National Sickle Cell Awareness Month

September is Chronic Pain & Suicide Awareness month


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Telemedicine patients with opioid use disorder struggle to fill prescriptions

I was talking to a gal this week that I have known for 3+ decades and she is involved with a local recovery center because her Nephew also had a fatal OD. She was telling me that the judges in the drug courts are getting really pissed because people assigned to the drug court are not able to obtain or maintain sobriety because of the erratic available of all controlled meds, just like a lot of chronic pain pts are dealing with.  Here is a hyperlink to the nearly 600 page agreement between the 45 state AG and the three major drug wholesalers https://www.pharmaciststeve.com/?attachment_id=49645 

where they agreed to reduce the amounts of controlled meds that are sold to community pharmacies, and not share with those pharmacies what the amount of controls they are being allotted to each community pharmacy.

If anyone is interested, each wholesaler is licensed by the state board of pharmacy in each state, and

state boards of pharmacy typically have oversight of drug wholesalers, though the extent and specifics vary by state. Their primary charge,  is to protect public health by regulating the safe handling, storage, and distribution of pharmaceuticals, which includes oversight of wholesale distributors to ensure drugs move securely through the supply chain.
Should all these pts who are having difficulty in getting their controlled meds because the pharmacy they patronize, cannot get enough inventory of controlled meds from these drug wholesalers. File complaints with the BOP over the major drug wholesaler are not meeting their goals as outlined by the BOP regulations?  Here is a hyperlink to all the boards of pharmacy https://nabp.pharmacy/about/boards-of-pharmacy/ if you wish to file a complaint for not being able to get your controlled medications because of the agreement that the three major drug wholesalers made to sell less controlled meds to all community pharmacies.

Telemedicine patients with opioid use disorder struggle to fill prescriptions

https://stateline.org/2025/08/22/telemedicine-patients-with-opioid-use-disorder-struggle-to-fill-prescriptions/

Nearly a third of patients surveyed had a hard time getting buprenorphine.

Nearly a third of telemedicine patients with opioid use disorder had to go without buprenorphine because they had trouble filling their prescription at a pharmacy, according to a new study.

The study, published in the medical journal JAMA Network Open this month, surveyed 600 telemedicine patients across five states: Florida, Michigan, New Jersey, Ohio and Texas. The U.S. Food and Drug Administration has approved buprenorphine for treatment of opioid use disorder. The drug reduces a patient’s cravings for opioids and reduces the likelihood of a fatal overdose.

The most common reason that patients had trouble was that buprenorphine was unavailable at the pharmacy, followed by coverage-related issues and the pharmacy’s hesitancy in filling a telemedicine prescription.

Previous research has shown that some pharmacists, fearing scrutiny, hesitate to dispense buprenorphine, which is a controlled substance. The U.S. Drug Enforcement Administration and the U.S. Department of Health and Human Services say people with opioid use disorder “who need buprenorphine [should be] able to access it without undue delay,” the authors note.

Roughly half of the patients who participated in the survey were covered by Medicaid. A majority of patients had been in treatment for at least six months, and half lived in rural areas.

The analysis didn’t find statistically significant differences between patients in rural and non-rural areas. But the authors noted that the study only surveyed participants from those five states, and results might be different in other ones.

In general, they noted, patients living in rural areas might have a harder time finding buprenorphine and other opioid use disorder drugs at a pharmacy because there are fewer pharmacies in rural areas.

The study underscores recent data suggesting a lack of access to opioid use disorder medication. An analysis released last year by the federal Centers for Disease Control and Prevention found that in 2022, only a quarter of people with opioid use disorder received recommended medications. About 4% of U.S. adults have opioid use disorder.

Other research has shown many pharmacies lack buprenorphine. Two studies found that between 42% and 51% of U.S. pharmacies did not have buprenorphine in stock, and availability varied widely across states.

The JAMA Network Open study was led by Workit Health, a telemedicine addiction treatment app that operates in four of the states included in the survey. Researchers from the University of Pittsburgh, Johns Hopkins University, and Geisinger Commonwealth School of Medicine in Pennsylvania also contributed. In their conflict of interest disclosures, some of the authors reported holding equity in Workit Health.

Community pharmacies are in crisis. Three things need to change

Walgreens’ chief pharmacy officer proposes fixes to a system that broke long ago

https://www.statnews.com/2025/08/12/community-pharmacy-crisis-rite-aid-bankruptcy-walgreens/

Earlier this year, the second largest independent pharmacy chain in America, Rite-Aid, filed for bankruptcy. While many were caught off guard, I wasn’t. After 30 years in community pharmacy, I saw this coming. Financial pressure has been building for years. Burnout among pharmacists exploded during the pandemic. Now, access to care is deteriorating before our eyes.

This isn’t just an industry trend; it’s a system failure. The alignment of incentives around generics that once benefited the entire health care system is no longer in place. And the industry left holding the bag is community pharmacy.

Pharmacists are the most accessible health care providers in America. Nearly 90% of Americans live within 5 miles of a pharmacy. Patients interact with their pharmacist 12 times more often than their primary care provider. Chronic care patients, who account for 90% of U.S. health care spending, often engage with their pharmacy 35 to 50 times per year.

