Dying To Be Free

There’s A Treatment For Heroin Addiction That Actually Works.Why Aren’t We Using It?

http://projects.huffingtonpost.com/dying-to-be-free-heroin-treatment

The last image we have of Patrick Cagey is of his first moments as a free man. He has just walked out of a 30-day drug treatment center in Georgetown, Kentucky, dressed in gym clothes and carrying a Nike duffel bag…

He had been a dominant wrestler in high school… (Thinking about you, Cameron.)

(I’m also thinking about how sports and athletics can injure and maim kids before they even get the chance to become adults.)

In the months before Patrick’s death, Sydney Pangallo, 23, a recent Recovery Works alumna, suffered a fatal overdose. Dan Kerwin, 23, attended a Recovery Works program in the spring, and his sister found him dead of an overdose during the July 4th weekend. Tabatha Roland, 24, suffered a fatal overdose in April — one week after graduating from Recovery Works. And in November, Ryan Poland, 24, died of an overdose. He too was a Recovery Works graduate…

New York City had 420 heroin overdose deaths in 2013 — the most in a decade…

“Bupe,” as it’s become known, was originally approved for pain relief…

I’m not sure that’s right (but I’m too depressed to look it up).

If an addict uses it improperly by injecting it, the naloxone kicks in and can send the person into withdrawal — the opposite of a good time…

Is that a nice way of saying torture?

Doctors recommend tapering off the medication only with the greatest of caution. The process can take years given that addiction is a chronic disease and effective therapy can be a long, grueling affair. Doctors and researchers often compare addiction from a medical perspective to diabetes. The medication that addicts are prescribed is comparable to the insulin a diabetic needs to live…

I’m not sure this is true, either.  Most people who become addicted to drugs actually stop using on their own.  It’s only a small percentage of drug addicts that might require medication for the rest of their lives…

In American culture, self-help runs deep. Heroin addiction isn’t only a disease – it’s a crime…

Karyn Hascal, The Healing Place’s president and CEO, said she would never allow Suboxone in her treatment program because her 12-step curriculum is “a drug-free model. There’s kind of a conflict between drug-free and Suboxone.”

Oh, c’mon… Until rehabilitation programs recognize cigarettes, sugar and caffeine as drugs, they will continue to be seen as hypocrites.

In letters home from an abstinence-based facility in Prestonsburg, Kentucky, Kayla Haubner gushed about how she was taking to the program, but worried it wouldn’t be enough…

Recovery Kentucky facilities across the state admitted to HuffPost dropout rates as high as 75 percent…

The state’s treatment providers have little idea how their patients fare once they walk out the door…

(Just like New Mexico’s Department of Health and the Medical Cannabis Program, when patients are unable to renew.)

Like so many others, Tabatha Roland, the 24-year-old addict from Burlington, wanted to get sober but felt she had hit a wall with treatment…

I asked about a former resident, Keith Lillard, a 29-year-old who overdosed in October 2013…

To this day, getting locked up is the de facto treatment for a large percentage of addicts…

Zachary Smith, a Northern Kentucky resident, attended a South Carolina boarding school for issues with pills and marijuana in 2006…

Dr. McLellan, of the Treatment Research Institute, recalled a prominent facility he encountered in 2014 that made addicts wear diapers if they violated its rules…

In October 2013, he advised the mother of Jesse Brown, a 29-year-old Idaho addict who, as a precondition of his early release from prison, was compelled to enter a psychologically brutal “therapeutic community” behind bars. Years earlier, Brown had suffered a traumatic brain injury in a car accident. His short-term memory was shot, and he crumbled at the slightest sign of stress…

The question was not whether Brown would have succeeded in the program, Deitch said, but “would he have been able to survive?” Brown compared being in the “therapeutic community” to torture. “It felt like you were a prisoner of war,” he said…

Such official endorsements are not winning policy debates. A recent windfall from the state’s settlements with pharmaceutical companies over allegations of corrupt practices has meant more than $30 million in new funding for addiction treatment and prevention programs. None of it is being used on medically assisted treatment…

Shawn Hopper overdosed three times within three weeks of his release from jail; the third was fatal. Michael Glitz overdosed 10 days after leaving jail. Amanda Sue Watson died of an overdose a week after being transferred from jail to an abstinence-based halfway house. Henry Lee fatally overdosed one day after being released from the Kenton County jail. Desi Sandlin fatally overdosed the day she was released from jail…

Brianna Ballard, 30, was revived by paramedics following a 2011 overdose, but was then arrested for the overdose. Released from the Kenton County jail on Feb. 1, 2013, she then fatally overdosed three days later in her bedroom at her mother’s house in Villa Hills, Kentucky. Her mother, Dotie Oliver, said Ballard sought treatment in jail, but didn’t receive any…

France established buprenorphine’s effectiveness years ago. Between 1995 and 1999, the country reduced overdose deaths by 79 percent as buprenorphine use in treatment became widely accepted…

See: https://painkills2.wordpress.com/2014/12/02/whats-the-drugopioid-epidemic-look-like-in-france/

Dr. Preston Gazaway had been prescribing Suboxone for a decade in Maryland’s Baltimore and Howard counties. After the other doctor in his practice became gravely ill in 2012, Gazaway took on his partner’s Suboxone patients. Worried about what might happen to the addicts if they were suddenly cut off from their medication, he went over his 100-patient limit. A few months later, two plainclothes DEA agents appeared at his office with a letter from the Department of Justice giving them permission to inspect his patient files….

