Coca-Cola Co. said it’s eyeing the cannabis drinks market, becoming the latest beverage company to tap into surging demand for marijuana products. Coke’s possible foray into the marijuana sector comes as beverage makers are trying to add cannabis as a trendy ingredient while their traditional businesses slow.

According to a report from BNN Bloomberg Television, the company says it’s monitoring the nascent industry and is interested in drinks infused with CBD -- the non-psychoactive ingredient in marijuana that treats pain but doesn’t get you high. The Atlanta-based soft drinks maker is in talks with Canadian marijuana producer Aurora Cannabis to develop the beverages.

"We are closely watching the growth of non-psychoactive CBD as an ingredient in functional wellness beverages around the world," Coca-Cola spokesman Kent Landers said in an emailed statement to Bloomberg News. "The space is evolving quickly. No decisions have been made at this time." Landers declined to comment on Aurora.

Coca-Cola has already been diversifying as consumption of soda continues to decline. The company, with its iconic brands ranging from Coke and Sprite to Powerade, announced it will acquire the Costa Coffee chain for $5.1 billion in August, and has expanded into other products including juice, tea and mineral water over the past decade.

Last month, Corona beer brewer Constellation Brands Inc. announced it will spend $3.8 billion to increase its stake in Canopy Growth Corp., the Canadian marijuana producer with a value that exceeds $10 billion.

Molson Coors Brewing Co. is starting a joint venture with Quebec’s Hexo’s Corp., formerly known as Hydropothecary Corp., to develop cannabis drinks in Canada. Diageo PLC, maker of Guinness beer, is holding discussions with at least three Canadian cannabis producers about a possible deal, BNN Bloomberg reported last month. Heineken NV’s Lagunitas craft-brewing label has launched a brand specializing in non-alcoholic drinks infused with THC, marijuana’s active ingredient.

The discussions with Aurora are focused on CBD-infused drinks to ease inflammation, pain and cramping, according to the BNN Bloomberg report. CBD, or cannabidiol, is the chemical in the pot plant often used for medicinal purposes, and doesn’t produce the high that comes from THC, or tetrahydrocannabinol. There are no guarantees of any deal between Aurora and Coca-Cola, according to the report. Aurora Comment

Heather MacGregor, a spokeswoman for Aurora, said in an emailed statement that the cannabis producer has expressed specific interest in the infused-beverage space, and intends to enter that market, BNN Bloomberg’s David George-Cosh reported.

While marijuana remains illegal at the national level in the U.S., there is growing acceptance of the use of CBD derived from marijuana to treat illnesses ranging from chronic pain to anxiety and epilepsy. The first-ever medical treatment derived from a marijuana plant will hit the U.S. market soon, after regulators in June gave an epilepsy treatment by GW Pharmaceuticals Plc the green light ...

Jose Atalo Felix-Beltran, Arturo Felix-Beltran (U.S. citizens), and Osvaldo Felix-Beltran (U.S. resident) living in Indio, California, were arraigned in federal court on charges that they conspired to distribute over 20,000 tablets of fentanyl. These three defendants are brothers who were arrested together on September 13, 2018, in El Centro, California,

According to a federal criminal complaint, these three brothers drove together to a restaurant located in El Centro, California, where they intended to sell 20,000 tablets of fentanyl to a purchaser who, unbeknownst to them, was an undercover Special Agent with the Drug Enforcement Administration. Two of the brothers attempted to flee the scene, but were apprehended following a brief foot chase. The third brother was not able to flee and, following a brief period of forcible resistance, was ultimately taken into custody.

This arrest followed a series of prior transactions where the brothers, together and at times alone, sold undercover DEA agents additional tablets of fentanyl.

At the brothers’ initial appearance in El Centro before U.S. Magistrate Judge Ruth Bermudez Montenegro, the United States requested detention based on risk of flight. Judge Bermudez Montenegro scheduled a detention hearing for September 21, 2018 at 1:30 p.m. and a preliminary hearing for September 27, 2018 at 1:30 PM.

The fentanyl tablets that were to be sold to undercover agents on September 13, 2018 were tablets of fentanyl manufactured to look like 30mg tablets of oxycodone.

The combined weight of the tablets seized from the three brothers on September 13, 2018, was approximately 2.23 kilograms of fentanyl. The retail street value of these fentanyl tablets is estimated to be $600,000.

This case is the result of ongoing efforts by the Organized Crime Drug Enforcement Task Force ("OCDETF"), a partnership that brings together the combined expertise and unique abilities of federal, state and local law enforcement agencies ...

So far, the California workers' compensation system has not been required to pay for "medical marijuana" as treatment for industrial injuries. But, in 2014, New Mexico became the first state to have a state appellate court order a workers’ compensation insurance carrier to provide reimbursement to an injured worker for medical marijuana

The Appellate Division of the Maine Workers' Compensation Board affirmed two different administrative law judge awards reimbursing workers for their medical marijuana expenses, Bourgoin v. Twin Rivers Paper Co. and Noll v. Lepage Bakeries.

And later, an ALJ in New Jersey issued an order in Watson v. 84 Lumber requiring reimbursement of an injured worker for medical marijuana payment

And now, Senators Brian Schatz (D-Hawaii) and Bill Nelson (D-Fla.) introduced legislation this week to allow doctors at the U.S. Department of Veterans Affairs to prescribe medical marijuana to veterans in the 31 states that have established medical marijuana programs.

This Act is to be cited as the "Veterans Medical Marijuana Safe Harbor Act."

The Act proclaims that "chronic pain affects the veteran population, with almost 60 percent of veterans returning from serving in the Armed Forces in the Middle East, and more than 50 percent of older veterans, who are using the health care system of the Department of Veterans Affairs living with some form of chronic pain."

"And it says "in 2011, veterans were twice as likely to die from accidental opioid overdoses as nonveterans. States with medical cannabis laws have a 24.8 percent lower mean annual opioid overdose mortality rate compared with States without medical cannabis laws."

