Benefits paid to injured workers continued to decline, while covered employment and wages continued to rise, according to data in the new Workers’ Compensation Benefits, Costs, and Coverage (2017 Data) report. Produced annually by the National Academy of Social Insurance.
Employee coverage has increased fairly steadily over the past two decades, but employer costs have fallen from just over $1.50 per $100 of covered wages in 1997 to $1.25 in 2017. Worker benefits decreased even more, from $1.17 twenty years ago to $0.80 per $100 of covered wages in 2017. “This year’s report shows that the trends that have dominated the workers’ compensation system for the past three decades – declines in both workers’ benefits and employers’ costs – continue to be sustained,” noted Les Boden, Chair of the Academy Study Panel on Workers’ Compensation Data and co-author of the report.
"To the extent that costs and benefits have fallen because of improved safety at work, that is, of course, good news. However, there is also evidence that suggests that many injured workers are not receiving the cash benefits and/or medical care they need, and that some states are achieving lower benefits by shifting costs rather than improving safety.
In addition to the full report, including sources and methods, an Executive Summary and four state-specific spotlights on Wyoming, Florida, Ohio, and Missouri are available for download. Additional highlights include:
-- Covered jobs increased in all jurisdictions except Alaska, North Dakota, West Virginia, and Wyoming. Covered wages increased in all jurisdictions except Wyoming.
-- Benefits per $100 of covered wages decreased in all jurisdictions except Missouri and Hawaii, where they increased by $0.09 and $0.04, respectively.
-- Costs per $100 of covered wages, or standardized costs, decreased in all but five jurisdictions, with the largest percent decrease (38.3 percent) in Oklahoma ...
Employee coverage has increased fairly steadily over the past two decades, but employer costs have fallen from just over $1.50 per $100 of covered wages in 1997 to $1.25 in 2017. Worker benefits decreased even more, from $1.17 twenty years ago to $0.80 per $100 of covered wages in 2017. “This year’s report shows that the trends that have dominated the workers’ compensation system for the past three decades – declines in both workers’ benefits and employers’ costs – continue to be sustained,” noted Les Boden, Chair of the Academy Study Panel on Workers’ Compensation Data and co-author of the report.
"To the extent that costs and benefits have fallen because of improved safety at work, that is, of course, good news. However, there is also evidence that suggests that many injured workers are not receiving the cash benefits and/or medical care they need, and that some states are achieving lower benefits by shifting costs rather than improving safety.
In addition to the full report, including sources and methods, an Executive Summary and four state-specific spotlights on Wyoming, Florida, Ohio, and Missouri are available for download. Additional highlights include:
-- Covered jobs increased in all jurisdictions except Alaska, North Dakota, West Virginia, and Wyoming. Covered wages increased in all jurisdictions except Wyoming.
-- Benefits per $100 of covered wages decreased in all jurisdictions except Missouri and Hawaii, where they increased by $0.09 and $0.04, respectively.
-- Costs per $100 of covered wages, or standardized costs, decreased in all but five jurisdictions, with the largest percent decrease (38.3 percent) in Oklahoma ...
"Balance billing," better known as surprise billing, occurs when a patient receives care from a medical provider outside of his insurance plan's network, and then the provider bills the patient for the amount insurance didn't cover. These bills can soar into the tens of thousands of dollars.
Surprise bills hit an estimated 1 in 6 insured Americans after a stay in the hospital. And the air ambulance industry, with its private equity backing, high upfront costs and frequent out-of-network status, is among the worst offenders.
Congress is considering legislation aimed at addressing surprise bills and air ambulance charges. And some states, including Wyoming and California, are trying to address the problem even though there are limits to what they can do, because air ambulances are primarily regulated by federal aviation authorities.
Here is an example of how a surprise bill might work. Before his double-lung transplant, Tom Saputo thought he had anticipated every possible outcome. But after the surgery, he wasn't prepared for the price of the 27-mile air ambulance flight from a hospital in Thousand Oaks, Calif., to UCLA Medical Center - which cost more than the lifesaving operation itself.
Saputo, 63, was diagnosed in 2016 with idiopathic pulmonary fibrosis, a progressive disease that scars lung tissue and makes it increasingly difficult to breathe. The retired Thousand Oaks graphic designer got on the list for a double-lung transplant at UCLA and started the preapproval process with his insurance company, Anthem Blue Cross, should organs become available.
But before a transplant could be arranged, he suddenly stopped breathing on the evening of July 7, 2018. His wife called 911. A ground ambulance drove the couple to Los Robles Regional Medical Center, 15 minutes from their house, where Saputo spent four days in the intensive care unit before his doctors sent him to UCLA by air ambulance.
He was on the brink of death, but just in time, the hospital received a pair of donor lungs. They were a perfect match, and two days after arriving at UCLA, Saputo was breathing normally again.
Much later, when Saputo opened a letter from Anthem, he discovered the helicopter company, which was out of his network, had charged the insurance company $51,282 for the flight. Saputo was responsible for the portion his insurance didn't cover: $11,524.79. By contrast, the charges from the day of his transplant surgery totaled $40,575 - including $31,605 for his surgeon - and were fully covered by Anthem.
In California, Democratic Gov. Gavin Newsom signed a bill in early October that will limit how much some privately insured patients will pay for air ambulance rides. Effective next year, the law, by state Assemblyman Tim Grayson, will cap out-of-pocket costs at patients' in-network amounts, even if the air ambulance company is out of network.
Wyoming is moving to treat the industry like a public utility, allowing the state's Medicaid program to cover all of its residents' air ambulance trips and then bill patients' health insurance plans. The state would then cap out-of-pocket costs at 2% of the patient's income or $5,000, whichever is less. Wyoming needs permission from the federal government to proceed.
Ultimately, though, state authority is limited because the federal Airline Deregulation Act of 1978 prohibits states from enacting price laws on air carriers.
Congress is considering several bipartisan bills on surprise billing. One measure by Sens. Lamar Alexander, R-Tenn., and Patty Murray, D-Wash., would ban balance bills from air ambulance companies. The bill passed committee and is now headed to the Senate floor for a vote, pending approval from Senate Majority Leader Mitch McConnell of Kentucky ...
Surprise bills hit an estimated 1 in 6 insured Americans after a stay in the hospital. And the air ambulance industry, with its private equity backing, high upfront costs and frequent out-of-network status, is among the worst offenders.
Congress is considering legislation aimed at addressing surprise bills and air ambulance charges. And some states, including Wyoming and California, are trying to address the problem even though there are limits to what they can do, because air ambulances are primarily regulated by federal aviation authorities.
Here is an example of how a surprise bill might work. Before his double-lung transplant, Tom Saputo thought he had anticipated every possible outcome. But after the surgery, he wasn't prepared for the price of the 27-mile air ambulance flight from a hospital in Thousand Oaks, Calif., to UCLA Medical Center - which cost more than the lifesaving operation itself.
Saputo, 63, was diagnosed in 2016 with idiopathic pulmonary fibrosis, a progressive disease that scars lung tissue and makes it increasingly difficult to breathe. The retired Thousand Oaks graphic designer got on the list for a double-lung transplant at UCLA and started the preapproval process with his insurance company, Anthem Blue Cross, should organs become available.
But before a transplant could be arranged, he suddenly stopped breathing on the evening of July 7, 2018. His wife called 911. A ground ambulance drove the couple to Los Robles Regional Medical Center, 15 minutes from their house, where Saputo spent four days in the intensive care unit before his doctors sent him to UCLA by air ambulance.
He was on the brink of death, but just in time, the hospital received a pair of donor lungs. They were a perfect match, and two days after arriving at UCLA, Saputo was breathing normally again.
Much later, when Saputo opened a letter from Anthem, he discovered the helicopter company, which was out of his network, had charged the insurance company $51,282 for the flight. Saputo was responsible for the portion his insurance didn't cover: $11,524.79. By contrast, the charges from the day of his transplant surgery totaled $40,575 - including $31,605 for his surgeon - and were fully covered by Anthem.
In California, Democratic Gov. Gavin Newsom signed a bill in early October that will limit how much some privately insured patients will pay for air ambulance rides. Effective next year, the law, by state Assemblyman Tim Grayson, will cap out-of-pocket costs at patients' in-network amounts, even if the air ambulance company is out of network.
Wyoming is moving to treat the industry like a public utility, allowing the state's Medicaid program to cover all of its residents' air ambulance trips and then bill patients' health insurance plans. The state would then cap out-of-pocket costs at 2% of the patient's income or $5,000, whichever is less. Wyoming needs permission from the federal government to proceed.
Ultimately, though, state authority is limited because the federal Airline Deregulation Act of 1978 prohibits states from enacting price laws on air carriers.
Congress is considering several bipartisan bills on surprise billing. One measure by Sens. Lamar Alexander, R-Tenn., and Patty Murray, D-Wash., would ban balance bills from air ambulance companies. The bill passed committee and is now headed to the Senate floor for a vote, pending approval from Senate Majority Leader Mitch McConnell of Kentucky ...
The Washington Post reports that a federal bankruptcy judge on Wednesday temporarily extended protection that halts scores of lawsuits against Purdue Pharma and members of the Sackler family, who founded the opioid maker, until April 8. The order by Judge Robert Drain continues a temporary injunction that was put in place last month and expired Wednesday. It came over the objections of some litigants who have argued that the Sackler family does not deserve such legal protection.
Purdue Pharma, the maker of OxyContin, filed for bankruptcy Sept. 15 as part of a broad opioid settlement proposal with 24 states but that is opposed by 24 states and the District of Columbia. Oklahoma and Kentucky separately have already settled with Purdue Pharma.
Officials representing the dissenting states and a number of municipalities have objected to the temporary injunction covering the Sacklers, who have not filed for personal bankruptcy. But some reached a deal with Purdue Pharma on Wednesday agreeing to voluntarily comply with the temporary injunction. The agreement allows those states to change their minds later and fight the injunction.
The Sacklers have agreed, for the first time, to provide more personal financial information, Marshall Huebner, an attorney representing Purdue, said during the hearing. But an attorney representing creditors said progress had been "slow and strained." OxyContin, which has been blamed as a major driver of America’s opioid epidemic, makes up about 90 percent of Purdue Pharma’s sales.
