Showing posts with label Drugs. Show all posts
Showing posts with label Drugs. Show all posts

October 27, 2019

False Positives and Jail: $2 Test Identified Bird Shit as Meth

                        Image result for donut crumbs as meth
Police across the country have used the same breed of shoddy $2 test to arrest people for cocaine that was really bird poopmeth that was actually crumbs from a glazed donut, and oxycodone that turned out to be vitamins.
In all of those cases, the possession or drug trafficking charges were eventually dropped after police sent the “drug” samples to a state lab that returned more-conclusive results. The original tests, known as presumptive field tests, have a history of being almost laughably wrong — if they weren’t putting people behind bars, even temporarily. And the follow-up lab tests that eventually, clear people’s names can take weeks, if not months.
In the meantime, innocent people may be spooked into taking a plea deal instead of risking a longer sentence at trial. And if they can’t afford their bail, they’ll languish in jail as they decide whether to take a guilty plea or wait on better test results. 
Cody Gregg, a homeless man in Oklahoma City, took the guilty plea in early October, supposedly because he wanted to get out of the city’s problem-plagued jail. Police charged him with possession after a field test incorrectly identified powdered milk inside a clear baggie as cocaine. He was sentenced to 15 years in prison and had been in jail for nearly two months before drug-lab results cleared him. 
“You cannot indict somebody — put somebody in jail — over something you know has a very high rate of false positives,” Omar Bagasra, a biology professor at Claflin University and director of the South Carolina Center for Biotechnology. “It’s ignorance.” 
Bagasra once participated in a study for the Marijuana Policy Project that found a common brand of police field tests incorrectly identified patchouli, spearmint, and eucalyptus as  weed. His team even warned about “the serious possibility of tens of thousands of wrongful drug convictions.” 
In an attempt to showcase just how faulty the tests were, the research team went before the National Press Club and repeatedly produced false positives for mundane things like chocolate bars.

A large group of false positives’ 

The most common presumptive field tests only cost a few dollars and are supposedly simple to use. That’s why they’re widely favored by police across the country and lead to thousands of arrests each year, according to a 2016 ProPublica investigation. The tests, however, have their downsides: They’re often not admissible in court, which is why police have to order follow-up testing from a lab.  
To complete the field test, all an officer usually has to do is drop a sample of the suspect substance into a little pouch, break a capsule containing compounds that cause a chemical reaction, and wait a few moments. The pouch turns a specific color to alert the officer that drugs may be present. 
The problem, according to Bagasra, is that the catalyzers, known as reagents, can positively react to a wide variety of chemicals but can’t distinguish to an officer what they might be reacting to. Plus, the colors the tests produce can be subjective, especially in bad lighting. (About 1 in 12 men are colorblind, and 88% of cops are men.) 
"You cannot indict somebody — put somebody in jail — over something you know has a very high rate of false positives." 
For example, the formula often used by local police to test for cocaine, cobalt thiocyanate, will likely turn a bright shade of blue when interacting with things like Benadryl or pain relievers, according to an online manual for Ohio’s state crime lab. Under the test’s description, the lab writes that there “is a large group of false positives.” 
That same test has incorrectly labeled drywalllaundry detergent, and whey protein powder as cocaine, resulting in arrests across the country.
Plus, instead of being used in a sterile lab, the tests are often quickly used on the side of the road, in a cop car, or at the local jail, where they can be misinterpreted under bad lighting. The tests also often rely on cops — not well-trained scientists — to administer them.  
The DOJ's Warning
In 2000, the Justice Department issued guidelines requesting the tests’ manufacturers include warning labels telling cops that the tests could produce false positives and therefore require appropriate training. But ProPublica’s investigation found those guidelines were largely ignored. Newer, more accurate tests are available, but police departments don’t typically buy them because they can cost tens of thousands of dollars. 
“If officers are not trained to get the message that a positive drug test is more equivocal than the label would make you think, you’ll have police officers thinking, ‘Positive means it’s definitely drugs,’” said Carl Takei, a senior staff attorney at the ACLU’s Trone Center for Justice and Equality. Instead, a positive result means that the presence of drugs can’t be ruled out but should be weighed with plenty of other evidence before officers proceed. 
Oklahoma City Police told VICE News that the officers did weigh other evidence in Gregg’s August arrest for possessing the powdered milk that tested positive for cocaine. 
For example, Gregg had a prior history of drug convictions and ran from police when they attempted to stop him for a missing taillight on his bicycle. Once they retrieved the backpack he was carrying, they found the clear bag of a “white powdery substance” and a scale, too. All of those things factored into his arrest — not just the presumptive drug test.

