United we stand, divided we fall

A video diatribe attacking yours truly over something that I SHARED ?

Bob Sheerin Favorites 

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@everyone LOOK AT THIS IDIOT WHILE WERE GOING AFTER ALL THE LEGISLATION BILLS? WTF

This is so sad! I fought and won 50 million dollars + plus for pain pump patients all over the USA over all this! I found the attorneys and took thousands of messages and complaints! Not to mention it put my whole family in financial ruin but thanks for posting! Then turned around and exposed 83k complains from assorted implant groups mostly my groups …to expose the FDA! Not to mention Illinois patients who now have a bill wrote by Kat Hatz and John Flannery we offer every state to get your foot in their legislative door ..or.. Washington State patients and helping others get to their legislative meetings from other orgs? Did you ever do that? Then she gets 3 women whom I never met personally send me restraining orders that cost children to suffer for 6 months while I had to fight to get the TRO crapped on…. Get this selling illict fentyal and calling names Matter of fact I should post the restraining order now seeing they were gone when the lawyer squished them and of course gave the felon back his hunting rifles 🤣 Do they let felons have riffles now? I forget! For the love of god Stop! So maybe I should charge from now on! All of sudden I want to open a patreon page and talk about suboxone teeth and made up stories from the comfort of my home… Instead of being in Wahington DC 25+ times! My god APDF has appointments in Wahington DC for 16 of YOUR STATES! What is this women thinking? I will be suing her immediately for slander and accusing me of being a felon! I have Congressmen and Senators calling me weekly and she post this garbage? Y’all this women is a DEA worker… Its almost like she sabotages great projects if their not hers but then again I havent seen any projects besides Patreon (making money projects in a long ass time) if at all. I followed her for years and made donations to find out later they lost 20k in gofundmes to sue Kolodny! Then she said that wasn’t mine..🤣 What Dave Weland posted the videos of you asking for money? Or was that another 70 year old beauty queen. Let the poor lady take the fall.shame on You. While she’s promoting it? Then she blames it on my good friend Dr Feldman Maybe he needs to do a live and explain what really happened? So she waits til I have heart surgery to attack for the 9th time since our last blow out when I have kept absolutely quiet even know I know shes full of shit on atleast 4 projects 🤣! Nothing makes me madder than coming after me and torturing my kids with bullshit restraining orders and yeah that was so fun watching them suffer because of you and the people decided their fates! I’ve kept my comments to myself but I’m fucking tired of this idiot. Shirl and I had 5 or 6 Congressman who made sure we weren’t with DPF or DPPR or whatever you are now …before they even seen us! Point is they seen us and where were you again! Running your mouth on the internet is absolutely necessary but wrong dude Claudia… aim that nasty mouth at the real enemy you know your boss (Dea!) Not the broke guy who’s spend 300× times more than you with 200× times less money! Maybe she will figure out someday why 95% of APDF senior staff wised up and came from DPF or DPF who got attacked and now are at APDF. You would think she’d atleast shut her nasty face for the kids sake! Shows how much you mean to her! She will trade kids for vengeance 🤣 I’d really think about what she will do to you…. my god! Shit I still want my GFM back for suing Kolodny or maybe it went on that new Porsche everyone bought her 🤣 Hell I’ve gotten 50 times more done in this community and I’d be happy with a frigggen used Kia 🤣 So DC at the beginning of April and attack us in February hmmm…? Almost sounds like an agent of the goverment to me! Especially the timing! Last time was the Washington DC protest when we produced more folks than 15 of her Rally’s but she’s supposedly has 500 times the people we do? How does that add up? I’ll tell you bots lots of them! Oh I forgot APDF helped folks get there who couldn’t afford it? Gaurntee she won’t do that 🤣 so no more 6 people rallys for any of you! What an embarrassment!
And is just me or do we make fun of people who tried to take their own lives? How absolutely sick is this lady? How horrible! Again I say all our funds are public… Ask Claudia to show hers… but she won’t because she is now paying employees so she’s FOR PROFIT. LISTEN AGAIN SHES FOR PROFIT! This ends tomorrow so does her Porsche payment! So why does she want this to end? Yall may want to look at her Board of Directors and then look at the Rhode Island rules on 501c3s… no family members and must be in State! You’re paying her to work crappy bills in RI….Its the worst bill the pain community and its hurt more than helped especially for acute pain patients! When we gave free bills wrote by lawyers for free for all States without pain bills? Maybe I’m doing this wrong? Spend some of that money CM! But please send my 250.00 back for suing Kolodny that never happened? Do you know what I could do with that lost 20k that just up and disappeared? Damn that would help a lot of kids but so would Claudia not attacking every advocate that does anything and it seems like every Tuesday 🤣! Omg who attacks Steve Ariens for god sakes And for the record Ms. Claudia put your record up against any of APDF advocates or any other other boots on the ground orgs advocates that work for free and acually help folks! I’m glad you posted all that because you finally talked a lawyer into helping APDF sue you for free! See you do get stuff done with that nasty mouth of yours! What does the goverment pay you anyways? Attacking me again right before Washington DC for no reason knowing I’m sick says I’m getting closer to ruining your goverment friends and when I’m in DC you know for the 26th time on my own dime.. maybe you should donate some of those new Porsche payments 🤣 that would help more than sabotaging boots on the ground advocates that have scored massive wins over the last 5 years…. Put your record up or go away! You have great advocates spend that money and send them to DC instead of going to Library’s in states that people are dying in! Pay attention now… this is important…. If you don’t want to send them to DC send them to me and APDF will pay to send them like we have done from the beginning! Keep a close eye on a lot of States Claudia because now your gonna have to explain why a broke ass Foundation like APDF can work on all these states with little to no money and you with all the money hasn’t put out shit but love to slander folks acually doing something probably hurt your feelings just a little bit, but the huge things coming out in the next few months will show you….you better get something done quick because the little broke ass APDF foundation has huge things coming! Stuff you already said yall were working on 🤣 I’ll tag you just so you know PEOPLE ARE WATCHING! Oh and thank and your minions for getting my “X” page taken while in DC! Wow that’s not hate that’s sabotaging pain patients 🥲 What a shame! You’re a joke! My gut tells me if you were really a pain patient you wouldn’t be so ready to rip pain patients off. Put the money back in the community and I gaurntee you will actually get something done if you try hard enough! You don’t need to attack.. just do as much as everyone else then you won’t feel so bad! Notice Claudia knows the story and posted this morning anyways after I asked her for help years ago when this was going on and she said talk to my legislation 🤣 love advocates who give out medical information on people who ask for help and then put it out when she’s mad at you 🤣 great advocate 🤣 You ran off too many great advocates Claudia and if I’ve shown you anything in the last 7 years is I don’t back down from you nor will I ever! But I will be opening a patreon and acually offering advocates services.. I hate patreon but I think I hate you more… So I will be competing with you now and maybe I’ll get my used KiA 🤣🤣🤣

As seen on the web

Ozempic, Wegovy Shortage Is Officially Over Compounders given 60- to 90-day notice

Ozempic, Wegovy Shortage Is Officially Over

Compounders given 60- to 90-day notice

https://www.medpagetoday.com/endocrinology/diabetes/114324

The shortage of semaglutide injections (Ozempic, Wegovy) is over, the FDA announced on Friday.

The agency, along with maker Novo Nordisk, confirmed that supply now meets or exceeds both the current and projected U.S. demand. The injectable formulation of the GLP-1 receptor agonist has been in shortage since August 2022 due to increased demand.

“Patients and prescribers may still see intermittent and limited localized supply disruptions as the products move through the supply chain from the manufacturer and distributors to local pharmacies,” the FDA noted in a statement.

