The Bipartisan Budget Act of 2015 (Public Law 114-74; November 2, 2015), made some changes to Social Security’s laws about claiming retirement and spousal benefits. Section 831 of the law (entitled “Closure of Unintended Loopholes”) made several changes to the Social Security Act and closed two complex loopholes that were used primarily by married couples. This fact sheet explains what is changing and how it might affect you.
Determining when to start your Social Security benefits is a complex and personal decision. We encourage you to research your options before you apply for benefits. You may also contact Social Security at 1-800-772-1213 (TTY 1-800-325-0778) to speak with a representative about your retirement options.
What was the loophole? The law provides incentives to delay claiming retirement benefits: monthly benefits grow larger for each month you delay receiving retirement benefits between full retirement age (currently 66) and 70. The loophole allowed some married individuals to start receiving spousal benefits at full retirement age, while letting their own retirement benefit grow by delaying it.
How is the law changing? Under existing law, if you are eligible for benefits both as a retired worker and as a spouse (or divorced spouse) in the first month you want your benefits to begin and are not yet full retirement age, you must apply for both benefits. You will receive the higher of the two benefits. This requirement is called “deemed filing” because when you apply for one benefit you are “deemed” to have also applied for the other.
Under the new law deemed filing is extended to apply to those at full retirement age and beyond. In addition, deemed filing may occur in any month after becoming entitled to retirement benefits. For example, if you begin receiving your retirement benefit and only later become eligible for a spousal benefit (or vice versa), you will be “deemed” to have applied for the second benefit as soon as you are eligible for it. Your monthly payment will be the higher of the two benefit amounts.
What is the rationale for this change? Historically, spousal benefits were designed to be paid only to the extent they exceeded any benefit the spouse earned based on his or her own work record. This change in the law preserves the fairness of the incentives to delay, but it means that you cannot receive one type of benefit while at the same time earning a bonus for delaying the other benefit.
Who will be affected? If you turn 62 on or after January 2, 2016, and will be eligible for benefits both as a retired worker and as a spouse (or divorced spouse), then the new law applies to you. Deemed filing applies to retirement benefits, not to survivor’s benefits. So, if you are a widow or widower, you may start your survivor benefit independently of your retirement benefit if you restrict the scope of your application. There are also some exceptions to deemed filing. For example, deemed filing does not apply if you receive spouse's benefits and are also entitled to disability, or if you are receiving spousal benefits because you are caring for the retired worker’s child. If you have questions about your specific situation, contact Social Security.
How and when is Social Security implementing this change? We have already implemented this change with specific instructions to our field office employees because the law applies to those who attain age 62 on January 2, 2016 or later. We are continuing to update our website and materials.
Example 1: Maria turns age 62 after January 1, 2016 and her husband, Joe, is 65. They have each worked enough years to earn a retirement benefit. In March of 2020, Maria has reached her full retirement age and files for benefits. Maria is eligible for a spousal benefit on Joe’s record. Maria must file for both benefits. She can no longer file only for the spousal benefit and delay filing for her own retirement. She will receive a combination of the two benefits that equals the higher amount.
Example 2: Jennie is a 62-year-old widow. She is eligible for retirement benefits based on her work history, and she is also eligible for survivor benefits based on her deceased husband’s record. She starts her survivor benefit this year, restricts the scope of her application to widow’s benefits, and does not start her own retirement benefit, allowing it to grow. At age 70, she starts her own increased retirement benefit, which she will receive for the rest of her life. The new law does not affect her because deemed filing does not apply to widow(er)s. Jennie will receive the higher of the two benefits.
What was the loophole? As described above, retirement benefits grow for each month you delay claiming, between full retirement age (currently 66) and 70. A loophole allowed a worker at full retirement age or older to apply for retirement benefits and then voluntarily suspend payment of those retirement benefits, which allowed a spousal benefit to be paid to his or her spouse while the worker was not collecting retirement benefits. The worker would then restart his or her retirement benefits later, for example at age 70, with an increase for every month retirement benefits were suspended.
How is the law changing? Under the new law, you can still voluntarily suspend benefit payments at your full retirement age (currently 66) in order to earn higher benefits for delaying. But during a voluntary suspension, other benefits payable on your record, such as benefits to your spouse, are also suspended. And, if you have suspended your benefits, you cannot continue receiving other benefits (such as spousal benefits) on another person’s record.
There are some exceptions. If you are a divorced spouse, you can continue receiving a divorced spousal benefit even if your ex-spouse voluntarily suspends his or her retirement benefit.
What is the rationale for this change? There is less rationale for paying dependents if the primary worker has not retired or is not receiving payment from Social Security. It also preserves the fairness of the incentives to delay, so that couples cannot simultaneously receive a benefit and get a bonus for delaying.
Who will be affected? The new law applies to individuals who request a suspension on or after April 30, 2016, which is 180 days after the new law was enacted. Remember, you must have reached your full retirement age (currently 66) in order to request a suspension.
