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Dear Judges,

In late April 2016, federal and local law enforcement agents conducted a raid on a Reno-area car dealership and doctor’s office following a months-long investigation into a pain pill drug ring. Nine people were arrested, including the general manager of the car dealership and a well-known family physician for their roles in the drug ring. Prosecutors alleged the drug ring distributed oxycodone and other opioids from the car dealership while the doctor, Robert Rand, distributed pain pills for non-medical purposes. Prosecutors also alleged the drug ring was linked to 60 deaths in the Reno area, including the death of a form University of Nevada, Reno football player.

When the story broke, the Reno Gazette-Journal aggressively pursued a series of explanatory and investigative stories exploring Nevada’s lax regulatory environment for opioids — the highly addictive narcotics used to treat pain. Through the reporting by Anjeanette Damon and Jason Hidalgo, the RGJ found that Nevada lawmakers haven’t created programs like other states to monitor pain pill prescriptions because of lobbying from the medical community. Damon and Hidalgo also found that Nevada has a disproportionately high number of narcotics prescribed to its citizens compared to other states. For example, Damon and Hidalgo found that Nevada doctors wrote 94 prescriptions for pain pills for every 100 Nevadans — a statistic that “scared the hell” out of the governor’s chief of staff.

Following the RGJ’s reporting, Gov. Brian Sandoval called on the state to expand its prescription drug monitoring program to identify over-prescribers. Sandoval also demanded a review of Nevada’s pain killer regulations. Meanwhile, as the case continues to make its way through the federal court system, the RGJ was the only media organization to formally ask the court to unseal the thousands of document involved in the investigation — a request, while ultimately denied, was necessary to make in the name of government transparency. It is for these reasons we urge your support for the Community Service Award in this year’s Nevada Press Association Better Newspaper Contest. Thank you for any consideration.

Sincerely,

Newspaper Contest. Thank you for any consideration. Sincerely, Brian Duggan Investigations editor Reno Gazette-Journal

Brian Duggan Investigations editor Reno Gazette-Journal

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District charges per page for records

Families of children with disabilities face steep bills, barriers

SIOBHAN MCANDREW

SMCANDREW@RGJ.COM

When Katherine Gutierrez was told her son may have been abused by an em- ployee at Alyce Taylor Elementary in Sparks, she asked for copies of his school files.

She wanted to see witness statements about the treatment of her 9-year-old son, who has Down syndrome. She want- ed to see the statement from the employ- ee accused of calling her son a brat, yanking on his arm and pulling him up by his pants, according to school records. But before the working mom of three and her husband could review the hun- dreds of pages of documents to see what their son may have suffered, the district wanted $373.50. While the district eventually gave Gu- tierrez the files for free — after emails and calls to top district administrators —

other parents of children with disabili- ties will have to pay, said the Washoe County School District. In a new policy, the district said it is enforcing a fee of 50 cents per page for copies of records re- quested by parents of children with dis- abilities. The RGJ contacted the other 16 school districts in Nevada. None charge for copies of school records, even for large requests. Clark County provides one copy for free and charges a $5 flat rate for any subsequent copies, no matter how many pages. The district said it is following all

state and federal regulation in charging 50 cents a page and enforcing the policy for all families. “State law allows the district to charge $.50 per page for public records,” district spokesperson Victoria Campbell wrote in an email. “The Washoe County School District feels this is a reasonable amount — allowed by law — to charge for these records.” The intent of the law was to permit a government agency to recoup expenses for requests that may require redacting

See RECORDS, Page 11A

THE PILL PR BLEM DOCTORS WHO OVER-PRESCRIBE CAN ESCAPE SCRUTINY IN NEVADA ANJEANETTE DAMON AND
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See PILLS, Page 6A

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6A

Sunday, May 15, 2016

Reno Gazette-Journal

Pills

Continued from Page 1A

the community-wide turmoil cre- ated by a doctor who grew a prac- tice on prescribing habits a feder- al prosecutor has described as criminal. Among other charges, Dr. Robert Rand is accused of illegal- ly distributing a controlled sub- stance that resulted in the death of 33-year-old Michael Yenick. “This case has definitely high- lighted that a focus should be on the providers,” Reno police Dep- uty Chief Tom Robinson said last week. “The users, they’re often just a symptom of the problem.” As with many states, Nevada has a robust prescription drug monitoring program, a database of every prescription for a con- trolled substance filled in the state, including the dosage, the number of pills and both the pa- tient’s and prescriber’s identifi- cation. Unlike many states, however, Nevada relies on the program solely to red flag the patients who may be “doctor shopping” or fill- ing enough prescriptions to iden- tify them as a potential pill abus- er. The database, it is hoped, can be used to get those addicted to pills the treatment they need, regulators said. Similar criteria that could red flag a doctor’s prescribing prac- tices, however, haven’t been de- veloped and are actively opposed by professional licensing boards such as the Board of Medical Ex- aminers. “It would be inappropriate, and it’s not the intent of the (pre- scription monitoring program), to find cases to investigate,” said Edward Cousineau, executive di- rector of the Board of Medical Examiners, which licenses med- ical doctors and investigates mal- practice complaints in the state. In fact, Las Vegas police had to request special legislation last session to give investigators ex- plicit access to the database after the pharmacy board stopped al- lowing them access, according to testimony at the Legislature. The community is just start- ing to learn of the ripple effect created by Rand’s arrest as part of a months-long investigation into a pill mill that federal inves- tigators believe was operating out of the Jones West Ford car dealership. Rand was one of nine people arrested, including the dealer- ship’s manager Richard “Richie”

West II and seven of his present and past co-workers. West, and many of his co-defendants, were Rand patients, according to As- sistant U.S. Attorney James Kel- ler. Yenick, who died in October from alcohol and oxycodone in- toxication, also was Rand’s pa- tient. In West’s detention hearing, Keller argued Rand ran a special “family and friends” program that allowed his patients to es- cape routine examinations and access prescriptions for a high number of pills. Federal agents confiscated a list of names enrolled in that pro- gram during a search of the doc- tor’s office, Keller said. Even before the bust, Drug Enforcement Administration and FBI agents worried the fall- out would have a significant ef- fect on the medical community, the substance abuse treatment community and the patients who would no longer have access to Rand’s prescriptions. Agents be- gan to put together a task force of various agencies to address the fallout days before the bust. On Thursday, scores of doc- tors, emergency medical re- sponders, public health workers, addiction counselors, social workers and law enforcement met for the first time to discuss what was described as an opioid addiction crisis in Nevada. The discussion, however, quickly turned to Rand. Dr. Annemarie Campione said her family practice has taken on many of Rand’s patients. Rand re- mains incarcerated pending a de- tention hearing to decide wheth- er he should be released on his own recognizance to face the charges. Campione said many of his pa- tients use no pain medication and saw him for unrelated health is- sues. Some of those who sought pain treatment from him, howev- er, came to Campione’s practice severely dependent, unable to get new prescriptions and in a state of detoxification, she said. “They are on boatloads of drugs,” Campione said. “I can’t believe they’re still even breath- ing.” In a raw display of candor, Campione said the number of people was so overwhelming she wished the city could set up a tent to address their needs quickly. The Crisis Call Center has also fielded calls from patients who can’t find a new doctor or who are having non-pain medication pre- scriptions being rejected by

having non-pain medication pre- scriptions being rejected by BRIAN DUGGAN/RGJ Dr. Robert Rand's biography on his

BRIAN DUGGAN/RGJ

Dr. Robert Rand's biography on his website is pictured.

