The War on Drugs spurred the nation’s current policing crisis

http://https://www.ocregister.com/2020/06/12/the-war-on-drugs-spurred-the-nations-current-policing-crisis/

SACRAMENTO – While growing up around Philadelphia in the 1970s, I had a number of interactions with police – none of which were particularly harrowing. On the night before Memorial Day, for instance, a friend and I were drinking beer (yes, we were underage) in a cemetery by the Delaware River when we saw lights flashing and were approached by officers.

Apparently, the police had gotten a tip that someone might be stealing the brass placards from the gravestones and we were in the wrong place at the wrong time. We didn’t have any ID, so my friend handed a stuffed animal with his name on it to the officer. The policeman laughed, realized that we weren’t up to any serious mischief, made sure we were OK to drive home and sent us on our way.

Quite frankly, I couldn’t imagine that scenario playing out in the same benign way today. I thought of that interaction as I’ve watched the angry, nationwide protests unfold over the disturbing death of George Floyd, where a Minneapolis officer placed his knee on his neck for nearly nine minutes. Many of my conservative friends, especially those who grew up in the world similar to the one I described above, have been caught off-guard by the depth of anger.

Even if some left-wing activists used the crisis to promote riots and mayhem, such mass protests do not happen in a bubble. Tens of thousands of people don’t take to the streets because of outside agitators, but because they are angry about things they’ve often experienced themselves. And many Americans – especially in minority communities – have experienced the brunt of an overall policing approach that has become overly militaristic.

Police strategies have changed dramatically in the past few decades – and not because of soaring crime. Despite recent spikes, crime rates now are much lower than at any time since the 1960s, and police can absolutely take some credit for that. I’m not naïve here. Police abuse has been a problem as long as there have been police. I’ve read about the segregated South and the way police routinely terrorized African-Americans. But something significant has happened in the years following my cemetery experience.

I point to the nation’s War on Drugs as a prime culprit. Recent commentary has correctly focused on various reasons for our current policing mess. Just as teachers’ unions make it impossible to fire bad teachers, police unions make it impossible to fire overly aggressive and even corrupt officers. Then “limited immunity” protects cops from being sued even when they violate people’s constitutional rights.

The federal 1033 program provides decommissioned military-style hardware to police departments. So, instead of sending a beat cop to deal with a routine arrest or disturbance, police nowadays like to bring out the toys – i.e., those tank-like vehicles, SWAT teams and flash-bang grenades that are more appropriate for invaders than peace officers.

But few people have talked about the war on drugs, which started in the 1980s, and conditioned police departments to behave in this more militarized way. Police first took this approach during alcohol Prohibition, as others have noted, and then stepped up the efforts after America’s leaders looked for ways to combat a spreading drug epidemic. This issue isn’t only about race, of course, given how aggressive police behave even in suburban Southern California. But these ham-fisted policies fall disproportionately on minority communities.

One of the earliest drug-war policies is “civil asset forfeiture,” which lets law enforcement quickly snatch the proceeds of drug kingpins. Police don’t need to prove that you did anything wrong before they confiscate your car or other property. The police agency merely needs to assert that the property was used in the commission of a drug crime.

“Today, the old speed traps have all too often been replaced by forfeiture traps, where local police stop cars and seize cash and property to pay for local law enforcement efforts,” wrote two federal officials who helped create the program, in a 2014 Washington Post column. “This is a complete corruption of the process, and it unsurprisingly has led to widespread abuses.” It’s led to widespread anger, too, as police mainly seize poor people’s cars rather than cartels’ assets.

It wasn’t hard to predict what would happen when police take on a siege mentality and are provided with military hardware and exempted from constitutional limitations. In a 1996 editorial, William F. Buckley’s conservative National Review wrote that “the war on drugs has failed” and is “encouraging civil, judicial and penal procedures associated with police states.”

Twenty-four years later we’re seeing the fruits of those policies, even if most observers don’t see the connection. By all means, let’s review police-disciplinary procedures, union protections, racial bias and other causes of police abuse – but let’s not forget the way the drug war has often turned minor interactions like the one I had into violent confrontations.

