Not taking an action that can provide such benefit in fighting this (opioid) scourge is not only callus and inhuman but also morally indefensible!


 

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By:  Msgt. Thomas Tony Vance, Alexandria, Ky.

Callus and Morally Indefensible!

Mercy Health Hospitals in an Op-ed in the May 11, 2017 Kentucky Enquirer talks about the opioid epidemic and calls for a multi-pronged approach in dealing with it. Their program of Screening, Brief Intervention and Referral to Treatment, SBIRT, has screened thousands of patients. Unfortunately they do not give any stats that show the program is effective. They also state we should treat addiction as the disease it is. That is exactly what Nixon’s commission on drugs advised back in the early 70s. Instead we got the war on drugs!

As effective as the Mercy Health approach is, there is a more effective action that can drop the number of opioid overdose deaths by more than half. As reported in the Journal of the American Medical Association, States with medical cannabis laws see a 25% drop in opioid overdose deaths in the first year after legalizing medical marijuana which grows to 33% by year 6. We can cut our opioid overdose deaths by a third simply by legalizing medical marijuana.

In Colorado which has both medical and recreational marijuana legalization, have seen a drop of 66% since medical legalization was approved in 2012. They had 479 opioid overdose deaths for 2015 and that dropped to 442 for 2016.

Let us compare Kentucky and Colorado. Colorado has 5.5 million people and Kentucky has 4.5 million. Colorado has comparable medical and addiction services and is similar to Kentucky in many ways. The only major difference is Colorado has embraced marijuana legalization and Kentucky, even though medical legalization polls at 80% favorability and recreational at 60%, has rejected legalization. Colorado’s numbers for 2015 were 479 and Kentucky’s were 1278, almost 3 times that of Colorado.

Given the facts of the benefits of marijuana legalization in preventing opioid overdose deaths by more than half, as is the case in Colorado, no one can claim to be serious about opioid addiction and overdose deaths without including cannabis legalization as a tool to fight this epidemic. Cannabis legalization, in reality, has a better record of mitigating this epidemic than any other policy that has been tried or is currently in use! I dare our legislators to name another policy that can drop the number of these deaths by a third. They can’t.

Veterans suffering from chronic pain and Post Traumatic Stress stop taking an average of 8 different prescriptions for pain meds and meds to deal with the side effects of the various medicines they are given when they start using medical cannabis. Veterans claim far better outcomes than their counter parts who stay on the VA cocktail prescribed for pain and PTSD.

We need credible action to fight this devastating epidemic. What we are currently doing is not effective. Adding addiction services will help but it seems the easiest, most effective and credible action we can take right now is simply to legalize cannabis for medical and recreational uses and watch the numbers fall! Not taking an action that can provide such benefit in fighting this scourge is not only callus and inhuman but also morally indefensible!

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(KY) This Week at the State Capitol


For Immediate Release

February 17, 2017

This Week at the State Capitol

February 13 – 17, 2017

FRANKFORT — Headlines in recent days have made it clear that Kentucky’s problems with heroin, other illegal opioids and prescription drug abuse, continue to take lives and devastate communities at a shocking rate.

In-state newspapers have recently reported the more than 52 drug overdoses occurred over a 32-hour period in Louisville, and nine overdose calls came in over 12 hours in Madison County. A national publication reported that one rural Kentucky county filled enough prescriptions over 12 months to supply 150 doses of painkillers to every person in the county.

The same conversations held across the state about the way the drug crisis is impacting the court system, police, health care workers, treatment facilities, social workers, prison officials and families are also being held in the State Capitol. Those deliberations resulted in a number of bills aimed at addressing the issue, including several bills that took steps forward in the legislative process this week.

On Tuesday, the Senate approved Senate Bill 14, which is aimed at getting drug dealers off the streets by strengthening penalties for trafficking in heroin and fentanyl, a powerful synthetic opioid. Under the legislation, which was approved on a 36-0 vote, trafficking in less than two grams of these substances would be elevated to a Class C felony punishable by five to 10 years in prison.

Later in the week, a pair of bills addressing the drug crises were also approved in the House committees.

House Bill 333 would make it a felony to illegally sell or distribute any amount of fentanyl, carfentanil – a powerful opioid intended for large animals – and related drugs. Trafficking any amount of these drugs could result in up to 10 years in prison under the legislation. The bill would also restrict prescriptions for some painkillers to a three-day supply, though exceptions would be allowed in some circumstances. House Bill 333 was approved by the House Judiciary Committee and now goes to the full House for consideration.

The House Education Committee approved House Bill 145, which would help fight opioid addiction by requiring that public school students be educated about the dangers of prescription pain killers and their connection to addiction to heroin and other drugs.

Bills on other issues that advanced in the General Assembly this week include the following:

· Senate Bill 1 is a sweeping education reform measure that sets the course to change educational standards and accountability for public schools. The more than 100-page-long bill is an omnibus measure aimed at empowering state education officials, locally-elected school board members and teachers to decide the best teaching methods for their communities. It would set up several committees and advisory panels to review educational standards. The bill would change how students are tested, and it would also set up a new way for intervening in low-performing schools by placing more power in the local school district during those interventions. The bill passed the Senate on a 35-0 vote and now goes to the House for consideration.

· House Bill 14 would give police, firefighters, and emergency medical services personnel protection under the state’s hate crime statutes. Under the bill, those who assault, kidnap, or commit certain other violent offenses against first responders could face stricter sentencing in court. Currently only the legally-protected classes of race, color, religion and national origin, as well as sexual orientation, are covered under the state’s hate crime statute. House Bill 14 passed the House on a 77-13-1 vote and has been sent to the Senate.

