‘Young miracle’: Baby recovers from Ebola in Congo outbreak

They call her the "young miracle." A baby who was admitted to an Ebola treatment center just six days after birth is now recovered from the virus. Congo's health ministry calls the baby the youngest survivor in what is now the world's second-deadliest Ebola outbreak. The ministry late Thursday tweeted a photo of the infant, swaddled and … Continue reading “‘Young miracle’: Baby recovers from Ebola in Congo outbreak”

They call her the "young miracle." A baby who was admitted to an Ebola treatment center just six days after birth is now recovered from the virus.

Congo's health ministry calls the baby the youngest survivor in what is now the world's second-deadliest Ebola outbreak.

The ministry late Thursday tweeted a photo of the infant, swaddled and with tiny mouth open in yawn or squall, surrounded by caregivers who watched over her 24 hours a day for weeks.

The baby's mother, who had Ebola, died in childbirth, the ministry said.

WOMAN'S TWEETS DETAILING HEART ATTACK GO VIRAL

The infant was discharged from the treatment center in Beni on Wednesday. "She went home in the arms of her father and her aunt," the ministry said.

Experts have reported worryingly high numbers of children with Ebola in this outbreak, which Congo's health ministry says now has 515 cases, 467 of them confirmed, including 255 confirmed deaths.

The tiny survivor is named Benedicte. In video footage shared by UNICEF, she is shown in an isolated treatment area, cradled in the arms of health workers in protective gear or cuddled by Ebola survivors, called "nounous," who can go without certain gear such as masks. The survivors are crucial with their reassuring presence, the health ministry said.

"This is my first child," her father, Thomas, says. "I truly don't want to lose her. She is my hope." He gazes at his daughter through the clear protective plastic.

Children now account for more than one-third of all cases in this outbreak, UNICEF said earlier this week. One in 10 Ebola cases is in a child under 5 years old, it said, and children who contract the hemorrhagic fever are at greater risk of dying than adults.

While Ebola typically infects adults, as they are most likely to be exposed to the lethal virus, children have been known in some instances to catch the disease when they act as caregivers.

OREGON INMATE'S FLU-RELATED DEATH LEADS FAMILY TO SUE STATE FOR $7.5 MILLION

Few cases of Ebola in babies have historically been reported, but experts suspect transmission might happen via breast milk or close contact with infected parents. Ebola is typically spread by infected bodily fluids.

The World Health Organization also has noted that health centers have been identified as a source of Ebola transmission in this outbreak, with injections of medications "a notable cause."

So far, more than 400 children have been left orphaned or unaccompanied in this outbreak as patients can spend weeks in treatment centers, UNICEF said. A kindergarten has opened next to one treatment center in Beni "to assist the youngest children whose parents are isolated" there, it said.

Health expert have said this Ebola outbreak, the 10th in Congo, is like no other as they face the threat of attack from armed groups and resistance from a wary population in a region that had never faced an Ebola outbreak before. Tracking suspected contacts of Ebola victims remains a challenge in areas controlled by rebels.

The latest WHO assessment , released Thursday, simply calls the circumstances "unforgiving."

And now, Congo is set to hold a presidential election on Dec. 23, with unrest already brewing .

Health experts offer solutions for unintended consequences of opioid crackdown

This is the third of a three-part series on the nation's struggle to address its crippling opioid crisis, and the unintended victims left in its wake. Read Part 2 here: Doctors caught between struggling opioid patients and crackdown on prescriptions

Many Americans today will attend several funerals before they get their first gray hair.

That’s in large part because of drug overdoses, now the leading cause of death among Americans aged 50 and younger. More than 70,000 people in the U.S. last year died from overdoses, most of which involved illegal opioids.

The overdose problem – and a rise in suicides, another byproduct of the drug epidemic — is so pervasive it’s being blamed for a drop in U.S. life expectancy.

