Photo taken this morning around 7:30am.
Day: 07/09/2015
Cannabinoids, like those found in marijuana, occur naturally in human breast milk
http://www.naturalnews.com/036526_cannabinoids_breast_milk_THC.html#
(NaturalNews) Woven into the fabric of the human body is an intricate system of proteins known as cannabinoid receptors that are specifically designed to process cannabinoids such as tetrahydrocannabinol (THC), one of the primary active components of marijuana. And it turns out, based on the findings of several major scientific studies, that human breast milk naturally contains many of the same cannabinoids found in marijuana, which are actually extremely vital for proper human development.
Cell membranes in the body are naturally equipped with these cannabinoid receptors which, when activated by cannabinoids and various other nutritive substances, protect cells against viruses, harmful bacteria, cancer, and other malignancies. And human breast milk is an abundant source of endocannabinoids…
Insurance companies and the war against pain patients
http://www.managedcaremag.com/archives/2015/6/confronting-epidemic-opioid-overdoses
Meanwhile, the Coalition Against Insurance Fraud, a group that includes insurers, government regulators, and consumer groups, estimates opioid abuse costs over $70 billion each year…
There are some bright spots in this otherwise grim picture. The rate of increase in opioid overdoses has notably slowed in recent years; in fact, the number of deaths from opioid overdose declined by 5% from 2011 to 2012. Many states have implemented polices that require providers to check databases of prescriptions for controlled substances before they prescribe certain medications…
Most of the blame for the opioid abuse epidemic has been directed at the companies that make and market the drugs. But private and government payers have also been criticized for, at the very least, not doing enough to stop it. Stingy coverage of a more integrated approach to chronic pain management means doctors are more apt to depend on opioid prescriptions, say the critics. There’s also been some finger pointing at formularies that put tamper-resistant opioids on more expensive tiers and impede access to the buprenorphine–naloxone combination (Suboxone) used to treat opioid addiction. The GAO and Pro Publica, the not-for-profit investigative journalism organization, have published reports critical of the CMS and its Medicare Part D program for allowing dangerous prescribing practices, including excessive prescription of opioids.
But if you are part of the problem, you can also be part of the solution, and health plans have been taking steps to rein in rampant opioid prescribing. For instance, Aetna implemented a misuse, waste, and abuse program involving clinical pharmacists, care managers, and behavioral health clinicians. The program coordinates efforts across departments to encourage safe prescribing, identify members at risk, and provide appropriate support to fight addiction.
“When an opioid pharmacy claim overlaps with a buprenorphine pharmacy claim, we notify the prescriber within 48 to 72 hours by fax,” explains Celynda Tadlock, PharmD, vice president of Aetna Pharmacy Management. “An Aetna pharmacist then calls the provider three days following the fax notification. Ultimately, we want the provider to contact the member to stop continued opioid use.”
Anthem identifies members who have filled 10 or more prescriptions for controlled substances within a three-month period. (Members with cancer or multiple sclerosis are excluded.) Over 61% of the members identified had a reduction in the number of opioids after the intervention.
CeltiCare Health Plan in Massachusetts looks at providers’ prescribing practices and the percentage of their prescriptions that are controlled substances. Outliers are flagged for educational outreach, typically starting with a letter or phone call sharing the data that compares their prescribing practices to those of their peers.
“We can and do refer them to our behavioral component for face-to-face education,” says Robert LoNigro, MD, CeltiCare’s chief medical officer. Of course, physicians are given a chance to explain their prescribing patterns. CeltiCare is exploring additional programs, including a hot line for providers to obtain real-time information about opioid prescribing and risk-modeling tools to help them identify which of their patients might be at a higher risk for misusing opioid medications.
