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Debunking The Myths

Common sense in pain management -- read Chronic Pain & Opioids: Debunking the Myths, by Frank B. Fisher, MD -- also available in PDF. And check out this public service ad based on Debunking the Myths.


Physicians are under intense scrutiny because of concerns over prescription drug diversion and abuse. At the same time, they are also under pressure from patients and advocates to prescribe adequate pain medication. It is a difficult balancing act and sometimes, overzealous law enforcement can tip the scales. For more information click here.


The Cato Institute published this tremendous analysis of pain management policy by Professor Ronald T. Libby of the University of North Florida. Download a copy of the full report, and also check out this CSDP public service ad which excerpts the Libby report.

A Michigan study confirms what many patients already know: Pharmacies in minority and low-income areas are less likely to carry sufficient supplies of pain medications. Click here to read more about this study on access to pain medication which was published in the Journal of Pain in Oct. 2005.


Pain management: where healthcare and drug control policies intersect. Click here for more about pain management, diversion, and related items. Also check out this new CSDP public service ad on the federal war against physicians over pain management.


Florida Governor Charlie Crist and his cabinet voted unanimously to grant pain patient Richard Paey a full pardon for his 2004 conviction on drug trafficking and possession charges. For more information, click here.


The re-trial of Doctor William Hurwitz came to an end in July 2007. The doctor's sentence was reduced to less than five years. He was originally given 25 years. For more information, click here.


A federal judge is challenging the plea agreement entered into earlier in 2007 between prosecutors and Purdue Pharma, the manufacturer of OxyContin. For more information, click here.


The New York Times Magazine featured a cover story on pain management issues in their June 17, 2007 edition. Click here to read the story in full.


Purdue Pharma, manufacturer of OxyContin, and three current and former executives were allowed to plead guilty in federal court to misleading the public about Oxy's risks. For more information, click here.


Federal re-trial of pain specialist Dr. William Hurwitz ends – some charges dismissed, acquittal on some charges but guilty verdicts on others. For more information click here.


Commutation Urged After Appeal Fails

Chronic pain patient Richard Paey lost in the appeal of his sentence on drug charges and faces a mandatory minimum 25-year-sentence. For more information click here .


DEA Issues Policy Statement On Pain Management

The US Drug Enforcement Administration has issued a new policy statement on pain management and prescribing practices. For details, click here. Also, a full copy of the notice as published in the Federal Register is available by clicking here.


The 4th Federal Circuit Court of Appeals has granted a new trial to Dr. William Hurwitz of Virginia. Dr. Hurwitz had been accused of drug trafficking for prescribing large quantities of narcotics to patients. For more information click here.


Rightwing talkshow host Rush Limbaugh reached a plea deal with prosecutors – charges to be dropped in 18 months if he completes treatment, avoids re-arrest. For more info, click here.


One of the first physicians in the nation to be charged with the deaths of patients from narcotics abuse was found guilty of one count of manslaughter and five counts of narcotics trafficking in her retrial in Florida. Dr. Asuncion Luyao faces maximum 30 year prison term – an appeal is planned. Click here for more info.


First Annual Opioid Certification Program

Presented by the Opioid Management Society & the Journal of Opioid Management, the conference will be held April 22-23, 2006, at The Conference Center at Harvard Medical, Boston, MA. To register, contact the Opioid Management Society.


The cover story in Harvard Magazine's Nov-Dec 2005 issue is "The Science of Hurt," by Kathleen Koman. Download and read a PDF copy of this tremendous article.


FDA, doctors win versus DEA on question of final approval of new painkilling drugs. Click to read more.


Chronicle AM: DEA Annual Threat Assessment Released, Trump Opium Event Thursday, More... (10/24/17)

The White House could announce a national opioid emergency on Thursday, the DEA releases its annual drug threat assessment, the Maine legislature approves a marijuana regulation bill, and more.

