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    Professor David Marcinko was a board certified surgical fellow, hospital medical staff President, public and population health advocate, and Chief Executive & Education Officer with more than 425 published papers; 5,150 op-ed pieces and over 135+ domestic / international presentations to his credit; including the top ten [10] biggest drug, DME and pharmaceutical companies and financial services firms in the nation. He is also a best-selling Amazon author with 30 published academic text books in four languages [National Institute of Health, Library of Congress and Library of Medicine].

    Dr. David E. Marcinko is past Editor-in-Chief of the prestigious “Journal of Health Care Finance”, and a former Certified Financial Planner® who was named “Health Economist of the Year” in 2010. He is a Federal and State court approved expert witness featured in hundreds of peer reviewed medical, business, economics trade journals and publications [AMA, ADA, APMA, AAOS, Physicians Practice, Investment Advisor, Physician’s Money Digest and MD News] etc.

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A 4/20 [Medical] Cannabis Culture Day Pictorial

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About Four-Twenty Day

[By Anonymous DEA Agent]

Today is … 420, 4:20, or 4/20 (pronounced four-twenty).

And, it refers to consumption of cannabis and, by extension, a way to identify oneself with cannabis subculture. Observances based on the number include the time (4:20 p.m.) as well as the date (April 20).

Again … that’s today as this ME-P was published @ 4:20 p.m., EST!

THE DEA DESTROYS A POT FARM

PHOTOS: 

  1. Photo taken after the “grow” was eradicated. There is still no “pot” of gold at the end of the rainbow.
  2. DEA taking one of many seized vehicles/equipment.
  3. The marijuana farm was operating under the name “Brian’s Green Thumb Farm.”
  4. Inside the barn, Agents found rows and rows of drying marijuana.
  5. Over 2,000 pounds of drying marijuana from the barn, bagged and ready for destruction.
  6. Air view of the massive “grow” from the guard tower.
  7. One of two sleeping shelters, each guarding the middle perimeter. In the back, one of four tents, each positioned in the corners for guards.
  8. The plant being ripped out of the ground by the backhoe.

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Assessment

Link: http://en.wikipedia.org/wiki/420_(cannabis_culture)

UPDATE 2019: Carl’s Jr. will become the first major fast-food chain to debut a cannabis-infused burger:

LINK: http://www.msn.com/en-us/foodanddrink/foodnews/carls-jr-will-become-the-first-major-fast-food-chain-to-debut-a-cannabis-infused-burger/ar-BBW1Q7H?li=BBnbfcL

Conclusion

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About the Opioid Crisis

And, Drug Distributors

[By Vitaliy Katsenelson CFA]

I don’t know anyone personally who has been affected by the opioid epidemic in the US. And I truly hope I never will. I don’t know if I would be able to maintain objectivity in my analysis of drug distributors and their involvement in this epidemic if I had experienced getting a call at night informing me that my loved one had died from a drug overdose. Drug overdoses killed 70,237 Americans in 2017. Of these deaths, 47,600 (67.8%) involved opioids and 17,000 involved prescription opioids (24% of total overdose deaths). Legally prescribed opioids are killing 47 of us every day.

How did we get here?

According to the National Institute on Drug Abuse: “In the late 1990s, pharmaceutical companies reassured the medical community that patients would not become addicted to prescription opioid pain relievers, and healthcare providers began to prescribe them at greater rates. This subsequently led to widespread diversion and misuse of these medications before it became clear that these medications could indeed be highly addictive.”

Today pharma distributors are used as scapegoats for the opioid epidemic – not because they are guilty but because they have money and they are “drug distributors.” They are dragged through the same mud as the tobacco companies and British Petroleum (after it spilled millions of gallons of oil in the Gulf of Mexico). Despite negative headlines, we own drug distributors.