The DEA agents let him off easy. Vermont, a state with a long waiting list for medically based drug treatment, suspended a doctor’s license over incomplete paperwork…

Ronni Katz, a former public health official in Portland, Maine, recalled the devastating impact of the state’s two-year lifetime limit on Suboxone. She said Medicaid recipients were cut off at the beginning of 2013 from their prescriptions and many relapsed. “People were suddenly left without their dose,” she said. “They had to do something. It drove people back into the street. We definitely saw the effects.”

One 22-year-old woman addicted to Percocet told researchers in that 2011 report that the stigma of medical treatment for addiction motivated her to buy buprenorphine on the black market. “I wanted to try to do it myself because at first I didn’t want my family to know that I was on [pain pills],” she said. “So if I could get off of them without making it obvious, like by going to treatment and stuff, then I would.”

Nickels did stipulate that NA is a “program of abstinence” and explained that a member who takes a medication like Suboxone or methadone violates that philosophy. “They are taking a drug to treat their addiction,” she said. “They are not clean in our eyes.”

She sounds like a nun.

Quenton Erpenbeck used heroin for 16 months…

Taylor Walters went through a detox, then a three-month outpatient program, and in late December 2012, a 45-day inpatient program. His mother, Sheryl, was desperate for a doctor who would prescribe him Suboxone. She spent three days working the phones, pleading with doctors. “I was crying and begging,” she said…

Three years ago, Holly Specht took her son Nicholas, an addict threatening suicide, to an ER. Nicholas protested that the effort would be a waste of time, and he was right: A doctor discharged him after a mere 15-minute consultation…

Coroner records show that Travis Yenchochic, 29, overdosed five times in the 18 months before his fatal OD in 2013…

Medicaid has tried to deny payment for Suboxone if a patient has failed a drug test while it has also used clean tests to deny payment. Why pay for Suboxone for a drug-free patient?

Duke had come to work at Droege as a way to honor her brother Josh, 28, who fatally overdosed on heroin on January 13, 2011 – six days after completing a 45-day rehab in Cincinnati…

Even the WSJ doesn’t fact check

http://www.wsj.com/articles/dea-restricts-narcotic-pain-drug-prescriptions-1408647617

8/22/2014, DEA Restricts Narcotic Pain Drug Prescriptions

“If you’re treating someone with a condition so painful they require treatment with a highly addictive drug, that’s someone who should be monitored closely,” said Andrew Kolodny, chief medical officer for the nonprofit addiction treatment organization Phoenix House, who campaigned for the change for five years.

No, I don’t believe that’s correct — Kolodny has been campaigning for longer than five years. (See Wired article of 2005.)  And of course Mr. Kolodny thinks patients should be “monitored closely” — that’s how doctors (and Phoenix House) make money.

Part of the reason for treatment is so that people are free to live their lives the best they can — not to become addicted to the medical industry and doctor bills.

(April 2005) The Bitter Pill

http://archive.wired.com/wired/archive/13.04/bupe.html

“We’re doing all the work for the drug company,” Sederer says laughing. “Here you have a couple of psychiatrists launching a marketing campaign!”

Kolodny reminds his colleagues of the drug’s advantages. He stresses that bupe in the form of Suboxone is safe and almost impossible to abuse, a huge selling point at many of the clinics they will visit…

Sounds like Big Pharma selling opioids… And I believe they got in trouble for that.

Until the early 20th century, you could order just about any narcotic you wanted from the Sears, Roebuck & Co. catalog: morphine, heroin, opium. But in 1914, Congress passed the Harrison Narcotic Act, barring doctors from prescribing opiates to known addicts…

Meanwhile, methadone regulations effectively ostracized addiction treatment from the medical mainstream. Most med schools leave it off the curriculum for all but psychiatry students, who get a mere four weeks of exposure. When young doctors train at big-city hospitals, most of their encounters with addicts are hard cases showing up in the ER in the middle of the night. “The top attendings make fun of them,” Salsitz says…

The doctors ask about side effects. Good news there. They ask whether it shows up on a drug screen (methadone does, so many people who might face a urine test at work avoid it). Nope, Kolodny says, a bupe patient’s urine tests negative – more good news. They ask about the potential for black-market dealing; inmates learn to hold their methadone in their throat, spit it back up, and sell the spit. That’s pretty much impossible, Kolodny says, to nods of approval. Will inmates be able to keep receiving bupe after they leave prison? Some, but not all, Kolodny says. That’s because of the nearly 300 doctors in New York licensed to prescribe bupe, only a handful will accept Medicaid, even though it covers the treatment.