[image:1 align:left caption:true]Marijuana Policy

Maine Legislature Passes Marijuana Regulation Bill, Governor May Veto. The legislature approved a bill to regulate the state's impending legal marijuana market Monday, but not by big enough a margin to withstand an expected veto by Gov. Paul LePage (R). The bill would set up a licensing system and set a 10% sales tax and a weight-based excise tax for transactions between growers and retailers. If LePage vetoes the bill, the result could be "chaos" that would throw "oxygen onto the fire of the black market," said Sen. Roger Katz (R-Augusta) in remarks reported by the Bangor Daily News. LePage has said he wants to postpones retail sales until next year.

Heroin and Prescription Opioids

White House to Host Opioid Event on Thursday. The White House Office of National Drug Control Policy has announced that it will host an event Thursday on "the nationwide opioid crisis." The announcement did not make clear what the event will be, but could be the declaration of a national emergency around the opioid crisis. President Trump surprised his advisors last week by saying he would make such an announcement this week.

Trump Opioid Commission Member Not Optimistic. In an interview Monday, Trump opioid commission member former Rep. Patrick Kennedy (D-RI) said he was not optimistic that any recommendations from the commission will lead to any effective action to ameliorate the opioid crisis. Kennedy told the Washington Post "the worry is that" the commission's final recommendations, set for release next week, "won't be adopted."

Drug Store Group Offers Recommendations to Ease Opioid Crisis. The National Association of Chain Drug Stores, which has been criticized on some fronts for contributing to the crisis, has suggested four public policy initiatives that could help rein it in. Among the policy prescriptions are a seven-day limit for initial opioid prescriptions, nationwide electronic prescription monitoring, the use of manufacturer-funded envelopes to return unused opioids, and regulation of synthetic opioids. The association did not address the impact such policy prescriptions could have on chronic pain patients.

Law Enforcement

DEA Releases 2017 National Drug Threat Assessment. The agency released its annual report Monday, and it concentrates on the opioid crisis. The report notes the high number of prescription opioid overdose deaths, warns that heroin is a "serious public health and safety threat," notes the rise of fentanyl, says "the methamphetamine threat remains prevalent," "the cocaine threat continues to rebound," and that the emergence of new psychoactive substances remains "a challenge," among other findings. It qualifies Mexican drug trafficking organizations as "the greatest criminal drug threat in the United States."



Chronicle AM: CVS to Limit Opioid 'Scrips, Sessions Slams Legal Pot (Again), More... (9/21/17)

The attorney general makes clear yet again that he doesn't like legal weed, a Kentucky court throws out a medical marijuana lawsuit, one of the nation's largest pharmacy chains is moving to tighten up on opioid prescriptions, Rodrigo Duterte is ready to kill his own kid for the sake of the drug war, and more.

[image:1 align:right caption:true]Marijuana Policy

Sessions Attacks Marijuana Legalization Again. "I've never felt that we should legalize marijuana," Sessions said Wednesday in San Diego in remarks reported by Reuters. "It doesn't strike me that the country would be better if it's being sold at every street corner," he added, noting that it remains prohibited under federal law. But despite the attorney general's repeated anti-legalization comments, the Justice Department has yet to move seriously against states where it is legal. Last week, Deputy Attorney General Rod Rosenstein said the Cole memo, which set the Obama administration's largely laissez-faire policy toward legal pot states, is now under review.

Maine Legislators Propose Online and Drive-Through Pot Sales. Proposed regulations from the legislature's marijuana committee would let adults buy pot over the Internet and at drive-through windows at licensed pot shops. The rules are not yet set, however, and opponents are seeking to tighten access. Stay tuned.

Las Vegas Gets First 24-Hour Pot Shop. The city council voted unanimously Wednesday to allow a pot shop, Oasis Cannabis, to stay open 24 hours a day. It will be the first 24/7 pot shop to be located near the Strip, but other pot shops in nearby North Las Vegas are already open around the clock. In approving the move, the council overrode its own city code, which requires pot businesses to shut down between 3:00am and 6:00am.