The crisis has led to a rush of public health and law enforcement initiatives at all levels of government. The federal government has vowed to cut prescription opioids by a third. More than 30 states have passed some type of legislation aimed at attacking the opioid epidemic.

“Defeating this epidemic will require the commitment of every state, local, and federal agency,” President Donald Trump said in a March speech in New Hampshire. “Failure is not an option. Addiction is not our future. We will liberate our country from this crisis.”

We’re targeting the most vulnerable and sickest people who have been on opioids a long time.

— Dr. Stefan Kertesz, addiction specialist and professor at the University of Alabama at Birmingham School of Medicine.

The government response to the epidemic has many medical professionals, patients and their families welcoming the long overdue debate about the risks vs. benefits of opioid use. But it has also set off alarm bells for many of the millions of Americans with chronic pain who legally take opioids, under their doctor’s supervision, and are suffering a range of unintended consequences that have left them undertreated, ignored, and desperate for alternatives.

The root of the problem, according to dozens of pain patients, doctors, scholars, and others who spoke to Fox News for this story, are the Centers for Disease Control and Prevention (CDC) guidelines for opioid prescribing that were issued in 2016. While the guidelines are credited with focusing attention on prescribing practices, critics say they’ve been adopted by too many as hard and fast rules that must be enforced across the board, rather than serve their intended advisory purposes.

“We’re targeting the most vulnerable and sickest people who have been on opioids a long time,” said Dr. Stefan Kertesz, an addiction specialist and professor at the University of Alabama at Birmingham School of Medicine.

TOUGH NEW OPIOID POLICIES LEAVE SOME CANCER AND POST-SURGERY PATIENTS WITHOUT PAINKILLERS

Striking the right balance between getting control of the overdose epidemic and protecting access to treatment that brings relief to pain sufferers is a public health imperative.

The failure to do so threatens to exact a heavy price on the tens of millions of Americans whose pain is severe and disabling, and who are not driving the drug overdose epidemic.

Neglect of this large population of patients has the potential to prompt many to seek illegal opioids, or to become another statistic in the crisis of the rising U.S. suicide rate. Some have told Fox News that they have traveled, or plan to go to another country to obtain prescription opioids from doctors or pharmacies — a risky move for manifold reasons.

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So what’s the solution? Medical professionals, patients and others familiar with the opioid crisis and the fallout from the government crackdown have offered a variety of ideas.

RESETTING CDC GUIDELINES

Many believe the most urgent need is to address misunderstandings about the CDC guidelines. Clinicians and health experts say the CDC needs to make clear, in a high-profile way, what the guidelines were – and were not – meant to address. A letter signed by more than 300 health professionals, including former drug czars in the Clinton, Nixon and Obama administrations, calls on the CDC to examine the impact of the guidelines and publicly clarify them.

“Many doctors and regulators incorrectly believed that the CDC established a threshold of 90 MME as a de facto daily dose limit,” the letter said. “Soon, clinicians prescribing higher doses, pharmacists dispensing them, and patients taking them came under suspicion.”

The letter said that because the guidelines do not offer alternative pain care options, “patients have endured not only unnecessary suffering, but some have turned to suicide or illicit substance use. Others have experienced preventable hospitalizations or medical deterioration.”

The letter added: “We urge the CDC to issue a bold clarification…particularly on the matters of opioid taper and discontinuation.”

Richard A. Lawhern, a prominent advocate on behalf of chronic pain patients and co-founder of the Alliance for the Treatment of Intractable Pain, goes even further, suggesting the CDC should scrap its guidelines, and write new ones.

"The resulting document is fatally flawed,” Lawhern said, “and needs to be withdrawn for a major revision in an open public process by qualified experts in community practice for chronic pain treatment, assisted by representatives or advocates from chronic pain communities.”

CLARITY ON LEGAL PAINKILLERS

Many have acknowledged the need for better data about opioid use, on everything from the precise role that legal vs. illicit drugs have played in the national overdose crisis to more accurate information on the effect of dosage changes.

