PBM industry: your appropriate healthcare and well being – may not be their number one goal

Posted on November 15, 2022 by Pharmaciststeve

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Substance-use struggles are a daily occurrence for the 1 in 10 Americans battling addiction

Posted on November 14, 2022 by Pharmaciststeve

For >100 yrs, our country, we have had between 1%-2% of our population being serious addicts to opiate and similar substances.  Currently it is being reported that some 70K-75K /yr die from a OD/poisoning of illegal Fentanyl.  Now it is stated that abt 9% of our population are seriously addicted to the abuse of the drug ALCOHOL and that drug is involved with abt 100,000/yr deaths.

Congress created both the DEA and the ATF in 1973.  Does anyone find it strange that Congress assigned two dangerous & potentially addicting drugs (Alcohol & Nicotine) to one new federal agency and created a second federal agency (DEA) to handle what ended up being “controlled substances”.  At the same time these two different new federal agencies took totally different approaches to deal with the manufacturing, wholesaler and retail distribution system under their control.   Of course, the two potentially addicting drugs under the ATF generates a very substantial tax revenue for various bureaucracies.

 

Here’s How Managers Can Make the Office Holiday Party Recovery-Friendly

https://www.pharmaciststeve.com/dea-proposed-cut-in-pharmas-opiate-production-quotas/

For many companies, this December will be the first time since 2019 that employees can come together for an in-person holiday party. However, mental health experts warn that more employees may be dealing with alcohol addiction than in years past, and managers should be mindful of employees who are in recovery or trying to cut back on their alcohol consumption.

“Substance-use struggles are a daily occurrence for the 1 in 10 Americans battling addiction, and it only got worse with the pandemic,” said Marc Turner, interim president and CEO of Gateway Foundation, which manages 16 drug and alcohol treatment centers in Illinois.

Since 2019, more people have had to face the reality that they have an alcohol use disorder and need to navigate the world differently while others are trying to cut back on their alcohol dependence, Turner said.

In the early days of the COVID-19 pandemic, an increasing number of people turned to alcohol to cope. According to the Centers for Disease Control and Prevention, as of June 2020, 13 percent of Americans reported starting or increasing substance use as a way of coping with stress related to the pandemic.

This increase in alcohol consumption was sustained through at least November 2020, according to a study by RTI International, a nonprofit research institute in Research Triangle Park, N.C. The study found that, compared with February 2020, alcohol consumption in November 2020 was 39 percent higher, in terms of drinks per month.

Meanwhile, about 22.3 million Americans—more than 9 percent of adults—live in recovery after some form of substance-use disorder, according to a peer-reviewed study published in October by the Recovery Research Institute at Massachusetts General Hospital.

“While many have long awaited the opportunity to gather in person with co-workers to celebrate the holidays once again, it’s important for those who are planning holiday celebrations to be aware of the significant increases in those reporting substance abuse issues since the pandemic, and to create an event everyone can enjoy and where everyone feels safe,” said Barbie Winterbottom, CEO of the Business of HR, a consulting firm based in Tampa, Florida. “Creating an event that is psychologically safe and inclusive is critically important for all employees to feel a sense of belonging.”

Here are four ways to make the office holiday party more inviting to employees who are in recovery or trying to cut back on their alcohol consumption.

Make the event about more than just drinking.

Create an event that employees can enjoy even if they’re not drinking, said Ashley Loeb Blassingame, co-founder and chief people officer of Lionrock Recovery, an online substance abuse counseling service based in Petaluma, Calif.

“Make sure the whole premise of the party isn’t based on consumption of alcohol,” she said. Find an activity that gets everyone engaged and talking. Possible ideas include cookie decorating, games and contests, or attending a concert or sporting event.

An officewide gift exchange is a fun activity that involves everyone, but be sure to set ground rules ahead of time by letting people know that no alcohol or substance-related gifts are allowed, said Lisa Blanchard, chief clinical officer at Spectrum Health Systems in Worcester, Mass.

Put mocktails on the menu.

The event invitation should clearly state that alcoholic and nonalcoholic beverages will be available, so employees know they will have options, Winterbottom said.