Medical Marijuana

Kentucky Court Dismisses Lawsuit Aimed at Governor, Attorney General. A lawsuit filed against Gov. Matt Bevin (R) and Attorney General Andy Beshear (D) seeking to force them to legalize medical marijuana in the state was thrown out Wednesday. A Franklin circuit court judge ruled that legal precedent makes it clear that only the legislature can regulate the use of marijuana in the state -- not the executive branch and not the courts.

Heroin and Prescription Opioids

CVS to Limit Opioid Prescriptions in Bid to Address Crisis. The national drug store chain announced Thursday it will take steps to limit initial prescriptions to seven-day supplies for new patients facing acute pain. It will instruct pharmacists to contact prescribing doctors if they see prescriptions with what they believe are more opioids than necessary. The chain will also cap daily dosages and require new patients to get medications that offer short-period pain relief instead of longer duration ones. CVS did not address how the moves would impact patients suffering from chronic pain.

Nevada Governor Sets Opioid Task Force Meeting. Gov. Brian Sandoval (R) has announced that the state's task force on opioid abuse is set to meet Monday. He said the task force will hear updates from state and federal agencies on their progress in fighting opioid abuse. The task force has already made the overdose reversal drug naloxone available to first responders, Sandoval noted.

Asset Forfeiture

lIllinois Governor Signs Civil Asset Forfeiture Reform Bill. Gov. Bruce Rauner (R) signed House Bill 303 into law on Tuesday. The new law does not end civil asset forfeiture, but raises the bar for seizures, mandates the collection and reporting of seizure data, and imposes new sanctions for abuse or violations of asset forfeiture rules. Under the new law, the government's burden of proof standard rises from probable cause to a preponderance of the evidence. The law also provides that possession of small amounts of drugs will no longer be a legal basis for forfeiture.

International

Duterte Tells Cops to Kill His Own Son if Drug Smuggling Rumors Are True. In a not very reassuring effort to demonstrate that his own family is not above the law, Philippines President Rodrigo Duterte said in a speech Wednesday that police could kill his children if they prove to be involved in drugs. The remarks came amid reports that his 42-year-old son Paolo was involved in drug smuggling. According to the Sydney Morning Herald, Duterte said he warned his son: "My orders are to kill you if you are caught, and I will protect the police who kill you." That way, people wouldn't think the first family was getting special treatment. "That's better ... so I can say to the people: "There, you keep talking. That's my son's corpse,' he said.



Chronicle AM: CA Safe Injection Site Blocked for Now, No Toronto Pot Lounges, More... (9/19/17)

The California safe injection bill comes up two votes short of passing this year, Toronto authorities ignore the pleas of pot lounge operators for a place under legalization, Virginia's Democratic attorney general comes out with a plan to fight opioid overdoses, and more.

[image:1 align:left caption:true]Marijuana Policy

New Mexico Democratic Gubernatorial Candidates Want to Legalize It, Republicans Not So Much. Three leading Democratic contenders for the party's gubernatorial nomination support legalization, while the sole Republican in the race does not. Democrat Peter DeBenedittis released a statement Monday calling for legalization, prompting Democrats Jeff Apodaca and US Rep. Michelle Lujan Grisham to come out for it as well. The sole Republican, US Rep Steve Pearce opposes legalization, as does one Democrat, state Rep. Joseph Cervantes. But Cervantes noted that he has sponsored legislation reducing penalties for possession.

Medical Marijuana

Arkansas Deadline Sees Rush of Applicants for Grower, Distributor Licenses. A Monday deadline for grower and distributor applications saw applicants flood the state office building where the paperwork is delivered. Firm numbers weren't available, but applicants overwhelmed the clerks on duty and faced hours-long waits to get processed.

Heroin and Prescription Opioids

Virginia Attorney General Releases Plan to Fight Opioid Epidemic. State Attorney General Mark Herring (D) on Monday released a plan to address the growing number of deaths caused by the use of heroin, fentanyl, and prescription opioids. Among the proposals: harsher laws for people dealing in fentanyl, enhanced electronic prescription monitoring, requiring health insurers to cover alternative treatments for pain, teaching schoolchildren about opioids beginning in middle school, and an investigation into price gouging by companies selling naloxone. News accounts don't indicate any discussion in Herring's plan of the need to ensure the availability of opioid pain relievers to those patients who do need them, nor any critical examination of his proposal for increased sentences.