Over the summer, a U.S. Health and Human Services special task force on pain management formulated a draft report of recommendations for the guidelines and noted muddled data on deaths involving illegal opioids vs. prescribed drugs.

“The national crisis of illicit drug use along with overdose deaths are confused with the appropriate therapy of patients who are being treated for pain,” the draft report said. “This confusion has created a stigma that contributes to barriers to proper access to care.”

Federal data on overdose deaths generally do not offer specific statistics on how many involved patients who were prescribed opioids, though other data – such those compiled by states – indicate they account for a small minority.

AS DOCTORS TAPER OR END OPIOID PRESCRIPTIONS, MANY PATIENTS DRIVEN TO DESPAIR, SUICIDE

In November, a data and software company serving emergency medical services, fire departments and hospitals, released national opioid overdose data based on approximately 15,000 records collected between January and October of this year, and found that 94 percent of opioid overdoses involved illicit drugs, with only 4 percent being prescribed.

But that hasn’t stopped political leaders from developing policies and initiatives around cutting prescriptions as well as the supply of opioids. Trump vowed to cut opioid prescriptions by 30 percent over three years.

And many state and government officials are boasting about opioid prescription reductions, giving a misleading impression, Kertesz said, that progress is taking place in the drug overdose epidemic.

The [CDC opioid guideline] document is fatally flawed and needs to be withdrawn for a major revision in an open public process by qualified experts in community practice for chronic pain treatment, assisted by representatives or advocates from chronic pain communities.

— Richard Lawhern, co-founder of the Alliance for the Treatment of Intractable Pain

Many medical groups and health researchers also are calling for the CDC to address the fallout – such as reports of pain patients suffering withdrawals — from misguided implementation of its guidelines.

Kertesz, a lead author of the letter to the CDC, said that the many anecdotal reports of suicides and suicidal plans coming from pain patients who are being undertreated or cut off by doctors must be studied by the agency.

“It’s a large number of anecdotes,” he said, adding that if forcibly tapering or cutting off patients from opioids is leading to suicidal thoughts, “who will stand up to defend that policy, would we be ethically comfortable with that?”

The American Medical Association (AMA) recently released a resolution critical of the CDC guidelines that said: “We urge the CDC to follow through with its commitment to evaluate the impact by consulting directly with a wide range of patients and caregivers, and by engaging epidemiologic experts to investigate reported suicides, increases in illicit opioid use and, to the extent possible, expressions of suicidal ideation following involuntary opioid taper or discontinuation.”

In an interview with Fox News in 2017, Richard Baum, then-acting director of the Office of National Drug Control Policy, said the dialogue about the opioid epidemic has been misleading.

“This is framed as an opioid epidemic. But when you look under the hood at the report of people who overdose on fentanyl and heroin, they often have other drugs on board – cocaine, methamphetamine, other pharmaceuticals,” Baum said. “So we have a multi-drug threat that’s complicated. It means people often aren’t using [just] heroin, fentanyl, they’re also using cocaine.”

“Sometimes we inadvertently simplify it,” Baum said, “[saying] that it’s only one drug that’s causing the problem, but a lot of drug users use multiple drugs so we absolutely have to focus and are focusing on heroin and fentanyl and the opioids as the number one threat.”

LOOKING BEYOND DOSAGES

Health experts say the Drug Enforcement Administration (DEA) and state authorities must not be so narrowly focused on quantity and dosage when looking at prescribers who might require disciplinary action.

“No entity should use [morphine milligram equivalent] – thresholds as anything more than guidance, and physicians should not be subject to professional discipline, loss of board certification, loss of clinical privileges, criminal prosecution, civil liability, or other penalties or practice limitations solely for prescribing opioids at a quantitative level above the MME thresholds found in the CDC Guidelines for Prescribing Opioids,” according to the AMA.

