Dear Judges,

In late April 2016, federal and local law enforcement agents conducted a raid on a Reno-area car
dealership and doctors 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 Nevadas 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 havent 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 governors chief of staff.

Following the RGJs 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
Nevadas 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 years Nevada Press Association Better
Newspaper Contest. Thank you for any consideration.

Sincerely,

Brian Duggan
Investigations editor
Reno Gazette-Journal
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SUNDAY, MAY 15, 2016

District charges per page for records

Families of children She wanted to see witness statements
about the treatment of her 9-year-old
with disabilities face son, who has Down syndrome. She want-
ed to see the statement from the employ-
steep bills, barriers ee accused of calling her son a brat,
yanking on his arm and pulling him up by
his pants, according to school records.
SIOBHAN MCANDREW But before the working mom of three
SMCANDREW@RGJ.COM and her husband could review the hun-
dreds of pages of documents to see what
When Katherine Gutierrez was told their son may have suffered, the district
her son may have been abused by an em- wanted $373.50.
ployee at Alyce Taylor Elementary in While the district eventually gave Gu-
Sparks, she asked for copies of his school tierrez the files for free after emails
files. 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 JASON HIDALGO RENO GAZETTE-JOURNAL

Nevada has a pill problem.

From the number of people dying from prescription pain pill overdoses
to the sheer amount of narcotics that doctors prescribe, Nevada tops na-
tional lists.
At the same time, Nevada lawmakers pushed by a strong lobby of
doctors have resisted instituting programs used in other states that
could flag practitioners who may need intervention for their prescribing
practices.
That regulatory gap is exacerbated by professional licensing boards
that say its not within their purview to initiate investigations against
members outside of the formal complaint process.
But the arrest this month of a Reno family practice physician charged
with illegally distributing controlled substances brought into sharp focus

See PILLS, Page 6A

Only in the Sunday RGJ

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Susan Leak said she worried about ending up home-
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6A Sunday, May 15, 2016 Reno Gazette-Journal Reno Gazette-Journal Sunday, May 15, 2016 7A

Pills West II and seven of his present

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, theyre 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-
tients and prescribers 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 doctors prescribing prac-
tices, however, havent been de-
veloped and are actively opposed
by professional licensing boards
such as the Board of Medical Ex-
aminers.
It would be inappropriate,
and its 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 Rands 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-
ships manager Richard Richie
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 Rands pa-
tient.
In Wests 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-
tors 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
Rands 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 Rands 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 Campiones 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 cant hydrocodone distribution rate. In
believe theyre 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
cant find a new doctor or who are
having non-pain medication pre-
scriptions being rejected by patients well-being. Some doc-
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 Sandovals 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, Nevadas
most widely prescribed opioid. In
2012, nearly 1.04 million grams
was distributed via retail in the
state. Thats more than double
what doctors prescribed in 2006.
Nevadas distribution rate is
third highest in the country.
Nevada also ranks third for its
tions are targeted on the users
2012, doctors prescribed more
than 799,000 grams of hydroco-
done -- nearly three times the
rate of New Jersey, which has tri-
ple Nevadas population.
Woodard said the reasons for
the high prescription rates arent
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
sults in a formal complaint filing.
BRIAN DUGGAN/RGJ
tors are advocating for that prac-
tice to stop.
While a high distribution rate
isnt 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.
Thats not necessarily happen-
ing in Nevada.
Federal agents involved in the
investigation into Rand wont
comment on the case, saying the
investigation is continuing and
more indictments may be com-
ing.
But a Reno police source said
it wasnt 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 Yenicks
death. The monitoring program
then showed the extent of Rands
prescribing habits.
Rands indictment alleges the
doctor began illegally distribut-
ing controlled substances in 2012.
Robinson admitted that most
of his departments investiga-
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 dont have the re-
sources to mine data for problem
prescribers.
The Board of Medical Examin-
ers wont comment on complaints
against its doctors until its been
through an investigation and re-
sponders and friends and family
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- members of addicts.
plaints against Rand exist. But when it came to imple-
According to a Reno Gazette- menting more reporting and edu-
Journal review of publicly avail- cation requirements on doctors,
able complaint documents, the Sandoval had a fight on his hands.
Board of Medical Examiners has The bill initially required that
launched 20 formal investiga- doctors receive two hours of con-
tions into doctors accused of tinuing education on opioid ad-
some sort of prescription irregu- diction every year. The bill that
larity involving pain medication passed allows licensing boards to
since 2013. recommend doctors take one
Fifteen resulted in some sort hour of training a year.
of disciplinary action, including a The legislation also included a
public reprimand, probation or li- new requirement that doctors
cense suspension. check the prescription drug mon-
Attacking Nevadas prescrip- itoring database before prescrib-
tion drug program was one of ing a narcotic to a new patient in
Sandovals top five priorities in certain cases.
last years legislative session, Another requirement: the pre-
Willden said. scription drug monitoring pro-
He introduced an omnibus bill gram now must send copies of the
that included legal protections reports generated on a potential
for those who seek help for some- doctor-shopping patient to the
one who has overdosed and al- prescribers licensing board.
lows for expanded distribution of According to the minutes of
naloxone, which can reverse the the legislative hearings on the
effects of an opioid and stop an bill, the medical community
overdose from killing, to first re- fought against the additional re-
quirements for doctors. In the
bills 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 theyve known
and cared for. And they said doc-
tors shouldnt have to worry
about Big Brother looking over
their shoulders.
It makes me pause every shoulder every second, Willden
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. ently.
JASON BEAN/RGJ
Willden said the state needs to
strike a balance in over-regulat-
ing doctors to the point they dont
want to practice here. Nevada
suffers from a severe doctor
shortage in many disciplines as it
is.
We dont want to look like a
state thats holding a 10-pound
hammer and have doctors think-
ing were looking over their
the right thing.
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 its
up to the different licensing
boards to decide how to use those
reports.
According to interviews, each
board treats the reports differ-
First, the pharmacy board
doesnt 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.
Whos to say whats normal or
whats 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 thats not meant to
minimize the problem with
opioid addiction or the programs
role in combating it.
The governors 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
states doctors, said they use the
reports to remind doctors to
check that their patients arent
suffering from an addiction. It
would be inappropriate to use
them to initiate an investigation,
Cousineau said.
Ive talked to many doctors
over the years and theyve im-
plored me, they dont 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
their practice.
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
havent 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
doesnt use it to initiate investiga-
tions.
We dont 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
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 deceaseds
prescription history in the data-
base to see if any related doctors
have troubling prescription prac-
tices.