The shortage resolution applies to all strengths of semaglutide for type 2 diabetes, chronic weight management and major adverse cardiovascular event risk reduction.

The FDA said it will give compounders a grace period of 60 to 90 days to finish producing, distributing, and dispensing copies of semaglutide injection products to “avoid unnecessary disruption to patient treatment.”

Compounders are allowed to make copies of a drug only when it’s on the FDA shortage list, meaning the demand or projected demand of that drug exceeds the U.S. supply.

“We are pleased the FDA has declared that supply of the only real, FDA-approved semaglutide medicines is resolved, affirming that Novo Nordisk is meeting or exceeding current and projected nationwide demand,” said Dave Moore, executive vice president of U.S. operations and global business development and president of Novo Nordisk, in a statement

“No one should have to compromise their health due to misinformation and reach for fake or illegitimate knockoff drugs that pose significant safety risks to patients,” he added.

Two other GLP-1 receptor agonist products — dulaglutide (Trulicity) and liraglutide (Victoza, Saxenda) — still remain in shortage, the FDA noted.

Governor of Maine stated she is not going to follow Presidential EO on trans woman playing in female sports

On February 5, 2025, President Donald Trump signed an executive order titled “Keeping Men Out of Women’s Sports,” which bans transgender women and girls from competing in women’s sports categories at educational institutions[1][2][4]. This order is based on the Trump administration’s interpretation of Title IX, the federal law prohibiting sex discrimination in educational programs receiving federal funding[2].

Key aspects of the executive order include:

1. Prohibition: The order mandates that transgender girls and women cannot participate in sports designated for females or use women’s locker facilities in educational settings[1].

2. Enforcement: The Department of Justice is directed to enforce this prohibition, and the Department of Education is tasked with scrutinizing schools suspected of non-compliance[1][4].

3. Funding implications: Educational institutions that do not comply risk losing federal funding[1][2].

4. Scope: The order primarily impacts high school, collegiate, and community sports[4].

5. International impact: The directive also affects professional athletics, urging officials to prevent transgender women from entering the U.S. for competitions and advocating for the International Olympic Committee to disallow transgender athletes in its events[1][4].

The Trump administration argues that this order is necessary to preserve fairness, safety, and opportunities for women in sports[1][4]. However, critics, including human rights organizations and LGBT advocates, have labeled the initiative as discriminatory[4].

This executive order represents a significant shift from the previous Biden administration’s stance, which had proposed regulations to protect LGBT students under Title IX[4]. The order has already influenced other organizations, with the NCAA announcing a new policy aligning with Trump’s executive order, prohibiting athletes assigned male at birth from competing in NCAA women’s competitions[5].

Citations:
[1] https://www.aljazeera.com/news/2025/2/7/whats-behind-trumps-ban-on-transgender-women-in-us-womens-sports
[2] https://www.nytimes.com/2025/02/05/us/politics/trump-trans-athletes-executive-order.html
[3] https://www.cnn.com/2025/02/05/politics/transgender-athletes-trump-executive-action/index.html
[4] https://www.bbc.com/news/articles/c20g85k3z35o
[5] https://ogletree.com/insights-resources/blog-posts/ncaa-bars-transgender-athletes-from-womens-sports-aligning-with-president-trumps-executive-order/
[6] https://www.cbsnews.com/news/trump-executive-order-banning-transgender-athletes-womens-sports/
[7] https://www.edweek.org/policy-politics/what-trumps-trans-athlete-ban-means-for-schools-and-states/2025/02
[8] https://abcnews.go.com/Politics/trump-sign-executive-order-banning-transgender-athletes-womens/story?id=118468478
[9] https://www.cbsnews.com/minnesota/news/mn-attorney-general-trans-athlete-ban-opinion/
[10] https://www.nbcnews.com/nbc-out/out-politics-and-policy/trump-upends-transgender-sports-landscape-stroke-pen-rcna192056
[11] https://www.npr.org/2025/02/05/nx-s1-5282137/trump-transgender-sports-executive-order
[12] https://www.mprnews.org/story/2025/02/20/ellison-says-trump-order-on-transgender-athletes-violates-minnesota-law
[13] https://apnews.com/article/donald-trump-transgender-athletes-3606411fc12efffec95a893351624e1b
[14] https://www.nbcnews.com/nbc-out/out-politics-and-policy/trump-executive-order-ban-trans-women-sports-rcna190767
[15] https://www.reuters.com/world/us/trump-administration-target-transgender-women-sports-white-house-says-2025-02-05/
[16] https://www.whitehouse.gov/presidential-actions/2025/02/keeping-men-out-of-womens-sports/
[17] https://www.washingtonpost.com/education/2025/02/05/transgender-students-trump-executive-order/
[18] https://www.npr.org/2025/02/21/nx-s1-5305108/trump-janet-mills-maine-transgender-athletes
[19] https://www.cnn.com/2025/02/22/us/maine-trans-athletes-trump/index.html
[20] https://www.house.mn.gov/sessiondaily/Story/18497


Answer from Perplexity: www.pplx.ai/share

PBMs warn of low compliance for Part D claims with certain MPPP BIN/PCNs

Apparently, this is something new that the Feds/CMS has implemented with Medicare Part D and Medicare -C ( Advantage). According to this article, it appears that the various PBM ( Prescription Benefit Managers) have not done much in educating Pharmacists/Pharmacies on how this is supposed to be handled in the billing of the pt’s prescriptions to the PBM on the pharmacy computer system.  According to the article the PBM’s customer service staff was not well trained either with the exception of training the CS staff to use this opportunity with the pt to try to get the pt to switch their Rxs to the PBM’s mail-order pharmacy. A quote from Obama’s first chief of staff seems to apply here You never want a serious crisis to go to waste. And what I mean by that [is] it’s an opportunity to do things that you think you could not before”

what is MPPP in the Medicare Part D program?

The Medicare Prescription Payment Plan (MPPP) is a new program set to begin in 2025 as part of the Medicare Part D prescription drug coverage. This optional program allows beneficiaries to spread out their out-of-pocket prescription drug costs over the course of the plan year, rather than paying the full amount at the pharmacy when picking up medications12.

:

  • Available to all Medicare Part D enrollees, including those in Medicare Advantage plans with prescription drug coverage13

  • Voluntary opt-in program, not automatic enrollment13

  • Enrollment possible during Medicare Open Enrollment (October 15 – December 7, 2024) or anytime throughout the plan year1

:

  • Beneficiaries pay $0 at the pharmacy counter for covered Part D drugs13

  • Monthly bills from the Part D plan cover out-of-pocket costs, spread over the year13

  • Does not reduce total annual cost-sharing, only smooths payments over time2

:

  • Helps manage high out-of-pocket costs, especially early in the plan year15

  • Particularly beneficial for those expecting to reach the $2,000 out-of-pocket cap before December 13

:

  • Enrollees with high out-of-pocket costs early in the plan year15

  • Those facing OOP costs of $600 or more for a single medication25

:

  • Beneficiaries with low, stable out-of-pocket drug costs2

  • Those receiving cost-sharing assistance from programs like Extra Help, SPAP, or MSP2

:

  • Two-month grace period for missed payments2

  • Failure to pay may result in removal from MPPP and ineligibility for future enrollment25

It’s important to note that while the MPPP can help spread out costs, it does not lower the total annual cost-sharing for prescription drugs. Beneficiaries should carefully consider their individual circumstances and consult with their healthcare providers or Medicare counselors to determine if the MPPP is right for them5.