Rather than having only soda and juice available as alternatives to alcoholic drinks, be more creative and offer nonalcoholic beer and mocktails. “Present the nonalcoholic option as equal,” said Casey Davidson, a Seattle-based life and sobriety coach and owner of Hello Someday Coaching.

For instance, place the nonalcoholic options on the bar along with wine, beer and other alcoholic drinks being served. If waiters are passing around trays of drinks, make sure there are nonalcoholic options on that tray, she said. If there’s a seated dinner, avoid having wine glasses on the table waiting to be filled by waiters, because to say no, an employee would have to put a hand over the glass and ask the waiter not to fill it.

“The sober curious movement is growing, and lots of people are struggling with their alcohol consumption, so it’s important to normalize not drinking,” Davidson said.

Consider having a daytime event.

Many holiday parties tend to be after work or on the weekends, and that timing is often associated with drinking. “Consider a brunch or lunch party where it wouldn’t be appropriate for drinking, as the staff will need to get back to work after,” said Nicole Lacherza-Drew, Psy.D., owner of Vici Psychological Care, LLC, in Denville, N.J.

Keep the celebration optional.

Some employees may not want to celebrate the holidays at all, so be sure to keep holiday celebrations optional. “Remind employees that it is their choice whether or not to participate, and company leadership should make it clear that attendance is optional,” said Star Carter, co-founder, chief operating officer and general counsel at Kanarys Inc., a Dallas-based software firm that focuses on diversity, equity and inclusion data.

Also, make it easy for employees to leave the party when they’re ready. For instance, don’t require employees to stay until after the CEO makes a toast, Turner said. “Allow employees to make an individual choice in how they will navigate the holiday party.”

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DEA: when their own statistics do not support their actions – they DO IT ANYWAY !

Posted on November 14, 2022 by Pharmaciststeve

The primary function of bureaucrats is to perpetuate and grow the bureaucracy.  How are they to meet those goals without being able to create additional crisis that takes more people and larger budget.

Here is a recent article DEA PROPOSED cut in pharmas’ opiate production quotas     about the DEA cutting opiate production quota, when their statistics shows – within statistical margin of error – they were as close as possible to the pharmas having adequate production to “MAYBE” have sufficient quantities to meet the legit medical needs of pts in our society.  I have been an observer of our various bureaucrats and you can put money on… that when they propose something… and have a public comment period … they are most likely going to implement whatever they propose… without the first word in the proposal being changed.  Here is a quote from a pharmacist that held the second highest office in the USA

“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

 

Op-Ed: Don’t let Adderall scarcity trigger a repeat of the opioid epidemic

https://www.latimes.com/opinion/story/2022-11-14/adderall-shortage-supply-methamphetamine-addiction-crisis

U.S. pharmacies are critically low on Adderall and its generic equivalents, leaving more than 26 million patients scrambling and competing for the pills since late summer. The scarcity is going to last for many more months because of supply chain problems as well as federal restrictions on manufacturers and imports.

If we don’t act fast, this shortage could trigger two major public health crises.

Many people who have been taking this amphetamine-based stimulant – whether prescribed for attention deficit or narcolepsy or used illicitly as a performance or party drug – will lose access. This carries serious physical and mental health risks.

Amphetamine withdrawal symptoms, including depression, are not easily addressed with other kinds of drugs. So as countless individuals are confronting having to rapidly taper or stop, we’re facing a real possibility of a public health disaster on a scale not seen since the prescription opioid crisis that began a decade ago.

Instead of enduring withdrawal, other individuals cut off from Adderall are likely to turn to alternative stimulants like crystal meth, fueling a much broader crisis.

The early 2010s taught us that dependence and addiction don’t simply disappear when the pills do. At that time, catastrophic regulation failures contributed to widespread opioid dependence and addiction. The government response to the prescription opioid crisis focused on rapidly reducing supply: crackdowns on pill mills, tightened restrictions on prescribing and reformulation of products to make them harder to snort and inject. This approach backfired, pushing many users onto the illicit market.

As a chemical analog of prescription opioids, heroin was widely available and far cheaper than its pharmaceutical cousins. But its unpredictable quality and link with injection drug use made heroin a much more dangerous alternative; the recent rise in fentanyl contamination has further fueled the crisis. Overdose rates have continued to soar, spiking from 16,000 during the height of the prescription opioid crisis to more than 100,000 annually. The number of cases of blood-borne infections like HIV and hepatitis has spiked in tandem.

