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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: 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.



Will UNGASS 2016 Be the Beginning of the End for the War on Drugs?

This article is by Ann Fordham and Martin Jelsma, and is republished from

read more



Chronicle AM: DC Council See-Saws on Pot Clubs, Fed Judge Throws Out Pot Credit Union Lawsuit, More (1/6/16)

Marijuana business access to banking services takes a hit from a federal judge, DC marijuana social clubs take a hit from the city council, Vermont legalization prospects get downplayed, pain patients are in the cross-hairs, and more.

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

Federal Judge Throws Out Marijuana Credit Union Lawsuit. US District Court Judge R. Brooke Johnson today dismissed a lawsuit seeking approval from the Federal Reserve branch in Kansas City for the first credit union for pot businesses in the state. Jackson said he was compelled to dismiss the suit because marijuana remains illegal under federal law.

DC City Council Approves, Then Bans Marijuana Social Clubs. In a topsy-turvy day, the council first voted 7-6 to let an emergency ban on pot social clubs expire, but moments later, two council members switched positions, and the ban was extended a a 9-4 vote. The ban remains in effect for 90 days, and activists will continue to agitate for it to be allowed to expire.

Vermont Legislative Leaders Pour Cold Water on Legalization Prospects This Year. As the legislative session opens, House Speaker Shap Smith (D) said that there are still too many unanswered questions about how legalization would work and that he doesn't think it is ready for a full debate at this time. Minority Leader Sen. Joe Benning (R) said he, too, had similar questions and that the effort was "not quite ready for prime time." Both Smith and Benning said they generally support legalization.

Medical Marijuana

Georgia Medical Marijuana Cultivation Bill Filed. State Rep. Allen Peake (R-Macon) has filed House Bill 722 (not yet available on the legislative website), which would allow the state to issue up to six licenses for medical marijuana growers. The legislature last year passed a bill allowing for the use of high-CBD marijuana, but included no provisions for growing it in the state.

New Psychoactive Substances

Florida Grand Jury Calls for Statewide Bans on Broad Classes of NPSs. Empaneled to confront the use of "flakka," a synthetic cathinone called alpha-PDP, a Broward County grand jury has issued a report calling for a state law that would ban entire classes of new psychoactive substances, such as synthetic cathinones, rather than limited bans on specified chemical compounds. The report calls for passage of the 2016 Florida Designer Drugs Enforcement Act proposed Monday by Attorney General Pam Bondi (R). Flakka has been linked to some 60 deaths in the state over the past four years.

Pain Treatment

CDC Proposed Opiate Prescribing Guidelines for Chronic Pain Include Provisions for Drug Testing All Pain Patients -- Still Time to Comment. The Centers for Disease Control (CDC) Guideline for Prescribing Opioids for Chronic Pain includes provisions for requiring drug testing of all pain patients -- including those with cancer or terminal illnesses. Comment on the proposed guidelines here. Comments are open until January 13.

International

Mexico City Mayor Supports Marijuana Legalization, Says Would Hurt Cartels. Mayor Miguel Angel Mancera said last week that marijuana legalization is an issue of personal freedom and that it would hurt illegal drug trafficking organizations. "My position is always in defense of freedom," he told El Universal. "I do support legalization." Legalizing marijuana would not be attractive for drug cartels, he added, saying "it would be a blow to them." Mancera's comments come as the country prepares for a national debate on legalization later this month.



Chronicle AM: UN Decriminalization Drama, Global Undertreatment of Pain Report, More (10/19/15)

A thousand march for marijuana in Dallas, a few dozen in Montgomery; a UNODC document calling for drug decriminalization gets leaked, then yanked; the Global Commission on Drug Policy issues a report on pain, and more.

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

Dallas March for Marijuana Brings Nearly a Thousand to the Streets. Around a thousand people joined a march calling for marijuana law reform in Texas Saturday. The march was organized by Dallas-Fort Worth NORML. Click on the link for more.

Dozens Turn Out for Alabama Rally for Marijuana Law Reforms. Several dozen people took to the foot of the state capitol last Friday to call for marijuana decriminalization and access to medical marijuana. Efforts to pass a medical marijuana bill have stalled in the legislature.

Medical Marijuana

Seneca Nation Moving Toward Medical Marijuana. The Seneca Nation of Indians is preparing to vote early next month on whether to authorize the National Council to start drafting laws and regulations to govern medical marijuana. The vote would be only a first step toward the tribe getting in the medical marijuana business. The Justice Department opened the door for tribes to get involved in pot operations with a memo last fall.

Kansas Silver Haired Legislature to Renew Push for Medical Marijuana. The Silver Haired Legislature, which advocates for senior citizens, is again calling on the legislature to pass medical marijuana. At a meeting earlier this month in Topeka, the group adopted three proposed bills it will push to see passed in the next term. Click on the link for more details.

International

UN Bid to Urge Drug Decriminalization Foiled. The UN Office on Drugs and Crime (UNODC) has withdrawn a document calling on governments to consider "decriminalizing drug use and possession for personal consumption" after at least one country objected. The document was leaked by Sir Richard Branson over the weekend, and when a journalist violated the UNODC's embargo on release of the document, UNODC walked back the report.

Global Commission on Drug Policy Releases Report on Undertreatment of Pain. The Global Commission on Drug Policy (GCDP) today released its third thematic report, The Global Crisis of Avoidable Pain: The Negative Impact of Drug Control on Public Health. The report was launched by Commissioners, former Swiss President Ruth Dreifuss, UN Secretary General Special Envoy on HIV/AIDS in Eastern Europe and Central Asia, Michel Kazatchkine and former United Nations Special Rapporteur on the right to health, Anand Grover. The report finds that three-quarters of the world's population has no access to pain-relieving drugs and that "the reasons for this have little to do with issues of cost or scarcity of supplies- and everything to do with the prohibition and repressive stand the world has taken on drugs. States are obsessed by the fear that people will use controlled medicines, such as morphine as drugs, thereby neglecting the important medical uses." Click on the title link to read the report.

WOLA Discussion on Impact of Drug Policy on Human Rights in the Americas Wednesday. The Washington Office on Latin America (WOLA) is hosting the discussion in Washington, DC, at lunch time Wednesday. Click on the link for speakers, more information, and to RSVP.

State Department Cuts Some Mexico Drug War Funding Over Human Rights Concerns. The State Department has concluded that Mexico failed to reach some human rights goals in its drug war, triggering the cutoff of millions of dollars of drug war assistance. The move only affects a small portion of overall US drug war aid to Mexico, but does signal growing frustration with alleged abuses by Mexican security forces. Some 15% of aid provided to Mexican security forces is subject to human rights provisions, meaning that Mexico lost $5 million of a total of $148 million in US drug war funding this year. That $5 million was instead diverted to Peru to help finance coca eradication.

Mexico Supreme Court to Take Up Marijuana Legalization Next Week. The high court is set to discuss a legal challenge that could effectively legalize the use and production of marijuana. The challenge comes from a non-profit that filed an injunction against the Mexican health regulatory body COFEPRIS over a 2013 ruling by that body. The hearing is set for October 28.

Norway's Two Largest Cities to Move Toward Giving Free Heroin to Addicts. The cities of Oslo and Bergen are set to begin heroin-assisted treatment pilot programs after the Labor Party won local elections there, but they will have to win approval from the national parliament first. Parliament rejected a 2012 effort to start the programs. Norway has the world's second highest drug overdose rate, after Estonia.



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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