Questioning A Doctor’s Prescription For A Sore Knee: 90 Percocets

by Michelle Andrews

Doctors often prescribe more opioid painkillers than necessary following surgery, for a variety of reasons.

Doctors often prescribe more opioid painkillers than necessary following surgery, for a variety of reasons.

I recently hobbled to the drugstore to pick up painkillers after minor outpatient knee surgery, only to discover that the pharmacist hadn’t yet filled the prescription. My doctor’s order of 90 generic Percocet exceeded the number my insurer would approve, he said. I left a short time later with a bottle containing a smaller number.

When I got home and opened the package to take a pill, I discovered that there were 42 inside.

Talk about using a shotgun to kill a mosquito. I was stiff and sore after the orthopedist fished out a couple of loose pieces of bone and cartilage from my left knee. But on a pain scale of 0 to 10, I was a 4, tops. I probably could have gotten by with a much less potent drug than a painkiller like Percocet, which contains a combination of the opioid oxycodone and the pain reliever acetaminophen, the active ingredient found in over-the-counter Tylenol.

When I went in for my follow-up appointment a week after surgery, I asked my orthopedist about those 90 pills.

“If you had real surgery, like a knee replacement, you wouldn’t think it was so many,” he said. He told me the electronic prescribing system sets the default at 90. So when he types in a prescription for Percocet, that is the quantity the system orders.

Such standard orders can be overridden, but that is an extra step for a busy physician and takes time.

As public health officials grapple with how to slow the growing opioid epidemic — which claims 91 lives each day, according to federal statistics — the over-prescription of narcotics after even minor surgery is coming under new scrutiny.

While patients today are often given opioids to manage postoperative pain, a large supply of pills may open the door to opioid misuse, either by the patients themselves or others in the family or community who can access the leftovers.

Post-surgical prescriptions for 45, 60 or 90 pills are “incredibly common,” says Dr. Chad Brummett, an anesthesiologist and pain physician at the University of Michigan Medical School.

Last year, the Centers for Disease Control and Prevention released a general guideline saying that clinicians who prescribe opioids to treat acute pain should use the lowest effective dose and limit the duration to no longer than seven days.

But more detailed guidance is necessary, clinicians say.

“There really aren’t clear guidelines, especially for surgery and dentistry,” Brummett says. “It’s often based on what their chief resident taught them along the way or an event in their career that made them prescribe a certain amount.”

Or, as in my case, an automated program that makes prescribing more pills simpler than prescribing fewer.

Brummett is co-director of a Michigan program that has released recommendations for post-surgical opioid prescribing for a growing list of procedures.

To determine the extent to which surgery may lead to longer-term opioid use, Brummett and his colleagues examined the insurance claims of more than 36,000 adults who had surgery in 2013 or 2014 for which they received an opioid prescription. None of the patients had prescriptions for opioids during the prior year.

The study, published online in JAMA Surgery in June, found that three to six months after surgery, roughly 6 percent of patients were still using opioids, having filled at least one new prescription for the drug. The figures were similar whether they had major or minor surgery. By comparison, the rate of opioid use for a control group that did not have surgery was just 0.4 percent.

Some insurers and state regulators have stepped in to limit opioid prescriptions. Insurers routinely monitor doctors’ prescribing patterns and limit the quantity of pills or the dosage of opioid prescriptions.

At least two dozen states have passed laws or rules in just the past few years aimed at regulating the use of opioids.

Last year in my state of New York, Gov. Andrew Cuomo signed legislation that reduced the initial opioid prescription limit for acute pain from 30 days to no more than a seven-day supply.

As my experience demonstrated, however, a seven-day limit (those 42 pills in my case) can still result in patients receiving many more pills than they need. (For those who find themselves in a similar situation with excess pills, there is a safe and proper way to dispose of them.)

Still, some worry that all this focus on overprescribing may scare physicians away from prescribing opioids at all, even when appropriate.

“That’s my concern, that people are so afraid of things and taking it to such an extreme that patient care suffers,” says Dr. Edward Michna, an anesthesiologist and pain management physician at Brigham and Women’s Hospital in Boston. Michna is on the board of the American Pain Society, a research and education group for pain management professionals. Michna has been a paid consultant to numerous pharmaceutical companies, some of which manufacture narcotics.

But other doctors say that one of the reasons doctors call in orders for lots of pills is convenience.

“When you land on the front lines, you hear, ‘I like to write for 30 or 60 pills because that way they won’t call in the middle of the night’ ” for a refill, says Dr. Martin Makary, a professor of surgery and health policy at Johns Hopkins School of Medicine.

Makary is spearheading a consortium of Hopkins clinicians and patients that provides specific guidelines for post-surgical opioid use. The program, part of a larger effort to identify areas of overtreatment in health care, also identifies outlier prescribers nationwide to encourage them to change their prescribing habits.

The Hopkins group doesn’t have an opioid recommendation for my surgery. The closest procedure on their website is arthroscopic surgery to partially remove a torn piece of cartilage in the knee called the meniscus. The post-surgical opioid recommendation following that surgery: 12 tablets.

Rehab that puts alcoholic pilots back in the cockpit

The words CLEARED FOR TAKEOFF are welcomed by air travelers in a hurry. They’re even more welcomed by airline pilots who once feared they’d never fly again. Our Cover Story is reported by Tony Dokoupil:

Many alcoholics can tell you the exact moment they hit rock bottom. Former airline Captain Lyle Prouse hit his at 30,000 feet.

On March 8, 1990, he was at the controls of Northwest Flight 650, Fargo to Minneapolis, with 58 people aboard, and after a night of heavy drinking on a layover, he was drunk.

“I think on the tab were 14 rum and cokes for me,” Prouse said. “And depending on the testimony you listen to, the figure goes up to 18 or 19. I don’t know.”

His blood-alcohol content that morning was at least 0.13 percent: Too drunk to drive, and more than triple the limit for flying.

Dokoupil asked, “Did you have any doubts about getting on that plane?”

