https://www.dispatch.com/story/news/courts/2025/06/10/former-mount-carmel-doctor-william-husel-testifies-in-defamation-trial/84119853007/

Former doctor William Husel broke down on the witness stand during testimony in his defamation trial against his former employer as he told a jury about the day he learned he was charged with prescribing fatal doses of medicine to patients. 

The former Mount Carmel doctor began his testimony on June 9 and continued into Tuesday, June 10. It’s the first time he has testified in public about the care he provided to his patients while at Mount Carmel. 

The 49-year-old is suing Mount Carmel, its parent company, Trinity Health Corporation, and Mount Carmel’s former CEO, Ed Lamb, for defamation. He says public statements the hospital made about him related to his prescribing fatal doses of opioids to patients did irreparable damage to his reputation, career and personal life.

In a 2022 criminal trial, Husel was acquitted of wrongdoing in many instances. Prosecutors eventually dropped several remaining charges against him, but he had previously stated that he was only providing comfort care to suffering patients. 

Attorneys for the hospital spent part of their time questioning Husel, laying a foundation to establish that he had a history of accusations of over-prescribing medication to patients before his indictment.  

Husel, who paused to compose himself several times as he became emotional, told a jury about the impact Mount Carmel’s statements, beginning in January 2019, had on his life and the lives of his wife and their two daughters.

He said the first inkling he had that something might be wrong was on the evening before Mount Carmel’s first public statement. Husel testified a nurse called him and told him, “D-Day was coming, and it’s going to be really bad.” 

Husel said the following day, after the first medical malpractice suit was filed against him by a patient’s family and Mount Carmel’s public statement, he opened his Facebook account to find more than 1,000 messages, many of them hateful.

“They said I was a serial killer, that I should rot in prison, that I should be buried under the prison,” Husel said. 

While Husel did not address any of Mount Carmel’s statements specifically, he said he couldn’t comprehend why the families of patients he had cared for were suing him. 

“Why would I do CPR on someone, save their life and then an hour later intentionally kill them,” Husel said. 

Husel also described having reporters try to get a comment from him about the lawsuits and being pointed at or talked about when he went to restaurants or stores — something he says continues to happen to this day. 

Husel told the jury that he and his wife, Mariah, live in her parent’s home, which he described as a “double-wide trailer” with two bedrooms and a bathroom. He said he does not work, while his wife is working full-time and working towards a Master’s degree, and he often sleeps on the floor.

Husel also testified about the day he learned a grand jury had indicted him on 25 counts of murder. He said he got a call from his attorney, who wouldn’t tell him what charges he was facing. Husel cried as he talked about watching his children taking a bath that night, knowing he would be turning himself in to police the next day.

“I started thinking I’m never going to see my kids again,” Husel said.

Eleven of the 25 murder charges were later dismissed. A Franklin County jury found Husel not guilty of the remaining 14 charges after a 2022 trial. A month after the trial’s conclusion, Husel voluntarily surrendered his medical license, which the Ohio Medical Board then permanently revoked.

Powell Miller, an attorney for the hospital system, began cross-examining Husel on June 10, asking him about findings the state medical board had made when suspending Husel’s license in 2019. Those findings, shown to the jury, include that Husel gave “inappropriate and excessive” doses of medication to multiple patients who died within minutes of receiving the doses of fentanyl.

Mount Carmel’s public statements said Husel’s dosing was “significantly excessive and potentially fatal.”

Cross-examination is expected to continue on June 10.

Prior to being questioned by the hospital system, Husel testified about the death of 82-year-old Melissa Penix, who died on the last night Husel worked in the ICU before the hospital placed him on leave.

“Why are you crying,” Husel’s attorney asked.

“Just because it was my last night at work there,” Husel said. “When I started thinking about the husband crying and not wanting to let her go, it makes me sad to think about that.”

Husel described wanting to make Penix comfortable and avoid suffocation, what her family said was her “greatest fear in life.” Husel ordered a 2,000 microgram dosage of fentanyl for Penix, who died five minutes later.

