#for example one is 100 years old and the other is dea-

[0vergrowngraveyard]

my boys, my sons

they are so different

[deulwight-blog]

Dear Internet: How I'd Stop SOPA

It is the first step because your physical dependence on alcohol must be overcome before any other kind of rehab will be effective. Alcohol and drug rehabilitation is also known as “drug rehab” which covers all the terms used for medical treatment which includes the psychoactive substances like street drugs and prescription drugs like alcohol, amphetamines or cocaine and heroin. In most states, there are laws that make it illegal to possess and distribute controlled substances such as drugs. The fact is that scammers are constantly evolving and inventing newer and cleverer ways to get you to willingly give them money. As there are pet pharmacies available to give you those Frontline pet medications, you should be aware of the producing company's reputation (that's if they are trusted to provide the best medicines). Although electronic razors are good, they do have shortcomings too. 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[wazafam]

The UK has tons of great crime dramas, whether it’s BBC’s Sherlock, which retells the 100-year-old tale for the modern age, or the psychological drama, Luther. British crime shows are completely unique from those in the US. However, the caliber of US crime dramas from HBO and ABC are unrivaled, thanks to the sheer amount of money that goes into them, and that’s no different when it comes to Breaking Bad.

RELATED: Breaking Bad Characters, Ranked Least To Most Likely To Win The Hunger Games

The set, costume design, storytelling, and outlandish characters in Breaking Bad are unlike anything seen in a British drama, but that doesn’t mean the island doesn’t have the talent to fill Bryan Cranston and company’s boots.

10 Mike - Tom Wilkinson

Though Mike (Jonathan Banks) has one of the biggest kill counts in Breaking Bad and is ultimately a pretty bad guy, the audience still sympathizes with him. He’s old and clearly regrets most of his actions in his later life, which makes him one of the most conflicted and complex characters in the show.

Tom Wilkinson is a similar age to Banks, and he has the same regretful, melancholy look, not to mention that he can play a bad guy extremely well, as proven in Batman Begins.

9 Marie - Rachel Weisz

There isn’t too much to Marie (Betsy Brandt) besides her equal love of purple and Hank, but she’s one of the funniest characters on the show, especially with the way she gets on Hank’s nerves by collecting minerals. The character is superbly acted by Brandt, and it’d take a lot to match what the actress brought to the table.

However, Rachel Weisz, though she doesn’t do much television work, would kill it as Marie, as her dry humor in movies like The Lobster is exactly the kind of approach that would be perfect to bring Marie to life in a British version of Breaking Bad.

8 Hank - Robert Graves

Easily most familiar for playing Inspector Greg Lestrade in BBC’s Sherlock, the role of Hank (Dean Norris) isn’t too dissimilar of a role to that of Lestrade. They’re both law enforcers, though neither of them is the smartest, but the characters’ similarities aren’t the only reasons why Robert Graves should play Hank.

RELATED: Breaking Bad Meets Mad Men: 5 Couples That Would Work (& 5 That Wouldn't)

Greg Lestrade is a great character, but he was always sidelined and didn’t get much of a story arc in any of the Sherlock seasons. However, by playing Hank, the DEA agent who is tasked with hunting down his own brother-in-law, he’d finally get exactly the story arc he deserves.

7 Kuby - Simon Pegg

There have been some shining examples of stunt casting in TV, and one of them was with Kuby (Bill Burr), one of Saul Goldman’s fixers, as Burr is one of the most world-famous comedians right now.

Keeping up the stunt casting for the same role, though Simon Pegg might not exactly be a comedian, it’d still send fans into a frenzy if the goofball-turned-spy appeared as Kuby. And it isn’t just stunt casting, as Simon Pegg is actually perfect for the role too.

6 Saul Goodman - Damien Lewis

With Saul Goodman (Bob Odenkirk) being the slimiest character on the show, Damien Lewis doesn’t really scream the same vibe, as he was a charmer in Homeland, a billionaire playboy in Billions, and he even portrayed Steve McQueen, the coolest movie star in the world.

However, he’s one of the greatest British actors working today, so he could easily play a down-on-his-luck lawyer. And most of the characters Lewis plays, including the ones mentioned, have some seriously seedy undertones.

5 Gustavo Fring - Charles Dance

With so many credits to Charles Dance’s name over the past 35 years, most are antagonistic roles in some shape or form. And as Giancarlo Esposito has become the go-to actor to play level-headed villains ever since his role of Gustavo Fring, Dance is almost the British version of Esposito, as he starred as the evil Tywin Lannister in Game of Thrones, Benedict in Last Action Hero, and many others.

Considering how Dance usually plays his characters as well-mannered but totally sinister, he’s the best option to play the best villain of Breaking Bad.

4 Todd - Matt Smith

Todd (Jesse Plemons) is a tough character to play, as he’s the worst Todd in TV history, due to being completely psychotic and having absolutely no social skills whatsoever, but at the same time, he’s kind of goofy and sort of charming.

Being millions of Doctor Who fans’ favorite Doctor, Matt Smith’s bread and butter is goofy and charming. Not only that, but his career post-Doctor Who shows how easily Smith can play a psychopath, as he plays a psychotic criminal in Lost River and the T-5000 in Terminator Genisys.

3 Skyler - Olivia Colman

Olivia Colman isn’t just Queen Elizabeth II in The Crown, she’s the queen of British television too. From first featuring in sitcoms such as The Office, Peep Show, and Green Wing, she clearly loves television, as even after having won an Academy Award, she still presses on and stars in several different shows concurrently.

And though Skyler doesn’t exactly have the funniest lines and is actually one of the most serious characters in Breaking Bad, nobody could make the role her own more than Colman, as she can play more serious and dark roles just as well, if not better.

2 Jesse Pinkman - Alfie Allen

Alfie Allen rose to fame from playing Theon Greyjoy in Game of Thrones, one of the biggest badasses in a show full of badasses. And though Jesse Pinkman (Aaron Paul) isn’t necessarily a badass (far from it in most cases), Alfie has shown he can act a fool too, as he plays Iosef Tarasov in John Wick and spends the whole movie hiding from the Baba Yaga.

RELATED: Breaking Bad: The Main Characters, Ranked By Loyalty

Allen has developed into such an incredible actor, and as Jesse, he seems confident in the first season but slowly becomes derailed the more he gets involved with Walt, finally becoming a giant ball of emotions in the finale, and the Jojo Rabbit actor would be perfect for the role.

1 Walter White - Peter Capaldi

There are two sides to Walter White: there’s family man Walt and then there’s the evil drug-slinging meth-king, Heisenberg. Bryan Cranston perfectly played both sides and remains one of the best depictions of a man turned completely evil. Not only has Capaldi proven he has the warmer Walter side by portraying the Doctor in Doctor Who, but he would also be a killer Heisenberg too.

Peter Capaldi has perfectly shown off how great he is at being wholly evil, as his iconic role as the evil spin doctor, Malcolm Tucker, in the political dramedy The Thick Of It (which was the influence for the more famous Veep) is one of the greatest performances of the 21st century. It shows how much power he can have over people, just like Heisenberg.

NEXT: 10 Questionable Parenting Choices In Breaking Bad

What If Breaking Bad Was Made In The UK? (Recasting The Characters) from https://ift.tt/3s73aE2

[jeffgrant4real]

Thoughts Before El Camino

Thursday, October 10, 2019  5:46 PM  Anytown, USA

So, the Breaking Bad movie comes out at 2 AM, my time. I’ll get to it probably around 6 or 7, depending on when I get up. I can see me waking up at 3 something to have to pee and just watching the thing right then and there. Yep. My morning will be a disaster but an awesome one. My anticipation level right now is so high I’ve barely considered what will happen if I just don’t like the movie. It’s strange. That’s usually a fear but knowing it was written and directed by Vince Gilligan I know, at the very least, it will be extremely interesting. I have so much faith in that guy. I feel like it’ll fly by and then it’ll just be over and I’ll be sad. I mean, I’ll be okay, it’s just funny anticipating new Breaking Bad content and knowing it’ll be over so quickly. But knowing me I’ll rewatch it several times. I watched each episode of the show usually at least twice when they’d air (and then listen to 2 or 3 podcasts about them). There was always so much to dig into and learn about so it was a satisfying thing to do.

I want to talk about my expectations before I see it. I was thinking earlier that we’re in a special place right now because after tomorrow We’ll know what happens in the movie. So all my guessing and what not won’t matter. So… what am I expecting and hoping for?

Vaguely, I think a lot of it will be Jesse going around doing something sneaky but also reflecting on the past couple years of his life. I think there will be flashbacks throughout where we’ll see old characters again. What I’m wondering about there is how those flashbacks will tie into the current story. Like, if he just remembers moments (we probably never saw) there needs to be a point to it. It won’t just be like, “Awe, I miss Mike.” It’ll be, “Awe, I miss Mike... Now where did we bury that money that one time we had a meaningful conversation about life?”

I’m curious what the actual plot of the story will be. Like is he trying to destroy evidence? Will he just turn himself in? Will he end up in jail or join the DEA as some kind of consultant because of everything he knows? He could escape using Ed the vacuum repairman but… I mean, Walt and Saul both did that. We haven’t seen anyone just straight up face the consequences, legally. But would that be interesting? Maybe somehow (no clue how) Kim Wexler could come in and be his lawyer. That doesn’t even make logical sense to me right now. Also, one of the major big cards Better Call Saul has yet to play is if she’s still around and/or alive during the Breaking Bad years. If this is revealed in the movie it would take something away from BCS. I think they’ll hold off on that, though I’d be happy to see her, of course. It would be interesting to see the “moral compasses” of both shows meeting each other.

And yeah, I’m curious what ties it will have to Better Call Saul. I’m assuming most of it will deal with the fallout from the events of Breaking Bad, but it would make sense for them to include something to tease the new season of BCS. Could Jesse track down Gene in Omaha somehow? Seems unlikely, but…?

Another thing, I don’t know why so many people seem to be wondering if Walter White is still alive. That seems like goofy speculation to me. I mean, Breaking Bad was HIS story and it ended when he died. Why would Vince Gilligan change that? It wouldn’t make sense from a character standpoint. That would lesson the show and I don’t think that’s a thing anyone would want to risk. I 100% think Bryan Cranston is in the movie and I guess it would have to be a flashback of some sort.

Oh, and another thing about the flashback thing. I’m wondering if it’ll be a thing where it’s Jesse looking off and thinking and then it cuts to the flashback, as if it’s his memory, or if it’ll just be a storytelling thing. I feel like Breaking Bad did more of the latter. It would show you some old moment, but it wouldn’t be because a character was thinking about it. It would have a relevance to whatever the current story was. I’m thinking of one example of the opposite though, in the finale when Walt is in his old house and for a second flashes back to Hank. I’m sure that happened more. I mean, Better Call Saul is pretty much entirely a character looking back and remembering an earlier time in his life. Hmm. So much to think about.

I feel like Skyler, Walt Jr. and Marie will probably be in it, though I’m not sure how it would bring them in. Well, I mean… No, it would make sense since they’d be on the side of law enforcement trying to find Jesse. I can see him wanting to somehow make amends with them, not because he was ever close with them but… They’re all dealing with the absence of Walt, which I can see being an odd bonding element. (that sounded science-y!) If anything he could tell them what happened with Hank… and also with Walt later at the compound. A lot of his value to the family, as well as law enforcement, is as a witness, though he was of course guilty of his own crimes.

Jesse is such an interesting character to explore. He’s so complicated. He really has done horrible horrible things, but he’s also a victim and many of those things wouldn’t have happened without Walter. And he’s suffered so much already, at least in the minds of the audience he’s paid for a lot of his sins. Though of course the criminal justice system is a whole other story there. And just thinking of how they would deal with him and everything he’s been through… Gosh, you could make a long, boring TV show of just law enforcement trying to parse out what kind of punishment this guy deserves.

I think about his confession tape and wonder what happened to it. If memory serves it was taken from Marie’s house by Jack’s gang and they watched it (and laughed at it) near the end of the series. I think that was in Granite State? I think they mentioned that they were going to destroy it but I don’t remember if they showed them doing that. I mean, it could very likely still exist somewhere on that compound, which is at the current moment being flooded by police. I can see them finding that and having some clarity. In fact… that would be a good storytelling device to help get the police up to speed on most of what Jesse’s been through. Like, it would be more interesting if they had a good idea of most of his situation already, if that makes sense. I feel like that tape has to play some part in the story.

