Tag Archives: Diagnosis and treatment

FDA approves first treatment for kids with peanut allergy


The first treatment for peanut allergies is about to hit the market, a big step toward better care for all kinds of food allergies — but still a long way from a cure.

Friday’s approval by the Food and Drug Administration promises to bring some relief to families who’ve lived in fear of an accidental bite of peanuts at birthday parties and play dates, school cafeterias and restaurants. Named Palforzia, it was developed by Aimmune Therapeutics.

“It’s been a life-changer,” said Nina Nichols, 18, of Washington, whose first encounter with peanuts as a toddler — a peanut butter cracker shared by a friend — required a race to the emergency room. She entered a Palforzia research study as a teen and calls it “a security blanket.”

The treatment is a specially prepared peanut powder swallowed daily in tiny amounts that are gradually increased over months. It trains children’s and teens’ bodies to better tolerate peanut so that an accidental bite is less likely to cause a serious reaction, or even kill in severe cases.

Palforzia users still must avoid peanuts just like they always have.

The treatment is not for everyone. Palforzia can cause side effects, including occasional severe allergic reactions. The FDA is requiring that doctors and their patients enroll in a special safety program, and patients must take the first dose and each increased dose under supervision in a certified health center.

And if youngsters stop taking the daily dose, they lose the protection.

Shots have long been used to induce tolerance for allergies to bee stings or pollen. But swallowing an allergen to build tolerance is a new twist — one that scientists call “oral immunotherapy.” And peanuts are just the first food to be tackled. Tests for eggs, milk and tree nuts are underway.

But because of the drawbacks, scientists also are developing next-generation options that work differently. Next up for FDA review: A skin patch for peanut allergy.

“For so long, we had nothing to offer these patients,” said Dr. Pamela Guerrerio of the National Institutes of Health, which funded much of the research that led to food allergy therapies. “We finally have a treatment. That’s a big step.”

Aimmune executives said Friday they hope doctors can begin prescribing the treatment in “a matter of weeks.” They set the treatment’s list price at $890 a month, but how much patients will pay depends on their insurance. Aimmune says it is working with insurance companies for coverage, and will offer a patient co-pay assistance program.


Millions of Americans have food allergies, including about 1 in 13 children, and the numbers have increased in recent years. Peanut allergy is the most common one among children, and among the most dangerous. Accidental exposures are frequent, with about 1 in 4 affected children winding up in the emergency room every year.

What happens: The immune system overreacts to the food by triggering an inflammatory cascade. On average, children can experience hives, wheezing or worse from just a 30th of a single peanut, sometimes even less, said Dr. Hemant Sharma, who leads oral treatment studies at Children’s National Hospital in Washington.

Until now, all doctors could advise was to read food labels and avoid anything that might contain hidden peanuts. Decades ago, attempts at shots were deemed too risky for food allergies. Then, in 2006, researchers at Duke University and the University of Arkansas reported tantalizing signs that swallowed treatments might work instead.


Doctors prescribe a miniscule Palforzia starting dose. The powder, stored in a capsule, is mixed into any unheated food, such as Nichols’ favorite fruit smoothies. Patients take the first dose in a doctor’s office, in case of a bad allergic reaction. Every few weeks, the dose is increased until after about six months, they’re taking the equivalent of about one peanut.

In a study of nearly 500 children, two-thirds who received Palforzia could eat the equivalent of two peanuts — and some three or four — compared to just 4% of patients given a dummy drug.

A few hundred allergy doctors around the country already offer their own version of the treatment, using store-bought peanut flour — or similar options for other food allergies — to customize doses for patients outside of research studies.


Palforzia users still must carry their rescue medicine, such as EpiPens, to treat severe allergic reactions. Most experience at least mild side effects, such as hives or stomachaches, and about a fifth dropped out of the study, said Dr. Scott Sicherer, a pediatric allergist at Mount Sinai Hospital in New York.

As for severe reactions, they struck about 9% of patients treated in the Palforzia study, nearly three times the number in the placebo group and prompting debate about the drug’s usefulness.

“There is a trade-off,” Sicherer said. Families and doctors together will have to decide “does it make sense for me or my child?”


Other allergy treatments in the pipeline:

–DBV Technologies’ Viaskin is a daily patch that contains small amounts of peanut protein absorbed through the skin, in hopes of fewer side effects.

—Allergen drops under the tongue are in early-stage testing but showed promise in a recent study from the University of North Carolina, Chapel Hill.

—Shots to block allergic reactions deliver antibodies that tamp down the inflammatory cascade that follows accidental exposure. A Stanford University pilot study suggested a single shot could block a peanut reaction for two to six weeks.

“Palforzia is a step forward,” said Children’s National’s Sharma. “What all of us hope for that would be truly revolutionary is a treatment that’s curative, that really gets rid of the food allergy permanently.”


The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content.


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Physician going through life in jail for 1000’s of opioid doses


By the point drug enforcement brokers swooped into his small medical workplace in Martinsville, Virginia, in 2017, Dr. Joel Smithers had prescribed a couple of half 1,000,000 doses of extremely addictive opioids in two years.

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Sufferers from 5 states drove a whole bunch of miles to see him, spending as much as 16 hours on the street to get prescriptions for oxycodone and different highly effective painkillers.

“He is performed nice harm and contributed … to the general downside within the heartland of the opioid disaster,” mentioned Christopher Dziedzic, a supervisory particular agent for the Drug Enforcement Administration who oversaw the investigation into Smithers.

Up to now 20 years, opioids have killed about 400,000 Individuals, ripped households aside and left communities — many in Appalachia — grappling with ballooning prices of social providers like legislation enforcement, foster care and drug rehab.

Smithers, a 36-year-old married father of 5, is going through the potential for life in jail after being convicted in Could of greater than 800 counts of illegally prescribing medication, together with the oxycodone and oxymorphone that prompted the demise of a West Virginia lady. When he’s sentenced Wednesday, the most effective Smithers can hope for is a compulsory minimal of 20 years.

Authorities say that, as a substitute of operating a authentic medical follow, Smithers headed an interstate drug distribution ring that contributed to the opioid abuse epidemic in West Virginia, Kentucky, Ohio, Tennessee and Virginia.