The proposed law would "allow veterans to use, possess, or transport medical marijuana and to discuss the use of medical marijuana with a physician of the Department of Veterans Affairs as authorized by State law, and for other purposes."

In addition to creating a temporary, five-year safe harbor protection for veterans who use medical marijuana, the bill would also direct the VA to research how medical marijuana could help veterans better manage chronic pain and reduce opioid abuse.

"In the 31 states where medical marijuana is legal, patients and doctors are able to see if marijuana helps with pain management. Our veterans deserve to have that same chance," Senator Schatz said. "This bill does right by our veterans, and it can also shed light on how medical marijuana can help with the nation’s opioid epidemic."

The bill is supported by the American Academy of Pain Medicine, Veterans Cannabis Project, Veterans for Medical Cannabis Access, Americans for Safe Access, NORML, Marijuana Policy Project, Drug Policy Alliance, Multidisciplinary Association for Psychedelic Studies, Veterans Cannabis Coalition and National Cannabis Industry Association.

The bill however is in conflict with the federal Controlled Substances Act (21 U.S.C. 801 et seq.). The federal government classifies marijuana as a schedule 1 drug, meaning it's perceived to have no medical value and a high potential for abuse. The classification puts marijuana in the same category as heroin and a more restrictive category than schedule 2 drugs like cocaine and methamphetamine ...

Chronic pain, one of the most common reasons adults seek medical care. Chronic pain contributes to an estimated $560 billion each year in direct medical costs, lost productivity, and disability programs.

High Impact Chronic Pain (HICP), is a new concept that describes those with pain lasting three months or longer and accompanied by at least one major activity restriction.

The concept of HICP was first proposed by the National Pain Strategy to better identify those with significant levels of life interference.

The National Pain strategy was core recommendation of the 2011 Institute of Medicine Report: Relieving Pain in America. Recommendation 2-2 said that "The Secretary of the Department of Health and Human Services should develop a comprehensive, population health-level strategy for pain prevention, treatment, management, education, reimbursement, and research that includes specific goals, actions, time frames, and resources."

The National Pain Strategy, is the first national effort to transform how the population burden of pain is perceived, assessed, and treated, recognizes the need for better data to inform action and calls for estimates of chronic pain and high-impact chronic pain in the general population.

Together, the HICP population constitutes some 4.8 percent of the U.S. adult population. About 83 percent of people with HICP were unable to work for a living, and one-third had difficulty with self-care activities such as washing themselves and getting dressed. Almost 11 million U.S. adults have High Impact Chronic Pain.

Activity limitations were more common in the chronic pain population than in groups with other chronic health conditions, such as stroke, kidney failure, cancer, diabetes, or heart disease.

"By differentiating those with HICP, a condition that is associated with higher levels of anxiety, depression, fatigue, and cognitive difficulty, we hope to improve clinical research and practice," said M. Catherine Bushnell, Ph.D., scientific director in the NCCIH Division of Intramural Research and another author of the study.

"It is crucial that we fully understand how people’s lives are affected by chronic pain. It will help improve care for individuals living with chronic pain and strategically guide our research programs that aim to reduce the burden of pain at the population level," said Linda Porter, Ph.D., director of the Office of Pain Policy at NINDS ...

The California Department of Fair Employment and Housing (DFEH) reached a settlement in an employment discrimination case with the County of Los Angeles involving two complainants who were denied or delayed positions with the County due to the County’s over broad pre-employment medical examination requirements.

One of the complainants was denied a position with the Los Angeles County Sheriff’s Department for more than 4 years because it was revealed during her pre-employment medical exam that she had a thyroid condition, although she did not have any restrictions on her ability to perform the job.

The other complainant was denied a position with the County when he revealed during his pre-employment medical exam that he had a prior knee injury although he too did not have any work restrictions.

DFEH found cause to believe violations of the Fair Employment and Housing Act had occurred and filed civil complaints in Los Angeles County Superior Court in April and June 2017 (case numbers BC663789 and BC658050).

In settling the case, the County of Los Angeles agreed to amend its civil service rules about pre-employment medical examinations and will overhaul its medical examination process to only consider medical information that is directly relevant to the job being applied for.

In addition, the County will provide regular disability discrimination training and has agreed to be subject to three years of monitoring by a neutral third party and DFEH to ensure compliance with the agreement.

The County will also pay a total of $560,000. Of that, $410,000 will be paid directly to a complainant and $150,000 to the DFEH for fees and costs. (The second complainant previously resolved the financial aspect of his case.)

"California employers are only permitted to seek medical information from applicants that is directly related to the job for which they are applying," said DFEH Director Kevin Kish. "Overbroad requests for medical information or denying an applicant a job because of future risk of injury is unlawful."

Alexandra Seldin, Senior Staff Counsel, Olivia Tran, Senior Staff Counsel, and Paula Pearlman, Assistant Chief Counsel represented DFEH in this proceeding ...

Employers in California and elsewhere are closely watching case law that slowly erodes limits to employer liability for actions regarding the use of Medical Marijuana outside the workplace. A recent decision in a federal trial court in Connecticut is one of the cases that are making employers nervous about their policies.

In the case of Noffsinger v. SSC Niantic Operating, No. 3:16-cv-01938 (D. Conn.), a federal judge ruled that refusing to hire a medical marijuana user because she tested positive on a pre-employment drug test violates Connecticut's medical marijuana law as it granted summary judgment to the job applicant on her employment discrimination claim.

Plaintiff Katelin Noffsinger was diagnosed with post-traumatic stress disorder (PTSD) in 2012 after being in a car accident. Her caregiver recommended treating her PTSD with medical marijuana, which she began using in 2015. In accordance with Connecticut Palliative Use of Marijuana Act (PUMA), plaintiff registered with the Department of Consumer Protection in November 2015 as a qualifying patient for the use of medical marijuana.