What else?

There have been bits in the promotional materials at the junkyard and it seems like Jesse needs Joe to dig up something and… I really am not sure what that could be. Is the RV still there all crushed up? I can’t remember the details of that. I don’t know what object could be there that could help Jesse out. Hmm… I am excited for him to go back there though.

There are also moments in the trailer where it seems like he’s going back to the Nazi compound and… Gosh, I don’t know why in the world he’d want to go back there. Again, there would have to be something there he either needs to get back or destroy. But that is so so risky.

Hmm.

I’m trying to think in an overall way just what I’m hoping for, like since this is the new ending for this character… I guess I’m not expecting it to be “happy”. I don’t even know what a happy ending would look like for Jesse. I would be surprised if it ended with him just dying… though maybe that would put him out of his misery. It’d be a pretty hopeless ending though, and I feel like the ending will be more satisfying than that. That was the goal when they were ending the show, to make it satisfying, and I’m expecting that to be the goal for this thing. I would like to see Jesse find some peace, but I also wouldn’t mind him facing the real justice of his actions. Like, he seems to want to live an honest life at this point and I don’t know if being a fugitive on the run and living in hiding would even satisfy him.

Or!

Maybe he will use Ed and disappear and that’ll be a whole thing… but then at the very end he turns himself in anyway. Something like that would make sense. I just feel like as a character he’d want to be judged rightly somehow. Yeah. Guess we’ll find out soon enough.

Anyway, I’m about to take some sleeping pills so I can wake up at 4 in the morning to take part in an important cultural moment. What are you doing?  

[thisdaynews]

How Legal Weed Is Killing America’s Most Famous Marijuana Farmers

New Post has been published on https://thebiafrastar.com/how-legal-weed-is-killing-americas-most-famous-marijuana-farmers/

How Legal Weed Is Killing America’s Most Famous Marijuana Farmers

EUREKA, Calif. — On a sunny day in the spring, Thomas Mulder walked through his greenhouse, down a narrow path between two long, knee-high, wooden planters. In a few weeks, the greenhouse would be full of marijuana plants a foot or two high—indica-sativa hybrid strain Sour G, or White Tahoe Cookies with its characteristic golden hairs around the flower. A few more months and the plants would reach Mulder’s shoulders. But at that moment, the planters were empty as Mulder gestured with his hands to show how tall his crop would eventually become. Mulder has three greenhouses that sit on this flat patch of land deep in the mountains of Humboldt County. This part of his farm is accessible only by a steep, newly pavedroad that passes in and out of Humboldt Redwoods State Park, and giant trees crowd so close on either side of the property that you don’t even notice Mulder’s farm until the last bend of the road.

It’s pretty obvious why Mulder’s parents chose this place in the late 1970s to grow marijuana. Back then, camouflage ropes pulled tall branches over the clearing to hide the illegal but highly prized crop from Drug Enforcement Administration helicopters; huckleberry bushes grew among marijuana for extra concealment. Now, the array of bright white buildings would be easily spotted from above, that is if anyone was up there looking. The berry bush camouflage came out when Mulder bought this land a decade ago when California became the first state to approve medical marijuana.

Story Continued Below

Since then, as the stigma around marijuana has evaporated in a grassroots legalization movement that has swept the nation, Mulder’s farm has thrived in a three-county region known as the Emerald Triangle that has become to high-grade cannabis what Napa Valley is to wine—a tentpole of the Northern California economy. In an ideal season, Mulder’s farm produces about 1,000 pounds of cannabis, an amount that should earn him $1.5 million. After taxes, fees and farm operating expenses, Mulder can expect about $100,000 in net income. It has afforded him enough money to own his own house and set aside a retirement account and a college fund for his children.No longer an outlaw like his parents, Mulder is the very picture of middle-class respectability. He has served on the local school board for a decade without anyone batting an eye at how he earns a living.

In theory, business should have gotten better for Mulder after voters passed Proposition 64 in 2016, legalizing recreational marijuana. But the opposite has happened.

The costs of shifting his farm from California’s loosely regulated medical marijuana program into the stringent legal market have been high. Mulder actually lost money last year—the worst loss his farm has ever experienced—and he had to dip into his retirement fund and his children’s college fund to keep from closing. A few years ago, his retirement savings totaled over $80,000. After last year, he says, he has about $500 left.

Mulder is not alone. As industrial-sized growers in places like California’s famously fertile Central Valley have flooded the market, the price of legal marijuana has plummeted by more than half. An array of upfront fees and stricter regulations, combined with a lack of access to bank loans, are all reasons farmers in Humboldt and neighboring Mendocino and Trinity counties say they can’t afford to remain in the legal market. Only 2,200 farmers applied for cannabis licenses last year, according to California NORML,compared with the estimated 30,000 or more growers who existed in the Emerald Triangle pre-legalization. It’s hard to know how many of the rest are continuing to grow in the illicit market. An estimated 10 percent of growers have simply shut down. Some expect that number to rise fivefold by year’s end.

“The regulatory climate in California and the cost of all of those regulations certainly does make the prospect of a viable small farm really small,” says Trillian Schroeder, a cannabis farm consultant in Humboldt County.

In effect, legal marijuana is doing what the DEA’s war on drugs never managed to accomplish. Some observers fear the era of cannabis in Humboldt—legal and otherwise—is over.

Mulder voted for Prop 64, reasoning that the initial proposals—like a one-acre cap on licenses—were designed to help farmers. But now he’s not so sure it was the right call.

“I don’t want to see more victims of the war on drugs,” Mulder says. “But now it’s different because it’s a different war—it’s pricing [farmers] out.”

“I wish I could go back in time,” he says. “Maybe not pass Prop 64.”

***

When medical marijuana was first legalizedwith the passage of the Compassionate Care Act in 1996, some of Humboldt’s farmers were wary of coming forward and registering with a government they had seen for so long as the enemy. Eventually, though, many came out of the illicit market to grow in licensed medical collectives. The medical industry that existed from 1996 to 2016 had some regulations—there was a limit to the number of plants a farm could grow, for example, set by each county individually. Farmers had to apply for a license and pay taxes to the state. And in the late 2000s, some towns—such as Oakland—started putting local sales taxes in place. But in the spectrum of regulatory oversight, it was a modest burden.

Under Prop 64, though, cannabis has become what some in the industry call “the most regulated crop in the nation’s most regulated state.” Each plant must be meticulously monitored through a central system called “track and trace.” There are separate state and county regulations, and the county requirements—from additional taxes to environmental impact studies—can be drastically different for farmers in different parts of the state. And where farmers once paid just income and maybe some sales taxes on their medical marijuana, they are now paying taxes before they grow, after they grow, and after they sell.

Zoning certificates and water board fees can cost $3,000 to $5,000, but the biggest costs come in environmental and structural changes to the property. Many Humboldt farms lie in the mountains, deliberately out of the way to avoid easy detection, at the end of long dirt roads that are hard to navigate. Paving the dirt roads alone can cost over $100,000.

Some farms have discovered their land includes habitat for endangered species like the spotted owl. When these farmers apply for construction permits to meet Prop 64 requirements like paved roads or new, California Department of Agriculture-compliant processing facilities, they are told they need to wait two years for an environmental impact study, certifying the proposed changes won’t disturb endangered habitat. The farmers are caught in a bureaucratic trap: If they don’t build immediately, the farms won’t be considered compliant, and therefore may not receive a new license to keep growing.

Other farms have man-made geological features, such as culverts, that were put in by previous tenants—often loggers. Under state and local regulations, these man-made features have to be returned to a more ecologically friendly form, a process which also requires engineering fees and construction costs to repair.

And for farms that have good existing infrastructure on good land, there are still high taxes and fees they have to pay in addition to their startup costs. The “canopy tax” is a county tax on the space in which a farmer will grow his crop—levied before anything is grown. Last year, it was $1 per square foot. Many farmers grow multiple plots of 5,000 or 10,000 square feet, so canopy taxes can quickly reach the tens of thousands of dollars. The cultivation tax, meanwhile, is a state tax levied on harvested marijuana before it is sold, regardless of whether it sells. Neither the canopy or cultivation taxes supplant state or federal income taxes, which also have to be paid on the revenue from cannabis sales.

For Mulder, the cultivation tax on dried cannabis flower last year was $148 per pound. After paying it, a modest $15,000 profit turned into an $80,000 loss.

“It’s death by a thousand cuts,” says Schroeder, the farm consultant.

Some of these farmers feel that they are being held to standards intended for “big ag” that don’t make sense for small family farms. “You know, $20,000 to a big avocado farm is absolutely nothing,” Schroeder says. “But you put that same cost onto a small three-person farm, it’s a big hurdle for them to overcome.”

One Humboldt County farmer, Wendy Kornberg, says she cannot hire temporary workers to help her harvest her crop because she would need a bathroom on her property that is compliant with the Americans with Disabilities Act. Getting a cement truck up her hill to construct such a bathroom without paving the road first is impossible, and she won’t have the money to pave until harvest is over. So her 70-year-old mother has been helping out, instead.

Kornberg, a second-generation cannabis farmer, has used most of her savings trying to meet state and local licensing requirements.

She applied for a permit to construct a rainwater pond to water her crops. The building and planning department said her papers were in order, and all she needed was her county cannabis license in order to build. She waited eight months for that license. When it was issued, it included extra requirements for the pond, raising the cost from $20,000 to as high as $100,000. She had to scrap the pond altogether, and the lack of water meant she grew and harvested only about 10-15 percent of her annual yield, even after paying $53,000 in canopy taxes and fees.

“If you were a corn farmer, and you were only cultivating 100 acres of corn, and you’re suddenly told, ‘OK, you can only cultivate 10 acres of corn,’ you’re basically going to be bankrupt,” Kornberg said. “It’s ridiculous to think a farm can operate at 10 percent.”

***

In other industries,startup costs or unexpected regulation changes are funded by small-business loans. In the marijuana industry, however, access to loans is almost impossible to come by. Cannabis’ status as a Schedule I drug means the federal government considers it as dangerous as heroin, and consequently banks won’t open accounts, issue loans, or open lines of credit for businesses in the industry. Farmers can’t apply for crop insurance, either, or file for bankruptcy if their farm collapses.

There are some loans available, but they are high-interest private loans or venture capital—both of which many farmers don’t trust.

Mariah Gregori says she could really use a loan. Gregori spent 20 years building her homestead in the mountains with her partner and their children. But when she began the process of switching her farm into the regulated market, she found that the costs of making her land compliant were more than her farm was worth—and far more than she had the money to pay.

So Gregori, 41, and her partner drained their savings and bought a new piece of land, on a flat patch near a river. There, they are building a new cannabis farm from the ground up, gambling that the costs of bringing this flat land up to code will be cheaper than wading through the regulatory minefield her original farm presented.

Just trying to build and permit the same water tank she has at her homestead on the new farm plot is promising to cost Gregori over $50,000, and Gregori says she cannot get a line of credit to help build her water supply and make other improvements to the new property. She also can’t write off business expenses like $50,000 water tank projects on her federal taxes.

“I mean this is my life … it’s the only thing we’ve ever worked for,” Gregori says. “We’ve done it since out of high school.”

***

The California state governmentis not oblivious to the fact that taxes and regulations have overburdened the state’s cannabis industry. In fact, it’s suffering too.

State-wide revenue from cannabis taxes in 2018—the industry’s first year under full legalization—met only 30 percent of projections set by the state. California projected $1 billion in tax revenue, but at the end of 2018 had seen only $345 million, according to the Orange County Register.

On the local level, Humboldt County decided this year to charge its farmers the canopy taxes after the harvest rather than before growing, so farmers can pay from their revenue. And in Sacramento, a law called the “Temporary Cannabis Tax Reduction Bill” was introduced by state Rep. Rob Bonta (D-Oakland) and California State Treasurer Fiona Ma, but did not pass out of committee. Their bill would have temporarily suspended some taxes for three years, with the hopes of giving farmers as much capital as possible to get on their feet, and Bonta plans to reintroduce the bill next year.