In court docket filings and at trial, they described an workplace that lacked primary medical provides, a receptionist who lived out of a again room throughout the work week, and sufferers who slept outdoors and urinated within the car parking zone.

At trial, one lady who described herself as an addict in contrast Smithers’ follow to tablet mills she frequented in Florida.

“I went and obtained remedy with out — I imply, with none form of bodily examination or bringing medical data, something like that,” the girl testified.

A receptionist testified that sufferers would wait as much as 12 hours to see Smithers, who typically stored his workplace open previous midnight. Smithers didn’t settle for insurance coverage and took in near $700,000 in money and bank card funds over two years.

“Folks solely went there for one purpose, and that was simply to get ache remedy that they (might) abuse themselves or promote it for revenue,” Dziedzic mentioned.

The opioid disaster has been many years within the making and has been fueled by a mixture of prescription and road medication.

From 2000 to 2010, annual deaths linked to prescription opioids elevated almost fourfold. By the 2010s, with extra crackdowns on tablet mills and extra restrictive pointers on prescriptions, the variety of prescriptions declined. Then individuals with addictions turned to even deadlier opioids. However the variety of deaths tied to prescription opioids did not start to say no till final yr, in line with knowledge from the U.S. Facilities for Illness Management and Prevention.

Martinsville, the place Smithers arrange store, has been notably laborious hit.

A metropolis of about 14,000 close to Virginia’s southern border, Martinsville as soon as was a thriving furnishings and textile manufacturing heart that billed itself because the “Sweatshirt Capital of the World.” However when factories started closing within the 1990s, 1000’s of jobs had been misplaced. Between 2006 and 2012, the town had the nation’s third-highest variety of opioid tablets acquired per capita, in line with an Related Press evaluation of federal knowledge.

Andrew Kolodny, a Brandeis College physician who has lengthy been crucial of opioids, mentioned that lately, docs grew to become much less comfy writing a lot of opioid prescriptions and plenty of huge prescribers retired. That opened a chance for others.

“If you happen to’re one of many guys nonetheless doing this,” he mentioned, “you are going to have tons of sufferers pulling down your door.”

Throughout his trial, Smithers testified that after he moved to Virginia, he discovered himself flooded with sufferers from different states who mentioned many close by ache clinics had been shut down. Smithers mentioned he reluctantly started treating these sufferers, with the purpose of weaning them off excessive doses of immediate-release medication.

He acknowledged throughout testimony that he typically wrote and mailed prescriptions for sufferers he had not examined however insisted that he had spoken to them over the telephone.

As soon as, he met a girl within the car parking zone of a Starbucks, she handed him $300 and he gave her a prescription for fentanyl, an opioid ache reliever that’s 50 to 100 instances stronger than morphine.

When space pharmacists began refusing to fill prescriptions written by Smithers, he directed sufferers to far-flung pharmacies, together with two in West Virginia. Prosecutors say Smithers additionally used some sufferers to distribute medication to different sufferers. 4 individuals had been indicted in Kentucky on conspiracy costs.

At his trial, Smithers portrayed himself as a caring physician who was deceived by some sufferers.

“I discovered a number of classes the laborious approach about trusting people who I shouldn’t have trusted,” he mentioned.

Smithers’ lawyer advised the choose he had been identified with melancholy and anxiousness. Relations mentioned by means of a spokesperson that they consider his choices had been influenced by private stress, and emotional and psychological pressure.

Even earlier than he opened his Martinsville follow in August 2015, Smithers had raised suspicions. West Virginia authorities approached him in June 2015 a couple of criticism along with his follow there, however once they returned the following day with a subpoena, they discovered his workplace cleaned out and a dumpster full of shredded papers and untested urine samples.

A few of Smithers’ sufferers have remained fiercely loyal to him, insisting their extreme continual ache was eased by the highly effective painkillers he prescribed.

Lennie Hartshorn Jr., the daddy of the West Virginia lady who died two days after taking medication Smithers prescribed, testified for the protection.

Hartshorn mentioned his daughter, Heather Hartshorn, advised somebody “she would slightly be lifeless than in ache on a regular basis.” In response to a kind Heather Hartshorn crammed out when she went to see Smithers, she had continual ache in her decrease again, legs, hips and neck from a extreme automotive accident and a fall.

When requested by Smithers’ lawyer if he blames Smithers for something, Lennie Hartshorn mentioned he doesn’t.

Smithers has been denied bond whereas he awaits sentencing. His lawyer didn’t reply to inquiries from AP. Smithers has mentioned he plans to enchantment.


Related Press reporters Geoff Mulvihill and Riin Aljas contributed to this story.


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Alabama gov begins therapy for cancerous spot on her lung


Alabama Gov. Kay Ivey underwent a scheduled outpatient process on Friday as she will get set for specialised radiation therapy for most cancers, her workplace mentioned.

Ivey introduced Thursday that medical doctors had found a malignant spot on her lung. She described the most cancers as having been caught early and mentioned it might not intervene in her capability to meet her duties as governor. She went to the College of Alabama at Birmingham to have the preliminary process completed.

“The governor’s outpatient process immediately at UAB went properly and as deliberate. She is again in Montgomery and appears ahead to returning to her common schedule subsequent week,” Ivey Press Secretary Gina Maiola wrote in a press release.

The governor’s workplace has not disclosed the precise kind of most cancers she was recognized as having. The workplace mentioned the outpatient process will allow her to endure a sequence of radiation remedies.

The 74-year-old Republican governor mentioned the spot was found in a routine examination and was later confirmed to be what she referred to as a tiny, remoted malignancy.

“The excellent news is I’m one of many lucky ones the place this was found early, and it is rather treatable,” Ivey mentioned in a press release.

“Naturally, I welcome your prayers and your help. Simply as so many others who’ve been affected by most cancers, I’m assured of God’s plan and objective for my life and really feel extraordinarily lucky this was caught so early.”

Dr. Suresh S. Ramalingam, deputy director of the Winship Most cancers Institute of Emory College, mentioned the prognosis for lung most cancers varies with the stage of the illness. He mentioned stage one lung cancers have the perfect outcomes, and among the many subtypes of lung most cancers, non-small cell lung cancers sufferers are inclined to have higher outcomes in comparison with small cell lung cancers sufferers.