As part of that deal, the Sacklers agreed to relinquish control of their firm and contribute at least $3 billion to the settlement, an amount that would be derived at least in part from the sale of an overseas drug company it owns.
Some state attorneys general have argued that is not enough from a family whose wealth Forbes has estimated at $13 billion. If the Sacklers want special protection from the bankruptcy court, they should be forced to give a detailed accounting of their wealth, North Carolina Attorney General Josh Stein said in September. Stein has sued eight members of the family individually.
Purdue Pharma said during Wednesday’s hearing that it had started looking for an outside monitor as part of its negotiations with creditors and states that have yet to sign on to the settlement. The company also has agreed to new restrictions on its behavior during the bankruptcy, including limiting its lobbying, said Huebner, the company attorney.
There has been substantial progress, he said, adding: "The goal is always to get to a deal whenever it is possible." ...
Purdue Pharma, the maker of OxyContin, filed for bankruptcy Sept. 15 as part of a broad opioid settlement proposal with 24 states but that is opposed by 24 states and the District of Columbia. Oklahoma and Kentucky separately have already settled with Purdue Pharma.
Officials representing the dissenting states and a number of municipalities have objected to the temporary injunction covering the Sacklers, who have not filed for personal bankruptcy. But some reached a deal with Purdue Pharma on Wednesday agreeing to voluntarily comply with the temporary injunction. The agreement allows those states to change their minds later and fight the injunction.
The Sacklers have agreed, for the first time, to provide more personal financial information, Marshall Huebner, an attorney representing Purdue, said during the hearing. But an attorney representing creditors said progress had been "slow and strained." OxyContin, which has been blamed as a major driver of America’s opioid epidemic, makes up about 90 percent of Purdue Pharma’s sales.
As part of that deal, the Sacklers agreed to relinquish control of their firm and contribute at least $3 billion to the settlement, an amount that would be derived at least in part from the sale of an overseas drug company it owns.
Some state attorneys general have argued that is not enough from a family whose wealth Forbes has estimated at $13 billion. If the Sacklers want special protection from the bankruptcy court, they should be forced to give a detailed accounting of their wealth, North Carolina Attorney General Josh Stein said in September. Stein has sued eight members of the family individually.
Purdue Pharma said during Wednesday’s hearing that it had started looking for an outside monitor as part of its negotiations with creditors and states that have yet to sign on to the settlement. The company also has agreed to new restrictions on its behavior during the bankruptcy, including limiting its lobbying, said Huebner, the company attorney.
There has been substantial progress, he said, adding: "The goal is always to get to a deal whenever it is possible." ...
The San Mateo County Superior Court issued an order appointing the California Department of Insurance’s Conservation and Liquidation Office as conservator of California Insurance Company (CIC) and directing the conservator to take immediate possession of the workers’ compensation insurer in response to the company’s willful violation of state law and established pattern of continually flouting California’s regulatory processes.
The Department of Insurance sought the order after company officials unilaterally and illegally attempted to merge its business with a New Mexico-based insurer without first securing the Department’s prior approval.
The order also blocks the attempted merger, which seeks to divest California of its regulatory oversight over this entity. If CIC is permitted to consummate this illegal transfer, CIC employer policyholders, employees with serious work-related injuries and other claimants entitled to vital and necessary insurance benefits, will be left holding policies of a non-admitted insurer not qualified to transact insurance in California.
Effective immediately, the Department of Insurance’s Conservation and Liquidation Office will serve as conservator to protect the company’s existing policyholders and covered workers from an insurer attempting to operate without the approval and authority to continue to transact insurance in California.
The conservator will, to the fullest extent of the law, ensure that California Insurance Company policyholders remain covered under their existing policies and retain the full protections provided to them under California law.
This action follows an established pattern and practice by company officials of illegal actions, misrepresentations, and willful disregard for the authority of the Department of Insurance and other states’ regulators:
-- In 2016, the Department of Insurance issued a precedential decision In the Matter of the Appeal of Shasta Linen Supply, Inc. stating that California Insurance Company (CIC) "created a product to circumvent California’s statutory and regulatory requirement; a product that ultimately enriched CIC at the expense of California employers."
-- The Department subsequently served California Insurance Company officials with a Cease and Desist Order for selling unapproved workers’ compensation policies to unsuspecting business owners in what amounted to a "bait and switch" scheme.
-- Other states including Vermont, Wisconsin, New York, and New Jersey have also taken regulatory actions against the same company officials’ affiliated companies for engaging in similar unapproved transactions within those states.
While the Department of Insurance was in the process of reviewing the company’s application for sale, on October 9, with less than 48 hours’ notice to California, company officials attempted to transfer the ownership of California-domiciled California Insurance Company to a New Mexico entity called "California Insurance Company II."
The California Department of Insurance denied an application for approval of the sale of California Insurance Company on October 18, citing, among other reasons, the applicants’ abrupt and unilateral attempt to merge the company with a New Mexico-based entity without seeking or obtaining California’s prior approval.
California law is unequivocal in giving the Department of Insurance the responsibility and power to review transactions of California-based insurers in order to protect policyholders and the public. No company can evade this authority if it wants to sell insurance in this state ...
The Department of Insurance sought the order after company officials unilaterally and illegally attempted to merge its business with a New Mexico-based insurer without first securing the Department’s prior approval.
The order also blocks the attempted merger, which seeks to divest California of its regulatory oversight over this entity. If CIC is permitted to consummate this illegal transfer, CIC employer policyholders, employees with serious work-related injuries and other claimants entitled to vital and necessary insurance benefits, will be left holding policies of a non-admitted insurer not qualified to transact insurance in California.
Effective immediately, the Department of Insurance’s Conservation and Liquidation Office will serve as conservator to protect the company’s existing policyholders and covered workers from an insurer attempting to operate without the approval and authority to continue to transact insurance in California.
The conservator will, to the fullest extent of the law, ensure that California Insurance Company policyholders remain covered under their existing policies and retain the full protections provided to them under California law.
This action follows an established pattern and practice by company officials of illegal actions, misrepresentations, and willful disregard for the authority of the Department of Insurance and other states’ regulators:
-- In 2016, the Department of Insurance issued a precedential decision In the Matter of the Appeal of Shasta Linen Supply, Inc. stating that California Insurance Company (CIC) "created a product to circumvent California’s statutory and regulatory requirement; a product that ultimately enriched CIC at the expense of California employers."
-- The Department subsequently served California Insurance Company officials with a Cease and Desist Order for selling unapproved workers’ compensation policies to unsuspecting business owners in what amounted to a "bait and switch" scheme.
-- Other states including Vermont, Wisconsin, New York, and New Jersey have also taken regulatory actions against the same company officials’ affiliated companies for engaging in similar unapproved transactions within those states.
While the Department of Insurance was in the process of reviewing the company’s application for sale, on October 9, with less than 48 hours’ notice to California, company officials attempted to transfer the ownership of California-domiciled California Insurance Company to a New Mexico entity called "California Insurance Company II."
The California Department of Insurance denied an application for approval of the sale of California Insurance Company on October 18, citing, among other reasons, the applicants’ abrupt and unilateral attempt to merge the company with a New Mexico-based entity without seeking or obtaining California’s prior approval.
California law is unequivocal in giving the Department of Insurance the responsibility and power to review transactions of California-based insurers in order to protect policyholders and the public. No company can evade this authority if it wants to sell insurance in this state ...
The embattled ex-CEO of a string of now-shuttered Merced-area health clinics that served thousands of low-income patients signed an agreement to plead guilty to defrauding Medi-Cal of millions of dollars.
Sandra Haar, 59, of Merced, was sentenced to five years in prison and ordered to pay $6,107,846 in restitution for health care fraud and conspiracy to receive kickbacks. Haar was ordered to self-surrender on Jan. 15, 2020, to begin serving her sentence.
Haar was the founder and chief executive officer of Horisons Unlimited, a nonprofit public benefit corporation that provided health and dental services in Merced and surrounding communities. She was a nurse practitioner who had been CEO of the clinic since its opening in 2004
According to its 2014 tax filings, Horisons reported nearly $7.6 million in revenue, with functional expenses of $6.7 million.
According to court documents, between January 1, 2014, and March 2017, Haar orchestrated a scheme to bill Medicare and Medi-Cal for services she knew were not reimbursable, and she profited by over $3.7 million from her fraud.
For example, Haar billed Medi-Cal for health and dental services that were not rendered and for unnecessary health care services. She also billed Medi-Cal for office visits with purportedly licensed doctors when the patients instead were dispensed Suboxone, an opioid medication, in the parking lots of McDonald’s and Rite Aid in baggies.
According to court documents, Haar also received thousands of dollars in kickbacks in cash from an account executive at a laboratory in exchange for using it for patients’ laboratory testing.
This case was the product of an investigation by the Federal Bureau of Investigation, the U.S. Department of Health and Human Services Office of Inspector General (HHS OIG), the California Department of Health Care Services, and the California Bureau of Medi-Cal Fraud & Elder Abuse.
...
Sandra Haar, 59, of Merced, was sentenced to five years in prison and ordered to pay $6,107,846 in restitution for health care fraud and conspiracy to receive kickbacks. Haar was ordered to self-surrender on Jan. 15, 2020, to begin serving her sentence.
Haar was the founder and chief executive officer of Horisons Unlimited, a nonprofit public benefit corporation that provided health and dental services in Merced and surrounding communities. She was a nurse practitioner who had been CEO of the clinic since its opening in 2004
According to its 2014 tax filings, Horisons reported nearly $7.6 million in revenue, with functional expenses of $6.7 million.
According to court documents, between January 1, 2014, and March 2017, Haar orchestrated a scheme to bill Medicare and Medi-Cal for services she knew were not reimbursable, and she profited by over $3.7 million from her fraud.
For example, Haar billed Medi-Cal for health and dental services that were not rendered and for unnecessary health care services. She also billed Medi-Cal for office visits with purportedly licensed doctors when the patients instead were dispensed Suboxone, an opioid medication, in the parking lots of McDonald’s and Rite Aid in baggies.
According to court documents, Haar also received thousands of dollars in kickbacks in cash from an account executive at a laboratory in exchange for using it for patients’ laboratory testing.