Meanwhile, California’s Senate did pass a bill that will create a state-chartered bank to offer bank accounts to cannabis busineses, though Bonta says it will not issue loans or lines of credit. Ultimately, he says, banking is the purview of the federal government. Congress is working on the issue of cannabis banking right now, with the SAFE Banking Act legislation. The bill passed the House Financial Services Committee in April with a bipartisan vote of 45-15.

Democrat Representative Jared Huffman’s California district includes Humboldt County, and he is a co-sponsor of the House bill. “Criminalizing banking for businesses that are legal under state law is completely absurd,” Huffman said in a statement, adding the SAFE act has overwhelming public support.

While it enjoys widespread support in the U.S. House—165 members from both parties have already signed on to co-sponsor the bill, and it is backed by the American Banking Association—its passage isn’t guaranteed in the Senate. Since pushing through a legalization of hemp (the nonpsychoactive cousin of cannabis that is being used as a substitute crop in tobacco country) in the 2018 Farm Bill, Senate Majority Leader Mitch McConnell (R-Ky.) has said he will not bring a cannabis legalization bill to the floor. If McConnell doesn’t block a vote in the full Senate, though, the banking bill has support on both sides of the aisle, including five Republicans, among them Rand Paul of Kentucky, Kevin Cramer of North Dakota and Cory Gardner of Colorado, as well as Democrats such as Kamala Harris of California and Bernie Sanders (I-Vt.) and lawmakers from states where cannabis is still illegal, such as Senator Tim Kaine (D-Va.).

Should that federal bill not pass, California’s lawmakers don’t yet have a solution—though some say they are working on one. Some have proposed using cryptocurrency or credit unions.

Meanwhile, though, Humboldt County’s economy has been hit hard by cannabis legalization. Humboldt was the only county that lost sales tax revenue last year—dropping 2 percent from 2017 to 2018, or $424,000. In Eureka, it dropped 3 percent. Meanwhile, California, over the same period, saw a 4 percent increase.

“For us, it was such an important part of our economy that [legalization] really has been an upheaval to the way we’ve been doing business for decades,” says Mayor Susan Seaman of Eureka, Humboldt’s largest town.

Seaman says Eureka has seen a marked decrease in sales tax in the past year, as farmers spend their money on fees and regulations rather than in town. This change in spending has led some noncannabis businesses in Humboldt County to close, while others have dramatically shifted their inventory in order to stay afloat.

Humboldt County’s Small Business Development Center did an unscientific survey of its members in June 2018, and of those who answered, only 28 percent believed business would be better in 2018 than it was in 2016. In the same survey, more business owners selected “changes in the cannabis industry” as the reason for the economic decline than any other factor.

Over the past three decades, cannabis farmers in Humboldt put their income back into the local economy, buying clothes and home goods, machinery and cars, and eating in local restaurants.

In Eureka, sales tax revenue decreased in the past year despite cannabis manufacturers like Los Angeles-based Papa & Barkley bringing over 100 jobs to the area. And should the small cannabis farms go under, Seaman worries the new jobs won’t stay.

Annie Bignon, 37, owned a boutique clothing store in Garberville called Indigo Denim Bar. In 2017, Indigo Denim Bar saw a 30-percent drop in revenue. July 2018 was the tipping point, when her shop registered 60 percent less revenue than the previous July.

She and her husband—who owns a construction business—both grew up in Humboldt. “It was a thriving community, with people who had the disposable income,” Bignon said. But in November 2018, they decided to leave Garberville and open her store elsewhere, before they lost everything. Now, they and their two kids live four hours south, in Sebastopol. Every time she talks about it, Bignon starts crying. Her family was one of five from the same block who moved in the past year. Two families moved to northern Humboldt, but the other three—including Bignon’s—left the county entirely. “One of my friends said ‘Who’s going to still be here?’”

On his farm on the backside of the mountain, Thomas Mulder continues to lose sleep over farm expenses. But he has a good reason to keep going, he says. His son Tyson, 8, loves to grow things. While regulations keep Tyson out of the cannabis plots, he attentively listens to everything his father teaches him about running a farm—from creating healthy soil to road upkeep. He helps out wherever he can, filling in potholes on the road and working with vegetables and trees in his own garden space.

Like other second-generation farmers, Mulder believes in the greater Humboldt community and wants to see it continue to flourish. Cannabis farmers have done a lot of good in Garberville, he says, like donating money to refurbish the local school. Now, as his daughter nears graduation from high school, he wants to make sure there is a future for her and for her brother in Humboldt County.

“I’m not saying my kids have to join the industry,” Mulder says. “But I want to make sure … that I’ll have something to pass on to them, and this farm will still be around.”

Read More

[adoredzero-blog]

Rescheduling Marijuana, I to III

February 15, 2018 by Kailyn Brown

The lawsuit that could change the classification of marijuana as a Schedule I Drug began yesterday morning at the Southern District of New York’s Courthouse in Manhattan with overwhelming support pouring in from throughout the country. According to the attendees at 500 Pearl Street a second courtroom was opened to allow as many supporters as possible to view the proceedings via live video stream. Both court rooms were standing only. The lawsuit has become one of great importance as last month Attorney General Jeff Sessions rescinded policy to protect marijuana in the US, regardless of state laws that protect medicinal and/or recreational use. This order puts legally established businesses, patients and consumers at risk of federal prosecution... again.

So what exactly would rescheduling marijuana mean? There are 5 classes of controlled drugs under federal law: I, II, III, IV, V. Below is the definition for each Schedule.

Schedule I Schedule I drugs, substances, or chemicals are defined as drugs with no currently accepted medical use and a high potential for abuse. Some examples of Schedule I drugs are: heroin, lysergic acid diethylamide (LSD), marijuana (cannabis), 3,4-methylenedioxymethamphetamine (ecstasy), methaqualone, and peyote

Schedule II Schedule II drugs, substances, or chemicals are defined as drugs with a high potential for abuse, with use potentially leading to severe psychological or physical dependence. These drugs are also considered dangerous. Some examples of Schedule II drugs are: Combination products with less than 15 milligrams of hydrocodone per dosage unit (Vicodin), cocaine, methamphetamine, methadone, hydromorphone (Dilaudid), meperidine (Demerol), oxycodone (OxyContin), fentanyl, Dexedrine, Adderall, and Ritalin

Schedule III Schedule III drugs, substances, or chemicals are defined as drugs with a moderate to low potential for physical and psychological dependence. Schedule III drugs abuse potential is less than Schedule I and Schedule II drugs but more than Schedule IV. Some examples of Schedule III drugs are:Products containing less than 90 milligrams of codeine per dosage unit (Tylenol with codeine), ketamine, anabolic steroids, testosterone

Schedule IV Schedule IV drugs, substances, or chemicals are defined as drugs with a low potential for abuse and low risk of dependence. Some examples of Schedule IV drugs are:Xanax, Soma, Darvon, Darvocet, Valium, Ativan, Talwin, Ambien, Tramadol

Schedule V Schedule V drugs, substances, or chemicals are defined as drugs with lower potential for abuse than Schedule IV and consist of preparations containing limited quantities of certain narcotics. Schedule V drugs are generally used for antidiarrheal, antitussive, and analgesic purposes. Some examples of Schedule V drugs are: cough preparations with less than 200 milligrams of codeine or per 100 milliliters (Robitussin AC), Lomotil, Motofen, Lyrica, Parepectolin

The lawsuit is aiming to reschedule marijuana from a Schedule I to a Schedule III Drug, which places it at lower abuse potential than Percocet or Vicodin.   (Vicodin was classified as Schedule III until recently when it was moved up to a Schedule II). The current classification not only inaccurately defines marijuana, it has created a human rights issue about access to a reliable medicine and a better quality of life.

The 98 page complaint argues the case for legalization by referencing both constitutional and historical data, even citing documents from the Nixon administration that suggests that President Nixon ignored the recommendation to decriminalize marijuana for personal use in order to utilize the drug policy to target black Americans and anti-war protesters. Another piece of information in the suit cites that the Justice Department and the Financial Crimes Enforcement Network within the Treasury Department issued guidelines on how banks could provide legal marijuana businesses services, meaning the government wants the right prosecute people for following the guidelines in which the government setup for them to operate within financially. The summary is that the government has kept marijuana illegal based solely on politics and not scientific fact. 

It appears Manhattan Federal Judge Alvin Hellerstein is of a similar opinion yesterday as he made a comment to Assistant U.S. Attorney Samuel Dolinger. Dolinger, who fought to dismiss the lawsuit stated that “There is no acceptable medical use for marijuana in the United States”. To which Judge Hellerstein responded “How can you say that there is no currently accepted medical use in the United States? Your argument does not hold.”

At one point the federal judge said to Michael Hiller, the lawyer to the five plaintiffs, that his clients are living proof of the medical benefits of marijuana. “How could anyone say your clients lives have not been saved by marijuana? You can’t.” 

The plaintiffs consist of:

7-year-old Jagger Cotte who uses marijuana to treat Leigh’s syndrome, a severe neurological disorder.

12-year-old Alexis Bortell who uses marijuana to control epilepsy.

Jose Belen, an Iraq War veteran who uses marijuana to treat PTSD.

Marvin Washington, a retired NFL Super Bowl champion who co-founded a hemp-based sport performance product that is THC free.

Cannabis Cultural Association, a New York-based team that promotes inclusion and leadership for people of color and other marginalized groups within the cannabis industry.

This group of people, though significant in their individual struggles, signify a much larger group of Americans that are also living proof that marijuana has wide ranging medicinal benefits and that scientifically we have not even begun to skim the surface of the multitude of potential benefits that come with its research. 

However, as Dolinger cited Wednesday, the plaintiffs have not petitioned the DEA to reclassify the scheduling of marijuana and the precedence that the judge uphold the existing constitution of marijuana law. Hiller’s response was that the administration process to petition the DEA take an average of 9 years. 9 years is too long for plaintiff Alexis Bortell who will become 18-years-old in 6 short years and simply wants the freedom to use her medicine without legal implications constantly shadowing her. With 30 states legalizing marijuana in some form within such a short number of years, petitioning the DEA now would not be actively progressing towards full legalization at this stage in the movement. And this team is about progression.

While Judge Hellerstein acknowledged the plaintiff’s claims, he also acknowledged the governments argument to petition the DEA stating “When agencies are set up to do the very thing that you want me to do, the right thing to do is defer to the agency.” For now the judge delayed in making his decision to dismiss the case, a decision that does not have a due date.

But it does seems that the plaintiffs felt optimistic about this hearing. Sebastian Cotte, Jagger’s father said this leaving the courthouse, “I think the judge made it very clear that he agrees and understands that cannabis is helping Alexis and Jagger and so many other people. We’re going to keep fighting because we have to make this happen for everybody. We’re in it for the long run.”

If this isn’t the case to change the law it will be one of the fundamental building blocks towards that highly sought after goal.

[michaelwalshblog-blog]

Opioid-law scandal sheds light on lobbying by industry-funded ‘patient access’ groups

Rep. Thomas Marino, R-Pa., flanked by House Speaker John Boehner of Ohio, left, and House Majority Leader Eric Cantor of Va., right, speaks during a news conference on Capitol Hill in Washington, Friday, Sept. 23, 2011. (AP Photo/Susan Walsh)

Rep. Tom Marino, President Trump’s pick for drug czar, unceremoniously withdrew his name from consideration after a public outcry over his ties to the pharmaceutical industry, including sponsoring a bill that weakened the Drug Enforcement Administration’s (DEA) ability to crack down on suspicious opioid sales. But the news stories that led him to quit also raised questions about how it could have passed through Congress with virtually no opposition and been signed into law by then-President Barack Obama — an ally in the fight against opioid abuse.

The machinations of Washington are complex, but it’s hard to overstate the influence — often behind the scenes — of lobbyists. For years, the opioid industry has been funding non-profit organizations that promote patient access to their drugs. These medical organizations pushed for Congress to approve Marino’s Ensuring Patient Access and Effective Drug Enforcement Act, which serves the interests of major drug distributors and retailers.

