VA suicide prevention funding for paid media advertising -

Allocated $6.2 million

Actually spent only $57K as of Sep 2018

Was projected to spend total of $1.5M in FY 2018 (which ended 30 Sep 2018)

And we wonder why so many vets commit suicide?

https://www.medpagetoday.com/publichealthpolicy/militarymedicine/77097?xid=nl_mpt_DHE_2018-12-26&eun=g1185334d0r&pos=23&utm_source=Sailthru&utm_medium=email&utm_campaign=Daily%20Headlines%202018-12-26%202018-12-26&utm_term=NL_Daily_DHE_Active

VA Chief Grilled on Unspent Suicide Prevention Funds

—Also called on the carpet at congressional hearing for errors in caregiver programs

by Shannon Firth, Washington Correspondent, MedPage Today

December 21, 2018

WASHINGTON – The Department of Veterans Affairs spent only a fraction of the money allocated to the agency for suicide prevention outreach according to a recent oversight report. Also, some veterans with disabilities have been arbitrarily downgraded or cut from caregiver programs, according to recent media investigations.

Members of both the House and Senate Committees on Veterans Affairs grilled VA Secretary Robert Wilkie Jr. about the details of these critical findings during a joint hearing on Wednesday.

On average 20 veterans commit suicide every day, yet a Government Accountability Office report released on Monday found that outreach efforts at the VA related to suicide prevention waned in 2017 and 2018.

Of $6.2 million allocated to paid advertising for suicide prevention, the VA spent only $57,000 as of September 2018, despite the department's assertion that suicide prevention was its top clinical priority.

The report, however, clarified that in total the Veterans Health Administration (VHA) is projected to have spent a total of $1.5 million on paid media in fiscal year 2018, although that's still far short of the funds available to the agency.

The office attributed the department's failure to spend its money appropriately to leadership turnover and reorganization.

Specifically, the GAO noted that the reason the VHA had not spent the leftover monies for paid media aimed at suicide prevention was that "changes in leadership and organizational realignment of the program" delayed approval of a formal plan for the campaign.

The report also noted that while the VHA maintains metrics for its campaign, such as how many people are estimated to have seen its anti-suicide messages, it does not have specific targets for them.

Rep. Beto O'Rourke (D-Texas) zeroed in on this particular finding, and asked the Secretary how he measures his success in addressing veteran suicide.

"How do you know how you're doing against that priority [suicide prevention]? What are your goals?"

Wilkie clarified that 14 of the 20 suicides that happen each day happen among veterans are outside of the VA system.

O'Rourke said that fact has been known for years. "I'm not blaming you for where we are… I want to know what your goal is and how we're doing against it."

"The goal is to do our best to make sure we have done everything possible," Wilkie said.

"We'll never be able to judge you on that," O'Rourke interrupted.

Wilkie, 56, then explained that most of the men completing suicide are his father's age. "That means these are problems that are fifty years in the making," he said.

O'Rourke, still not satisfied with Wilkie's response, asked if he agreed with the GAO's finding that the agency does not have targets for preventing suicide.

One of Wilkie's lieutenants at the VA, Steven Lieberman, MD, broke into the discussion, attempting to rescue his colleague from O'Rourke's interrogation. He said the VA agreed with the report's conclusions and its recommendations.

As for goals, Lieberman said, "We are in the process of developing more robust ones."

Wilkie faced more challenging questions from Sen. Patty Murray (D-Wash.) who highlighted a recent NPR story that described how veterans have been incorrectly downgraded from caregiver support programs, including some double and triple amputees.

Wilkie said the problems highlighted by NPR were corrected within 48 hours.

"Those are not isolated cases, we're hearing many of them" Murray said. She asked Wilkie for his assurance that no one else would be terminated or downgraded until he has made sure that program regulations are correctly applied.

"Absolutely, I will make that commitment and I will brief these committees," Wilkie responded.

