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Debunking The Myths

Common sense in pain management -- read Chronic Pain & Opioids: Debunking the Myths, by Frank B. Fisher, MD -- also available in PDF. And check out this public service ad based on Debunking the Myths.


Physicians are under intense scrutiny because of concerns over prescription drug diversion and abuse. At the same time, they are also under pressure from patients and advocates to prescribe adequate pain medication. It is a difficult balancing act and sometimes, overzealous law enforcement can tip the scales. For more information click here.


The Cato Institute published this tremendous analysis of pain management policy by Professor Ronald T. Libby of the University of North Florida. Download a copy of the full report, and also check out this CSDP public service ad which excerpts the Libby report.

A Michigan study confirms what many patients already know: Pharmacies in minority and low-income areas are less likely to carry sufficient supplies of pain medications. Click here to read more about this study on access to pain medication which was published in the Journal of Pain in Oct. 2005.


Pain management: where healthcare and drug control policies intersect. Click here for more about pain management, diversion, and related items. Also check out this new CSDP public service ad on the federal war against physicians over pain management.


Florida Governor Charlie Crist and his cabinet voted unanimously to grant pain patient Richard Paey a full pardon for his 2004 conviction on drug trafficking and possession charges. For more information, click here.


The re-trial of Doctor William Hurwitz came to an end in July 2007. The doctor's sentence was reduced to less than five years. He was originally given 25 years. For more information, click here.


A federal judge is challenging the plea agreement entered into earlier in 2007 between prosecutors and Purdue Pharma, the manufacturer of OxyContin. For more information, click here.


The New York Times Magazine featured a cover story on pain management issues in their June 17, 2007 edition. Click here to read the story in full.


Purdue Pharma, manufacturer of OxyContin, and three current and former executives were allowed to plead guilty in federal court to misleading the public about Oxy's risks. For more information, click here.


Federal re-trial of pain specialist Dr. William Hurwitz ends – some charges dismissed, acquittal on some charges but guilty verdicts on others. For more information click here.


Commutation Urged After Appeal Fails

Chronic pain patient Richard Paey lost in the appeal of his sentence on drug charges and faces a mandatory minimum 25-year-sentence. For more information click here .


DEA Issues Policy Statement On Pain Management

The US Drug Enforcement Administration has issued a new policy statement on pain management and prescribing practices. For details, click here. Also, a full copy of the notice as published in the Federal Register is available by clicking here.


The 4th Federal Circuit Court of Appeals has granted a new trial to Dr. William Hurwitz of Virginia. Dr. Hurwitz had been accused of drug trafficking for prescribing large quantities of narcotics to patients. For more information click here.


Rightwing talkshow host Rush Limbaugh reached a plea deal with prosecutors – charges to be dropped in 18 months if he completes treatment, avoids re-arrest. For more info, click here.


One of the first physicians in the nation to be charged with the deaths of patients from narcotics abuse was found guilty of one count of manslaughter and five counts of narcotics trafficking in her retrial in Florida. Dr. Asuncion Luyao faces maximum 30 year prison term – an appeal is planned. Click here for more info.


First Annual Opioid Certification Program

Presented by the Opioid Management Society & the Journal of Opioid Management, the conference will be held April 22-23, 2006, at The Conference Center at Harvard Medical, Boston, MA. To register, contact the Opioid Management Society.


The cover story in Harvard Magazine's Nov-Dec 2005 issue is "The Science of Hurt," by Kathleen Koman. Download and read a PDF copy of this tremendous article.


FDA, doctors win versus DEA on question of final approval of new painkilling drugs. Click to read more.


Chronicle AM: AG Nominee Stokes MJ Fears, Global Commission Calls for Drug Decrim, More... (11/21/16)

Donald Trump has nominated a harsh drug warrior to head the Justice Department, Montanans will see a slew of bills aiming at making their medical marijuana system more workable (and at least one that wants to kill it), the Global Commission on Drugs called for drug decriminalization, and more.