“Field testing of possible drugs by officers is a presumptive test only and is simply one part of the totality of the circumstances that can lead an officer to believe that enough probable cause exists to legally effect an arrest,” Capt. Larry Withrow, a spokesperson for the Oklahoma City Police Department, told VICE News in an email. 
Nonetheless, Withrow said: “We are reviewing our presumptive test procedures to determine if improvements can be made in this area.” He added that the department hasn’t had any problems with field tests before.
In Tulsa County, Oklahoma, about 100 miles away from where Gregg was arrested, public defender Natalie Leone said she handles a drug case with false positives from field tests about once a month. 
This past May, Tulsa police found one of her clients, Carl Fisher, with a glass container of liquid that tested positive for meth in the field. Fisher, who’s homeless, was asleep in a car in a residential parking lot when officers approached him with guns drawn because they considered the car stolen. They tased him multiple times and dragged him out of the car, body-camera footage shows.
Fisher was arrested on drug charges, resisting arrest, and assault on a police officer. He was behind bars for nearly two months on what was initially a $160,000 bail before state lab results cleared him. He then remained in jail until October, when he agreed to plead no contest to the charge of resisting arrest.


October 19, 2019

Did You Know There is "El Chapo Jr.?"When Police Tried to Arrest Him WWIII Broke Out

The reason I still follow some aspects of this story is that we are not finished with El Chapo familia. They still have power, drugs, and influence. It's a good thing they are not friends of Trump or there would be a pardon coming along. By the way NYS passed and the Governor signed a law which is retroactive that says that the state can prosecute anyone that gets a pardon from the President and is accused of breaking a law in NY.. Sorry, Manaford. He has stayed quiet waiting for one, even meeting with some administration officials but he is doomed, Trump or no Trump, that is as it appears now since in this country sometimes night time is confused with a foggy day.

 Heavily armed gunmen went on a shooting rampage through the city of Culiacán, the capital of Sinaloa state on Mexico's Pacific coast, battling security forces after authorities attempted to arrest a son of imprisoned drug lord Joaquín "El Chapo" Guzmán.
The gunfire from what appeared to be sniper rifles and truck-mounted machine guns sent residents of the western city scrambling for cover. Burning vehicles littered the streets as the gunmen faced off against the National Guard, army and police.
ovidio guzman lopez
 Ovidio Guzman Lopez, the oldest Chapo son. For some reason the press in Mexico don't like print his face so a lot of people don't know what he looks like. 

Reportan enfrentamientos entre militares y hombres armados en .

No se sabe el origen del enfrentamiento.
: El enfrentamiento inició en el Sector Tres Ríos, pero se ha extendido a otros puntos de .

Vean el tipo de armas que se están usando.

Mexico's security secretary, Alfonso Durazo, said the fighting began when about 30 National Guard and army troops patrolling the city were fired on from a house occupied by Ovidio Guzmán López, who is wanted in the U.S. on drug trafficking charges.
Durazo said the security forces took control of the house and found Guzmán, who is also known as "El Ratón," inside. Soon after, the house was surrounded by "a greater force" of heavily armed gunmen and the troops withdrew.
"With the goal of safeguarding the well-being and tranquility of Culiacán society, officials in the security Cabinet decided to suspend the actions," he said.
Durazo did not initially specify whether authorities arrested Guzmán or let him go. Media outlets in Mexico later reported that for government had released the fugitive.
Shortly after the confrontation, gunmen – some wearing black masks — took off on a rampage, driving through the city in trucks firing heavy caliber weapons. 
Videos posted to social media show multiple gunmen shooting down major thoroughfares. Residents abandoning cars and burning vehicles are seen on multiple roads.

