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Government Opioid Response: Darknet, The Post Office, & China

by Countable | 1.31.18

What’s the story?

In his State of the Union address on Tuesday night President Trump briefly addressed the opioid crisis, pledging to "get tougher" on drug dealers and pushers in order to combat the “scourge” that currently claims an average of 7 Americans every hour.

But speeches are one thing. Actions are another. What are the latest updates on the administration’s efforts to combat the opioid crisis?

Per the Washington Post, on Tuesday Attorney General Jeff Sessions announced a 45-day "surge" of “Drug Enforcement Administration (DEA) agents and investigators…focus[ing] on pharmacies and prescribers who are dispensing unusual or disproportionate amounts of opioid drugs.”

The House Energy and Commerce Committee discovered in their investigation of the opioid industry that two drug distribution companies had shipped more than 20 million pain pills to two pharmacies four blocks apart in Williamson, W.Va., a town with a population of 2,900. The DEA hopes to uncover more of these abuses of the system.

On Monday the Post also reports that Sessions announced the formation of a new team at the FBI dubbed J-CODE (Joint Criminal Opioid Darknet Enforcement), which aims to disrupt the growing number of illicit opioid sales online.

Countable reported Tuesday on coordinated efforts between U.S. and Chinese officials to address the use of the U.S. Postal Service to ship illicit synthetic opioids direct to users in the U.S. from China, following a congressional investigation into the issue.

And early Wednesday, Dr. Brenda Fitzgerald, head of the Centers for Disease Control, resigned from her post after Politico broke a story that she had invested money in tobacco company stocks after she took over heading the agency. Fitzgerald had also recused herself from testifying to Congress on electronic health records that track the use of opioids, due to her investment in companies associated with the data tracking.

Among other efforts, the CDC distributes tens of millions in grants to local authorities to combat the opioid epidemic. It is unlikely Fitzgerald’s departure will affect the distribution of funds, but from the perspective of the opioid crisis it is a difficult time to have the federal government’s public health agency without a leader.

A permanent replacement for Fitzgerald will need to be confirmed. The CDC has announced Dr. Anne Schuchat as acting director.

The Hill reported Wednesday that a group of Senate Democrats have requested that the Government Accountability Office work to document all of the efforts undertaken by the administration since the president declared the crisis a public health emergency out of concern about the inadequacies of the campaign overall.

What do you think?

Are you satisfied with the federal government’s response to the opioid epidemic? What are your ideas for what needs to be done? What are we missing?

Tell us in the comments what you think, then use the Take Action button to tell your reps!

— Asha Sanaker

(Photo Credit: AARP.org)

Countable

Written by Countable

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(63)
  • Amy
    01/31/2018
    ···

    The Republicans cut Social and drug programs with their sequestration and sent many citizens out to the streets, lost with their addictions with only jail as an answer. It's great that the macho NARC teams are busting large dealers but none of it will matter much if we don't address addiction. The fewer addicts, the less dealing will be a desirable pursuit. Supply and demand you free marketeers. I'm not overly impressed with the tough guys against drugs tactic. STOP cutting social services and mental and emotional health funding. STOP. Do you realize how many clinics might be funded just from the tax dollars that support trumps weekends at Miralago?

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  • Laurie
    02/01/2018
    ···

    As a human suffering severe and difficult to treat Rheumatoid Arthritis, I am deeply concerned about the attack on physicians and patients and access to opiate medications. To eliminate and/or limit access to medications that allow for some semblance of a quality of life is inhumane and misguided at best. I’ve had access to opiates for well over ten years and have NEVER abused my medications. It is a lifeline to sanity some days and a RX that sits in my safe untouched other days. Opiate derived medications are a tool that pain patients need in their toolbox. Today’s political attack on pain medications has all pain patients deeply concerned that there’ll be a day, for some that day has come, that no relief can be found. I assure you that when that day comes, suicides among the chronically ill and pain patients will spike. This war on opioids is effectively an attack against patients suffering chronic pain and debilitating diseases and is an ineffective campaign against addiction! Addiction needs to be addressed as the mental health problem that it is, and funded appropriately. Treating medical patients like addicts is harming patients in need of care and compassion and relief and is not addressing the real problem—addiction. As someone whom suffers periods of intolerable pain, I implore that you re-examine the unintended consequences of the attack on opiates. I assure you that I fully understand the risk of opiates as my own son abused them and became addicted—but the key word is ABUSED. So I do understand that there is risk in opiates, but there’s is also grave risk in taking them from a population that desperately needs them. Criminalizing physicians and patients is reprehensible, as is criminalizing addiction. Addiction has long been classified as a mental health disorder; why does this country, politicians, judges, and leadership still choose to treat it as if it’s crime? When Reagan declared his “War on Drugs” he set a tone that has only perpetuated ignorance and cruelty and resulted in the incarceration of millions that needed mental health and addiction treatment, not a jail cell. It is beyond time for this to change, and time the attack on doctors and patients stops.