Ramalingam, who just isn’t treating Ivey, mentioned statements from Ivey’s physician and workplace point out she has an early stage illness.

“The truth that the governor’s most cancers was discovered early goes to place her in an excellent, very excessive proportion of treatment with stage one lung most cancers with this type of radiation remedy. Success charges are extremely excessive,” Ramalingam mentioned.

Ramalingam pressured the necessity for folks to concentrate on the necessity for lung most cancers screening to catch the illness early when remedies could be best. He mentioned many lung cancers should not caught till they’re in superior levels.

The American Most cancers Society and American Most cancers Society Most cancers Motion Community issued a press release of help for Ivey and inspiring folks to debate screening.

“The American Most cancers Society and our volunteers are very involved to be taught Gov. Kay Ivey has been recognized with lung most cancers however are inspired that it was discovered early,” mentioned Ginny Tucker, Alabama govt director of the American Most cancers Society.


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The rise and fall of an Eagle Scout’s lethal fentanyl empire


The picture that flashed onto the courtroom display screen confirmed a younger man lifeless on his bed room flooring, naked toes poking from the cuffs of his rolled-up denims. Lurking on a trash can on the fringe of the image was what prosecutors stated delivered this demise: an odd, U.S. Postal Service envelope.

It had arrived with 10 spherical, blue tablets inside, the markings of pharmaceutical-grade oxycodone stamped onto the floor. The younger man took out two, crushed and snorted them. However the tablets had been poison, prosecutors stated: counterfeits containing deadly grains of fentanyl, a potent artificial opioid that has written a lethal new chapter within the American opioid epidemic.

The envelope was postmarked from the suburbs of Salt Lake Metropolis.

That is the place a clean-cut, 29-year-old faculty dropout and Eagle Scout named Aaron Shamo made himself a millionaire by constructing a fentanyl trafficking empire with not rather more than his laptop and the assistance of some mates.


This story was produced in partnership with the Pulitzer Middle on Disaster Reporting.


For 3 weeks this summer time, these suburban millennials climbed onto the witness stand at his federal trial and provided an unprecedented window into how fentanyl purchased and bought on-line has remodeled the worldwide drug commerce. There was no testimony of underground tunnels or gangland murders or something {that a} wall on the southern border would possibly cease. Shamo referred to as himself a “white-collar drug vendor,” drew in co-workers from his time at eBay and peppered his messages to them with smiley-face emojis. His legal professional referred to as him a idiot; his major protection was that he is not sensible sufficient to be a kingpin.

How he and his mates managed to flood the nation with a half-million faux oxycodone tablets reveals the convenience with which fentanyl now strikes all over the world, threatening to increase the epidemic past America’s borders. It’s so potent, really easy to move, consultants say, large-scale traffickers not require subtle networks to ship it to any nook of the globe. All they want is a mailbox, web entry and other people with an urge for food for opioids. And consumption charges are rising from Asia to Europe to Latin America as pharmaceutical corporations promote painkillers overseas.

The case towards Shamo detailed how white powder as much as 100 occasions stronger than morphine was purchased on-line from a laboratory in China and arrived in Utah through worldwide mail; it was formed into perfect-looking replicas of oxycodone tablets within the press that thumped in Shamo’s basement and resold on the web’s black markets. Then it was routed again into the postal system in hundreds of packages addressed to properties throughout this nation awash with prescription painkiller dependancy.

When Shamo took the stand to attempt to spare himself a lifetime in jail, he started with a nervous chuckle. He careened from one matter to the subsequent in a monologue prosecutors would later describe as masterful manipulation to persuade the jury he thought his drug-dealing was serving to individuals. Clients wrote thanks notes as a result of their docs refused to prescribe extra painkillers, he stated. It felt like “a win-win state of affairs” — he acquired wealthy and his clients acquired medication.

One in every of them was a struggling 21-year-old named Ruslan Klyuev who died in his bed room in Daly Metropolis, California, the envelope from Utah at his toes. Shamo was charged in connection to that overdose alone, however when investigators scoured the listing of consumers they stated they counted dozens extra lifeless.


The query earlier than this jury is being debated all throughout America: Twenty years into the opioid epidemic, is there such a factor as justice for 400,000 misplaced lives?

The most important civil litigation in historical past is testing how the pharmaceutical trade ought to be held accountable for inundating the nation with billions of addictive ache tablets. Purdue Pharma, seen by many as the first villain for deceptively pushing the blockbuster drug OxyContin, reached a tentative $12 billion settlement this week with about half the states and roughly 2,000 native governments. Attorneys basic who did not signal on say the determine is way too low. A trial of different pharmaceutical corporations is scheduled for subsequent month, through which communities will contend that their mass advertising and marketing of prescription painkillers sparked an epidemic.

This disaster started within the 1990s and has since spiraled into waves, every worse than the one earlier than: Prescription opioids unfold dependancy, then a crackdown on prescribing paved the highway to heroin, which led to fentanyl — an artificial opioid made completely in a laboratory. Traffickers added it to heroin to spice up its efficiency and profitability. That transition occurred slowly at first, then with extraordinary ferocity.

By 2017, deaths from artificial opioids had elevated greater than 800 p.c, to 28,466, dragging the USA’ general life expectancy down for a 3rd consecutive 12 months for the primary time in a century. Fentanyl deaths have been reported overseas, in Canada, Sweden, Estonia, the UK. International locations with surging prescription opioid dependancy, like Australia, concern they’re on the brink.

“Fentanyl would be the bubonic plague,” stated Mike Vigil, former chief of worldwide operations for the Drug Enforcement Administration, warning that any nation with a burgeoning prescription opioid drawback may quickly discover itself following American footsteps. “It is only a matter of time.”

Nobody can say precisely how or why fentanyl, first synthesized in 1959 as a strong painkiller, entered the trendy illicit drug market, stated Bryce Pardo, a researcher on the Rand Company. In 2013, individuals started overdosing on heroin laced with fentanyl in New England and Ohio, and it unfold from there. Shabbir Safdar, the Partnership for Secure Medicines’ government director, stated the primary recognized demise from a fentanyl-laced capsule was in San Francisco in October 2015.