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2A Wednesday, June 22, 2016 Reno Gazette-Journal
OBITUARIES
Callahan, Eileen Rose
Carpenter, William L. *
Colbath, Barbara G.
Cypher, Trina Fay Poleviyuma
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On RGJ.com
Dorman, Alvin Al
Hollinger, Nancy Jean Wood
* Denotes In Loving Memory
Complete obituaries, 7C
SIOBHAN MCANDREW
HIGHER EDUCATION REPORTER
775-788-6417
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TREVON MILLIARD
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775-788-6343 Gov. Brian Sandoval heads a planning meeting in Carson City on Tuesday ahead of the Governor's Prescription Drug Summit.
tmilliard@rgj.com
CHRIS MURRAY
Sandoval
WOLF PACK REPORTER
775-788-6543
determining whether a lem with opioids is not painkiller epidemic.
cmurray@rgj.com physician is an overpre- good and that there is Is it a medical prob-
@MurrayRGJ scriber is something that something systemic lem or is it a legal prob-
SETH A. RICHARDSON
Continued from Page 1A is not clear cut, said Larry that needs to be ad- lem? one prescriber said
BREAKING NEWS REPORTER Pinson, executive secre- dressed. during public comment.
775-788-6301 tary of the Nevada State Status quo isnt work- That needs to be ad-
srichardson@rgj.com The state announced at Board of Pharmacy. ing and we need to do dressed first.
@SethARichardson
the public meeting that it Whats the line? Pin- something, Sandoval The strongest testimo-
BENJAMIN SPILLMAN has received grant money son said. Whos going to said. ny in the meeting came,
OUTDOORS REPORTER to hire biostatisticians to draw those lines? One point everyone however, from people
775-788-6435
bspillman@rgj.com improve tracking of pre- The pharmacy board agreed on is that there is a who talked about how
@ByBenSpillman scriber and patient data at also stressed that the Pre- problem and addressing painkiller addiction has
the geographic and demo- scription Monitoring Pro- the issue will not be easy. impacted themselves and
JOHNATHAN WRIGHT
FOOD & DRINK REPORTER graphic level. An investi- gram was only designed Funding challenges for their families. The com-
775-327-6770 gation by the Reno Ga- to track doctor shoppers, existing programs and ments included vivid de-
jwright@rgj.com zette-Journal in May not overprescribers. A new options that could scriptions of the slow de-
@RGJTaste found that overprescrib- board representative con- make a difference were scent of loved ones into
ing doctors can escape firmed, however, that pre- mentioned several times opioid abuse, with some
scrutiny in Nevada be- scribing data is part of the during the meeting. leading to deadly results.
cause the program focus- information that the pro- Theres also the balanc- Such experiences show
es on pill users but not pre- gram captures. ing act faced by prescrib- why it is important to ad-
scribers. Representatives of the ers between helping pa- dress the problem and
There was pushback Board of Medical Examin- tients with a legitimate seek answers, not ex-
from the pharmacy board ers also cautioned against need and watching out for cuses, Sandoval said.
about expanding use of making hasty actions those who abuse the medi- Ive seen the reports,
the Prescription Monitor- when addressing the is- cations. Part of the chal- youve seen the reports,
ing Program to catch phy- sue, warning that it could lenge is the legal tightrope Ive listened to the experi-
sicians who prescribe a cause unintended conse- that some prescribers say ences of the families and
large amount of painkill- quences. Sandoval, how- they have to navigate, es- their grieving, Sandoval
Mega number: 10 ers. Figuring out how ever, said doing nothing pecially given the in- said. They want an-
much is too much when when theres a clear prob- creased attention on the swers.
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SUNDAY, MAY 29, 2016