May 31, 2019

King’s Pin Son Collects His Prize For Testifying Against “El Chapo"

Image result for Vicente Zambada
Vincente Zambada "El Mayo" Mexico's Tops leader of the Sinoloa Cartel

CHICAGO — From the time he was a boy, Vicente Zambada was groomed to be the future leader of the Sinaloa cartel. The eldest son of Ismael “El Mayo” Zambada, Mexico’s most powerful drug trafficking organization was his by birthright. He followed in his father’s footsteps for years, becoming his top lieutenant and emissary. But it was ultimately his ill-fated attempt to quit the cartel that landed him in a U.S. federal courthouse Thursday. 

With a dark tousle of hair, a fresh shave, and a gray suit with a pink tie, the 44-year-old Zambada swaggered into the courtroom of Judge Ruben Castillo like a man accustomed to getting his way. He pleaded guilty in 2013 to smuggling cocaine and heroin, but his sentencing was repeatedly delayed as U.S. authorities pumped him for information and used his testimony to put away several of Mexico’s most notorious narcos, including his father’s longtime partner, Joaquín “El Chapo” Guzmán.

Citing his “extraordinary and unprecedented” cooperation, prosecutors in Chicago recommended a 17-year sentence for Zambada rather than the maximum of life in prison. Amanda Lipscomb, a prosecutor who worked the Chapo case and questioned Zambada when he was on the witness stand, praised his “positive attitude” and said he “provided the jury with a unique perspective into the inner-workings of the cartel.” She said a reduced sentence for Zambada was needed in order to “incentivize other criminals out there who engage in serious drug trafficking who are thinking about engaging with the government.”

Judge Castillo went even further, reducing Zambada’s sentence to 15 years. With credit for time he has already served in the U.S,. and Mexico, Zambada could be allowed to walk free in five — or less, with good behavior.

As Zamabda stood before him, swaying gently on his feet, Castillo spoke at length about his sentencing decision. He noted that Zambada was perhaps the highest-level drug trafficker who had appeared in his court, but his case still made no dent in the flow of drugs to the U.S.

“His sins are washed away merely because he testified. The government buys testimony in exchange for reduced sentences.”
“After 25 years of being a federal judge, if there is a so-called drug war, we are losing,” Castillo said. “It’s time for us to think about doing something different.”

Castillo noted that he is of Mexican descent and lamented the high death toll from the drug war in Mexico, which he called “the only crisis at the border.” He also used the occasion to lambast President Donald Trump, though he referred to him as “someone in D.C.… I don’t want to say his name.”

The judge also criticized Trump for speaking out against cooperators. “Are you kidding me?” Castillo said. “They are cooperating with the Justice Department.”

Zambada was far from the only former high-level drug trafficker called to testify against Chapo, who was convicted Feb. 12 after a dramatic three-month trial in Brooklyn. Chapo now faces life in prison, though he is seeking a new trial. Thirteen other cooperators took the stand, including Zambada’s uncle Jesus “El Rey” Zambada. All of them sought leniency in their own cases, but the younger Zambada — known as “El Vicentillo” — is the first to find out exactly how much prosecutors were willing to give up in order to convict Chapo. The answer, it seems, is quite a lot. 

