“The moral test of a government is how it treats those who are at the dawn of life, the children; those who are in the twilight of life, the aged; and those who are in the shadow of life, the sick and the needy, and the handicapped.” – Hubert Humphrey
passionate pachyderms
Pharmacist Steve steve@steveariens.com 502.938.2414
Even in retirement from my faculty responsibilities, my time is fully occupied with pharmacy and other activities to the point that I am challenged to keep up with email communications. As a consequence, I do not participate in or visit social media sites, although pharmacy friends faithfully forward to me social media posts in which they know I will be interested. One such friend who had been terminated by CVS and is pursuing litigation just sent me several hundred comments posted by pharmacists and pharmacy technicians, most of whom work in chain pharmacies. I read them all and they are depressing. They are highly critical of chain pharmacy management, PBMs, state boards of pharmacy, colleges of pharmacy, and pharmacy associations. The comments are characterized by stress, frustration, and even desperation, and I recognize the validity of the concerns that are voiced. As these pharmacists and technicians have experienced, concerns and recommendations I have voiced in numerous editorials have been ignored, rejected, or even ridiculed. However, they and I recognize that the issues and concerns are so important – for pharmacists, our profession, and the care and safety of the patients served – that we must continue the fight. We can’t give up, and the very fact that we continue to voice our concerns is evidence that we still care, even when many of our own colleagues have been silent. Apathy and silence are among our greatest challenges!
Rays of hope
Many of the social media posts address the devastating impact that the pharmacy benefit managers (PBMs) have had on the economic survival of community pharmacies and horrible working conditions that increase the risk of errors and jeopardize the quality and safety of services for patients. The largest PBMs have become so wealthy, powerful, and dominant that they have been able to crush dissent and challenges. However, an increasing number of individuals outside of the profession of pharmacy have become aware of the secret deals, deception, and fraud in which these PBMs are engaged. The persistence of Leslie Rutledge, the Arkansas Attorney General, was essential in achieving a U. S. Supreme Court ruling that supported pharmacy’s position with respect to activities and regulation of PBMs.
“Benefit Managers Investigated” is the title of an article in the May 12, 2021 issue of The Wall Street Journal (Anna Wilde Mathews; page A6). Excerpts from this article are provided below:
“Several states are investigating pharmacy benefit managers with some saying they are focused on whether the companies fully disclosed details about their business and potentially received overpayments under state contracts, according to state officials and documents.”
“States including Ohio, Oklahoma, Georgia, New Mexico, Kansas, Arkansas, and Mississippi, as well as the District of Columbia, are scrutinizing PBMs, according to the offices of state attorneys general and auditors…”
“Among the companies under scrutiny are units of Centene Corp, UnitedHealth Group Inc, and CVS Health Corp.”
Ohio Attorney General Dave Yost’s office which recently sued Centene, alleging it had misled the state’s Medicaid program about its pharmacy related costs, is quoted as saying, “I’m aware of many states that are looking at this” and “before this is all done, I will be surprised if we don’t have a dozen or more states” that will bring complaints against PBMs.
“At many large companies, including UnitedHealth, Centene, Cigna Corp. and CVS, the same parent owns both a PBM and a managed care operation.”
“In addition to Centene, the Ohio Medicaid program uses UnitedHealth, among others. In March, the state filed its suit against Centene, which is seeking millions of dollars in damages. Earlier, the state sued Cigna’s Express Scripts….and UnitedHealth’s OptumRx…,” alleging overcharges.
“Several states, according to publicly available contracts and state officials, have hired the same law firm, Liston and Deas, to investigate PBMs.”
There are rays of hope! Individual pharmacists and our associations must contact these and other state attorneys general to provide examples, documentation, and other support for their investigations.
On March 10 my wife made several purchases at the Rite Aid store in our community. As she was leaving she tripped and fell, and was in severe pain. I was in our car in the parking lot, and I and five other individuals quickly convened in the entranceway of the store to assist her. Several individuals wanted to call 911 but I indicated I would take her to a nearby hospital. I pulled our car into the front entrance area to the store and several men assisted me in lifting my wife into our car. Because my car was in the front entrance area, customers arriving at or leaving the store had to walk around our car. No employee of Rite Aid spoke with us.
