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.)

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Your doctor works for the DEA

http://www.pharmaciststeve.com/?p=15297

Michael Minas, MD, 51, a solo, independent family practice doctor in Eagle, Idaho, was indicted in June, 2014, with seventeen counts of distributing a controlled substance outside the usual course of professional practice and not for a legitimate medical purpose…

First Dr. Minas considered accepting a plea agreement based on 17 charges, but then, like the rest of us innocent physicians, decided to trust the justice system and go to trial. So the US Attorney countered by adding 129 additional charges to ensure conviction (total of 146)…

In an article by John Sowell of the Idaho Statesman, the prosecution is reported to say that Dr. Minas’s family practice clinic focused on pain, as if that was a crime. As a family practitioner whose primary practice also became pain management in a rural area because there was no one else willing, I can verify that this is not a crime and does not reflect illegal activity, but compassionate patient-oriented medicine…

Next comes the warnings to physicians of the future. The new laws being presented in states and now the federal government, makes even the simplest decision in pain management by a physician criminal…

The attorneys say Minas, as one of a few independent physicians in the Treasure Valley not affiliated with the Saint Alphonsus and St. Luke’s health care systems, was targeted by the government to set an example to doctors throughout Idaho who continue to provide pain medication outside a pain clinic setting. I expand that to read “outside a hospital-owned setting.” …

I know that in my case, the people [patients] I suspected to be drug dealers were never charged with anything when I informed the drug enforcement officer in my county, Mr. Larry Finley…

CDC Condones Torture

http://www.nejm.org/doi/full/10.1056/NEJMp1515917

(4/21/2016) Reducing the Risks of Relief — The CDC Opioid-Prescribing Guideline

By Thomas R. Frieden, M.D., M.P.H., and Debra Houry, M.D., M.P.H.

My comment:

Where are the studies that show there’s a difference between cancer pain and other chronic pain? Why does a cancer patient deserve adequate and affordable treatment, while chronic pain patients are forced to suffer? Because a small percentage (of rich, white patients) may become addicted? Does the CDC contend that dependence and addiction are the same thing?

Mr. Frieden, what the CDC has done (along with the DEA) is legalized torture, the definition of which is to “inflict severe pain on.” (Do you think chronic pain can’t ever be characterized as severe or acute?) Torture is also “the action or practice of inflicting severe pain on someone as a punishment or to force them to do or say something…” (That’s a great definition of the drug war.)

You’re not only punishing chronic pain patients, you are torturing them. Admit it. Admit the blatant discrimination in these “guidelines.” Admit that being an alcoholic does not give you any experience with the treatment of chronic pain.

I am a 30-year intractable pain survivor. The only treatment option I have left is the right to die. Thanks, CDC. (Also posted at painkills2 on WordPress.)

“Thank you! Your comment listed below has been successfully submitted for the moderator to review.”

Comments open through April 27, 2016

Update (4/21/2016):

My comment was approved for posting on the CDC’s website, but they removed this language:

“Admit it. Admit the blatant discrimination in these ‘guidelines.’ Admit that being an alcoholic does not give you any experience with the treatment of chronic pain.”

Thinking of you, Tonya Martin

http://www.thenation.com/article/state-where-giving-birth-can-be-criminal/

At around midnight on November 13, Tonya Martin slipped out into the yard that separated her trailer from the one in which her grandparents live on a lot in the eastern hills of Tennessee. Just two months earlier, the Monroe County Sheriff’s Department arrested Martin after she gave birth to a son. Her crime: delivering a child at Sweetwater Hospital with drugs—some kind of opioid—in his system.

Martin couldn’t shake her addiction or the depression that plagued her. The 34-year-old mother gave up the newborn for adoption. Not long after, Martin’s boyfriend found her dangling from the clothesline pole in her grandmother’s yard. He tried to resuscitate her, but it was too late…

DSC02327 (2)

http://www.motherjones.com/politics/2016/03/tennessee-drug-use-pregnancy-fetal-assault-murder-jail-prison-prosecution

When she went into labor in late 2014, Brittany Hudson couldn’t go to the hospital. The 24-year-old East Tennessee native had been abusing prescription drugs for years and knew that, under a new state law, if her baby was born showing signs of her drug use, Hudson could be sent to jail. That was the reason she’d forgone prenatal care for most of her pregnancy. Hudson was already in labor when she went with a friend to see a midwife, but it was too late. She gave birth to her daughter in the backseat of her friend’s car on the side of the road, where her friend cleaned her up after. Then she turned around and went home….

Hudson didn’t have much time alone with her new daughter. Someone reported her to law enforcement, and just days after giving birth, she was contacted by the police, who asked her to check in at the hospital, where her newborn, Braylee, went into withdrawal. Almost a week later, while Braylee was still in intensive care, Hudson was arrested, charged with assault, and jailed.

