Amendment to Controlled Substances Act: Hydrocodone

Amendment to Controlled Substances Act: Hydrocodone H.R. 1285: To Amend the Controlled Substances Act to Make Any Substance Containing Hydrocodone a Schedule II Drug Jill Garreth Abstract This paper describes H.R. 1285, a bill proposed to amend the Controlled Substances Act to make any substance containing hydrocodone a Schedule II drug. It explores the historical, sociocultural, ethical, economic and the political/legislative environment in which the bill was introduced. Some of the difficulties encountered include the bill being referred to the House Committee of Judiciary and the House Committee of Energy and Commerce (H.R. 1285-113th Congress: To Amend the Controlled Substances Act to Make Any Substance Containing Hydrocodone A Schedule II Drug, 2013). Since being referred to both committees, there has been no further action taken on this bill by Congress (H.R. 1285-113th Congress: To Amend the Controlled Substances Act to Make Any Substance Containing Hydrocodone A Schedule II Drug, 2013). Stakeholders in the passage of this bill include physicians, pharmacists, advanced practice nurses, patients and long term care (LTC) facilities. The likelihood that H.R. 1285 will pass is very small due to the fact that the Drug Enforcement Agency (DEA) recently made a ruling that changed hydrocodone to a schedule II drug (Drug Enforcement Administration, 2014). Because of the DEA’s actions, it seems unnecessary to push forward with H.R. 1285. Keywords: hydrocodone, schedule II drugs, controlled substances, DEA H.R. 1285: To Amend the Controlled Substances Act to Make Any Substance Containing Hydrocodone a Schedule II Drug Introduction H. R. 1285 is a bill introduced March 20, 2013 to amend the Controlled Substances Act to make any substance containing hydrocodone a Schedule II drug (H.R. 1285-113th Congress: To Amend the Controlled Substances Act to Make Any Substance Containing Hydrocodone A Schedule II Drug, 2013). H.R. 1285 â€Å"amends the Controlled Substances Act to remove dihydrocodeinone (hydrocodone) from classification as a schedule III controlled substance. Directs the Attorney General to immediately allow manufacturers and distributors to store hydrocodone compound products in accordance with the physical security requirements for schedule III, IV, and V controlled substances for three years beginning on the date enactment of this Act. Requires the Comptroller General to submit a report on the reclassification of hydrocodone products under this Act, including: (1) an assessment of the degree to which the reclassification of such products under this Act impacts the ability of patients with legitimate m edical needs, particularly those in rural areas and nursing home facilities, to access adequate pain management; and (2) recommendations necessary to address any issues relating to patient access to adequate pain management† (H.R. 1285-113th Congress: To Amend the Controlled Substances Act to Make Any Substance Containing Hydrocodone A Schedule II Drug, 2013). H.R. 1285 is a piece of legislation that could directly affect the prescriptive authority of an advanced practice nurse (DEA Issues Info, 2012). Some states only allow an advanced practice nurse the authority to write prescriptions for drugs rated Schedule III and below and because of that, H.R. 1285 has the potential to affect advanced practice nurses in at least nine states (DEA Issues Info, 2012). Environment Historical Title 21 of the United States Code Controlled Substances Act classifies drugs based on three criteria (U.S. Code: Title 21-Food and Drugs, 2012). The criteria used to determine the schedule of the drug is the potential for abuse of the drug, whether the drug has an acceptable medical purpose and the type of dependence the drug may perpetuate (U.S. Code: Title 21-Food and Drugs, 2012). Between 2004 and 2009 products containing hydrocodone had an increase in demand of approximately 125% (Drug-Related Hospital Emergency Room Visits, 2011). Florida Congressman Vern Buchanan introduced this bill to help combat the growing prescription drug epidemic in his home state of Florida and wants to make hydrocodone combination products more difficult to obtain and prescribe (Congressman Vern Buchanan representing Florida, 2014). Sociocultural There are more than just health concerns that have brought this issue to forefront. There have been many studies done that show a direct link to drug abuse and crime. According to the Bureau of Justice, 30% of offenders in state detention facilities stated that they would likely commit crimes in order to get money for drugs (Bureau of Justice Statistics, 2004). In Florida, at least 7 people die daily from prescription drug overdoses (Congressman Vern Buchanan representing Florida, 2014) and at least 75 people die daily nationwide (Drug Enforcement Administration, 2014). Crime and drug overdoses are just a few of the sociocultural considerations that caused Congressman Buchanan to introduce H.R. 1285. Ethical One ethical implication that pushes H.R. 1285 to the forefront of legislation is that because hydrocodone is a prescription medication, prescribers have an ethical responsibility to assist