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Your Pain, Your Rights: Dealing With Your Physician And Your Hospital

https://rsds.org/your-pain-your-rights-dealing-with-your-physician-and-your-hospital/

Although I had concentrated on legal issues relating to pain in terminal illness, I had never even heard of CRPS until I got a call from a young mother in  California with the crippling syndrome. She had gone from being an athletic, employed, confident woman to one who could not care for her two-year old,  couldn’t work, and feared her husband was getting fed up with her inabilities and constant complaints. She was stitched to life by her innate determination, her love for her daughter and not much else. The tragic aspect of her story was that she knew, from experience, that she could get significant pain relief from a combination of fentynl patches and breakthrough medication.

Her HMO balked at the cost of fentynl and suggested that she was not really hurting. A physician at the clinic told her she was drug seeking. A clinic pharmacist yelled at her when she came to pick up medications and told her not to come back for “her drugs.” It took an HMO appeal, a complaint to the state insurance commissioner, and filing a complaint in a local court to get her relief. A little over a year later, a re-evaluation started it all over again.

In advising her, I learned that chronic pain, just like end-of-life pain, could be safely treated with opioids, and that the barriers for adequate pain management were much higher for those with chronic pain than those with terminal illnesses. I also had begun to understand that living with severe chronic pain is
as bad as dying with it-and lasts longer.

Advocacy at the systemic level may eventually make multidisciplinary pain management a reality at all disease and income levels. In the meantime, many chronic pain sufferers will continue to fight it out one physician and one appointment at a time-not always successfully. As with much of medical care, self-advocacy
is absolutely necessary. You need to know your rights and familiarize yourself with policies and procedures in domiciliary care to ensure you receive appropriate and effective treatment.

Getting Off on the Right Foot

CRPS patients with untreated pain often feel that the physicians they consult are unfeeling, paternalistic, judgmental gate-keepers. Although this image may fit some, it is more useful to see the prescriber in a different light and do your best to respond to his limitations, which may include:

• lingering doubts about whether CRPS is a real syndrome
• poor training in pain management, or training against using opioids for chronic pain because, despite reassuring words, his state medical board takes a hard line on physicians who prescribe them.
• feedback from a pharmacist that the physician is prescribing too much pain medicine
• intense pressure from your HMO to hold costs down by not prescribing the more expensive formulations
• bad experiences with other opioid patients, making him feel that chronic pain makes for needy, time-consuming and difficult patients
• the knowledge that honest physicians have unfairly been indicted for their prescribing habits.

For all these reasons, physicians are often fearful and wary of chronic pain patients and they cannot help but wonder which one will get him in trouble. The physician who simply refuses to use opioids for anything but acute pain, and then only for brief periods, is not going to help you, even though the AMA ethical standards require member physicians to provide patients with “adequate pain control, respect for patient autonomy, and good communication.1” However, he should be willing to refer you to someone who will provide effective pain care. In Florida, California and a few other states, physicians are legally required either to treat pain or refer. In other states, the obligation is usually defined in the medical board regulations. Certain specialty boards have adopted standards or guidelines on the use of opioids to treat chronic pain.

If you would like to provide your physician with state laws and guidelines regarding opioid treatment, they are available online at http://www.medsch.wisc.edu/painpolicy/matrix.htm

Prescribers who use opioids for pain management must feel secure about treating you and your pain and must overcome his comfort level limitation on dosage. Therefore, put aside your anger and frustration to present yourself as effectively as possible. Let the physician know that you are responsible and willing to cooperate to protect you both. Bring all the records you have to the first visit and let him know if opioids have helped you in the past. Be aware, however, that physicians are conditioned to see this as demanding a particular opioid; be clear that you are only informing.

Good physicians will have some practice management tools in place, so don’t take it personally if you are asked to sign a pain “contract” and to submit to blood or
urine monitoring. Contracts are actually a form of detailed and interactive informed consent. Good physicians will regard some contract violations as reason to evaluate and discuss what certain actions mean and will understand that actions that look like abuse can also be clear signals of under-treated pain, dysfunctional living arrangements, or manifestations of depression or anxiety.

Let the physician know if you need to “violate” one of the contract rules-such as requesting early refills so that you can go out of town or increase the dose in a time of particularly serious pain. However, you still have pain, call the physician before you increase the dose and ask for an appointment to talk about titration. If you can’t afford an interim visit, try to speak with him by telephone to explain how you are feeling, or have a friend or relative call him to express concerns.

