MICHIGAN VS. OHIO STATE: LOW HANGING FRUIT AND THE DEA TARGETING OF YOUR HEALTHCARE PROVIDER

MICHIGAN VS. OHIO STATE: LOW HANGING FRUIT AND THE DEA TARGETING OF YOUR HEALTHCARE PROVIDER

REPORTED BY

youarewithinthenorms.com

NORMAN J CLEMENT RPH., DDS, NORMAN L.CLEMENT PHARM-TECH, MALACHI F. MACKANDAL PHARMD, BELINDA BROWN-PARKER, IN THE SPIRIT OF JOSEPH SOLVO ESQ., IN THE SPIRIT OF REV. C.T. VIVIAN, JELANI ZIMBABWE CLEMENT, BS., MBA., WILLIE GUINYARD BS., JOSEPH WEBSTER MD., MBA, BEVERLY C. PRINCE MD., FACS., LEROY BAYLOR, JAY K. JOSHI MD., MBA, ADRIENNE EDMUNDSON, ESTER HYATT PH.D., WALTER L. SMITH BS., IN THE SPIRIT OF BRAHM FISHER ESQ., MICHELE ALEXANDER MD., CUDJOE WILDING BS, MARTIN NDJOU, BS., RPH., IN THE SPIRIT OF DEBRA LYNN SHEPHERD, BERES E. MUSCHETT, STRATEGIC ADVISORS

Neat, Plausible, and Generally Wrong:
A Response to the CDC Recommendations for Chronic Opioid Use

BY

Stephen A. Martin, MD, EdM;
Ruth A. Potee, MD, DABAM; and
Andrew Lazris, MD

STEPHEN A. MARTIN, MD, EdM

Abstract:

“The American crisis of opioid addiction and overdose compels our strongest efforts toward successful prevention and treatment. Recommendations from the Centers for Disease Control and Prevention (CDC) for chronic opioid use, however, move away from evidence, describing widespread hazards that are not supported by current literature. This description, and its accompanying public commentary, are being used to create guidelines and state-wide policies.

These recommendations are in conflict with other independent appraisals of the evidence — or lack thereof — and conflate public health goals with individual medical care. The CDC frames the recommendations as being for primary care clinicians and their individual patients.

Yet the threat of addiction largely comes from diverted prescription opioids, not from long-term use with a skilled prescriber in a longitudinal clinical relationship. By not acknowledging the role of diversion — and instead focusing on individuals who report functional and pain benefit for their severe chronic pain — the CDC misses the target.

We provide here a review of the evidence regarding long-term opioid use for chronic pain in order to a) better point public health efforts, and b) reduce harm from consequent restriction of these medications for patients who have substantial benefit in their use.”

LOW HANGING FRUIT

A REPUBLICATION OF MS KATHERINE ROSENBURG-DOUGLAS’S STORY AND THE DRUG INDUSTRIAL COMPLEX WHICH WITHHOLDS PAIN MEDICATION PRESCRIBED BY YOUR DOCTOR
Column: “…Condemn the opioid epidemic, sure…but remember those of us in chronic pain who need help.”
KATHERINE ROSENBERG-DOUGLAS

KATHERINE ROSENBERG-DOUGLAS

CHICAGO TRIBUNE |JUL 12, 2019 AT 7:34 PM

“I broke my back while Rollerblading when I was 21. After three surgeries beginning at age 30, I’ve recovered enough that I’ve gone on to what looks like a normal life. I’m a married mother of twin 4-year-olds, so I am relatively stressed, but fortunately, I’m otherwise relatively healthy.

I’m also on a fentanyl patch delivering slow and steady pain relief to keep me feeling like I can get out of bed, and morphine for breakthrough pain when life requires more of me than merely getting out of bed — and anyone who has ever had a 4-year-old knows each day is far more demanding than that. Just driving my kids to school or sitting for longer than 20 minutes at a time is a struggle.”

 

“I DON’T FEEL COMFORTABLE”

Joseph L. Webster MD SR., MD, MBA, FACP, BS. PHARMACY:

” It is not the purview nor is the pharmacist trained to ‘challenge the diagnosis of the physician and to do so verbally or otherwise with the patient. It erodes the ‘doctor-patient relationship and destroys the ‘confidence’ of the patient in his/her physician. At the very least it is ‘unethical’ and may very well be a HIPPA violation and beneath the standard of care as a pharmacist.”

THE PHARMD, “SECOND GUESSING A PROVIDERS DIAGNOSES”

‘THE MOST DANGEROUS TYPE OF PHARMACIST’

AND THEIR FAILURE TO UNDERSTAND THE PATHOPHYSIOLOGY OF PAIN

Pain and pain management is a very complex issue. More often than not in chronic (non-acute) pain which is considered a disease, comorbidities need to be addressed. The “uncomfortable pharmacist,” has failed to develop a basic understanding of pain pathophysiology and neuroscience and the basic structures and function of the Nervous System which is a complex structure that coordinates voluntary and involuntary actions by transmitting signals to and from different parts of the body.

