[HARMRED] Prescription drug abuse, deaths target of new Washington law

[Monte Levine]

The new Washington law sucks!!!

Those of us dealing with chronic pain and in need of opiate based
medications are treated like criminals. Two days ago i had the pharmacist
at Group Health Cooperative, the oldest health cooperative in the nation,
question my prescriptions and why i needed my Norco when i had gotten
oxycodone two weeks previously. They refer to these medications as
narcotics, a value laden term.  Both prescriptions written by one of the
very few pain specialists in the state. Am I going to need to give my
pharmacist a copy of my CT scan report?

One of the unintended results of this misguided law and subsequent
regulations is that our exchange has tripled since last spring. Those young
pill popping young ones moved to toxic tar heroin. These days high school
age people don't start with pharmaceuticals They  are more likely to start
by smoking heroin.

My regular doctor dropped me because i was honest about my drug use. No
referral. No nothing. I started speaking with our exchange participants and
what i was told is what do you expect? I thought my doctor was the
exception. No that is the norm.

I am lucky in that our attorney friend who has saved us from three
prosecutions since 2001 is good friends with one of the state's 6 pain
specialists that were listed on the State DOH web site and got both me and
my partner in to see him. We now are getting properly medicated and have no
*need* to use illicit drugs.

The only way we are going to get a handle on illicit drug use is to
regulate through legalization and educate, educate, educate and have
treatment on demand. The door one enters to get drugs for non medical use
would be the same one used to enter treatment and detox.

Washington state passed the first comprehensive legislation to deal with
the AIDS epidemic in 1988. I hope no other state follows in our footsteps
once again and passes the same type of legislation and subsequent rules
regarding the dispensing of opiate based medications.

Many, if not all doctors, who prescribe opiate based medications for relief
of an acute, temporary condition neglect talking to their patients about
how to come off the medications, or how long the doctor expects them to be
on those opiates. Usually it's, well you're done, goodbye. If anyone has
any history of drug use they know where to go and how to alleviate the pain
of detox and we wind up seeing them in our exchanges, if they are lucky
enough to have one in their area.

If one is being cared for under a Labor and Industries claim they can only
get a two week supply of opiate based medications at one time. This past
week we had some heavy snow and people could not get to their pharmacies to
pick up their meds, so they suffered.

Tar heroin is the most toxic form of the drug. I asked our lawyer friend,
one of the best drug defense attorneys on the West Coast, why only toxic
tar is available here when right across the border, in Vancouver, China
white is available.

His answer is that the Mexican Cartels have made it known they will kill
anyone who tries to compete with them. The result of our archaic drug laws
is that all that is available here is a highly acidic version of heroin
that eats away veins quickly. We see more and more people, most under the
age of twenty-five, starting groin and/or neck injecting, which has very
serious health consequences. I would say that it's a Public Health
emergency and my health officer agrees.

Another issue with tar is that it takes so much to get off as one builds
tolerance. It is not unusual to hear of someone shooting a gram and a half
of the gooey shit The only way to get that much into one  shot is by using
a 3 cc syringe and injecting into one of the major veins.

Our law makers and the various committees from the State agencies that drew
up these regulations did not realize and seem to not care about the
unintended consequences of their actions. Making people living with chronic
pain feel like criminals is not the way to handle the issue of over
prescribing of opiate based medications.

I asked a group of young men that came into the exchange together to get
3cc syringes with 1" 25g needles if they knew how dangerous the practice of
femoral injection is. They looked at each other and told me they knew of
two people that had lost a leg because of femoral injection. It didn't stop
them from walking out with a box of them.

Be well, y'all. Thanks for posting this Mark so that i could rant a bit
this morning. Looking forward to seeing you in Portland for the Harm
Reduction Conference.

monte levine

On Wed, Jan 25, 2012 at 10:59 AM, Mark Kinzly <markkinzly at yahoo.com> wrote:

