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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.


Making Matters Worse: DEA's Move to Restrict Opioid Prescriptions Pushed Users to the Dark Web

By the end of 2013, the country's quiet opioid addiction crisis was no longer so quiet. Opioid overdose deaths that year topped 16,000, more than four times the same statistic for 1999. That prompted a number of measures at the state and federal level to rein in opioid prescriptions, including a move by the DEA in October 2014 to tighten its policies around some of the most commonly prescribed opioids.

[image:1 align:left caption:true]The new DEA policy -- aimed at popular opioids such as Vicodin and Lortab -- imposed restrictions on doctors' prescribing and made it more difficult for patients to get refills. In one sense, the policy was a success: Prescriptions for those drugs decreased almost immediately. But new research adds to an increasing body of evidence that restricting opioid prescribing has not solved the opioid crisis but instead worsened it.

Since the DEA policy shift, opioid overdose deaths continued to grow with more than 40,000 fatal opioid overdoses in 2016. And while prescription opioid overdose deaths have slightly decreased -- there were about 14,000 that year -- overdose deaths from heroin and non-prescription synthetic opioids such as fentanyl went through the roof. Heroin and illicit synthetics accounted for nearly two-thirds of all opioid overdose deaths in 2016.

In the new study, published this week in the British Medical Journal, researchers examining the impact of the DEA policy shift found evidence that while the change indeed lowered prescribing rates for the opioids in question, it was also linked to an increase in illicit online sales of those drugs in Dark Web drug markets.

The researchers used software called DATACRYPTO to crawl encrypted Dark Web marketplaces where people can anonymously buy damned near anything, from drugs to guns to credit card numbers. DATACRYPTO harvested data on which drugs were for sale, their country of origin, and the number of customer comments on each seller's comments page. Researchers used that last figure as a proxy for how much of a drug that seller sold. They examined sales of prescription opioids, sedatives, stimulants, and steroids, as well as heroin. It was only with prescription opioids that they found a significant Dark Web sales bump.

Here's what they found: "The sale of prescription opioids through US cryptomarkets increased after the schedule change, with no statistically significant changes in sales of prescription sedatives, prescription steroids, prescription stimulants, or illicit opioids."

According to their data, prescription opioids doubled their market share of U.S. Dark Web drug sales thanks to the DEA policy change. By July 2016, opioids represented 13.7% of all drug sales in U.S. cryptomarkets, compared with a modeled estimate of 6.7% of all sales.

While the researchers were careful to not make claims of causation -- only correlation -- their conclusion speaks for itself: "The scheduling change in hydrocodone combination products coincided with a statistically significant, sustained increase in illicit trading of opioids through online US cryptomarkets. These changes were not observed for other drug groups or in other countries. A subsequent move was observed towards the purchase of more potent forms of prescription opioids, particularly oxycodone and fentanyl."

Not only is the DEA policy change linked to increased Dark Web opioid sales, it is also linked to a move toward more powerful, and thus more dangerous, opioids. The researchers noted that while fentanyl was the least purchased Dark Web opioid in the summer of 2014, it was the second most frequently purchased by the summer of 2016. Fentanyl killed as many people as prescription opioids that year.

This study -- one of the few that examines supply reduction (as opposed to demand reduction) as a means reducing drug use -- strongly suggests that supply-side interventions carry unintended consequences, especially the resort to more dangerous and more powerful substitutes. The study's authors refer to this effect as "the iron law of prohibition, whereby interventions to reduce supply, such as increased enforcement and changes to drug scheduling, lead to illicit markets dominated by higher potency products."

Perhaps better than restricting opioid prescriptions, which has deleterious impacts on the tens of millions of Americans suffering chronic pain, or other supply-side interventions, would be increased access to addiction treatment, as well as greatly expanded harm reduction measures to try to get people off opioids and keep them alive in the meantime.



Chronicle AM: DOJ to Clamp Down on Pain Pills, Sanders Files Opioid Bill, More... (4/18/18)

Maine lawmakers pass another legal marijuana implementation bill, this time with veto-proof majorities; the Justice Department eyes a crackdown on pain pill production, Bernie Sanders takes aim at opioid makers and distributors, and more.

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

Maine Legislature Passes Legal Marijuana Implementation Bill, Governor Vows Veto. The state Senate on Tuesday approved the bill that would finally allow retail marijuana sales. The bill passed the House earlier and now goes to the desk of Gov. Paul LePage, who has threatened to veto it because it doesn't combine the state's adult use marijuana and medical marijuana regimes. LePage vetoed a similar bill last year. But this time around, the bill passed with enough support to overcome a veto. LePage has 10 days to sign, veto, or let the bill become law without his signature.

Medical Marijuana

Bipartisan Bill to Let VA Study Medical Marijuana Filed. A group of House Democrats and Republicans have filed HR 5520, the VA Medicinal Cannabis Research Act. The bill would clarify that the Veterans Administration has the authority to study medical marijuana and encourages the agency to do so. The bill would require the VA to report regularly to Congress about its progress on medical marijuana research. The bill is being championed by leaders in the House Veterans Affairs Committee and has 34 cosponsors.