This case was the product of an investigation by the Federal Bureau of Investigation, the U.S. Department of Health and Human Services Office of Inspector General (HHS OIG), the California Department of Health Care Services, and the California Bureau of Medi-Cal Fraud & Elder Abuse.
...
Drug law enforcement officers from China and the United States will jointly brief the media on Thursday on a fentanyl smuggling case, in an unusual disclosure of rare Sino-U.S. cooperation in cracking down on fentanyl crimes.
China’s National Narcotics Control Commission and enforcement officers from both countries will give "detailed information" at a press conference in Xingtai city in northern Hebel province about a fentanyl smuggling case that was jointly uncovered by both sides, according to a notice circulated by the State Council Information Office.
Reporters will also be able to view a live broadcast of the trial at the Xingtai court, before the press conference.
Fentanyl is a cheap, relatively easy-to-synthesize opioid painkiller 50 times more potent than heroin that has played a major role in a devastating U.S. opioid addiction crisis.
U.S. officials say China is the main source of illicit fentanyl and fentanyl-related substances that are trafficked into the United States, much of it through international mail. China denies that most of the illicit fentanyl entering the United States originates in China.
U.S. President Donald Trump accused Chinese President Xi Jinping in August of failing to meet his promises to crack down on the deluge of fentanyl and fentanyl analogues flowing into the United States. China labeled that "blatant slander".
The dispute over fentanyl comes with the United States in the middle of a major trade dispute with China.
China’s National Narcotics Control Commission said in September that Sino-U.S. cooperation on investigating and prosecuting fentanyl-related substances was "extremely limited", even though counter-narcotics law enforcement departments from both sides had long maintained a good cooperative relationship.
The sudden show of cooperation announced on Tuesday coincides with intense bilateral negotiations over a phase-one trade agreement which Trump said he hoped to sign with Xi ...
China’s National Narcotics Control Commission and enforcement officers from both countries will give "detailed information" at a press conference in Xingtai city in northern Hebel province about a fentanyl smuggling case that was jointly uncovered by both sides, according to a notice circulated by the State Council Information Office.
Reporters will also be able to view a live broadcast of the trial at the Xingtai court, before the press conference.
Fentanyl is a cheap, relatively easy-to-synthesize opioid painkiller 50 times more potent than heroin that has played a major role in a devastating U.S. opioid addiction crisis.
U.S. officials say China is the main source of illicit fentanyl and fentanyl-related substances that are trafficked into the United States, much of it through international mail. China denies that most of the illicit fentanyl entering the United States originates in China.
U.S. President Donald Trump accused Chinese President Xi Jinping in August of failing to meet his promises to crack down on the deluge of fentanyl and fentanyl analogues flowing into the United States. China labeled that "blatant slander".
The dispute over fentanyl comes with the United States in the middle of a major trade dispute with China.
China’s National Narcotics Control Commission said in September that Sino-U.S. cooperation on investigating and prosecuting fentanyl-related substances was "extremely limited", even though counter-narcotics law enforcement departments from both sides had long maintained a good cooperative relationship.
The sudden show of cooperation announced on Tuesday coincides with intense bilateral negotiations over a phase-one trade agreement which Trump said he hoped to sign with Xi ...
The Drug Enforcement Administration is alerting the public of dangerous counterfeit pills killing Americans.
Mexican drug cartels are manufacturing mass quantities of counterfeit prescription pills containing fentanyl, a dangerous synthetic opioid that is lethal in minute doses, for distribution throughout North America.
Based on a sampling of tablets seized nationwide between January and March 2019, DEA found that 27 percent contained potentially lethal doses of fentanyl.
"Capitalizing on the opioid epidemic and prescription drug abuse in the United States, drug trafficking organizations are now sending counterfeit pills made with fentanyl in bulk to the United States for distribution," said DEA Acting Administrator Uttam Dhillon. "Counterfeit pills that contain fentanyl and fentanyl-laced heroin are responsible for thousands of opioid-related deaths in the United States each year."
Fentanyl and other highly potent synthetic opioids remain the primary driver behind the ongoing opioid crisis, with fentanyl involved in more deaths than any other illicit drug.
Much of U.S. fentanyl originates in China, but is pressed into pills in Mexico and smuggled into the U.S.
A lethal dose of fentanyl is estimated to be about two milligrams, but can vary based on an individual’s body size, tolerance, amount of previous usage and other factors.
The full Fentanyl Signature Profiling Program Report on the recent drug sampling and testing is available on the DEA.gov website ...
Mexican drug cartels are manufacturing mass quantities of counterfeit prescription pills containing fentanyl, a dangerous synthetic opioid that is lethal in minute doses, for distribution throughout North America.
Based on a sampling of tablets seized nationwide between January and March 2019, DEA found that 27 percent contained potentially lethal doses of fentanyl.
"Capitalizing on the opioid epidemic and prescription drug abuse in the United States, drug trafficking organizations are now sending counterfeit pills made with fentanyl in bulk to the United States for distribution," said DEA Acting Administrator Uttam Dhillon. "Counterfeit pills that contain fentanyl and fentanyl-laced heroin are responsible for thousands of opioid-related deaths in the United States each year."
Fentanyl and other highly potent synthetic opioids remain the primary driver behind the ongoing opioid crisis, with fentanyl involved in more deaths than any other illicit drug.
Much of U.S. fentanyl originates in China, but is pressed into pills in Mexico and smuggled into the U.S.
A lethal dose of fentanyl is estimated to be about two milligrams, but can vary based on an individual’s body size, tolerance, amount of previous usage and other factors.
The full Fentanyl Signature Profiling Program Report on the recent drug sampling and testing is available on the DEA.gov website ...
Now that the dust has settled on AB-5, the new law that classifies more independent contractors as employees, industries that are expected to be affected include: golf caddies, exotic dancers, some freelance journalists, cable installers, bartenders, and most delivery drivers. The Recording Industry Association of America, and the American Association of Independent Music. AB5 could make workers, including producers, engineers, musicians, publicists and background vocalists, full-time employees.
According to the Freelancing in America survey, there is a reported 57 million American freelancers contributing an excess of $1 trillion dollars to the economy each year. And California based freelance writers are now cast as industry pariah by some employers.
The Hollywood Reporter stated many publications are going to avoid working with California freelancers to avoid potential lawsuits. They’ve admitted to already seeing SEO, transcription and writing job notices explicitly state California freelancers won’t be considered.
The exemption for freelance journalists contains what some say is a potentially career-ending requirement for a writer to remain a freelancer: If a freelance journalist writes for a magazine, newspaper or other entity whose central mission is to disseminate the news, the law says, that journalist is capped at writing 35 "submissions" per year per "putative employer." At a time when paid freelance stories can be written for a low end of $25 and high end of $1 per word, some meet that cap in a month just to make end's meet.
Amy Lamare, who writes for money site Celebritynetworth.com and YourTango.com, adds, "Everyone's freaking out, like my anxiety is going through the damn roof."
Many publications that employ California freelancers aren’t based in the state and it’s not clear how AB 5 will affect them. Still, some are choosing to opt out entirely. Indeed, several freelance writers who spoke to THR say that various out-of-state employers - some with offices in California - have already told them they’re cutting ties with California freelancers.
"I have heard from clients that they're just going to avoid working with California freelancers," freelance entertainment writer Fred Topel says (Topel chose not to name those clients in case they change their minds). THR has additionally reviewed several job notices in transcription, blogging and SEO writing that have explicitly stated that California freelancers will not be considered.
Large California-based news media brands are still figuring out the logistics of how to comply with the law. Asked how he plans to handle the implementation of AB 5 next year, San Diego Union-Tribune publisher and editor-in-chief Jeff Light says, "We're in the process of sorting through the implications right now. Unfortunately, I suspect a number of freelancers will end up with less work from us as a result of the 35-piece limit. I don't have anything more detailed than that at this point."
Of the freelancer exemption, San Francisco Chronicle publisher Bill Nagel says, "This was a poorly considered part of the law, likely based on a fundamental misunderstanding of why companies use freelancers. There are situations in which we cannot make a freelancer an employee, which inhibits our First Amendment rights as a publication. It also seems odd and problematic that broadcast freelancers are treated differently than their colleagues in print media. Unfortunately, AB 5 will limit opportunities for some freelancers and silence a number of voices in the market. We will, of course, comply with the law."
Meanwhile, national outlets are remaining mostly silent publicly. The Los Angeles Times - which just negotiated its first newsroom union contract - The New York Times, The Washington Post, The Wall Street Journal and Southern California News Group (which owns the O.C. Register and Los Angeles Daily News) declined to comment. USA Today owner Gannett, which has freelancers at papers in California, and movie website Rotten Tomatoes, which is based in Los Angeles, did not respond to requests for comment.
...
According to the Freelancing in America survey, there is a reported 57 million American freelancers contributing an excess of $1 trillion dollars to the economy each year. And California based freelance writers are now cast as industry pariah by some employers.
The Hollywood Reporter stated many publications are going to avoid working with California freelancers to avoid potential lawsuits. They’ve admitted to already seeing SEO, transcription and writing job notices explicitly state California freelancers won’t be considered.
The exemption for freelance journalists contains what some say is a potentially career-ending requirement for a writer to remain a freelancer: If a freelance journalist writes for a magazine, newspaper or other entity whose central mission is to disseminate the news, the law says, that journalist is capped at writing 35 "submissions" per year per "putative employer." At a time when paid freelance stories can be written for a low end of $25 and high end of $1 per word, some meet that cap in a month just to make end's meet.
Amy Lamare, who writes for money site Celebritynetworth.com and YourTango.com, adds, "Everyone's freaking out, like my anxiety is going through the damn roof."
Many publications that employ California freelancers aren’t based in the state and it’s not clear how AB 5 will affect them. Still, some are choosing to opt out entirely. Indeed, several freelance writers who spoke to THR say that various out-of-state employers - some with offices in California - have already told them they’re cutting ties with California freelancers.
"I have heard from clients that they're just going to avoid working with California freelancers," freelance entertainment writer Fred Topel says (Topel chose not to name those clients in case they change their minds). THR has additionally reviewed several job notices in transcription, blogging and SEO writing that have explicitly stated that California freelancers will not be considered.
