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Making Sense of the DEA's New Proposed Policy Statement on Pain Prescribing

There are definitely mixed feelings in the pain medicine community when it comes to the DEA's new proposed policy statement on prescribing pain medications. While everyone is pleased that the agency has loosened up its prescribing rules—allowing doctors to write three one-month pain med prescriptions at a time—there is some dispute over whether the DEA's latest policy statement represents anything other than the agency doing business as usual. For Dr. Frank Fisher the new policy statement represents little more than "window dressing," he told the Chronicle this week. The problem, Fisher said, was that physicians are still intimidated by the DEA and as a result, chronic pain patients are going untreated. Siobhan Reynolds of the patients' and physicians' advocacy group the Pain Relief Network used the exact same word, "window dressing," to describe the new policy statement. Reynolds, whose husband, a chronic pain patient, died just weeks ago as the family traveled across the country seeking relief for him, talked about a DEA "reign of terror that has cost people their lives, including my husband Sean." But some physicians working in the pain management and addiction medicine fields have a much brighter view. Dr. Howard Heit, a Fairfax, Virginia, physician called the new prescribing rules "a great step forward." The DEA is "responding to the health care community," he said. There is much more. Look for a Chronicle article tomorrow that delves deeper into this. As for those Louisiana heroin lifers, I guess they'll just have to wait another week. None of the people who asked me so urgently to write about their plight three weeks ago have managed to return my repeated calls seeking more information.
Location: 
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Heroin Lifers, DEA Pain Guidance, California Lowest Priority Initiatives

Those are the feature stories I think I will be doing this week. It doesn't always happen that way, though. Some readers may recall that I was going to do the Louisiana heroin lifer story last week, but I didn't manage to get ahold of any of the people critical to the story. I'm back on it again this week. Similarly, something may break during the week. This typically happens on Thursday, the day we're supposed to be wrapping up the Chronicle. I'll also be looking into the DEA's release last week of a new policy statement on pain management. Some reformers have hailed it as a victory for the movement, but others are not so sure, and neither am I. I'll be talking to a wide range of people who are involved in this issue to try to find out what this really means. Meanwhile, elections are only a matter of weeks away. I'll be taking a look this week at how things are going in Santa Barbara, Santa Cruz, and Santa Monica, the three California cities where "lowest law enforcement priority" marijuana initiatives are on the ballot. And, of course, there will also be the seven or eight shorter pieces we do each week.
Location: 
United States

Marijuana: In Annual Harvest Roundup, 98% of All Marijuana Seizures Are Ditchweed

The fact may get lost in the hype about multi-million dollar outdoor marijuana garden seizures at this time of year, but the vast majority of all marijuana plants seized by law enforcement are ditchweed. For those who didn't grow up in the Midwest, ditchweed is feral marijuana descended from the hemp plants farmers produced as part of the war effort in World War II.

https://stopthedrugwar.org/files/dodgecounty.jpg
National Guard marijuana (or more likely ditchweed) eradication team, Dodge County, Minnesota
Like the hemp plants whence it came, ditchweed has negligible levels of THC, the psychoactive component of marijuana. An old saying in the Midwest is that you could smoke a joint of it the size of a telephone pole and all you would get is a headache.

According to official DEA figures, police seized an estimated 223 million marijuana plants last year. But 219 million of them, or 98%, were ditchweed. That figure is in line with previous years. And a whopping 212 million plants came from Indiana alone. Missouri came in second with 4.5 million plants, Kansas third with 1.1 million, and Wisconsin fourth with 272,000. Most states reported no ditchweed seizures.

The DEA pays for the ditchweed eradication boondoggle, something for which National Organization for the Reform of Marijuana Laws executive director criticized it in a statement noting the annual seizure figures. "The irony, of course, is that industrial hemp is grown legally throughout most of the Western world as a commercial crop for its fiber content," he said. "Yet the US government is spending taxpayers' money to target and eradicate this same agricultural commodity."

Your tax dollars at work.

DEA Feeling the Pain

The DEA’s war on pain doctors got a facelift today as explained in their ironically titled press-release “Working Together: DEA and the Medical Community”.

From DEA.gov:

Today, DEA is unveiling a proposed rule that will make it easier for patients with chronic pain or other chronic conditions, to avoid multiple trips to a physician. It will allow a physician to prescribe up to a 90-day supply of Schedule II controlled substances during a single office visit, where medically appropriate. The Notice of Proposed Rulemaking is accompanied by a policy statement, “Dispensing Controlled Substances for the Treatment of Pain,” which provides information requested by medical professionals regarding DEA’s position on this important issue.

