have a 45-day window for entering prescriptions, and doctors complain that the system functions slowly.

The bill will also place stiff fines on doctors who fail to immediately report prescriptions: $500 for first-time offenders and up to thousands for repeated offenses. The bill’s central aim is to keep powerful opioid and anti-anxiety prescription drugs, particularly oxycodone — the active ingredient in the opioid painkiller OxyContin — out of the hands of addicts and drug dealers.

When abused, oxycodone can produce a high similar to heroin, but for patients in severe pain, especially chronic pain, oxycodone simply provides relief rather than any high.

A concern of physicians, pharmacists, pain patients and medical organizations now is that the new system is being set up hastily and without enough input from the medical community. The result, they say, will be an overburdened system in which patients in serious pain have difficulty accessing their medications, since many doctors will likely stop prescribing powerful prescription drugs to avoid facing fines. Many also fear the new regulations will have negative unintended consequences, like an increase in heroin use and production.

The I-Stop bill has two central components. The first is the requirement that within a year from it becoming law, all narcotic prescriptions must be put into the system in real-time. The second mandate is that by the end of 2014, a new electronic prescription system must be in place, nullifying the need for the paper prescription pads that can be stolen. It’s new regulatory terrain because no other state has both of these requirements…

The main drug being eyed is oxycodone, prescriptions for which rose 82 percent in New York state between 2007 and 2010…

The result, he adamantly believes, is that a huge number of primary care physicians who might only fill between 10-20 prescriptions a day, will simply stop prescribing them. Not only will they stop prescribing oxycodone, they’ll stop prescribing hydrocodone, which the I-Stop bill will change to a Schedule II drug

To give you an idea of how bad it already is for pain patients, in recent years many New York City pharmacies have stopped carrying OxyContin altogether, because they fear robberies and the hassle of addicts trying to get forged scripts filled…

Portenoy’s own department will be exempt from the I-Stop requirements because it also offers a hospice program for patients…

“Our pain practice sees thousands of patients and most of those patients are characterized by chronic pain, and among those patients referred to a pain specialist group, the risk of abuse is very high. It could be as high as 30 or 40 percent. That’s different from addiction,” said Portenoy.

“Addiction is a genetically determined medical disorder that’s distinct from, but related to abuse, and it’s different from tolerance and withdrawal. How many patients are addicts? That is relatively low. How many patients are engaging in drug abuse? How many are using alcohol or marijuana, or doctor shopping? It’s relatively high,” Portenoy said…

Gee, with friends like that, who needs enemies?  (See Brainy Quotes on Enemies.)  However, if I were a doctor who specialized in pain, I might mention that incidents of drug abuse by pain patients can mean more than just a problem with addiction — it usually means that their pain is being under-treated.

However, a 2008 study by the Miami School of Medicine found that 96 percent of people who were prescribed opioid medications did not become addicted to them.

Another study of 28,000 people conducted by the Treatment Research Institute in Pennsylvania found that 78 percent of people in rehab for prescription drug addiction had never been prescribed their drug of choice, and instead began buying them off the street.

And perhaps the most powerful testament to why pain patients need protections from over-regulation came from an ECRI Institute study, which found that only 0.27 percent of 5,000 patients prescribed opioid medications ever became addicted…

…Portenoy said the state needs to commit more seriously to the personalized nature of pain and addiction.

“The bottom line is that pain specialists now nationally endorse a concept called universal precautions, which means every patient being considered for chronic therapy needs to undergo an evaluation of risks looking for the potential abuse and addiction, and every patient’s treatment should be individualized,” he said.

The medical industry — and specifically, the pain management industry — is not on the side of pain patients.

It seems like a no-win situation. Rehab is expensive, and methadone treatment has highly mixed results. However, a more radical form of treatment that involves work between doctors and addicts, rather than law enforcement officials and the criminal justice system, might be the most effective tool in reducing the problem.

A study released last May by the Canadian Medical Association found that opiate addicts who were slowly weaned off of their drugs of choice by a doctor were 40 percent less likely to abandon treatment than those being treated with methadone. While that method of treatment has long been used in Switzerland and the Netherlands, it’s not likely to be accepted anytime soon in the United States, where the war on drugs has cost $1 trillion over the past 40 years, according to the Associated Press.

Funny, I think they’re talking about Dr. Kolodny’s “miracle” drug, buprenorphine, but the article never mentions it by name.