· Senate Bill 78 would require public schools across Kentucky would to go smoke-free by next school year. The bill would outlaw the use of all tobacco products, including electronic cigarettes, on elementary, middle and high school campuses in addition to buses. The bill was approved by the Senate on a 25-8-2 and has been sent to the House.

· Senate Bill 75 would increase the amount donors can contribute to election campaigns. Under the legislation, individuals and political action committees could donate $2,000 in the primary and general elections in Kentucky– up from the $1,000 limit. The bill passed the Senate on a 27-10 vote and has been delivered to the House.

· House Bill 192 would make it easier for 16- and 17-year-olds in foster care to apply for driver’s permits and driver’s licenses. The bill, which passed 96-0 before being sent to the Senate,  would allow those in foster care to get a driver’s license or permit without requiring them to have a parent’s or other adult’s signature on the permit or license applications.

Members of the General Assembly are eager to receive feedback on the issues under consideration. You can share your thoughts with lawmakers by calling the General Assembly’s toll-free message line at 800-372-7181.

You can also write any legislator by sending a letter with the lawmaker’s name to: Capitol Annex, 702 Capitol Avenue, Frankfort, Kentucky 40601.

–END–

The price of a life-saving overdose treatment has increased 680% to $4,500 in the last 3 years


An emergency medication often referred to as an “antidote” for opioid overdoses has been skyrocketing in price over the last few years.

The device, the only auto-injector version of naloxone, is called Evzio, and it’s made by Kaleo. 

Naloxone instantly reverses opioid overdoses by blocking the drug from interacting with the brain’s receptors. It has been on the market since 1971.

In 2014, when Evzio was approved in the US, the list price was $575 for a two-pack. Now, it has a list price of $4,500 — an increase of 680%.

Kaleo, a private company based in Richmond, Virginia, also owns Auvi-Q, the emergency epinephrine device that made headlines in October 2016 when the company announced it would come back to the US as competition to the EpiPen after getting recalled a year earlier. The Auvi-Q and Evzio use the same auto-injector technology to deliver their respective emergency medications. 

The list price for a two-pack of the Auvi-Q comes in at $4,500 as well, though the company maintains that the cash price for people without insurance is $360 and that more than 200 million people will be able to get the device with a $0 copay. That list price is roughly 640% higher than the list price of the EpiPen, which was singled out in August 2016 for increasing the price of a two-pack by 500% over the course of seven years.

Now, the list prices of the two drugs is catching the eye of Democratic Senator Amy Klobuchar of Minnesota, who sent a letter Friday to Kaleo asking for more information about the company’s pricing strategy.

List prices don’t often tell the whole story when it comes to a drug’s price. There are other players in the system that each take a piece, which means that what a drugmaker actually receives could be lower even as the list price rises. Kaleo declined to comment on its average net price for Evzio. 

“When setting the ‘list’ price for products, kaléo always starts with the needs of the patient first and then engages with multiple stakeholders in the healthcare system,” Kaleo’s vice president of corporate affairs Mark Herzog said in a statement emailed to Business Insider. “Following these discussions, in order to help ensure our product is available as an option to most patients for $0 out-of-pocket, we set the list price at $4500.”

The rationale of the company’s pricing strategy didn’t seem to satisfy Klobuchar. 

auvi q 

“I understand that Kaleo is trying to mitigate the impact on consumers by providing Evzio for free to cities, first responders, and drug treatment programs, and offering various programs to help ensure that no consumer pays the $4,500 price for Auvi-Q,” Klobuchar wrote. “While these subsidies and programs are noteworthy, I am concerned that they do not address the underlying problem of rising prescription drug costs.”

This isn’t the first time rising naloxone prices have been called out. Until recently, Evzio’s price had been $3,750 per two-pack. And across the board, naloxone prices have been skyrocketing, as Business Insider’s Harrison Jacobs has reported.

However, most other naloxone options — syringes, and a nasal spray — have list prices in the hundreds for sets of 10 vials or two nose sprays. As a proportion of total naloxone market, Evzio made up roughly a third of prescriptions in 2016, according to data from IMS Health.

It remains to be seen how many prescriptions transfer from the EpiPen to the Auvi-Q. Before it was recalled, Auvi-Q only had a small share of the market at a list price of around $500.

But its high list price is already turning off health insurers and pharmacy benefits managers. FiercePharma reports that Cigna, Humana, and the pharmacy benefits manager Express Scripts have come out against the pricing strategy for Auvi-Q, while Aetna is putting it on restricted coverage. The device officially launches in the US on February 14. 

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Embattled Doc Suffers Another Setback in PHS Fight


Pauline Anderson

January 27, 2017

Michael Langan, MD, a Boston-based internal medicine specialist who has fought the Massachusetts Physician Health Service (PHS) and Board of Registration in Medicine for years to reinstate his license, has suffered a setback but is bolstered by a new development.

A justice of the Supreme Judicial Court of Massachusetts has denied Dr Langan’s petition to invalidate the 2013 suspension of his medical license for not meeting conditions to have his license reinstated.

However, a new law has enabled Dr Langan to access his records. According to Dr Langan, these documents show that the court did not consider key evidence in his case, as demonstrated by the fact that his hearing occurred before the date of receipt that is stamped on the documents. This may offer an opportunity to reopen his case.