in combatting the misuse and abuse of this drug (Hamburg, 2014). H.R. 1285 is not designed to make it more difficult for patients with a legitimate need to obtain the medication but it is designed to assist the providers in making better educated decisions when prescribing medications that have such a high potential for abuse (Drug Enforcement Administration, 2014). Economic Economic factors that have made this issue important is not necessarily related to the cost of the drug but the cost of the effects of abuse of the drug. â€Å"Prescription opioid abuse costs were about $55.7 billion in 2007. Of this amount, 46% was attributable to workplace costs (e.g., lost productivity), 45% to healthcare costs (e.g., abuse treatment), and 9% to criminal justice costs† (Centers for Disease Control, 2014). In 2010 there were 49 million uninsured people in the United States (US Census Bureau, 2011). Rising healthcare costs and uninsured people need to be a consideration when legislators review H.R. 1285. Political/Legislative H.R. 1285 has been assigned to the House Committee on Energy and Commerce and the House Committee on Judiciary (H.R. 1285-113th Congress: To Amend the Controlled Substances Act to Make Any Substance Containing Hydrocodone A Schedule II Drug, 2013). The House Committee on Energy and Commerce has the responsibility of reviewing the Food and Drug Administration’s (FDA) ability to establish the effectiveness and safety of prescription and over-the-counter (OTC) drugs in the United States (Longest Jr., 2010). The House Committee on Judiciary has jurisdiction over revision to existing codes so it has an important role regarding amending the existing drug scheduling (United States House of Representatives Judiciary Committee, 2014). Despite the fact that both committees have a Republican majority, there has still been no movement on this bill. Difficulties Encountered H.R. 1285 was introduced on March 20, 2013 by Florida Republican Representative Vern Buchanan (H.R. 1285-113th Congress: To Amend the Controlled Substances Act to Make Any Substance Containing Hydrocodone A Schedule II Drug, 2013). This bill has 54 co-sponsors of which 32 are Republican and 22 are Democrat (H.R. 1285-113th Congress: To Amend the Controlled Substances Act to Make Any Substance Containing Hydrocodone a Schedule II Drug, 2013). H.R. 1285 has been referred to the House Committee of Judiciary and the House Committee of Energy and Commerce and the committee chair makes the determination on whether the bill moves forward (H.R. 1285-113th Congress: To Amend the Controlled Substances Act to Make Any Substance Containing Hydrocodone A Schedule II Drug, 2013). One difficulty noted in regards to H.R. 1285 is the fact that there has been no action taken since its introduction to Congress. There is no optimistic timeline to predict if H.R. 1285 is going to be passed. Speaking pess imistically, H.R. 1285 will not pass at all. As of October 6, 2014 a Drug Enforcement Administration’s (DEA) ruling took effect that is essentially in the same spirit as H.R. 1285 (Drug Enforcement Administration, 2014). This ruling reschedules hydrocodone from a schedule III drug to a schedule II drug (Drug Enforcement Administration, 2014). Since the DEA has already changed the schedule of hydrocodone and it has already been implemented, there is no need for further movement of H.R. 1285. Stakeholders in the passage of H.R. 1285 include physicians, pharmacists, advanced practice nurses, long term care (LTC) facilities and patients. LTC facilities have been especially vocal on this topic due to the fact they believe that any further regulation or change in the scheduling of certain narcotics will have a negative effect on patients in their facilities and the ease in which these patients will have access to them (Garrison Mitty, 2010). Nurses who work in these types of facil ities are encouraging others to join professional organizations and write to their legislators to make their voices heard (Garrison Mitty, 2010). Effects Some positive effects of H.R. 1285 are increased awareness for prescribers of the dangers of opioid dependence related to hydrocodone and a decrease in â€Å"doctor shopping† related to the tighter regulation and monitoring of hydrocodone (Phillips, 2013). Negatives of H.R. 1285 include increased difficulty for patients in LTC facilities to access physicians and obtain prescriptions needed to adequately address their pain needs (Garrison Mitty, 2010). Because of the tighter prescriber restrictions related to refills and the types of prescriptions accepted, those who reside in LTC facilities could have to wait longer to receive refills on much needed pain medication (Garrison Mitty, 2010). International The U.K. has similar problems to the U.S. when it comes to prescription drug abuse (Weisburg et al., 2014). The U.K. has the Health Act of 2006 which created Accountable Officers that track and audit the prescriptions written (Weisburg et al., 2014). The U.K. also has trialed a real-time monitoring system to be able to monitor irregular prescribing practices for certain drugs (Weisburg et al., 2014). Although it was only a trial of a computerized system, it showed great promise