If we don’t act now, we won’t just lose pharmacies. We’ll lose one of the most efficient, cost-effective access points in the U.S. health care system. Here’s where the change must start:

1. Reimburse for care, not just pills

Let’s be blunt: Pharmacies are regularly reimbursed below cost. In some states, Medicaid pays less than $1 per prescription, not even enough to cover the label and bottle, let alone a licensed professional’s time.

Meanwhile, pharmacists deliver care every single day: immunizations, test-and-treat services (where a provider conducts a diagnostic test and provides treatment in the same visit, often without requiring a separate doctor’s appointment or lab processing), chronic disease management, medication adherence programs. But the current payment model only recognizes pills, not the professional judgment or clinical expertise behind them.

Between 2009 and 2015, roughly one in eight pharmacies closed, with closures disproportionately impacting independent pharmacies and low-income neighborhoods, according to a study published in the Journal of the American Medical Association. Within a matter of weeks, Rite-Aid closed at least 150 stores in Pennsylvania — a sizable percentage of the state’s approximately 2,600 licensed pharmacies.

Fixing this problem means establishing:

  • Minimum dispensing fees that reflect pharmacies’ actual operating costs
  • Patient freedom to go to the pharmacy of their choice without interference by PBMs who steer them toward affiliated pharmacies.

The economics of pharmacy are upside down. Without structural reform, we’ll lose the infrastructure that fills more than 6 billion prescriptions each year.

2. Build smarter systems that actually support pharmacy

Today’s pharmacy model is labor-intensive, fragmented, and inefficient. Pharmacists spend 40–60% of their day on administrative tasks: prior authorizations, insurance paperwork, chasing down refills.

That’s not a workforce problem. That’s a systems problem.

It’s time to scale clinical pharmacy and offload the rest. That means:

  • Micro-fulfillment and central fill for high-volume scripts
  • Remote verification and centralized operations across enterprise systems
  • AI-driven tools to handle refill reminders, adherence programs, insurance adjudication, and even inventory optimization.

Technology isn’t a threat; it’s the only way we scale personalized care without burning out the people delivering it.

3. Let pharmacists practice — everywhere

Pharmacists are health care providers. They complete six to eight years of clinical training, yet outdated state laws and federal policies often tie their hands.

Some states allow test-and-treat. Others don’t. Some payers offer reimbursement for care. Others don’t. The result is a fragmented system where access depends more on ZIP code than need.

Other countries like the U.K. and Canada already empower pharmacists to test, treat, and prescribe for common conditions such as strep throat, urinary tract infections, and seasonal allergies — resulting in clear benefits to access and outcomes. The U.S. is falling behind.

Fixing this requires:

  • Federal recognition of pharmacists as health care providers and reimbursement consistency across state lines
  • Full integration of pharmacy into care teams under value-based models and accountable care organizations.

Some states — like Alaska, Florida, Idaho, Iowa, and New Mexico — are moving forward, but federal policy must catch up, especially in programs like Medicare.

And it must catch up soon.

According to the American Association of Colleges of Pharmacy, pharmacy school applications have dropped nearly 60% over the past decade. Loan debt is up. Morale is down. And students are being told, explicitly or implicitly, that community pharmacy is dying. If we don’t fix the system, that prophecy will fulfill itself.

This isn’t just about the profession. It’s about public health. Who’s going to administer flu shots, manage blood pressure, or help patients stay on track with their diabetes medications if half the nation’s pharmacies shut their doors? Who will manage chronic care for aging Americans if we decimate one of the only health care access points they consistently rely on?

And yes — pharmacists are asking: What are pharmacy chains doing about it? What’s Walgreens doing?

We hear you.

At Walgreens, we know we have to lead differently. That’s why we’re investing in programs like PharmStart, which helps pharmacy technicians become pharmacists — with fully funded education and real career pathways. We’ve expanded centralized services and micro-fulfillment centers to reduce operational strain in stores. And we’re advocating for payment reform that finally reimburses pharmacists for care, not just pills.

Are we where we need to be yet? No. But we’re making changes because the profession — and the people in it — deserve better.

I’ve seen the soul of this profession. Pharmacists stay late to help patients. They deliver meds to homebound seniors. They do more than they’re paid for, because it matters. We can’t afford to lose that.

Fix the system. Fund the care. Let pharmacists deliver care to their patients.

States have made real progress modernizing pharmacy practice and advancing some pharmacy benefit manager reforms. But at the federal level, we’ve been here before, almost crossing the finish line on critical reforms only to see key provisions stripped from broader legislation and postponed once again.

We can’t keep kicking the can down the road and hoping this crisis will solve itself. Policymakers need to act now to recognize pharmacists as health care providers, reform the broken reimbursement system, and protect community pharmacies.

If we don’t act now, the next community pharmacy to close might be the one your family depends on.

Rick Gates is chief pharmacy officer for Walgreens and chair of the National Association of Chain Drug Stores.

 

Pharmacist prescription refusal lawsuit highlights human rights, religious rights

https://www.fox9.com/news/pharmacist-prescription-refusal-lawsuit-highlights-human-religious-rights

Two Twin Cities pharmacists say they lost work when they refused to fulfill prescriptions for gender transition and emergency contraception.

Refusal on faith

Pharmacists won’t fulfill:

They cited religious objections, but one of them says she was fired and the other had hours reduced. 