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  • Helena
    01/31/2018
    ···

    Pharmaceutical companies in the late 1990s assured the medical community that prescription opioid pain relievers were non addictive. Therefore, healthcare providers started to prescribe them for their patients. These pharmaceutical companies then hired lobbyists to discourage the passing of regulations against opioid use. This has resulted in the crisis we have today. We need stronger guidelines and regulations on the approval of drugs and greater testing on their long term effects. Prior approval by the FDA should be mandatory before a drug can be promoted or sold. The government needs to increase funding for medication, treatment, and make Naloxone more available in order to prevent deaths. This should be treated as a health issue, and those dealing with addiction should not be stigmatized.

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  • Carolyn
    01/31/2018
    ···

    Myth #4: The guidelines will help reduce opioid abuse and overdoses The early results are not promising. The prescribing of opioid pain medication was in decline years before the guidelines were issued, yet overdose death rates continued climbing. In recent months, opioid overdoses in several northeastern states have spiked, with most of the deaths blamed on illicit fentanyl smuggled into the country from China, Mexico and Canada. Most disturbingly, drug traffickers are learning how to manufacture counterfeit pain medication with fentanyl. The DEA says the U.S. is being “inundated” with hundreds of thousands of these fake pills. It’s not just street addicts being victimized by the fentanyl scam. Some are pain patients who turned to the black market for relief because they could no longer get opioid prescriptions legally. “Fentanyls will continue to appear in counterfeit opioid medications and will likely appear in a variety of non-opiate drugs as traffickers seek to expand the market in search of higher profits. Overdoses and deaths from counterfeit drugs containing fentanyls will increase as users continue to inaccurately dose themselves with imitation medications,” the DEA said in a report this summer. counterfeit oxycodone COUNTERFEIT OXYCODONE Pain patients predicted that illegal drug use would soar in a survey conducted by Pain News Network and the International Pain Foundation last October. Asked what would happen if the CDC guidelines were adopted, nearly 60% said pain patients would get their opioids through other sources or off the street. Another 72% said use of heroin and other illegal drugs would increase. And 78% predicted more patient suicides. Could the CDC have seen this coming? In its urgency to get the guidelines adopted, the agency never took a hard look at the unintended consequences the guidelines could have: "Concerns have been raised that prescribing changes such as dose reduction might be associated with unintended negative consequences, such as patients seeking heroin or other illicitly obtained opioids or interference with appropriate pain treatment. With the exception of a study noting an association between an abuse-deterrent formulation of OxyContin and heroin use… CDC did not identify studies evaluating these potential outcomes

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  • Baron
    01/31/2018
    ···

    It’s not hard to find which pharmaceutical companies are pushing their drugs on the public. Just follow the money. It comes in the form of lobbyists. Also find which elected officials are receiving such money. Make it a crime to sell, lobby, receive money for illegal drug distribution. When the higher ups go to jail, the flow of drugs will almost stop.

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  • Carolyn
    01/31/2018
    ···