Today’s Adderall shortage is setting up a similar crisis. For those losing adequate access to prescription amphetamine, illicit alternatives – especially methamphetamine – are readily available. Just as with heroin, years of increasingly punitive policies, aggressive law enforcement, government fear-mongering and growing public panic failed to address the “meth problem.”

If anything, interventions like the Combat Methamphetamine Epidemic Act of 2005 disrupted meth production by a domestic cottage industry, cementing its reorganization as an international, industrial-level cartel operation – dramatized in the narrative arc of “Breaking Bad.” This made meth more ubiquitous, more potent and cheaper than ever.

Crisis events and cardiac arrests involving stimulants are already at an all-time high. Methamphetamine injection is helping to drive infectious disease cases. And there are also concerns about street stimulants, including counterfeit pills, being contaminated with fentanyl, creating the risk of opioid overdose.

Enter the Adderall shortage.

A massive influx of people forced to switch from a pharmaceutical amphetamine to street methamphetamine would be nothing short of a nightmare. But there is still time to prevent a stimulant remake of the tragic scenario we have seen play out with opioids.

The F.D.A. has powerful tools at its disposal to ease the Adderall shortage. This includes attracting and fast-tracking approval for international manufacturers and helping rapidly develop domestic production.

Maintaining a reliable, safe supply of amphetamine medications is crucial to avoid a major public health crisis. Bigger thinking is also vital to prevent other similar crises from occurring in the future.

The current Adderall shortage is a symptom of deep structural dysfunction in our institutions, policies and systems responsible for drugs. As with opioids, stewardship of prescription stimulants in American healthcare is poor, often vacillating between excess and deficit. We need far more nuanced, patient-centered approaches to medication access that are not bogged down in drug panics and concerns about law enforcement.

Meanwhile, our streets are flooded with illicitly manufactured alternatives of unpredictable content and dosage, despite cavalier investments in criminal justice efforts to stem their supply. Instead, cost-effective lasting solutions like housing, social services, and wrap-around supports are necessary to make our society healthier and safer.

Bold actions are urgently needed to prevent history from repeating itself.

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Is this why 90%+ of people taken to Federal Court – ARE FOUND GUILTY ?

Posted on November 13, 2022 by Pharmaciststeve

Bauer appeal says judge prevented a fair trial

https://sanduskyregister.com/news/426344/bauer-appeal-says-judge-prevented-a-fair-trial/

PORT CLINTON — The federal judge who presided over a Port Clinton doctor’s trial in Toledo for over prescribing painkillers prevented a fair trial by banning a dozen medical experts from testifying for Dr. William Bauer, defense attorneys say.

The defense experts barred from testifying include a college professor, who an endowed chair at Indiana University; and a Toledo scientist, also a professor, who has dozens of research publications and thousands of citations.

U.S. District Judge Jack Zouhary also gave the jury flawed instructions contradicted by a 9-0 Supreme Court ruling issued after Bauer’s trial, states an appeal brief filed Tuesday at the U.S. Sixth Circuit Court of Appeals.

The appeal says that the prosecution witness, the only expert permitted by Zouhary, gave flawed testimony that is contradicted by new CDC guidelines, the appeal contends.

While the new CDC rules were issued after the trial, the problems the new CDC guidelines tried to fix were known at the time of trial but kept from the jury by Zouhary’s rulings, the appeal contends.

Bauer, 85, is currently serving a five-year prison term in a minimum security prison in Morgantown, West Virginia, after being convicted of multiple charges in July 2021 over allegations that he over prescribed pain medications and committed fraud on federal health care programs by not following good medical practices.

A jury convicted Bauer of 76 counts of distribution of controlled substances and 25 counts of health care fraud.

The appeal filed by two of Bauer’s attorneys, Cleveland lawyers Orville Stifel II and John Gibbons, lists nine experts Bauer had planned to call to the stand on his behalf. Prosecutors waited for months to object to all nine, claiming at the eve of the trial that the defense had filed insufficient reports.

After prosecutors complained that not all of the nine were medical doctors, the list included doctors but also medical specialists including a pharmacist, the defense offered three more doctors. All 12 were excluded by Zouhary, the appeal says.