On Jan. 26, 2015, a number of organizations nominally interested in ensuring legitimate access to pain medication wrote to Marino, Rep. Peter Welch (D-Vt.), Rep. Marsha Blackburn (R-Tenn.) and Judy Chu (D-Calif.) praising their fight for the now-controversial legislation. They argued that the country needs need a balanced approach to the opioid abuse crisis that ensures access for pain patients while stopping drug abusers. Among the groups were the Alliance for Patient Access, which describes itself as “a national network of physicians dedicated to ensuring patient access to approved therapies and appropriate clinical care” and the American Academy of Pain Management (which has since been renamed the Academy of Integrative Pain Management), which describes itself as a national professional organization advancing “integrative pain care approaches” defined by the National Institute of Health.

As of June 2017, the Alliance for Patient Access’ list of associate members and financial supporters contains over two dozen pharmaceutical companies, including Pfizer and Purdue Pharma. The latter’s marketing practices have been blamed for fueling the opioid epidemic.

“Federal agencies, law enforcement, pharmaceutical industry participants and prescribers each play a role in working diligently to prevent drug abuse and diversion,” they wrote. “However, it is also imperative that legitimate patients are able to obtain their prescriptions without disruption.”

OxyContin pills are arranged for a photo at a pharmacy in Montpelier, Vt. (Photo: Toby Talbot/AP)

Andrew Kolodny, the co-director of opioid policy research at Brandeis University, said this argument — that legitimate pain medication patients should not pay the price for the fight against drug abuse — is how the opioid lobby has framed (and continues to frame) the issue of prescription abuse from the beginning.

“These pain organizations make the case for the opioid lobby. But if you scratch the surface, you’ll find that the pain organizations that signed the letter are receiving money from the opioid lobby,” Kolodny told Yahoo News.

Kolodny said the opioid lobby often uses “phony front groups” to support their efforts in blocking any reduction in prescribing — very effectively.

An explosive investigaiton by the Washington Post and “60 Minutes” published Sunday revealed that Marino had accepted large donations from the pharamceutical industry while pressing for the legislation that they favored.

The next day, Missouri Sen. Claire McCaskill, the top-ranking Democrat on the Homeland Security and Governmental Affairs Committee, announced that she would introduce legislation to repeal the law.

Heroin users prepare to shoot up on the street in a South Bronx neighborhood which has the highest rate of heroin-involved overdose deaths in the city on October 7, 2017 in New York City. (Photo: Spencer Platt/Getty Images)

Adriane Fugh-Berman, a professor of pharmacology at Georgetown University Medical Center, said that the pharmaceutical industry creates or co-ops nonprofits to use as their mouthpieces. This is called third-party strategy: removing the drug industry’s fingerprints to make their marketing looks like education or grassroots advocacy. She said by paying off groups, Big Pharma ensures their espousal of market-friendly opinions (such as endorsing new drugs to fight problems caused by old drugs) — and their silence on drug costs.

Fugh-Berman also directs PharmedOut, a research and education project at Georgetown that exposes the effect of drug marketing on prescribing. PharmedOut recently released a list of patient and consumer advocacy groups that do not receive payments from the pharmaceutical industry. They could only identify ten health advocacy groups in the U.S. and six in Canada. Although Fugh-Berman acknowledges they may have missed a few (and plans to update accordingly), the number of truly independent voices is still tiny compared to the 7685 patient advocacy groups in the U.S. None of the 19 pain organizations that signed the letter to Marino and others appears on the list.

“The voices of industry-funded groups drown out the voices of independent groups. That’s what is meant to happen,” Fugh-Berman told Yahoo News. “The industry-funded groups are undermining public health in this country.”

Fugh-Berman, who used to chair the National Women’s Health Network, cited the controversy surrounding the female-libido boosting pill flibanserin, sold under the trade name Addyi, as an example of how independent groups can differ drastically from industry-funded groups on these issues.

She said Sprout Pharmaceuticals gave money to women’s groups as part of a public relations campaign. The result was two conflicting sets of advice to women, from groups that did, or did not, take the grants. The independent women’s groups said that viewing low libido as a disease was an invention of the pharmaceutical industry, and that drug is actually dangerous, whereas the others called Addyi the biggest step forward in women’s health since the birth control pill.

“Unfortunately, the media represented this as a cat fight among the women’s groups,” Fugh-Berman said. “But if you actually separated it by funding, 100 percent of the groups that got money supported the drug and 100 percent that didn’t take money opposed the drug.”

On these issues, she wishes that more people would hear from the groups that can truly represent the interests of consumers or patients because they are not beholden to corporate funders.

“Those groups struggle for money. They struggle for survival,” she said.

Legitimate chronic pain organizations do exist. Kolodny noted that Pain Australia teamed up with a medical organization to keep codeine from being an over-the-counter drug.

“A legitimate pain organization would not be against efforts to address the opioid crisis or efforts to promote more cautious prescribing because opioids are lousy drugs for chronic pain,” Kolodny said.

Fugh-Berman said opioids are great medications for severe pain — such as the days after surgery or end-of-life care — but do not work well for chronic pain: they cause addiction, respiratory depression, cardiovascular disease, etc.

The Centers for Disease Control and Prevention estimates that 91 Americans die from an opioid overdose every day and that more than a half-million died from drug overdoses from 2000 to 2015.

The pharmaceutical and health products industry consistently ranks toward the top of lists of contributors to federal election campaigns. The Center for Responsive Politics reports that the industry donated $28,103,688 to congressional campaigns with $23,215,767 going to incumbents during the 2016 election cycle. Congress has already received $6,965,956 for the 2018 elections.

Read more from Yahoo News:

64 hours in October: How one weekend blew up the rules of American politics

FBI document cache sheds light on inner workings of Russia’s U.S. news (and propaganda) network

Russian trolls were schooled on ‘House of Cards’

Will Weinstein’s disgrace change anything for women?

Photos: U.S.-backed militias defeat Islamic State in Raqqa, Syria

[titheguerrero]

Who Benefits from our Current Health Care Dysfunction? - Mallinckrodt's Leadership Maintains Impunity After Well Publicized Opioid Settlement

The Latest Mallinckrodt Settlement Jeff Sessions, the current US Attorney General, is ginning up a lot of press coverage of his recent crackdown on makers of narcotics.  For example, per the Washington Post on July 11, 2017...

The Justice Department and Mallinckrodt Pharmaceuticals reached a $35 million settlement Tuesday to resolve allegations that the company failed to report signs that large quantities of its highly addictive oxycodone pills were diverted to the black market in Florida, where they helped stoke the opioid epidemic. The agreement is the first with a major manufacturer of the opioids that have sparked a crisis of overdoses and addictions across the country. The Justice Department said the deal establishes 'groundbreaking' new standards that require the company to track its drugs as they flow through the supply chain to consumers in an effort to control the epidemic. The company had argued that once it passed the drugs to wholesale distributors, it was not responsible for illegal diversion of the painkillers as they were sent to retailers and then pain patients. 'The Department of Justice has the responsibility to ensure that our drug laws are being enforced and to protect the American people,' Attorney General Jeff Sessions said in a statement. 'Part of that mission is holding drug manufacturers accountable for their actions. Mallinckrodt’s actions and omissions formed a link in the chain of supply that resulted in millions of oxycodone pills being sold on the street.'

A Slap on the Wrist with a Wet Noodle Hold them accountable? With a $35 million dollar settlement? That should really strike fear into the hearts of evil-doers.  After all, this settlement is tiny compared to the magnitude of the behavior.

At one point, the government calculated that it could have assessed the company $2.3 billion in fines for nearly 44,000 violations of the federal Controlled Substances Act, according to confidential government documents obtained by The Post.

And,

Between 2008 and 2012, about 500 million of Mallinckrodt’s pills ended up in Florida, 66 percent of all oxycodone sold in the state, The Post reported. Nearly 180,000 people died of overdoses of prescription painkillers between 2000 and 2015, and the abuse of pharmaceutical opioids is widely blamed for a crisis that now involves many thousands of overdoses on heroin and fentanyl.

Then, the settlement is tiny compared with the company's revenues.  For example, according to a recent company press release, Mallinckrodt had

Fiscal 2016 net sales of $3.381 billion, up 15.7%, principally driven by volume in Specialty Brands;...

Furthermore, the settlement let the company deny wrongdoing, stating

'While Mallinckrodt disagreed with the U.S. government’s allegations, we chose to resolve the legacy matter in order to eliminate the uncertainty, distraction and expense of litigation and to allow the company to focus on meeting the important needs of its patients and customers,' Michael-Bryant Hicks, the company’s general counsel, said in the release.

In addition, as we have seen in many other legal settlements arranged by US authorities, no individual at the company who oversaw, authorized, directed, or implemented the questionable actions paid any penalty. In fact, top executives at Mallinckrodt continue to make out like proverbial bandits.  Earlier this year the St Louis Post-Dispatch reported:

Mallinckrodt Chief Executive Mark Trudeau's pay jumped 29 percent to $12.6 million as the company rewarded him for a year when profits more than doubled. Mallinckrodt, a drug company that is legally Irish but has its headquarters in Hazelwood, disclosed details of its executive pay in a proxy statement last week. Trudeau's pay included a salary of $1.04 million and a bonus of $1.6 million, which was 127 percent of the target amount. He also received $5.9 million in stock and $3.9 million in options, with some of the stock depending on Mallinckrodt's revenue growth and total shareholder return between 2016 and 2018. An earlier stock award, from 2014, paid out at 200 percent of its targeted amount. That brought Trudeau shares worth $2.5 million at current prices. Trudeau also received $101,003 in contributions to a supplemental savings plan and $16,535 in tax reimbursement. The tax reimbursement was for executives whose spouses or partners attended a national sales conference.

So Mr Sessions  thought he was holding them accountable? At least the Washington Post coverage added some dissent,

Joseph T. Rannazzisi, who supervised DEA efforts to control diversion of opioids for a decade before he retired in 2015, said Tuesday that multimillion-dollar fines have not deterred large pharmaceutical corporations accused of failing to report suspicious orders of pain pills to the DEA. 'These fines mean nothing to Fortune 500 companies,' he said. 'Large corporations see these fines as the cost of doing business. Unless there are meaningful sanctions brought against these companies, they will continue to violate the law.'

So the extremetly lenient treatment of Mallinckrodt and its top executives in this case will likely not deter health care corporate leaders from pursuing future bad behavior that is in the their self-interest.  Plus this case provides another example of the impunity of big health care organizations and their top executives.  Just the Latest Mallinckrodt Settlement And wait, there is more.  The latest settlement did not seem to be informed by any knowledge of the company's previous transgressions.  Like many other big health care organizations, Mallinckrodt and its predecessors have a long history of bad behavior which at worst has resulted in previous lenient settlements, wrist slaps, and executive impunity.  Consider some examples from this decade alone.  The 2013 Settlement of Kickbacks to Doctors As we noted in this post, for a few million dollars, Mallinckrodt settled allegations that it gave kickbacks to physicians to prescribe its antidepressants and sleeping tablets. The 2015 Questcor Shareholder Suit Alleging Deception As reported by the St Louis Business Journal,

Mallinckrodt PLC (NYSE:MKN) has announced a preliminary $38 million settlement in a shareholder lawsuit related to Questcor Pharmaceuticals Inc. The settlement is pending approval by the U.S. District Court for the Central District of California. Mallinckrodt, a Dublin, Ireland, company with its U.S. headquarters in St. Louis, acquired Questcor in 2014 for $5.6 billion. The settlement would resolve a class action lawsuit brought against Questcor alleging misstatements from former company officers and directors related to H.P Acthar Gel. Acthar, a drug used to treat autoimmune and inflammatory conditions, generated net sales for Questcor of $761.3 million in 2013.