Panama leak only tip of Nevada iceberg

Dozens of firms creating ming, Nevada and Delaware.
A USA TODAY examination of the
slew of shell companies limited records that are available
some states are making corporate rec-
with foreign addresses ords increasingly invisible shows that
Mossack Fonseca registered less than 2
STEVE REILLY USA TODAY percent of the Nevada companies that
are linked to addresses outside the Unit-
Mossack Fonseca, the focus of the ed States. A similar review of Wyo-
Panama Papers leak, is far from the only mings more secretive records shows
company mass-producing shell compa- that just 24 of more than 2,000 foreign-
nies in secrecy-friendly states like Wyo- based businesses registered since 1990
were created by Mossack Fonsecas
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 states Division of Corpora-
tions totaled $928 million in 2014 near-
ly 30 percent of the states 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 U.S. states
and territories and amount distributed in Nevada.
JASON HIDALGO JHIDALGO@RGJ.COM

OXYCODONE
3 RD
Growing up in the 1960s, Denise Everett was shy and somewhat socially awk- 12 1.04 million grams
ward. For a Southern California teenager who wanted to fit in with her peers, it 06 514,544 grams
was not an ideal combination. Everett would eventually find her version of
courage through various substances. It started with alcohol around age 16. I HYDROCODONE
3 RD
12 799,452 grams
discovered it was a wonderful social lubricant, Everett said. After enrolling
06 604,561 grams
in Chico State considered the No. 1 party school west of the Mississippi
SOURCE: U.S. DEA | GANNETT

alcohol continued to be Everetts substance of choice. But she also dabbled in

MORPHINE
5TH
other popular drugs, including marijuana, amphetamines and cocaine. Everetts 12 346,309 grams
dependence would cost her. I didnt finish college, said Everett, who moved 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
5TH 12
06
169,571 grams
202,535 grams

Only in the Sunday RGJ

Why has the old clock stopped
ticking? When will it be fixed?
The clocks insides were taken out a few months ago
and sent for repair to a Massachusetts clock compa-
ny because of a maintenance snafu that caused lu-
brication to run dry. It is expected to be running
again in a few weeks.
Ask the RGJ, 4A

Pack falls in MW tourney RUCKUS AND RAGE AT RALLY

New Mexico beat Nevada 14-4 in the championship San Diego police arrested 35
game on Saturday night in Albuquerque, N.M. The protesters Friday outside a
Lobos earned the MWs automatic NCAA Regional Donald Trump rally after a
bid. The Pack won 20 of its final 24 games this sea- demonstration devolved into
son, with three of those losses being to New Mexico. chaos, according to police.
Sports, 1C USA Today, 1B

