Substance Abuse Newsletter November 2017

The following is a compendium of news reports over the past month that may be of interest to our AG offices who are dealing with substance abuse issues. Neither the National Association of Attorneys General nor the National Attorneys General Training & Research Institute expresses a view as to the accuracy of news accounts, nor as to the position expounded by the authors of the hyperlinked articles.

Opioids

The Department of Justice announced that the Drug Enforcement Administration (DEA) intends to take immediate action against the flow of illicit fentanyl analogues into this country which has contributed to the increase in overdose deaths linked to synthetic opioids by scheduling all fentanyl-related substances on an emergency basis. When the DEA’s order takes effect, anyone who possesses, imports, distributes, or manufactures any illicit fentanyl analogue will be subject to criminal prosecution in the same manner as for fentanyl and other controlled substances. The temporary scheduling will go into effect no earlier than 30 days after the DEA publishes its notice of intent and will last up to two years, with a possibility of a one-year extension if certain conditions are met. The action will make it easier for federal prosecutors and agents to prosecute traffickers of all forms of fentanyl-related substances.

On October 26, 2017, President Donald Trump declared opioid abuse in America to be a public health emergency. The transcript of his statement may be accessed here.

The statement from Food and Drug Administration’s Commissioner Scott Gottlieb, M.D., on new strategies for addressing the crisis of opioid addiction through innovation in packaging, storage and disposal may be found here.

The statement from Food and Drug Administration’s Commissioner Scott Gottlieb, M.D. on FDA advisory about deadly risks associated with kratom may be found here.

In October 2017, the Substance Abuse and Mental Health Services Administration published a study titled: Key Substance Use and Mental Health Indicators in the United States: Results from the 2015 National Survey on Drug Use and Health. The study provides national and state-level data on mental health and the use of tobacco, alcohol, illicit drugs (including non-medical use of prescription drugs) in the United States. NSDUH is sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA), an agency in the U.S. Department of Health and Human Services (DHHS). The full content of the study may be found here.

People who turn to surgery in their struggle with obesity may be more vulnerable to opioid dependence after their procedure, new research suggests. Long-term use of these highly addictive painkillers is more common after weight-loss surgery than after general surgery, the researchers reported. "Patients undergoing bariatric [weight-loss] surgery may be particularly vulnerable to opioid dependence, possibly because of chronic knee and back pain associated with morbid obesity," explained study author Dr. Amir Ghaferi, an associate professor of surgery at the University of Michigan. The researchers surveyed more than 14,000 people who had weight-loss surgery in Michigan and found that 73 percent did not take opioid medications in the year before their surgery. Of these patients, almost 9 percent were still taking opioid medications a year after they started taking them for post-op pain. The rate of new long-term opioid use among these patients was 46 percent higher than the 6 percent rate reported among general surgery patients who had not taken opioids before their surgery.

Medical/Marijuana/Synthetics

As part of the U.S. Food and Drug Administration’s ongoing efforts to protect consumers from health fraud, the agency issued warning letters to four companies illegally selling products online that claim to prevent, diagnose, treat, or cure cancer without evidence to support these outcomes. Selling these unapproved products with unsubstantiated therapeutic claims is not only a violation of the Federal Food, Drug and Cosmetic Act, but also can put patients at risk as these products have not been proven to be safe or effective. The deceptive marketing of unproven treatments may keep some patients from accessing appropriate, recognized therapies to treat serious and even fatal diseases. In this case, the illegally sold products allegedly contain cannabidiol (CBD), a component of the marijuana plant that is not FDA approved in any drug product for any indication. CBD is marketed in a variety of product types, such as oil drops, capsules, syrups, teas, and topical lotions and creams. The companies receiving warning letters distributed the products with unsubstantiated claims regarding preventing, reversing or curing cancer; killing/inhibiting cancer cells or tumors; or other similar anti-cancer claims. Some of the products were also marketed as an alternative or additional treatment for Alzheimer’s and other serious diseases.

Maine Gov. Paul LePage (R) vetoed a bill that would legalize the sale of recreational marijuana, nearly a year after residents voted to set up a system to sell and regulate the drug. The governor said that, while the Obama administration said it would not enforce federal marijuana law, the Trump administration has said it has concerns about legal marijuana. LePage said he sought guidance from U.S. Attorney General Jeff Sessions on the matter. “Until I clearly understand how the federal government intends to treat states that seek to legalize marijuana, I cannot in good conscience support any scheme in state law to implement expansion of legal marijuana in Maine,” LePage stated.

