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  • ShereeKrider 9:23 pm on September 20, 2016 Permalink | Reply
    Tags: addiction, H.B. 1, heroin, , , naloxone, , overdose deaths, pill mill bill, Poppy   

    The Law of Unintended Consequences: Illicit for Licit Narcotic Substitution 


    Image result for heroin plant

    Originally written July 15, 2014 at LINK below

    Martin R. Huecker, MD and Hugh W. Shoff, MD, MS

     

    The dealers will not use it. Heroin dealers have explicit knowledge of the addictive properties of their product. The heroin addict is no longer the desperate character living under a bridge. She is a 17-year-old high school senior who runs out of her grandmother’s oxycodone. He is the stockbroker who weighs the economics of purchasing one oxymorphone on the street for $100 or ten doses of heroin for $200. Because these people are ingesting and injecting products of unknown composition and unfamiliar potency, they can potentially overdose. If lucky, they end up in the emergency department rather than the morgue.

    Kentucky ranks third in the nation in drug overdose mortality rate per 100,000 persons, with opioid pills making up the majority.1 In response to these statistics, the State of Kentucky passed House Bill One (HB1) in April 2012, effective October 2012. Also known as “the pill mill bill,” HB1 contains provisions intended to limit opioid prescriptions by pain management physicians and by other acute care providers such as emergency physicians. To prescribe narcotic pain medications, physicians must perform a full history and physical, prescribe only a short course, educate the patient on risks of controlled substances, and obtain a report from a statewide prescription monitoring program (PMP) (Kentucky All Schedule Prescription Electronic Reporting [KASPER]).2

    As a result, the number of registered KASPER users in Kentucky has gone from 7500 to 23,000 from December, 2011 to November, 2012. Reports are up from 3300 to 17000 in the same time frame.3 According to the same press release, Kentucky witnessed a decrease of 10.4% total prescriptions in the first six months since HB1 was enacted.3

    Mandating PMP reports, as sixteen states currently do, leads to an increase in reports, but so far no statistical difference in opioid overdose mortality.1,4,5,6 In fact, this legislation may not even lower the rate of opioid consumption, rather may shift which opioids are being prescribed.6

    Researchers in Ohio looked at the impact of real time PMP information on opioid prescriptions. With PMP data, providers changed prescriptions in 41% of cases; 61% giving fewer opioids but 39% prescribing more opioids.7

    House Bill One was intended to and has reduced opioid prescriptions in Kentucky. Forty-four pain clinics in Kentucky closed overnight.8 Preliminary analysis at a large, metropolitan emergency department has shown a decrease in prescriptions for hydrocodone and oxycodone, along with a decrease in ED administration of these medications. This type of “pill mill” legislation has been passed in Louisiana, Florida, Texas and California with varying results.9

    Florida had a sharp decrease in opioid prescriptions after similar legislation. Having 90 of the top 100 physicians on the Drug Enforcement Agency (DEA) 2010 list of top opioid purchasers, Florida saw the number decrease to 13 in 2011, and zero as of April 2013.10 In 2011, Ohio passed a “pill mill bill” to crack down on pain management clinics.11 This legislation led to seizing of 91,000 prescription pills with 38 doctors and 13 pharmacists losing their medical licenses. In the end, 15 medical professionals were convicted on diversion charges.11 With all of this, pill overdose deaths began to decline, but heroin overdoses “skyrocketed.”11

    The unintended but foreseeable consequence of such measures has been increase in distribution, abuse, and overdose of heroin. Heroin has gained market share in a similar way in the past. In 2010, Purdue Pharma began manufacturing a reformulated OxyContin after a $600 million fine for misrepresentation.12 Endo Pharmaceuticals Inc. followed in 2011 with an Opana ER reformulation. This resulted in making the pills harder to crush into powder for snorting or injecting.13,14 States such as Florida, Ohio, Minnesota, and Utah have seen patients turn to heroin after crackdown on prescription opioid availability.11,14

    The New England Journal of Medicine warned us of what would be a two-fold increase in heroin use after the reformulation of Oxycontin.15 In the 2010 ODLL report, the United States DEA also attempted to warn health care organizations that Oxycontin users might switch to heroin.16,17 The first paper we know of to report this warning was published 3 years later in 2013.16 This paper, a qualitative study of the transition of opioid pill users to heroin users, provides insight into the economic and convenience factors associated with the switch. The researchers interviewed a small sample of heroin users, forty-one in all. All but one of the 19 heroin users aged 20–29 started with pills and progressed to heroin – “termed pill initiates.”16

    Numerous popular news reports directly implicate decreased opioid pill availability in the rise of heroin abuse and overdose.16 However, very little discussion of this phenomenon has entered the emergency medicine literature.