Noffsinger accepted a job offer from defendant SSC Niantic Operating Company, LLC d/b/a Bride Brook Health & Rehabilitation Center. But the offer was contingent on drug testing, and plaintiff told defendant that she was qualified under PUMA to use marijuana for medical purposes to treat her post-traumatic stress disorder. After her drug test came back positive for THC consistent with the use of marijuana, defendant rescinded its job offer.

She filed suit against the employer in federal court. After the parties conducted discovery they cross-moved for summary judgment.

Bride Brook argued that its refusal to hire Noffsinger is allowed by an exception to PUMA's anti-discrimination provision (when "required by federal law or required to obtain federal funding"). It argued that the federal Drug-Free Workplace Act (DFWA) barred it from hiring Noffsinger because that law prohibits federal contractors from allowing employees to use illegal drugs. Marijuana is illegal under federal law.

The court rejected Bride Brook's argument, noting that the DFWA does not require drug testing and does not regulate employees who use illegal drugs outside of work while off-duty.

Similarly, the court rejected Bride Brook's argument that hiring Noffsinger would violate the False Claims Act. It held that hiring an employee who uses medical marijuana outside of work while off-duty would not defraud the federal government.

Bride Brook also argued that it did not violate PUMA because it did not discriminate against Noffsinger based on her status as a medical marijuana user; rather, it had relied on the positive drug test result. The court dismissed this argument, concluding that acceptance would render a medical marijuana user's protection under the statute a nullity.

While the court held that the employer had engaged in employment discrimination, it declined to award Noffsinger attorney fees or punitive damages because those types of damages are not expressly recoverable under PUMA.

Additionally, the court dismissed Noffsinger's claim for negligent infliction of emotional distress, because the employer did not engage in "unreasonable conduct" and Noffsinger chose to give notice to her prior employer that she was resigning before she had advised Bride Brook of her medical marijuana use.

Although this is a development at the trial court level in a jurisdiction outside of California which is not binding precedent here, nonetheless employment law attorneys who have been watching these cases evolve in Connecticut and elsewhere suggest that employers should consider the marijuana laws affecting their workplaces now, before an issue arises, and adjust their policies as necessary ...

Over the past decade, American doctors failed to provide a written medical justification for nearly one-third of opioid prescriptions.

Researchers from RAND Corporation and Harvard Medical School published a study Tuesday in the journal Annals of Internal Medicine showing 28.5 percent of the roughly 809 million doctor visits that resulted in a prescription for opioid painkillers between 2006 and 2015 lacked medical records showing a chronic pain condition or any symptoms of pain related to the patient, reports CNN.

Roughly 5.1 percent of opioid prescriptions were written for cancer patients suffering from breakthrough pain, while 66.4 percent were for patients with non-cancer related pain. Researchers note that while a lack of documented justification does not necessarily reveal "a nefarious purpose on the part of the doctor," it might explain in part how Americans became so dependent on opioids.

"For these visits, it is unclear why a physician chose to prescribe an opioid or whether opioid therapy is justified," said Dr. Tisamarie B. Sherry, a researcher for RAND Corporation and lead author of the study, according to CNN. "The reasons for this could be truly inappropriate prescribing of opioids or merely lax documentation. - If a doctor does not document a medical reason for prescribing an opioid, it could mean that the prescription is not clinically appropriate."

A study published Aug. 1 in medical journal The BMJ reveals that between 2007 and 2016, the percentage of commercially insured patients prescribed opioids held steady at 14 percent.

The study, lead by Molly Moore Jeffery of the Mayo Clinic in Rochester, Minnesota, investigated the individual patient data of 48 million people with health insurance, both commercial and through Medicare. The prescription data was then converted into milligram morphine equivalents (MME). They found the average MME dosage across all patients reviewed in the study was higher in 2016 than in 2007, a level Jeffery said is a "point where you see a greater risk of overdose."

The researchers advocate for a general shift within the medical community away from opioids, however, Jeffery does not advocate legislative solutions that end up impacting patient access to crucial medication.

Data released by officials with the CDC on July 11 shows the majority of opioid-linked deaths are the result of synthetic opioids like fentanyl. The report shows synthetic opioids killed roughly 27,000 people across the U.S. over the 12-month period ending November 2017, up from roughly 19,413 lives in 2016 and 9,580 lives in 2015 ...

Lahkwinder Singh and his corporation, Lovely Singh Inc., have been convicted for the illegal trafficking of pharmaceuticals.

While doing business as a franchise of shipping company Postal Annex, Lovely Singh Inc. facilitated the shipment of controlled pharmaceutical drugs such as hydrocodone, Xanax and oxycodone through the mail.

Lahkwinder Singh, the CEO of the company was sentenced i to 36 months in federal prison. The 36-month sentence is one of the longest imposed in the Southern District of California for a structuring conviction.

Singh’s closely held corporation, Lovely Singh, Inc., was ordered to forfeit $1,000,000, and serve a 5-year term of probation.

Singh owned and operated Postal Annex franchises in Lemon Grove, California, under the name Lovely Singh. According to the complaint, Singh engaged in a multi-year pattern of cash transactions below the $10,000 threshold to avoid detection by banks and law enforcement, with the intent to deposit Lovely Singh’s cash proceeds free from scrutiny.

The plea agreement admits that Singh and his co-defendant Lovely Singh Inc. distributed Schedule II controlled substances to persons throughout the United States.

Couriers imported pre-packaged quantities of controlled substances into the United States from Mexico and delivered them to the Postal Annexes. The substances were then illegally sold for prices ranging between $1 and $100.

The plea agreement also states that Singh attempted to set up $2,955,521 of currency transactions through 469 cash deposits at several domestic financial institutions. Singh conducted multiple deposits of less than $10,000 in cash on the same day. He also made deposits into at least 19 different bank accounts over the course of several business days.