I can see why bupe gained popularity in some circles…

On the drive back to his office downtown, Kolodny’s Treo rings twice, just minutes apart. Two more people looking for bupe treatment at his private practice…

Utah, #10 on the list of States Where People Live Longest

http://udohnews.blogspot.com/2014/08/cdc-awards-utah-1-million-to-address.html

8/14/2014, CDC Awards Utah $1 Million to Address Prescription Drug Overdose Prevention

(Salt Lake City, UT) – The Centers for Disease Control and Prevention has announced that Utah will be one of five states in the country to receive more than $1 million over the next three years to help prevent prescription drug overdoses and address the patient and prescribing behaviors that drive it…

Data from the Utah Department of Health (UDOH) show:

• An average of 21 adults died each month from prescription drug overdose in Utah. Oxycodone, methadone, and hydrocodone are the top three prescription pain medications that contributed to these deaths.

• Utah has the fifth highest rate of drug overdose deaths in the United States. In 2011, Utah had 19.5 drug overdose deaths per 100,000 people compared to 13.2 deaths per 100,000 people in the U.S. In 2012, 261 people died from prescription pain medication overdoses in Utah.

• Opioid prescribing rates in Utah are higher than the U.S rate. In 2012, Utah providers wrote 85.8 opioid pain reliever prescriptions per 100 people (individuals may have had more than one opioid pain reliever prescribed to them), the twenty-second highest prescribing rate in the country and above the U.S. rate (82.5/100 people).

• 24.5% of Utahns reported using some type of prescribed opioid during the previous year. Most Utahns who die from a drug-related death suffer from chronic pain and take prescribed pain medications. (2008 BRFSS)

This new funding will give states a surge of resources and direct support from CDC to apply the most promising prevention strategies. Overall, CDC has committed $6 million over the next three years to help five states (Kentucky, Oklahoma, Tennessee, Utah and West Virginia) improve their prescription drug monitoring programs, and conduct rigorous state policy evaluations to understand the most effective prevention strategies.

In an era of budget cuts — like to payments for Medicaid doctors — who do you think is funding the CDC’s war against pain patients?  Perhaps the funds are from the ACA?

http://www.cnn.com/2013/12/20/health/pain-pillar/

12/20/2013, Prominent pain doctor investigated by DEA after patient deaths

What makes the allegations against Lifetree so stunning: Before it was sold in 2010, the clinic was run for more than a decade by Dr. Lynn Webster, an anesthesiologist and pain medicine specialist who is considered a leading expert on how to safely prescribe opioids — drugs that act on the brain to dull a person’s perception of pain.

I don’t know Dr. Webster’s history, but I assume this account is going to be one-sided…

“Dr. Webster teaches a system that supposedly makes this treatment safe and effective,” said Dr. Andrew Kolodny, president of Physicians for Responsible Opioid Prescribing. “But when you think about the fact that he’s had multiple deaths in his clinic from overdose, it suggests that the system he is teaching is seriously flawed.”

Ah, the arrival of Mr. Kolodny… It’s so funny, when I read statements from Kolodny, I hear tiny squeaking noises, like… a mouse.

About three people die every hour in the United States after overdosing on prescription drugs, according to the Centers for Disease Control and Prevention; most of those deaths involve prescription opioids. Utah has one of the highest drug overdose rates in the country…

In fact, the longer a patient takes high doses of prescription opioids, the more likely they are to become addicted and eventually overdose. Many pain management experts say overprescribing is at the heart of the overdose problem.

I’m too tired to point out what’s wrong with these statements…

“If you listen to what some of the leading pain specialists are saying today about opioids, they’re saying these past 15-20 years have been a disaster,” said Kolodny, a psychiatrist and chief medical officer at the Phoenix House, a nonprofit addiction treatment organization. “We’re harming far more of our patients than we’re helping when we prescribe opioids aggressively.”

Ah, Kolodny, what are we gonna do with you?

And now we have another grieving loved one playing the blame game:

Webb said his wife complained about migraines and jaw pain, and for years found relief with 30-pill-per-month prescriptions of Tylenol 3 and 4, painkillers containing acetaminophen and codeine. “One day she took a little bit too much medication and felt good,” said Webb. “So then she did it again, and did it again, and did it again, and then pretty soon the 30 pills wasn’t working.” 

Gee, I wonder if his wife would describe what happened in the same way?  Sounds like her jaw pain was getting worse… Maybe her husband wanted her to have surgery instead of drug therapy?

Tina Webb was accused of doctor shopping — going from doctor to doctor to get multiple pain prescriptions filled — and in 2005 was referred to Lifetree for monitoring. When she began treatment there, it was under an agreement with the district attorney. According to a document related to her case, she “…recognizes that she has not managed her pain appropriately,” and needed monitoring by a pain management clinic. But monitoring is not what Tina Webb got at Lifetree, said Webb. She was first seen by Webster, then on subsequent visits had her care handled by a nurse practitioner.