    Myth #5: There are better alternatives than opioids There are many different types of non-opioid medications, ranging from over-the-counter pain relievers like ibuprofen and acetaminophen to prescription drugs like Lyrica (pregabalin) and Neurontin (gabapentin). There are also several non-pharmacological treatments like acupuncture, massage, physical therapy, and cognitive behavioral therapy (CBT). The CDC guidelines make it sound like these alternative treatments always work and are readily available to every patient: "Many nonpharmacologic therapies, including physical therapy, weight loss for knee osteoarthritis, complementary and alternative therapies, psychological therapies such as CBT, and certain interventional procedures can ameliorate chronic pain. In particular, there is high-quality evidence that exercise therapy for hip or knee osteoarthritis reduces pain and improves function immediately after treatment. Several nonopioid pharmacologic therapies (including acetaminophen, NSAIDs, and selected antidepressants and anticonvulsants) are effective for chronic pain. In particular, acetaminophen and NSAIDs can be useful for arthritis and low back pain. Selected anticonvulsants such as pregabalin and gabapentin can improve pain in diabetic neuropathy, post-herpetic neuralgia, and fibromyalgia." But when we asked over 2,200 pain patients what they thought about these alternative treatments, most said they didn’t work. Three out of four patients said over-the-counter pain relievers “did not help at all” and 64% said the same about nonpharmacological treatments such as exercise and weight loss. Non-opioid medications like Lyrica, Neurontin and Cymbalta fared a little better, with only about half of patients saying they did not help. But many also complained about side effects from the drugs, such as weight gain, anxiety and withdrawal symptoms. Some patients are being coerced into treatments they don’t want, such as epidural steroid injections. Over a third of the patients recently surveyed by Lana Kirby, founder of Veterans and Americans United for Equality in Medical Care, said they have been told by a healthcare provider that they must have an operation or invasive procedure or they’ll no longer get opioids or be discharged from the practice. “Respondents are being threatened with pain care protocols that are not optimal, such as epidural injections and installation of durable medical equipment. If they refuse, their access to oral medications, even where they have been used impactfully, is systematically reduced or suspended,” said Terri Lewis, PhD, a patient advocate and researcher who analyzed the survey findings. Over half the patients (57%) in that survey said they had been discharged by a doctor because they required opioid treatment. Of those who were discharged, only half were able to find a new physician. Perhaps the most telling response in that survey is that half of the patients admit considering suicide as a way to end their pain. “Patients increasingly report that they are harmed directly and indirectly as changes to their healthcare routines have resulted in limited access, reduced quality of healthcare interactions, and increased out of pocket cost,” said Lewis. “To a person, respondents report that they feel humiliated, degraded, shamed, and stigmatized by the loss of choice over their physician patient alliance and program of care. "The regulatory changes have increased negative responses to them within their support system (treated like addicts, lack of care for emergencies, pharmacy hassles, and fear of physician). Many now acknowledge that their doctor’s appointment conversation is all about keeping the physician safe from DEA oversight or license restrictions as opposed to optimizing the consumer’s activity and functioning levels.” In just five months, it is clear the guidelines are having a major impact on the pain community in the United States. More people are suffering from untreated pain and more are dying from drug overdoses. Yet there is no sign the CDC has any intention to revise and clarify the guidelines or to dispel the myths that surround them.

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  • Wallace
    02/01/2018
    ···

    Let’s take action to reduce addiction but let’s not forget about alleviating pain!

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  • Carolyn
    01/31/2018
    ···

    HERE IS EXACTLY WHAT HAS CAUSED ESTABLISHED PAIN PATIENTS DYING! Myth #3: The guidelines require doctors to drop patients if they fail a drug test False. The guidelines specifically recommend against this practice: "Providers should not terminate patients from care based on a urine drug test result because this could constitute patient abandonment and could have adverse consequences for patient safety, potentially including the patient obtaining opioids from alternative sources and the provider missing opportunities to facilitate treatment for substance use disorder." Yet patients tell us they’re being dropped after just one failed test. “I have been in pain management for the past 8 years. Suddenly, I went to my appointment one day the doctor rudely told me that I'm not welcome back and the reason I even have an appointment is because they want to tell me I failed my UA (urine test) for cocaine," wrote on patient. "First of all, I don't do cocaine. I smoked weed. How come I would test positive for cocaine but not for weed?” As Pain News Network has reported, the point-of-care (POC) urine drug tests widely used by doctors are wrong about half the time -- frequently giving false positive or false negative results for drugs like oxycodone, methadone, methamphetamines and antidepressants. According to one study, POC tests give false positive readings for cocaine about 12 percent of the time, and they fail to find signs of marijuana – a false negative -- about 21 percent of the time. The guidelines suggest that prescribers not even test for THC – the active ingredient in marijuana: "Providers should not test for substances for which results would not affect patient management or for which implications for patient management are unclear. For example, experts noted that there might be uncertainty about the clinical implications of a positive urine drug test for tetrahydrocannabinol (THC)." The CDC admits urine drug tests “can be subject to misinterpretation” but recommends their use anyway, before opioid therapy begins and at least once annually thereafter. If “unexpected results” are found, the guidelines say they should be verified by more expensive laboratory tests.