It’s nice to see the spirit of cooperation take hold at DEA, but recent history tells a different story. I’d bet the average pain management specialist feels less like a partner here and more like the groom at a shotgun wedding.

Indeed, this is a not-so-subtle attempt to smooth over the public relations nightmare that has resulted from the agency’s relentless harassment of pain management doctors:

Also new today, DEA is launching a new page on its website (www.dea.gov) called “Cases Against Doctors.” Everyone will be able to see for themselves the criminal acts committed by those few physicians who are subject to prosecution or administrative action each year.

The Cases Against Doctors page reeks of insecurity on DEA’s part, suggesting that widespread criticism may have affected Karen Tandy, who’s usually numb from heavy doses of self-righteousness.

Update: USA Today and Washington Post have the story. Both note the hostile relationship DEA has fostered with the medical community. Washington Post describes the regulations as an unambiguous concession to the medical community, which has generally gotten the cold shoulder from DEA on this issue.

Still, to the extent that DEA has capitulated here, it probably has more to do with last month’s reversal of the Hurwitz conviction than any sudden recognition that maybe doctors have useful ideas about how to define legitimate medical practices.

Location: 
United States

Pain Medicine: DEA Set to Ease Restrictions on Schedule II Prescriptions

Under a proposed rule unveiled Wednesday, the Drug Enforcement Administation would allow doctors prescribing Schedule II drugs, such as morphine or Oxycontin, to fill prescriptions for 90 days instead of 30 days. Currently, pain patients can only get 30-day non-refillable prescriptions, requiring them to make additional visits to the doctor's office just to get a new prescription written. Doctors and patients have complained that the DEA's strict regulation of Schedule II drugs has forced doctors to limit their prescriptions, with patients going untreated as a result.

At a Wednesday press conference in Washington, DEA administrator Karen Tandy attempted to signal that the agency was hearing those concerns. "Today's policy statement reaffirms that DEA wants doctors to treat pain as is appropriate under accepted medical community standards," said Tandy in remarks reported by the Associated Press. "Physicians acting in accordance with accepted medical practice should be confident that they will not be criminally charged."

While the number of doctors who faced federal charges over their prescribing practices is relatively small, it is increasing -- from 38 in 2003 to 67 last year. Other pain management physicians have faced state criminal charges of administrative sanctions, and pain patient and physician advocacy groups complain that the agency is interfering with and having a chilling effect on the practice of pain medicine.

The move was welcomed by the American Medical Association, with AMA board member Dr. Rebecca Patchin telling the AP it was a step toward improving the care of pain patients. "Relieving suffering while doing everything we can to prevent the abuse of controlled substances reflects appropriate patient care, a standard which is easier to achieve when a strong patient-physician relationship exists," said Dr. Patchin. "We need to provide access to pain relief for patients with legitimate needs, and the DEA proposal would help in doing this."

Others were less sanguine. "Ms. Tandy states here, as she has on many occasions, that doctors need not fear criminal prosecution as long as they practice medicine in conformity with what these drug cops think is 'appropriate,'" said Siobhan Reynolds, president of the Pain Relief Network. "If that isn't a threat, it will certainly pass for one within the thoroughly intimidated medical community."

DEA Issues Policy Statements on Pain Management, Prescribing Practices

Here are the links to the two DEA policy statements. I tried pasting them into this blog, but that crashed it. Sorry about that.

http://a257.g.akamaitech.net/7/257/2422/01jan20061800/edocket.access.gpo.gov/2006/pdf/E6-14517.pdf

Drug Enforcement Administration

Dispensing Controlled Substances for the Treatment of Pain

ACTION: Policy Statement.