Finally, do not be shocked or offended if he asks you to have a psychiatric consultation. This need not mean that he thinks your pain is “all in your head”. Depression and anxiety are almost synonymous with chronic pain, as is social isolation. Many studies show that a psychological evaluation and even ongoing psychological care can substantially improve pain management, as can other modalities, such as neurocognitive feedback. And, of course, it gives your physician some “cover” to have another professional involved. If money is an issue, let him know.

It is a good idea to bring a relative or friend who will talk to your physician about your suffering and the functional difference that pain medicine makes because prescribers are reassured when a patient using opioids has a visible support structure. It is also less likely that the physician will be rude or patronizing in front of a supportive friend or relative.

Some pain management physicians who are anesthesiologists by training have a firm bias toward invasive procedures over medical management, so they may suggest that you repeat sympathetic blocks or expensive tests even if a previous physician has already tried them. You have no obligation to go along, particularly
if your records reflect a history of procedures. The physician is obliged to seek your informed consent, which requires a discussion of risks and alternatives. Although you do not have to give it, the unfortunate upshot may be that he declines to treat you further.

You and Your Physician: What are Your Rights?

Reality dictates that some physicians, even in the face of clear pain, will not be willing to prescribe opioids. More commonly, they are willing to prescribe low doses but have a personal comfort level limit that may or may not be adequate for you. Moreover, if you push him to titrate doses above that comfort level, he may decide that you are a drug seeker. This serious ethical problem-the physician putting his perceived personal safety before his patient-is a deplorable situation
that can lead to abandonment.

A physician can abandon a patient whom he views as drug seeking or who has in some way “violated” the informed consent agreement. Although state laws and medical ethical rules do not allow abrupt termination of a physician-patient relationship, a prescriber does not have to keep you in his practice. If you are stable and able to find another physician, he can terminate you if he provides a brief written explanation of his reasons. An oral message is insufficient. The physician
must also agree to continue your care for at least 30 days and he should also provide a referral.

However, if you are at a critical or important point in your treatment, abandonment by notice and 30-day care is not permissible under common law. This restriction should apply to a patient taking opioids for pain because the consequences of withdrawal for a person who has a chronic illness could be significant.
Additionally an un-medicated patient may face a return of the pain that had been mediated by the opioids; he will almost certainly experience anxiety and distress. In short, a period without continuity of care could constitute a medical emergency. It seems logical that refusal to treat a patient until the patient has obtained another physician (or perhaps until it becomes clear that the patient is not making a serious effort to transfer care) should constitute abandonment.

What Can You Do?

Try Informal resolution. Deal with the termination immediately. If the physician is in a clinic setting, ask the head of the clinic if another physician there will take over your care. Speak to other health care professionals who know you well enough to be comfortable calling to explain that you are genuinely in pain and are a reliable, conscientious person.

Ask for a meaningful referral. Tell your prescriber you will need his help in finding another physician and you have a right to his assistance.  Get your records and review them carefully. Federal privacy law (HIPAA) requires your physician to provide your records promptly and to charge you no more than his actual costs of copying. It also allows you to have your records corrected if they contain errors. Review them for accuracy and look closely at what they say about the reason for termination. Phrases like “drug seeking” or “possibility of abuse” will hurt your efforts to find another physician. If he has used these phrases, write him a letter, preferably through an attorney, and use the words “abandonment,” defamation” and “emotional distress” if the attorney confirms that they are appropriately used in your state.

File a Complaint with the State Medical Board. Every state has a medical board that reviews all complaints and takes action when necessary. Only two state boards have disciplined any prescriber for under treating pain, so it is not possible to see this yet as a meaningful remedy. However, as more complaints are made and individual physicians show a pattern of patient abandonment, state boards are more likely to act.

State board complaints are not complicated. You do not need an attorney, but if you have one, take advantage of his advice. The forms themselves are simple and straightforward and are available on your state’s website. You can also order them by phone. Make your complaint more effective by writing a clear statement of what happened to you and any difficulties that you are having in finding another physician. Avoid a long, rambling statement. It may help if you number each paragraph and tell your story chronologically. If possible, have someone else read it to make sure it seems clear.

Do not feel limited by a form that does not allow much space for your comments.

Explain the emotional and physical impact of the termination. If you think your physician terminated you unfairly, state why. Make it clear if he was verbally abusive! Attach brief statements by anyone who has observed the impact that the termination has had on you and any other documents that may help the board understand that you are a legitimate pain patient with a serious medical condition.