So now they’re suing Walgreens and the Minnesota Board of Pharmacy.

Walgreens pharmacists Dora Ig-Izevbekhai and Rachel Scott say their Christian religion guides them against filling doctor’s prescriptions for gender transition and abortion medications.

For years, they say Walgreens let them hand off those patients to other pharmacists.

“Both Minnesota and the federal government of the United States have statutes that require employers to accommodate the religious practices of their employees if it can be done so without posing an undue hardship on the employer’s business,” said plaintiff’s attorney Nicholas Nelson of the Upper Midwest Law Center.

Can they or can’t they?

An evolving law:

But in 2022 and 2023, the pharmacists say Walgreens told them their religious accommodation was illegal under Minnesota law.

By that time, state courts had ruled against a Minnesota woman who claimed discrimination when an Aitkin County pharmacist denied her emergency contraception when her nearest option was at least an hour away through a snowstorm.

But the state appeals court ruled in her favor in 2024 and the ruling has stuck. She was awarded about $673,000 in attorney’s fees in June 2025.

Rights rivalry

Who would be hurt?:

Transgender advocates say when a pharmacist refuses to fill a prescription, it can be dangerous.

“It can delay necessary care, put a patient’s health at risk, and send the harmful message that they don’t deserve to be treated with dignity,” said Ash Lazarus Orr, press relations manager at A4TE.

Attorneys who fought the contraception case tell FOX 9 the state’s Human Rights Act would also apply to gender transition drugs.

“People deserve access to the healthcare they need, including prescriptions, and should be able to fill those prescriptions free from discrimination or bias,” said a statement sent to us by Gender Justice, which helped in the discrimination case. “We will continue to stand for the rights of all patients to receive respectful, unbiased care.”

But Nelson says the new case he filed on behalf of the pharmacists isn’t quite the same.

“They were not telling people, no you can’t have these drugs,” he said. “They were just handing the prescription to another pharmacist or otherwise making arrangements for the prescription to get filled.”

So the potential conflict between the state’s Human Rights Act and the constitutional freedom of religion isn’t necessarily put to the test here.

Nelson acknowledged there could be a situation where it’s a one-pharmacist town or there’s a snowstorm again, but that’s not what happened with his clients.

MAYDAY… MAYDAY…The Government is not your Doctor per Dr. Marty Makary, head of the FDA

Black And White American Flag Upside Down

 

 

 

 

 

 

Below is number of videos from various parts of our bureaucracy. Also below is just a few of the videos that I was able to find where our bureaucrats are not happy about the path we are on… a number of the citizens of our country apparently feels the same. The head of our FDA , Dr. Marty Makary, head of the FDA, states that the GOVERNMENT IS NOT YOUR DOCTOR. There is a law on the books from 1935 basically states the same. It seems that in the 162 yrs since Lincoln gave his Gettysburg address, we are no longer a government of the people, by the people, for the people. Unless you only count the 535 members of Congress.  Below is a list of the current Congress, their number of years in Congress and their age. Note the YOUNGEST is 72 y/o and the oldest is 91 y/o.

Congress formally limited the number of terms of our President may serve by proposing the Twenty-second Amendment to the Constitution on March 21, 1947; this amendment was ratified on February 27, 1951, establishing a two-term limit for U.S. Presidents.

But apparently Congress has never seen the need to impose term limits on themselves. Below is a list of the longest serving members of our current Congress and their age and years in Congress.

Part of Abraham Lincoln’s abraham lincoln clipart free 20 free Cliparts | Download images on ...Gettysburg address: November 19, 1863

that this nation, under God, shall have a new birth of freedom—and that government of the people, by the people, for the people, shall not perish from the earth.”

42 USC 1395: Prohibition against any Federal interference

https://uscode.house.gov/view.xhtml?req=(title:42%20section:1395%20edition:prelim)

From Title 42-THE PUBLIC HEALTH AND WELFARE CHAPTER 7-SOCIAL SECURITY SUBCHAPTER XVIII-HEALTH INSURANCE FOR AGED AND DISABLED

§1395. Prohibition against any Federal interference

Nothing in this sub chapter shall be construed to authorize any Federal officer or employee to exercise any supervision or control over the practice of medicine or the manner in which medical services are provided, or over the selection, tenure, or compensation of any officer or employee of any institution, agency, or person providing health services; or to exercise any supervision or control over the administration or operation of any such institution, agency, or person.

(Aug. 14, 1935, ch. 531, title XVIII, §1801, as added Pub. L. 89–97, title I, §102(a), July 30, 1965, 79 Stat. 291 .)

Statutory Notes and Related Subsidiaries

Short Title

For short title of title I of Pub. L. 89–97, which enacted this subchapter as the “Health Insurance for the Aged Act”, see section 100 of Pub. L. 89–97, set out as a Short Title of 1965 Amendment note under section 1305 of this title.

Protecting and Improving Guaranteed Medicare Benefits

Pub. L. 111–148, title III, §3601, Mar. 23, 2010, 124 Stat. 538 , provided that:

“(a) Protecting Guaranteed Medicare Benefits.-Nothing in the provisions of, or amendments made by, this Act [see Short Title note set out under section 18001 of this title] shall result in a reduction of guaranteed benefits under title XVIII of the Social Security Act [42 U.S.C. 1395 et seq.].