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  • Rick
    01/31/2018
    ···

    I have never seen such great research like Carolyn just presented. How can anyone have a more profound recommendation than what she has presented. Thank you Carolyn, if the FDA is looking for a new head. You should be considered. I am forwarding your research to our representatives in Penna. to educate them and maybe to let them know someone really understands this problem and has real concrete recommendations about proper changes. Well done!

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  • Carolyn
    01/31/2018
    ···

    Myth #2: The guidelines establish a limit on the highest dose of opioids False. The guidelines recommend that prescribers should “use caution” when prescribing opioids at any dose and “additional precautions” when dosages exceed 50 mg (morphine equivalent) a day. Prescribers are warned to “generally avoid” increasing dosages over 90 mg a day, but are never told they cannot exceed it. The guidelines are also written in a way that emphasize the dosing recommendations are mainly intended for new patients, not established patients who’ve been on high opioid doses for years without any problems. The guidelines recommend that physicians “collaborate” with those patients on a new treatment plan – a practice known as informed consent: "Established patients already taking high dosages of opioids, as well as patients transferring from other providers, might consider the possibility of opioid dosage reduction to be anxiety-provoking, and tapering opioids can be especially challenging after years on high dosages because of physical and psychological dependence… For patients who agree to taper opioids to lower dosages, providers should collaborate with the patient on a tapering plan. Experts noted that patients tapering opioids after taking them for years might require very slow opioid tapers as well as pauses in the taper to allow gradual accommodation to lower opioid dosages." Still, many patients say they are being abruptly tapered to lower doses without having any input into the decision. “I have severe chronic pain issues along with fibromyalgia and was barely getting by on 150 mg opioids per 24 hours, and now am being tapered down to the new 90 mg in 24 hours. I have gone from being relatively functional to nearly home bound,” said Diane. “My pain management doctor announced to me, that he and his two other partners in the pain management clinic, are reducing all non-cancer chronic pain patients to the CDC's guideline of 90 mg morphine equivalent. He told me they had to follow these guidelines,” says Rich Martin.

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  • Carolyn
    01/31/2018
    ···

    Studies have shown that addiction patients rarely find what they need by using prescriptions from their doctors. We need to start putting real numbers and percentages to the problem – not combining all narcotics under the umbrella of the buzz word “opioids.” The narcotics or opioids killing people are not from our prescription pads. Read more here: http://www.newsobserver.com/opinion/op-ed/article145348794.html#storylink=cpy

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  • Tootie
    01/31/2018
    ···

    Pe ople with intractable, chronic pain are being kicked to the curb when it's not even prescription opiates that are the problem! Suicides by people suffering from chronic pain are increasing, including a direct relation of Vets who've had their pain medications reduced or cut completely and increase in suicides. Due to the DEA going after doctors, many are now completely refusing to prescribe pain medications, making it even more difficult for people living with chronic pain...and even cancer patients....to find a doctor willing to prescribe any pain relief. And then because the few who will still prescribe end up with more & more patients, they then become the target of the DEA because they look like outliers instead of just being the doctors willing to prescribe. The CDC guidelines are being used like a cudgel, beating people with chronic pain into the ground. Patients are being forced tapered, with no discussion or opportunity to debate the actions. I take a lot of herbal and homeopathic tinctures, more so in the fall/winter, which are made with alcohol! So of course my UA picks up alcohol but instead of having a honest, trusting conversation, the results are simply used as a reason to force taper me off my pain relief. I've had 4 back surgeries and am on SSDI due to the surgeries and now the adjacent segment disease caused by the fusions. Without pain relief my quality of life becomes crawling from the bed to the couch, which gives no meaning to life. The advent of the prescription monitoring programs have pretty much eliminated those who were doctor shopping and most of the pill mills have been closed. The OD's now are due to heroin, much of it laced with fentanyl. It is NOT prescription pain medications that are the problem but we are still being targeted while the DEA does nothing about the heroin & illegal fentanyl issue. Denying chronic pain patients their pain medications is not going to stop an addict from OD'ing!

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  • Nona
    01/31/2018
    ···

    Nice well supported posts Carolyn. You are absolutely correct that we need to examine our assumptions and analyze data to find effective responses.