It was a daunting improvement: The DEA estimates 3.four million Individuals misuse prescription painkillers, in comparison with 475,000 heroin customers — that means the pool doubtlessly uncovered is 10 occasions larger.

There are two sources of provide. Mexican cartels and packages shipped direct from China, the place it’s produced in an enormous and under-regulated chemical sector. A Senate investigation final 12 months discovered huge portions of fentanyl pouring in from China via the Postal Service. The report largely blamed dated expertise that left customs inspectors sifting via packages manually in search of “the proverbial needle in a haystack.” The Postal Service wrote in a press release to The Related Press that it’s working exhausting with its worldwide counterparts to shut these loopholes, and is bettering its expertise to intercept fentanyl shipments.

By the point a seized bundle heading from China to Utah led investigators to Shamo, he had already turned fentanyl into a minimum of 458,946 doubtlessly toxic tablets, the federal government stated. There are lots of extra like him, officers say, upstart traffickers urgent pure Chinese language-made fentanyl into tablets of their basements and kitchens with unsophisticated gear. In a single batch, one capsule might need no fentanyl and one other sufficient to kill an individual immediately. One agent at Shamo’s trial in contrast it to creating chocolate-chip cookies, provided that too many chips ended up in a “cookie,” whoever ate it dropped lifeless.

For traffickers, the revenue margins are irresistible: The DEA estimates a kilogram of fentanyl synthesized for a couple of thousand {dollars} may make a vendor greater than $1 million.

“Any moron can principally develop into a significant drug kingpin by dealing in fentanyl,” stated Vigil. “You possibly can have someone with an IQ minus 100 who turns into an in a single day multimillionaire.”


Aaron Shamo dreamed of entrepreneurial riches. He idolized Steve Jobs and Invoice Gates, and studied self-improvement books like “Assume and Develop Wealthy.”

He and a longtime good friend, Drew Crandall, labored at eBay after failed stints in faculty. However Crandall was fired and Shamo determined it was “unfair” that he nonetheless needed to work, so he give up. They needed simple cash.

Shamo grew up in Phoenix with three older sisters. As a young person, he began smoking pot and refusing to attend providers with The Church of Jesus Christ of Latter-day Saints. His mother and father despatched him to boarding college in Utah, the place he earned his Eagle Scout badge. He later met Crandall via their shared love of longboarding they usually moved in collectively. Crandall was awkward and shy; Shamo was charismatic, and prided himself on serving to his good friend discuss to women.

The pair concocted a plan to promote their Adderall, prescribed for consideration deficit dysfunction, on the darkish internet — a wild, unregulated layer of the web reached via a particular browser. There are underground marketplaces there that mimic Amazon or eBay, the place weapons and medicines and pirated software program are traded. Cash is exchanged anonymously via cryptocurrencies like bitcoin.

They discovered what they wanted on the internet, looking with queries like “the best way to ship medication.” It was really easy. They expanded, ordering medication in bulk, breaking them down and promoting at a mark-up, all whereas barely having to go away the home.

They used the postal system like a drug mule, peddling the membership drug MDMA, magic mushrooms, date rape medication — they as soon as purchased a kilogram of cocaine from Peru. They recruited mates, providing them $100 to have parcels mailed to their properties, no questions requested.

However the revenue margins had been slim and their ambitions had been larger: They purchased a capsule press, ordered the sedative alprazolam on-line from India and watched YouTube movies to determine the best way to flip it into faux Xanax, an anti-anxiety treatment. Crandall, math minded, created the recipe. They blended it up by shaking it in mason jars.

Then Crandall fell in love.

His new girlfriend grew suspicious when he would sneak away to bundle medication. When she confronted him at a celebration, he tearfully confessed. She forgave him, if he promised to go away the enterprise. They purchased one-way tickets to New Zealand.

Then an area drug vendor made a suggestion to Shamo that will change the course of his life: There was a fortune to be made in producing faux oxycodone.

Shamo enlisted his gymnasium buddy, Jonathan Luke Paz, to assist him. Shamo ordered fentanyl on-line from China, arrange the capsule press within the basement and purchased dyes and stamps to match fashionable prescribed drugs. Then they handed them over to the native vendor, who examined them on his personal clients. The primary batches had been weak or speckled in colour, he advised them, or did not react like actual oxycodone when customers heated it on tinfoil to smoke it.

However they had been getting higher.

“Near being cash within the financial institution,” the vendor messaged Shamo. “You probably did it, bro.”

On the primary day of 2016, Shamo wrote out his objectives for the upcoming 12 months: He could be wealthy. All the ladies would need him.

“I’ll overachieve,” he wrote. “I’ll overcome.”

He went on-line together with his merchandise a month later. Some had been specified as fentanyl, however some weren’t, purporting as an alternative to include 30 milligrams of oxycodone. Shamo named this new retailer Pharma-Grasp.


As winter turned to summer time, gross sales skyrocketed. Pharma-Grasp began promoting hundreds of tablets per week, charging round $10 every.

On June 6, a comparatively small order got here in: 10 tablets, to be shipped to an house home in Daly Metropolis, a working-class suburb of San Francisco.

Like each order, it was despatched in an encrypted e mail to 2 former eBay co-workers in command of distribution. Alexandrya Tonge and Katherine Bustin counted out the tablets of their suburban condominium, packaged the shipments and dropped them within the mail.

The envelope arrived on the doorstep at Three p.m. on June 11.

Below completely different circumstances, Shamo might need been mates with the 21-year-old man who lived there. Ruslan Klyuev, a Russian immigrant, was additionally an aspiring tech entrepreneur at the hours of darkness internet. He had a child face: rosy cheeks and curly hair. Klyuev cherished to cook dinner and would make extravagant meals for the home.

However his relationship ended, his internet design enterprise sputtered and he grew to become estranged from his household, stated Barry, a roommate who spoke on the situation that his final identify not be printed. His feelings toggled between sorrow and elation, and he struggled with substance abuse.

After ingesting vodka, Klyuev crushed two of the tablets with a battery and snorted the powder with a rolled-up sticky notice, based on testimony. He began drifting out and in of sleep. He could not arise.

He was discovered lifeless the subsequent day, with fentanyl, alcohol and a substance related to cocaine in his system.

