Study: Opioid Overdoses Often Occur at Low Doses

http://www.pharmaciststeve.com/?p=11050

http://www.painnewsnetwork.org/stories/2015/7/17/study-opioid-overdoses-often-occur-at-low-doses

Overdoses from opioid painkillers occur frequently in people who are taking relatively small doses of pain medication, according to a new study that has some experts calling for more restrictions on opioid prescribing.

Researchers at the University of Washington School of Public Health analyzed Medicaid data on opioid overdoses in Washington State between 2006 and 2010 – and found that many non-fatal overdoses didn’t fit the usual profile of a long term opioid user taking high doses of pain medication.

Less than half of those patients were “chronic users” who had been prescribed opioids for more than 90 days. And only 17% percent of the overdoses involved patients taking a high morphine-equivalent dose of over 120 mg per day — what is considered a “yellow flag” in Washington State for possible opioid abuse.

Surprisingly, nearly three out of ten (28%) patients who overdosed were taking a relatively low opioid dose of just 50 mg per day. Sedatives were involved in nearly half of the overdoses.
In 2007, Washington State adopted some of the toughest regulations in the country on opioid prescribing — guidelines that the researchers believe should be even more restrictive…

Based on the recommendations of this and other studies, Washington State’s Interagency Guideline on Prescribing Opioids for Pain was recently revised to caution doctors about prescribing opioids at any dose. The new guidelines extend to the treatment of acute pain, not just chronic pain. Physicians are also advised not to prescribe opioids unless their patients showed “clinically meaningful improvement” in physical function, in addition to pain relief…

More recent data suggest that the “epidemic” of painkiller abuse is abating. Hydrocodone prescriptions fell by 8% last year and it is no longer the most widely prescribed medication in the U.S. A recent report by a large national health insurer found that total opioid dispensing declined by 19% from 2010 to 2012 and the overdose rate dropped by 20 percent.

According to the National Institutes of Health, only about 5% of patients taking opioids as directed for a year end up with an addiction problem.

Addiction is just a symptom of a larger problem

It’s very sad that it has taken all these deaths for middle-class America to open its eyes to drug abuse and addiction. While this article and the survivors mentioned in it are focusing on one drug — heroin — the truth is that drug addicts are rarely using just one drug. The media talks about drugs like opioids and heroin, while rarely mentioning the other drugs involved, which usually include alcohol.

Alcohol is legal, cheap, and easy to obtain, which is why so many people abuse it. Compared to other drugs, it is the most lethal for the user’s brain and body, and acts like poison in large doses and with long-term use. But there will never be another war against alcohol, like the current war against pain patients and illegal drugs. The fact is that prohibition has never worked, as history has shown. Which is why making only certain drugs illegal doesn’t work either — because drugs are not the main problem with addiction.

And while it’s important to bring these stories of addiction into public view, I’m not sure this is helping to reduce stigma. Part of the stigma and shame is when family members and treatment centers force drug users into abstinence, as if that’s the only way to manage and treat drug addiction. And when drug addicts believe this to be true, the inevitable relapse just makes them feel worse about themselves. When a patient loses hope for recovery, it’s a recipe for disaster, tragically ending in overdoses and suicide.

Part of reducing the stigma is looking at the causes of drug addiction, which include things like mental illness, violence, rape, and PTSD, along with DNA and a sensitivity to specific drugs. Instead of just looking at the addiction itself, we must also look at why someone begins using drugs and why they continue. Is it an undiagnosed or untreated mental illness? Is it untreated or under-treated pain?  Is it low self-esteem, insecurity, self-hate, or overwhelming anxiety? But I have a feeling that former middle-class America doesn’t want to talk about the family and social issues that contribute to drug addiction.

Only talking about and treating the drug addiction doesn’t work.  Addiction is just a symptom of a larger problem.

http://www.pharmaciststeve.com/?p=11026

http://www.nytimes.com/2015/07/12/us/obituaries-shed-euphemisms-to-confront-heroins-toll.html

WEST SPRINGFIELD, Mass. — When George P. Gauthier died of an opiate overdose in May at 44, his sister, Cindy Gauthier-Rivera, wrote an obituary that was more like a cry from the heart.

His destructive addictions to heroin, painkillers and alcohol had cost him his marriage, his children, his job and eventually his life, she wrote from her home here in western Massachusetts. An outgoing man who dressed well and loved music and poetry, he had wanted to become a drug counselor, saving others from the abyss. Instead, he plunged further into it; he was found dead at their mother’s house, just a few miles from his sister…

Over the same period, heroin-related overdose deaths nearly quadrupled, with more than 8,200 reported in 2013…

Jack Pond was also called Son, Daddy, Brother and Friend and Jack was an addict,” began Jack Pond Ringler’s obituary in The Gazette in Colorado Springs in November. He was 26.

After Wade B. Pickett Sr., 34, was found dead of a heroin overdose in early May in the bathroom of the metal shop where he was a welder, his wife, Tiffany, wrote of his addiction in The Express-Times in Easton, Pa. “I am sorry if this obituary offends, hurts or shames some people,” she wrote. “I hope that it might help save some people from the incredible heartache we are experiencing.”