pharmacists. Statistics show that Nevada ranks in the top five states when it comes to prescribing certain pain pills. Overall, Nevada doctors wrote 94 prescriptions per 100 people in 2012, the latest data available. “That scared the hell out of me,” said Mike Willden, Gov. Bri- an Sandoval’s chief of staff. “That means every man, woman and child in Nevada had access to a prescription.” Stephanie Woodard, a clinical psychologist with the Nevada Di- vision of Public and Behavioral Health, said 94 prescriptions per 100 people puts Nevada just above average with other states. But a Reno Gazette-Journal analysis of DEA data showed that for certain drugs, Nevada ranks among the highest in the country. Take oxycodone, Nevada’s most widely prescribed opioid. In 2012, nearly 1.04 million grams was distributed via retail in the state. That’s more than double what doctors prescribed in 2006. Nevada’s distribution rate is third highest in the country. Nevada also ranks third for its hydrocodone distribution rate. In 2012, doctors prescribed more than 799,000 grams of hydroco- done -- nearly three times the rate of New Jersey, which has tri- ple Nevada’s population. Woodard said the reasons for the high prescription rates aren’t totally clear, but could be attrib- uted to the fact that in 1999, med- ical professionals listed pain as the fifth vital sign to assess for a patient’s well-being. Some doc-

tors are advocating for that prac- tice to stop. While a high distribution rate isn’t necessarily an indication that doctors are acting criminal- ly, some states are using their prescription drug monitoring programs as both an investiga- tory tool to flag bad actors and educate doctors about their pre- scribing habits. That’s not necessarily happen- ing in Nevada. Federal agents involved in the investigation into Rand won’t comment on the case, saying the investigation is continuing and more indictments may be com- ing. But a Reno police source said it wasn’t the prescription moni- toring program that initially flagged Rand as a suspect. That happened after evidence was un- covered of illicit drug use and in- tensified in the wake of Yenick’s death. The monitoring program then showed the extent of Rand’s prescribing habits. Rand’s indictment alleges the doctor began illegally distribut- ing controlled substances in 2012. Robinson admitted that most of his department’s investiga- tions are targeted on the users and the peddlers of pain pills, not the prescribers. He said there could be a stronger role for li- censing boards to play, but added they typically don’t have the re- sources to mine data for problem prescribers. The Board of Medical Examin- ers won’t comment on complaints against its doctors until it’s been through an investigation and re- sults in a formal complaint filing.

an investigation and re- sults in a formal complaint filing. JASON BEAN/RGJ A law enforcement official

JASON BEAN/RGJ

A law enforcement official is seen during a raid on the home of Richard West Jr. in Reno on April 28.

No public documents on com- plaints against Rand exist. According to a Reno Gazette- Journal review of publicly avail- able complaint documents, the Board of Medical Examiners has launched 20 formal investiga- tions into doctors accused of some sort of prescription irregu- larity involving pain medication since 2013. Fifteen resulted in some sort of disciplinary action, including a public reprimand, probation or li- cense suspension. Attacking Nevada’s prescrip- tion drug program was one of Sandoval’s top five priorities in last year’s legislative session, Willden said. He introduced an omnibus bill that included legal protections for those who seek help for some- one who has overdosed and al- lows for expanded distribution of naloxone, which can reverse the effects of an opioid and stop an overdose from killing, to first re- sponders and friends and family

members of addicts. But when it came to imple- menting more reporting and edu- cation requirements on doctors, Sandoval had a fight on his hands. The bill initially required that doctors receive two hours of con- tinuing education on opioid ad- diction every year. The bill that passed allows licensing boards to recommend doctors take one hour of training a year. The legislation also included a new requirement that doctors check the prescription drug mon- itoring database before prescrib- ing a narcotic to a new patient in certain cases. Another requirement: the pre- scription drug monitoring pro- gram now must send copies of the reports generated on a potential doctor-shopping patient to the prescriber’s licensing board. According to the minutes of the legislative hearings on the bill, the medical community fought against the additional re- quirements for doctors. In the

bill’s first hearing before the As- sembly Healthcare Committee, only doctors testified against it. They cited concerns that doc- tors would be afraid to make le- gitimate use of pain pill prescrip- tions for patients they’ve known and cared for. And they said doc- tors shouldn’t have to worry about Big Brother looking over their shoulders. “It makes me pause every time I start to write a script for any controlled substance; I should not have to feel like that,” Dr. Ivan Goldsmith of Las Vegas told lawmakers during the hear- ing. “At the end of the day, the doctor and the patient have the relationship, not the government in the middle. Doctors should be the ones who decide what is best for their patients. This bill has a chilling effect on that.” What resulted was a compro- mise on how the prescription drug monitoring program should be used to flag problem prescrib- ers.

Willden said the state needs to strike a balance in over-regulat- ing doctors to the point they don’t want to practice here. Nevada suffers from a severe doctor shortage in many disciplines as it

is. “We don’t want to look like a state that’s holding a 10-pound hammer and have doctors think- ing we’re looking over their shoulder every second,” Willden said. He said the new law should be given time to work before asking for stricter legislation. The Pharmacy Board, which runs the prescription drug mon- itoring program, is responsible for sending reports on potential pill abusers to the boards that li- cense prescribers such as doc- tors, nurses and dentists. But it’s up to the different licensing boards to decide how to use those reports. According to interviews, each board treats the reports differ- ently.

Reno Gazette-Journal

Sunday, May 15, 2016

7A

First, the pharmacy board doesn’t believe it has a role in flagging prescribers that show a troubling pattern. The board sets criteria for flagging a patient, such as how many different doctors a patient is getting prescriptions from, and how many prescriptions they are filling in a certain time peri-

od. But executive director Larry Pinson said it would be inappro- priate for the board to set similar criteria to flag a doctor. “Who’s to say what’s normal or what’s OK,” Pinson said. “It might be appropriate for a physi- cian to be prescribing a ton of narcotics according to his spe- cialty.” Pinson said that’s not meant to minimize the problem with opioid addiction or the program’s role in combating it. “The governor’s office has a real legitimate concern,” he said. “There are people who are just simply dying because they are taking too many narcotics. They are dying and we need to do something about that. “The goal is not to get people arrested and put in jail, but get them the treatment they need and get them fixed.” So, the reports on individual patients go to the various licens- ing boards. Then what? The Board of Medical Examin- ers, which licenses the bulk of the state’s doctors, said they use the reports to remind doctors to check that their patients aren’t suffering from an addiction. It would be inappropriate to use them to initiate an investigation, Cousineau said. “I’ve talked to many doctors over the years and they’ve im- plored me, they don’t want con- straints, whether through statute or regulation, that limits their subjective ability to treat pa- tients,” Cousineau said. “Ninety- nine percent of doctors are doing the right thing.” The Nursing Board goes a lit- tle further, asking their practitio- ner to send a letter back to the board describing why the opioids being prescribed to a patient who has been red flagged is appropri- ate, said executive director Cathy Dinauer. Barbara Longo, executive di- rector of the Board of Osteopath- ic Medicine, said they have been monitoring the reports from the pharmacy board and so far haven’t seen any of their licens- ees prescribing large amounts repeatedly to red-flagged pa- tients.

Longo said the board uses the database to investigate a com-

plaint received on a doctor, but doesn’t use it to initiate investiga- tions. “We don’t just randomly run our providers, no way,” she said. “But if we have a complaint that alleges that is happening, that is part of the investigation to (run the provider through the data- base.)” While Nevada has resisted us- ing the database to find problem prescribers, other states have found success in reducing distri- bution and overdose rates by making broader use of the pre- scription drug monitoring pro- gram.

A 2014 study by the Prescrip-

tion Drug Monitoring Program Center of Excellence at Brandeis University found the programs “are uniquely positioned to help identify prescribers at risk of over-prescribing or prescribing inappropriately.” The data can be used to find prescribers who deviate from ac- cepted medical practices and al- low licensing boards to inter- vene, the study found. Interven- tion can include better education or a more formal investigation process. Other states have deployed the program in a variety of ways to do just that. In Arizona, the pharmacy

board created prescriber report cards that identify doctors pre- scribing at a statistically higher rate than their peers. The prac- tice has raised awareness among prescribers, and the state has seen a reduction in the amount of pain medication prescribed in some counties. Other states, such as Tennes- see, Texas and Kentucky, report abnormal prescribing data to li- censing boards and law enforce- ment. Still others conduct out- reach to physicians with a high number of doctor-shoppers at their practice. “Identifying and intervening where appropriate with at-risk prescribers is a key strategy in efforts to control prescription drug misuse and diversion,” the report said. “The CDC has re- cently recommended focusing efforts on prescribers not follow- ing accepted medical practice.”

A local law enforcement offi-

cer also suggested the state could better track drug overdose deaths, looking up the deceased’s prescription history in the data- base to see if any related doctors have troubling prescription prac- tices.