His was the one demise with which Shamo could be charged. His protection legal professional, Greg Skordas, argued that neither his demise nor any others might be undoubtedly linked with Shamo’s operation.

However in paperwork, prosecutors related Shamo to a veritable slaughter:

A 24-year-old man in Seattle overdosed three weeks after he purchased tablets from Pharma-Grasp in March 2016.

Later that spring, 40 tablets had been shipped to a 21-year-old in Washington, D.C. He died in his dorm room 11 days later.

In Utah, a 29-year-old software program analyst named Devin Meldrum had been looking since he was a young person for a treatment for cluster complications that felt like knives stabbing his cranium, stated his father, Rod.

Medical doctors had prescribed opioids however restricted the dosage, so he purchased a backup provide from Pharma-Grasp. On Aug. 13, 2016, he ran out of tablets days earlier than his refill. As he acquired prepared for mattress, he texted his fiance and took a capsule from his reserve for the primary time, his father stated.

He was lifeless earlier than she arrived to say goodnight, blue on his rest room flooring.

His father is not certain Shamo even now understands the magnitude of what occurred: “Does he even comprehend what number of households have had their hearts torn out?”


On-line, Pharma-Grasp was getting rave evaluations.

“These will make u a millionaire in below a 12 months, assure,” wrote one shopper who referred to as himself “Reliable Cash.”

He was a vendor in Portland named Jared Gillespie. He purchased 80,000 tablets from Pharma-Grasp, based on paperwork filed towards Gillespie in Oregon. He knew he was shopping for fentanyl tablets, the Oregon prosecutors alleged, however the individuals shopping for from him had no option to know that. They’re unknown and uncounted.

Shamo provided steep reductions for bulk consumers. Tonge, one in all his distributors, testified that she started to query Shamo’s declare that he was serving to sufferers who could not get treatment: Why would one individual want 5,000 tablets?

Her vacuum cleaner would develop into a essential piece of proof. Its mud bin was crammed with tablets. The operation had grown so frantic, pumping out tens of hundreds of tablets a month, that once they spilled onto the ground, they weren’t price saving.

Tonge and her accomplice complained that the orders had been coming too shortly, so Shamo employed a “runner” named Sean Gygi to choose up the packages and drop them within the mail, dozens of them a day.

Drug manufacturing grew to become routine: Shamo as soon as wrote himself a to-do listing, and included a reminder to “make blues,” the road identify for oxycodone, together with getting a haircut, washing his sheets, cleansing the kitchen. And Shamo deliberate to increase. He purchased one other press so massive brokers would later want a tow truck to pull it out of his storage.

The cash was pouring in, and out.

Shamo employed a private assistant; she did his procuring, had his automotive detailed. He stuffed a duffel bag with $429,000 money and requested his mother and father to carry it. He bragged to mates about VIP bottle service at golf equipment and playing in Las Vegas. He shopped for actual property in Puerto Rico; took pictures sipping champagne on a cruise ship; purchased designer denims, an 88-inch tv, a ship and a BMW.

Crandall and his girlfriend posted pictures on Instagram of journeys to Laos, Thailand, Singapore, kayaking and partying. However he was operating out of cash and agreed to develop into a distant customer support consultant. The listing of individuals accepting packages from China ballooned to greater than a dozen. Everybody was making simple cash and getting textual content messages from Shamo dotted with “lol” and “superior!”

Shamo penned one other notice: “I’m Shamo. I’m superior. My mates love me. I created an empire.”

However at the same time as he cheered himself on, there have been indicators of hazard.

One buyer reported an overdose demise. Shamo scanned obituaries, then declared it was a faux, Crandall stated. Then a message stated tablets had been making individuals sick.

Crandall forwarded it to Shamo with a dismissive query: Ought to he inform them to “suck it up?” Or ship extra tablets to pacify them?


They did not realize it, however a suspicious customs agent on the Los Angeles Worldwide Airport had flagged a field from Shanghai, China, pulled it off the belt and seemed inside. The agent discovered 98.7 grams of fentanyl powder — sufficient to make virtually 100,000 tablets. The field was destined for Utah.

Brokers seemed for extra packages making their method from China to Utah, and finally one arrived, stated an agent with Homeland Safety Investigations who spoke on situation of anonymity to guard ongoing investigations. On Nov. 8, 2016, postal inspectors seized a field en route from a port metropolis in China recognized to regulation enforcement as a fentanyl-trafficking hub. It was addressed to Gygi, Shamo’s “runner,” so brokers arrived at his home with a search warrant.

Gygi stated he thought the a whole bunch of envelopes he’d put within the mail contained the social gathering medication he generally took himself. Informed it was fentanyl, the agent recalled, Gygi drooped.

He agreed to put on a wire whereas he picked up the packages, like he did on daily basis. However as an alternative of dropping them within the mail, he delivered them to police.

This single day’s cargo contained 34,828 fentanyl tablets destined for properties in 26 states.

4 days later, on Nov. 22, 2016, brokers stood on Shamo’s stoop, shouted via a bullhorn, then broke the door down with a battering ram. They had been wearing neon-orange hazmat fits with clear bowls round their faces that made them appear to be astronauts.

Shamo got here up the steps in a T-shirt and shorts, a masks and gloves in his pocket. A capsule press downstairs was operating, in a room with powder caked on the partitions and the furnishings.

Others had been raiding the stash at Bustin and Tonge’s condominium. Veteran vice officers would say that they had by no means seen so many tablets, even in worldwide operations. In complete, they packed up over 74,000 fentanyl tablets awaiting distribution.

In Shamo’s sock drawer, brokers discovered stack after stack of money. There was extra money in a protected within the closet. Brokers totaled up greater than $1.2 million, not together with the cash he had tied up in Bitcoin or luggage he’d stashed together with his household. Investigators finally caught up with Paz, whom Shamo paid round a greenback per capsule, and he surrendered $800,000 extra.

Crandall was in Laos, nonetheless touring together with his girlfriend, when he heard the information. He saved his drug-related knowledge on a flash drive, threw it down a storm drain and despatched an e mail to the darkish internet market: “This account has been compromised.” After a couple of months, he figured he was within the clear. He and his girlfriend deliberate their wedding ceremony and invited friends to satisfy them in Hawaii for the massive day: Might 12, 2017. They purchased rings, and a gown.