The doctors who weren’t allowed to testify for Bauer include Fletcher A. White, currently listed on the Indiana University School of Medicine website as the Vergil K. Stoelting Professor of Anesthesia, an endowed chair.

“Dr. White is an expert in the field of chronic pain mechanisms,” according to the website, which discussed White’s 30 years of research into neuroscience.

Another expert excluded from testifying is John T. Wall, professor of neuroscience at the University of Toledo, who so far has published 62 research papers.

The appeal contends that the exclusion of experts such as White, Wall and Beth Dille, director of practice management for primary care at Mercy Health in Cleveland, was an abuse of discretion by Zouhary, “thereby turning the trial into a one-sided contest that defendant was required to fight with both hands tied behind his back.”

The prosecution expert, Dr. Timothy King, is an Indiana anesthesiologist who makes large amounts of money testifying for the federal government.

A footnote in the appeals brief states that federal prosecutors paid King $125,000 a day before the trial and an additional $5,000 a day during the trial. The appellate brief states that all of Bauer’s witnesses “were testifying as a matter of principle and refused to accept any payment.”

The Bauer appeal claims that King’s testimony about supposed limits in prescribing painkillers is contradicted by new CDC guidelines.

Although the new guidelines had not been published by the time of the trial, the mistakes the new rules were trying to fix would have been explained by the experts prevented from testifying by Zouhary, the brief says.

The appellate brief also cites a unanimous 2022 decision by the U.S. Supreme Court, Ruan v. United States.

Xiulu Ruan and Shakeel Khan were convicted of drug trafficking after federal prosecutors said they wrote too many prescriptions for opioids. The Supreme Court ordered lower courts to determine if the two doctors are entitled to new trials.

The court ruled that the two doctors, convicted in separate cases in Alabama and Wyoming, were entitled to argue they wrote their prescriptions in good faith because they believed they were medically necessary.

The case shows that Zouhary misinformed the jury on the law, the appeal claims.

Zouhary, 70, was nominated to the federal bench by President George W. Bush and confirmed in 2006.

After Bauer was convicted but before he was sentenced, Zouhary rejected a motion for a new trial, citing “overwhelming evidence against defendant.” The judge’s ruling did not mention that Zouhary himself had barred a dozen witnesses from testifying for the defense.

The prosecution has not yet filed its response to the appeal.

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Doc’s office raided: purportedly treating addicts with a drug called buprenorphine

Posted on November 12, 2022 by Pharmaciststeve

Chad Hall, DO

https://doctorsofcourage.org/chad-hall-do/

Chad Hall, DO, 43, of Las Vegas, NV was acquitted of all 19 charges against him on Nov 9, 2022. Interesting, though, that there is no news of this achievement in the media. There was notice of his indictment in June, 2019 and the mistrial called in August, 2022 from his first trial.  Good for him that he hung on and won! I would hope that this shows to you that the media simply acts as an arm of the government. You can’t trust them anymore than you do the Department of Justice.

The History of the case

Chad Hall, DO was charged along with Ronald Smith, MD, Michael Halprin, APRN, Janell Olson, and Eghomware Igbinovia, with conspiracy to possess with intent to distribute and with distributing buprenorphine, a Schedule III opioid prescribed for opioid addiction. Dr. Hall was also charged with distribution of Valium, obtaining a controlled substance by misrepresentation and maintaining a drug-involved premises. Dr. Hall is the only one charged to have succeeded in winning. The other four have pleaded guilty and are still awaiting sentencing.

Two are hoping for a reduced sentence for their testimony against Dr. Hall. Too bad for them. They’ll be going to prison.

The press release contained the standard propaganda comment by US Attorney Trutanich to sway Jury opinion:

“The U.S. Attorney’s Office will target and prosecute doctors who illegally dispenses addictive opioids, thus placing personal greed above the health and safety of his or her patients.”

But prescribing buprenorphine to an addict is what is was designed for and has nothing to do with a doctor’s financial status.

But the government loves to pull the “He’s in it for the money” card. The usual government agencies—FBI. DEA, Nevada State Board, United States Attorney’s Office, and local law enforcement would have monetarily gained with a conviction THEY are “in it for the money”. Even to the point that, in 2017, the Department of Justice funded a dedicated opioid prosecutor to the US Attorney’s office for the District of Nevada.

