Perhaps Congress is part of this long game. In 2000, Congress passed the Decade of Pain Law… where practitioners were ENCOURAGED to treat pain. The Joint Commission came up with the “Fifth Vital Sign” and made it a MAJOR STANDARD for hospitals and others credentialed by the JC to meet. When the bill expired, it was not renewed and the Party that was in the majority when it was  initially passed was not in the majority when it could have been renewed.  I think that there was a fair amount of careless prescribing C-III opiates and probably a large amount of careless refilling of those same Rxs.

If the insurance companies helped the DEA, I have always thought it was strange that Congress has been claiming that they want to get prescription prices down and Congress has been going after the Pharmaceutical industry when it is common knowledge that the PBM industry gets untold number of tens or hundreds of millions of dollars from kickback/discount/rebates for meds the PBM pays for from individual pharmas.  Currently the top 5 PBM’s are owned by INSURANCE COMPANIES.  A lot of bilateral “back scratching” between DEA/Congress/insurance companies ?

How many of the Federal judges are in lock-step with the DEA ?  The J&J lawsuit being sued by numerous cities/counties/states, etc for being a public nuisance for being the wholesaler of raw opiate powder to the pharma industry.  The Federal Judge determined that the case was going to be a BENCH TRIAL… the Judge was going to be Judge, jury and executioner. Totally unexpectedly J&J was found guilty and fined 572 million dollars.

Recently Walgreen, CVS, Walmart settled a lawsuit over them being guilty of contributing to the opiate crisis for just 13 billion dollars

A federal judge in August ruled CVS, Walgreens and Walmart must pay a combined $650.6 million to two Ohio counties for damages related to the opioid crisis.

Teva Pharmaceutical Industries in July announced a $4.35 billion proposed nationwide settlement

Purdue Pharma and the Sackler families in March announced a settlement with a group of states that would require the Sacklers to pay out as much as $6 billion

Kroger $85 million settlement of all opioid litigation claims with the State of New Mexico.  Kroger has two active matters pending in West Virginia and Texas scheduled for trial in 2023 and 2024, respectively.

Judicial system: When the facts don’t support the charges… you just fabricate the facts ?

Pieces of the puzzle on how the DEA really functions

There was a recent prescriber being in federal court and the federal judge rejected the defendant’s 12 experts lined up to testify for him… and the defense was not told until a day or two before the trial. The only “expert” that was allowed to testify in this trial was hired by the prosecutor and was known as a frequently used – well paid – expert for the government and reportedly has no real expertise in pain management.

MARC MOORE: THE DIRTY COP OF MANTIS, IN THE TRIAL OF LESLY POMPY, MD. (MICHIGAN)  this trial is, which currently going on…it has been reported that the Judge will  not consider the recent SCOTUS Ruan/Kahn (9-0 vote) which basically told the DEA that they could not objective criteria in judging a prescriber in treating a pt for subjective diseases.

I have heard numerous attorneys state that when someone is taken to federal court … 90%+ are found guilty. maybe this is why all these corporations just PAY UP.  Odds are they are going to be found guilty and by agreeing to PAY UP while stating that the company while not admitting to any wrong doing.

Does this suggest that all three branches of our Federal Gov and many states and their various bureaucracies are all in lock-step with the DEA’S 50 y/o agenda ?  Where else, but American, can companies and entities be sued/fined for selling a LEGAL PRODUCT ?

The DEA’s Long Game

https://www.daily-remedy.com/the-deas-long-game/

The canary in the coal mine is a metaphor alluding to the initial sign of an impending calamity.

An apt metaphor for what just transpired. Recently, the Drug Enforcement Agency (DEA) issued a public safety alert informing the public about a, “sharp increase in fake prescription pills containing Fentanyl and Meth[amphetamines]”.

The alert was the canary in the coal mine, but the impending calamity is not what we are led to believe. We knew of a rise in counterfeit prescription pills for many years. It was a rise induced directly by DEA policies inflicted upon patients.

The impending calamity is not the risks counterfeit pills pose to the public, but the legal liability the DEA faces for its failed policies.

For years, federal agencies and physician advocacy groups remained in lockstep on the causes of the opioid epidemic. Lax prescription guidelines, over prescribing by willing physicians, and the addictive nature of opioids – we heard it all.