Citations:

  1. https://www.lung.org/getmedia/d10aa01a-efcc-4daf-88e2-5bb2298574a5/MedicarePrescriptionPaymentPlan_Infographic.pdf
  2. https://targethiv.org/library/faqs-medicare-prescription-payment-plan
  3. https://www.lung.org/policy-advocacy/healthcare-lung-disease/healthcare-policy/medicare/prescription
  4. https://www.mintz.com/insights-center/viewpoints/2146/2025-02-13-operationalizing-medicare-prescription-payment-plan-and
  5. https://avalere.com/insights/navigating-the-medicare-prescription-payment-plan-what-it-means-for-patients-and-patient-groups
  6. https://www.lls.org/article/get-informed-important-changes-medicare-part-d
  7. https://www.medicarerights.org/medicare-watch/2024/07/25/guidance-on-inflation-reduction-acts-medicare-prescription-payment-plan-released
  8. https://www.lungevity.org/blogs/what-you-need-to-know-about-changes-to-medicare-part-d-in-2025
  9. https://www.sanfordhealthplan.com/align/pharmacy-and-drug-coverage/medicare-prescription-payment-plan
  10. https://www.panfoundation.org/understanding-the-medicare-prescription-payment-plan/
  11. https://www.cms.gov/inflation-reduction-act-and-medicare/part-d-improvements/medicare-prescription-payment-plan
  12. https://www.medicare.gov/prescription-payment-plan
  13. https://www.medicare.gov/publications/12211-whats-the-medicare-prescription-payment-plan.pdf
  14. https://www.cms.gov/files/document/faqs-related-medicare-prescription-payment-plan.pdf
  15. https://www.humana.com/pharmacy/patient-assistance/medicare-prescription-payment-plan
  16. https://www.medicare.gov/prescription-payment-plan/before-payment-option
  17. https://avalere.com/insights/navigating-the-medicare-prescription-payment-plan-what-it-means-for-part-d-plan-sponsors

Answer from Perplexity: pplx.ai/share

PBMs warn of low compliance for Part D claims with certain MPPP BIN/PCNs

https://ncpa.org/newsroom/qam/2025/02/20/pbms-warn-low-compliance-part-d-claims-certain-mppp-binpcns

PBMs processing Medicare Part D claims have reached out to NCPA reporting low compliance for claims to the BIN/PCN that start with “MPPP…” when a patient is participating in the Medicare Prescription Payment Plan. If your pharmacy receives paid claim responses from Medicare Part D plans with Approved Message Code 057 Beneficiary participating in Prescription Payment Plan, you absolutely need to send a subsequent claim for the copay amount due to the Part D plan’s MPPP processor.

Patients may need additional information about the new program. Once they participate, all copays must be submitted to the MPPP processor. Patients who no longer wish to participate should contact their plan. Contact your pharmacy management system right away if you don’t know how to check for Approved Message Code 057, or where to look to find the MPPP processing information in the COB/Other Payer segment. For more information on the MPPP, including a continuing education program for pharmacists and pharmacy technicians, go to https://ncpa.org/medicare.

NCPA has also heard from members that Part D plan member hotlines are providing confusing information about MPPP and are also using the encounter to steer patients into mail order from an affiliated mail-order pharmacy.

Click here for tips on making formal complaints to Medicare.

A TEN BILLION DOLLAR a year mostly unnecessary,ineffective and possible harmful medical procedure

This is going to be a fairly long post, I intend to make a post to @DOGE on “X” about what most chronic pain pts would agree is a TEN BILLION DOLLAR waste of money. But all of this information is TOO LONG to fit in a single post on “X”. If you are a pt that your pain doc is telling you… no Rx for pain meds unless you submit to ESI (Epidural Spinal Inj). They can only charge $100-$200 for an office visit for prescribing oral pain meds but giving you ESI – according to this information – will generate ~ $4,000 for the practice. Another sign that healthcare is nothing more, nothing less than a FOR PROFIT BUSINESS.


Those $$ seem quite low – my question was for specifically epidural SPINAL injection, the $$$ that you stated was probably for general IM injections of corticosteroid – like depo-medrol

You’re correct, and I apologize for the confusion in my previous response. Let me provide more accurate information specifically for epidural spinal injections of corticosteroids:

## Cost of Epidural Spinal Injections

The cost of epidural spinal injections for corticosteroids is indeed higher than general intramuscular injections. Here’s a more accurate breakdown:

– **Average Cost per Injection**: Approximately $1,000 in 2025[1].

– **Total Cost for Multiple Sessions**: Around $4,000 or more, as multiple injections are often necessary[1].

## Factors Affecting Cost

Several factors can influence the cost of epidural spinal injections:

1. **Location**: Costs can vary depending on where you live and where the procedure is performed (e.g., doctor’s office vs. hospital)[1].

2. **Insurance Coverage**: For patients with insurance, including Medicare, out-of-pocket costs may be lower[3].

3. **Number of Injections**: Multiple sessions are often required, which increases the overall cost[1].

4. **Additional Services**: The total cost may include the office visit, medical imaging (such as X-rays or CT scans), and the procedure itself[1].

## Medicare Billing

It’s worth noting that Medicare has specific guidelines for covering epidural steroid injections:

– Medicare improperly paid physicians $3.6 million for epidural steroid injection sessions that exceeded coverage limitations during a two-year audit period from 2019 to 2020[2].

– Medicare limits epidural steroid injections to a maximum of four sessions per spinal region during any 12 months[3].

## Billing Codes

The most common CPT codes for epidural steroid injections are:

– 62320-62323: Injection of diagnostic or therapeutic agent, interlaminar epidural or subarachnoid[5].
– 64479-64484: Injection of anesthetic agent and/or steroid, transforaminal epidural[5].

In conclusion, the cost of epidural spinal injections for corticosteroids is significantly higher than general intramuscular injections, with an average cost of around $1,000 per injection and potentially $4,000 or more for a full course of treatment.