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Sandoval

Continued from Page 1A

The state announced at the public meeting that it has received grant money to hire biostatisticians to improve tracking of pre- scriber and patient data at the geographic and demo- graphic level. An investi- gation by the Reno Ga- zette-Journal in May found that overprescrib- ing doctors can escape scrutiny in Nevada be- cause the program focus- es on pill users but not pre- scribers. There was pushback from the pharmacy board about expanding use of the Prescription Monitor- ing Program to catch phy- sicians who prescribe a large amount of painkill- ers. Figuring out how much is too much when

determining whether a physician is an overpre- scriber is something that is not clear cut, said Larry Pinson, executive secre- tary of the Nevada State Board of Pharmacy. “What’s the line?” Pin- son said. “Who’s going to draw those lines?” The pharmacy board also stressed that the Pre- scription Monitoring Pro- gram was only designed to track doctor shoppers, not overprescribers. A board representative con- firmed, however, that pre- scribing data is part of the information that the pro- gram captures. Representatives of the Board of Medical Examin- ers also cautioned against making hasty actions when addressing the is- sue, warning that it could cause unintended conse- quences. Sandoval, how- ever, said doing nothing when there’s a clear prob-

lem with opioids is not good and that there is “something systemic” that needs to be ad- dressed. “Status quo isn’t work- ing and we need to do something,” Sandoval said. One point everyone agreed on is that there is a problem and addressing the issue will not be easy. Funding challenges for existing programs and new options that could make a difference were mentioned several times during the meeting. There’s also the balanc- ing act faced by prescrib- ers between helping pa- tients with a legitimate need and watching out for those who abuse the medi- cations. Part of the chal- lenge is the legal tightrope that some prescribers say they have to navigate, es- pecially given the in- creased attention on the

painkiller epidemic. “Is it a medical prob- lem or is it a legal prob- lem?” one prescriber said during public comment. “That needs to be ad- dressed first.” The strongest testimo- ny in the meeting came, however, from people who talked about how painkiller addiction has impacted themselves and their families. The com- ments included vivid de- scriptions of the slow de- scent of loved ones into opioid abuse, with some leading to deadly results. Such experiences show why it is important to ad- dress the problem and “seek answers, not ex- cuses,” Sandoval said. “I’ve seen the reports, you’ve seen the reports, I’ve listened to the experi- ences of the families and their grieving,” Sandoval said. “They want an- swers.”

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cancer or heart disease before the pain??? Sadly pain is often the final symptom. This
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CowGirl Zero Da Bull One

Mrs. W at 31 years of age presents for examination. She is referred by her husband a satisfied patient. She has suffered from chronic severe pain in the right pelvis and groin for 12 years and has been completely disabled all this time. She is medicated with

fentanyl an opioid narcotic for pain.

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and treatment was pain medication and monthly injections. Her examination revealed a severe

posterior external rotation of the right Ilium, partially separated from the sacrum, lumbar, cervical and cranial sacral subluxations. From these examination findings I knew the cause was a traumatic event. Upon further review she remembered she did suffer trauma. At 19 years of age she was dating a rodeo rider and decided she could ride a BULL. Her first and last bull ride lasted only a second and ended with an impact, buttocks/pelvis spine and head to the arena. She was sore and bruised but walked away. Now many years later just prolonged sitting was enough to trigger her pain. The number one reason people come to my office is pain, all too often pain is the last symptom. The problem has been ongoing yet silent. Often I see patients in horrible pain from doing virtually nothing. I ask you how long can one have

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TODAY’S

Panama leak only tip of Nevada iceberg

Dozens of firms creating slew of shell companies with foreign addresses

STEVE REILLY USA TODAY

Mossack Fonseca, the focus of the Panama Papers leak, is far from the only company mass-producing shell compa- nies in secrecy-friendly states like Wyo-

ming, Nevada and Delaware. A USA TODAY examination of the limited records that are available — some states are making corporate rec- ords increasingly invisible — shows that Mossack Fonseca registered less than 2 percent of the Nevada “companies” that are linked to addresses outside the Unit- ed States. A similar review of Wyo- ming’s more secretive records shows that just 24 of more than 2,000 foreign- based businesses registered since 1990

were created by Mossack Fonseca’s Wyoming branch. The states have become willing part- ners in the lucrative front-company business that generates millions of dol- lars in revenue for the government. Indeed, the review of corporate-reg- istration data shows there are more than 50 firms in Nevada that have registered as many or more different companies than Mossack Fonseca, and many with bundles of businesses tracing back to

shared addresses in places from Pana- ma to islands off the European coast. The motive for U.S. states appears to be simple: mountains of cash. In Delaware, which does not levy sales or personal property taxes, reve- nue from the state’s Division of Corpora- tions totaled $928 million in 2014 — near- ly 30 percent of the state’s overall tax revenue. Almost 90 percent came from

See PANAMA, Page 10A

THE PILL PR BLEM RANKING NEVADA Opioid epidemic taxing lives, communities Opioid painkiller distribution among
THE PILL PR
BLEM
RANKING NEVADA
Opioid epidemic taxing lives, communities
Opioid painkiller distribution among U.S. states
and territories and amount distributed in Nevada.
JASON HIDALGO
JHIDALGO@RGJ.COM
OXYCODONE
Growing up in the 1960s, Denise Everett was shy and somewhat socially awk-
ward. For a Southern California teenager who wanted to fit in with her peers, it
was not an ideal combination. ¶ Everett would eventually find her version of
courage through various substances. It started with alcohol around age 16. ¶ “I
discovered it was a wonderful social lubricant,” Everett said. ¶ After enrolling
in Chico State — considered the No. 1 party school west of the Mississippi —
alcohol continued to be Everett’s substance of choice. But she also dabbled in
other popular drugs, including marijuana, amphetamines and cocaine. Everett’s
dependence would cost her. ¶ “I didn’t finish college,” said Everett, who moved
‘12
1.04 million grams
‘06
514,544 grams
HYDROCODONE
‘12
799,452 grams
‘06
604,561 grams
MORPHINE
‘12
346,309 grams
‘06
274,282 grams
See PAINKILLERS, Page 6A
CODEINE
Pharmacy technicians Julie Railey, right, and Erin Zepkowski work at Campus Pharmacy at the University
of Nevada, Reno on Thursday. JASON BEAN/RGJ
‘12
169,571 grams
‘06
202,535 grams
33333333333333333RRRRRRRRRRRRRRRRRRRRRRRRRRRRRDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDD
33333333333333333RRRRRRRRRRRRRRRRRRRRRRRRRRRRRDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDD
5555555555555555TTTTTTTTTTTTTTTTHHHHHHHHHHHHH
5555555555555555TTTTTTTTTTTTTTTTHHHHHHHHHHHHH
SOURCE: U.S. DEA
|
GANNETT

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Why has the old clock stopped ticking? When will it be fixed?

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6A

Sunday, May 29, 2016

Reno Gazette-Journal

Painkillers

Continued from Page 1A

to Reno afterward. “I just couldn’t seem to keep things together to finish.” It wasn’t until the late ’80s that Everett sought help and turned her life around, eventually earning a master’s degree in counseling and education psychology in

1992.

Today, Everett works as the director of Access to Healthcare Network’s care man- agement department. Given her past prob- lems plus decades in various jobs that tackled dependency, Everett has had a front row seat to the drug abuse problem. “There always seems to be a ‘drug du jour,’” Everett said. “Now there’s the opioid epidemic.” The confluence of high prescription rates, poor disposal habits and the notion that pain pills are legal and therefore “saf- er” has led to an explosion in opioid medi- cation abuse in the United States. Meanwhile, the centers tasked with helping its victims find themselves squeezed after the rise of managed care in the United States, which put more empha- sis on a profit-based model of healthcare. “We have fewer resources for sub- stance abuse disorders in Washoe County now than we did when I got sober 29 years ago,” Everett said. “It’s just not a lucrative field.”

