Substance Abuse Newsletter October 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 National Association of Attorneys General (NAAG) is endorsing the federal bill, “Road to Recovery Act” (H.R. 2938) which will help address a lack of treatment for those suffering from drug addiction. The legislation will make treatment affordable for those who need it, and create market incentives for new treatment resources. America’s opioid crisis, including addiction to prescription pain relievers, is getting dramatically worse. A recent study indicates that drug overdoses claimed as many as 65,000 American lives in 2016, a 24 percent increase from the year before. “…we cannot arrest our way out of this problem, because it is not just a public safety challenge—it is a public health challenge as well,” reads the NAAG letter sent today to U.S. House of Representative leaders and signed by 39 attorneys general in the states and District of Columbia. “If we truly want to end this crisis, we need to focus on its root causes, including a lack of treatment for those suffering from addiction.”

Attorney General George Jepsen led a bipartisan group of attorneys general from across the country in letters to 15 health care companies that provide pharmacy benefit management (PBM) services encouraging the companies to implement programs to mitigate prescription opioid abuse. The attorneys general also sent a letter to the president and CEO of CVS Health Corporation applauding the company's recent program that automatically enrolled all commercial, health plan, employer, and Medicaid clients in an opioid abuse mitigation program. The multistate PBM letters were sent to: Argus Health Systems, Inc., Benecard Servies LLC, Envision Pharmaceutical Services LLC, Envolve Health, Express Scripts, Inc., Humana, Inc., Magellan Rx Management, MedImpact Healthcare Systems, Inc., Navitus Health Solutions LLC, OptumRX Inc., PerformRx, Prime Therapeutics, Inc., ProCare Rx, RxAdvance, and WellDyneRx.

The Justice Department announced that federal grand juries in the Southern District of Mississippi and the District of North Dakota returned indictments against two Chinese nationals and their North American based traffickers and distributors for separate conspiracies to distribute large quantities of fentanyl and fentanyl analogues and other opiate substances in the United States. The Chinese nationals are the first manufacturers and distributors of fentanyl and other opiate substances to be designated as Consolidated Priority Organization Targets (CPOTs). CPOT designations are those who have “command and control” elements of the most prolific international drug trafficking and money laundering organizations. “(Defendants) Xiaobing Yan, Jian Zhang and their respective associates represent one of the most significant drug threats facing the country – overseas organized crime groups capable of producing nearly any synthetic drug imaginable, including fentanyl, and who attempt to hide their tracks with web-based sales, international shipments and cryptocurrency transactions,” said DEA Acting Administrator Patterson.

The U.S. Food and Drug Administration (FDA) is advising that the opioid addiction medications buprenorphine and methadone should not be withheld from patients taking benzodiazepines or other drugs that depress the central nervous system (CNS). The combined use of these drugs increases the risk of serious side effects. The FDA is requiring this information to be added to the buprenorphine and methadone drug labels along with detailed recommendations for minimizing the use of medication-assisted treatment (MAT) drugs and benzodiazepines together.

Nevada Attorney General Adam Paul Laxalt announced the appointment of Terry Kerns as Nevada’s first ever statewide opioid coordinator in the Office of the Nevada Attorney General. In this role, Kerns will endeavor to bridge the gap between local law enforcement and state victims’ service providers, to ensure a coordinated response to opioid crisis in Nevada. Kerns, a recently retired Special Agent with the Federal Bureau of Investigation (FBI) and a registered nurse, will work to identify and implement best practices concerning the opioid crisis in other states; identify and expand on current best practices regarding the continuum of care from incarceration to release; expand on criminal justice interventions regarding prescription drugs in the community; and bolster law enforcement cooperation with health care providers.