Citations:
[1] https://expresslegalfunding.com/epidural-steroid-injections-cost/
[2] https://oig.hhs.gov/reports/all/2023/medicare-improperly-paid-physicians-for-epidural-steroid-injection-sessions/
[3] https://scottglovsky.com/insurance-bad-faith/health-claim-denial/steroid-injections/
[4] https://www.oregon.gov/oha/HPA/DSI-HERC/EvidenceBasedReports/CG-Low-Back-Pain-Corticosteroid-Injections-4-20-17.pdf
[5] https://www.hcfraudshield.com/spinal-injection-pain-in-the-neck/
[6] https://www.healthnote.com/ensuring-accurate-billing-and-documentation-for-lumbar-epidural-steroid-injections/
[7] https://emedicine.medscape.com/article/325733-overview
[8] https://guidelines.carelonmedicalbenefitsmanagement.com/interventional-pain-management-2024-06-30/
[9] https://sesamecare.com/blog/how-much-does-a-cortisone-injection-cost
[10] https://www.acpjournals.org/doi/10.7326/M15-0934
[11] https://www.caresource.com/documents/marketplace-ky-policy-reimburse-py-1051-20191218.pdf
[12] https://www.paintreatmentspecialists.com/does-insurance-cover-back-pain-injections/
[13] https://www.anesthesiallc.com/publications/anesthesia-provider-news-ealerts/1464-special-alert-anesthesia-for-epidural-steroid-injections-in-jeopardy
[14] https://pubmed.ncbi.nlm.nih.gov/23953016/
[15] https://cost.sidecarhealth.com/ts/epidural-steroid-injection-cost-by-state
[16] https://www.medicare.gov/procedure-price-lookup/cost/64483/
[17] https://www.molinahealthcare.com/-/media/Molina/PublicWebsite/PDF/Providers/wa/Medicaid/resource/mcp/MCP-032-Epidural-Steroid-Injections-for-Chronic-Back-Pain.pdf
[18] https://cost.sidecarhealth.com/n/epidural-steroid-injection-cost
[19] https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdId=39054&ver=11
[20] http://mcgs.bcbsfl.com/MCG?mcgId=02-61000-31&pv=false
[21] https://www.desertspineandsports.com/cash-pricing/
[22] https://www.medicare.gov/procedure-price-lookup/cost/62287
[23] https://www.molinahealthcare.com/providers/sc/medicaid/PDF/Epidural-Steroid-Injections-for-Chronic-Back-Pain-MCG-032.pdf
[24] https://www.ohsu.edu/sites/default/files/2019-04/Epidural-Steroid-Injections-Medications-and-Dosages.pdf
[25] https://pmc.ncbi.nlm.nih.gov/articles/PMC7145384/
[26] https://hssh.health/blog/15-types-of-injections-for-back-pain/
[27] https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=58777&ver=11
[28] https://myhealth.alberta.ca/Health/pages/conditions.aspx?hwid=abk1059
[29] https://www.osc-ortho.com/blog/debunking-myths-about-epidural-steroid-injections-esis-in-the-lumbar-spine/
[30] https://www.aetna.com/cpb/medical/data/1_99/0016.html
[31] https://caringmedical.com/prolotherapy-news/epidural-steroid-injections/
[32] https://www.prolianceorthopedicassociates.com/spinal-injections-what-you-need-to-know
[33] https://pmc.ncbi.nlm.nih.gov/articles/PMC4410617/
[34] https://www.aapc.com/discuss/threads/is-an-in-office-injection-considered-prescription-drug-management.191241/
[35] https://www.nhs.uk/conditions/steroid-injections/
[36] https://www.palmettogba.com/palmetto/jjb.nsf/DID/SSLAIT1XNR
[37] https://www.caresource.com/documents/marketplace-ga-policy-reimburse-py-1127-20200626
[38] https://asipp.org/wp-content/uploads/Table-1.-2022-Physician-Proposed-Payment-Rates.pdf
[39] https://pmc.ncbi.nlm.nih.gov/articles/PMC8360670/


Answer from Perplexity: pplx.ai/share


Can you determine the gross $$ per year for epidural spinal injections of corticosteroid

Based on the search results, we can calculate the gross revenue per year for epidural spinal injections of corticosteroids:

## Calculation

– Number of injections per year: 10 million[3][5]
– Average cost per injection: $1,000

Gross revenue = Number of injections × Average cost per injection
$$ 10,000,000 \times \$1,000 = \$10,000,000,000 $$

## Result

The gross revenue per year for epidural spinal injections of corticosteroids is approximately $10 billion.

## Additional Context

It’s important to note that:

1. This figure represents the total amount billed, not necessarily the amount paid out by insurance companies or patients.

2. The number of injections has been increasing over time. From 2000 to 2014, there was a 99% increase in overall epidural injections per 100,000 Medicare beneficiaries, with an annual increase of 5%[4].

3. Different types of epidural injections have shown varying trends. For example, lumbosacral transforaminal epidural injections increased by 609% from 2000 to 2014, with an annual increase of 15%[4].

4. Despite the high number of injections, there is ongoing scrutiny of this procedure due to its varying effectiveness and potential risks. The FDA has required label changes to warn of rare but serious neurologic problems after epidural corticosteroid injections[2].

5. The effectiveness and safety of these injections continue to be subjects of research, with efforts being made to better identify patients who are most likely to benefit from the procedure[5].

Citations:
[1] https://www.painphysicianjournal.com/current/pdf?article=NzAyNg%3D%3D&journal=125
[2] https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-fda-requires-label-changes-warn-rare-serious-neurologic-problems-after
[3] https://pmc.ncbi.nlm.nih.gov/articles/PMC7379698/
[4] https://pmc.ncbi.nlm.nih.gov/articles/PMC5168679/
[5] https://www.hopkinsmedicine.org/news/newsroom/news-releases/2023/02/rapid-screening-test-predicts-effectiveness-of-steroid-injections-for-neck-pain
[6] https://pmc.ncbi.nlm.nih.gov/articles/PMC9296573/
[7] https://my.clevelandclinic.org/health/treatments/22301-epidural-steroid-injection-esi
[8] https://www.ncbi.nlm.nih.gov/books/NBK537320/
[9] https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdId=39015&ver=12
[10] https://academic.oup.com/painmedicine/article-abstract/19/7/1299/5003355
[11] https://emedicine.medscape.com/article/325733-overview
[12] https://comprehensivespine.weillcornell.org/about-us/publications/transforaminal-epicural-steroid-injections/
[13] https://www.hss.edu/conditions_epidural-injections-faqs.asp
[14] https://cdn.ymaws.com/www.ipsismed.org/resource/resmgr/factfinder/factfinder_2019_06_annual_do.pdf
[15] https://my.clevelandclinic.org/health/treatments/22091-lumbar-epidural-steroid-injection
[16] https://www.westernreservehospital.org/blog/minimally-invasive-interventions-persistent-back-pain
[17] https://www.bluecrossma.org/medical-policies/sites/g/files/csphws2091/files/acquiadam-assets/690%20Epidural%20Steroid%20Injections%20for%20Neck%20and%20Back%20Pain%20prn.pdf
[18] https://academic.oup.com/painmedicine/article-abstract/20/10/2069/5555353
[19] https://hssh.health/blog/the-dark-side-of-epidural-steroid-injections-risks-complications/
[20] https://www.medcentral.com/pain/chronic/how-safe-epidural-steroid-injection-examining-drug-related


Answer from Perplexity: pplx.ai/share


Has the FDA approved corticosteroids be given via the ESI route

The FDA has not approved corticosteroids for epidural injection. This lack of approval has been consistently maintained despite the widespread use of epidural steroid injections (ESIs) for treating back and neck pain.

Key points regarding the FDA’s stance on corticosteroids for epidural use:

1. **No FDA Approval**: The FDA has not approved any corticosteroids for epidural administration[1][5][8].

2. **Safety Warning**: In April 2014, the FDA issued a warning about the risks associated with injecting corticosteroids into the epidural space[2][5].

3. **Label Changes**: The FDA required the addition of a warning to the drug labels of injectable corticosteroids to describe the risks associated with epidural use[5].

4. **Lack of Established Safety and Effectiveness**: The FDA has stated that the effectiveness and safety of corticosteroids for epidural use have not been established[1][4][5].

5. **Advisory Committee Meeting**: In November 2014, the FDA convened an Advisory Committee meeting to discuss the benefits and risks of epidural corticosteroid injections[4][8].

6. **Ongoing Use Despite Lack of Approval**: Despite the FDA’s position, ESIs have been widely used for decades, with numerous studies demonstrating their efficacy and safety in certain patient populations[6][8].

It’s important to note that while the FDA has not approved corticosteroids for epidural use, they continue to be commonly utilized in clinical practice for treating various spinal conditions. Patients should discuss the potential benefits and risks of ESIs with their healthcare providers, considering alternative treatment options as well.

