Monday, July 23, 2018

Why Are Dealers Mixing Fentanyl in Heroin?


We see or hear on the news about Fentanyl quite often these days. Most of the news is about people who overdosed on a mixture of Heroin and Fentanyl, or how many times more potent than Morphine Fentanyl is.

Drugs are about money, it doesn’t matter if its prescription drugs from your doctor, illegal drugs from the street or the money law enforcement receive in grants; drugs are always, about money.

In this case the new guidelines, regulations, and laws have helped both sides to make a lot of money. Drug Cartels found out Fentanyl was cheap and easy to make. According to Stratfor.com it costs about $3,300 to make a kilo (2,2 lbs) of Fentanyl.

CNN tells us recently Nebraska State Troopers seized 118 pounds of Fentanyl in a traffic stop. That amount is enough to overdose 26 million people. That amount cost the cartels $180,000 to make.

But this time we told then what the change in guidelines, regulations, and laws would do. After 40 years of the war on drugs we knew what the unintended consequences would be, illegal drugs would fill the void.

Heroin.net tells us the average cost of a single dose (0.1 g) of heroin purchased on the street has been reported as approximately $15–$20 in the U.S. state of Ohio.
So the 26 million doses would have been worth $390,000,000 street price to Cartels for that one shipment. And trust me cartels never put their eggs in one basket, how many shipments got past troopers that day?

Now cartels are manufacturing Carfentanil also called Carfentanyl.
According to Wikipedia Carfentanil is an analog of the synthetic opioid analgesic fentanyl. A unit of carfentanil is 100 times as potent as the same amount of fentanyl, 5,000 times as potent as a unit of heroin and 10,000 times as potent as a unit of morphine

The problem is how the drug world distribution works. At the top if you mess with quality you may not do well in the drug world. But as the something like Carfentanil with a potency 10,000 times that of morphine shifts down through the drug world, everybody is going to step on it. Imagine the profit for a drug dealer?

In 1mg of Carfentanil you have the equivalent of 10,000 doses of Morphine, wow. The problem for little Donny drug dealer is how to evenly distribute 1mg of Carfentanil into 9,999 mg’s of whatever little Donny drug dealer is using for cut.

If little Donny drug dealer makes a mistake and it’s easy when we’re talking about overdosing a little over 1/10,000th of a milligram.

Prohibition doesn’t work…..

Wikipedia
Heroin.net
CNN
Stratfor.com

Friday, July 20, 2018

Arizona Medical Board Doesn't Have a Plan for Pain Patients and It's Costing Lives

In 1990 Dr Albert Yeh of Golden Valley Arizona was arrested by DEA for over prescribing opioids, and another pain doctor just up and left Needles California. In 2009 there was also a significant spike in suicides in Mohave Counrt. I can't prove the coloration between the loss of two pain physicians and the increase in suicides, but someone might want to look into that.   

Dr Yeh was the type of bad physician DEA needs to go after. You'll understand about Dr Yeh when you read the the DEA special agents statement in the affidavit for seizure warrant below. 

Most physicians who treat pain and have problems with DEA do so because of technician violations of the law like medical records. I think most of these violations could be dealt with by education rather than arrest. 

On the patients side the Arizona Medical Board needs to have a plan in place on what to do if patients were to lose their physician who treats chronic pain with opioids..

Currently there is no plan for how to assist pain patients when a prescriber who treats patients with opioids should be arrested. 

Some of Dr Yeh's were people looking for drugs, and news spreads fast. That doesn't mean some of his patients have a legitimate need for opioid pain medications.

How many of Dr Yeh's patients committed suicide?
How many of Dr Yeh's patients turned to the street?
How many of Dr Yeh's patients overdosed because of unknown street doses?

What are WE going to do?


AFFIDAVIT FOR SEIZURE WARRANT
COUNTY OF MARICOPA
STATE OF ARIZONA
Your Affiants, Phoenix Police Detective Jamie Barilla and Erin Hager, a Diversion
Investigator with the United States Drug Enforcement Administration (DEA) Tactical Diversion Task Force, being first duly sworn upon oath depose and say:

On March 25, 2008, an Arizona peace officer acting in an undercover capacity posing as a new patient at Dr. YEH’s Golden Valley medical clinic met with Dr. YEH.
That agent, Arizona State Attorney General’s Office Special Agent (SA) Cheryl Thomas, was instructed by Dr. YEH’s staff at the clinic to complete paperwork entitled ‘Narcotic Contract’ which indicated that no early refills would be issued, and paperwork entitled ‘pain diagram,’ which was left blank by SA Thomas.