[Moar at website]

Part 1 of 2

Latest news, history, and background of the FDA's move to ban the herbal medicine pain reliever kratom:

https://www.medpagetoday.com/painmanagement/opioids/77083?xid=nl_mpt_DHE_2018-12-26&eun=g1185334d0r&pos=20&utm_source=Sailthru&utm_medium=email&utm_campaign=Daily%20Headlines%202018-12-26%202018-12-26&utm_term=NL_Daily_DHE_Active

Noose Tightens Around Kratom

—FDA attacks mount and DEA moves closer to Schedule I designation

by John Gever, Managing Editor, MedPage Today

December 22, 2018

In April, we reported on an FDA order to remove some kratom products from the market because of Salmonella contamination. That turned out to be the opening shot in a war that the federal government has declared on the herbal product – or, at least, that's how kratom's advocates see it. In this story, we review what has happened since with the opioid mimic and the government's efforts to discourage its use.

Kratom comes from an Asian plant, Mitragyna speciosa, that has long been a mild recreational drug and part of folk remedies. In recent years, it has gained a following in North America with claims that it can relieve pain that conventional drugs can't touch, and that it can also relieve symptoms of opioid withdrawal. It's sold in smoke shops, "alternative medicine" storefronts, and, of course, online from countless vendors.

Its mechanism of action isn't entirely clear. That's partly because it's an herbal product with dozens of possible active compounds. However, attention has focused on two alkaloids that bind to mu-opioid receptors, which are also the target for conventional opioids. But its activity is also different from opium derivatives, earning it the moniker "atypical opioid."

The FDA has made no secret of its wish that kratom would simply go away. The agency's ability to regulate herbal products is limited to ensuring safety and to prevent vendors from making overt unapproved health claims. But when it comes to kratom, the agency has pulled both of those levers as hard as it can.

'No Proven Medical Uses'

Since that recall notice was issued April 3, the FDA pushed additional vendors of kratom products to pull products for safety reasons, some because of actual positive results on Salmonella tests and others "out of an abundance of caution." The CDC also joined the effort, identifying nearly 200 individuals who developed Salmonella infections tied to kratom, including 50 who were hospitalized. Although the CDC declared the outbreak over on May 24, the FDA continued to issue recall announcements related to Salmonella for more than a month afterward.

In May, the FDA also took the campaign in a different direction, accusing three sellers of kratom products of making unapproved health claims. These companies, according to the agency, had asserted their kratom products had the "ability to help in the treatment of opioid addiction and withdrawal. The companies also make claims about treating pain, as well as other medical conditions like lowering blood pressure, treating cancer and reducing neuron damage caused by strokes."

Perhaps concerned that the actions might be misinterpreted, FDA Commissioner Scott Gottlieb, MD, issued a lengthy statement in early July explaining the agency's Salmonella testing procedures and also his thinking about kratom in general. "As we have previously stated, there are no proven medical uses for kratom and the FDA strongly discourages the public from consuming kratom," Gottlieb said, adding, "Kratom is an inherently addictive product that can cause harm, which is reason enough not to consume it." A few days later, in another lengthy statement about opioid addiction generally, Gottlieb lumped kratom together with fentanyl as dangerous products often shipped through the mail.

Another batch of warning letters for unapproved health claims went out in early September. In announcing them, Gottlieb hammered on the lack of "well-controlled scientific studies" to demonstrate kratom's effectiveness for relieving pain or opioid withdrawal symptoms, or on how it may interact with other agents and the adverse effects that could result. "We cannot allow kratom products with unsubstantiated claims to prevent those with [opioid use disorder] from seeking treatments that have been demonstrated to be safe and effective," he thundered.

In late November, the FDA raised another concern with kratom: "disturbingly high levels of heavy metals in kratom products," an FDA release said. "Among the heavy metals we found were lead and nickel at levels not considered safe for human consumption."