At the hospital it was determined that my wife’s left hip was fractured and she had surgery the following day. Following 3 days in the hospital and 11 days in a rehab facility, my wife was discharged with a continued need for physical therapy and occupational therapy, and the prospect of a long period of challenging recuperation.
Soon after my wife’s visit to Rite Aid on March 10, we received via email the We Care Rite Aid Customer Satisfaction Survey, with a potential to win a cash prize of $1,000 for those who completed it. We completed the survey and noted our strong dissatisfaction with the fact that no employee at the store responded to the drama at the front entrance to speak with us then or since. The last question on the survey asked if we wanted someone to contact us. We responded “yes,” described the experience, and provided our contact information. More than two months have gone by and we have not received a response from anyone at Rite Aid. Does Rite Aid only read the positive responses on their surveys?
Perhaps we should not be shocked that Rite Aid has not responded to my wife’s experience when it continues to reject requests that it discontinue the sale of tobacco products that put their customers at risk of serious illness and death. However, it can respond promptly to rectify some errors. We receive emailed advertisements from Rite Aid on almost a daily basis. On May 12 we received an email with the message, “Mother’s Day is Sunday! Don’t Get Caught Empty-Handed!” (Mother’s Day had already been observed on March 9). When the error was recognized, Rite Aid snapped into action and issued a message the next day (May 13), “Whoops! Silly us Mother’s Day has Passed! Let’s talk about Women’s Health this Sunday with great deals on Women’s Products.”
Unsubstantiated allegations that were unaddressed for too long gained a life of their own. This website addresses questions, corrects falsehoods and sets the record straight based on publicly available, verifiable information. Judge for yourselves whether the prevailing narrative about Purdue Pharma, OxyContin and the Sackler family represents the truth.
Documents being released in Purdue’s bankruptcy show that Sackler family members who served on the company’s Board acted ethically and lawfully. The proposed resolution to the litigation, which includes the Sackler family relinquishing ownership of Purdue and also contributing $4.275 billion to address the opioid crisis, is intended to provide help rapidly for communities and people in need. The Sackler family regrets that OxyContin, which continues to help people suffering from chronic pain, unexpectedly became part of the opioid crisis.
Detailed video presentations of these facts are available on this website. This video provides an abbreviated summary of the topics discussed throughout these pages, including the false allegation that OxyContin is responsible for creating the opioid crisis even though the medicine was never more than 4% of all opioid prescriptions:
“The court of public opinion is sometimes the most powerful court.”
MIKE MOORE, PLAINTIFF’S ATTORNEY – DECEMBER 2018[2]
The strategically invented false narrative has succeeded. When plaintiffs’ lawyers decided to target Purdue and the Sackler family, they were candid about their approach and strategy. For years, the news media and plaintiffs’ lawyers have falsely blamed Purdue, OxyContin and the Sackler family for causing the opioid epidemic based on hyperbolic and sensationalized attacks that are unsupported by actual evidence.
“Litigation is a blunt instrument; it’s not a surgical tool… But it provokes interest quicker than anything I’ve ever seen.”
“Vilification of this industry has not even begun yet.”
“This litigation will vilify them. It won’t make the companies look like they’re legitimate businesspeople. It’ll make them look like they took advantage and made billions of dollars on lots of people who died from their products.”
The plaintiffs’ lawyers hired clandestine help: The most prominent, supposedly “independent” experts making misleading comments about OxyContin, Purdue and the Sackler family were actually surreptitiously being paid as litigation consultants. And some of the most prominent studies used to malign OxyContin are actually riddled with errors and incorrect.
The false narrative gained further traction in 2018 when Massachusetts became the first state to name the Sackler family specifically in lawsuits against Purdue. That lawsuit included numerous false claims that were quickly copied by other states.
How Can OxyContin Be Responsible for Opioid Crisis When the Medicine Was Never More Than 4% of Prescriptions for Opioids?