Here is why:

They distribute legally prescribed medicine to pharmacies that are approved by several government agencies, including the DEA. Doctors write scripts; pharma distributors order medicine from pharma manufacturers and deliver them to pharmacies. The sad truth about the opioid epidemic is that 21-29% of patients who were prescribed them for chronic pain misused them, and 8-12% of those who received an opioid prescription developed an opioid use disorder.
However, just as truck drivers cannot be held liable for delivering cigarettes to convenience stores, pharma distributors are not manufacturers of drugs and cannot be held liable for the addictive properties of the drugs they distribute or the fact that doctors overprescribe them and patients misuse them.
Also, the DEA should be responsible for limiting the illegal use of opioids. That is its job – DEA stands for Drug Enforcement Agency. It has legal and enforcement resources that distributors lack. And it has a lot more data and tools. Drug distributors do their part and provide data to the ARCOS database that DEA manages.
***
drugs
***
However, each individual distributor has data only for the drugs it distributes, while DEA has data (which it doesn’t share with distributors) for all opioid sales to pharmacies. The DEA is in a much better position to spot suspicious activity in orders than distributors. The DEA controls how much legal opioid is manufactured in the US every year and has been increasing quotas of opioids produced.
Opioids constitute only a very small percentage of the $450 billion in drugs distributed in the US, and thus incentives for distributors to overdistribute opioids are very limited. Though lawyers and the media keep saying that distributors are some of the largest companies in the S&P 500 by sales, they forget to mention that distributors operate on razor thin margins of less than 2%. Comparing the distributors (not even the makers) of legal medicine, that helps millions of people cope with excruciating pain, to cigarette companies that have a 40% pretax profit margin on a product that doesn’t have a societal benefit, and is almost guaranteed to cause cancer if you use it long enough, creates awesome headlines but has little substance.
  • What if DEA was the one distributing all the opioid drugs to pharmacies instead of McKesson, Cardinal Health, and Amerisource Bergen?
  • Would fewer people get addicted to opioids?
  • Would opioids be less accessible? Remember, DEA sets the production targets every year.
Maybe DEA would catch a few bad actors sooner – it has more data than distributors and a specific skillset and mindset aimed at catching criminals.
But in the big scheme of things, even if DEA distributed opioids nothing would really change. Doctors would still prescribe them; some patients would still get addicted to them … and so on. Distributors will likely settle lawsuits for two reasons:
First, McKesson already settled with the FDA for $150 million for “failure to report suspicious orders of pharmaceutical drugs.”
***
Second, McKesson and other drug distributors don’t want to be involved in costly and protracted litigation. We don’t know how much the settlement will be, but it is very unlikely to be in the hundreds of billions of dollars and likely (see reasons above) to be hundreds of millions or a few billion dollars.
***
Assessment
Today McKessonʻs market capitalization is $25 billion. We think the company is worth at least $50 billion (at 15 times earnings), thus there is a $25 billion of margin of safety. If the lawsuit costs the company less than $25 billion, McKesson will be a profitable investment; if not, then the market is right and we are wrong.

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Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

***

The Pill Mill Epidemic

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What it is – How it works?

michelle

[By Michelle Peterman]

miche.peterman@gmail.com

People who are getting access to prescription medication illegally are on the rise, thanks to what the government and drug addiction specialists call “Pill Mills.”

The United States has a significant enough problem with people addicted to illegal substances, such as heroin, cocaine, and methamphetamines.

What Is A Pill Mill?

You may be asking yourself, “What’s A Pill Mill?” All over the US there are legitimate doctors and pain management centers that are in place to assist patients with managing pain. These centers take great care to make sure patients do not become addicted to their medications and will provide assistance if they do.

Unfortunately, there are pain management centers that operate as these “Pill Mills” and are glorified drug dealers. These people are as bad as the drug suppliers and traffickers who sell Heroin or Ice on the streets. Pill Mills will often have a walk in appointment policy, minimum record keeping methods, and armed guards. Other signs include accepting cash-only, no physical exams, and supplying patients with doses of narcotics that are over the authorized limits.

Many people who are legally prescribed medication may start self-medicating and become addicted, needing more and more drugs. These same individuals often turn to pill mills to gain access to prescriptions that more ethical doctors would not give them.

***

pill mill

***

Pill Mill Issues in Florida

It has been said that Florida is the epicenter of the pill mill industry. In 2010, as many as seven people were dying every day as a result of a prescription medication overdose in the State of Florida, and countless other deaths were occurring throughout The States. Authorities believed that Florida had become a haven for drug abusers and distributors to make huge profits in dispensing narcotics illegally.