> Prescription drug abuse, deaths target of new Washington law
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> <http://www.spokesman.com/stories/2012/jan/22/prescription-drug-abuse-deaths-target-of-new/?utm_source=Join+Together+Daily&utm_campaign=863486ab7a-JT_Daily_News_Report_Calls_on&utm_medium=email#>
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> Tags:addiction <http://www.spokesman.com/tags/addiction>methadone<http://www.spokesman.com/tags/methadone>
> oxycodone <http://www.spokesman.com/tags/oxycodone>OxyContin<http://www.spokesman.com/tags/oxycontin>
> pain <http://www.spokesman.com/tags/pain>painkillers<http://www.spokesman.com/tags/painkillers>
>   <http://www.spokesman.com/photos/reprints/SR1201181142358790/>
> Joshua Dameron, seen standing on a downtown Spokane street last week, is
> still in rehab for a painkiller addiction that lasted several years after a
> work accident damaged his back. He’s clean now and says, “It feels great.”
>
> <http://www.spokesman.com/photos/2012/jan/22/152914/><http://www.spokesman.com/stories/2012/jan/22/prescription-drug-abuse-deaths-target-of-new/?photos>
> Related stories
>
>    - 1990s saw hard push for legal opiatesJanuary 22, 2012<http://www.spokesman.com/stories/2012/jan/22/1990s-saw-hard-push-for-legal-opiates/>
>    - Mom’s nightmare becomes a cause January 22, 2012<http://www.spokesman.com/stories/2012/jan/22/moms-nightmare-becomes-a-cause/>
>
> A note about this project This story is part of an ongoing collaboration
> between InvestigateWest, an independent nonprofit newsroom covering the
> Pacific Northwest, and  Seattle-based public broadcast station KCTS 9. An
> accompanying documentary airs Jan. 30 at 9 p.m. on KSPS Channel 7.2. At the
> height of his addiction, Joshua Dameron would cruise through emergency
> rooms in Spokane, hoping to score his next fix.
> Dameron got hooked on prescription pain medication after suffering a
> herniated disk while working in a dynamite factory. He’s one of thousands
> of Washington citizens who have gotten addicted to narcotic pain
> medications over the last decade. One doctor called the pain meds, which go
> by names such as Vicodin, Percoset and OxyContin, just a “fancy form
> of heroin.”
> “I was addicted to pills, like, bad,” said Dameron. When he exhausted his
> supply, he would hit the ERs, telling doctors his back hurt. Eventually he
> was downing 20 Percosets a day. Once, he says, he got so desperate he broke
> his own little finger to get more drugs.
> Dameron eventually wound up in drug court for forging prescriptions. He’s
> been living in a halfway house and hopes he’s kicked the pills for good.
> Spokane County has one of the highest rates of deaths from prescription
> drug overdoses in the state, at 12.8 per 100,000 people. Statewide, the
> death rate is 7.1 deaths per 100,000 people, and in King County it’s 6
> per 100,000.
> Prescription drug abuse is at epidemic levels throughout the state and
> elsewhere in the country, despite lawmakers’ attempts to get a grip on it.
> Deaths from prescription drug overdoses in Washington have skyrocketed
> nearly twentyfold since the mid-1990s and now outstrip those from
> traffic accidents.
> Washington has been one of the hardest-hit states, in part because of
> aggressive prescribing practices coupled with lack of oversight by the
> Department of Health.
> An InvestigateWest analysis of U.S. Drug Enforcement Administration data
> shows Washington ranked fourth-highest nationally in per-capita prescribing
> of methadone in 2006 (the most recent year for which reliable data is
> available) and 11th for oxycodone – the two biggest killers.
> “The higher deaths, and probably abuse, too, I believe has to do with
> higher supply or availability,” said Jennifer Sabel, an epidemiologist with
> the state Department of Health.
> Even more disturbing, more than half of all prescription-drug-related
> deaths occur in the state’s poorest and most vulnerable population – people
> on Medicaid. A 2009 federal study showed the age-adjusted risk of death
> from prescription opiates in Washington was nearly six times higher for
> Medicaid enrollees than for those not on the program.
> “Medicaid has about a death a day from prescription narcotics, and in the
> last two years it’s continued to escalate,” said Dr. Jeff Thompson, medical
> director for Washington’s Medicaid program.
> New law outlines dosing limits
> The cause of the epidemic has many roots, including a major shift over the
> last decade in how the medical community treats chronic pain. In addition,
> aggressive marketing of opiates by drug companies, the inability to track
> overprescribers, patient demand for quick fixes, the lack of insurance
> coverage for alternative treatments, and cost-saving moves by the state all
> have helped fuel the rise in death rates.
> With a law that took effect this month, Washington state is making a bold
> attempt to reduce overdose deaths, by launching the first dosing limits for
> doctors and others who prescribe these medicines. The law has been heralded