The court decision, which was handed down in December by Associate Justice Geraldine Hines, states that although Dr Langan completed required psychiatric evaluations, he “did not submit a suitable worksite or substance abuse monitoring plan. In combination with his violation of the LoA [Letter of Agreement] meeting requirement, the board’s decision to affirm its prior suspension of petitioner’s license to practice medicine is supported by the record. The board’s decision to deny reinstatement in the absence of an acceptable plan is affirmed.”

“It’s unbelievable; everyone is dumbfounded,” said Dr Langan of the decision.

Dr Langan is appealing the denial of his petition, a process that will take an estimated 6 months.

He maintains that the PHS committed “forensic fraud” and concealed doing so.

“If I couldn’t win with all the direct evidence of felony crimes that you don’t need to be a lawyer to recognize, then I don’t think anyone can,” he told Medscape Medical News.

The PHS is a confidential resource for physicians and medical students seeking help for a variety of physical and behavioral health concerns, which may include difficulties with substance use.

In 2007, Dr Langan was at Massachusetts General Hospital (MGH) and Harvard University when he approached the PHS to help him with his dependence on Vicodin, an opioid analgesic.

He became dependent on Vicodin after a bout of chickenpox during residency, when he developed shingles. He stressed that there were no work-related problems associated with use of this drug.

He was an inpatient at the Talbott Recovery Center in Georgia for more than 3 months, after which he signed the requisite 5-year contract with the PHS that included regular drug testing.

According to Dr Langan, there were no problems until mid-2011, when a report from the US Drug Testing Laboratories found he was positive for phosphatidylethanol (PEth), a blood marker for chronic alcohol use.

The level detected was 365.4 ng/mL, which “is the equivalent of drinking a half gallon of whisky a day,” or a sign of end-stage alcoholism, said Dr Langan, who insists he has never had an alcohol problem.

“That the test was invalid at this point should have been self-evident,” said Dr Langan.

Lab Fraud? Continue Reading

Suspecting that there had been “lab fraud” and that he would “end up being admitted for 3 months,” Dr Langan said he requested, but was denied, an independent evaluation outside the 12-step PHP-approved list of facilities. Because his request was denied, he attended one of the approved facilities, Hazelden Addiction Treatment Center, in Minnesota, where he “was cleared.”

“They noted no past or present history of alcohol use or abuse and sent me back after a 4-day evaluation,” he said.

An independent investigation by James G. Flood, PhD, who has been chief of toxicology at MGH for nearly 30 years, concluded in a November 5, 2012, letter to Dr Langan’s lawyer “that there is a purposeful and intentional act by PHS” to show Dr Langan’s test as valid “when in reality this test was invalid and involved both fatal laboratory errors” and inadequate review of the results.

Any confirmatory, positive finding based on the July 2011 test “should be reversed, rectified and remediated,” Dr Flood writes.

Among the “many errors in sample collection, processing and transportation,” said Dr Flood, was that the documentation that was received with the specimen did not have a date and time of specimen collection. Moreover, the person who collected the specimen was not properly identified, the signature of the sample donor was missing, and there was no tamper-proof seal affixed to the specimen.

Dr Flood claims the sample was directed to the wrong laboratory, where it sat for several days. The storage conditions of the sample while at that laboratory were not documented.

Following an investigation by the College of American Pathologists, in October 2012, Dr Langan’s laboratory test result was corrected from having a positive result to being an invalid test, but he said he did not learn of this change until months later.

In a letter to the Massachusetts Board of Registration in Medicine, Luis T. Sanchez, MD, who at the time was the director of the Massachusetts PHS, said the amended report indicates that the “external chain of custody protocol [for that sample] was not followed per standard protocol.”

Dr Sanchez noted that, on the basis of the revised report, “PHS will continue to disregard the July 2011 PEth test result.”

Dr Langan requested the record of the chain of custody pertaining to his testing. This document showed that the test was “not only invalid but falsely created,” said Dr Langan. He added that it included a fax from the PHS requesting that his identification number be added to an already positive test and that the chain of custody be updated.

“You can’t update a chain of custody, as it is generated in real time,” said Dr Langan. “This is forensic fraud. It clearly shows collusion between the PHS and the lab.”

In an October 2012 letter, Dr Sanchez alleged that Dr Langan did not attend required peer support group meetings, but according to Dr Langan, this claim is “without fact or support.” Dr Langan maintains that he attended all required meetings. He also maintains that the PHS actions were in “retaliation” for requesting the chain of custody record.

Massachusetts PHS Director Dr Sanchez did not respond to a request from Medscape Medical News for clarification.

Medscape Medical News also sought comment on recent developments in Dr Langan’s case from the Massachusetts Attorney General’s Office, which declined to comment.

“The AG’s [Attorney General’s] Office often defends state agencies in litigation and we typically do not comment on behalf of our clients, who in this case is the Board of Registration in Medicine,” Emily Snyder, deputy press secretary, Office of Massachusetts Attorney General, told Medscape Medical News in an email.

Intentional Delay?

Dr Langan alleges that the PHS “intentionally delayed” his efforts to undergo a psychiatric evaluation that was necessary to have his license reinstated. He said the PHS insisted he get this evaluation out of state, even though he suggested three Boston-area board-certified experts.

The Board of Registration in Medicine eventually approved an evaluation by Patricia Recupero, MD, from the Law and Behavioral Health Program at the University of Rhode Island.