These deposits were conducted with the purpose of avoiding a Currency Transaction Report, which is the report a financial institution must file for cash deposits exceeding $10,000 during any banking day. These cash deposits included money received in return for shipping controlled substances from the Postal Annex stores.

Singh was ultimately charged with and found guilty of Structuring Currency Transactions with One or More Financial Institutions ...

Scientists at the Salk Institute have developed a technique to directly convert the cells in an open wound into new skin cells. The approach relies on reprogramming the cells to a stem-cell-like state and could be useful for healing skin damage, countering the effects of aging and helping us to better understand skin cancer.

"Our observations constitute an initial proof of principle for in vivo regeneration of an entire three-dimensional tissue like the skin, not just individual cell types as previously shown," says Salk Professor Juan Carlos Izpisua Belmonte, holder of the Roger Guillemin Chair and senior author of the new paper, published in the journal Nature on September 5, 2018. "This knowledge might not only be useful for enhancing skin repair but could also serve to guide in vivo regenerative strategies in other human pathological situations, as well as during aging, in which tissue repair is impaired."

Cutaneous ulcers -- wounds that can extend through multiple layers of the skin -- are typically treated surgically, by transplanting existing skin to cover the wound. However, when the ulcer is especially large, it can be difficult for surgeons to graft enough skin. In these cases, researchers are able to isolate skin stem cells from a patient, grow them in the lab and transplant them back into the patient. However, such a procedure requires an extensive amount of time, which may put the patient's life at risk and is sometimes not effective.

Izpisua Belmonte and Salk Research Associate Masakazu Kurita, who has a background in plastic surgery, knew that a critical step in wound recovery was the migration -- or transplantation -- of basal keratinocytes into wounds. These stem-cell-like cells act as precursors to the different types of skin cells. But large, severe wounds that have lost multiple layers of skin no longer have any basal keratinocytes. And even as these wounds heal, the cells multiplying in the area are mainly involved in wound closure and inflammation, rather than rebuilding healthy skin.

Izpisua Belmonte and Kurita wanted to directly convert these other cells into basal keratinocytes -- without ever taking them out of the body. "We set out to make skin where there was no skin to start with," says Kurita.

The researchers first compared the levels of different proteins of the two cell types (inflammation and keratinocytes) to get a sense of what they'd need to change to reprogram the cells' identities. They pinpointed 55 "reprogramming factors" (proteins and RNA molecules) that were potentially involved in defining the distinct identity of the basal keratinocytes. Then, through trial and error and further experiments on each potential reprogramming factor, they narrowed the list down to four factors that could mediate the conversion to basal keratinocytes.

When the team topically treated skin ulcers on mice with the four factors, the ulcers grew healthy skin (known as epithelia) within 18 days. Over time, the epithelia expanded and connected to the surrounding skin, even in large ulcers. At three and six months later, the generated cells behaved like healthy skin cells in a number of molecular, genetic and cellular tests.

The researchers are planning more studies to optimize the technique and begin testing it in additional ulcer models. "Before going to the clinic, we have to do more studies on the long-term safety of our approach and enhance the efficiency as much as possible," says Kurita ...

Holly Merrill-Miller pled no contest to misdemeanor workers’ compensation fraud. The Honorable Lawrence Brown sentenced Miller to 3 years probation and ordered her to pay $8,382.31 in restitution.

Holly Miller was a 33-year-old nursing assistant with Sutter Health when she allegedly suffered an injury to her wrist.

On September 22, 2015, she claimed a patient grabbed her hand, twisted it and repeatedly jerked it, causing pain and swelling.

Miller was placed on restricted duty by the treating physician, but she complained her pain was getting worse.

Images were taken, which didn’t show an obvious injury. However, Miller continued to complain of increased pain and stress. After canceling several medical appointments, she was returned to work.

In November 2015, surveillance was conducted on Miller which showed her using her right hand without any apparent limitations or pain.

When the treating physician saw the video surveillance, he stated it was at odds with what Miller stated she could and could not do. Miller reiterated her complaints. The physician explained he had seen surveillance videos of her activity levels and was returning her to work with no restrictions.

This case was investigated and prosecuted by the District Attorney's Insurance Fraud Unit ...

A former president of Purdue Pharma, the controversial drug manufacturer widely considered to have ignited the opioid epidemic through its aggressive marketing of OxyContin, has been awarded a patent for a new opioid addiction treatment. Dr. Richard Sackler is one of the six individuals on the patent issued in January, the Financial Times first reported Friday.

Critics expressed concern that Sackler, whose family is worth an estimated $13 billion largely from Purdue’s sale of opioid painkillers, now stands to profit further from medication that treats addiction to the very drugs peddled by his family.

The patent covers a new formulation of buprenorphine in a wafer form. The medication is shown to help people struggling with opioid addiction, and the Food and Drug Administration has already approved the drug in tablet and film form.

Sackler, who served as Purdue’s president from 1999 to 2003, was instrumental in pushing OxyContin’s sales through one of the largest pharmaceutical marketing campaigns in history. The campaign worked: Doctors previously averse to prescribing opioids for pain management due to their addictiveness were convinced by Purdue’s aggressive tactics that OxyContin was safe to prescribe.

Purdue later admitted that its marketing campaign was a sham.

The company was ordered to pay $635 million after it and three top executives pleaded guilty to misleading doctors about the addictiveness of OxyContin and its potential for abuse between 1996 and 2001. Put into perspective, the fine represents less than one-quarter of the sales revenue OxyContin generated for the Sacklers during that six-year period.

Purdue’s legal woes are far from over. The company is currently facing over 400 lawsuits from cities across the country in addition to 26 lawsuits by state attorneys general for downplaying the risks of OxyContin as part of an allegedly fraudulent marketing scheme to boost sales of OxyContin

Purdue has denied the allegations in the lawsuits and has recently taken steps to address the opioid crisis it helped create. The company has backed safer prescribing practices and announced Wednesday it’s contributing $3.4 million to a company developing a low-cost emergency medication for suspected opioid overdoses ...