In some situations, we will honor requests received before April 30, 2016, that we are unable to process until after April 30, 2016. For example, there could be a situation where you are already full retirement age, and you contact us to apply for benefits before April 30, 2016, expressing your intent to apply for, and suspend, your benefits. If we cannot take your application until June 2016, we will honor the request for voluntary suspension that we received before April 30, 2016.
If you voluntarily suspended benefits prior to April 30, 2016, you may remain in voluntary suspense status, and the new law will not affect you. Also, if you submit your request before April 30, 2016 and your spouse or children become entitled to benefits either before or after that date, they will not be affected by the new rules and will continue to receive payment.
How and when is Social Security implementing this change? We have developed instructions for our field office employees so they can answer questions before this change takes effect for suspension requests that are submitted on or after April 30, 2016.
Example: Thomas will turn 66 in 2016, and Maria will turn 62. Thomas starts his retirement benefit at his full retirement age, 66, in June 2016, and Maria starts her spousal benefit based on his record. Thomas immediately suspends his benefit. In past years, that would have meant that Maria could continue receiving spousal benefits while Thomas could restart his own benefit at age 70 and receive an increase for each month he waited. Now, because Thomas reached his full retirement age and requested the suspension after April 30, 2016, he is subject to the new law. He can still choose to voluntarily suspend his benefit after his full retirement age, but if he does suspend his benefits, Maria’s spousal benefit will also be suspended.
For more information about these changes, contact Social Security at 1-800-772-1213 (TTY 1-800-325-0778).
Events listed alphabetically by state.
Los Angeles, California: Various times and locations. Events sponsored by SoCalCOSH.
April 25, 5pm. Screening of "A Day's Work." UCLA James West Alumni Center.
April 27, Time and location TBA. Rally in Support of Permanent Overtime Pay for the Domestic Workers Alliance and CSUDH 8th Annual Labor, Social and Economic Justice Fair, 1000 E. Victoria Street, Carson.
April 28, 10am-11:30am. Workers Memorial Day Rally and Press Conference.
May 1, noon. May Day Health and Safety contingent at May Day March, Olympic & Figueroa.
Oakland, California: April 28, 4:30pm. Lake Merritt/Frank H. Ogawa Plaza.
"Reclaim Labor, Reclaim Lives." Join Worksafe, Centro Legal de la Raza, and Street Level Health Project/Oakland Workers' Collective for an evening of remembrance. At 4:30, meet at the Lake Merritt Ampitheatre, located between 12th Street and 1st Avenue on Lake Merritt Boulevard, and march to City Hall (1 Frank H. Ogawa Plaza) for a 5:30pm rally. Flyers in English and Spanish.
Los Angeles, California. April 25, 5pm. UCLA James West Alumni Center, 325 Westwood Plaza.
UCLA LOSH presents the Los Angeles premiere of the award-winning documentary "A Day's Work." This free screening will be followed by a panel of local experts who can answer your questions about what temporary worker issues look like in Southern California and how you can get involved.
San Francisco, California. April 28, 7pm. ILWU Local 34, 801 2nd Street.
The Injured Workers National Network hosts. Speakers include Brenda Barros of SEIU 1021, Dr. Larry Rose (Past Medical Director of CAL-OSHA), Daryle Washington of IBT 350, and Daniel Berman (author of "Death on the Job."
Ukiah, California: April 28, 5:30pm. Clubhouse, 107 S. Oak Street.
Honoring workers from Mendocino County who have been killed or injured on the job.
Hartford, Connecticut. April 28, 5pm. State Capitol, 210 Capitol Avenue.
Following the ceremony at the Capitol, wreathes will be laid at the Workers Memorial in Bushnell Park. Sponsored by the Connecticut AFL-CIO and the Health & Safety Committee.
Lake Park, Florida. April 28, 6pm-8:30pm. The Kelsey Theater, 700 Park Avenue.
The ceremony will include Presentation of Colors by the Palm Beach County Firefighters Pipes & Drums and Honor Guard, Pledge of Allegiance and National Anthem by Young Singers of the Palm Beaches, Invocation and Prayer for the Fallen, Special Guest Speakers including State Attorney Dave Aronberg, Vergie Bain (OSHA), County Commissioner Shelley Vana and more. This event is free to all who attend. Appetizer buffet and cash bar. Sponsored by the Palm Beach-Treasure Coast AFL-CIO.
Miami, Florida. April 28, 11:45am. Port Miami-Seamen's Center, 1015 N. America Way.
RSVP for event.
Temple Terrace, Florida. April 28, 3pm. Council Chambers, 11250 N. 56th Street.
Join the USF SafetyFlorida Consultation Programs and USF OSHA Training Institute Education Center as we honor those workers, acknowledge their suffering families and recognize affected communities.