Dr Recupero’s November 2013 report determined that Dr Langan “is safe to return to the practice of medicine without further supervision,” that he “has an excellent prognosis and a very low risk of relapse,” and he “has not had an alcohol use, abuse or dependence problem.”

Many of the conflicts between the PHS and Dr Langan revolve around positive test findings, Dr Recupero notes in her letter.

It is “critical to understand” the inadequacies of such tests for physician monitoring for purposes of relapse, she notes. She added that the source of the alcohol in Dr Langan’s test results cannot be determined and that many products – mouthwash and hand sanitizers among them – can create a false-positive test.

Dr Langan acknowledges he used hand sanitizers in the course of his work as a physician. Owing to severe allergies, he also uses prescribed asthma inhalers, which contain alcohol as a propellant.

Dr Recupero also notes that “almost without exception,” Dr Langan’s test findings have been below the minimum level to declare a test positive and that positive findings “are not a sign of relapse.”

It was her opinion that, should he require additional treatment and supervision, the PHS should not be involved. A spokesperson for the PHS confirmed that it has not been involved in matters related to Dr Langan for at least 3 years.

Dr Langan said that since it suspended his medical license, the board has “engaged in a persistent pattern of ignoring my every reasonable effort at trying to be reinstated” and has “abused the administrative law process to accomplish this.”

Medscape Medical News contacted the Massachusetts medical board as well as its counsel, Deb Stoller, but received no response.

“Close to Homeless”

A memorandum to the Supreme Judicial Court, filed May 13, 2016, proposed a settlement between Dr Langan and the board. In return for the immediate reinstatement of Dr Langan’s license, he would be monitored for a maximum of 3 months by Dr Recupero and Timothy E. Wilens, MD, codirector of the Center for Addiction Medicine at MGH.

That memorandum was accompanied by letters from Dr Recupero and Dr Wilens agreeing to the terms, but according to Dr Langan, it has been “ignored.”

“The board did not acknowledge or address the proposals in any way,” said Dr Langan.

Dr Langan maintains that he “never ever” had any patient care or malpractice problems during his 15 years at MGH. In fact, his supervisors and colleagues reported that his work performance has been “superlative” on all counts, he said.

Many in the addiction medicine and psychiatric community support Dr Langan. He has letters from high-profile physicians in the field who verify that he is safe to practice medicine.

A first petition was filed in the Supreme Court on October 22, 2014, but the judge dismissed it because it had not been filed within the required 60-day period. Dr Langan’s most recent petition was filed July 3, 2015.

The past few years, he said, have taken a toll on his family. They have lost their home and health insurance because of his inability to practice his profession.

Disheartened by this latest setback, Dr Langan is looking into the possibility of becoming licensed in another state and leaving Massachusetts.

But Dr Langan has renewed hope. Under Massachusetts’ new Public Records Reform Law, which went into effect January 1, 2017, “the board was forced to comply with my request for records within 10 days,” and has done so, he said.

According to Dr Langan, these records show some irregularities that may bolster his case.

“A letter dated December 15, 2011, introducing exculpatory evidence was date-stamped January 17, 2012, almost 1 month after the hearing where it was submitted as evidence. All of the other documents had either illegible or absent date-stamps,” he said.

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Why Donald Trump’s Agenda for the Drug War Is the Dopiest Thing You’ve Ever Seen


A frightening mix of cruel and superficial.

By Phillip Smith / AlterNet

November 2, 2016

One means of judging the competing presidential candidates is to examine their actual policy prescriptions for dealing with serious issues facing the country. When it comes to drug policy, the contrasts between Hillary Clinton and Donald Trump couldn’t be more telling.

The country is in the midst of what can fairly be called an opioid crisis, with the CDC reporting 78 Americans dying every day from heroin and prescription opioid overdoses. Both candidates have addressed the problem on the campaign trail, but as is the case in so many other policy areas, one candidate has detailed proposals, while the other offers demagogic sloganeering.

Hillary Clinton has offered a detailed $10 billion plan to deal with what she calls the “quiet epidemic” of opioid addiction. Donald Trump’s plan consists largely of “build the wall.”

That was the centerpiece of his October 15 speech in New Hampshire where he offered his clearest drug policy prescriptions yet (though it was overshadowed by his weird demand that Hillary Clinton undergo a drug test). To be fair, since then, Trump has also called for expanding law enforcement and treatment programs, but he has offered no specifics or cost estimates.

And the centerpiece of his approach remains interdiction, which dovetails nicely with his nativist immigration positions.

“A Trump administration will secure and defend our borders,” he said in that speech. “A wall will not only keep out dangerous cartels and criminals, but it will also keep out the drugs and heroin poisoning our youth.”

Trump did not address the failure of 40 years of ever-increasing border security and interdiction policies to stop the flow of drugs up until now, nor did he explain what would prevent a 50-foot wall from being met with a 51-foot ladder.

Trump’s drug policy also takes aim at a favorite target of conservatives: so-called sanctuary cities, where local officials refuse to cooperate in harsh federal deportation policies.

“We are also going to put an end to sanctuary cities, which refuse to turn over illegal immigrant drug traffickers for deportation,” he said. “We will dismantle the illegal immigrant cartels and violent gangs, and we will send them swiftly out of our country.”

In contrast, Clinton’s detailed proposal calls for increased federal spending for prevention, treatment and recovery, first responders, prescribers, and criminal justice reform. The Clinton plan would send $7.5 billion to the states over 10 years, matching every dollar they spend on such programs with four federal dollars. Another $2.5 billion would be designated for the federal Substance Abuse Prevention and Treatment Block Grant program.

