Panacea

Jimmy:  It seems weird that we haven’t got medicinal marijuana, but we’ve got medicinal heroin.

Stephen:  Yes, I suppose so… Except of course that there’s no real painkiller available except the one that we get from the poppy, which includes morphine and heroin… We just can’t make a drug that does the same thing…

Jack:  Mummy’s hugs. And if they don’t work, heroin.

Welcome to Pink Week

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You’ve just been pinked. And expect to be pinked every day for the next week. Because it’s Pink Week. So, please feel free to go pink this week. (You know what they say, once you go pink, your shit don’t stink.)

From My Dictionary:  Pinked is a nice version of punked.

Do you know how your state government is funded?

In New Mexico, the state government’s revenue comes from 1.9% in corporate taxes, 19.8% in property taxes, 14.6% in individual income taxes, 13.8% in “other” taxes, and almost 50% in sales taxes.

In Texas, it’s 0% in corporate taxes, 45.2% in property taxes, 0% in individual income taxes, 10.5% in “other” taxes, and 44.3% in sales taxes.

Look up your state and see who’s paying the bills:

http://taxfoundation.org/article/sources-state-and-local-tax-revenues

http://taxfoundation.org/blog/states-without-income-taxes-rely-varying-forms-revenue

According to the latest U.S. Census Bureau data, state-level individual income taxes make up the largest share of total state government tax collections. In 2011, state governments brought in $259 billion through these taxes, approximately 34 percent of total collections.

However, there are currently 9 states that do not tax wage income (New Hampshire and Tennessee tax interest and dividends): Alaska, Florida, Nevada, New Hampshire, South Dakota, Tennessee, Texas, Washington, and Wyoming. The composition of tax collections in these states varies considerably. For example, Florida, South Dakota, and Washington each raised about 60 percent of their collections through sales taxes in 2011; nearly double the national average…

Corporations may have all the power, but we’re the ones who pay the most in taxes. We’re the ones who provide the most revenue for cities, counties, and states. Instead of supporting the citizens of a state, corporations use all the money they’re not paying in taxes to bribe politicians.

And now you know why so many states are having economic difficulties, even in the midst of what has been called a “recovery.” Just look at the column for corporate taxes in the chart at the link. Have corporate taxes ever been this low in history? Have corporations ever made so much profit, to the point that it’s become indecent? (Not for Apple, of course, which has stratospheric profit margins.) Is free-market, trickle-down economics independent of supply and demand? Is that why it doesn’t work?

Of course, government revenue is also dependent on the stock market. State finances are intimately intertwined with Wall Street, which on days like today, is bad news. And it’s also bad news for anyone with a 401(k) or other retirement account. Stock prices will recover, but just like after every other stock market crash, retirement accounts will likely suffer long-term damage from today’s roller coaster ride.

I’m no expert on the economy or Wall Street, but I know gambling when I see it. And I don’t see how anyone can feel safe and stable within an economy that’s addicted to gambling. How do you make long-term plans when you’re dependent on Wall Street, the biggest gambler in the world? Sure, you win when Wall Street wins, but the gains are small in comparison. On the other hand, when Wall Street loses, everyone else loses big and many don’t recover.

Progress?

What would progress in the opioid war look like? For the government, progress is a decrease in the supply of opioids, along with the number of doctors prescribing (treating pain). And of course it means a decrease in the number of drug overdoses and deaths. In this Bloomberg article, New Mexico is highlighted as a state that’s making progress, but that’s not the reality.

Unfortunately, any “progress” in the opioid war is bad news for patients.

http://www.bloomberg.com/news/articles/2016-06-23/opioid-crisis-draws-failed-response-from-most-states-group-says

Kentucky, New Mexico, Vermont among states making progress

States were evaluated on six criteria, including the availability of treatment; mandatory education for doctors who prescribe opioids; and access to naloxone, which can reverse the effect of opioids. Michigan, Missouri and Nebraska didn’t meet a single one of the standards, according to a report from the council. Twenty-four other states were labeled as “failing” because they meet just one or two of the six objectives. While Kentucky, New Mexico, Tennessee and Vermont passed at least five, no state had a perfect score…

Does this look like progress to you?

https://nmhealth.org/publication/view/marketing/2117/

In 2014, there were 540 deaths to drug overdose in New Mexico.