Bloomington, Illinois. April 28, 6am. Law and Justice Center, 104 E. Front Street.
This year’s commemoration is dedicated to John Hoeniges, a McLean County employee, who perished in a fall on May 26, 2015. Besides honoring Hoeniges, names of over 200 local workers who have lost their lives on the job will be read.
Decatur, Illinois: April 28, 5:30pm. Northwest corner of the Macon County Courthouse lawn, 253 W. Wood St.
Decatur Trades and Labor Assembly Workers’ Memorial Day Service.
Peoria, Illinois. April 28, 5pm. Peoria Labor Temple, 400 NE Jefferson Avenue.
The Labor Council of West Central Illinois hosts a march to the Workers' Memorial Monument at City Hall. For more info, email Mikeverett34@gmail.com
Rockford, Illinois: April 28, 5pm. E.J. ‘Zeke’ Giorgi Building, 200 South Wyman Street.
The Rockford United Labor Workers’ Memorial Day Ceremony.
Springfield, Illinois. April 28, 5:30pm. Illinois State Library Atrium, 200 S. 2nd Street.
Cedar Rapids, Iowa: April 28, 5:30pm. IBEW 405 Hall, 1211 Wiley Blvd SW.
Hawkeye Labor Council hosts this observance.
Clinton, Iowa. April 28, 1pm. Clinton River Front, 130 3rd Avenue South.
The Clinton Labor Congress will have a memorial ceremony open to the public.
Iowa City, Iowa. April 26, 2016, 7:00pm-9:00pm. University of Iowa, Callaghan Auditorium, College of Public Health Building,145 North Riverside Drive.
Screening of "A Day's Work," followed by discussion. Sponsored by the University of Iowa, the Heartland Center for Occupational Health & Safety, and TemporaryEmployees.org.
Waterloo, Iowa. April 28, 5:30pm. Black Hawk Labor Temple, 1695 Burton Avenue.
The Black Hawk Union Council will have a short program with speakers and a light meal. For more info, email firstname.lastname@example.org.
Cumberland, Maryland: April 28, noon. City Hall Plaza, 57 N. Liberty Street.
Observance with speakers.
Boston, Massachusetts. April 28, Noon-1:15pm. In front of State House, 24 Beacon Street.
Commemoration. We encourage families to bring enlarged photos of your loved one orsend a photo to MassCOSH and they will enlarge it. Sponsored by the Massachusetts Coalition for Occupational Safety and Health (MassCOSH), Massachusetts AFL-CIO, and Greater Boston Labor Council. For rain location, please call 617-825-7233 x14.
Duluth, Minnesota: April 25, 7am. Wellstone Hall -- Duluth Labor Temple, 2002 London Road.
The annual AFL-CIO Worker's Memorial pancake breakfast will be served from 7-9am with welcoming statements by the City of Duluth Mayor and Central Labor Body President t 8:30am. At 9:15am a tree planting ceremony will take place outside on the grounds of the Duluth AFL-CIO Labor Temple.
St. Cloud, Minnesota. April 28, 11am. 4150 2nd Street South.
The Greater Minnesota Worker Center hosts a commemoration/press event.
Minnesota Building and Construction Trades hosts a commemoration.
Commemoration sponsored by St. Louis Labor Council.
Lincoln, Nebraska: April 28, 7pm. State Capitol, 1445 K Street.
7th Annual Candlelight Vigil sponsored by United Support and Memorial for Workplace Fatalities (USMWF). There will also be a Nebraska's 5th Annual Safety Training, April 28-29, 9am-3pm, at Country Inn & Suites, at the Airport Exit off of I-90.
Screening of film "A Day's Work," followed by a panel discussion following featuring the film maker, temp workers, and worker advocates. Event co-sponsored by the New Hampshire Coalition for Occupational Safety and Health, New Hampshire AFL-CIO, BDB Health Promotions, UNH Occupational Health Surveillance Program.
Annual Dinner and Memorial Presentation. co-sponsored by the New Hampshire Coalition for Occupational Safety and Health. Buffet Dinner and Speakers. We add the names of workers killed in 2015 to our memorial plaque.
New Brunswick, New Jersey. April 24, 2016, 3pm. Anshe Emeth Memorial Temple, 222 Livingston Avenue.
NJ Work Environment Council and New Labor Rally and March.
Amherst, New York. May 10. UAW Region #9, 35 George Karl Boulevard.
WNYCOSH hosts a screening of "A Day's Work" at the Buffalo Central Labor Council monthly meeting.
Binghamton, New York. April 29, 6pm-8pm. Bundy Museum of History and Art, 129 Main Street.
In honor of Workers' Memorial Day and May Day, the Occupational Health Clinical Centers has organized state-wide screenings of the award-winning documentary film "A Day's Work." This screening is co-sponsored by the Broome Tioga Green Party, People's Press, Student-Labor Alliance, and the Workers Center of the Southern Tier. The museum's film series in commemoration of Workers' Memorial Day continues on May 12, 6pm, with the film "Who Needs Sleep," about the sweatshop hours worked by film crews.