Husel was fired in December 2018 amid concerns about the dosages of fentanyl he was prescribing for patients taken off life support. 

Husel is seeking $18 million in damages, which his attorneys have said is an estimate of the amount of money Husel would have made as a doctor.

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https://who13.com/news/iowa-gov-reynolds-signs-bill-to-reform-pharmacy-benefit-managers/

DES MOINES, Iowa (KCAU) — Iowa Gov. Kim Reynolds signed a bill Wednesday aimed at bringing changes to pharmacy benefit managers, also known as PBMs.

The legislation, Senate File 383, aims to help prevent more independent and rural pharmacies from closing their doors in the Hawkeye State.

PBMs are the middlemen between health insurance companies and pharmacies. Whenever you fill a prescription, the PBM determines how much the pharmacy actually gets paid for dispensing your medication.

In recent years, that amount has sometimes been less than what it costs the pharmacy to fill a prescription, forcing them to either refuse the fill, or take a financial loss.

Senate File 383 would attempt to prevent that by adding requirements for how much pharmacies must be reimbursed for filling medications, to ensure they get paid a fair price.

It also adds other patient protections, like preventing PBMs from hitting you with a monetary penalty if you choose a non-preferred pharmacy, or requiring you to use a mail-order pharmacy service to use your insurance coverage.

As of Wednesday, a total of 32 states have passed similar legislation, according to the Iowa Governor’s Office.

Opponents of the measure have argued the bill would increase health insurance premiums, but supporters maintain that in states that have previously passed similar legislation, that has not come to pass.

Governor Reynolds released a statement Wednesday explaining her reasoning for signing the bill. In part, it says, “The new bill takes steps toward addressing these challenges by targeting PBM practices that harm both patients and independent pharmacies. Local pharmacies, especially in rural areas, are vital to community health and local hospitals but are being driven out by opaque, one-sided contracts.”

You can read the governor’s full statement here.

The Iowa Pharmacy Association applauded the bill’s passage Wednesday. CEO Kate Gainer said, “Governor Reynolds’ leadership and the Iowa Legislature’s bipartisan support of SF 383 sends a powerful message that the health of Iowa communities comes first. For too long, PBMs have put profits over patients, contributing to the closure of more than 200 pharmacies in Iowa since 2014. This law gives us the tools to level the playing field and protect access to care, especially in rural areas.”

The Iowa Association of Business and Industry, however, opposed the bill’s signing, releasing a statement saying, “ABI is disappointed in today’s action. ABI testified at every turn in favor of legislation that would support small independent pharmacies in Iowa. The bill that the Governor signed today is not that. Senate File 383 includes expensive, unneeded provisions that are going to drive up the costs of pharmacy services in Iowa without any discernable improvement in patient care. Iowans – including businesses and employees – will bear these costs at the pharmacy counter and in the structure of their health care plans. This is an additional headwind in an already challenging business environment. Now law, ABI will take every opportunity to mitigate the increased costs on our members and their team members throughout Iowa.”

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Has anyone noticed that PBMs are running TV commercials about how they can save everyone money on their prescriptions. What they don’t say is that while you MAY pay less out of pocket. Your insurance company may pay multiple times what it would cost them if you pay for your prescription and you send in a claim to get reimbursed.

Below is some information on how opaque the insurance/PBM industry’s financial disclosures are, and all of these companies are publicly traded companies.

Over the years, there have been several times when bureaucrats have tried to set up some sort of bureaucratic oversight mechanism to on the PBMs, and every time the PBMs industry brings out its “dog & pony show” about how much more pts will end up paying for their prescriptions if the PBM industry has some bureaucratic oversight and regulations that if the PBM industry was not able to control the prices of prescriptions, all the community pharmacies would jack-up their prices and they would make some profits that the PBM industry would loose.

Who would imagine that inserting numerous middlemen into our Rx distribution system? Each with their own operating overhead and interest in generating a net profit, and they could save EVERYONE some money. Apparently, the majority of bureaucrats and many at the top of many large corporations believed the PBMs “dog & pony show”.

