Tag Archives: drugs

Warren wants to pull pot shops out of banking limbo

As pot shops sprout in states that have legalized the drug, they face a critical stumbling block — lack of access to the kind of routine banking services other businesses take for granted.

U.S. Sen. Elizabeth Warren, a Massachusetts Democrat, is leading an effort to make sure vendors working with legal marijuana businesses, from chemists who test marijuana for harmful substances to firms that provide security, don’t have their banking services taken away.

It’s part of a wider effort by Warren and others to bring the burgeoning $7 billion marijuana industry in from a fiscal limbo she said forces many shops to rely solely on cash, making them tempting targets for criminals.

After voters in Warren’s home state approved a November ballot question to legalize the recreational use of pot, she joined nine other senators in sending a letter to a key federal regulator, the Financial Crimes Enforcement Network, calling on it to issue additional guidance to help banks provide services to marijuana shop vendors.

Twenty-eight states have legalized marijuana for medicinal or recreational use.

Warren, a member of the Senate Banking Committee, said there are benefits to letting marijuana-based businesses move away from a cash-only model.

“You make sure that people are really paying their taxes. You know that the money is not being diverted to some kind of criminal enterprise,” Warren said recently. “And it’s just a plain old safety issue. You don’t want people walking in with guns and masks and saying, ‘Give me all your cash.””

A spokesman for the Financial Crimes Enforcement Network said the agency is reviewing the letter.

There has been some movement to accommodate the banking needs of marijuana businesses.

Two years ago, the U.S. Department of the Treasury gave banks permission to do business with legal marijuana entities under some conditions. Since then, the number of banks and credit unions willing to handle pot money rose from 51 in 2014 to 301 in 2016.

Warren, however, said fewer than 3 percent of the nation’s 11,954 federally regulated banks and credit unions are serving the cannabis industry.

Taylor West, deputy director of the National Cannabis Industry Association, a trade organization for 1,100 marijuana businesses nationwide, said access to banking remains a top concern.

“What the industry needs is a sustainable solution that services the entire industry instead of tinkering around the edges,” Taylor said. “You don’t have to be fully in favor of legalized marijuana to know that it helps no one to force these businesses outside the banking system.”

Sam Kamin, a professor at the University of Denver Sturm College of Law who studies marijuana regulation, said there’s only so much states can do on their own.

“The stumbling block over and over again is the federal illegality,” he said.

The federal government lumps marijuana into the same class of drugs as heroin, LSD and peyote. Democratic President Barack Obama’s administration has essentially turned a blind eye to state laws legalizing the drug, and supporters of legalizing marijuana hope Republican President-elect Donald Trump will follow suit.

Trump officials did not respond to a request for comment. During the presidential campaign, Trump said states should be allowed to legalize marijuana and has expressed support for medicinal use. But he also has sounded more skeptical about recreational use, and his pick for attorney general, Alabama U.S. Sen. Jeff Sessions, is a stern critic.

Some people in the marijuana industry say the banking challenges are merely growing pains for an industry evolving from mom-and-pop outlets.

Nicholas Vita, CEO of Columbia Care, one of the nation’s largest providers of medical marijuana products, said it’s up to marijuana businesses to make sure their financial house is in order.

“It’s not just as simple as asking the banks to open their doors,” Vita said. “The industry also needs to develop a set of standards that are acceptable to the banks.”

What the 114th Congress did and didn’t do

Congress has wrapped up the 114th session, a tumultuous two years marked by the resignation of a House speaker, a fight over a Supreme Court vacancy, bipartisan bills on health care and education and inaction on immigration and criminal justice.

The new Congress will be sworn-in Jan. 3.

What Congress passed or approved

  • A hard-fought budget and debt agreement that provided two years of relief from unpopular automatic budget cuts and extended the government’s borrowing cap through next March.
  • The end of a 40-year-old ban on crude oil exports.
  • A rescue package for financially strapped Puerto Rico, creating an oversight board to supervise some debt restructuring and negotiate with creditors.
  • A sweeping biomedical bill that would help drug and medical device companies win swifter government approval of their products, boost disease research and drug-abuse spending and revamp federal mental health programs. It would also include money for preventing and treating abuse of addictive drugs like opioids.
  • The first overhaul of the Toxic Substances Control Act since it was approved in 1976.
  • A sweeping rewrite of education law, giving states more power to decide how to use the results of federally mandated math and reading tests in evaluating teachers and schools.
  • An aviation bill that attempts to close gaps in airport security and shorten screening lines.
  • An extension of a federal loan program that provides low-interest money to the neediest college students.
  • The USA Freedom Act, which extends some expiring surveillance provisions of the USA Patriot Act passed after the 9/11 attacks.
  • A bipartisan measure that recasts how Medicare reimburses doctors for treating over 50 million elderly people.
  • Legislation reviving the federal Export-Import Bank, a small federal agency that makes and guarantees loans to help foreign customers buy U.S. goods.
  • $1.1 billion to combat the threat of the Zika virus.
  • Defense legislation rebuffing President Barack Obama’s attempts to close the prison at Guantanamo Bay, Cuba, and blocking the Pentagon from starting a new round of military base closings.
  • Legislation authorizing hundreds of water projects, including measures to help Flint, Michigan, rid its water of poisonous lead, and to allow more of California’s limited water resources to flow to Central Valley farmers hurt by the state’s lengthy drought.
  • Expanded law enforcement tools to target sex traffickers.
  • Legislation that would tighten several security requirements of the visa waiver program, which allows citizens of 38 countries to travel to the U.S. without visas.
  • Cybersecurity legislation that would encourage companies to share cyber-threat information with the government.
  • A renewal of health care and disability payments to 9/11 first responders who worked in the toxic ruins of the World Trade Center.
  • A bill allowing families of Sept. 11 victims to sue Saudi Arabia in U.S. courts for its alleged backing of the attackers, enacted in Obama’s first veto override.
  • A permanent ban on state and local government Internet taxes.
  • A bill that boosts government suicide prevention efforts for military veterans.
  • Confirmation of Eric Fanning to be Army secretary, making him the first openly gay leader of a U.S. military service.
  • The election of a new House speaker, Republican Rep. Paul Ryan of Wisconsin.