In the obituary for Daniel Joseph Wolanski, 24, of Avon Lake, Ohio, who fell victim to heroin in April, his family wrote, “Someone you know is battling addiction; if your ‘gut instinct’ says something is wrong, it most likely is.” …

Kurt Byrne, who says he has been clean for 17 months, encouraged his mother to go public and said the candid obituaries seemed like a necessary step. “It’s a healthy step toward taking away the stigma,” he said. “And if it’s Johnny from next door, it opens people’s eyes that this isn’t just people on the street corners.”

Tracey Marino, whose 23-year-old son, James, recently died from a heroin overdose at home in Stratford, Conn., omitted that detail from his obituary. “People who knew and loved him knew what killed him,” she said in an email. “But to people who I knew were judgmental, I tell them he died of cardiac arrest. Because I did not want his legacy to be he was a drug addict by people who have NO clue about addiction.” …

Richard Vachon, 69, a retired cook in Manchester, found his son, Cody, 21, on the floor of their home in May, dead of a heroin overdose, which he wrote in his son’s obituary. Once he feels “less shaky,” the heartbroken father said, he wants to “speak my mind and see if I can reach someone through my experience.”

One woman, Elizabeth Sue Sleasman, 37, of Bellingham, Wash., took the extraordinary step of writing her own brutally frank obituary, which her parents published after she died; she realized her death was inevitable and wanted to warn other addicts about what lay ahead…

http://www.obitsforlife.com/obituary/749511/Sleasman-Elizabeth.php

I entered the Methadone treatment and stopped using, but unfortunately my drinking habit kept on and I started using again…

Drug stores refusing to fill pain medications

http://www.pharmaciststeve.com/?p=11005

Pharmacist Steve said:  The above post appeared in a closed FB page for chronic pain… I’M SPEECHLESS !

The Walgreens that I have used for the last 27 years & is the closest to my house – just UNDER a mile away (.94 mile) has a new Pharmacy Manager who will not fill my class 2 prescriptions because I am in a different zip code!! Seriously how do I even reason with this type of insanity????

Under comments:

Barbara Fowler, on July 8, 2015 at 10:47 am said:
Reporting Walgreens won’t help. I’ve been fighting with Walgreens for 3 years over my pain meds and I’ve written letters of complaint to every entity you can imagine, including their own CEO, and nothing has changed. My best advice is to take your business elsewhere. The only thing they will ever understand is what impacts their pocket so I am encouraging everyone I know to go elsewhere. I know that is easier said than done these days, but the privately owned pharmacies are your best chance. Go in and explain your situation in person and talk to them. If you live in the Orlando area, I can recommend a great guy who is very supportive and wants to help. Good luck to you.

http://www.wthr.com/story/22916123/2013/07/23/walgreens-pharmacists-now-turning-away-some-customers-who-need-pain-meds

INDIANAPOLIS – Some Walgreens customers are sharing painful stories about their recent trip to the drug store. They say those routine visits to get pain medication were anything but routine, ending in humiliation, threats and accusations…

Robert had gotten his pain pills from the same Walgreens drug store for two years without incident. When he recently went to get a refill, that changed.

He was told the drug store now had to verify his prescriptions by talking with his doctor — and that could take up to five days. Since Robert had just one day of pain pills left (both his doctor and his insurance company prohibit him from getting his painkiller prescriptions filled early), the longtime Walgreens customer asked for his prescription back so he could take it to a different pharmacy.

The pharmacist refused.

“He said, ‘I’ve already started the process and now it’s out of my hands. I am not giving it back to you,'” Robert recalls. “I felt kind of panicked and I told him, ‘I don’t think you can do that.’ That’s when he told me to leave or he’d call the police… I had no choice but to leave them there until he was able to fill them.” …

The pharmacy will call and further investigate. They’ll say ‘Why is this patient getting this script? What’s wrong with them? What’s the diagnosis? How long are they going to be on it? How long have they been on it?'” explained Dr. Ed Kowlowitz, who runs the Center for Pain Management in Indianapolis. “They’re not just filling scripts anymore.”

Walgreens says its new policy is designed to curb prescription drug abuse, which is now a national epidemic.

But there’s another reason for the new rules: Walgreens has no choice.

They are part of a new settlement agreement the company reached with the U.S. Department of Justice and the U.S. Drug Enforcement Agency…

Just one day after Walgreens settled its $80 million federal complaint involving improper dispensing of pain medication, J.C. drove to her local Walgreens to get a monthly refill of her painkillers. That’s when she learned her Walgreens pharmacist no longer wanted her business.

“They refused [to fill] it. He said, ‘We suggest you take it to CVS. At this point we’re just feeding an addiction.’ He was very loud and it was right in the open when he basically called me an addict. At that point, I was just so upset I left,” J.C. said…

Under comments:

Donna Gargiulo Gonzalez Collins
Although my doctor wrote me a prescription for Tramadol for 6 pills a day (1 every 4 hours) Walgreens said they will only allow me to have 90 pills for 30 days. They say that is their policy! That is only 3 pills a day! How can Walgreens change my prescription going against my doctors orders? What can I do about this? By the way my insurance company also approved payment for my prescription as the doctor wrote it.