While Trump advocates increased border and law enforcement, including a return to now widely discredited mandatory minimum sentencing for drug offenders, Clinton does not include funding for drug enforcement and interdiction efforts in her proposal. Such funding would presumably come through normal appropriations channels.

Instead of a criminal justice crackdown, Clinton vows that her attorney general will issue guidance to the states urging them to emphasize treatment over incarceration for low-level drug offenders. She also supports alternatives to incarceration such as drug courts (as does Trump). But unlike Trump, Clinton makes no call for increased penalties for drug offenders.

Trump provides lip service to prevention, treatment and recovery, but his rhetorical emphasis illuminates his drug policy priorities: more walls, more law enforcement, more drug war prisoners.

There is one area of drug policy where both candidates are largely in agreement, and that is marijuana policy. Both Clinton and Trump have embraced medical marijuana, both say they are inclined to let the states experiment with legalization, but neither has called for marijuana legalization or the repeal of federal pot prohibition.

If Clinton’s drug policies can be said to be a continuation of Obama’s, Trump’s drug policies are more similar to a return to Nixon’s.

Phillip Smith is editor of the AlterNet Drug Reporter and author of the Drug War Chronicle.

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Black market fentanyl use increasing in Kentucky


  • Deborah Highland
  • Aug 15, 2016
  • ent3

    Fentanyl, an opioid painkiller 50 to 100 times more powerful than morphine, was found in the toxicology screens of 420 people who died in Kentucky last year of drug overdoses.

    That’s a 247 percent increase from 2014, when 121 people who died of drug overdoses had fentanyl in their toxicology screens, according to numbers provided by Van Ingram, executive director for the Kentucky Office of Drug Control Policy.

    “We’re seeing a huge uptick in fentanyl in Kentucky,” Ingram said.

    Pharmaceutical fentanyl is used in hospitals during surgery and is also provided in pain patches to people with severe, chronic pain, such as a cancer patient. But unlike opioid pain pills that have been diverted to the black market for years, pharmaceutical fentanyl isn’t what street dealers or drug abusers are using, Ingram said.

    “We’re not seeing pharmaceutical fentanyl being diverted but instead it is being produced out of the country and being smuggled in,” Ingram said.

    The drug is being made in clandestine labs primarily in Mexico and China, he said.

    “We’ve not seen a lot of labs in the United States, although there have been a few. The real danger of fentanyl is it is so powerful that skin exposure or powder exposure through the mouth and nose can put law enforcement at great risk,” Ingram said.

    Recently, the DEA sent out a warning to law enforcement agencies urging officers not to conduct field testing on suspected fentanyl and to instead package it and send it off to a crime lab for testing, he said.

    Most often when police encounter fentanyl, it’s found in heroin or being sold as heroin. But with the availability of pill presses, some dealers are using fentanyl to make pills that look like real pharmaceutical products such as oxycodone. 

    “If an individual buys pills off the street, there is really no assurance that what it says on the pill is really what they are getting because of the black market use of pill presses and other drugs,” Bowling Green-Warren County Drug Task Force Director Tommy Loving said. “By buying pills on the street, it could actually turn out to be a fatal error in judgment.”

    The DEA has seized pills all over the country that look like one drug but in reality contain illegally produced fentanyl, Ingram said.

    “It’s really scary stuff with people making their own opioids and shipping them across the country,” he said.

    “What we’re seeing is a lot of fentanyl analogs as well. It’s not the same chemical compound you would find in pharmaceutical fentanyl. You don’t know what you’re getting, or how powerful it is,” Ingram said.

    Narcotics investigators in Warren County haven’t seen much of the drug, Loving said.

    “But we’re very much aware of it, and it’s dangerous,” he said.

    “It’s much more potent than heroin and there are different versions of it being manufactured. … A little bit of this powder, if you come into contact with it on your fingers or skin or happen to breathe a little bit of it, can be fatal. And we are looking into obtaining Narcan for all of our detectives in part due to this danger that they may now be exposed to,” Loving said.

    Narcan is a drug that counteracts the effects of an opioid overdose.

    South Central Kentucky Drug Task Force Director Jacky Hunt already has Narcan for his investigators, who unknowingly encountered the drug last year during an undercover drug buy. Officers thought the purchase was of heroin. 

    When Hunt received the lab testing results of the substance his agency bought, the drug turned out to be fentanyl instead.

    “My guys handled fentanyl and didn’t even know it,” Hunt said.

    The drug is most often seen with heroin in Kentucky or sold as heroin, Ingram said.

    Ingram’s office has written some grant requests to try to obtain Narcan for law enforcement in an attempt to save as many lives as possible, he said.

    — Follow Assistant City Editor Deborah Highland on Twitter at twitter.com/BGDNCrimebeat or visit bgdailynews.com.

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    Cannabis

    Maryland has recently been cited as a state with a high rate of opioid addiction, and now some are seeing legalizing marijuana as taking a lead against the epidemic and are also urging southern states like Kentucky to join in.


    https://i1.wp.com/cdn.inquisitr.com/wp-content/uploads/2016/05/Tennessee-Congressional-Candidate-Had-180-Marijuana-Plants-On-Property.jpg

    Maryland has recently been cited as a state with a high rate of opioid addiction, and now some are seeing legalizing marijuana as taking a lead against the epidemic and are also urging southern states like Kentucky to join in.

    Newsmax reports that nine states will be voting on marijuana legalization in 2016, but is there some specific reason Maryland is urging southern states to join in?

