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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: Weed on the Ballot in 4 States This Election Day, OH Sentencing Reform, Too, More... (11/6/18)

Marijuana policy initiatives are on the ballot in four states today, so is sentencing reform in Ohio, the FDA approves a powerful new opioid, El Chapo goes on trial in New York, and more.

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

Marijuana Legalization, Medical Marijuana on the Midterm Ballot Today. It's not just about control of the Congress. Four states are seeing statewide marijuana policy initiatives: In Michigan and North Dakota, legalization is on the ballot; in Missouri and Utah, medical marijuana in on the ballot. Also, a number of Ohio localities are voting on decriminalization, and in Wisconsin, a number of localities will be voting on non-binding referenda on whether to legalize marijuana. Come back tomorrow for results.

Heroin and Prescription Opioids

FDA Approves Opioid Pain Reliever 1,000 Times Stronger Than Morphine. The Food & Drug Administration has approved a new opioid pain reliever that is a thousand times stronger than morphine and ten times stronger than fentanyl. The new drug, Dsuvia, will be used as a fast-acting alternative to intravenously administered opioids in hospitals. Critics warned that the new drug could be abused, but FDA Commissioner Scott Gottlieb said in a statement that it will only be used with "very tight restrictions."

Law Enforcement

El Chapo Goes on Trial in New York City. Longtime Sinaloa Cartel leader Joaquin "El Chapo" Guzman has gone on trial in New York City this week. El Chapo was extradited to the US in 2017 after escaping from a Mexican prison and being recaptured months later, and now faces a 17-count federal indictment for his role heading the cartel, including money laundering, firearms, and multiple murder charges. Although El Chapo has been out of circulation for more than a year, the Sinaloa Cartel remains arguably the most powerful of Mexican drug trafficking organizations.

Sentencing

Ohio Votes on Whether to Defelonize Drug Possession Today. Voters in the Buckeye State will have a chance to approve the Issue 1 sentencing reform initiative. The initiative would move most drug possession charges from felonies to misdemeanors. It would also allow some nonviolent offenders to receive 25% sentence reductions and would also prohibit jail time as a sentence for using or possessing drugs until the third offense within 24 months. Come back tomorrow for results.

International

Israeli Finance Minister Criticizes Delay in Approving Medical Marijuana Exports. Finance Minister Moshe Kahlon blamed the Public Security Ministry for foot-dragging on allowing exports of the herb, thus "harming Israel's economy, farmers and local industry," and called for the cabinet to act to approve exports and advance legislation. "For more than six months, the Public Security Ministry has been preventing the plan from being put on the cabinet's agenda, thereby harming Israel's economy, farmers and local industry," Kahlon wrote in a memo Monday to the cabinet secretary. "During these months a number of countries around the world, including Australia and Canada, began to export medical cannabis."



Chronicle AM: New DOJ Task Force to Target Cartels, CA Pain Summit Next Month, More... (10/16/18)

The Justice Department creates a new anti-cartel task force, a California summit will address issues around chronic pain and the war on drugs, the New York Assembly holds a hearing on marijuana legalization, and more.

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

New York State Assembly Holds Hearing on Marijuana Legalization. Four legislative committees held a joint hearing on marijuana legalization in Albany Tuesday. The hearing covered how marijuana should be legalized, taxed, and regulated. The hearing comes ahead of next year's legislative session when lawmakers are expected to take up proposals to legalize the herb.

Medical Marijuana

New Jersey Will Let Dispensaries Post Price Information. State officials announced late last week that medical marijuana dispensaries can post their product prices online, so now patients can shop around and be better-informed consumers. "Medical marijuana patients should benefit from online price information just as shoppers do when they buy a car, a plane ticket or any other consumer goods," Department of Health Commissioner Shereef Elnahal said in a statement. Listing prices is not mandatory, however.

Heroin and Prescription Opioids

California Pain Summit Set for Next Month. Over a hundred California physicians, administrators, policymakers, and advocates will be meeting at the For Grace's Change Agent Pain Summit in Los Angeles on November 2. For Grace is a group devoted to dealing with women's issues around pain. The aim of the summit is to create a patient-centered state-level pain policy is to localize key recommendations from the National Institutes of Health's National Pain Strategy in the Golden State. Among those attending will be Diane Hoffman, director of the Law and Health Care Program and Jacob A. France Professor of Health Care Law at the University of Maryland. "There's an imbalance in our drug control laws and policies between treating pain and reducing drug diversion and addiction. And it's hurting pain patients," said Hoffman. "The efforts to restrict prescribing and eliminate Medicaid coverage of opioids, like what has been proposed in Oregon and the outright abandonment of patients is outrageous. We need more leadership from the medical community," she added.

Law Enforcement

Justice Department Creates New Task Force Targeting Cartels, MS-13. Attorney General Jeff Sessions announced at a Washington conference Monday that the Justice Department has created a new task for aimed at breaking three Mexican drug cartels and the MS-13 street gang. Sessions described the groups, along with Hezbollah, as top transnational organized crime threats and said DOJ would "develop a plan to take each of these groups off the streets for good." The three cartels named are the Sinaloa Cartel, the New Generation Jalisco Cartel, and the Gulf Clan. All of this because the last half-century of drug prohibition has worked so well.

New Jersey Legislative Committee Advances Parole System Reform. The Assembly Law and Public Safety Committee voted 4-3 Monday to advance a bill, Assembly Bill 1986, which rewards good behavior and encourages rehabilitation by allowing for the release of low-risk individuals from prison after they have served their basic sentence, provided they commit no serious disciplinary infractions while incarcerated and participate in rehabilitation programs.



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.



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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