JW Smythe
Same here. Ongoing pain management prescription was refused because it’s “against policy” to fill it. They’ve been filling it. They flagged it in their system so I can’t fill it at *any* Walgreens. I went to a dozen other pharmacies today trying to find one that had it in stock. They’re all out of stock…

John Blaine · Bradenton, Florida
I have just got refused meds form Walgreens. Doesn’t calling the doctors for more information violate HIPPA laws? I believe they can only check if the meds have been perscribed. I just got refused service at walgreens for pain killers that I have been taking for 18 years. It took years for the doctors and I to come up with a combination of meds to ease the pain so I could have some kind of quality of life. My choices for my pains were, To keep taking these meds, Have a Morphine pack put in me or to have my leg cut off…

Marcy Elizabeth Pedersen · Cypress College
Walgreens treated me so badly, that i was having very depressing scary thoughts. I just had a pulmonary embolism, and needed my meds filled, but instead the pharmacist shredded the prescription and told me i didn’t need it and to go back to the emergency room!

http://www.medschat.com/Discuss/walgreens-oxycodone-filling-tricks-235565_p1_s2.htm

Chronic whiner Says:
Fri, Jun 19 ’15, 7:13 PM

The exact same situation happened to me. I live in South Eastern Michigan. Same elevated lived enzymes, also chronic, debilitating illnesses that began with a shoddy gastric bypass in August of 2005, followed by 19 surgeries in an attempt to rectify the problems, and due to severe malnourishment, a feeding tube for 3 years, a severe blockage where my esophagus and pouch met, I now have degenerative disc disease in my neck, bulging and herniated discs all down my spine, scoliosis, arthritis, osteoporosis…. There’s more, I’m not even touching on the mental anguish, PTSD, etc etc… Pardon my tangent. My point is, my doc did the same. Put me on oxycodone to lesson the Tylenol I was taking, but I could not fill the script. 2 days of phone calls (that was a joke) and unbelievable mileage… And I STILL was unable to fill the script. My doc reluctantly had to prescribe the norco after all… No other option worked as well…

tanya Says:
Sat, May 23 ’15, 11:31 AM

Yeah walgreens told me the same thing the last time i tried to fill with them. They said they couldn’t fill pain meds with muscle relaxers or pain meds with anxiety meds. He called it a south florida drug cocktail and then he flagged my file so that any walgreens i went to would refuse me. I was with them for years n years…

legalpain Says:
Thu, Mar 12 ’15, 12:35 PM

I was a 8 year customer @ CVS I’ve been at the same pain doctor 10 yrs and then the pharmacy manager refused to fill my 6 scripts. Only 2 are narco! My wife and just spent 6 hours just trying to get them filled at another CVS. Yesterday between my pain appt and trying to find a pharmacy (again I’ve never filled early out of fear and same CVS 8 yrs) I spent 8 hours.
I’m on methadone and for some magical reason it can only be found at the place who refused me.  I even called corporate trying to find out what happened. And all I get is it’s all up to pharmacy manager and a big wig named Cathleen in corp.

Since when did pharmacist get to play GOD with my life? I never wanted any of this. I have a dying wife and son with multiple health problems. Money is tight and last month I had repeated seizurs from methadone while the CVS I always went to decided to fill one last time.
Now where do I go?

Pain doctor in Kentucky charged in 5 deaths

http://www.pharmaciststeve.com/?p=10937

Pharmacist Steve says:  Barb saw this particular pain doc for a couple years. I was a lot more impressed by this particular doc’s pt care than the doc that owned the clinic nor the doc that replaced him… shortly afterwards Barb left the clinic’s practice. Dealing with chronic pain pts that are suffering from pain, depression, anxiety and other issues… are at a twice the risk of committing suicide. SOOOO.. 5 pts committed suicide over a several year period.. in this country we have 40,000 commit suicide every year.. IT HAPPENS..

The fraudulent billing is nothing but “fluff charges”… the report is that Jamie was headed off to some sort of conference/seminar/medical convention and was rushing to make sure that all his pts had their needed medication.. and there was some sort of mis-communication to the individual/company that did the billing for the practice. Fraudulent billing practices tend to be more routine and ongoing for more than THREE DAYS.

LOUISVILLE, Ky. — A pain doctor who promises on his website to help patients “return to a life they once knew” has been indicted by a federal grand jury on charges of illegally prescribing medications that resulted in the deaths of five patients.

Dr. Jaime Guerrero, who has offices in Louisville and Jeffersonville, Ind., was charged in a 32-count indictment with causing the deaths by issuing prescriptions for oxycodone, methadone and hydrocodone for no medical purpose from 2009 through 2012.

He faces a maximum sentence of life in prison if convicted…

One of his patients, Lee Bullock, told WAVE-TV then that Guerrero was treating him for degenerative disc disease and that he thought he was a very good doctor. “He monitors all his patients very close,” he told the station. “He does a lot of drug screens, urine tests and pill counts.”