    The drug cartels have capitalized on the United States opioid appetite and now decreased supply of pills. The route from Mexico to Detroit, then south through Ohio, ends up in northern and central Kentucky. The Kentucky State Police recovered 433 samples of heroin in 2010. In 2012 the number was 1349.13 In Lexington, KY, the eight total heroin arrests in 2011 exploded into 160 in the first 6 months of 2013.18,19 Undercover narcotics officers in Lexington find it easier to buy heroin than marijuana.

    Heroin-related overdoses in Kentucky increased from 22 cases in 2011 to 143 cases in 2012, and 170 in the first 9 months of 2013.8,20,21 Kentucky’s percentage of overdose deaths involving heroin went from 3.2 in 2011 to 19.5 in 2012 and up to 26 in 2013.8.21 This phenomenon has occurred in Florida, California, Massachusetts, New York, Oregon, Washington and Ohio.11,2224

    The emergency medicine literature has minimal recent discussion of heroin overdose management in the ED; nor have we discussed secondary prevention. Supportive therapy suffices in the ED, with liberal naloxone use and airway protection. State and federal actions to curb heroin deaths can be effective. Good Samaritan laws, present in only one third of states, protect from prosecution those lay individuals attempting to help themselves or companions in overdose situations.

    Also present in only one third of states are laws to expand community access to reversal agents such as naloxone. Twenty-two states have laws requiring or recommending education for opioid prescribers. Medicaid expansion to cover substance abuse treatment has occurred thus far in less than half (24) of states.1

    As more states enact measures intended to reduce total opioid prescriptions, legislators and healthcare providers alike must be aware of the predictable and devastating rise in heroin sales, abuse, and overdose. Funding for this legislation should include monies allocated toward substance abuse treatment programs and availability of naloxone. Similarly, pill mill bills could universally be coupled with Good Samaritan laws in anticipation of the increase in parenteral opioid overdoses. Funds could be allocated to lay population education via public service announcements. Stricter punishments for drug traffickers could accompany such legislative changes. Many of these measures have been presented as interventions to combat prescription opioid abuse and can now be applied to the subsequent heroin abuse and overdose dilemma.9

    At the first line of medical care, emergency physicians must be involved in efforts to minimize collateral damage in this long-term process of curing America’s addiction to opioid drugs and their horrible consequences.

    CONTINUE READING…

     
  • ShereeKrider 7:25 pm on September 11, 2015 Permalink | Reply
    Tags: , , , , drug death, Eva Holland, , heroin, overdose, parents   

    The reality of addiction… 


    Eva Holland

    Yesterday at 1:38pm · Instagram ·

    I’m sure this photo makes a lot of people uncomfortable it may even piss a few people off but the main reason I took it was to show the reality of addiction. If you don’t choose recovery every single day this will be your only way out. No parent should have to bury their child and no child as young as ours should have to bury their parent. This was preventable it didn’t have to happen but one wrong choice destroyed his family. I know a lot of people may be upset I’m putting it out in the open like This but hiding the facts is only going to keep this epidemic going. The cold hard truth is heroin kills. You may think it will never happen to you but guess what that’s what Mike thought too. We were together 11 years. I was there before it all started. I knew what he wanted out of this life, all his hopes and dreams. He never would’ve imagined his life would turn out this way. He was once so happy and full of life. He was a great son, brother, friend but most importantly he was a great dad. He loved those kids more than anything. But as we all know sometimes life gets tough and we make some wrong choices. His addiction started off with pain pills then inevitably heroin. He loved us all so much he decided enough was enough and went to rehab at the end of last year. He got out right before Christmas as a brand new man. He had found His purpose for living again, he found his gorgeous smile again, he became the man, the son, the brother, the dad that we all needed him to be again. He did so good for so long but then a couple months ago It started with a single pill for a "tooth ache" which inevitably lead him back down the road of addiction instead of staying the coarse of recovery. He said he could handle it, that he could stop on his own and didn’t need to get help again. Well he was wrong, last Wednesday he took his last breath. My kids father, the man I loved since I was a kid, a great son and a great person lost his battle. I just needed to share his story in case it can help anyone else.

    Eva Holland's photo.

     
  • ShereeKrider 2:03 am on November 1, 2013 Permalink | Reply
    Tags: Cannabis sativa, , heroin, , , Obama’s administration, Schedule 1 drug   

    Pot Block! Trapped in the Marijuana Rescheduling Maze 


    One citizen-journalist’s journey into the drug war bureaucracy shows why previous efforts to reschedule pot have been DEA’d on arrival.