[image:1 align:left caption:true]Marijuana

Trump's Pick of Jeff Sessions as AG Raises Fears in Marijuana Industry. President-elect Donald Trump (R) has nominated anti-marijuana Alabama Republican Sen. Jeff Sessions to head the Justice Department, setting off alarms in the marijuana industry. As attorney general, Sessions would oversee federal prosecutors and the DEA and could move to undo the Obama administration's policy of largely allowing the states to set their own course on pot policy.

Colorado Bureaucrats Nix On-Site Pot Consumption for Bars. Just a week after voters in Denver approved a social use initiative allowing restaurants and bars to seek permits to allow on-site consumption of marijuana, the Department of Public Health and Environment has announced that it will not allow liquor license-holders to obtain such permits. The department said using alcohol and marijuana together increases impairment. But proponents of the measure said alcohol establishments already rely on the judgment of servers and that the move would allow consumers to use marijuana products without having to go outside or hide behind closed doors.

Medical Marijuana

Arizona Dispensary Operator Eyes 2018 Expansion Initiative. The owners of the Wellness Center, an Apache Junction dispensary, are moving toward an initiative to expand the state's medical marijuana program. The move comes a week after a legalization initiative was narrowly defeated. The initiative would expand the list of qualifying conditions for marijuana and it would allow people who live more than a mile from a dispensary to grow their own. The current law bars people who live within 25 miles of a dispensary from growing their own.

After Initiative Victory, Medical Marijuana Bills Pile Up in Montana. Montanans voted last week to restore their state's medical marijuana system, which had been gutted by the Republican legislature in 2011, and now the legislature faces at least 10 bills designed either to make the system more workable or to try to thwart the will of the voters once again. It's going to be a busy session in Helena.

Heroin and Prescription Opioids

Kentucky Legislator Files Bill to Limit First-Time Opioid Prescribing. State Rep. Jeff Taylor (D-Hopkinsville) has prefiled a bill, BR 202, that would limit first-time adult prescriptions for non-chronic pain relief to a seven-day supply. The bill does include an exception that would allow a doctor to prescribe a longer supply if deemed medically necessary.

Kratom

Still Ten Days Left to Comment on Proposed Kratom Ban. Anyone who wants to commit on the DEA's plan to schedule kratom has until December 1 to do so. Click on the link for more information.

International

New Report Calls on UK to Legalize Marijuana. A new report from the Adam Smith Institute says that Great Britain's drug strategy "has failed in its core aims to prevent people from using drugs, manufacturing drugs, and to put a stop to the crime, corruption and death that is taking place on an industrial scale around the world," and calls on the government to legalize marijuana. The report is winning support from a cross-party parliamentary group that includes former deputy prime minister Nick Clegg.

Global Commission on Drugs Calls for Global Drug Decriminalization. In its annual report, the Global Commission on Drugs has called for an end to criminal and civil penalties for drug possession and more research into alternative regulatory models. The report comes months after the commission sharply criticized the United Nations' refusal to embrace more radical drug reforms at its UNGASS on Drugs last spring. Commission member Richard Branson called the UN's status quo approach "fatally flawed" at the time.



Using Medical Marijuana to Reduce Dependence on Opiates in an Aging, Aching Population [FEATURE]

Pain is a drag. And chronic pain is a never-ending drag. Unfortunately, as we grow older, we can expect to increasingly suffer its torments. Half of older adults who live on their own report suffering from chronic pain. For people in elderly care facilities, that figure jumps to somewhere around 80%.

[image:1 align:left caption:true]An aging population with its associated aches and pains is one reason opioid pain prescriptions have increased so dramatically this century. Opiates are a very popular pain management technique, despite the well-known problems with them, primarily addiction and lethality. They can ease your pain, but they can also kill you or get you strung out. And opiate users report other problems less severe, but still affecting quality of life, such as constipation and foggy-headedness.

In recent years, we have seen increasing evidence that one substance can reduce both pain and the reliance on opioids to treat it, and that its use can have a positive impact on fatal opioid overdoses. That substance is marijuana.