In addition to his relatively short sentence, Zambada disclosed during his testimony against Chapo that U.S. authorities had already arranged to bring his wife and children across the border and provide security for them. He is expected to receive a rare S-visa, which puts foreign-born cooperators in major criminal investigations on the path to a green card and U.S. citizenship. The Treasury Department also agreed to lift sanctions on Zambada’s wife, who was allowed to bring $400,000 with her to the U.S. for living expenses. Under the terms of his plea, Zamabada agreed to forfeit his illicit drug proceeds — which prosecutors say are a whopping $1.37 billion, but it’s unclear when — if ever — he will be forced to pay up.

Chapo’s former attorney, Eduardo Balarezo, who cross-examined Zambada during the trial, called his sentence and other benefits “a prime example of the corrupt nature of the federal criminal justice system.”

“Vicente Zambada admitted to being responsible for trafficking hundreds of tons of drugs to the United States,” Balarezo said. “Yet his sins are washed away merely because he testified. The government buys testimony in exchange for reduced sentences.” 

In a sentencing memo filed earlier this month, federal prosecutors told Castillo that Zambada was a reluctant participant in the cartel who tried to do the right thing by cooperating. Prosecutors said Zambada “shied away from involvement” in the drug business,” and only got involved “as a result of the unavailability of his father.” Because his dad was in hiding, prosecutors said, cartel members constantly asked Zambada to relay messages to him.

Zambada himself offered a similar story during Chapo’s trial, but said the turning point came in the early ‘90s when a war broke out between the Sinaloa cartel and their rivals in Tijuana. Zambada was called to his father’s side for safety reasons, and he learned how to run the cartel by watching him operate. “I started realizing how everything was done,” he said. “And little by little I started getting involved in my father's business.”

The 71-year-old El Mayo has been a legend in the Mexican drug trade for more than three decades. While other major traffickers have been killed or captured over the years, Mayo has remained free for his entire criminal career. With Chapo now out of the picture, Mayo has reportedly consolidated power and now leads the cartel from his remote hideouts in the mountains of Sinaloa. The U.S. State Department is currently offering a $5 million reward for information that leads to his arrest.

Before long, Mayo’s heir apparent was coordinating multi-ton cocaine shipments from Colombia and overseeing a team of assassins. The younger Zamabda maintains he never personally killed anyone, but he acknowledged during Chapo’s trial there were "several times” when people were kidnapped, tortured, and killed on his orders.

After Zambada was indicted in the U.S. on drug charges, he tried to find a way out that didn’t involve death or life in prison. “I wanted to get out of the cartel,” he recalled. “I wanted to retire from everything with my dad and with my Compadre Chapo's permission.”

In March of 2009, with the blessing of both his father and Chapo, Zambada met with DEA agents at a hotel in Mexico City to discuss leaving the cartel and becoming an informant. Such an arrangement was not unprecedented. Since around 2005, DEA agents had been secretly meeting with a Sinaloa lawyer named Humberto Loya-Castro. He was an adviser to Chapo, and he was feeding the DEA information about rival groups. Loya-Castro’s own federal indictment disappeared in 2008 as a result of his cooperation. Zambada wanted the same deal.

Loya-Castro was present during the meeting between Zambada and the DEA, but the plan for the cartel scion to become a snitch was derailed a few hours after the rendezvous, when Zambada was arrested by Mexican special forces. He was extradited in 2010 and agreed to become an informant in late 2011, after spending nearly two years in solitary confinement at a federal jail in downtown Chicago.

Prior to his cooperation, Zambada claimed in a 2011 court filing that he could not be prosecuted because the DEA had given Chapo and Mayo “carte blanche” to smuggle drugs into the U.S. in exchange for providing tips that helped Mexican and U.S. authorities “capture or kill thousands of rival cartel members.” The Justice Department has acknowledged that the meeting with Loya-Castro and Zambada occurred, but it has steadfastly denied that Zambada was ever promised immunity. 

During the Chapo trial, attorneys were under court orders not to mention Zambada’s past claims about having permission from U.S. authorities to traffic drugs. It was mentioned briefly when Zambada described his plan to “retire from everything with my dad and with my Compadre Chapo's permission,” but ultimately Zambada’s testimony was focused on Chapo, who is the godfather to Zambada’s youngest child.