Harm Reduction

California Safe Injection Site Bill Falls Short in State Senate. A bill that would have opened the way to safe injection sites in the state has come up two votes short in the state Senate. The measure, Assembly Bill 186, is not dead, however. Even though the Senate did not vote to pass it, it did vote to reconsider it next year.

International

Toronto Just Says No to Marijuana Lounges. Despite the pleas of pot consumption lounge owners, some of whom have been open for years, the city's municipal standards and licensing committee voted 4-1 to limit marijuana businesses to government-run stores. The committee also voted to increase penalties for businesses that allow on-site consumption. The city is staying within the parameters set by the Ontario provincial government, which recently announced plans for a government monopoly on pot sales.

Lesotho Becomes First African County to Issue Medical Marijuana License. The country's health ministry has licensed a South African company, Verve Dynamics, to manufacture medical marijuana products, marking a first for the continent.

Peru Medical Marijuana Bill Advances. Spurred by a recent raid on a makeshift medical marijuana facility that mothers were using to soothe their sick children, the Peruvian congress is advancing a medical marijuana bill. The bill has now passed the congressional Committee on National Defense and heads to the full Congress for debate and a final vote. President Pablo Kucyzinski has supported the legislation.

Amnesty International Criticizes Indonesia's Turn to Harsh Drug War. The government's tough stance against drug dealers is leading to an increasing death toll, the human rights group said. Amnesty's Indonesian affiliate said some 80 people had been killed by police in the drug war so far this year, more than four times as many as last year.

(This article was prepared by StoptheDrugWar.org"s lobbying arm, the Drug Reform Coordination Network, which also pays the cost of maintaining this web site. DRCNet Foundation takes no positions on candidates for public office, in compliance with section 501(c)(3) of the Internal Revenue Code, and does not pay for reporting that could be interpreted or misinterpreted as doing so.)



Chronicle AM: AG Nominee Stokes MJ Fears, Global Commission Calls for Drug Decrim, More... (11/21/16)

Donald Trump has nominated a harsh drug warrior to head the Justice Department, Montanans will see a slew of bills aiming at making their medical marijuana system more workable (and at least one that wants to kill it), the Global Commission on Drugs called for drug decriminalization, and more.

[image:1 align:left caption:true]Marijuana

Trump's Pick of Jeff Sessions as AG Raises Fears in Marijuana Industry. President-elect Donald Trump (R) has nominated anti-marijuana Alabama Republican Sen. Jeff Sessions to head the Justice Department, setting off alarms in the marijuana industry. As attorney general, Sessions would oversee federal prosecutors and the DEA and could move to undo the Obama administration's policy of largely allowing the states to set their own course on pot policy.

Colorado Bureaucrats Nix On-Site Pot Consumption for Bars. Just a week after voters in Denver approved a social use initiative allowing restaurants and bars to seek permits to allow on-site consumption of marijuana, the Department of Public Health and Environment has announced that it will not allow liquor license-holders to obtain such permits. The department said using alcohol and marijuana together increases impairment. But proponents of the measure said alcohol establishments already rely on the judgment of servers and that the move would allow consumers to use marijuana products without having to go outside or hide behind closed doors.

Medical Marijuana

Arizona Dispensary Operator Eyes 2018 Expansion Initiative. The owners of the Wellness Center, an Apache Junction dispensary, are moving toward an initiative to expand the state's medical marijuana program. The move comes a week after a legalization initiative was narrowly defeated. The initiative would expand the list of qualifying conditions for marijuana and it would allow people who live more than a mile from a dispensary to grow their own. The current law bars people who live within 25 miles of a dispensary from growing their own.