Pharmacy robberies in Upstate New York

http://regionalnewsnetwork.blogspot.com/2015/01/olean-police-make-arrest-in-pharmacy.html

1/8/2015, Olean Police Make Arrest In Pharmacy Robbery

St. Olean, N.Y.  Witnesses stated that a white male possibly 18 to 28 years of age walked in the store and handed the clerk a note demanding Suboxin. There was no weapon displayed and no one was injured…

http://www.cnycentral.com/news/story.aspx?id=1138293#.VK9lvivF_bY

12/18/2014, Pennellville man arrested for Phoenix pharmacy robbery

PHOENIX, NY — 22-year-old Cody Michael Hall is accused of robbing Medicine Place in the Village of Phoenix on December 9th. Police say at the time Hall was wearing a mask and carrying a black handgun. He entered the pharmacy just before 5pm and stole narcotics…

http://www.theharlemvalleynews.com/8805/86214/a/upstate-robbery

8/22/2014, Upstate Robbery

On August 22, 2014, an unknown suspect broke into the Willsboro Pharmacy, 3932 State Route 22 in Willsboro, and stole an undetermined amount of inventory.  At approximately 4:25 a.m., the white male suspect threw a brick through a front window, entered the pharmacy, and filled a white garbage bag with merchandise…

http://www.saratogian.com/general-news/20130826/ballston-spa-man-us-navy-trainee-charged-in-weekend-cvs-holdup

8/26/2013, Ballston Spa man, US Navy trainee, charged in weekend CVS holdup

http://news10.com/2013/06/27/man-arrested-in-saratoga-springs-cvs-robbery/

6/27/2013, Man arrested in Saratoga Springs CVS robbery

SARATOGA SPRINGS, N.Y. – Saratoga Springs Police have arrested a man accused of robbing the CVS Pharmacy of over 4,000 Hydrocodone pills earlier this week.

http://newyork.cbslocal.com/2012/01/02/investigation-continues-into-deadly-seaford-pharmacy-robbery/

1/2/2012, Investigation Continues Into Deadly Seaford Pharmacy Robbery

SEAFORD, N.Y. (CBSNewYork) – Investigators are still trying to determine who shot and killed an off-duty federal law enforcement agent during a pharmacy robbery on Long Island on New Year’s Eve… But while Capano was inside the pharmacy, investigators say a man identified as 43-year-old James McGoey, of Hampton Bays, announced a holdup while brandishing a pellet gun and demanded the prescription painkiller oxycontin and some cash… It is still unclear whether the robbery suspect shot 51-year-old John Capano or whether the veteran ATF agent was struck by a bullet fired by another off-duty officer who responded to the scene.

http://www.thblack.com/links/RSD/NatureMed2011_17_905.pdf

8/2011, Politicians get tough in wake of fatal pharmacy thefts

However, it’s unclear whether the threat of longer prison times can turn the tide of robberies. Pharmacy theft increased 81% between 2006 and 2010, according to the US Drug Enforcement Administration, with 1.3 million pills stolen last year, primarily opioid painkillers such as oxycodone and hydromorphone…

http://www.cbsnews.com/news/david-laffer-charged-with-murder-in-ny-pharmacy-shooting/

6/23/2011, David Laffer charged with murder in NY pharmacy shooting

(CBS/WCBS/AP) MEDFORD, N.Y. – New York man David Laffer and his wife Melinda Brady have been arrested in connection with Sunday’s execution-style murders at a Long Island pharmacy that shocked the New York City metropolitan area and left four people dead.

http://newyork.cbslocal.com/2011/06/19/4-killed-in-medford-pharmacy-shooting/

6/19/2011, 4 Killed In Medford Pharmacy Shooting

The suspect, who stole prescription drugs from the store, is described as a white man with a thin build…

2/18/2014, The Rise and Fall of New York City’s Biggest Pill Mill

http://nymag.com/daily/intelligencer/2014/02/rise-and-fall-of-nycs-biggest-pill-mill.html

On February 5, the DEA and NYPD brought down what’s been described as the largest pill mill in the northeast, a string of medical clinics called Astramed with storefronts on Southern Boulevard and Westchester Avenue in the Bronx, which sold prescriptions for 5.5 million Oxycodone pills with a street value of half a billion dollars. Twenty-five people were arrested, including alleged gang members with aliases like Ra-Ra, Grande, Cash Money, Booby, Coco, Crusader Rob, and Pork Chop. By all accounts, Astramed was, as one DEA agent puts it, “an out-of-control place.” Crowds lined up outside the entrance like it was a nightclub, complete with bouncers; double-parked cars with out-of-state plates idled while dealers from as far away as Florida made buys.

For all the talk of an Oxy epidemic in New York — Attorney General Eric Schneiderman has noted that, in a state with 19.4 million people, pharmacists filled 13 million prescriptions for opiate-based painkillers drugs in 2012 — the DEA has never brought down a clinic here before. The fact that the case involves not just drug-dealers but practicing doctors makes it all the more monumental, given how the writing of prescriptions isn’t, in and of itself, illegal (strictly speaking, Astramed’s customers weren’t buying pills; they were buying scrips)…

Mary Lou Retton Chats About Her Isolated College Years and Her Two Titanium Hips

http://www.more.com/mary-lou-retton

10/11/2007, ’80s Olympian Retton hawks partial knee device

Retton, said Jones, “shares a story that reaches out to the younger generation of Baby Boomers out there with a compelling message about not living in chronic pain.”