There will also be an observance hosted by the Central New York Labor Federation on April 30 at noon, at the Binghamton Factory Fire Commemorative Plaque (on Wall Street, near the Martin Luther King statue on the River Trail.)
Ithaca, New York. May 1, 4:30pm-6:30pm. Cinemapolis, 120 E. Green Street.
In honor of Workers' Memorial Day and May Day, the Occupational Health Clinical Centers has organized state-wide screenings of the award-winning documentary film "A Day's Work."This screening is co-sponsored by the Tompkins County Workers Center and Midstate COSH. Suggested donation of $10 (no one will be turned away for lack of funds.
Massena, New York. April 30, 11am-1pm. Massena Central High School, 84 Nightengale Avenue.
In honor of Workers' Memorial Day and May Day, the Occupational Health Clinical Centers has organized s tate-wide screenings of the award-winning documentary film "A Day's Work." This screening is co-sponsored by the Jefferson, Lewis, and St. Lawrence Counties Central Trades and Labor Council, PEF Region 7, People Project, and Workforce Development Institute.
New York, New York. April 28, 11:30am. 46th Street and 8th Avenue.
Join NYCOSH, the Central Labor Council, and other labor partners as we commemoratethose we have lost and work to create safer working conditions. We'll meet at the location a worker, Christian Ginesi, died in a preventable construction incident last May.
Plattsburgh, New York. May 4, Time and location TBA.
In honor of Workers' Memorial Day and May Day, the Occupational Health Clinical Centers has organized state-wide screenings of the award-winning documentary film "A Day's Work." This screening is co-sponsored by the Northeast Central Trades and Labor Council, PEF Region 7, and the Workforce Development Institute.
Potsdam, New York. May 5, 4pm - 6pm. SUNY Potsdam, 104 Kellas Hall, 44 Pierrepont Avenue.
In honor of Workers' Memorial Day and May Day, the Occupational Health Clinical Centers has organized state-wide screenings of the award-winning documentary film "A Day's Work." This screening is co-sponsored by PEF Region 7, SUNY Potsdam Department of Sociology, and the Unitarian Universalist Church of Canton.
Rochester, New York: April 28, 5:00pm. Highland Park Workers Memorial Monument, 180 Reservoir Avenue.
Observance hosted by the Rochester and Genesee Valley Area Labor Federation.
In addition, there will be a May 2nd screening of "A Day's Work," co-sponsored by the Occupational Health Clinical Centers, and People Organizing for Worker Empowerment and Respect. Time and location TBA.
Syracuse, New York. April 29, 8am-10am. Pensabene's Casa Grande, 135 State Fair Boulevard.
Unity Breakfast. Ticket information here. Flyer is here. Co-sponsored by Central New York Area Labor Federation, AFL-CIO, Greater Syracuse Labor Council, Occupational Health Clinical Centers, Workers' Center of CNY, Greater Syracuse County Occupational Safety & Health, Workforce Development Institute (WDI).
In addition, on May 3 at 6pm, In honor of Workers' Memorial Day and May Day, the Occupational Health Clinical Centers has organized a screening of the award-winning documentary film "A Day's Work" at the NYSUT Office, 4983 Brittonfield Parkway. This screening is co-sponsored by the Central New York Area Labor Federation.
Akron, Ohio. April 28, 11am. Outside ICWU Workers Memorial area, 1655 W. Macket Street.
Event will include presentation of Colors by color guard, National Anthem, invocation, various speakers, placing of wreath, taps, rifle salute, moment of silence, benefiction.
Canton, Ohio. April 28, 2016, 10:00am. Hall of Fame Central Labor Council, 1329 Market Avenue North.
Cincinnati, Ohio. April 28, 5:30pm. UAW Local 547 Union Hall, 10020 Reading Road.
Cincinnati AFL-CIO and United Auto Workers (UAW) are co-sponsoring the 11th Annual Workers' Memorial Day Ceremony. Including regional speakers and a cookout. For more info, email Pmclinden@cincinnatiaflcio.org
Columbus, Ohio. New Memorial Park, May 21, 2016. 25 Marcon Boulevard.
Honoring Worker Memorial Day. A joint effort of the Columbus-Franklin County AFL-CIO, the Buckeye Chapter of the American Society of Landscape Architects and the City of Columbus, Workers Memorial honors Franklin County workers who have died on the job since 1992.
Lima, Ohio. April 26, 6:30pm. Rose Marie Duffy Lodge, 1870 Robb Avenue.
Dinner program with speakers. For more info, email email@example.com
Newark, Ohio. April 28, 6:30pm. Licking-Knox CLC/GMP Union Hall, 350 Hudson Avenue.
RSVP for commemoration.