Hitting home in Nevada

For many people who abuse prescrip- tion pain medication, the problem typical- ly starts out as a normal treatment for pain, said Leslie Baker, a campus pharma- cy manager at the University of Nevada, Reno and geriatric pharmacist at the San- ford Center for Aging. In the case of opioids such as oxycodone and hydrocodone, the drugs work by bind- ing to receptors in the brain and mimick- ing chemicals it produces to block pain sig- nals. Large doses over time can build toler- ance, however, requiring even bigger dos- es to get the same effect. “It’s like having four beers every night and pretty soon you don’t get the same feel- ing anymore,” Baker said. “So you start drinking six beers a night.” Large frequent doses can also cause the body to stop making those chemicals, lead- ing to severe withdrawals should a person quit using the drugs. At this point, it is now a full-blown addiction. Once it gets to this juncture, the downward spiral begins for many caught in addiction’s grasp. “Addiction is really about the loss of control,” said John Firestone, executive di- rector and counselor at recovery facility The Life Change Center. “You can choose to use a drug, but once you lose control, the idea of choice is no longer the same.” Further complicating the problem in Nevada is the state’s high rate of prescrip- tions for opioids such as oxycodone and hy- drocodone.

tions for opioids such as oxycodone and hy- drocodone. PHOTOS BY JASON BEAN/RGJ A bottle of

PHOTOS BY JASON BEAN/RGJ

A bottle of hydrocodone is seen at Campus Pharmacy at the University of Nevada, Reno Thursday.

Campus Pharmacy at the University of Nevada, Reno Thursday. “You can choose to use a drug,

“You can choose to use a drug, but once you lose control, the idea of choice is no longer the same.”

JOHN FIRESTONE

EXECUTIVE DIRECTOR AND COUNSELOR AT THE LIFE CHANGE CENTER

According to the latest data available from the U.S. Drug Enforcement Admini- stration, Nevada ranked third in the nation for its rate of oxycodone distribution based on its population in 2012. That year, Nevada retail outlets distributed 1.04 mil- lion grams of oxycodone — more than dou- ble the amount in 2006. The amount is also double the distribution of Illinois, which has five times Nevada’s population. State distribution rates ranked third for hydro- codone and fifth for morphine and co- deine. Doctors in the state also prescribed 94 pain pills per 100 people in the state dur- ing that year. Nevada’s high distribution rates for opioids such as hydrocodone was accom- panied by another trend. “We have seen a steady increase in ER and inpatient encounters (for opioids), at least between 2010 and 2014,” said clinical psychologist Stephanie Woodard of the Ne- vada Division of Public and Behavioral Health. Nationally, usage has been trending younger, with people ages 25 to 45 now ac- counting for most prescription pain pill use, according to the DEA. The agency also started to see increased usage several years ago in those age 18 to 25, said Sarah Pullen, a group supervisor with the DEA’s Los Angeles division, which oversees Ne- vada. In Washoe County, the prescription pain pill epidemic has exacted a human toll. In 2015, opioid painkillers caused 48 overdose deaths. The number is down from 72 deaths in 2011. The issue hit close to home in Northern

Nevada with the death of former Nevada and Bishop Manogue High School football player Michael Yenick in October from an oxycodone overdose. The 33-year-old’s death triggered a federal investigation that led to the arrest of several people as part of an alleged drug ring, including Re- no physician Dr. Robert Rand. “There’s been a downward trend in overdose death rates, but it’s still pretty appalling,” said Mike Willden, chief of staff for Gov. Brian Sandoval. “This didn’t start yesterday or even two years ago, this has been problematic years and years ago.”

‘Skittles parties’

For people in the medical field, recov- ery services and government, the reason for Nevada’s high prescription rates for opioids remains a mystery. “I really don’t know,” campus pharma- cy manager Baker said. “It’s a little baf- fling, actually.” Baker thinks it’s just prescribing habit. Clinical psychologist Woodard believes it likely stems from a decision in 1999 by medical professionals to emphasize pain as a key indicator for a patient’s well-be- ing. Once considered an undertreated prob- lem nationwide, the increased emphasis on alleviating pain caused the pendulum to swing to the other side. Others also pointed to marketing efforts by pharmaceutical companies, not just to consumers but doc- tors as well, for contributing to the issue. As a general rule, the Pharmaceutical

to the issue. As a general rule, the Pharmaceutical Pharmacy technicians Julie Railey, right, and Erin

Pharmacy technicians Julie Railey, right, and Erin Zepkowski work at Campus Pharmacy at the University of Nevada, Reno on Thursday.

Research and Manufacturers of America (PhRMA) says it does not get involved in how its members promote their drugs. “We can’t as a trade association tell our members not to advertise,” said Priscilla VanderVeer, PhRMA deputy vice presi- dent of communications. “It goes against antitrust requirements.” Physicians are limited these days in the types of benefits they can receive from pharmaceutical companies, Baker said. Drug samples have become more tightly controlled as well within the last 10 years, Baker added. Big Pharma also has less incentive now to promote its opioid drugs. With Oxycon- tin coming off patent in 2013, for example, generics have taken over the market, with insurance providers preferring their low- er cost. According to PhRMA, more than 95 per- cent of drugs abused today are generic be- cause they don’t have abuse-deterrent for- mulations such as pills designed to be un- crushable or that turn gelatinous when liq- uefied to make them difficult to inject. “Obviously, we’re aware of the criti- cism against us, but we don’t want to get into an argument about whose fault it is,” VanderVeer said. “What we’re saying is we have a problem and we should fix it.” There is an even greater sense of urgen-

cy to fix the problem as it starts to affect larger populations. One big concern in- volves usage by children, including gath- erings known as “Skittles parties.” These parties feature an assortment of pills that kids have procured from their family’s medicine cabinet and are dumped together for participants to pick from. The drugs range from Valium, Prozac and Xanax to opioids such as Oxycontin and Lortab. Nevada is not exempt from children ex- perimenting with prescription drugs. “We’re concerned with what we’re see- ing in the Nevada Youth Risk Behavior Survey with roughly 1 in 5 kids indicating that they have taken a prescription drug that they don’t have a prescription for,” Willden said. “That’s alarming.” In addition to drugs potentially harming children who may have pre-existing condi- tions, mixing various prescription drugs can be harmful to healthy kids as well. Mixing an opioid like Oxycontin with ben- zodiazepines such as Xanax is a toxic com- bination seen in many overdose deaths. Of more than 16,600 overdose deaths in 2010, 30 percent involved a combination of an opioid and benzodiazepine, according to the Centers for Disease Control and Pre- vention. Mixing opioids with alcohol can be dangerous as well. “Just because they found it in their par-

ents’ medicine cabinet or grandpa’s night stand, they bring it to a party because it’s a prescription pill so they think it must be safe,” VanderVeer said. “This tends to be their first exposure to these medicines, which is bad.” Add a feeling of invincibility and chil- dren and prescription drugs can be a dan- gerous mix, said the DEA’s Pullen. “One thing we’ve found across the board with young people is a tendency to believe that a prescription drug is safer than an illicit drug,” Pullen said. “We know many prescribed opioids are every bit as strong and addictive as any street drug.”

No easy fix

Just as there is no magic wand for ad- diction, there is no easy solution for fixing the opioid epidemic. One challenge is that it involves a large ecosystem with many players, such as doc- tors, hospitals, pharmacies, drug compa- nies and consumers. “There are a lot of factors that make this difficult,” Firestone said. “You’re looking at a really big system, so it’s not as easy as just using common sense and throwing it to the medical community.” In addition to educating the public, edu- cating medical professionals more about

Reno Gazette-Journal

Sunday, May 29, 2016

7A

pain was mentioned frequently by several sources. Schools such as the University of Nevada School of Medicine already have such measures in place, according to spokeswoman Anne McMillin. “We do have required activities in which students are educated on pain man- agement and opioid use,” McMillin said. The activities include teaching pharma- cology and substance abuse to first- and second-year students and acute and chron-

ic pain management for third years.