Blue Cross and Blue Shield of Massachusetts spotted a problem in its claims data about three years ago when it became clear that a small percentage of its members were being prescribed a disproportionate share of opioid analgesics, says Tony Dodek, MD, the plan’s associate chief medical officer. The insurer introduced a program—developed with an outside panel of physicians, pain experts, and addiction specialists—to reduce the volume of opioid prescribing while protecting those members with legitimate treatment needs. Steps include limiting the supply of short-acting opioid analgesics to two 15-day periods over two months (with some well-defined exceptions) and requiring providers who prescribe long-acting opioids to start with short-acting medications. Dodek says his company also began sending prescribers reports that list their patients for whom they have prescribed opioids. During the first 18 months of this effort, called the Prescription Pain Medication Safety Program, prescriptions for short-acting opioids fell by 20%, and prescriptions for long-acting ones fell by 50%…
PBMs and the national drugstore chains are also talking up their efforts to quell opioid abuse. For example, on its website Express Scripts describes a program designed to limit opioid abuse among those getting prescriptions through worker compensation. When an injured worker presents a prescription at the pharmacy, the company’s claims processing system calculates its morphine equivalent dose (MED). If the prescription dose is over certain MED limits, it is submitted to the payer for a special review and the prescribing physician is sent a reminder about the guidelines for prescribing opioids. The company also uses a pharmacy “lock in” program for some claimants. Their prescriptions for drugs likely to be abused can be filled at just one pharmacy and sometimes the script can be written by just one prescriber.
Two years ago, CVS Health executives announced in the pages of the New England Journal of Medicine that the company had identified physicians with unusual patterns of prescribing high-risk drugs (alprazolam, a benzodiazepine, and carisoprodol, a muscle relaxant, as well as hydrocodone, oxycodone, and methadone) by combing through its huge cache of claims data. The company discovered 42 outliers and banned 36 from fulfilling prescriptions at their stores.
But the DEA has gone after CVS—and its rival, Walgreens—as part of a crackdown on prescription drug abuse. Last month, CVS agreed to pay a $22 million settlement after a DEA investigation found that employees at two of its pharmacies in Sanford, Fla., dispensed controlled substances without legitimate prescriptions. In 2013, Walgreens reached an $80 million settlement after the DEA found problems with record keeping and prescribing practices at a distribution center and six of its retail outlets in Florida…
Andrew Kolodny, MD, praises payers who are getting involved in fighting the opioid abuse epidemic. Kolodny, the chief medical officer of Phoenix House, a New York City drug and alcohol rehabilitation program, and president of Physicians for Responsible Opioid Prescribing, calls Blue Cross and Blue Shield of Massachusetts’s program “very smart.” It is important, he says, for payers to work on reducing the number of Americans starting opioid therapy for chronic pain because once they are on it, stopping is often difficult. Kolodny spreads blame for the opioid addiction epidemic around: “The FDA has been awful on this issue,” and he mentions a “well-financed misinformation campaign” by pharmaceutical companies. But he would also like to see state medical boards and the medical community get more involved. Tamper-resistance opioids might be helpful but because most people get addicted to the oral formulations he expects them to make “only a very small dent in this problem.” It comes down to this for Kolodny: “Opioids are lousy drugs for most people with chronic pain,” and we have to come up with better ways for helping people suffering with pain that won’t go away.
Let me make this one fact very clear: Andrew Kolodny is not an expert on the treatment of chronic pain.
Andrew Kolodny: Enemy #1 of All Pain Patients
Many primary care physicians – the top prescribers of prescription pain pills in the United States – don’t understand basic facts about how people may abuse the drugs or how addictive different formulations of the medications can be, new Johns Hopkins Bloomberg School of Public Health research suggests.
This lack of understanding may be contributing to the ongoing epidemic of prescription opioid abuse and addiction in the U.S.
If opioid abuse and addiction is an epidemic, pray tell, what would you call the ever-increasing suicide rate? More people die from suicide and guns than opioids, and neither of those issues are called epidemics.