Candlelight Vigil sponsored by Oklahoma AFL-CIO. On April 1, 8am-5pm, the Oklahoma Safety Council and ASSE Oklahoma City is having a volunteer day to make wooden silhouettes of the fallen to be displayed on April 28
Portland, Oregon. April 25, 7pm. IBEW Union Hall, 15937 NE Airport Way.
The Northwest Oregon Labor Council hosts a commemoration.
Salem, Oregon. April 28, noon. Oregon State Capitol Mall, outside the Labor and Industry Building, 350 Winter Street, NE.
Commemoration hosted by Oregon AFL-CIO.
Coatesville, Pennsylvania. April 28, 8:00am. Steelworkers Memorial Iron and Steel Museum• 50 South 1st Avenue.
Ceremony includes steel beam recovered at the World Trade Center.
Erie, Pennsylvania: April 28, 6pm - 7pm. Erie City Council Chambers, City Hall, 626 State St, Room 400.
Erie-Crawford Central Labor Council, AFL-CIO 30th Annual Workers’ Memorial Service. Prayer service, speaker program, reading of names and placing of memorial wreath at the Workers’ Monument in Perry Square.
Harrisburg, Pennsylvania. April 28, 8am - 10am. Passage to India Restaurant, 525 S. Front Street.
Harrisburg Region Central Labor Council Workers’ Memorial Day Breakfast and Memorial Observance. Observance held at the Monument in Labor's Grove, a short distance from the restaurant.
Philadelphia, Pennsylvania. April 29, 8:30am. Sheet Metal Workers Hall, 1301 S. Columbus Blvd.
PHILAPOSH will have a breakfast program. A reading of names of those who died from work-related injuries and illnesses in the Tri-State area in 2016 will take place followed by a casting of flowers into the Delaware river, reaffirming our commitment to prevent injury, illness and death on the job. Accompanied by Brian Wydlitz on the bagpipes, playing "Amazing Grace." Participants should register and pay for breakfast.
Reading, Pennsylvania. April 30, noon. Heritage Park, 6th and Canal Streets.
Join the United Labor Council of Reading Berks for a lineup of local speakers and light refreshments.Bring your own chair.
Providence, Rhode Island. April 27, 3pm-5:30pm. Occupational and Environmental Health Center, 410 South Main Street, 3rd Floor.
Program on OSHA's Construction Confined Space Rule. Pre-registration is requested. Sponsored by Rhode Island Committee on Occupational Safety and Health.
Knoxville, Tennessee. April 30, 2016, noon. Knoxville-Oak Ridge Area Central Labor Council, 1522 Bill Williams Ave.
Observance and release of Knox Area Workers' Memorial Day Committee Workers Memorial Day report. Co-sponsored by the Central Labor Council, Jobs with Justice of East Tennessee, and the Interfaith Worker Justice of East Tennessee. Email for more information.
Nashville, Tennessee. April 28, 7pm. UAW 737 Hall, 6207 Centennial Boulevard.
The Central Labor Council of Nashville and Middle Tennessee hosts thiscommemoration.
Corpus Christi, Texas. April 28, noon. IBEW Local Union 278, 2301 Saratoga.
A BBQ Sandwich Lunch to remember those who have suffered and died on the job and to renew the fight for safe jobs. Guest Speakers will be Marianne McGee, OSHA Compliance Assistance Specialist; Travis Clark, OSH AREA Director; and Becky Moeller, Retired Texas AFL-CIO President. Hosted by the Coastal Bend Labor Council.
Houston, Texas. April 28, 6pm. Various locations.
USW Local 6000 hosts a commemoration at the IBEW Local Union 716, 1475 North Loop West, Suite 400.
Fe y Justicia hosts a vigil. Email for more information.
Bellingham, Washington: April 28, noon. Bellingham Library lawn, 210 Central Ave.
Observance sponsored by Northwest Washington CLC.
Seattle, Washington. April 27, 11:30am, Lyceum Room, Husky Union Building, University of Washington.
Memorial sponsored by Martin Luther King County Labor Council.
Morgantown, West Virginia. April 28, 6pm. Public Safety Building, 200 Spruce Street.
Commemoration sponsored by the West Virginia AFL-CIO.
Menomonie, Wisconsin. April 28, 4:30pm. Dean and Sue Bar and Grill, 2002 Midway Road.
The Greater West Central Labor Council (Wisconsin) is hosting a Workers Memorial Day event. A free supper will be provided from 4:30-6:30 followed by a program from 6:30 p.m. - 7:00 p.m. Please bring a dessert to pass. For more info, email firstname.lastname@example.org.
Milwaukee, Wisconsin. April 28, 5pm. Carl F. Zeidler Union Square.
Join WisCOSH to commemorate lives lost in the last year.
Rhinelander, Wisconsin. April 30, 11:00am. Pioneer Park, Kemp Street and Oneida Avenue.