“(b) Ensuring That Medicare Savings Benefit the Medicare Program and Medicare Beneficiaries.-Savings generated for the Medicare program under title XVIII of the Social Security Act under the provisions of, and amendments made by, this Act shall extend the solvency of the Medicare trust funds, reduce Medicare premiums and other cost-sharing for beneficiaries, and improve or expand guaranteed Medicare benefits and protect access to Medicare providers.”


BELOW is a HELP WANTED AD  from DEA from a couple of days ago:

We’re Hiring: Diversion Investigators at the DEA 🚨

The Drug Enforcement Administration (DEA) is seeking highly motivated professionals to join our team as Diversion Investigators. This critical role is at the forefront of protecting public health and safety by preventing the diversion of controlled substances from legitimate channels into illegal distribution.

As a Diversion Investigator, you will:
Conduct regulatory investigations and compliance inspections of manufacturers, distributors, pharmacies, and practitioners.
✅ Develop cases against unlawful handlers of controlled substances.
✅ Partner with law enforcement and healthcare stakeholders to safeguard our communities.
✅ Contribute directly to DEA’s mission of combating the opioid crisis and protecting lives.

Why Join DEA?
✔️ Impactful mission work protecting communities nationwide
✔️ Professional growth and specialized training opportunities
✔️ Federal benefits and career stability
✔️ A chance to serve at the intersection of healthcare, regulation, and law enforcement

📢 Apply today and take the next step toward a career that makes a difference.
👉 https://lnkd.in/d43jdsVy


Dr. Marty Makary, head of the FDA, states that the GOVERNMENT IS NOT YOUR DOCTOR

Wenstrup: COVID-19 Pandemic Eroded the Doctor-Patient Relationship, Severely Harmed America’s Healthcare System

 

‘Make America free of addicts’ campaign launches to help Trump lower overdose deaths

Make America free of drug addicts

Another article and another group that is not  smart enough to find out that there is more that just one Fentanyl analog. Article and group that if their kid, friend, relative that is not smart enough to question that buying drugs on the street and they are upset because they died for buying basically some substance off of someone selling it on the street – what could go wrong?

list of all the 100-200 different Fentanyl analogs – only FOUR have been approved to be safe for use in humans.  https://en.wikipedia.org/wiki/List_of_fentanyl_analogues

FIRST ON FOX: A new campaign launched on Monday to help fulfill President Donald Trump’s pledge to reduce fentanyl overdose deaths, which are one of the nation’s deadliest public health crises.

The campaign, titled Make America Fentanyl Free, is described as a privately-funded multi-million-dollar ad blitz on national and local television, and across all major social media platforms, including X, Instagram, YouTube, TikTok and Facebook.

The effort, which was first shared with Fox News Digital on Monday, aims to reduce the number of Americans killed by fentanyl, a highly potent and extremely dangerous synthetic opioid. Fentanyl and fentanyl-related drugs have been responsible for most drug overdose deaths in the U.S. for nearly a decade.

“The Make America Fentanyl Free ad campaign was launched to support President Trump’s efforts to save American lives from deadly fentanyl, which continues to be a leading cause of death for Americans between the ages of 18 and 45,” organizers said in a statement.

DRUG DEADLIER THAN FENTANYL SPREADS ACROSS THE AMERICAS

President Donald Trump signs fentanyl bill

President Donald Trump speaks during a bill signing ceremony in the East Room of the White House in Washington, D.C., on July 16, 2025. Trump signed legislation that strengthens criminal penalties for fentanyl, hailing it as a historic step toward justice in his latest effort to address the public health crisis spurred by the deadly drug. (Al Drago/Bloomberg via Getty Images)

Organizers emphasized that the mission of the campaign, which is also online at MakeAmericaFentanylFree.com, is to inform Americans about the devastating effects of fentanyl, and pointed out that “ingesting as little as three grains of fentanyl can be lethal within minutes.”

The campaign is also intended to educate the public about the hidden dangers of fentanyl, which is frequently disguised in other substances, such as cocaine and marijuana. 

TRUMP SIGNED FENTANYL LAW WILL END ‘CAT AND MOUSE’ WITH TRAFFICKERS

“Make America Fentanyl Free is working with President Trump to aggressively make sure every American understands the danger of fentanyl,” the narrator in the ad says.

Make America Fentanyl Free campaign launches

A new campaign titled Make America Fentanyl Free launched on Monday to help fulfill President Donald Trump’s pledge to reduce fentanyl overdose deaths, which are one of the country’s deadliest public health crises. (Make America Fentanyl Free)

The effort also intends to “send a strong unequivocal message to Mexican drug cartels that actions leading to American deaths or harm will result in serious consequences.”

The Trump administration says it has lowered fentanyl deaths in the U.S. by beefing up security along the nation’s borders, emphasizing law enforcement, and raising tariffs against China and Mexico to keep fentanyl and other lethal drugs out of the country.

Organizers touted that “on day one in office, President Trump shut down the dangerous, open border and stemmed the flow of deadly fentanyl through our country. As a result, fentanyl traffic at the border fell by 54% in the first months of the Trump Administration.”

FATHER WHOSE SON DIED FROM FENTANYL WARNS ‘OVERDOSES CAN HAPPEN TO ANYONE’

But organizers said their effort is needed to “continue eradicating deadly fentanyl from our communities.”