What Congress did not pass or approve

  • Confirmation of Obama’s pick for the Supreme Court, Merrick Garland.
  • Confirmation of 51 federal judges nominated by Obama, including 44 district court nominees and seven appeals court nominees.
  • Gun control legislation.
  • Bills that would have halted federal payments to Planned Parenthood.
  • Comprehensive or incremental changes to immigration law.
  • $1 trillion worth of agency budget bills that will be kicked into next year, complicated by a familiar battle over the balance between Pentagon spending and domestic programs and a desire by Republicans to get a better deal next year from the Trump administration. Congress passed a four-month extension of current spending instead.
  • A bipartisan criminal justice bill that would have reduced some mandatory sentences for low-level drug offenders and increased rehabilitation programs.
  • The first comprehensive energy bill in nearly a decade, which would speed exports of liquefied natural gas and create a new way to budget for wildfires.
  • War powers for Obama to fight Islamic State militants.
  • A bill forcing the president to allow construction of the Keystone XL oil pipeline from Canada. Obama rejected the pipeline in 2015 after seven years of indecision.
  • The Trans-Pacific Partnership, a multinational trade agreement involving 11 other Pacific Rim countries. Congress did give the president Trade Promotion Authority, allowing Congress to ratify or reject trade agreements negotiated by the executive branch, but not change or filibuster them.
  • Child nutrition bills that would have scaled back the Obama administration’s standards for healthier school meals.

A tip sheet for workers and workplaces where pot is legal

Changing marijuana laws aren’t necessarily making weed more welcome in the workplace.

For now, many employers seem to be sticking with their drug testing and personal conduct policies, even in states where recreational marijuana use is now permitted. Others are keeping a close eye on the still evolving legal, regulatory and political environment.

Voters in California, Massachusetts, Maine and Nevada voted Nov. 8 to approve the use of recreational marijuana, joining Colorado, Washington, Oregon and Alaska, where it had previously been legalized. (A recount of Maine’s close result is scheduled.) More than two dozen states have medical marijuana programs.

But the drug is still against federal law.

A closer look at what it all means for workers and businesses:

CAN MY EMPLOYER STILL TEST ME FOR POT?

Bottom line: You can’t come to work high. You can still be drug tested. And you can still be fired — or not hired — for failing a drug test even if you’re not the least bit impaired at work.

All the states with legalized recreational pot have exemptions for workplace drug policies.

In Massachusetts, for example, the law includes language stating that “the authority of employers to enact and enforce workplace policies restricting the consumption of marijuana by employees” is not changed.

“Yes, you may be able to have (marijuana) at home, but that doesn’t mean it’s OK in the workplace,” said Edward Yost, an HR specialist with the Society for Human Resources Management.

WHAT ABOUT WORKPLACE SAFETY?

Advocates for marijuana legalization said it was never their intention to compromise safety, a central reason offered by employers for drug testing.

“We don’t want anyone to come to work impaired on any drugs,” said David Boyer, campaign manager for the ballot initiative in Maine.

A 2013 survey by the employee screening firm HireRight found 78 percent of employers conducted drug tests either randomly, as a condition of employment, after accidents or for some combination of those reasons.

The federal government requires drug testing for some workers, including truck drivers and others in transportation.

Quest Diagnostics, which performed nearly 11 million laboratory-based drug tests for employers in 2015, said the percentage of tests coming back positive has shown a modest increase in recent years. Nearly half of all positive tests showed evidence of marijuana use.

CAN I GET FIRED EVEN IF I’M NOT HIGH?

THC, the psychoactive chemical in cannabis, can stay in a person’s system for days or even weeks, experts say — long after the buzz has subsided.

“It’s the equivalent of firing somebody who drank a glass of wine on Friday evening and then came to work on Monday,” said Tamar Todd, legal director for the Drug Policy Alliance, who believes employers should reconsider zero-tolerance policies in light of changing laws and attitudes.

A number of efforts are underway to develop an accurate method, akin to the Breathalyzer for alcohol, to measure actual marijuana impairment. Such a test might be useful not only for employers, but also for police and prosecutors trying to determine what constitutes driving under the influence of marijuana in states where recreational pot is legal.

WHAT SHOULD COMPANIES DO?

At a minimum, companies should review their current polices, make sure their managers are trained and make clear to employees that marijuana use on or off the job can still land them in trouble, said James Reidy, a New Hampshire-based attorney who advises clients around the country on drug testing issues.

Tina Sharby, chief human resources officer for an Easter Seals affiliate with about 1,700 employees in New England, said the organization, which provides services for people with special needs, is monitoring the evolving legal and regulatory environment but is sticking with its drug testing protocols for now.

“We have a drug-free workplace policy, and we believe that the current policy we have is effective,” Sharby said.

But drug testing and zero-tolerance rules can also make it difficult for businesses with a need to recruit young professionals who may harbor more liberal attitudes toward pot.

“We have ski industries out here, and if they really took a hard line on marijuana use, they would have to shut down,” said Curtis Graves, information resource manager for the Colorado-based Mountain States Employers Council.