Again, no individual who presided over, authorized, directed or implemented the misstatements suffered any negative consequences. Note that H. P. Acthar gel, when marketed by Questcor, was one of the earliest examples of a company gaming the system to increase the prices of an old drug to outrageous levels (see our posts here). The Questcor Anti-Competitive Practices Settlement Then in early 2017 Mallinckrodt settled a case involving unfair competition, as reported by Reuters,

Mallinckrodt Plc (MNK.N) has agreed to pay $100 million to settle allegations that a subsidiary broke U.S. antitrust law by sharply increasing the price of a multiple sclerosis drug while ensuring that no rival medicine appeared on the market, the Federal Trade Commission said on Wednesday. Mallinckrodt's share price dropped sharply to just under $43 from above $49 on a report Wednesday, which proved incorrect, that the FTC would sue Mallinckrodt. It spiked above $50 after news of a settlement and closed at $46.53, down 5.8 percent. In 2001, Questcor bought the rights to Acthar, a type of hormone-based drug used to treat infantile spasms as well as multiple sclerosis. Over time, the company raised the price from $40 per vial to more than $34,000, the FTC said. Questcor was acquired by Mallinckrodt in 2014. Acthar, which is off patent, represented 34 percent of Mallinckrodt's $3.4 billion in net sales for fiscal 2016, the company said in a government filing. Per patient, Medicare spent more on Acthar than for any other drug in 2015, putting out $504 million for just 3,104 patients, according to the Medicare Drug Spending Dashboard. Several U.S. drug makers have been criticized for sharp increases in drugs, notably Turing Pharmaceuticals' Daraprim and Mylan's (MYL.O) EpiPen. The U.S. Centers for Medicare and Medicaid Services reported 11 drugs saw price increases of more than 100 percent in 2015. 'This is an egregious case of a monopolist doing a deal to eliminate potential competition and keep its power over pricing. It is abhorrent that lifesaving drugs cost New Yorkers tens of thousands of dollars,' said Attorney General Eric Schneiderman in a statement.

Again, Mallinckrodt denied all wrongdoing,

'We continue to strongly disagree with allegations outlined in the FTC's complaint, believing that key claims are unsupported and even contradicted by scientific data and market facts,' a company representative said in a statement.

And of course, to repeat, no one at the company who presided over, authorized, directed or implemented the anti-competitive practices suffered any negative consequences. After that settlement, Sy Mukherjee wrote in Fortune that the

$100 million fine [was] for purposefully maintaining a monopoly on a drug that brought in one third of Mallinckrodt's $3.4 billion net 2016 sales. Although Mallinckrodt will have to sell off its U.S. license for the competing Novartis therapy, it has no obligation to lower Acthar's list price or hit pause on the price hikes since drug makers have carte blanche over their pricing in the U.S. This highlights a critical moral hazard in the biopharma industry and the system of using fines to punish bad actors. Back when I was the editor of the trade publication BioPharma Dive, I had a fascinating conversation with Patrick Burns, Acting Executive Director and President of Taxpayers Against Fraud, a group that brings forward whistleblower cases under the anti-fraud False Claims Act. Burns argued that fines are ultimately ineffective because in the U.S., we 'privatize the profits and we communitize or communize, if you will, the costs.' What Burns means is that, ultimately, news of a big fine can cause a short-term (and relatively insignificant) dent in a company's revenue stream and some PR backlash that can drive its stock price down (Mallinckrodt's shed about 7% of its market cap since the settlement). But ultimately, most of the people who suffer from that stock dip are the public and investors, not the executives who chose to engage in the bad behavior in the first place. That helps explain why some drug companies have been repeat offenders on practices like bribery and kickbacks. Burns presented a much more provocative alternative to the fines system: ban the executives responsible for the fraud or other bad behavior from working in the industry for a number of years, or actually send them to jail.

Of course, that would be hard to do as long as our top political leaders are the best buddies of the multi-millionaires and billionaires who run the big pharmaceutical companies and other huge health care organizations that generate our health care dysfunction. Summary and Discussion Mallinkcrodt made settlements of four legal cases since 2010, involving kickbacks to physicians, various deceptions, and anti-competitive behavior.  The settlements never involved severe enough penalties to the company to really affect its bottom line, never required admission of responsibility, or any accountability by top executives whose huge remuneration were doubtlessly based on the revenues brought in by bad behavior.  Yet US Attorney General continued the Kabuki performance by proclaiming he would "hold them accountable."  Sessions just slapped the company on the wrist again, with a wet noodle. That will show them. This shows that despite all the hoopla lately about health care reform, our political debate completely misses most of the causes of our health care dysfunction. There is suddenly a brief lull in the ongoing battle about whether to "repeal and replace Obamacare."  This was cast as a health care reform debate, but really at best "Obamacare" (the Affordable Care Act, or ACA) was a somewhat jury-rigged attempt to increase health insurance coverage without any substantial decrease in the US dependence on large often locally dominant for-profit insurance companies to provide health care insurance.  There was no serious discussion of alternatives, including "single-payer" government health insurance, much less a return to smaller non-profit insurance which might have some local accountability (see this post about Wendell Potter's Deadly Spin for an account of how non-profit insurance executives sold their organizations out to for-profits, greatly personally profiting from the process). Even more to the point, there was no serious discussion of why US health care is the most expensive in the world, yet provides thoroughly mediocre service and outcomes, and still leaves many patients uninsured (see this LA Times article summarizing the latest Commonwealth Fund  report). But while so many people are making fortunes from the current system, and are able to use their money to influence the ongoing debate, do not expect much change.  The case above is just one example showing how executives of big health care corporations can make millions while avoiding accountability for their actions. As I have said until blue in the face,... We will not make any progress reducing current health care dysfunction if we cannot have an honest conversation about what causes it and who profits from it.  True health care reform requires ending the anechoic effect, exposing the web of conflicts of interest that entangle health care, publicizing who benefits most from the current dysfunction, and how and why.  But it is painfully obvious that the people who have gotten so rich from the current status quo will use every tool at their disposal, paying for them with the money they have extracted from patients and taxpayers, to defend their position.  It will take grit, persistence, and courage to persevere in the cause of better health for patients and the public.  Article source:Health Care Renewal

[silviajburke]

The Health Care System Is Completely Broken

This post The Health Care System Is Completely Broken appeared first on Daily Reckoning.

Forget ObamaCare, RyanCare, and any Future ReformCare they might come up with. It’s just shuffling the deck chairs on the Titanic.

The fact is, it’s time to start planning for what we’ll do when the current healthcare system implodes.

As with many other complex, opaque systems in the U.S., only those toiling in the murky depths of the healthcare system know just how broken the entire system is.

Only those dealing daily with the perverse incentives, the Kafkaesque procedures, the endlessly negative unintended consequences, the soul-deadening paper-shuffling, the myriad forms of fraud, the recalcitrant patients who don’t follow recommendations but demand to be magically returned to health anyway, and of course the hopelessness of the financial future of a system with runaway costs, a rapidly aging populace and profiteering cartels focused on maintaining their rackets regardless of the cost to the nation or the health of its people.

Whew, got that out all in one breath.

Ask any doctor or nurse, and you will hear first-hand how broken the system is, and how minor policy tweaks and reforms cannot possibly save the system from imploding. Based on my own first-hand experience and first-hand reports by physicians, here are a few of the hundreds of reasons why the system cannot be reformed or saved.

Say 6-year old Carlos gets a tummy-ache at school. To avoid liability, the school doesn’t allow teachers to provide any care whatsoever. The school nurse (assuming the school has one) doesn’t have the diagnostic tools on hand to absolutely rule out the possibility that Carlos has some serious condition, so the parents are called and told to take Carlos to their own doctor.

Their pediatrician is already booked, so Carlos ends up waiting in the ER (emergency room). Neither the school nurse nor the parents see the symptoms as worrisome or dangerous, but here they are in ER, where standards of care require a CT scan and bloodwork.

Hours later, Carlos is released and some entity somewhere gets an $8,000 bill — for a tummy-ache that went away on its own without any treatment at all.

Since the Kafkaesque billing system rewards quick turn-arounds, observation is frowned upon unless it can be billed. So if observation is deemed necessary (to avoid any liability, of course), Carlos might be wheeled into an “observation room” filled with other people, where a nurse pops in every once in a while. This adds $3,000 to the bill.

(Never mind the stress on Carlos being in such unfamiliar surroundings; he might have felt better if he hadn’t been subjected to the anxieties that come with being enmeshed in the healthcare system’s straight-jacket of standards of care.)

If Carlos doesn’t feel better after all this, then the bill is set to balloon bigtime because an overnight stay in the hospital is the next step — and if there isn’t a 100% certainty that there is no chance of his stomach-ache becoming something serious, then the system will insist on overnight observation as the only legally defensible option.

There are other ways to increase the fees without actually providing additional care; was Carlos receiving “critical care”? Of course he was, because, well, it pays better, and by definition any ER visit is critical care.

This example is just the tip of the iceberg, but you get the point: all institutional care decisions ultimately revolve around thwarting future liability claims and maximizing the billing value of each interaction or procedure.

You’ve probably seen some of the racketeering that passes for “business as usual” in the pharmaceutical arm of the “healthcare” industry. A pharma company that spent $500,000 trying to keep pot illegal just got DEA approval for synthetic marijuana. Pinworm prescription jumps from $3 to up to $600 a pill.

Off-patent medications double or triple in cost, and then double or triple again with a few years, without any justification. To extend expiring patents, Big Pharma corporations petition the FDA to change the target audience for the med, and this trivial administrative change awards the corporation years more of lucrative patent protection.

The scams are endless, the skims are endless, the fraud is endless, the waste is endless, the fortunes expended to limit “winner take all” liability claims are endless, the paperwork churn is endless and the perverse incentives and negative unintended consequences are endless.

Everyone knows the system is unsustainable, perverse and insane, but they are powerless to change it within the system as it is. The usual sort of political horsetrading that passes for “reform” yielded ObamaCare, which did essentially zero to limit costs or cartel rackets.

A system based on parasitic predation by all the cartel players cannot be reformed or saved from its own perverse incentives and skyrocketing costs. The foundations of U.S. healthcare are rotten to the core.

“Reform” is an appealing delusion, but the rot is so deep and so pervasive it is embedded in the society and the culture, beyond the reach of legislative overhauls, no matter how well-meaning.

The trends cannot be reversed by policy tweaks and tucks. Consider: The U.S. spends more than twice as much per person than our advanced competitors such as Japan and France.

The U.S. spends 2.5 times more per person than the OECD (i.e. the industrialized nations) average:

Wages have risen 16%, GDP rose 168%, and healthcare soared 818%. Do you reckon wage earners might have a hard time paying for healthcare nowadays?

If healthcare had risen only as much as official inflation, each household would be saving $10,000 per year — $100,000 each decade. $100K here and $100K there, and pretty soon you’re talking real money in a conventional wage-earner household budget.

Projections of skyrocketing Medicare and Medicaid program costs guarantee national bankruptcy. The projection of 90 million Medicare enrollees is predictable, but there is no reason to believe costs will be limited to $20,000 per enrollee annually.

U.S. health care costs more in every category than other healthcare systems.Tweaking policy in one slice does nothing to limit the staggering increases being logged in all the other tranches of the system.

America’s healthcare system is the perfection of the fraud triangle: the pressure to increase billings, fees and profits is immense, the rationalizations are unlimited (it’s within the legal guidelines, etc.) and the opportunities for fraud are equally unlimited.

Individual caregivers and administrators want a different, better role and a better outcome, but each is trapped in the system as it is — and reform is impossible given the systemic foundations, incentives and legal framework.

It’s time to start planning for what we’ll do when the current system implodes.We might start by considering the “impossible” health care solution: go back to cash.

Regards,

Charles Hugh Smith for The Daily Reckoning

The post The Health Care System Is Completely Broken appeared first on Daily Reckoning.

[thecloudlight-blog]

New Post has been published on Cloudlight

New Post has been published on https://cloudlight.biz/shriram-transport-finance-a-year-of-single-digits/

Shriram Transport Finance: a year of single digits

Shriram Shipping Finance’s internet earnings dropped to approximately Rs150 crore from over Rs300 crore each within the first 3 quarters of financial 12 months 2017.

The fourth sector consequences of Shriram Transport Finance Co. Ltd (STFC), a non-banking finance business enterprise engaged in industrial car finance, were discouraging. The transition to spotting non-appearing property (NPA) to 120 days from one hundred fifty days has hit it tough. The word that NPA reputation from the March 2016 quarter to the December 2016 area changed into maintained on the premise of one hundred fifty days.