The DEA and other authorities told Fox News they are judicious when taking action against prescribers, stressing the number who face punitive measures are just a small part of the more than 1 million registered with the agency to handle controlled substances.

Ronald Chapman II, a Michigan attorney who represents doctors accused of overprescribing, said sometimes a prescribing problem doesn’t rise to the level of a crime, and should be addressed administratively. Many prescribers trigger so-called “red flags” by errors or omissions in pain patients’ medical records, he said, and shouldn’t automatically be treated as sinister.

“We have a lot of hammers out there looking for a nail,” Chapman said.

Physicians should not be subject to professional discipline, loss of board certification, loss of clinical privileges, criminal prosecution, civil liability, or other penalties or practice limitations solely for prescribing opioids at a quantitative level above the MME thresholds found in the CDC Guidelines for Prescribing Opioids.

— American Medical Association

John Martin, the DEA’s administrator of the Diversion Control Division, said his agency has taken steps to reach out to pharmacists and clarify how investigators go about opening cases.

“I’m sure there are doctors … out there that are afraid” to prescribe opioids now, Martin said, “but that’s part of our responsibility in communication. We had that issue with pharmacists over the years.”

Martin said DEA officials have met with more than 15,000 pharmacists and pharmacy technicians “to educate them on proper prescribing on the regulations, diversion and so forth.”

Martin said the agency is undertaking a similar effort aimed at doctors.

“We’re making them aware of what we’re actually looking for, so ways that they can reduce diversion and education so they understand the different regulations out there, what they can and can’t do,” he said.

But when prescribers are targeted by authorities, sometimes they lose access to their patients' medical records, and either are forced to stop treating them because they lose their controlled substance prescribing rights or their medical license through suspension or revocation. Often, their patients are left to scramble, with nothing to fill the void of a doctor taken out of commission, and an abrupt loss of a medical treatment plan. Pain patient advocacy groups, and health care experts, say that authorities undertaking an investigation or disciplinary action  must have a plan in place for patients who are under the care of such health care providers.

Health professionals also argue that regulators and law enforcement authorities must stay in their lane, so to speak, and not interfere in the doctor-patient relationship in an effort to address the largely illegal opioid crisis.

"The key is to get the government out of medicine entirely," said Dr. Kenneth W. Fogelberg, who specializes in obstetrics and gyneacology. "Let the politicians and lawyers do what they do and let us practice medicine. We have licenses and DEA certificates and most of us know what we're doing."

"In 2006, we were required to take a course in pain management. The thrust of the course was that we were underprescribing and our patients were in pain. If a patient said she had pain  I was expected, by the patient and the hospital nurse, to medicate. If I did not, I was written up. She might be sitting in bed reading a comic book but, if she said, 'my pain is an 8' (out of 10) she was to be medicated."

"Now, MDs are blamed for overprescribing," Fogelberg said. "Pain is subjective and I only can judge by what a patient tells me, but we are pretty good at separating legitimate pain from drug-seeking behavior. If the governments, both state and local, would let doctors doctor, we could handle this, but with their insatiable thirst for control of everything, the situation just keeps getting worse."

MORE RESEARCH ON RISKS – AND BENEFITS

Most health experts agree more studies are needed on the effectiveness and dangers of opioid use.

“In medical school in the 1990s, it was taught that dosage does not matter if you go up slowly,” Dr. Deborah Dowell, lead author of the CDC guidelines, told Fox News. “Now we know there is an increased risk of opioid overdose.”

In an editorial in the “Annals of Internal Medicine,” Dowell noted “little evidence has been available to help weigh the benefits and harms of reducing or discontinuing opioids in patients already receiving long-term therapy or to guide clinicians in how to taper opioids safely and effectively.”

Other agencies, such as the Department of Health and Human Services (HHS) and the Food and Drug Administration (FDA), are moving ahead with their own guidelines on opioid prescribing and pain management. In August, FDA Commissioner Scott Gottlieb referred to the CDC guidelines as a commendable initial step, and said that his agency was working on developing evidence-based guidelines that would look at opioid prescribing.