After Initiative Victory, Medical Marijuana Bills Pile Up in Montana. Montanans voted last week to restore their state's medical marijuana system, which had been gutted by the Republican legislature in 2011, and now the legislature faces at least 10 bills designed either to make the system more workable or to try to thwart the will of the voters once again. It's going to be a busy session in Helena.

Heroin and Prescription Opioids

Kentucky Legislator Files Bill to Limit First-Time Opioid Prescribing. State Rep. Jeff Taylor (D-Hopkinsville) has prefiled a bill, BR 202, that would limit first-time adult prescriptions for non-chronic pain relief to a seven-day supply. The bill does include an exception that would allow a doctor to prescribe a longer supply if deemed medically necessary.

Kratom

Still Ten Days Left to Comment on Proposed Kratom Ban. Anyone who wants to commit on the DEA's plan to schedule kratom has until December 1 to do so. Click on the link for more information.

International

New Report Calls on UK to Legalize Marijuana. A new report from the Adam Smith Institute says that Great Britain's drug strategy "has failed in its core aims to prevent people from using drugs, manufacturing drugs, and to put a stop to the crime, corruption and death that is taking place on an industrial scale around the world," and calls on the government to legalize marijuana. The report is winning support from a cross-party parliamentary group that includes former deputy prime minister Nick Clegg.

Global Commission on Drugs Calls for Global Drug Decriminalization. In its annual report, the Global Commission on Drugs has called for an end to criminal and civil penalties for drug possession and more research into alternative regulatory models. The report comes months after the commission sharply criticized the United Nations' refusal to embrace more radical drug reforms at its UNGASS on Drugs last spring. Commission member Richard Branson called the UN's status quo approach "fatally flawed" at the time.



Using Medical Marijuana to Reduce Dependence on Opiates in an Aging, Aching Population [FEATURE]

Pain is a drag. And chronic pain is a never-ending drag. Unfortunately, as we grow older, we can expect to increasingly suffer its torments. Half of older adults who live on their own report suffering from chronic pain. For people in elderly care facilities, that figure jumps to somewhere around 80%.

[image:1 align:left caption:true]An aging population with its associated aches and pains is one reason opioid pain prescriptions have increased so dramatically this century. Opiates are a very popular pain management technique, despite the well-known problems with them, primarily addiction and lethality. They can ease your pain, but they can also kill you or get you strung out. And opiate users report other problems less severe, but still affecting quality of life, such as constipation and foggy-headedness.

In recent years, we have seen increasing evidence that one substance can reduce both pain and the reliance on opioids to treat it, and that its use can have a positive impact on fatal opioid overdoses. That substance is marijuana.

As the Johns Hopkins Bloomberg School of Public Health reported in 2014, "In states where it is legal to use medical marijuana to manage chronic pain and other conditions, the annual number of deaths from prescription drug overdose is 25% lower than in states where medical marijuana remains illegal."   

Now, new research findings from Care By Design, one of California's leading medical marijuana producers, add more evidence of the positive role marijuana can play in treating chronic pain and reducing dependence on opioid pain medications. The study surveyed 800 patients, mostly between 50 and 70, more than 80% of whom reported suffering from chronic pain, half of whom reported suffering from acute pain, and more than 40% of whom reported suffering from both.

These patients were in a world of hurt and had tried a number of pain management tools—opiates, medical marijuana, anti-inflammatory agents (NSAIDS), nerve blockers, exercise/physical therapy, and surgery—with respondents reporting trying an average of four of them. A quarter of patients reported having tried all six.  

The patients reported that marijuana was very effective for pain, with few negative side effects.  That was in striking distinction to opiates, which patients also said were effective for pain, but had a significant negative impact on quality of life for a significant number of them. In fact, the differences between the two substances in terms of quality of life were so dramatic they led to dramatic changes in patient behavior.

[image:2 align:right caption:true]"This survey brings some very important information to light," said Care By Design spokesman Nick Caston. "We see here in our patient data that cannabis is improving the quality of life of our patients—particularly elderly patients suffering from age-related pain—and that it does so without the dangerous side effects of other pain management modalities. 