After Colorado became the first state to legalize recreational marijuana in 2012, surveys showed an uptick in workplace drug testing, Graves said, but that trend has begun to shift in the other direction.

“Employers who have a zero-tolerance policy maybe shouldn’t apply that to non-safety sensitive workers, because if they do testing on them, they run the risk of inviting an invasion of privacy claim,” suggested Amanda Baer, a Boston-area attorney who specializes in labor and employment issues.

WHAT DO THE COURTS SAY?

Adding to the uncertainty is the scarcity of legal precedent in states that have legalized recreational marijuana. But several cases involving employees with permits to use medical marijuana have reached the courts, and most have been decided in employers’ favor.

The most widely cited case is a 2015 Colorado Supreme Court that upheld Dish Network’s firing of a disabled man who used medical marijuana and failed a drug test. The court ruled that a state law barring employers from firing workers for off-duty behavior that is legal did not apply because pot remains illegal under federal law.

Similar rulings have been issued in other states including California, Montana and Washington.

As medical marijuana programs become more common even in states where recreational pot remains outlawed, some companies have begun to weigh accommodations for workers with permission to use marijuana for an existing health condition.

 

Costs of widely prescribed drugs jumped up to 5,241 percent in recent years

Jess Franz-Christensen did not realize the seriousness of her son’s Type 1 diabetes diagnosis until staff in the doctor’s office offered to call an ambulance to take him to the hospital.

Her next shock: The cost of Jack’s medicines.

The drugs, administered through an insulin pump, cost $1,200 a month.

“We’re really fortunate. We’re able to pay for stuff,” said Franz-Christensen, whose husband, Scott, is a physicist, while she stays home to care for Jack, 8, and their daughter, Kendall, 11.

“But there are people who are making decisions whether to feed their kid or get test strips — whether to pay rent or get a vial of insulin. It’s heart-breaking.”

Prices for insulin products have nearly doubled in recent years, including Lantus SoloSTAR — one of the drugs that Medicaid and Medicare spent the most on in 2015. Its price increased by 81.5 percent between 2011 and 2014, according to data analyzed by the Wisconsin Center for Investigative Journalism. The data were provided by California-based First Databank, a supplier of U.S. commercial drug pricing information.

The costs of seven widely prescribed antibiotics, cancer drugs, arthritis medications and other prescriptions have escalated between 29 percent and 5,241 percent in recent years, according to a joint investigation by the Wisconsin Center for Investigative Journalism, Wisconsin Health News and Wisconsin Public Radio.

The investigation examined the impacts of and reasons behind the overall rise in prescription costs, including drug price increases since 2011, using proprietary First Databank data.

Overall, the price of insulin nearly tripled between 2002 and 2013, prompting calls this month for a federal investigation by former Democratic presidential candidate Sen. Bernie Sanders from Vermont.

“They (drug companies) are making billions and billions of dollars on people who literally can’t afford it,” said Franz-Christensen, who has joined #MyLifeIsNotForProfit, a national grassroots parent movement.

Recent nationwide news coverage has focused on the rising cost of EpiPens, which counteract potentially fatal allergic reactions to peanuts, bee stings and other triggers. But the $600 cost for a two-pack of that medicine is just one example of lifesaving drugs with skyrocketing prices.

Synthroid, which is used to treat hypothyroidism, is the most commonly prescribed medication in the United States and has been on the market for more than 60 years. In just the past six years, it has nearly doubled in price, according to the Center’s analysis. The generic version of Synthroid, levothyroxine, has gone from 14 cents to 46 cents per pill, an increase of 231 percent between 2011 and 2016, the analysis shows.

A single two-week dose for Humira, a medication that treats conditions including rheumatoid arthritis, has increased 129 percent since 2011, to $2,000, according to First Databank data analyzed by the Center.

The price increases, which continue to mount, place economic and emotional pressure on patients and their families, squeeze the budgets of health care providers and raise costs for taxpayers in Wisconsin and nationwide, the joint investigation found.

Lack of competition raises costs

Spending on medications is rising for a variety of reasons:

  • Some pharmaceutical companies have taken action to extend the patent protections on their products, blocking cheaper generic versions from being developed.
  • As some companies stop making certain low-cost drugs, other companies gain monopolies over the market.
  • Companies are introducing more high-cost “speciality” drugs that treat lifelong conditions.
  • As the nation’s population ages, the demand for prescription drugs increases; more than half of Americans now use them.

In one practice known as “product hopping,” a company makes changes to a drug to extend its patent protections, keeping others from entering the market with cheaper alternatives.

Wisconsin Attorney General Brad Schimel filed an antitrust lawsuit in September alleging that the makers of Suboxone, a drug used to treat opiate addiction, changed the product from a tablet to a film that dissolves in the mouth to block alternatives and “maintain monopoly profits.”

Drug maker Indivior said it takes “these allegations seriously” and “intends to defend this and other related actions.”

“As long as drugs are on patent protection, manufacturers at that point have monopoly pricing ability and they can price their products at levels that the market will bear,” said Chuck Shih, who leads Pew Charitable Trusts’ specialty drugs research initiative.

In addition, as competitors drop out of the market, the remaining companies are “raising prices significantly and earning substantial profits,” said Larry Levitt, senior vice president for special initiatives at the California-based Kaiser Family Foundation.

The price jumps have caught the attention of Congress, which held hearings after Turing Pharmaceuticals increased the price of a drug that treats toxoplasmosis — an illness that can cause brain damage, blindness, miscarriage or birth defects — by 5,000 percent shortly after acquiring it.

The increase in the price of EpiPens has also drawn congressional scrutiny. Between 2010 and 2016, the price has more than quadrupled, according to data from First Databank.