(6/11/2015) Tackling prescription drug abuse

There are signs that strategies to address prescription drug abuse are starting to work but will an increase in illegal drug use be the payoff?

http://www.pharmaceutical-journal.com/news-and-analysis/features/tackling-prescription-drug-abuse/20068685.article

But regulators and doctors need to strike a balance between keeping the drugs away from those who might abuse them, and ensuring that they are available for patients who genuinely need them. Regulations, according to Boyd, run up against “a quality of life issue”. She says: “I would never want patients to not have access to these medications.” …

Already, the FDA has announced that generic versions of OxyContin cannot be sold without abuse-deterrent properties, and it looks like Health Canada is about to do the same. To clarify the situation for the pharmaceutical industry, in April 2015 the FDA released guidelines on how it will evaluate abuse deterrence, so that companies can put the claims on their labels. “I would like the majority of opioids to have abuse-deterrent formulations as soon as possible,” says Throckmorton…

Despite all these hurdles, it looks like the United States is slowly getting its prescription drug abuse epidemic under control. The number of overdose deaths from prescription drugs has levelled off since 2011, and seems to be on the decline.

Overdose deaths from some opioid painkillers also seem to have plateaued in the UK in the past few years, but the overall picture is less rosy. For example, deaths from tramadol overdose have seen a sharp increase. But there have been moves to get it under control. Tramadol was recently reclassified in the UK, which Stannard hopes will lead to more careful prescribing and a drop in the number people misusing it…

It may be too soon to celebrate though. As prescription opioids gained popularity among drug users over the past decades, rates of heroin use plummeted. But now, as authorities have cracked down, and prescription drugs such as OxyContin have become harder to get hold of and abuse, heroin is making a big comeback. The number of heroin overdose deaths in the United States increased fivefold between 2001 and 2013. “As opioid use has declined, opiate use in the form of heroin has increased,” says Boyd. “We are seeing an epidemic of heroin problems now.”

Half of veterans who died from opioid overdoses also received benzos

http://www.psypost.org/2015/06/half-of-veterans-who-died-from-opioid-overdoses-also-received-benzos-35059

In a recent study, nearly half of all veterans who died from drug overdoses while prescribed opioids for pain were also receiving benzodiazepines, or benzos, which are common medications for the treatment of anxiety, insomnia and alcohol withdrawal. Veterans prescribed higher doses of benzodiazepines while concurrently receiving opioids were at greater risk of overdose death than those on lower doses of benzodiazepines…

I think it’s odd that this study doesn’t include information about any of the other drugs these patients were taking.  The study didn’t include antidepressants, anti-psychotics, mood stabilizers, muscle relaxers, alcohol, or illegal drugs, even though it’s obvious that this group includes veterans who suffer from different mental illnesses. It also includes all opioids, from codeine to fentynal, as if these drugs worked in the same way.

The VA has been using opioids to treat PTSD, combining them with antidepressants, benzos and mood stabilizers, so it looks like not all of these veterans were strictly chronic pain patients. But with studies like this, I’d say the VA was coming for veterans’ benzos.

And isn’t it odd that the media and politicians rarely mention benzos when talking about the opioid “epidemic”?  No, only pain medications are criminalized.

http://www.bmj.com/content/350/bmj.h2698.full

We limited methadone prescriptions in this study to those prescribed to treat pain by excluding prescriptions in which dosing instructions indicated the methadone was prescribed for maintenance, oral or effervescent methadone formulations unless the dosing schedule indicated more than once a day dosing, or the dosing schedule was once a day unless the instructions indicated the methadone was prescribed for pain. Buprenorphine is not currently indicated for pain treatment in the VHA and was not included in this analysis…

Of the 422,786 veterans in the study population, 112,069 (27%) had filled at least one prescription for benzodiazepine during the study period. Those who received benzodiazepines were more likely to be women (33% of women v 26% of men received benzodiazepines), middle aged, white, and live in wealthier areas. Additionally, they were more likely to have had a recent hospital admission for mental health or substance use disorder, to have a diagnosis of a substance use disorder or several psychiatric disorders, including post-traumatic stress disorder, other anxiety disorders, depression, and bipolar or psychotic disorders, and to use other drugs...

One Nation, Under Sedation

https://www.propublica.org/article/medicare-paid-for-nearly-40-million-tranquilizer-prescriptions-in-2013

More than a decade ago, when lawmakers created Medicare’s drug program, called Part D, they decided not to pay for anti-anxiety medications. Some of these drugs, known as benzodiazepines, had been linked to abuse and an increased risk of falls and fractures among the elderly, who make up most of the Medicare population.

But doctors didn’t stop prescribing the drugs to Medicare enrollees. Patients just found other ways to pay for them. When Congress later reversed the payment policy under pressure from patient groups and medical societies, it swiftly became clear that a huge swath of Medicare’s patients were already using the drugs despite the lack of coverage.

In 2013, the year Medicare started covering benzodiazepines, it paid for nearly 40 million prescriptions, a ProPublica analysis of recently released federal data shows. Generic versions of the drugs — alprazolam (which goes by the trade name of Xanax), lorazepam (Ativan) and clonazepam (Klonopin) — were among the top 32 most-prescribed medications in Medicare Part D that year…

Some geriatric psychiatrists worry that doctors may have turned to the drugs in place of antipsychotic medications to sedate patients with conditions such as dementia. In the past several years, Medicare has pushed to reduce the use of antipsychotics, particularly in nursing homes, because of strong warnings about their risks…

Fall River, Mass., psychiatrist Claude Curran wrote more than 11,700 prescriptions for benzodiazepines (including refills) in 2013, ranking him behind only four other doctors, all from Puerto Rico. He said the drugs worked well for his patients, many of whom are trying to kick addictions to narcotics but struggle with anxiety and depression.