Let me search for specific information about mail-order pharmacy revenues and profits for the major PBMs.Let me search for more specific information about mail-order pharmacy revenues and profits.Based on my searches, I can provide some general information about mail-order pharmacy revenues, though specific profit breakdowns by mail-order operations are not typically disclosed separately by the major PBMs.

Mail-Order Pharmacy Market Overview:

Market Size and Growth:

• The Global Mail Order Pharmacy Market is estimated to be valued at USD 144.72 Bn in 2025 and is expected to reach USD 439.58 Bn by 2032, exhibiting a compound annual growth rate (CAGR) of 17.2%

Key Players in Mail-Order:

The same “Big Three” PBMs that dominate the overall market also control most mail-order pharmacy operations:

1. CVS Caremark – Operates CVS mail-order pharmacies
2. Express Scripts – Operates Express Scripts Pharmacy mail-order services
3. OptumRx – Operates OptumRx mail-order pharmacy services

Financial Context:

While specific mail-order profit margins aren’t typically disclosed separately, we know that:

• Pharmacy benefit managers CVS Caremark, OptumRx and Express Scripts inflated costs for specialty generic drugs to treat diseases such as cancer and HIV to the tune of $7.3 billion over six years
• Mail-order pharmacies are particularly profitable for PBMs because they:
  • Allow for bulk purchasing and dispensing
  • Reduce overhead costs compared to retail locations
  • Enable better inventory management
  • Often handle specialty and high-cost medications
  • Generate higher profit margins through direct-to-consumer delivery

Limitations in Available Data:

The challenge with providing exact mail-order specific revenue and profit figures is that:

1. Integrated Operations: Mail-order pharmacy operations are typically integrated into the broader PBM business and not reported as separate line items
2. Private Financial Data: Specific profit margins for mail-order operations are considered proprietary business information
3. Complex Revenue Streams: PBMs generate revenue through multiple channels (rebates, dispensing fees, spread pricing, administrative fees) that aren’t easily separated by delivery method

The mail-order pharmacy segment represents a significant and rapidly growing portion of the overall PBM business, with the market expected to triple in size over the next 7-8 years, but specific revenue and profit breakdowns for this segment remain closely guarded by the major PBMs.

I’ll search for current information about the top 5 Pharmacy Benefit Managers (PBMs) and their financial performance.Let me search for more specific financial data on the major PBM companies.Based on the search results, I can provide information about the top PBMs and their financial scale, though specific profit breakdowns by PBM division are not always separately reported since these are parts of larger healthcare conglomerates.

Top 5 PBMs by Market Share and Revenue Scale:

The “Big Three” that dominate ~80% of the market:

1. CVS Caremark (CVS Health) – Part of CVS Health’s overall operations
2. Express Scripts (Cigna) – Part of Cigna’s Evernorth division
3. OptumRx (UnitedHealth Group) – Part of UnitedHealth’s Optum division

Additional major players: 4. Humana Pharmacy Solutions/CenterWell 5. MedImpact Healthcare Systems (largest privately-held PBM)

Financial Scale:

UnitedHealth Group (includes OptumRx):

• 2024 revenues hit $400.3 billion – a 6% year-over-year increase – and full-year earnings from operations were $32.3 billion
• UnitedHealth Group reported $5.5 billion in profit for the fourth quarter of 2024

Overall PBM Market:

• The three largest PBMs make up about 80% of the market share covering about 270 million people with a market of almost $600 billion in 2024

Key Context:

• From 2017 to 2022, the companies — UnitedHealth Group’s Optum, CVS Health’s CVS Caremark and Cigna’s Express Scripts — marked up prices at their pharmacies by hundreds or thousands of percent, netting them $7.3 billion in revenue in excess of the acquisition costs of the drugs

The challenge with providing exact PBM-specific revenue and profit figures is that these businesses are integrated into much larger healthcare companies. The total addressable market for PBMs is approaching $600 billion annually, with the top three controlling about 80% of that market. However, the parent companies (CVS Health, Cigna, UnitedHealth) don’t always break out PBM-specific profit margins in their public filings, as these operations are strategically integrated with their insurance and healthcare delivery businesses.