Retton, a 1984 Olympic gold medalist, has served as a spokeswoman for Pfizer’s Detrol and General Nutrition Centers. She underwent a hip replacement with Biomet’s Magnum in 2005 at the age of 37. Biomet is betting she can speak to a growing number of younger people undergoing the procedures. The company is positioning Oxford Partial Knee as a quicker-healing, less-invasive option that allows patients to retain more healthy bone.

http://www.nytimes.com/1986/02/25/science/knee-microsurgery-boon-to-some-but-overuse-is-a-growing-concern.html

(1986) Knee Microsurgery:  Boon to some, but overuse is a growing concern

Arthroscopic surgery is increasingly being used to correct problems in the shoulder and elbow and to some extent in the ankle, wrist and hip as well… [And the jaw joints.]

http://www.medicalnewstoday.com/articles/270681.php

12/30/2013, Knee ops to repair torn cartilage are ‘waste of time’

A report on the Finnish Degenerative Meniscal Lesion Study (FIDELITY), published recently in the New England Journal of Medicine, finds that the benefits of keyhole operations to repair degenerative meniscal tears are no better than sham operations.

Previous studies have shown that keyhole surgery on the knee does not help patients with osteoarthritis and such procedures have become less common for arthritis sufferers. In the meantime, keyhole surgery to repair torn cartilage has risen significantly, despite lack of evidence that it actually helps, says the Finnish team…

http://www.nytimes.com/2013/12/26/health/common-knee-surgery-does-very-little-for-some-study-suggests.html?pagewanted=all&_r=0

12/25/2013, Common Knee Surgery Does Very Little for Some, Study Suggests

(1985) Knee injuries in gymnastics.

http://www.ncbi.nlm.nih.gov/pubmed/3838151

A review of injury patterns to the knee joint in gymnastics seen at our sport medicine clinic over a six and one-half year period reveals the patellofemoral pain syndrome to be more than twice as frequent as any other type of injury. Sprains are second in frequency but first in order of problems requiring emergency surgical treatment. The intensity of training correlates with the various overuse syndrome encountered, and the perfection of intricate routines and tricks can lead to significant injury of ligaments and menisci.

http://www.sportsmed.org/uploadedFiles/Content/Medical_Professionals/

Professional_Educational_Resources/Publications_and_Resources/Sports_

Medicine_Update/SMU_2008/SMU%20Jan%20Feb%2008%20Web.pdf

(2008) Evaluation and Management of Gymnastic Injuries

Due to the large number of youth gymnasts training at high levels, both acute and overuse injuries are very common. In one epidemiologic study, it was noted that the average elite young female gymnast trains 5.36 days per week and 5.04 hours per day…

Due to the fact that the upper extremity is used as a weight-bearing joint in gymnastics, injuries to the shoulder and elbow are very common. A wide range of injuries can occur to these joints, but a few are more unique to gymnasts…

In conclusion, gymnastics is a very demanding sport for the athlete and for those involved in providing medical care. Gymnasts often suffer a significant number of injuries during their careers and to numerous body parts including the upper and lower extremities and the spine. Although many of these injuries are similar in nature to those suffered by elite athletes
in other sports, certain musculoskeletal injuries are much more common or unique to gymnastics.

http://www.everydayhealth.com/fitness-pictures/the-health-risks-of-high-school-sports.aspx

(2012) The Health Risks of High School Sports

Thirty to 40 million children and teens participate in organized sports annually, the American Academy of Pediatrics reports. Of those, millions are injured each year — though overall injury rates have declined over the past 40 years…

The injury rate per 100,000 participants remains highest for gymnasts — 6.96 female athletes are injured for every 100,000 and 6.14 male athletes are seriously injured for every 100,000. (In football, by contrast, only 0.80 per 100,000 received a serious injury. But because more students play football, higher numbers of students are injured.) Amazingly, no deaths have been reported in the past 20 years. And, the quantity of injured high-school athletes remains relatively low because rates of gymnastic participation are declining. In 2011, only 561 male and 1,486 female gymnasts competed at a high-school level: Most high school gymnasts compete in private clubs with well-trained coaches, Mueller says.

http://www.orthop.washington.edu/?q=patient-care/articles/sports/common-sports-injuries-and-sports-injury-prevention-tips.html

Common Sports Injuries and Sports Injury Prevention Tips

Gymnastics.  Injuries most commonly occur in the ankles, feet, lower back, knees, wrists, and hands, often from overuse or simple stress. Injuries are rarely severe, but if left untreated they can lead to chronic pain and bone fractures. Each year, more than 86,000 gymnastics-related injuries are treated in hospitals, doctors’ offices, clinics, and ambulatory surgery centers.