Dr. Hall’s trial began August 24, 2022. But five days into it, the government asked for—and received—a mistrial because one of their expert witnesses would be unavailable due to an emergency medical condition (COVID).

The Media Doesn’t Help

Media reports stated that Dr. Hall’s clinic—Detoxification Solutions—was “fake” and that: “The now-closed clinic purported to treat addicts with a drug called buprenorphine.”

Well, that’s what addiction centers do! Buprenorphine is an opioid that is used for opioid abuse similar to methadone. But Dr. Hall was accused of selling buprenorphine out of the clinic to users who had no medically documented reason to take the drug. This was probably based on the FBI agent who received a controlled substance by posing as an addict. So at least Nevada jurors are smarter than the rest of the country, to see that if the agent “purports to be an addict”, then the doctor is not acting criminally by treating him as an addict and prescribing the appropriate medication.

So congratulations, Dr. Hall. You are one of the few to escape a prison sentence. But please, be aware that as long as the CSA exists, you are a target. I hope you and your family can get back to a normal life.

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Who said that dead bodies DON’T TALK ?

Posted on November 12, 2022 by Pharmaciststeve

I looked up Lincoln,CA… has a population of abt 51K and in central CA west of Reno, NV

 

 

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DEA PROPOSED cut in pharmas’ opiate production quotas

Posted on November 12, 2022 by Pharmaciststeve

Apparently this was buried in a “whole mess” of fed publication on 10/18/2022 and last day to make comments in on Nov 17th and as I write this blog post only 56 comments have been made.  As I read this publication, the DEA statistical analysis of various PDMP shows that <1% of pharma opiates are being diverted… a <1% conclusion is within the margin of error.  It also suggests that the DEA has no interest in abandoning the 2016 CDC opiate dosing guidelines and it seems clearly that they have – internally – made the 90 MME their “line in the sand”… any prescriber providing >90 MME/day of opiates to a pain pt is OUTSIDE what they have determined as the standard of care and best practices and thus ILLEGALLY PROVIDING OPIATES TO A PT.

Below is the comments that I left on this fed publication and I have provided the hyperlink to the site to leave comments.

https://www.federalregister.gov/documents/2022/10/18/2022-22638/proposed-aggregate-production-quotas-for-schedule-i-and-ii-controlled-substances-and-assessment-of#open-comment

I find the proposed reduction of opiate production.. is much like trying to drive a car – only looking into the rear view mirror. A accident is almost assured and there will be people harmed and/or killed. First using the 6 yr old CDC opiate dosing guidelines which has been stated by many as being mis-used and causing many chronic pain pts to be under treated and the new 2022 guidelines that are suppose to give prescribers more latitude in providing appropriate dosing and better pain management to chronic pain pts.
The stated percent of current diversion should be consider statistically within the error of compiling such a statistical outcome. It also ignores that the growth in our population and a certain percent will end up being chronic pain pts.
There are TWO MILLION survivors of vehicular accidents every year, some of those are going to become chronic pain pts, maybe as many as 20%-30%.
Taking in consideration the current volume of illegal immigrants, out population in 2023 may expand 4-6 million. Historically, it is claimed that 20% of our population deal with chronic pain. So by the end of 2023, we could have 2-3 million more chronic pain pts than we have today.
At the very least, the DEA should take a break this year in reducing opiate production quota and see how appropriate prescribing – per the new 2022 CDC guidelines – shakes out.
According to this seizures of illegal fentanyl in fiscal year 2021 was up 134% and according to this in the first nine months of 2022 illegal fentanyl seizures were up 377%
it has been reported that 70K-75K OD/poisoned by illegal fentanyl last year. abt THREE TIMES the number that died from the use/abuse of some opioid. With those numbers, the DEA is concerned about <1% diversion of pharma opiates ?
If the DEA proceed to further cut pharmas’ quotas, it will just validate that the DEA still “living in the past”.. using mis-used CDC guidelines, trying to obtain a unrealistic goal of ZERO pharma opiates while doing little/nothing towards the dramatic escalation of OD/poisoning from illegal fentanyl… and busting prescribers for fabricated reasons… here is a recent outcome of a DEA action on a prescriber’s practice — DEA Suspension of Doctor’s License Leads to Double Suicide https://www.painnewsnetwork.org/stories/2022/11/9/dea-suspension-of-doctors-license-leads-to-suicides
but… all wars have COLLATERAL DAMAGE – RIGHT?