“No. I mean, I wouldn’t fly the airplane if I thought I was gonna die.”

The plane landed safely, but Prouse and his crew were arrested, and became the first commercial airline pilots convicted of flying while intoxicated. Prouse was sentenced to 16 months in federal prison.

“No other pilot in all of American commercial aviation damaged the profession like I did,” he said. “That was a knife in my heart. That hurt.”

Lyle Prouse’s career was a longshot from Day One: Raised by alcoholic parents, he joined the Marines and fought his way from a ground unit into a fighter jet, and a decorated career. Somewhere along the way, though, he became an alcoholic himself.

“Our pilots are just like all people; they have some of the same shortcomings that any of us could have,” said Peggy Gilligan, the former FAA administrator in charge of safety. She says a drinking problem is not necessarily the end of a pilot’s career.

“There are lots of things that initially might disqualify you from being a pilot, but with proper care and treatment, with proper rehabilitation, you can return to the flight deck,” she said.

And in fact, for decades, the FAA has been doing exactly that: quietly sending pilots diagnosed as substance abusers back to work.

It’s called the Human Intervention Motivation Study, or HIMS. And before you panic, consider this: it may be one of the most successful rehab programs ever.

Eighty percent of pilots who enter the program do not relapse at all. And of those that do relapse, most relapse only once.

Dokoupil asked, “There’s never been an issue with a pilot undergoing treatment while flying?”

“That’s right,” said Gilligan.

“Why aren’t you screaming this good news from every rooftop in Washington, D.C.?”

“That’s a really good question!” she laughed.

Right now, under the HIMS program, there are upwards of 1,300 pilots flying with a special medical license for addiction.

Since the mid-1970s, 6,000 pilots have been treated and returned to the cockpit … pilots like Captain Dana Archibald, whose career nearly crashed in the late 1990s when he missed a flight after a drunken binge.

“I just stopped showing up for work,” he said.

“You’re just telling your boss that you got the flu?” asked Dokoupil.

“I would tell him every story in the book, because I’m an alcoholic. I’d tell ’em anything they wanted to hear, just so I wouldn’t get in trouble.”

In another era, addicted pilots would be fired or forced to keep their addictions a secret. The FAA says that’s all changed.

“What we don’t want, to this day, are pilots who hide something that could present a risk,” Gilligan said.

Of course, addiction isn’t just a pilot’s problem; millions of Americans are struggling with addiction. Most of the people who need treatment are not in it, and relapse is common. But for airline pilots, those rules don’t seem to apply.

Dr. Lynn Hankes, who ran an addiction treatment center in South Miami. He says the airline pilots he treated were more likely to get sober, and stay that way.

A member of the general public, he notes, is three times more likely to have a relapse than a pilot.

Why? “Because they don’t have the system in place,” Dr. Hankes said.

For pilots, that system means a month or so in an FAA-approved rehab facility, then monitoring and drug tests. And if the FAA clears them to fly again, the treatment usually continues for at least three years.

It’s not foolproof, but it works.

“Since the inception of the HIMS program, in the last 43 years there has never been even one, not a single commercial passenger-carrying airline incident or accident, that has been alcohol- or drug-related,” Dr. Hankes said. “That’s the proof in the pudding.”

“If the general public had a HIMS-style program available to them, do you think relapse rates would fall as low as they are for pilots?” Dokoupil asked.

“Well, that’s the big question. There’s a key element missing in the general public, and that is, we don’t have the leverage.”

“Everybody is afraid of losing something.”

“Yeah, but it’s very easy to hide out there in the general public. If you threaten a pilot with taking away his wings, it’s like threatening a doctor with taking away his stethoscope. That’s a lot of leverage. If they want to get back to the cockpit or the operating room, they gotta jump through the hoops.”

And jump they do: Similar programs have been used successfully by doctors and flight attendants, and now police and fire departments are interested, too.

For pilots, it’s about a lot more than just winning back their wings.

Dana Archibald told Dokoupil that, were it not for the HIMS program, “I certainly wouldn’t be a pilot, but more importantly, I don’t know if I’d be alive.”

Archibald is now a full-time 737 captain with a major airline flying out of Miami.

And the Lyle Prouse story ends far differently than he ever could have hoped. After his arrest, he was a broken man on the verge of suicide.

“I lost the will to live,” he said. “And I thought I was too tough for that.”

“How close do you think you came to taking your own life?” Dokoupil asked.

“I was within an eyelash. I was not romancing the idea or considering the idea — I was within an eyelash of executing the idea.”

But after he got out of prison, he was placed into the HIMS program, and in 1993 — against all odds — he was re-hired by Northwest Airlines.

Five years later, Prouse retired honorably as the captain of a 747.

“I’ve gotten to live out more miracles than anybody I know,” he said.

What are the miracles? “That I flew again. That my wife stayed with me. That my kids still love me. That I got sober. That I didn’t die like my parents did.

“I just came back from a pilot reunion at Northwest. And I get an email from one of the gals. She said, ‘You’re a very loved and respected member of the Northwest Family.’ I didn’t have that in 1990.”

Prouse added, “I suppose without sounding preachy or evangelistic, the only thing I can attribute it to is God’s grace.”

Dokoupil said, “What’s that saying? ‘God watches over –‘”

“‘Fools and drunks’? Something like that. Well, I certainly earned that!”







FDA chief warns about kratom to treat opioid addiction; will seek more regulatory power

Citing 36 deaths, the Food and Drug Administration chief warned  consumers Tuesday not to use the herbal supplement kratom to ease opioid withdrawal and announce plans to step its regulatory oversight to combat the opioid epidemic.

The FDA public health advisory on kratom follows the Drug Enforcement Administration’s reversal or at least delay of plans to classify kratom as a controlled substance on the same level as heroin and LSD.

FDA commissioner Scott Gottlieb says the FDA plans to work with the DEA to determine how kratom should be classified.