Ever wonder why some people seem to feel less pain than others? A study conducted at Wake Forest School of Medicine may have found one of the answers-mindfulness.

"Mindfulness is related to being aware of the present moment without too much emotional reaction or judgment," said the study's lead author, Fadel Zeidan, Ph.D., assistant professor of neurobiology and anatomy at the medical school, part of Wake Forest Baptist Medical Center. "We now know that some people are more mindful than others, and those people seemingly feel less pain."

The study is an article in press, published ahead-of-print in the journal Pain.

The researchers analyzed data obtained from a study published in 2015 that compared mindfulness meditation to placebo analgesia. In this follow-up study, Zeidan sought to determine if dispositional mindfulness, an individual's innate or natural level of mindfulness, was associated with lower pain sensitivity, and to identify what brain mechanisms were involved.

In the study, 76 healthy volunteers who had never meditated first completed the Freiburg Mindfulness Inventory, a reliable clinical measurement of mindfulness, to determine their baseline levels. Then, while undergoing functional magnetic resonance imaging, they were administered painful heat stimulation (120°F).

Whole brain analyses revealed that higher dispositional mindfulness during painful heat was associated with greater deactivation of a brain region called the posterior cingulate cortex, a central neural node of the default mode network. Further, in those that reported higher pain, there was greater activation of this critically important brain region.

The default mode network extends from the posterior cingulate cortex to the medial prefrontal cortex of the brain. These two brain regions continuously feed information back and forth. This network is associated with processing feelings of self and mind wandering, Zeidan said.

"As soon as you start performing a task, the connection between these two brain regions in the default mode network disengages and the brain allocates information and processes to other neural areas," he said.

"Default mode deactivates whenever you are performing any kind of task, such as reading or writing. Default mode network is reactivated whenever the individual stops performing a task and reverts to self-related thoughts, feelings and emotions. The results from our study showed that mindful individuals are seemingly less caught up in the experience of pain, which was associated with lower pain reports."

The study provided novel neurobiological information that showed people with higher mindfulness ratings had less activation in the central nodes (posterior cingulate cortex) of the default network and experienced less pain. Those with lower mindfulness ratings had greater activation of this part of the brain and also felt more pain, Zeidan said.

"Now we have some new ammunition to target this brain region in the development of effective pain therapies. Importantly this work shows that we should consider one's level of mindfulness when calculating why and how one feels less or more pain," Zeidan said. "Based on our earlier research, we know we can increase mindfulness through relatively short periods of mindfulness meditation training, so this may prove to be an effective way to provide pain relief for the millions of people suffering from chronic pain." ...

A former Oakland orthopedic surgeon, and once popular AME, John D. Warbritton, III, was sentenced to 7 years in prison for transportation of child pornography.

Warbritton was a graduate of Harvard Medical School in 1980, and had an office at Frank Ogawa Plaza in Oakland. He surrendered his medical license on April 7, 2017, after the California Medical Board accused him of sexually harassing two of his workers' compensation patients.

The DWC said Warbritton was one of 20 medical providers it recently suspended from participating in the workers' compensation system.

The criminal indictment, which was filed on Oct. 13, 2016, alleges that Warbritton violated federal law by knowingly transporting child pornography. He was initially released on an unsecured bond.

But, after the United States Pretrial Services officer reported a violation of his conditions of release (possessing child pornography images on a mobile phone), the Honorable Magistrate Judge Elizabeth D. Laporte held a bail review hearing on January 17, 2017, and detained Dr. Warbritton. He was placed in the Santa Rita Jail.

Last May, he filed a Motion to Reopen his Detention Hearing. His lawyers claimed that "At the time of the alleged offense conduct and the subsequent pretrial release violation in this matter, Dr. Warbritton was suffering from both opioid use disorder and sexual impulsivity disorder." They claim he subsequently began treatment with Carolyn Ann Schuman, M.D. for his opioid addiction, and that "his incarceration ultimately allowed him to "dry out" from the use of opioids and allowed the Suboxone treatment employed by Dr. Schuman to take effect."

Prosecutors opposed the Motion claiming "defendant has been a hands-on offender because the defendant was arrested after returning to the United States from Thailand, where he admitted to agents he has spent long periods of time for the last several years" And among the child pornography taken from him by authorities, "one photo collage depicted the defendant along with an Asian female aged 8-10 years old. ....This photograph collage also raises concerns about whether the defendant may be a hands-on offender or someone who was preparing to do so."

Prosecutors concluding by saying there are no conditions of release that could reasonably assure the safety of the community. Warbritton remains in custody awaiting trial.

Warbritton ultimately pleaded guilty to the child pornography charge on May 16, 2018. According to his plea agreement, in 2016, Warbritton traveled from Bangkok, Thailand, to San Francisco International Airport with electronic devices containing child pornography. Specifically, Warbritton was traveling with a laptop and a cellular telephone, both of which contained images depicting children under the age of 12 engaged in sexually explicit conduct.

The plea agreement describes some of the images that were on the devices, including depictions of grown men engaged in sexual acts with girls under the age of 12. Warbritton stipulated that between 150 and 300 images of child pornography were on his electronic devices as he traveled to SFO.

In addition to the prison term, Judge Breyer also ordered Warbritton to serve a seven-year term of supervised release to begin after the prison term ends ...

The Department of Industrial Relations and its Division of Workers’ Compensation posted a progress report on the department’s Independent Medical Review (IMR) program.

IMR is the medical dispute resolution process that uses medical expertise to obtain consistent, evidence-based decisions and is one of the most important components of Senate Bill 863, Governor Edmund G. Brown Jr.’s landmark 2012 workers’ compensation reform.

"This shows that Independent Medical Review - which replaced a system where injured workers had to wait for medical treatment while disputes were litigated - continues to provide a timely, efficient process for resolving treatment disputes and supporting appropriate care," said George Parisotto, DWC Administrative Director.