---------------------------

http://a257.g.akamaitech.net/7/257/2422/01jan20061800/edocket.access.gpo.gov/2006/pdf/E6-14520.pdf

Drug Enforcement Administration

Issuance of Multiple Prescriptions for Schedule II Controlled Substances

Location: 
Washington, DC
United States

Drug Election Agency

Location: 
Boulder, CO
United States
Publication/Source: 
Daily Camera
URL: 
http://www.dailycamera.com/bdc/editorials/article/0,1713,BDC_2489_4963104,00.html

Bungled DEA Raid Raises Troubling Questions

California NORML Release, Aug 31 2006 Yesterday's DEA raid at Trichome Healing Center in Van Nuys ended in a stand-down. No arrests were made. An undercover DEA team arrived without a warrant. One agent tried to gain entry with a bad ID, but was turned down. The agent blew his cool, a security guard saw his gun and thought he was a robber; a scuffle broke out, and other agents came to the rescue. After several hours, the DEA procured a warrant from a local judge. The DEA left the scene after midnight, but not before calling in a professional safecracker to clean out the premises. In the meantime, patient advocates were on hand protesting. Degee Coutee called an LAPD operator, who appeared unaware of the raid. LAPD arrived and reassured the crowd that they had a right to protest and take pictures. Aside from its comic incompetence, this raid raises troubling questions. For the past couple of years, it has typically been DEA policy not to raid medical marijuana dispensaries without support from the local police. The exception has been when a particular DEA investigation (such as a grow bust) has led them to a dispensary. It is possible that the DEA were acting in cooperation with rogue elements of the LAPD, such as the North Hollywood narcotics division, who have recently been hassling dispensaries. ( There is an unconfirmed rumor that officer John Smith of NoHO PD may have been present at the raid.) This could have gone on unbeknownst to the rest of LAPD. It is also possible that DEA had some particular lead that took them to Trichome Healing, but it seems doubtful that they would have used a warrantless undercover investigation of this kind to make the bust.. More disturbing is the possibility that this could be part of a wider DEA undercover operation aimed at penetrating and taking down the LA dispensaries. It would be a departure from recent policy for DEA to do so without support from local police and without evidence that the dispensaries are violating Prop. 215. (Note that the DEA were in fact trying to get Trichome Healing to violate 215 by selling without a valid recommendation). Whatever the truth, it is important the LA area residents organize & respond now to defend patients' access to medicine. There will be a public emergency meeting to address the situation at 4 PM this Saturday, Sept 2 at LA Patients and Caregivers Group, 7213 Santa Monica Blvd, West Hollywood. Angelenos should call on the city council and mayor to stop arbitrary police raids and defend safe access by enacting reasonable city regulations to legally license dispensaries, as in West Hollywood and LA County. - D. Gieringer, Cal NORML PS: In a seemingly unrelated incident, the LAPD raided another patients' collective in Van Nuys at the same time as the Trichome Healing raid. Police cleaned out a storage room rented by the After Hours Collective, which is not a dispensary but a delivery collective serving over 100 patients. Police might have been tipped off by fire inspectors, who had visited the space earlier and seen some plants growing. Joey Naffah, director of Trichome Healing, says that he let the inspectors in feeling that everything was legal and within SB 420 guidelines. After the police came, they confiscated a score of plants and drilled into the collective's safe to remove a few pounds of medicine. - D. G. First hand report on the Trichome Raid from Weedtracker: http://weedtracker.com/forums/showthread.php?p=90576 Thc Raided I Was There For Part Of It What I understand to have happened before I arrived: In the early afternoon, on Wednesday August 30th, a DEA agent appeared at THC's door with a phony ID. THC's security guard spotted the forgery and refused entry to the DEA agent. Realizing this wasn't going to be as easy as he thought, the officer spoke the words "Don't hurt me" into his transmitter. This was apparently the signal for his fellow agents to follow him in. At no time was this DEA agent under any threat from THC or its security force, but, by characterizing his situation as urgent I'm sure he's provided a lovely excuse for exigent circumstances, thus justifying the initial lack of a warrent. My understanding is that they've already put out a press release claiming an imminent threat to the officer's safety justified their actions. They are lying. Hopefully THC's security system was beaming to remote locations and they've got the fact the officer was never in any danger right there on the security feed. The poor receptionist soon found herself facing not one, not two, but THREE loaded guns pointed at her face, this despite the fact she already had