New Mexico has the 2nd highest drug overdose death rate in the U.S.

https://nmhealth.org/publication/view/help/1832/

In 2014, 450 New Mexicans died by suicide (21.1 deaths per 100,000 residents)

The New Mexico suicide rate is more than 50% higher than the United States rate

http://www.practicalpainmanagement.com/resources/ethics/new-mexico-approach-improving-pain-addiction-management

However, New Mexico decided not to establish a “trigger” dosage threshold because of concern that such a policy would interfere with the patient-provider relationship. Instead, the state requires a mandatory continuing medical education course covering both prescription drug abuse prevention and the treatment of pain…

Opioid prescribers are mandated to sign up with the New Mexico Board of Pharmacy prescription monitoring program (PMP) and obtain a patient PMP report for the preceding 12 months when initially prescribing chronic opioid therapy (ie, ≥10 days) and every 6 months thereafter…

https://painkills2.wordpress.com/2015/09/06/unm-project-echo-bites-the-dust/

New Mexico is one of 16 states that successfully competed for the four-year grant from the U.S. Centers for Disease Control and Prevention. The grant is from a new program called Prescription Drug Overdose: Prevention for States that helps states address the ongoing prescription drug overdose epidemic.

It appears that a bucket load of education and the PDMP were not enough to make a real difference in the number of overdoses in New Mexico. In fact, after a few years of seeing a small decrease in overdoses, the latest statistics show an increase.

Which leaves me to wonder what is being taught in these continuing education classes and seminars on chronic pain and addiction. Since this education is being funded by the government — and disseminated with the help of the medical industry — I assume everyone is learning to comply with the new CDC rules. And treating pain according to the CDC rules is not going to work for very many patients.

http://amarillo.com/news/2016-02-04/new-mexico-lawmakers-look-curb-opioid-addiction

More New Mexicans died in 2014 of drug overdoses than in any other year on record…

Neurologist Joanna Katzman, president of the American Academy of Pain Management and head of the University of New Mexico’s Pain Consultation and Treatment Center, said continued education for medical professionals who prescribe opioids as well as better access to care for patients dealing with chronic pain must still be part of the equation.

“Chronic pain overlaps with addiction. Chronic pain overlaps with mental health,” she said, pointing to higher incidences of depression, anxiety and even suicide. “We need to really think about increasing treatment for chronic pain, increasing access to treatment.”

Dr. Katzman can talk a good game, making it seem like she could be on the side of pain patients. But I can’t imagine that too many pain patients would agree with her view of what constitutes treatment:

https://painkills2.wordpress.com/2016/03/18/addiction-clinics-masquerading-as-pain-clinics/

Click to access Michael-Landen-Prescribing-and-Drug-Overdose-Deaths-in-NM-May-7-2016.pdf

Council leading joint process to develop common language for the 7 licensing boards to use in developing their chronic pain management rules by 1/1/17

If you’re a pain patient in New Mexico, you should keep a watch out for these new rules. I assume they will mostly be in line with the new CDC rules, but I also assume that they will include a lot more restrictions on what doctors can prescribe.

I’m sorry, but I think things are about to get a lot worse, not only for patients in New Mexico, but in every state.

Is this the future for pain patients?

http://nyketamine.com/

NY Ketamine Infusions, LLC., offers ketamine infusion therapy treatments for those throughout the Tri-State area as well as NYC suffering from chronic pain syndromes and depression…

Chronic pain can be dramatically altered or even eliminated by ketamine infusions. Certain types of pain considered to be “neuropathic” in origin are considered to be most responsive to ketamine therapy. Examples of these kinds of pain are trigeminal neuralgia, complex regional pain (CRP), diabetic neuropathies, phantom limb pain, post herpetic neuralgia and fibromyalgia. However, other types of chronic pain such as chronic temporal mandibular joint (TMJ) pain, some headaches, and musculoskeletal pain may also benefit from ketamine infusions.

The few stories I’ve read from patients who have used ketamine treatments have been mostly positive, with the caveat that the treatments don’t last very long. It’s similar to how steroid injections can work, lasting for weeks or months, until it’s time for more.

Cost? Covered by insurance? You won’t find that information on the above website.