> as one of the toughest in the nation, but loopholes and pitfalls in the
> system remain.
> One of the biggest is a gaping hole in the state’s
> information-tracking system.
> Most emergency rooms are not equipped to assess whether someone has
> already been seen across town in another ER, said Dr. Darin Neven, medical
> director for the Consistent Care Program at Providence Sacred Heart Medical
> Center in Spokane. Like Dameron, many addicted patients feed their habits
> by going to ERs or “doctor-shopping.” They fake or exaggerate injuries and
> illnesses to get doctors to prescribe pain meds.
> The trend is so bad that some ERs, including those throughout the Swedish
> Medical Center system in Seattle, no longer hand out prescriptions for
> oxycodone, one of the most commonly abused pain pills.
> It has also prompted the emergency rooms in Spokane to band together and
> mount a pilot program that uses a shared database to track people who
> obtain pain meds in the ER.
> “We’re walking a fine line here,” said Neven. “We don’t want to become
> policemen, and yet these are deadly drugs.”
> The Spokane ER data-sharing network started in 2006 and has now spread to
> four emergency rooms in Spokane and 19 others across the state. Neven,
> along with Lee Taylor of the Spokane County Medical Society, has applied
> for a grant to expand the program to all the ERs in the state.
>  To date, the program has flagged 633 “frequent users” of the ERs and
> helped enroll them in programs to better manage their pain and addictions.
> The data-sharing network in Spokane is being watched as a model by other
> urban hospital centers.
> Limitations of the law
> Still, other challenges remain for reducing prescription drug abuse.
> Under the new law, doctors and other prescribers with patients who need
> more than 120 milligrams a day must seek a second opinion from a pain
> specialist. But there are few of those.
> Medicaid is already struggling to comply. Despite having thousands of
> patients currently over the threshold limit, the agency can only get one or
> two evaluated by a pain specialist each month, said Thompson.
> “Access is an issue,” acknowledged Dr. Gary Franklin, medical director for
> the state’s Department of Labor and Industries, adding that telemedicine
> consultation programs and other efforts to increase capacity are helping
> but still don’t fill the need.
> The new law makes Dr. Merle Janes, of Valley Rehab & Emergency in Spokane,
> angry. He said legitimate pain patients and doctors who prescribe for them
> are paying the price for the policy changes designed to nab addicts. People
> in real pain can’t get adequate relief, he says.
> “It’s been a disaster for all these people,” Janes said.
> Janes was part of a group that attempted to sue the state, saying the new
> rules were unfairly harming legitimate pain patients. The suit, which was
> dismissed, challenged the guidelines for being “arbitrary, vague and
> overbroad” and charged that recent investigations by the Medical Quality
> Assurance Commission – the state’s disciplinary agency – were motivated
> by “opiophobia.”
> Dr. David Tauben, a clinical associate professor and director of medical
> education in pain management at the University of Washington, agreed that
> not enough doctors are treating pain well.
> “But this problem was happening well before the new law,” Tauben said.
> He’s optimistic that the new law will actually encourage more doctors to
> treat pain patients because they will have guidelines to follow.
> Lax oversight
> Another obstacle to the success of the state’s new pain policy is the
> continuing lax oversight of prescribing habits.
> While the law gives state regulators a reason to discipline doctors, the
> statute does not require the state to check whether doctors or other
> medical professionals are breaking it.
> Unlike the federal Drug Enforcement Administration, which does monitor
> whether medical professionals with narcotic permits are following its
> rules, or the state’s Medicaid program, which tracks how much narcotic
> medication its doctors prescribe, state licensing agencies don’t check on
> practitioner compliance with laws and regulations. The system relies on
> complaints from patients or other professionals to trigger investigations.
> As a result, the Medical Quality Assurance Commission can’t say how much
> of a problem excessive prescribing is for Washington doctors, dentists,
> advanced nurse practitioners, physician assistants and other providers
> licensed to prescribe these powerful medications.
> An InvestigateWest review of recent cases against medical professionals
> found only a handful over a three-month period. The majority of those
> disciplinary actions involve medical workers who are themselves addicted. A
> few, however, had been disciplined for excessive prescribing.
> Prescription-monitoring programs
> One reason there has been little oversight of prescribing habits in
> Washington is that until this year there hasn’t been a systematic way to