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Two Women Faced Chemo. The One Who Survived Demanded a Test to See if It Was Safe.

https://www.medpagetoday.com/hematologyoncology/chemotherapy/115929

A common chemotherapy drug can be deadly for those deficient in the enzyme that metabolizes it

JoEllen Zembruski-Ruple, while in the care of New York City’s renowned Memorial Sloan Kettering Cancer Center, swallowed the first three chemotherapy pills to treat her squamous cell carcinoma on Jan. 29, her family members said. They didn’t realize the drug could kill her.

Six days later, Zembruski-Ruple went to Sloan Kettering’s urgent care department to treat sores in her mouth and swelling around her eyes. The hospital diagnosed oral yeast infection and sent her home, her sister and partner said. Two days later, they said, she returned in agony — with severe diarrhea and vomiting — and was admitted. “Enzyme deficiency,” Zembruski-Ruple texted a friend.

The 65-year-old, a patient advocate who had worked for the National Multiple Sclerosis (MS) Society and other groups, would never go home.

Covered in bruises and unable to swallow or talk, she eventually entered hospice care and died March 25opens in a new tab or window from the very drug that was supposed to extend her life, said her longtime partner, Richard Khavkine. Zembruski-Ruple was deficient in the enzyme that metabolizes capecitabine, the chemotherapy drug she took, said Khavkine and Susan Zembruski, one of her sisters. Zembruski-Ruple was among about 1,300 Americans each year who dieopens in a new tab or window from the toxic effects of that pillopens in a new tab or window or its cousin, the IV drug fluorouracil known as 5-FU.

Doctors can test for the deficiencyopens in a new tab or window — and then either switch drugs or lower the dosageopens in a new tab or window if patients have a genetic variant that carries risk. The FDA approved an antidote in 2015opens in a new tab or window, but it’s expensive and must be administered within 4 days of the first chemotherapy treatment.

Newer cancer drugs sometimes include a companion diagnostic to determine whether a drug works with an individual patient’s genetics. But 5-FU went on the market in 1962 and sells for about $17 a dose; producers of its generic aren’t seeking approval for toxicity tests, which typically cost hundreds of dollars. Doctors have only gradually understood which gene variants are dangerous in which patients, and how to deal with them, said Alan Venook, MD, a colorectal and liver cancer specialist at the University of California San Francisco.

By the time Zembruski-Ruple’s doctors told her she had the deficiency, she had been on the drug for 8 days, said Khavkine, who watched over his partner with her sister throughout the 7-week ordeal.

Khavkine said he “would have asked for the test” if he had known about it, but added “nobody told us about the possibility of this deficiency.” Zembruski-Ruple’s sister also said she wasn’t warned about the fatal risks of the chemo, or told about the test.

“They never said why they didn’t test her,” Zembruski said. “If the test existed, they should have said there is a test. If they said, ‘Insurance won’t cover it,’ I would have said, ‘Here’s my credit card.’ We should have known about it.”

Guidance Moves at a Glacial Pace

Despite growing awareness of the deficiency, and an advocacy group made up of grieving friends and relatives who push for routine testingopens in a new tab or window of all patients before they take the drug, the medical establishment has moved slowly.

A panel of the National Comprehensive Cancer Network, or NCCN — specialists from Sloan Kettering and other top research centers — until recently did not recommend testing, and the FDA does not require it.

In response to a query from KFF Health News about its policy, Sloan Kettering spokesperson Courtney Nowak said the hospital treats patients “in accordance with NCCN guidelines.” She said the hospital would not discuss a patient’s care.

On Jan. 24, the FDA issued a warningopens in a new tab or window about the enzyme deficiency in which it urged healthcare providers to “inform patients prior to treatment” about the risks of taking 5-FU and capecitabine.

On March 31 — 6 days after Zembruski-Ruple’s death — the network’s expert panel for most gastrointestinal cancers took a first step toward recommending testing for the deficiency.