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6A Sunday, May 29, 2016 Reno Gazette-Journal
Painkillers
Continued from Page 1A
to Reno afterward. I just couldnt seem to
keep things together to finish.
It wasnt until the late 80s that Everett
sought help and turned her life around,
eventually earning a masters degree in
counseling and education psychology in
1992.
Today, Everett works as the director of
Access to Healthcare Networks 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 theres 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. Its 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.
Its like having four beers every night
and pretty soon you dont 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 addictions 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 states high rate of prescrip-
tions for opioids such as oxycodone and hy-
drocodone.
A bottle of hydrocodone is seen at Campus Pharmacy at the University of Nevada, Reno Thursday.
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 Nevadas 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.
Nevadas 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 DEAs
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
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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-olds
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.
Theres been a downward trend in
overdose death rates, but its still pretty
appalling, said Mike Willden, chief of
staff for Gov. Brian Sandoval. This didnt
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 Nevadas high prescription rates for
opioids remains a mystery.
I really dont know, campus pharma-
cy manager Baker said. Its a little baf-
fling, actually.
Baker thinks its 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 patients 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
2016
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 cant 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 dont 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, were aware of the criti-
cism against us, but we dont want to get
into an argument about whose fault it is,
VanderVeer said. What were 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 familys
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.
Were concerned with what were 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 dont have a prescription for,
Willden said. Thats 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.
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ents medicine cabinet or grandpas night
stand, they bring it to a party because its 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 DEAs Pullen.
One thing weve 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. Youre
looking at a really big system, so its 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
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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, PhRMAs 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. couraging law enforcement agencies to
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 addiction, a common mantra given by
said. But right now theres 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- for nearly three decades, its important to
tinue to be crucial in addressing the addic-
tion problem. Resources, however, remain
a challenge, according to several in the
field.
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says balancing its budget to match needs is
a constant struggle. Theres always a rela-
tionship between availability and quality
of service to resources, but hiring staff
does not come cheap, especially medical
professionals like doctors.
Its a matter of money, Firestone said.
It always is.
Everett of Access to Healthcare Net-
work echoed Firestones sentiments. Ever-
ett pointed to the closure of a Saint Marys
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. Youre working mostly with
people who dont have financial resources,
dont have anything to tap into and seldom
have insurance.
One thing that has helped is the Afford-
able Care Acts 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 were 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. Theres also a movement toward en-
start treating addicts more as victims in-
stead of criminals. One agency that has
seen such pushback is the DEA.
Were 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
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. Its 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
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 youre paying attention.
6A Sunday, May 29, 2016 Reno Gazette-Journal
Painkillers
Continued from Page 1A
to Reno afterward. I just couldnt seem to
keep things together to finish.
It wasnt until the late 80s that Everett
sought help and turned her life around,
eventually earning a masters degree in
counseling and education psychology in
1992.
Today, Everett works as the director of
Access to Healthcare Networks 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 theres 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. Its 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.
Its like having four beers every night
and pretty soon you dont 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 addictions 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 states high rate of prescrip-
tions for opioids such as oxycodone and hy-
drocodone.
A bottle of hydrocodone is seen at Campus Pharmacy at the University of Nevada, Reno Thursday.
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 Nevadas 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.
Nevadas 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 DEAs
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
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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-olds
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.
Theres been a downward trend in
overdose death rates, but its still pretty
appalling, said Mike Willden, chief of
staff for Gov. Brian Sandoval. This didnt
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 Nevadas high prescription rates for
opioids remains a mystery.
I really dont know, campus pharma-
cy manager Baker said. Its a little baf-
fling, actually.
Baker thinks its 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 patients 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
2016
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 cant 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 dont 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, were aware of the criti-
cism against us, but we dont want to get
into an argument about whose fault it is,
VanderVeer said. What were 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 familys
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.
Were concerned with what were 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 dont have a prescription for,
Willden said. Thats 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.
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ents medicine cabinet or grandpas night
stand, they bring it to a party because its 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 DEAs Pullen.
One thing weve 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. Youre
looking at a really big system, so its 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
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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, PhRMAs 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. couraging law enforcement agencies to
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 addiction, a common mantra given by
said. But right now theres 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- for nearly three decades, its important to
tinue to be crucial in addressing the addic-
tion problem. Resources, however, remain
a challenge, according to several in the
field.
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says balancing its budget to match needs is
a constant struggle. Theres always a rela-
tionship between availability and quality
of service to resources, but hiring staff
does not come cheap, especially medical
professionals like doctors.
Its a matter of money, Firestone said.
It always is.
Everett of Access to Healthcare Net-
work echoed Firestones sentiments. Ever-
ett pointed to the closure of a Saint Marys
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. Youre working mostly with
people who dont have financial resources,
dont have anything to tap into and seldom
have insurance.
One thing that has helped is the Afford-
able Care Acts 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 were 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. Theres also a movement toward en-
start treating addicts more as victims in-
stead of criminals. One agency that has
seen such pushback is the DEA.
Were 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
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. Its 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
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 youre paying attention.
 Reno Gazette-Journal Sunday, July 17, 2016 1E

RENO GAZETTE-JOURNAL

Voices
CONTACT MARK ROBISON | 775-788-6420 | MROBISON@RGJ.COM RGJ.COM

THE OPINION OF THE RGJ EDITORIAL BOARD

DRUG CASE SECRECY

A PUBLIC DISSERVICE
U.S. Attorneys 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 RGJs 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 strangers underwear drawer.
Bryant said the purpose of the RGJs 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 someones 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 INSIDE