Brokers had been ready once they stepped onto American soil in Honolulu.


When Crandall sat on the witness stand, he was slump-shouldered and shackled, clumsily making an attempt to maneuver his handcuffs to drag a tissue out of the field to wipe his eyes. Within the two years since his arrest, he has been imprisoned in a county jail and watched his fellow inmates endure the brutal fallout of an opioid epidemic. They stole from their mother and father, cycled out and in of jail and shivered, sweated, sobbed via withdrawal.

He’d helped feed this, he realized. For cash.

He and Shamo’s different ex-partners and packagers pleaded responsible, agreed to testify towards their good friend and hoped for mercy.

The story they advised satisfied the jury to convict Shamo of 12 counts, together with persevering with prison enterprise, the so-called “kingpin cost” that’s sometimes reserved for drug lords like El Chapo and carries a compulsory life sentence. The jury deadlocked, although, on the 13th depend: the demise of Klyuev.

The bust was one of many largest operations within the nation in 2016. However the fentanyl commerce has solely grown extra subtle since. By comparability, Shamo now seems “small-time,” stated Safdar, with the Partnership for Secure Medicines. Probably the most infamous Mexican drug cartels have transitioned to fentanyl, at the same time as homegrown upstarts like Shamo’s proliferate.

Seizure knowledge within the United Nations World Drug Report reveals trafficking shortly increasing worldwide. In 2013, 4 nations reported fentanyl seizures. By 2016: 12 nations. In 2017, 16 nations reported seizing fentanyl.

There is no such thing as a cause to imagine it is not going to unfold additional. In Africa and the Center East, the artificial opioid tramadol is extensively abused, a lot of it illicitly manufactured in Asia. If that market transitions to fentanyl it might be catastrophic, stated Scott Stewart, a former agent with the State Division. In Australia, prescription opioid consumption has quadrupled. Marianne Jauncey, medical director of a Sydney harm-reduction middle, cannot consider any cause fentanyl will not quickly arrive — all they will do is put together for the day that it does.

As Shamo was convicted, a single darkish internet market nonetheless had 32,000 listings for medication, hundreds of them claiming to be oxycodone. There was no option to inform whether or not they originated in a pharmacy or someone’s basement.

One vendor even borrowed a model of Shamo’s identify. Pharmamaster peddles oxys on-line, bought in bulk at a reduction. It has, it boasts, an “limitless” provide.

“Pharma-grade A++,” the listings promise. “24-hour delivery!”

EDITOR’S NOTE: This story was produced in partnership with the Pulitzer Middle on Disaster Reporting.


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German party co-leader steps down after cancer diagnosis


An interim leader of Germany’s junior governing party is stepping down after being diagnosed with breast cancer.

The Social Democrat Party’s Manuela Schwesig says she is confident of making a full recovery but needs treatment and won’t be able to attend every public appointment in the coming months.

Schwesig said Tuesday she plans to give up her position in the center-left party’s national leadership but keep her other job as governor of Germany’s Mecklenburg-Western Pomerania state.

Schwesig became one of the Social Democrats three interim party leaders following the June resignation of Andrea Nahles. New leadership will be installed in December.

Malu Dreyer, another state governor, will have to lead the Social Democrats alone for a few weeks. The third interim leader, Thorsten Schaefer-Guembel, is joining Germany’s international development agency on Oct. 1.


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FDA says Novartis withheld knowledge downside earlier than drug approval


U.S. regulators wish to know why Novartis did not disclose an issue with testing knowledge till after the Swiss drugmaker’s $2.1 million gene remedy was accepted.

The Meals and Drug Administration stated Tuesday the manipulated knowledge concerned testing in animals, not sufferers, and it is assured that the drug, known as Zolgensma, ought to stay in the marketplace. The company stated it is investigating and can contemplate prison or civil penalties if acceptable.

Zolgensma was accepted in Might for kids below 2, turning into the costliest therapy ever. It is a one-time therapy for a uncommon inherited situation, spinal muscular atrophy, which destroys a child’s muscle management.

The FDA stated in a press release that AveXis Inc., the Novartis AG subsidiary that manufactures Zolgensma, informed the company 5 weeks after the approval a few “knowledge manipulation concern” that resulted in inaccurate details about testing in animals. The company stated the corporate knew about the issue earlier than the FDA accepted Zolgensma. The incorrect knowledge is a small subset of the testing data that the FDA evaluated.

Appearing FDA Commissioner Ned Sharpless tweeted that “the company will use its full authorities to take motion.”

In a press release Tuesday night, Novartis stated that after AveXis realized of alleged knowledge manipulation in a single animal testing process, the corporate instantly started investigating. As soon as it had “interim conclusions,” it shared them with the FDA.

Novartis did not say why it did not notify the FDA earlier than it accepted Zolgensma. Novartis said that the animal check in query is not utilized in making the remedy for sufferers and that Zolgensma is protected and efficient.

FDA workers inspected the corporate’s Irvine, California, manufacturing plant in current weeks, then issued a report discovering a number of deficiencies, together with not absolutely following high quality management procedures.

Spinal muscular atrophy strikes about 400 infants born within the U.S. annually and is a high genetic reason for toddler loss of life. Zolgensma works by supplying a wholesome copy of the defective gene that causes the situation.


Observe Linda A. Johnson at https://twitter.com/LindaJ—onPharma .


The Related Press Well being and Science Division receives help from the Howard Hughes Medical Institute’s Division of Science Training. The AP is solely accountable for all content material.


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Area hit arduous by opioids embraces jail-based therapy


As western Massachusetts struggles with a dramatic spike in deadly overdoses, officers are embracing a controversial resolution: sending males who haven’t dedicated any crimes to jails and prisons for court-ordered habit therapy.

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Hampden County Sheriff Nick Cocchi has designated a wing of his jail for the therapy of males civilly dedicated for substance abuse causes. It is the one facility in western Massachusetts housing the lads, and simply certainly one of three in all the state for males.

Whereas some are attempting to finish the apply, Cocchi and his supporters — together with native mayors and lawmakers — say the jail’s year-old Stonybrook Stabilization and Therapy Facilities is vital to curbing the opioid drawback within the county, which incorporates the previous manufacturing cities of Springfield and Holyoke.