Worried that President Trump’s FDA might do nothing, Venook said, the panel — whose guidance shapes the practices of oncologists and health insurers — recommended that doctors consider testing before dosing patients with 5-FU or capecitabine.

However, its guidance stated that “no specific test is recommended at this time,” citing a lack of data to “inform dose adjustments.”

Sloan Kettering “will consider this guidance in developing personalized treatment plans for each patient,” Nowak told KFF Health News.

The new NCCN guidance was “not the blanket recommendation we were working toward, but it is a major step toward our ultimate goal,” said Kerin Milesky, a public health official in Brewster, Massachusetts, who’s part of an advocacy group for testing. Her husband, Larry, died 2 years ago at age 73 after a single treatment of capecitabine.

European drug regulatorsopens in a new tab or window began urging oncologists to test patients for deficiency in May 2020. Patients with potentially risky genetics are started on a half-dose of the cancer drug. If they suffer no major toxicity, the dose is increased.

A Lifesaving Ultimatum?

Emily Alimonti, a 42-year-old biotech salesperson in upstate New York, chose that path before starting capecitabine treatment in December. She said her doctors — including an oncologist at Sloan Kettering — told her they didn’t do deficiency testing, but Alimonti insisted. “Nope,” she said. “I’m not starting it until I get the test back.”

The test showed that Alimonti had a copy of a risky gene variant, so doctors gave her a lower dose of the drug. Even that has been hard to tolerate; she’s had to skip doses because of low white blood cell counts, Alimonti said. She still doesn’t know whether her insurer will cover the test.

Around 300,000 people are treated with 5-FU or capecitabine in the United States each year, but its toxicity could well have prevented FDA approval were it up for approval today. Short of withdrawing a drug, however, U.S. regulators have little power to manage its use. And 5-FU and capecitabine are still powerful tools against many cancers.

At a January workshop that included FDA officials and cancer specialists, Venook, the NCCN panel’s co-chair, asked whether it was reasonable to recommend that doctors obtain a genetic test “without saying what to do with the result.”

But Richard Pazdur, MD, the FDA’s top cancer expert, said it was time to end the debate and commence testing, even if the results could be ambiguous. “If you don’t have the information, how do you have counseling?” he asked.

Two months later, Venook’s panel changed course. The price of tests has fallen below $300 and results can be returned as soon as 3 days, Venook said. Doubts about the FDA’s ability to further confront the issue spurred the panel’s change of heart, he said.

“I don’t know if FDA is going to exist tomorrow,” Venook told KFF Health News. “They’re taking a wrecking ball to common sense, and that’s one of the reasons we felt we had to go forward.”

On May 20, the FDA posted a Federal Register noticeopens in a new tab or window seeking public input on the issue, a move that suggested it was considering further action.

Venook said he often tests his own patients, but the results can be fuzzy. If the test finds two copies of certain dangerous gene variants in a patient, he avoids using the drug. But such cases are rare — and Zembruski-Ruple was one of them, according to her sister and Khavkine.

Many more patients have a single copy of a suspect gene, an ambiguous result that requires clinical judgment to assess, Venook said.

A full-gene scan would provide more information but adds expense and time, and even then the answer may be murky, Venook said. He worries that starting patients on lower doses could mean fewer cures, especially for newly diagnosed colon cancer patients.

Power Should Rest With Patients

Scott Kapoor, MD, a Toronto-area emergency room physician whose brother Anil, a much-loved urologist and surgeon, died of 5-FU toxicity at age 58 in 2023, views Venook’s arguments as medical paternalism. Patients should decide whether to test and what to do with the results, he said.

“What’s better — don’t tell the patient about the test, don’t test them, potentially kill them in 20 days?” he said. “Or tell them about the testing while warning that potentially the cancer will kill them in a year?”

“People say oncologists don’t know what to do with the information,” said Karen Merritt, whose mother died after an infusion of 5-FU in 2014. “Well, I’m not a doctor, but I can understand the Mayo Clinic report on it.”