In a rare acknowledgment of the depth of desperation among pain patients whose long-time opioid treatment had been abruptly cut down or cut off, Gottlieb expressed concern about suicides.

"In select patients and for certain medical conditions, opioids may be the only drugs that provide relief from devastating pain," Gottlieb said in a statement on the agency's website. "We’ve heard from some of these patients, and listened carefully to their concerns about having continued access to necessary pain medication. We’ve heard their fear of being stigmatized as a person with addiction, and the challenges they face in finding health care professionals willing to work with patients with chronic pain."

"Tragically, we know that for some patients, loss of quality of life due to crushing pain has resulted in increased thoughts of or actual suicide," Gottlieb said. "This is unacceptable."

Little evidence has been available to help weigh the benefits and harms of reducing or discontinuing opioids in patients already receiving long-term therapy or to guide clinicians in how to taper opioids safely and effectively.

— Dr. Deborah Dowell, lead author of the 2016 CDC guidelines on opioid prescribing

And this fall, Trump signed into law a bipartisan measure that calls on the FDA to assess “existing opioid…guidelines, examine how these guidelines were developed and any potential gap” in data.

Some experts say more should be done in the classroom to help better educate health professionals on treating pain.

“We have to look at our culture and attitude toward people with pain – and people with addiction – but mostly with pain,” said Dr. Lynn Webster, former president of the American Academy of Pain Medicine and author of “The Painful Truth: What Chronic Pain Is Really Like and Why It Matters to Each of Us.” “In our medical schools, there are less than seven hours on average of education about pain. Even though it affects more people than any other problem, it is the number one public health problem. But we’ve spent little on research to try to find a solution to this. We need to make pain and addiction a core of our medical education curriculum.”

RESEARCH INTO NON-OPIOID ALTERNATIVES

Webster has called for major funding in alternative pain treatment, which could offer relief with fewer risks and side effects. There’s also a need for quicker treatments for patients in urgent need of relief.

Stricter pre-authorization policies for prescription and non-opioid treatments, such as physical therapy, many times mean delays that leave patients in pain.

Several physicians told Fox News they’ve had to wait several days, or longer, for prescription pre-authorization. They also said there is much more paperwork required now in connection to pain management, leaving more room for error and, by extension, more potential for red flags that could lead to disciplinary action.

Most people interviewed by Fox News agreed there should be a concerted move toward a multi-faceted, more comprehensive way to treat pain. And, they stressed, because severe, unrelenting pain can lead to anxiety and depression, mental health must be an important part of treating the condition.

DOCTORS CAUGHT BETWEEN STRUGGLING OPIOID PATIENTS AND CRACKDOWN ON PRESCRIPTIONS

“There is a lack of multidisciplinary physicians and other health care providers who specialize in pain,” the AMA noted. “These physicians and other health care providers include pain specialists, addiction psychiatrists, psychologists, pharmacists, and others who are trained to be a part of the pain management team.”

Among the AMA recommendations was “Expand graduate medical residency positions to train in pain specialties including adult pain specialists, pediatric pain specialists, behavioral health providers, pain psychologists, and addiction psychiatrists,” and “expand availability of non-physician specialists including, but not limited to, physical therapists, psychologists, and behavioral health specialists.”

Some physicians and pain patients would like to see medical marijuana legalized in more states, and on the federal level. Military veterans who get their medical treatment from Veterans Administration health facilities say that even if they reside in states where cannabis is legal for health reasons, they cannot get a prescription because it is not legal on a federal level.

"My patients have benefitted by many opiate alternatives," said Montana-based Dr. Mark Ibsen, who stopped prescribing opioids after running into trouble with state medical officials and the DEA over allegations, which he said were untrue, that he was unjustifiably giving high doses to pain patients. "Eighty percent of my patients on opiates got off with cannabis."