Zambada worked closely with Chapo and was privy to the cartel’s deepest secrets, and he did not hold back on the witness stand, detailing how Mayo and Chapo organized massive drug shipments, murdered rival traffickers, and doled out more than $1 million in bribes per month to corrupt Mexican politicians, police commanders, and military generals.

Zambada’s attorney, Frank Perez, told the judge that the decision to testify against Chapo was not easy for his client.

“He struggled with that,” Perez said. “He did not want to testify. He was concerned about the consequences he would suffer, and not just him but his friends and family.”

“This feeling of repentance has been with me for years.”
When it was Zambada’s turn to speak Thursday, he addressed the court in Spanish and began by “asking all those people for forgiveness who I hurt one way or another, either directly or indirectly.”

Zambada said he had made “some bad decisions” in his life, “which I truly regret.” He added that he felt he “can be a better father, a better husband, a better son, and most of all a better human being.”

“I would like to tell your honor this repentance did not just come about just yesterday nor did it come about just because I’m in front of you about to receive a sentence,” Zambada said. “This feeling of repentance has been with me for years.”

In addition to Chapo, Zambada dished on the leaders of the Beltrán-Leyva Organization and Damaso Lopez, a former right-hand man for El Chapo who is now serving life in U.S. federal prison. Also known as “El Licenciado,” Lopez was among those who testified against Chapo during his trial.

Federal prosecutors say Zambada is “one of the most well-known cooperating witnesses in the world and he and his family will live the rest of their lives in danger of being killed in retribution.”

“If there is a so-called drug war, we are losing.”

Even with Chapo behind bars, little seems to have changed in Chicago or elsewhere in the U.S. Chapo was named “Public Enemy No. 1” in 2013 because he was blamed for supplying drugs that fueled gun violence in Chicago, but the impact of his capture and conviction is negligible at best. Shootings are down about 12 percent across Chicago so far this year, according to police, but Cobe Williams, deputy director of the Cure Violence program the University of Illinois in Chicago, said the positive trend is not linked to Chapo or Zambada.

“El Chapo and this other guy ain’t got nothing to do with what’s going on in Chicago,” said Williams said. “None of this got nothing to do with what’s going on in Chicago.”

A native of the gang-plagued Englewood neighborhood on the South Side, Williams said the decline in shootings was the result of work by groups like his, which seeks to intervene in neighborhood disputes before such conflicts escalate to violence.

“A lot of things that drive the violence is personal,” Williams said. “People have personal altercations or beef. It ain’t no gang relationship. People get that twisted. It’s personal.”

Meanwhile, the DEA has moved on to target other groups that traffic drugs to Chicago. While Mexico’s new president has floated some radical new ideas to reduce drug violence, the status quo remains the same. Drugs continue to flow across the U.S.-Mexico border. El Chapo is gone, but his sons now run his faction of the cartel. Another one of Mayo’s sons, Serafín Zambada, was released from U.S custody last September after striking a plea deal that allowed him to serve less than six years in prison. Mayo has at least two other sons still in Mexico, including one awaiting extradition to the U.S. and another who is still on the run.

Castillo seemed to recognize the futility of the situation during Zambada’s sentencing.

“We need to discuss demand and fund treatment,” he said. “If you don’t address the demand, there will be plenty of people to fill the role of sending drugs to this country.”


