07/06/14 Doug McVay
Century of Lies
Doug McVay report: This week: research into medical cannabis and PTSD among veterans stymied, the CDC raises an alarm over prescription drug use, and we look at pain management for our nation's military.
Century of Lies July 6, 2014
DEAN BECKER: The failure of Drug War is glaringly obvious to judges, cops, wardens, prosecutors and millions more. Now calling for decriminalization, legalization, the end of prohibition. Let us investigate the Century of Lies.
DOUG McVAY: Hello and welcome to Century of Lies. I'm your guest host, Doug McVay, editor of Drug War Facts dot org. Century of Lies is a production of the Drug Truth Network. DTN is supported through the generosity of the James A. Baker III Institute for Public Policy and of listeners like you. Find us on the web at drug truth dot net, where you can find past programs and you can subscribe to our podcasts. You can follow me on twitter, where I'm at drug policy facts, and also at doug mcvay. The Drug Truth Network is on Facebook, be sure to give its page a Like, you can find Drug War Facts on Facebook as well, please give it a like and share it with friends.
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Now, let's get to the news.
Dr. Suzanne Sisley, a physician and researcher studying cannabis and PTSD among military veterans, has been fired by the University of Arizona. Dr. Sisley, a professor in the university's psychiatry department, had actually obtained federal approval for her research into the usefulness of cannabis for treating the post-traumatic stress suffered by our military veterans. Unfortunately, a state legislator – Arizona state senator Kimberly Yee – blocked funding ng for the research. Supporters of the research program, particularly military veterans, were outraged by Yee's move and some even organized a recall effort against her. The effort was called off a few days after it began. Some – many – believe that the Dr's dismissal was an attack of revenge, political payback, that the Senator and her supporters pressured the university to dismiss Sisley. The university not surprisingly denies this, yet refuses to give any reasons for Dr. Sisley's dismissal. I recently spoke with Amanda Reiman, the California policy director for the Drug Policy Alliance who is also an academic researcher and a noted authority on medical cannabis, about the situation, here's what she had to say:
AMANDA REIMAN: What’s going on with Dr. Sisley is really a travesty and as someone, myself, who comes from academia there’s a big problem out there with this. This is bubbling up to the surface. It’s definitely an undercurrent that runs through all academic institutions where you either have the support of your institution or you don’t and that really matters because if you don’t have the support of your institution what you choose to study, the results you choose to publish are all going to be influenced by that. That’s not academic freedom. That’s not what we assume is happening when people are conducting research studies - especially for a university to get in the way of a study to help veterans. It’s almost unbelievable. You really have to sit there and think for a minute that here was an individual, a highly successful, very brilliant, well-published researcher who has every skill needed to conduct this kind of research who has been fighting to get access to this medicine for years and years to do this research with veterans which we’ve seen from research from Israel and other places is so promising.
This isn’t like a “shot in the dark” kind of research project. This is something that is building upon very good evidence that already exists. She came so close to the federal government finally agreeing to give the marijuana for this study ...to have this happen to the University of Arizona to feel that it is in their best interest, society’s best interest, veterans’ best interest to completely be sure that this study doesn’t happen is just beyond me. I mean it’s just beyond me.
I can’t even imagine. I teach at UC Berkeley. I’ve done research through UC Berkeley on cannabis with medical cannabis patients. My university has never been anything but supportive. They are extremely excited about my work. They talk about my work. It’s something that as a scientist you feel really good feeling that support. I can’t even imagine being in an academic environment where I felt like I couldn’t come out of a closet about the research I was doing.
As you mentioned the real losers in this situation...I mean Dr. Sisley is a brilliant woman. Regardless of what happens with this she’s going to find a place to do her research. It’s going to set this back but I have a lot of confidence in that.
Who is this really going to hurt? Who’s really, really going to suffer because of this decision by the University of Arizona? Our veterans. That’s really who is going to suffer. If they tried to do this to punish Dr. Sisley – yes, it’s going to be a blow to her but that’s not who they are really punishing.