Okay, Tina shouldn’t have been doctor shopping, but was it a sign of addiction or a sign of under-treated pain?  A district attorney involved with the treatment of pain… that’s just sad.

According to an analysis of her medical records, by a physician retained by Webb’s attorney, her dosages had increased by 600% since her first visit.

Hmmm… this does sound… funky.

Roy Bosley said he got the same response when he tried to contact Lifetree staff, including Webster, about Carol Ann Bosley‘s behavior… Soon afterward, Bosley said, his wife lost weight and shed her dependence on prescription opioids, managing her pain on Tylenol only. 

Wow, that’s an amazing transformation… Wonder how her liver and kidneys were handling all that Tylenol?

But just as she was adjusting to a life free of painkillers, Bosley said she got a phone call from Lifetree, requesting that the Bosleys both meet with Webster. During that meeting, Roy Bosley said Webster convinced his wife to resume taking prescription opioids. Just over a year later, in November 2009, Carol Ann Bosley died of an overdose.

“Adjusting to a life free of painkillers”?  That doesn’t sound good… And it doesn’t make sense that a doctor would convince a pain patient to “resume” taking opioids.  Obviously, there was a problem…

A few weeks after she died, Roy Bosley said he was surprised to find that her death certificate listed “suicide” as the cause of death. He said he broached the issue with the medical examiner, and was stunned by his response. “I said, ‘Why did you label it suicide?’ And he says ‘Well, I called Dr. Webster. He told me that she committed suicide.'”

Dr. Edward Leis, the medical examiner who performed Carol Ann Bosley’s autopsy, denied having a conversation with Webster about her case. He said the original determination of suicide was made based on elevated levels of prescription oxycodone and alprazolam (a painkiller and a sedative) in Carol Ann Bosley’s system when she died.

So, why suicide and not unintentional overdose?

Leis said the amendment to her death certificate — although changes like that do not happen often — took into account additional information that Bosley provided about his wife’s state of mind before her death.

I can imagine what Mr. Bosley had to say about his wife… Should his grief be used in a medical document?

Similar to Carol Ann Bosley, after years of addiction, Tina Webb stopped taking painkillers. But it only lasted a month. Soon she was back at Lifetree asking to be prescribed opioids. Reluctantly, Bruce Webb said he participated in her new treatment plan, which involved him helping to administer his wife’s medication.

Damn, a babysitter…

What he did not know — what he said the staff at Lifetree never told him — is that Tina had become “opiate naive.” Her body could not handle pain medication at the level she was previously prescribed. “They put her back on the same drugs, the same dose,” said Webb, echoing an allegation in the lawsuit he filed against Webster and Lifetree. “So she took six pills that day (she died). That’s all it took.”

That sounds made up… As long as I was on — and off — opioids, I never became “opiate naive.” Perhaps his wife couldn’t take the pain (and all the monitoring) anymore.

“Sadly, the number of people with chronic pain has exploded over the last 10 years, escalating the problem of pain to an urgent, national crisis, one which demands a direct and honest dialogue that currently is not happening,” Webster’s statement said. “We need safer, more effective therapies and, ultimately, need to replace opioids as a treatment method so these tragedies never happen.”

Well, just as I thought, it looks like Dr. Webster went over to the dark side… Not that he didn’t have good cause to do so — nobody messes with the DEA. And there’s also that “new” Big Pharma drug that Dr. Webster is researching and funding…

Even years after their deaths, questions linger for both men; and the pain still smarts. It has been particularly difficult for Webb, who has tried to make sense of the loss for his two sons. He said, “…the heartache, the pain, the sleepless nights. It continues on. It’s not done.”

Yes, the blame game must go on… and on… and on. It’s called the Drug War.

http://www.hop-law.com/utah-family-awarded-1-6-million-verdict-over-patients-combined-painkiller-overdose-death/

Utah family awarded $1.6 million verdict over patient’s combined painkiller overdose death

A family of a Utah man who died from a combined drug overdose caused by treatment with opioid painkillers and other medications has been awarded a $1.6 million verdict against the hospital where the overdose occurred…

Lawyers Against Pain Patients:  Prescription painkillers are among the deadliest drugs used by patients in the U.S., according to FDA statistics.

10/1/2014, ‘If we control those prescriptions, we control the disease’

http://america.aljazeera.com/watch/shows/fault-lines/FaultLinesBlog/2014/10/1/-if-we-control-thoseprescriptionswecontrolthedisease.html

The United States is going through what the Centers for Disease Control and Prevention (CDC) has called the worst drug addiction epidemic in the country’s history.

I have yet to see this actual quote from the CDC — I think the media is just repeating what Kolodny from PFROP has been saying.

The Education and Rehabilitation of At-Risk Juveniles

Click to access EducationAtRiskJuveniles.pdf

Phoenix House Academy Descanso (CA)

Even though the Descanso facility is promoted as a voluntary drug treatment center, the Grand Jury’s visit disclosed mostly involuntary commitments. On the date of the Grand Jury’s visit there were 24 boys and 14 girls. Some of the commitments are through the Drug Court (San Diego Juvenile Court) and some of them are through private or family placement.