If you want to follow up with the board, talk with the clerk to make sure it was put on the docket. Find out who is responsible for the investigation and ask to speak with him. Answer any questions and ask to be kept informed of case progress.

Consult an Attorney About a Formal Action

Abandonment is a tort (legal wrong) that may give you cause for a legal action against your physician. To prove abandonment you usually have to show (a) a physician-patient relationship; (b) that was terminated or neglected by the physician and (c) that caused you harm. An attorney can advise you about
your state’s requirements. Additionally, there is a tort called “infliction of severe emotional distress,” which requires (a) an action taken by the defendant (b) which was reasonably foreseeable to cause severe distress; and (c) that it did in fact cause severe emotional distress. Some states require a physical injury, but there is some precedent that recognizes pain as such. A growing body of medical evidence that untreated pain has serious physical consequences would
substantiate this view. If the defendant physician knew and intended to cause the emotional harm, a more serious tort is invoked. The requirements of these torts are often complicated and you should discuss your state’s precedents with your attorney.

Do not take a suit lightly and do not expect a windfall. Litigation is very hard on anyone with a chronic illness and even more so with RSD because of the stress involved. It prevents you from moving on. If you cannot afford to pay an attorney, you will have to convince one that the case is worth taking on a contingency basis; experience has proven this difficult. Most attorneys know very little about opioids and even less about pain management. You will need to educate your attorney so that he can evaluate your case intelligently.

You can find additional information on legal assistance in the directory, In Pain and Agonizing Over the Bills. For a print
copy, contact the RSDSA office at (877) 662-7737.

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Seattle man, 70, beats coronavirus — then gets $1.1M hospital bill

https://www.foxnews.com/health/seattle-man-70-beats-coronavirus-then-gets-1-1m-hospital-bill-report-says

Coronavirus nearly killed Michael Flor.

After he got out of the hospital following a 62-day stay, the bill he received nearly killed him too.

“I opened it and said, ‘Holy (expletive)!,” the Washington state resident recalled, according to the Seattle Times.

The 181-page bill came with a total charge of $1.1 million, the report said.

Fortunately, because the 70-year-old man is covered by insurance, including Medicare, he will likely have to pay only a small portion of the tab.

In fact, because he suffered from the coronavirus, he might not have to pay anything at all, the Times reported.

Among the charges, according to the newspaper:

$408,912 – for 42 days in an intensive care unit (ICU) room that was special equipped as an isolation chamber because of the contagious nature of the virus.

$100,000 – for treatment as his heart, kidney and lungs all nearly failed during his stay.

$82,215 – for 29 days of ventilator use.

The prices, however, are typically far higher in the U.S. than in other wealthy countries, the Los Angeles Times noted last September.

“I feel guilty about surviving,” Flor told the Seattle paper. “There’s a sense of ‘Why me? Why did I deserve all this?’ Looking at the incredible cost of it all definitely adds to that survivor’s guilt.”

“I feel guilty about surviving. There’s a sense of ‘Why me? Why did I deserve all this?’ Looking at the incredible cost of it all definitely adds to that survivor’s guilt.”

— Michael Flor, coronavirus survivor

Flor said much of the guilt stems from knowing that taxpayers and other insurance customers will contribute to the cost of keeping him alive.

“It was a million bucks to save my life, and of course I’d say that’s money well-spent,” he says. “But I also know I might be the only one saying that.”

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Hip and knee replacements bolster marriages, study finds

https://www.foxnews.com/health/hip-and-knee-replacements-bolster-marriages-study-finds

Orthopedic surgeons are well aware that joint replacement surgeries can reduce patients’ pain and emotional distress, however a recent study explored how hip and knee replacements can improve marriages, too.

“It started with a thank you note,” Dr. Michael Tanzer, lead author and orthopedic surgeon at McGill University Health Center in Montréal, Québec, said in a press release. “My patient’s wife wrote to tell me how delighted she was to have her husband’s quality of life back because of the dramatic effect it had on her own life and their marriage. This one gesture of gratitude made me think about the impact of joint replacement surgery in a way I had taken for granted.”

The study noted how spouses of such patients often assume the role of caregiver. Research has demonstrated how spouses report reduced marital satisfaction, higher rates of depression and a lower quality of life.