They are punishing veterans because now this research is going to take longer to do, the access to medical cannabis for veterans is not going to be there and there is a high demand not just among veterans but among people who represent veterans for this kind of access. So they are extremely frustrated by this. It’s not that the University of Arizona is taking this out on one individual scientist. They are basically taking this out on the entire population of veterans, the people who support veterans, the people who fight for veterans’ rights, the people who love and care for veterans.
If they went after one woman they are ending up hurting thousands of people and it just doesn’t make sense over some kind of moral philosophy about the use of marijuana as a medicine. It’s just as egregious...there was never a better time to use that word – egregious.
DOUG McVAY: That audio by the way came courtesy of the Time4Hemp network and my program From Thought To Action.
The Centers for Disease Control has released some fresh reports on prescription drug use and overdoses in the US:
MODERATOR: This program is presented by the Centers for Disease Control and Prevention.
SPOKES PERSON: Every day 46 people in the US die from an overdose of prescription opioid painkillers. A surge in opioid prescribing is a key driver to the increase in overdoses but prescribing varies across the country. Health care providers in some states prescribe some painkillers almost 3 times as often as providers in other states.
More can be done to make painkiller prescribing safer and help prevent overdoses. States can increase the use of prescription drug monitoring programs which are state run databases that track prescriptions for painkillers and can help find problems in overprescribing.
Health care providers can try options that don’t involve opioid painkillers. They can also identify patients who are misusing painkillers and get them into treatment for substance abuse.
Everyone can help prevent overdoses by not taking painkillers more often than prescribed and by not selling or sharing prescription drugs.
To learn more visit http://cdc.gov/vitalsigns.
MODERATOR: For the most accurate information visit http://www.cdc.gov or call 1-800-CDC-INFO
DOUG McVAY: This is a delicate balance. On one hand, there are legitimate concerns over diversion, and misuse of prescription drugs. On the other hand, there are legitimate patients with chronic and acute pain conditions who are suffering because of law enforcement and the war on pain doctors. What to some may appear to be appropriate monitoring could be interpreted by others as a heavy-handed clamp down. Prescription monitoring programs can be a help for physicians, who may otherwise simply fail to note when a patient is being prescribed both benzodiazepines and opioid pain relievers, yet if these programs are used for fishing expeditions by law enforcement, then prescribing practices will be changed and not for the better.
Importantly, the CDC fails to mention the role of alcohol in apparent overdoses. We know from various sources including Drug Abuse Warning Network data that alcohol-in-combination is a major contributor to so-called drug-related emergency room visits and mortality. That's the kind of basic patient education that's needed.
Here in any case are some of the CDC's suggestions for what can be done.
The CDC suggests that among other things:
Healthcare providers can:
- Use prescription drug monitoring programs to identify patients who might be misusing their prescription drugs, putting them at risk for overdose.
- Discuss with patients the risks and benefits of pain treatment options, including ones that do not involve prescription painkillers.
- Follow best practices for responsible painkiller prescribing, including:
-- Screening for substance abuse and mental health problems.
-- Avoiding combinations of prescription painkillers and sedatives unless there is a specific medical indication.
-- Prescribing the lowest effective dose and only the quantity needed depending on the expected length of pain.
- Avoid taking prescription painkillers more often than prescribed.
- Dispose of medications properly, as soon as the course of treatment is done, and avoid keeping prescription painkillers or sedatives around "just in case."
- Help prevent misuse and abuse by not selling or sharing prescription drugs. Never use another person's prescription drugs.
Veterans issues. Prescription opioid use. Let's combine those subjects, and take a few minutes to listen to this from a Congressional hearing from back at the end of April this year. The Senate Veterans Affairs committee held a hearing on the Veterans Health Administration titled “Overmedication: Problems and Solutions.” The segment opens with committee chairman Bernie Sanders, Independent of Vermont. He's followed by ranking minority member Senator Richard Burr, Republican of North Carolina, then Senator Richard Blumenthal, Democrat of Connecticut.