Massachusetts High Court Urges Lawmakers to Clarify Law on Home Cultivation. In an opinion in a case of a medical marijuana patient arrested for growing 22 pot plants, the state's Supreme Judicial Court has urged lawmakers to revisit the law around home grows by patients. The law allows patients to grow enough marijuana to create a 60-day supply, defined in the state as 10 ounces. But the justices found the current law problematic and suggested a plant-based limit would be clearer. "Statutory and regulatory clarification would be most beneficial," wrote Justice Scott Kafker in the opinion in the case, Commonwealth vs. Richardson.

Hemp

Oklahoma Hemp Bill Heads to Governor's Desk. The Senate on Tuesday approved House Bill 2913, which would legalize industrial hemp production. The measure has already passed the House, so it now goes to the desk of Gov. Mary Fallin (R).

Heroin and Prescription Opioids

Justice Department Proposes New Regulations to Limit Prescription Opioid Production. Attorney General Jeff Sessions on Tuesday proposed new regulations for how the DEA sets opioid production quotas that could severely limit the amount of pain pills produced. "Under this proposed new rule, if DEA believes that a company's opioids are being diverted for misuse, then they will reduce the amount of opioids that company can make," Sessions said in prepared remarks. The proposed change must still go through the federal rule-making process before going into effect. It will be published in the Federal Register and opened to public comment in coming days.

Bernie Sanders Files Bill to Rein in Big Pharma on Opioids. Sen. Bernie Sanders (I-VT) on Tuesday filed Senate Bill 2961, which would ban drug companies from marketing opioids as non-addictive and fines them 25% of their profits if they violate the rule. The bill also seeks to stop pharmaceutical companies from distributing amounts of opioids "not medically reasonable," in a bid to stop distributors from flooding small towns with pills. "We know that pharmaceutical companies lied about the addictive impacts of opioids they manufactured," Sanders said in a statement. "They knew how dangerous these products were but refused to tell doctors and patients," he said. "Yet, while some of these companies have made billions each year in profits, not one of them has been held fully accountable for its role in an epidemic that is killing tens of thousands of Americans every year."

Harm Reduction

Maine Bill to End Age Restrictions on Naloxone Heads to Governor's Desk. Both houses of the legislature have approved Legislative Document 1892, which ends age restrictions on the opioid overdose reversal drug naloxone. Gov. Paul LePage (R) wants to limit naloxone access without a prescription to people 21 and over and has vetoed other naloxone access bills, but this bill has passed with a veto-proof majority. LePage has 10 days to act.

International

The Bangladeshi Department of Narcotics Control has proposed new drug legislation for the country which includes the use of the death penalty for people caught selling more than 200 grams of methamphetamine. Under current law, the maximum punishment is 15 years in prison. Bangladeshi law already allows the death penalty for some other drug offenses, including heroin trafficking, but its use is actually very rare in the country. The last execution for a drug offense was in 2009.



Chronicle AM: 11K Tainted MA Drug Cases Thrown Out, Chronic Pain Patients to Rally, More... (4/6/18)

Chronic pain patients will be rallying at state capitals Saturday to demand they not be sacrificed on the altar of the war on opioids, Massachusetts throws out 11,000 drug cases linked to a disgraced state lab chemist, and more.

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

New Jersey Group Pushes for More Minorities in Marijuana Business. The New Jersey Minority Alliance has been in talks with Sen. Nicholas Scutari (D), the lead sponsor of the marijuana legalization bill, Senate Bill 30, about revising it to expand minority inclusion. The group has a Social Equity Program under which communities adversely affected by the drug war would be given special consideration to establish marijuana operations. The plan would also remove barriers to entry related to prior drug arrests. Scutari says he finds the plan "interesting."

Heroin and Prescription Opioids

Chronic Pain Patients to Rally on Saturday. Concerned that the crackdown on prescription opioids in the midst of the country's opioid problem is leaving them without sufficient access to pain medications, chronic pain patients will be rallying in 45 state capitals on Saturday. The Don't Punish Pain Rally aims to fight the stigma against people with chronic or intractable pain and bring awareness to the many suffering under new prescription guidelines. "Our government really doesn't belong intruding into the physician-patient relationship and that's what's happening, said Deborah Toucheshawks, one of the senior rally organizers. "When I get a message [that] my family member has end-stage cancer and they won't give him anything for pain and now he wants to kill himself, that's a problem."

Criminal Justice

Massachusetts Court Throws Out 11,000 Drug Convictions Tainted By State Chemist. The state's highest court on Thursday threw out more than 11,000 drug convictions where evidence was tainted by being analyzed by disgraced state chemist Sonja Farak. Farak had worked as a chemist at the state's Amherst drug lab from 2004 until 2013, when she was arrested for stealing cocaine from the facility. She later admitted that during that entire period, she treated the drug lab's evidence supply as her own personal stash and tested seized drugs while under the influence of meth, cocaine, ketamine, ecstasy on a daily basis. Farak isn't the first state lab chemist to flame out and cost the state thousands of convictions. Last year, more than 21,000 convictions were thrown out in cases linked to Annie Dookhan, who admitted doctored the results of about one is six drug cases tried in the state between 2003 and 2012.



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.



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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