OxyContin Was Introduced in 1996, Long After Steady Increase in Prescribing Opioids
Prescription opioids have been used to treat pain since morphine[4] was invented in 1804 (and opioids have been used to treat pain since the Sumerians discovered poppy in 3400BC[5]). Beginning in the 1970s, opioid prescriptions began increasing significantly — with oxycodone increasing 40% and hydromorphone increasing 67% in just six years between 1979 and 1985.[6] Abuse of prescription opioids began increasing in the 1960s and was the basis of the film “Drugstore Cowboy” in 1989.
OxyContin: One Part in Long History of Prescription Opioids
“OxyContin” or “Oxy” Often Confused with oxycodone & Prescription Opioids Generally
Media reports and entertainment programs frequently use OxyContin as a description for all opioids — often confusing OxyContin with the generic oxycodone[7] that was first introduced in 1916. (This Apple TV description for the film “Crisis”[8] erroneously mentioned “OxyContin,” but the movie only ever said “oxycodone” or “oxy.”)
News outlets also routinely correct this mistake amid the rampant confusion between long-acting OxyContin and the generic medicine oxycodone.
Corrected description:
Original error:
Additionally, nearly every news outlet has required corrections to coverage about Purdue, OxyContin and the Sackler family:
WASHINGTON (Reuters) – A secretive U.S. Drug Enforcement Administration unit is funneling information from intelligence intercepts, wiretaps, informants and a massive database of telephone records to authorities across the nation to help them launch criminal investigations of Americans.
Although these cases rarely involve national security issues, documents reviewed by Reuters show that law enforcement agents have been directed to conceal how such investigations truly begin – not only from defense lawyers but also sometimes from prosecutors and judges.
The undated documents show that federal agents are trained to “recreate” the investigative trail to effectively cover up where the information originated, a practice that some experts say violates a defendant’s Constitutional right to a fair trial. If defendants don’t know how an investigation began, they cannot know to ask to review potential sources of exculpatory evidence – information that could reveal entrapment, mistakes or biased witnesses.
“I have never heard of anything like this at all,” said Nancy Gertner, a Harvard Law School professor who served as a federal judge from 1994 to 2011. Gertner and other legal experts said the program sounds more troubling than recent disclosures that the National Security Agency has been collecting domestic phone records. The NSA effort is geared toward stopping terrorists; the DEA program targets common criminals, primarily drug dealers.
“It is one thing to create special rules for national security,” Gertner said. “Ordinary crime is entirely different. It sounds like they are phonying up investigations.”
THE SPECIAL OPERATIONS DIVISION
The unit of the DEA that distributes the information is called the Special Operations Division, or SOD. Two dozen partner agencies comprise the unit, including the FBI, CIA, NSA, Internal Revenue Service and the Department of Homeland Security. It was created in 1994 to combat Latin American drug cartels and has grown from several dozen employees to several hundred.
Today, much of the SOD’s work is classified, and officials asked that its precise location in Virginia not be revealed. The documents reviewed by Reuters are marked “Law Enforcement Sensitive,” a government categorization that is meant to keep them confidential.
“Remember that the utilization of SOD cannot be revealed or discussed in any investigative function,” a document presented to agents reads. The document specifically directs agents to omit the SOD’s involvement from investigative reports, affidavits, discussions with prosecutors and courtroom testimony. Agents are instructed to then use “normal investigative techniques to recreate the information provided by SOD.”
A spokesman with the Department of Justice, which oversees the DEA, declined to comment.
But two senior DEA officials defended the program, and said trying to “recreate” an investigative trail is not only legal but a technique that is used almost daily.
A former federal agent in the northeastern United States who received such tips from SOD described the process. “You’d be told only, ‘Be at a certain truck stop at a certain time and look for a certain vehicle.’ And so we’d alert the state police to find an excuse to stop that vehicle, and then have a drug dog search it,” the agent said.
“PARALLEL CONSTRUCTION”
After an arrest was made, agents then pretended that their investigation began with the traffic stop, not with the SOD tip, the former agent said. The training document reviewed by Reuters refers to this process as “parallel construction.”
The two senior DEA officials, who spoke on behalf of the agency but only on condition of anonymity, said the process is kept secret to protect sources and investigative methods. “Parallel construction is a law enforcement technique we use every day,” one official said. “It’s decades old, a bedrock concept.”