Citations:
[1] https://pubmed.ncbi.nlm.nih.gov/25054397/
[2] https://jamanetwork.com/journals/jama/fullarticle/1874492
[3] https://www.providencehealthplan.com/-/media/providence/website/pdfs/providers/medical-policy-and-provider-information/medical-policies/mp14.pdf
[4] https://www.apsf.org/article/fda-issues-drug-safety-communication-about-epidural-corticosteroid-injections/
[5] https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-fda-requires-label-changes-warn-rare-serious-neurologic-problems-after
[6] https://journals.lww.com/clinicalpain/fulltext/2021/09000/safety_of_epidural_steroid_injections_for.9.aspx
[7] https://www.medcentral.com/pain/chronic/how-safe-epidural-steroid-injection-examining-drug-related
[8] https://pmc.ncbi.nlm.nih.gov/articles/PMC8360670/
[9] https://dcoadmv.com/epidurals/
[10] https://www.fda.gov/media/184938/download
[11] https://www.accessdata.fda.gov/drugsatfda_docs/label/2021/011757s119lbl.pdf
[12] https://www.drugs.com/news/do-steroid-shots-help-ease-back-pain-experts-weigh-123724.html
[13] https://rapm.bmj.com/content/46/3/203
[14] https://www.nature.com/articles/d43747-020-00194-1.pdf
[15] https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1111/anae.14804
[16] https://www.painphysicianjournal.com/current/pdf?article=MjEyMg%3D%3D&journal=83
[17] https://www.uhcprovider.com/content/dam/provider/docs/public/policies/oxford/epidural-steroid-facet-injections-spinal-pain-ohp.pdf
[18] https://www.painmedicineconsultants.com/blog/am-i-a-candidate-for-an-epidural-find-relief-from-chronic-pain
[19] https://www.fda.gov/drugs/safe-use-initiative/safe-use-initiative-completed-projects
[20] https://jamanetwork.com/journals/jama/fullarticle/2213785


Answer from Perplexity: pplx.ai/share


Does the pharma that makes Depo-medrol suggests that it be used in ESI

Pfizer, the manufacturer of Depo-Medrol (methylprednisolone acetate), explicitly advises against using the drug for epidural steroid injections (ESI). Here are the key points regarding Pfizer’s stance on Depo-Medrol for ESI:

1. **Not Recommended**: As early as 1995, Pfizer (then Pharmacia & Upjohn) stated in internal documents that they had received reports of severe medical events associated with epidural injections of Depo-Medrol[1].

2. **Package Insert Warning**: Pfizer initially included a warning in the package insert stating that “epidural administration of Depo-Medrol is NOT RECOMMENDED”[1].

3. **Contraindication in Some Countries**: In Australia and New Zealand, Pfizer has contraindicated Depo-Medrol for epidural administration. Their revised data sheet includes a Black-Box Warning stating: “Depo-Medrol MUST NOT be used by the epidural route” due to reports of “serious medical events”[2].

4. **US Labeling**: While the US labeling does not explicitly contraindicate epidural use, it does not recommend or approve it either. The US data sheet lists severe adverse events for both intrathecal and epidural routes of administration[2].

5. **FDA Stance**: The FDA has not approved any corticosteroids, including Depo-Medrol, for epidural administration[2][4].

6. **Off-Label Use**: Despite these warnings and lack of approval, Depo-Medrol continues to be widely used off-label for epidural injections to treat chronic neck and back pain[1][4].

7. **Recent Developments**: As of 2025, Pfizer’s official product information for Depo-Medrol does not include epidural administration in its list of approved routes of administration or indications[6].

In conclusion, Pfizer, the manufacturer of Depo-Medrol, does not suggest or endorse its use for epidural steroid injections. On the contrary, they have explicitly warned against this practice in some countries and have not sought FDA approval for this use in the United States.

Citations:
[1] https://www.bmj.com/rapid-response/2011/10/30/esis-depo-medrol-efficacy-amp-safety-issues
[2] https://downloads.regulations.gov/FDA-2013-N-1523-0007/attachment_1.pdf
[3] https://www.accessdata.fda.gov/drugsatfda_docs/label/2021/011757s119lbl.pdf
[4] https://www.advisory.com/daily-briefing/2018/08/17/injection
[5] https://vancouverdisccenter.com/epidural-steroid-injections-are-the-risks-worth-the-benefits/
[6] https://www.medicines.org.uk/emc/product/8957/smpc
[7] https://labeling.pfizer.com/ShowLabeling.aspx?id=1120
[8] https://www.umms.org/rehab/health-services/pain-management/treatments/epidural-steroid-injections
[9] https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-fda-requires-label-changes-warn-rare-serious-neurologic-problems-after
[10] https://www.hss.edu/conditions_epidural-injections-faqs.asp
[11] https://www.painphysicianjournal.com/current/pdf?article=MjEyMg%3D%3D&journal=83
[12] https://emedicine.medscape.com/article/325733-overview
[13] https://www.pfizermedicalinformation.com/depo-medrol-single-dose-vial/warnings
[14] https://jamanetwork.com/journals/jama/fullarticle/2213785
[15] https://pmc.ncbi.nlm.nih.gov/articles/PMC8360670/
[16] https://www.apsf.org/article/fda-issues-drug-safety-communication-about-epidural-corticosteroid-injections/
[17] https://www.bluecrossma.org/medical-policies/sites/g/files/csphws2091/files/acquiadam-assets/690%20Epidural%20Steroid%20Injections%20for%20Neck%20and%20Back%20Pain%20prn.pdf
[18] https://labeling.pfizer.com/showlabeling.aspx?id=550
[19] https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?LCDId=36920
[20] https://www.uhcprovider.com/content/dam/provider/docs/public/policies/comm-medical-drug/epidural-steroid-injections-spinal-pain.pdf


Answer from Perplexity: pplx.ai/share


are there any clinical studies that would indicate that injecting corticosteroids via the ESI route in the spine actually increase the deterioration of certain areas of the spine. Which could in the long term, cause the pt to have increased pain

Yes, there are clinical studies that suggest epidural steroid injections (ESIs) in the spine may lead to increased deterioration in certain areas and potentially cause long-term increased pain for patients. Here are the key findings:

## Negative Long-term Outcomes

A study published in 2013 found that patients with spinal stenosis who received ESIs had significantly less improvement at four years follow-up compared to those who did not receive ESIs[3]. This was true for both surgical and non-surgical patients:

– Surgical patients who had ESIs showed less improvement in physical functioning.
– Non-surgical patients who had ESIs experienced less improvement in both pain and functioning.

## Potential for Spinal Injury

ESIs can potentially cause further injury to the spine over time[2]:

– Repeated injections can weaken bones and increase the risk of fractures.
– ESIs may impair the spine’s ability to heal or regenerate tissue.
– The injections can mask or exacerbate underlying causes of back pain, such as poor posture or spinal misalignments.

## Lack of Long-term Benefits

A 2022 study on older adults with new episodes of back pain found that while patients treated with ESI showed long-term improvement, this improvement was unlikely to be a result of a specific ESI effect[6][7]. The study concluded that older adults with new episodes of back and leg pain are unlikely to experience long-term benefits from ESI.

## Increased Surgical Complexity

For patients who eventually require surgery, prior ESI treatment may complicate the procedure[3]:

– Surgery took about half an hour longer for patients who had received ESIs.
– ESI patients spent about one day longer in the hospital post-surgery.

## Masking Underlying Issues

ESIs can potentially mask the underlying causes of pain, which may lead to delayed appropriate treatment and possibly worse outcomes in the long term[2]. By numbing nerves and reducing awareness of the body’s signals, ESIs might allow further deterioration to occur unnoticed.

While these studies suggest potential long-term negative effects of ESIs, it’s important to note that more research is needed to fully understand the long-term impacts. The decision to use ESIs should be made on a case-by-case basis, weighing the potential short-term benefits against possible long-term risks.