in assisting real-time monitoring of prescriptions written. Change to the Bill As with anything, there are always improvements that could be made. One way to refine H.R. 1285 is to implement mandatory education for prescribers. Requiring education in areas of opioid pain management, pain management alternatives and safe prescribing practices is one way that could improve policy outcomes (Weisburg et al., 2014). Another improvement that could be made is by establishing a universal standard to pain management and the dispensing of medication because by using a universal standard, improved outcomes can be expected (Gourlay et al., 2005). Another way to improve H.R. 1285 would be to include a plan to implement a national prescription drug monitoring program (PDMP) (Drug Enforcement Administration, 2014). Many states already have a PDMP in place but it only monitors statewide activity (Drug Enforcement Administration, 2014). In order for a PDMP to be effective, it would need to be nationwide and offer up to date information (Drug Enforcement Administration, 2014). Conclusions H.R. 1285 is a bill introduced to Congress to change the schedule of hydrocodone from a schedule III to a schedule II drug. Congressman Vern Buchanan introduced this bill because of the growing drug epidemic he witnessed in his home state of Florida (Congressman Vern Buchanan representing Florida, 2014). He describes seeing more pain management clinics that dispense prescriptions for drugs than McDonald’s restaurants (Congressman Vern Buchanan representing Florida, 2014). Although H.R. 1285 was referred to two separate committees, the likelihood that the bill will be passed is very slim. There has been no further action taken on the bill by either committee. Prescribers, patients and LTC facilities have a stake in whether or not H.R. 1285 passes. All have concerns regarding difficulty in prescribing medication to those who truly need it and maintaining access for the patients who are living in a LTC facilities. Due to the recent ruling of the DEA that changed hydrocodone conta ining products from a schedule III drug to a schedule II drug, it seems unnecessary for H.R. 1285 to move forward (Drug Enforcement Administration, 2014). References Bureau of Justice Statistics 2004 Bureau of Justice StatisticsBureau of Justice Statistics (2004). Bureau of Justice Statistics. Retrieved October 6, 2014, from http://www.bjs.gov 201410091059041289595843 Centers for Disease Control 2014 Prescription Drug Overdose in the United States: Fact SheetCenters for Disease Control (2014, July 3). Prescription Drug Overdose in the United States: Fact Sheet. Retrieved from http://www.cdc.gov 20141009115559483260035 Congressman Vern Buchanan representing Florida 2014 Congressman Vern Buchanan representing FloridaCongressman Vern Buchanan representing Florida (2014). Congressman Vern Buchanan representing Florida. Retrieved from http://www.buchanan.house.gov 201410091015471184166312 DEA Issues Info 2012 American Association of Nurse PractitionersDEA Issues Info (2012, June). American Association of Nurse Practitioners. Retrieved from http://www.aanp.org 20141008133918138817310 Drug Enforcement Administration 2014 Schedules of Controlled Substances: Rescheduling of hydrocodone combination products from Schedule III to Schedule IIDrug Enforcement Administration (2014, August 22). Schedules of Controlled Substances: Rescheduling of hydrocodone combination products from Schedule III to Schedule II. Retrieved October 7, 2014, from http://federalregister.gov/a/2014-19922 20141009113706118370533 Drug-Related Hospital Emergency Room Visits 2011 National Institue of Drug AbuseDrug-Related Hospital Emergency Room Visits (2011). National Institute of Drug Abuse. Retrieved October 1, 2014, from http://www.drugabuse.gov 20141008130227593245745 Garrison K Mitty E 2010 Pain management and the U.S. Department of Justice.Garrison, K., Mitty, E. (2010). Pain management and the U.S. Department of Justice. Geriatric Nursing, 31(3), 214-219. 20141009140312276748895 Gourlay D Heit H Almahrezi A 2005 Universal precautions in pain medicine: A rational approach to the treatment of chronic pain.Gourlay, D., Heit, H., Almahrezi, A. (2005). Universal precautions in pain medicine: A rational approach to the treatment of chronic pain. American Academy of Pain Medicine, 6(2), 107-112. 201410091514541512988925 Hamburg M A 20140403 FDA Commissioner Margaret A. Hamburg statement on prescription opioid abuseHamburg, M. A. (2014, April 3). FDA Commissioner Margaret A. Hamburg statement on prescription opioid abuse. Retrieved October 7, 2014, from http://www.fda.gov 20141009112410159525513 HR 1285-113th Congress: To Amend the Controlled Substances Act to Make Any Substance Containing Hydrocodone A Schedule II Drug 2013H.R. 1285-113th Congress: To Amend the Controlled Substances Act to Make Any Substance Containing Hydrocodone A Schedule II Drug (2013). Retrieved from http://www.govtrack.us 20141008132123465403199 Longest B B 2010 Health policymaking in the United StatesLongest Jr., B. B. (2010). Health policymaking in the United States (5th ed.). Chicago, IL: Health Administration Press. 