Reporting online June 23 in the Clinical Journal of Pain, the researchers found that nearly half of the internists, family physicians and general practitioners surveyed incorrectly thought that abuse-deterrent pills – such as those formulated with physical barriers to prevent their being crushed and snorted or injected – were actually less addictive than their standard counterparts. In fact, the pills are equally addictive…
Another finding from the new research: One-third of the doctors erroneously said they believed that most prescription drug abuse is by means other than swallowing the pills as intended. Numerous studies have shown that the most common route by which drugs of abuse are administered is ingestion, followed by snorting and injection, with the percentage of those ingesting the drugs ranging from 64 percent to 97 percent, depending on the population studied. Certain medications are more likely than others to be snorted or injected…
“Primary Care Physicians and Prescription Opioid Abuse: A National Survey” was written by Catherine S. Hwang, MSPH; Lydia W. Turner, MHS; Stefan P. Kruszewski, MD; Andrew Kolodny, MD; and G. Caleb Alexander, MD, MS…
http://www.bgsu.edu/news/2015/06/conference-looks-at-history-of-alcohol-and-drug-use.html
The opening session on June 18 will discuss “The Heroin/Opioid Epidemic in Northwest Ohio.” The panel discussion, from 7-9 p.m. in 201A Bowen-Thompson Student Union on BGSU’s campus, is free and open to the public. Panel participants include Dr. Andrew Kolodny, chief medical officer for Phoenix House Foundation in New York and executive director of Physicians for Responsible Opioid Prescription…
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2015 Summer Conference
Indiana Prosecuting Attorneys Council and Office of Indiana Attorney General
OPIOID EPIDEMIC
Dr. Andrew Kolodny
Chief Medical Officer, Phoenix House
President, Physicians for Responsible Opioid Prescribing
Brooklyn, NY
(6/12/2015) As VA cuts narcotic prescriptions, veterans with chronic pain cry foul
For nearly four decades, the Department of Veterans Affairs had prescribed James Andrews narcotic painkillers for back pain. But last year, the VA sent the Vietnam veteran a terse letter informing him that it had canceled his prescription for hydrocodone.
His doctor told him he’d tested negative for opioids — a sign that patients might be hoarding and selling their pills — but Andrews said he had no hydrocodone in his system because he took the medication only when his pain was unbearable.
“I was extremely upset. You can’t do that to somebody, especially someone with a failed spinal fusion,” he said. “Ask me how I’m taking them rather than cutting me off and assuming I’m doing something illegal, because I’m not.” …
The complaints have grown so loud that Disabled American Veterans, an influential advocacy group, has called for more “humane” pain management treatment as the VA seeks a balance between giving the painkillers to those who need them to function and reducing or discontinuing them for those who don’t.
The VA’s new guidelines and policies on opioids look good on paper. They call for exploration of alternative therapies and gradual tapering of veterans on long-term painkillers to avoid painful withdrawal symptoms. They call for conversations with veterans about options such as acupuncture and spinal cord stimulators before doctors discontinue narcotics. And they call for reducing the amount of narcotic painkillers given to individual veterans to safer levels…
Replacing opioids with acupuncture and spinal cord stimulators? Do these “treatments” have a better success rate than opioids? How many pain patients does acupuncture help — something like 10%, if that? How many VA doctors know anything about acupuncture? It’s not even a recognized medical specialty. And how many patients are harmed by stimulators?
At the heart of many complaints is a more robust painkiller contract, known as an informed consent agreement, that the VA requires veterans to sign, pledging to take their opioids as prescribed and to avoid alcohol and recreational drugs…
One of those patients was San Marcos resident Ezekiel Enriquez, 68, a Marine veteran who fought in Vietnam. The VA had prescribed him opioids, including hydrocodone, off and on for nearly a decade for herniated discs.
Like Andrews, Enriquez tested negative for opioids late last year and was abruptly cut off of his painkillers. Enriquez says flare-ups and dental pain caused him to sometimes finish his prescription early, meaning the medications were out of his system by the time he went to the Austin VA clinic to see his doctor. “They said, ‘We can’t give it to you any more, you broke the contract,'” he said…
While Central Texas officials have introduced such alternatives as aquatic therapy and chiropractic care, Enriquez said his doctor didn’t discuss such treatments with him, and suggested in a meeting that he might be selling his pills.
Replacing opioids with aquatic therapy and chiropractic care? How’s that working for you, VA?
Eventually another VA doctor put him on Tramadol, a less powerful painkiller that he says doesn’t relieve his pain as well as hydrocodone and makes him drowsy.
Some pain medicine experts warn against using urine drug tests as evidence that a patient isn’t taking painkillers because synthetic opioids such as hydrocodone stay in the bloodstream for only a couple of days.