Mitragyna speciosa, is a tropical evergreen tree in the coffee family native to Southeast Asia in the Indochina and Malaysia phytochoria

Kratom, a plant grown naturally in countries including Thailand and Malaysia, is widely sold in smoke shops and other locations as a powder that can be used in tea to slow the effects of opioid withdrawal. But it has addictive properties of its own, FDA says. public health advisory related to the FDA’s mounting concerns regarding risks associated with the use of kratom.

The FDA says kratom carries similar risks of abuse, addiction and in some cases, death, as opioids. It is also often used recreationally for its euphoric effects.

Along with opioid withdrawal, kratom is also believed to relieve fatigue, pain, cough and diarrhea. Anita Gupta, an osteopathic anesthesiologist and licensed pharmacist, has expressed concern about an increase in the use of kratom among her chronic pain patients.

Kratom users and advocates were “dismayed to learn of the DEA’s plan to classify kratom as a Schedule 1 substance – the same classification as LSD and heroin – despite anecdotal and scientific evidence indicating kratom could be an effective opioid alternative,” says Walter Prozialeck, chairman of the pharmacology department at Midwestern University Chicago College of Osteopathic Medicine.

As an active “drug”, kratom certainly has potential for causing harmful effects and can, itself be addictive,” Prozialeck, who co-authored a December 2016 study on kratom in the Journal of the American Osteopathic Association.  “However, overwhelming evidence indicates kratom is far less dangerous than classic opioids.”

 Studies from Asia indicate kratom, in its pure form, has not been linked to any deaths in that part of the world, says Prozialieck. He blames a “lack of quality control in western countries including the U.S., which can lead to dangerous alterations of kratom or the addition of other drugs.

“The therapeutic potential of kratom is real, but more research is urgently needed to evaluate its safety and efficacy,” he added. “One of my concerns is that a total ban will likely stifle such research.”

Because kratom is unregulated, “you never know the real strength, ingredients, or how it’s prepared,” agrees Chris Barth, who used the medication Suboxone to recover from a pain pill addiction a decade ago.

“Limited access and or lack of knowledge of approved treatments is what’s probably driving this.” says Barth. “It’s probably easier to ‘do it yourself’ with kratom ordered over the internet than find — if it’s available — and pay for FDA approved, doctor supervised treatment.”

Gottlieb also told his agency’s criminal investigations staff that he may ask Congress for more authority and resources to fight the opioid epidemic, according to remarks prepared for delivery Tuesday afternoon.

Gottlieb also says in the remarks that a new working group with Customs and Border Patrol is working on stepped-up enforcement at entry points for illegal narcotics.

The fact Gottlieb is speaking to the investigations staff is significant because “if they find people here who are opening the gates to these drugs, there may be opportunities for the FDA to investigate at a high level,” says Joshua Sharfstein, former principal deputy FDA commissioner in the Obama administration.

Importers, organized crime or others in the supply chain could be part of conspiracies to distribute illegal opioids, Sharfstein says.

FDA is already using import alerts and other authority to stop foreign, unapproved and misbranded drugs at the border to keep kratom shipments from entering the United States. Hundreds of shipments have already been detained and many are seized.

Still, more than 340 million packages reach the U.S. every year.

“Given that massive volume, it’s estimated that only a small percentage of the illicit drugs smuggled through the (international mail are being intercepted,” Gottlieb said.

While it’s very important to strengthen border enforcement, “the challenge is akin to pushing the tide back into the ocean,” says Sharfstein.

Gottlieb, who did two previous stints at the FDA, has publicly expressed misgivings about how long it took the agency to truly address the crisis.

What Doctors Facing the Opioid Crisis Need Next

By Alice Park

How do you confront an epidemic that has claimed more lives than the HIV/AIDS crisis at its peak? How do you counteract a system that incentivizes the flow of prescription painkillers from doctors to patients and ends up getting 3 million Americans addicted each year? And how do you reverse surging demand for prescription opioids’ illegal substitutes, which are more damaging and toxic but far cheaper and easier to obtain?

You could start by declaring a national public health emergency. That’s what President Trump did on Oct. 26, creating a 90-day window during which federal agencies–from the Food and Drug Administration, which regulates prescription drugs; to the Department of Health and Human Services, which oversees guidelines for treating addiction; to the Department of Justice, which is responsible for prosecuting illegal pill makers and drug dealers; to the National Institutes of Health, which studies how people first get addicted–must shift parts of their existing budgets to address the crisis. After 90 days, the President can renew the emergency status to extend the intensified response.

This is a move in the right direction. But Trump’s order did not make additional funding immediately available, leading those on the front lines of the epidemic to ask what, exactly, it will mean. “Unfortunately, nothing,” says Michael Botticelli, executive director of the Grayken Center for Addiction at Boston Medical Center and former director of National Drug Control Policy in the Obama Administration. “There are no new grant dollars, no new policy initiatives.”

Days after Trump’s declaration, his official White House commission on the crisis issued its final report, which called for many of the initiatives that are backed by experts like Botticelli. The findings make it clear that current strategies and funding are far from adequate.

“What we need is something like the Ryan White Care Act,” says Dr. Sarah Wakeman, medical director of the Substance Use Disorders Initiative at Massachusetts General Hospital. In 1990, Congress passed the act to provide funding for HIV patients who could not afford basic medical care and anti-HIV drugs. With $2.3 billion at its disposal, the fund currently provides care to more than half of all people infected with the virus in the U.S.

For the opioid epidemic, such additional funding would allow more people to receive medication-assisted treatment (MAT), which mimics opioids but has less addictive potential and can wean addicts off their dependence. Studies show that people given medications like methadone or buprenorphine are less likely to overdose or relapse.

Mandating that all health insurers cover substance-use-disorder treatment–as the Affordable Care Act does–would expand access to the medications and help reduce the stigma and controversy surrounding the practice of using drugs to treat drug addiction. But the Trump Administration’s reform efforts threaten to remove such coverage, most of which comes in the form of expanded Medicaid benefits. “If that’s taken away, then we’re back to square one,” says Cheryle Herr, clinical director for the Family Recovery Center in Liverpool, Ohio, which has been hit hard by the epidemic. “Our people are going to die.”

