The opioid painkiller and heroin epidemic – in one map/gif

The opioid painkiller and heroin epidemic led to a new record in drug overdose deaths in 2014 — more than 47,000 overdose deaths that year alone, and nearly two-thirds of them were linked to opioids and heroin.

But what does that death toll really look like? These maps, published by Socrata, contextualize how far and wide the opioid epidemic has spread, showing the rate of drug overdose deaths by county in 2004 and 2014…

As the maps show, it’s not just that overdose deaths rose as a result of the opioid crisis; these deaths also spread to all parts of the country. The deaths are, truly, an epidemic.

How did this happen? The short answer is that doctors believed what Pharmaceutical companies told them.

Big Pharma lied. RTFA.

Dependent on prescription drugs – before they are born

Administering methadone to a 4-week-old infant

As prescription drug abuse ravages communities across the country, doctors are confronting an emerging challenge: newborns dependent on painkillers…Infants…have to stay in the hospital for weeks while they are weaned off the drugs, taxing neonatal units and driving the cost of their medical care into the tens of thousands of dollars.

Like the cocaine-exposed babies of the 1980s, those born dependent on prescription opiates — narcotics that contain opium or its derivatives — are entering a world in which little is known about the long-term effects on their development. Few doctors are even willing to treat pregnant opiate addicts, and there is no universally accepted standard of care for their babies, partly because of the difficulty of conducting research on pregnant women and newborns.

Those who do treat pregnant addicts face a jarring ethical quandary: they must weigh whether the harm inflicted by exposing a fetus to powerful drugs, albeit under medical supervision, is justifiable.

“I’ve had pharmacies that have just called back and said: ‘This lady’s pregnant. Why do you want me to fill this scrip? I can’t do that,’ ” said Dr. Craig Smith, a family practitioner in Bridgton, Me. “But when you stop and think about what actually happens during withdrawal and how violent it can be, that would certainly be not in the baby’s best interest…”

There are no national figures that document the extent of the problem, but interviews with doctors, researchers, social workers and women who abused painkillers while pregnant suggest that it has grown rapidly, especially in rural regions, where officials say such abuse is most common…

RTFA. Please. This is an addictive disaster that is not slowing down in the least.

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Doctor and nurse practitioner charged in overdose deaths

A former Needham doctor and his nurse practitioner caused the overdose deaths of at least six people they knew to be drug-addicted by systematically prescribing them medically unnecessary painkillers in order to make a profit, according to charges handed up in federal court in Boston.

Dr. Joseph P. Zolot, a specialist in nonsurgical orthopedics, and nurse practitioner Lisa M. Pliner were indicted on charges of conspiring to illegally distribute controlled substances — including methadone, oxycodone, and fentanyl — and six counts each of distribution of controlled substances resulting in deaths. If convicted, they each face a mandatory sentence of 20 years to life in prison.

Law enforcement officials said it is one of the most significant cases of medical misconduct to reach a criminal court anywhere in the country.

“The conduct alleged in today’s indictment is incomprehensible,’’ US Attorney Carmen M. Ortiz said. “I hope it sends a strong message that the government will aggressively prosecute any medical professional who facilitates the distribution of dangerous and addictive drugs purely for financial gain.’’

Well, not any more incomprehensible than the pill factories masquerading as medical practices in Florida.

The indictment alleges that Zolot and Pliner knew their patients were addicted to drugs, including street drugs such as cocaine, but prescribed medically unnecessary painkillers in exchange for cash or payments from insurance companies. Authorities say patients then overdosed on those drugs, causing their own deaths…

“The deaths alleged by the government in [the] indictments are horrible tragedies; so too is the fact the government has chosen to charge Dr. Zolot with criminal conduct for the manner in which he practiced medicine and treated patients,’’ David Meier [Zolot’s lawyer] said. “His intent was to do good as a doctor. It was never his intent to cause harm, never mind death, to any patient…”

The prescription of painkillers for certain medical conditions is allowed even if the patient is a known addict — but only if the patient and the potential for abuse are monitored, according to standard medical procedures.

In this case, prosecutors said, the duo handed out an extraordinary number of prescriptions in blatant disregard for their patients’ safety, all for a profit.

“A license to practice is not a license to deal, and that is precisely what is alleged in this indictment,’’ said Steve Derr, special agent in charge of the Boston office of the US Drug Enforcement Agency.

RTFA. The details of the deaths in the case are there. I’m really of two minds about the case – not knowing any details, whether the accusations are true or false.

I’ve known physicians who prescribed painkillers for addicts. As the law states, there can be sound medical reasons for doing so. There’s also no shortage of doctors who pick up an easy buck prescribing for doctor-shoppers looking for a quick fix. I will follow the trial.

What 1st Amendment?

The Schneiders with Siobhan Reynolds
Daylife/AP Photo used by permission

Last week, I asked a lawyer from a libertarian group for a copy of a brief it had filed in a First Amendment case. Sounding frustrated and incredulous, he said a federal appeals court had sealed the brief and forbidden its distribution.