As the Johns Hopkins Bloomberg School of Public Health reported in 2014, "In states where it is legal to use medical marijuana to manage chronic pain and other conditions, the annual number of deaths from prescription drug overdose is 25% lower than in states where medical marijuana remains illegal."   

Now, new research findings from Care By Design, one of California's leading medical marijuana producers, add more evidence of the positive role marijuana can play in treating chronic pain and reducing dependence on opioid pain medications. The study surveyed 800 patients, mostly between 50 and 70, more than 80% of whom reported suffering from chronic pain, half of whom reported suffering from acute pain, and more than 40% of whom reported suffering from both.

These patients were in a world of hurt and had tried a number of pain management tools—opiates, medical marijuana, anti-inflammatory agents (NSAIDS), nerve blockers, exercise/physical therapy, and surgery—with respondents reporting trying an average of four of them. A quarter of patients reported having tried all six.  

The patients reported that marijuana was very effective for pain, with few negative side effects.  That was in striking distinction to opiates, which patients also said were effective for pain, but had a significant negative impact on quality of life for a significant number of them. In fact, the differences between the two substances in terms of quality of life were so dramatic they led to dramatic changes in patient behavior.

[image:2 align:right caption:true]"This survey brings some very important information to light," said Care By Design spokesman Nick Caston. "We see here in our patient data that cannabis is improving the quality of life of our patients—particularly elderly patients suffering from age-related pain—and that it does so without the dangerous side effects of other pain management modalities. 

"The study’s most striking finding was cannabis’ apparent impact on opiate reliance: Ninety-one percent of survey respondents reported that they decreased the amount of opiates they were taking or eliminated them altogether," Caston continued.

The study also found while marijuana, opiates, exercise/physical therapy, and NSAIDS all provided noticeable pain relief in more than half the patients, marijuana was the only pain management tool where there were no reports of worsening pain. And half of the patients using opiates reported that they had a negative impact on overall well-being, interfering with mood, energy, sleep, and functional abilities.

More than half of the patients reported using both marijuana and opiates to manage pain. But as noted above, nine out of 10 reduced or eliminated their opiate consumption after beginning to use marijuana. And nearly two-thirds (63%) said they were now off opiates altogether.

Over half of respondents reported that they had used both cannabis and opiates for pain management. Of great interest was the impact of cannabis therapy on opiate usage: Ninety-one percent of this subgroup reported that they used fewer or no opiates after beginning cannabis therapy. Sixty-three percent said that they went off opiates altogether.

"A tenet of healthcare in the United States is 'First, do no harm,'" the study concluded. "Patient reports of cannabis’ efficacy together with its low side effect profile suggest that it should be considered as a first-line treatment for pain and/or as an adjunct treatment to opiates rather than as a medication of last resort."

In other words, if we want to reduce the reliance on opioids, with all their negatives, for the management of pain in an aging population, we should be easing access to medical marijuana. With medical marijuana legal in 25 states, we're halfway there. 



Chronicle AM: UK Public Health Groups Call for Decrim, MPP Endorses Gary Johnson, More... (6/16/16)

Busy, busy: There's movement on marijuana banking, Gary Johnson picks up MPP's endorsement, a leading California cannabis oil producer gets busted, the AMA casts on leery eye on patient pain reports, a congresswoman wants to drug test the rich, British public health groups call for decrim, the Thai government wants to end the war on meth, and more.

[image:1 align:left caption:true]Marijuana Policy

Senate Committee Approves Measure to Ease Pot Businesses' Access to Financial Services. The Senate Appropriations Committee on Thursday voted 16-14 to approve an amendment that would bar the Treasury Department from punishing banks that do business with state-legal marijuana businesses. The amendment is part of the FY 2017 Financial And General Government Services Appropriations Act, which now heads for a Senate floor vote.

Marijuana Policy Project Endorses Libertarian Gary Johnson for President. MPP has formally endorsed Libertarian Party candidate Gary Johnson for president, saying he was the obvious choice as the most pro-marijuana legalization candidate on the ballot. The group said its endorsement was based solely on his marijuana policies.