A dozen current or former federal agents interviewed by Reuters confirmed they had used parallel construction during their careers. Most defended the practice; some said they understood why those outside law enforcement might be concerned.
“It’s just like laundering money – you work it backwards to make it clean,” said Finn Selander, a DEA agent from 1991 to 2008 and now a member of a group called Law Enforcement Against Prohibition, which advocates legalizing and regulating narcotics.
Some defense lawyers and former prosecutors said that using “parallel construction” may be legal to establish probable cause for an arrest. But they said employing the practice as a means of disguising how an investigation began may violate pretrial discovery rules by burying evidence that could prove useful to criminal defendants.
A QUESTION OF CONSTITUTIONALITY
“That’s outrageous,” said Tampa attorney James Felman, a vice chairman of the criminal justice section of the American Bar Association. “It strikes me as indefensible.”
Lawrence Lustberg, a New Jersey defense lawyer, said any systematic government effort to conceal the circumstances under which cases begin “would not only be alarming but pretty blatantly unconstitutional.”
Lustberg and others said the government’s use of the SOD program skirts established court procedures by which judges privately examine sensitive information, such as an informant’s identity or classified evidence, to determine whether the information is relevant to the defense.
“You can’t game the system,” said former federal prosecutor Henry E. Hockeimer Jr. “You can’t create this subterfuge. These are drug crimes, not national security cases. If you don’t draw the line here, where do you draw it?”
Some lawyers say there can be legitimate reasons for not revealing sources. Robert Spelke, a former prosecutor who spent seven years as a senior DEA lawyer, said some sources are classified. But he also said there are few reasons why unclassified evidence should be concealed at trial.
“It’s a balancing act, and they’ve doing it this way for years,” Spelke said. “Do I think it’s a good way to do it? No, because now that I’m a defense lawyer, I see how difficult it is to challenge.”
CONCEALING A TIP
One current federal prosecutor learned how agents were using SOD tips after a drug agent misled him, the prosecutor told Reuters. In a Florida drug case he was handling, the prosecutor said, a DEA agent told him the investigation of a U.S. citizen began with a tip from an informant. When the prosecutor pressed for more information, he said, a DEA supervisor intervened and revealed that the tip had actually come through the SOD and from an NSA intercept.
“I was pissed,” the prosecutor said. “Lying about where the information came from is a bad start if you’re trying to comply with the law because it can lead to all kinds of problems with discovery and candor to the court.” The prosecutor never filed charges in the case because he lost confidence in the investigation, he said.
A senior DEA official said he was not aware of the case but said the agent should not have misled the prosecutor. How often such misdirection occurs is unknown, even to the government; the DEA official said the agency does not track what happens with tips after the SOD sends them to agents in the field.
The SOD’s role providing information to agents isn’t itself a secret. It is briefly mentioned by the DEA in budget documents, albeit without any reference to how that information is used or represented when cases go to court.
The DEA has long publicly touted the SOD’s role in multi-jurisdictional and international investigations, connecting agents in separate cities who may be unwittingly investigating the same target and making sure undercover agents don’t accidentally try to arrest each other.
SOD’S BIG SUCCESSES
The unit also played a major role in a 2008 DEA sting in Thailand against Russian arms dealer Viktor Bout; he was sentenced in 2011 to 25 years in prison on charges of conspiring to sell weapons to the Colombian rebel group FARC. The SOD also recently coordinated Project Synergy, a crackdown against manufacturers, wholesalers and retailers of synthetic designer drugs that spanned 35 states and resulted in 227 arrests.
A slide from a presentation about a secretive information-sharing program run by the U.S. Drug Enforcement Administration’s Special Operations Division (SOD) is seen in this undated photo. REUTERS/John Shiffman
Since its inception, the SOD’s mandate has expanded to include narco-terrorism, organized crime and gangs. A DEA spokesman declined to comment on the unit’s annual budget. A recent LinkedIn posting on the personal page of a senior SOD official estimated it to be $125 million.
Today, the SOD offers at least three services to federal, state and local law enforcement agents: coordinating international investigations such as the Bout case; distributing tips from overseas NSA intercepts, informants, foreign law enforcement partners and domestic wiretaps; and circulating tips from a massive database known as DICE.