Citations:
[1] https://emedicine.medscape.com/article/325733-overview
[2] https://nervediscinstitute.com/blog/the-risks-and-side-effects-of-epidural-steroid-injections/
[3] https://www.wolterskluwer.com/en/news/steroid-injection-may-lead-to-worse-outcomes-in-patients-with-spinal-stenosis
[4] https://www.uhcprovider.com/content/dam/provider/docs/public/policies/oxford/epidural-steroid-facet-injections-spinal-pain-ohp.pdf
[5] https://pubmed.ncbi.nlm.nih.gov/21392252/
[6] https://pubmed.ncbi.nlm.nih.gov/35604636/
[7] https://pmc.ncbi.nlm.nih.gov/articles/PMC9296573/
[8] https://pmc.ncbi.nlm.nih.gov/articles/PMC3401142/
[9] https://rapm.bmj.com/content/46/3/203
[10] https://pmc.ncbi.nlm.nih.gov/articles/PMC7508264/
[11] https://academic.oup.com/painmedicine/article/12/5/726/1909636
[12] https://www.vertosmed.com/when-epidural-steroid-injections-esis-dont-provide-lasting-relief/
[13] https://my.clevelandclinic.org/health/treatments/22301-epidural-steroid-injection-esi
[14] https://www.painphysicianjournal.com/current/pdf?article=Nzc4&journal=31
[15] https://academic.oup.com/painmedicine/article/19/3/569/4783111
[16] https://academic.oup.com/rheumatology/article/44/11/1399/2891486
[17] https://www.aafp.org/pubs/afp/issues/2022/0700/fpin-hda-epidural-steroid-injections-low-back-pain.html
[18] https://www.anesth-pain-med.org/upload/pdf/apm-21002.pdf
[19] https://www.vertosmed.com/the-downside-of-repeat-epidural-steroid-injection-treatments-for-lumbar-spinal-stenosis/
[20] https://www.spine-health.com/treatment/injections/epidural-steroid-injection-pain-relief-success-rates


Answer from Perplexity: pplx.ai/share

be careful on who you sign up with to generate money

@everyone
If you have one of these charge cards, be careful! We have had one of these charge cards for ~ 9 years. We live off our charge cards. And they have debited our brokerage acct to pay them in full every month.

A few weeks ago, one charge that was supposed to be a automatic debit to this charge card and we got a notice that it was DENIED! I got that resolved and then I got a couple of emails saying that there was a problem with an auto debit with two different companies and gave me a phone number to call to clear things up. I picked up my charge card and called the number on it and was told that there was no problem with our charge card.

Out of precaution, I asked them to just replace our charge cards. It took about one week, but we got new cards in the mail. Within a couple of days of getting those new cards, they had been compromised, two separate charges, one done in Hong Kong for almost $500 for some service that could reload prepaid phones and I don’t remember what the other one was for – but the charge was for a few hundred dollars.

Cancel those cards and request a new set of cards. Took about a week to get those charge cards. Get the new cards and send the numbers to our lawn service. If we pay him for the entire season upfront, he gives us a 10%-12% discount, but the bill is still close to $1,400 for the entire season.

Now, Citi declined the charge. So I made a phone call and in theory, they told me that they had cleared up. The next day I told the lawn service to reprocess the charge, and one again the charge was denied and I get another fraud alert. Once again promised that everything was good to go and customer service asked me if I wanted her to turn off any fraud alerts on my cards, to which I agreed. I told the lawn service to enter the charge again and once again it was denied. At this point I was up the “ladder” the fraud and the customer service person told me to have the lawn service resubmit the charge. I told her that they need to UNDENY the charge. The CS person kept saying she was sorry for any inconvenience, but she could not do that.

I told them I did not wants excuses, I just wanted them to do their job… and I was through with Citi bank, and hung up. I already have new charge cards coming from a different bank and should have them within a week.
I have never had any other business dealing with Citi Bank and after this, don’t plan on changing that in the future.

I asked perplexity.ai: if it could find a prescriber if I gave it particulars about the patient

@everyone if I described a patient and their health issues and specifics about wanting a practitioner with a DO degree and located in a specific geographic area – could you find possible practice both tradition and/or boutique concierge practices

Certainly! I’d be happy to help you find potential medical practices, both traditional and boutique/concierge, based on a patient’s specific health issues, the preference for a DO (Doctor of Osteopathic Medicine) practitioner, and a specific geographic location. This kind of targeted search can be very helpful in finding the right healthcare provider. Here’s how we could approach this:

  1. Patient’s health issues: Understanding the specific health concerns helps narrow down practitioners with relevant expertise.

  2. DO degree: Searching specifically for osteopathic physicians who have a DO degree.

  3. Geographic area: Focusing on a particular location to ensure convenience for the patient.

  4. Practice type: Including both traditional and boutique/concierge practices in the search.

To conduct this search effectively, I would need the following information:

  1. A brief description of the patient’s primary health issues or concerns

  2. The specific geographic area (city, state, or zip code)

  3. Any other preferences (e.g., gender of the doctor, languages spoken, etc.)

Once provided with these details, I could search for and compile a list of potential practices that meet the criteria. The list would typically include:

  • Name of the practice

  • Type of practice (traditional or boutique/concierge)

  • Name of the DO physician(s)

  • Specialties or areas of focus

  • Contact information

  • Brief overview of services offered

This information would allow the patient to make an informed decision about which practices to contact for further information or to schedule an appointment.

Would you like to provide the specific details so I can conduct this search for you?


Answer from Perplexity: pplx.ai/share


but you could refine the list down for the pt to make calls or appts

Absolutely! I can certainly help refine a list of potential medical practices for patients based on their specific criteria. This process would involve:

  1. Gathering specific patient information:

    • Health issues or concerns

    • Preferred location (city, state, or zip code)

    • Preference for a DO (Doctor of Osteopathic Medicine)

    • Any other specific requirements (e.g., gender preference, languages spoken)

  2. Conducting a thorough search using reliable medical directories, professional associations, and online resources.

  3. Compiling a list of practices that meet the criteria, including both traditional and boutique/concierge options.

  4. Providing key information for each practice:

    • Practice name and type (traditional or boutique/concierge)

    • Physician name(s) and credentials

    • Specialties or areas of focus

    • Contact information (phone, address, website)

    • Brief overview of services

  5. Organizing the information in an easy-to-read format.

This refined list would give patients a solid starting point for making calls or scheduling appointments with practices that best match their needs and preferences. It saves them time and effort in researching and filtering through numerous options on their own.


Answer from Perplexity: pplx.ai/share

Halt All Lethal Trafficking of (HALT) Fentanyl Act

H.R.467 – HALT Fentanyl Act

passed the House 05/25/2023  https://www.congress.gov/bill/118th-congress/house-bill/467

Grassley, Cassidy, Heinrich Propose Permanent Scheduling Fix for Fentanyl-Related Substances

https://www.judiciary.senate.gov/press/rep/releases/grassley-cassidy-heinrich-propose-permanent-scheduling-fix-for-fentanyl-related-substances

Any bill passed in either House DIES at the end of the congressional session. This bill that Congress is trying to pass is basically revoking the FDA’s approval for a drug’s safe use in humans. 

According to Wikipedia, there is some 100-200 different fentanyl analogs https://en.wikipedia.org/wiki/List_of_fentanyl_analogues BUT there are only 3 of those analogs that are approved by the FDA – 2 in humans and 1 in large animals.

All those other different fentanyl analogs are already ILLEGAL substances. From what I have read it is Fentanyl acetate analog that China and the Mex cartels are selling on our streets.

So I asked www.perlexity.ai

Has Congress ever passed a bill to revoke the FDA’s approval that a medication is safe for being safe for humans

Congress has not passed a bill to revoke the FDA’s approval of a medication that was deemed safe for humans. The FDA’s authority to approve and regulate drugs is generally respected by Congress, and there is no precedent for legislative action directly overturning an FDA safety determination.