New York Assembly Passes Bill to Seal Records for Misdemeanor Marijuana Convictions. The Assembly has passed Assembly Bill 10092, which will seal the conviction records of people charged with misdemeanor offenses. Assembly Speaker Carl Heastie said the move was in response to New York City police charging people with misdemeanors for possession of marijuana in public. Simple possession is decriminalized in the state.

Medical Marijuana

Leading California Medical Marijuana Oil Maker Busted.Police, including DEA agents, raided five properties associated with a well-known medical marijuana products manufacturer in Northern California's Sonoma County Wednesday morning, detaining at least nine people and arresting one on suspicion of felony drug manufacture for his role in cannabis oil production.The operation raided was Care By Design (CBD Guild), which produces CBD-rich cannabis oils for use in sprays, gels, and cannabis oil cartridges for vaporizers. The company offers products with five different ratios of CBD to THC so "patients can adjust their cannabis medicine to suit their specific conditions and personal preferences." Police accused the operation of using dangerous and illegal butane extraction for their oils, but Care By Design says that is not the case.

Heroin and Prescription Opioids

AMA Resolutions Aim to Curb Opioid Abuse, Will Ignore Patients' Pain Reports. At its annual meeting in Chicago, the American Medical Association (AMA) approved a number of resolutions aimed at curbing the misuse of prescription opioids. One called for removing any barriers to non-opioid pain therapies, one calls for promoting increased access to the opioid overdose reversal drug naloxone (Narcan), but "the group also voted in favor of efforts to remove pain as a vital sign in professional standards, as well as disconnecting patient satisfaction scores from questions related to the evaluation and management of pain," a move that may not bode well for chronic pain patients.

Asset Forfeiture

Company Now Offers Asset Forfeiture Insurance to Cannabusinesses. CBZ Insurance Services is now offering coverage to protect state-legal marijuana businesses from the threat of seizure and asset forfeiture. The company's "search and confiscation" coverage applies only to entities that are state-legal and are found innocent of any raid-related charges. "A legally operating cannabis business has unique challenges other types of businesses don't have," said CBZ's Jeffrey Rosen. "One challenge is the threat of being shut down at any time by law enforcement. Whether you're a grower, distributor or manufacturer, search and seizure coverage is the best protection for a company's assets."

Drug Testing

Congresswoman Wants to Drug Test the Rich Before Approving Tax Deductions. US Rep. Gwen Moore (D-WI) has called for requiring wealthy Americans to undergo a drug test before approving their tax deductions. Moore said she will file the bill because she is "sick and tired, and sick and tired of being sick and tired, of the criminalization of poverty," referring to efforts pushed by Republican governors and legislators to impose drug testing requirements on people seeking public benefits. "We're not going to get rid of the federal deficit by cutting poor people off SNAP. But if we are going to drug-test people to reduce the deficit, let's start on the other end of the income spectrum."

International

British Public Health Bodies Call for Drug Decriminalization. Two leading public health bodies say drug use is a health issue, not a criminal one, and have called for drug decriminalization. The Royal Society for Public Health and the Faculty of Public Health said that criminalizing drug use has not deterred people from using drugs, and that those harmed by drug use are harmed again by punishment. "We have taken the view that it is time for endorsing a different approach," said Shirley Cramer, chief executive of the Royal Society. "We have gone to our stakeholders and asked the public and tried to gain some consensus from our community and the public, because that is very important." The society has detailed in its new line in the aptly named report Taking a New Line on Drugs.

Thailand Government Proposes Ending War on Meth and Regulating It Instead. Thai Justice Minister Paiboon Koomchaya has suggested removing meth from the country's dangerous illicit drug list and putting it in the same category as medicinal drugs, with controls -- not bans -- on distribution, sale, and use of the drug. Current measures to suppress the drug have not worked, he said. Paiboon's comments came in a discussion of the UN General Assembly Special Session on Drugs (UNGASS), which met in April. "The world has now surrendered to drugs, and has come to think of how to live with drugs. It is like a man suffering from cancer and having no cure and he has to live a happy life with the cancer," Gen Paiboon said. The government has drawn up a bill that would do that, he said.