This is a move in the right direction. But Trump’s order did not make additional funding immediately available, leading those on the front lines of the epidemic to ask what, exactly, it will mean. “Unfortunately, nothing,” says Michael Botticelli, executive director of the Grayken Center for Addiction at Boston Medical Center and former director of National Drug Control Policy in the Obama Administration. “There are no new grant dollars, no new policy initiatives.”

Days after Trump’s declaration, his official White House commission on the crisis issued its final report, which called for many of the initiatives that are backed by experts like Botticelli. The findings make it clear that current strategies and funding are far from adequate.

“What we need is something like the Ryan White Care Act,” says Dr. Sarah Wakeman, medical director of the Substance Use Disorders Initiative at Massachusetts General Hospital. In 1990, Congress passed the act to provide funding for HIV patients who could not afford basic medical care and anti-HIV drugs. With $2.3 billion at its disposal, the fund currently provides care to more than half of all people infected with the virus in the U.S.

For the opioid epidemic, such additional funding would allow more people to receive medication-assisted treatment (MAT), which mimics opioids but has less addictive potential and can wean addicts off their dependence. Studies show that people given medications like methadone or buprenorphine are less likely to overdose or relapse.

Mandating that all health insurers cover substance-use-disorder treatment–as the Affordable Care Act does–would expand access to the medications and help reduce the stigma and controversy surrounding the practice of using drugs to treat drug addiction. But the Trump Administration’s reform efforts threaten to remove such coverage, most of which comes in the form of expanded Medicaid benefits. “If that’s taken away, then we’re back to square one,” says Cheryle Herr, clinical director for the Family Recovery Center in Liverpool, Ohio, which has been hit hard by the epidemic. “Our people are going to die.”


Trump Calls Opioid Epidemic “National Shame” and “Human Tragedy

President Trump on Thursday decried the opioid epidemic ravaging America as a “national shame” and “human tragedy,” but one the U.S. will “overcome,” as he declared the crisis a national public health emergency.

“Working together, we will defeat this opioid epidemic,” Mr. Trump said Thursday, with first lady Melania Trump at his side. “It will be defeated. We will free our nation from the terrible affliction of drug abuse. And, yes, we will overcome addiction in America. We are going to overcome addiction in America. We have fought and won many battles and many wars before. And we will win again.”

Mr. Trump said the nation needs to face reality “right smack in the face,” and realize that hundreds of thousands of Americans are already addicted. The crisis claimed more than 64,000 lives in 2016 alone. The epidemic needs to be confronted aggressively, the president said, and his move allows for expanded telemedicine access and specialist appointments for patients, among other things. The president also said Americans can expect lawsuits against “bad actors” in the drug industry, and the U.S. Postal Service to step up its fentanyl detection. Mr. Trump said he will also bring up fentanyl, the exceptionally deadly opioid, when he visits Chinese President Xi Jinping in China next month.

But the president’s declaration of a national public health crisis falls short of what he promised in August, which was to declare the crisis a national emergency. Declaring the opioid epidemic a national public health emergency doesn’t free up additional funds, or give the federal government as much leverage in addressing the crisis as a national emergency would have. The president defied his own opioid commission, led by New Jersey Gov. Chris Christie, which had recommended declaring a national emergency.

“With approximately 142 Americans dying every day, America is enduring a death toll equal to Sept. 11 every three weeks,” the commission members wrote in July. “Your declaration would empower your cabinet to take bold steps and would force Congress to focus on funding and empowering the executive branch even further to deal with this loss of life.”

Former President Obama’s drug czar and executive director of the Grayken Center for Addiction at Boston Medical Center, Michael Botticelli, said what Mr. Trump did isn’t enough.

“While I commend the president and the first lady for calling attention to the opioid epidemic, I think it’s quite unfortunate and sad that none of the actions today I think are really going to have a major impact and urgent impact this epidemic,” Botticelli said.

“I think to issue a national emergency without additional resources is quite honestly very hollow and doesn’t speak to the tremendous pain and loss that we’re seeing in places all across the country,” he added.

In his speech Thursday, Mr. Trump got a little personal, pointing to his relationship with his brother as a reason why the U.S. needs to deter young people from trying drugs in the first place. Mr. Trump’s older brother, Fred Trump, had an alcohol addiction. But he always urged his younger brother not to drink.

“I learned myself, I had a brother Fred, great guy, best looking guy, best personality, much better than mine, but he had a problem,” the president said. “He had a problem with alcohol. And he would tell me don’t drink, don’t drink. He was substantially older and I listened to him and I respected. But he would constantly tell me don’t drink, he would also add don’t smoke. But he would say it over and over and over again.”

“And to this day I’ve never had a drink,” Mr. Trump continued. “And I have no longing for it. I have no interest in it. To this day I’ve never had a cigarette. Don’t worry, those are only two of my good things. I don’t want to tell you about the bad things. There’s plenty of bad things too. But he really helped me. I had somebody that guided me. And he had a very, very, very tough life because of alcohol, believe me, very, very tough, tough life. He was a strong guy, but it was a tough, tough thing that he was going through. But I learned because of Fred, I learned.”

The president said he expects to see a new report with recommendations from his opioid commission next week.

CBS News’ Arden Farhi contributed to this report.

Watchdog Warns About Replacing Opioid Epidemic With a Psychotropic One

​The mental health watchdog group Citizens Commission on Human Rights (CCHR) International warned that a drug being used to treat the opioid crisis in the United States could be like “switching seats on the Titanic.” A powerful psychoactive prescription drug, buprenorphine-naloxone, described as the gold standard treatment for opioid addiction, carries a warning in its Medication Guide that it contains “an opioid that can cause physical dependence.”[1] A Florida psychiatrist warns using this drug could be trading one addiction for another and that it is estimated to be 25 to 40 times more potent than morphine.[2] It has been reported the drug can also cause significant behavioral changes because of its psychoactive (mind-altering) properties.

