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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: OR Dems Just Say Yes, DEA Tightens Screws on Vicodin, CT's First Dispensary Opens, Peru Coca Eradication, Venezuela Plane Shootdowns (8/21/14)

Oregon Dems just say yes, Connecticut's first dispensary opens, the DEA tightens the screws on Vicodin, guess who's more likely to get busted for pot in Ferguson, Missouri, and more. Let's get to it:

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

Oregon Democratic Party Endorses Legalization Initiative. Oregon's Democratic Party has endorsed Measure 91, the New Approach Oregon marijuana legalization initiative. "A majority of Americans and large majority of Democrats now support state regulation of legal marijuana use," the party said. "Measure 91 is the right approach to legalization in Oregon, strictly regulating use while funding law enforcement and schools. Vote Yes on 91."

No Decriminalization Vote in Toledo in November. Even though Northwest Ohio NORML turned in sufficient signatures to qualify a decriminalization initiative for the local ballot earlier this month, voters will not have a chance to get their say in November because the city council failed to act by today. The council doesn't have another meeting set until last week. It's unclear if the initiative is now dead, or if it will go on the ballot at a later date.

Medical Marijuana

Connecticut Gets First Medical Marijuana Dispensary. The first dispensary in the state opened Wednesday night in South Windsor. Prime Wellness of Connecticut is the first of six dispensaries approved for licenses by the Department of Consumer Protection. The rest will be opening in coming weeks or months.

Prescription Opiates

DEA Tightens Rules on Popular Pain Relievers. It is about to get more difficult to obtain popular pain medications based on hydrocodone, including widely prescribed drugs such as Vicodin. The DEA announced today that it is moving hydrocodone combination drugs from Schedule III of the Controlled Substances Act (CSA) to Schedule II. Drugs containing only hydrocodone were already placed on Schedule II, but drug combinations containing hydrocodone plus other substances, such as aspirin or acetaminophen, have been Schedule III since the CSA was passed in 1970.The DEA will publish the final rule establishing the change in the Federal Register tomorrow. It will go into effect in 45 days.

Law Enforcement

Blacks in Ferguson, Missouri, More Than Three Times More Likely Than Whites to Be Arrested for Marijuana Possession. In its podcast this week, Missouri drug reform group Show-Me Cannabis points to the drug war connection in the tensions between police and residents in the predominantly black St. Louis suburb of Ferguson, plagued by more than 10 days of unrest since the killing of unarmed black teenager Michael Brown. Show-Me's John Payne points out that black residents of Ferguson are 3.25 times more likely to be arrested for marijuana possession than whites. Click on the title link to listen to the podcast.

International

West Africa Drugs Commission Head Says Region Must Step Up, Deal With Political Weakness. Former Nigerian President Olusegun Obasanjo, who also heads the West Africa Commission on Drugs, said countries in the region must confront their political and institutional weaknesses if they are to get a handle on the drug trade. "West Africa is no longer only a transit zone of drugs but an attractive destination where pushers take advantage of the weak political system to perpetuate their trade," he said during a meeting with Ghana's President John Mahama."We believe that we should confront openly the political and governance weaknesses which the traffickers exploit," Obasanjo said. "Drug barons can buy, they can do, and they can undo -- buy officials in the military, security and pervert justice." The commission has called on West Africa to decriminalize drug use and treat the issue as a public health problem.

Peru Aims to Eradicate 75,000 Acres of Coca Plants This Year. Peru's anti-drug agency, DEVIDA, says it has already eradicated 30,000 acres of coca plants this year and plans to eradicate another 45,000 acres by years' end. The eradication is being done manually and in tandem with $90 million crop substitution program. About 125,000 acres are under cultivation for coca. Peru is arguably the world's largest coca producer (vying with Colombia), and 90% of the crop is estimated to be destined for the illicit cocaine trade.

Venezuela Has Shot Down at Least Three Suspected Drug Planes in Last Year. At least three planes flying out of Mexico and suspected of carrying drugs have been shot down over Venezuela since last November. This Vice News report goes into detail on the search for one of the missing pilots.



DEA Tightens Rules on Popular Pain Relievers

It is about to get more difficult to obtain popular pain medications based on hydrocodone, including widely prescribed drugs such as Vicodin. The DEA announced today that it is moving hydrocodone combination drugs from Schedule III of the Controlled Substances Act (CSA) to Schedule II.

[image:1 align:left]Drugs containing only hydrocodone were already placed on Schedule II, but drug combinations containing hydrocodone plus other substances, such as aspirin or acetaminophen, have been Schedule III since the CSA was passed in 1970.