Unfortunately, these purported causes proved erroneous at best or deliberately misrepresented at worst. And implementation of policies based on these purported causes led to a rise in suicide and clinical stigmatization among chronic pain patients and patients with substance use dependencies.

This is an atrocity the DEA bears direct responsibility for.

The DEA orchestrated a culture of fear that can be described as medical McCarthyism, in which the fear of prosecution defined the quality of care for stigmatized patients. Accusations formed the basis of convictions as we saw physicians imprisoned for providing care and patients abruptly abandoned without legal recourse.

That is until now.

The American Medical Association (AMA) recently issued a report through its newly formed Substance Use and Pain Care Task Force recommending significant policy changes it believes would more effectively address the nation’s opioid epidemic. Stopping short of outright criticizing the DEA, the report proposes policy recommendations that diametrically oppose the DEA’s approach to the epidemic.

The report is simply the latest in a long line of published studies casting doubt on long held assumptions about the opioid epidemic. We know there is no correlation between opioid-related mortality and the number of opioid prescriptions. We know abruptly discontinuing opioids leads to adverse patient outcomes. And we know forcing physicians to reduce the number of opioid prescriptions leads to a rise in counterfeit prescription opioids.

All of which makes the public health alert by the DEA even more curious.

It is absurd to believe the DEA is not aware of the clinical consequences of its failed policies. And to issue a public health alert without acknowledging the basis for such an alert is deliberately deceptive – disrespecting the lives of patients lost through these policies and conveying a lack of accountability on the part of the DEA.

But lacking accountability is different from lacking awareness. The DEA is clearly aware that its aggressive approach to criminalizing the patient encounter has led to a rise in counterfeit prescription medications and adverse patient outcomes.

In Kentucky, a federal judge deemed a pain management practice liable for the suicide of a patient unable to receive adequate pain relief, who then committed suicide as a result of the untreated pain. The judge ruled that the physicians were liable for the suicide because they inappropriately reduced the patient’s opioid prescription dosage.

A ruling that implies patients have a right to be treated for pain, which when applied broadly to all chronic pain patients would hold the DEA liable for undue harms caused to patients based on its aggressive stance on opioid prescriptions.

Something the DEA is well aware of, but seems bent on assuming no accountability for, hoping the failed policies are seen as well-intentioned errors.

But in recently uncovered reports obtained through multiple FOIA (Freedom of Information Act) requests, it appears the DEA’s aggressive stance extends beyond erroneous policies and the unintended specter of clinical fear – to something far more nefarious, far more deliberate.

For years the DEA colluded with major insurance companies to obtain data on prescribing practices for physicians who treated patients in pain with prescription opioids, contracting covert, third-party data-mining companies to troll medical records without the consent of patients or the knowledge of physicians.

In 2016, these data-mining companies modified the data analysis, changing the definition of a high risk opioid prescriber to encompass a majority of physicians who prescribed opioids. The adjustment was a blatant attempt to coordinate and expedite the indictment of physicians, and to strengthen the likelihood of convictions.

It should come as no surprise that this is when we began to see a rise in physician imprisonments and a rise in counterfeit opioids. Both of which are a direct consequence of deliberately misrepresenting the trolled medical data.

Now, years later, lacking the support of physician advocacy groups, or the protection of public perception, the DEA finds itself confronting the ugly reality of its failed policies – and the ensuing liability.

But liability comes in different forms. Liability can be characterized as a harmless mistake or as a deliberate misrepresentation. The behavior of the DEA elucidated through the FOIA documents would suggest the latter.

Yet the public health alert provides a convenient rebuttal. A plausible excuse for the DEA to claim its failed policies were an honest mistake. The DEA can now say that when it realized its policies were leading to a rise in counterfeit opioid prescriptions, it issued a public health alert, suggesting the adverse clinical outcomes – the suicides and stigmatizations – were nothing more than an unintended consequence, an honest mistake.

For the DEA to issue a public health alert for a crisis that began years ago through its own policies is certainly a curious course of action – something we rarely see from federal agencies.

But a broader analysis reveals that the timing of the alert is less curious and more strategic. A canary in the coal mine – for the impending liability the DEA will soon face.

 

Filed under: General Problems