Some, however, say there needs to be continuing education for doctors as well. Prescribing habits, for example, can vary from one physician to another, and doctors must have a clear understanding of the im- pact their prescription philosophy for pain can have on patients, PhRMA’s Vander- Veer said. Although PhRMA does not tradi- tionally take positions on treatment guide-

lines, the organization says there should be

a discussion on the proper treatment re-

gimens for acute pain and chronic pain. “There are appropriate uses of these medicines, like patients who have had ma- jor surgeries or devastating accidents or some form of cancer,” VanderVeer said. “At the same time, somebody who got their tooth pulled probably does not need a 30- day supply of opioids.” Use of non-opioid painkillers as well as non-drug alternatives are gaining an in- creased look due to the increased attention on the opioid epidemic. There also are in- dications that opioid prescribing is down over the last 18 months in response to the national spotlight on the problem, Vander- Veer said. At the same time, suddenly curtailing the distribution of prescription opioids can have unintended consequences. States such as Florida, for example, have seen a rise in heroin use after cracking down on prescription pain pills as substance abuse victims seek an alternative. Nevada is no exception. Although overall drug overdose deaths have trended downward in Nevada in the last five years, the Silver State has seen a steady increase in both heroin deaths and death rates annually. From 2011 to 2015, an- nual deaths from heroin in Nevada rose from 41 to 75, and 5 percent of all drug overdose deaths to 12 percent of all drug overdose deaths. “Pills are still a problem,” Firestone said. “But right now there’s a big surge in heroin.” One common recommendation is to in- crease access and availability for drugs such as emergency narcotic antidotes as well as those used in medication-assisted treatment. Naloxone, for example, can po- tentially revive victims of an opioid over- dose. Meanwhile, drugs such as metha- done, buprenorphine and naltrexone can help reduce withdrawal symptoms associ- ated with addiction. Treatment and recovery clinics con- tinue to be crucial in addressing the addic- tion problem. Resources, however, remain

a challenge, according to several in the field. Firestone of The Life Change Center

says balancing its budget to match needs is

a constant struggle. There’s always a rela-

tionship between availability and quality of service to resources, but hiring staff does not come cheap, especially medical professionals like doctors. “It’s a matter of money,” Firestone said. “It always is.” Everett of Access to Healthcare Net- work echoed Firestone’s sentiments. Ever- ett pointed to the closure of a Saint Mary’s program many years ago as a sign of the financial challenges involved with addic- tion services, especially in a country dom- inated by for-profit models. “Working with folks with addiction is- sues is not a moneymaking proposition,” Everett said. “You’re working mostly with people who don’t have financial resources, don’t have anything to tap into and seldom have insurance.” One thing that has helped is the Afford- able Care Act’s expansion of Medicaid to cover substance abuse starting in 2014. The expansion was a big help in the battle to treat substance abuse but does not ad- dress all problems. “The Medicaid expansion gave unprec- edented access to insurance, especially for the impoverished who are typically our cli- ents,” said Kevin Quint, bureau chief of the Substance Abuse Prevention and Treat- ment Agency (SAPTA). “Our challenge … is to make sure we’re working collabora- tively to find services that exists within Medicaid to fund the gap, things like detox and residential services.” Robust reimbursement following a massive eligibility change is also an issue, according Firestone and Everett. In some cases, for example, Medicaid does not re- imburse as much as a service costs, which can make budgeting a challenge. One positive involves new develop- ments and approaches to treating addic- tion. There’s also a movement toward en- couraging law enforcement agencies to start treating addicts more as victims in- stead of criminals. One agency that has seen such pushback is the DEA. “We’re obviously a law enforcement agency so we often enforce criminal drug laws,” Pullen said. “That being said, most of our investigations are focused on dis- tributors and not users.” For those suffering within the throes of addiction, a common mantra given by

those who work with substance abuse is that it is possible to get help and live nor- mal, productive lives. The key is to seek help and use the resources available in the community, which can be easier said than done for substance abuse victims or even concerned loved ones. It’s especially im- portant for people not to treat addiction as

a moral deficit or view relapses as a moral

failure given the lingering nature of the disease, recovery advocates said. Even for folks such as Everett who have been clean for nearly three decades, it’s important to remain vigilant. “I think of addiction as a sleeping snake

in your brain,” Everett said. “Every once in awhile, it wakes up and looks around to see

if you’re paying attention.”

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6A

Sunday, May 29, 2016

Reno Gazette-Journal

Painkillers

Continued from Page 1A

to Reno afterward. “I just couldn’t seem to keep things together to finish.” It wasn’t until the late ’80s that Everett sought help and turned her life around, eventually earning a master’s degree in counseling and education psychology in

1992.

Today, Everett works as the director of Access to Healthcare Network’s care man- agement department. Given her past prob- lems plus decades in various jobs that tackled dependency, Everett has had a front row seat to the drug abuse problem. “There always seems to be a ‘drug du jour,’” Everett said. “Now there’s the opioid epidemic.” The confluence of high prescription rates, poor disposal habits and the notion that pain pills are legal and therefore “saf- er” has led to an explosion in opioid medi- cation abuse in the United States. Meanwhile, the centers tasked with helping its victims find themselves squeezed after the rise of managed care in the United States, which put more empha- sis on a profit-based model of healthcare. “We have fewer resources for sub- stance abuse disorders in Washoe County now than we did when I got sober 29 years ago,” Everett said. “It’s just not a lucrative field.”

Hitting home in Nevada

For many people who abuse prescrip- tion pain medication, the problem typical- ly starts out as a normal treatment for pain, said Leslie Baker, a campus pharma- cy manager at the University of Nevada, Reno and geriatric pharmacist at the San- ford Center for Aging. In the case of opioids such as oxycodone and hydrocodone, the drugs work by bind- ing to receptors in the brain and mimick- ing chemicals it produces to block pain sig- nals. Large doses over time can build toler- ance, however, requiring even bigger dos- es to get the same effect. “It’s like having four beers every night and pretty soon you don’t get the same feel- ing anymore,” Baker said. “So you start drinking six beers a night.” Large frequent doses can also cause the body to stop making those chemicals, lead- ing to severe withdrawals should a person quit using the drugs. At this point, it is now a full-blown addiction. Once it gets to this juncture, the downward spiral begins for many caught in addiction’s grasp. “Addiction is really about the loss of control,” said John Firestone, executive di- rector and counselor at recovery facility The Life Change Center. “You can choose to use a drug, but once you lose control, the idea of choice is no longer the same.” Further complicating the problem in Nevada is the state’s high rate of prescrip- tions for opioids such as oxycodone and hy- drocodone.

tions for opioids such as oxycodone and hy- drocodone. PHOTOS BY JASON BEAN/RGJ A bottle of

PHOTOS BY JASON BEAN/RGJ

A bottle of hydrocodone is seen at Campus Pharmacy at the University of Nevada, Reno Thursday.

Campus Pharmacy at the University of Nevada, Reno Thursday. “You can choose to use a drug,

“You can choose to use a drug, but once you lose control, the idea of choice is no longer the same.”

JOHN FIRESTONE

EXECUTIVE DIRECTOR AND COUNSELOR AT THE LIFE CHANGE CENTER

According to the latest data available from the U.S. Drug Enforcement Admini- stration, Nevada ranked third in the nation for its rate of oxycodone distribution based on its population in 2012. That year, Nevada retail outlets distributed 1.04 mil- lion grams of oxycodone — more than dou- ble the amount in 2006. The amount is also double the distribution of Illinois, which has five times Nevada’s population. State distribution rates ranked third for hydro- codone and fifth for morphine and co- deine. Doctors in the state also prescribed 94 pain pills per 100 people in the state dur- ing that year. Nevada’s high distribution rates for opioids such as hydrocodone was accom- panied by another trend. “We have seen a steady increase in ER and inpatient encounters (for opioids), at least between 2010 and 2014,” said clinical psychologist Stephanie Woodard of the Ne- vada Division of Public and Behavioral Health. Nationally, usage has been trending younger, with people ages 25 to 45 now ac- counting for most prescription pain pill use, according to the DEA. The agency also started to see increased usage several years ago in those age 18 to 25, said Sarah Pullen, a group supervisor with the DEA’s Los Angeles division, which oversees Ne- vada. In Washoe County, the prescription pain pill epidemic has exacted a human toll. In 2015, opioid painkillers caused 48 overdose deaths. The number is down from 72 deaths in 2011. The issue hit close to home in Northern

Nevada with the death of former Nevada and Bishop Manogue High School football player Michael Yenick in October from an oxycodone overdose. The 33-year-old’s death triggered a federal investigation that led to the arrest of several people as part of an alleged drug ring, including Re- no physician Dr. Robert Rand. “There’s been a downward trend in overdose death rates, but it’s still pretty appalling,” said Mike Willden, chief of staff for Gov. Brian Sandoval. “This didn’t start yesterday or even two years ago, this has been problematic years and years ago.”