Large California-based news media brands are still figuring out the logistics of how to comply with the law. Asked how he plans to handle the implementation of AB 5 next year, San Diego Union-Tribune publisher and editor-in-chief Jeff Light says, "We're in the process of sorting through the implications right now. Unfortunately, I suspect a number of freelancers will end up with less work from us as a result of the 35-piece limit. I don't have anything more detailed than that at this point."
Of the freelancer exemption, San Francisco Chronicle publisher Bill Nagel says, "This was a poorly considered part of the law, likely based on a fundamental misunderstanding of why companies use freelancers. There are situations in which we cannot make a freelancer an employee, which inhibits our First Amendment rights as a publication. It also seems odd and problematic that broadcast freelancers are treated differently than their colleagues in print media. Unfortunately, AB 5 will limit opportunities for some freelancers and silence a number of voices in the market. We will, of course, comply with the law."
Meanwhile, national outlets are remaining mostly silent publicly. The Los Angeles Times - which just negotiated its first newsroom union contract - The New York Times, The Washington Post, The Wall Street Journal and Southern California News Group (which owns the O.C. Register and Los Angeles Daily News) declined to comment. USA Today owner Gannett, which has freelancers at papers in California, and movie website Rotten Tomatoes, which is based in Los Angeles, did not respond to requests for comment.
...
The World Health Organization recently recognized occupational burnout as a legitimate health syndrome. While that may sound a bit excessive at first glance, consider the results of a recent survey involving 2,000 working Americans: A shocking 36% of respondents reported dealing with feelings of on-the-job burnout every single week. Another 56% say they get burnt out on on the job at least once per month.
On the other hand, if stress and exhaustion isn’t gripping you mentally and physically at your desk, sadly you’re in a small minority. Only 12% of surveyed employees say they have never felt burnt out while working in their current position.
Conducted by telecommunications company TollFreeForwarding.com, the survey also revealed that roughly four in 10 employees deal with weekly health issues brought on by job-induced burnout. More specifically, 40% suffer from anxiety regularly, 44% report feeling exhausted on a weekly basis, and 56% say that intense feelings of stress have become part of their weekly routine.
All of that burnout is creeping into other areas of people’s lives as well, with 54% of respondents saying their sleep patterns have suffered due to burnout, 44% say their work / life balance has been impacted, 37% have become less ambitious in their career motivations, and 36% have seen their overall productivity drop.
It isn’t just the employees who are paying for all this burnout, either. Sick days and loss of personnel is also costing many U.S. businesses. In all, 34% of respondents say they take a day off at least every six months due to burnout, and nearly half (48%) say they their job satisfaction has taken a blow due to burnout. In fact, over half of respondents (55%) have already considered leaving their job due to a perceived lack of support regarding burnout, stress, etc.
It seems many employees feel like their employers aren’t doing enough; 50% of respondents say the companies they work for need to do more to curb employee burnout. Another two-thirds (67%) are worried what all of that stress, anxiety, and exhaustion is going to do their bodies in the long-term.
"Burnout is now officially recognized as an illness, so we thought now was a good time to help uncover more about how employees are feeling in their workplace, and how much support they feel they’re getting," comments COO of TollFreeForwarding.com James O’Brien in a statement. "Awareness of overworking, and the health problems this can cause, is increasing. Here however, we’ve discovered there is much work to be done. What businesses must recognize is that not addressing burnout is not only bad for health reasons, it’s also bad for business."
Among the survey’s other findings was that healthcare workers are experiencing burnout symptoms at greater rates than any other profession. Furthermore, it’s clear from the survey’s findings that modern businesses and organizations need to address employee burnout in a proactive, not reactive, manner. For example, a "high-pressure working environment" was the most often-cited reason given by respondents for burnout (44%), followed by "lack of support or communication from management" (38%) ...
On the other hand, if stress and exhaustion isn’t gripping you mentally and physically at your desk, sadly you’re in a small minority. Only 12% of surveyed employees say they have never felt burnt out while working in their current position.
Conducted by telecommunications company TollFreeForwarding.com, the survey also revealed that roughly four in 10 employees deal with weekly health issues brought on by job-induced burnout. More specifically, 40% suffer from anxiety regularly, 44% report feeling exhausted on a weekly basis, and 56% say that intense feelings of stress have become part of their weekly routine.
All of that burnout is creeping into other areas of people’s lives as well, with 54% of respondents saying their sleep patterns have suffered due to burnout, 44% say their work / life balance has been impacted, 37% have become less ambitious in their career motivations, and 36% have seen their overall productivity drop.
It isn’t just the employees who are paying for all this burnout, either. Sick days and loss of personnel is also costing many U.S. businesses. In all, 34% of respondents say they take a day off at least every six months due to burnout, and nearly half (48%) say they their job satisfaction has taken a blow due to burnout. In fact, over half of respondents (55%) have already considered leaving their job due to a perceived lack of support regarding burnout, stress, etc.
It seems many employees feel like their employers aren’t doing enough; 50% of respondents say the companies they work for need to do more to curb employee burnout. Another two-thirds (67%) are worried what all of that stress, anxiety, and exhaustion is going to do their bodies in the long-term.
"Burnout is now officially recognized as an illness, so we thought now was a good time to help uncover more about how employees are feeling in their workplace, and how much support they feel they’re getting," comments COO of TollFreeForwarding.com James O’Brien in a statement. "Awareness of overworking, and the health problems this can cause, is increasing. Here however, we’ve discovered there is much work to be done. What businesses must recognize is that not addressing burnout is not only bad for health reasons, it’s also bad for business."
Among the survey’s other findings was that healthcare workers are experiencing burnout symptoms at greater rates than any other profession. Furthermore, it’s clear from the survey’s findings that modern businesses and organizations need to address employee burnout in a proactive, not reactive, manner. For example, a "high-pressure working environment" was the most often-cited reason given by respondents for burnout (44%), followed by "lack of support or communication from management" (38%) ...
A Hawthorne man was found guilty by a jury of 14 federal felonies for intentionally driving his family off a wharf and into the water at the Port of Los Angeles in a scheme to collect money on insurance policies he had taken out on their lives.
Ali F. Elmezayen, 45, was found guilty of four counts of mail fraud, four counts of wire fraud, one count of aggravated identity theft, and five counts of money laundering.
According to the evidence presented at his nine-day trial, Elmezayen bought from eight different insurance companies more than $7 million worth of life and accidental death insurance policies on himself and his family. Elmezayen paid premiums in excess of $6,000 per year for these policies - even though he reported income of less than $30,000 per year on his tax returns. Elmezayen began purchasing the insurance policies the same year he exited a Chapter 11 bankruptcy proceeding.
After purchasing the policies, Elmezayen repeatedly called the insurance companies - sometimes pretending to be his wife in whose name he had obtained some of the policies - to verify that the policies were active and that they would pay benefits if his wife died in an accident. Elmezayen also called at least two of the insurance companies to confirm they would not investigate claims made two years after the policies were purchased. These telephone calls were recorded and were played for the jury.
On April 9, 2015, 12 days after the 2-year contestability period on the last of his insurance policies expired, Elmezayen drove a car with his wife and two youngest children off a wharf at the Port of Los Angeles. The site of the crash was a loading dock and worksite for commercial fishermen.
Elmezayen swam out the open driver’s side window of the car. Elmezayen’s wife, who did not know how to swim, escaped the vehicle and survived when a nearby fisherman threw her a flotation device. Two of the couple’s three sons, who were 8 and 13 and who were both severely autistic, were strapped into the car and drowned. The third son was away at camp at the time and was not in the car at the time his father drove it into the water.
Elmezayen repeatedly lied - to law enforcement officers, insurance companies, and in subsequent civil litigation he filed concerning the crash - about the extent of the insurance he had purchased on his family, and specifically about whether he had insured his disabled children’s lives. The evidence at trial also showed that he attempted to persuade witnesses to falsely tell law enforcement that he had given the insurance proceeds to charity.
Elmezayen then collected more than $260,000 in insurance proceeds from Mutual of Omaha Life Insurance and American General Life Insurance on the accidental death insurance policies he had taken out on the children’s lives. He used part of the insurance proceeds to purchase real estate in Egypt as well as a boat.
Prosecutors argued that Elmezayen was an abusive husband and parent who "hatched a plan" to make all of his financial problems disappear.
Elmezayen will face a statutory maximum sentence of 212 years in federal prison.
...
Ali F. Elmezayen, 45, was found guilty of four counts of mail fraud, four counts of wire fraud, one count of aggravated identity theft, and five counts of money laundering.
According to the evidence presented at his nine-day trial, Elmezayen bought from eight different insurance companies more than $7 million worth of life and accidental death insurance policies on himself and his family. Elmezayen paid premiums in excess of $6,000 per year for these policies - even though he reported income of less than $30,000 per year on his tax returns. Elmezayen began purchasing the insurance policies the same year he exited a Chapter 11 bankruptcy proceeding.
After purchasing the policies, Elmezayen repeatedly called the insurance companies - sometimes pretending to be his wife in whose name he had obtained some of the policies - to verify that the policies were active and that they would pay benefits if his wife died in an accident. Elmezayen also called at least two of the insurance companies to confirm they would not investigate claims made two years after the policies were purchased. These telephone calls were recorded and were played for the jury.
On April 9, 2015, 12 days after the 2-year contestability period on the last of his insurance policies expired, Elmezayen drove a car with his wife and two youngest children off a wharf at the Port of Los Angeles. The site of the crash was a loading dock and worksite for commercial fishermen.
Elmezayen swam out the open driver’s side window of the car. Elmezayen’s wife, who did not know how to swim, escaped the vehicle and survived when a nearby fisherman threw her a flotation device. Two of the couple’s three sons, who were 8 and 13 and who were both severely autistic, were strapped into the car and drowned. The third son was away at camp at the time and was not in the car at the time his father drove it into the water.
Elmezayen repeatedly lied - to law enforcement officers, insurance companies, and in subsequent civil litigation he filed concerning the crash - about the extent of the insurance he had purchased on his family, and specifically about whether he had insured his disabled children’s lives. The evidence at trial also showed that he attempted to persuade witnesses to falsely tell law enforcement that he had given the insurance proceeds to charity.
Elmezayen then collected more than $260,000 in insurance proceeds from Mutual of Omaha Life Insurance and American General Life Insurance on the accidental death insurance policies he had taken out on the children’s lives. He used part of the insurance proceeds to purchase real estate in Egypt as well as a boat.