The DICE database contains about 1 billion records, the senior DEA officials said. The majority of the records consist of phone log and Internet data gathered legally by the DEA through subpoenas, arrests and search warrants nationwide. Records are kept for about a year and then purged, the DEA officials said.
About 10,000 federal, state and local law enforcement agents have access to the DICE database, records show. They can query it to try to link otherwise disparate clues. Recently, one of the DEA officials said, DICE linked a man who tried to smuggle $100,000 over the U.S. southwest border to a major drug case on the East Coast.
“We use it to connect the dots,” the official said.
“AN AMAZING TOOL”
Wiretap tips forwarded by the SOD usually come from foreign governments, U.S. intelligence agencies or court-authorized domestic phone recordings. Because warrantless eavesdropping on Americans is illegal, tips from intelligence agencies are generally not forwarded to the SOD until a caller’s citizenship can be verified, according to one senior law enforcement official and one former U.S. military intelligence analyst.
“They do a pretty good job of screening, but it can be a struggle to know for sure whether the person on a wiretap is American,” the senior law enforcement official said.
Tips from domestic wiretaps typically occur when agents use information gleaned from a court-ordered wiretap in one case to start a second investigation.
As a practical matter, law enforcement agents said they usually don’t worry that SOD’s involvement will be exposed in court. That’s because most drug-trafficking defendants plead guilty before trial and therefore never request to see the evidence against them. If cases did go to trial, current and former agents said, charges were sometimes dropped to avoid the risk of exposing SOD involvement.
Current and former federal agents said SOD tips aren’t always helpful – one estimated their accuracy at 60 percent. But current and former agents said tips have enabled them to catch drug smugglers who might have gotten away.
“It was an amazing tool,” said one recently retired federal agent. “Our big fear was that it wouldn’t stay secret.”
DEA officials said that the SOD process has been reviewed internally. They declined to provide Reuters with a copy of their most recent review.
Last week, my two stepsons’ father, a man who loved life, killed himself.
I would like to tell you why.
Two years ago, a 62-year-old father of three named Bruce Graham was standing on a ladder, inspecting his roof for a leak, when it slipped out from under him. He landed on top of the ladder on his back, breaking several ribs, puncturing a lung and tearing his intestine, which wasn’t detected until he went into septic shock. Following surgery, he lapsed into a two-week coma.
In retrospect, it’s unfortunate that he awoke from that coma because for all intents and purposes, his life ended with that fall. Not because his mind was affected — it was completely intact until the moment he took his life — but because while modern medicine was adept enough to keep him alive, it was unable or unwilling to help him deal with the excruciating pain that he experienced over the next two years. And life in constant excruciating pain with no hope of ever alleviating it is not worth living.
As a result of the surgery, Bruce developed abdominal scar tissue structures known as adhesions. Adhesions can be horribly painful, but they are difficult to diagnose because they don’t appear in imaging, and no surgery in America or in Mexico (where, out of desperation, he also sought treatment) could remove them permanently. Many doctors dismiss adhesions, regarding the patient’s pain as psychosomatic.
The pain prevented him from getting adequate sleep. And he could not eat without the pain spiking for hours. By the time of his death, he had lost almost half his body weight.
Prescription painkillers — opioids — relieved much of his pain, or at least kept it to a tolerable level. But after the initial recuperation period, no doctor would prescribe one, despite the fact that this man had a well-documented injury and no record of addiction to any drug, including opioids. Doctors either wouldn’t prescribe them on an ongoing basis due to the threat of losing their medical license or being held legally liable for addiction or overdose, or deemed Bruce a hypochondriac.
The federal government and states like California have made it extremely difficult for physicians to prescribe painkillers for an extended period of time. The medical establishment and government bureaucrats have decided that it is better to allow people to suffer terrible pain than to risk them becoming addicted to opioids.
They believe it is better to allow any number of innocent people to suffer hideous pain for the rest of their lives than to risk any patient getting addicted and potentially dying from an overdose.
Dr. Stephen Marmer, who teaches psychiatry at the UCLA School of Medicine, told me that he treated children with terminal cancer when he was an intern, and even they were denied painkillers, lest they become addicted.