Trump last month signed into law a bill permanently placing street versions of fentanyl on the list of controlled substances, which should make it easier to prosecute fentanyl traffickers and put them behind bars.

President Donald Trump, Gregory Swan, at fentanyl bill signing

President Donald Trump listens as a man who lost his son to fentanyl speaks before the signing of the “Halt All Lethal Trafficking of Fentanyl Act,” which strengthens prison sentences for fentanyl traffickers, at the White House in Washington, D.C., on July 16, 2025. (Andrew Caballero-Reynolds/AFP via Getty Images)

But the Trump administration has also been criticized when it comes to battling fentanyl deaths, for seeking major cuts to domestic programs that work to reduce drug demand.

And Democrats in California, taking aim at what they call Trump’s “unlawful deployment of military personnel to Los Angeles,” say the effort has slashed the California’s National Guard’s fentanyl and drug interdiction force by 32%, “directly harming California’s ability to fight the flow of illegal drugs into our communities.”

Organizers of the new effort highlight that Make America Fentanyl Free is a privately funded campaign “launched without taxpayer dollars.”

Some of the major contributions to fund the campaign have come from a number of the president’s major donors and allies, according to sources in Trump’s political orbit.

C-2

I am sorry that this got a little long. The cliff notes version is: 45+/- state AGs sued the 3 major drug wholesalers – that control about 85% of the wholesaler Rx med business. They got those wholesalers to agreed to ration the amount of controlled meds that they sell to community pharmacies. No concern if pts who have a medical necessity to treat pain or is using buprenorphine in getting and staying sober. Pts have been unable to get their necessary medication for a month or more and being thrown into cold turkey withdrawal and perhaps a torturous level of untreated pain or a addict trying to get and stay sober program gets disrupted. 

The wholesalers unable or unwilling to provide community pharmacies with controlled meds to meet the needs of pts who have a valid medical necessity for such controlled meds. This makes the wholesaler in violation of the State’s pharmacy practice act.

If  the board of pharmacy chooses to take action against these wholesalers, typically that is the responsibility of the state AG to act as the “attorney” for any/all licensing boards in the state.

The same AGs that were part of the wholesaler agreement  with the state AGs to cause this rationing of the controlled meds to begin with. Where these AGs so fixated on the billions of dollars they were going to get from those wholesalers that they hoped that no one would notice that the people that were going to be affected were disabled and/or seniors and discriminating against disabled people is a civil rights violation and/or they would just decline to press charges against other AGs for what harm they have concocted to mostly high acuity disabled/senior pts?

The 51 various state boards of pharmacy what is their primary charge, public safety or what else?

The primary charge of the 51 state boards of pharmacy (one in each state, D.C., and Puerto Rico) is public safety, specifically the protection of public health, safety, and welfare through the regulation of the pharmacy profession and the legal distribution of drugs.pharmacy.ohio+2

Core Responsibilities

  • Licensing and Regulation: Boards issue and renew licenses for pharmacists, pharmacies, technicians, and related entities to ensure only qualified individuals and businesses operate in the field.mo+2

  • Enforcement: They enforce state and federal pharmacy laws, investigate complaints, and take disciplinary actions such as suspension, revocation, or probation for violations or unsafe practices.pharmacytimes+2

  • Practice Standards: Boards establish and uphold standards of practice, including the ethical and professional conduct of pharmacy professionals.pharmacy.texas+1

  • Education and Outreach: Many boards provide educational resources, guidance, and updates to licensees and the public to promote compliance and awareness of pharmacy regulations.pharmacy.texas+1

Public Health Focus

  • Inspection and Compliance: Boards inspect pharmacies and monitor compliance with laws designed to prevent medication errors, diversion, and unsafe practices, with the ultimate goal of protecting patients and consumers.dpo.colorado+1

  • Complaint Investigation: They investigate consumer complaints and concerns regarding pharmacy services, taking action to address public risks and ensure accountability.tn+1

Other Functions

  • Rulemaking: Boards create and update rules and regulations in response to emerging healthcare issues, innovations, and changes in pharmacy practice.dpo.colorado+1

  • Disciplinary Action: They have authority to discipline licensees for unprofessional conduct, violations of law, or endangering the public.pharmacy.ohio+1

Summary Table: Board Charges

Primary Charge Additional Functions
Public health, Licensing, regulation, enforcement,
safety, and welfare practice standards, education,
inspections, complaint resolution

The overarching mandate is the protection of the publicnot professional, commercial, or sector interests. All other board activities support this foundational goal.pharmacytimes


aren’t drug wholesalers licensed by the state pharmacy board?

Yes, drug wholesalers are generally licensed by the state pharmacy boards in the United States. State Boards of Pharmacy are responsible for issuing, renewing, and regulating wholesale drug distributor licenses within their respective states, ensuring compliance with both state and federal laws.

Regulation Details

  • Each state requires wholesale drug distributors to obtain a license from its Board of Pharmacy before engaging in distribution activities within or into that state.

  • This licensing applies to wholesalers located both inside and outside of the state if they transport or sell drugs into the state.

  • In addition to state licensure, wholesalers often need to meet federal requirements—especially if distributing controlled substances—and may need special accreditation from the National Association of Boards of Pharmacy (NABP).