May 1, 2019

Ketamine Relieves Depression According to NHI~ Drug Enforcement Nervous~

  • Researchers uncovered how the fast-acting antidepressant ketamine’s effects are sustained over time in mice.
  • A better understanding of ketamine’s effect on brain circuits can help guide the development of future treatments for mood disorders.
Dendrites with spinesCloseup view of three dendrites with spines, which are responsible for receiving input from other nerve cells. Conor Liston, Science
Depression is a serious mood disorder with symptoms that include prolonged periods of sadness, hopelessness, and irritability. The symptoms can affect how you feel, think, and handle daily activities. Depression is usually treated with medications, psychotherapy, or a combination.
Chronic stress can lead to symptoms of depression. Studies in animals have shown that chronic stress also leads to the loss of communication between brain cells (neurons) in the prefrontal cortex area of the brain. The neurons lose dendritic spines, the small outgrowths on brain cells that receive signals from neighboring neurons. This leads to altered communication between brain cells.
Earlier this year, the FDA approved a form of the drug ketamine to treat depression. Ketamine is a fast-acting antidepressant that relieves depressive symptoms in hours instead of the weeks or longer that previous drugs required. In addition to being a major advance in treatment, ketamine provides an opportunity for researchers to investigate the short- and long-term biological changes underlying its effects on depression.
A research team led by Dr. Conor Liston of Weill Cornell Medicine investigated how ketamine affects the brain after mice experience chronic stress. They used high-resolution imaging to focus on neurons in the prefrontal cortex. The study was funded in part by NIH’s National Institute of Mental Health (NIMH). Results were published in Science on April 12, 2019.
The researchers examined neurons in the prefrontal cortex of mice exposed to long-term stress. They found that mice showing behaviors related to depression had an increased loss of, and decreased formation of, dendritic spines in their prefrontal cortex compared with mice not exposed to stress.
Dendritic spine remodeling
Dendritic spine remodeling. Images taken at baseline, after chronic stress, and after a single dose of ketamine. Red arrows point to eliminated spines; blue arrows to new spines.Conor Liston, Science
Treatment with ketamine rapidly relieved the abnormal behaviors in the stressed mice. The drug also quickly restored the coordinated activity of prefrontal neural circuits that were disrupted by chronic stress. However, the researchers found that ketamine didn’t work by halting the stress-induced spine loss. Instead, the drug led to formation of new functional spines.
The initial effects of ketamine on mouse behavior occurred independently of its effects on spine formation. While the drug affected behavior within three hours, formation of the new spines took 12 to 24 hours. Formation of spines in the mice correlated with their behavior two to seven days after treatment. Further experiments showed that the newly formed spines were crucial for sustained reversal of the negative effects from stress. When the ketamine-induced spines were eliminated, the mice again showed depression-like behaviors.
These insights into ketamine’s effects on brain circuits could guide future advances in managing mood disorders. “Our results suggest that interventions aimed at enhancing synapse formation and prolonging their survival could be useful for maintaining the antidepressant effects of ketamine in the days and weeks after treatment,” Liston says. 
References:  Sustained rescue of prefrontal circuit dysfunction by antidepressant-induced spine formation. Moda-Sava RN, Murdock MH, Parekh PK, Fetcho RN, Huang BS, Huynh TN, Witztum J, Shaver DC, Rosenthal DL, Alway EJ, Lopez K, Meng Y, Nellissen L, Grosenick L, Milner TA, Deisseroth K, Bito H, Kasai H, Liston C. Science. 2019 Apr 12;364(6436). pii: eaat8078. doi: 10.1126/science.aat8078. PMID: 30975859.
Funding: NIH’s National Institute of Mental Health (NIMH); Whitehall Foundation; Hartwell Foundation; One Mind Institute; Rita Allen Foundation; Klingenstein-Simons Fellowship in Brain Science.