Last week, Attorney General Jeff Sessions announced he is awarding nearly $20 million in federal grants to help law enforcement and public health agencies address prescription drug and opioid abuse. He is also assigning a dozen prosecutors to target opioid-related healthcare fraud.[3] But CCHR says this must include investigating the drugs being prescribed to treat this epidemic.

It is estimated that more than two million Americans are dependent on opioids.[4] On the other hand, in 2016, an article warned that buprenorphine-naloxone abuse is now an epidemic, based on 2013 statistics reported in The New York Times.[5] Between 2009 and March 2013, an estimated three million Americans were treated with the drug.[6] A report by the Substance Abuse and Mental Health Services Administration (SAMHSA) found a ten-fold increase in the number of emergency room visits involving buprenorphine. Over half of the 30,000 hospitalizations in one year were for non-medical use of the drug.[7] Approved to treat opioid addiction in 2002, it now sells illicitly on the streets for anywhere from $5 to $35 a pill.[8] Long-term users of buprenorphine-naloxone say it is more difficult to get off than painkillers or heroin because, unlike an intensely painful five to seven or even fourteen day detox from opiates, a buprenorphine-naloxone detox can last weeks or even months.

CCHR applauds Attorney General Sessions for tackling the opioid epidemic, the overall topic of drug overdoses, and the over-prescription of painkillers. It implores him to also look at the Medicaid and Medicare expenditures on, and abuse of, prescription psychotropic drugs, especially high prescribers of the drugs under Medicare Part D.

Citizens Commission on Human Rights

Dr. Steven R. Scanlan, board certified in general psychiatry and addiction medicine, says psychiatrists and doctors that prescribe the drug can charge $200 to $300 monthly, per patient, for a 5-to-10 minute checkup to renew a prescription. He warned that the lucrative nature of the drug “on a maintenance basis creates a disincentive to tapering the drug and its income-generating potential,” according to Bloomberg News. Withdrawal can cost $5,000 because it may take “four to five months, incorporating about 10 different drugs to detox the patient successfully,” he said.[9]

Cessation of the drug can cause the taker to “become sick with uncomfortable withdrawal signs and symptoms because your body has become used to this medicine,” according to the Medication Guide. Further, it “can cause serious and life-threatening breathing problems.” Further, “overdose and death can happen if you take benzodiazepines, sedatives, tranquilizers [which are addictive], antidepressants, or alcohol while using” the drug.[10] In 2011, buprenorphine-naloxone was also associated with at least 27 deaths in just one state.[11]

The opioid epidemic begets another lucrative business, CCHR says. Bloomberg News reported that by the mid-2000s, opioid abuse was expanding the need for treatment. Then two laws made it easier to get it. The first, in 2008, put mental disorders on par with other medical treatment for large group insurance — the Mental Health Parity and Addiction Equity Act. Two years later, the Affordable Care Act (ACA) made mental health and substance abuse treatment mandatory in the individual market and expanded Medicaid coverage.

Between 2009 and March 2013, it was estimated that buprenorphine-naloxone generated more than $1 billion in annual sales, or 20 percent of its manufacturer’s profit base. In February 2015, a full-year’s sales were reported at $1.1 billion.

As Bloomberg News pointed out under a section titled “Buying Binge,” “Americans’ addiction to drugs spelled opportunity for private equity from the moment the Affordable Care Act was signed seven years ago. The swelling numbers of people with insurance and the law’s insistence that mental health and drug abuse be covered by it spurred a surge in acquisitions.”[12]

Consider that one U.S. private for-profit behavioral hospital company expanded its facilities from six in 2011 to about 600 in 2017, including 105 centers for so-called “medication-assisted treatment for opiate abuse”—an almost 10,000 percent increase. The “large book of business in treating the opioid addiction” a company representative said, accounted for about 40 percent of its U.S. revenue.

The Mental Health Parity and Addiction Equity Act also contributed to mental health and substance abuse spending doubling between 2003 and 2014, to roughly $240 billion.[13] In 2016, spending was reported as having more than doubled over the past 12 years and now represents a $250 billion market in the United States.[14]

On July 13, 2017, former U.S. Rep. Bart Stupak (MI), writing in The Hill, pointed out that with any Affordable Health Care Act reform, the “waste, fraud and abuse of government funds associated with the treatment of opioid addiction” must be addressed. In particular, he cited several for-profit behavioral hospital chains profiting from this.[15]

Law enforcement is already facing prescribers abusing the system—adding weight to AG Session’s approach to tackling the opioid problem. In 2013, The New York Times reported, “Nationally, at least 1,350 of 12,780 buprenorphine doctors have been sanctioned for offenses that include excessive narcotics prescribing, insurance fraud, sexual misconduct and practicing medicine while impaired. Some have been suspended or arrested….”[16] Last year, the U.S. Department of Justice indicted three doctors that sold prescriptions for buprenorphine-naloxone and clonazepam in exchange for cash payments. None of the defendants conducted medical or mental health examinations as required by law in order to prescribe these controlled substances, a felony.[17] A psychiatrist, who ran an “anti-withdrawal drug empire” prescribing buprenorphine, was found guilty of nine counts of improper administration of controlled substances. Selling the drug for between $3 and $5 per pill, he made an annual profit of $280,000 on that drug alone. He claimed to be using buprenorphine to wean hundreds of patients from heroin and other addictions but prosecutors alleged he was merely getting them hooked on the anti-addiction drugs themselves. He was sentenced to 11-22 years in prison.

In addition to laws impacting the substance abuse treatment market, in 2013, the Substance Use Disorders Working Group for the American Psychiatric Associations’ Diagnostic and Statistical Manual of Mental Disorders (DSM5) broadened the symptoms of substance abuse,[18] thereby widening the potential for more patients. A professor of psychiatry involved with the working group, disclosed he advises the manufacturer of buprenorphine-naloxone on tracking abuse. He has also been a consultant for the manufacturer of another drug, naltrexone that reportedly combats alcohol and heroin addiction by preventing craving. And he has helped develop several new drugs to treat addiction.[19]

The psychiatrist admitted that DSM5 would lead to more use of psychoactive drugs for drug dependence. To many of those prescribed these mind-altering and potentially addictive drugs, the term “switching seats on the Titanic”— originally attributed to replacing heroin with methadone”— rings true.