BEFORE MAKING MEDICARE-FOR-ALL, OVERHAUL IT 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
N. George Marche of Reno is this weeks winner of the Silver Pen for a letter on Randi Thompson: Puerto Rico is too big to fail. 3E
Medicare. Published July 12, it reads: Weekly Silver Pen Froma Harrop: At Fox News, sexism is business. 4E
In his column, Sean Lehmann advocates Medicare for all. Dr. Lehmann is winners are selected by Bonnie Eberhardt Bobb: Protect Nevadas Gold Butte. 4E
correct, but insurance companies and brokers have gotten involved in Medicare. the newspaper's
Before extending Medicare to all, it needs to be simplified. Today there are over editorial board based
a dozen choices in healthcare and drug plans. Seniors cannot sign up for a plan on the quality of
without the help of brokers. A broker selects a plan based on the health needs of writing, clarity of Our editorial board
a senior at the beginning of the year. Seniors are responsible for changes in their expression and
Editorials reflect the consensus of the Reno Gazette-Journal
health or drug needs during the year. strength of opinion.
editorial board and are written by one of its members.
Brokers tell seniors that they furnish this service at no charge. Visiting doc- Potential winners do
tors and taking medications are necessary, not recreational. Increase the Medi- not have to agree with John Maher is president of the Reno Gazette-Journal.
care premium to reduce its cost, and provide one Medicare plan and one drug the newspaper's Kelly Ann Scott is the newspapers executive editor.
plan to cover everyone. This will eliminate most middlemen and provide the editorial position. Gannett.
health care needed by all, like the rest of the advanced countries of the world. Mark Robison is the RGJs engagement editor.
4E Sunday, July 17, 2016 Reno Gazette-Journal
OBAMA MUST ACT TO
PROTECT GOLD BUTTE
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, Nevadas 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.
Testing biases
personnel search
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 Renos ex-
am appears on the citys
website. Its biodata por-
tion is stuck in 1956. Thats
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.
Renos 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 dont care for books or
music much. I love my wife and children.
I dont let them get in the way of compa-
ny work.
Secrecy
Continued from Page 1E
mission to keep this community in-
formed, and it is about transparency in
the criminal justice system.
The RGJs 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
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, dont
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 dont 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
Buttes 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 Buttes Native
American artifacts. In April, members
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 ... and it fails to
measure ... conscientiousness ... it
didnt 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. Americas communities are be-
ing tested.
Patricia Gallimore is president of
the Reno-Sparks NAACP. Andrew Bar-
bano serves as first vice-president.
makes this case of tremendous impor-
tance to Reno-Sparks residents is that
there may be 60 deaths linked to Rands
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 publics name.
In essence, the government is saying:
Trust us when we raid someones busi-
ness and home to take whatever we want
as potential evidence, the public does not
of Nevadas 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 Buttes
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 Buttes 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-
At Fox News, sexism
is built into business
ONE VIEW
FROMA HARROP
What to make of
Gretchen Carlsons 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 shed seem
to have a good case.
But other complaints about inap-
propriate behavior at Fox News dont
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 dont 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?
Its 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.
(Its especially painful to watch one helped advance a business model that
of the survivors, Andrea Mitchell at
69, displaying arms and legs alongside
fully dressed men with lesser intel-
lects. It does not matter that shes in
terrific shape.)
Carlson sat on the Fox & Friends
set for years as an accomplice. She sol-
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. Attorneys Office says no
and that anyone who would claim other-
wise is just doing it for crass or selfish
reasons.
The U.S. Attorneys Office seems to
KURT KUZNICKI/ NEVADA OUTSIDE
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
Nevadas history is protected. A May poll
of Nevadans from both sides of the politi-
cal aisle shows that Im 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.
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
CNNs 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 wont be-
grudge their trading dignity for fame
and fortune, if thats their wish and they
dont pretend otherwise.
The main problem with Carlsons suit
is the timing. It was filed only after the
network decided to not renew her con-
tract. While gainfully employed, she
championed overt sexism. And thats
why the sisterhood probably isnt losing
a lot of sleep over Carlsons case, even
as it quietly hopes she prevails.
Follow Froma Harrop on Twitter
@FromaHarrop. She can be reached at
fharrop@gmail.com.
want a stenographer to regurgitate its
press releases rather than a free and vi-
brant media. It has forgotten the First
Amendments 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 publics duty to make sure the
government is using its power responsi-
bly.