Maximus Federal Services has been the Independent Medical Review Organization (IMRO) since the program’s inception in 2013 and is under contract to provide IMR through 2019.

In 2017, the IMRO processed 248,251 applications, a slight decrease from 2016. Concurrently, the IMRO issued 172,194 IMR determinations.

At the end of 2016, the average length of time the IMRO took to issue a determination, after the receipt of all necessary medical records, was 15 days. By mid-2017, this decreased to a monthly average of 11 days.

Overall, the IMRO overturned 8.3% of the utilization review decisions that denied treatment requests made by physicians treating injured workers.

Analysis of several variables, including the geographic region of the injured worker, the time elapsed since the worker’s work-related injury occurred, and representation by an attorney or other entity acting on behalf of the injured worker, shows similar rates of overturned case decisions.

As in the previous three calendar years, requests for pharmaceuticals in 2017 comprised nearly half (42.6%) the issues in dispute, with opioids the most common drug class (29.3%). Diagnostic tests, including radiology, imaging, and pathology, were the second-most-requested treatment category (16.2%).

Rehabilitation services - such as physical therapy, chiropractic, and acupuncture - were the third-most-requested category (14.1%).

The treatment category most often overturned was evaluation and management (with a 16.3% overturn rate), which includes specialist consultations and dental services, followed by behavioral and mental health services, which had an overturn rate of 16.3%.

Enhancements that may aid the IMR program continued in 2017. Updates to the Medical Treatment Utilization Schedule (MTUS) included several updated and new chapters as well as the adoption of a formulary. The Division of Workers’ Compensation (DWC) introduced its second online Physician Education Module.

Today’s report, as well as previous reports on IMR data, are posted on DWC’s IMR webpage under IMR program updates ...

The WCIRB has released its quarterly update on California statewide insurer experience valued as of March 31, 2018. Highlights of the report include:

California written premium for the first calendar quarter of 2018 is $5.0 billion, which is consistent with the written premium reported for the first calendar quarter of 2017. The decrease in 2017 following 7 consecutive years of increases is primarily driven by decreases in insurer charged rates.

The projected industry average charged rate per $100 of payroll for policies incepting between January 1, 2018 and March 31, 2018 is $2.38, which is 6% below the average rate charged for policies incepting in 2017. The July 1, 2018 approved advisory pure premium rates are on average 37% below those for January 1, 2015.

The projected combined ratio for 2017 is 5 points higher than 2016 as premium levels have lowered while average claim severities increased moderately. Despite the recent increase, combined ratios for 2014 to 2017 remain the lowest since the 2004 through 2006 period.The WCIRB projects the ultimate accident year combined loss and expense ratio for 2017 to be four points above that for accident year 2016, driven by higher medical severities for 2017 and lower premium rates.

Indemnity claim frequency increased by 11% from accident year 2009 to accident year 2014, but has decreased by 5% from accident year 2014 through the first three months of accident year 2018. Indemnity claims continue to settle quicker, steadily improving over the last 5 years. Frequency increases since 2011 have largely been attributed to increases in cumulative injury claims and claims from the Los Angeles Basin area.

Cumulative trauma (CT) claim rates continue to be at high levels in 2016 and the ratio of CT claims to all indemnity claims has increased by over 65% since 2005. The sharp increase in CT claims since 2012 is in the Los Angeles and San Diego areas, as CT claims in other regions of CA have decreased. The WCIRB will be publishing a study of CT claim patterns later this year.

Projected claim severity for 2017 is 2.5% higher than that for 2016, following several years of relatively flat severities. Severity growth over the last several years has been relatively modest as increases in average indemnity and ALAE costs have been in part offset by declines in average medical costs.

Indemnity severity increases in 2014 are largely attributable to SB 863 increases to PD benefits. Indemnity severity growth since 2014 has been relatively modest and generally consistent with wage inflation.

Decreases in medical severities from 2011 to 2015 were driven by the medical cost savings arising from SB 863. It is unclear whether the projected 2017 medical severity increase of 3% will develop downward like other recent years or if it represents a return the more typical rates of post-reform medical inflation.

Pharmaceutical costs per claim decreased 70% from 2012 to 2017. These reductions have been driven by SB 863’s IMR & IBR, reduced utilization of opioids, and changes to Medi- Cal reimbursement rates. The new drug formulary effective in 2018 is expected to further reduce pharmaceutical cost levels.

SB 1160 and AB 1244 made changes to lien filings effective 1/1/2017. Some of the lien activity in the fourth quarter of 2016 through the first quarter of 2017 may be impacted by the transition to the reforms. The number of liens filed since the first quarter of 2017 are 40% below pre-SB 1160 and AB 1244 levels.

The full report is available in the Research section of the WCIRB website (wcirb.com) and linked below: ...

The Labor Commissioner’s Office has cited six garment contractors $573,704 for labor law violations after uncovering a scheme where the contractors illegally operated under one license to avoid compliance. Four of the contractors did not have valid workers’ compensation coverage for their employees. Shared use of a garment manufacturing registration is illegal.

The Labor Commissioner’s Office discovered that most of the 57 employees at the contractors’ building downtown on South Broadway worked up to 65 hours a week for less than minimum wage. Two workers, ages 15 and 16, were operating industrial sewing machines in violation of California’s child labor laws.

The Labor Commissioner’s investigation began in July after receiving a lead from the Garment AB 633 Unit. Investigators visited the worksite, operating under the name Pure Cotton, Inc. Owner Kyung Ho Choi told them he collected rent but was not involved in the making of garments. His brother-in-law, Kuong Chan Kim, claimed that all of the workers were employed by his company, Union Supply, Inc., which was registered as a garment manufacturer. Further investigation revealed four other garment manufacturing contractors were operating in the building without garment licenses or workers’ compensation insurance. Kim charged each contractor a fee for the use of his license and insurance coverage, which concealed the actual number of workers.