The Mayo Clinic recommends starting patients on half a dose if they have one suspect gene variant. And “the vast majority of patients will be able to start treatment without delays,” Daniel Hertz, PharmD, PhD, a clinical pharmacologist from the University of Michigan, said at the January meetingopens in a new tab or window.

Some hospitals began testing after patients died because of the deficiency, said Lindsay Murray, of Andover, Massachusetts, who has advocated for widespread testing since her mother was treated with capecitabine and died in 2021.

In some cases, Venook said, relatives of dead patients have sued hospitals, leading to settlements.

Kapoor said his brother — like many patients of non-European origin — had a gene variant that hasn’t been widely studied and isn’t included in most tests. But a full-gene scan would have detected it, Kapoor said, and such scans can also be done for a few hundred dollars.

The cancer network panel’s changed language is disappointing, he said, though “better than nothing.”

In video tributesopens in a new tab or window to Zembruski-Ruple, her friends, colleagues, and clients remembered her as kind, helpful, and engaging. “JoEllen was beautiful both inside and out,” said Barbara McKeon, a former colleague at the MS Society. “She was funny, creative, had a great sense of style.”

“JoEllen had this balance of classy and playful misbehavior,” psychotherapist Anastatia Fabris said. “My beautiful, vibrant, funny, and loving friend JoEllen.”

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Too bad that Trump will not free all those chronic pain pts that are basically under house arrest since their pain management medications have been reduced or stopped. They are house, chair, bed confined because of their under/untreated pain, and many are not able to even provide minimum self-care.

All because our DOJ/DEA has pursued physicians treating chronic pain pts with FDA-approved medications. While over the last 16 yrs, certain parts of our Congress have been determined to leave our borders wide open, and tons and tons of illegal substances have come in across our borders and killing upwards of 100,000 people dying from illegal Fentanyl, mostly coming from China and Mexican cartels.

Maybe it is time for Trump to send some well-targeted Cruise Missiles to those clandestine labs that are making ILLEGAL FENTANYL and other illegal substances in Mexico.  No one can make me believe that some of our ALPHABETICAL FEDERAL GOVERNMENT DOESN’T KNOW WHERE MOST OR ALL ARE LOCATED!

FREE TINA PETERS

Trump ordered DOJ to secure the release of Tina Peters Who’s Stuck In Colorado Prison After Exposing alleged ‘El*ction Fr*ud’ hashtag#colorado  President Trump said Peters was the victim of political persecution.

“Tina is an innocent Political Prisoner being horribly and unjustly punished in the form of Cruel and Unusual Punishment,”

He accused Colorado’s Democratic Attorney General Phil Weiser of ignoring “Illegals committing Violent Crimes like Rape and Murder” while targeting Peters,

Who he described as “A 69-year-old Gold Star mother who worked to expose and document Democrat El*ction Fr*ud.”

“I am hereby directing the Department of Justice to take all necessary action to help secure the release of this ‘hostage’ being held in a Colorado prison by the Democrats, for political reasons.”

Peters served as the Mesa County Clerk from 2018 until 2021. She was convicted for allowing an unauthorized person, linked to MyPillow CEO Mike Lindell, to access Mesa County’s voting equipment.

She copied election data that was later posted online in an attempt to prove fr*ud.

Peters was indicted in 2022 on seven charges.

In 2024, she was found guilty on all seven counts, four of which were felonies.

Judge Matthew Barrett sentenced her to nine years in prison, saying

“I am convinced you would do it all over again,” calling Peters “as defiant a defendant as this court has ever seen.”

He accused her of showing no remorse, abusing her authority, and causing “immeasurable damage” to trust in the electoral process.

Peters is currently at the Larimer County Detention Center, awaiting transfer to a state prison to serve the remainder of her sentence.

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Engaging Community Pharmacists in Improving Treatment Outcomes for Patients with Opioid Use Disorder

https://forefdn.org/grantee-spotlight-engaging-community-pharmacists-in-improving-treatment-outcomes-for-patients-with-opioid-use-disorder/

In late 2022, Congress passed legislation allowing any DEA-registered prescriber to prescribe buprenorphine for the treatment of opioid use disorder. Only around half of U.S. pharmacies stock it, however, because of controlled substance purchasing and dispensing requirements.