Most addiction treatment programs are designed for adults and do not accept adolescents. With overdose deaths among teens on the rise, that treatment hole has become all the more important to fill. It's very hard for kids to get treatment," said Dr. Sharon Levy, one of the nation's few pediatric substance abuse specialists. Levy, who practices at Boston Children's Hospital, realized that there was a need to give more pediatricians the training they would need to treat addiction. "There are 750,000 physicians in this country who can prescribe pain medications, while there are only 37,000 who can prescribe the medication to treat people who have an addiction to pain medications," Levy said. "And only 1 percent [of those 37,000] are pediatricians. So there is a real gaping hole when it comes to getting these medications out to the kids who need them." In an effort to change that, Levy asked Dr. Jason Reynolds and Wareham Pediatrics (Massachusetts) to launch a pilot program designed to give pediatricians the training they would need to prescribe medications that could help teen addicts to get clean. “It makes it a lot easier for parents," said Jonas Bromberg, a clinical psychologist at Wareham who helped launch the program. “It's the idea that they're coming to this very familiar, safe place where they've had this long relationship. They don't need to go to a drug treatment program where there’s that kind of stigma involved. It's just going to the doctor's office."

United States Health and Human Services’ Center for Faith Based and Neighborhood Partnerships recently released an Opioid Epidemic Practical Toolkit for Faith and Community-based Leaders and Community Members suggesting practical steps that faith organizations and communities can take to address this public health crisis. The toolkit may be accessed here.

Medical/Marijuana/Synthetics

Kentucky's ban on medical marijuana has survived an initial test in court, with a judge ruling the state has a good reason to "curtail citizens' possession of a narcotic, hallucinogenic drug." Twenty-nine other states have legalized marijuana in some way, the most common being for medical purposes. While Kentucky lawmakers have embraced hemp — the fibers of the plant that are used to make rope, clothing and other products — and other uses for the cannabis plant, they have not considered a number of proposals that would let people use marijuana as medicine. Three people sued the governor and the attorney general earlier this year and asked a judge to throw out the ban because "denying sick people safe medicine" is unjust. Franklin Circuit Judge Thomas Wingate rejected that argument, ruling the state had good reason to ban the use of marijuana. He also said the state legislature has "discretion to regulate what is harmful to the public health and wellbeing." He told the plaintiffs their only option was to persuade the state legislature to lift the ban.

A new study conducted by Liberty Mutual Insurance and SADD (Students Against Destructive Decisions), reveals that a third of all teens surveyed (33 percent) perceive it to be legal to drive under the influence of marijuana in states where it’s been legalized for recreational use. Notably, 27 percent of parents surveyed believe it to be legal as well. While the survey found that 93 percent of parents think driving under the influence of alcohol is dangerous, only 76 percent feel that driving under the influence of marijuana is dangerous. The teen survey data echoes these findings with 88 percent of teens saying that driving under the influence of alcohol is dangerous compared to just 68 percent saying marijuana is dangerous. Overall, the study indicates that teens are receiving mixed messages about the dangers of marijuana use and driving, potentially putting themselves and others at risk, particularly with a quarter of teens (22 percent) admitting that driving under the influence of marijuana is common among their friends. Furthermore, only 73 percent of teens think that marijuana makes someone a worse driver while 88 percent feel the same about alcohol.

Marijuana legalization in Colorado led to a “reversal” of opiate overdose deaths in that state, according to new research published in the American Journal of Public Health. “After Colorado’s legalization of recreational cannabis sale and use, opioid-related deaths decreased more than 6% in the following 2 years,” write authors Melvin D. Livingston, Tracey E. Barnett, Chris Delcher and Alexander C. Wagenaar. The authors stress that their results are preliminary, given that their study encompasses only two years of data after the state's first recreational marijuana shops opened in 2014. While numerous studies have shown an association between medical marijuana legalization and opioid overdose deaths, this report is one of the first to look at the impact of recreational marijuana laws on opioid deaths.