April 2, 2019

The Government Can Regulate Opioids and Save Lives But It Can’t Regulate My Pain and Save Mine

                                                       Image result for killing pain

By John Heubusch

John Heubusch is a novelist and the executive director of the Ronald Reagan Presidential Foundation and Institute in Simi Valley, Calif. 
We had tried everything to stop the spread of my cancer. My doctor felt it was time for me to go home, get my affairs in order and say my goodbyes. “Get your Christmas shopping done early,” he said. “You have just a few months to live.”
Five years have passed since that grim day and, strange as it might seem, there have been times I’ve regretted undergoing the last-minute medical gambles that saved my life.
I am not alone. Victims of tragic accidents, disease onset, combat wounds, complicated surgeries, workplace injuries, gun violence or even a simple fall off a ladder are among the 20 million Americans like me who experience some form of high-impact, chronic and often debilitating pain. Many, given a second chance at life after a serious illness or injury, tragically choose suicide over pain. Why? The most unfortunate among them, those with life-altering, unspeakable pain, are being denied access to the medications they need to go on. Their doctors, now numbering nearly 70 percent of our front-line physicians, have enlisted in the nation’s war on opioids. Many have turned away from their patients in chronic pain. 
When you see news stories declaring that federal action is driving fewer questionable opioid prescriptions, that Purdue Pharma is in deep trouble for allegedly creating millions of OxyContin addicts, and that the United States has stepped up the fight to interdict drugs on our nation’s borders, no doubt there’s reason to applaud. Lives are being saved. The rising number of deaths since 2015 that necessitated this war on opioids is most often not the fault of doctors or their patients in chronic pain. The real blame — where the war will be won or lost — lies with the illegal trafficking of opioids on the street where you live.
The Centers for Disease Control and Prevention knew this when it trained its guns on the opioid epidemic three years ago. Revising its guidance to physicians in 2016, it sought to limit opioid treatment practices that were outside the bounds of common sense and sound public health. The CDC’s intended audience should have been small; a limited number of bad actors and a minority of doctors overprescribing for short-term pain were the CDC’s real target. But the guidelines were ambiguous and short-sighted. The immediate result: confusion at major medical conferences, inside hospital boardrooms and, most troubling, in just about every doctor’s office.
Next came the law of unintended consequences. At least 33 states, each seemingly eager to outdo the other, have passed their own measures to severely reduce or eliminate the use of such drugs to treat pain. “Just say no,” the national refrain from the 1980s in the war on crack cocaine, has become the standard of care for patients with severe pain. 
Enter President Trump. His battle cry, verbatim: “Whether you are a dealer or doctor or trafficker or a manufacturer, if you break the law and illegally peddle these deadly poisons, we will find you, we will arrest you, and we will hold you accountable.”
Lumped in with drug pushers and heroin traffickers, even law-abiding doctors who have responsibly treated patients in chronic pain with opioids began to cower. Just what were these new laws? What dosages for each unique patient with a unique set of needs will keep a doctor out of prison? Administrators of major medical research institutions, teaching hospitals, national pharmacy chains and most particularly overworked private practitioners were not going to wait for answers. With visions of Drug Enforcement Administration agents in their waiting rooms, they headed for their bunkers, leaving desperate patients behind.
We have reached the point where doctors believe the next prescription they write for opioids to treat chronic pain might be their last. In my own case, I’ve had to undergo countless unsuccessful procedures and near superhuman efforts to be granted barely enough medication to try to live a normal life. Even those doctors with the courage to prescribe them for chronic pain sufferers are finding the hurdles established by federal and state reporting requirements so onerous that they are simply turning patients away. 
Opioid prescriptions have shrunk substantially, but Washington’s goal now is to cut their number by a further one-third. In a bitter irony, opioid overdose deaths continue to hover at an all-time high. Many chronic pain patients, denied prescriptions, are self-medicating on the street, using synthetic drugs such as fentanyl, 50 times more powerful than heroin. There, danger and overdose lurk around every corner. Even worse, some who have lost all hope for pain relief are choosing to end their pain by ending it all. The risk of suicide among patients with chronic pain is twice that of those without it.
Three weeks ago, more than 300 medical experts wrote to the CDC noting the increase in suicides tied to the agency’s widely misapplied guidance. The patients in chronic pain they defend are not addicts. Far from it. There is a terrible truth for our government complicit in this crisis of its own making: Though it can regulate prescriptions for those in need, it cannot regulate pain.