The memorial rock nests in the pines on the right upon entering the Park. All workers and their families are invited to the tribute to those who have given their lives to earn a living. Keynote Speaker: Father Dean Einerson, Saint Augustine's Church.
Jackson, Wyoming. April 29, 10am. Town Council Chambers, 150 E. Pearl Avenue.
Join WYCOSH and allies for this commemoration.
PLEASE also join our workers' memorial day group to add events and stories -
Imagine pain in an arm or leg so intense that the sufferer would rather undergo an amputation than put up with it any longer. For those with complex regional pain syndrome (CRPS), this is not just a hypothetical nightmare—it is reality. According to the National Institute of Neurological Disorders and Stroke (NINDS), CRPS is a chronic condition most often affecting one limb (arm, leg, hand or foot), usually after an injury or trauma to that limb. The main complaint is pain that is way out of proportion to the severity of the initial injury. The cause of the condition isn't clearly understood, according to NINDS. It can manifest as visual swelling, redness and other abnormalities in a limb.
CRPS is widely considered to be the single worst source of pain—ranking higher on pain scales than childbirth, cancer and amputation. Yet the condition is rare and can be difficult to recognize. As a result, patients with CRPS—predominantly women, with an average age of 40, according to the National Institutes of Health—can search for an average of approximately four years before being properly diagnosed with the condition, according to a study published in the Scandinavian Journal of Pain. This long wait, compounded by the pain, can severely impact their daily living and quality of life. Although reports of those experiencing the symptoms of this condition have existed as long ago as the Civil War, according to a study published in The BMJ, no medication has yet been approved.
Randall Kaye, M.D. is the Chief Medical Officer at Axsome Therapeutics, Inc., a clinical-stage biopharmaceutical company currently enrolling patients at sites across the U.S., Canada, the U.K. and Australia in a clinical study, called CREATE-1, to evaluate its experimental medication AXS-02 for the treatment of chronic pain caused by CRPS. In this quest, Axsome is motivated by the many stories from CRPS patients, describing how difficult it can be to live with CRPS. Thought not yet approved, AXS-02 has been granted Fast Track and Orphan Drug Designation by the U.S. Food and Drug Administration and Orphan Medicinal Product Designation.
AXS-02 (disodium zoledronate tetrahydrate) is an oral, non-opioid, potentially first-in-class pain therapeutic being developed for the treatment of chronic pain caused by CRPS. The compound has multiple mechanisms of action to address chronic pain: it inhibits bone-resorbing osteoclasts, downregulates acid-sensing ion channels, reduces pro-inflammatory cytokine production and is anti-angiogenic.
As a result of his efforts at Axsome Therapeutics, Dr. Kaye is especially able to appreciate the need for novel approaches to CRPS and to oversee efforts to advance the state of care.
National Institute of Neurological Disorders and Stroke
Source: Washington Post
The Obama administration plans to forgive $7.7 billion in federal student loans held by nearly 400,000 permanently disabled Americans.
By law, anyone with a severe disability is eligible to have the government discharge their federal student loans. The administration took steps four years ago to make the process easier by letting people who are totally and permanently disabled use their Social Security designation to apply for a discharge, but few took advantage. The Department of Education is now taking it upon itself to identify eligible borrowers and guide them through the steps to discharge their loans.
“Too many eligible borrowers were falling through the cracks, unaware they were eligible for relief,” said Education Under Secretary Ted Mitchell in a statement. “Americans with disabilities have a right to student loan relief. And we need to make it easier, not harder, for them to receive the benefits they are due.”
Working with the Social Security Administration, the department has been identifying borrowers receiving disability payments and have the specific designation of “Medical Improvement Not Expected,” which indicates they are eligible for the discharge. The agencies found 387,000 matches in its first review. About 179,000 of those people are currently in default on their loans, putting them at risk of losing their tax refunds and having their Social Security benefits garnished.
Read more: https://www.washingtonpost.com/news/grade-point/wp/2016/04/12/obama-to-forgive-the-student-debt-of-permanently-disabled-people/
When 58-year-old Zyp Czyk* had a serious mountain biking accident in June, she refused to go to the emergency room even though her injuries knocked her out cold and her husband pleaded for her to seek help.
Instead, Czyk slept for two days—contrary to the conventional wisdom of what you’re supposed to do after sustaining a head injury. Only then did she finally agree to go to an urgent care center, where she discovered she had broken her collarbone and some ribs and needed surgery.
Czyk isn’t afraid of doctors, hospitals, or pain medication, and she’s not opposed to Western medicine. In fact, she’s been taking Oxycontin for chronic pain for nearly two decades. And that’s the problem: She feared that if she went to the hospital she might be labeled a drug-seeker, which could lead to her doctor cutting off her opioid prescription, leaving her without the treatment that makes her life bearable.