201410091217191092675209 Phillips J 2013 Prescription drug abuse: problem, policies and implications.Phillips, J. (2013). Prescription drug abuse: problem, policies and implications. Nursing Outlook, 61, 78-84. 201410091423161519538522 United States House of Representatives Judiciary Committee 2014 United States House of Representatives Judiciary CommitteeUnited States House of Representatives Judiciary Committee (2014). United States House of Representatives Judiciary Committee. Retrieved from http://www.judiciary.house.gov 201410091227131141156554 US Census Bureau 2011 Overview of Uninsured in the United States: A study of the 2011 current population surveyUS Census Bureau (2011, September). Overview of Uninsured in the United States: A study of the 2011 current population survey. Retrieved October 8, 2014, from http://hhs.gov 201410091201171076915503 US Code: Title 21-Food and Drugs 2012 Legal Information InstituteU.S. Code: Title 21-Food and Drugs (2012, January 14). Legal Information Institute. Retrieved from http://www.law.cornell.edu 20141008143645967177272 Weisburg D Becker W Fiellin D Stannard C 2014 Prescription opioid misuse in the United States and the United Kingdom: Cautionary lessons.Weisburg, D., Becker, W., Fiellin, D., Stannard, C. (2014). Prescription opioid misuse in the United States and the United Kingdom: Cautionary lessons. International Journal of Drug Policy, 20141009144237381562709

Nostradamus: The Truth Behind the Prophecies Essay -- Prophecy Prophet

  Ã‚  Ã‚  Ã‚  Ã‚  For Many years scholars and interpreters have been trying to find any truth that could possibly be found in the writings of Nostradamus. For many occasions people have been convinced that this man could see the future and he documented it in his many journals and books titled The Centuries. The writings and prophecies have been a controversial issue for many years. Most Nostradomus translators have more than likely misinterpreted his work because of his nearly illegible style of writings, thus false information is commonly found about this man of the past.   Ã‚  Ã‚  Ã‚  Ã‚  Nostradamus, a French Jew converted to Christian who lived in France in the 16th century. Born Michel de Nostredame on December 14th 1503 in St. Remy, France. He was the oldest of five children. His grandfather, Jean, taught him Latin, Greek, Hebrew, mathematics and astrology at an early age. Nostradamus received a medical degree in 1529 and became a physician. â€Å"Nostradamus made his reputation as a doctor of extraordinary skill gave generously to the poor.† (Sobel B)   Ã‚  Ã‚  Ã‚  Ã‚  Nostradamus was in his late when he frequently went into a meditative state and reported to have visions of the future. He began to document his visions in a number of journals in a mixture of Latin, French, and Greek quatrains, publishing his famous â€Å"Centuries† in 1558. Nostradamus had married twice, losing his first wife and children to the plague. Living in France from 1503-1566 AD, making a living as a wealthy French astrologer and physician, Nostradamus led an almost perfect life for his time.   Ã‚  Ã‚  Ã‚  Ã‚  The Frechman also predicted his own death which occurred on July 2, 1566. I t was the end of his foretelling the future on this planet.   Ã‚  Ã‚  Ã‚  Ã‚  De retour d`ambassade, don de roy mis au lieu,   Ã‚  Ã‚  Ã‚  Ã‚  Plus n1en fera: sera alle a Dieu   Ã‚  Ã‚  Ã‚  Ã‚  Parans plus proches, amis, freres du sang,   Ã‚  Ã‚  Ã‚  Ã‚  Trouve tout mort pres du lict et du banc.   Ã‚  Ã‚  Ã‚  Ã‚  When translated:   Ã‚  Ã‚  Ã‚  Ã‚  On his return from the embassy, having secured the kings gift,   Ã‚  Ã‚  Ã‚  Ã‚  He will be no more, (his spirit) having returned to God,   Ã‚  Ã‚  Ã‚  Ã‚  Nearby will be his close family, his friends and his brothers,   Ã‚  Ã‚  Ã‚  Ã‚  He will be found dead near the bed and the bench.   Ã‚  Ã‚  Ã‚  Ã‚  Nostradamus returned to his home late in the day returning from a visit of the king for which he was presented with three hundred gold crowns. After being worn out from the carriage ride home he decided t... ... predictions are fake many do believe that he could accurately predict the future.   Ã‚  Ã‚  Ã‚  Ã‚  Lets just think for a second, What could I predict for the future that will ensure my prediction to come true? The first thing that I would do is predict something to happen with fire. Come on how many events in the past, present, and future result in a fire? I would also predict it to happen in a large city like our ever so brilliant Nostradamus. Answer this, how many things have happened in the city as result to fire. Eventually it would come true and Nostradamus was no dummy.   Ã‚  Ã‚  Ã‚  Ã‚  Is it wrong to assume that Nostradamus could in fact predict the future? From the information gathered it is easy to come to the conclusion that the writings of Nostradamus can no more tell the future than a child’s nursery rhyme.   Ã‚  Ã‚  Ã‚  Ã‚  A prediction that can only be interpreted after the events it supposedly foresees have occurred is not a â€Å"predition† at all. Anyone could spew out a thousand vague â€Å"prophecies† and not have to explain what they meant until after the events they supposedly predicted had occurred. With this it is possible for anyone to manage a pretty impressive record for accuracy too.