Deadly overdoses surged greater than 80% in Hampden County from 2017 to 2018 at the same time as they declined statewide for the second straight 12 months in 2018, in accordance with state knowledge.

“Individuals coming into our program are offended, violent and sick,” Cocchi mentioned as he and different officers celebrated this system’s anniversary earlier this week. “They’re on the finish of the highway, and their households have acknowledged that if they do not intervene, they won’t survive.”

However the civil rights group Prisoners’ Authorized Providers of Massachusetts has sued the state in an effort to finish the usage of jails and prisons for forcibly treating males with habit.

The category motion lawsuit was filed in March on behalf of 10 males who complained of poor situations and mistreatment at one other civil dedication program run out of a state Division of Corrections jail.

A state fee has additionally just lately really helpful ending the apply of sending civilly dedicated males to jails and prisons, because the state did for ladies three years in the past, following an analogous lawsuit. Girls are actually despatched to substance abuse therapy services run or contracted by public well being companies, as most civilly dedicated individuals are in different states.

“This shouldn’t be a alternative between jail or nothing,” mentioned Bonnie Tenneriello, a workers lawyer with Prisoners’ Authorized Providers. “Why are we giving cash to a sheriff to run therapy applications relatively than funding civilian therapy?”

Underneath state legislation, relations can ask a choose to order their relations into therapy in the event that they’re unwilling to go voluntarily and are deemed a hazard to themselves or others.

No less than 35 states have such civil dedication legal guidelines, however Massachusetts is only one of a handful the place it is extensively used, The Related Press discovered final 12 months.

About 9,950 civil commitments requests had been filed in state courts within the finances 12 months that ended June 30. That is down from greater than 10,770 the prior 12 months however up considerably from the 6,105 in fiscal 12 months 2016 and the below 3,000 in fiscal 12 months 2006, in accordance with state knowledge.

Tenneriello and different opponents say forcing individuals into jails and prisons for therapy solely reinforces the stigma round habit. And research, together with the state’s personal analysis , additionally counsel compelled therapy largely would not work and will elevate the hazard of overdose for individuals who relapse after therapy.

Just like the state corrections-run civil dedication facility, Hampden County’s program takes place, at the very least initially, behind the razor wire of its safe jail campus.

Civilly dedicated males are additionally equally segregated from the common inmate inhabitants however required to put on corrections-issued uniforms and observe sure corrections protocols.

However, in an effort to make this system really feel much less institutional, cell doorways stay largely unlocked and program contributors aren’t handcuffed, Cocchi and a few just lately launched sufferers mentioned.

“Sure, it is a jail setting. There are corrections officers strolling round,” mentioned Keith Molyneux, a 40-year-old recovering from heroin habit who was among the many first to finish this system final 12 months. “However they’re extra dedicated to serving to you right here than to truly being a correctional officer. You undoubtedly really feel like they’re there to assist.”

After a couple of weeks of detoxing on the jail, most are ultimately transferred to a much less safe facility situated off-campus in a transformed nursing residence. There, the lads can put on civilian garments and are housed in rooms which might be bigger and extra dorm-like.

Early outcomes of the strategy — which additionally consists of well being care professionals administering habit therapy medicines and main counselling periods — are encouraging, Cocchi mentioned.

Since opening final Could, greater than 850 males have gone by way of this system, staying 47 days, on common — weeks longer than they do on the state’s different two services.

The longer stays improve the percentages that the lads will keep sober, Cocchi mentioned. Up to now, lower than 5% have needed to be recommitted, although two fatally overdosed after leaving this system.

Lawmakers, in the meantime, have dedicated $1 million to this system within the present state finances, proving the trouble has sturdy assist, regardless of its detractors, he mentioned.

“Allow us to proceed doing what we’re doing,” Cocchi mentioned. “Nobody else is doing this work out right here, however we’re doing it, and we’re doing it effectively. Why should not we be applauded and supported?”


Comply with Philip Marcelo at twitter.com/philmarcelo.


This story has been corrected to determine the Hampden County sheriff as Nick Cocchi, not Thomas Cocchi.


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Thai well being ministry receives hashish oil for medical use


Thailand’s well being ministry obtained its first batch of authorized medical marijuana Wednesday to be distributed in state-run hospitals.

Public Well being Minister Anutin Chanvirakul presided over the ceremonial handing over of 4,500 5 milliliter bottles of extracted hashish oil from the Authorities Pharmaceutical Group to the Public Well being Ministry.

“The liberty for medical utilization begins from this level onwards,” Anutin advised reporters at a information convention. Anutin was elected to the Home in March whereas main a political occasion that ran on the flagship coverage of legalizing medical marijuana.

The bottles of extracted hashish oil shall be distributed to 12 hospitals and administered to certified sufferers together with those that are a part of a analysis program and people present process chemotherapy.

The ministry expects to obtain 2,000 extra bottles by the tip of the month, and Anutin mentioned he desires the Thai folks to have entry to 1 million bottles of hashish oil extract inside 5 to 6 months.

Thailand’s legislature agreed to amend the nation’s drug regulation final 12 months to permit the licensed medical use of marijuana, in addition to kratom, a regionally grown plant historically used as a stimulant and painkiller.

Anutin mentioned he believes marijuana ought to be categorised as medication as a result of it may well relieve seizures and Parkinson’s illness and unwanted effects from chemotherapy.

Extracted hashish oil produced by the Thai authorities has three variations, one with tetrahydrocannabinol (THC), one with cannabidiol (CBD), and one other with each parts. The Authorities Pharmaceutical Group mentioned its merchandise include protected ranges of the chemical parts derived from marijuana vegetation.


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Medicare to cowl breakthrough gene remedy for some cancers


Increasing entry to a promising however pricey therapy, Medicare mentioned Wednesday it is going to cowl for some blood cancers a breakthrough gene remedy that revs up a affected person’s personal immune cells to destroy malignancies.

Officers mentioned Medicare will cowl CAR-T cell therapies for sure kinds of lymphoma and leukemia , makes use of which might be permitted by the Meals and Drug Administration. The associated fee can run to a whole lot of hundreds of {dollars} per affected person, not counting hospitalization and different bills.