Ibsen, whose license was reinstated, and who was never charged, said: "The key is to create a context for healing, which empowers the patient to interact with pain and their life in the most effective manner possible, and let go of what no longer works."

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Dr. Daniel Alford, the associate dean at Boston University’s School of Medicine’s Office of Continuing Medical Education, is on a mission to ensure that the next generation of doctors are better equipped to make decisions about safe opioid prescribing.

"We've been over-reliant, too opioid-centric in terms of our prescribing for chronic pain," Alford said. "Opioids shouldn't be the first choice, they should really be the last choice. But if opioids are to be prescribed, how do you do it in a way that maximizes risk to that patient. We should try to minimize dose escalation."

A prioirty, Alford said, is to improve the patient's quality of life.

"It's important to acknowledge and appreciate a person's pain, for them it's real," Alford said. "Until we have some method to say 'This is exactly where [the] pain is, our responsibility is to say 'I believe you.'"

Most of the time, he said, there's "zero percent risk" of being deceived by the patient.

"Based on their risk profile, to the best of your ability, you think about what treatment is best for them," he said.

If tapering is necessary, "I'm going to taper over a long period of time, I'm going to try to keep the patient engaged and I'm going to try to do what's really really hard, I'm going to try to get the patient into other forms of treatment," Alford said, adding that multi-modal treatment plans, combining medication and other therapy, often are successful.

But the approach won’t go very far if insurers won’t cover non-opioid or multidisciplinary treatments, health experts said.

“Insurance won’t pay for many evidence-based treatments,” said Michael Schatman, a clinical psychologist who runs Boston Pain Care, which uses an array of programs – including exercise, psychotherapy as well as prescription painkillers—to treat pain. “My program loses money every year.”

“Some patients need to be tapered, some need to be taken off opioids, they’re not good for everyone, but there’s a void because of our health care system,” he said.

At Boston Pain Care, patients go through multiple treatments simultaneously. Shatman claims it is more effective than the status quo approach, which often involves trying one treatment, perhaps two, which may not work. Often, patients are pressed to try different therapies, one at a time, until one offers some improvement.

“Sequential pain management is an incredible failure,” Schatman said. “As long as we have a for-profit insurance agency, it’s not going to get much better. We’re seeing the devolution of the profession of pain medicine to the business of pain medicine.”

MORE DIVERSE VOICES IN DISCUSSIONS ABOUT SOLUTIONS

The debate over opioids and pain management has become emotional, with the overdose crisis and the dearth of reliable data fanning the flames.

Some of the leading voices on different sides of the debate are calling for unity toward working on finding solutions to both pain management and the overdose crisis.

Schatman said he would like to see health experts who are firmly opposed to opioids sit at a table with peers who are supportive of them as a beneficial treatment and bat around ideas.

Many pain experts and health researchers say that committees for agencies such as CDC should include specialists in pain and pain patients.

Dr. Stephen Gelfand, a rheumatology consultant from South Carolina, was quoted in OpioidInstitute.org saying that forced tapering is concerning. But, he added, “there is also a significant percentage of these patients who actually have the disease of addiction and need addiction treatment services including medication-assisted therapy.”

And so, he said, “we also need to have victim advocates who have survived and overcome the scourges of addiction as the result of opioid overprescribing to sit on these patient advisory boards at every level of decision-making.”

Elizabeth Llorente is Senior Reporter for FoxNews.com, and can be reached at Elizabeth.Llorente@Foxnews.com. Follow her on Twitter @Liz_Llorente.

Tough new opioid policies leave some cancer and post-surgery patients without painkillers

Despite protestations that new federal and state hard lines on painkiller prescriptions do not affect cancer patients or people fresh out of major surgeries, many of those in health care’s trenches feel differently.

Dr. Dan Laird was treating an elderly man in Nevada who, despite efforts by the physicians and other doctors to save his leg, ended up having to undergo an amputation. “He lost the battle, his leg was cut off,” Laird said.