Purpose of Licensing

  • The primary goal is to safeguard the drug supply chain, preventing the introduction of counterfeit, diverted, or otherwise unsafe drugs and protecting public health and safety.

In summary, state pharmacy boards hold the authority for licensing and regulating drug wholesalers, and distributing without proper licensure is unlawful in every state.


state AGs suing drug wholesalers and wholesalers signed an agreement to ration controlled meds sold community pharmacies, resulting in pharmacies are not able to provide controlled meds – especially opioids and Buprenorphine and pts are not being able to get their medically necessary meds sporadically causing some pain pts being thrown into cold turkey withdrawal and torturous level of untreated pain and putting pts in recovering from possibly compromising their progress in reaching sobriety. Is the part of the BOP primary charge of public safety being compromised and are they obligated to take some sort of legal action to correct this potentially illegal rationing and harm to those pts. who would/should the BOP hire to seek a legal remedy?”

Yes, current and recent enforcement actions and agreements are causing wholesalers to ration controlled medications to community pharmacies—resulting in sporadic and sometimes complete restriction of access to medically necessary opioids and buprenorphine for patients, including those with severe pain or opioid use disorder. This has resulted in some patients experiencing untreated pain or withdrawal, which can compromise their recovery and lead to serious, even torturous, health consequences.

Board of Pharmacy’s Responsibility and Obligation

State Boards of Pharmacy (BOPs) have a primary legal charge to protect public health and safety by ensuring safe access to medications. When access to controlled substances is compromised for legitimate medical need, the mission of public protection may be undermined, particularly when actions result in harm to otherwise legitimate patients. While BOPs primarily regulate pharmacies and pharmacists, they also license and oversee wholesalers within their states.

Potential Board Actions in Response

  • Legal Action Against Wholesalers: There is precedent for litigation when wholesalers abruptly or unfairly cut off or severely ration controlled substance supplies to pharmacies without clear evidence of diversion or improper dispensing. Courts have sometimes ruled against wholesalers in these circumstances, ordering them to resume supplying medications when no unlawful conduct by the pharmacy was demonstrated.

  • Regulatory Complaints: Boards could initiate disciplinary investigations or refer cases to state attorneys general or the Drug Enforcement Administration (DEA) if there is evidence that a wholesaler’s practices violate public health statutes or constitute unfair/illegal rationing that causes patient harm.

  • Advocacy and Policy Action: Boards may also advocate for regulatory clarity and reasonable thresholds, and in some cases have issued formal guidance or endorsed calls for distributors to re-examine purchasing thresholds so that legitimate patient needs are met.

  • Specialized Legal Counsel: Boards would typically hire or assign state government attorneys with experience in health law, pharmacy regulation, or administrative law to pursue legal remedies. In some cases, they may work with the state Attorney General’s Office—which already leads major enforcement and public protection lawsuits, including those involving the drug supply chain.

  • Subject Matter Experts: The Board may also rely on pharmacy regulatory experts, compliance officers, or external consultants to build a case demonstrating patient harm or procedural violations by wholesalers.

Summary Table: Board of Pharmacy Actions

Issue Board Obligation Legal Avenue Counsel/Agency Involved
Rationing of controlled meds Protect public safety Litigation, investigation, State AG, Board legal counsel,
harming patient access Ensure access to disciplinary complaint health law experts
necessary medications

State Boards of Pharmacy are obligated to respond and may pursue legal or regulatory remedies if wholesalers’ actions violate their core mandate of protecting patients and ensuring proper medication access.


Since this rationing of these controlled substances are a direct/indirect result of an agreement between 45 state AGs and 3 major drug wholesalers. So isn’t those 45 state AGs suing those 3 major drug wholesalers and the resulting agreement may be violating the Americans with Disability Act since most of these pts are on Medicare disability and discriminating against disabled people is a civil rights violation.. what sort of path should be taken by the pts to get their necessary medications restored going forward

The state Attorneys General (AGs) settlement with drug wholesalers that resulted in rationing of controlled substances to pharmacies may indeed raise serious Americans with Disabilities Act (ADA) concerns, especially if disabled patients—who disproportionately rely on Medicare and medications like opioids or buprenorphine for legitimate medical needs—face blanket denials of access. Under the ADA, people with disabilities, including those in recovery or with chronic pain, are protected from policies or agreements that deny them access to medically necessary treatments solely based on their status or prescribed medication.

Potential ADA Violations and Civil Rights

  • The ADA prohibits both direct and indirect discrimination by public and private actors, including healthcare systems and entities involved in patient care.

  • Blanket restrictions or policies that effectively bar access to essential medications, without individualized assessment, can constitute discrimination under the ADA if they result in denial of treatment for people with disabilities.

  • The Justice Department has recently taken enforcement actions under the ADA in cases where people in recovery or needing opioid medications were denied access, establishing a foundation for legal challenges in healthcare rationing scenarios.

Pathways for Patients to Restore Access

1. File ADA Complaints

  • Patients can file complaints with the U.S. Department of Justice, Civil Rights Division, or with their regional ADA Center, to trigger federal investigation or mediation.

  • State protection and advocacy agencies can also assist in preparing documentation and complaints.