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I can SENSE all the law firms creating a strategy to sue for health damages to people’s health harmed

Posted on November 11, 2022 by Pharmaciststeve

EXCLUSIVE: Donuts, cereal and pizza should be redefined as DRUGS: Scientists say highly processed foods are just as addictive and harmful as CIGARETTES

https://www.dailymail.co.uk/health/article-11413339/Donuts-chips-pizza-redefined-DRUGS-scientist-say.html

Processed foods are as addictive and dangerous as cigarettes, experts say

Researchers say the products meet the same addiction standards as nicotine 

The foods have been linked to obesity, diabetes, heart disease and other issues

The pair of scientists is calling for restrictions on the marketing of the foods 

Highly-processed foods should be reclassified as drugs because they are as addictive and harmful as cigarettes, scientists argue.

Researchers claim items like donuts, sugary cereals and pizza meet the meet official criteria that established cigarettes as a drug in the 1990s.

These include causing compulsive use and mood altering affects on the brain, and having properties or ingredients that reinforce addiction or trigger cravings.

Ultra processed foods – which also include things like soda, chips, pastries and candies – contain high amounts of unnatural flavorings, preservatives and sweeteners.

These properties give them their delicious flavor — but also make them high in calories, fat, sugar or salt, which raise the risk of obesity and other chronic illnesses.

Researchers led by Dr Ashley Gearhardt, a psychology professor at the University of Michigan, told DailyMail.com these foods are more like a drug because of how distant they are in taste and texture from natural foods.

‘They are industrial produced substances designed to deliver sugar and fat,’ Dr Alexandra DiFeliceantonio, a health behaviors research professor at Virginia Tech University, said.

‘They are not foods anymore. These are these products that have been really well designed to deliver addictive substances.’

The researchers want the marketing of these foods to children to be restricted, the same way nicotine advertising cannot be directed at kids. But they have stopped short of calling for an outright age ban.

Highly-processed foods should be reclassified as drugs because they are as addictive and harmful as cigarettes, scientists argue

Highly-processed foods should be reclassified as drugs because they are as addictive and harmful as cigarettes, scientists argue  

Dr Ashley Gearhardt (left), a psychology professor at the University of Michigan, said that HPFs are more like a drug than they are a food. Dr Alexandra DiFeliceantoni (right), a health behaviors research professor at Virginia Tech, described the foods as vessels to deliver addictive substances.

America’s obesity crisis has largely been tied to the prevalence of ultra-processed foods. The foods are believed to make up around 50 per cent of the American diet.

As a result, around 70 per cent of Americans are obese according to Centers for Disease Control and Prevention (CDC), with 40 per cent classed as obese.

Dr Gearhardt warned that even people who of a healthy weight are still at risk of developing cancer and other issues down the line from eating junk food.

The foods have been linked to a jump in diseases like colorectal and kidney cancer, and Alzheimer’s in the US, among other diseases.

Constantly spiking blood-sugar, through eating sugary foods, can also lead to diabetes. 

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NO ONE IS ABOVE THE LAW — EXCEPT THOSE WHO ARE PART OF THE JUDICIAL SYSTEM ?

Posted on November 11, 2022 by Pharmaciststeve

Jessica Spayd, ANPJessica Spayd, ANP

https://doctorsofcourage.org/jessica-spayd/

In early October 2019 my life changed forever. The woman I love was ripped from my life by an overzealous and unscrupulous Federal Government. I was not alone in my loss. Her 9-year old son lost his mother, her father lost his daughter, countless others lost a friend they cherished and loved. Worst of all, her patients had their care unceremoniously stripped away from them, throwing them to the winds of a culture that callously classified them as drug addicts undeserving of compassion. She was viciously attacked as a drug dealer by the government prosecutors and the media.Her name is Jessica Spayd, and until that fateful day she was an Advanced Nurse Practitioner that owned and operated a small health care clinic in the town of Eagle River, just outside of Anchorage, Alaska’s largest city. Jessica had become the latest victim of a misguided nationwide persecution of pain providers across the country. The government, in their zeal to show the country they are doing something about the opiate crisis affecting so many, have chosen that instead of pursuing true drug dealers, or dealing with the actual problem of addiction, they would instead laser focus their efforts on law-abiding medical professionals. And what an easy target these medical professionals turn out to be. Everything they do is diligently documented in various forms from electronic medical records to the PDMP to medical examiner’s reports when, tragically, one of their patients passes away.