“It’s a profound problem,” said the lawyer, Paul M. Sherman, with the Institute for Justice. “We want to bring attention to important First Amendment issues but cannot share the brief that most forcefully makes those arguments.”

The brief was filed in support of Siobhan Reynolds, an activist who thinks the government is too aggressive in prosecuting doctors who prescribe pain medications.

The Institute for Justice does not represent Ms. Reynolds, and it is not a party in the case. Its submission, made with a second libertarian group, Reason Foundation, was an amici curiae — or friends of the court — brief. It relied only on publicly available materials.

But it was sealed by the United States Court of Appeals for the 10th Circuit, in Denver, citing grand jury secrecy rules. The court then denied the groups’ motion to unseal their own brief. That ruling itself is sealed, too, but I have seen parts of it…

The brief paints an unflattering picture of the United States attorney’s office in Kansas, which may have overreacted to Ms. Reynolds’s adamant public defense of two medical professionals, Stephen J. Schneider and his wife, Linda K. Schneider, who were indicted in 2007 for illegally distributing prescription painkillers to patients who overdosed on them.

In 2008, Tanya J. Treadway, a federal prosecutor, asked the judge in the Schneiders’ case to prohibit Ms. Reynolds, who is not a lawyer and had no formal role in the case, from making “extrajudicial statements.” In the vernacular, Ms. Treadway asked for a gag order.

Judge Monti L. Belot of Federal District Court in Wichita denied that request, saying Ms. Treadway was seeking an unconstitutional prior restraint on speech…

RTFA. An amazing tale of the lengths a prosecutor can and will go to to impose a gag order.

Ms. Reynolds has not only been gagged – and subject to daily fines – the gag has been upheld by a secret court hearing. The grand jury procedure was used to silence critics and maintain secret proceedings.

The merits of the original case are not the question. Judges and prosecutors who hold their actions as above the law and sacrosanct are at cross-purposes to free speech and transparency.

Pain clinics raided – pipeline to pillheads!

Narcotics investigators have raided three South Florida pain clinics suspected of feeding a black-market pipeline of prescription painkillers stretching to Kentucky and other Appalachian states.

Agents with the DEA, the Broward County Sheriff’s Office and the Palm Beach Sheriff’s Office carted away boxes of records after serving search warrants at American Pain in Lake Worth, Executive Pain in West Palm Beach and the East Coast Pain Clinic in West Palm Beach on Wednesday morning.

The clinics are owned or managed by Christopher and Jeffrey George, 29-year-old twin brothers from Royal Palm Beach. Neither one is a licensed medical professional. Both have criminal records.

What sort of patent-leather regulatory authority allows thugs like this to run medical clinics?

The Miami Herald highlighted the George brothers in an investigation of the pain clinic business published last year. The Herald investigation showed that loose regulations have made South Florida a haven for storefront clinics selling oxycodone and other painkillers at a pace unseen anywhere else in the country.

Several sheriffs in Kentucky — a prime hot spot for illegal painkillers — told The Herald they routinely arrested people trafficking oxycodone bought from a Wilton Manors clinic called South Florida Pain, also owned by Christopher George, records show. South Florida Pain later merged with American Pain in Boca Raton, and then relocated to Lake Worth…

The George brothers have run afoul of law enforcement before. In 2003, Jeffrey George pleaded guilty to felony charges of dealing in stolen property and resisting arrest, records show. Christopher George also pleaded guilty to grand theft and possession of steroids with intent to sell, records show.

Their criminal pasts, however, did not prevent the Georges from owning or managing pain clinics selling dangerous narcotics — a loophole some lawmakers hope to close during the legislative session.

Under current law, the state licenses only medical facilities that take insurance — and most pain clinics only take cash. So while the state requires criminal background checks for employees at licensed facilities, there is no such requirement at cash-only pain clinics.

Sounds like the Florida legislature is willingly incompetent. Ready and able to comply with the demands of gangsters at a moment’s notice. Until someone gets caught.

FDA warns makers of unapproved narcotics

Seeking to remove unapproved drugs from the marketplace, the Food and Drug Administration has ordered nine companies to stop manufacturing narcotics whose therapeutic claims have not been proved.

The FDA’s warning letters notified the companies they may be subject to legal action if they do not stop manufacturing and distributing “prescription unapproved products” that include high-concentrate morphine sulfate oral solutions and immediate-release tablets containing morphine sulfate, hydromorphone or oxycodone.

This action does not include oxycodone capsules. All of these drugs are used for pain relief and are forms of previously approved medications…

If these drugs are not off the market by those deadlines, a company could face seizure of the narcotics and legal action…

The FDA believes Americans have access to plenty of legal narcotics for pain relief and removing these unapproved drugs will not create a shortage.

Anyone remember the FDA standing up on their hind legs like this…oh, say, a couple of years ago?