CCHR applauds AG Sessions for tackling the opioid epidemic, the overall topic of drug overdoses, and the over-prescription of painkillers. It implores him to also look at the Medicaid and Medicare expenditures on and abuse of prescription psychotropic drugs, especially high prescribers of the drugs under Medicare Part D.

CCHR is a mental health industry watchdog organization that works for patient protections and encourages the public to take action against mental health abuse. In the course of its 48 years it has helped obtain more than 180 laws that implement legal rights and informed consent procedures. It maintains an easily-searchable online psychiatric drugs side effects database for consumers to learn about adverse psychotropic drug effects reported to the FDA. As a nonprofit, CCHR relies on memberships and donations to carry out its mission and actions. Click here to support the cause.

Contact: Amber Rauscher at or (323) 467-4242.


[1] “Addicted to a Treatment for Addiction,” The New York Times, 28 May 2016,;
[2] Steven R. Scanlan, MD website, 1 Nov. 2010,
[3] “Sessions: $20M in Federal Grants Will Help Address Opioid Crisis,” Townhall, 22 Sept. 2017,
[4] “Drug Deaths in America Are Rising Faster Than Ever,” The New York Times, 5 June 2017,
[5] “How Big Pharma Is Cashing in on Addiction to Alcohol and Illicit Drugs,” AlterNet, 18 Mar. 2016,
[6] Christopher Moraff, “Suboxone Creator’s Shocking Scheme to Profit Off of Heroin Addicts,” Daily Beast, 5 Oct. 2016,
[8] “The ‘bupe’ fix Promoted by the U.S. as a treatment for opiate addiction, buprenorphine has become one more item for sale in the illegal drug market,” Baltimore Sun, 16 Dec. 2007,; Laura Krantz, “Special Report: State spends millions on addiction-fighting drug that is diverted for street sale,” VTDigger, 11 Feb 2014,
[9] Op cit., Steven R. Scanlan, MD website, 1 Nov. 2010.
[11] “Suboxone® Sales Estimated to Reach $1.4 Billion – More Than Viagra® or Adderall®,” A Weekly FAX from the Center for Substance Abuse Research, Vol. 21, Issue 49, 10 Dec. 2012,
[12] “Private Equity Sees No End to the Drug and Mental-Health Gold Rush,” Bloomberg News, 30 Mar. 2017,
[13] Lauren Silva Laughlin, “Acadia Healthcare grows as mental health treatment soars,” Fortune, 29 Oct. 2015,
[15] Fmr Rep. Bart Stupak, “Eliminating fraud is key to adequate funding for opioid treatment,” The Hill, 13 July 2017,;
[16] Deborah Sontag, “Addiction Treatment With a Dark Side,” The New York Times, 16 Nov 2013,
[18] Michael Dhar, “Psychiatry’s Contested Bible: How the New DSM Treats Addiction,” Pacific Standard Magazine, 8 May 2013,
[19] Michael Dhar, “Psychiatry’s Contested Bible: How the New DSM Treats Addiction,” Pacific Standard Magazine, May 2, 2013,

CVS Limits Opioid Prescriptions to 7 Days

(CNN) In a new effort to tackle the deadly opioid addiction crisis in the United States, pharmacy giant CVS announced Friday that it will limit opioid prescriptions to seven days for certain conditions. This restriction will apply to patients who are new to pain therapy.

The new pharmacy program will also limit the daily dosage of pain pills based on their strength and will require use of immediate-release formulations before extended-release opioids — intended for severe, long-term pain treatment — are dispensed. The changes will roll out February 1 and cover all commercial, health plan, employer and Medicaid clients.

CVS, which manages medications for nearly 90 million plan members, is one of the largest pharmaceutical chains in the US, with approximately 9,600 CVS Pharmacy stores and more than 1,100 walk-in medical clinics.

“With a presence in nearly 10,000 communities across the country, we see firsthand the impact of the alarming and rapidly growing epidemic of opioid addiction and misuse,” said Larry J. Merlo, president and CEO of CVS Health.

Sales of prescription opioids quadruple from 1999 to 2014

From 1999 to 2014, sales of prescription opioids in the US almost quadrupled, according to the US Centers for Disease Control and Prevention, yet there has been no change in pain reported by Americans.

CVS said its pharmacists will counsel patients with opioid prescriptions about the risk of dependence and addiction based on CDC guidelines. These educational sessions will also emphasize the importance of keeping medications secure in the home and proper disposal of unused medications.
To help patients wanting to follow these guidelines, the company will almost double the number of drug disposal units in its Medication Disposal for Safer Communities Program from 800 to 1,550 kiosks. This expansion will begin this fall with locations in Florida, Massachusetts, North Carolina, Pennsylvania, South Carolina and the District of Columbia.

These moves put CVS’s pharmacy program more in line with the CDC’s opioid prescribing guidelines. Express Scripts, the country’s largest pharmacy benefits manager, has similar limits in place.

An ‘impactful’ move?

“I think it’s going to be helpful. I think it’s going to be impactful,” said Dr. Andrew Kolodny, director of Physicians for Responsible Opioid Prescribing, who saw the announcement as more than a public relations move. “It will be expensive. … This will be a real administrative burden” for CVS, he said.
Studies have found that longer prescription durations, as well as higher dosages, increase the likelihood of chronic use. CVS’s steps are meant to curb not just potential long-term opioid use but also potential opioid misuse.

“There are millions of prescription bottles sitting in our bathroom cabinets and on our bedroom nightstands right now, including far too many prescription opioids that ultimately are used non-medically,” said Dr. Caleb Alexander, co-director of the Johns Hopkins Center for Drug Safety and Effectiveness.