“First of all, they’re reliable,” he said. “Second of all, they’re cheap because they’re all generic … They tickle the brain in the same way alcohol does.”  Without benzodiazepines, he added, patients in recovery often need higher doses of methadone, which carries significant risks of its own…

The vast majority of Curran’s Medicare patients were younger than 65 and qualified for coverage based on a disability. Disabled patients made up about a quarter of Part D’s 35 million enrollees in 2013, but used benzodiazepines disproportionately, accounting for about half of all prescriptions…

Rodriguez readily acknowledged the risks of the drugs for elderly users — recently, researchers found that the longer a person took benzodiazepines, the higher his or her risk of being diagnosed with Alzheimer’s Disease. The drugs’ labels say they are generally for short-term use but many patients take them for years…

Many paid out of pocket for the relatively inexpensive drugs, which can cost less than $10 for a 30-day supply…

A worrisome aspect of the newly released data is that some doctors appear to be prescribing benzodiazepines and narcotic painkillers to the same patients, increasing the risk of misuse and overdose. The drugs, paired together, can depress breathing.

ProPublica found that this pattern was most common in southeastern states, which struggle with opioid abuse and overdoses. In 2013, 158 doctors in Florida wrote at least 1,000 prescriptions each for opioids and for benzodiazepines, tops in the nation. Alabama, Kentucky and Tennessee also had unusually high numbers of doctors who often prescribed both narcotics and benzodiazepines. The data does not indicate if the prescriptions were given to the same patients, although that prospect worries experts…

Dr. Leonard J. Paulozzi, a medical epidemiologist at the Centers for Disease Control and Prevention, co-authored an analysis showing that benzodiazepines were involved in about 30 percent of the fatal narcotic overdoses that occurred nationwide in 2010.

“It increases the possibility of overdoses,” he said.

Click to access select-benzodiazepines-10-16-14.pdf

Select Benzodiazepines to Have Daily Quantity Limits (Vermont)

The National Institute of Drug Abuse (NIDA) and the DEA has identified benzodiazepines as one of the classes of prescription drugs with a high potential for diversion and abuse…

http://www.justice.gov/usao-edtn/criminal-division/drug-diversion-task-force

The Drug Diversion Task Force was created to help combat the growing abuse and trafficking of prescription drugs. Unscrupulous doctors, physician assistants, and pharmacists may be involved in the illegal distribution of controlled substances, including oxycodone, oxycontin, morphine, methadone, fentanyl, hydrocodone, and xanex…

Another pain doctor bites the dust

http://www.pharmaciststeve.com/?p=10722

Pawan Kumar Jain, 62, of Las Cruces, N.M., was arraigned this morning in Las Cruces federal court on a 114-count superseding indictment which alleges that, among other crimes, Jain’s over-prescribing of opioid pain medication resulted in the deaths of four patients…

According to the superseding indictment, Jain allegedly committed the offenses charged between April 2009 and June 2010, in Doña Ana County, N.M. During that period, Jain was a licensed physician with a neurology subspecialty who operated a pain management medical practice in Las Cruces. Jain’s medical license was suspended in June 2012 and subsequently revoked in Dec. 2012 by the New Mexico Medical Board.

Each of the 63 dispensing charges in the superseding indictment alleges that Jain unlawfully dispensed prescription painkillers, primarily Oxycodone and methadone, to patients outside the usual course of medical practice and without a legitimate medical purpose. The maximum statutory penalty for a conviction on each of the 63 dispensing charges is 20 years in prison and a $1,000,000.00 fine…

It’s just great that law enforcement and government agencies now decide what is a legitimate medical purpose for prescribing medications.  Everyone wants to play doctor.

The 51 healthcare fraud charges allege that Jain engaged in a scheme to defraud two health care benefit programs, Medicare and Medicaid, by causing claims to be submitted for payment for prescription medications he dispensed to patients outside the usual course of medical practice and without legitimate medical purpose. The maximum statutory penalty for a conviction on each of the health care fraud charges is ten years in prison and a $250,000.00 fine…

This case was investigated by the DEA’s Tactical Diversion Team in El Paso, Texas and the FBI’s Healthcare Fraud Unit with assistance from the New Mexico Medical Board and the New Mexico Board of Pharmacy. The case is being prosecuted by Assistant U.S. Attorneys Sarah M. Davenport and Richard C. Williams of the U.S. Attorney’s Las Cruces Branch Office…

This case is being prosecuted pursuant to the New Mexico Heroin and Opioid Prevention and Education (HOPE) Initiative. The HOPE Initiative is a collaborative effort between the U.S. Attorney’s Office and the University of New Mexico Health Sciences Center that is partnering with the Bernalillo County Opioid Accountability Initiative with the overriding goal of reducing the number of opioid-related deaths in the District of New Mexico… The law enforcement component of the HOPE Initiative is led by the Organized Crime Section of the U.S. Attorney’s Office and the DEA in conjunction with their federal, state, local and tribal law enforcement partners. Targeting members of major heroin and opioid trafficking organizations for investigation and prosecution is a priority of the HOPE Initiative…

The medical industry is now forever in bed with law enforcement.  When you see a pain doctor, you’re basically talking to a DEA agent.  Think of the money involved in paying all these people to make the treatment of pain and/or addiction a criminal offense.  If there were as many “initiatives” and funding to treat chronic pain and mental illness, all the rest of this stuff wouldn’t even be needed.

