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PostPosted: Sat Sep 17, 2016 1:53 am 
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Saw my sub Dr today. He told me some new gungho agent in the Hawaii Narcotics Enforcement Division has decided to make it his mission to ruin thousands of peoples' lives. Hawaii revised statues apparently don't have a buprenorphine provision--the law currently still says narcotics can't be prescribed for detox or maintenance. We have Walgreen's, CVS, and a few dozen independent pharmacies. Walgreen's has, after a call from the NED agent, STOPPED dispensing suboxone for maintenance. CVS and the others haven't yet. suboxone doctors are being called and informed by this same that they're breaking the law unless they are dispensing it directly to patients themselves, or prescribing for non addiction use like pain. And apparently a psychiatrist here scripting it to one person for depression was also told it's illegal him to; that the only person could script bup off label is a suboxone doctor! (Wrong and kind of inconsistent). The local paper was going to run a story about it but my sub Dr (amazing man and strong advocate) requested they not run it yet, to buy time for a counter strategy even if it's just a few days. Hawaii legislature won't be in session again until Jan 2017. Short of the AG making some sort of emergency non Enforcement declaration, thousands of people here are about to be forced into relapse and numerous deaths will result!!! I have completed college, become a licensed professional gotten married, have 7 month old twins, and a normal life thanks to suboxone. This is all in jeopardy without sooner y serious lobbying.

I suspect the law is a relic that's decades old and simply hasn't been updated; as far back as 2009 the relevant portion has stated:

A prescription may not be issued for the dispensing of narcotic drugs listed in any schedule for the purpose of "detoxification treatment" or "maintenance treatment" except as follows: (A) The administering or dispensing directly (but not prescribing) of narcotic drugs listed in any schedule to a narcotic drug-dependent person for "detoxification treatment" or "maintenance treatment" shall be deemed to be "in the course of a practitioner's professional practice or research" so long as the practitioner is registered separately with the department and the federal Drug Enforcement Agency as required by section 329-32(e) and complies with Title 21 Code of Federal Reulations Section 823(g) and any other federal or state regulatory standards relating to treatment qualification, security, records, and unsupervised use of drugs; and (B) Nothing in this section shall prohibit a physician or authorized hospital staff from administering or dispensing, but not prescribing, narcotic drugs in a hospital to maintain or detoxify a person as an incidental adjunct to medical or surgical treatment of conditions other than addiction;

It's that "but not prescribing" part that all this hinges on I believe. I couldn't find anything else that it might be. States are allowed to make laws more restrictive than the feds. And I bet there are other states with the exact same wording in their laws but nobody has enforced it.

There's no exception in Hawaii law comparable to DATA federal law that allowed for suboxone in 2000. Not that I could find.

We're screwed here, this one agent (whose name I've left out) is about to destroy thousands of lives.

What can we do??? It's not like we have a strong l lobbying interest like RB anthymore.


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PostPosted: Sun Sep 18, 2016 5:38 am 
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*Crickets chirping* anybody here?? Damn, I'd think this issue would get more support considering there are 49 other states that may well have the same laws on the books.

Anyway apparently this rogue agent has been reigned in. Reportedly the AG stated that even if this law were to be enforced, this agent had not been correctly approaching it. Shortly thereafter Walgreen's began calling sub patients back in to refill their scripts.

The way I see it, yes, technically every outpatient sub dr in Hawaii has been violating the controlled substance act for up to 16 years. But enforcing would mean charging someone with a crime, arrest/indictment, court case.

Not phone calls with threats, that directly affect the delivery of important, life saving medication.

Sure would love to hear a legal opinion on this. My sub Dr was planning on sending people to the ER, but my friend is an er Dr and he said he's never scripted sub to anyone and no effing way he ever would.


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PostPosted: Sun Sep 18, 2016 7:45 am 
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Honestly JB I think you got your answer.My thought was that clearer heads would see just what this agent was doing and take action.
This treatment is to big and working to well for one man to stop imo. The fed law is the law. This agent for whatever reason gave it a shot and lost, thank god. Crazy stuff..

Plus,most of us are not getting our scripts in Hawaii. .

My 2 cents..glad it worked out..


Razor


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PostPosted: Sun Sep 18, 2016 8:24 am 
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Remember though, States are allowed to make laws more strict than federal, and it overrides federal law. So the fact that it's OK in federal law is irrelevant; just means the DEA won't be the ones kicking doors in. (But if states make LESS restrictive laws, like medical marijuana, federal law trumps it).

This is not an isolated incident. There's a good chance many states have identical Controlled Substance Acts. Without each state creating a specific loophole for sub, it's HIGHLY likely this same danger exists for many other states. This should serve as a compelling warning to every single person on this forum to look at their state's laws and see if they're also at risk for this happening.

We're not out of the woods yet, as Hawaii law as written still states no narcotic can be *prescribed* to treat addiction. Crisis has been averted for now, but that could easily change, especially now that it's come to people's attention.
My sub Dr's attorney is pretty freaked out for his practice if that says anything...

(This precedent is set in federal law, the 1914 Harrison Act I believe; the 2000 DATA law creates the suboxone loophole, thanks to strong lobbying by Reckit-benkeiser, sub's original owner. Who, patent expired and generics available, now is a tiny fraction of what it once was. Addicts don't have a strong political lobby for Medication Assisted Treatment anymore as a result.)

Hawaii, with a population of 1.4 million, is number 40th most populous state, below Idaho and above Maine. It's not like some banana republic with people living in grass shacks on the beach. So, yeah, as you stated, most people aren't getting sub in Hawaii; but lots still are. And as I already said this could easily affect any other state. My dr and I did some quick calculations based off the number of sub doctors here and estimate about 2,000 people are on sub maintenance. Enough people that hundreds would relapse and dozens could die, but not enough for it to be a major public health concern, or create much political pressure for change to the laws. Just like everywhere else, active opioid addicts vastly outnumber those on sub.

Razor why don't you take a look at your state's prescription laws and see if it says the same thing... That info would be beneficial to this topic. Some quick googling shows that quite a few States have passed laws restricting suboxone in various troubling ways in just the last few years.


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PostPosted: Sun Sep 18, 2016 4:27 pm 
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While I do appreciate your concern on this subject and agree with many of your findings and facts, I can not at this point in time and recovery walk about in fear tbat one day in the great state of W.VA, or most other states, someone will come aloug and blow the dust off an old law and ruin my day or recovery.

This kind of fear can only take my eye off of the work Ive been doing. With this pandemic of opioid addiction ravaging most of the country, I see nothing to be gained in any state by taking away the most proven method of relief from the deadly surg that is killing 100 people a day in the US.Im not saying it is impossible, but highly unlikely.

Be it 2000 in your state or 2, no one who now lives a "clean enough" life today because of this med should have there treatment put in jeopardy. Im sure most other states have different laws that make sub treatment difficult. Tennessee and Ohio, maybe Kentucky and others do have new laws in place other than what the Feds require. But not to just take it all away.

As you said, the addicts could die. It would cause havoc that I could not imagine.

A very foolish act it would be. I try to keep the faith and honestly most people really dont want to even think about losing there treatment.

I do hope it all works out in Hawaii, and for all of us.

Razor...


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Fond Du Lac Psychiatry
Dr. Jeffrey Junig, M.D., Ph.D.

  • Board Certified Psychiatrist
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