In 2011, government took action and many pain management centers, medical practices, and clinics were raided. This happened in South Florida with the intention to crack down on the many “pill mills” that the authorities strongly suspected were prescribing Oxycodone in extremely high doses outside of controlled substance authority guidelines.

The authorities also found during their investigation that patients were recruited via the Internet. Six clinic owners and various other staff were indicted on charges that they conspired together to illegally supply patients with over 660,000 high and illegal doses of Oxycodone and collected over $22 million in profits.

***

pill mill

***

The DEA Wages War Against Pill Mills in the South

In 2010, Florida had over nine hundred registered pain management centers. As of January 2014, that number dropped to around three hundred and fifty clinics.

However, it seems that Georgia is now dealing with many of those businesses that fled Florida after stricter measures were implemented. Huffington Post reports that “The DEA is prosecuting pain clinic operators who used to do business in Florida and picked up and moved to Georgia immediately after Florida passed tougher restrictions in 2011.”

Moreover, just recently, Drug Enforcement Administration Raids ‘Pill Mills’ in Four Southern States, including Arkansas, Alabama, Louisiana, and Mississippi.

Assessment

Prescription drug abuse has been declared a massive epidemic in the United States and yet another fight the authorities are trying to win. Tougher regulations and crackdowns from the DEA seem to be making a dent in this major issue.

More:

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ABOUT

Michelle is a former communications associate who transitioned into building her own freelance business. She enjoys health and staying on top of the latest news.  Sitting by the beach is one of her favorite activities in her free time.

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Today is “World Pharmacist” Day

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Brainchild of the International Pharmaceutical Federation [IPF]

[By Dr. David Edward Marcinko MBA CMP™]

DEM blue tieWorld Pharmacists Day was the brainchild of the International Pharmaceutical Federation (IPF), with the council of this organization voting to establish the event in the late 2000s during a conference they staged in Istanbul, Turkey.

The aim of the day is to bring attention to pharmacies and the positive benefits they offer when it comes to health and FIP encourages all its members to get involved to make the event a success.

***

WPD

***

Each year the organization announces a different theme so that associations and individuals in the pharmaceutical industry can put together national campaigns or local projects to showcase the good work they do in helping to improve the health of people around the world. This can include giving lectures, holding exhibitions, or organizing an activity day for adults and kids to demonstrate the many ways that a pharmacy can help them.

Link: http://worldpharmacistsday.org/

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3 Steps to Take Before Buying Healthcare E-Signature Solutions

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More on Paperless Healthcare Records

[By Patrick McTosh]

The movement towards paperless healthcare is growing. Every year, more and more health professionals are beginning to implement EMRs and EHRs as a way to turn their file cabinets into data on a hard drive. While EHRs help the problems of storing paper, they do not create documents that can be legally, securely and efficiently shared with third parties and patients during day to day activities.

These issues can be addressed by implementing an electronic signature solution. These types of solutions allow professions to create documents for physician orders, prescriptions, patient admissions, consent forms and other important medical documents in a timely and relatively paper free manner.

Verify EHR or EMR Integration

It’s important to ensure that whatever electronic signature software is compatible with your current EHR and EMR software. While most e-signature solution providers claim they have specialized services for healthcare organization, it’s best to confirm with a phone call or email that they have experience integrating their services with the EMR that is currently in use.

Verify Local Legislation & Signature Guidelines

Hospital accreditors have already recognized e-signatures as equivalent to paper signatures. However, it’s always important to verify federal and state regulations regarding e-prescriptions and electronic signatures.

For example, the latest DEA regulations on electronic prescriptions require digital signatures to have at least a biometric authentication. In addition, some states have not adopted the Uniform Electronic Transactions Act and therefore have difference laws pertaining to the legality of e-signatures.

Most e-signature providers specializing in healthcare tend to be on top of these things because better legal compliance is one of the benefits of e-signatures as a whole, but it’s always better do double check.

eHRs

Ensure It’s Human Error Proof

Many e-signature solutions attempt to reduce the risk of human error due to lost, damage or incorrectly completed forms which can cause significant delays. As most e-signature software will actually guide the signer through the complete process ensuring that the document meets necessary requirements before sealing the document with a tamper-evident digital seal.

Assessment

However, not all providers have such precautions against human errors, but it is definitely a must in the healthcare industry.