BERNIE SANDERS: Hello. Within the veterans’ community and, in fact, throughout our nation both in the public sector and the private sector we face, as a nation, a very serious problem of overmedication. The result of that overmedication is significant numbers of people treated in the Department of Defense facilities, in VA facilities and in the private sector become dependent upon those medications intended to help them and ease their pain. Pain relief is a huge problem in the country and how we treat that pain in the most effective way is really what we are discussing today.
Some people who are treated with a whole lot of medication become addicted and I think we all know what happens when people become addicted. Some, in fact, will end up losing their lives through overdoses. In my state and throughout this country this is a huge problem as well.
This is a major issue that has been discussed on this committee during the last year and we are really glad we have such a distinguished panel with us today to help us discuss this issue.
Before we get to this issue I did want to say a word, a very brief word about another issue that has attracted a lot of attention in this country and that is the developing situation at the VA Medical Center in Phoenix. I think everyone in this room knows some very, very serious allegations have been made regarding delays in health care access and as a result the possible deaths of veterans.
I just want to make it very, very clear that I take and this committee takes these allegations very, very seriously and we are going to do everything that we can to get to the bottom of this story and get to the truth.
Right now and I just spoke to the Inspector General yesterday of the VA there is a thorough investigation taking place in Phoenix. Richard Griffin who is the VA’s acting Inspector General told me that he has the resources that he needs to thoroughly investigate that situation.
I expect that the inspector general’s office will conduct its investigation thoroughly and provide this committee with an objective analysis of the allegations – the very serious allegations – that have been made.
As I indicated the other day it is my intention to hold a hearing on this issue once the inspector general’s inquiry is complete. On this issue I want to make two brief points. First, we will get to the bottom of what has happened in Phoenix but we will reach conclusions based on an objective investigation of the facts – not TV reports but an objective investigation of the facts.
In the meantime we should not let these allegations impugn the excellent work done throughout this country by hundreds of thousands of VA doctors, nurses, administrators and staff at all levels – many of whom are veterans themselves or are closely related to veterans.
I have been all over this country. I’ve just come back from the VA in Minneapolis, Minnesota and my assessment is that we have some great people doing some great work. I would just mention, in passing, that a recent survey by the American Consumer Satisfaction Index (an independent consumer survey) pointed out that patient satisfaction is incredibly high – higher, perhaps, than in the private sector within the VA. I can tell you that in Vermont this story is true all over this country that when veterans walk into the VA they feel very, very good about the quality of care that they get.
I don’t want anything that is happening or may have happened in Phoenix to impugn the very good work done by people throughout this country.
Getting back to the issue at hand...as a nation we must remember that for many veterans chronic pain is a part of their daily life. According to VA data the most common diagnosis among post-9/11 veterans is muscular/skeletal ailments including joint, neck and back disorders. Chronic pain is a common symptom of this cluster of these conditions. VA research demonstrates greater than 50% of male veterans using VA primary care report instances of chronic pain and that the prevalence of chronic pain may be even higher among women veterans.
Therefore options for managing chronic pain among our veteran population are paramount to improving quality of life and reintegration. Additionally, PTSD along with other mental health diagnosis such as depression and anxiety are frequently diagnosed among our veterans. According to the most recent data from the VA more than 55% of our post-9/11 veterans have been diagnosed with some type of mental health disorder.
Just as with chronic pain it is critical that these veterans receive the treatment that they need and they deserve. Oftentimes opiates are used to treat both chronic pain and certain mental health disorders. While opiates can be quite effective in treating these conditions they also come with significant risks which is what we are going to be discussing today.
Therefore it is critical that these medications are prescribed to the right patients with careful monitoring and a clear understanding of proper usage.
RICHARD BURR: It is critical we ensure the VA is taking the necessary steps to address the overuse of certain medications and the potential risks of misuse in dual prescriptions.