Alternatively, here in Albuquerque, there’s oxygen therapy:

http://www.pro-oxygen.com/

We offer a recreational Oxygen Bar as well as Hyperbaric Oxygen therapy and portable Boost Oxygen cans to enhance your body’s ability to heal, reduce swelling, relieve joint pain, improve recovery time, increase athletic performance and promote an overall feeling of wellness.

$1 a minute, or $150 for 90 minutes.

Breathing has become expensive, lol.

The drug war targets teenagers

https://mic.com/articles/145837/footage-shows-officer-tasing-teen-dropping-his-limp-body-on-pavement-during-traffic-stop#.gpqTP3Aq3

Police were ordered by a federal judge on Monday to release dashcam footage that shows a former officer using a Taser stun gun on a teenage boy until he sustained brain damage during a routine traffic stop in Missouri in 2014.

Bryce Masters, who was 17 when the incident occurred, was pulled over by former Officer Timothy Runnels, who initially told authorities that he made the stop because the license plate of Masters’ car was linked to an outstanding arrest warrant. Later, he said that he had smelled marijuana in the car, a small amount of which was found in Masters’ pants pocket…

After an extended back-and-forth, during which Masters repeatedly asks, “Am I under arrest?” Runnels deploys his Taser for a full 23 seconds — the equivalent of discharging the weapon four individual times, and enough to cause the teen to go into cardiac arrest.

The footage also shows Runnels dropping Masters’ limp body to the concrete after putting him in handcuffs…

Former Independence police officer sentenced to 4 years for tasing arrest that put teen in coma

As part of his guilty plea, Runnels admitted that he deprived the minor of his civil rights by deliberately dropping the minor face first onto the ground while the minor was restrained and not posing a threat to Runnels or others. According to the court filings, Runnels also admitted that his actions resulted in bodily injury to the minor.

During a sentencing hearing the government provided evidence that Runnels deployed his Taser into the minor’s chest during a traffic stop and then caused the electric current to run for approximately 20 seconds, four times longer than officers are trained to deploy a Taser…

The drug war has given law enforcement a lot of power. And this is just one video out of hundreds that have made it on to YouTube showing how dangerous it is to question the police. How dangerous it is to believe you have any other option than to follow orders. (And if at all possible, record, because you’ll never know when other cameras are not functioning properly, for whatever reason.)

As an old, white woman, I watched this video and thought, well, that would never happen to me. (After being disgusted and nauseated at how one human being can treat another human being, just because of a suspicion of weed.)

And yet, that’s not really true. Maybe I don’t fit the profile of a stoner — as Bryce Masters apparently did, just because of his youth — but with the opioid war, I know cops are looking for more than just weed. And more senior citizens are using medical cannabis every day. (There’s an internet rumor that the DEA will be rescheduling cannabis to Schedule II in August of this year.)

When I was taking pills, I rarely drove with them in my possession (not that I needed to), just in case I got stopped. Living in Texas, you could get stopped for any reason whatsoever, even if you’re doing nothing wrong. I’m guessing that there are still pain patients who don’t fear the cops, thinking if they follow all the rules, they’ll be fine.

But I want pain patients to understand that the cops don’t look at you as a chronic pain patient — just like most doctors, cops look at pain patients as drug addicts. And if you’re ever unfortunate enough to have a run in with the cops (or ER/hospital doctors), expect to be treated like a drug addict.

Don’t ever think that the drug war is helping our kids, because it’s easy to see that it does more harm than good. The drug war turns our kids (and pain patients) into criminals.

How the government creates criminals (asset forfeiture)

http://www.newyorker.com/magazine/2013/08/12/taken

They pulled into a mini-mart for snacks. When they returned to the highway ten minutes later, Boatright, a honey-blond “Texas redneck from Lubbock,” by her own reckoning, and Henderson, who is Latino, noticed something strange. The same police car that their eleven-year-old had admired in the mini-mart parking lot was trailing them. Near the city limits, a tall, bull-shouldered officer named Barry Washington pulled them over.

He asked if Henderson knew that he’d been driving in the left lane for more than half a mile without passing.

No, Henderson replied. He said he’d moved into the left lane so that the police car could make its way onto the highway.

Were there any drugs in the car? When Henderson and Boatright said no, the officer asked if he and his partner could search the car.