Medicare Administrator Seema Verma mentioned the choice will present constant and predictable entry nationwide, opening up therapy choices for some sufferers “who had nowhere else to show.”

CAR-T makes use of gene remedy strategies to turbocharge the affected person’s personal immune system cells, reprogramming them to harbor a “receptor” that zeroes in on most cancers, after which to develop a whole lot of thousands and thousands of copies. The revved-up immune cells are returned to the affected person’s bloodstream and may proceed to struggle most cancers for months or years.

Though negative effects will be extreme, research have proven the therapy to be extremely efficient in opposition to sure kinds of cancers. Researchers are working so as to add extra varieties to that record.

Medicare has been weighing the choice for months. This system usually units the tone for personal insurance coverage as properly.

In its announcement, Medicare mentioned it is going to cowl CAR-T when the therapy is offered in establishments which might be enrolled with the FDA in a particular program to advertise security. It should additionally cowl the therapy for different makes use of, if they’re really useful by agency-approved medical analysis literature.

CAR-T makes use of a distinct technique than different gene-therapy strategies. As an alternative of attempting to repair disease-causing genes, it focuses on the affected person’s immune system, particularly the T cells that battle overseas substances within the physique. The issue with most cancers is that malignant cells can usually evade detection by the affected person’s T cells. CAR-T helps the physique’s personal T cells do a greater job of recognizing tumors.

Medicare covers greater than 60 million seniors and other people with disabilities.


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After years of ready, medical marijuana offered in Louisiana


A Marine veteran fighting PTSD and a lady preventing most cancers grew to become a number of the first folks to buy medical marijuana in Louisiana on Tuesday, because the state grew to become the primary within the Deep South to dispense therapeutic hashish, 4 years after state lawmakers agreed to present sufferers entry to it.

9 pharmacies are licensed to dispense medical marijuana throughout Louisiana and most are anticipated to open this week. Louisiana joins greater than 30 different states that permit medical marijuana in some type. And although marijuana is banned on the federal stage, a congressional modification blocks the Justice Division from interfering with states’ medical marijuana applications.

A 41-year-old fight veteran from Belle Chasse, Louisiana, made his buy at Capitol Wellness Options on Tuesday. He stated he’d tried medical marijuana in California and it modified his life however he was comfortable to have the ability to buy it in his dwelling state.

“It has turn into a actuality to my household this morning, waking up and understanding that I’d be capable to go dwelling and for the primary time in my lengthy wrestle, I will be capable to do that legally in entrance of my household,” Gary Hess informed reporters earlier than making his buy. “That is unbelievable.”

GB Sciences, considered one of two state-sanctioned growers, started transport medical marijuana to Louisiana’s registered dispensaries Tuesday morning, after state regulators not too long ago accomplished last checks and cleared it for launch. Lots of of sufferers in Louisiana have been awaiting the beginning of this system after years of labor by lawmakers, who created the regulatory framework in 2015 for allotting the hashish. There even have been regulatory disputes and different hurdles.

State Sen. Fred Mills, a pharmacist in St. Martin Parish who sponsored the medical marijuana legislation, by no means thought it might take years for sufferers to realize entry. He stated he has repeatedly acquired “troublesome calls” from folks with most cancers, seizures and different debilitating situations and their relations asking when hashish will attain pharmacy cabinets.

“The hardest factor has been not having the ability to give folks a definitive timeline that they may make plans for,” Mills stated.

Randy Mire, proprietor of Capitol Wellness Options in Baton Rouge, noticed three sufferers Tuesday and hosted a ribbon-cutting ceremony at his spa-like workplaces within the state’s capitol. He has lots of extra sufferers ready. He stated he particularly wished to create a welcoming workplace area so sufferers might really feel secure and that they have been in a spot the place they would not be judged.

For lots of the sufferers, Tuesday was an enormous aid, he stated.

“Possibly they’ve had to make use of medical marijuana not legally up to now and now they’re in a position to even have a authorized suggestion for this,” he stated.

Solely the Louisiana State College and Southern College agricultural facilities are licensed to develop medicinal-grade pot.

Regulatory disagreements between GB Sciences, LSU’s grower, and state regulators in Louisiana’s agriculture division slowed getting the product to cabinets, with medical marijuana advocates claiming the company created pointless regulatory hurdles.

In the meantime, Southern broke ties with the primary firm it selected to develop marijuana, delaying its efforts. Southern’s new grower Ilera Holistic Healthcare planted its first crop two weeks in the past and estimates its first product might be accessible by fall on the earliest.

Underneath the 2015 legislation and extra adjustments handed since then, Louisiana is permitting medical marijuana to deal with a protracted record of ailments and issues, comparable to most cancers, seizure issues, epilepsy, glaucoma, post-traumatic stress dysfunction and Parkinson’s illness.

Albert Anthony was at Capitol Wellness Options along with his spouse Jeanette, who suffers from a uncommon kind of mind most cancers. He stated she hadn’t tried medical marijuana earlier than however he had and hoped it might have some advantages for her comparable to rising her urge for food.

“That is an excellent feeling, you realize, which you can get a product that is authorized now and we’re simply glad to see it come to go,” he stated.

Medical doctors do not difficulty a prescription however a “doctor suggestion type,” a authorized nuance geared toward retaining docs from jeopardizing their medical licenses as a result of federal legislation prohibits prescribing marijuana. Eighty-eight docs across the state have been accredited for the Louisiana allow required to supply medical-grade pot to sufferers.

Agriculture Commissioner Mike Pressure, whose company regulates medical marijuana, stated 4,760 doses of therapeutic hashish have been within the first batch of mint-flavored product launched Tuesday. The second batch, anticipated in a few week, will include 4,300 doses in cherry-flavored product, he stated.

Marijuana will be accessible in oils, tablets, liquids, topical functions and an inhaler, comparable to that utilized by bronchial asthma sufferers — however not in a smokeable type.

GB Sciences’ first product will likely be liquid tinctures, in three completely different concentrations. John Davis, GB Sciences Louisiana president, stated he expects to have dissolving strips taken by mouth accessible in a month, adopted by topical lotions.

Pharmacies set their very own value for the merchandise, and insurance coverage will not be masking the associated fee, so sufferers should pay out of pocket. Mire stated the associated fee at his pharmacy will vary from $99 to $200 per product.


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