The charges against Jessica were serious. The government had entrapped Jessica by sending an undercover agent in to persuade her to prescribe opiates to him. After two visits in which she said she could not prescribe what he wanted, but instead would prescribe Suboxone, he returned a third time and she finally relented and gave him the prescription he desired. This would form the basis of their argument of “outside the normal and customary” medical practice; or “for no legitimate medical purpose”. In addition to the charges they fabricated by framing her, they charged her with causing the deaths of 5 of her patients (even though the medical examiner’s report in all 5 cases was inconclusive when it came to the question of whether their death was a direct result of Jessica’s “reckless prescribing practices”). And of course they charged her for running her business as a “pill mill”. Interestingly, a “pill mill” is not defined in statute, but it is rather a casual pejorative bantered about in open court with no evidence to support the claim. Finally, Jessica faced the one true charge in all of this; she had unfortunately been convinced by a former patient to write prescriptions to a friend of his knowing full well the prescriptions were for her former patient, not his friend.

Fortunate for Jessica, her business property was in an LLC and her retirement was in a 401(k). Unbeknown to us, these assets cannot be automatically forfeited. It was with the small nest egg that Jessica was able to secure a private defense attorney. In what would turn out to be an unfortunate piece of advice, Jessica agreed to waiver her right to a speedy trial. For three years we lived in anguishing pain at the thought of facing trial, but (after a 7-month detention after denial of bail) Jessica was able to live her life with those of us that love her. We buoyed our hopes on our belief that the justice system was interested in finding the truth.

In June 2022 the U. S. Supreme Court released their Ruan ruling. In that, the justices said the government can no longer use their tried-and-true “outside of normal and customary” strategy but would instead be required to prove that a provider had malicious intent to cause harm by prescribing opiates. Armed with this victory, and knowing Jessica was innocent of the most serious charges against her, we continued preparing for trial.

The trial began in late September 2022. We knew immediately that this was not going to be what we expected. The prosecutor started lying and offering baseless character assassinations against Jessica during opening statements, a trend that continued through the last breath of his closing. The government’s witnesses lied on the stand. The prosecutor broke the law and trial procedure by bringing up irrelevant points about Jessica and her witnesses in open court, in front of the jury. Not in one or two isolated incidents, but multiple times. Each time the judge would clear the jury and excoriate the prosecution for their abhorrent behavior. But nothing changed. The lies and character assassination continued. After three-and-a-half weeks of brutal and baseless accusations by the prosecution, Jessica’s defense started. As mentioned, the prosecution attempted (successfully) to libel Jessica’s witnesses in front of the jury. To counter the character assassination attacks, Jessica’s first witnesses exalted her character and compassion as a professional medical provider, and how their lives had suffered with the end of their pain care. The prosecution would not stand for this and they convinced the judge that such testimony was detrimental to a “fair trial” (some bullshit about jury nullification).

In the end, Jessica’s defense lasted only a little over 3 days. The damage had been done by the prosecution and a willing accomplice sitting on the bench. There was no overcoming it. Even still, the rendering of “guilty on all charges” was devastating, leaving us all in shock. Our faith in the justice system shattered. We are all professionals. We do not dabble in the criminal world. This was our first exposure to the criminal “justice” system. And it was a truly horrifying experience.

Addendum by Linda Cheek, MD

Ms. Spayd was charged on October 17, 2019 with 3 counts of distributing a controlled substnace resulting in death, 4 counts of distribution of a controlled substance, and one count of maintaining a drug involved premises. More charges were added before the trial. She was convicted on October 28, 2022 of 10 counts. She was held in jail from her arrest October 17, 2019 to April, 2020.