Pain management seems to be the Achilles’ heel of modern medicine, for philosophical reasons as well as medical. Remarkably, Dr. Thomas Frieden, former director of the Centers for Disease Control and Prevention, wrote in The New England Journal of Medicine last year, “Whereas the benefits of opioids for chronic pain remain uncertain, the risks of addiction and overdose are clear.”
To most of us, this is cruel. Isn’t the chance of accidental death from overdose, while in the meantime allowing patients to have some level of comfort, preferable to a life of endless severe pain?
Though I oppose suicide on religious/moral grounds and because of the emotional toll it takes on loved ones, I make an exception for people with unremitting, terrible pain. If that pain could be alleviated by painkilling medicines, and law and/or physicians deny them those medicines, it is they, not the suicide, who are morally guilty.
Bruce was ultimately treated by the system as an addict, not worthy of compassion or dignity. On the last morning of his life, after what was surely a long, lonely, horrific night of sleeplessness and agony, Bruce made two calls, two final attempts to acquire the painkillers he needed to get through another day. Neither friend could help him. Desperate to end the pain, he picked up a gun, pressed it to his chest and pulled the trigger. In a final noble act, he did not shoot himself in the head, even though that is the more certain way of dying immediately. He had told a friend some weeks earlier that if he were to take his life, he wouldn’t want loved ones to experience the trauma-inducing mess that shooting himself in the head would leave. Instead, he shot himself in the heart.
An autopsy confirmed the presence of abdominal adhesions, as well as significant arthritis in his spine.
May Bruce Graham rest in peace. Some of us, however, will not live in peace until physicians’ attitudes and the laws change.
New Zantac 360° is now formulated with a different active ingredient, famotidine — an H2-receptor antagonist (H2RA) — to both prevent and relieve your patients’ heartburn fast, with just one pill.
Famotidine is an FDA-approved safe and effective medication1 that’s clinically proven to prevent heartburn and provide fast relief and long-lasting acid control1,2 — for up to 12 hours*,2,3,4,5,6. Available in two strengths and offering flexible OTC heartburn control, recommend Zantac 360° today for the short-term management of occasional heartburn.
New Zantac 360º Can Prevent or Relieve Heartburn Fast with Famotidine
New Zantac 360° is now formulated with the #1 doctor recommended H2 blocker*, famotidine — a highly selective and long-acting H2RA that prevents heartburn when taken as little as 15 minutes before eating or drinking and relieves heartburn fast.1 Famotidine selectively targets and blocks H2 receptors on parietal cells in the stomach to decrease gastric acid.5,8,9
Clinical studies show that famotidine, the active ingredient in Zantac 360º, can control stomach acid for up to 12 hours, day or night. †,2,3,4,5,6 Studies also show that both famotidine 10mg (Zantac 360º Original Strength) and 20mg (Zantac 360º Maximum Strength) can act fast, with significantly more patients reporting complete relief of heartburn within 1 hour vs. placebo (p<0.001, 20mg; p<0.004, 10 mg)1.
We need to show the country the data in how the attacks on doctors for money have recked havoc on patient care. Here is a really simple survey that any clinic that has had any involvement with government—medical board, state, or federal–even the knock and chat, needs to fill out so we can present this information to those who can create change. So, if you are a provider or clinic owner, please go to
and fill it out and submit it. If you are a patient, send this link to your physician.
Also, providers, please send the link to your medical associations for them to pass on to their members. They can benefit from the gathering of this information as well. We are trying to write a paper on the effects of these attacks on the medical profession and therefore the medical care available.
Linda Cheek is a teacher and disenfranchised medical doctor, turned activist, author, and speaker. A victim of prosecutorial misconduct and outright law-breaking of the government agencies DEA, DHHS, and DOJ, she hopes to be a part of exonerating all doctors illegally attacked through the Controlled Substance Act. She holds the key to success, as she can offset the government propaganda that drugs cause addiction with the truth: The REAL Cause of Drug Abuse. Get a free gift to learn how the government is breaking the law to attack your doctor: Click here to get my free gift
We Can’t Give Up!