Seventeen senators, including Democratic Wisconsin Sen. Tammy Baldwin, sent a letter to EpiPen maker Mylan in early November asking for more pricing information. The senators said the skyrocketing prices were raising costs for taxpayers and jacking up insurance premiums.

Lawmakers on the state and federal level are calling for new regulations to rein in drug prices. A dozen states have enacted laws requiring greater transparency in drug pricing and other measures, but no state has enacted price controls.

California voters rejected a proposal earlier this month to implement their own price control system, which would require state agencies to pay the same rates negotiated by the U.S. Department of Veterans Affairs. The two sides poured more than $100 million into the effort, most of it from pharmaceutical companies opposed to the measure.

Holly Campbell, spokeswoman for the Pharmaceutical Research and Manufacturers of America, attributed the increase in EpiPen prices to a U.S. Food and Drug Administration backlog in approving new generics and a “lack of competition” in the market.

Working poor hit hard

For those without insurance or who cannot afford their share, the rising cost of medications has left them facing hard choices.

Kathryn Drexler, a registered nurse and certified diabetic educator at the free Living Healthy Community Clinic in Oshkosh, said some of her patients ration their insulin. So many are asking the clinic for medication help “that it’s draining our budget,” she said.

“I think it’s hitting the working poor the hardest,” Drexler said. “They can’t afford their co-pays, and they can’t afford insulin out of pocket.”

Free clinics provide care and drugs to the roughly 323,000 people, or 5.7 percent of state residents who lack insurance, as well as some people who are underinsured. And while drug companies offer free prescriptions to certain low-income people with no insurance, generic medications — which comprise eight out of every 10 prescriptions — do not qualify.

University of Wisconsin pediatric endocrinologist Dr. Ellen Connor said the price increases have thrown some of her patients into despair.

“Families — this is what they agonize over,” Connor said. “They lose sleep over it. I have parents sobbing in the office over this. They feel like failures because they had lost jobs and couldn’t afford $500 of medications a month. It breaks your heart.”

For the insured, drug price hikes have contributed to higher deductibles and co-pays, said Dr. Tim Bartholow, chief medical officer for the not-for-profit insurer WEA Trust in Madison.

The price increases are hitting hospitals too, costing University of Wisconsin Hospitals and Clinics an additional $14 million in the past year, according to Steve Rough, pharmacy director.

Rough noted large increases among generic drugs with no competitors.

“I call it generic price-jacking, where companies purchase the rights to a low-cost generic drug that is routinely used in the care of many patients, just for the sole purpose of raising the price to make money, because they can,” he said.

Taxpayers left with hefty tab

Prescription drugs are a growing portion of health care spending nationwide, accounting for 16.7 percent or $457 billion of total U.S. health care spending in 2015 — about double the percentage from the 1990s, according to a report released in March.

The U.S. Department of Health and Human Services report found the number of prescriptions is rising, but most of the spending growth is due to rising prices and a shift toward more expensive medications.

The state’s Medicaid program — which receives both federal and state funding — spent $329.4 million in the fiscal year between July 2011 and June 2012 on prescription drugs, according to the Legislative Fiscal Bureau. By July 1 of this year, annual spending had grown to $427.7 million — a 30 percent increase. The amount can vary year to year because of rebates the program receives from drug manufacturers.

Elizabeth Goodsitt, Wisconsin Department of Health Services spokeswoman, said the program has taken numerous steps to address growing costs, such as requiring patients to get prior approval before receiving more expensive medications.

Meanwhile, a September poll from the Kaiser Family Foundation found that 55 percent of Americans nationwide reported taking prescription drugs. About 26 percent of them — or 14 percent of the U.S. population — found it somewhat or very difficult to pay the cost of their prescription medication.

Even generics now too expensive

Paul Hoffmann, manager of the Bread of Healing Clinic in Milwaukee, said his free clinic can no longer afford to provide some generic medications.

“I’ve been a pharmacist for 35 years, and this is a phenomenon that we never saw,” Hoffmann said. “All these long-standing generics that have been generic for some 20, 30 years are going up in astronomical prices.”

He cited doxycycline, used to treat infections. First Databank figures show the price skyrocketed by 12,024 percent from 2011 to early 2013 because of drug shortages. The price has dropped, but the antibiotic is still 5,240 percent higher than in 2011 — or more than 50 times more expensive.

Lawmakers eye transparency initiatives

Some state lawmakers are looking for ways to curb drug prices. Rep. Debra Kolste, D-Janesville, plans to introduce legislation next year requiring the Office of the Commissioner of Insurance to collect information about the cost of drugs to public health care programs and develop a strategy to reduce prices.

Meanwhile, Baldwin has co-authored a bill at the federal level requiring pharmaceutical companies to submit a report to the federal government a month before increasing a product’s price by 10 percent or more.

PhRMA spokeswoman Campbell called the proposal “a thinly veiled attempt to build a case for government price setting.”

But observers say the conversation around drug pricing has changed.

“You have these very high profile seemingly outrageous price hikes that have focused the attention of policymakers in a way that I haven’t seen before,” said Levitt, of the Kaiser Family Foundation. “There’s a window where we could see some policy changes.”

Franz-Christensen hopes Congress will fix the problem.

“The people that can’t afford it, they’re so overwhelmed,” she said. “They can’t fight. … If it’s hard for us, people who have everything, imagine the people who don’t.”

Cara Lombardo and Andrew Hahn of the Wisconsin Center for Investigative Journalism contributed to this report.