Osteoarthritis is the most common form of arthritis and occurs when the protective cartilage that cushions the ends of bones wears down over time, according to the Mayo Clinic. In severe joint damage, hips and knees are most often replaced to relieve pain and improve mobility.

Tanzer said the team conducted a pilot study to evaluate spouses’ perception of patients’ pain and disability before and after total hip or knee replacement.

The study’s sample of 33 couples, who were on average 68 years old, revealed that the spouses rated the patients’ pain levels “significantly” higher, both before and after surgery, as opposed to what the patients reported.

Patients said the most significant effect from surgery was their improved mobility. Other benefits included resuming leisure and sporting activities, an improvement in pain and improvement in social and family lives.

Meanwhile, spouses had different priorities.

Most of them said the largest advantage post-surgery was the ability to carry on with social and leisure activities with their partner. Other benefits included no longer witnessing the patient suffering, a diminished caregiver burden and a sense of independence to resume their normal life, among other advantages.

“As an orthopedic surgeon, it’s important to consider the well-being of your patient’s spouse and know that they too are likely experiencing the burdens of living with a functional disability,” Tanzer said.

“The emotional and social impact as well as the physical challenges can be many and by continuing to research and bring more resources to the clinical setting, we can help both orthopedic surgeons and patients create a better quality of life from diagnosis through to treatment.”

In the study, couples had been married for an average of 36.5 years. To participate in the study, subjects had to have been living with a spouse for at least five years before the surgery. The patients lived with an osteoarthritis diagnosis for an average of seven years, with an average wait time of 8.7 months to receive an operation.

The study was released as part of the American Academy of Orthopedic Surgeons’ Virtual Education Experience called “Marital Relationship and Quality of Life in Couples Following Joint Replacement Surgery.”

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19 Detroit Healthcare Professionals Indicted for Unlawful Prescribing

https://www.healthcaredefenseblog.com/post/19-detroit-healthcare-professionals-indicted-for-unlawful-prescribing

The United States Attorney for the Eastern District of Michigan indicted nineteen healthcare professionals today, June 11, 2020. See Indictment Below.

The indictment alleges that between September 2017 and June 2020 the Defendants engaged in a scheme involving the unlawful distribution of opioids. The indictment alleges that the conspiracy was between medical clinics, rehab centers and pharmacies involving nearly two million controlled substances of a value of over $41 million. The Indictment alleges over forty-four independent violations of 21 U.S.C. 841(a) and it also alleges that the nineteen defendants engaged in a conspiracy to violate 21 U.S.C. 846 – controlled substance conspiracy. The indictment was issued by Detroit’s Healthcare Fraud Unit and will be prosecuted by Brandy McMillion and Mitra Jafary-Hariri, two federal prosecutors in that division. The Detroit Healthcare Fraud Unit is very experienced at prosecuting healthcare fraud and opioid trafficking cases.

All defendants are innocent until proven guilty and prior experience with the Detroit Healthcare Fraud unit has revealed that it aggressively charges healthcare practices on the basis of statistics rather than actual patient care. This practice is a new tactic by the DOJ and can lead to charging errors and unnecessary government scrutiny.

In order to convict health professional for unlawful distribution of controlled substances (sometimes referred to as running a pill mill) the Government must prove that the physicians prescribed controlled substances for “other than a legitimate medical purpose and outside the course of professional practice”. This is a very difficult standard to meet. The Government must show that prescriptions were not for pain but rather in order to achieve some other unlawful purpose.

To Learn More About the Standard See Our Resources Page Here

To Learn More About the History of the Controlled Substance Act Click Here

Defense of unlawful distribution charges requires a focused defense that highlights the patient care provided to each individual patient and knowledge of Federal Drug Laws, CDC Guidelines for Prescribing, and the standards of practice for pain management (ASIPP, ASAM, etc.). As this case progresses, there are sure to be a significant number of Michigan pain patients separated from their provider. Often, prosecutors and the DEA fail to consider this fact because they believe that all prescriptions issued in such a practice are unlawful.

To Learn More About Government Prosecution Tricks Click Here

Before agreeing to any plea to unlawful distribution, a physician must consult with an experienced healthcare defense attorney who understands the law, medicine, and applicable standards. If you are a provider facing Government scrutiny read this before considering a plea of guilty.