[Go to part 2]

>>4483808

Part 2 of 2:

Schedule I Ban?

But the biggest impact the FDA has made on actual kratom use went unmentioned in the agency's many press releases over the year. In 2012 and 2014, the agency included kratom on so-called import alerts for drugs and drug ingredients that are illegal to import. These alerts authorize federal agents to seize products at ports of entry. A Feb. 26 web posting noted several seizures occurring in 2014 and 2016, but nothing more recent.

But kratom consumers say they've found it increasingly difficult to find the product for sale, and they blame the import alerts for drying up supplies. At the online Pain News Network, a Nov. 16 article quoted the head of the American Kratom Association – an advocacy group for vendors and customers – as saying several suppliers had reported having tons of the product confiscated. The article's headline, and the advocacy group's leader, used the term "shadow ban" to describe the import crackdown.

The article's readers confirmed the difficulty in obtaining kratom. "Two of my main suppliers that I have done business with for years told me and they lost thousands," one wrote in the comments section.

An actual ban may also be coming. The Drug Enforcement Administration has been considering designating kratom as Schedule I, which would make it illegal to sell, manufacture, import, or possess. In early November, the Department of Health and Human Services sent the DEA a letter supporting such a designation.

Whether or when the DEA will reach a decision is unclear. The agency had previously announced its intention in 2016 to implement a Schedule I ban, but backed away after consumers and vendors objected that there was no scientific basis for such a move. However, the HHS declaration that kratom has no medical value and is dangerous gives the DEA more cover for a ban.

The online science-and-culture publication Inverse reported in November that the DEA appears to have made up its mind to take the step, but is still crafting an announcement. When the publication asked a DEA spokesman how the agency will rule, the response was: "I think that there's a good indication based on what we already heard from [Health and Human Services], what they've provided, and what Dr. Gottlieb has been saying… That should have given everybody a good idea."

last updated 12.21.2018

December 26, 2018

— David Swanson

I have suffered chronic pain for much of my life. I have been off and on opioids since before my first back surgery in 1973. I tried kratom years ago after reading about it just as a back up maybe in case the rush to make it harder for actual pain sufferers to get relief to save the addicts got worse. It does undoubtedly kill pain. In my case it gave me extreme abdominal pain not unlike ulcers. Too bad for me. If all the recreational opioid users don't OD soon I am afraid that our government will enact some other terrible draconian laws further limiting options for chronic pain sufferers. I am hoping not to have that 4th back surgery I need until someone actually knows how to perform one and rely on pain management to lead a greatly diminished slightly tolerable life.

December 26, 2018

— AG CNP

Another assinine rule from a government with "opiophobia", and an FDA that is driven by corporate pharmaceutical interests. I am disappointed by my colleagues who seem to have abandoned their commitment to alleviate suffering in a sensible and safe manner, and have allowed government agencies and politicians with no medical knowledge to dictate how we care for our patients.

Kudos to New York for making cannabis legal. Perhaps instead of surrendering patient care to corporate America,physicians and nurses should defend their profession, and protect their patients from government over-reach. Kratom may not be the best choice, but for a vast population of patients who have a gutless healthcare provider who is now afraid to prescribe appropriate medication for pain, it is one of the few available options. Its effective, affordable and readily available, and the corporate medical complex has not been able to cash in, or dominate its use.

Hey medicine…how about we stand up for patients for a change. Keeping Kratom legal is important, in a world where many people have few other options.

December 26, 2018

— Waismann Method

Kratom comes from Southeast Asia where they use it to treat pain conditions. It has gained popularity in the U.S. as a way to relieve pain and help treat opioid addiction. However, the main chemical in kratom attaches to the opioid receptors and effects the body similarly. It can offer pain relief and help suppress coughing but there is potential for harmful side effects, abuse and addiction. In addition, the lack of regulation makes in unsafe because it can be contaminated or additives can lead to unintended side effects and symptoms.

[End of part 2]