County and governmental agency funding makes up 98% of the budget and private donations make up the remainder. Staff counselors are private contractors trained by the national Phoenix House group. The Phoenix House model is a national program that integrates residential treatment with on-site school instruction. Throughout the country more than 150 Phoenix House programs provide a broad array of treatment, prevention, and recovery services and treat more than 17,000 adults and adolescents each year.

http://www.27east.com/news/article.cfm/Wainscott/43226/Youth-Charged-With-Sexual-Assault-At-Phoenix-House-In-Wainscott
11/19/2013:  The Phoenix House has been a not-for-profit behavioral healthcare provider since 1972 and provides more than 123 programs in 11 states. Currently, the Phoenix House has 6,000 men, women and teens at its various facilities.

Q&A with Mr. Kolodny

https://www.painedu.org/spotlight.asp?spotlightNumber=132

In the Spotlight. Read our monthly interviews with leaders in the pain management field

Physicians for Responsible Opioid Prescribing. An Interview with Andrew Kolodny, MD.

[Who elected Kolodny as a “leader” in the pain management field?  What are his credentials in pain management?]

This was about ten years ago, and at the time our effort to reduce drug overdose deaths was focused on heroin. Although overdose deaths from opioid analgesics were already beginning to rise, we were unable to appreciate that a new epidemic was developing. To reduce overdoses we worked on expanding access to effective treatment, namely [mostly] buprenorphine.

[10 years ago, Kolodny began focusing on heroin abuse, and how have his efforts paid off? Considering his connections with Big Pharma, I’d say pretty well — for him.]

The task wasn’t easy because many physicians have negative views of people with addiction and are not interested in obtaining their buprenorphine certification.

[“Negative views” is quite an understatement, wouldn’t you say?  In case Mr. Kolodny forgot, drug abuse and addiction are crimes in this country.  As is suicide, by the way.]

According to the CDC, this new opioid epidemic is far worse than the heroin epidemic of the 1970s and the crack cocaine epidemic of the 1980s.

[Did the CDC actually say this?  And what about the current heroin epidemic?]

For myself and many others in the fields of pain, addiction, public health, emergency medicine, toxicology, and the lay public, especially people who have lost loved ones to overdose deaths, we feel that sitting on the sidelines and watching the problem get worse is simply not an option.

[Kolodny is in the field of pain? When did this happen?  Are “people who have lost loved ones to overdose deaths” also in fields of medicine?]

We mainly found each other through research publications. Several of our original members are quite prominent in their respective fields. Individuals like Jane Ballantyne MD, Len Paulozzi MD, MPH, Michael Von Korff ScD, Gary Franklin MD, MPH and Irfan Dhalla MD, MSc, are all well known for their work in this area.

[Good to know.]

What we all had in common was a concern that the epidemic was largely caused by aggressive opioid prescribing for chronic non-cancer pain and that this change in practice was not supported by strong evidence.

[Your “concern” is now public policy, thanks so much, Mr. Kolodny and crew.  But this is a rather narrow focus on a rather large and complex problem.  And when one doesn’t look for evidence, or is selective about which evidence to believe, one usually doesn’t find it.]

We believe that opioids are an important option in palliative care and for acute pain. Although we presume that there might be some patients with chronic non-cancer pain that can benefit from treatment with opioids, we strongly agree with the recent Institute of Medicine’s report’s statement that the effectiveness of opioids for chronic pain is “far from certain.”

Is anything really certain in medicine? I mean, there are many things that work which are “far from certain” (according to the medical industry), like medical cannabis.  And just because something has been determined by one agency as “far from certain,” that doesn’t mean opioids should only be used for end-of-life care and acute pain.  

You “presume that there might be some patients with…”?  Aren’t presumptions (and concerns) also “far from certain”?  

Mr. Kolodny, I assume (or presume) that you and your colleagues don’t suffer from chronic pain (but even if any of you do), so it must be really easy for you to determine what’s best for about 100 million chronic pain patients. (You elitist, egotistical, narrowly-focused, making-money-off-other’s-misery, know-it-all, handsomely-paid, alleged and pretend “expert.”)

Residential Treatment Centers (RTCs)

Excepts from:

Click to access Residential_Treatment_Centers.pdf

However, a recent study that looked at a 7- to 8-year follow-up period found no evidence of positive effects on the outcomes measuring substance use problems, criminal activity, and psychological functioning. Although Phoenix Academy appeared to have short-term effects, no long-term effects were evident…

In 2004, Federal funding supported the placement of 200,000 youths in government or private residential facilities, which include youths not involved in the juvenile justice system (GAO 2008b)…

In addition, the costs of placing youths in residential programs such as RTCs can be substantial to the juvenile justice system (Bettman and Jasperson 2009). A report from the Justice Policy Institute (2009) estimates that reporting States spend an average of $7.1 million a day keeping youths in residential facilities…

In addition to these limitations, many of the treatments and services, whether psychotropic or psychosocial, delivered to youth in RTCs lack a foundation in research (Foltz 2004). For instance, Foltz calls attention to the widespread use of medications that have largely been tested only on adult populations and are prescribed “off label” to adolescents in treatment. Few evidence-based practices have been tested in RTCs, because of, in part, issues such as the lack of fit between Medicaid reimbursement and many evidence-based interventions (Bright et al. 2010). Moreover, a lack of funding can mean that inadequate services are available. In a survey of New York State RTCs, it was found that, because of budget constraints, facilities were forced to hire staff with limited formal education (Baker, Fulmore, and Collins 2008).