The surgery took place on a weekend in the fall. On Monday, the man called Laird in agony and desperation. He had been discharged from the Valley Hospital Medical Center in Las Vegas during the weekend, with no painkiller prescription.

DOCTORS CAUGHT BETWEEN STRUGGLING OPIOID PATIENTS AND CRACKDOWN ON PRESCRIPTIONS

“No pain medication!” Laird told Fox News in an interview. “Having a limb amputated is one of the most painful things you can have done. And the tibia is one of the most painful parts of the leg. He had unimaginable, horrific pain. I was so mad, I called the hospital.”

“They said that the new [Nevada] law means we can’t prescribe to patients when we discharge them,” Laird said, recalling what he said he was told.

But Laird is also a malpractice attorney – and knew the state law chapter and verse.

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Laird said confusion over national and state policies and regulations concerning opioid prescribing is common among health practitioners. “The state law is ridiculously long. I’d prescribed my patient opioids for months, and because he had been receiving opioids from another physician," a hospital doctor did not prescribe any painkillers.

A spokesperson for the hospital contacted by Fox News did not offer comment for the story.

AS DOCTORS TAPER OR END OPIOID PRESCRIPTIONS, MANY PATIENTS DRIVEN TO DESPAIR, SUICIDE

Nevada’s opioid law, which took effect in January, limits the first prescription of opioid for acute pain to seven days and increases the amount of paperwork that must be filed for preauthorization for long-term painkillers.

In his 25 years of practicing medicine, Laird said, “I’ve never seen anything like this, an environment where it’s acceptable to mistreat chronic pain patients, where there’s an animus toward chronic pain patients.”

No pain medication! Having a limb amputated is one of the most painful things you can have done. And the tibia is one of the most painful parts of the leg. [The patient] had unimaginable, horrific pain. 

— Dr. Dan Laird

Like many health care providers, Laird said it’s right to take a hard look at opioids, and prescribing practices that needed tightening.

“Opioids are dangerous drugs. They have to be prescribed with extreme caution,” he said. “But for people who’ve had their leg cut off, or someone who has cancer, or has been in a bad car crash, there’s nothing worse than leaving them in pain.”

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“There’s anticipatory panic, (among physicians)” Laird said. “Doctors perceive a liability for prescribing opioids.”

In Michigan, Dr. Fran Van Alstine, a specialist in palliative and hospice care at the Munson Medical Center, has also seen how far the long arm of the war on opioids can reach.

HEALTH EXPERTS OFFER SOLUTIONS FOR UNINTENDED CONSEQUENCES OF OPIOID CRACKDOWN

The state has a 14-day day limit on opioid prescriptions, even for patients like his, who have advanced cancer, chronic lung disease, congestive heart failure.

He said he recently had to jump through hoops to get a painkiller refill for a terminally ill patient who was released from a hospital, and about to enter hospice care. The insurer denied the prescription because the man’s medication record showed “red flags” – opioids prescribed by more than one doctor, at high dosages.

“Our patients have been in and out of hospitals. They get prescriptions from different doctors, they have serious, life-limiting illnesses,” Van Alstine said. “They’re actively dying and in pain. We put in a diagnosis in his records, so there’s no question what we’re using the opioids for. [The restrictions] are an exercise in silliness. In hospice, addiction is the last of our concerns.”

The man died 24 hours after finally getting a refill – spending his final days in pain.

Elizabeth Llorente is Senior Reporter for FoxNews.com, and can be reached at Elizabeth.Llorente@Foxnews.com. Follow her on Twitter @Liz_Llorente.

Generic drugmaker to sell alternative to EpiPen injectors

Generic drugmaker Sandoz announced plans Thursday to start selling an alternative to the EpiPen in the U.S. early next year.

The EpiPen injector is used to halt life-threatening allergic reactions to insect bites, nuts and other foods. Brand-name EpiPen, which dominates the market, has been in short supply since spring because of production problems.