Define an SLA and state why it is required in a risk adverse organization Essay

1. This is a closed-book, closed-notes quiz. No reference material (including assignments and labs) will be permitted for use during the quiz session. 2. The quiz contains the following types of questions: * Short essay type 3. Place your answers in the space immediately following each question. Quiz Questions 1. Define an SLA and state why it is required in a risk adverse organization. A SLA is a service level agreement, which is a contract between the ISP and the company. A SLA gives the company an idea of how much time they will be without services, should something happen with the ISP. A SLA is important to a company in making recovery plans, knowing what critical systems need to be available for a continuance of business and formulation of disaster recovery. 2. Using the user domain, define risks associated with users and explain what can be done to mitigate them. The user domain has several risk’s involved, as people are involved and there is no way employees can be monitored without the use of CCTV. Social engineering a person trying to obtain information through malicious means. The greatest tool in mitigating risk in the user domain is training and reminders for users to be aware of their surroundings. No acceptable user’s policy, AUP, or lack of training employees on the correct usage of the network. User accounts left active, if the employee is terminated, and another employee has the log on credentials. Mitigation would to be disabling all user accounts upon termination. . 3. Using the workstation domain, define risks associated within that domain and explain what can be done to reduce risks in that domain. The use of USB’s or disk, the files could contain viruses and infect other files or applications on the network. No acceptable user’s policy, AUP, or lack of training employees on the correct usage of the network. The users staying signed into their accounts when leaving their desk. Session timeout would help with this risk, but training and follow up with need to be done as well. 4. List four compliance laws or regulations or mandates, and explain them. HIPAA- covers all healthcare industries and states all patient information must be encrypted in storage, transmissions, and restrictions on access to the information. SOX- cover all publically traded companies and require auditing of the accounting procedures of the business. The reports required by SOX are reported to the SEC. Access to the financial information is restricted and based on need to know. FISMA- covers government agencies and is to ensure all assets of the government are protected. Assets like information, operations and actual machinery are protected from hackers or internal threats. Guidelines to develop a security guideline for government agencies, requires regular audits. CIPA-Child Internet Protection Act- covers federally funded entities’ than provide internet services to individuals, schools and libraries. The Act requires content filters to be used to prevent children from being exposed to harmful content, pornography and illicit sites on the internet. 5. Define risk with a formula. Explain what each variable means. Risk= Threat x Vulnerability- Threat is any compromise in the network that can be used for malicious behavior, an example worm, or Trojan horse. Vulnerability- is a weakness in the software or OS of a network that can be exploited for malicious intent. The two multiplied equals a risk to the information, assets or intellectual property of a business.

The Great Gatsby By Baz Luhrmann - 1290 Words

Lost in The Valley of Ashes Baz Luhrmann’s 2013 highly anticipated rendition of the poignant love story The Great Gatsby, is awarded for his sumptuous sets, glamorous costumes and of course his venerable casting. However, does the intricate Baz Lurhman successfully convey the complex themes in Fitzgerald’s classic? Rachel Spackman scrutinizes and compares the latest films’ rendition of the novel. Baz Luhrmann’s extravagant production of the classic ‘The Great Gatsby’ is filled with lavish visual displays, gaudy costuming and esteemed casting. However, behind the fame and opulence of this extravagant adaptation, Luhrmann fails to highlight the true eminence of the classic and is lost in the valley of ashes. Revered on the list of â€Å"100 Best Novels of the Twentieth Century† and fundamental virtue for educationalists, F. Scott Fitzgerald has successfully enlightened the literature world with his classic, ‘The Great Gatsby’. 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