In her trial, the government used the same witnesses as before, Drs. Timothy King and Timothy Munzing, and they used their usual testimony of their standard of care, which was definitely defeated by Ruan/Kahn. But obviously, that doesn’t matter. The propaganda wins.

The defense had 4 witnesses. But the government, using illegal gross government misconduct, sent their agents to the witnesses offices and intimidated them so that two backed out.

Understand that this is not going to stop unless we get the Controlled Substance Act repealed entirely. As long as people believe that drugs cause addiction, it is not safe to prescribe any controlled substance. The government will convict anyone they target, through lies, perjury, and propaganda.

Here is a recent post from my blog, two young men caught transporting 150k illegal fentanyl tabs, charged with charged with possession, transportation and selling of illegal drugs…. it was decided that these two “bad boys” did not presented a risk to public safety....released on their own recognizance..

Alleged drug traffickers released from California jail days after caught with 150K illegal fentanyl pills

 

Here is a video from attorney Ron Chapman explaining out the DOJ/DEA uses various techniques and procedures to “entrap” prescribers to write for a controlled substance for a theoretical pt
https://www.tiktok.com/@compliancetok/video/7164386298743213358?is_copy_url=1&is_from_webapp=v1&q=ron%20chapman&t=1668210698467

 

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When the Part D insurer goes the “extra step” to deny pt their medications

Posted on November 10, 2022 by Pharmaciststeve

I got a phone call this week, a pt that has a Part D program, that is owned by a FOR PROFIT CORPORATION… that just owns about 10,000 community pharmacies, PBM Caremark, Aetna  Insurance and Silver Scripts Part D.

I would label this pt as a high acuity, intractable chronic pain pt with two very “painful” health issues.  The Part D didn’t want to pay for the medication that has been working for the pt, but had THREE PREFERRED MEDS – one of the meds the pt even had a health issue that would make one of their contraindicated for the pt…  and the other two the pt had tried before and either they didn’t work well and/or the pt was allergic to the med.

The pt found out that the employee of Caremark who made the decision to deny the medication that the pt had clinical proof that it work for the pt and the employee was a RETIRED PHYSICIAN… who was a GP or FP… no real experience with any experience with the two very painful diseases that the pt was dealing with… of course, this physician consultant … followed the Part D policy to recommend what appeared to be the three meds that cost the Part D the LEAST…

Of course, the pt’s physician appealed the denial and resulted in a rather quick repeat denial… and the pt & the physician wanted to appeal the first appeal and the pt was told that the Part D had done two more appeals on the pt’s behalf and those two other appeals were ALSO DENIED !!!

The pt was informed that the Part D allowed 3 appeals on the original denial of the claim, to the Part D was done with her claim.

I have read stories about these retired physicians that do Medical reviews for insurance companies … get BONUSES based on the $$$ that their decisions have saved the insurance companies.

This pt and/or the Physician was pretty well versed and had already tied to initiate a ALJ ( Administrative Law Judge) appeal and was told that there was no way that they could get an expedited ALJ hearing…  I don’t remember how long a back log there was, but apparently the pt may end up without their necessary medication.

Pts who find themselves in a similar position – playing games with the FOR PROFIT PART D and/or MEDICARE ADVANTAGE (part c) There is a potential option, especially for those pts with Regular Medicare.  If a pt’s prescriber requests a ambulatory  pain pump,  Our independent pharmacy  use to be a fairly large Home Medical Equipment vendor and unless they changed the rules… Pump are paid for by Medicare Part B and when Part B pays for such/similar equipment, Part B pays for the medication that goes in the pump.

Medicare Part B guidelines to cover HME stuff is pretty black/white guidelines, nothing like the somewhat arbitrary coverage of Part D and/or Medicare Advantage.  Besides all this, using a ambulatory pump… will allow the pt to get as good or better pain management than taking oral meds and because the medication is administered as a Sub-Q injection… the pt will need only 20%- 30% of the mgs that the pt took orally.  To the best of my knowledge, the CDC guidelines only address oral meds.

If anyone is interested in looking into ambulatory pumps… so a web search for “ambulatory pain pumps” and/or “diabetic insulin pump”… and I would do a search in U-tube as well..  The ambulatory pain pump and diabetic insulin pump are very similar pieces of equipment… and millions of diabetics uses these insulin pumps and have been using them for at least 15 yrs.

 

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