Sandoz will sell prefilled syringes with the same medicine, the hormone epinephrine, under the name Symjepi. The price will be $250 for two, without insurance.

Two generic versions of EpiPen are sold in the U.S. for $300 a pair, including one from EpiPen seller Mylan. The company started selling its own generic after it was blasted for repeated hikes that pushed up its list price from $94 to $608 for a pair of brand-name EpiPens.

What people pay varies, though, depending on insurance, discounts and the pharmacy.

MOM WITH CANCER WHOSE SEARCH FOR BONE MARROW DONOR WENT VIRAL GIVES BIRTH TO TWINS

Mylan's injectors are made by a subsidiary of Pfizer, which is upgrading factories to fix quality problems. That resulted in production slowdowns. Pfizer said Thursday it's shipping some injectors and expects to ship more in the coming months.

The shortages triggered temporary shortages of other similar products, including Auvi-Q. As a result, U.S. regulators let some manufacturers extend expiration dates.

Sandoz, part of Novartis AG., will sell syringes with an adult dose made by Adamis Pharmaceuticals Corp. A children's version will follow.

Israel's Teva Pharmaceutical Industries began selling limited quantities of its new generic EpiPen in the U.S. last week.

FDA finds traces of heavy metals in kratom products

The U.S. Food and Drug Administration said on Tuesday it had found high levels of heavy metals such as lead and nickel in some kratom products, following field investigations.

The regulator has been clamping down on the substance, which advocates say help ease pain and reduce symptoms of opioid withdrawal, but which the FDA says has similar effects to narcotics such as opioids and has resulted in dozens of deaths.

SOUTH DAKOTA REPORTS FIRST FLU DEATH OF SEASON

Levels of metal in kratom-based products would likely not result in poisoning based on single use, but could cause people to suffer if used persistently, FDA commissioner Scott Gottlieb said.

"The findings of identifying heavy metals in kratom only strengthen our public health warnings around this substance," Gottlieb said here in a statement.

While kratom is not controlled under the Federal Controlled Substances Act, the U.S. Drug Enforcement Administration has listed it as a “drug and chemical of concern”.

CASES OF MYSTERIOUS POLIO-LIKE ILLNESS HIGHEST IN US SINCE 2016, CAUSING CONCERN

Leaves of the kratom tree, native to Southeast Asia, can be used as a stimulant or sedative.

The FDA said it was contacting the companies marketing kratom products to inform them of the metal testing results.

The agency has in the past issued warnings against companies marketing these products for opioid use disorder, and has warned of high rates of salmonella in the products.

FDA finds traces of heavy metals in kratom products

The U.S. Food and Drug Administration said on Tuesday it had found high levels of heavy metals such as lead and nickel in some kratom products, following field investigations.

The regulator has been clamping down on the substance, which advocates say help ease pain and reduce symptoms of opioid withdrawal, but which the FDA says has similar effects to narcotics such as opioids and has resulted in dozens of deaths.

SOUTH DAKOTA REPORTS FIRST FLU DEATH OF SEASON

Levels of metal in kratom-based products would likely not result in poisoning based on single use, but could cause people to suffer if used persistently, FDA commissioner Scott Gottlieb said.

"The findings of identifying heavy metals in kratom only strengthen our public health warnings around this substance," Gottlieb said here in a statement.

While kratom is not controlled under the Federal Controlled Substances Act, the U.S. Drug Enforcement Administration has listed it as a “drug and chemical of concern”.

CASES OF MYSTERIOUS POLIO-LIKE ILLNESS HIGHEST IN US SINCE 2016, CAUSING CONCERN

Leaves of the kratom tree, native to Southeast Asia, can be used as a stimulant or sedative.

The FDA said it was contacting the companies marketing kratom products to inform them of the metal testing results.

The agency has in the past issued warnings against companies marketing these products for opioid use disorder, and has warned of high rates of salmonella in the products.