LESLY POMPY MD, ON TRIAL MONROE MICHIGAN LOW HANGING FRUIT

https://video.foxnews.com/v/5977750216001

“ The American Medical Association strongly supports a pharmacist carrying out his or her corresponding responsibility under state and federal law, but the past few years are rife with examples of patients facing what amounts to interrogations at the pharmacy counter as well as denial of legitimate medications”

https://www.foxnews.com/health/doctors-abandon-opioid-prescribing-as-state-and-federal-authorities-step-up-enforcement

LOW HANGING FRUIT

The American Medical Association wrote on June 16, 2020:

While the AMA understands that the apparent goal of the Centers for Disease Control (CDC) Guideline was to reduce opioid prescribing, we believe the proper role of the CDC is to improve pain care. Therefore, it follows that a dedicated effort must be made to undo the damage from the misapplication of the CDC Opioid Guidelines.

We are concerned that such a careful approach to identifying the precise combination of pharmacologic options could be flagged on a prescription drug monitoring program as indications wrongly interpreted as so-called “doctor shopping” and cause the patient to be inappropriately questioned by a pharmacist. The AMA strongly supports a pharmacist carrying out his or her corresponding responsibility under state and federal law, but the past few years are rife with examples of patients facing what amounts to interrogations at the pharmacy counter as well as denials of legitimate medication.”

Josh Bloom, ACSH’s Director of Chemical and Pharmaceutical Science:

In today’s anti-opioid climate, a “one-size-fits-all” mindset has become the foundation of government-dictated medicine. And it’s awful medicine. For example, the deeply flawed policies enacted as law all over the country are based on the “one-size-fits-none” concept of morphine milligram equivalents (MME) – the maximum amount of an opioid medication that is permitted per patient per day.

https://www.cato.org/multimedia/cato-daily-podcast/follow-science-opioids

IN FACT, the CDC MME chart, the entire concept of morphine milligram equivalents may be convenient for bureaucrats. Still, because of differences in the absorption of different drugs into the bloodstream, half-life of different drugs, the impact of one or more other drugs on opioid levels, and large differences in the rate of metabolism caused by genetic factors are not only devoid of scientific utility but actually causes far more harm than help by creating “guidelines” that are based upon a false premise. When a policy is based on deeply flawed science, the policy itself will automatically be fatally flawed. It cannot be any other way.
Table 1. MME equivalents. Source: CDC

While MME values are touted as useful predictors of the total “opioid load” that a patient can receive, they are nothing of the sort. And MME-based policies don’t just fail because of differences in the size of patients; they fail for multiple reasons.

1. Flawed science yields meaningless results

Morphine is normalized to 1.0 and the conversion factor reflects the relative potency of other opioid drugs. So, if the daily MME – the maximum dose of a drug allowed – is 90 mg. This assumption could not be less accurate. Once we see the profound differences in the properties of the drugs and the difference between individuals who take them it becomes clear that not only is the CDC chart flawed, but the MME is little more than a random number.

2. Not all opioids are created equal, especially in the body

Anyone with even a passing knowledge of pharmacology would immediately be skeptical of data in the chart. Bioavailability. One of the many pharmacokinetic properties required to establish how a drug will fare within the body is called bioavailability – a critical determinant for whether a drug will be effective if taken orally.

3. Bioavailability is a measure of how well a pill will be absorbed in the gut and subsequently enter the bloodstream.

4. Half-life and metabolism

Although critical, bioavailability is far from the only measure of an oral drug’s effect on people or animals is primarily metabolized by two different cytochrome P450 enzymes called 3A4 and 2D6.

The difference in metabolizing enzymes itself is a substantial concern when comparing two different drugs, but it becomes even more so when other drugs are part of the picture. The only certainty is uncertainty

“NOT AT WALGREENS”

PROMOTING MEDICATION SAFETY

Most opiate pain medication when abused are not used by the individual to whom the medication was prescribed. In this country only health care providers and pharmacies are authorized to dispense medications.

However how many individuals have received medications from relatives or friends. Unfortunately it is a common practice and no one even thinks they are breaking the law and are a factor in the opiate epidemic.

We need to devise a simple common sense method to return unused medication including opiate pain medication to the physician who wrote the prescription or the pharmacy who dispensed the medication. Just like we have state drug monitoring programs, we need a state prescription disposal system. This should be easily done.

Once the prescribed medication has exceeded the time it was prescribed for the patient should be notified by the pharmacy and the prescriber that their medications has exceeded the period it was prescribed for. All unused medications has to then be accounted for. Did the patient use all of the medication?