‘Skittles parties’

For people in the medical field, recov- ery services and government, the reason for Nevada’s high prescription rates for opioids remains a mystery. “I really don’t know,” campus pharma- cy manager Baker said. “It’s a little baf- fling, actually.” Baker thinks it’s just prescribing habit. Clinical psychologist Woodard believes it likely stems from a decision in 1999 by medical professionals to emphasize pain as a key indicator for a patient’s well-be- ing. Once considered an undertreated prob- lem nationwide, the increased emphasis on alleviating pain caused the pendulum to swing to the other side. Others also pointed to marketing efforts by pharmaceutical companies, not just to consumers but doc- tors as well, for contributing to the issue. As a general rule, the Pharmaceutical

to the issue. As a general rule, the Pharmaceutical Pharmacy technicians Julie Railey, right, and Erin

Pharmacy technicians Julie Railey, right, and Erin Zepkowski work at Campus Pharmacy at the University of Nevada, Reno on Thursday.

Research and Manufacturers of America (PhRMA) says it does not get involved in how its members promote their drugs. “We can’t as a trade association tell our members not to advertise,” said Priscilla VanderVeer, PhRMA deputy vice presi- dent of communications. “It goes against antitrust requirements.” Physicians are limited these days in the types of benefits they can receive from pharmaceutical companies, Baker said. Drug samples have become more tightly controlled as well within the last 10 years, Baker added. Big Pharma also has less incentive now to promote its opioid drugs. With Oxycon- tin coming off patent in 2013, for example, generics have taken over the market, with insurance providers preferring their low- er cost. According to PhRMA, more than 95 per- cent of drugs abused today are generic be- cause they don’t have abuse-deterrent for- mulations such as pills designed to be un- crushable or that turn gelatinous when liq- uefied to make them difficult to inject. “Obviously, we’re aware of the criti- cism against us, but we don’t want to get into an argument about whose fault it is,” VanderVeer said. “What we’re saying is we have a problem and we should fix it.” There is an even greater sense of urgen-

cy to fix the problem as it starts to affect larger populations. One big concern in- volves usage by children, including gath- erings known as “Skittles parties.” These parties feature an assortment of pills that kids have procured from their family’s medicine cabinet and are dumped together for participants to pick from. The drugs range from Valium, Prozac and Xanax to opioids such as Oxycontin and Lortab. Nevada is not exempt from children ex- perimenting with prescription drugs. “We’re concerned with what we’re see- ing in the Nevada Youth Risk Behavior Survey with roughly 1 in 5 kids indicating that they have taken a prescription drug that they don’t have a prescription for,” Willden said. “That’s alarming.” In addition to drugs potentially harming children who may have pre-existing condi- tions, mixing various prescription drugs can be harmful to healthy kids as well. Mixing an opioid like Oxycontin with ben- zodiazepines such as Xanax is a toxic com- bination seen in many overdose deaths. Of more than 16,600 overdose deaths in 2010, 30 percent involved a combination of an opioid and benzodiazepine, according to the Centers for Disease Control and Pre- vention. Mixing opioids with alcohol can be dangerous as well. “Just because they found it in their par-

ents’ medicine cabinet or grandpa’s night stand, they bring it to a party because it’s a prescription pill so they think it must be safe,” VanderVeer said. “This tends to be their first exposure to these medicines, which is bad.” Add a feeling of invincibility and chil- dren and prescription drugs can be a dan- gerous mix, said the DEA’s Pullen. “One thing we’ve found across the board with young people is a tendency to believe that a prescription drug is safer than an illicit drug,” Pullen said. “We know many prescribed opioids are every bit as strong and addictive as any street drug.”

No easy fix

Just as there is no magic wand for ad- diction, there is no easy solution for fixing the opioid epidemic. One challenge is that it involves a large ecosystem with many players, such as doc- tors, hospitals, pharmacies, drug compa- nies and consumers. “There are a lot of factors that make this difficult,” Firestone said. “You’re looking at a really big system, so it’s not as easy as just using common sense and throwing it to the medical community.” In addition to educating the public, edu- cating medical professionals more about

Reno Gazette-Journal

Sunday, May 29, 2016

7A

pain was mentioned frequently by several sources. Schools such as the University of Nevada School of Medicine already have such measures in place, according to spokeswoman Anne McMillin. “We do have required activities in which students are educated on pain man- agement and opioid use,” McMillin said. The activities include teaching pharma- cology and substance abuse to first- and second-year students and acute and chron-

ic pain management for third years.

Some, however, say there needs to be continuing education for doctors as well. Prescribing habits, for example, can vary from one physician to another, and doctors must have a clear understanding of the im- pact their prescription philosophy for pain can have on patients, PhRMA’s Vander- Veer said. Although PhRMA does not tradi- tionally take positions on treatment guide-

lines, the organization says there should be

a discussion on the proper treatment re-

gimens for acute pain and chronic pain. “There are appropriate uses of these medicines, like patients who have had ma- jor surgeries or devastating accidents or some form of cancer,” VanderVeer said. “At the same time, somebody who got their tooth pulled probably does not need a 30- day supply of opioids.” Use of non-opioid painkillers as well as non-drug alternatives are gaining an in- creased look due to the increased attention on the opioid epidemic. There also are in- dications that opioid prescribing is down over the last 18 months in response to the national spotlight on the problem, Vander- Veer said. At the same time, suddenly curtailing the distribution of prescription opioids can have unintended consequences. States such as Florida, for example, have seen a rise in heroin use after cracking down on prescription pain pills as substance abuse victims seek an alternative. Nevada is no exception. Although overall drug overdose deaths have trended downward in Nevada in the last five years, the Silver State has seen a steady increase in both heroin deaths and death rates annually. From 2011 to 2015, an- nual deaths from heroin in Nevada rose from 41 to 75, and 5 percent of all drug overdose deaths to 12 percent of all drug overdose deaths. “Pills are still a problem,” Firestone said. “But right now there’s a big surge in heroin.” One common recommendation is to in- crease access and availability for drugs such as emergency narcotic antidotes as well as those used in medication-assisted treatment. Naloxone, for example, can po- tentially revive victims of an opioid over- dose. Meanwhile, drugs such as metha- done, buprenorphine and naltrexone can help reduce withdrawal symptoms associ- ated with addiction. Treatment and recovery clinics con- tinue to be crucial in addressing the addic- tion problem. Resources, however, remain

a challenge, according to several in the field. Firestone of The Life Change Center

says balancing its budget to match needs is

a constant struggle. There’s always a rela-

tionship between availability and quality of service to resources, but hiring staff does not come cheap, especially medical professionals like doctors. “It’s a matter of money,” Firestone said. “It always is.” Everett of Access to Healthcare Net- work echoed Firestone’s sentiments. Ever- ett pointed to the closure of a Saint Mary’s program many years ago as a sign of the financial challenges involved with addic- tion services, especially in a country dom- inated by for-profit models. “Working with folks with addiction is- sues is not a moneymaking proposition,” Everett said. “You’re working mostly with people who don’t have financial resources, don’t have anything to tap into and seldom have insurance.” One thing that has helped is the Afford- able Care Act’s expansion of Medicaid to cover substance abuse starting in 2014. The expansion was a big help in the battle to treat substance abuse but does not ad- dress all problems. “The Medicaid expansion gave unprec- edented access to insurance, especially for the impoverished who are typically our cli- ents,” said Kevin Quint, bureau chief of the Substance Abuse Prevention and Treat- ment Agency (SAPTA). “Our challenge … is to make sure we’re working collabora- tively to find services that exists within Medicaid to fund the gap, things like detox and residential services.” Robust reimbursement following a massive eligibility change is also an issue, according Firestone and Everett. In some cases, for example, Medicaid does not re- imburse as much as a service costs, which can make budgeting a challenge. One positive involves new develop- ments and approaches to treating addic- tion. There’s also a movement toward en- couraging law enforcement agencies to start treating addicts more as victims in- stead of criminals. One agency that has seen such pushback is the DEA. “We’re obviously a law enforcement agency so we often enforce criminal drug laws,” Pullen said. “That being said, most of our investigations are focused on dis- tributors and not users.” For those suffering within the throes of addiction, a common mantra given by

those who work with substance abuse is that it is possible to get help and live nor- mal, productive lives. The key is to seek help and use the resources available in the community, which can be easier said than done for substance abuse victims or even concerned loved ones. It’s especially im- portant for people not to treat addiction as

a moral deficit or view relapses as a moral

failure given the lingering nature of the disease, recovery advocates said. Even for folks such as Everett who have been clean for nearly three decades, it’s important to remain vigilant. “I think of addiction as a sleeping snake

in your brain,” Everett said. “Every once in awhile, it wakes up and looks around to see

if you’re paying attention.”