The Labor Commissioner’s Office issued stop work orders to the four contractors operating illegally under the Union Supply, Inc. license and their inventory was confiscated. They were cited for violating wage statement and garment registration provisions, and failure to cover employees with workers’ compensation insurance.

- Cindy Soon Yun, with 20 employees, was cited $118,600. She was also cited for violating child labor laws.
- Sun Park, with 10 employees, was cited $158,855.
- Pil Chang, with 8 employees, was cited $37,450.
- Francisco Tecum Son, with 4 employees, was cited $18,000.
- Union Supply, Inc., with 15 employees, was cited $240,300.
- Pure Cotton, Inc., which has no employees, was cited $500.

The Labor Commissioner’s Office is currently pursuing wage theft investigations of the contractors.

The Garment Manufacturing Act of 1980 requires that all industry employers register with the Labor Commissioner and demonstrate adequate character, competency, and responsibility, including workers’ compensation insurance coverage. Garment manufacturers who contract with unregistered entities are automatically deemed joint employers of the workers in the contract facility. Clothing confiscated from illegal operations cannot be sold, and will be donated to non-profit organizations in the Los Angeles area.

The Labor Commissioner also administers a special wage claim adjudication process for garment workers pursuant to California’s AB 633, passed in 1999. This law provides not only an expedited process for garment workers to file wage claims but also provides a wage guarantee where garment manufacturers are responsible for wage theft at their contractors’ facilities ...

U.S. drug prices fell again in the second quarter of 2018, likely due to a new tactic insurers are using to limit financial assistance drugmakers provide directly to consumers, according to research firm Sector and Sovereign Research (SSR).

Reuters reports that real U.S. drug prices, which includes discounts and rebates drugmakers provide to insurers and pharmacy benefit managers (PBMs), fell 5.8 percent in the quarter, compared with a 0.7 percent increase a year earlier, SSR analyst Richard Evans said in a research note on Tuesday. That is in line with how far prices fell in the first quarter, he said.

But lower "real" drug prices means drugmakers are receiving less revenue on sales, but does not necessarily translate into savings for patients as employers and payers are more likely to reap the benefit.

Evans believes "copay accumulator" programs, which effectively force drug companies to continue to assist patients with their copays, were to blame for the declining real drug prices.

"Unless manufacturers adapt their copay support programs fairly drastically, net price declines may worsen in 2019," Evans said.

Gilead Sciences Inc, Eli Lilly and Co, Novo Nordisk and GlaxoSmithKline Plc made the largest contribution to the real drug price decline in the quarter, according to the report.

In recent years, insurers have tried to guide patients toward less expensive treatments by making them pay a higher portion of a drug’s costs. Drugmakers responded by raising the financial aid they offer in the form of "copay assistance" cards - similar to a debit card - that reduce consumer costs at the pharmacy.

PBMs, which manage prescription drug coverage for large U.S. employers, say these payments shield consumers from drug costs, making it easier for manufacturers to raise prices. Insurers have to make up the difference.

Many PBMs introduced the copay accumulator approach for their corporate customers this year. The programs prevent copay card funds from counting toward a patient’s required out-of-pocket spending before insurance kicks in on expensive specialty drugs.

Major pharmaceutical companies are trying to limit the damage from the tactic. Still, most large drug companies did not address the issue of copay accumulators during conference calls to review second quarter results. Amgen Inc and Eli Lilly played down the effect the programs were having their own bottom lines.

Evans said he believes more employers will add the programs next year. A recent survey of large corporate employers by the National Business Group on Health showed that around 25 percent of respondents already had copay accumulator programs in place, and another 3 percent will be adding them next year. An additional 21 percent is considering the programs for 2020 or 2021, the survey found ...

The California Chiropractic Association, filed a lawsuit in the San Francisco Superior Court on August 31, against One Call Care Management and Align Networks, Inc. claiming that the defendants engaged in "acts of unfair competition." It seeks an injunction against the alleged practices, and money damages.

The California Chiropractic Association (CalChiro) was established in 1928, and is a Sacramento-based statewide, nonprofit organization of chiropractic doctors and allied industries. CalChiro is comprised of 27 districts and three student chapters. CalChiro is governed by a board of directors elected by its 2,200 members.

One Call Medical, Inc. is a New Jersey corporation that lists with its principal place of business in Jacksonville, Florida. Align Networks, Inc. was acquired by One Call in 2013 and is also a Florida corporation, and a subsidiary and division of One Call. One Call establishes provider networks for the workers' compensation community.

According to the allegations of the complaint One Call "is known in the industry as a "cost containment" firm. In essence, One Call is nothing more than a for-profit "middleman" in California’s workers’ compensation system. OCM operates as an unlicensed network broker, contracting, on the one hand, with the payors of workers’ compensation services, including workers’ compensation insurers, self-insured employers and third party administrators, to handle the scheduling and payment of treatment visits for injured workers, and, on the other hand, with the health care professionals who provide health care services to injured workers at the deeply discounted rates imposed by OCM."

They go on to allege that One Call "generally pays its contracted chiropractors significantly below what chiropractors would be paid under the 2018 California Official Medical Fee Schedule ("OMFS") for workers’ compensation treatment services."

However, the complaint alleges that "unlike traditional PPO arrangements, injured workers are not simply free to select a health care provider from among the contracted health care professionals. Rather, OCM assigns injured workers to the provider of OCM’s choosing, thus further ensuring it maximizes its revenue by assigning these injured workers to the providers who have acquiesced to the deepest discounts."

But then the plaintiffs allege that One Call illegally keeps most of the difference in the reduced fee. They allege for example, "assume OCM agrees to provide all the services one of its client’s injured workers need for 10% less than the OMFS for workers’ compensation treatment services; that is, the client agrees to pay OCM 90% of the OMFS for workers’ compensation treatment services for treatment services needed by its employees and insureds. If OCM then pays its contracted chiropractor 50% of the OMFS, OCM would retain 40% of the OMFS for its management services - nearly as much as the chiropractor received for the provided chiropractic treatment."