Czyk is just one of the more than 100 million Americans with chronic pain caught in the latest drug war crossfire. These patients and their doctors are often targeted by federal agencies like the Centers for Disease Control (CDC) and the Drug Enforcement Agency (DEA) in an intensifying crackdown on painkillers that fall in the same class of drugs—opioids—as heroin. But these efforts are as misguided as most “supply-side” drug war initiatives, and the collateral damage tends to be excruciating.
Last week, the CDC released a report showing that the rate of heroin overdose deaths in America quadrupled between 2002 and 2013. In a press briefing, CDC director Thomas Friedman said that rising use of medical opioids “primed” Americans for heroin addiction and called for “an all-of-society response,” including a reduction in prescriptions and better law enforcement. Likewise, in its 2015 assessment of the threat from heroin, the DEA reported, “Increased demand for, and use of, heroin is being driven by both increasing availability of heroin in the US market and by some controlled prescription drug (CPD) abusers using heroin.”
You’d never know it from the official government line, but while the “opioid epidemic” islinked to increased use of pain medications, the overwhelming majority of addictions do not start with a prescription—and most opioid prescriptions do not cause addiction.
All of which is to say that chronic pain patients are bearing the brunt of yet another drug war blunder.
Like Czyk, those who genuinely need painkilling drugs are now subject to policies like random reports to the doctor’s office for pill counts, prescription limits, extra refill appointments, urine testing, and other restrictions that can become expensive and onerous. Worse, they are often made to stop taking drugs that help them. While she knew she risked her health by postponing care after her crash, Czyk tells me that she felt waiting offered less risk than being falsely labeled an “addict” and was “not as dangerous as losing my pain medications.”
Opioid addiction usually begins in the same place that all other addictions start: in the childhoods, traumas, mental illnesses, and genes of those affected.
Her fears are far from unrealistic given reports of pain doctors being arrested and charged with crimes resulting from so-called overprescribing, lea
But according to a new study in the journal Addictive Behaviors, the greatest predictor of whether a person misuses opioids is not poor health—instead, it’s having used illegal drugs in the past year.
Opioid addiction usually begins in the same place that all other addictions start: in the childhoods, traumas, mental illnesses, and genes of those affected.
Drug warriors don’t like to tell this story. In the stereotypical account, addiction starts with an evil doctor—probably high on Big Pharma propaganda—hooking innocent patients. For example, when Massachusetts Governor Charlie Baker was inaugurated this January, he incorrectly described the experience of the parents of a young man who died of an overdose.
“After a routine medical procedure their 19-year-old son, Evan, was prescribed opiates for pain,” Baker said. “Slowly and unknowingly, he became addicted to them. When the prescription ended, he turned to heroin,”
In fact, Evan started taking drugs with his friends, who introduced him to pills the same way they did marijuana—no doctors were involved. It’s not clear what put him in the 10 to 20 percent of drug users who become addicted, but it definitely wasn’t pain treatment.
And Evan’s route to opioid addiction is by far the most common. Since the Substance Abuse and Mental Health Service Administration (SAMHSA) started collecting this data, it has always found that over 75 percent of people who misuse painkillers get them from friends, relatives, dealers, or other illicit sources—not physicians.
Data on people who start pain treatment yields the same conclusion: The vast majority don’t misuse their drugs.
Even among the most frequent users, less than a third see doctors to get their drugs.
And there’s more research supporting the idea that the vast majority of opioid addiction starts on the street. In 2014, a national study of nearly 136,000 emergency room patients admitted for overdoses containing opioids found that just under 13 percent had a chronic pain diagnosis. And a 2008 study, this one from an addiction-ravaged region in West Virginia, found that 78 percent of victims had a history of substance misuse and nearly two-thirds possessed prescription drugs that were not prescribed to them.
Looking at people treated for Oxycontin addiction alone, a study in theAmerican Journal of Psychiatry found that the vast majority—78 percent—never had a legitimate prescription and a similar number reported cocaine use and previous treatment for substance abuse.
Unless you’re ready to believe that doctors can turn pain patients into coke fiends, the simpler explanation is that painkiller addiction hits people who are already abusing other drugs. These people know where to buy stuff like coke and heroin, unlike pain patients—a.k.a. your parents and grandparents—who tend to be unfamiliar with how street drug markets operate.
Data on people who start pain treatment yields the same conclusion: The vast majority don’t misuse their drugs. Here, Czyk’s case is typical. Formerly a computer systems administrator, she had suffered inexplicable pain since childhood. Eventually, she was diagnosed by specialists at Stanford with Ehlers Danlos Syndrome, a painful connective tissue disorder that often manifests in visible bruises. She says she has never misused her drugs, and even initially refused to take enough of them to effectively treat her pain.
In 1995, Czyk’s doctor suggested that she try a newly-introduced drug called Oxycontin. “I took it as prescribed,” she tells me. “I took as little I could as get away with.” She adds that her doctor finally sat her down and said she’d get more relief if she “took enough that it would actually work.”