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Reno Gazette-Journal

Sunday, July 17, 2016

1E

RENO GAZETTE-JOURNAL

Voices

CONTACT » MARK ROBISON |

775-788-6420

|

MROBISON@RGJ.COM » RGJ.COM

MARK ROBISON | 775-788-6420 | MROBISON@RGJ.COM » RGJ.COM THE OPINION OF THE RGJ EDITORIAL BOARD DRUG
THE OPINION OF THE RGJ EDITORIAL BOARD DRUG CASE SECRECY A PUBLIC DISSERVICE U.S. Attorney’s
THE OPINION OF THE RGJ EDITORIAL BOARD
DRUG CASE SECRECY
A PUBLIC DISSERVICE
U.S. Attorney’s Office claims we should just trust
its word on arrests, seizures in pain pill ring case
W hen officials imply it is indecent for the public to scrutinize what the government does,
a civics lesson is in order.
The latest example comes in the case of arrests surrounding an alleged pain pill ring
in Reno. So far, the DEA and FBI have arrested nine people, including Dr. Robert Rand and
Richard “Richie” West II.
The Reno Gazette-Journal asked the court to unseal the arrest affidavit and lift the gag
order on defense attorneys.
Assistant U.S. Attorney Shannon Bryant wrote in a response to the RGJ’s motion: “Permit-
ting the press to paw through the files of this 'very active' and 'ongoing' investigation will
absolutely jeopardize the integrity of this very important criminal investigation.”
The condescension in her words are palpable — “permitting the press to paw through the
files” — likening the document-handling skills of a respected, award-winning news organiza-
tion to a pervert pawing through a stranger’s underwear drawer.
Bryant said the purpose of the RGJ’s motion was to sell newspapers. No, it is about our
See SECRECY, Page 4E
In essence, the government is saying: Trust us —
when we raid someone’s business and home to take
whatever we want as potential evidence, the public
does not deserve to know the justifications behind
the arrests and property seizures.

THE SILVER PEN

BEFORE MAKING MEDICARE-FOR-ALL, OVERHAUL IT

N. George Marche of Reno is this week’s winner of the Silver Pen for a letter on Medicare. Published July 12, it reads:

In his column, Sean Lehmann advocates Medicare for all. Dr. Lehmann is correct, but insurance companies and brokers have gotten involved in Medicare. Before extending Medicare to all, it needs to be simplified. Today there are over

a dozen choices in healthcare and drug plans. Seniors cannot sign up for a plan

without the help of brokers. A broker selects a plan based on the health needs of

a senior at the beginning of the year. Seniors are responsible for changes in their

health or drug needs during the year. Brokers tell seniors that they furnish this service at no charge. Visiting doc- tors and taking medications are necessary, not recreational. Increase the Medi- care premium to reduce its cost, and provide one Medicare plan and one drug plan to cover everyone. This will eliminate most middlemen and provide the health care needed by all, like the rest of the advanced countries of the world.

Weekly Silver Pen winners are selected by the newspaper's editorial board based on the quality of writing, clarity of expression and strength of opinion. Potential winners do not have to agree with the newspaper's editorial position.

INSIDE

Charles Krauthammer: Resisting the revisionists 2E Amy Goodman and Denis Moynihan: This is not crime. 2E Cory Farley: Unlimited vacation? It sounds like a trap. 3E Randi Thompson: Puerto Rico is ‘too big to fail.’ 3E Froma Harrop: At Fox News, sexism is business. 4E Bonnie Eberhardt Bobb: Protect Nevada’s Gold Butte. 4E

Our editorial board

Editorials reflect the consensus of the Reno Gazette-Journal editorial board and are written by one of its members.

» John Maher is president of the Reno Gazette-Journal.

» Kelly Ann Scott is the newspaper’s executive editor. Gannett.

» Mark Robison is the RGJ’s engagement editor.

4E

Sunday, July 17, 2016

Reno Gazette-Journal

OBAMA MUST ACT TO PROTECT GOLD BUTTE
OBAMA MUST ACT TO
PROTECT GOLD BUTTE

KURT KUZNICKI/ NEVADA OUTSIDE

Using the Antiquities Act to protect Native American history can help us right a wrong that took place in 1876, says Bonnie Eberhardt Bobb.

Using the Antiquities Act to protect history can help us right a wrong

ONE VIEW BONNIE EBERHARDT BOBB

Nevada has a deep history of using our desert landscapes for development purposes. Austin, where I live, is consid- ered a “living ghost town” with our well- preserved mining history from the 1860s. About 80 miles northeast of Las Vegas, the area “Gold Butte” is named for a ghost town where miners prospect- ed for gold, mica, magnesite, copper and zinc in the early 1900s. Today, Nevada’s economy is more di- verse, with agriculture playing a valu- able role in addition to mining and tour- ism. I am with the Western Sustainable Agriculture Working Group, and we con- nect grass-roots promoters of sustain- able agriculture in the West to each other and to the nation. For example, WSAWG works with ranchers who respect indige- nous rights and who recognize that some federal lands are not suitable for graz- ing.

Some have said that protecting our public lands is bad for ranching. I sup- port using public lands to graze cattle if the cows stay out of sensitive areas, don’t damage the land, and are able to find enough to eat to stay healthy. The recent- ly designated Basin and Range National Monument protects grazing rights; how- ever, grazing is not appropriate in a place like Gold Butte. Generally, cattle are just fine to be left to graze across the West without having regular human contact; I have friends who let their cattle roam and don’t know exactly where they are at all times. What concerns me though is that the cows roaming illegally on Gold Butte are scrounging for food and water. Gold Butte’s landscape just is not suited to support a herd of cows. And that leaves the herds struggling and less productive. What also concerns me deeply is the vulnerability of Gold Butte’s Native American artifacts. In April, members

of Nevada’s Paiute tribes embarked on a “culture walk” through Gold Butte. They found petroglyphs peppered with bullet holes and ancient burial and campsite ar- tifacts destroyed or stolen. In order to safeguard Gold Butte’s unique cultural history, the area needs to be permanently protected as a national monument. Such a designation would help pre- serve archaeological resources dating back at least 3,000 years, including rock art, caves, and campsites. Creating a na- tional monument will also help the public learn about Gold Butte’s more recent his- tory, including pioneer mining camps dating back to the 1700s. Without protec- tion, Gold Butte is left vulnerable to van- dalism and unregulated tourism. Like Republican and Democratic presidents before him, President Obama has the authority through the Antiquities Act to designate existing federal lands as national monuments. Using the Antiqui- ties Act to protect Native American his-

tory can help us right a wrong that took place in 1876 when the federal govern- ment removed 1 million acres from the territory of the Moapa Band of Paiute In- dians. Since Congress is not making pro- gress these days, I hope President Oba- ma protects Gold Butte before he leaves office, so that this valuable portion of Nevada’s history is protected. A May poll of Nevadans from both sides of the politi- cal aisle shows that I’m not alone — 71 percent support designating Gold Butte as a national monument. Across the West, agricultural provid- ers of equipment, supplies and services benefit from public lands. Some portions must be provided permanent protection for future generations and to maintain our agricultural heritage and rural life- style. Gold Butte in Nevada is one such place. Dr. Bonnie Eberhardt Bobb is director of the Western Sustainable Agriculture Working Group.