“Testing the urine does not tell you if the patient took the medicine,” said pain specialist Dr. C.M. Schade, director emeritus of the Texas Pain Society. And urine tests are especially poor tools for detecting opioids in a patient taking painkillers on an as-needed basis, which many doctors recommend for chronic conditions.
Cutting patients off of painkillers cold turkey “is unsafe medicine,” Schade said…
But several patients say they weren’t given a Plan B. Bill Williams, a 62-year-old Vietnam veteran from Brackettville, had his longtime hydrocodone prescription canceled earlier this year after he tested positive for marijuana. But he said his doctor didn’t discuss the situation with him as spelled out in the guidelines.
“I would have thought they would give me the courtesy of a phone call rather than shoot me a letter,” he said. “I thought we had a little better relationship than that.”
And Enriquez said he learned of his doctor’s decision when he called the VA to ask why he hadn’t received his monthly prescription…
“We are in our last years already, where you don’t know if you are going wake up or not,” he said. “If we take the medications responsibly and it’s helping, why do you take it away from us?”
Not only, why do you take away something that works, but what the hell are you going to replace it with? Cruelty and suffering?
Alleged shortages in pain meds
https://www.facebook.com/PatientsUnitedForDeaReform
Michael Kaslof
Yesterday at 5:43pm
I believe that I have a sympathetic pharmacist and he has flat out told me that he may not be able to fill my RX’s in the coming months. As with many out there, I have been on pain meds for many years and have been with the same Dr and pharmacy. Last month, I had to settle for a half the normal monthly dose due to supposed shortage. It Was a really bad month. I now have to make a decision whether to take my chances every month or go to rehab and live with the daily excruciating pain. The government has even started having my Dr piss test me 5 to 6 times per year. The last time I was randomly tested was years ago. I don’t really care except that the Dr bills my insurance company $4000+ for a $40 test. The system needs to be fixed. I feel for everyone out there who has to deal with pain and cannot get any relief.
Catherine Zeta-Jones Sheds Light on Bipolar II Disorder
The revelation that the seemingly unshakable actress Catherine Zeta-Jones has been diagnosed with bipolar II disorder illustrates the hallmarks of the disease: it can strike at any time in a person’s life and is often brought on by prolonged stressed…
According to Galynker, there’s hope for most who have been diagnosed with bipolar disorder. “It is not curable, but it is treatable with medications and psychotherapy.” said Galynker. “People with bipolar illness can have productive lives like anybody else, once they’re in treatment and compliant with treatment.” …
Although mental health conditions, including bipolar disorder are often stigmatizing, ABC News consultant Howard Bragman says Zeta-Jones’ public announcement of her condition may help others seek help for their own mental health…
http://www.starpulse.com/news/index.php/2015/07/09/catherine-zetajones-leggy-mini-dress-a
Morning
“I wake up every morning at nine and grab for the morning paper. Then I look at the obituary page. If my name is not on it, I get up.” Benjamin Franklin
(Photo taken 7/6/2015.)
Veteran with PTSD Faces Life Sentence for Growing 6 Pot Plants
http://www.hightimes.com/read/veteran-ptsd-faces-life-sentence-growing-6-pot-plants
Last year, Kris Lewandowski, a disabled three-term Iraqi War veteran with PTSD, was arrested in Oklahoma for growing and using pot to treat his symptoms, but that was just the beginning of his problems.
After being medically and honorably discharged from the Marines and declared 100 percent disabled due to severe post-traumatic stress disorder, Lewandowski, 33, began to grow pot to treat his PTSD after his prescription medicine began to affect his liver and worsen his mental state.
In June 2014, his wife Whitney called for help when Kris suffered an episode and chased her and their two sons out of the house with a knife, before barricading himself in the home.
The police arrived and Kris surrendered peacefully. Then authorities found six pot plants in his garden. Local media referred to it as domestic disturbance that turned into a “major pot bust.”
Oklahoma law has no provision for medical marijuana usage and cultivation of any amount. Among the strictest drug laws in the country, Oklahoma has 54 state prison inmates serving life without parole for drug violations, according to NORML.
“They tossed him in jail like an animal,” Whitney Lewandowski told Buzzfeed about Kris’ detention.
Kris was ultimately released on bond and hired a lawyer, but then had to drop him.
