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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: 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.



Chronicle AM: Bratton Blames MJ for Prohibition Violence, Opioid Prescriptions Decline, More... (5/23/16)

Bill Bratton misses the point on prohibition and violence, Nebraskans will have to wait for medical marijuana, Fentanyl is displacing heroin in Vancouver, and more.

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

New York City's Top Cop Blames Marijuana Legalization -- Not Prohibition -- for Black Market Violence. NYPD Commissioner Bill Bratton Sunday criticized states that have legalized weed because there is violence around the black market in his city, which hasn't legalized weed. "Here in New York, the violence we see associated with drugs, the vast majority of it, is around the issue of marijuana, which is ironic considering the explosion in use of heroin now in the city," Bratton said. "Interestingly enough, here in New York City most of the violence we see -- violence around drug trafficking -- is involving marijuana and I have to scratch my head as we are seeing many states wanting to legalize marijuana, and more liberalization of policies."

Medical Marijuana

No Medical Marijuana Initiative for Nebraska This Year. Cornhusker medical marijuana advocates have decided to delay a petition drive to get the issue on the ballot until 2018. They cited the late start this year and the expense involved.

Rhode Island Senate Approves Adding PTSD to List of Qualifying Conditions. The Senate last Friday unanimously approved a bill that will add PTSD to the list of debilitating medical conditions that qualify a patient for medical marijuana. The bill now heads to the House.

Heroin and Prescription Opioids

Opioid Prescriptions are Falling for the First Time in 20 Years. Two reports from health information providers show that opioid prescriptions have declined in recent years. IMS Health reported a 12% decline in opioid prescriptions nationally since 2012, while Symphony Health Solutions reported an 18% drop during those years. IMS said prescriptions have fallen in 49 states, with only South Dakota showing an increase. The figures could have implications not only for overdose and addiction rates, but also for pain patients. "The climate has definitely shifted," said Dr. Daniel B. Carr, the director of Tufts Medical School's program on pain research education and policy. "It is now one of reluctance, fear of consequences and encumbrance with administrative hurdles. A lot of patients who are appropriate candidates for opioids have been caught up in that response."

International

In Vancouver, Heroin Has Been Displaced by Fentanyl. The synthetic opioid has been identified in half of all drug overdoses in the city this year, which is on track to exceed last year's drug overdose toll. Advocates for drug users in the city's Downtown East Side say there's no more heroin on the street after it has been pushed out by the cheaper and more potent Fentanyl. "Traditionally, heroin comes in about four different colors,"said the longtime drug advocate Hugh Lampkin of the Vancouver Area Network of Drug Users, describing a bland palette of beiges, browns and blacks. "Well now you're seeing multiple colors, like colors of the rainbow: green and pink and orange and white... Right away, when you see these colors that's a pretty good indicator that it's fentanyl that you're doing. The people who are controlling the supply, they're passing off what should be heroin as fentanyl because of the close proximity of the high."

Afghans Celebrate Bumper Opium Harvest. Hundreds of laborers from across the Pashtun heartland gathered in Naqil, Uruzgan province, to harvest a bumper crop of opium poppies and celebrate with after-work games in a festival-like atmosphere. "This is the only time of the year to make money," said Afzal Mohammad, who came all the way from Kandahar, standing amid chest-high poppy stalks nearby. "People work here for about 15 days and then are jobless for the rest of the year."



Chronicle AM: CDC Urges Docs to Severely Limit Pain Pill Prescribing, NY Rep Wants Safe Injection Sites, More... (3/16/16

Another poll has a national majority for pot legalization, the Vermont legalization bill is now before the House, the CDC urges doctors to really cut back on pain pill prescriptions, a New York assemblywoman wants supervised injection sites, a Mexican governor wants a pilot program of opium cultivation, and more. 

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

Another Poll Has a Narrow National Majority for Legalization. A new national tracking poll conducted by Morning Consult has support for legalization at 52%, with 43% opposed and 5% undecided. That's in line with other major national polls in recent years that generally show support for legalization in the 50s. The most recent Gallup poll had it at 60%.