March 28, 2019

The Opioid Crisis is Fueled By The Lack of Giving Patients The Correct Pain Meds

 Nerve pain

The federal government released a report last week that came to a striking conclusion: More than 80 percent of the roughly two million people struggling with opioid addiction in the United States are not being treated with the medications most likely to nudge them into remission or prevent them from overdosing. This denial of care is so pervasive and egregious, the report’s authors found, that it amounts to a serious ethical breach on the part of both health care providers and the criminal justice system.

The Food and Drug Administration has approved three medications to treat opioid use disorder — methadone, buprenorphine, and naltrexone. All of them work by binding to the brain’s opiate receptors in a way that reduces the cravings that people addicted to drugs like OxyContin and heroin experience, but without causing the same euphoric high as those drugs. Methadone and buprenorphine have proved especially effective. Patients who take one of those medications are half as likely to die from their addiction; they are also more likely to stay in treatment, and they tend to have better long-term health outcomes.

Neither drug is new or experimental — methadone was approved to treat opioid addiction in 1972 and buprenorphine in 2002. Some countries have shown that increasing access to them can significantly drive down the rate of overdose deaths. In France, for example, policies that enabled more doctors to prescribe buprenorphine helped lead to a tenfold increase in the number of people whose opioid use disorder was being treated and to a nearly 80 percent decline in overdose deaths in just four years.

Yet, many drug courts and most residential treatment programs in the United States prevent participants from using these medications; and the rehabilitation programs that do offer them rarely offer all three options. The treatments are not available in most emergency rooms, as The Times has reported, even though studies show that patients given buprenorphine in an E.R. are twice as likely to be in treatment a month later than those who are given an information pamphlet. They are also not available in most prisons, even though a significant portion of the federal inmate population suffers from opioid use disorder. Opioid overdose is a leading cause of death among those who’ve been recently released. 

Part of the problem is stigma and a profound lack of awareness. Methadone and buprenorphine are opioids. They are weaker than drugs like OxyContin, fentanyl and heroin that have fueled the current crisis, but many law enforcement and medical professionals still see them as trading one addiction for another. Or they mistakenly believe that the medications should be used only temporarily, to help wean patients off stronger opioids. Or they see them as an optional complement to behavioral interventions instead of an essential component of opioid addiction management.

None of these perceptions is supported by the balance of scientific evidence.

There’s also a logistical barrier to getting these drugs into the hands of people who need them. Doctors are allowed to give methadone only at specialized clinics where patients must report every day for their dose. Lines at such clinics are often long, and according to the federal report, which came from the National Academies of Sciences, Engineering, and Medicine, Medicaid does not cover the treatment in at least 14 states.

Buprenorphine is available by prescription, but health care professionals must obtain a special license to write those prescriptions, a process that requires them to complete hours of additional training, grant the Drug Enforcement Administration access to all of their patient records and agree to strict limits on the number of patients they can treat with the medication. In many states, would-be buprenorphine prescribers also must submit to stringent criteria for insurance reimbursement. These restrictions also are not justified by scientific evidence. They are not employed by other countries, and they are not used to manage the treatment of other chronic medical conditions in the United States.

Fewer than seven percent of the nation’s doctors have gone through the trouble of clearing these hurdles. As a result, more than half of all counties have no licensed buprenorphine prescriber at all. That’s too bad. According to the national academies report, just about anyone with opioid use disorder — teenagers, pregnant women, people with other serious medical conditions — can be treated safely and effectively with the medication.

President Trump declared a public health emergency to respond to the opioid crisis in 2017, but so far that declaration has led to very little meaningful action. Congress passed a suite of opioid bills in the fall, but that legislation contained almost no funding. And in most states, strategies that might truly mitigate the disaster — from evidence-based addiction treatments like methadone and buprenorphine to proven harm-reduction approaches like needle exchanges and safe injection sites — remain vastly underutilized or outright illegal.

The editorial board represents the opinions of the board, its editor and the publisher. 

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