As a consequence, its internet income dropped to approximately Rs150 crore from over Rs300 crore each within the first 3 quarters of the financial year 2017. In truth, March sector gross NPAs extended 25.6% in comparison to the December sector, barely higher than expectancies.

The good information is: the impact of demonetization seems to be waning, says the firm. Tips of recovery post demonetisation are visible. For instance, disbursements increased 29% sequentially, even though they have been 17% lower compared to the same duration remaining year. However, the base changed into better in remaining yr’s March sector. property beneath management (AUM) grew at eight%, a ways slower than the 15% boom seen in the December zone.

Arters of economic yr 2017.

The fourth area results of Shriram Transport Finance Co. Ltd (STFC), a non-banking finance company engaged in industrial car finance, had been discouraging. The transition to recognizing non-acting assets (NPA) to one hundred twenty days from 150 days has hit it difficult. Be aware that NPA popularity from the March 2016 area to the December 2016 region was maintained on the premise of one hundred fifty days.

As a consequence, its internet income dropped to approximately Rs150 crore from over Rs300 crore every within the first three-quarters of economic 12 months 2017. In truth, March area gross NPAs increased 25.6% compared to the December region, slightly better than expectancies.

Shriram Properties, Xander enter into $350 mn deal

Underneath the deal, Xander acquires one hundred in step with cent stake in Shriram’s Gateway SEZ in Chennai for USD 190 million (Rs 1,250 crore), with an in addition commitment of USD 160 million (Rs 1,040 crore) towards an expansion of the IT SEZ, the organization stated in a statement.

Realty player Shriram Houses today stated it has signed a USD 350 million (Rs 2,290 crore) cope with Xander Organization, making it the biggest personal equity deal within the real estate area.

Under the deal, Xander acquires 100 in step with cent stake in Shriram’s Gateway SEZ in Chennai for USD one hundred ninety million (Rs 1,250 crore), with a further commitment of USD 160 million (Rs 1,040 crore) closer to enlargement of the IT SEZ, the organization stated in an announcement.

The deal entails 1.7 million square toes of occupied and operational SEZ, and a partnership with Shriram Properties to deliver the Beneath production 1.9 million square toes, it stated.

“This acquisition demonstrates our continued hobby in massive, nicely located property with boom ability throughout gateway cities in India, and enhances our existing office portfolio,” stated Rohan Sikri, senior partner, The Xander Institution.

He further stated that with this deal, Xander is increasing its current Chennai footprint.

“We see the opportunity to supply additional delivery in a marketplace in which vacancy is hastily falling,” Sikri added.

Shriram Gateway is a 58-acre incorporated township venture such as workplace space, a shopping mall, and residential apartments.

Shriram will hold to broaden and personal the residential and retail components comprising 2.6 million square toes while Xander will have the ability to broaden an additional 1 million square feet of office area, it said.

“The task gives a plethora of possibilities and is a source of employment generation across numerous sectors in Tamil Nadu. We plan to increase many such combined used development tasks across towns in India. With this association we can be able to enhance our position as a leader in the actual property area,” handling director, Shriram Houses M Murali said.

Auto Transport & Car Shipping Industry Exposed

Car shipping enterprise is administered via ninety% with the aid of the agents! Most of the people of vehicle delivery businesses do not very own automobile trailers. They do not have the workforce or budget to marketplace themselves to the general public or the customer service crew to offer to assist to their customers. They generally depend on word of mouth or neighborhood advertising to get the business. Companies deeply rely upon the brokers to refill their trucks and keep them moving.

Auto shipping agents have to get entry to hundreds of transporters and might commonly accommodate you on any place you can want to get your automobile picked up or brought to. Working with a good broker might also assist you to get a better rate or discover a corporation you would not otherwise discover to your very own. The dealer may offer you with a greater competitive rate quote and provide you higher assist. The various drivers are one guy operations or are below-staffed to offer you with fine customer support.

How did the auto delivery industry work?

While you get a quote from exceptional businesses/agents – they all compete on your commercial enterprise. But the truth is you are truly bidding for the drivers to move your vehicle. If your quote is simply too low, your vehicle will no longer be picked or it may take few weeks for the shipping.

Right here is an example on how this works: let’s say the course is (NJ to FL). There’s usually 20-forty cars ready to be picked up at the dispatch board which is used by all truckers within the industry. They are all priced from high to low. The drivers might be more interested in loads that are paying more. So in case, you picked the bottom quote and there are 10 vehicles all quoted better at the listing, your vehicle could be sitting at your driveway for awhile. Your load might be the final to get picked up, otherwise, you definitely might also by no means get a driver assigned whilst a bent dealer guarantees you the arena and takes your cash.

The way to get the right Vehicle delivery quote?

Within the industry in which money talks – your price range will decide the charge to get your vehicle picked up and delivered. Deciding on the bottom automobile shipping quotes isn’t usually encouraged. We continuously hear court cases from clients who first handled low balled fees and then went with a better quote – were given their motors picked up with 2-four commercial enterprise days.

Search Google for “Automobile shipping costs”, “automobile transport fees”, or “vehicle delivery fees” and check out numerous Vehicle transport enterprise websites. Get costs from person organizations, or comparison sites and evaluate prices. You may check the organization’s music report on sites like delivery Opinions.

Stop Bad Financial Habits And Choose A Fresh Start

Humans are frequently inspired to provide an unsolicited recommendation to others approximately the perfect way to manage finances. Despite the fact that of the desire make sense, most people of those are very common in trendy. You should exercise caution when you bring together an economic method out from this facts, even though it is essential to create a unique and regular plan.

Nevertheless, you show up to be still left together with the unanswered query. How would you save you the decline of funds on stuff which might be of no use, and but method coping with your individual budget?

The Situation: Quite a few People, including you, don’t absolutely recognize how important it’s miles to shop coins with reference to their destiny. Discern out the way to keep first then spend, no longer the alternative manner round. Even as this is advanced to no financial savings in any way, it is in reality now not the proper manner to build a super savings plan.

Steps To coping with Your man or woman finances Properly.

Indexed here are some vital recommendations that you could don’t forget if you wish to lessen costs for the future. Those techniques have helped A variety of People achieve success at taking better proper care of their budget.

Placed 20% Of The Profits Into savings

In case you are to achieve success inside the foreseeable destiny, perform the other of simply what the average person does. As opposed to saving something remains, shop first and spend afterward. Even if you are waiting for a discounted check than normal, make certain to store 20% out from each and each unmarried take a look at which you receive. Make certain to deposit this cash once you get hold of cash. You will have found out a critical lesson, and saving the amount of cash than allows you to paintings your manner down taking suitable care of the entirety, bills first.

Saving cash assists you to create a healthy financial addiction to help you to price range your money efficaciously for the rest of your way of life. You may likely feel a lot much less burdened about budget when you realize which you have an pressing Scenario fund to be had.

Don’t Complicate Matters

It is obvious the iPhone 7 is terrific. Your pals and associates have purchased it,but the iPhone 6 plus is one which you surely offered a few time in the past. At the same time as a lot of Those new devices are amusing and interesting to have, you absolutely don’t want a new telephone until your antique smartphone is loss of life. You ought to in no way buy it until you really need an iPhone 7.

Can that new smartphone do something that your particular old model cannot do? it’s far vital to from time to time deal with your self with luxuries, just Make sure this actually is something extremely good as opposed to a number of those unwanted conduct one does time and again. Additional money is the nice cash to pay, now not the 20% you will be saving.

[yes-dal456]

Fentanyl Overdoses Are Rising And Science Can't Keep Up

Bribery. Conspiracy. Racketeering.

Those are just three of the accusations that federal prosecutors leveled against two Alabama physicians in April as part of a 22-count criminal indictment ― alleging that Drs. John Couch and Xiulu Ruan ran an opioid pill mill in exchange for hundreds of thousands of dollars in kickbacks from a pharmaceutical company.

Couch and Ruan were arrested in 2015 after prescribing Medicare patients a combined $4.9 million in Subsys ― a potent form of fentanyl, taken via mouth spray and designed to treat severe cancer pain ― between 2013 and 2014.

Some of those prescriptions were “diverted and/or abused by drug traffickers and addicts,” prosecutors say, and may have contributed to the opioid crisis currently gripping the nation.

Couch and Ruan deny the allegations. 

A third doctor, Michigan neurologist Dr. Gavin Awerbuch, pleaded guilty in November to health care fraud and to prescribing Subsys without a legitimate medical purpose. Awerbuch prescribed more Subsys than any other dispenser in the country, according to the U.S. Attorney’s Office.

Couch, Ruan and Awerbuch’s alleged misdeeds signify more than a few rogue doctors attempting to turn a profit at the expense of patient health. The accusations against the physicians are part of a larger story about America’s insidious fentanyl problem and the doctors and pharmaceutical companies who’ve fueled it.

Many Americans first heard of fentanyl last year, when the singer Prince died after accidentally overdosing on the drug. Officials found pills in the pop icon’s home that were labeled as hydrocodone. Upon testing, it turned out these pills contained fentanyl. (It’s not clear whether the pills were mislabeled or illegally produced, or whether Prince even knew they contained fentanyl.)

But fentanyl has been a growing presence in the U.S. for some time now. According to the Centers for Disease Control and Prevention, the number of drug products seized by law enforcement that contained fentanyl increased by 426 percent between 2013 and 2014, and synthetic opioid overdose deaths rose by nearly 80 percent in that period.

Fentanyl is a synthetic opioid that doctors typically prescribe to chronic pain patients, like those with end-stage cancer, as an injection, a patch or a lollipop. It has a high potential for abuse and can be fatal even in small amounts.

Because it induces extreme relaxation and euphoria, fentanyl is also sold on the black market. And since fentanyl is cheap, it’s frequently mixed with more-expensive heroin or cocaine, something users aren’t always aware of when they buy it.

Fentanyl is “not a joke,” Dr. Sanjay Gupta, a neuroscientist and chief medical correspondent for CNN who serves on the American Pain Association’s board of directors, told The Huffington Post. “It’s 100 times stronger than morphine. It’s really lethal.” 

Now, a HuffPost analysis of available state-by-state data on synthetic opioid and fentanyl deaths and fentanyl seizures by law enforcement illustrates a troubling trend: Synthetic opioid overdose deaths driven by fentanyl, one of the strongest opioids on the market, are rising. 

These data highlight pockets of the United States ― the Eastern Seaboard and Appalachia in particular ― where fentanyl seizures and overdose deaths indicate a rapidly evolving problem that law enforcement and science aren’t keeping up with.

“We have not peaked yet,” said Dr. Peter Friedmann, associate dean for research at the University of Massachusetts Medical School and chief research officer at the nonprofit Baystate Health.

“It’s going to be a big issue over the next couple of years,” said Friedmann, who has spent more than two decades studying substance abuse and addiction treatments. “I really think that the policy hasn’t caught up to the pharmacology.”

The rise of fentanyl

Although reports of fentanyl abuse date back to the 1970s, the current crisis has roots in the 1990s movement to end chronic pain.

It grew out of a series of compounding missteps. Pharmaceutical companies aggressively marketed opioids to doctors as safe and non-addictive during a period when those same doctors were under pressure to eliminate patient pain. The logical answer seemed to be to write more pain-pill prescriptions.

By 2003, 20 percent of 20- to 25-year-olds were abusing painkillers, compared to 7 percent of early-20-somethings a decade earlier, according to The New York Times. When the government restricted opioid prescriptions and cracked down on so-called “pill mills,” addicted patients turned to a cheaper and prescription-free alternative: heroin.

It’s a well-trod path. Forty percent of injection drug users abused prescription opioids before they tried heroin, according to a small study published in the journal Substance Abuse and Rehabilitation in 2011.

Fentanyl is just the latest iteration of cheap and potent synthetic opioids. (In fact, authorities are battling an even newer synthetic drug, known as U-47700, in several states.)

Other fentanyl analogues include sufentanil, which is approximately eight times more potent than fentanyl, and carfentanil, which is about 100 times more potent than fentanyl and 10,000 times more potent than morphine.  

Carfentanil is “used for tranquilizing elephants,” Friedmann said, noting that overdoses tend to happen when there’s a mismatch between a person’s tolerance level and the potency of the opiate they use.