The officers found the couple’s cash and a marbled-glass pipe that Boatright said was a gift for her sister-in-law, and escorted them across town to the police station…

The report describes their children as possible decoys, meant to distract police as the couple breezed down the road, smoking marijuana. (None was found in the car, although Washington claimed to have smelled it.) …

They could face felony charges for “money laundering” and “child endangerment,” in which case they would go to jail and their children would be handed over to foster care. Or they could sign over their cash to the city of Tenaha, and get back on the road. “No criminal charges shall be filed,” a waiver she drafted read, “and our children shall not be turned over to CPS,” or Child Protective Services…

Later, she learned that cash-for-freedom deals had become a point of pride for Tenaha, and that versions of the tactic were used across the country…

http://www.npr.org/2016/06/07/481058641/new-mexico-ended-civil-asset-forfeiture-why-then-is-it-still-happening

Now she and her parents sit around the dining table sifting through all the paperwork from the city. Her mother Cynthia doesn’t understand the legal logic here, the fact that they stand to lose their car for the actions of somebody else. But that’s how civil forfeiture works. The government can take possession of something that’s believed to be connected to a crime, regardless of who actually owns that thing and whether or not there’s been a conviction…

http://www.washingtonpost.com/news/the-watch/wp/2016/06/08/new-frontiers-in-asset-forfeiture/

The Oklahoma Highway Patrol has a device that also allows them to seize money in your bank account or on prepaid cards. It’s called an ERAD, or Electronic Recovery and Access to Data machine, and state police began using 16 of them last month.

Here’s how it works. If a trooper suspects you may have money tied to some type of crime, the highway patrol can scan any cards you have and seize the money…

News 9 obtained a copy of the contract with the state. It shows the state is paying ERAD Group Inc., $5,000 for the software and scanners, then 7.7 percent of all the cash the highway patrol seizes…

A report published last year found that of the $6 million seized by Oklahoma law enforcement agencies over the previous five years, two-thirds was taken from people who were never charged with a crime…

http://www.nytimes.com/2016/06/21/us/supreme-court-says-police-may-use-evidence-found-after-illegal-stops.html

WASHINGTON — The Supreme Court ruled on Monday that evidence found by police officers after illegal stops may be used in court if the officers conducted their searches after learning that the defendants had outstanding arrest warrants…

In a dissent that cited W. E. B. Du Bois, James Baldwin and Ta-Nehisi Coates, Justice Sotomayor said the court had vastly expanded police power.

“The court today holds that the discovery of a warrant for an unpaid parking ticket will forgive a police officer’s violation of your Fourth Amendment rights,” she wrote. “Do not be soothed by the opinion’s technical language: This case allows the police to stop you on the street, demand your identification and check it for outstanding traffic warrants — even if you are doing nothing wrong…

Justice Sotomayor added that many people were at risk. Federal and state databases show more than 7.8 million outstanding warrants, she wrote, “the vast majority of which appear to be for minor offenses.” There are, she added, 180,000 misdemeanor warrants in Utah. And according to the Justice Department, about 16,000 of the 21,000 residents of Ferguson, Mo., are subject to arrest warrants.

Justice Ruth Bader Ginsburg joined most of Justice Sotomayor’s dissent, along with all of a separate dissent from Justice Elena Kagan. But Justice Sotomayor reserved her most personal reflection for a part of her dissent in which she wrote only for herself, setting out in detail the dangers and indignities that often accompany police stops.

“For generations,” she wrote, “black and brown parents have given their children ‘the talk’ — instructing them never to run down the street; always keep your hands where they can be seen; do not even think of talking back to a stranger — all out of fear of how an officer with a gun will react to them.”

“We must not pretend that the countless people who are routinely targeted by police are ‘isolated,’” she wrote. “They are the canaries in the coal mine whose deaths, civil and literal, warn us that no one can breathe in this atmosphere. They are the ones who recognize that unlawful police stops corrode all our civil liberties and threaten all our lives. Until their voices matter, too, our justice system will continue to be anything but.”

Justin Driver, a law professor at the University of Chicago, said Justice Sotomayor’s dissent was remarkable. It is, he said, “the strongest indication we have yet that the Black Lives Matter movement has made a difference at the Supreme Court — at least with one justice.”