Panel: Quashing Prescription Drug Abuse Demands Community Effort

http://www.aafp.org/news/practice-professional-issues/20141202statelegopioids.html

According to Robert Twillman, Ph.D., director of policy and advocacy for the American Academy of Pain Management, of the tens of thousands of prescription drug overdose deaths in the United States each year, more than 75 percent can be attributed to use of multiple drugs. Furthermore, he suggested, the rates of prescription overdose may be higher in recent years because people are misusing more often — not because a greater number of individuals are misusing.

Risk assessment related to an opioid prescription should include assessment of individuals who come in contact with the patient.

Sounds like the AAFP (American Academy of Family Physicians) is advising doctors to hire the FBI to do background checks on pain patients before a prescription is even written.  How would you like your doctor’s office calling all your friends and family to determine if they are safe to be around you while you are treated with pain medication?

Allain cautioned that the intent of the program is to reduce drug diversion and potential overdose or misuse and it should not be interpreted as a law enforcement tool.

Man, who are ya’ll trying to fool?  With DEA involvement, the PDMP should not be “interpreted” as being used for law enforcement?  Huh?  At the beginning of this article, it states:  “The best ways to battle this problem involve cooperation among physicians, pharmacists and law enforcement officers.”

Your doctors and pharmacists are now part of the drug war, part of the DEA, part of state health departments, part of a national tracking database… Seriously, pain patients are being bar-coded, tagged, marked… forever and ever, amen.  As a pain patient, you are no longer a “patient” or a healthcare consumer — you are a potential criminal, addict, and suicide case.  You are a hazard to your community.

The medical industry keeps going full-speed-ahead in the wrong direction and traveling down the wrong road.  And while I like the fact that doctors appear to be destroying their own business and place in society, it’s just plain tragic that pain patients are now on their own.

And how much do you want to bet that Project Lazarus, mentioned in this article, is the same kind of organization as Phoenix House?

What about the children?

The are numerous Google hits for Dr. Kolodny’s speaking engagements, but this one for the Children’s Safety Network (link below) says it all.

Mr. Kolodny wants parents everywhere to be constantly watching their children for signs of drug addiction — as if most kids are potential addicts.  (Pain patients, sound familiar?)  Mr. Kolodny must convince everyone that their kids are in danger of addiction, so he can make money from their treatment.  Do you know how many “rehabilitation” centers he runs?

Mr. Kolodny and the media use the term “nonprofit” to describe Phoenix House, as if that term gives this federally-funded corporation some kind of legitimacy.  As if they help people who suffer from addiction out of the goodness of their hearts. Sure, a nonprofit, I get it — just like the Komen Foundation, the Red Cross, and GPS Crossroads are nonprofits.

http://www.childrenssafetynetwork.org/webinar/overview-opioid-addiction-epidemic

“For New York City, he helped develop and implement multiple programs to improve the health of New Yorkers and save lives, including city-wide buprenorphine programs, naloxone overdose prevention programs and emergency room-based screening, brief intervention and referral to treatment (SBIRT) programs for drug and alcohol misuse.”

If you take opioids and go to the ER for any reason, watch out… You’ll be referred to a “treatment program” before the nurse takes your temperature.  And like I said, tomorrow we’ll look to see if Mr. Kolodny’s programs made a difference, because, it’s funny, but while mentioning his involvement, I haven’t run across a mention of whether the programs were successful or not.

Tomorrow…

What’s the drug/opioid epidemic look like in France?

Part of the reason buprenorphine (Suboxone, etc.) is being pushed in the U.S. is because France tried this experiment first.

France approved buprenorphine in 1996, and in 2010, reported “a five-fold reduction in overdose deaths and a sixty-fold drop in the number of active injection drug users.”  (As in the U.S., figures are always 2 or 3 years behind the current year.)  (France has free needle exchanges and similar progressive programs.)  But just like Dr. Kolodny’s corporation, Phoenix House, France began by offering “treatment” instead of jail to victims of the drug war, including the use of buprenorphine to treat substance abuse and addiction.  So, shall we see how France is doing?