When the government restricted opioid prescriptions and cracked down on so-called “pill mills,” addicted patients turned to a cheaper and prescription-free alternative: heroin.

In addition to prescription fentanyl, Mexican cartels smuggle black-market fentanyl across the border, and Chinese suppliers sell both the drug and the equipment to make it online. 

“We have seen an influx of fentanyl directly from China,” Carole Rendon, now the U.S. attorney for the Northern District of Ohio, told the health news site Stat last year. “It’s being shipped by carrier. It’s hugely concerning.” 

It used to be that shutting down a major production site would help curb fatal overdoses. When fentanyl-related deaths surged in 2007, for example, the Drug Enforcement Administration traced the outbreak to a single site in Mexico. They shuttered the lab and the deaths stopped. Today, with decentralized units popping up around the country, it’s harder for law enforcement agents to crack down. 

The cheapest and deadliest of drugs

Part of what’s driving this public health crisis is that fentanyl is almost unthinkably potent. Patients with fentanyl prescriptions have overdosed even when they took the medication exactly as prescribed. DEA agents in St. Louis are learning to self-administer overdose reversal drugs in case they’re exposed in the line of duty. There’s a good reason officers are taking precautions: A speck of fentanyl the size of a few grains of salt can kill a 250-pound man, according to The Associated Press. 

Fentanyl’s potency means that the overdose reversal drug naloxone, sold under the brand name Narcan, is less effective at reviving fentanyl overdose victims. A person overdosing on fentanyl could need twice as much naloxone to recover as a person overdosing on heroin ― and if the emergency responder doesn’t know which drug the person took, they might not administer enough medication to save them.

When Cathy Messina found her 21-year-old son David overdosing on her bathroom floor in 2014, she prayed her 911 call would bring first responders who could save her son. What she didn’t know at the time was that the batch of heroin her son overdosed on ― which came in a package stamped with the label “Bad News” ― was laced with fentanyl. David was pronounced dead at the hospital.

Messina isn’t sure whether David knew his heroin was cut. He may have wanted a better high than pure heroin could provide. Or he, like many drug users, simply may not have known that “Bad News” heroin contained fentanyl. Some dealers mix the cheap and powerful drug with heroin to improve their profit margins, and may or may not tell customers that their product is cut. Other dealers may be too far down the supply chain to know if the heroin they’re selling is tainted. 

“Clandestine fentanyl is available throughout the United States, most commonly in the white-powder heroin market,” Melvin Patterson, an agent with the DEA, told U.S. News & World Report last year. “Fentanyl is added to heroin to increase its potency, or is mixed with and sold as fentanyl or disguised as highly potent heroin.” 

“It’s all about money,” Friedmann said. “Back in the day, dealers didn’t want to kill their clients. You want them to be repeat customers. But now, there are just so many people that they just don’t care.”

Tracking fentanyl east of the Mississippi

Simultaneous growth in synthetic opioid and fentanyl overdose death rates in the East suggests that fentanyl is fueling the region’s epidemic of opioid overdose.

Between 2014 and 2015, 15 states and Washington, D.C., reported at least a 50 percent increase in their synthetic opioid death rates. The areas in question were all east of the Mississippi River. The fentanyl death rate surged in the East that same period ― New Hampshire, for example, saw a 95 percent increase in its fentanyl-related death rate between 2014 and 2015, nearly double the 2015 figures of any other state.

In New England and Appalachia, law enforcement reported more fentanyl seizures than anywhere else in 2014, with Ohio (1,245 seizures), Massachusetts (630) and Pennsylvania (419) in the top three fentanyl confiscation slots.

So far, only 18 states and D.C. have made available any 2015 data on fentanyl overdose deaths (three of those had less than a 50 percent increase in their synthetic opioid death rates between 2014 and 2015, so they are not included in the chart above). Those limited data aren’t encouraging. Massachusetts saw a 103 percent increase in fentanyl deaths between 2014 and 2015, and West Virginia recorded a 229 percent increase year over year. The CDC doesn’t release data on fentanyl-specific deaths by state, so these data come from statewide health departments or medical examiners, and are based only on cases where medical examiners actually test for the presence of fentanyl ― meaning these numbers may be undercounts.

Experts aren’t sure why fentanyl seizures and death rates have risen on the East Coast and in Appalachia more than in the West.

“It’s [a] really hard problem to say there’s one cause,” said Nancy Campbell, a professor at Rensselaer Polytechnic Institute in Troy, New York, who has published several books on drug policy and treatment.

“Many social, economic and political conditions would lead fentanyl to becoming available in these kind of places on [the] Eastern Seaboard,” Campbell said. 

Some people start out using opioids to manage physical pain, Campbell said, but transition to using them for emotional reasons.

“They realize as they are using these pharmaceutical opioids, that they don’t just relieve pain from sports injuries or dental work,” Campbell said. “Their problems become less compelling.”

Deaths from fentanyl overdose are most highly concentrated among white men ages 25 to 54. And while heroin users once clustered around major trafficking hubs like New York City, Chicago or Los Angeles, today people living on the outskirts of large metro areas and in medium-sized cities are more likely to die from fentanyl overdose than people in metro areas with a population of 1 million or more, according to the CDC.

Potentially contributing to the East-West fentanyl discrepancy is the fact that white powder heroin is easier to cut with fentanyl than darker heroin, because the two light-colored drugs look so similar.

“The West Coast is really marked by a kind of heroin called black tar,” said Traci Green, an epidemiologist and deputy director of the Injury Prevention Center at Boston Medical Center. “On the East Coast we see a lot of white powder heroin, which looks disturbingly like fentanyl powder.”

Experienced heroin users may think they can distinguish fentanyl from heroin by color, smell or taste. But when mere grains of fentanyl can trigger an overdose, there’s no room for miscalculation.

“The margin of error is very small with fentanyl,” Green said. 

The case of Ohio

“The moment we saw the first few cases of fentanyl coming across from the Department of Health, we did a deep dive,” said Andrea Boxill, deputy director of an opiate action team established by Ohio Gov. John Kasich (R).

It seemed odd to Boxill and others that they were seeing fentanyl on the streets of Ohio but that there had only been a few reported deaths from the highly lethal drug. As it turned out, not all of the state’s coroners and medical examiners were testing for it.

Once they started testing, “we started seeing more numbers,” Boxill said.

Testing isn’t just a problem in Ohio. Synthetic opioids are evolving so rapidly that it’s hard for emergency rooms and forensics labs to keep pace. “Many of the emergency departments around the country don’t test for fentanyl,” Green said. If a lab hasn’t previously encountered fentanyl or a fentanyl analogue, the drug’s “fingerprint” probably isn’t in the lab’s database, and won’t show up on a toxicology or forensic report. 

In Ohio, better testing indeed yielded higher overdose statistics. The state’s number of recorded overdose deaths hit a record high in 2015, with 3,050 people dying that year. Ohio officials cited fentanyl overdoses as the culprit. 

The danger isn’t just that fentanyl is potent and deadly. It’s that the landscape of synthetic drug use is changing so quickly that law enforcement and science can’t keep up.

Boxill also noted that the shipping routes to and from several major drug-source areas ― including the Southwest border, Chicago, Detroit, New York City, Atlanta and Canada ― go through Ohio. The state’s central location makes it especially vulnerable. “Ohio has the eighth-largest national highway system, which carries the seventh-highest volume of traffic in the nation, allowing drug transporters to blend in with the natural flow of traffic,” a 2011 Justice Department report notes.

States and emergency rooms that aren’t yet testing for fentanyl could be dealing with more of a problem than they realize.

“[High] level of testing isn’t necessarily coming to every emergency department and every forensic lab,” Green said. “We hope it’s getting to everybody. But the pace of change is exceptionally fast for the synthetic area.”

Jonathan Caulkins, a professor at Carnegie Mellon University who researches drug control strategies, made a similar observation.

“The pace of change may be even greater in the next decade,” he said. “I don’t just mean increasing use. I can imagine significant changes in types of opioids, source of supply, relations to crime and violence. It’s a fluid situation.”

In other words, the danger isn’t just that fentanyl is potent and deadly. It’s that the landscape of synthetic drug use is changing so quickly that law enforcement and science can’t keep up.  

Rethinking addiction discrimination

Some authorities are beginning to push back. In July, U.S. Surgeon General Vivek Murthy issued an unprecedented letter to 2.3 million health care professionals, asking them to commit to solving the country’s opioid epidemic. 

In his letter, Murthy emphasized that doctors need to change how they prescribe opioids for pain. He also urged doctors to lead the way in reframing addiction as a chronic medical condition, not a moral failing. Murthy has authored a 400-page report, “Facing Addiction in America,” that outlines evidence-based treatments and advocates for prevention and treatment funding.

“We need everyone in our country to help change how we think about addiction,” he said. “For far too many people, the stigma around addiction prevents them from stepping forward for help.” 

Murthy is calling for better access to medication as a way to treat both heroin addiction and prescription opioid addiction.

“What many people don’t realize is that these are scientifically proven treatment strategies, which help people live productive and fulfilling lives,” he said. “That’s why we have to make sure that those are accessible to more people.”

Although Friedmann thinks the surgeon general’s report is a positive step, he wishes it had come sooner.

“We’ve known that this is a problem ― this is a disease ― for some time,” he said. “I wish he would have [issued the report] years ago.”

Messina, for her part, is putting Murthy’s ideas into action in Bucks County, Pennsylvania, where her son David overdosed. She educates the families and friends of people with substance use problems about overdose reversal drugs, and has worked to ensure that local police officers carry naloxone.

“People have to realize that this is a disease,” Messina said. “Yes, drugs are illegal, but everyone has to open up their minds and stop judging people.”

“I’m not ashamed of David,” she said. “I’m proud of him.”

This story is brought to you by The Huffington Post’s new health reporting project, The Scope. To read more stories like this one, follow us on Facebook and Twitter. Have a tip? Email us at scopestories@huffingtonpost.com

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[imreviewblog]

Fentanyl Overdoses Are Rising And Science Can't Keep Up

Bribery. Conspiracy. Racketeering.

Those are just three of the accusations that federal prosecutors leveled against two Alabama physicians in April as part of a 22-count criminal indictment ― alleging that Drs. John Couch and Xiulu Ruan ran an opioid pill mill in exchange for hundreds of thousands of dollars in kickbacks from a pharmaceutical company.

Couch and Ruan were arrested in 2015 after prescribing Medicare patients a combined $4.9 million in Subsys ― a potent form of fentanyl, taken via mouth spray and designed to treat severe cancer pain ― between 2013 and 2014.

Some of those prescriptions were “diverted and/or abused by drug traffickers and addicts,” prosecutors say, and may have contributed to the opioid crisis currently gripping the nation.

Couch and Ruan deny the allegations. 

A third doctor, Michigan neurologist Dr. Gavin Awerbuch, pleaded guilty in November to health care fraud and to prescribing Subsys without a legitimate medical purpose. Awerbuch prescribed more Subsys than any other dispenser in the country, according to the U.S. Attorney’s Office.

Couch, Ruan and Awerbuch’s alleged misdeeds signify more than a few rogue doctors attempting to turn a profit at the expense of patient health. The accusations against the physicians are part of a larger story about America’s insidious fentanyl problem and the doctors and pharmaceutical companies who’ve fueled it.

Many Americans first heard of fentanyl last year, when the singer Prince died after accidentally overdosing on the drug. Officials found pills in the pop icon’s home that were labeled as hydrocodone. Upon testing, it turned out these pills contained fentanyl. (It’s not clear whether the pills were mislabeled or illegally produced, or whether Prince even knew they contained fentanyl.)

But fentanyl has been a growing presence in the U.S. for some time now. According to the Centers for Disease Control and Prevention, the number of drug products seized by law enforcement that contained fentanyl increased by 426 percent between 2013 and 2014, and synthetic opioid overdose deaths rose by nearly 80 percent in that period.

Fentanyl is a synthetic opioid that doctors typically prescribe to chronic pain patients, like those with end-stage cancer, as an injection, a patch or a lollipop. It has a high potential for abuse and can be fatal even in small amounts.

Because it induces extreme relaxation and euphoria, fentanyl is also sold on the black market. And since fentanyl is cheap, it’s frequently mixed with more-expensive heroin or cocaine, something users aren’t always aware of when they buy it.