her hands up and could not possibly have been a threat to anyone's safety. Interestingly enough, one of the DEA officers was dressed enough like THC's security staff to lure people in. One of the people who got snagged was a driver for a vendor, who was delivering a shipment of edibles. This gentleman was hassled, and the edible shipment was seized by the DEA. We know this story to be true, because the person who manufactured the edibles came down and spoke to us about what had happened. Thankfully, they let the driver go. The guy was pretty brave, he actually requested the Feds return the edibles to him, which they of course, declined to do. To the best of my knowledge, no patients were detained or charged. However, the alert guard who spotted the forged ID was kept in the facility from the time the feds arrived until nearly 1 am in the morning, and we saw no food or water being delivered, so this gentlemen was given less consideration by his own government then the Geneva convention would have afforded him if he was a prisoner of war. My understanding was that he was cuffed during the episode. My god, could you imagine being in handcuffs for eleven hours? He must have been in agony. Degee got the call at CPG and started rallying the troops. Ana and Degee were already there when I arrived in the late afternoon. ASA put out an alert and Weedtracker picked it up. People began arriving, at the height I think there must have been at least fifty people. What Happened After I Arrived: Several dispensary owners closed immediately and brought their staffs. Alert participants, realizing it was the dinner hour went and got dinner for everyone and water and chips circulated. One gentleman arrived in a huge pickup truck with a couch in the back. Anyone who needed to rest had a couch they could use. Whenever the DEA poked their noses out of the door, we immediately began chanting and demonstrating. Because there were back and front entrances, people split into two groups watching both exits carefully. Photos were taken of DEA vehicles and the officers. As patients arrived we explained what was going on and asked them to post on Weedtracker, so others would know not to come down if they were looking for medicine. The media was out in force, and stayed with us for much of the time. One station did a live remote with all of us standing in the background. Much love to NBC, Fox and the gentlemen filming a documentary for sharing OUR side of the story. As the evening wore on a van arrived, containing several gentlemen. As it was obvious they were there to aid the DEA, we peacefully surrounded the van and began chanting, holding up our signs. They decided it might be expeditious to leave and did so. Boy, did THAT cheer us up. Shortly thereafter, the local constables arrived, went upstairs and spoke with the DEA. We asked as many questions of the police as we could, they were not very forthcoming, but did inform us we had the right to protest. More men in blue arrived, but other than forcing us to stay behind a police tape they were pretty polite. More time passed. Another vehicle arrived with more DEA helpers. This time, as our local men and blue were present, we were not able to surround the car. My understanding was that they were needed to crack open the safe. We waited and watched. At last the back door opened to the dispensary and the agents began loading cardboard boxes into the bevy of cars they'd brought with them, I believe Ana counted no less than eight cars. The police herded us as far away as they could, Degee and Ana really got in their faces about this, but it was either move or be arrested, the police explained to us, so we moved. But fear not, our voices were heard. "Theif!" we screamed. "Robbers!" "How does it feel to steal medicine from sick people? Your mother must be SO proud." Other less restrained remarks were also uttered. They left as quickly as they could, no doubt because it was after midnight and they wanted to leave as badly as the rest of us. The good news is that they didn't arrest the guards. These gentlemen, after being detained for what, twelve hours? then went about their business, securing the premises as best they could. We all crowded around the front door and gave them some love, they are the real heros of this story. Please everyone, there will be an emergency meeting on Saturday to discuss what we can do to stop the DEA. It will be held at CPG beginning at 4 pm. If you are not a member of CPG just tell the guard at the door that you're there for the meeting. Dispensary owners, please come, if you cannot, please designate someone on your staff to attend and serve as your representative. Patients, if you can possibly attend, please come. The DEA has begun closing us down. We must all hang together now, or surely, we will hang separately. It's 3am now, I'm dead tired and hurt. Please forgive the grammar and spelling, the words are blurring on the page. -------------- California NORML (415) 563-5858 // [email protected] 2215-R Market St. #278, San Francisco CA 94114 --------------
Location: 
Los Angeles, CA
United States