This scheme, according to the allegations of the plaintiffs "violates California’s Unfair Competition Law, Cal. Bus. & Prof. Code §§ 17200, et seq. ("UCL"), as well as the numerous California laws that prohibit Defendants from engaging in illegal payment schemes, prohibiting referral systems for workers’ compensation treatment services that are directly tied to financial incentives, prohibiting Defendants from operating without the required authorizations as a physician network service provider, claims administrator or claims adjustor, and otherwise interfering with the health care services being provided to injured workers by their chiropractors."

One Call and Align have 30 days to answer or otherwise respond to the allegations of the complaint ...

Addiction specialists say they’re expecting an onslaught of teens addicted to Xanax and other sedatives in a class of anti-anxiety drugs known as benzodiazepines, or 'benzos." Many teens view Xanax as a safer and more plentiful alternative to prescription opioids and heroin - with similar euphoric effects.

But addiction experts warn that the pills kids are taking, often found in their parents’ or grandparents’ medicine cabinets, can be just as deadly as opioids, especially when taken in combination with other drugs or alcohol. And it’s much harder to kick the habit.

Nationwide, prescription drug abuse among adolescents has dropped dramatically in the last 15 years, according to survey results published in December by the National Institute on Drug Abuse. Last year’s results indicate that about 4 percent of high school seniors misused prescription painkillers, a sharp decline from 2004, when nearly 1 in 10 teens misused opioids.

In fact, an increasing percentage of high school kids - at least 26 percent of seniors in 2014, up from 5 percent in 1976 - are abstaining from all substances, including alcohol, marijuana and tobacco, according to an historical analysis of the survey data published in July.

Even so, addiction practitioners say they’re seeing a surge in the number of young patients who are hooked on Xanax. Many take high daily doses of the drug, sometimes in deadly combination with opioids and alcohol.

"Adolescent benzo use has skyrocketed" said Sharon Levy, director of adolescent addiction treatment at Boston Children’s Hospital and lead author of the adolescent drug use study "and more kids are being admitted to hospitals for benzo withdrawal because the seizures are so dangerous." At the same time, she said, far fewer kids are seeking treatment for prescription opioid addiction.

Marc Fishman, an addiction psychiatrist and professor at Johns Hopkins University School of Medicine, said benzos are quickly overtaking opioids as the primary prescription drug of abuse among the adolescent patients he sees at Mountain Manor Treatment Centers in Baltimore and other Maryland locations. And many of them are extreme, high-dose users, he said.

Like opioids prescribed for pain, benzodiazepines prescribed for anxiety eventually stop working, forcing users to take higher and higher doses to get the same effect. Kids who can’t get the pills at home buy them on the dark web or concoct designer versions of benzos in their bathtubs, he said.

But no medicines exist to blunt the withdrawal symptoms and cravings associated with benzodiazepine addiction. Instead, patients typically enter residential treatment where a specialist gradually tapers them off the medication. If stopped too quickly, benzodiazepine withdrawal can result in seizures and even death.

The burgeoning abuse of Xanax and other benzodiazepines among high school kids and young adults over the last several years primarily stems from the fact that there are more of the pills out there, Levy argued.

As more adults are prescribed Xanax, Valium, Ativan and other benzodiazepines to calm their nerves and promote sleep, "we’re creating these vast reservoirs for kids to find," she said.

The other problem, she said, is that adolescents think the benzos are safe because their parents use them. Many kids say they don’t take the pills to get high; they take them to feel normal, Levy said. “Some patients even ask me to just prescribe Xanax for them so they don’t have to buy it illegally. They think it’s good for them."

"That one idea - that something is safe or beneficial or medical - has launched many an epidemic in the past," Levy said. "So, my colleagues and I are watching this with trepidation."
...

A recent study published in the JAMA Open claims that about one in eight essential medicines in low- and middle-income countries may be fake or contain dangerous mixes of ingredients that put patients’ lives at risk.

Researchers examined data from more 350 previous studies that tested more 400,000 drug samples in low- and middle-income countries. Overall, roughly 14 percent of medicines were counterfeit, expired or otherwise low quality and unlikely to be as safe or effective as patients might expect.

And the lead study author Sachiko Ozawa of the University of North Carolina at Chapel Hill said that while the study didn’t examine high-income countries, drug quality concerns are by no means limited to less affluent nations.

Much of the research to date on counterfeit or otherwise unsafe medicines has focused on Africa, and about half of the studies in the current analysis were done there. Almost one in five medications tested in Africa were fake or otherwise potentially unsafe, researchers report in JAMA Network Open.

Another third of the studies were done in Asia, where about 14 percent of medicines tested were found to be counterfeit or otherwise unsafe.

Antibiotics and antimalarials were the most tested drugs in the analysis. Overall, about 19 percent of antimalarials and 12 percent of antibiotics were falsified or otherwise unsafe.

While fake or improperly made medicines undoubtedly harm patients, the current analysis couldn’t tell how many people suffered serious side effects or died as a result of falsified drugs.

But researchers did try to assess the economic impact of counterfeit or improperly made medicines and found the annual cost might run anywhere from $10 billion to $200 billion.

"Even in high-income countries, purchasing cheaper medicines from illegitimate sources online could result in obtaining substandard or falsified medicines," Ozawa said. "Verify the source before you buy medications, and make policymakers aware of the problem so they can work to improve the global supply chain of medicines."‘’

The report "provides important validation of what is largely already known," Tim Mackey of the Global Health Policy Institute in La Jolla, California, writes in an accompanying editorial. "It is important to note that although the study is comprehensive, its narrow scope means it only provides a snapshot of the entire problem, as it is limited to studies conducted in low- and middle-income countries and to those medicines classified as essential by the World Health Organization." ...