Sean Kirkby reports for Wisconsin Health News, an independent, nonpartisan, online news organization serving Wisconsin health care professionals and decision makers. Dee J. Hall is managing editor of the Wisconsin Center for Investigative Journalism. Bridgit Bowden is a reporter for Wisconsin Public Radio. The nonprofit Center (www.WisconsinWatch.org) collaborates with WPR, Wisconsin Public Television, other news media and the University of Wisconsin-Madison journalism school. All works created, published, posted or disseminated by the Center do not necessarily reflect the views or opinions of UW-Madison or any of its affiliates.

Surgeon general report: ‘Addiction is not a character flaw’

In what may be his last significant act as President Barack Obama’s surgeon general, Dr. Vivek Murthy released a report calling for a major cultural shift in the way Americans view drug and alcohol addiction.

The report, “Facing Addiction in America,” details the toll addiction takes on the nation — 78 people die each day from an opioid overdose; 20 million have a substance use disorder — and explains how brain science offers hope for recovery. While its findings have been reported elsewhere, including by other federal agencies, the report seeks to inspire action and sway public opinion in the style of the 1964 surgeon general’s landmark report on smoking.

With President-elect Donald Trump taking office, it’s uncertain whether access to addiction treatment will improve or deteriorate. Trump and the Republican-led Congress are pledging to repeal and replace the 2010 Affordable Care Act, which made addiction treatment an essential health benefit.

In an interview this week, Murthy said he hasn’t spoken to Trump but looks forward to working with his administration to save lives with expanded access to treatment.

“We have made progress,” Murthy said. “How do we keep that progress going? A key part is making sure people have insurance coverage.”

The Associated Press reviewed the report ahead of its official release. Here’s a look at what’s in it and some early reaction:

 

MEDICATION MYTHS

The surgeon general’s report refutes abstinence-only philosophies as unscientific and supports medications such as buprenorphine and methadone that are used to treat opioid addition. That may annoy supporters of traditional 12-step programs who see medications as substituting one addiction for another.

Medication-assisted treatment for opioid addiction can take time. “One study suggested that individuals who receive MAT for fewer than 3 years are more likely to relapse than those who are in treatment for 3 or more years,” the report states.

 

TV-STYLE INTERVENTIONS

Staged interventions, like those depicted on TV, may backfire. Planned surprise confrontations “have not been demonstrated to be an effective way to engage people in treatment,” the report says. The trouble with the approach? According to the surgeon general’s report, it can heighten resistance and attack the self-worth of the addict.

 

ALCOHOLICS ANONYMOUS

Alcoholics Anonymous was founded in 1935 because mainstream medicine wasn’t treating alcohol disorders. That started a legacy of separating addiction treatment from the rest of medicine.

The report makes room for AA and other recovery support services, noting they don’t require health insurance and are free, but it also says they “are not the same as treatment and have only recently been included as part of the health care system.”

AA gets praise for adaptability. American Indians, for instance, have incorporated Native spirituality and allowed families to attend meetings. Research shows AA to be “an effective recovery resource,” the report concludes.

 

HIGHER ALCOHOL TAXES

Alcohol tax policies get a nod in a section on evidence-based prevention: “Higher alcohol taxes have also been shown to reduce alcohol consumption.” Other policies suggested by research include limiting the density of stores selling alcohol, banning Sunday sales and holding bars liable for serving minors.

 

WHAT ABOUT MARIJUANA?

The report suggests learning from alcohol and tobacco policies to find out what works to minimize harm as marijuana becomes legal.

Voters in eight states have approved adult use of recreational marijuana and more than two dozen states have medical marijuana laws. The report cites “a growing body of research” suggesting marijuana’s chemicals can help with “pain, nausea, epilepsy, obesity, wasting disease, addiction, autoimmune disorders, and other conditions.”

Murthy supports easing existing barriers to marijuana studies, but said that he’s worried the legalization movement is moving faster than research. “Marijuana is in fact addictive,” he said.

 

NOT A MORAL FAILING

Addiction is a chronic illness, not a character flaw or a moral failing, the report says. Stigma and shame have kept people from seeking help and weakened public investment.

Murthy issues a call to action in the preface: “How we respond to this crisis is a moral test for America. Are we a nation willing to take on an epidemic that is causing great human suffering and economic loss?”

 

RED STATE-BLUE STATE ISSUE

Ohio Republican Sen. Rob Portman, co-sponsor of bipartisan legislation passed this year that creates grants to expand treatment programs, said he hopes the report raises awareness.

“We have to change the way we talk about addiction and break the stigma to help more Americans suffering from this disease get the treatment and recovery they need,” Portman said.

Addiction should be a bipartisan issue, said Democratic former U.S. Rep. Patrick J. Kennedy, an addiction treatment advocate.

“This affects all of America, but it really affects the Trump voter,” Kennedy said. Red states such as West Virginia, Ohio and Kentucky have the highest overdose rates, Kennedy said. Enforcing laws that require insurers to cover addiction treatment will be a test of Trump’s “promise to put average Americans ahead of corporate interests,” said Kennedy.

Written opioid prescriptions drop 10 percent in Wisconsin

A system to track prescription painkillers in Wisconsin to prevent abuse shows a nearly 10 percent drop in the number of opioid prescriptions written and filled compared to this time last year.

Wisconsin’s Controlled Substance Board recently published its first quarterly report on the prescription drug monitoring database, which was established in 2013, Wisconsin Public Radio reported.

The report does not say what percentage of doctors, dentists or pharmacists check the database, but officials said its use has steadily increased. Doctors will be required to check it next year.

The Wisconsin Medical Society’s chief medical officer, Donn Dexter, said the organization is working to educate physicians on the database and get them ready for the mandates.

A year after the database started in 2014 only 30 percent of pharmacists used the database and 8 percent of doctors. Dexter said with the new database implemented in January that number is sure to go up.