2. Seek Legal Counsel

  • Contact civil rights attorneys experienced in disability and healthcare law to evaluate the agreement’s effects as potential ADA violations.

  • Large disability advocacy groups (e.g., Disability Rights Advocates, ACLU) might also take up systemic cases that affect many patients.

3. State and Federal Agency Involvement

  • Notify the state Board of Pharmacy, state medical boards, and the state’s disability ombudsman to urge review and intervention.

  • Consider complaints to the Office for Civil Rights (OCR) at the U.S. Department of Health and Human Services (HHS), especially if Medicare/Medicaid access is affected.

4. Public Advocacy

  • Collaborate with pain and recovery patient groups, physicians, pharmacists, and advocacy organizations to launch public awareness campaigns and request intervention from legislators and regulators.

Summary Table: Patient Pathways for Redress

Path Agency/Resource Reference
ADA complaint filing DOJ Civil Rights Division, regional ADA Center
Legal counsel/lawsuit Civil rights attorneys, advocacy orgs
Regulatory complaint State Board of Pharmacy, HHS OCR, State AG
Public/policy advocacy Patient/disabled groups, medical advocates

In summary: The ADA likely provides a pathway for affected patients to challenge and seek redress against denial of essential controlled medications due to state AG–wholesaler agreements, especially where blanket rationing causes harm to people with disabilities. Prompt legal, regulatory, and advocacy action may help restore access to necessary medications.


Since the state AGs are part of our larger DOJ/judicial system and they are the ones who initiated the lawsuit and settled the lawsuit without going to trial and the BOP is responsible for protecting public safety and the state AG should be the “attorney” for representing the BOP, but the AG’s office is one of the 45 AG who initiated the lawsuit against the 3 major drug wholesalers. Could it be that the AGs were more interested in this “money grab” that they might have hoped that no one would put together the 2+2 question?

There is a documented perception among patients, advocates, and some public health experts that the major state AG opioid settlements—including those negotiated outside of court with the three major wholesalers—have prioritized large monetary recoveries over ensuring continuous medication access or fully remedying public health harms. This has led to public criticism that some AGs and states may be using these settlement funds to fill budget gaps, rather than transparently and directly addressing the needs of those harmed by medication supply restrictions.

AG’s Dual Role and Potential Conflict of Interest

  • The Attorney General (AG) typically serves as the chief legal representative for state agencies, including the Board of Pharmacy (BOP) when legal action is required.

  • However, when the AG’s office is also the lead plaintiff in high-profile settlements—especially ones with major public health and civil rights implications—this may create a conflict of interest if consequences of those settlements directly undermine patient access to care.

  • Critics and advocates have called out this tension, noting that the structure and aftermath of the settlements can appear as a “money grab,” especially when there is little transparency or oversight regarding how funds are spent and when patients experience negative repercussions.

Public Scrutiny and Transparency

  • Investigative reports and crowdsourced databases have been launched to track opioid settlement spending, as many advocates worry that elected officials—including AGs—are using the windfall for general budgetary needs rather than directly remedying overdose and medication access issues.

  • Calls for dedicated, transparent spending and for holding AGs accountable are increasing as victims and those in recovery feel left behind.

2+2 Question: Was Public Interest Sidelined?

  • Many patients, pharmacists, and public commentators have indeed begun to “put together” the connection between the nature of the settlement deals and the resulting negative impacts on medication access.

  • While not all AGs rejected trial in exchange for a settlement—some, like Washington’s AG, refused “insufficient” settlements and pushed for court—most states settled, and the fallout has been exactly as patient advocates feared.

Summary Table: AG Settlements and Public Trust

AG Role Public Perception Potential Issue Evidence
Prosecutor/Plaintiff Money prioritized over patient care Conflict of interest, “money grab”
State Agency Counsel Representing BOP, but also settling Undermined BOP mission, patient harm

In summary: Substantial public criticism, growing calls for transparency, and watchdog efforts all point to concerns that state AGs may have prioritized financial recovery over patient welfare and uninterrupted medication access. This dual role can indirectly compromise the primary public safety charge held by Boards of Pharmacy and undermine public trust, particularly as the consequences of these settlements become more visible.


the Trump administration has been floating the idea of merging the ATF with the DEA:What could go wrong?

What should be asked is why back in 1973, that Congress put two legal drugs (Nicotine & Alcohol)  Into a separate and distinct sub-agency under the DOJ while putting all the other potentially abused/addicting drugs in and under the control of the DEA? Could we see some sort of tracking (PDMP) and daily limits (Ounces of grain alcohol equivalents per day) on how much alcohol & nicotine (Mgs of Nicotine/day) a person can purchase? An estimated 600,000/yr deaths from the use/abuse of alcohol & Nicotine. Six to EIGHT times the deaths from the use/abuse of  illegal Fentanyl/yr. Also, what does GUNS have any business being managed/controlled by the DEA?

What Should Be Done About the ATF?

https://www.americas1stfreedom.org/content/from-the-editor-what-should-be-done-about-the-atf/

When a federal agency becomes corrupted by politics, especially unconstitutional politics, something must be done. Government agencies are supposed to treat all citizens equally. A free people should not have to contend with federal agencies being weaponized against them.

Nevertheless, a few administrations have weaponized the Bureau of Alcohol, Tobacco, Firearms and Explosives (ATF) against our freedom.