    The Hill explained in an opinion piece on August 4 that Maryland will be fighting back at the opioid epidemic in their state by legalizing marijuana. They also state that some drug treatment specialists in Maryland are considering medical cannabis as treatment for opioid addiction due to a recent study from the University of Georgia.

    Citizens in the state of Kentucky have also expressed an interest in this form of opioid treatment, but medical marijuana is still illegal in the state despite recent considerations, as previously reported by the Inquisitr.

    Part of the reason that Maryland could be urging other states to join in with legalizing cannabis pertains to the lack of opioid treatment options in other states in the south.

    For example, NPR reported on June 15 that those in the opioid treatment industry in Georgia were outraged when the state decided to place limits on opening new clinics.

    The rehabilitation clinics they do have are needed because Georgia has almost 70 opioid treatment programs. By contrast, nearby Tennessee has 12, Alabama has 24, and Mississippi has one.

    Although any clinic for opioid addiction is better than no clinic at all, many Kentuckians have learned from states like Massachusetts, that they need to have medical marijuana options, specifically for opioid addiction, according to CBS News.

    States that use marijuana to treat addiction could also become leaders because the numbers of opioid deaths are rapidly increasing nationwide.

    Whether it is heroin, painkillers, or fentanyl, Americans are now dying at higher rates from opioid drugs, and the rate exceeds other types of accidents. For example, Vox wrote on June 2 that more Americans were killed by painkillers (42,000) in 2014 than car crashes (34,000), or gun violence (34,000).

    Naturally, any help Kentucky can get to fight opioid addiction with or without legalizing marijuana would be welcome, and a 2015 report from the Boston Globe about the epidemic in Eastern Kentucky quoted a drug treatment prevention worker stating the following.

    “We’ve lost a whole generation of people who would have been paying taxes, and buying homes, and contributing to society.”

    Eastern Kentucky has been highly documented in regards to having one of the worst opioid epidemics in America, and an investigative report about the Appalachian crisis in the Guardian in 2014 stated that “stigma and inadequate access to treatment are the biggest barriers to overcoming the ongoing crisis in Appalachia and across the country.”

    However, outside of being an effective treatment for battling the state’s opioid epidemic, many Kentuckians are excited to see the other improvements that legalizing marijuana, or hemp, could have for economies like the one in Eastern Kentucky.

    According to some reports, the process begins with decriminalizing marijuana. The act of decriminalization of marijuana will also likely protect the prominent illegal operations already deeply entrenched in Eastern Kentucky, as described by Columbus Dispatch.

    Kentuckians for Medical Marijuana published a 2013 study by Charles B. Fields, Ph.D., Professor of Justice Studies at Eastern Kentucky University, that stated “economic benefits… can be realized by the State of Kentucky by both receiving tax benefits and reducing expenditures enforcing current marijuana laws.”

    In other words, there is a price to pay to keep marijuana illegal in Kentucky, and legalizing cannabis or decriminalizing the growing, selling, or distribution could reduce Kentucky’s overall drug enforcement costs.

    Currently, the unregulated marijuana industry in Eastern Kentucky produces an estimated $4 billion per year, according to a commonly cited 2008 History Channel documentary on Appalachia called Hillbilly: The Real Story.

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    Heroin use and addiction are surging in the U.S., CDC report says


    Heroin use

    Rate of heroin use in the U.S. has climbed 63% in the past decade, according to experts at the CDC and FDA

    The rate of heroin abuse or dependence has jumped 90% between 2002 and 2013, new CDC report says

    Heroin use surged over the past decade, and the wave of addiction and overdose is closely related to the nation’s ongoing prescription drug epidemic, federal health officials said Tuesday.

    A new report says that 2.6 out of every 1,000 U.S. residents 12 and older used heroin in the years 2011 to 2013. That’s a 63% increase in the rate of heroin use since the years 2002 to 2004.

    Opioids prescribed by doctors led to 92,000 overdoses in ERs in one year

    The rate of heroin abuse or dependence climbed 90% over the same period, according to the study by researchers from the U.S. Food and Drug Administration and the Centers for Disease Control and Prevention.

    Deaths caused by heroin overdoses nearly quadrupled between 2002 and 2013, claiming 8,257 lives in 2013.

    In all, more than half a million people used heroin in 2013, up nearly 150% since 2007, the report said.

    Heroin use remained highest for the historically hardest-hit group: poor young men living in cities. But increases were spread across all demographic groups, including women and people with private insurance and high incomes — groups associated with the parallel rise in prescription drug use over the past decade.

    The findings appear in a Vital Signs report published in the CDC’s Morbidity and Mortality Weekly Report.

    "As a doctor who started my career taking care of patients with HIV and other complications from injection drugs, it’s heartbreaking to see injection drug use making a comeback in the U.S.," said Dr. Tom Frieden, director of the CDC.

    Overdoses fell after 2 narcotic painkillers were taken off the market

    All but 4% of the people who used heroin in the past year also used another drug, such as cocaine, marijuana or alcohol, according to the report. Indeed, 61% of heroin users used at least three different drugs.

    The authors of the new study highlighted a “particularly strong” relationship between the use of prescription painkillers and heroin. People who are addicted to narcotic painkillers are 40 times more likely to misuse heroin, according to the study.

    Once reserved for cancer and end-of-life pain, these narcotics now are widely prescribed for conditions ranging from dental work to chronic back pain.