> track the information.
> Washington has been slow to adopt a statewide monitoring program that
> would enter all patient prescriptions in one shared database. The
> Legislature created such a program in 2007 but pulled its funding the next
> year, and it never got up and running.
> Currently, 35 other states have such programs in place, and the
> information has led to a reduction in prescription fraud and provided a way
> to identify doctors who have excessive prescribing habits.
> The lack of such a program here frustrated Chris Johnson, policy director
> for the Washington attorney general’s office. “We know from the war on meth
> that tracking sale of precursor drugs had helped curb the problem,” he
> said. “We figured the same approach could help stem the wave of
> prescription drug abuse.”
> Johnson was part of a group that has now helped secure temporary funding
> to mount a prescription-monitoring program in Washington. But the funds
> will be exhausted by June, he said.
> And even this program has limitations. Prescribers are not required to
> consult the new database before writing a prescription. Participation
> is voluntary.
> In Kentucky, where it is also voluntary, only about 20 percent of doctors
> used it, Franklin said.
> It’s also unclear how Washington will use the information it collects.
> The administrators of the program will be reviewing the data to identify
> potential inappropriate prescribing patterns, said Chris Baumgartner, the
> program’s director. The system has the capability to pinpoint doctors and
> others who prescribe large amounts of opiates, but it hasn’t been decided
> yet whether the program will automatically produce and distribute reports
> on those individuals to various licensing agencies for investigation.
> Other states have found that such proactive reporting results in reducing
> prescription drug abuse.
> The Medical Quality Assurance Commission has the authority to survey the
> database for prescription abuse but said it does not plan to do so.
> Too many drugs, too little treatment
> Even as the system for collecting data improves, two other significant
> obstacles to reducing prescription drug addiction remain.
> The first is the sheer volume of pills in people’s medicine cabinets,
> which have become the nation’s de-facto illicit painkiller dispensary.
> Teenagers and even younger children pilfer their parents’ medicine
> cabinets for drugs, which get passed around or sold on school campuses and
> the street, said Mark Thomas, acting special agent in charge of the DEA’s
> Northwest division. According to the latest national survey, more than 70
> percent of people who abuse prescription drugs get the pills from friends
> or family, not a doctor or other prescriber.
> Stepping back further, the underlying problem is that there are not enough
> treatment options for drug addiction.
> “We know about 10 percent of people, including kids, who need treatment
> get it,” said Gina Grappone, director of Science and Management of
> Addictions, a Seattle-based nonprofit that provides resources for families
> and treatment for young people.
> Methadone maintenance programs, which use one of the oldest and most
> effective ways of treating addiction to narcotics, have long waiting lists
> and are simply unavailable in many parts of the state, said Ron Jackson,
> executive director of Evergreen Treatment Services. The stigma of being
> dependent on methadone, in some cases for the rest of your life, also
> serves as a major deterrent to treatment, as does the logistical nightmare
> of having to travel to a methadone clinic on a daily basis.
> A growing number of doctors are licensed to prescribe Suboxone – another
> opioid medication used for addiction that’s provided through a doctor’s
> office. But it’s expensive and its long-term efficacy has yet to be proved.
> Meanwhile, the number of new addicts continues to grow as people get
> hooked younger and younger.
> “The largest group of people entering treatment for prescription abuse
> right now is made up of young people between the ages of 18 and 24,” said
> Caleb Banta-Green, a research scientist at the University of Washington’s
> Alcohol and Drug Abuse Institute.
> Addiction experts predict that the number of deaths from prescription
> drugs, which fell slightly in the past year, will see a surge in the years
> to come as this large group of younger addicts ages and becomes debilitated
> by the drugs.
> Deaths from opiates tend to pick up in the mid-40s because the long-term
> abuse of these drugs is hard on the body, said Banta-Green. “People are
> dying 30 years earlier than they should.”
>
>
> **
> OUR CALLING IS THE PLACE WHERE OUR INNER JOY AND OUR INNER TERROR MEET
> http://www.youtube.com/watch?v=y1NIBD2KZtI&feature=related
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> http://overdoseprevention.blogspot.com/
> Mark Kinzly
> 2 Thunder Hill
> York, ME 03909
> markkinzly at yahoo.com
> 860-724-5339
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