Does the patient need a refill? If the patient needs a refill the prescriber can give him a appointment. If the patient doesn’t need a refill any and all unused medications should be returned to the prescriber or pharmacy. If we build this into our health care system, the accidental use of all unused medication will be eliminated.

Walter F. Wrenn III M.D.

LOW HANGING FRUIT

THE RED FLAG – Distance

The DEA has developed criminal elements of free commerce by criminalizing distance travel as an element of criminal conduct. Whereby a pharmacist is a licensed practitioner who has advanced knowledge of the chemical-physical properties of medications, mechanism of actions, their dosage forms design, will likely not refer to GOOGLE MAPS as an element of patient treatments.
OPE’RA, PARIS, lie-de-France, France September 4, 2017

More dangerously, as a result of the DEA’s aggressive policing of community pharmacies many are reluctant to fill any legitimate narcotic analgesic medication prescriptions for non-acute pain patients.
TRAUMATIZING THE AFFLICTED

In the exploring role and purpose of the DEA that acts as an unregulated medical agency policing the medical profession without legal standards and grounds.
GUN SHOT WOUND

The DEA Diversion Investigator claims in arbitrary reasoning; their actions are based on factors applied that “traveling long distances to fill prescriptions can be a red flag of abuse and diversion if a patient travels a significant distance to a particular pharmacy.
REBBECCA

Some patients are known to spend days on end looking for a pharmacy to fill their prescriptions to no avail. This has caused massive concerns in the chronic pain disease medical/dental community, where one of the most important goals of any therapy is continuing staple treatment without disruptions.

DEA GUIDELINES PROMOTE DISPARITY

It is well understood amongst medical/dental practitioners when disruptions in therapy occur, many of the deleterious effects are likely to happen. For example, patients diagnosed with Sickle Cell Anemia are many times profiled as addicts, rather than as persons with a chronic disease condition needing treatment for pain.
BULLET WOUND WHERE RIGHT ELBOW WAS DESTROYED (PRONTO PHARMACY 05/18)

Other examples include persons who have survived traumatic accidents such as automobile accidents, gunshot wounds (civilian and military), notwithstanding leukemia, and other cancers.
CANCER OF LEG 9/29/17 PRONTO PHARMACY

Indeed, pain management becomes even much more difficult when anxiety and diminished mobility complicates the treatment plans.

Further, it is well understood, when both medical/dental practitioners and patients can locate a Pharmacy that will fill pain control prescriptions with dignity and respect, both parties will often share that information with others. Most importantly however, “red flags” are guidelines created by DEA in which the agency “lacks the authority to issue guidelines that constitute advice relating to the general practice of medicine and further lacks authority to promulgated new regulations regarding the treatment of pain. (see Clement vs. DEA case 22-600 awaiting review for certiorari before United States Supreme Court) See Id. Sadly, when challenged in court, the DEA hides behind the great deference awarded to administrative agencies.
Pain you can’t see

Ms. Rosenburg-Douglas further wrote:

” I have a number of diagnoses. Failed back syndrome, a medical term that means just what it says and suggests surgery didn’t help. A “bone stimulator” was implanted during one surgery to encourage growth between pieces of cadaver bone and my own vertebrae, but too much bone grew in around my sciatic nerve, giving me sciatica, or a burning sensation from my rear down my left leg to my toes, which often are numb and tingling (I take another medication for nerve pain).
A monitor shows pain management specialist Dr. Richard Caner performing a spinal injection procedure on Chicago Tribune reporter Katherine Rosenberg-Douglas on July 2, 2019, at PrairieShore Pain Center in Lincolnshire. Rosenberg-Douglas has needed opioids to control severe pain for more than a decade. (Erin Hooley / Chicago Tribune)

My left leg has so much atrophied muscle that it drags behind my right and I had a pronounced limp, but the fentanyl patch largely has eliminated that by providing more steady pain relief. I am disabled, but no longer outwardly appear so, which, along with my age, probably accounts for the daily dirty looks people shoot me when I park in handicapped spaces.
Chicago Tribune reporter Katherine Rosenberg-Douglas is helped to her ride from friend Courtney Holbrook with the help of medical assistant Mario Flores after undergoing a spinal injection procedure on July 2, 2019. The use of a fentanyl patch has helped to correct a pronounced limp. (Erin Hooley / Chicago Tribune)

I understand why police, politicians, and many doctors want to combat the opioid epidemic, but I’m tired of people throwing around that term and lumping me in with a group of drug abusers.

I support the spirit behind their efforts, but can’t support any more regulation on controlled substances. We have now overcorrected, and anyone who requires pain medicine is looked upon as a criminal.

It was once hard to imagine being in more pain than I am, but the current regulations added a new layer of suffering. Please remember opioids exist for a reason and don’t let it get any more difficult for those already in agony”

FOR NOW, YOU ARE WITHIN

THE NORMS

LOW HANGING FRUIT

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