Prosecutors argued that Elmezayen was an abusive husband and parent who "hatched a plan" to make all of his financial problems disappear.
Elmezayen will face a statutory maximum sentence of 212 years in federal prison.
...
A federal grand jury in San Diego returned a superseding indictment that charges U. S. Navy servicemembers Dr. Michael Villarroel, Paul Craig, and Christopher Toups with fraud, false claims and conspiracy to defraud the United States.
The charges arise from a scheme where the defendants filed fraudulent claims to obtain unearned benefits from the Traumatic Servicemembers Group Life Insurance Program ("TSGLI").
The TSGLI program is an insurance program that compensates servicemembers who suffer serious and debilitating injuries while on active duty. The program is funded by fees paid directly by individual service members and the Department of Defense.
Dr. Michael Villarroel, a Commander in the U.S. Navy, was the medical doctor for the Explosive Ordinance Disposal Expeditionary Support Unit One ("EOD ESU One") from March 2010 through May 2013. In that capacity, Dr. Villarroel knowingly signed off on false and fraudulent TSGLI applications on behalf of multiple servicemembers that were part of or connected to EOD ESU One.
Both Christopher Toups, a former Chief Petty Officer Construction Mechanic, and Paul Craig, a former Lt. Commander in the U.S. Navy, filed fraudulent TSLGI applications. To support their applications, each defendant submitted fabricated applications that included forged signatures and altered hospital records. According to the superseding indictment, Craig fraudulently collected $150,000 and Toups collected at least $100,000.
In addition to Christopher Toups, four other individuals were previously indicted in connection with this scheme. Three of those individuals – Richard Cote, Earnest Thompson, and Kelene Meyer – have pleaded guilty to conspiracy to commit wire fraud, and as part of their plea, admitted that the conspirators defrauded the TSGLI program of nearly $2 million.
According to the plea agreement, Meyer, a former nurse in the U.S. Navy, stated that Toups, Villarroel, and she received kickbacks for creating and filing the fraudulent TSGLI applications for other U.S. Navy servicemembers ...
The charges arise from a scheme where the defendants filed fraudulent claims to obtain unearned benefits from the Traumatic Servicemembers Group Life Insurance Program ("TSGLI").
The TSGLI program is an insurance program that compensates servicemembers who suffer serious and debilitating injuries while on active duty. The program is funded by fees paid directly by individual service members and the Department of Defense.
Dr. Michael Villarroel, a Commander in the U.S. Navy, was the medical doctor for the Explosive Ordinance Disposal Expeditionary Support Unit One ("EOD ESU One") from March 2010 through May 2013. In that capacity, Dr. Villarroel knowingly signed off on false and fraudulent TSGLI applications on behalf of multiple servicemembers that were part of or connected to EOD ESU One.
Both Christopher Toups, a former Chief Petty Officer Construction Mechanic, and Paul Craig, a former Lt. Commander in the U.S. Navy, filed fraudulent TSLGI applications. To support their applications, each defendant submitted fabricated applications that included forged signatures and altered hospital records. According to the superseding indictment, Craig fraudulently collected $150,000 and Toups collected at least $100,000.
In addition to Christopher Toups, four other individuals were previously indicted in connection with this scheme. Three of those individuals – Richard Cote, Earnest Thompson, and Kelene Meyer – have pleaded guilty to conspiracy to commit wire fraud, and as part of their plea, admitted that the conspirators defrauded the TSGLI program of nearly $2 million.
According to the plea agreement, Meyer, a former nurse in the U.S. Navy, stated that Toups, Villarroel, and she received kickbacks for creating and filing the fraudulent TSGLI applications for other U.S. Navy servicemembers ...
School bus driver Colleen Knowles sought workers' compensation from her employer, Mountain Empire Unified School District.
The District is a self-insured employer under the workers' compensation scheme, and its workers' compensation claims are administered through the San Diego County Schools Risk Management Joint Powers Authority. The JPA purchased excess workers' compensation insurance to cover claims exceeding a set retention. The District is an additional insured under those policies.
When a dispute over compensation arose, Knowles and the District sought adjudication before the Workers' Compensation Appeals Board. An administrative law judge ultimately approved their stipulation that Knowles suffered a "specific" injury on May 6, 2003.
The distinction between a "cumulative" and a "specific" injury matters for determining which of JPA's excess insurance policies was triggered. As JPA's excess insurer during the stipulated injury date, Kemper Insurance Company indemnified the JPA until it went insolvent. The JPA then approached California Insurance Guarantee Association, a statutorily created insolvency insurer of last resort, to make up what Kemper had failed to pay.
But CIGA is only obligated to pay "covered claims," defined to exclude claims for which other insurance is available. On this basis CIGA denied coverage, asserting Knowles suffered a cumulative injury, which meant that JPA might recover from a different excess insurer (other than Kemper).
CIGA then sued the JPA and the District for declaratory relief, asserting that because Knowles suffered a cumulative injury, JPA's claim was not a "covered claim." In their cross-complaint, defendants sought reimbursement from CIGA of benefit payments made to Knowles after Kemper went insolvent.
The trial court granted both of Defendants motions for summary judgment on the complaint and cross-complaint. and entered judgment in their favor, requiring CIGA to reimburse $129,836.91 plus costs. CIGA appealed that decision.
Central to the court's ruling, and to CIGA's appeal, is a jurisdictional question: Does the superior court have jurisdiction to find that Knowles suffered a cumulative injury even if this conflicts with the stipulation before the WCAB, or is injury characterization an issue within the WCAB's exclusive jurisdiction? The court granted defendants' motions because it believed the WCAB had exclusive jurisdiction to decide the nature of Knowles's injury. The Court of Appeal agreed that it did, in the published case of CIGA v the San Diego County Schools Risk Management Joint Powers Authority.
Although this issue appears to be one of first impression in California, federal courts have rejected WCAB exclusivity in similar cases involving excess workers' compensation insurance. (San Francisco BART Dist. v. General Reinsurance Corp. (N.D.Cal. 2015) 111 F.Supp.3d 1055, 1074 (BART I), affirmed (9th Cir. 2017) 726 F.App'x. 562 (BART II); San Diego Cty. Schs. Risk Mgmt. Joint Powers Auth. v. Liberty Ins. Corp., et al. (2018) 339 F.Supp.3d 1019, 1030 (Liberty).)
The Court of Appeal we agreed with these authorities and concluded, based on the purpose of excess insurance, that the superior court has jurisdiction to characterize Knowles's injury in this action differently than was reflected in the WCAB stipulation.
Accordingly, it reversed the judgment and direct the trial court to enter a new order denying defendants' motions for summary judgment ...
The District is a self-insured employer under the workers' compensation scheme, and its workers' compensation claims are administered through the San Diego County Schools Risk Management Joint Powers Authority. The JPA purchased excess workers' compensation insurance to cover claims exceeding a set retention. The District is an additional insured under those policies.
When a dispute over compensation arose, Knowles and the District sought adjudication before the Workers' Compensation Appeals Board. An administrative law judge ultimately approved their stipulation that Knowles suffered a "specific" injury on May 6, 2003.
The distinction between a "cumulative" and a "specific" injury matters for determining which of JPA's excess insurance policies was triggered. As JPA's excess insurer during the stipulated injury date, Kemper Insurance Company indemnified the JPA until it went insolvent. The JPA then approached California Insurance Guarantee Association, a statutorily created insolvency insurer of last resort, to make up what Kemper had failed to pay.
But CIGA is only obligated to pay "covered claims," defined to exclude claims for which other insurance is available. On this basis CIGA denied coverage, asserting Knowles suffered a cumulative injury, which meant that JPA might recover from a different excess insurer (other than Kemper).
CIGA then sued the JPA and the District for declaratory relief, asserting that because Knowles suffered a cumulative injury, JPA's claim was not a "covered claim." In their cross-complaint, defendants sought reimbursement from CIGA of benefit payments made to Knowles after Kemper went insolvent.
The trial court granted both of Defendants motions for summary judgment on the complaint and cross-complaint. and entered judgment in their favor, requiring CIGA to reimburse $129,836.91 plus costs. CIGA appealed that decision.
Central to the court's ruling, and to CIGA's appeal, is a jurisdictional question: Does the superior court have jurisdiction to find that Knowles suffered a cumulative injury even if this conflicts with the stipulation before the WCAB, or is injury characterization an issue within the WCAB's exclusive jurisdiction? The court granted defendants' motions because it believed the WCAB had exclusive jurisdiction to decide the nature of Knowles's injury. The Court of Appeal agreed that it did, in the published case of CIGA v the San Diego County Schools Risk Management Joint Powers Authority.
Although this issue appears to be one of first impression in California, federal courts have rejected WCAB exclusivity in similar cases involving excess workers' compensation insurance. (San Francisco BART Dist. v. General Reinsurance Corp. (N.D.Cal. 2015) 111 F.Supp.3d 1055, 1074 (BART I), affirmed (9th Cir. 2017) 726 F.App'x. 562 (BART II); San Diego Cty. Schs. Risk Mgmt. Joint Powers Auth. v. Liberty Ins. Corp., et al. (2018) 339 F.Supp.3d 1019, 1030 (Liberty).)
The Court of Appeal we agreed with these authorities and concluded, based on the purpose of excess insurance, that the superior court has jurisdiction to characterize Knowles's injury in this action differently than was reflected in the WCAB stipulation.
Accordingly, it reversed the judgment and direct the trial court to enter a new order denying defendants' motions for summary judgment ...
Investigators seized over 44 pounds of fentanyl in an Ohio drug bust, a quantity large enough to wipe out the state's entire population "many times over," officials revealed Wednesday.
The raid unfolded in Dayton last week. In addition to the fentanyl, investigators seized some 1,500 grams of suspected methamphetamine, 500 grams of suspected heroin, three firearms and $30,000, the Montgomery County Sheriff’s Office announced.
"Twenty kilograms of fentanyl is enough to kill the entire population of Ohio, many times over," Vance Callender, the Homeland Security Investigations special agent in charge for Michigan and Ohio, said in a statement.
Officers arrested three suspects -- Shamar Davis, 31, Anthony Franklin, 30, and Grady Jackson, 37. All faced charges including possession with intent to distribute 400 or more grams of fentanyl, the Montgomery County Sheriff's Office said in a statement.