The NMPHA is the New Mexico Pharmacists Association, part of the Bernalillo County Opioid Accountability Initiative.  (Who can keep track of all these anti-drug agencies?) Here’s a presentation from their 2014 summit:

http://www.nmpha.org/Resources/Documents/Opioid%20Initiative%20

Presentation%20to%20NMPHA%202014.pdf

This group includes the Heroin Awareness Committee (Healing Addiction in Our Community), an advocacy group started by Jennifer Weiss, who’s son died from a heroin overdose and now runs addiction “treatment” centers.  An interesting conflict of interest, as it means more money for her business.

Part of this group’s recommendations for action:

-Support policies to expand evidence-based early childhood support programs, including home visiting focusing first on low-income families  [emphasis theirs]

-For pain control, promote evidence-based alternatives for Rx opioids [Good luck finding any.]

-Reduce supply of Rx opioid pain medication by increasing access to and usage of Prescription Monitoring Program database AND prescribing guidelines to limit over-prescription of opioids

It’s very sad that the University of New Mexico, along with Molina Health Care, are involved in the drug war.  Are there any pain patients in these agencies and anti-drug groups?  What do you think?

Congress, Help Combat Prescription Drug Abuse

http://www.pharmaciststeve.com/?p=10327

http://blogs.rollcall.com/beltway-insiders/congress-help-combat-prescription-drug-abuse-commentary/#disqus_thread

Commentary by Cynthia Reilly (directs The Pew Charitable Trusts’ prescription drug abuse project)

Experts convened by the Centers for Disease Control and Prevention concluded in 2012 that PRRs have the potential to save lives and lower health care costs by reducing opioid use to safer levels. These programs have already yielded benefits for patients enrolled in them. In Oklahoma, Medicaid patients in a PRR program used fewer narcotic medications, decreased their visits to multiple pharmacies and physicians to obtain these drugs, and made fewer visits to emergency departments. Opioid doses were reduced by 40 percent for patients enrolled in the Ohio Medicaid PRR program…

The problem is that current federal law prevents Medicare from using PRRs. But there is significant bipartisan momentum building for change…

Click to access pdo_patient_review_meeting-a.pdf

My comment:

“The result is that the doctor and pharmacist improve care coordination and patients have access to the pain medication they need while lowering the risk of overdose.”

I think you’re cherry-picking the results. Lowering the risk of overdose does not equal pain patients getting the medications and care they need. In fact, the results show that pain patients are being abandoned by their doctors, with even fewer doctors willing to treat anyone labeled as a chronic pain patient, both in the Medicaid and Medicare programs.

“These programs have already yielded benefits for patients enrolled in them.”

None of the results you’ve mentioned indicate any benefit for pain patients. The results say that programs saved money, but nothing is said about how these programs affected pain patients.  I would have thought you would at least know of the deaths caused by methadone because Medicaid has approved that drug for chronic pain patients due to its low cost.

As the CDC’s 2012 report indicates:

“Although the published literature demonstrates a positive impact on cost and some medical and pharmacy utilization measures, there is a clear need for more current and robust evaluations of PRR programs to examine impact on health-related outcomes such as hospitalizations and overdose deaths [the suicide rate, and the increased number of patients filing for disability].,,”

Disband The DEA

http://www.cannalawblog.com/disband-the-dea/

I wouldn’t have posted this, except it looks like my comment has been censored…

painkills2 a day ago Pending

It made sense to legalize and regulate alcohol, so we did that. It makes sense to do the same for cannabis, so we’re going to do that too. “Hard” drugs like heroin and meth are actually legally available in regulated formulations through Big Pharma, so why discriminate against them?

Drugs are drugs, including caffeine, nicotine, and sugar. An end to the drug war includes legalizing and regulating all drugs, as these are medical issues, not criminal ones. Drug users end up being criminalized, including those who suffer from addiction, and everyone knows that’s not right. Imprisoning those who suffer from mental health issues isn’t right. How can anyone disagree with that?

And giving the FDA more power is not the answer. The FDA brought us drugs like antidepressants and Vioxx. The agency removes drugs like Pallodone from the market, when methadone has the exact same problems:

“high levels of palladone could slow or stop breathing, or cause coma or death; combining the drug with alcohol use could lead to rapid release of hydromorphone, in turn leading to potentially fatally high levels of drugs in the system”

http://prescriptiondrugs.procon.org/view.resource.php?resourceID=005528

And because methadone is cheap, it’s prescribed to Medicaid patients, some of whom have died of overdoses. And then those deaths are blamed on “opioids,” and now there’s a war against chronic pain patients.

The only answer is: No. More. Drug. War.