(This article was prepared by StoptheDrugWar.org"s lobbying arm, the Drug Reform Coordination Network, which also pays the cost of maintaining this web site. DRCNet Foundation takes no positions on candidates for public office, in compliance with section 501(c)(3) of the Internal Revenue Code, and does not pay for reporting that could be interpreted or misinterpreted as doing so.)



Chronicle AM: CA MJ Driving Bill Killed, OH MedMJ Init Quits, More... (5/31/16)

An effort to create a per se marijuana DUID law in California ran into a brick wall of science, the Ohio effort to put a medical marijuana initiative on the ballot shuts down, a US senator seeks an investigation into Purdue Pharma over its claims on OxyContin's extended effectiveness, and more.

[image:1 align:left caption:true]Marijuana Policy

California Driving While High Bill Killed. A bill that sought to create a per se marijuana drugged driving level of 5 nanograms of THC per milliliter of blood has been killed in the Assembly Appropriations Committee. The committee killed it and a bill that would have let police use oral swabs to strengthen cases after cannabis industry officials said they were not supported by science.

Medical Marijuana

Illinois Medical Marijuana Program Gets Extension, Expansion. The House Friday voted to approve a plan to expand the state's medical marijuana program by adding PTSD and terminal illness to the program's list of qualifying conditions and by extending the program for an additional 2 ½ years. Gov. Bruce Rauner (R) has now come around and says he supports the bill, which still needs a final Senate vote. The measure is Senate Bill 10.

Ohio Medical Marijuana Initiative Backers Call It Quits. Faced with a medical marijuana bill approved by the legislature and awaiting the governor's signature, Ohioans for Medical Marijuana announced Saturday that they were ending their campaign to put an initiative on the November ballot. The Marijuana Policy Project-backed effort decided to call it quits because "the reality is that raising funds for medical marijuana policy changes is incredibly difficult, especially given the improvements made to the proposed program by the Ohio General Assembly and the fact that the Governor is expected to sign the bill." The bill passed by the legislature will allow people with about 20 different diseases and conditions to use marijuana, but not to smoke it.

Heroin and Prescription Opioids

US Senator Calls on Feds to Investigate Purdue Pharma Over OxyContin Time-Effectiveness Claims. A US senator has called for a federal investigation of Purdue Pharma, the manufacturer of OxyContin, in the wake of reports that the money-making pain reliever wears off early in many patients, leaving them exposed to pain and increased risk of addiction. Sen. Edward Markey (D-MA) Friday sent letters to the Justice Department, the Food and Drug Administration, and the Federal Trade Commission urging them to begin probes of the Connecticut-based drug maker.

New York Overdose Tracking Bill Goes to Governor. The Senate and the Assembly have both approved a bill that requires the state Health Department to track non-fatal drug overdoses in a bid to get a more complete picture of opioid drug use in the state. The bill is now on the desk of Gov. Andrew Cuomo (D).



US Senator Calls on Feds to Investigate Purdue Pharma Over OxyContin Time-Effectiveness Claims

This article was produced in collaboration with AlterNet and first appeared here.

A US senator has called for a federal investigation of Purdue Pharma, the manufacturer of OxyContin, in the wake of reports that the money-making pain reliever wears off early in many patients, leaving them exposed to pain and increased risk of addiction.

[image:1 align:right]Sen. Edward Markey (D-MA) Friday sent letters to the Justice Department, the Food and Drug Administration, and the Federal Trade Commission urging them to begin probes of the Connecticut-based drug maker.

The move comes in the wake of a Los Angeles Times investigation into Purdue Pharma's claim that OxyContin relieves pain for 12 hours, which was one of the drug's main selling points. But the Times found that the effects often wear off before that, leaving patients cycling between relief and intense pain and suffering from opiate withdrawals before their next scheduled pill.