The DEA will publish the final rule establishing the change in the Federal Register tomorrow. It will go into effect in 45 days.

This is the end result of a rescheduling request first submitted in 1999, and another indication of retreat from the looser prescribing of opiate pain medications that began about 15 years ago. It comes as prescription overdose deaths and rising levels of heroin addiction are sparking public and official concern.

"Almost seven million Americans abuse controlled-substance prescription medications, including opioid painkillers, resulting in more deaths from prescription drug overdoses than auto accidents," said DEA administrator Michele Leonhart. "Today's action recognizes that these products are some of the most addictive and potentially dangerous prescription medications available."

Moving these hydrocodone combination products to Schedule II will significantly tighten access to them. Patients will not be able to get refills on the same prescription, but will have to go back to the doctor's office to get another one. Doctors will no longer be able to call in prescriptions. And pharmacies will have to store the drugs in secured vaults.

"This is substantial," said Dr. Nathaniel Katz, assistant professor of anesthesia at Tufts University School of Medicine in Boston. "It's a sign of a shift toward more cautious opioid prescribing. This will be an inconvenience to some, but policy is a machete not a scalpel and you have to figure out where to use it. I think people will be more helped than harmed," he told the New York Times.

But Dr. John Mendelson, a professor of medicine at the University of California-San Francisco, and an addiction specialist, told the Times he thought the change would lead to an increase in prescriptions of other drugs such as oxycodone, and a rise in the use of heroin.

Other pain management experts have yet to offer opinions, but there is likely to be criticism that the move will create more obstacles for chronic pain sufferers, including those who have problems making it to the doctor's office for a visit to get a prescription written. As many as 100 million Americans suffer from chronic pain, according to a 2011 study from the Institute of Medicine.



House Passes Pain Meds Bill

The House of Representatives on Tuesday passed House Resolution 4709, the Ensuring Patient Access and Drug Enforcement Act of 2014. The measure sponsored by Rep. Tom Marino (R-PA) passed on a voice vote.

[image:1 align:right]Attempts in recent years to tighten up access to opiate pain medications have led to insistent charges that legitimate pain patients are left to suffer needlessly. This bill attempts to both reduce the diversion of prescription medications and ensure that people with medical needs for them have access.

The bill does the former by amending the Controlled Substance Act (CSA) to clarify that when the Justice Department issues a license to manufacture, distribute, or dispense a controlled substance "consistent with the public health and safety," that means the issuance of the license has a substantial relation to the CSA's purpose of preventing diversion and abuse.

It also clarifies that when the Justice Department issues a finding of "imminent danger" justifying the immediate suspension of such a license, that means a significant, current risk of death or serious bodily injury is more likely to occur without such a suspension.

The bill includes language providing some protections to licensees who face a revocation of their registrations. The Justice Department must provide specific grounds for doing so, and if it alleges a legal violation, it must cite the specific law. The Department would also have to give the registrant the opportunity to present a corrective plan of action.

When it comes to ensuring patient access to prescription pain medications, the bill calls for the Department of Health and Human Services, through the Food and Drug Administration and the Centers for Disease Control and Prevention, to assess "how patient access to medications could be adversely impacted by federal and state enforcement activities" and identify "how collaboration between agencies and stakeholder can benefit patients and prevent diversion and abuse of controlled substances."

The bill specifies that such an evaluation include consultation with patient groups, as well as pharmacies, drug manufacturers, health care providers, state attorneys general, state and federal law enforcement agencies, health insurance providers, common carriers, and wholesale drug distributors.

The measure now goes to the Senate.



Chronicle AM -- July 15, 2014

The Obama administration comes out against congressional interference with the District of Columbia's decriminalization law, Dana Rohrabacher comes out as the first Republican congressman to support marijuana legalization, the Smarter Sentencing Act picks up more sponsors, and more. Let's get to it:

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

White House Comes Out Against Congress Blocking DC Decriminalization Law. In a statement of administration policy on pending appropriations bills, the White House Monday came out "strongly" against a congressional move to bar the District from spending money to implement its new decriminalization law. "The Administration strongly opposes the language in the bill preventing the District from using its own local funds to carry out locally- passed marijuana policies, which again undermines the principles of States' rights and of District home rule. Furthermore, the language poses legal challenges to the Metropolitan Police Department's enforcement of all marijuana laws currently in force in the District," the statement said.