The case is pending before Judge Bernard Friedman and Magistrate David R. Grand. More updates to follow.

Ronald W. Chapman II@RonChapmanAtty is a healthcare defense attorney and specializes in representing physicians and other health professional in government investigations and indictments related to the practice of medicine. He speaks nationally on the topic and has appeared in national publications. He obtains frequent victories for his clients facing government scrutiny.

In reading the court papers the actual total of oral doses was 1,951,148 and out of the 19 charged – 6 had the legal right to prescribe.   The actual time frame involved is ab 34 months ( Sept 2017 – June 2020).

According to this.. it would appear that no pt records were reviewed, no pts had any in person physical exam.. this is a statistical conclusion of guilty. The charges were determined by a GRAND JURY.. and it is claimed that our GRAND JURY system is so designed that if a prosecutor wanted to get a “ham sandwich” charged… it would be quite possible.  As I understand our GRAND JURY system.. only the prosecutor presents “the facts” to the GRAND JURY from which the final conclusion/charges are reached.

The law suit only mentions the strengths of Oxycodone 30 mg and Oxymorphone 40 mg… the first is available as a IR & ER in that strength and the latter is only available as a ER.

So these 6 prescribers collectively – on average – prescribed 57,387 doses/month over the 34 month period.

Meaning that – on average – each prescriber wrote for 9,654 doses/month

Using dosing averages that would represent best practices and standard of care for chronic pain pts..  each prescriber would have 46 pts/month

Looking at 5 day work week.. each prescriber – on average – would be writing prescriptions for abt 9 pts/day.

The typical prescriber will see upwards of 30 pts in any given day.  So these numbers would suggest that LESS THAN 1/3 of the pt office visit would result in a opiate Rx written.  This doesn’t seem to describe what is typically described as what is a “pill mill”

These conclusions are based on averages and what information that was provided in the lawsuit… which there is a link to the *.pdf on the above link to the original article.

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Pain-Warriors – the movie -to be released May 25th – pre-order now from Amazon

Dear friends ,

We DID it ! Pain Warriors is officially released , and available for viewing worldwide . A big thank you for everyone’s belief in us .

We need your support , at this crucial time of programming Pain Warriors across North America and beyond , while the film is fresh out of the door.

Our reviews on IMDb are up to 17 ! From my direct community outreach efforts , the past 2 weeks .

Good reviews , Lots of them , are what make us noticed and desirable to Media, cable TV and Netflix , etc.

Please , if you, your spouse, family member or friend has viewed our film and you are not in the tail credits , leave a review NOW on the IMDb site link below. Time is of the essence.

We are in our peak selling time to broadcasters.

Thanks so much, Tina Petrova
May the force be with us ! Team Pain Warriors.

Here is the direct link below to the IMDb review page .

https://www.imdb.com/title/tt8438478/reviews

www.tinapetrova.com

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those in our legal system seems to be getting some of their “own medicine” … there is data after data that shows that <1% of those prescribed opiates for chronic pain will become addicted. 

How the media and “black lives matters” have turned on ALL POLICE FORCES… and now they are claiming that <1% of cops are “bad apples”, but it seems that few are buying that fact/argument.

Now the marches and protests are entering their third week.

I haven’t heard anything about holding US Marshals, FBI, DEA, and SWAT to a higher standard and reducing the budgets of these parts of our judicial system as being suggested as to what should happen to other police groups.

Perhaps the community of subjective diseases should take notice… particularly of the numbers that have been marching in the streets and how many days – in a row -they have been marching and so far what has been accomplished.. a lot of talk ?  Chicago recently had the most shooting in a single day in over 60 yrs.

And those in the community wonders why having a few dozen people show up for a protest and nothing happens …. and they wonder why ?

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People Rarely Die After Using Opioids Prescribed for Them

https://reason.com/2020/01/23/people-rarely-die-after-using-opioids-prescribed-for-them/

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almost weekly we are hearing more stories of pharmacists using one of 40 excuses that twitter is giving us. pharmacists have a duty and a right to interfere with prescriptive instructions and stop any prescription for cause, AKA not out of their own prejudge and fears. the courts have ruled that pharmacists can not refuse to fill because of moral beliefs. And that needs to include any phone reasons not based on a reason that finding Broadway covers picking out pain medicines to sabotage. This is raw discrimination and depriving somebody of needed prescription drugs is more than cruel.

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