Marijuana: DEA Steps in Deep Doo-doo in Denver With Abortive Bid to Defeat November Legalization Initiative

Jeff Sweetin, the DEA special agent in charge in Denver, probably wishes he had just kept his mouth shut. It was bad enough that the University of Colorado newspaper the Daily Camera reported Sunday that one of his special agents had sent out an e-mail on a Department of Justice account seeking a campaign manager for “Colorado’s Marijuana Information Committee,” an apparent astroturf organization being set up to defeat the Colorado marijuana legalization initiative. That initiative would legalize the possession of up to an ounce of marijuana by adults.

But then Sweetin really stepped in it, telling the Daily Camera that the law "allows his agency to get involved in the process to tell voters why they shouldn’t decriminalize pot" and that the committee had raised $10,000 from "private donations, including some from agents' own accounts."

That was enough to draw out the initiative's sponsor, SAFER Colorado, which criticized the agency for unwarranted interference in a state electoral matter. "Taxpayer money should not be going toward the executive branch advocating one side or another," the group's executive director, Steve Fox, told the Daily Camera. "It's a wholly inappropriate use of taxpayer money."

But SAFER Colorado wasn’t alone in taking offense at the untoward DEA actions. The state's two largest and most influential newspapers, the Rocky Mountain News and the Denver Post, both condemned the move in editorials. The News' position was clear from its headline: "DEA Should Keep Out of State Politics."

The Post took a more concerned approach, worrying that the DEA politicking might pass the bounds of propriety, if not legality. "Providing facts to people who want them is one thing," the Post wrote. "Using the agency as a platform to influence elections is another. Sweetin says he clearly understands the difference. We certainly hope that's the case."

If Sweetin hoped the story would just go away, he didn’t help matters any when he further clouded the waters when KMGH-TV in Denver Tuesday reported that: "Sweetin said, despite reports to the contrary, his office is not campaigning against it or fundraising. When asked about the committee and the $10,000 mentioned in the E-mail, Sweetin said, 'There is no $10,000 in money that I've ever heard of.'"

That led SAFER Colorado to raise a whole series of questions about which version of the DEA activism was true, which they kindly sent to Colorado media. "We think it's really fishy that the same DEA agent who made it clear the committee had funds from private donors and agents is now saying he's never heard of this money," said campaign coordinator Mason Tvert. "We think DEA thought they could actively campaign against us, but then got told by some sort of legal counsel it couldn’t happen that way. In any case, we're just trying to spin this into the biggest story we can," he told Drug War Chronicle.

Alert: Stop the DEA Subversion of Elections (DrugSense)

STOP THE DEA SUBVERSION OF ELECTIONS *********************PLEASE COPY AND DISTRIBUTE************************* DrugSense FOCUS Alert #335 - Tuesday, 29 August 2006 Sunday we learned that the Drug Enforcement Agency is encouraging its agents to use government time and equipment to oppose the Colorado marijuana initiative. They claim that this action is legal, not a violation of the Hatch Act. Our government considers the direct government interference by the governments of other countries in their elections to be unfair -- an ethical standard which should apply equally in the United States. Please contact your elected representatives at both federal and state level to demand that the DEA and the Office of National Drug Control Policy, including the Drug Czar, refrain from the subversion of the initiative and referendum process in the cities and states where marijuana initiatives will be on the ballot. Our tax dollars should never be used to undermine initiatives. Please also contact the DEA offices in your area to let them know what you think of their unethical political activities. Phone numbers are on this webpage http://www.dea.gov/contactinfo.htm You may remind them that the news reports puts the lie to their often stated position that they only enforce the laws - that they do not write the laws. The article, reprinted in other Colorado newspapers, that exposed DEA Agent Michael Moore's unethical activities is at http://www.mapinc.org/drugnews/v06/n1137/a09.html. Please also do what you are able to do to support the various marijuana related initiatives. Below is a list of initiatives pending a vote at the state and local level. Please use the links to find out how to donate or otherwise support the initiatives. Thanks for your effort and support. It's not what others do it's what YOU do CALIFORNIA: Santa Barbara Lowest Law Enforcement Priority Policy Ordinance http://sensiblesantabarbara.org Santa Cruz Lowest Law Enforcement Priority Policy Ordinance http://www.taxandregulate.org/sc06/index.htm Santa Monica Lowest Law Enforcement Priority Policy Ordinance http://www.sensiblesantamonica.org COLORADO: The Colorado Alcohol-Marijuana Equalization Initiative http://www.saferchoice.org/safercolorado/ MICHIGAN: The Flint Coalition for Compassionate Care will have a medical marijuana initiative on the ballot in first city wide election of 2007, possibly in February or May. Details will be posted to this webpage when they are available http://www.drugsense.org/caip MONTANA: The Missoula County Lowest Law Enforcement Priority initiative has just been approved for the November ballot http://www.responsiblecrimepolicy.org NEVADA: Question 7 on the Nevada ballot http://www.regulatemarijuana.org SOUTH DAKOTA: The only state wide medical marijuana initiative on the ballot this year http://www.sdmedicalmarijuana.org Notes: Updates on local initiatives will be added to this webpage as we receive additional information http://www.drugsense.org/caip Your letters to the editor help move public opinion towards supporting change in marijuana policies and law. Every day new targets for your letter writing efforts may be found at http://www.mapinc.org/pot.htm Prepared by: Richard Lake for DrugSense
Location: 
CO
United States

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