“The reason it wasn’t used is I think our doctors are already very busy,” Dexter said.

He said it is challenging to implement because it’s difficult to use.

The purpose of the database is to crackdown on patients getting various prescriptions from doctors and filling the same prescription with multiple pharmacists.

“One thing that the Medical Society is working hard on is that the pendulum doesn’t swing too far; so that patients that need pain control still get pain control,” said Dexter.

Law enforcement also uses the database most commonly for stolen prescriptions.

Pot-legalization movement seeks first foothold in Northeast

Having proven they can win in the West, advocates for recreational marijuana hope the Nov. 8 election brings their first significant electoral victories in the densely populated Northeast, where voters in Massachusetts and Maine will consider making pot legal for all adults.

Supporters believe “yes” votes in New England would add geographical diversity to the legalization map, encourage other East Coast states to move in the same direction and perhaps build momentum toward ending federal prohibitions on the drug.

“We have to get to a point where we can win legalization voter initiatives in other parts of the country,” said Keith Stroup, founder of the National Organization for the Reform of Marijuana Laws, or NORML, a leading group in the legalization movement.

Three other states — California, Arizona and Nevada — are also voting on recreational pot. If the California initiative passes, marijuana will be legal along the entire West Coast. Washington, Oregon, Colorado and Alaska have already voted to permit it. The District of Columbia also passed a legalization measure in 2014, but it has no regulatory framework for retail sales and possession remains illegal on federal property.

Several Eastern states are among the 25 that already allow some form of medicinal marijuana, but none in the region has approved recreational pot.

Big money is at stake, which helps explain why marijuana supporters have raised more than $6 million in Massachusetts and about $1.3 million in Maine, most from outside those states.

Analysts from Cowen and Co. issued a report last month forecasting a $50 billion legal cannabis market in the U.S. by 2026, a nearly tenfold increase over today. But such growth would be predicated on federal legalization. Passage of the November state referendums would be a “key catalyst” toward that end, analysts wrote.

Higher marijuana usage in the West may help explain why the region has been a more fertile ground for legalization, said Matt Simon, New England director for the Marijuana Policy Project, another major pro-legalization group.

“More people have direct experience with marijuana or know someone who has, and that leads to it being demystified,” Simon said.

Recent polls on the New England ballot questions, which propose significantly lower tax rates than those in Colorado and Washington, indicate the “yes” sides trending ahead in both states. Still, passage is far from guaranteed.

In Massachusetts, a socially liberal state, voters previously decriminalized small amounts of marijuana and approved it for medicinal use. This year’s initiative has met formidable opposition from politicians, business leaders, clergy and even billionaire casino magnate Sheldon Adelson, who recently donated $1 million to opposing groups.

The state’s popular Republican Gov. Charlie Baker and Boston’s Democratic Mayor Marty Walsh are among many elected officials fighting the idea. Their arguments include concerns that edible pot products resembling candy or other treats could fall into the hands of children, and that marijuana can be a “gateway” to far more dangerous drugs.

“The availability of marijuana for adolescent users already constitutes an environmental factor for the later use of other illicit drugs,” the state’s four Roman Catholic bishops said in a recent statement. “Its legalization will only serve to worsen this problem.”

A TV ad urging a “no” vote imagines a neighborhood overrun by pot shops and a mother shocked to see her own son emerge from one of the stores. Legalization proponents dismissed the ad as a “smear-and-fear” tactic.

“There is a puritanical streak that runs through New Englanders,” said NORML’s Stroup, a onetime Boston resident.

The Puritans lost their influence centuries ago, and the phrase “banned in Boston” is an anachronism. Yet uneasiness persists when it comes to issues that would have once been considered sinful. Massachusetts, for example, only recently authorized casino gambling and did so in a limited and highly regulated form.

In Maine, critics worry about disrupting the state’s well-established medical marijuana program.

“We want to make sure patients don’t lose access and that small growers will still be able to flourish,” said Catherine Lewis, director of education for Medical Marijuana Caregivers of Maine.

Portland, the state’s largest city, legalized possession of up to 2.5 ounces of marijuana in 2013, but the statewide prohibition still makes buying and selling the drug illegal.

Marijuana companies that have focused largely on Western states are watching developments closely, sensing new regional opportunities for investment and growth.

“The Northeast specifically is going to be a very powerful market because of the population density,” said Derek Peterson, chief executive of Terra Tech Corp., which operates cannabis cultivation, production and retail facilities.

Marc Harvill, client services and training manager for Denver-based Medicine Man Technologies, said the firm has already fielded inquires for consulting services from potential retail operators in New England should the ballot questions pass.

“The sky’s the limit,” he said.

Hispanic woman fired for reporting harassment by pro-Trump co-workers

A Hispanic woman says her white co-workers at an Iowa claims office used images of Donald Trump to racially harass her for months after they learned she was angered by his description of Mexican immigrants as rapists, according to a civil rights lawsuit she filed against her company.

Alexandra Avila’s co-workers at Sedgwick Claims Management Services — where they administered benefits for Wal-Mart employees — began calling her an “illegal immigrant” even though she’s a natural-born U.S. citizen, according to the lawsuit filed Monday in Iowa district court. The suit claims her former co-workers placed a picture of an angry-looking Trump as Avila’s computer’s screensaver, signed her up to volunteer for his campaign and sent her racist memes, including one that read: “How’s Mr. Donald Trump going to deport all these illegals? Juan by Juan.”

The Republican presidential candidate’s promise to build a border wall to keep out Mexican immigrants has for months contributed to racial tensions nationwide. “Build a wall” chants have been used by high school students to taunt Latino opponents at sporting events in multiple states, including Iowa, Wisconsin and Indiana. At Kent State University, Latinos marching in the Homecoming parade this month said they were taunted with the same chant.