Conclusion

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Fake Sandwich Drug Concealment

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Hiding illegal drugs in a plastic “sandwich”

By Anonymous

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Fake Sandwich Concealment

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Why President Nixon Signed the Controlled Substances Act in 1970

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The DEA History

[By Staff Reporters]

Doctors prescribe harmful and potentially addictive drugs, and they all hold a DEA license to do so.

But, did you know that one of the foundations upon which the Drug Enforcement Administration was created is the Controlled Substances Act (CSA)? It was signed into law as part of a broader set of laws called The Comprehensive Drug Abuse Prevention and Control Act of 1970.

The CSA

As all doctors and nurses know, the CSA created five schedules for controlled substances ranging from Schedule I, the most restrictive classification to Schedule V, the least so.

Schedule I drugs have a 1) High potential for abuse 2) No currently accepted medical use in treatment in the United States and c) Lack of accepted safety for use under medical supervision.

Medicare and Medicaid drug capsules

Definition of Controlled Substance Schedules

An updated and complete list  of the schedules is published annually in Title 21 Code of Federal Regulations  (C.F.R.) §§ 1308.11 through 1308.15.

Substances are placed in their respective schedules based on whether  they have a currently accepted medical use in treatment in the United States,  their relative abuse potential, and likelihood of causing dependence when  abused.  Some examples of the drugs in  each schedule are listed below.

Schedule I Controlled Substances

Substances in this schedule have no currently accepted  medical use in the United States, a lack of accepted safety for use under  medical supervision, and a high potential for abuse.

Some examples of substances listed in Schedule I are:  heroin, lysergic acid diethylamide (LSD), marijuana (cannabis), peyote,  methaqualone, and 3,4-methylenedioxymethamphetamine (“Ecstasy”).

Schedule II Controlled Substances

Substances in this schedule have a high potential for abuse  which may lead to severe psychological or physical dependence.

Examples of Schedule II narcotics include: hydromorphone  (Dilaudid®), methadone (Dolophine®), meperidine (Demerol®), oxycodone  (OxyContin®, Percocet®), and fentanyl (Sublimaze®, Duragesic®).  Other Schedule II narcotics include:  morphine, opium, and codeine.

Examples of Schedule II stimulants include: amphetamine  (Dexedrine®, Adderall®), methamphetamine (Desoxyn®), and methylphenidate  (Ritalin®).

Other Schedule II substances include: amobarbital,  glutethimide, and pentobarbital.

Schedule III Controlled Substances

Substances in this schedule have a potential for abuse less  than substances in Schedules I or II and abuse may lead to moderate or low  physical dependence or high psychological dependence.

Examples of  Schedule III narcotics include: combination products containing less than 15  milligrams of hydrocodone per dosage unit (Vicodin®), products containing not  more than 90 milligrams of codeine per dosage unit (Tylenol with Codeine®), and  buprenorphine (Suboxone®).

Examples of Schedule III non-narcotics include:  benzphetamine (Didrex®), phendimetrazine, ketamine, and anabolic steroids such  as Depo®-Testosterone.

Schedule IV Controlled Substances

Substances in this schedule have a low potential for abuse  relative to substances in Schedule III.

Examples of Schedule IV substances include: alprazolam  (Xanax®), carisoprodol (Soma®), clonazepam (Klonopin®), clorazepate  (Tranxene®), diazepam (Valium®), lorazepam (Ativan®), midazolam (Versed®),  temazepam (Restoril®), and triazolam (Halcion®).

Schedule V Controlled Substances

Substances in this schedule have a low potential for abuse  relative to substances listed in Schedule IV and consist primarily of  preparations containing limited quantities of certain narcotics.

Examples of Schedule V substances include: cough  preparations containing not more than 200 milligrams of codeine per 100  milliliters or per 100 grams (Robitussin AC®, Phenergan with Codeine®), and  ezogabine.

The Nixon Connection

CSA as part of the Comprehensive Drug Abuse Prevention and Control Act was signed into law by President Richard Nixon on October 27, 1970.

RMN

[President Nixon Signs the Controlled Substances Act] 

Assessment

This picture was taken on that day at the White House. Behind the president is Attorney General John Mitchell and next to the president is BNDD Director Jack Ingersoll.

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