Most states list deadly methadone as a ‘preferred drug’

http://www.pharmaciststeve.com/?p=10188

Methadone overdoses kill about 5,000 people every year, six times as many as in the late 1990s, when it was prescribed almost exclusively for use in hospitals and addiction clinics where it is tightly controlled. It is four times as likely to cause an overdose death as oxycodone, and more than twice as likely as morphine. In addition, experts say it is the most addictive of all opiates. Yet as many as 33 states make it easy for doctors to prescribe the pain medicine to Medicaid patients, no questions asked.

In those states, methadone is listed as a “preferred drug,” meaning Medicaid will cover its costs without any red tape. If a drug is not on a preferred list, doctors must explain why they are prescribing it before the prescription can be filled and paid for by Medicaid…

No, methadone is not the “most addictive” of all opiates.  It’s not even the strongest.  The problem with methadone is that it stays in your system for a long time, unlike hydrocodone and other opioids.  Pain patients and doctors don’t understand the dangers of taking methadone, and so some patients prescribed this drug have died.  But they’re dying of ignorance in how to use the drug, not from the drug itself.  Because methadone isn’t that strong of an opioid, many pain patients take it more often than what is prescribed.  However, for those who suffer from drug addiction, methadone has proven to work just fine.

In fact, methadone has similar problems like those listed for Palladone when used to treat chronic pain, which the FDA removed from the market:

http://prescriptiondrugs.procon.org/view.resource.php?resourceID=005528

35 FDA-Approved Prescription Drugs Later Pulled from the Market

Cause for recall:  high levels of palladone could slow or stop breathing, or cause coma or death; combining the drug with alcohol use could lead to rapid release of hydromorphone, in turn leading to potentially fatally high levels of drugs in the system

And restricting the use of methadone just makes it that much harder to obtain for those who suffer from drug addiction, so that’s not the answer either.  Really, it’s hard to understand why doctors don’t know this stuff.

When blogs refuse to moderate comments

https://getwellcoaching.wordpress.com/2015/01/22/fentany-and-morphine-addiction-how-to-stop-them-right-away/

FENTANY AND MORPHINE ADDICTION – HOW TO STOP THEM RIGHT AWAY

I’ve never heard of Fentany — do you mean Fentanyl?

If you had gone to the doctor because you are suffering from chronic pain, and you have been prescribed something called morphine, fentany or methadone, these are opioids that are derived from poppy seeds that are very addicting and also very powerful painkillers. Many people will use them illegally simply because they give you a high that makes it possible for you to experience euphoria and pain relief at the same time.

Most chronic pain patients don’t experience euphoria with pain medications — the euphoria you speak of is felt by those who take these drugs but are not in pain.  Chronic pain sucks up every bit of that side effect, especially after a short adjustment time. Most chronic pain patients only get a small percentage of relief when taking pain medications, and very few experience enough pain relief to feel euphoria.

Opioids and morphine derivatives are one of the most addicting substances on the planet, and here’s how you can end your addiction right away.

Sounds like you’re only trying to spread fear, not information.  Trying to convince people not to use pain medications, no matter how much pain they’re in, preferring that people just suffer.

Opioids And Morphine Derivatives

The reason that these products are so incredibly addicting is because they affect a certain area connected to your central nervous system which are called your mu receptors. These are derived from poppyseed which can create a number of different products including codeine, Norco, Vicodin, Percocet, and many other drugs that are extremely popular on the street today. You can get prescriptions for them if you legitimately are experiencing chronic pain on a regular basis.

Actually, no, there’s a war against pain patients going on right now, and many can’t even find doctors to treat them, let alone prescribe pain medications.  Then many patients have the problem of finding a pharmacy that will fill prescriptions for many of the drugs used to treat chronic pain (except antidepressants, of course). Your post was written in January 2015 — what, don’t ya’ll read the news?

They will also be given to people that I’ve gone through severe surgery, one that can lead to very painful recovery times.

Ya’ll obviously need a proofreader for your blog.  Hey, is this blog a front for the DEA? They are notoriously bad spellers, although sometimes they do it on purpose in an attempt to fool gullible readers.

Treatments For Opiate Addictions

There is no easy way to get over an opiate addiction if you have been taking these drugs for several years.

Addiction or dependence?  Which one are you talking about?  Do you even know the difference between the two?  

No, withdrawal isn’t easy, but then living with constant pain isn’t actually a cake walk either.

Even if you have only have them for a couple months, the withdrawals will be tremendous. Shaking, vomiting, and an uncontrollable desire to get more of them into your system is going to plague you for several weeks until you can get through the withdrawals, allowing you to reset your mu receptors so that you won’t have to read them in your system anymore which is the goal of all those that are addicted.

painkills2 on April 23, 2015 at 8:47 am said:
Your comment is awaiting moderation.
Actually, cigarettes and alcohol are more addicting than opioids. And if you’re going to mention chronic pain and opioid use, then perhaps you should include the fact that dependence is different than addiction. Also, after only a couple of months of use, the withdrawal from opioids will not be “tremendous” for most people, especially if you wean yourself off of them, a little at a time.