Massachusetts Sheriffs Oppose Legalization Initiative. More of the usual suspects weigh in against legalization, with the state's sheriffs saying it would destigmatize drug use and make it easier for teens to get their hands on the weed. Last week, the state Hospital Association and leading elected officials, including Gov. Charlie Baker (R), Attorney General Maura Healey (D), and Boston Mayor Marty Walsh (D) came out against the initiative from the Campaign to Regulate Marijuana Like Alcohol in Massachusetts.  

Vermont Legalization Bill Now Before House. Senate Bill 241, the pot legalization bill, is now before the House Judiciary Committee. On Tuesday, Sen. Dick Sears (D-Bennington) and Sen. Joe Benning (R-Caledonia) introduced the bill to the committee.

Medical Marijuana

Georgia CBD Cannabis Oil Bill Revived. Supporters of House Bill 722, which would expand access to CBD cannabis oil, have resurrected the measure by attaching its language to an old Senate bill. It could go to a House vote as early as today. The bill would expand conditions that qualify for CBD cannabis oil and allow companies outside the state to ship it in. Language that would have allowed in-state marijuana cultivation to produce the oil was stripped out earlier in the House.

More Michigan Medical Marijuana Dispensary Raids. The West Michigan Enforcement Team (WEMET) has raided four dispensaries for allegedly selling medical marijuana to cardholders who were not their registered patients. Two were in Saugatuck, one in Allegan City, and one in Pullman. Twelve other Northern Michigan dispensaries were raided last week.

Ohio Medical Marijuana Campaign Resubmits Initiative. That didn't take long. Last Friday, Attorney General Mike DeWine (R) rejected the Ohioans for Medical Marijuana initiative because of deficiencies in its summary. On Tuesday, the campaign submitted revised language. After 20 days of review by state officials, the campaign will then have until July to gather 306,000 valid voter signatures to qualify for the November ballot.

Criminal Justice

Massachusetts Conference Committee Agrees on Ending Driver's License Suspensions for Drug Offenders. House and Senate negotiators announced Tuesday that they had reached agreement on a bill to end the state's long-running policy of automatically suspending for five years the driver's licenses of people convicted of drug crimes. The relic of the 1980s drug war will be officially repealed after the full House and Senate vote on the amended bill. Both houses passed bills, and the conference committee has been ironing out the differences. More than 30 other states have taken similar steps.

Heroin and Prescription Opioids

CDC Urges Docs to Reduce Prescribing Pain Relievers. In a move bitterly decried by chronic pain advocates, the Centers for Disease Control and Prevention (CDC) said Tuesday doctors should only prescribe opioid pain relievers as a last resort. Instead, doctors should urge their patients to try physical therapy, exercise, and over-the-counter medications before using opioids to treat chronic pain. The CDC is recommending not using opioids except to treat cancer and for palliative end-of-life care, using the lowest effective dose of opioids, and limiting prescriptions to three days for short-term pain.

Harm Reduction

New York Assemblywoman Wants Supervised Injection Facilities Statewide. Assemblywoman Linda Rosenthal (D-Manhattan) said Tuesday she will soon introduce a bill to establish the harm reduction facilities. Rosenthal's move comes after Ithaca Mayor Svante Myrick hoisted a proposal for such a facility there. "New York, and nearly every other state across the country, is grappling with a heroin and opioid addiction crisis that has grown to epidemic proportions," said Rosenthal, who heads the Assembly's Committee on Alcoholism and Drug Abuse, in a statement. "Addiction is a public health crisis, and we must address it as such, with aggressive, community-based solutions that reduce harm and provide access to life-saving treatment services."

International

Mexican Governor Proposes Legalizing Opium Cultivation.  Hector Astudillo, governor of violence-plagued Guerrero, said Monday that legalizing opium cultivation for medical purposes might help reduce the violence in his state and the idea should be considered. "Let's do some sort of pilot scheme," Astudillo, a member of President Enrique Pena Nieto's Institutional Revolutionary Party, said. "Provided it's used for medical issues ... It's a way out that could get us away from the violence there has been in Guerrero," he added.



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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