Fentanyl is “not a joke,” Dr. Sanjay Gupta, a neuroscientist and chief medical correspondent for CNN who serves on the American Pain Association’s board of directors, told The Huffington Post. “It’s 100 times stronger than morphine. It’s really lethal.” 

Now, a HuffPost analysis of available state-by-state data on synthetic opioid and fentanyl deaths and fentanyl seizures by law enforcement illustrates a troubling trend: Synthetic opioid overdose deaths driven by fentanyl, one of the strongest opioids on the market, are rising. 

These data highlight pockets of the United States ― the Eastern Seaboard and Appalachia in particular ― where fentanyl seizures and overdose deaths indicate a rapidly evolving problem that law enforcement and science aren’t keeping up with.

“We have not peaked yet,” said Dr. Peter Friedmann, associate dean for research at the University of Massachusetts Medical School and chief research officer at the nonprofit Baystate Health.

“It’s going to be a big issue over the next couple of years,” said Friedmann, who has spent more than two decades studying substance abuse and addiction treatments. “I really think that the policy hasn’t caught up to the pharmacology.”

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The rise of fentanyl

Although reports of fentanyl abuse date back to the 1970s, the current crisis has roots in the 1990s movement to end chronic pain.

It grew out of a series of compounding missteps. Pharmaceutical companies aggressively marketed opioids to doctors as safe and non-addictive during a period when those same doctors were under pressure to eliminate patient pain. The logical answer seemed to be to write more pain-pill prescriptions.

By 2003, 20 percent of 20- to 25-year-olds were abusing painkillers, compared to 7 percent of early-20-somethings a decade earlier, according to The New York Times. When the government restricted opioid prescriptions and cracked down on so-called “pill mills,” addicted patients turned to a cheaper and prescription-free alternative: heroin.

It’s a well-trod path. Forty percent of injection drug users abused prescription opioids before they tried heroin, according to a small study published in the journal Substance Abuse and Rehabilitation in 2011.

Fentanyl is just the latest iteration of cheap and potent synthetic opioids. (In fact, authorities are battling an even newer synthetic drug, known as U-47700, in several states.)

Other fentanyl analogues include sufentanil, which is approximately eight times more potent than fentanyl, and carfentanil, which is about 100 times more potent than fentanyl and 10,000 times more potent than morphine.  

Carfentanil is “used for tranquilizing elephants,” Friedmann said, noting that overdoses tend to happen when there’s a mismatch between a person’s tolerance level and the potency of the opiate they use.

When the government restricted opioid prescriptions and cracked down on so-called “pill mills,” addicted patients turned to a cheaper and prescription-free alternative: heroin.

In addition to prescription fentanyl, Mexican cartels smuggle black-market fentanyl across the border, and Chinese suppliers sell both the drug and the equipment to make it online. 

“We have seen an influx of fentanyl directly from China,” Carole Rendon, now the U.S. attorney for the Northern District of Ohio, told the health news site Stat last year. “It’s being shipped by carrier. It’s hugely concerning.” 

It used to be that shutting down a major production site would help curb fatal overdoses. When fentanyl-related deaths surged in 2007, for example, the Drug Enforcement Administration traced the outbreak to a single site in Mexico. They shuttered the lab and the deaths stopped. Today, with decentralized units popping up around the country, it’s harder for law enforcement agents to crack down. 

The cheapest and deadliest of drugs

Part of what’s driving this public health crisis is that fentanyl is almost unthinkably potent. Patients with fentanyl prescriptions have overdosed even when they took the medication exactly as prescribed. DEA agents in St. Louis are learning to self-administer overdose reversal drugs in case they’re exposed in the line of duty. There’s a good reason officers are taking precautions: A speck of fentanyl the size of a few grains of salt can kill a 250-pound man, according to The Associated Press. 

Fentanyl’s potency means that the overdose reversal drug naloxone, sold under the brand name Narcan, is less effective at reviving fentanyl overdose victims. A person overdosing on fentanyl could need twice as much naloxone to recover as a person overdosing on heroin ― and if the emergency responder doesn’t know which drug the person took, they might not administer enough medication to save them.

When Cathy Messina found her 21-year-old son David overdosing on her bathroom floor in 2014, she prayed her 911 call would bring first responders who could save her son. What she didn’t know at the time was that the batch of heroin her son overdosed on ― which came in a package stamped with the label “Bad News” ― was laced with fentanyl. David was pronounced dead at the hospital.

Messina isn’t sure whether David knew his heroin was cut. He may have wanted a better high than pure heroin could provide. Or he, like many drug users, simply may not have known that “Bad News” heroin contained fentanyl. Some dealers mix the cheap and powerful drug with heroin to improve their profit margins, and may or may not tell customers that their product is cut. Other dealers may be too far down the supply chain to know if the heroin they’re selling is tainted. 

“Clandestine fentanyl is available throughout the United States, most commonly in the white-powder heroin market,” Melvin Patterson, an agent with the DEA, told U.S. News & World Report last year. “Fentanyl is added to heroin to increase its potency, or is mixed with and sold as fentanyl or disguised as highly potent heroin.” 

“It’s all about money,” Friedmann said. “Back in the day, dealers didn’t want to kill their clients. You want them to be repeat customers. But now, there are just so many people that they just don’t care.”

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Tracking fentanyl east of the Mississippi

Simultaneous growth in synthetic opioid and fentanyl overdose death rates in the East suggests that fentanyl is fueling the region’s epidemic of opioid overdose.

Between 2014 and 2015, 15 states and Washington, D.C., reported at least a 50 percent increase in their synthetic opioid death rates. The areas in question were all east of the Mississippi River. The fentanyl death rate surged in the East that same period ― New Hampshire, for example, saw a 95 percent increase in its fentanyl-related death rate between 2014 and 2015, nearly double the 2015 figures of any other state.

In New England and Appalachia, law enforcement reported more fentanyl seizures than anywhere else in 2014, with Ohio (1,245 seizures), Massachusetts (630) and Pennsylvania (419) in the top three fentanyl confiscation slots.

So far, only 18 states and D.C. have made available any 2015 data on fentanyl overdose deaths (three of those had less than a 50 percent increase in their synthetic opioid death rates between 2014 and 2015, so they are not included in the chart above). Those limited data aren’t encouraging. Massachusetts saw a 103 percent increase in fentanyl deaths between 2014 and 2015, and West Virginia recorded a 229 percent increase year over year. The CDC doesn’t release data on fentanyl-specific deaths by state, so these data come from statewide health departments or medical examiners, and are based only on cases where medical examiners actually test for the presence of fentanyl ― meaning these numbers may be undercounts.

Experts aren’t sure why fentanyl seizures and death rates have risen on the East Coast and in Appalachia more than in the West.

“It’s [a] really hard problem to say there’s one cause,” said Nancy Campbell, a professor at Rensselaer Polytechnic Institute in Troy, New York, who has published several books on drug policy and treatment.

“Many social, economic and political conditions would lead fentanyl to becoming available in these kind of places on [the] Eastern Seaboard,” Campbell said. 

Some people start out using opioids to manage physical pain, Campbell said, but transition to using them for emotional reasons.

“They realize as they are using these pharmaceutical opioids, that they don’t just relieve pain from sports injuries or dental work,” Campbell said. “Their problems become less compelling.”

Deaths from fentanyl overdose are most highly concentrated among white men ages 25 to 54. And while heroin users once clustered around major trafficking hubs like New York City, Chicago or Los Angeles, today people living on the outskirts of large metro areas and in medium-sized cities are more likely to die from fentanyl overdose than people in metro areas with a population of 1 million or more, according to the CDC.

Potentially contributing to the East-West fentanyl discrepancy is the fact that white powder heroin is easier to cut with fentanyl than darker heroin, because the two light-colored drugs look so similar.

“The West Coast is really marked by a kind of heroin called black tar,” said Traci Green, an epidemiologist and deputy director of the Injury Prevention Center at Boston Medical Center. “On the East Coast we see a lot of white powder heroin, which looks disturbingly like fentanyl powder.”

Experienced heroin users may think they can distinguish fentanyl from heroin by color, smell or taste. But when mere grains of fentanyl can trigger an overdose, there’s no room for miscalculation.

“The margin of error is very small with fentanyl,” Green said. 

The case of Ohio

“The moment we saw the first few cases of fentanyl coming across from the Department of Health, we did a deep dive,” said Andrea Boxill, deputy director of an opiate action team established by Ohio Gov. John Kasich (R).

It seemed odd to Boxill and others that they were seeing fentanyl on the streets of Ohio but that there had only been a few reported deaths from the highly lethal drug. As it turned out, not all of the state’s coroners and medical examiners were testing for it.

Once they started testing, “we started seeing more numbers,” Boxill said.

Testing isn’t just a problem in Ohio. Synthetic opioids are evolving so rapidly that it’s hard for emergency rooms and forensics labs to keep pace. “Many of the emergency departments around the country don’t test for fentanyl,” Green said. If a lab hasn’t previously encountered fentanyl or a fentanyl analogue, the drug’s “fingerprint” probably isn’t in the lab’s database, and won’t show up on a toxicology or forensic report. 

In Ohio, better testing indeed yielded higher overdose statistics. The state’s number of recorded overdose deaths hit a record high in 2015, with 3,050 people dying that year. Ohio officials cited fentanyl overdoses as the culprit. 

The danger isn’t just that fentanyl is potent and deadly. It’s that the landscape of synthetic drug use is changing so quickly that law enforcement and science can’t keep up.

Boxill also noted that the shipping routes to and from several major drug-source areas ― including the Southwest border, Chicago, Detroit, New York City, Atlanta and Canada ― go through Ohio. The state’s central location makes it especially vulnerable. “Ohio has the eighth-largest national highway system, which carries the seventh-highest volume of traffic in the nation, allowing drug transporters to blend in with the natural flow of traffic,” a 2011 Justice Department report notes.

States and emergency rooms that aren’t yet testing for fentanyl could be dealing with more of a problem than they realize.

“[High] level of testing isn’t necessarily coming to every emergency department and every forensic lab,” Green said. “We hope it’s getting to everybody. But the pace of change is exceptionally fast for the synthetic area.”

Jonathan Caulkins, a professor at Carnegie Mellon University who researches drug control strategies, made a similar observation.

“The pace of change may be even greater in the next decade,” he said. “I don’t just mean increasing use. I can imagine significant changes in types of opioids, source of supply, relations to crime and violence. It’s a fluid situation.”

In other words, the danger isn’t just that fentanyl is potent and deadly. It’s that the landscape of synthetic drug use is changing so quickly that law enforcement and science can’t keep up.  

Rethinking addiction discrimination

Some authorities are beginning to push back. In July, U.S. Surgeon General Vivek Murthy issued an unprecedented letter to 2.3 million health care professionals, asking them to commit to solving the country’s opioid epidemic. 

In his letter, Murthy emphasized that doctors need to change how they prescribe opioids for pain. He also urged doctors to lead the way in reframing addiction as a chronic medical condition, not a moral failing. Murthy has authored a 400-page report, “Facing Addiction in America,” that outlines evidence-based treatments and advocates for prevention and treatment funding.

“We need everyone in our country to help change how we think about addiction,” he said. “For far too many people, the stigma around addiction prevents them from stepping forward for help.” 

Murthy is calling for better access to medication as a way to treat both heroin addiction and prescription opioid addiction.

“What many people don’t realize is that these are scientifically proven treatment strategies, which help people live productive and fulfilling lives,” he said. “That’s why we have to make sure that those are accessible to more people.”

Although Friedmann thinks the surgeon general’s report is a positive step, he wishes it had come sooner.

“We’ve known that this is a problem ― this is a disease ― for some time,” he said. “I wish he would have [issued the report] years ago.”

Messina, for her part, is putting Murthy’s ideas into action in Bucks County, Pennsylvania, where her son David overdosed. She educates the families and friends of people with substance use problems about overdose reversal drugs, and has worked to ensure that local police officers carry naloxone.

“People have to realize that this is a disease,” Messina said. “Yes, drugs are illegal, but everyone has to open up their minds and stop judging people.”

“I’m not ashamed of David,” she said. “I’m proud of him.”

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