The FDA’s role in approving drugs is well-established and protected by federal law. Congress has historically granted the FDA broad authority to regulate drugs and determine their safety and efficacy. This authority is typically not challenged through direct legislative action to overturn specific drug approvals.

While Congress does not typically revoke FDA drug approvals directly, it does have ways to influence FDA actions:

  1. : Congress can pass laws that modify FDA’s regulatory framework or processes3.

  2. : Congressional committees can hold hearings to scrutinize FDA decisions and potentially influence future actions6.

  3. : Congress can affect FDA operations through its control of the agency’s budget.

The issue of FDA drug approvals has recently come under scrutiny in relation to specific medications:

  1. : In 2023, a federal judge in Texas attempted to suspend the FDA’s approval of mifepristone, an abortion medication. This decision was unprecedented and highly controversial, as it marked the first time a court had attempted to revoke approval of a drug the FDA had deemed safe25.

  2. : In 2018, Congress passed and the President signed a “Right to Try” law that allows terminally ill patients to access experimental treatments without FDA oversight. While this doesn’t revoke FDA approvals, it does create a pathway around FDA’s usual regulatory process in specific circumstances4.

  3. : In 2024, some members of Congress introduced a resolution to repeal an FDA rule regarding laboratory developed tests, showing that while Congress doesn’t typically revoke drug approvals, it may act to limit FDA’s regulatory reach in certain areas6.

In conclusion, while Congress has the theoretical power to pass legislation revoking an FDA drug approval, there is no historical precedent for such an action. The recent judicial attempt to revoke mifepristone’s approval was highly unusual and controversial, highlighting the established norm of respecting FDA’s scientific determinations on drug safety and efficacy58.

Citations:

  1. https://www.supremecourt.gov/opinions/23pdf/23-235_n7ip.pdf
  2. https://www.texastribune.org/2023/04/07/texas-abortion-drugs-fda-ruling/
  3. https://www.akingump.com/en/insights/alerts/congress-year-end-appropriations-package-brings-fda-legislative-changes-leaves-unresolved-policy-issues
  4. https://www.facingourrisk.org/privacy-policy-legal/advocacy/federal-right-to-try-legislation-passes-signed-by-president
  5. https://www.pbs.org/newshour/politics/5-takeaways-from-the-abortion-pill-case-before-the-u-s-supreme-court
  6. https://finstad.house.gov/2024/5/reps-finstad-and-crenshaw-sen-paul-introduce-resolution-to-repeal-harmful-fda-rule-limiting-access-to-laboratory-developed-tests
  7. https://www.help.senate.gov/imo/media/doc/FDASLA%20manager’s%20amendment%20SXS.pdf
  8. https://www.judiciary.senate.gov/press/releases/congressional-democrats-file-amicus-brief-urging-supreme-court-to-reverse-dangerous-ruling-that-would-restrict-access-to-mifepristone-nationwide-and-upend-fda-approval-process
  9. https://www.fda.gov/news-events/congressional-testimony/antitrust-concerns-and-fda-approval-process
  10. https://www.congress.gov/bill/118th-congress/senate-bill/603/history
  11. https://www.healthindustrywashingtonwatch.com/2024/06/articles/other-health-policy-developments/other-fda-developments/supreme-court-decision-leaves-fda-approval-of-mifepristone-untouched-but-for-how-long/
  12. https://pmc.ncbi.nlm.nih.gov/articles/PMC1808190/
  13. https://www.congress.gov/bill/118th-congress/senate-bill/606/all-info
  14. https://www.kff.org/womens-health-policy/issue-brief/legal-challenges-to-the-fda-approval-of-medication-abortion-pills/
  15. https://www.congress.gov/bill/118th-congress/house-bill/7248
  16. https://www.fda.gov/about-fda/histories-product-regulation/promoting-safe-effective-drugs-100-years
  17. https://www.nytimes.com/2023/04/10/health/abortion-pill-fda.html
  18. https://www.congress.gov/bill/117th-congress/senate-bill/4348
  19. https://www2.law.umaryland.edu/marshall/crsreports/crsdocuments/RL3279703082005.pdf
  20. https://horsford.house.gov/media/in-the-news/supreme-court-unanimously-preserves-access-to-abortion-medication-mifepristone

Answer from Perplexity: pplx.ai/share

Is it just me, or with it being claimed that 30%+ of members of Congress are attorneys and many judges are making decisions that seems to be in conflict with COMMON SENSE?

Since only 1%-2% of known Fentanyl analogs are approved by the FDA as safe to use in humans or animals. Fentanyl was approved ~ 60+ yrs ago after going thru 10+ yrs of clinical trials and has been available for healthcare practitioners to prescribe for all these decades and a judge or Congress should be able to make it ILLEGAL. Since 98%-99% of all known Fentanyl analogs are already ILLEGAL. If they pass this bill, the bottom line is that they will be overruling all the FDA years of clinical trials and practitioners’ experience using this medication, and make those 3 FDA approved Fentanyl analogs classified as a C-1 and thus become an ILLEGAL MEDICATION – like Heroin

Here is a partial list from www.perplexity.ai – notice that several Fentanyl analogs are listed.

Based on the information provided in the search results, here is a list of DEA Schedule I substances:

  • Heroin

  • Acetyl-alpha-methylfentanyl

  • Acetylfentanyl

  • Acryl fentanyl

  • AH-7921

  • Alpha-methylfentanyl

  • Beta-hydroxyfentanyl

  • Butyryl Fentanyl

  • Furanyl fentanyl

  • Isobutrylfentanyl

  • 3-Methylfentanyl

  • LSD (Lysergic acid diethylamide)

  • Peyote

  • Psilocybin (“magic mushrooms”)

  • MDMA (3,4-methylenedioxymethamphetamine or “ecstasy”)

  • Mescaline

  • Marijuana (cannabis, THC)

  • Synthetic marijuana and analogs (Spice, K2)

  • GHB (gamma-hydroxybutyric acid)

  • Methaqualone (Quaalude)

  • Khat (Cathinone, Cathine)

  • Bath Salts (3,4-methylenedioxypyrovalerone or MDPV)

  • Acetorphine

  • Desomorphine

  • Etorphine (except hydrochloride salt)

It’s important to note that this list is not exhaustive, as Schedule I contains numerous other substances135. The DEA classifies these drugs as having no currently accepted medical use in the United States, a high potential for abuse, and a lack of accepted safety for use under medical supervision136.