“We’ve been watching the epidemic get worse, hidden in plain sight, for far too long, and these types of policies are necessary to reduce the incredible oversupply of prescription opioids,” Alexander said.

Balancing patients’ needs

The American Academy of Pain Medicine “supports any initiative that would help limit the effects of over prescribing medications or leading to excessive unused medicines that could lead to harm to a patient or family members or their community,” said Dr. Steven Stanos, president of the academy.

Stanos worries that CVS’s recommendations could be interpreted too rigidly and affect patients. “We would want it to balance the needs of the patient and doesn’t intrude on the relationship between the patient and the physician and how they made that decision,” Stanos said.

It’s a sentiment echoed by Dr. Patrice Harris, chairwoman of the American Medical Association’s opioids task force. “When patients seek physician help for an opioid use disorder — or need comprehensive care for chronic pain — one-size-fits-all limits, such as blanket prior authorization protocols, may cause delays in care that could severely harm patients,” she said.

CVS said its guidelines are flexible and recognize that there maybe situations that require more than a seven-day prescription or a higher-dose opioid. For times like those, physicians will be able to seek exceptions.

CVS is also committing $2 million to federally qualified community health centers that provide medication-assisted treatment and other addiction recovery services.

The President’s opioid commission says that about 142 Americans die every day from a drug overdose, equal to the death toll from the September 11 attacks every three weeks. Most of those overdoses are from opioids.

Though there were over 30,000 fatal overdoses from opioid drugs in 2015, public health experts believe that for every fatal overdose, there are 30 non-fatal overdoses. That would mean over 900,000 overdoses in 2015 alone.

According to the CDC, drug overdoses are the leading cause of unintentional death in the US.

Faces of an Epidemic: Stories of the Victims of America’s Opioid Crisis

Faces of an Epidemic: Stories of the Victims of America’s Opioid Crisis — and the Fight to Save Lives

By @stevehelling and

Jack and Hunt Freeman were Texas brothers with a lot going for them. Hunt, 26, was a charismatic salesman at a Harley Davidson shop; Jack, 29, worked as a golf assistant at an upscale country club.

But the two also liked to party with alcohol and recreational drugs — first using marijuana and cocaine in high school and, later, moving on to heroin.

The brothers entered rehab multiple times, but neither could stay clean for long. On Valentine’s Day, Hunt fatally overdosed, sending Jack into a drug-fueled tailspin.

Three months later he overdosed, too.

“I wouldn’t want anyone to go through what we’ve been through,” their mother, Kim Freeman, tells PEOPLE in this week’s issue in a special report on the opioid crisis in America.

“To lose two children,” Freeman says, “is unimaginable.”

Heroin and other opioids are claiming lives throughout the U.S. at a staggering rate. According to the Centers for Disease Control, drug overdoses now kill more Americans than either guns or car accidents: 52,000 in 2015 alone, the most recent year for which statistics are available.

One person dies of an overdose every 10 minutes.

The vast majority of those deaths, approximately 80 percent, have taken place in white communities. Experts suggest this is in part because white Americans generally have better access to health care and are more likely to be prescribed narcotics, and research shows that four in five heroin users first abused prescription pills.

People become addicted to drugs such as OxyContin, Percocet and Vicodin while being treated for a medical condition and then seek out more pills — or heroin — on the street when their prescription runs out.

“This problem of addiction truly does start in the medicine cabinet,” Russ Baer, a special agent for the Drug Enforcement Administration, tells PEOPLE. “It starts with the misuse and abuse of prescription opioid painkillers.”

A few of the people who overdosed on opioids in America (left to right, starting from top left): Katie Golden, 17; Garrett Moody, 27; Alison Collins, 22; Clyde Henderson, 62; Jacklyn Mastromauro, 29; Robert Mapps, 22; William Godwin II, 47; Samantha Roser, 23; Wolf Schinzel Sr., 47; Analicia Sutherland, 21; Ethan Beck, 26; Constance Crawford, 24; Ashley Nunnally, 26; Richard Cosner, 30; Celeste Tumminello, 25; Bryan Clay, 27; Jessica Caruso, 36 and Jack Freeman, 29.

What addiction is not, according to one retired police commander, is “a character flaw.”

The death rate from overdoses of heroin and prescription painkillers has more than quadrupled since 1999, prompting thousands of Americans to take action, including Philadelphia librarian Chera Kowalski and Stop the Heroin co-founder Bill Schmincke.

Kowalski, 33, was raised by parents who faced their own struggles with heroin. After witnessing an overdose on library property, she was trained, along with 25 other staffers, to administer Narcan, a nasal spray used for the emergency treatment of opioid overdoses.

In the past year she says she has saved six lives — providing six more chances for recovery.

“Once we can tell the Narcan works, there’s a huge sense of relief,” she says. “It provides me with hope that if they live, they have the opportunity to seek treatment, because long-term recovery is possible.”

Schmincke, 52, of Egg Harbor Township, New Jersey, began the nonprofit Stop the Heroin with his wife, Tammy, after watching son Steven spiral from occasional marijuana use into a severe opioid addiction that landed him in rehab several times.

“He was a good kid; the drugs just got him,” Schmincke says.

“We’re about awareness now,” he says of their organization, which helps people transition from rehab to sober living. “We’d like to bring light to people who don’t understand addiction. They think these people out there are junkies and drug addicts, which they’re not. They’re in the grasp of a demon.”

Trump to Hold Briefing on Opioid Crisis Tuesday

With the opioid crisis intensifying and dozens of Americans dying of drug overdoses each day, President Trump plans to hold “a major briefing” on the issue with top administration officials at his private golf club on Tuesday afternoon.

A White House spokesman described the briefing as simply “an update on the opioid crisis” and said that the president is still reviewing a preliminary report from a commission on the crisis that urgently recommended more than a week ago that he declare a national emergency.

During his campaign, the president promised he would swiftly end the crisis by building a wall along the southern U.S. border to stop the flow of heroin into the country, boosting funding for recovery programs and approaching the problem with a humanitarian mind-set instead of a law-and-order one. In November’s election, Trump overperformed the most in counties with the highest drug, alcohol and suicide mortality rates, according to a Pennsylvania State University study.