SA Thomas informed Dr. YEH’s medical assistant she did not have a referral from another doctor, nor did she have any xrays with her. The only medical evaluation performed by the medical assistant consisted of placing what resembled a pulse oximeter on SA Thomas’s finger.

Without first introducing himself, Dr. YEH immediately asked SA Thomas what kind of pain she was having. SA Thomas responded that she didn’t feel good, that she had aches and a headache. When asked specifically if she had pain in her shoulders and arms, SA
Thomas replied “no.” Upon having SA Thomas stand on her toes and her heels, Dr. YEH told SA Thomas that, “You’re fine, what can I do for you, what can I do to make you feel better.”

SA Thomas told Dr. YEH she had taken Vicodin (hydrocodone) in the past. Dr.
YEH then issued SA Thomas one prescription for 120 Lortab tablets (hydrocodone – 30 day supply), one prescription for 120 Robaxin tablets (prescription-only muscle relaxer –30 day supply), and a third prescription for an X-ray of the spine.

Friday, July 6, 2018

How Many Times Do We Need to Read About Pain Patient Suicides

Even though pain is the most common reason patients see a doctor, pain wasn't treated in the 90's. Pain was undertreated and patients were committing suicide for lack of pain control. I carried a stack of death certificates from pain patients who took their life as noted in the 1996 article about the fight for pain relief below.
LINK to 1996 Article in Kingman Daily Miner  

There Are Two Side to Every Story.....
Pain and Suicide: The Other Side of the Opioid Story
Jack never said much during his office visits. He was
mostly silent and followed my instructions. But he did
quietly express fear of the pain if I continued to reduce his
pain medications. During the third clinic visit of this process, he said, “I can’t live like this, Doc.” I said, “It will get better,” hoping more than knowing my statement would be true. 

I counseled him that the pain may worsen for a while, but that—in time—this new regimen would be for the best. I heard his words but not his cry for help.

Three days later I got a call from his daughter. Jack had died from a self-inflicted gunshot wound. He left a note saying he couldn't live with the pain anymore. He could not see a future. He had no hope. He had no life. He loved her but felt he was of no value to her or to anyone.

These are more stories of patients who couldn't take the pain and the fight just became too much.....

How Chronic Pain Killed My Husband 

Sherri’s Story: A Final Plea for Help

Video: Lisa’s Story – FM Patient Commits Suicide

Some People Still Need Opioids 

When pain patients commit suicide if they leave a note everyone understands it was because of the pain. If they choose to end the pain by saving enough pills to overdose and don't leave a note, they're just another overdose.

If you are thinking about suicide PLEASE Call the National Suicide Prevention Lifeline 1-800-273-8255 and talk to someone

Physicians Who Do Harm to Patients MUST Be Held Responsible 

Tuesday, July 3, 2018

Good News Dr Vaipiani is a Board Certified Pain Specialist

Good News Dr Vaipiani is a Board Certified Pain Specialist. I want to thank Shawn at the Kingman Daily Miner for finding Dr Vaipiani listed in the American Board of Pain Medicine Director in Nevada.

I hope Dr Vaipiani lets the American Board of Pain Medicine know to also list him in Arizona. I didn't think to look in Nevada for an Arizona pain doc, and I didn't search by name, I looked at all the physicians listed in Arizona.

You can also find some information about the 2018 Arizona Opioid Epidemic Act and Arizona House Bill 2001 HERE

I don't know anything about Dr Vaipiani except what I've read. If any patients know how he is with patients, please let other patients know. Here or on Facebook. If you use Facebook please let me know.

Thanks
Jay

Update... Just My Opinion... July 19th 2018

In a 2017 article in the Kingman Daily Miner Dr Valpiani said, "in Mohave County, with its high percentage of the population on Medicaid, roughly half of the people on pain pills are abusing them".

The doctor patient relationship is built on trust. Trust that the physician will do what's best in the patients interest, and the patient is honest about their medical condition. How can a physician treat patients fairly if they believe half of the patients who walk through the door are lying to him. 

When treating pain patients most times there is objective evidence like MRI's and nerve conduction studies. 

Benjamin Franklin said, "it is better 100 guilty persons should escape than that one innocent Person should suffer". 


He was talking about the criminal justice system, but I think he would say the same about pain treatment today, that it is better 100 Patients should escape with pills than that one innocent Patient should suffer.


Jay