The Obama administration’s Operation Fast and Furious gun-running scandal was perhaps the most shocking example of how far ATF leadership, as a sub-agency in the U.S. Department of Justice (DOJ), was willing to go to get the gun control they desired.

Well, the Biden administration’s creation and use of an ATF zero-tolerance policy to put as many federal firearms licensees (FFLs) out of business as they could is a close second.

ATF attempts, under the Biden administration, to reinterpret or write gun-control laws, as if this agency has the power the U.S. Constitution grants the U.S. Congress, offers a series of egregious examples on the weaponization of this law-enforcement agency against citizens.

So then, what is the Trump administration now supposed to do with the ATF?

Perhaps the best answers are in the details. President Donald Trump (R) began substantive change within federal agencies last February with an executive order titled “Protecting Second Amendment Rights,” in which he tasked Attorney General Pam Bondi with implementing changes to get the ATF, and other agencies, back in line with the U.S. Constitution.

Reforms to the ATF, as this was going to print, were reportedly coming fast. Indeed, the Department of Government Efficiency (DOGE) reportedly sent lawyers to assist the ATF with the goal of changing or repealing 47 regulations—a reference to President Trump as the 47th president.

Meanwhile, the Trump administration has been publicly floating the idea of merging the ATF with the Drug Enforcement Administration (DEA). This would likely require congressional approval, but the ATF has been beneath other agencies before—most notably, the Internal Revenue Service (IRS). Like the ATF, the DEA is also a sub-agency of the DOJ.

From a budgetary standpoint, it is easy to see how consolidating the ATF and DEA makes sense. But some worry that doing so could make the ATF even more powerful, and then, as a supercharged agency, it could be used by a future president with Joe Biden’s politics against American gun owners.

One way or another, however, reform is coming. Bondi’s establishment of a Second Amendment Task Force to advance, protect and promote compliance with the Second Amendment, as President Trump mandated via executive order, as well as changes in senior ATF leadership, indicate that change in the culture within the ATF is well underway.

Indeed, the ATF quickly announced an end to the Biden administration’s “zero-tolerance” policy. They are also reportedly reconsidering the last administration’s final rules regarding “engaged in the business”  and “stabilizing braces.” 

The ATF also recently issued two new rulings that allow for the importation of non-lethal training rounds, or “simunition” rounds. The training rounds were banned for import in 2023 by the Biden administration.

Indeed, an ATF announcement last May said, in part, that the ATF is “ushering in a new chapter—marked by transparency, accountability, and partnership with the firearms industry. This is not the same ATF of the last four years.”

UPDATED 08-27-2025: I NEED/WANT YOUR OPINION


you will need either a laptop computer or desk top computer to do this

This blog post will be my 11,011 blog post since I started in 2012 and my blog is approaching THREE MILLION PAGE VIEWS.

I have been around the chronic pain community since 2012. There are a few things that have remained common over all those years. 

1. Here are some people who want to be a advocate and come into the community and after a few months, they discover that the community has segregated into hundreds or thousands of different groups/tribes.

2. There seems to be a lot of in-fighting within the various communities. Often resulting of a few self proclaimed pain advocates that splinter off and create a new group to advocate for the community.

3. There is a lot of what is referred to as “keyboard warriors” that do a lot of whining, bitching, moaning to others on FP and other websites. They are seemingly the same chronic painers that are waiting for some White Knight on a White Horse to come over the horizon to save their ass.

Would anyone be interested on a fairly simple process to generate letters to send to members of Congress.  The letter head at the left I just asked AI  to generate a letterhead

I asked AI to find all the members of Congress that represents my zip code. took it about 1-2 minutes to get all the contact info on my two Federal Senators and the House member for the district I was in.

You put the contact info to your 2 senators and 1 house member and you go to AI. load the letterhead as an attachment to the AI. You then tell AI that you want a letter to send those Senators and House member and you tell what the subject matter is and the “catch words” that you want to be in your letter. 

You copy the text of the letter and paste it into your letter head that the AI created.

I have found a few free fax programs that you can send at fax from your computer over the internet.

If you don’t have a word processor, there is a free word processor that is compatible with Windows’ suite  of  office software

Say.. you set up to contact your 2 Senators and 1 Representative  to send them letters. After you get it all set up. you could “pepper” them with letters EVERY WEEK, ONCE A MONTH. All you have to do is create a new text for the letter. If you email or fax your letter(s), Other than your time, the cost is ZERO. There is an estimated 100 million chronic pain pts. if 10% of those chronic pain pts could send a letter once a week. My money on is that if all those 535 members got TEN MILLION LETTERS/EMAILS A WEEK,  The community could get their attentions, especially if most of the letters state that they are going to vote for whoever that is running against the incumbent. After 53 years of the DEA overseeing the war on drugs, how much worse could it be, if we KICKED ALL THE INCUMBENTS OUT OF OFFICE – that would be 435 House members and 33-34 Senators. That is 87% of Congress that would be GONE in Jan, 2027!

Let me know if you want this “tool” to help you express your concerns to Congress. If I get little/no response, I will presume that most of the community is happy with the outcomes/changes to their access to pain management with all their whining, bitching, moaning to others on the FB pages.

 

This is where things start:

  https://www.pharmaciststeve.com/communications/