Selected excerpts from:  http://www.emcdda.europa.eu/publications/country-overviews/fr

The number of drug-induced deaths showed a constant increase between 2003 and 2010, and were mainly attributed to deaths due to heroin and methadone overdoses. In 2011, based on the General Mortality Register, 340 drug-induced deaths were recorded, a reduction from the 392 cases reported in 2010. In 2011 the majority of victims were male (249 cases). The mean age of the deceased was 45.7 years (significantly higher for females than for males). Toxicological data available from the Special Mortality Register (SR) indicates that opioids prevail, mainly methadone or buprenorphine, alone or in combination with other psychoactive substance. Opioids were involved in more than three-quarters of deaths recorded in the SR.

Since 1995 opioid substitution treatment (OST) has constituted the main form of treatment for opiate users, and has been integrated into a total therapeutic strategy for drug dependence, including for drug users in prison. Methadone and HDB [buprenorphine] are used for OST, though HDB, introduced in 1996, is still the most widely prescribed substitution substance. In rare cases, morphine sulphate is provided as substitution. Several directives regulate the dose, place of delivery and duration of OST.

France is a transit area for illicit drugs smuggled to the Netherlands, Belgium, the United Kingdom and Italy. As in most European Union countries, cannabis is the most widely available and accessible of all illicit substances… In 2010 a total of 157,341 drug-law offences were reported, of which 87.5 % were cannabis-related, 6.8 % heroin-related and 4.1 % cocaine-related.

Among all treatment clients, 44 % reported cannabis as their primary drug, followed by 43 % for opioids and 6 % for cocaine. Among new treatment clients, 63 % reported cannabis as their primary drug, followed by 27 % for opioids (mainly heroin) and 4 % for cocaine.

The high number and proportion of cannabis users among treatment demand clients in France is related to several factors — the establishment some years ago of specialised consultation centres for young users, mainly cannabis users, and of CSAPAs, and the fact that cannabis also remains the main drug in court-ordered treatment cases.

Following a period of policy development, France’s new Government Plan for Combating Drugs and Addictive Behaviours 2013–17 was launched on 19 September 2013. It takes a comprehensive and global approach towards illicit and licit drugs (narcotics, alcohol, tobacco, psychotropic medicines and new synthetic products) and other forms of addictions (gambling, gaming, doping)… The prevention of drug, alcohol or psychotropic use in the workplace, incorporating the use of screening, has been a priority for occupational physicians since 2012… Moreover, since 2005 some 300 youth addiction outpatient clinics (CJCs) have been opened throughout France to carry out ‘early intervention’.

Funny how the drug war has created similar victims all over the world. The strategy that France and Phoenix House are using — offering “treatment” instead of jail, especially for young people — doesn’t appear to be working.  At least for the victims, who are forever labeled as drug addicts. And all the cannabis users (who may have a potential addiction rate of about 3%) are now introduced to a bunch of people with serious drug problems. Drugs don’t have the stigma for young people that they do for older folks, so I imagine there’s a good-sized underground drug market for people who suffer from addiction — and for a large number of people who don’t, or didn’t before they were forced into these programs.

Governments in both countries introduced buprenorphine, which increased access and use of this drug — which, coincidentally, also increased the instances of abuse and overdoses involving buprenorphine.  And in France, along with methadone, buprenorphine is the opioid that’s causing the most damage.

Because general practitioners in the U.S. don’t want to treat drug addicts, sales of buprenorphine are small compared to France (which is how this drug is mostly distributed in that country). But, thanks to Dr. Kolodny, pretty soon, when it comes to buprenorphine, America will look worse than France.

The good news is that it looks like French citizens have turned to cannabis, when they are able to, and that legalizing medical cannabis in that country would really help.

Since Dr. Kolodny last worked in Brooklyn, NY, tomorrow we’ll look into what damage the drug war is doing in that state. Sound like fun?

Let’s get to know Phoenix House

Wikipedia:  Phoenix House was founded in 1967 by six heroin addicts who met at a detoxification program in a New York hospital. Phoenix House played a role in creating the country’s first correctional treatment unit, a model now widely replicated in prisons throughout the country and abroad. Phoenix House was also an early provider of treatment as an alternative to prison.

In 1983, Phoenix House opened its first Phoenix House Academy, a residential high school where teens receive substance abuse treatment as well as daily on-site academic education. Eleven Phoenix House Academies now operate in seven states and have been designated a “model program” by the U.S. Department of Justice in 2005. The organization is funded mostly by government contracts, but also receives philanthropic support for a portion of its $100 million annual budget. In addition to residential treatment, Phoenix House’s continuum of care includes prevention and education, outpatient services, sober living and recovery support, as well as specialty programs for mothers with young children, crimininal justice clients, and the military community.

Phoenix House is affiliated with COAF (Center on Addiction and the Family). COAF helps families affected by alcohol and other drug abuse and also runs the Facts on Tap education campaign for college students.

After completing work on Cadillac Records, Beyoncé Knowles donated her entire salary to Phoenix House. Beyoncé also visited the Phoenix House Career Academy at Jay Street in Brooklyn, New York in preparation for portraying singer Etta James, who was once addicted to heroin. Beyoncé and her mother and business partner Tina Knowles later founded the Career Academy’s Beyoncé Cosmetology Center, which offers a seven-month cosmetology training program for adults.