Testing biases

personnel

search

Agriculture Working Group. Testing biases personnel search ONE VIEW PATRICIA GALLIMORE AND ANDREW BARBANO Local police
Agriculture Working Group. Testing biases personnel search ONE VIEW PATRICIA GALLIMORE AND ANDREW BARBANO Local police

ONE VIEW PATRICIA GALLIMORE AND ANDREW BARBANO

Local police depart- ments suffer from a long- standing lack of person- nel diversity. A major rea- son lies with the psycho- graphic portion of applicant aptitude tests. A sample of Reno’s ex- am appears on the city’s website. Its “biodata” por- tion is stuck in1956. That’s when Fortune Magazine Editor William H. Whyte published his landmark bestseller, “The Organization Man.” Gregory Peck starred in the clas- sic film “The Man in the Gray Flannel Suit” the same year. Both titles treat in- stitutional momentum toward conformi- ty, and thus sterility. Professor Whyte exposed the “go along to get along” momentum which dominates large organizations. (See the “Dilbert” comic strip in this newspaper.) Whyte reveals how to cheat on a person- ality test. Six decades later, an entire in- dustry has grown up around doing just that. Google at will. There are purportedly no right or wrong answers, but Whyte advised, “When asked for word associations or comments about the world, give the most conventional, run-of-the-mill answer possible.” Reno’s test instructions advise, “The credit that is assigned to each answer choice is based on how successful em- ployees describe themselves when hon- estly responding to these questions.” Translation: fit in. Whyte added “When in doubt about the most beneficial answer to any ques- tion, repeat to yourself: ‘I loved my fa- ther and my mother, but my father just a little bit more. I like things pretty much the way they are. I never worry much about anything. I don’t care for books or music much. I love my wife and children. I don’t let them get in the way of compa- ny work.”

Actual questions asked by personnel managers have included, “Who was the disciplinarian in your family?” Woebe- tide the applicant who says mother, which may well bias the system against some minority applicants. Reno asks “What do you feel has been your major accomplishment out- side of work? A. Family activities. B. Development of self. C. Community ac-

tivities. D. Development of social activ- ities. E. Something else.” Evaluators look for patterns among responses to 54 such questions. “Dr. M.L. Dantzker, former Fort Worth, Texas, police officer, criminal justice professor and mental health specialist, wrote his doctoral disserta- tion on the role psychologists play in the pre-hiring screenings of police recruits,” Truthout.org writer Candice Bernd reported last year. Dantzker noted that “normative da- ta for police officers under-represents

women and minorities

measure

didn’t do anything for truly recognizing whether a person had the proper traits or not to be a police officer.” The Sparks Police Department cur- rently numbers three African-Ameri- cans among a force of more than 100. Reno has an even lower percentage, five among about 320. Minorities may not apply for many reasons, but testing geared toward or- ganizational sameness only serves to widen what author Jelani Cobb last week called a trench which has become a canyon, where the public feels jeopar- dized by police who in turn feel endan- gered by a heavily armed populace. In 1970, former Nevada Attorney General and future Supreme Court Chief Justice Charles Springer advo- cated hiring “better police” to help heal the wounds of the 1960s. Unbiased test- ing opens doors for that better police force. America’s communities are be- ing tested. Patricia Gallimore is president of the Reno-Sparks NAACP. Andrew Bar-

bano serves as first vice-president.

and it fails to

it

conscientiousness

At Fox News, sexism is built into business

conscientiousness At Fox News, sexism is built into business ONE VIEW FROMA HARROP What to make

ONE VIEW

FROMA HARROP

What to make of Gretchen Carlson’s suit against Fox News Chair- man Roger Ailes alleg- ing sexual harassment? If Ailes did demand sex as a condition of her employment and Carlson can prove it, then she’d seem to have a good case. But other complaints about “inap- propriate” behavior at Fox News don’t sit quite right: So she was mocked on the air over her high hemlines and paid slithering compliments about “looking good today.” On the air, a male co-host pulled down her arm to shut her up. I mean, what ballpark did she think she was playing in? With a few exceptions, the Fox News sets purposely pair men in busi- ness attire with women in sleeveless, short dresses — some featuring ador- able peekaboo cutouts revealing cleavage. You don’t need a fashion an- thropologist to tell you that this dress code screams inferior status. I hit upon “Fox & Friends” on Satur- day morning when the discussion cen- tered on the Dallas tragedy. There was Abby Huntsman, all arms and legs in a flamingo-pink dress, flanked by two male anchors encased in conservative business suits with ties. Huntsman was offering the smartest commen- tary, but how many viewers took no- tice? It’s not just Fox News Channel. All over TV you see women doing news dressed for the cover of Cosmo. The need to play the babe is why so many newswomen get yanked off the air the moment they age. Carlson herself is now 50. (It’s especially painful to watch one of the survivors, Andrea Mitchell at 69, displaying arms and legs alongside fully dressed men with lesser intel- lects. It does not matter that she’s in terrific shape.) Carlson sat on the “Fox & Friends” set for years as an accomplice. She sol-

diered through the lame sexist joshing. She once stomped off the set in seeming complaint but came back saying she was kidding. Her recent book praised and thanked Ailes with profusion. Now, we can say this is entertain- ment. She was hired to perform as the ditzy foil to the men. The formula in- cludes a revolt against politically cor- rect feminism. Whatever. In the age of hipster an- drogyny, the female hootchy-kootchy on Fox News Channel seems increasing- ly dated. It may account in part for CNN’s narrowing the ratings gap with the once-dominant Fox News, particu- larly among younger viewers. The fashion industry has been in on promoting retrograde aesthetics for working women. Decades ago, there was a brief “dress for success” move- ment, urging women to wear suits in professional settings. But the notion of women getting by with a work wardrobe of five business uniforms — as men do — could not be tolerated. Women in suits with those floppy bow ties were quickly made fun of. The message was: You can flaunt your femininity at the office and be powerful at the same time. That women in well-tailored suits are actual- ly quite alluring (check out the Hitch- cock movie heroines) got lost in the de- mands of selling fast fashion. Some may argue that enduring fra- ternity-level taunts was the only way some of these women could get on cam- era, become famous and make good

money. That may be so. And I won’t be- grudge their trading dignity for fame and fortune, if that’s their wish and they don’t pretend otherwise. The main problem with Carlson’s suit

is the timing. It was filed only after the

network decided to not renew her con- tract. While gainfully employed, she helped advance a business model that

championed overt sexism. And that’s why the sisterhood probably isn’t losing

a lot of sleep over Carlson’s case, even as it quietly hopes she prevails. Follow Froma Harrop on Twitter @FromaHarrop. She can be reached at fharrop@gmail.com.

Secrecy

Continued from Page 1E

mission to keep this community in- formed, and it is about transparency in the criminal justice system. The RGJ’s specific request involves the affidavit used to justify those nine ar- rests. Large portions of the arrest affida- vit were redacted, especially intercept- ed text messages and cellphone conver- sations. One detail in the documents that

makes this case of tremendous impor- tance to Reno-Sparks residents is that there may be 60 deaths linked to Rand’s prescriptions. Once the arrests were made, the docu- ments to justify those arrests became part of the official public case record. Having access to these public records allows the Reno Gazette-Journal — and anyone else — to see what government agents are doing in the public’s name. In essence, the government is saying:

Trust us — when we raid someone’s busi- ness and home to take whatever we want as potential evidence, the public does not

deserve to know the justifications be- hind the arrests and property seizures. Also, it is saying in effect: We are allowed to dribble out self-interested details that help our case but the defense should not be allowed to say anything. The investigating and prosecuting agencies have tremendous power, and that higher power must be kept in check by an equally high level of scrutiny. The U.S. Attorney’s Office says no and that anyone who would claim other- wise is just doing it for crass or selfish reasons. The U.S. Attorney’s Office seems to

want a stenographer to regurgitate its press releases rather than a free and vi- brant media. It has forgotten the First Amendment’s explicit protections for freedom of speech and freedom of the press that encourage such scrutiny in or- der to maintain a healthy democracy. Displaying such a disrespectful atti- tude toward common media requests that have been widely upheld by the courts denigrates the First Amendment and the public’s duty to make sure the government is using its power responsi- bly.