“We just couldn’t afford him,” Whitney explained.
The family then moved to California—with permission from the authorities. Since Kris did not qualify for a public defender, he assumed his case was on hold while he searched for a new lawyer. Instead, the court in Oklahoma held a jury trial, which he missed, not having been informed it was even scheduled.
“We can’t even get anyone to talk to us,” Whitney told Buzzfeed. “We would have gladly been there.”
The Oklahoma judge then issued a fugitive warrant, and last month, Kris was arrested again at his son’s preschool where the family had gathered for a water day celebration. With guns drawn, deputies took Kris to Orange County Jail, where he remains.
One must ask: Is this how the United States treats a disabled man who served when asked by his country?
Whitney Lewandowski recently set up a GoFundMe page to raise money for legal expenses, and Kris’ next hearing is scheduled for July 22.
Marijuana Might Help Alleviate the Latest Drug Epidemic
http://www.hightimes.com/read/marijuana-might-help-alleviate-latest-drug-epidemic
The growing acceptance of the medical use of marijuana is also relevant to this problem, as cannabis therapeutics provide a safe alternative to the use of prescription opioid pain relief drugs. Marijuana has proven pain-relief properties, however unlike opiates, it does not affect the medulla—the part of the brain that controls heart rate and breathing…
250 labels used to stigmatise people with mental illness
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1925070/
Most young people who are mentally ill do not seek help. Yet mental illnesses among children and adolescents are common, affecting about 10% of young people. The rates for some mental disorders, including suicide, are increasing. Up to half of those who fail to complete secondary school have mental illness. Those who do, more often turn to friends and family for help than to health professionals. Teenagers seek help less often than adults. As few as 4% of young people with a mental illness seek help from a family doctor, and consultation rates are especially low among young men. This paper argues that the stigma against mental illness is a powerful (and potentially reversible) contributory factor towards the reluctance of many young people to seek help for mental illness…
Conclusion: Our findings suggest the hypothesis that help-seeking by mentally ill young people may be improved by interventions that address both their lack of factual information about mental illness, and those which reduce their strong negative emotional reactions towards people with mental illness.
Click to access NAABT_Language.pdf
Stigma remains the biggest barrier to addiction treatment faced by patients. The terminology used to describe addiction has contributed to the stigma. Many derogatory, stigmatizing terms were championed throughout the “War on Drugs” in an effort to dissuade people from misusing substances. Education took a backseat, mainly because little was known about the science of addiction. That has changed, and the language of addiction medicine should be changed to reflect today’s greater understanding. By choosing language that is not stigmatizing, we can begin to dismantle the negative stereotype associated with addiction…
http://www.talkingdrugs.org/ending-stigma-people-first-language-drug-use
There is an endless list of words frequently deployed to describe both recreational and problematic drug users — “druggie”, “crackhead,” “addict,” “junkie” — with the language overwhelmingly derogatory and offensive…
As the Drug Policy Alliance notes, there is “no physical or psychiatric condition [that] is more associated with social disapproval and discrimination than substance dependence.” As the sociologist Erving Goffman wrote in the 1960s, stigmatization is an informal social control and one that seriously damages an individual’s social identity.
Yet, in spite of this, the vitriol aimed at drug users lingers.
Stigmatizing language pervades all spheres, from society and medical professionals, to the media and politicians. When the latter group do admit to having tried drugs in the past, their tone is generally one of deep regret. These supposedly guilt-laden “confessions” imply that there is always a severe lack of judgement present when an illicit substance is consumed and reinforces the idea that any form of illicit drug use is fundamentally wrong. Hardly the case.
A recently published Substance Abuse article unravels the complex web of language around drug use, highlighting the detrimental impact stigma can have, particularly in the field of addiction…
The Storm
Thunder and lightning
crackles and booms
making we wish
the storm would end soon
Thunder crashes
then lightning flashes
Rain hits the concrete
the sound can’t compete
Wish I had some bud
to keep me from frowning
At least I can hope
the roaches are drowning
Mother Nature’s so funny
keeping me awake
Time for some chocolate
for sanity’s sake
(Photo taken 6/27/2015.)
All Things Chronic 