"The study’s most striking finding was cannabis’ apparent impact on opiate reliance: Ninety-one percent of survey respondents reported that they decreased the amount of opiates they were taking or eliminated them altogether," Caston continued.

The study also found while marijuana, opiates, exercise/physical therapy, and NSAIDS all provided noticeable pain relief in more than half the patients, marijuana was the only pain management tool where there were no reports of worsening pain. And half of the patients using opiates reported that they had a negative impact on overall well-being, interfering with mood, energy, sleep, and functional abilities.

More than half of the patients reported using both marijuana and opiates to manage pain. But as noted above, nine out of 10 reduced or eliminated their opiate consumption after beginning to use marijuana. And nearly two-thirds (63%) said they were now off opiates altogether.

Over half of respondents reported that they had used both cannabis and opiates for pain management. Of great interest was the impact of cannabis therapy on opiate usage: Ninety-one percent of this subgroup reported that they used fewer or no opiates after beginning cannabis therapy. Sixty-three percent said that they went off opiates altogether.

"A tenet of healthcare in the United States is 'First, do no harm,'" the study concluded. "Patient reports of cannabis’ efficacy together with its low side effect profile suggest that it should be considered as a first-line treatment for pain and/or as an adjunct treatment to opiates rather than as a medication of last resort."

In other words, if we want to reduce the reliance on opioids, with all their negatives, for the management of pain in an aging population, we should be easing access to medical marijuana. With medical marijuana legal in 25 states, we're halfway there. 



The Drug Enforcement Administration worked with pain management specialists to develop pain prescription guidelines so that law enforcement could do its job and physicians could do theirs. A month later, DEA pulled the guidelines.


In a letter, 30 state attorneys general take DEA to task over withdrawal of pain management prescription guidelines. Check out this public service ad on the letter.


OxyContin has been the center of controversy as pain management has moved to the front of the public consciousness. Much of what's been reported is exaggerated. Click here for more news and information about Oxy and pain management issues.


Excerpts from Cato Institute Analysis*:

"The government is waging an aggressive, intemperate, unjustified war on pain doctors."

"By demonizing physicians as drug dealers and exaggerating the health risk of pain management, the federal government has made physicians scapegoats for the failed drug war. Even worse, the Drug Enforcement Administration's renewed war on pain doctors has frightened many physicians out of pain management altogether, exacerbating an already serious health crisis - the widespread undertreatment of intractable pain."

"Experts agree that tens of millions of Americans suffer from undertreated or untreated pain ... According to one 1999 survey, just one in four pain patients received treatment adequate to alleviate suffering."

"The medical evidence overwhelmingly indicates that when administered properly, opioid therapy rarely, if ever, results in 'accidental addiction' or opioid abuse."

"Pain specialists make an important distinction between patients who depend on opiates to function normally - to get out of bed, tend to household chores, and hold down jobs - and

addicts who take drugs for euphoria, and whose lifestyles deteriorate as a result of taking opiates, instead of improving. The DEA makes no such distinction."

"The relationship between a doctor and his patient is crucial to the proper assessment and treatment of the patient's condition. The DEA's aggressive investigative procedure poisons the doctor-patient relationship from both sides."

"The DEA continues to lower its evidentiary standards, making it nearly impossible for many doctors to determine what is and isnít permitted."

"Large quantities of narcotics routinely go missing en route from manufacturers to wholesalers and from wholesalers to retailers. The DEA itself acknowledges this problem. Given the poor job the DEA is doing of monitoring the narcotics it's charged with overseeing ... DEA's attempt to blame physicians for the drugs' street availability seems arbitrary, unjustified, and capricious."

Common Sense for Drug Policy
www.CommonSenseDrugPolicy.org, www.DrugWarFacts.org

H. Michael Gray, Chair; Robert E. Field, Co-Chair
info@csdp.org

* "Treating Doctors as Drug Dealers: The DEA's War on Prescription Painkillers" by Professor Ronald T. Libby, June 16, 2005.
http://www.cato.org/pubs/pas/pa545.pdf

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