How the government creates criminals

http://www.thedailybeast.com/articles/2016/04/15/feds-pill-crackdown-drives-pain-patients-to-heroin.html

The Centers for Disease Control and Prevention issued a broad set of recommendations in March for physicians and treatment facilities that dispense opiate medications. The same week Massachusetts Gov. Charlie Baker signed into law some of the most restrictive regulations ever governing the therapeutic use of narcotic drugs—including limiting first-time prescriptions for opioid pain medication to seven days worth of pills. At least six states have passed similar measures restricting the amount and potency of narcotic medications doctors can prescribe…

[Christopher] Baltz was in his third year of treatment for chronic pain resulting from a severe motorcycle accident and was being prescribed a high dose of oxycodone when Florida Gov. Rick Scott declared war on the state’s robust pain management industry in 2011…

Scott’s crackdown led to the closure of some 400 pain management clinics almost overnight, while a coordinated effort by the Drug Enforcement Administration targeted pharmacies suspected of over-dispensing controlled substances.

This took the form of more aggressive enforcement of a decades-old federal mandate known as “corresponding responsibility” that holds pharmacies legally accountable for ensuring the drugs they dispense are being used for a “legitimate medical purpose.”

In theory, the policy is designed to add another check in the process of preventing drug abuse and diversion. In practice, it places pharmacists in the unwarranted position of policing doctors, and discriminating against patients on the basis of often arbitrary red flags (for instance, paying for their prescriptions in cash).

The net effect of the crackdown in Florida was profound and acute. Prescription drug deaths dropped precipitously within the first year-—but heroin deaths rose 39 percent, as patients cut off from legal opioids turned to illegal drugs for relief…

In spring 2013—two days after receiving a courtesy call confirming his monthly appointment—Baltz showed up at his pain management clinic only to find it had been closed down. Within weeks he was making regular trips to Miami to buy heroin.

“The government wants to prevent people abusing pain medication, but there’s no exit strategy,” said Baltz. “I never even saw heroin until this happened.” …

According to the United Nations, 5.5 billion people around the world already suffer from inadequate pain treatment. This includes roughly a third of all cancer patients in the U.S.

Dr. Webster is one of hundreds of doctors and pharmacies that have been investigated by the DEA since it launched its OxyContin Action Plan in 2001. The plan signaled a shift in federal enforcement tactics away from a focus on illicit street drugs and toward preventing controlled pharmaceuticals from falling into the wrong hands. Over the next 13 years the DEA added more than 1,500 personnel and more than doubled its budget. It also significantly ramped up administrative audits of registrants authorized to dispense controlled substances. (As The Daily Beast reported last year, over the same period the DEA was increasing its quotas of Schedule II pharmaceuticals approved for commercial sale).

During one year alone (2009-2010) the number of regulatory investigations conducted by the DEA’s Office of Diversion Control (responsible for policing prescription drugs) more than tripled, according to the Government Accountability Office…

Federal law requires that all prescriptions for controlled substances be for a “legitimate medical purpose,” but it doesn’t define the term…

Ironically, there is evidence that restricting patient access to pain medicine could actually lead to more overdoses, not fewer. Medical examiners are already unsure of how many deaths attributed to “unintentional overdose” are actually suicides. Chronic pain patients frequently suffer from ancillary mental health problems—including depression, anxiety and insomnia—and are at least twice as likely to commit suicide.

In 2013, when the Department of Veterans Affairs responded to a runaway painkiller problem with a new Opioid Safety Initiative, reports surfaced of patients being cut off their medication without proper dose reductions. Within months the agency came under fire for its new policy when a 52-year-old Navy veteran shot himself in the head in front of an outpatient clinic in Virginia after he was forced off his pain meds.

“The medications were the only thing that was helping him, and when they took that away from him, his life just went downhill,” a friend of the dead man told a local paper…

Meanwhile, there is evidence that the majority of prescription opioids that are diverted for illicit use come from the acute care setting, not the treatment of chronic pain.

I’m not sure that makes sense, if this is also true:

From the New York Times:  “And so although emergency physicians write not quite 5 percent of opioid prescriptions, E.R.s have been identified as a starting point on a patient’s path to opioid and even heroin addiction…”

But perhaps it just shows how small the diversion problem really is, even though we’ve spent so much money (and ruined so many lives) in the effort to combat it.