    Harmon Leon

    October 30, 2013

     

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    Under the Controlled Substances Act, marijuana is classified as a Schedule 1 drug in America. According to the Drug Enforcement Administration, Cannabis sativa is as dangerous as heroin. (You know… as in heroin!) To justify this ranking, the DEA has declared that the plant has absolutely no medical value. Zero. Nada. Zip. The federal government has determined that this position is backed by science.

    Marijuana’s current status as one of the most dangerous drugs in America became official in 1970, during the Nixon administration. (Putting matters in ludicrous perspective, cocaine and even Breaking Bad meth are Schedule II.) Every administration since then has treated marijuana as mad, bad and dangerous to know, with virtually no attempt made to reclassify it. And that list includes the current one.

    About the Author
    Harmon Leon

    Harmon Leon is the author of six books, including The American Dream, The Harmon Chronicles and Republican Like Me. His…

    “It’s a bit of an Alice in Wonderland scenario with the Obama administration,” explains Kris Hermes of American for Safe Access (ASA). “He made statements prior to being elected about changing the policy on marijuana, but in reality the opposite has happened.”

    Not only have there been more medical marijuana arrests during Obama’s administration than the entire Bush regime, but even in states like California and Washington, there’s been a steady rise in the number of people being raided even though they’re in full compliance with state law. The federal government has threatened landlords and financial institutions working with medical marijuana businesses; the IRS has been involved with audits; pro-pot lawmakers have been bullied; and veterans using marijuana for conditions like post-traumatic stress disorder have been denied medical benefits by the Veterans Administration—all because of marijuana’s Schedule I status.

    On the other hand, dropping pot down a notch to Schedule II (let alone III, IV or V, or removing it from the Controlled Substances Act completely) would be a big step in resolving the clash between state and federal law, since such a move would at least acknowledge marijuana’s medical utility and allow doctors to legally prescribe it.

    So what can be done to reschedule marijuana in a country where the “drug czar” is required by law to oppose any attempt to legalize the use of a Schedule I substance—in any form?

    Time to put on our citizen-journalist’s hat and go through the looking glass into the bizarre legal labyrinth of the rescheduling process. Kris Hermes warned that it wouldn’t be easy: “Bureaucrats shut down and refuse to talk when it’s convenient for them not to talk… when it suits their purpose!”

    I Contact the DEA

    Phoning the DEA is an unnerving experience—a sensation similar to being in high school and calling your dad at 2 am to inform him that you’ve crashed the family car (though now safe in the knowledge that the NSA will keep tabs on me).

    I get a DEA representative on the phone. He goes by the name Rusty. (Perhaps because of his employer’s corroded views on ending the drug war?)

    “Could I get any information regarding the rescheduling of medical marijuana?”

    “I don’t want to spark a debate,” Rusty from the DEA replies. “I don’t know if that’s something we’d weigh in on. I don’t know what the point would be—our stance is pretty much on our website.”

    Rusty from the DEA informs me that the agency’s position on medical marijuana can be found under the tab astutely labeled “The Dangers and Consequences of Marijuana Abuse.” (The thirty-page PDF reads like some bureaucrat’s idea for a remake of Reefer Madness.)

    The key words in this manifesto: dangers, consequences, abuse. That doesn’t seem to indicate much willingness to consider pot’s medical value. Apparently, the DEA is still convinced that cancer victims are merely “abusing” marijuana to alleviate their chemotherapy-induced vomiting and nausea.

    Rusty from the DEA adds: “You know, Congress can change this at any point—which people seem to forget.”

    Perfect. That would be the same body that recently shut down the federal government and threatened the United States with default. But while the DEA might say that rescheduling is up to Congress, according to the ASA, that’s not exactly the case. The DEA actually delays the process—with no time limit imposed for answering rescheduling petitions, the agency takes the longest possible time before reaching a decision. (And then it says no.) To get around to denying the ASA’s rescheduling petition, it took the federal government a whopping nine years.

    I Contact the FDA

    According to a memorandum of understanding between the DEA and the Food and Drug Administration, a rescheduling petition has to go through the FDA. (Despite the fact that the DEA is under no obligation to recognize the conclusions of that agency.) Meanwhile, roughly every nineteen minutes, an American dies of accidental prescription-drug overdose—and these are pills approved by the FDA. (“Approved!”) Since the big pharmaceutical companies can’t make money off homegrown medical marijuana, might that be swaying the FDA’s recommendation?

    “Can I ask a few questions about the rescheduling of medical marijuana?” I ask an unnamed FDA representative.