Avila, a 32-year-old mother of one who worked at Sedgwick for three years, claims she faced similar heckling at her white-collar workplace in Coralville, Iowa, from the beginning of Trump’s campaign in June 2015 until after she was fired five months later.

“It’s been a weird political season where one candidate is taking public stances on things that, if the same words were said in the workplace, might constitute violations of our civil rights laws,” said Avila’s attorney, Paige Fiedler. “His candidacy has emboldened some people to feel like that doesn’t violate social norms anymore.”

Lesley Gudehus, spokeswoman for Memphis, Tennessee-based Sedgwick, declined comment on the lawsuit.

Avila, born in California to Mexican parents, told colleagues she was upset with Trump’s 2015 campaign launch when he said of Mexican immigrants: “They’re bringing drugs. They’re bringing crime. They’re rapists.”

Soon after, the lawsuit claims, colleagues removed the photo Avila had of her young daughter as her computer screensaver and replaced it with a picture of Trump yelling and pointing his finger. When Avila removed the photo, they kept switching it back to Trump, the suit alleges.

An email arrived from the Trump campaign last fall thanking her for the support and asking how she wanted to help, according to the suit. Avila also claims her colleagues sent offensive memes, including one showing a brown-skinned man that read: “Found Jesus — he stabbed me twice.”

When her department was voting on a potluck menu, one co-worker said Avila was ineligible because she was an “illegal immigrant,” drawing laughter from Avila’s boss, the lawsuit claims. Avila contends that after she complained about the harassment, the company accused her of falsifying timecards by claiming she worked minutes more time than she actually did.

Avila was fired last November and escorted out, with Sedgwick saying it would send her personal property later. When her belongings arrived from FedEx, Avila says they contained a handwritten note that called her “La Trumpa” and added: “Illegal immigrants can’t vote or work. Good luck finding a job.”

“Getting that box in the mail was a horrific experience,” Fiedler says.

After her firing, a co-worker sent her an invitation to a Trump rally on Facebook, the lawsuit claims.

The lawsuit, which names Sedgwick and two supervisors, alleges Avila suffered discrimination based on national origin and that the company failed to pay wages she earned.

 

Wisconsin man sentenced for sex trafficking

Monta Groce, 30, of Sparta, Wisconsin, was sentenced this week to 25 years in prison for using violence, threats and coercion to compel three young women suffering from heroin addiction to prostitute for his profit in Wisconsin and Minnesota.

In July, a  jury convicted Groce of three counts of sex trafficking by force, threats or coercion; one count of conspiracy to engage in interstate transportation for prostitution; one count of interstate transportation for prostitution; one count of maintaining a property for drug trafficking; one count of using a firearm in furtherance of drug trafficking and one count of witness retaliation.

The sentence was announced by Deputy Assistant Attorney General Vanita Gupta, head of the Justice Department’s Civil Rights Division, along with U.S. Attorney John W. Vaudreuil of the Western District of Wisconsin and Special Agent in Charge R. Justin Tolomeo of the FBI’s Milwaukee Division.

“Groce beat, tormented and enslaved vulnerable young women struggling with heroin addiction,” said Gupta.  “He treated them as sex slaves rather than human beings and his unconscionable actions offend the most basic standards of human decency.  Nothing can undo the harm Groce inflicted or the pain he caused, but hopefully this sentence provides some measure of closure and relief for the victims.”

“Sex trafficking is modern slavery, and cannot be tolerated in any civilized nation,” said Vaudreuil.  “These crimes, which took place in a small Wisconsin city, demonstrate that sex trafficking is not just a big city issue; it is a horrible problem in rural America too.  We will continue to work with our local, state and federal law enforcement partners to bring to justice those who violently exploit vulnerable victims in Wisconsin.”

“Sex trafficking has no boundaries and can occur anywhere,” said Tolomeo.  “When combined with drug addiction, the results are devastating.  Groce used heroin and violence to force victims into prostitution.  The FBI will continue to work with its law enforcement partners to target these predators.”

Evidence presented at trial included the testimony of the three victims identified in the indictment as Jane Does 1 through 3. They testified that Groce sold heroin in Sparta between December 2012 and April 2013.  During that time, he enticed the victims to begin prostituting for his profit by providing them with heroin .  As their dependency increased, he turned to violence and threatened to cut off their heroin supply if they disobeyed him, withheld money earned from prostitution or otherwise refused to prostitute.

Groce further kept some of the victims in perpetual debt by fronting them heroin and charging fines as punishment.

He advertised the victims on Backpage.com and paid other addicts to drive them from Wisconsin to Minnesota to prostitute.

 

The case was investigated by FBI’s Milwaukee Division with assistance from the Sparta Police Department and Monroe County, Wisconsin, Joint Investigative Task Force.

Policy Prescriptions: Clinton and Trump and health care

Hillary Clinton has been involved in the nation’s health care debate for more than 20 years and, as her campaign likes to say, she has the scars to prove it.

The Democratic presidential candidate failed in her 1990s effort to steer her husband’s universal coverage program through Congress, as the complex plan collapsed for lack of political support. Since then, she has tacked sometimes to the right on health care, and sometimes to the left.

Clinton is campaigning as the candidate of continuity and would leave all major health care programs in place. She has a long list of tweaks and adjustments that reflect her familiarity with policy and would expand the government’s role in health care.

Donald Trump calls President Barack Obama’s health care law “a disaster,” and vows to repeal it. He’d provide a new tax deduction for health insurance premiums, but also limit federal support for Medicaid, which covers low-income people. An independent analysis recently estimated his seven-point plan would cause 20 million people to lose coverage.