A D.C. woman was sentenced Friday to 10 years in prison for voluntary manslaughter for beating her boyfriend to death with a baseball bat while she was high on "love boat." When police responded to a call in February 2017 to investigate a report of a disturbance in a house in Northeast, Thomasine Bennett, who is now 68, directed them to a barricaded closet where they found Walter M. Clark, 63, with his hands tied and in a fetal position, suffering from multiple blunt force injuries. He was unconscious and unresponsive, police said. Bennett told police she had beaten Clark with a baseball bat over a period of a day and a half after he made her smoke “love boat” the previous night. She was reportedly referring to a mixture of marijuana and embalming fluid. Clark was taken to a hospital where he was pronounced dead.

Northern Michigan University is the first known university in the U.S. to offer a four-year degree in the study of marijuana. Students enrolled in the Medicinal Plant Chemistry program will take classes in science, finance, and marketing. The program is titled “Medicinal Plant Chemistry” according to Brandon Canfield, the associate professor of chemistry who started the program. Several accredited colleges and universities offer credit and noncredit courses in marijuana. The University of California at Davis has an undergraduate course on the Physiology of Cannabis, the University of Denver offers a course on the Business of Marijuana, and Vanderbilt’s law school has a Marijuana Law and Policy course.

Methamphetamine

For more than a year while he was dean of USC’s medical school, Dr. Carmen Puliafito abused drugs on days he worked as an eye doctor in university facilities and “would return to his medical office to see patients within hours of using methamphetamine,” a state investigation alleges. Puliafito consumed heroin, methamphetamine, and other drugs on a near-daily basis at the Keck School of Medicine campus and in other locations, and the physician supplied drugs to other people, including a teenager and a patient in an addiction treatment facility, according to a filing that details the results of an investigation conducted for the Medical Board of California. It may have serious implications for both Puliafito, who could lose his medical license, and the reputation of the university that kept a troubled person in one of its most important and sensitive posts. Arthur Caplan, the founding head of the Division of Medical Ethics at New York University’s Langone Medical Center, called the medical board filing describing Puliafito’s alleged misconduct a “grim litany” and said it ranks among the worst cases against a physician that he had seen.

Other

A Miami physician was sentenced today to 97 months in prison and three years of supervised release, for his role in a $4.8 million health care fraud scheme that involved the submission of false and fraudulent claims to Medicare and the illegal prescribing of controlled substances, including oxycodone and hydrocodone. Roberto A. Fernandez, M.D., 51, of Miami, was sentenced by U.S. District Judge Cecelia M. Altonaga of the Southern District of Florida. Judge Altonaga also ordered Fernandez to pay $4.8 million in restitution, jointly and severally with his co-conspirators. Fernandez pleaded guilty on July 11 to one count of conspiracy to commit health care fraud and wire fraud in connection with a scheme, that ran from April 2011 to February 2017, involving the submission of false and fraudulent claims to Medicare and the illegal prescribing of controlled substances, including oxycodone, hydrocodone, and alprazolam. As part of his guilty plea, Fernandez admitted that he referred Medicare beneficiaries to pharmacy owners in exchange for illegal health care kickbacks. Fernandez admitted knowing that the pharmacy owners were billing and receiving reimbursements from Medicare for prescription drugs based upon the prescriptions he sold and that many of his prescriptions were medically unnecessary. For example, he admitted providing prescriptions for expensive, name brand drugs, including HIV/AIDS medications that conflicted with other HIV drugs already prescribed to the beneficiaries.

If you get medications online for your pets, be careful, the U.S. Food and Drug Administration cautions. Some websites sell unapproved or counterfeit drugs, make fraudulent claims, sell prescription drugs without requiring a prescription, or sell expired drugs. As a result, you could buy drugs that are unsafe for your pet. When ordering pet medications online be sure you're dealing with a reputable pharmacy. One way to do that is to look for pharmacy websites ending in ".Pharmacy," said Dr. Martine Hartogensis, deputy director of the Office of Surveillance and Compliance in the FDA's Center for Veterinary Medicine. Or order your pet medications from an outsourced prescription management service that's used by your veterinarian. These state-licensed internet pharmacy services work directly with the veterinarian and require a prescription be written by the veterinarian. Check if your veterinarian uses an internet pharmacy service.


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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