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The Prohibition Amendment, known as the Eighteenth Amendment, was ratified on January 16, 1919, and prohibited the manufacture, sale, and transportation of intoxicating liquors in the United States.

It was later repealed by the Twenty-first Amendment on December 5, 1933.

16th Amendment and the Establishment of Modern Income Tax (1913)

Congress had established our income system in 1913, and from what I have read, since states had to ratify an amendment, Congress and the states were covering all the financial bases because they knew that there would be a loss of alcohol tax revenues due to alcohol prohibition. What they didn’t foresee was all the alcohol being smuggled in from Canada, and that everyone and their Brother had built stills to make Moonshine.

They had raised income taxes to compensate for the loss of Alcohol taxes, but apparently they just couldn’t stand all the alcohol that was still being sold and consumed, and the Feds & the States not getting any tax revenue off of it. So they repealed the 18th Amendment with the 21st Amendment 14 yrs later.

Then we have the Controlled Substances Act that was signed into law in abt 1970. The CSA created the BNDD ( Bureau of Narcotics & Dangerous Drugs), as I remember, the BNDD really did not do much, but in 1973, Congress created the DEA with 1200 employees, and they appeared to take their job seriously.  They had numerous campaigns with slogans.  “Just Say NO” was the most infamous slogan back then.

In abt 2000, Congress passed a bill, “The Decade of Pain Law,” that strongly encouraged prescribers to properly treat a pt’s chronic pain. The Joint Commission (JC) labeled this law as the “Fifth Vital Sign” and made it a major standard for hospitals to meet to maintain their JC accreditation. 

When the law expired ten years later, the political party in the majority of Congress had FLIPPED, and the law was not renewed. Opioid Rxs peaked in the 2010-2012 time frame. Florida did not have an active PDMP when the Decade Pain Law was in force. Early in the 2010 decade Rick Scott became Florida’s Governor, and Pam Bondi became attorney general.  They got the FL legislature to get a PDMP up and running in FL.

When Bondi ran for a second term, her TV ads stated that she ran over “200 oxy docs” out of Florida.

It would seem that the Tobacco lawsuit settlement that was settled in ~ 1999 gave a lot of bureaucrats and law firms the idea to start suing anyone and everyone who is involved in the opioid distribution system.

Purdue Pharma, whose Rx opioids were only 4% of all opioids, got sued into bankruptcy. From all the fines that were imposed on them by our judicial system. The advertising agency for Purdue Pharma got sued and ended up owing 350 million for helping Purdue Pharma promote the opioid products.

The pharmacy chains have had “rapid fire” lawsuits over the last 10-15 yrs. Rite Aid, which once had 5,000 stores, is now in bankruptcy and having a fire sale on the last 1,000 stores. Those stores will be bought up, and most will be closed, and those stores will be closed and the Rx files will be transferred to the buyer of those Rite Aid stores.

Walgreens, which once promoted that they were “the Pharmacy where America Shopped,” has been shedding a few hundred stores annually for a long time. A company that was once valued at 100 billion dollars is being sold off to an “investor group” for 10 billion.

The DOJ/DEA is so brazen that they are suing major companies with just ALLEGATIONS, which appear to be gathered from some “data mining” of filled opioid Rxs databases. Sort of a GUILTY UNTIL PROVEN INNOCENT.

Over the last 10-15 years, the DOJ/DEA has extracted 100 of billions of dollars out of all the companies and some practitioners that are involved with providing controlled medications to patients who have a valid medical necessity for these FDA-approved medications.

Is this an example of where prohibition has proved to be an easy source of money from entities that are providing a legal product?

Does this suggest that there is going to be a huge number of corporate corpses in the wake of this new wave of extortion of various entities that are selling a legal product to pts who have seen a prescriber who provides them a legal prescription for controlled substances?