Although opioids can make people sleepy, Czyk had the opposite experience. “I was able to work,” she says, “When I took the pills, my energy went up because the pain [had been] so tiring.” Ever since, she says she’s used it judiciously. While chronic pain patients may suffer withdrawal symptoms if they stop using a drug abruptly, this is the not same thing as addiction, which is defined by experts as compulsively using a drug in the face of negative consequences.
by Sahid Fawaz
Anti-union, anti-regulation types always speak about the utopia that allegedly exists in a free market. Well, over a hundred years ago an unregulated workplace existed in America and it wasn't pretty. And children were among the most innocent of victims of free market greed run amok. These eleven pictures capture that era when children were often sent to work as young 5 years old, with many never getting a chance at education or a normal childhood. It's a good thing that unions and progressives were around to champion the interests of those who couldn't stand up for themselves and finally put an end to child labor for those under 12 years old with the Fair Labor Standards Act of 1938.
The Centers for Disease Control and Prevention, in long-awaited guidelines on prescribing opioid medications for pain, gives tepid endorsement for the use of urine testing before and during opioid therapy for pain, despite its statements that, “Urine drug tests do not provide accurate information about how much or what dose of opioids or other drugs a patient took,” and "The clinical evidence review did not find studies evaluating the effectiveness of urine drug screening for risk mitigation during opioid prescribing for pain.”
"Urine drug testing results can be subject to misinterpretation and might sometimes be associated with practices that might harm patients (e.g., stigmatization, inappropriate termination from care),” the guidelines state. Indeed, Cal NORML regularly hears from patientswho are terminated from pain management medications because of their use of medical marijuana.
"Clinicians should not test for substances for which results would not affect patient management or for which implications for patient management are unclear,” the CDC states. "For example, experts noted that there might be uncertainty about the clinical implications of a positive urine drug test for tetrahyrdocannabinol (THC)”...Clinicians should not dismiss patients from care based on a urine drug test result because this could constitute patient abandonment and could have adverse consequences for patient safety."
"We applaud the CDC's reasoned approach to the use of urine testing and its drawbacks when used on pain patients," said Ellen Komp, Deputy Director of California NORML. "Considering that opioid overdose deaths are significantly lower in states with medical marijuana programs,we are sorry the agency apparently didn't read the letter Elizabeth Warren recently sent to its chief calling for marijuana legalization as a means of dealing with the problem of opiate overdose."
Also from the guidelines:
"Experts agreed that prior to starting opioids for chronic pain and periodically during opioid therapy, clinicians should use urine drug testing to assess for prescribed opioids as well as other controlled substances and illicit drugs that increase risk for overdose when combined with opioids, including nonprescribed opioids, benzodiazepines, and heroin [notice THC is not included.]” The use of "a relatively inexpensive immunoassay panel for commonly prescribed opioids and illicit drugs” was acknowledged but its drawbacks were noted (does not detect synthetic opioids (e.g., fentanyl or methadone) and might not detect semisynthetic opioids (e.g., oxycodone). These panels are often where THC is detected.
"Most experts agreed that urine drug testing at least annually for all patients was reasonable. Some experts noted that this interval might be too long in some cases and too short in others, and that the follow-up interval should be left to the discretion of the clinician. Previous guidelines have recommended more frequent urine drug testing in patients thought to be at higher risk for substance use disorder. However, experts thought that predicting risk prior to urine drug testing is challenging and that currently available tools do not allow clinicians to reliably identify patients who are at low risk for substance use disorder."
"Some clinics obtain a urine specimen at every visit, but only send it for testing on a random schedule. Experts noted that in addition to direct costs of urine drug testing, which often are not covered fully by insurance and can be a burden for patients, clinician time is needed to interpret, confirm, and communicate results.”
Called "the nation's top federal health agency," CDC sought the input of experts to assist in reviewing the evidence and providing perspective on how CDC used the evidence to develop the draft recommendations.
UPDATE 2/26 PM: This response was received from CDC spokesperson Courtney Lenard:
It is prudent for clinicians to restrict use of any medical test to situations when results of the test would be helpful in decisions about patient management. This is particularly important when testing or test results might have unintended negative consequences for patients. Some experts noted that in some cases, positive THC results might have legal or other consequences for patients but might not inform patient care decisions. While CDC is not stating that urine tests for THC should never be used, the guideline recommends that clinicians should only test for substances (including THC) if the clinician knows how he or she would use the results to inform patient management.
Regarding the statement “However, experts thought that predicting risk prior to urine drug testing is challenging and that currently available tools do not allow clinicians to reliably identify patients who are at low risk for substance use disorder.”: this statement refers to the difficulty in risk-stratifying patients for urine drug testing, given that most other available tools would not allow clinicians to accurately predict which patients are at low enough risk for substance use disorder that urine drug testing would not be needed.