Tag Archives: diversion

Diversion of Blame and the Opioid Crisis

Diversion of Blame and the Opioid Crisis – By Richard Dobson, MD – Pain News Network – Sept 2018

Dr. Dobson proposes an interesting model of how blame for the “opioid crisis” has fallen on pain patients instead of the drug abusers and drug dealers that are responsible for it.

…after years of bewilderment, I have come upon a clinical description that seems to describe the plight of people who suffer from chronic pain. Let me try to simplify this complicated and mystifying condition.

First, a brief overview of the current situation.  

There are five basic groups of people involved in the opioid crisis:   Continue reading

DEA Revises Opioid-Quota Rules Unchanged

DEA Revises Opioid-Quota Rules, Leaving Out Requested Change by Kerry Dooley Young – July 13, 2018

The Drug Enforcement Administration (DEA) will update its established procedures for setting production quotas for addictive drugs without heeding a recommendation from medical groups regarding shortages of injectable opioids.

The DEA on July 11 announced its final decision on changes to its regulations regarding aggregate production quotas (APQs), which it said were initially issued in 1971.

When a policy is close to 50 years old, it shouldn’t be revised or changed as much as thrown out entirely. So much more is known about medications and drugs in general than 50 years ago, it’s ludicrous that such old policies are still used at all.   Continue reading

U.S. fines CVS for failing to report opioid theft

U.S. fines CVS for failing to report opioid theft in New York – June 28, 2018 – Jonathan Stempel

CVS Health Corp agreed to pay a $1.5 million civil fine to resolve U.S. charges that some of its pharmacies in Nassau and Suffolk counties in New York failed to report in a timely manner the loss or theft of prescription drugs, including the opioid hydrocodone.

This is where the real diversion is coming from: the supply chain. Massive quantities of opioid tablets are embezzled, stolen, or “lost” as the pills are transported from the manufacturer to their warehouses, to various other warehouses, and finally to pharmacies.  Continue reading

Fallout From Telling Doctors How to Prescribe

Limiting Opioid Prescribing: The Fallout From Rules Telling Doctors How to PrescribeKenneth W. Lin, MD, MPH – May 08, 2018

Hello, everyone. I’m Dr Kenny Lin, a family physician at Georgetown University Medical Center in Washington, DC, and I blog at Common Sense Family Doctor.

The 2016 guideline on prescribing opioids for chronic non-cancer pain from the Centers for Disease Control and Prevention (CDC),[1] which I discussed in a previous Medscape commentary, recommends that clinicians “should avoid increasing dosage to greater than or equal to 90 morphine milligram equivalents (MME) per day or carefully justify a decision to titrate dosage” to that level.  Continue reading

DEA plan to stem supply of prescription drugs

DEA plan to stem supply of prescription drugs draws skepticism April 2018 – By Lev Facher @levfacher

Here is another article in support of yesterday’s post: DEA Draws Firestorm of Criticism for New Quotas

With pressure building on the the Drug Enforcement Administration to stem the supply of prescription drugs, a new proposal aims to empower the agency to more aggressively limit manufacturing levels and to put hundreds of drug makers on notice. It’s not yet clear whether the proposal will achieve either goal.

This is a policy that’s completely out of step with reality – overdoses moved on from prescription opioids to illicit opioids (often laced with fentanyl).  Continue reading

Suspected opioid drug thefts persist at VA centers

Suspected drug thefts persist at VA centers | WISH-TV  – Hope Yen, AP – May 2017

Federal authorities are investigating dozens of new cases of possible opioid and other drug theft by employees at Veterans Affairs hospitals, a sign the problem isn’t going away as more prescriptions disappear.

Data obtained by The Associated Press show 36 criminal investigations opened by the VA inspector general’s office from Oct. 1 through May 19. It brings the total number of open criminal cases to 108 involving theft or unauthorized drug use

The numbers are an increase from a similar period in the previous year.   Continue reading

Abuse-Deterrent Opioids A Double-Edged Sword

Are Abuse-Deterrent Opioid Products A Double-Edged Sword? – Practical Pain Management – May 16, 2017 – By Jasmine Shah, PharmD and Ryan W Rodriguez, PharmD, BCPS

Solving the opioid epidemic is complex because of the multifactorial underlying causes. Complicating this issue is the need to maintain access to opioids for patients with chronic pain conditions for which prescription opioid analgesics are the only effective treatment.

Any attempts to mitigate opioid abuse must not have the unintended consequence of eliminating a viable treatment option for patients using opioid medications appropriately and experiencing meaningful clinical improvement.  Continue reading

Lyrica and Neurontin Linked to Opioid Overdoses

Lyrica and Neurontin Linked to Opioid Overdoses — Pain News Network – May 2017

“It is important that doctors and people dependent on opioids are aware that the number of overdose deaths involving the combination of opioids with gabapentin or pregabalin has increased substantially and that there is evidence now that their concomitant use – either through co-prescription or diversion of prescriptions – increases the risk of acute overdose deaths,” said Matthew Hickman, a Professor of Public Health and Epidemiology

The idea that Lyrica and Neurontin are being abused may be surprising to many patients and doctors, but the drugs are increasingly being used by addicts.   Continue reading

Rx Drug Diversion an Issue at VA Hospitals

Prescription Drug Diversion an Issue at VA Hospitals  – Mar  2017 – Jennifer Barrett, Assistant Editor

I’ve long believed that the quantities of illicit Rx opioids available on the black market cannot be accounted for by pills stolen from “grandma’s medicine cabinet”. I think opioids are/were being diverted at a much higher level and involve huge quantities. By now, however, pills have become much too expensive in comparison to cheap heroin and illicitly manufactured fentanyl additives.

Employees involved in manufacturing, distribution, and pharmacy stocking aren’t as carefully monitored as individual pain patients, and diversion of mass quantities is so profitable that some of the staff involved in the supply chain are undoubtedly corruptible.  Continue reading

‘Inhumane treatment’ of pain patients

Strict limits on opioid prescribing risks ‘inhumane treatment’ of pain patients – By @StefanKertesz – Feb 2017

Lately I’ve been seeing dire warnings on Twitter:

  • Its important to have some sense before we make CDC suggestions enforceable, punitive, and not patient centric. https://t.co/G512mieHAf
  • No trials have tested impact of involuntary, nonexpertly-managed Opioid discontinuations. Risk of harm is high https://t.co/G512mieHAf
  • The road to hell is paved with good intentions. Making CDC #opioid guideline mandatory is ill-advised https://t.co/G512mieHAf
  • Let’s hit pause before @CMSGov makes @CDCgov #opioid Guideline mandatory  https://t.co/G512mieHAf

Stefan Kertesz, MD, is one of our most powerful advocates because he is an addiction specialist who speaks up for the right of both pain patients and addicts to receive treatment that is scientifically valid and individualized to the patient.   Continue reading