The Times also found that Purdue knew about the problem since OxyContin first appeared in 1996, but continued to claim that it worked for the full 12 hours in part to protect its revenues. The newspaper reported that when faced with the problem, Purdue instructed doctors to prescribe stronger doses, not more frequent ones. Stronger doses of opioid pain relievers are more likely to be implicated in overdose deaths.

"These are serious allegations," Markey wrote in his letter to Attorney General Loretta Lynch. "They raise questions about ongoing deception by Purdue, harm to the public, continued costs to the United States, and the availability of further judicial recourse against Purdue. If upon investigation these allegations are substantiated, the Department should take legal action" against the drug company.

Purdue has rejected the Times' findings, noting that the FDA had approved OxyContin as a 12-hour drug.

"We promote our medicines only within the parameters approved by FDA and, given FDA has not approved OxyContin for eight-hour use, we do not recommend that dosing to prescribers," the statement said.

That's not good enough for Markey, who represents a state hard-hit by problems with prescription opioids and heroin. More than 1,300 people died from opioid overdoses in the state last year, according to the state Department of Public Health.

In his letter to the FDA and FTC, Markey called Purdue "the leading culprit in the current opioid and heroin overdose epidemic" and accused it of making "false and misleading claims about the longevity of OxyContin's pain-relieving properties."

The FDA and FTC should "investigate these claims and take action to protect patients and consumers from the harm caused by Purdue Pharma's deceptive marketing materials."

Justice, FDA, and FTC all say they are studying Markey's letter.



The Drug Enforcement Administration worked with pain management specialists to develop pain prescription guidelines so that law enforcement could do its job and physicians could do theirs. A month later, DEA pulled the guidelines.


In a letter, 30 state attorneys general take DEA to task over withdrawal of pain management prescription guidelines. Check out this public service ad on the letter.


OxyContin has been the center of controversy as pain management has moved to the front of the public consciousness. Much of what's been reported is exaggerated. Click here for more news and information about Oxy and pain management issues.


Excerpts from Cato Institute Analysis*:

"The government is waging an aggressive, intemperate, unjustified war on pain doctors."

"By demonizing physicians as drug dealers and exaggerating the health risk of pain management, the federal government has made physicians scapegoats for the failed drug war. Even worse, the Drug Enforcement Administration's renewed war on pain doctors has frightened many physicians out of pain management altogether, exacerbating an already serious health crisis - the widespread undertreatment of intractable pain."

"Experts agree that tens of millions of Americans suffer from undertreated or untreated pain ... According to one 1999 survey, just one in four pain patients received treatment adequate to alleviate suffering."

"The medical evidence overwhelmingly indicates that when administered properly, opioid therapy rarely, if ever, results in 'accidental addiction' or opioid abuse."

"Pain specialists make an important distinction between patients who depend on opiates to function normally - to get out of bed, tend to household chores, and hold down jobs - and

addicts who take drugs for euphoria, and whose lifestyles deteriorate as a result of taking opiates, instead of improving. The DEA makes no such distinction."

"The relationship between a doctor and his patient is crucial to the proper assessment and treatment of the patient's condition. The DEA's aggressive investigative procedure poisons the doctor-patient relationship from both sides."

"The DEA continues to lower its evidentiary standards, making it nearly impossible for many doctors to determine what is and isnít permitted."

"Large quantities of narcotics routinely go missing en route from manufacturers to wholesalers and from wholesalers to retailers. The DEA itself acknowledges this problem. Given the poor job the DEA is doing of monitoring the narcotics it's charged with overseeing ... DEA's attempt to blame physicians for the drugs' street availability seems arbitrary, unjustified, and capricious."

Common Sense for Drug Policy
www.CommonSenseDrugPolicy.org, www.DrugWarFacts.org

H. Michael Gray, Chair; Robert E. Field, Co-Chair
info@csdp.org

* "Treating Doctors as Drug Dealers: The DEA's War on Prescription Painkillers" by Professor Ronald T. Libby, June 16, 2005.
http://www.cato.org/pubs/pas/pa545.pdf

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