Hudson was charged under Tennessee’s new fetal-assault statute, passed in the spring of 2014 as part of a push to combat an opioid addiction epidemic in the state. The newly revised measure, which is the first law of its kind in the nation, allows the state to prosecute women for illegally using narcotics while pregnant, if the child is born “addicted to or harmed by” the drugs…

For example, a pregnant woman in her ninth month was arrested in 2014 for “engaging in conduct which placed her baby in eminent danger or death or serious bodily injury,” according to the warrant. What did she do? Drove without a seatbelt…

By 2010, Tennessee’s opioid overdose rate was almost twice as high as the national average, and in 2012 Tennessee was the second-highest opioid-prescribing state, after Alabama. That year, the state’s lawmakers enacted the Prescription Safety Act, meant to combat opioid abuse. The statute required that physicians use a centralized database to look up their patients’ records before prescribing more pain medication. But it didn’t make a dent in the problem. Opioid abuse continued to rage throughout the state, and in 2014, the number of opioid-related deaths increased from the year before, surpassing the number of people killed by car accidents or gunshots…

theinfluence.org/how-the-myth-of-the-addicted-baby-hurts-newborns-and-moms/

The idea that vast numbers of pregnant women are putting their infants at risk by using drugs like heroin is misguided; nationally, about 5 percent of pregnant women report use of illegal drugs (mostly marijuana) during pregnancy. Nonetheless, media hype has crafted a narrative of disgust around parents of babies with NAS…

http://www.theguardian.com/commentisfree/2016/apr/12/pregnant-women-addiction-healthcare-not-handcuffs

NAS is a highly treatable condition without long-term effects… But even more damning is this: the law hasn’t decreased NAS births statewide. Since its implementation, such births have actually increased…

Another Sexual Assault in Service of the Drug War

https://reason.com/blog/2016/04/12/another-sexual-assault-in-service-of-the

Suddenly claiming to smell the odor of burnt marijuana coming from Carbone’s car, Maiella arrested her on suspicion of driving under the influence…

At the Lawrence County Correctional Center, Carbone was forced to remove her clothing, “bend over, spread her buttocks, and cough.” Carbone says two corrections officers, April Brightsue and Niesha Savage, mistakenly thought they saw a plastic bag protruding from her vagina, so they repeatedly instructed her to “prod her personal areas by inserting her fingers into her vagina” in the hope of dislodging the imaginary item. Then they had her bend over, spread her buttocks, and cough again. Carbone was “crying hysterically” and insisting that she was not concealing anything inside her body…

Maiella, the arresting officer, asked Salem and Lamancusa what he should do next, and they instructed him to take Carbone to Jameson Hospital in New Castle for “an internal examination of her body cavities.” At the hospital, the cops found a doctor, Bernard Geiser, who agreed that Carbone needed treatment “for a possible overdose, rectal packing and/or oral intake of a controlled substance.” But Carbone did not consent to “treatment,” and the police did not obtain a warrant authorizing the procedures that followed.

Carbone “was restrained to a bed by her wrists and ankles” as Geiser “performed an internal inspection of her vagina and rectum.” He did not find anything…

Since Geiser and the cops thought Carbone “might have something located deeper in her vagina and rectum,” she was subjected to an involuntary CT scan, which found no foreign objects…

Still determined to discover contraband, Geiser “performed a second internal examination of [Carbone’s] vagina and rectum,” then instructed two nurses to perform a third. They also swabbed her vagina “for testing.” After none of these inspections turned up evidence of a crime, Maiella told Carbone she was free to go…

Thinking of Nathan Eaton and Tod Abrams

http://thecoastalstar.com/profiles/blogs/delray-beach-xanax-addiction-and-death

Tod Abrams’ last act, in a life that included a once-thriving career as a Hollywood film executive and fathering a son whom he said he adored, was to tie a pair of bathrobe cords together, loop them around his neck and fix a knot below his left ear. Then he hanged himself from a metal rod in a closet.

“The anguish, anxiety and nightmares were unbearable,” the 52-year-old Abrams had written in a note to his family. Police found it on a dresser in his room on Aug. 30 last year, after he had been dead for a few hours. It was only a month after he had sought help with his addiction to Xanax, a sedative used to treat anxiety, at a $60,000-a-month residential facility run by Caron Treatment Centers in an upscale oceanside neighborhood in Delray Beach.

“I haven’t slept in 4 days and I’m probably beginning to hallucinate,” his note went on. “The people here were very kind but the program was too rigorous, too difficult. I’m too fatigued to proceed on. I don’t have the strength.” …

http://www.marinij.com/article/NO/20160327/NEWS/160329827

The father of a man who died at a Center Point drug treatment center in San Rafael three years ago has sued Center Point, alleging the facility’s failure to follow state regulations led to his son’s death.

Nathan Eaton, 32, was found dead in his room at the Manor, Center Point’s facility at 603 D St., at 7:05 a.m. March 9, 2013, according to the county coroner’s report. Dr. Joseph Cohen, the county’s chief forensic pathologist, concluded Eaton died of “acute methadone intoxication.” …

There are 14 entities licensed by the state to operate drug treatment facilities in Marin County, operating out of 27 separate locations. Of the 200 licensed drug treatment beds in the county, all but 90 are licensed for detox services. Center Point operates 84 of those beds in centers not licensed for detox.

Adam Weintraub, a spokesman for the state Department of Health Care Services, said both licensed and unlicensed detox centers are not required to have medical personnel on the premises or on call…

Weintraub said the state does not keep track of how many overdose deaths occur at drug treatment facilities. He said coroners are not required to report overdose deaths to the Department of Health Care Services…

Harris said the Department of Health Care Services’ Licensing and Certification Division made inquires about Eaton’s death in April 2013. There is no indication, however, that any disciplinary action was taken…