Scientists at the University of California, Davis, partnered with biotech firm Front Range Biosciences (FRB) to conduct the genomics research to advance understanding of cannabis for medical and nutraceutical uses. The research team at UC Davis has previously mapped the genomes of the cabernet sauvignon grape and the arabica coffee bean and now wants to focus on the hemp plant because of its commercial potential. The joint initiative with FRB will involve isolating DNA from hemp that is low in THC—the principal psychoactive constituent of cannabis. “UC Davis is renowned as the leading agriculture university in the world and we are excited to work with Dr. Cantu’s team to improve this crop to reduce pesticide residues and excessive application of fertilizers, in preparation for production targeting medically beneficial compounds,” said Jonathan Vaught, CEO of FRB.

A recent article in the University of California Irvine’s Clinical Practice and Cases in Emergency Medicine Journal, titled “Pediatric Death Due to Myocarditis After Exposure to Cannabis,” reports on an 11-month-old male who, following cannabis exposure, suffered cardiac arrest and died. The authors indicate a possible relationship exists between the exposure and the cardiac arrest. Read the full content of the article here.

Constellation Brands is making a foray into marijuana, a precedent-setting move for the alcohol industry. Constellation will pay about $191 million (US dollars) for a 9.9 percent stake in Canopy Growth Corp., a Canadian seller of medicinal-marijuana products. Canopy trades on the Toronto Stock Exchange under the ticker WEED. Constellation, based in Victor, N.Y., said it has no plans to sell cannabis in the U.S. or other markets until it is legal "at all government levels." For now, it's more a matter of identifying markets with growth potential, said Chief Executive Officer Rob Sands, whose company sells Corona beer, Svedka vodka, and other brands.

Methamphetamine

San Ysidro-based U.S. Border Patrol agents arrested a 24-year-old man after border patrol dogs caught him smuggling 130 pounds of liquid methamphetamine. A canine team was screening vehicles and alerted agents to his vehicle’s gas tank, according to the U.S. Customs and Border Protection (CBP). Agents sent the 2002 BMW Sedan to an in-depth inspection and discovered the methamphetamine through a ports imaging system. The methamphetamine has a street value of about $455,000.

Other

A Mississippi-based nurse practitioner was charged in an indictment for her role in a multi-million dollar scheme to defraud TRICARE, the health care benefit program serving U.S. military, veterans and their respective family members. A Mississippi-based physician was charged in a separate indictment filed last week for his role in a similar scheme. Susan Perry N.P., 58, of Grand Bay, Alabama, and Albert Diaz M.D., 78, of Ocean Springs, Mississippi, were charged in separate indictments, in the Southern District of Mississippi. Perry was charged in a 13-count indictment with one count of conspiracy to commit health care fraud and wire fraud, four counts of wire fraud, one count of conspiracy to distribute and dispense a controlled substance, one count of distributing and dispensing of a controlled substance, one count of conspiracy to solicit and receive healthcare kickbacks, four counts of soliciting and receiving healthcare kickbacks and one count of making false statements. The indictments allege that both Perry and Diaz participated in schemes to defraud TRICARE by prescribing medically unnecessary compounded medications, some of which included Ketamine, a controlled substance, to individuals they had not examined, for the purpose of having a Hattiesburg-based compounding pharmacy dispense these medically unnecessary compounded medications and to seek reimbursement from TRICARE. According to the indictments, between February 2013 and October 2016, TRICARE reimbursed the compounding pharmacy more than $3.3 million for compounded medications prescribed by Perry, and between October 2014 and December 2015, TRICARE reimbursed the compounding pharmacy more than $2.3 million for compounded medications prescribed by Diaz. Diaz is alleged to have submitted falsified patient records in response to an audit conducted by TRICARE to make it appear as though he had examined patients before prescribing the compounding medications.


Joanne Thomka is the Editor of Substance Abuse News and may be reached at 202-326-6269. Substance Abuse News is a publication of the National Association of Attorneys General. Any use and/or copies of this newsletter in whole or part must include the customary bibliographic citation. NAAG retains copyright and all other intellectual property rights in the material presented in this publication. For content submissions or to contact the editor directly, please e-mail jthomka@naag.org.

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