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  • crossover.rw
    02/01/2018
    ···

    All natural opioid alternatives like THC, CBD and Kratom are very effective at not only helping to reduce pain but to alleviate the withdrawal symptoms associated with opiates. Kratom is a fantastic plant that has the ability to act like an opiate but also like caffeine. PArt of the coffee family, it has been used for generations in Asia to combat everything from depression to fatigue and pain. Safe, natural alternative should be employed by the healthcare community at all levels if they really care about the people they are supposed to be helping. The only thing that will stand in the way of these treatments is BIg Pharma and the lobbying money they throw at our current government officials. See www.facebook.com/crossover.rw for more information about kratom.

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  • April
    02/01/2018
    ···

    The government, FDA, DEA, need to stop worrying about plants and homeopathic treatments and focus on the influx of dangerous research chemicals being shipped in from other countries. The strict prescribing guidelines are doing more harm than good leaving chronic pain patients who never abused their medication with no other option but to commit suicide or search for relief on the black market because they have no quality of life due to debilitating pain. Perhaps some finding should go into researching why so many Americana suffer from chronic pain in the first place, and why the ever growing cases of auto immune disorders? The FDA is already in big pharma's pocket, being led by a man with clear and obvious ties to pharmaceutical companies, Scott Gottlieb. They've approved drugs hastily with little and sometimes bitched research as well as harmful additives to our food that have been banned in other countries, meanwhile trying to ban botanicals and dietary supplements that have proven safe and beneficial over thousands of years of use because plants can't be patented which takes profit away from the pharmaceutical industry. Too many government agencies signing away power to sub agencies allowing laws to be passed and amended, all without the consent of the people. The FDA needs new leadership, someone who isn't invested in the pharmaceutical industry, and we need to let doctors treat their patients rather than letting a bunch of suits without a medical license decide how a patient or illness should be treated.

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  • James
    02/01/2018
    ···

    As a person who suffers debilitating pain from RSD, it is frightening to see a war on opiates, I do not abuse my medication, I take diluted for breakthrough pain, I have never taken more than prescribed, in fact I take less than prescribed, there are months when I may take 1 or 2 pills, to live some semblance of a tolerable pain life, the thought that I am being lumped in with addicts & may not have use of this medicine is frightening, there is a difference between being dependent on a drug & being addicted, I do not see this Administration educating the public of the difference, nor do I see the government understanding this, people with addiction problems are pre determined to be addicts, it is just a matter of drug of choice, they need treatment & a program to stay away from all substances, do not punish all people, because of addiction

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  • RadicalModerate
    01/31/2018
    ···

    Deregulate cannabis in all forms for everyone. Then let the market drive change. Sounds like conservatism, so don’t tell any republicans that poor people will be benefit, or it’ll never happen.

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  • Jennifer
    02/01/2018
    ···

    I live in Arkansas, we are 2nd only to Alabama for the numbers of prescriptions, per person. We have an opioid addiction seminar and almost non of the local leadership attended. There are so many people so out of touch with the reality of addiction. Until this is a REAL problem nothing will get better. The Municipal League is suing on behalf of the cities the local distributors and manufactures.

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  • HockeyGuy
    01/31/2018
    ···

    Follow the money and you will find both, the cause and the solution of the opioid addiction! Greed is a predator that feeds upon the weak and unhealthy by seducing them with false expectations of well being!

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  • Carolyn
    01/31/2018
    ···

    Myth #1: The CDC prescribing guidelines are mandatory False. The guidelines are voluntary and intended only for primary care physicians, yet they are being widely implemented by many prescribers, including pain management specialists and even some oncologists. Here is what the guidelines actually say: "This guideline provides recommendations for the prescribing of opioid pain medication by primary care providers for chronic pain in outpatient settings outside of active cancer treatment, palliative care, and end-of-life care. Although the guideline does not focus broadly on pain management, appropriate use of long-term opioid therapy must be considered within the context of all pain management strategies… The guideline offers recommendations rather than prescriptive standards; providers should consider the circumstances and unique needs of each patient." The voluntary nature of the guidelines was reinforced in a recent letter to a pain patient by Debra Houry, MD, Director of the CDC’s National Center for Injury Prevention, which oversaw the guidelines’ development. “The Guideline is a set of voluntary recommendations intended to guide primary care providers as they work in consultation with their patients to address chronic pain,” wrote Houry in her letter to Rich Martin, a retired pharmacist disabled by chronic back and hip pain. “The Guideline is not a rule, regulation, or law. It is not intended to deny access to opioid pain medication as an option for pain management. It is not intended to take away physician discretion and decision-making.”

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