    “We are priming people to addiction to heroin with overuse of prescription opiates,” Frieden said at a news conference Tuesday. “More people are primed for heroin addiction because they are addicted to prescription opiates, which are, after all, essentially the same chemical with the same impact on the brain.”

     

    Frieden said the increase in heroin use was contributing to other health problems, including rising rates of new HIV infections, cases of newborns addicted to opiates and car accidents. He called for reforms in the way opioid painkillers are prescribed, a crackdown on the flow of cheap heroin and more treatment for those who are addicted.

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    CONTINUE READING…

    Can medical marijuana curb the heroin epidemic?


    Author

    1. Miriam Boeri

      Associate Professor of Sociology at Bentley University

    Disclosure Statement

    Miriam Boeri does not work for, consult to, own shares in or receive funding from any company or organisation that would benefit from this article, and has no relevant affiliations.

    The Conversation is funded by Howard Hughes Medical Institute, Robert Wood Johnson Foundation, Alfred P Sloan Foundation and William and Flora Hewlett Foundation. Our global publishing platform is funded by Commonwealth Bank of Australia.

     

    In the 1930s, Harry J. Anslinger, the first head of the Federal Bureau of Narcotics, embarked on a fierce anti-marijuana campaign. Highlighted by the 1936 anti-marijuana film Reefer Madness – where marijuana is depicted as a dangerous narcotic that makes good kids become sex-crazed killers – his propaganda efforts also maliciously linked marijuana use to African Americans and ethnic minorities.

    Attitudes towards marijuana have changed since 1936, when the Federal Bureau of Narcotics released Reefer Madness. Wikimedia Commons

    By 1970, legislation codified cannabis as one of the nation’s most dangerous drugs: the Controlled Substance Act classified marijuana as a Schedule 1 drug, meaning it possessed high potential for abuse and had no acceptable medical use. Over 40 years later, the classification remains.

    But research has shown that marijuana, while still criminalized at the federal level, can be effective as a substitute for treating opioid addicts and preventing overdoses. Massachusetts, which recently legalized medical marijuana – and where heroin overdoses have soared – could be a fertile testing ground for this potentially controversial treatment.

    The medical case for marijuana

    Before being criminalized, marijuana was used in the US to cure depression and a variety of other mental health ailments. Many studies have supported the therapeutic benefits of cannabinoids, along with the ability of marijuana’s psychoactive ingredients to treat nausea, help with weight loss, alleviate chronic pain, and mitigate symptoms of neurological diseases.

    Other research, however, contradicts claims regarding the benefits of cannabidiol treatment. Some say marijuana actually poses a risk for psychosis and schizophrenia. Although the FDA has approved some synthetic cannabinoids for medical treatment, federal agencies do not support marijuana as a legitimate medicine until more clinical studies have been conducted.

    The scientific debate over the harms and benefits of marijuana has impeded federal lawmakers from moving forward on marijuana legislation reform. As a result, in 23 states, medical marijuana has become legalized by popular vote.

    Marijuana policy dilemma

    With each state crafting unique medical marijuana regulations, we find ourselves at a crucial turning point in drug policy. Public health professionals claim the road map used by “big tobacco” will be copied with legal marijuana, and addiction rates for marijuana will increase to those we see for tobacco. Others warn that if medical marijuana is used indiscriminately and without focused education on the uses and forms of medical marijuana, a prescription pain pill-like crisis could occur.

    Among drug treatment specialists, marijuana remains controversial. Although some research has shown marijuana to be an alternative treatment for more serious drug addiction, addiction treatment specialists still view marijuana as highly addictive and dangerous. These views handicap policy reform, but despite its status as a Schedule 1 drug, recent research shows marijuana could be part of the solution to the most deadly drug epidemic our country has seen in decades.

    Massachusetts: a case study

    In 2012 Massachusetts became the 18th state to legalize medical marijuana, though the first 11 dispensaries are not scheduled to open until sometime in the coming year. This situation presents an opportunity to implement sensible, research-based policy.

    Massachusetts, like many states across the US, has seen a dramatic rise in opioid addition fueled by the increase in opiate prescription pills. In Boston, heroin overdoses increased by 80% between 2010 and 2012, and four out of five users were addicted to pain pills before turning to heroin.

    Meanwhile, the leading cause of death among the Boston’s homeless population has shifted from AIDS complications to drug overdoses, with opiates involved in 81% of overdose deaths. This is an alarming finding given recent expansion in clinical services for the city’s homeless.

    Addiction specialists and health care professionals in Boston have been at the forefront of integrating behavioral and medical care. Naloxone and methadone are currently the main solutions to address the growing opiate addiction and overdose problem. But Naloxone is an overdose antidote, not a cure or a form of preventative therapy.

    Methadone, like heroin and other opioids, has a very narrow therapeutic index (the ratio between the toxic dose and the therapeutic dose of a drug). This means that a small change in dosage can be lethal to the user. Marijuana, however, has one of the safest (widest) therapeutic ratios of all drugs.

    Research shows that marijuana has been used as a form of self-treatment, where users take cannabis in lieu of alcohol, prescription opiates, and illegal drugs. That’s one reason why researchers are calling for marijuana to be tested as a substitute for other drugs. In this capacity, marijuana can be thought of as a form of harm reduction. While researchers don’t seek to discount some of the drug’s potential negative effects, they view it as a less damaging alternative to other, harder drugs. Despite these findings, marijuana is rarely incorporated in formal drug treatment plans.