DC City Council Passes Emergency Resolutions Condemning Congressional Interference. The council Monday approved two emergency resolutions opposing a recent effort led by US House Representative Andy Harris (R-MD) to use congressional oversight to block the District of Columbia from spending any of its locally-raised revenues to enact marijuana reform. Read more on DC marijuana politics in a feature article here later today.

Dana Rohrabacher, First Republican Congressman to Back Marijuana Legalization. California Republican US Rep. Dana Rohrabacher told the Christian Science Monitor Monday that he supports legalizing marijuana and would "probably" endorse a 2016 California legalization initiative if it qualifies for the ballot. Rohrabacher is the first sitting Republican congressman to explicitly endorse legalization. About 40 congressional Democrats have expressed support for legalization.

National Press Club Newsmakers Event Next Week Centers on Marijuana Policy. The National Press Club in downtown Washington, DC, will host a news conference next Thursday on medical and recreational marijuana legalization. The news conference will feature Bill Piper, national affairs director for the Drug Policy Alliance, and Dr. Kevin Sabet of the anti-legalization group Project SAM (Smart About Marijuana). The event is open to all credentialed journalists and National Press Club members. Click on the link for event details.

Medical Marijuana

Missouri Governor Signs CBD Cannabis Oil Bill. Gov. Jay Nixon (R) yesterday signed into law a bill allowing Missourians with epilepsy that cannot be treated by conventional means to use low-THC, high-CBD cannabis oil. Patients will have to register for the state and have a neurologist aver that conventional treatments have not worked.

Los Angeles Moves to Shut Down Medical Marijuana Farmers' Market. Los Angeles City Attorney Mike Feuer has said he will today seek a restraining order to block a Boyle Heights medical marijuana farmers' market from doing it again. The farmers' market occurred two weekends ago. It isn't clear if there are plans to do it again.

Prescription Opiates

University of Wisconsin Pain Policy Study Group Releases Two Reports. The reports are Achieving Balance in State Pain Policy: A Progress Report Card (CY 2013) and Achieving Balance in State and Federal Pain Policies: A Guide to Evaluation (CY 2013). The first report contains a grade for each state and the District of Columbia, which represents the extent that state policies can support pain management and patient care. The second report explains PPSG's evaluation method and criteria as well as its "principle of balance," which says that "efforts to prevent drug diversion and abuse are essential and should avoid interfering with healthcare practice and patient care."

Law Enforcement

Oklahoma Narcs on the Lookout for Kratom. The Oklahoma Bureau of Narcotics is worried about kratom, a Southeast Asian shrub whose leaves are mildly psychoactive and who some users claim is useful as a means of breaking opiate addictions. The OBN says it is not a "major problem" yet, but that it has received worried phone calls from a half-dozen parents. Kratom is on the DEA's list of drugs to watch, but the federal agency has made no move to ban it.

Sentencing

Smarter Sentencing Act Picks Up Two More Cosponsors. Reps. Mark Pocan (D-WI) and Donald Payne (D-NJ) are the latest to sign onto the Smarter Sentencing Act, which would reduce some federal drug sentences by retroactively adjusting crack and powder cocaine sentences and allowing judges to sentence below mandatory minimums in some cases. The act now has 44 cosponsors -- 30 Democrats and 14 Republicans. Similar legislation has been filed in the Senate.

International

Dutch Senate Wants Justice Minister to Explain What He's Doing About Illegal Marijuana Production. The Senate has summoned Justice Minister Ivo Opstelten to explain what he is doing about "the backdoor problem" -- the fact that while cannabis coffee shops can sell marijuana without legal penalty, there is no legal source for the marijuana they sell. Opstelten and Home Affairs Minister Ronald Plasterk will appear before the Senate in September. Despite the pleas of numerous mayors, Opstelten has refused to allow experiments with regulated marijuana production.



Chronicle AM -- July 11, 2014

A St. Paul drug raid is raising questions about police tactics, the hemp industry wants to clarify something, Tennessee gets its first bust under a law criminalizing drug-using pregnant women (and its first threat of a legal challenge), Pennsylvania issues opiate prescribing guidelines, and more. Let's get to it:

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

New Mexico Municipal Decriminalization Initiatives Halfway There on Signatures. Decriminalization initiative signature-gathering campaigns in Albuquerque and Santa Fe are at the halfway point in terms of signatures gathered. Two groups, Progress Now New Mexico and Drug Policy Action, the campaign arm of the Drug Policy Alliance, are leading the effort. The campaigns reported having half the 5,673 signatures needed in Santa Fe. They also need 11,203 signatures in Albuquerque; organizers say they are more than halfway there in the Duke City as well.