Founder Michael Rosenthal opposes the legalization of marijuana, and has opposed needle exchanges to provide clean needles to addicts.

10/15/2012, Phoenix House Founder Joins Anti-Legalization Teleconference.  See more at: http://www.phoenixhouse.org/news-and-views/news-and-events/phoenix-house-founder-joins-anti-legalization-teleconference/#sthash.p9fbOtke.dpuf

(Some of the) Board of Directors

Richard L. Plepler: Co-President, Home Box Office

Tina Brown: Founder, The Daily Beast

William D. Rifkin: Vice Chairman of Mergers and Acquisitions, J.P. Morgan

Byron R. Wien: Vice Chairman, Blackstone Advisory Services, The Blackstone Group, L.P.

Charles A. Heimbold, Jr.: Former Ambassador to Sweden and Chairman Emeritus, Bristol-Myers Squibb Company

Brendan L. Hoffman: President and Chief Executive Officer, Lord & Taylor

Frank Doroff: Vice Chairman Ready To Wear and Bloomingdale’s Direct, Bloomingdale’s

http://search.newyork.bbb.org/reports.aspx?cid=C942

$61 million+ from government contracts (FYE 6/2013)

http://www.nydailynews.com/new-york/phoenix-houses-accused-exec-perk-flap-article-1.1326700

4/24/2013, Phoenix Houses of N.Y. misused $223,000 in state funds: audit.  New York Controller Thomas DiNapoli found Phoenix Houses of New York spent state funds to pay for perks for its executives.

http://www.phoenixhouse.org/

“Phoenix House is a nonprofit drug & alcohol rehabilitation organization with over 130 programs in nine states, serving 18000 adults and teens each year.”

http://www.phoenixhouse.org/news-and-views/news-and-events/howard-p-meitiner-appointed-to-new-york-state-behavioral-health-services-advisory-council/#sthash.rFdaii66.dpuf

8/2/2013, Howard P. Meitiner Appointed to New York State Behavioral Health Services Advisory Council – Phoenix House President & CEO Howard P. Meitiner is appointed to the Behavioral Health Services Advisory Council by Governor Andrew Cuomo, confirmed by the New York State Senate.  Our services include treatment for substance abusers with mental health problems and programs for mothers with children, outpatient and residential treatment for military personnel, veterans, and their families, impaired driver programs, and a detoxification program center.

https://www.linkedin.com/pub/howard-meitiner/4/45/248

http://www.glassdoor.com/Overview/Working-at-Phoenix-House-EI_IE105573.11,24.htm

Revenue: $50 to $100 million (USD) per year

Competitors: Unknown

3/28/2014, Time to Reroute the Preschool-to-Prison Pipeline [Right into rehab]

Click to access Phoenix-House_2012-Annual-Report1.pdf

http://www.corporationwiki.com/New-York/New-York/howard-p-meitiner/34225648.aspx

http://www.patrickmcmullan.com/site/search.aspx?t=person&s=Howard+P.+Meitiner

If you want to be legitimate, you gotta have an awards ceremony.

“Our Military Services Program in New York, tailored to the special needs of veterans, operates a treatment program on Long Island, with a broad array of ancillary services. The program expanded in FY 2012, opening a Manhattan unit that provides both outpatient services and residential care.”

“Our agenda for youth has broadened with the addition of new adolescent services.”

Watch out, parents, they’re coming for your kids!

“Since 2008, marijuana use is up 18% for adolescents 12 to 17.”

Thank god!  That means they’re not drinking alcohol or snorting spice.

9/29/2014, Hydrocodone rescheduling takes effect Oct. 6

http://www.oncologypractice.com/home/article/hydrocodone-rescheduling-takes-effect-oct-6/de64f17d11e9aa618df299f3ce168b20.html

Dr. Andrew Kolodny, for one, is applauding the rescheduling of HCPs, saying that the explosion in prescriptions for HCPs such as Vicodin (hydrocodone/acetaminophen) has been the single biggest contributor to the rise in opioid addiction.

[Liar, liar, pants on fire.  Again.]

“I think this is going to have an enormous impact on bringing the epidemic to an end,” Dr. Kolodny, chief medical officer at the Phoenix House Foundation and director of Physicians for Responsible Opioid Prescribing, said in an interview.

Well, then nothing more needs to be done, right?  No more restrictions?  But, Dr. Kolodny, you advocate for restrictions all over the place.  You freaking sell out.

Dr. Kolodny disclosed that Physicians for Responsible Opioid Prescribing does not accept any industry funding. It is a financed as a Phoenix House program.

Well, well, well.  Now, who funds Phoenix House?  Would that be the federal government?

Cancer patients be like, phew, at least the medical industry doesn’t want to take away pain medications to treat cancer.  Yes, cancer patients, but what happens when you’re in remission? How long do you think it will be before cancer patients aren’t allowed pain medications either?