    “I’m looking into this for you,” she replies.

    Moments later…

    “We cannot comment on this topic due to pending citizen petitions, other than to say our analyses and decision-making processes are ongoing.”

    Not much to work with there, though I’m intrigued by the mention of “pending citizen petitions.” I press on: “What would be the process needed for medical marijuana to be approved by the FDA?”

    “As you are aware, Schedule 1 drugs have no currently accepted medical use in treatment in the United States, and as I indicated before, we cannot comment on this topic of rescheduling due to pending citizen petitions.”

    My information parade has been rained out. Why so cagey? After all, the FDA approved Marinol, whose active ingredient is 100 percent synthetic THC (i.e., the stuff that makes pot so dangerous and addictive that it has to be classified as Schedule I). And Marinol, strangely enough, is Schedule III—even though no pot plant in the history of marijuana has tested at 100 percent THC. (Even the strongest pot these days clocks in at under 40 percent.)

    So my basic question goes unanswered, though the FDA representative does grant me an open invitation to check out the agency’s website—anytime I please!

    My inquiry at the Justice Department yields similar results: “Hi Harmon—DOJ’s enforcement policy on marijuana is in the attached. Thanks.”

    My attempt at securing a comment from the DC Circuit Court of Appeals—which threw out the ASA’s appeal on its rescheduling petition—doesn’t go much better: “I’m sorry. I don’t know the answer to your question. I am sure there must be subject matter experts out there who would know.… Good luck!”

    Down and Down the Rabbit Hole…

    At the heart of the approval process is the National Institute on Drug Abuse. Ironically—or maybe not—the organization is funded by the federal government. Catch-22: for the DEA to reschedule marijuana, scientific studies authorized by NIDA have to prove its medical benefits. This is basically like putting the mice in charge of the mousey snacks. In his now-famous about-face on medical marijuana, Dr. Sanjay Gupta pointed out how many of NIDA’s studies are actually designed to find detrimental effects—with only about 6 percent, he estimates, looking into medical benefits. The end result of NIDA’s efforts: the almost-complete suppression of research into the therapeutic value of marijuana.

    “Will Dr. Sanjay Gupta’s statement have any impact on rescheduling medical marijuana?” I ask the NIDA rep.

    NIDA’s response: “The best resource for questions about rescheduling is the Drug Enforcement Administration.” (A phone number is provided.)

    Reaching deep into my citizen-journalist’s bag of tricks, I try a more straightforward approach: “What would it take to have medical marijuana rescheduled? Clearly we’re at a crossroads where public opinion is changing, yet the federal government doesn’t want to change its stance. Is it left to further scientific studies or any other factors?”

    The Nation is facing a crippling postal rate hike—donate by October 31 to help us foot this $120,272 bill.

    “You’ll need to contact the DEA for questions about rescheduling.”

    And so I’m back at square one. It turns out that getting an answer from the federal government on rescheduling marijuana is a lot like contacting the local Scientology center and asking them to go on record about the planet Xenu. In the meantime, the Supreme Court recently declined to hear ASA’s appeal on its rescheduling petition—the one that the DEA waited nine years to reject, and that the DC Circuit Court turned down on appeal, declaring that only Congress has the power to amend the Controlled Substances Act.

    If the federal government is determined to maintain marijuana as a highly illegal Schedule 1 substance—despite overwhelming scientific evidence to the contrary and an ongoing sea change in public opinion—then perhaps its best ploy at this point would be to sit on its hands and do absolutely nothing.

    Mission accomplished.

    Also In This Issue

    Katrina vanden Heuvel: “Why Its Always Been Time to Legalize Marijuana

    Mike Riggs: “Obama’s War on Pot

    Carl L. Hart: “Pot Reform’s Race Problem

    Harry Levine: “The Scandal of Racist Marijuana Possession Arrests—and Why We Must Stop Them

    Martin A. Lee: “Let a Thousand Flowers Bloom: The Populist Politics of Cannabis Reform

    Martin A. Lee: “The Marijuana Miracle: Why a Single Compound in Cannabis May Revolutionize Modern Medicine

    Kristen Gwynne: “Can Medical Marijuana Survive in Washington State?

    Atossa Araxia Abrahamian: “Baking Bad: A Potted History of High Times

    Various Contributors: “The Drug War Touched My Life: Why I’m Fighting Back

    And only online…

    J. Hoberman: “The Cineaste’s Guide to Watching Movies While Stoned

    Seth Zuckerman: “Is Pot-Growing Bad for the Environment?

    Harmon Leon

    October 30, 2013

    CONTINUE READING…

     
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