"The quantity of fentanyl in this case amounts to chemical warfare and a weapon of mass destruction," Ohio Attorney General Dave Yost said. "I applaud the work of our task force and our law enforcement partners - this is an enormous amount of deadly drugs that will no longer be on our streets."
"This multi-million dollar fentanyl seizure clearly shows the enormity of the opioid problem in this area," Acting Special Agent in Charge Joseph M. Deters of the FBI's Cincinnati Division added. "Law enforcement will continue to work aggressively to address the illegal drug supply, but there is also a continuing need to address demand as well."
Ohio was one of four states in the U.S. -- along with Pennsylvania, Massachusetts and New Hampshire -- that saw an increase of more than 500 fentanyl-related incidents from 2014 to 2015, according to the latest data available from the U.S. Centers for Disease Control and Prevention.
Most recently, the state grappled with a surge of overdoses linked to fentanyl, resulting in six deaths over the span of 24 hours this past September. Prior to that, in July, nine people died from overdoses in a two-day period ...
The raid unfolded in Dayton last week. In addition to the fentanyl, investigators seized some 1,500 grams of suspected methamphetamine, 500 grams of suspected heroin, three firearms and $30,000, the Montgomery County Sheriff’s Office announced.
"Twenty kilograms of fentanyl is enough to kill the entire population of Ohio, many times over," Vance Callender, the Homeland Security Investigations special agent in charge for Michigan and Ohio, said in a statement.
Officers arrested three suspects -- Shamar Davis, 31, Anthony Franklin, 30, and Grady Jackson, 37. All faced charges including possession with intent to distribute 400 or more grams of fentanyl, the Montgomery County Sheriff's Office said in a statement.
"The quantity of fentanyl in this case amounts to chemical warfare and a weapon of mass destruction," Ohio Attorney General Dave Yost said. "I applaud the work of our task force and our law enforcement partners - this is an enormous amount of deadly drugs that will no longer be on our streets."
"This multi-million dollar fentanyl seizure clearly shows the enormity of the opioid problem in this area," Acting Special Agent in Charge Joseph M. Deters of the FBI's Cincinnati Division added. "Law enforcement will continue to work aggressively to address the illegal drug supply, but there is also a continuing need to address demand as well."
Ohio was one of four states in the U.S. -- along with Pennsylvania, Massachusetts and New Hampshire -- that saw an increase of more than 500 fentanyl-related incidents from 2014 to 2015, according to the latest data available from the U.S. Centers for Disease Control and Prevention.
Most recently, the state grappled with a surge of overdoses linked to fentanyl, resulting in six deaths over the span of 24 hours this past September. Prior to that, in July, nine people died from overdoses in a two-day period ...
California workers' compensation reforms enacted in 2003 and 2004 introduced a new process for approving medical services for injured workers, including the adoption of mandatory utilization review (UR) using evidence-based medicine guidelines.
Nearly a decade later, state lawmakers included reforms in SB 863 that added a new element to the medical service approval process, mandating the use of independent medical review (IMR) to resolve disputes over medical necessity.
The California Workers' Compensation Institute's latest study of California's medical benefit delivery process expands on earlier analyses to determine the proportion of requested and/or delivered care that is approved versus denied after UR and IMR by service category.
Results show that 94.1 percent of services performed or requested from January 1, 2018 to October 31, 2018 were either approved (92.5 percent) or approved with modifications (1.6 percent), and 5.9 percent were denied, though outcomes varied by service category.
Evaluation and management services (e.g., office and emergency department visits, consultations) represented 29 .1 percent of the medical services in the 2018 data set and had an approval rate of 99.7 percent.
Surgery services were approved with or without modifications 94.9 percent of the time, while 89.4 percent of physical medicine services (physical therapy, chiropractic manipulation, and acupuncture) were approved with or without modifications.
The study also examines the impact of the UR provisions of 2016 legislation (SB 1160), which effective Janua1y 1, 2018, exempted certain services from prospective UR.
One goal of SB 1160 was to speed delivery of medical care, and while the study does find that the proportion of physical medicine services performed in the first 30 days increased from 2017 to 2018, there was no meaningful change in the delivery of other services. At the same time, the total volume of services performed in the first 60 days from injury did not increase and the denial rate for these services remained very low in both periods, ranging from 0.0 to 4.8 percent.
For the first time, the authors were able to estimate the proportion of UR denials and modifications that underwent IMR and found that an estimated 29 percent of UR modification and denial decisions were appealed and reviewed by an IMR physician.
However, an examination of the top law firms identified in the UR data reveals that the IMR referral rates by applicant attorneys varied greatly. Some attorneys submitted nearly all of their clients' treatment modifications and denials to IMR, while others sent none.
The last section of the study continues the Institute's monitoring of IMR volumes and results. After a 7 percent increase in volume from 2017 to 2018, IMR volume for the first half of 2019 appears to be dropping back toward 2017 levels.
As in 2018, IMR reviewers have upheld UR decisions 88 percent of the time through the first half of 2019. In addition, a small number of physicians continue to drive a disproportionate share of the IMR volume, with the top 1 percent associated with 44 percent of the IMR decisions ...
Nearly a decade later, state lawmakers included reforms in SB 863 that added a new element to the medical service approval process, mandating the use of independent medical review (IMR) to resolve disputes over medical necessity.
The California Workers' Compensation Institute's latest study of California's medical benefit delivery process expands on earlier analyses to determine the proportion of requested and/or delivered care that is approved versus denied after UR and IMR by service category.
Results show that 94.1 percent of services performed or requested from January 1, 2018 to October 31, 2018 were either approved (92.5 percent) or approved with modifications (1.6 percent), and 5.9 percent were denied, though outcomes varied by service category.
Evaluation and management services (e.g., office and emergency department visits, consultations) represented 29 .1 percent of the medical services in the 2018 data set and had an approval rate of 99.7 percent.
Surgery services were approved with or without modifications 94.9 percent of the time, while 89.4 percent of physical medicine services (physical therapy, chiropractic manipulation, and acupuncture) were approved with or without modifications.
The study also examines the impact of the UR provisions of 2016 legislation (SB 1160), which effective Janua1y 1, 2018, exempted certain services from prospective UR.
One goal of SB 1160 was to speed delivery of medical care, and while the study does find that the proportion of physical medicine services performed in the first 30 days increased from 2017 to 2018, there was no meaningful change in the delivery of other services. At the same time, the total volume of services performed in the first 60 days from injury did not increase and the denial rate for these services remained very low in both periods, ranging from 0.0 to 4.8 percent.
For the first time, the authors were able to estimate the proportion of UR denials and modifications that underwent IMR and found that an estimated 29 percent of UR modification and denial decisions were appealed and reviewed by an IMR physician.
However, an examination of the top law firms identified in the UR data reveals that the IMR referral rates by applicant attorneys varied greatly. Some attorneys submitted nearly all of their clients' treatment modifications and denials to IMR, while others sent none.
The last section of the study continues the Institute's monitoring of IMR volumes and results. After a 7 percent increase in volume from 2017 to 2018, IMR volume for the first half of 2019 appears to be dropping back toward 2017 levels.
As in 2018, IMR reviewers have upheld UR decisions 88 percent of the time through the first half of 2019. In addition, a small number of physicians continue to drive a disproportionate share of the IMR volume, with the top 1 percent associated with 44 percent of the IMR decisions ...
Some of the country's largest ride-sharing companies proposed a California law on Tuesday that would let them continue to treat drivers as independent contractors while also guaranteeing them a minimum wage and money for health insurance.
The state Legislature enacted legislation this year, AB-5, requiring ride-sharing companies to treat drivers as employees, which would let them form a union and entitle them to benefits like a minimum wage and workers compensation.
But the law proposed Tuesday would exempt ride-sharing companies. The proposal must be approved by voters, not the state Legislature. If passed, it would supersede the Legislature's action and any similar ordinances passed by local governments. It also prevents lawmakers from passing another law to block it.
The proposal will only get on the ballot in November 2020 if supporters can gather roughly 660,000 signatures from registered voters. Uber, Lyft and DoorDash have already pledged $90 million to support the effort, making it one of the most expensive ballot measures ever.
"We believe the nature of this work is truly unique," said Brandon Castillo, spokesman for the Protect App-Based Drivers & Services Coalition. He said lawmakers are "forcing an employment model that just doesn't work for the nature of this work."
Castillo noted the coalition is willing to negotiate with lawmakers. If the Legislature passes a similar law by June 25, they would withdraw the ballot measure, he said.
That appears unlikely. Democratic Assemblywoman Lorena Gonzalez, who authored the bill requiring companies to treat drivers as employees, called the proposed ballot measure "disingenuous." She argues it still would not give workers retirement benefits and overtime pay, and it would not let them organize a union.
"These billion-dollar corporations still refuse to offer their workers what every other employee in California is entitled to," she said.
The new proposal would require drivers receive at least 120% of the state or local minimum wage, whichever is higher. It would let drivers keep all tips. It requires companies to pay drivers 30 cents a mile for expenses.
And drivers who work at least 15 hours a week would get money for health insurance. They could work for multiple companies and get multiple stipends. But companies could ask drivers to prove they have health insurance as a requirement for getting that money.
The proposal is already dividing drivers ...
The state Legislature enacted legislation this year, AB-5, requiring ride-sharing companies to treat drivers as employees, which would let them form a union and entitle them to benefits like a minimum wage and workers compensation.
But the law proposed Tuesday would exempt ride-sharing companies. The proposal must be approved by voters, not the state Legislature. If passed, it would supersede the Legislature's action and any similar ordinances passed by local governments. It also prevents lawmakers from passing another law to block it.
The proposal will only get on the ballot in November 2020 if supporters can gather roughly 660,000 signatures from registered voters. Uber, Lyft and DoorDash have already pledged $90 million to support the effort, making it one of the most expensive ballot measures ever.
"We believe the nature of this work is truly unique," said Brandon Castillo, spokesman for the Protect App-Based Drivers & Services Coalition. He said lawmakers are "forcing an employment model that just doesn't work for the nature of this work."
Castillo noted the coalition is willing to negotiate with lawmakers. If the Legislature passes a similar law by June 25, they would withdraw the ballot measure, he said.