And I’ll just add this to my comment:  The title of your post doesn’t reflect what’s in the body of it. “How to stop them right away” — there isn’t even an attempt to answer this question.  Is that because it involves maintenance drugs like methadone and buprenorphine, which your blog is likely against?

Hey, is this blog a front for the NIDA?

There is no useful information on your blog, getwellcoaching.  Please stop following mine, as I don’t want my blog connected to yours in any way.

Thinking of you, Molly Alice Parks

http://www.huffingtonpost.com/2015/04/23/dad-obituary-drug-overdose-daughter-molly-parks_n_7123336.html

After losing his daughter to a heroin overdose, a grieving dad penned an honest obituary for his child. He says he wanted to highlight the dangers of drug addiction, and to help others who may be fighting similar battles.

Molly Parks, 24, died on April 16. Her body was found in the restroom at her job; she still had a needle stuck in her arm.

Parks, who lived in Manchester, New Hampshire, had battled drug addiction for several years. But her dad, Tom Parks, told the Washington Post that there were signs recently that she’d maybe taken a turn for the better.

After three stints in rehab last year, she got a job delivering pizza. She reportedly worked 55 hours a week, and was seemingly getting her life in order…

“Molly graduated from Old Orchard Beach High School in 2009 and attended one year at SMCC until her addiction took over. Most recently, she was employed as a delivery driver for Portland Pie Co. in Manchester, NH. She enjoyed theater, fashion, reading – especially Harry Potter, and will always be remembered for fearless personality and her trademark red lipstick…”

I believe there is a connection between the amount of risks someone is willing to take and the illness of addiction.  I also think there’s a connection between the amount of stress someone who’s addicted to drugs can handle, especially during the first couple of years of being drug free. I don’t want to question this family’s attempts to help her, but if she had been on methadone maintenance therapy or something similar, perhaps she wouldn’t have gone back to heroin.

Need help? In the U.S., call 1-800-662-4357 for the Substance Abuse and Mental Health Services Administration’s 24-hour helpline.

(Photo taken 10/9/2014.)

Fentanyl deaths linked to heroin soar in Kent County, MI

http://www.pharmaciststeve.com/?p=9991

The growth in heroin use in recent years is helping spur use of narcotics with similar properties, such as fentanyl and methadone. In 2013, methadone was the leading cause of prescription overdose deaths in Kent County. Nationwide, it accounted for nearly one-third of all fatal overdoses – a six-fold increase over the last 10 years…  Methadone and fentanyl are relatively inexpensive. And with the cost of heroin rising because of demand, people are looking for a cheap alternative.

You will never see a headline about anyone dying from cannabis (only).  And the growth in heroin use is because of the DEA’s war against prescription medications, thanks so much.  But the DEA has reported that heroin is the cheapest drug available on the street, alleging that pain patients are switching to heroin because of the price and decreased access to prescription medications. Those who use illegal heroin don’t have to pay a doctor to prescribe it for them, keeping the cost very low, while methadone requires expensive visits to the doctor — unless the methadone being used on the street is coming from other sources, like Mexico.

However, states are forcing pain patients on Medicaid to use methadone because it’s the cheapest pain medication, which explains the increased number of overdose deaths attributed to this drug.  So, it appears that the states, in trying to save money, have actually created these problems.  And it’s very hard to believe that fentanyl is cheaper than heroin or methadone.

8/29/2011, New pain-management rules leave patients hurting

http://www.seattletimes.com/seattle-news/new-pain-management-rules-leave-patients-hurting/

Denis Murphy’s last doctor got suspicious when he saw him sitting in a restaurant. Murphy, 72, who contracted a painful nerve disorder after a case of shingles, had told the doctor his condition is so painful he often has to stand up. At his next appointment, the doctor accused him of flimflamming him: making up a story to score narcotic pain relievers…

Murphy, a retired IRS pension-plan examiner and manager from Edmonds, was humiliated. Now, he has a new doctor and a new prescription — but also a growing fear that he could suddenly lose the only relief he’s found in six years. Then, he worries, he’ll find himself back in the throes of pain he describes as “a blowtorch to my testicles.” He has reason to worry.

Over the last several months, an effort in Washington to curb a steep rise in prescription-drug overdose deaths — the most ambitious crackdown in the nation — has prompted a number of doctors and clinics to stop taking new chronic-pain patients on opiates, and in some cases to cut off current pain patients…

“A lot of it is because other providers have stopped doing it,” said Dr. Peter McGough, chief medical officer for UW Medicine’s Neighborhood Clinics. “I think there’s been a fair amount of patient abandonment going on.”

Dr. Carl Olden, head of the family practitioners’ group, said pain-management specialists in Yakima are overwhelmed with pain patients, particularly those on Medicaid, who say their primary-care doctors no longer prescribe the meds they seek.

Linda Van De Bogart, 62, an Eastern Washington resident who has an often-painful genetic defect called Ehlers-Danlos Syndrome, as well as ADD, has been on pain meds for 25 years.

But after being dismissed by her doctor when she and her husband had fallen behind on their clinic bills, she’s had no success finding a new provider after calling dozens of doctors and clinics, she says…

Across the state, more than half of those who died were patients on Medicaid, according to state figures, and the most common pain drug was methadone, increasingly prescribed for Medicaid patients after the state restricted other medications…