We have seen the Feds reverse alcohol prohibition because they were failing to generate some tax revenue. Who believes that the Feds are going to ease up on the extortion and prosecution of all entities that are selling the legal product of FDA-approved controlled substances?

What other chronic health issues is “Uncle Sam” going to decide are “too expensive” for our society to manage and/or treat? Over the last 16 yrs we have seen our national debt increase FOUR FOLD ( from 9 trillion to abt 37 trillion).

U.S. Debt Credit Rating Downgraded, Only Second Time In Nation’s History

Death with Dignity laws – 11 states have laws, and 4 have it under consideration to make it the law. Have we come to the point where if you are not a “maker”, you should do what is best for our society, as a whole, to “check out”?

Oregon was the first state to pass such a law in 1989  https://deathwithdignity.org/history/

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This is a single example of where the $$ goes that the pt hands over at the Rx counter. If anyone has noticed, all of sudden the PBM industry is now advertising on TV claiming how much money they are saving people.

When I first started working in a pharmacy back in the summer of 1968. There was no PBM industry, and 90 %+ of all prescriptions were BRAND NAME, and the average Rx price was in the $4-$5 range. The PBM industry came around at the end of 1969. Today, 85 % + of Rxs are generics, and 85 % of Rxs are paid for by PBMs. The average Rx price today is in the $70 range.  If the PBM industry had not gotten involved in the prescription business, and nothing had changed, the average Rx price would be around $40. If we just had the change of brand names to generics at the same percentages, the average Rx price would probably be in the $25-$30 range. Just imagine if we didn’t have the PBM to save us money and require prior authorizations, mandatory generic substitution, step therapy, day’s supply limitations, and numerous other things that do nothing to improve a pt’s therapy and QOL.

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Pharmacogenomics – the core of individualized, precision medication therapy.

For the pts who are having a difficult time getting their pain managed properly. Having your PGx (DNA) testing done. The test is from a simple cheek swab.  Send it off to the lab, and in a couple of weeks, you will typically get a somewhat semi-vague report.  The report that you will first get can be as much as 70 +/- pages, listing some general plus or minuses comparing your CYP-450 liver enzymes with your medications and gives you some recommendations about how your body metabolizes the medications that you take. The graphic to the right is what a medical professional will work with to help them narrow down which particular medication in a particular category will work best with your CYP-450 liver enzymes, and your body will metabolize a particular med best.

An example is that Hydrocodone has to be metabolized to its active metabolite, which is Hydromorphone. If your body poorly metabolizes Hydrocodone, you are not going to get very good pain management.

Some prescribers do not believe in this system. The MME and Narxcare do not take PGx into consideration when determining a pt’s most appropriate dose. Most insurance companies don’t want to pay for PGx testing because they don’t see how it is going to increase their bottom line. Most don’t care if it improves the pt’s QOL.

1. https://www.pbm.va.gov/PBM/AcademicDetailingService/Documents/508/IB10-1721_PGx_Provider_IntoToPrecisionMedicine_P97138.pdf
2. https://pmc.ncbi.nlm.nih.gov/articles/PMC10233068/
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8. https://www.ccjm.org/content/87/2/91
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19. https://pmc.ncbi.nlm.nih.gov/articles/PMC3351041/
20. https://www.mayo.edu/research/centers-programs/center-individualized-medicine/patient-care/pharmacogenomics/patients
21. https://www.jax.org/education-and-learning/clinical-and-continuing-education/clinical-topics/genetic-testing/pharmacogenomic-communication
22. https://pmc.ncbi.nlm.nih.gov/articles/PMC3299179/
23. https://pmc.ncbi.nlm.nih.gov/articles/PMC6789586/
24. https://guidelines.carelonmedicalbenefitsmanagement.com/pharmacogenomic-testing-2024-10-20-updated-2025-04-01/
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27. https://www.pharmacytimes.com/view/pharmacogenomics-the-vanguard-of-precision-medicine
28. https://pubmed.ncbi.nlm.nih.gov/40399951/

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