That appears unlikely. Democratic Assemblywoman Lorena Gonzalez, who authored the bill requiring companies to treat drivers as employees, called the proposed ballot measure "disingenuous." She argues it still would not give workers retirement benefits and overtime pay, and it would not let them organize a union.
"These billion-dollar corporations still refuse to offer their workers what every other employee in California is entitled to," she said.
The new proposal would require drivers receive at least 120% of the state or local minimum wage, whichever is higher. It would let drivers keep all tips. It requires companies to pay drivers 30 cents a mile for expenses.
And drivers who work at least 15 hours a week would get money for health insurance. They could work for multiple companies and get multiple stipends. But companies could ask drivers to prove they have health insurance as a requirement for getting that money.
The proposal is already dividing drivers ...
Evidence is weak for whether medicinal cannabis treatments can relieve mental illnesses such as anxiety, depression and psychosis, and doctors should prescribe them with great caution, researchers said on Monday.
Reuters Health published a review of scientific studies that analyzed the impact of medicinal cannabinoids on six mental health disorders, the researchers found "a lack of evidence for their effectiveness."
Their findings have important implications for countries such as the United States, Australia, Britain and Canada, where medical cannabis is being made available for patients with certain illness, said Louisa Degenhardt, a drug and alcohol expert at Australia’s University of New South Wales in Sydney.
"There is a notable absence of high-quality evidence to properly assess the effectiveness and safety of medicinal cannabinoids ... and until evidence from randomized controlled trials is available, clinical guidelines cannot be drawn up around their use in mental health disorders," she said as her results were published in The Lancet Psychiatry journal.
Despite a lack of clinical trial evidence, anecdotally some military veterans and others who suffer post-traumatic stress disorder (PTSD), depression and anxiety say they have found cannabis helpful in easing some of their symptoms. Other conditions cannabis is used for include nausea, epilepsy, and traumatic brain injury, but this study did not examine its impact on those.
Medicinal cannabinoids include medicinal cannabis and pharmaceutical cannabinoids, as well as their synthetic derivatives, THC, or delta-9-tetrahydrocannabinol - the main psychoactive ingredient of cannabis - and cannabidiol, or CBD.
"Cannabinoids are often advocated as a treatment for various mental health conditions," Degenhardt said. "(But) clinicians and consumers need to be aware of the low quality and quantity of evidence ... and the potential risk of adverse events."
Degenhardt’s team sought to look at all available evidence for all types of medicinal cannabinoids. They included all study designs and investigated the impact on remission from and symptoms of depression, anxiety, attention-deficit hyperactivity disorder (ADHD), Tourette syndrome, PTSD and psychosis. They analyzed 83 published and unpublished studies covering around 3,000 people between 1980 and 2018.
They found that pharmaceutical THC - either with or without CBD - made psychosis worse, and did not significantly affect any other primary outcomes for the mental illnesses analyzed.
It also increased the number of people who reported side effects, and the number who decided to withdraw from a study due to side effects.
Tom Freeman, an addiction and mental health expert at Britain’s Bath University who was not involved with the study, said the findings highlighted an urgent need for high-quality trials of medical cannabis to strengthen the evidence - particularly given what he said was "significant demand" from patients ...
Reuters Health published a review of scientific studies that analyzed the impact of medicinal cannabinoids on six mental health disorders, the researchers found "a lack of evidence for their effectiveness."
Their findings have important implications for countries such as the United States, Australia, Britain and Canada, where medical cannabis is being made available for patients with certain illness, said Louisa Degenhardt, a drug and alcohol expert at Australia’s University of New South Wales in Sydney.
"There is a notable absence of high-quality evidence to properly assess the effectiveness and safety of medicinal cannabinoids ... and until evidence from randomized controlled trials is available, clinical guidelines cannot be drawn up around their use in mental health disorders," she said as her results were published in The Lancet Psychiatry journal.
Despite a lack of clinical trial evidence, anecdotally some military veterans and others who suffer post-traumatic stress disorder (PTSD), depression and anxiety say they have found cannabis helpful in easing some of their symptoms. Other conditions cannabis is used for include nausea, epilepsy, and traumatic brain injury, but this study did not examine its impact on those.
Medicinal cannabinoids include medicinal cannabis and pharmaceutical cannabinoids, as well as their synthetic derivatives, THC, or delta-9-tetrahydrocannabinol - the main psychoactive ingredient of cannabis - and cannabidiol, or CBD.
"Cannabinoids are often advocated as a treatment for various mental health conditions," Degenhardt said. "(But) clinicians and consumers need to be aware of the low quality and quantity of evidence ... and the potential risk of adverse events."
Degenhardt’s team sought to look at all available evidence for all types of medicinal cannabinoids. They included all study designs and investigated the impact on remission from and symptoms of depression, anxiety, attention-deficit hyperactivity disorder (ADHD), Tourette syndrome, PTSD and psychosis. They analyzed 83 published and unpublished studies covering around 3,000 people between 1980 and 2018.
They found that pharmaceutical THC - either with or without CBD - made psychosis worse, and did not significantly affect any other primary outcomes for the mental illnesses analyzed.
It also increased the number of people who reported side effects, and the number who decided to withdraw from a study due to side effects.
Tom Freeman, an addiction and mental health expert at Britain’s Bath University who was not involved with the study, said the findings highlighted an urgent need for high-quality trials of medical cannabis to strengthen the evidence - particularly given what he said was "significant demand" from patients ...
Johnson & Johnson received grand jury subpoenas in August from the U.S. attorney’s office for the Eastern District of New York related to its opioid medication policies, the company said in a regulatory filing on Monday.
J&J said the subpoenas were related to anti-diversion policies and procedures and the distribution of its opioid medications developed by its Janssen pharmaceuticals unit.
The company said in the filing it believes the investigation relates to monitoring and reporting programs by manufacturers and distributors of opioids under the Controlled Substances Act.
"Like other companies that have manufactured opioid medications, Janssen has received subpoenas and investigative demands from various government entities, and this includes the August 2019 subpoena from the United States Attorneys Office for the Eastern District of New York," the company said in a statement emailed to Reuters.
J&J said it understands the subpoenas are part of a "broader, industry-wide investigation" and said the company believes its anti-diversion policies and procedures complied with the law.
Johnson & Johnson last week lowered its previously reported third-quarter profit to account for a proposed $4 billion cash settlement related to the opioid crisis.
That followed a Reuters report citing sources that drug distributors McKesson Corp, AmerisourceBergen Corp and Cardinal Health had offered to pay $18billion in cash over 18 years, while J&J would pay $4 billion in cash.
The drug industry faces roughly 2,600 lawsuits brought bystate and local governments, hospitals and other entities seeking to hold drugmakers and distributors responsible for the toll of opioid abuse.
In August, an Oklahoma judge ordered J&J to pay $572.1 million to the state for its part in fueling an opioid epidemic, a sum that was substantially less than investors had expected ...
J&J said the subpoenas were related to anti-diversion policies and procedures and the distribution of its opioid medications developed by its Janssen pharmaceuticals unit.
The company said in the filing it believes the investigation relates to monitoring and reporting programs by manufacturers and distributors of opioids under the Controlled Substances Act.
"Like other companies that have manufactured opioid medications, Janssen has received subpoenas and investigative demands from various government entities, and this includes the August 2019 subpoena from the United States Attorneys Office for the Eastern District of New York," the company said in a statement emailed to Reuters.
J&J said it understands the subpoenas are part of a "broader, industry-wide investigation" and said the company believes its anti-diversion policies and procedures complied with the law.
Johnson & Johnson last week lowered its previously reported third-quarter profit to account for a proposed $4 billion cash settlement related to the opioid crisis.
That followed a Reuters report citing sources that drug distributors McKesson Corp, AmerisourceBergen Corp and Cardinal Health had offered to pay $18billion in cash over 18 years, while J&J would pay $4 billion in cash.
The drug industry faces roughly 2,600 lawsuits brought bystate and local governments, hospitals and other entities seeking to hold drugmakers and distributors responsible for the toll of opioid abuse.
In August, an Oklahoma judge ordered J&J to pay $572.1 million to the state for its part in fueling an opioid epidemic, a sum that was substantially less than investors had expected ...
Labor Code 3208.3 supposedly set a standard for evaluating psychiatric injuries in California workers' compensation claims.
The code requires that the worker be diagnosed using the terminology and criteria of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Third Edition-Revised, or the terminology and diagnostic criteria of other psychiatric diagnostic manuals generally approved and accepted nationally by practitioners in the field of psychiatric medicine. We are currently on the Fifth Edition.
But, no two people are exactly alike. Therefore, attempting to classify each unique individual’s mental health issues into neat categories just doesn’t work. That’s the claim coming out of a new study published in the scientific journal Psychiatry Research, that is sure to ruffle some psychologists’ feathers.
More people are being diagnosed with mental illnesses than ever before. Multiple factors can be attributed to this rise; many people blame the popularity of social media and increased screen time, but it is also worth considering that in today’s day and age more people may be willing to admit they are having mental health issues in the first place.
That’s why a new study conducted at the University of Liverpool has raised eyebrows by concluding that psychiatric diagnoses are "scientifically meaningless," and worthless as tools to accurately identify and address mental distress at an individual level.
Researchers performed a detailed analysis on five of the most important chapters in the Diagnostic and Statistical Manual of Mental Heath Disorders (DSM). The DSM is considered the definitive guide for mental health professionals, and provides descriptions for all mental health problems and their symptoms. The five chapters analyzed were: bipolar disorder, schizophrenia, depressive disorders, anxiety disorders, and trauma-related disorders.
Researchers came to a number of troubling conclusions. First, the study’s authors assert that there is a significant amount of overlap in symptoms between disorder diagnoses, despite the fact that each diagnosis utilizes different decision rules. Additionally, these diagnoses completely ignore the role of trauma or other unique adverse events a person may encounter in their life.
Perhaps most concerning of all, researchers say that these diagnoses tell us little to nothing about the individual patient and what type of treatments they will need. The authors ultimately conclude that this diagnostic labeling approach is "a disingenuous categorical system."