    A recent study might change this policy. Comparing states with and without legalized medical marijuana, it found a substantial decrease in opioid (heroin and prescription pill) overdose death rates in states that had enacted medical marijuana laws. In their conclusions, the researchers suggested that medical marijuana should be part of policy aimed to prevent opioid overdose.

    Outside marijuana’s harms and benefits, missing in this discussion is the social environment of drug use. Drug use is social in nature. Where and with whom drugs are used influences why and how they are used. Socially acceptable or moderate use of drugs can be learned through social rituals in socially controlled settings.

    Studies in the Netherlands found that using marijuana in Amsterdam coffeehouses encouraged a “stepping-off” hard drug use. These studies also found that when young people used marijuana in a controlled coffeehouse setting instead of a polydrug-using environment, they learned to use marijuana moderately without combining with other drugs. Along with providing access to marijuana, it’s important to instruct users on safe and effective medical marijuana consumption.

    Since Massachusetts has not yet opened its medical marijuana dispensaries, it is too early to see if medical marijuana legislation will help reduce opiate addiction in the Commonwealth. Using recent research findings, Massachusetts policymakers have a unique opportunity to implement medical marijuana policies that address its contemporary opiate overdose. Medical marijuana could be part of drug treatment for heroin and opiates.

    For homeless people, however, getting a marijuana card is expensive and buying medical marijuana from a dispensary is beyond their economic means. Street drugs are more prevalent in their social setting, easier to obtain, and can be much cheaper. From a policy perspective, addressing the alarming rates of overdose deaths among the homeless in Boston could mean distributing medical marijuana cards to homeless addicts for free and providing reduced cost medical marijuana.

    What if medical marijuana cards were offered to homeless addicts? Wikimedia Commons

    Formerly demonized and later legislated as a Schedule 1 substance, marijuana could diminish the damage wrought by harder drugs, like heroin. While opioid use is a nationwide epidemic, Massachusettes – long at the forefront of developing scientifically based public policy – has the opportunity to be at the forefront of cutting-edge, socially-informed drug policy.

    This is the second in a series of three articles on alternative strategies to treat addiction. To read the first in the series, click here.

    CONTINUE READING…

    Why Do Clinics Deny Painkillers To Medical Marijuana Patients?


    By Steve Elliott ~alapoet~

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    Should health care facilities have the power to make lifestyle decisions for you — and punish you when your choices don’t measure up to their ideals? More and more hospitals are making exactly those kinds of decisions when it comes to people who choose to use marijuana — even legal patients in medical marijuana states. Apparently, these places don’t mind looking exactly as if they have more loyalty to their Big Pharma benefactors than they do to their own patients.

    A new policy at one Alaska clinic — requiring patients taking painkilling medications to be marijuana free — serves to highlight the hypocrisy and cruelty of such rules, which are used at more and more health care facilities, particularly the big corporate chains (the clinic in question is a member of the Banner Health chain).

    Tanana Valley Clinic, in Fairbanks, started handing out prepared statements to all chronic pain patients on Monday, said Corinne Leistikow, assistant medical director for family practice at TVC, reports Dorothy Chomicz at the Fairbanks Daily News-Miner.


    “We will no longer prescribe controlled substances, such as opiates and benzodiazepines, to patients who are using marijuana (THC),” the statement reads in part. “These drugs are psychoactive substances and it is not safe for you to take them together.” (This statement is patently false; marijuana has no known dangerous reactions with any other drugs, and in fact, since marijuana relieves chronic pain, it often makes it possible for pain patients to take smaller, safer doses of opiates and other drugs.)

    LIAR, LIAR: Corinne Leistikow, M.D. says “patients who use opiates and marijuana together are at much higher risk of death.” We’d love to see the study you’re talking about, Corinne.

    “Your urine will be tested for marijuana,” patients are sternly warned. “If you test positive you will have two months to get it out of your system. You will be retested in two months. If you still have THC in your urine, we will no longer prescribe controlled substances for you.”

    TVC patient Scott Ide, who takes methadone to control chronic back pain, also uses medical marijuana to ease the nausea and vomiting caused by gastroparesis. He believes TVC decided to change its policy after an Anchorage-based medical marijuana authorization clinic spend three days in Fairbanks in June, helping patients get the necessary documentation to get a state medical marijuana card.

    “I’m a victim of circumstance because of what occurred,” Ide said. “I was already a patient with her — I was already on this regimen. We already knew what we were doing to get me better and work things out for me. I think it’s wrong.”

    Ide, a former Alaska State Trooper, said he was addicted to painkillers, but medical marijuana helped him wean himself off all medications except methadone.

    Leistikow admitted that the new policy may force some patients to drive all the way to Anchorage, because there are only a few chronic pain specialists in Fairbanks. Still, she claimed the strict new policy was “necessary.”

    The assistant medical director is so eager to defend the clinic’s new policy that she took a significant departure from the facts in so doing.

    “What we have decided as a clinic — we’re setting policy for which patients we can take care of and which ones we can’t — patients who use opiates and marijuana together are at much higher risk of death, abuse and misuse of medications, of having side effects from their medications, and recommendations are generally that patients on those should be followed by a pain specialist,” Leistikow lied.

    Patients who use opiates and marijuana together are NOT in fact at higher risk of death, abuse, misuse and side effects; I invite Ms. Leistikow to produce any studies which indicate they are. As mentioned earlier, pain patients who also use marijuana are usually able to use smaller, safer doses of painkillers than would be the case without cannabis supplementation.

    CONTINUE READING HERE…