Trump’s ideas on health care have shifted over time, and his latest plan hews to basic GOP talking points. He’s expressed a belief that an economically advanced country like the United States can’t have people “dying in the street” for lack of medical care.

Here is a summary of their proposals:

MEDICARE

The government’s premier health insurance program covers about 57 million people, including 48 million seniors and 9 million disabled people under age 65. It enjoys strong support from voters across the political spectrum, although its long-term financial outlook is uncertain.

CLINTON: She would authorize Medicare to negotiate drug prices with pharmaceutical companies, and she supports allowing patients to import lower-cost prescriptions from abroad. Medicare beneficiaries represent a big share of the market for medications.

Clinton would also allow people ages 55-64 to buy into Medicare, although her campaign has not released much detail on how that would work.

TRUMP: He promises not to cut Medicare, and has suggested that other Republicans like House Speaker Paul Ryan made a political mistake by calling for major changes. But it remains unclear how Trump’s proposed repeal of “Obamacare” would affect its improvements to Medicare benefits, including closing the prescription drug coverage gap known as the “doughnut hole.”

Earlier, Trump spoke approvingly of giving Medicare legal authority to negotiate prescription drug prices, but that idea currently is not mentioned in his health care plan. Instead, he also supports allowing drug importation.

MEDICAID

The federal-state program for low-income individuals covers more than 70 million people, from pregnant women and children to elderly nursing home residents. Under Obama’s health care law, states can expand the program to include more low-income adults. Medicaid has sometimes carried a social stigma, but polls show the program has a solid base of public support.

CLINTON: She’d work to expand Medicaid in the 19 states that have yet to take advantage of the health law. She’s proposing three years of full federal funding for those states, the same deal given to states that embraced the law right away.

TRUMP: In 2015 Trump told an interviewer: “I’m not going to cut Social Security like every other Republican. And I’m not going to cut Medicare or Medicaid. Every other Republican’s going to cut.”

But his campaign plan would convert Medicaid into a block grant, ending the open-ended federal entitlement and capping funding from Washington. Over time, such an approach is likely to result in a big cut.

PRIVATE INSURANCE

About 177 million people under age 65 have private health insurance, with nearly 9 in 10 getting their coverage through an employer. Rising out-of-pocket costs such as insurance deductibles and copayments are a sore point with consumers.

CLINTON: She has proposed a new tax credit of up to $5,000 per family, or $2,500 for an individual, for households that face “excessive” out-of-pocket costs. The credit would be refundable, meaning that people who don’t owe income tax could still get money back. An independent analysis of her plan defined “excessive” costs as exceeding 5 percent of household income.

Clinton would also require insurers to cover three sick visits to the doctor each year without patients needing first to meet their plan’s deductible, the annual amount patients pay before their insurance kicks in.

TRUMP: He has no similar proposals on out-of-pocket expenses but has called for requiring hospitals, clinics and doctors to disclose prices so patients can shop around to reduce costs. And he would expand the use of tax-sheltered health savings accounts, used to pay for medical expenses not covered by insurance.

PRESCRIPTION DRUGS

More than half of U.S. adults take prescription drugs, and according to a recent Kaiser Family Foundation poll most of those patients report no major problems affording their own medications.

But consumers have been alarmed by the introduction of breakthrough drugs costing tens of thousands of dollars a year, along with a spate of seemingly random price hikes for older medications. More than 3 out of 4 say the cost of prescription drugs is unreasonable. A majority favors government action to curb costs.

CLINTON: She has several proposals, including a new government board with the power to penalize drug companies for “unjustified, outlier price increases,” a monthly limit of $250 on patients’ copayments for prescription drugs, lowering the period of protection from generic competition for biologic drugs from 12 years to 7 years, and requiring drug companies to provide rebates for medications used by low-income Medicare recipients.

Those ideas are on top of Medicare negotiations and allowing patients to import lower-cost prescription drugs from abroad.

TRUMP: In addition to backing drug importation, he also has called on Congress to remove barriers to competition from lower-price, equally effective medications.

‘OBAMACARE’

The 2010 Affordable Care Act expanded coverage for the uninsured and made carrying health insurance a legal obligation for most people. It offers subsidized private insurance for people who don’t have access to a job-based plan, along with a state option to expand Medicaid.

About 11 million people are covered through the law’s private insurance markets, while the Medicaid expansion has added at least 9 million to that program. It’s unclear if all those people were previously uninsured, but experts say the law deserves most of the credit for 21 million gaining coverage since its passage. Americans, however, remain deeply divided over “Obamacare.”

CLINTON: She wants to strengthen Obama’s signature law. Clinton would resolve a “family glitch” that denies health insurance subsidies to some dependents, sweeten subsidies for people buying coverage on the health law’s markets, and offer a new government-sponsored insurance plan to compete with private companies.

Her proposals would expand coverage to about 9 million more uninsured people, according to a recent study by the Commonwealth Fund and the RAND Corporation.

But Clinton would repeal the law’s tax on high-cost insurance, known as the “Cadillac Tax.” Many economists are critical, saying repeal of the tax would eliminate a brake on costs.

TRUMP: He would completely repeal the 2010 law and start over again. Trump has proposed a tax deduction for health insurance premiums, and also allowing insurers to sell policies across state lines, a longstanding GOP idea.

Critics say a deduction, usually claimed after the end of the tax year, wouldn’t do much to help lower-income people squeezed to pay premiums.

And the idea of selling across state lines has been opposed in the past by state insurance commissioners and attorneys general, who warned that it would undercut consumer protections. The insurance industry is divided, with smaller companies fearing it would favor major insurers.