It has been estimated that as many as 50 percent of male veterans and as high as 75 percent of female OEF/OIF veterans struggle with pain. The prevalence of chronic pain will likely increase as more service members transition into the VA system. These numbers demonstrate the need for VA to provide quality pain management services to ensure veterans with chronic pain are able to live productive and healthy lives.
According to the Center for Investigative Reporting, between 2001 and 2012 the number of VA prescriptions within four opiate categories -- including hydrocodone, oxycodone, methadone, and morphine -- surged 270 percent. Additionally, during 2012, VA providers wrote more than 6.5 million prescriptions within the same opiate categories.
I found these numbers alarming, in combination with recent media reports that describe veterans with known and documented drug addictions who are still being prescribed these types of medications. I would just like to highlight a couple stories----
A veteran with PTSD who self-medicated using oxycodone and heroin and later struggled to become clean and sober. This veteran, who is still struggling with PTSD and his addiction, now faces a new battle with the VA system, which continues to prescribe him opiates even though his electronic health record documents his addiction and the subsequent detox provided by VA.
Another veteran, while still on active duty, says he was injecting himself with anti-inflammatory drugs prescribed by military doctors. When he was treated by VA, they only responded to his pain by “loading him up on narcotics.” This veteran goes on to make the following statement, “There were better options to treat my pain, and those weren’t presented to me first. The priority was treating me the fastest, seemingly least expensive way, and it was the most detrimental.”
Now, is this the “patient-centered” or “veteran-centric” care that we constantly hear VA describing? Even in today’s testimony from the Department, we will hear that “care is increasingly personalized, proactive and patient driven.” If these stories reflect what VA believes is personalized, proactive, and patient driven, we have more problems to address than just the quality of care and long wait times.
When it comes to the care we are providing to those who have sacrificed so much for our nation, we can’t afford to get it wrong. This Committee needs to hold VA accountable to ensure they are providing world-class care. Right now, with the media reports and even VA’s own research, I am not sure we are. Today, VA will describe their policies, directives, and initiatives to ensure opioid therapies are prescribed to veterans in a safe manner. It is our obligation to hold VA accountable and ensure that they are providing the highest standard of care to those who are already in the system.
Mr. Chairman, thank you for calling this hearing.
RICHARD BLUMENTHAL: Thank you Mr. Chairman. I want to thank our witnesses for being here and for your dedicated hard work to the service of our veterans and our nation and thank you Mr. Chairman and ranking member Mr. Burr.
I want to join in expressing my very strong alarm about the reports from Arizona. If true, these reports indicate not only a betrayal of trust but also, very bluntly, a violation of our criminal laws in shredding documents and obstugating documents that are important to protect the public trust.
I hope that the Inspector General will complete his report as quickly as possible to restore that trust and confidence in the integrity of our system. I want to place on the record a request that we be informed as to what the timetable is for completing that investigation because I very much share the chairman’s concern that the committee has an obligation separately and independently of the Inspector General which has been articulated by the ranking member as well that we uncover whatever the facts are here and make sure that we fulfill our responsibility and I believe that if the Inspector General’s investigation lags that we should proceed independently.
I agree that we should make use of the Inspector General’s investigation as it proceeds promptly but I think that we should require some kind of preliminary report to us as to what the claims are and what the preliminary findings are because the reports about a secret waiting list and about neglect of care and about disregard of the responsibility to provide that care are beyond alarming they are truly angering.
I want to also express my interest and concern about the subject of this investigation. I’ve seen in Connecticut, as we have around the country, an epidemic of overuse and abuse of these powerful painkillers and other prescription drugs. They are not only deeply concerning themselves but they are potentially a gateway to other abuse such as heroin. We’ve seen it in Connecticut. I know that Vermont has as well how these prescription drugs can be a gateway to heroin use and other abuse of drugs and so, particularly when it comes to our veterans, we need to make sure that we do whatever possible to prevent this kind of overuse and abuse. I know that the alternative care that we will discuss today is integral to that effort.
Thank you, very much, Mr. Chairman.