"Although diagnostic labels create the illusion of an explanation they are scientifically meaningless and can create stigma and prejudice. I hope these findings will encourage mental health professionals to think beyond diagnoses and consider other explanations of mental distress, such as trauma and other adverse life experiences." Lead researcher Dr. Kate Allsopp explains in a release.
According to the study’s authors, the traditional diagnostic system being used today wrongly assumes that any and all mental distress is caused by a disorder, and relies far too heavily on subjective ideas about what is considered "normal."
...
The code requires that the worker be diagnosed using the terminology and criteria of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Third Edition-Revised, or the terminology and diagnostic criteria of other psychiatric diagnostic manuals generally approved and accepted nationally by practitioners in the field of psychiatric medicine. We are currently on the Fifth Edition.
But, no two people are exactly alike. Therefore, attempting to classify each unique individual’s mental health issues into neat categories just doesn’t work. That’s the claim coming out of a new study published in the scientific journal Psychiatry Research, that is sure to ruffle some psychologists’ feathers.
More people are being diagnosed with mental illnesses than ever before. Multiple factors can be attributed to this rise; many people blame the popularity of social media and increased screen time, but it is also worth considering that in today’s day and age more people may be willing to admit they are having mental health issues in the first place.
That’s why a new study conducted at the University of Liverpool has raised eyebrows by concluding that psychiatric diagnoses are "scientifically meaningless," and worthless as tools to accurately identify and address mental distress at an individual level.
Researchers performed a detailed analysis on five of the most important chapters in the Diagnostic and Statistical Manual of Mental Heath Disorders (DSM). The DSM is considered the definitive guide for mental health professionals, and provides descriptions for all mental health problems and their symptoms. The five chapters analyzed were: bipolar disorder, schizophrenia, depressive disorders, anxiety disorders, and trauma-related disorders.
Researchers came to a number of troubling conclusions. First, the study’s authors assert that there is a significant amount of overlap in symptoms between disorder diagnoses, despite the fact that each diagnosis utilizes different decision rules. Additionally, these diagnoses completely ignore the role of trauma or other unique adverse events a person may encounter in their life.
Perhaps most concerning of all, researchers say that these diagnoses tell us little to nothing about the individual patient and what type of treatments they will need. The authors ultimately conclude that this diagnostic labeling approach is "a disingenuous categorical system."
"Although diagnostic labels create the illusion of an explanation they are scientifically meaningless and can create stigma and prejudice. I hope these findings will encourage mental health professionals to think beyond diagnoses and consider other explanations of mental distress, such as trauma and other adverse life experiences." Lead researcher Dr. Kate Allsopp explains in a release.
According to the study’s authors, the traditional diagnostic system being used today wrongly assumes that any and all mental distress is caused by a disorder, and relies far too heavily on subjective ideas about what is considered "normal."
...
Dr. Roger A. Kasendorf, an osteopathic physician practicing in La Jolla, agreed to pay $125,000 to resolve allegations that he illegally prescribed opioids to his patients. The highly addictive and frequently abused opioids he prescribed included fentanyl, hydromorphone, oxymorphone, and oxycodone.
In response to the Justice Department’s focus on combatting the opioid epidemic, the Drug Enforcement Administration (DEA) and the U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG) investigated Dr. Kasendorf’s prescribing practices.
This investigation arose from data analytics tools which allow the Department of Justice to perform a variety of functions, including identifying statistical outliers, such as which doctors prescribe the highest opioid dosages and which doctors prescribe combinations of opioids and other drugs known to increase the risk of addiction, abuse, and overdose.
Based on the investigation, the United States contends that Dr. Kasendorf wrote prescriptions for opioids, including fentanyl, that were not issued for a legitimate medical purpose and while not acting in the usual course of his professional practice in violation the Controlled Substances Act and the False Claims Act.
The Centers for Disease Control and Prevention (CDC), the American Academy of Pain Medicine, the American Pain Society, state agencies and medical boards, and other medical literature provide guidance on appropriate practices when prescribing opioids.
One common tool is for health care providers to determine the Morphine Milligram Equivalent (MME, also commonly referred to as Morphine Equivalent Dose or MED) of prescribed opioids. MME is a uniform scale used to determine daily opioid dosage by using an equivalency factor to calculate a dose of morphine that is equivalent to the prescribed opioid.
The CDC recommends primary care clinicians who prescribe opioids for chronic pain outside of active cancer treatment, palliative care, or end-of-life care should avoid increasing opioid daily dosage over 90 MME or carefully justify a decision to titrate daily dosage to over 90 MME.
Prescribers should also seek to avoid prescribing opioid pain medication in combination with benzodiazepines (e.g., Xanax, Valium, Klonopin) when possible, and should consider whether the benefits outweigh the risks of combining opioids with other depressants (i.e., muscle relaxants and sleep medications).
...
In response to the Justice Department’s focus on combatting the opioid epidemic, the Drug Enforcement Administration (DEA) and the U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG) investigated Dr. Kasendorf’s prescribing practices.
This investigation arose from data analytics tools which allow the Department of Justice to perform a variety of functions, including identifying statistical outliers, such as which doctors prescribe the highest opioid dosages and which doctors prescribe combinations of opioids and other drugs known to increase the risk of addiction, abuse, and overdose.
Based on the investigation, the United States contends that Dr. Kasendorf wrote prescriptions for opioids, including fentanyl, that were not issued for a legitimate medical purpose and while not acting in the usual course of his professional practice in violation the Controlled Substances Act and the False Claims Act.
The Centers for Disease Control and Prevention (CDC), the American Academy of Pain Medicine, the American Pain Society, state agencies and medical boards, and other medical literature provide guidance on appropriate practices when prescribing opioids.
One common tool is for health care providers to determine the Morphine Milligram Equivalent (MME, also commonly referred to as Morphine Equivalent Dose or MED) of prescribed opioids. MME is a uniform scale used to determine daily opioid dosage by using an equivalency factor to calculate a dose of morphine that is equivalent to the prescribed opioid.
The CDC recommends primary care clinicians who prescribe opioids for chronic pain outside of active cancer treatment, palliative care, or end-of-life care should avoid increasing opioid daily dosage over 90 MME or carefully justify a decision to titrate daily dosage to over 90 MME.
Prescribers should also seek to avoid prescribing opioid pain medication in combination with benzodiazepines (e.g., Xanax, Valium, Klonopin) when possible, and should consider whether the benefits outweigh the risks of combining opioids with other depressants (i.e., muscle relaxants and sleep medications).
...
A new research review reported by Reuters Health suggests that people with chronic back and neck pain who receive chiropractic care may be less likely to use opioid painkillers.
Researchers examined data from six previously-published smaller studies with a total of more than 62,000 participants with spinal pain. Across all of the studies, 11% to 51% of the patients used chiropractic care.
People who saw a chiropractor were 64% less likely to use opioids than people who didn’t, researchers report in the journal Pain Medicine.
"Patients with spinal pain who visit a chiropractor may receive treatments such as spinal manipulation, massage, acupuncture, exercises and education as appropriate,' said lead author Kelsey Corcoran of Yale School of Medicine in New Haven, Connecticut.
"These therapies may lead to decreased pain, improved range of motion and increased function," Corcoran said by email. "If a patient’s pain is well controlled by the treatment they received from a chiropractor, they may subsequently need less pain medications or even none at all."
Chiropractors don’t prescribe opioids. However, all of the studies in the analysis examined whether receipt of chiropractic care was associated with whether patients also received opioid prescriptions from other clinicians.
It’s not clear from this analysis whether people already using opioids to manage pain might be able to cut back or eliminate opioid use after getting chiropractic care.
"In general, I think that patients wishing to avoid Rx (especially opioid) would do well to seek care from providers who can provide potentially helpful alternatives to opioid treatments - this could include chiropractors, physical therapists, massage therapists, pain psychologists, yoga instructors, and mindfulness-based stress reduction classes, etc.," said Dan Cherkin, an emeritus senior scientific investigator at Kaiser Permanente Health Research Institute in Seattle, Washington, who wasn’t involved in the study.
The challenge is that some of these options aren’t always available or covered by insurance, Cherkin added.
Still, organizations such as the Veterans Health Administration and the American College of Physicians currently recommend that patients try conservative treatments commonly delivered by doctors of chiropractic instead of opioids, said Christine Goertz, a researcher at Duke University in Durham, North Carolina, who wasn’t involved in the study.
"The current study indicates that patients who follow these recommendations are, in fact, less likely to receive an opioid prescription," Goertz said by email ...
Researchers examined data from six previously-published smaller studies with a total of more than 62,000 participants with spinal pain. Across all of the studies, 11% to 51% of the patients used chiropractic care.
People who saw a chiropractor were 64% less likely to use opioids than people who didn’t, researchers report in the journal Pain Medicine.
"Patients with spinal pain who visit a chiropractor may receive treatments such as spinal manipulation, massage, acupuncture, exercises and education as appropriate,' said lead author Kelsey Corcoran of Yale School of Medicine in New Haven, Connecticut.
"These therapies may lead to decreased pain, improved range of motion and increased function," Corcoran said by email. "If a patient’s pain is well controlled by the treatment they received from a chiropractor, they may subsequently need less pain medications or even none at all."
Chiropractors don’t prescribe opioids. However, all of the studies in the analysis examined whether receipt of chiropractic care was associated with whether patients also received opioid prescriptions from other clinicians.
It’s not clear from this analysis whether people already using opioids to manage pain might be able to cut back or eliminate opioid use after getting chiropractic care.
"In general, I think that patients wishing to avoid Rx (especially opioid) would do well to seek care from providers who can provide potentially helpful alternatives to opioid treatments - this could include chiropractors, physical therapists, massage therapists, pain psychologists, yoga instructors, and mindfulness-based stress reduction classes, etc.," said Dan Cherkin, an emeritus senior scientific investigator at Kaiser Permanente Health Research Institute in Seattle, Washington, who wasn’t involved in the study.
The challenge is that some of these options aren’t always available or covered by insurance, Cherkin added.
Still, organizations such as the Veterans Health Administration and the American College of Physicians currently recommend that patients try conservative treatments commonly delivered by doctors of chiropractic instead of opioids, said Christine Goertz, a researcher at Duke University in Durham, North Carolina, who wasn’t involved in the study.
"The current study indicates that patients who follow these recommendations are, in fact, less likely to receive an opioid prescription," Goertz said by email ...
