[HARMRED] Prescription drug abuse, deaths target of new Washington law
Donald Grove
donaldgrove at verizon.net
Wed Jan 25 15:15:00 CST 2012
Amen Monte!
And while I agree with what you and Eliza say in terms of the impact of
the policies that are criminalizing more people, I have difficulty
accepting the idea of unintended consequences. The War on Drugs is
state terrorism, and it is not accidental. At this point, with such a
comprehensive national system of suspicion, accusation, incarceration
and ostracism, which has resulted in no limitation whatsoever of the
availability or use of illicit drugs, its not possible for me to believe
that continuing encroachments are unintended.
dsg
On 1/25/2012 3:54 PM, Eliza Wheeler wrote:
> What Monte said! Right on.
>
> Supply side regulations have never worked to reduce death or the other
> harmful consequences of drug use. They only increase harms to people
> who use drugs with the unintended consequences Monte talked about. I
> would have much rather seen a ramping up of overdose prevention and
> naloxone distribution in Washington to combat overdose deaths.
>
> Eliza Wheeler
> DOPE Project Manager
> Harm Reduction Coalition
> 1440 Broadway Suite 510
> Oakland, CA 94612
> Phone: 510-444-6969 ext. 16
> Email:wheeler at harmreduction.org
> Website:www.harmreduction.org
> Facebook:www.facebook.com/DOPEProject
> Follow the DOPE Project on Twitter @DOPEProject
>
> On 1/25/2012 12:40 PM, Monte Levine wrote:
>> 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
>> <mailto:markkinzly at yahoo.com>> wrote:
>>
>>
>> Prescription drug abuse, deaths target of new Washington law
>>
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>> <http://www.facebook.com/sharer.php?u=http%3A%2F%2Fwww.spokesman.com%2Fstories%2F2012%2Fjan%2F22%2Fprescription-drug-abuse-deaths-target-of-new%2F&src=sp>
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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#>
>> ------------------------------------------------------------------------
>> .
>> 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>
>> 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/>
>>
>>
>> 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 causeJanuary 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
>> <http://www.youtube.com/watch?v=y1NIBD2KZtI&feature=related>
>> http://vimeo.com/moogaloop.swf?clip_id=2539741
>> http://overdoseprevention.blogspot.com/
>> Mark Kinzly
>> 2 Thunder Hill
>> York, ME 03909
>> markkinzly at yahoo.com <mailto:markkinzly at yahoo.com>
>> 860-724-5339 <tel:860-724-5339>
>>
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