JOHNNY ISAKSON: Thank you for calling the hearing. I want to echo the words of ranking member Burr that the Arizona situation is troubling for all of us. I’m glad we are going to get to the bottom of it. I hope we can do so as expeditiousness as possible and I hope that we can take action to help support the VA in finding out where there is a problem if there is one and then correcting it.
I would point out that Dr. Pesel and I have become close friends over the past 18 months because of incidents that neither of us wish would have happened but his quick response in Atlanta has been greatly appreciated as well has his response in Augusta and the fact that he is going to be visiting in the next week is very much appreciated and his attention to those matters.
To me the VA situation we had in Augusta 2 or 3 years ago on the sterilization of colonoscopy equipment, the difficulty we had in Atlanta with the suicide situation and the postponement or the untimely follow up with mental health patients and now what’s happening in Arizona should be a warning call for all of us.
We have 340,000 great employees at the VA. They do a tremendous job. As the chairman and his ranking member said I am very proud of what they do but if there is becoming to grow a culture of “it doesn’t matter” or “it is not important” we need to nip that in the bud and see to it that the VA is to every veteran and to this country what it was promised to be and what it must be.
I think it is important and incumbent on this body to get to the bottom – where ever the facts lead us – and to get leadership of the VA to go with us so hand and hand we can correct the inequities that are going on.
My last point is this...pharmaceutical therapy is a God send in terms of pain, in terms of management of disease and other chronic illness but it also can interact inappropriately with other drugs for other ailments. It can also be overprescribed. It also can mask a greater problem partially with regard to mental health. This is a terribly important hearing today.
I am not a person of medicine nor a person of science but I am familiar enough with what goes on in terms of drug abuse and “the one drug leading to another” . We cannot allow ourselves to take the easy way out in terms of pain management and therapy for our veterans. We need to always be looking for the long-term benefit of that veteran not just the short-term benefit of easing the pain when we are prescribing the powerful opiates that we are talking about.
Thank you for calling this hearing, Mr. Chairman.
BERNIE SANDERS: Thank you for your very apt and important remarks and I agree with virtually everything you said.
DOUG McVAY: And finally:
North Carolina has joined the ranks of states allowing some level of access to medical cannabis. Governor Pat McRory signed House Bil11220 on Thursday, July 3. according to the governor's office:
“A rare treatment that includes cannabidiol oil from hemp plants to treat drug-resistant epilepsy, which is particularly prevalent in children, will now be available in clinical trials in North Carolina thanks to legislation signed into law by Governor Pat McCrory.
“Haley Ward, age 5, was among the child patients in attendance at the signing of House Bill 1220. She was the namesake for the ‘Hope 4 Haley and Friends’ legislation as it went through the General Assembly.
“Under the provisions of the new law, medical professionals are now able to conduct evidence-based studies exploring the safety and efficacy of treating intractable epilepsy with the hemp plant oil extract. Neurologists affiliated with University of North Carolina at Chapel Hill, Duke, East Carolina and Wake Forest universities are specifically encouraged to undertake the studies in the new law.”
These laws are extremely limited. Some will benefit, so it's better than nothing. Yet still, many will be left to suffer.
That's it for this week. I'm Doug McVay and this was Century of Lies. Thank you for listening. You can find a recording of this show and past shows at the website drug truth dot net, where you can check out our other programs and subscribe to our podcasts. Follow me on Twitter, where I'm @ Drug Policy Facts and @ Doug McVay. The Drug Truth Network is on Facebook, be sure to give its page a Like, you can find Drug War Facts on Facebook as well, please give it a like and share it with friends. Spread the word. Remember: Knowledge is power.
We'll be back next week with more news and commentary on the drug war and this Century Of Lies. For now, for the drug truth network, this is Doug McVay saying so long. So long!
For the Drug Truth Network, this is Dean Becker asking you to examine our policy of Drug Prohibition.
The Century of Lies.
This show produced at Pacifica Studios at KPFT, Houston.
Transcript provided by: Jo-D Harrison of www.DrugSense.org