Medical Marijuana

Minnesota Governor Names 16 to Medical Marijuana Task Force. Gov. Mark Dayton (DFL) has named the members of a state task force charged with monitoring the effectiveness of the state's new limited medical marijuana law. Included are four patients or their parents, four law enforcement entities, four substance abuse treatment providers and four health care providers. It also includes two lawmakers each from the House and Senate, as well as the commissioners of Health, Human Services and Public Safety. Click on the link for a list of members.

Hemp

Hemp Industries Association Clarifies That CBD Extracts Are Not "Hemp Oil." The trade group the Hemp Industries Association has released a statement emphasizing that cannabidiol (CBD) extracts are not "hemp oil" and warning against misbranding them as such. The CBD extracts are made from marijuana flowers for medicinal purposes, while hemp oil, produced by pressing hemp seeds, is a food item containing only tiny amounts of CBD. Click on the link to read the full statement.

Pregnancy

First Woman Arrested Under Tennessee's New Law Criminalizing Pregnant Women Who Use Drugs. A 26-year-old Monroe County woman has been charged with assault on her fetus for using methamphetamine shortly before she gave birth under a new law that allows prosecutors to press assault and child endangerment charges against women who use drugs. Under that law, "a woman may be prosecuted for assault for the illegal use of a narcotic drug while pregnant, if her child is born addicted to or harmed by the narcotic drug." But neither doctors nor prosecutors have shown any harm to the woman's newborn baby.

Tennessee ACLU Seeking to Challenge New Law Criminalizing Pregnant Women Who Use Drugs. The ACLU of Tennessee is currently seeking plaintiffs to challenge the new law criminalizing pregnant women who use drugs. The law is the first of its kind in the country. "This dangerous law unconstitutionally singles out new mothers struggling with addiction for criminal assault charges," said Thomas Castelli, Tennessee ACLU legal director. "By focusing on punishing women rather than promoting healthy pregnancies, the state is only deterring women struggling with alcohol or drug dependency from seeking the pre-natal care they need. ACLU-TN stands ready to challenge this law and encourages any woman concerned about the impact this law will have on her to contact us." Click on the link for more information.

Prescription Opiates

Pennsylvania Releases Guidelines for Prescribing Opiates. State officials and the Pennsylvania Medical Society have released new voluntary opiate prescribing guidelines as part of an effort to reduce overdose deaths. The guidelines are aimed at family practice doctors who are not pain treatment specialists. A University of Wisconsin pain policy specialist, James Cleary, said the guidelines were "very responsible," but raised concerns that opiates remain available for those who truly need them. Task force members responded that finding the proper balance was critical.

Law Enforcement

St. Paul SWAT Drug Raid Scores Bong, Grinder; Leaves Two Dogs Dead. A St. Paul, Minnesota, police SWAT team executing a no-knock search warrant at a family home burst through the front door without notice at 7:00am and promptly shot and killed the family's two pet pit bulls. "The first thing I heard was 'boom,'" said homeowner Larry Lee Arman. "Bop, bop, bop, bop, bop. Right in front of us. I was laying right there and I really thought I was being murdered," he said "I don't want to say by who. I thought it was, like, the government." Police said they thought they were entering a dangerous environment and had a right to eliminate potential threats with lethal force, but Arman said he wasn't a dangerous drug dealer, only a pot smoker. The SWAT team's haul seems to bear him out. They seized only "clothing, a glass bong, and suspected marijuana remnants in a metal grinder."

International

New York Times Takes a Look at Barcelona's Cannabis Clubs. The New York Times has a lengthy profile of Barcelona's burgeoning cannabis social club scene. It reports that the clubs, where members may buy and consume marijuana, now have 165,000 members, and that they are creating marijuana tourism. Officials are concerned.

Barcelona Police Arrest Cannabis Club Leaders. Police in Barcelona Friday arrested the president and at least three other members of the city's cannabis club federation FEDCAC. The group said it was not told why they were arrested, but other Spanish press reports said it was on money laundering charges. The bust comes as the city tries to crack down on the burgeoning clubs, which are legal under Spanish law, but have been testing the limits.

Transnational Institute Analyzes Colombia/FARC Accord on Drugs, Finds It Lacking. In a policy briefing on the Colombian peace accords, the Transnational Institute finds that FARC guerrillas are only "part of the problem" in the "complex scenario" of Colombian drug trafficking; that it effectively excludes rural settlers, indigenous and African-descent communities; that the agreement ratifies existing prohibition-based approaches to drugs; and that it ignores the ongoing progress in adopting other drug control models. Other than that…



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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