Now, more than 200 days into his presidency, activists say the president has done little to help.

Republicans in Congress have proposed cutting Medicaid in ways that health-care advocates say would reduce access to drug treatment for many, and the president’s budget proposal calls for reducing funding for addiction treatment, research and prevention efforts. Several Republican lawmakers who did not vote for their party’s plan to repeal and replace the Affordable Care Act earlier this summer said that the legislation would make it more difficult for their states to combat the heroin epidemic.

In March, Trump established the President’s Commission on Combating Drug Addiction and the Opioid Crisis, which is led by New Jersey Gov. Chris Christie (R). The group was charged with studying “ways to combat and treat the scourge of drug abuse, addiction, and the opioid crisis.”

Last week, the commission issued a preliminary report that described the overdose death toll as “September 11th every three weeks” and urged the president to immediately “declare a national emergency under either the Public Health Service Act or the Stafford Act.”

Doing so would allow the administration to remove some barriers and waive some federal rules, such as one that restricts where Medicaid recipients can receive addiction treatment. It would also put pressure on Congress to provide more funding. But some advocates worry that such a declaration would also expand the powers of the president and attorney general in a way that could allow abuse of law enforcement authority.

Christie said in an interview with CNN’s “State of the Union” on Sunday that he has received a “really good response from the White House” on the recommendations.

“We urge the president to take these steps,” Christie said. “He’s taking this commission seriously, as we are. And we make some very aggressive recommendations. And I’m confident he will adopt them.”

A White House spokesman said Tuesday morning that the “administration is still completing the review process of the recently submitted interim report” and is not yet ready for any announcements.

The preliminary report also calls for expanded access to drug treatment for Medicaid recipients, increased use of medication-assisted treatments, development of non-opioid pain relievers, wider use of a drug that can reverse an opiate overdose and more protections for individuals who report a drug overdose to first responders or law enforcement officials.

The report makes no mention of building a wall along the southern border or some of the tough-on-crime measures pushed by Attorney General Jeff Sessions, including expanding the use of mandatory minimum sentencing for drug crimes and seizing more cash and property from individuals suspected of drug crimes.

The opioid crisis has been building for years. In the mid-2000s, prescription overdose deaths began to rise, following aggressive marketing and widespread prescribing of the drugs that started in the late 1990s. When authorities began cracking down on prescription opioid abuse, increasing the street price of such drugs, some users turned to illicit street drugs such as heroin, which is sometimes mixed with powerful synthetic opiates such as fentanyl, making it even more deadly.

In 2015, more than 33,000 people died of opioid overdose, with another 20,000 dying from other drugs, according to Centers for Disease Control and Prevention figures. And deaths from drug overdoses rose sharply in the first nine months of 2016, the government reported Tuesday. The rate of overdose deaths increased every three months last year, reaching a record 19.9 per 100,000 people in the third quarter, up from 16.7 for the same three months in 2015. Data for the last three months of 2016 or this year is not yet available.

Since his election, Trump has continued talking about the opioid crisis and making broad promises. In his inaugural address, Trump said “drugs that have stolen too many lives and robbed our country of so much unrealized potential,” vowing that “this American carnage stops right here and stops right now.”

In a January phone call with Mexican President Enrique Peña Nieto, a transcript of which was obtained by The Washington Post earlier this month, Trump bragged that he won New Hampshire because the state “is a drug-infested den,” a problem that he blamed on “drug lords in Mexico.” New Hampshire had the second-highest rate of drug overdose deaths in the nation in 2015, according to the Centers for Disease Control and Prevention.

During a campaign rally last week in West Virginia, which had the nation’s highest rate of deaths in 2015, Trump promised that “we are going to solve that problem.” In a Tuesday morning tweet, Trump called the opioid crisis “a major problem for our country.”

The president’s briefing is set to start at 3 p.m. at the Trump National Golf Club in Bedminster, N.J., and Health and Human Services Secretary Tom Price plans to be there, according to guidance from the White House.

A small group of reporters will be allowed to briefly observe at least part of the meeting, making this the president’s first public appearance since he arrived at the golf resort Friday evening for an 17-day vacation that has been pitched as a “working vacation” while parts of the White House are renovated. Photos trickled out on social media over the weekend showing the president zooming around the resort in a golf cart and greeting guests at a wedding being held at the club.

Lenny Bernstein, Christopher Ingraham and John Wagner in Washington contributed to this report.

U.S. to Crack Down on Opioid Treatment Programs

WASHINGTON (Reuters) – U.S. Attorney General Jeff Sessions will unveil this week a major crackdown on healthcare fraud involving opioid treatment programs, Bloomberg News reported on Wednesday, citing two people familiar with the matter.

The Justice Department enforcement action will target hundreds of people nationwide who run drug addiction treatment centers and who have filed bogus claims, as well as those who have filed reimbursement claims for drugs they sold illegally, Bloomberg cited one of the people as saying.

Representatives for the department did not immediately reply to a request for comment on the report.

U.S. and state authorities are grappling with a national opioid addiction epidemic. Opioids, including prescription painkillers and heroin, killed more than 33,000 people in the United States in 2015, more than any year on record, according to the U.S. Centers for Disease Control and Prevention.

The planned nationwide sweep will lead to arrests in cities that include Miami, Chicago, Detroit and Los Angeles, with scores of arrests expected in southern Florida, Bloomberg reported.

It will focus on fraud against private insurers by treatment programs that have taken advantage of more generous coverage offered under the Affordable Care Act, former President Barack Obama’s signature healthcare law, according to Bloomberg.

Both of the people who discussed the initiative asked not to be named because they were not authorized to speak publicly about it, Bloomberg said.

In a related development, the Justice Department on Tuesday said Mallinckrodt Plc, one of the largest manufacturers of the generic opioid painkiller oxycodone, will pay $35 million to resolve allegations it failed to report suspicious drug orders.