Dr. Daniel del Portal, who teaches emergency medicine at Temple University’s Lewis Katz School of Medicine, says the modern health care system often incentivizes doctors in acute care settings to find a quick fix for patient complaints. “The pressure is on physicians to make patients happy at any costs,” he told The Daily Beast…

Really? How many doctors have you known that made an effort to make you happy? I don’t ever recall feeling happy after leaving the doctor’s office.

Finally, doctors say there is little use in recommending alternative treatments for patients if they can’t afford them. Pain pills are cheap, and usually fully covered by insurance; physical therapy, chiropractic care, and yoga are expensive, and almost always include co-pays (if they are covered at all)…

Sure, the only reason pain patients don’t use alternative treatments is because of the cost. That really flies in the face of how many pain patients pay out-of-pocket for these alternative treatments, as many are forced to do before they are even given access to opioids.

The fact is that alternative treatments have not proven to be very successful, and their gains are extremely short-lived. This is about treating constant, daily pain, not an injury that will improve over time. For instance, I’m sure there are plenty of pain patients who would welcome a daily massage (if they could afford it), but I would need painkillers before I agreed to let someone work on my body. It would be a treatment that caused more pain, just like so many others I’ve tried. Seems to me that most of the treatments which cause more pain don’t provide as much benefit as their practitioners would have you believe. “No pain, no gain” doesn’t really work when we’re talking about chronic pain.

Another problem is that many of these alternative treatments can be practiced at home, but unless you’re being seen by a doctor, disability insurance companies will question if you’re really suffering from chronic pain. And what’s the point of paying for a doctor if all she can prescribe are these alternative treatments? Because you really don’t need a prescription for yoga, meditation, stretching and exercise, and many other alternative treatments. (Doctors suck.)

Jill the Windmill

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Photos taken on Saturday, when I drove all the way to the grower’s market, but came away empty-handed. I figured it was too early for peaches and tomatoes, but I was at least hoping to catch the pizza dude. Unfortunately, he wasn’t there.

https://painkills2.wordpress.com/2015/06/20/my-trip-to-the-growers-market/

And now I can’t stop thinking about wet and juicy peaches.

https://painkills2.wordpress.com/?s=peaches

Make America Safe Again

Maybe pain patients should ask Donald Trump how he feels about the opioid war. He’s old and has no doubt taken painkillers before. (Maybe he’s even taking them now?) Does Trump believe that painkillers are only necessary for certain kinds of pain? Does Trump believe that the DEA and the medical industry get to decide which patients deserve treatment?

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Make America Safe Again — No More Drug War

Facebook comments that disappear

I use Facebook to make comments, but I’m not that familiar with how the software works. When I made a comment on this Consumer Affairs article through my Facebook account, I expected it to show up in my activity log. But my comment was deleted by Consumer Affairs, so it doesn’t appear in my Facebook account. (I guess everybody hates — and prefers to silence — a critic.)

That doesn’t seem right, but I guess it’s just another reason to dislike Facebook. After all, why would I want to use the same blogging platform as Mark Zuckerberg?

https://www.consumeraffairs.com/news/study-most-patients-getting-opioids-have-leftover-pills-061516.html

My censored comment:

Most deaths related to an opioid overdose are due to a combination of drugs, not just the opioid. If Consumer Affairs would like to see responsible reporting on the drug war, here’s one (lonely) example:

http://www.theguardian.com/us-news/commentisfree/2016/jun/08/opioid-epidemic-drug-mix-overdose-death

“Opioid use on its own is not dangerous, and it’s time we stop demonizing it.”

New York (with Bloomberg at the helm) is the poster state for how not to fight the drug war. That state (with help from Kolodny and PFROP) has been at the forefront of restricting access to prescription pain medications and increasing the amount of addiction clinics (along with the use of drugs like methadone, bupe, and Narcan).

http://www.huffingtonpost.com/2013/01/11/new-victims-in-the-war-on_n_2455917.html

And look where New York is at now — they’ve gone from bad to worse.

This study is a day late and a dollar short. The problems with diversion aren’t being caused by patients anymore, and it was only a small percentage of patients who were responsible for diversion anyway. If Consumer Affairs is going to “report” on the drug war, it should include other stories about diversion, like from DEA agents, pharmacies, hospitals, and nurses. The longer the medical industry blames patients, the more guilty it looks.