Citations:

  1. https://www.drugs.com/article/csa-schedule-1.html
  2. https://www.rosalindfranklin.edu/research/centers/research-support-offices/environmental-health-and-safety/controlled-substances/
  3. https://en.wikipedia.org/wiki/Controlled_Substances_Act
  4. https://www.in.gov/health/overdose-prevention/general-information/drug-schedules-1-5/
  5. https://en.wikipedia.org/wiki/List_of_Schedule_I_controlled_substances_(U.S.)
  6. https://www.campusdrugprevention.gov/content/drug-scheduling-and-penalties
  7. https://www.deadiversion.usdoj.gov/schedules/schedules.html
  8. https://www.duffysrehab.com/resources/articles/schedule-of-drugs/
  9. https://dhhs.ne.gov/licensure/Open%20Meeting%20Act%20Docs/APRN%205.20.22%20C1a%20DEA%20-%20Midlevel%20Pracitioners%20by%20State.pdf
  10. https://uscode.house.gov/view.xhtml?req=%28title%3A21+section%3A812+edition%3Aprelim%29
  11. https://www.federalregister.gov/documents/2018/09/28/2018-21121/schedules-of-controlled-substances-placement-in-schedule-v-of-certain-fda-approved-drugs-containing
  12. https://www.cancer.gov/publications/dictionaries/cancer-terms/def/schedule-i-drug
  13. https://americanaddictioncenters.org/prescription-drugs/classifications
  14. https://drexel.edu/studentlife/community-standards/code-of-conduct/drug-free-schools-and-community-act/drug-use
  15. https://www.deadiversion.usdoj.gov/schedules/orangebook/c_cs_alpha.pdf
  16. https://www.mass.gov/info-details/learn-about-massachusetts-controlled-substances-registration-mcsr-for-practitioners
  17. https://www.drugs.com/csa-schedule.html
  18. https://www.dea.gov/drug-information/csa
  19. https://www.ncbi.nlm.nih.gov/books/NBK557426/
  20. https://www.chfs.ky.gov/agencies/os/oig/dai/deppb/Documents/KentuckyScheduledDrugList.pdf

Answer from Perplexity: pplx.ai/share

HALT Fentanyl Act Halt All Lethal Trafficking of Fentanyl Act or the HALT Fentanyl Act

@everyone

This bill has passed the House and there is a similar bill in the Senate but has not been assigned a number yet.  senator young 02172025

The hyperlink above is the letter/email that I sent to Senator Young’s LA who is overseeing this bill. I suggest that you read that letter to help you get up to speed on why making ALL FENTANYL ANALOGS is a bad idea.

PLEASE, JUST DON’T CUT AND PASTE my letter and send it to your two Senators if a politician gets a number of correspondences that are exactly the same thing. they will just believe that the person sending in their correspondence is not their own idea/belief.

This bill means that all Fentanyl products will become a Schedule C-I, basically all Fentanyl products will be ILLEGAL

H.R.467  Halt All Lethal Trafficking of Fentanyl Act or the HALT Fentanyl Act

https://www.congress.gov/bill/118th-congress/house-bill/467

Kelly, Heinrich, Cassidy, Grassley Introduce Bipartisan Halt All Lethal Trafficking of Fentanyl Act

https://www.kelly.senate.gov/newsroom/press-releases/kelly-heinrich-cassidy-grassley-introduce-bipartisan-halt-all-lethal-trafficking-of-fentanyl-act/

Legislation would permanently place fentanyl-related substances into Schedule I of the Controlled Substances Act, helping law enforcement combat fentanyl trafficking, while advancing scientific and medical research

Senators Mark Kelly (D-AZ), Martin Heinrich (D-NM), Bill Cassidy (R-LA), and Chuck Grassley (R-IA) introduced the Halt All Lethal Trafficking of (HALT) Fentanyl Act to permanently classify fentanyl-related substances (FRS) as Schedule I drugs under the Controlled Substances Act. This permanent scheduling will give law enforcement the tools they need to keep extremely lethal and dangerous drugs off our streets and ensure scientists can research and better understand these substances.

“Fentanyl is devastating Arizona communities, and we need to give law enforcement every tool to crack down on traffickers while supporting scientific research on these substances and treatments,” said Kelly. “By permanently classifying fentanyl-related substances as Schedule I, this bipartisan bill will help prevent these dangerous drugs from ending up in our neighborhoods while saving lives.”

“We’re losing nearly 75,000 Americans each year to illicit fentanyl overdoses. I refuse to accept this reality, and that’s why I’m working to deliver tools law enforcement personnel need to keep deadly fentanyl off our streets and out of our communities,” said Heinrich. “Permanently scheduling fentanyl and its analogues will help federal and local law enforcement crack down on illegal trafficking and allow prosecutors to build stronger, longer-term criminal cases. Our HALT Fentanyl Act will help stop the flow of these deadly drugs into our communities and save lives.”

Background:

The Centers for Disease Control and Prevention (CDC) estimates that there were 107,543 overdose deaths in the United States in 2023. Fentanyl and fentanyl-related substances accounted for nearly 75,000 of those deaths. Since 1999, the overdose crisis has increasingly been characterized by deaths involving these illicitly manufactured synthetic opioids, such as fentanyl-related substances (FRS), whichare commonly sold through illicit drug markets for their fentanyl-like effect, and are often mixed with heroin or other drugs, such as cocaine, or pressed in to counterfeit prescription pills. During this same period, overdose deaths involving synthetic opioids (excluding methadone) increased 103-fold. By comparison, overdose deaths involving heroin and prescription opioids increased 2.5-fold and 4.1-fold, respectively.

Traffickers are continually altering the chemical structure of fentanyl to evade regulation and prosecution, sometimes with tragic results. Since 2013, China has been the principal source of fentanyl, fentanyl-related substances, and the precursor chemicals from which they areproduced. Chinese products are commonly shipped to Mexico and smuggled into the United States illicit drug market. Traffickers have favored fentanyl-related substances to skirt around committing the crime of trafficking fentanyl and fentanyl analogues. In 2023, the Drug Enforcement Administration (DEA) seized nearly 12,000 pounds of illicit fentanyl, including fentanyl powder and more than 78 million pills laced with illicit fentanyl. The 2023 seizures were equivalent to more than 388.8 million lethal doses of fentanyl.

In 2018, as an initial response to this unprecedented crisis, the DEA issued a temporary scheduling order that placed FRS in Schedule I, under the Controlled Substances Act (CSA), after classifying it as an imminent hazard to public safety. Previously, Congress has only closed this loophole temporarily by designating fentanyl-related substances as Schedule I drugs. Congress has extended the FRS temporary scheduling order several times, most recently on December 21, 2024, with a measure that expires on March 31, 2025.

Clear and Enforceable Criminal Penalties for Fentanyl Trafficking:

A permanent scheduling of FRS is necessary to make penalties for criminals clear and enforceable under the Drug Enforcement Administration (DEA), reducing the supply and availability of illicitly manufactured FRS. The HALT Fentanyl Act places the strongest controls and penalties on FRS, which have no accepted medical use and a high abuse potential.

Specifically, the HALT Fentanyl Act will permanently impose the following quantity-based federal trafficking penalties on FRS:

  • Mandatory minimum penalties: 5 years for 10 grams or more (10 years for second offense); and 10 years for 100 grams or more (20 years for second offense).
  • Discretionary maximum penalties: 40 years for 10 grams or more (life for second offense); and life for 100 grams or more.

Expanded Scientific and Medical Research

More closely aligning the research and registration process for schedule I substances, including FRS, with Schedule II substances will facilitate increased FRS research. By accommodating more medical research into fentanyl-related substances, the bill would establish a new, streamlined registration process for research funded by the Department of Health and Human Services (HHS), the Department of Veterans Affairs (VA), or under an Investigative New Drug (IND) exemption from the Food and Drug Administration (FDA).

Specifically, the HALT Fentanyl Act will enhance our understanding of these illicitly manufactured substances by:

  • Allowing researchers in the same institution to participate in multiple scientific studies.
  • Permitting researchers with ongoing studies to examine newly added schedule I substances.
  • Allowing researchers to manufacture small quantities of FRS without a separate registration.

The legislation is cosponsored by Senators Maggie Hassan (D-NH), Ruben Gallego (D-AZ), Roger Marshall (R-KS), Todd Young (R-IN), Steve Daines (R-MT), Eric Schmitt (R-MO), Shelley Moore Capito (R-WV), Catherine Cortez Masto (D-NV), Mike Rounds (R-SD), John Kennedy (R-LA), Jeanne Shaheen (D-NH), and Angus King (I-ME).

Full text of the HALT Fentanyl Act can be found here.

A section-by-section summary of the HALT Fentanyl Act can be found here.