A Crucial Element of Democracy

This is a blog by Robert Gutierrez ...
While often taken for granted, civics education plays a crucial role in a democracy like ours. This Blog is dedicated to enticing its readers into taking an active role in the formulation of the civics curriculum found in their local schools. In order to do this, the Blog is offering a newer way to look at civics education, a newer construct - liberated federalism or federation theory. Daniel Elazar defines federalism as "the mode of political organization that unites separate polities within an overarching political system by distributing power among general and constituent governments in a manner designed to protect the existence and authority of both." It depends on its citizens acting in certain ways which Elazar calls federalism's processes. Federation theory, as applied to civics curriculum, has a set of aims. They are:
*Teach a view of government as a supra federated institution of society in which collective interests of the commonwealth are protected and advanced.
*Teach the philosophical basis of government's role as guardian of the grand partnership of citizens at both levels of individuals and associations of political and social intercourse.
*Convey the need of government to engender levels of support promoting a general sense of obligation and duty toward agreed upon goals and processes aimed at advancing the common betterment.
*Establish and justify a political morality which includes a process to assess whether that morality meets the needs of changing times while holding true to federalist values.
*Emphasize the integrity of the individual both in terms of liberty and equity in which each citizen is a member of a compacted arrangement and whose role is legally, politically, and socially congruent with the spirit of the Bill of Rights.
*Find a balance between a respect for national expertise and an encouragement of local, unsophisticated participation in policy decision-making and implementation.
Your input, as to the content of this Blog, is encouraged through this Blog directly or the Blog's email address: gravitascivics@gmail.com .
NOTE: This blog has led to the publication of a book. The title of that book is TOWARD A FEDERATED NATION: IMPLEMENTING NATIONAL CIVICS STANDARDS and it is available through Amazon in both ebook and paperback versions.

Tuesday, July 10, 2018

A DANGEROUS MILL


[Note:  This posting is a continuation of a report on the development of a civics unit of study.  This unit is directing students to formulate informed positions on the opioid epidemic.  Presently, this development, in real time, is reporting a set of factoids on a mode of dispensing illicit opioids which is a contributing element of this epidemic.]
In the existing opioid distribution network, there are various players, some in places as far away as China, some closer to home.  Neighborhood distributors have carved for themselves a meaningful niche in this supplier system.  They are called “pill mills.”  They are clinics or doctors’ offices in which the people working in them are willing to provide opioid prescriptions to “patients” who are willing to pay for them.  That is, they are distributed without a bona fide medical reason.
          Usually, the process entails a person going to those medical facilities, being subjected to an extremely superficial exam, and getting a prescription for painkillers.  For this service, the person can be charged a fee ranging from $200 to $400.  It has been reported that these facilities can deal with 60 patients per day – a profitable day’s business.[1] And their role in the overall distribution chain extends to being suppliers to street sellers.  This maneuver may call on a dealer to hire third parties to go to pill mills to acquire the painkiller prescriptions.[2]
          Of course, these activities are illegal and with the large volumes involved, the authorities are aware of the activities.  This has resulted in attempts to shut down such prescription sources.  Florida has made a concerted effort.  In the year 2015, the authorities there closed 250 pill mills.[3] The state has altered its regulations to prohibit clinics from issuing opioid prescriptions and this, in turn, has notably lowered the dispensing of prescription opiates.[4] Florida’s efforts have garnered it some attention. 
          The Journal of the International Society for Pharmacoepidemiology, PDS, reports that due to that state’s laws and its drug monitoring efforts, high-risk individuals – users of high opioid doses over extended periods of time – or those people who are classified as “opioid shoppers” through various suppliers are recording reduced levels of consumption.  That journal concludes:  “Compared with Georgia, Florida’s prescription drug monitoring program and pill mill law were associated with large reductions in prescription opioid utilization among high-risk patients.”[5]
          How bad have some cases of these pill mill distributions been?  One case of note has been that of a Pennsylvania doctor.  He prescribed about 3 million pills in a 19-month period to about 2800 patients.  He has been arrested and his attorney is reported as saying the doctor hopes to be released on bail – his patients need care.  Oh, to date, the authorities are charging the doctor with the deaths of five of his patients.[6]
          The next posting will look at supply chains or trafficking.

[1] “Signs of a Pill Mill in Your Community,” Kentucky Government Publication, pdf, n.d., accessed July 8, 2018, https://docjt.ky.gov/Magazines/Issue%2041/files/assets/downloads/page0019.pdf .

[2] Sam Quinones, Dreamland:  The True Tale of America’s Opiate Epidemic (New York, NY:  Bloomsbury Press, 2015).  This source has an extended timeline of this epidemic in the introductory pages of the book.

[3] “America’s Pill Mills:  A Look into the Prescription Opioid Problem,” DrugAbuse.Com, n.d., accessed July 8, 2018, https://drugabuse.com/featured/americas-pill-mills/ .

[4] “More ‘Pill Mill’ Doctors Prosecuted Amid Opioid Epidemic,” Healthline, May 19, 2016, accessed July 8, 2018, https://www.healthline.com/health-news/pill-mill-doctors-prosecuted-amid-opioid-epidemic#1 .

[5] “Impact of Florida’s Prescription Drug Monitoring Program and Pill Mill Law on High-Risk Patients:  A Comparative Interrupted Time Series Analysis,” Pharmacoepidemiology and Drug Safety (PDS), February 28, 2018, accessed July 8, 2018, https://onlinelibrary.wiley.com/doi/abs/10.1002/pds.4404 .

[6] “Doctor Charged in Deaths of 5 Patients from Opioid Overdoses,” Associated Press/CBS News release, December 22, 2017, accessed July 8, 2018, https://www.cbsnews.com/news/doctor-raymond-kraynak-charged-deaths-patients-opioid-overdoses-pennsylvania/ .  For another case study see Sam Quinones, “Dr. Procter’s House,” Dreamland – a blog, October 3, 2016, accessed July 8, 2018, http://samquinones.com/reporters-blog/2016/10/03/dr-procters-house/ .

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